Gastrointestinal System
A client is admitted to the hospital with a history of cancer of the liver and jaundice. In relation to the jaundice, the nurse expects the client to report the presence of what symptom?
# Pruritus Diarrhea Blurred vision Bleeding gums ----------------------------------------------------------------- Itching associated with jaundice is believed to be caused by accumulating bile salts in the skin. Diarrhea, blurred vision, and bleeding gums are not related to jaundice.
A client is scheduled for gastrointestinal surgery. What is the most important nursing action that should be implemented the evening before surgery?
Describing the specific surgical procedure # Ensuring the bowel preparation is initiated Encouraging the client to socialize with other clients Providing the client's food preferences for the evening meal ----------------------------------------------------------------- It is essential that the gastrointestinal tract be cleansed for surgery; proper visualization and prevention of peritonitis depend on the intestine being as clean of feces as possible. A specific and detailed description may cause anxiety and is unnecessary unless the client asks for this information. Encouraging the client to socialize with others is not the priority; however, therapeutic communication between the nurse and the client should be encouraged. Generally with gastrointestinal surgery, clear liquids are prescribed at least 24 to 48 hours before surgery and then nothing by mouth after midnight the night before surgery.
The nurse assesses for which major complication in a client who has had a gastroscopy?
Difficulty swallowing Increased gastrointestinal (GI) motility Nausea with vomiting # Abdominal distention with pain ----------------------------------------------------------------- Abdominal distention, which may be associated with pain, can indicate perforation, a complication that can lead to peritonitis. A local inflammatory response to insertion of the fiberoptic tube may result in a sore throat and dysphagia once the anesthesia wears off; difficulty swallowing is expected. Increased GI motility, together with cramping, is an expected response. Nausea with vomiting is not indicative of any particular problem in this situation.
A nurse is reviewing a list of current medications with a client who has developed gastrointestinal bleeding. Which medication prescription should the nurse discuss with the primary healthcare provider?
Digoxin # Ibuprofen Famotidine Atorvastatin ----------------------------------------------------------------- Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that can cause bleeding in the gastrointestinal (GI) tract; clients with a history of GI bleeding should not take NSAIDs. Digoxin is an antidysrhythmic used to slow and strengthen the heart rate; it does not contribute to GI bleeding. Atorvastatin is a cholesterol-reducing drug and is not contraindicated with GI bleeding. Famotidine is a histamine (H2) blocker to reduce acid secretion in the stomach; it does not cause GI bleeding.
A client with dementia and a percutaneous endoscopic gastrostomy (PEG) tube is being cared for at home. Which action provides evidence that a family member is effectively managing the client's care?
Empty feeding bag stays attached to the tubing. Tube is flushed with air after medication is given. Replacement of the tube is done on a weekly basis. # Head of the bed remains elevated after the feeding. ----------------------------------------------------------------- The client's upper body must be elevated to prevent aspiration and promote digestion. Attaching the empty feeding bag to the tubing is not necessary. The end of the gastrostomy tube just needs to be covered. The tube is flushed with water, not air, before and after food or medication is given; excess air in the gastrointestinal tract can cause abdominal distention and cramping. Because the tube was inserted by a surgical procedure, it is replaced only when a problem is identified, and usually only by the healthcare provider.
A client with cancer of the colon is admitted to the hospital for a hemicolectomy. What does the nurse expect the preoperative plan of care to include?
Giving oil-retention enemas daily for two days preoperatively # Administering cleansing enemas and then neomycin Having a Sengstaken-Blakemore tube at the bedside A high-protein and high-carbohydrate regular diet for two days preoperatively ----------------------------------------------------------------- After the bowel is cleansed, neomycin is given to decrease gram-negative bacteria in the colon, which should limit postoperative infection. Oil-retention enemas are used to alleviate constipation; oil-retention enemas are not prescribed before surgery because they contaminate the bowel with oil. A Sengstaken-Blakemore tube is used for a client with ruptured esophageal varices, not for a client having a hemicolectomy. A diet to decrease bulk and empty the colon generally is prescribed; usually it is a clear liquid diet.
A client has surgery for an incarcerated hernia. The healthcare provider returns the incarcerated tissue to the abdominal cavity and uses a mesh to reinforce the muscle wall. What specific instructions should be included in the discharge instructions?
Reduce dietary roughage. # Avoid lifting heavy items. Increase dietary potassium intake. Keep the head of the bed elevated. ----------------------------------------------------------------- Avoiding lifting helps prevent increased intraabdominal pressure that may disrupt the surgical repair. Roughage helps prevent constipation, thus avoiding straining and increased intraabdominal pressure. There is no indication for potassium supplements. The client can assume any position of comfort.
A healthcare provider prescribes dietary and medication therapy for a client with the diagnosis of gastroesophageal reflux disease (GERD). What is most appropriate for the nurse to teach the client about meal management?
Snack daily in the evenings # Divide food into four to six meals a day Eat the last of three daily meals by 8:00 PM Suck a peppermint candy after each meal ----------------------------------------------------------------- The volume of food in the stomach should be kept small to limit pressure on the lower esophageal sphincter. Snacking in the evening can cause reflux. The last meal should be eaten at least three hours before bedtime; individual bedtimes vary. Peppermint promotes reflux because it relaxes the lower esophageal sphincter, allowing food to be regurgitated into the esophagus.
The nurse identifies that a client who had extensive abdominal surgery appears depressed. Which nursing action is the most appropriate?
# Talking with the client and encouraging exploration of feelings Asking the client's primary healthcare provider to prescribe an antidepressant medication Understanding that the client's depression is an expected response to surgery Reassuring the client that feelings of depression will lift after returning home ----------------------------------------------------------------- The nurse must first explore the client's feelings; an honest discussion with emphasis on concerns helps promote adjustment. Asking the client's healthcare provider to prescribe an antidepressant medication may be necessary if the depression continues. Postoperative depression is not an expected response to surgery. Reassuring the client that feelings of depression will lift after returning home is false reassurance because there is no guarantee that the depression will lift at home.
A nurse is evaluating a client's response to receiving an intermittent gravity flow percutaneous endoscopic gastrostomy (PEG) tube feeding. Which clinical finding indicates that the client is unable to tolerate a continuation of the feeding?
Passage of flatus # Rise of formula in the tube Rapid inflow of the feeding Tenderness of epigastric area ----------------------------------------------------------------- A rise in the level of formula within the tube indicates a full stomach. Passage of flatus reflects intestinal motility, which does not pose a potential problem. A rapid inflow is the result of positioning the container too high or using a feeding tube with too large a lumen. Epigastric tenderness is not necessarily caused by a full stomach.
A client is admitted to the hospital with ascites. The client reports drinking a quart (liter) of vodka mixed in orange juice every day for the past three months. To assess the potential for withdrawal symptoms, which question would be appropriate for the nurse to ask the client?
# When was your last drink of vodka?" "What prompts your drinking episodes?" "Do you also eat when you drink?" "Why do you mix the vodka with orange juice?" ----------------------------------------------------------------- The nurse must determine when the client had the last drink to gauge when the body may react to lack of alcohol (withdrawal). Factors that prompt drinking are important but do not affect the body's response to withdrawal from the substance. Whether the client also eats when the client drinks will not influence the body's response to withdrawal from the alcohol. Whether the client mixes vodka with orange juice will not influence the body's withdrawal from the alcohol.
A nurse is assessing two clients. One client has ulcerative colitis, and the other client has Crohn disease. Which is more likely to be identified in the client with ulcerative colitis than in the client with Crohn disease?
Inclusion of transmural involvement of the small bowel wall Higher occurrence of fistulas and abscesses from changes in the bowel wall Pathology beginning proximally with intermittent plaques found along the colon # Involvement starting distally with rectal bleeding that spreads continuously up the colon ----------------------------------------------------------------- Ulcerative colitis involvement starts distally with rectal bleeding that spreads continuously up the colon to the cecum. In ulcerative colitis, pathology usually is in the descending colon; in Crohn disease, it is primarily in the terminal ileum, cecum, and ascending colon. Ulcerative colitis, as the name implies, affects the colon, not the small intestine. Intermittent areas of pathology occur in Crohn. In ulcerative colitis, the pathology is in the inner layer and does not extend throughout the entire bowel wall; therefore, abscesses and fistulas are rare. Abscesses and fistulas occur more frequently in Crohn disease.
