GI quiz 470

The nurse is preparing to insert a nasogastric tube into a 68-year-old patient with an abdominal mass and suspected bowel obstruction. The patient asks the nurse why this procedure is necessary. Which of the following responses is most appropriate? "The tube will help to drain the stomach contents and prevent further vomiting." "The tube will push past the area that is blocked, and thus help to stop the vomiting." "The tube is just a standard procedure before many types of surgery to the abdomen." "The tube will let us measure your stomach contents, so that we can plan what type of IV fluid replacement would be best."

"The tube will help to drain the stomach contents and prevent further vomiting."

what does pretreatment of lactase prep do?

(e.g. lactacid drops) before ingestion can reduce symptoms. Ingestion of lactase enzyme tablets with the first bite of food can reduce symptoms.

What are clinical manifestations for appendicitis?

1. generalized abdominal pain, w/i 2-12 hrs pain localizes in right lower quadrant 2. Anorexia, moderate malaise, mild fever, nausea and vomiting. 3. Usually constipation occurs ; occasionally diarrhea. 4. Rebound tenderness, involuntary guarding, generalized abdominal rigidity.

what is total gastrectomy

100% of stomach removed - esophagus attached to jejunum

what is Billroth II surgical procedure

50% of stomach removed - remaining stomach attached to jejunum

what is billroth I surgical procedure for stomach cancer

50-75% of stomach removed - remaining stomach attached to duodenum

The client developed a paralytic ileus after abdominal surgery. 1. Administer a laxative of choice 2. Encourage client to increase oral fluids 3. Encourage client to take deep breaths 4. Maintain a patient nasogastric tube

: 4. A paralytic ileus is the absence of peristalsis; therefore, the bowel will be unable to process any oral intake. A nasogastric tube is inserted to decompress the bowel until surgical intervention or until bowel sounds return spontaneously.

what is dumping syndrome?

: rapid evacuation of bowel 15 to 30 minutes after eating: patient experiences cramping, borborygmi (audible bowel sounds), and urge to defecate

what is stomach cancer?

Adenocarinoma of the stomach wall More prevalent in men of poverty - those living in urban areas

A colectomy is scheduled for a 68-year-old woman with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this patient? Instruction on irrigating a colostomy Administration of a cleansing enema A high-fiber diet the day before surgery Administration of IV antibiotics for bowel preparation

Administration of a cleansing enema

when can pt with appendicitis surgery ambulate

Ambulation day of surgery or POD #1

what is bowel obstruction?

Blockage of inside of intestine Interrupts normal flow of contents

what is splenic trauma and when do s/s occur

Blunt force trauma is typical MOI. Signs and symptoms may not developed until 24 hours later.

how can you diagnose peritonitis?

CBC, CT scan, US, xray, peritoneoscopy

what are s/s of bowel obstruction

Cramping abdominal pain, nausea, vomiting (often of fecal matter), abdominal distension

what is esophageal varices?

Dilated veins in lower part of esophagus Common in ETOH abusers, patients with liver disease May produce massive upper GI bleeds

how can you diagnose stomach cancer

Endoscopy and biopsy, Complete blood count Elevated liver enzymes and serum amylase may indicate liver and pancreatic metastasis

what is peptic ulcer disease?

Erosion of the lining of the stomach, duodenum, or esophagus -MAY CAUSE SIGNIFICANT GI BLEED

what is ectopic pregnancy

Fertilized egg is implanted outside the uterus. Growth causes rupture and can lead to massive bleeding. Patient c/o of severe RLQ or LLQ pain with radiation.

what is treatment for e coli

Fluid and Electrolyte replacement

where do you find e coli?

Found in undercooked meats (hamburger, ham & turkey) Also raw milk & unpasteurized juice/contaminated juice or sewage contaminated water

what is acute abdomen mean?

General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? Low pitched and rumbling above the area of obstruction High pitched and hypoactive below the area of obstruction Low pitched and hyperactive below the area of obstruction High pitched and hyperactive above the area of obstruction

High pitched and hyperactive above the area of obstruction

what are complications with peritonitis

Hypovolemic shock Sepsis Paralytic ileus Acute respiratory distress syndrome ***can be fatal if no treatment

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Anastomosis site inflammation

Impaired peristalsis

what is peptic ulcer disease increased by? decreased by?

Increased by coffee, stress, spicy food, smoking Decreased by alkaline food, antacids

what is cholecystitis?

Inflammation of gall bladder Commonly associated with gall stones More common in 30 to 50 year old females

what is pancreatitis

Inflammation of pancreas Triggered by ingestion of EtOH; large amounts of fatty foods

what is gastroenteritis?

Inflammation of stomach or small intestine mucosa

what is PID? pelvic inflam disease

Inflammation of the fallopian tubes and tissues of the pelvis Typically lower abdominal or pelvic pain, nausea, vomiting

where is pain for splenic trauma

LUQ but may present atypical to other quadrants.

what about mets and stomach cancer

Large percentage have metastasis at time of diagnosis

what is peritonitis?

Localized or generalized inflammation of peritoneum

what is AAA?

Localized weakness of blood vessel wall with dilation Pulsating mass in abdomen Can cause lower back pain

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which of the following instructions would be most helpful to prevent further episodes of constipation? Maintain a high intake of fluid and fiber in the diet. Reduce intake of medications causing constipation. Eat several small meals per day to maintain bowel motility. Sit upright during meals to increase bowel motility by gravity.

Maintain a high intake of fluid and fiber in the diet.

what is a kidney stone?

Mineral deposits form in kidney, move to ureter Often associated with history of recent UTI

what is treatment for gastroenteritis

Most cases are self-limiting and do not require hospitalization -NPO status until vomiting stops Fluids with glucose & electrolytes to replace fluids and energy demands

what is important for treatment of appendicitis??

NO HEAT - CAN CAUSE RUPTURE

what are s/s of cholecystitis

Nausea, vomiting; RUQ pain, tenderness; fever

what is s/s pancreatitis

Nausea, vomiting; abdominal tenderness; pain radiating from upper abdomen straight through to back Signs, symptoms of hypovolemic shock

what are s/s of diverticulitis

Pain Perforation Risk for severe peritonitis

what are recommendations for stomach cancer

Patient encouraged to eat small frequent meals Fluids not taken with meals: 30-45 mins before or after meal Increase intake of protein and fats: rebuild body tissues/meet energy needs

how can we diagnose appendicitis?

Physical exam WBC (shows inc with inc neutrophils) urinalysis to rule out urinary abdominal xray ultrasound or CT scan

what are s/s of shock

Poor skin signs (pale, diaphoresis) Sustained tachycardia Hypotension

what is diverticulitis

Pouches become blocked and infected with fecal matter causing inflammation

what is inguinal hernia?

Protrusion of the intestine through a tear in the inguinal canal. Usually identified by abnormal mass in lower quadrant, with or without pain. Strangulation can lead to necrosis.

Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse? Notify the physician. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one.

Reposition the tube and check for placement.

The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis? Rovsing sign Referred pain Chvostek's sign Rebound tenderness

Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.

what are s/s of kidney stones?

Severe flank pain radiates to groin, scrotum Nausea, vomiting, hematuria

what are s/s of stomach cancer?

Signs/symptoms of anemia (caused by erosion of tissue and blood loss) Peptic Ulcer Disease Indigestion (early fullness after meals, weight loss, dysphagia, and constipation) Mass is usually palpated and/or seen upon inspiration in abdominal area

what does steady pain vs cramps pain mean?

Steady pain - inflammatory process Crampy pain - obstructive process

what are s/s of peptic ulcer disease

Steady, well-localized epigastric or LUQ pain Described as a "burning", "gnawing", "aching"

what is botulism

Toxin from clostridium botulinum Sources: improperly canned or preserved foods

what are indicators of concern?

Unstable or significant change from baseline in vital signs Positive postural changes Evidence of on-going bleeding Severe, unremitting pain

what is an imp question to ask when getting history?

Was onset of pain gradual or sudden? (this helps diagnose!!!)

what are s/s of peritonitis?

abdominal pain - tenderness over area of involvement Rebound tenderness, muscular rigidity, and spasms will makes patients lie still and breathe shallowly due to pain with movement Fever, abdominal distention, tachycardia, tachypnea, nausea/vomiting and altered bowel habits may also be present

what is food poisoning?

acute GI episode/disorder (not a disease)

what are main causes of bowel obstruction?

adhesions, hernias, fecal impactions, tumors

what else should you look at for diagnosing patient with abdomen problem

age, history, ranking of frequency

what should you avoid with e coli?

anti-diarrheal agents (want to poop e coli all out)

what is most common treatment for appendicitis?

appendectomy

what is primary peritonitis

bacteria from blood borne pathogens, genital tract organisms or cirrhosis with ascites *** worry about these pts more!!-they are a lot sicker -comes from line contamination

what is secondary peritonitis

bile, enzymes or bacteria from ruptured appendix, trauma, Ischemic bowel disorders, GI obstruction, pancreatitis, and peritoneal dialysis

what are s/s of e coli in adult

bloody diarrhea and abdominal cramps

what can e.coli cause?

can cause hemorrhagic colitis Can be life threatening for very young & elderly

what is major emergency situation with AAA (abdominal aortic aneurysm)

can rupture, emergency situation that causes abdominal pain -main concern with aneurysm; dissection!!!! (very short time to live)30 mins from door to OR...need to meet this!

what is special consideration for adults over 30 and abdominal pain

consider possibility of referred cardiac pain

what about consideration with females and abdominal pain

consider possible gyn problem, especially tubal ectopic pregnancy

what can reduce risk of stomach cancer

consuming whole grains, fresh fruits and vegetables

what will blood in esophageal varices be?

dark red blood

how can you diagnose e coli

detecting bacterium in stool **antibiotic treatment remains controversial

what are risk factors for stomach cancer

diet high in smoked foods, salted fish/meats & pickled vegetables Infection with H. Pylori at an early age Pernicious anemia, atrophic gastritis, peptic ulcer disease Smoking & obesity

where does pain radiating to Right shoulder, angle of right scapula mean

gall bladder, liver, spleen

what are s/s of e coli in young children

hemolytic uremic syndrome causing destruction of RBCs and kidney failure

when should you really notify physician with appendicitis?

if pain suddenly ceases, this indicates perforation, which is a medical emergency.

what are signs to look for peritonitis?

increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia

what are attacks of cholecystitis triggered by

ingestion of fatty foods

where does pain radiating to flank or groin mean?

kidney, ureter

what is complaint of peptic ulcer disease

lies very still with complaint of intense, steady pain, rigid abdomen with exam, suspect perforation

what are complications of appendicitis?

major complication of appendicitis is perforation of the appendix, which can lead to peritonitis, abscess formation (collection of purulent material), or portal pylephlebitis, which is septic thrombosis of the portal vein caused by vegetative emboli that arise from septic intestines.

The nurse would question the use of which of the following cathartic agents in a patient with renal insufficiency? Bisacodyl Lubiprostone Cascara sagrada Milk of magnesia

milk of magnesia

what is pancreatitis stereotype

most pts have some ETOH abuse (NOT ALL) -there is stereotype they have drinking problem

what are s/s of gastroenteritis/

nausea/vomiting, diarrhea, abdominal cramps, abdominal distention, fever, ↑ WBCs, blood or mucous in stool

what are s/s of botulism

nausea/vomiting; abdominal pain CNS: H/A, dizziness, muscular in coordination/weakness, breathing difficulty, paralysis, coma

When do colorectal cancer symptoms present?

not until disease is advanced

what about age and diverticulitis

older you are, more at risk.. u can live with diverticulosis, need to do something about diverticulitis -not always have abdominal pain

what do pts with kidney stones need?

ou usually need IV narcotics... -very bad pain -need to understand pain management

how is e. coli spread

person to person contact

what do you always worry about with peptic ulcer disease?

rupture!!!

what is position comfortable for appendicitis

semi fowlers with knees flexed

what about abdominal distention?

skin is shiny...when you get super distended and taught (really bad cases)

what is treatment for stomach cancer

surgical removal of tumor -Correction of anemia (blood transfusions) and malnutrition before surgery is important to decrease complications Chemotherapy & Radiation therapy may be used if surgical cure is not available (gastrectomy

what are postop complications to report for appendicitis?

temperature, nausea and vomiting, or abdominal distention; these may indicate infection.

what happens if peritonitis occurs with appendicitis

treatment involves.. • GI Intubation • Parenteral replacement of IV fluids and electrolytes • Administration of Antibiotics

what is treatment for botulism

ventilation maintenance, antitoxin therapy

what are causes of gastroenteritis (3 types)

viral (rotavirus), bacterial (e. coli, salmonella, c. diff) or parasitic (giardia)

what is GERD?

will have diffuse pain, or get tired Signs & symptoms can mimic cardiac pain. Usually onset after eating Typically resolved with medication

what are medications used for appendicitis?

• Intravenous fluids replacements • Analgesics

what are 2 types of food poisoning?

• acute bacterial diseases; issues in GI • botulism: (neurologic symptoms)

what are s/s of food poisoning?

• think of nausea , vomiting and abdominal pain