Session 9 GI Nurse Prac Exam 3 (part 2)

A client is scheduled for a colonoscopy. What does the nurse tell the client to do before the procedure is performed? "Begin a clear liquid diet 12 to 24 hours before the test." "Do not eat or drink anything for 12 hours before the test." "Give yourself tap water enemas until the fluid returns are clear." "You will have to drink a contrast liquid 2 hours before the test."

"Begin a clear liquid diet 12 to 24 hours before the test."

A nurse is providing teaching to a client with gastroesophageal reflux disease (GERD). Which of the following statements by the client indicates a need for further teaching? In other words, which one of these statements is FALSE? "I should elevate the head of my bed while sleeping." "I drink no more than 4 cups of coffee a day." "I take my time when I am eating." "I avoid foods and drinks made with chocolate."

"I drink no more than 4 cups of coffee a day."

Which patient statement requires a focused GI assessment? "Spicy foods upset my stomach." "I have had dentures for 3 years." "I experience occasional constipation." "I take ibuprofen 600 mg three times a day for arthritis pain."

"I take ibuprofen 600 mg three times a day for arthritis pain."

non-mechanical bowel obstruction

(e.g., paralytic ileus) (stomach falls asleep; no bowel sounds or gas passing- common with ABD surgery

GERD Complications

-Barrett Esophagus (increased risk for adenocarcinoma) -esophagitis -scar tissue/stricture formation (dysphagia)

Which client is more likely to develop gallstones? 45-year-old female with a family history of gallstones 55-year-old male with a history of diabetes mellitus 62-year-old female with a history of irritable bowel syndrome 60-year-old obese female with a history of diabetes mellitus

60-year-old obese female with a history of diabetes mellitus

A nurse is teaching a client who has gastroesophageal reflux disease (GERD) about managing his/her illness. Which of the following recommendations should the nurse include in the teaching? Limit fluid intake not related to meals Chew on mint leaves to relieve indigestion Avoid eating within 2-3 hours of bedtime Season foods with black pepper

Avoid eating within 2-3 hours of bedtime

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? Abdominal pain relieved by bending the knees Chronic diarrhea, abdominal pain, and fever Epigastric cramping Hypotension with vomiting

Chronic diarrhea, abdominal pain, and fever

Which one is correct? Clients with CD experience about 20 loose, bloody stools daily The peak incidence of UC is between 15 and 40 years of age Very few complications are associated with CD Clients with UC may experience hemorrhage

Clients with UC may experience hemorrhage

Gastritis Clinical manifestations

Epigastric pain, nausea and vomiting, weight loss, decreased appetite, and stool color changes -Pain may be exacerbated with spicy food ingestion

An upper GI endoscopy (esophagogastroduodenoscopy/EGD) might be used to discover the reason for? (Select all that apply): A.GERD B.Barrett's Esophagus C.Lower intestine abnormalities D.Ulcer E.Hemorrhoids F. Cancer

GERD, Barretts, Ulcer, Cancer

Gastritis vs. gastroenteritis

Gastritis only involves the stomach (vomiting) Gastroenteritis involves the stomach and intestines (vomiting and diarrhea)

While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy/EGD), the nurse should implement which of the following interventions? Administer a preparation to clean the GI tract, such as Golytely or Fleet Phospho-Soda Tell the client he/she must be on a clear liquid diet for 24 hours before the procedure Inform the client that he/she will receive a sedative before the procedure Tell the client that he/she may eat and drink immediately after the procedure

Inform the client that he/she will receive a sedative before the procedure

After abdominal surgery, what client assessment finding alerts the nurse to the fact that peristaltic movement is returning? Passing flatus Reports of hunger Absence of nausea Presence of normal bowel sounds

Passing flatus

mechanical bowel obstruction

Refers to a bowel obstruction that occurs as a result of blockage of the bowel lumen. (tumor, etc)

Which food does the nurse instruct a client undergoing chemotherapy for oral cancer with secondary stomatitis to avoid? Broiled fish Ice cream Salted pretzels Scrambled eggs

Salted pretzels

A 68-year-old client presents to the ED the day after Thanksgiving, stating that he has "eaten and drunk quite a bit." He says that about 1 hour ago he experienced a sudden onset of pain in the left upper quadrant that radiates to his left flank. He rates the pain as an 8 on a 0-to-10 scale. The client is admitted with acute pancreatitis. Which laboratory finding corroborates the diagnosis of acute pancreatitis? -Serum lipase, 150 U/L (normal = 0-160 U/L) -Serum amylase, 200 U/L (normal = 23 to 85 U/L) -White blood cells (WBCs), 6000 mcL (normal = 4800-10,800 mcL) -Serum glucose, 80 mg/dL (normal = 82-110 mg/dL)

Serum amylase, 200 U/L (normal = 23 to 85 U/L)

Which factors place a client at risk for gastrointestinal (GI) problems? (Select all that apply.) Eating a high-fiber diet Smoking Socioeconomic status Some herbal preparations Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Smoking Socioeconomic status Some herbal preparations Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

intestinal obstruction

Sometimes called an ileus, it occurs when contents cannot pass through the intestine

patient teaching: GERD

Take meds Eat small, frequent feedings Don't lie down for at least one hour after meals Elevate the HOB 4-8 inches when sleeping

bowel obstructions: tx

can be removed by surgical or non-surgical means

oral cancer complications

infiltration to muscles and underlying tissue, difficulty eating, talking (AIRWAY!)

gastritis cause

inflammation of the stomach: · The onset of INFECTION with Helicobacter pylori can result in acute gastritis; H. pylori is a gram-negative bacterium that penetrates the mucosal gel layer of the gastric epithelium

oral cancer malignancies common seen with:

intense exposure to the sun, excessive alcohol consumption, and pipe or cigarette smoking.

GERD

most common GI problem seen in adults; stomach contents leak back due to the lower esophageal sphincter not closing properly

oral cancer: epidimiology

squamous cell (most common) (rapid growth); basal cell carinomas (grow slowly and become invasive overtime)

common complications of hernias

strangulation of intestines, intestinal obstruction and or necrosis of the bowel

Gastritis nursing implications

· Stop smoking; or using nicotine in general · GI rest 6-12 hour of NPO, slow reintroduction of clear liquids (broth, tea, gelatin, carbonated beverages) Gradually increase to BRAT diet (bananas, rice, applesauce, and toast) · Protect against toxic substance exposure in work place · Encourage patient to seek treatment for reflux issues

what to avoid and what to eat with problems in oral cavity

•Teach the patient to avoid commercial mouthwashes, particularly those with high alcohol content, and lemon-glycerin swabs •Assist the patient in selecting soft, bland, and nonacidic foods

mouth care for issues in oral cavity

•Use a soft toothbrush or gauze for oral care •Encourage frequent rinsing of the mouth with warm saline, sodium bicarbonate (baking soda) solution, or a combination of these solutions

A client is being discharged after a colonoscopy. Which of the following is true? (Select all that apply): -The client may return to work four hours after being discharged. -The client may have gastric cramping after the procedure. -If polyps are removed, the client may see blood in the stool. -The client may take public transportation to return home once discharged. -Before the client returns home, he/she will receive preliminary results of the colonoscopy.

The client may return to work four hours after being discharged. The client may have gastric cramping after the procedure. If polyps are removed, the client may see blood in the stool. Before the client returns home, he/she will receive preliminary results of the colonoscopy.

GERD Triggers include

alcohol and caffeinated products (e.g., coffee, soda, chocolate, and/or tea) as well as mints (peppermint/spearmint)

Gastritis Management

· Use caution in taking large doses of aspirin, other NSAIDs (e.g., ibuprofen), and corticosteroids · Avoid excessive intake of caffeine · Be sure that foods and water are safe, to avoid contamination well balanced diet, manage stress, limit alcohol

oral cancer: clinical manifestations

•Early symptoms affect the floor of the mouth or tongue •Asymptomatic in the early stages

oral cancer management

•Radiation therapy •Medications: chemo and/or agents that target and block growth factors