Singleton Review
After a subtotal gastrectomy for cancer of the stomach, a client develops dumping syndrome. The client says, "What does it mean when the health care provider said that I am experiencing dumping syndrome?" What information should the nurse include in a response to this question? 1 Nausea resulting from a full stomach 2 Reflux of gastric contents into the esophagus 3 Buildup of flatulence within the large intestine 4 Rapid passage of concentrated fluid into the small intestine
4 Rapid passage of concentrated fluid into the small intestine
What kind of pain could an issue with the gallbladder commonly present as? (Cholecystitis) A. Right lower quadrant B. mid-epigastric radiates to RUQ or right scapula C. periumbilical pain D. mid-epigastric radiates to back
B. mid-epigastric radiates to RUQ or right scapula
NO caffine and coffee with which PUD?
Crohns
Avoid spicy foods with...
Inflammatory bowel disease (colitis/chrons)
Ulcerative colitis affects...
Just the mucosa layer of GI tract (inner layer)
The surgeon is the _______ of the surgical team
Leader preform surgery effictively and safety
Chrons disease is located...
Occurs anywhere along the GI tract
What kind of pain does gastric ulcers cause?
PAIN IS HIGH IN THE EPIGASTRUM burning or gaseous pain
Patient assessment findings that require follow up (gallbladder)
Right upper quadrant tenderness Dark amber colored urine Patient oral temperature 100.4F
Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori? a. Sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol) b. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) c. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix) d. Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan)
b. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
A family member of a 28-year-old patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will a. decrease nausea and vomiting. b. inhibit development of stress ulcers. c. lower the risk for H. pylori infection. d. prevent aspiration of gastric contents.
b. inhibit development of stress ulcers.
What kind of pain does duodenal ulcers cause?
burning or cramplike pain in midepigastric or back
The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? a. Antibiotic(s), antacid, and corticosteroid b. Antibiotic(s), aspirin, and antiulcer/protectant c. Antibiotic(s), proton pump inhibitor, and bismuth d. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)
c. Antibiotic(s), proton pump inhibitor, and bismuth
Crohn's Disease is differentiated from other inflammatory bowel disorders by which finding? a. Diarrhea b. Malabsorption of nutrients. c. Bowel segments that are cobblestone in appearance. d. Absence of inflammation or ulceration
c. Bowel segments that are cobblestone in appearance.
A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring? a. Malnutrition b. Bile reflux gastritis c. Dumping syndrome d. Postprandial hypoglycemia
c. Dumping syndrome
Fluticasone is a...
corticosteroid
Dexamethosone is a ...
corticosteroid treats inflammation
A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about a. substitution of acetaminophen (Tylenol) for the NSAID. b. use of enteric-coated NSAIDs to reduce gastric irritation. c. reasons for using corticosteroids to treat the rheumatoid arthritis. d. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
d. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? a. Back pain 3 or 4 hours after eating a meal b. Chest pain relieved with eating or drinking water c. Burning epigastric pain 90 minutes after breakfast d. Rigid abdomen and vomiting following indigestion
d. Rigid abdomen and vomiting following indigestion
With bacterial conjunctivitis, the patient should...
discard all opened or used lens care products or cosmetics
Dumping syndrome is (in peptic ulcer disease) ...
dizzy, cramping, urge to defecate, not drinking fluids during eating Eat small frequent meals High in proteins and fat Low in carbs Lie down after meals
Duodenal ulcers are greater in ________
men
Gastric ulcers are greater in ______
women
Avoid fiber with...
IBD (Ulcerative Colitis or Crons)
Jaundice is found when ...
No bile flow to duodenum, bilirubin accumulates in blood (obstruction of bile flow)
Gastric ulcers cause discomfort _________ hours after meal
1-2
When should you take sucralfate?
1-2 hrs before or after antiacid MOST EFFECTIVE AT LOW pH Protects esophagus, stomach, and duodenum BINDS WITH PROTIENS / STIMULATES SECRETION OF MUCUS
Duodenal ulcers cause discomfort _________ hours after meal
2-5
TO administer ear drops to a baby, pull the pinna....
Down and back
The nurse is completing patient education for a patient to be discharged after undergoing an open cholecystectomy. Which statement by the patient indicates effective teaching by the nurse? 1. "I must take my pain meds every 4 hours" 2. "I can get in the pool and go swimming in 2 weeks" 3. I need to limit my activity to prevent getting tired" 4. "I should not be carrying the laundry baskets upstairs"
4. "I should not be carrying the laundry baskets upstairs"
Which clinical manifestation would support a diagnosis of allergic conjunctivitis? A. Itching B. Sore throat C. Photophobia D. Yellow discharge
A. Itching
Ulcerative colitis and Crohns disease share these manifestations/complications:
Abdominal pain Diarrhea cancer c. diff perforation
Chrons disease affects...
Affects the whole bowel lining (all layers)
What is the role of the circulating nurse in surgery?
Assists in positioning the patient Counts sponges and instruments Reviews the preoperative assessment Implements plan of care
The nurse is caring for a client with cholecystitis. Which clinical manifestation would the nurse expect the client to exhibit? A. Dysphagia B. Fever C. Hiccups D. Bradycardia
B. Fever
A patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is reporting nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient most likely experiencing? A. Gastroparesis B. Fascia dehiscence C. Dumping Syndrome D. Somogyi effect
C. Dumping Syndrome
What to avoid with peptic ulcer disease?
Caffeine
PUD is more common in population of
Caucasion / jewish genetics
RUQ pain is associated with
Cholecystitis
Cobblestoning is associated with...
Chron's disease Patches along GI tract
Severe weight loss is assoicated with
Chrons disease
Methotrexate is most useful in patients with ...
Chrons disease who cannot stop corticosteroid use without a flare up or in whom other drugs have been ineffective
How to clean the eyes?
Clean from inner to outer canthus Clean eyes which different corners of towel
The nurse is teaching a client with cholelithiasis about a new prescription for ursodiol. Which client statement indicates to the nurse that the teaching was successful? A. "If I take this for a long time it might damage my liver, so I will need checkups of my liver function." B. "There is a good chance I will experience diarrhea, so I might need my dosage reduced." C. "This medicine should take away the orange color from my skin." D. "I might have some slight diarrhea or constipation, but that is a normal side effect of the medicine."
D. "I might have some slight diarrhea or constipation, but that is a normal side effect of the medicine."
The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, board-like abdomen
D. A rigid, board-like abdomen
How do proton pump inhibtors work?
Decrease secretion Omeprazole Pantoprazole
Primary manifestation of ulcerative colitis is...
Diharrhea As many as 20 a day
Ursodiol and Chenodiol are effective by...
Dissolving gallstones Used or patients that cannot get surgery to remove
4 F's Risk Factors:
Female Fat Fertile Forty
Duodenal ulcers are found in ...
Fist 1-2 cm of duodenum
Aspirin can increase risk of....
GI bleed when peptic ulcer disease is present
Proton pump inhibitors are more effective than ...
H2 recceptor blockers in reducing gastric acid secretion and promoting ulcer healing
Famotidine is a...
H2 receptor blocker Relieves epigastric pain reduces secretion
What are the three major complications of Peptic ulcer disease?
Hemorrhage Perforation Gastric outlet obstruction
Which medication will substitute penicillin (amoxicillin) if the patient has an allergy?
Metronidazole is used instead of amoxicillin in the triple drug regimen
Dantrolene is a...
Muscle relaxant Treatment for malignant hypothermia!!!
What medications cannot be taken with Peptic ulcer disease?
NO NSAIDS unless administered with PPI, H2 receptor, or misoprostol
The scrub nurses role in surgery is ...
Prepares surgical set up Maintains surgical asepsis Drape and handle instruments Assist surgeon by passing equipment and supplies
Misoprostol is effective by...
Preventing stomach ulcers while taking NSAIDS
How does sucralfate work?
Protects lining esophagus stomach and duodenum (antiulcer medication)
The anethesists role in surgery is ...
Provides anethesia to the patient
Where is pain with choleysistis?
RUQ
Avoid what kind of foods with IBD?
Spicy foods
Ulcerative colitis is located...
Starts in rectum and continuous up the colon LLQ
If patient is dx with peptic ulcer disease but also takes aspirin for pain, the patient should...
Talk to doctor or prescriber for pain med alternative
ORAL erythromycin or azithromycin is used for ...
Treats clamydial conjunctivitis Not topical, ORAL
Acute otitis media is an infection of the ...
Tympanum, ossicles, and space of the middle ear Swelling occurs in the auditory tube and traps bacteria
Affects the mucosa and submucosa of the colon and rectum a. Ulcerative colitis b. Crohn's disease
Ulcerative colitis
NPO with which PUD?
Ulcerative colitis
Rectal bleeding is common with...
Ulcerative colitis (20 poops a day)
To administer ear drops to a pt over 3yrs of age, pull the pinna...
Up and back
You'd rather have ___________ than chrons disease
ulcerative colitis