The Concept of Digestion

The abdominal x-ray will be used first to diagnose

A suspected bowel obstruction

Functional gastrointestinal disorders in childhood include:

Abdominal pain. Dyspepsia. Irritable bowel syndrome.

Nursing interventions for caring for a patient receiving total parenteral nutrition (TPN) include:

Adhering to infection control protocols. Monitoring the TPN site for infection. Monitoring blood and urine glucose levels. Assessing lung sounds and monitoring for edema.

Digestive Health Promotion Digestive Issues

Adopt healthy digestive habits. Make lifestyle changes to reduce symptoms. Involve family and social support to achieve health goals.

Abnormal Digestive Assessment Findings Inspection

Asymmetrical contours Marked pulsations Engorged veins Marked distention Bruising around the umbilicus (Cullen sign) or bruising of the flanks (Grey Turner sign) indicative of pancreatic necrosis with retroperitoneal or intra-abdominal bleeding

Dietary changes needed when a patient has an alteration in digestion include:

Avoiding highly process foods. Avoiding high-fat content . Avoiding alcohol. Avoiding caffeinated beverages. Increasing dietary fiber. Increasing fluid intake.

Disorders associated with absorption problems include:

Celiac disease. Crohn disease. Pernicious anemia. Lactose intolerance. Acute and chronic pancreatitis. Liver failure.

Digestive Health Promotion Consumption

Consume foods that support health: fruits and vegetables, whole grains, and lean meats. Avoid highly processed and high-fat foods. Use healthy cooking techniques. Avoid alcohol and caffeine. Maintain adequate water consumption. Practice safe food and beverage storage.

The nurse is caring for a patient with intractable nausea and vomiting. Which intervention should the nurse make a priority?

Corect Monitoring vital signs, skin turgor and condition, and weight Unselected Restricting fluid intake for 1 hour before and after meals Unselected Giving clear liquids as tolerated Unselected Encouraging separate intake of clear fluids and food

The nurse notes that a patient is prescribed an antacid. Which information should the nurse include when teaching the patient about this medication?

Correct "Antacids are alkaline substances that are commonly used to relieve simple acid indigestion." Unselected "Antacids work to help suppress the volume of acidity coming from the lower gastrointestinal (GI) tract." Unselected "Antacids promote motility by enhancing esophageal clearance and gastric emptying." Unselected "Antacids bind the acid-secreting enzyme that functions as the proton pump, thereby disabling it."

A patient experiencing severe constipation and blood in the stool is scheduled for an endoscopy. Which teaching should the nurse provide about this procedure?

Correct "Do not eat any food or drink fluid for 8 hours before the procedure." Unselected "You will be drinking 16 to 20 ounces of liquid barium before the procedure." Unselected "After the test, you will be prescribed laxatives to help with constipation." Unselected "You can have something to eat and drink immediately after the procedure."

A patient seeks medical attention for nausea and vomiting that has been occurring for 3 days. Which question should the nurse ask to help determine the reason for this patient's symptoms?

Correct "Do you currently take any medications?" Unselected "Have you experienced any weight loss?" Unselected "Do you have a history of digestive problems?" Unselected "Have your bowel movements been normal?"

A patient asks what can be done for heartburn that occurs during the night. Which recommendation should the nurse make to this patient?

Correct "Elevate your head with a few pillows." Unselected "Take antacids before going to bed." Unselected "Take an acid reducer before going to bed." Unselected "Avoid eating an hour before going to bed."

After hearing about enteral and parenteral nutrition approaches, a patient asks, "What's the difference between them?" Which statement should the nurse make to this patient?

Correct "Enteral nutrition is achieved through a tube into the stomach or small intestine, while parenteral nutrition is achieved through the veins." Unselected "Enteral nutrition provides only part of the nutritional needs, while parenteral nutrition provides all the nutritional needs." Unselected "Parenteral nutrition is achieved through a tube into the stomach or small intestine, while enteral nutrition is achieved through the veins." Unselected "Enteral nutrition is used short term, while parenteral nutrition is used long term."

The nurse suspects that an older adult patient has diverticular disease. Which question should the nurse ask to determine if the patient is experiencing this health problem?

Correct "Have you experienced any constipation or diarrhea?" Unselected "When was the last time you had anything to eat?" Unselected "Have you eaten any new foods?" Unselected "How much fluid have you had to drink in the last 24 hours?"

The nurse teaches a patient with nausea and vomiting caused by chemotherapy about ways to improve oral intake. Which patient statement should indicate to the nurse that additional teaching is required?

Correct "I will drink clear fluids and eat dry foods at separate times." Unselected "As soon as I feel better, I will start eating bland foods." Unselected "I will try clear liquids and dry foods and see how I feel afterward." Unselected "I will sit up straight to avoid feeling nauseated after I eat."

The nurse prepares to administer the first dose of a proton pump inhibitor (PPI) to a patient with gastroesophageal reflux disease (GERD). Which information should the nurse include when teaching about the mechanism of action of this medication?

Correct "It reduces gastric acid secretion." Unselected "It stimulates gastric emptying." Unselected "It temporarily reduces gastric pain." Unselected "It neutralizes gastric acid secretion."

A patient with nausea and vomiting does not like the prescribed medication because it causes drowsiness. Which statement by the nurse is appropriate?

Correct "Peppermint oil can be used when you are nauseated, and it will not make you sleepy." Unselected "Probiotics are an excellent choice and do not have the side effects the medication does." Unselected "Currently, there is nothing as effective as the medication you have been prescribed." Unselected "Metoclopramide is a drug used for nausea and vomiting and is a better choice for you."

An older adult patient asks the nurse to explain the difference between prebiotics and probiotics. Which response should the nurse make to this patient?

Correct "Prebiotics act as food for the probiotics." Unselected "Probiotics are ineffective without prebiotics." Unselected "Prebiotics help control the growth of the probiotics." Unselected "Prebiotics are microbiotics that help with digestion and prevent infection."

The nurse is caring for a patient with diverticular disease. Which statement should the nurse include when teaching the patient about this health problem

Correct "Small sacs form and push through weak spots in the colon." Unselected "The diverticula result from an inflamed colon." Unselected "Infection causes the small sacs, or diverticula." Unselected "The disease results from a weakened intestinal wall."

During an assessment, the mother of a 2-month-old baby who is being breastfed reports that the baby is experiencing frequent episodes of flatulence but appears happy most of the day. Which response should the nurse make to this mother?

Correct "This is normal. Your child has a decreased level of digestive enzymes, which leads to flatulence." Unselected "This is not normal. Your child is likely reacting adversely to a protein in your milk." Unselected "This is normal. Your child has an increased level of digestive enzymes, which leads to flatulence." Unselected "This is not normal. Your child has an increased inflammatory reaction, which should be discussed with the healthcare provider."

The nurse is caring for a patient with a suspected bowel obstruction. Which diagnostic test should the nurse expect to be completed first for this patient?

Correct Abdominal x-ray Unselected Upper GI (gastrointestinal) series Unselected Barium swallow Unselected Endoscopy

After inserting a nasogastric tube, the patient complains of nausea and begins to vomit. Which action should the nurse take?

Correct Assess tube placement. Unselected Administer an antiemetic as prescribed. Unselected Provide the patient with sips of water. Unselected Instruct the patient about relaxation techniques.

The nurse is seeing pregnant patients in the women's health clinic. Which digestive changes that affect the entire pregnancy should the nurse explain to a patient ?

Correct Constipation Unselected Vomiting Unselected Heartburn Unselected Dyspepsia

A patient is admitted for treatment of malnutrition. Which information should the nurse collect first when assessing this patient?

Correct Current height and weight Unselected Serum electrolyte lab results Unselected Nutritional history Unselected Signs of lethargy and poor skin turgo

The nurse is caring for an infant who has not had a bowel movement for over 3 days. Which finding should the nurse expect when assessing this patient's abdomen?

Correct Dullness over the abdominal region Unselected Tympany over the bladder Unselected Absence of peristolic waves Unselected Dullness over the liver and spleen

The nurse prepares information to teach a group of community members about foods to promote digestive health. Which foods should the nurse recommend in this teaching?

Correct Fruit Unselected Yogurt Unselected Ham Unselected Cheese

The nurse reviews the reasons for a patient to develop a problem with digestion. Which alteration in digestion should the nurse consider to be an alteration in motility?

Correct Gastroesophageal reflux disease (GERD) Unselected Crohn disease Unselected Gastrectomy Unselected Celiac disease

The nurse is obtaining a history on a patient experiencing constipation. Which finding should the nurse expect when assessing this patient?

Correct Hemorroids Unselected Hyperactive bowel sounds Unselected Tympany over the left lower quadrant Unselected Marked pulsations in the abdomen

A patient reports constipation that has been occurring over the past few weeks. Which finding should the nurse expect when listening to this patient's bowel sounds?

Correct Hypoactive bowel sounds Unselected Normal bowel sounds Unselected Hyperactive bowel sounds Unselected Absent bowel sounds

The nurse is caring for a patient experiencing nausea and vomiting due to the side effects of chemotherapy. Which center of the brain, when stimulated, should the nurse explain as contributing to this patient's nausea?

Correct Medulla Unselected Pons Unselected Midbrain Unselected Hippocampus

A patient is traveling out of the country. Which information should the nurse provide to help the patient prevent developing a problem with digestion while traveling?

Correct Obtain immunizations. Unselected Avoid spicy foods. Unselected Increase fiber and water intake. Unselected Take a probiotic daily.

A patient is experiencing constant heartburn. Which action should the nurse take to help this patient?

Correct Position the patient to decrease pressure on the abdomen. Unselected Advise the patient to incorporate bland foods into the diet. Unselected Encourage the patient to avoid food an hour before bedtime. Unselected Encourage the patient to drink juices and carbonated soft drinks.

The nurse is preparing a presentation on the different types of problems with digestion that have a genetic tendency. Which condition should the nurse include in the session?

Correct Pyloric stenosis Unselected Hepatitis Unselected Diarrhea Unselected Acute enteritis

A patient receiving chemotherapy continues to experience nausea after receiving medication. Which additional action should the nurse take to help with this patient's nausea?

Correct Remove food from the room. Unselected Encourage the patient to relax in a supine position. Unselected Assist the patient to ambulate. Unselected Coach the patient to lean forward and place the head between the legs.

A patient with ongoing gastrointestinal issues asks for ways to improve digestion. Which information should the nurse include when responding to this patient?

Correct Sit upright when eating. Unselected Lie down for 2 hours after eating. Unselected Limit the intake of fluids. Unselected Reduce the amount of daily exercise.

A patient with intermittent constipation and diarrhea admits to not eating a healthy diet. Which teaching should the nurse provide to help this patient?

Correct Suggest using probiotics. Unselected Discuss the advantages of restricting caloric intake. Unselected Discuss vitamin supplementation. Unselected Encourage the patient to see a dietitian.

A patient has been experiencing nausea and vomiting for several days. Which action should the nurse recommend to promote this patient's fluid and electrolyte balance?

Correct Taking small sips of apple juice Unselected Avoiding all food preparation Unselected Ingesting small quantities of broth and crackers Unselected Restricting fluid intake to 1 hour after meals

A patient with bloating, bloody stools, and difficulty swalllowing is prescribed a barium swallow. What reason should the nurse realize this diagnostic test has been prescribed for the patient?

Correct To diagnose esophageal varices Unselected To complete a swallow study Unselected To Assess vocal cords Unselected To diagnose throat cancer

Genetics may play a role in which digestive diseases/disorders

Crohn disese GERD pyloric stenosis celiac disease pancreatitis.

Digestive health problems in the older adult include:

Decreased saliva production. Decreased esophogeal motility. Atrophied stomach mucosa. Decreased hydrochloric acid and pepsin levels. Loss of nerve cells in the GI tract. Decreased intestinal surface area. Decreased secretions in the small intestine. Decreased secretion in the stomach. Decreased secretion in the pancreas. Decreased secretion in the liver. Decreased liver size and ability to clear body waste. Increased risk of diverticulitis. Increased risk for gallstones.

Abnormal Digestive Assessment Findings Percussion

Dullness in the left lower quadrant (can indicate stool in the colon) Dullness over the bladder (may indicate distention) Dullness over the liver or spleen (may indicate hepatic or splenic enlargement)

Interventions for nasogastric/gastric tube enteral feedings include:

Ensuring proper placement before initiating enteral feeding. Monitoring for aspiration and diarrhea in the patient receiving enteral feedings.

Common causes of nausea and vomiting include:

Food. Stress. Medications. Smells. Tastes.

Disorders associated with motility problems include:

Gastroesophageal reflux disease (GERD). Diarrhea. Pyloric stenosis. Impaired esophageal motility. Constipation. Irritable bowel syndrome. Encopresis.

A health interview for alteration in digestion includes:

Health history. Appetite. Symptoms of abdominal discomfort. Family history.

Symptoms that antacids treat include:

Heartburn. Chest discomfort. Acid indigestion.

Abnormal Digestive Assessment Findings Auscultation

Hyperactive bowel sounds (may be loud, higher pitched, and rushing) Hypoactive bowel sounds (slow and sluggish) Absent bowel sounds Bruits and venous hums Friction rubs over the liver and spleen

Complementary and alternative therapies to treat alteration in digestion include:

Hypnotherapy. Acupuncture. Peppermint oil. Turmeric. Ginger

Digestive Health Promotion Elimination

Increase fiber and water intake. Engage in regular exercise.

Interventions to reduce digestive disorders in pregnancy include:

Increasing fiber and water intake. Eating multiple small meals. Avoiding spicy, fatty, and greasy foods.

Potential adverse outcomes of TPN include:

Infection. Glucose intolerance. Elevated blood urea nitrogen (BUN) levels in patients with renal impairment. Fluid overload. Dehydration. Electrolyte imbalance. Pneumothorax. Brachial plexus injury. Embolus.

Left Upper Quadrant

Left lobe of liver Spleen Stomach Body of pancreas Left adrenal gland Portion of left kidney Splenic flexure of colon Portions of transverse and descending colon

Right Upper Quadrant

Liver and gallbladder Pylorus Duodenum Head of pancreas Right adrenal gland Portion of right kidney Hepatic flexure of colon Portions of ascending and transverse colon

Left Lower Quadrant

Lower pole of left kidney Sigmoid colon Portion of descending colon Bladder (if distended) Left ovary and salpinx Uterus (if enlarged) Left spermatic cord Left ureter

Right Lower Quadrant

Lower pole of right kidney Cecum and appendix Portion of ascending colon Bladder (if distended) Right ovary and salpinx Right spermatic cord Right ureter

Malnutrition Assessment: Abnormal Findings: Nails Skin Eyes Nervous System Musculoskeletal System Cardiovascular System Gastrointestinal System

Nails -Nails will be soft and spoon shaped when iron deficiency is present. -Splinter hemorrhages indicate vitamin C deficiency. Hair -Dull, dry, scarce hair is seen with deficiencies of protein, zinc, and linoleic acid. -Gray patches or asymmetrical graying may indicate protein or copper deficiency. Skin -Flaky, dry skin may indicate deficiency of vitamins A or B and/or linoleic acid. -Cracks and hyperpigmentation indicate niacin deficiency. -Bruising may indicate deficiency of vitamins C or K. Eyes -Inadequate levels of vitamin A cause eyes to become dry and soft. -Pale conjunctivae indicate iron deficiency; red conjunctivae indicate insufficient levels of riboflavin. Nervous System -Patients deficient in thiamine will present with decreased reflexes and may experience peripheral neuropathies. -Irritability and/or disorientation also may be seen with thiamine deficiency. Musculoskeletal System -Muscle wasting is seen with deficits in protein, carbohydrate, and fat metabolism. -Calf pain occurs with thiamine deficiency; joint pain may occur with vitamin C deficiency. -Low potassium levels can cause muscle cramping, especially in the legs. Cardiovascular System -Heart size and rate may increase with thiamine deficiency. -Diastolic blood pressure may be increased with a high intake of fat. -Lowered cardiac output and decreased blood pressure may occur with caloric deficiencies over a long period. Gastrointestinal System -Cheilosis (sores at corner of mouth) is seen in vitamin B-complex deficiencies, especially riboflavin deficiencies. -Stomatitis and spongy, bleeding gums may also be seen in malnutrition. -Gingivitis can be caused by vitamin C deficiency.

Digestive Health Promotion Prevention

Prevent diseases that lead to digestive disorders. Remain current with immunizations. Obtain immunizations pertinent to travel.

Patient education for nausea includes:

Restricting intake to small quantities of clear liquids (tea, apple juice, broth, Jell-O) and dry foods such as soda crackers to help reduce nausea and prevent vomiting. Avoiding food-preparation odors if they produce nausea. Restricting fluid intake for 1 hour before and after meals and otherwise stressing the need to maintain fluid intake to prevent dehydration. Seeking additional medical help if unable to take in fluids or keep food down. Providing information about electrolyte-replacement solutions such as sports drinks and commercially available electrolyte-replacement solutions.

Digestive Health Promotion General Issues

Sit upright when eating. Exercise regularly. Maintain a healthy weight. Avoid foods that cause digestive problems. Limit alcohol intake.

Cultural considerations include the following:

Some religions restrict or prohibit the consumption of certain foods or types of foods. A number of religions observe fast or feast days in which the amount and types of food consumed are based on customary practices. Patients with culturally based dietary practices may be less likely to adhere to dietary recommendations that do not take their cultural practices into account.

Diagnostic tests to assess gastrointestinal (GI) function include the following: Abdominal x-ray

These x-rays may be ordered for a patient to assist in diagnosing obstructions, perforations, and structural abnormalities.

Diagnostic tests to assess gastrointestinal (GI) function include the following: Computed tomography (CT) scan

This noninvasive tool takes many views of the digestive tract from many different angles to produce cross-sectional images of the organs and soft tissues. CT scan images can provide much more information than x-rays.

Diagnostic tests to assess gastrointestinal (GI) function include the following: Upper GI endoscopy

This procedure directly visualizes the mucous membrane lining of the esophagus, stomach, and duodenum. A flexible fiber optic endoscope is used to visualize inflammation, ulcerations, tumors, or varices, and video imaging may illustrate gastric mobility.

Diagnostic tests to assess gastrointestinal (GI) function include the following: Upper GI series

This test is used to diagnose esophageal varices, inflammation, ulcerations, hiatal hernia, foreign bodies, polyps, diverticula, and tumors of the esophagus, stomach, and duodenal bulb.

Abnormal Digestive Assessment Findings Palpation

Tightness, guarding, or discomfort with palpation Crepitus Irregularities of the abdominal wall such as hernias Tenderness or pain

Interventions to avoid heartburn include:

Treatment with over-the-counter antacids or acid reducers. Decreasing pressure on the abdomen. Losing weight. Wearing loose-fitting clothing. Maintaining proper position to decrease abdominal pressure. Avoiding eating within several hours of going to bed. Elevating the head of bed. Avoiding spicy foods and foods with high acidity. Avoiding cigarettes.

Function of Metoclopramide

a promotility agent, stimulates gastric emptying

An upper GI series (also known as a barium swallow) is conducted to diagnose

esophageal varices inflammation ulcerations hiatal hernia foreign bodies polyps diverticula, tumors of the esophagus, stomach, and duodenal bulb

Functions of Antacids

neutralize gastric acid and relieve pain at the site of esophageal and gastric mucosa

Function of A proton pump inhibitor (PPI)

reduces gastric acid secretion by inhibiting the action of the hydrogen-potassium-ATP pump

What does the endoscopy directly visualizes

the mucous membrane lining of the esophagus, stomach, and duodenum.