Chapter 46: Management of Patients With Gastric and Duodenal Disorders
A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect? Peritonitis Dehiscence of the surgical wound A normal reaction to surgery Dumping syndrome
Dumping syndrome Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.
A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? Ineffective treatment for the peptic ulcer Gastric penetration A reaction to the medication given for the ulcer Perforation of the peptic ulcer
Perforation of the peptic ulcer Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (board-like) abdomen; and hypotension and tachycardia, indicating shock.
A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? "Expect a metallic taste when taking this medicine, which is normal." "Do not drive when taking this medication." "Take the medication with milk." "Be sure to wear sunscreen while taking this medicine."
"Be sure to wear sunscreen while taking this medicine." Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. A sectioned portion of the stomach is joined to the jejunum. The antral portion of the stomach is removed and a vagotomy is performed. The vagus nerve is cut and gastric drainage is established.
A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.
The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction. Amount of hydrochloric acid (HCL) secretion in the stomach Patient's age Presence of H. pylori Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Amount of hydrochloric acid (HCL) secretion in the stomach A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer evidences hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.
The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition? Systemic infection Pernicious anemia Peptic ulcers Colostomy
Peptic ulcers Chronic gastritis caused by Helicobacter pylori is implicated in the development of peptic ulcers. Chronic gastritis is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia. Chronic gastritis is not implicated in system infections and/or colostomies.
Which of the following appears to be a significant factor in the development of gastric cancer? Diet Ethnicity Gender Age
Diet Diet seems to be a significant factor: a diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. The typical patient with gastric cancer is between 50 and 70 years of age. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer.
A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects the client's stools to have which description? Coffee-ground-like Clay-colored Black and tarry Bright red
Black and tarry Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.
The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? Vitamin C Vitamin A Vitamin E Vitamin B12
Clients with chronic gastritis from vitamin deficiency usually have evidence of malabsorption of vitamin B12 caused by the production of antibodies that interfere with the binding of vitamin B12 to intrinsic factor. However, some clients with chronic gastritis have no symptoms. Vitamins A, C, and E are not affected by gastritis.
Which ulcer is associated with extensive burn injury? Cushing ulcer Curling ulcer Peptic ulcer Duodenal ulcer
Curling ulcer Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.
Which medication is classified as a histamine-2 receptor antagonist? Esomeprazole Famotidine Metronidazole Lansoprazole
Famotidine Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.
The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage? Hematemesis Hypertension Polyuria Bradycardia
Hematemesis The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.
A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed? Penetration Perforation Hemorrhage Pyloric obstruction
Hemorrhage Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.
Review the following four examples of ideal body weight (IBW), actual weight, and body mass index (BMI). Using three criteria for each example, select the body weight that indicates morbid obesity. IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2 IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 IBW = 132 lbs; weight = 184 lbs; BMI = 28 kg/m2 IBW = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2
IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 The criteria for morbid obesity are a body weight that is twice IBW and a BMI that exceeds 30 kg/m2.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? Mental confusion Bradypnea Hypertension Bradycardia
Mental confusion Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? Stool specimen Nasogastric tube insertion Oral contrast Pelvic x-ray
Nasogastric tube insertion The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.
Peptic ulcer disease occurs more frequently in people with which blood type? O B A AB
O People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.
Which of the following is considered an early symptom of gastric cancer? Weight loss Dyspepsia Pain relieved by antacids Bloating after meals
Pain relieved by antacids Symptoms of early disease, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms of progressive disease include weight loss, bloating after meals, and dyspepsia.
Which of the following is the most successful treatment for gastric cancer? Radiation Chemotherapy Palliation Removal of the tumor
Removal of the tumor There is no successful treatment for gastric carcinoma except removal of the tumor. If the tumor can be removed while it is still localized to the stomach, the patient may be cured. If the tumor has spread beyond the area that can be excised, cure is less likely.
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? Six small meals daily with 120 mL fluid between meals Six small meals and 120 mL fluid daily Three meals and three snacks and 120 mL fluid daily Three meals and 120 ml fluid daily
Six small meals daily with 120 mL fluid between meals After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.
A client is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What surgical procedure will the nurse prepare the client for? Pyloroplasty Vagotomy Billroth II Billroth I
Billroth I A Billroth I is the removal of the lower portion (antrum) of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. A vagotomy is a surgical dissection of the vagus nerve to decrease gastric acid. A pyloroplasty is a procedure to widen the pylorus. A Billroth II is the removal of the lower portion (antrum) of stomach with anastomosis to the jejunum.
A critical care nurse is closely monitoring a patient who has recently undergone surgical repair of a bleeding peptic ulcer. The nurse should prioritize assessments of which of the following signs and symptoms of a recurrence of hemorrhage? Bradypnea and pursed lip breathing Restlessness and cyanosis Peripheral and pulmonary edema Hypotension and tachycardia
Hypotension and tachycardia Rebleeding has multiple manifestations. However, an increase in heart rate and decrease in blood pressure are key signs of a hemorrhage that are present in nearly all patients who are experiencing rebleeding.
A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? Notify the health care provider. Reposition the tube. Increase the suction level. Irrigate the tube.
Notify the health care provider. The nurse should notify the health care provider because an NG tube that fails to drain during the postoperative period may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
Clients with Type O blood are at higher risk for which of the following GI disorders? Duodenal ulcers Esophageal varices Diverticulitis Gastric cancer
Duodenal ulcers Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A sectioned portion of the stomach is joined to the jejunum. The vagus nerve is cut and gastric drainage is established. The antral portion of the stomach is removed and a vagotomy is performed. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.
A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.
A client with acute gastritis asks the nurse what might have caused the problem. What is a possible cause of acute gastritis? Excessive alcohol intake Overuse of allergy medicine Drinking fruit juices Dietary indiscretion Radiation therapy
Dietary indiscretion Excessive alcohol intake Radiation therapy Possible causes of gastritis include dietary indiscretion, overuse of aspirin and other nonsteroidal anti-inflammatory drugs, excessive alcohol intake, bile reflux, and radiation therapy. Allergy medicine and fruit juices are not causes of acute gastritis.
A critical care nurse is closely monitoring a patient who has recently undergone surgical repair of a bleeding peptic ulcer. The nurse should prioritize assessments of which of the following signs and symptoms of a recurrence of hemorrhage? Restlessness and cyanosis Peripheral and pulmonary edema Bradypnea and pursed lip breathing Hypotension and tachycardia
Hypotension and tachycardia Rebleeding has multiple manifestations. However, an increase in heart rate and decrease in blood pressure are key signs of a hemorrhage that are present in nearly all patients who are experiencing rebleeding.
A nursing student is caring for a client with gastritis. Which of the following would the student recognize as a common cause of gastritis? Choose all that apply. Irritating foods Overuse of aspirin Participation in highly competitive sports DASH diet Ingestion of strong acids
Ingestion of strong acids Irritating foods Overuse of aspirin Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. A DASH diet is an acronym for Dietary Approaches to Stop Hypertension, which would not cause gastritis. Participation in competitive sports also would not cause gastritis.
Which medication classification represents a proton (gastric acid) pump inhibitor? Famotidine Omeprazole Metronidazole Sucralfate
Omeprazole Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.
A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? Esophageal ulcer Meckel's ulcer Curling's ulcer Peptic ulcer
Curling's ulcer Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.
The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage? Polyuria Hypertension Bradycardia Hematemesis
Hematemesis The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.
A client who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the client reported cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the nurse educate the client about regarding this event? Dumping syndrome Celiac disease Bile reflux Gastric outlet obstruction
Dumping syndrome Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated (i.e., with defecation).
A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. Cimetidine Famotidine Omeprazole Nizatidine
Omeprazole Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.
A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. Bladder Pancreas Duodenum Lungs Liver
Pancreas Duodenum Liver Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.
Which is a true statement regarding gastric cancer? Most clients are asymptomatic during the early stage of the disease. Most cases are discovered before metastasis. Women have a higher incidence of gastric cancer. The prognosis for gastric cancer is good.
Most clients are asymptomatic during the early stage of the disease. Most clients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer. The prognosis is poor because the diagnosis is usually made late because most clients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.
A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which explanation from the nurse would be most accurate? "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems." "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." "Caffeine increases the fluid volume in your system, which irritates your digestive organs."
"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Caffeine is a diuretic that causes decreased fluid volume and potential dehydration. It does not lead to hemorrhage and does not interfere with absorption of vitamin B12.
A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? "These medications will coat the ulcer and decrease the acid production in my stomach." "The medications will kill the bacteria and stop the acid production." "I should take these medications only when I have pain from my ulcer." "My ulcer will heal because these medications will kill the bacteria."
"The medications will kill the bacteria and stop the acid production." Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? "I should stop all my medications if I develop any side effects." "I have learned some relaxation strategies that decrease my stress." "I should continue my treatment regimen as long as I have pain." "I can buy whatever antacids are on sale because they all have the same effect."
"I have learned some relaxation strategies that decrease my stress." The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.
A client has been taking famotidine at home. What teaching should the nurse include with the client? Famotidine will inhibit gastric acid secretions. Famotidine will neutralize acid in the stomach. Famotidine will shorten the time required for digestion in the stomach. Famotidine will improve the mixing of foods and gastric secretions.
Famotidine will inhibit gastric acid secretions. Famotidine is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion. Famotidine will not neutralize acid in the stomach, but inhibits acid secretion. Famotidine will not shorten digestion time and will not improve food mixing with gastric secretions.
A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) "It is a hereditary disease." "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "It is probably your nerves." "Is it possible that you are overusing aspirin."
"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." Acute gastritis is often caused by dietary indiscretion—the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.
A nurse is teaching a client who has experienced an episode of acute gastritis. The nurse knows further education is necessary when the client makes which statement? "My appetite should come back tomorrow." "Once I can eat again, I should stick with bland foods." "I should limit alcohol intake, at least until symptoms subside." "I should feel better in about 24 to 36 hours."
"My appetite should come back tomorrow." The gastric mucosa is capable of repairing itself after an episode of gastritis. As a rule, the client recovers in about 1 day, although the appetite may be diminished for an additional 2 or 3 days. Acute gastritis is also managed by instructing the client to refrain from alcohol and food until symptoms subside. When the client can take nourishment by mouth, a nonirritating diet is recommended.
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems? Gastric cancer Duodenal ulcer Acute gastritis Gastric ulcer
Acute gastritis A client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. A client with a duodenal ulcer will present with heartburn, nausea, excessive gas and vomiting. A client with gastric cancer will have persistent symptoms of nausea and vomiting, not sudden symptoms. A client with a gastric ulcer will have bloating, nausea, and vomiting, but not necessarily hiccups.
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? Notify the health care provider. Irrigate the client's NG tube. Place the client in the high-Fowler's position. Assess the client's abdomen and vital signs.
Assess the client's abdomen and vital signs. Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? Place the client in the high-Fowler's position. Assess the client's abdomen and vital signs. Notify the health care provider. Irrigate the client's NG tube.
Assess the client's abdomen and vital signs. Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.
A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what? Eating Having a bowel movement Suppressing emesis Drinking milk
Eating Taking antacids, eating, or vomiting often relieves the pain. Pain occurs about 2 hours after eating. Milk is contraindicated in relieving peptic ulcer pain.
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Barium study of the upper gastrointestinal tract Gastric secretion study Stool antigen test Endoscopy
Endoscopy Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.
A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? A reaction to the medication given for the ulcer Gastric penetration Ineffective treatment for the peptic ulcer Perforation of the peptic ulcer
Perforation of the peptic ulcer Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (board-like) abdomen; and hypotension and tachycardia, indicating shock.
Which is an accurate statement regarding gastric cancer? Most gastric cancer-related deaths occur in people younger than 40 years. Females have a higher incidence of gastric cancers than males. A diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer. The incidence of stomach cancer continues to decrease in the United States.
The incidence of stomach cancer continues to decrease in the United States. While the incidence in the United States continues to decrease, gastric cancer still accounts for 10,700 deaths annually. While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years of age. Males have a higher incidence of gastric cancers than females. More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.
Which of the following interventions are appropriate for clients with gastritis? Select all that apply. Discourage cigarette smoking. Provide general education about how to prevent recurrences. Use a calm approach to reduce anxiety. Give the client food and fluids every 4 hours. Notify the physician of indicators of hemorrhagic gastritis.
Use a calm approach to reduce anxiety. Discourage cigarette smoking. Notify the physician of indicators of hemorrhagic gastritis. The nurse should use a calm approach when answering questions and providing teaching. He or she should discuss smoking cessation and monitor for any indicators of hemorrhagic gastritis. The client will take nothing by mouth for up to a few days until symptoms subside. The nurse needs to develop an individualized teaching plan for the client that includes information about stress management, diet, and medications.
A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect? Vasomotor symptoms associated with dumping syndrome Dehiscence of the surgical wound A normal reaction to surgery Peritonitis
Vasomotor symptoms associated with dumping syndrome Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.
