GI

ANS: ileostomy An opening in the ileal portion of the small intestine is an ileostomy, and the fecal effluent will be watery to thick liquid that will contain some digestive enzymes. DIF: Cognitive Level: Knowledge REF: Text reference: p. 866 OBJ: Identify types of fecal and urinary diversions. TOP: Ileostomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

An opening that is in the ileal portion of the small intestine is an ____________.

• Use of antibiotics change the flora in the gut • Cephalosporin and quinolone use - Increase risk of overgrowth of Clostridium Difficile

Antibiotic use with regards to GI, what does it do?

1. Degeneration and atrophy of gastric mucosal surfaces with decreased production of HCL -> delayed gastric emptying 2. Atrophy of muscle and mucosal surfaces and thinning of villi and epithelial tissues -> decreased motility and transit time which lead to complaints of indigestion and constipation 3. Decrease in mucus secretion and decrease in elasticity of rectal wall-> decreased absorption of nutrients, leading to decreased sensation to defecate and increased constipation 4. Decreased tone of internal anal sphincter -> fecal incontinence from decrease or loss of sphincter control 5. Decrease of tone/function of the intestine and colon -> the contents move so rapidly through the intestine and colon that there is inadequate time for the GI secretions and oral contents to be absorbed -> diarrhea

5 physiologic changes that may occur in the older adult's gastrointestinal tract that may negatively impact bowel elimination.

c. Necessary because it will be an adjustment. ANS: C The child's age dictates the type and extent of psychologic preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms with the use of visual aids. It is necessary to prepare this age child for procedures. The preschooler is not yet concerned with body image. PTS: 1 DIF: Cognitive Level: Application REF: 1393 OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Implementation

A 3-year-old child with Hirschsprung's disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. Not necessary because of child's age. b. Not necessary because the colostomy is temporary. c. Necessary because it will be an adjustment. d. Necessary because the child must deal with a negative body image.

D. Dermatitis Herpetiformis The answer is D. Patients will Celiac Disease may exhibit skin rashes. Dermatitis Herpetiformis is a VERY itchy blister type rash that can be present on the elbows, knees, buttocks, or hairline. All the other options are not typically present in Celiac Disease

A patient, who was recently diagnosed with Celiac Disease, has blister type bumps on the elbow and knees. The patient reports it is extremely itchy. As the nurse, you know this is as known as: A. Seborrheic Dermatitis B. Psoriasis C. Dyshidrotic Eczema D. Dermatitis Herpetiformis

A-diphenoxylate b-atropine c-loperamide ATI: Opioids - diphenoxylate/atropine (Lomotil), loperamide (Imodium)

A pt has come in with diarrhea, the pharmacological management details that of administering which of the following opioids? Select all: A-diphenoxylate b-atropine c-loperamide d-bisacodyl

• Acute - lasts less than 2 weeks • Chronic - more than 4 weeks

Acute vs chronic diarrhea?

• regular schedule • Emptied every 4-6 hours or when pt empties bladder • Disposable pouches • Change bag every 5-7 days

Changing the appliance: Ileostomy?

ANS: A a. Place a pouch over the newly created stoma. Immediately after a fecal surgical diversion, it is necessary to place a pouch over the newly created stoma to contain effluent when the stoma begins to function. The pouch will keep the patient clean and dry, will protect the skin from drainage, and will provide a barrier against odor. Dressings would obstruct the opening and would become saturated with fecal material. Preparing multiple pouches in advance would be counterproductive; in the immediate postoperative period, the stoma may be edematous and the abdomen distended. These symptoms eventually resolve, but during this time, it will be necessary to revise the pouching system to meet the changing size of the stoma and the changes in body contours. DIF: Cognitive Level: Application REF: Text reference: p. 868 OBJ: Describe methods used to maintain the integrity of the peristomal skin. TOP: Immediate Postsurgical Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

In caring for a patient who had a fecal surgical diversion, which nursing intervention is essential? a. Place a pouch over the newly created stoma. b. Place a dressing over the stoma. c. Wait several days before placing a pouch. d. Prepare several pouches in advance.

- Prevent infection - Meticulous skin care - Pain management - IV Fluid maintenance - NG tube - Oral feeds once stool passed - Family support

Post-operative Care: Anal Malformation?

ANS: D d. Transverse or ascending colon If the opening is in the transverse or ascending colon, the effluent will vary from thick liquid to semi-formed stool. A colostomy in the descending or sigmoid colon generally results in a stool similar to that normally passed through the rectum. An opening in the ileal portion of the small intestine is an ileostomy, and the fecal effluent will be watery to thick liquid that will contain some digestive enzymes. DIF: Cognitive Level: Analysis REF: Text reference: p. 866 OBJ: Explain differences in the color and consistency of effluent based on the type of ostomy. TOP: Position of the Ostomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

The nurse is caring for a patient who has an ostomy. The nurse notices that the effluent ranges from a thick liquid to a semi-formed stool. The nurse recognizes that this is indicative of which location? a. Descending colon b. Ileal portion of the small intestine c. Sigmoid colon d. Transverse or ascending colon

A-Light tan and oily what is it called when it is oily?

The parents of a child are concerned about the appearance of their child's stools. Which of the following descriptions is consistent with the stools produced by a patient diagnosed with celiac disease? A-Light tan and oily B-Green and watery C-Long and ribbon-like D-Red and gel-like

D-"Be sure to read all food labels carefully."

When providing dietary counseling for the parents of a child diagnosed with celiac disease, the healthcare provider should include which of the following information in the teaching plan? A-"Instead of breads you may serve pasta products." B-"Avoid starchy vegetables like peas and potatoes." C-"Wheat, corn, and rice should be avoided." D-"Be sure to read all food labels carefully."

ANS: colostomy An opening in the large intestine or colon is a colostomy, and the fecal effluent will vary in consistency depending on where the opening in the colon is surgically created. DIF: Cognitive Level: Knowledge REF: Text reference: p. 866 OBJ: Identify types of fecal and urinary diversions. TOP: Colostomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

A ______________ is an opening in the large intestine or colon for elimination of fecal material.

D-Adherence to a gluten-free diet

A patient is diagnosed with celiac disease-related iron-deficiency anemia. Which of the following interventions would be most effective in correcting this patient's anemia? a-Inclusion of iron-rich foods b-Administration of erythropoietin c-Daily iron supplements d-Adherence to a gluten-free diet

C. Flat intestinal villi The answer is C. Normally, the intestinal villi look like little finger-like projections. The villi aid in the absorption of the nutrients by increasing the surface area for absorption. However, when Celiac Disease occurs the villi are DAMAGED (attacked by the immune system) and they will appear FLAT. This will decrease the surface area for absorption and lead to malnourishment issues in the patient.

A patient is suspected to be suffering from Celiac Disease. The physician orders an endoscopy. If the patient has Celiac Disease, what finding will be discovered with the endoscopy? A. Over exaggerated intestinal villi B. Ulcerations in the small intestine, specifically the Jejunum C. Flat intestinal villi D. Cobble-stone appearance throughout the small intestine

a. Refer to a nutritionist for detailed dietary instructions and education. ANS: A The main consideration is helping the child adhere to dietary management. Considerable time is spent in explaining to the child and parents the disease process, the specific role of gluten in aggravating the condition, and those foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1424 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

An important nursing consideration in the care of a child with celiac disease is to: a. Refer to a nutritionist for detailed dietary instructions and education. b. Help the child and family understand that diet restrictions are usually only temporary. c. Teach proper handwashing and Standard Precautions to prevent disease transmission. d. Suggest ways to cope more effectively with stress to minimize symptoms.

• Also known as imperforate anus

Anal Malformation another name is?

• Low- residue diet - low fiber, restricts milk, prune juice, has less than 7-10 grams of fiber per day. • Give strained fruits and vegetables - vitamins A &C • Avoid seeds • Reintroduce foods one at a time • Give Gatorade in summer

Diet and Fluids: Ileostomy?

- Instruct patient to notify physician for signs and symptoms of dehydration or electrolyte imbalance, including: • extreme thirst • dry skin and oral mucous membranes • decreased urine output • weakness, fatigue • headache, dizziness • muscle cramps • abdominal cramps, nausea, vomiting • shortness of breath • orthostatic hypotension

Fluid and Electrolyte Imbalances: Ileostomy

- Isolate until cause is identified - Control symptoms - Prevent complications - Treat underlying cause - Medications: • Opioids

Management diarrhea?

- Watery stools (small intestine) - Soft stools (large intestine)

Manifestations differences between small and large intestine (diarrhea)?

- Assess for passage of meconium x 24 hrs. - Assess for presence of anal dimple - Assess for stool in the urine

Manifestations and Assessment Anal Malformation?

•Peristomal skin irritation - from leakage from bad fit - Use skin barrier •FVD •urinary calculi from dehydration •cholelithiasis - gallstone - bc of changes in the absorption of bile acids postoperatively - severe UR abd pain that radiates to the back and right shoulder •Stenosis of the site from scar tissue

Preventing Complications: Ileostomy?

• Techniques for cleansing -Use a mild, pH-balanced soap or no soap at all and just water. • Application and management of the pouching system: -Measure stoma with each pouch change for first 8 weeks. • Signs and symptoms of stoma or peristomal skin complications: -A healthy stoma appears pink or red and moist, and should protrude about ¾ inch (2 cm) from the abdominal wall.

Post- Operative Education: Ileostomy?

B "My immune system reacts to gluten and damages my gut."

The healthcare provider is teaching a patient diagnosed with celiac disease about the disease process. Which of the following statements made by the patient would indicate a correct understanding of the teaching? A-"I have an allergy to the proteins that are found in wheat." B-"My immune system reacts to gluten and damages my gut." C-"The bacteria in my gut are not able to ferment the gluten." D-"I'm glad that I can still eat bread made with rye flour."

ANS: C c. Note the condition of the stoma in her notes. The stoma should be red or pink and moist. After assessment the nurse will note the appearance of the stoma in the patient HER. If it is gray, purple, or black, report this to the charge nurse or physician immediately. Pressure is applied to control active bleeding. The information given in the question does not indicate that there is a need to change the appliance at this time. DIF: Cognitive Level: Application REF: Text reference: p. 870 OBJ: Describe methods used to maintain the integrity of the peristomal skin. TOP: Condition of Ostomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

The nurse is caring for a patient who had a colostomy placed 5 days earlier. The nurse notes that the stoma is red and moist. Which action should the nurse take? a. Notify the physician immediately. b. Apply pressure. c. Note the condition of the stoma in her notes. d. Change the appliance pouch.

d. Surgical removal of affected section of bowel. ANS: D Most children with Hirschsprung's disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet until the child is physically ready for surgery. The colostomy that is created in Hirschsprung's disease is usually temporary.

Therapeutic management of most children with Hirschsprung's disease is primarily: a. Daily enemas. b. Low-fiber diet. c. Permanent colostomy. d. Surgical removal of affected section of bowel.

ANS: A, B, C, D In addition to the stresses of illness and surgical recovery, patients with ostomies face body image changes, fear of social rejection, concern about sexual function and intimacy, and the need for help with personal care. It is very important to provide an effective pouching system to facilitate the emotional adjustment to the ostomy. A supportive nurse makes the initial period of adjustment easier. DIF: Cognitive Level: Analysis REF: Text reference: p. 868 OBJ: Identify types of fecal and urinary diversions. TOP: Physical and Emotional Stressors Related to Ostomy Placement KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

The nurse is caring for a patient who will have surgery in the morning to have a colostomy placed. The nurse is aware of the physical and emotional stresses that the patient will experience. These include which of the following?(Select all that apply.) a. Body image changes b. Fear of social rejection c. Sexual function and intimacy issues d. Loss of independence e. Heightened immunity

ANS: C c. Ileal portion of the small intestin An opening in the ileal portion of the small intestine is an ileostomy, and the fecal effluent will be watery to thick liquid that will contain some digestive enzymes. A colostomy in the descending or sigmoid colon generally results in a stool similar to that normally passed through the rectum. If the opening is in the transverse or ascending colon, the effluent will vary from thick liquid to semi-formed stool. DIF: Cognitive Level: Analysis REF: Text reference: p. 866 OBJ: Explain differences in the color and consistency of effluent based on the type of ostomy. TOP: Position of the Ostomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

The nurse is caring for a patient with an ostomy. The nurse notes that the ostomy is putting out watery effluent. The nurse recognizes that this is indicative of which location? a.Descending colon b. Sigmoid colon c. Ileal portion of the small intestine d. transverse colon

ANS: effluent The output from the stoma is called the effluent. DIF: Cognitive Level: Knowledge REF: Text reference: p. 866 OBJ: Identify types of fecal and urinary diversions. TOP: Effluent KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

The output from a urinary or fecal stoma is called the _______________.

ALL A-Serum Immunoglobulin A B-Biopsy C-Fecal fat measurement D-Diet Changes--> Improvement with removal of gluten food which is most definitive?

What are some test one can do to dx celiac in a pt? Select All: A-Serum Immunoglobulin A B-Biopsy C-Fecal fat measurement D-Diet Changes Improvement with removal of gluten food

ANS: A a. A moist, reddish-pink stoma Normal findings in a patient with a postoperative ostomy that is healing include a stoma that is moist and reddish-pink, skin that is intact and free of irritation, and sutures that are intact. The stoma is edematous initially and shrinks over the next 4 to 6 weeks. A necrotic stoma is manifested by a purple or black color and a dry instead of moist texture. The stoma is functioning normally when the stoma drains a moderate amount of liquid or soft stool and flatus in the pouch. Flatus indicates the return of peristalsis after surgery. Flatus is noted by bulging of the pouch. (Flatus may not be observable if the pouch has a gas filter.) DIF: Cognitive Level: Application REF: Text reference: p. 870 OBJ: Pouch a fecal or urinary diversion. TOP: Pouching a Colostomy or Ileostomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

When providing care for a patient with a colostomy or an ileostomy, the nurse recognizes that which is an expected assessment finding? a. A moist, reddish-pink stoma b. A dry, purplish stoma c. Erythema on the skin around the stoma d. No drainage noted from the stoma when washed

D-Weight less than normal for height and age Children with Hirschsprung's disease often have failure to thrive, and weigh less than normal due to malabsorption of nutrients. The abdomen is usually distended, not scaphoid. Cyanosis is associated with congenital heart disease. Hyperactive reflexes may be present in conditions such as cerebral palsy that affect upper motor neurons.

Which assessment finding would be most likely found on an infant diagnosed with Hirschsprung's disease? A-Scaphoid abdomen B-Cyanosis of distal extremities C-Hyperactive reflexes D-Weight less than normal for height and age

A. Antinuclear antibody (ANA) The answer is A. Option A is a type of test used to assess for Lupus NOT Celiac Disease. Options B, C, D are antibodies screened in patients with suspected Celiac Disease.

Which of the following is not an anti-body blood test ordered by a physician to diagnose Celiac Disease? A. Antinuclear antibody (ANA) B. Tissue Transglutaminase Antibodies (tTG-IgA) C. IgA Endomysial antibody (EMA) D. IgA serum

1. The colon has an aganglionic segment.

Which of the folowing statements best describes Hirschsprung's disease: 1. The colon has an aganglionic segment. 2. There is passage of excessive amounts of meconium in the neonate. 3. It results in excessive peristalic movmeents within the gastrointestinal tract. 4 It results in frequent evacuation of solids, liquids, gas.

C. Gliadins The answer is C. There are several proteins in wheat. One of them is called GLUTEN. Gluten itself is constructed with a group of proteins called GLIADIN and glutenin. Gliadin is the problem with Celiac Disease because it triggers an immune response.

You're educating a group of nursing students about the pathophysiology of Celiac Disease. You ask the group to identify the specific protein that plays a role in the immune reaction experienced in Celiac Disease. Which answer is correct? A. Zein B. Globulins C. Gliadins D. Glutamate

The answers are B, C, F. These items should be avoided in Celiac Disease. Options A, D, E (don't let the "wheat" part of buckwheat confuse you...they are not related).

You're helping a mother, whose child was recently diagnosed with Celiac Disease, read food labels. Which items below, if listed as the ingredients, should the mother avoid feeding her child? A. Millet B. Wheat C. Malt D. Corn E. Buckwheat F. Rye

A. Pork barbeque sandwich The answer is A. The pork is okay to eat but the bread of the sandwich is not. Sandwich bread (bun) typically is made up of wheat which contains gluten. All the other options are okay to eat.

Your patient was admitted 3 days ago for treatment of severe malnourishment secondary to Celiac Disease. The patient is doing well and will be discharged tomorrow. When you arrive to the patient's room, the patient's friends and family are visiting and have brought dinner for the patient. Which food item below should the patient avoid consuming? A. Pork barbeque sandwich B. Steak and steamed broccoli C. Braised chicken with carrots D. Vegetables and rice

• Ileostomy -Usually performed after total colectomy -Drainage typically loose to semi formed and is produced at frequent intervals. - Collection: • Continuous drainage into ostomy bag • Kock Continent pouch

• Ileostomy (what is it...etc)?

- Can be normal appearing at first inspection • Thin translucent anal membrane • Deep anal dimple - Failure to pass meconium within first 24 hours What is meconium?

Clinical manifestations Anal Malformation?

Stool softeners - docusate sodium (Colace) docusate sodium and senna (Peri-Colace) Stimulant laxatives - bisacodyl (Dulcolax)

Common pharm treatment(s) for constipation (Two)?

• Sedation, dizziness, lightheadedness, drowsiness (diphenoxylate/atropine) • Anticholinergic effects (dry mouth, urinary retention)

Common side effects of GI opioids?

- Medications • Complications of laxative overuse • Never give laxatives with acute constipation associated with fever, nausea, abdominal pain - Obstructions - Metabolic or neuromuscular disorders • (Hirschsprung, Parkinson, MS), - Colon disease (IBS) - Endocrine disorders (DM, hypothyroid)

Constipation risk factors?