GI test 2
colon cancer risk factors
-Age > 50 -Family hx -Crohns or UC -Diet: high fat, high red meat, low fruits, low fiber -african american descent -Smoking -Obesity -DM
2) The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to see documented in the record?
diarrhea
Cullen's sign
ecchymosis in umbilical area (seen with pancreatitis)
ulcerative colitis physical findings
fever, diarrhea up to 20 liquid stools per day, stool contains mucus blood or pus, high pitched bowel sound, rectal bleeding
Hernia: Physical Findings
few symptoms, protrusion or lump, abdominal bulge in affected area, pain, when incarcerated or has severe abdominal pain, distention, cramping and vomiting
Diverticulitis lab tests
hemaglobin and hemocrit-decreased, ESR- increased, WBC- increased, stool for occult blood can be positive
Hepatitis diet
high carb and calorie, low fat
hernia client edu
instruct client to wear truss pad with hernia belt and put on before rising each morning, check for skin irritation, truss doesnt cure a hernia avoid straining
Large bowel obstruction (LBO) signs and symptoms
less common then SBO, symptoms develope slowly, dehydration slowly, constipation, vomiting, diarrhea, ribbon like stool, metabolic acidosis possible
Cirrhosis Medications
meds are administered sparingly especially opioids, sedatives, barbiturates because the metabolism of most meds is dependent on a functioning liver
Small Bowel Obstruction (SBO) signs and symptoms
wave like abdominal pain, vomiting, epigastric or upper abdominal distension, abdominal pain, discomfort, loss of fluid and electrolytes
xxx
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21) A client with Crohn's disease has a prescription to begin taking antispasmodic medication. The nurse should schedule the medication so that each dose is taken at which time?
• 30 minutes before meals
22) The nurse has assisted the primary health care provider with a liver biopsy, which was done at the bedside. Upon completion of the procedure, the nurse should assist the client into which position?
• Right side-lying with a small pillow or towel under the puncture site
11) The nurse is reviewing the health care record of a client with a diagnosis of chronic pancreatitis. The nurse should determine that which data noted in the record indicate poor absorption of dietary fats?
• Steatorrhea
risk factors for hepatitis A
Crowded, unsanitary conditions Food and water contamination
Chron's disease lab findings
H&H-decreased ESR-increased WBC- increased c-reactive protein-increased serum albumin- decreased folic acid & b12- decreased anti-glycqn antibodies- increased stool for occult blood- may be positive urinalysis- WBC K+, mg, ca- decreased
Pancreatitis nursing care
* Pancreatitis patients but them in fetal position, NPO, gut rest, prepare antecubital site for PICC cuz they'll probably be getting TPN/Lipids, nasogastric tube
Liver biopsy pre procedure
-explain procedure -witness informed consent -NPO after midnight on the day of procedure
pancreatitis complications
-hypovolemia -pancreatic infection -coagulation defects
Hepatitis Nursing Care
-prevent transmission -supportive care -prevention of complications
Cirrhosis lab values
1) Elevated AST & ALT 2) Low platelet count and low albumin* 3) Increased total bilirubin (more conjugated) 4) Elevated ALP
ulcerative colitis and crohns disease medications
5 aminosailcylic acid:anti inflam. sulfonamides: sulfasalazine nonsulfamides
risk factors for hepatitis C
IV drug use (or intranasal) Blood exposure Needle stick Sexual exposure Jail time Body piercing Tattoo Vertical transmission Hospitalization Medical procedures
Sulfonamides nursing interventions
Increase fluid intake to at least 2000 mL/day. Monitor CBC and renal function. Monitor for rash, superinfection. Avoid during third trimester. Avoid antacids.
Pancreatitis lab tests
Serum amylase and lipase increased, WBC increased, platelets decreased, calcium and magnesium decreased, glucose increased
Hepatitis C Virus (HCV)
a blood-borne disease that is spread through contact with blood and other body fluids that are contaminated with this virus. it is describes as a silent epidemic because it can be present in the body for years, and destroy the liver, before any symptoms appear. there is no vaccine available
ulcerative colitis expected findings
abdominal pain/cramping often LLQ pain, anorexia and weight loss
pancreatic enzymes- pancrelipase (viokase)
aid with digestion of fats and proteins when taken with meals and snacks
liver biopsy intra procedure
assist client into the supine position with the RUQ, assist relaxation, exhale and hold breath for 10 seconds, resume breathing once needle is withdrawn
liver biopsy post procedure
assist client to a right-side lying position for several hours assess for respiratory complaints assess for abdominal pain/ abdominal bleeding
what do you monitor for TPN
blood glucose
ulcerative colitis
chronic inflammation of the colon with presence of ulcers
Cirrhosis physical findings
cognitive changes, altered sleep wake pattern, depression, GI bleeding, ascites, jaundice
cirrhosis nursing care
monitor resp status, skin integrity, vital signs, neurologic status
cholecystectomy laparoscopic approach
provide immediate post of care, ambulant,. monitor incision, talk about pain control, activities are often resumed after 1 week?, report indications of bile leak-pain, vomiting, abdominal discomfort
cholecystectomy care
report absence of draining, with manifestations, inspect surrounding skin for evidence of infection or bile leak, monitor color and amount of bile, clamp the tube 1 hr before and after meals, monitor stool color (clay color until biliary flow is reestablished), monitor bile peritonitis (pain, fever, jaundice), expect removal of tube 1-3 weeks, empty drainage bag every 8 hr or as prescribed.
Cholecystitis expected findings
sharp pain RUQ radiating to R shoulder, pain when deep inspiration, intense pain, dyspepsia, eructation, gas, fever, nausea, vomiting
Pancreatitis expected Findings
sudden onset of severe boring pain (goes through body), epigastric,radiating to back, left flank, shoulder, worse when lying down, nausea, vomiting, weight loss, anorexia. respirations are shallow as pt tried to splint painful area
cholecystectomy
surgical removal of the gallbladder
client edu for sulfonamides
take med with full glass of water after meals, avoid sun exposure, increase fluid intake to 2L/day, can cause urine, skin and contact lenses to yellow, notify provider if nausea, vomiting, anorexia, sore throat, rash, bruising, or fever occur
Hepatitis A Virus (HAV)
the most prevalent type of hepatitis. caused by the highly contagious HAV virus and is transmitted mainly through contaminated food and water
Hepatitis B virus
virus that causes inflammation of the liver; transmitted through any body fluid, including vaginal secretions, semen, and blood
3) The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions should the nurse expect to be prescribed? Select all that apply.
• Administer antacids, as prescribed. • Encourage coughing and deep breathing. • Administer anticholinergics, as prescribed
13) The client arrives at an emergency department complaining of severe abdominal pain. The initial diagnosis is acute abdomen, and an x-ray and an abdominal ultrasonogram are prescribed to be obtained immediately. The nurse prepares the client for these diagnostic tests and reviews the primary health care provider's prescriptions. Which prescription should the nurse most likely question if written on the primary health care provider's prescription form?
• Administration of an opioid analgesic
17) A client is admitted to the hospital with a diagnosis of acute pancreatitis. The nurse should plan care, knowing that most likely, which problem will occur with this disorder?
• Alteration in comfort related to abdominal pain
23) The nurse notes that the medical record of a client diagnosed with cirrhosis states that the client has asterixis. To effectively verify this information the nurse should take which action?
• Ask the client to extend the arms
26) The nurse is reinforcing instructions to a client and his family about alcohol abuse and chronic cirrhosis. The nurse determines to include which essential elements in the discharge teaching guide? Select all that apply.
• Avoid potentially hepatotoxic over-the-counter drugs. • Teach symptoms of complications and when to seek prompt medical attention. • Explain that cirrhosis of the liver is a chronic illness and the importance of continuous health care. • Avoid spicy and rough foods and activities that increase portal pressure such as straining at stool, coughing, sneezing and vomiting.
20) The nurse is instructing a client who had a herniorrhaphy about how to reduce postoperative swelling following the procedure. Which should the nurse suggest to the client to prevent swelling?
• Elevate the scrotum
risk factors for hepatitis B
• Frequent exposure to blood, blood products, or other body fluids • Health care workers: hemodialysis staff, oncology and chemotherapy nurses, personnel at risk for needlesticks, operating room staff, respiratory therapists, surgeons, dentists • Hemodialysis • Male homosexual and bisexual activity • IV/injection drug use • Close contact with carrier of HBV • Travel to or residence in area with uncertain sanitary conditions • Multiple sexual partners • Recent history of sexually transmitted disease • Receipt of blood or blood products (eg, clotting factor concentrate
12) A client with a possible hiatal hernia complains of difficulty swallowing. Which other sign/symptom associated with a hiatal hernia should the nurse recognize?
• Heartburn and regurgitation
16) The nurse is interpreting the laboratory results of a client who has a history of diagnosed chronic ulcerative colitis. The nurse should determine that which result indicates a complication of ulcerative colitis?
• Hemoglobin 10.2 g/dL
4) It has been determined that a client with hepatitis has contracted the infection from contaminated food. Which type of hepatitis is this client most likely experiencing?
• Hepatitis A
19) The nurse is reviewing the medication record of a client with a diagnosis of acute gastritis. Which medication noted on the client's record should the nurse most likely question?
• Ibuprofen
7) The nurse caring for a client diagnosed with acute pancreatitis and has a history of alcoholism is monitoring the client for complications. The nurse determines that which data collected is most likely indicative of paralytic ileus?
• Inability to pass flatus
6) The client admitted to the hospital with a diagnosis of viral hepatitis is complaining of a loss of appetite. In order to provide adequate nutrition, which action should the nurse encourage the client to take?
• Increase intake of fluids
14) The nurse is reinforcing discharge instructions to a client with a hiatal hernia. Which considerations should the nurse include in the teaching session? Select all that apply.
• It is advisable to stop smoking cigarettes • Wait at least 1 hour after meals to perform chores • Be sure to elevate the head of the bed during sleep
After a client undergoes a liver biopsy, the nurse places the client in the prescribed right-side lying position. The nurse understands that the purpose of this intervention is to accomplish which?
• Limit bleeding from the biopsy site
15) The nurse is caring for a client in the emergency department who has right lower quadrant abdominal pain. After noting a white blood cell count of 16,500 cells/mm3, the nurse should question which prescription?
• Milk of magnesia
10) A nurse organizing care for a client diagnosed with hepatitis plans to meet the client's safety needs by performing which action?
• Monitoring prothrombin and partial thromboplastin values
25) A client arrives at the emergency department complaining of severe abdominal pain and is placed on NPO status. During a quick assessment the nurse observes that the client has both Cullen's sign and Grey Turner's sign and pancreatitis is suspected. The nurse should assist to implement which action first?
• Obtain vital signs and draw blood for laboratory analysis
8) A client with a diagnosis of viral hepatitis has no appetite, and food makes the client nauseated. The nurse should conclude that which intervention is most appropriate?
• Offer small, frequent meals
9) The nurse is participating in a health screening clinic and is preparing materials about colorectal cancer. The nurse should include which risk factor for colorectal cancer in the material?
• Personal history of ulcerative colitis or gastrointestinal (GI) polyps
18) The nurse is caring for a client diagnosed with a resolved intestinal obstruction who has a nasogastric tube in place. The primary health care provider has now prescribed the nasogastric tube to be discontinued. To best determine the client's readiness for discontinuation of the nasogastric tube, which measure should the nurse check?
• Presence of bowel sounds in all four quadrants
24) The nurse is caring for a client with a neurogenic bowel due to a lower motor neuron spinal cord injury below T12 resulting in flaccid functionality. Besides triggering or facilitating techniques for defecation, what are some of the strategies the nurse needs to address to reestablish defecation patterns? Select all that apply.
• Suppository use • Manual disimpaction • Consistent toileting schedule
5) The nurse is evaluating the effect of dietary counseling on the client diagnosed with cholecystitis. The nurse determines the client understands the instructions given if the client states that which food item is most appropriate to include in the diet?
• Turkey and lettuce sandwich