AH 1 Exam 3 GI .pdf

https://quizlet.com/231586221/gi-system-flash-cards/ ❖ Planning: Bisacodyl (ducolax) ❖ Laxative used for preparation of colonoscopy also GOLYTELY is used. ❖ Clear liquid diet for at least 1 hr prior ❖ NPO after midnight ❖ Colon cleansing is of utmost importance. ❖ Bisacodyl may be administered at be...

https://quizlet.com/231586221/gi-system-flash-cards/ ❖ Planning: Bisacodyl (ducolax) ❖ Laxative used for preparation of colonoscopy also GOLYTELY is used. ❖ Clear liquid diet for at least 1 hr prior ❖ NPO after midnight ❖ Colon cleansing is of utmost importance. ❖ Bisacodyl may be administered at bedtime for morning results, taken on an empty stomach to produce quicker results, taken with a full glass of water. Bisacodyl is a: stimulant laxative, it stimulates peristalsis, it is used for colonoscopy prep, also for short term use of constipation. A client who has constipation is prescribed bisacodyl suppository. The nurse explains that bisacodyl does what? Acts on smooth intestinal muscle to increase bulk and peristalsis. ❖ Teaching: Ileostomy Surgical opening of the ileum to drain stool. Post op: ASSESS! Teach about dietary changes and appliances that can help manage gas and odor. Foods that decrease odor: buttermilk, cranberry juice, parsley, and yogurt. Foods that decrease Gas: yogurt, crackers, and toast. Teach to watch for indications of stoma ischemia (pale pink/bluish purple color and dry appearance or necrosis (black or purple in color) QUESTIONS: ❖ Immediately after having surgery to create an ileostomy, which goal has the highest priority? Maintaining fluid & electrolyte balance. ❖ Initial drainage from an ileostomy: dark green, loose, and odorless. Drainage gradually thickens and becomes yellow to brown. ❖ Instruct to empty pouch: when ⅓ to ½ is full. Advise use of skin barrier and prompt attention to signs of leakage. ❖ A nurse is teaching a patient with a new ileostomy about incorporating preventive strategies at home. To prevent excoriation and breakdown of the peristomal skin, the nurse should instruct the patient to: Empty pouch when it’s no more than half full ❖ A nurse is providing preoperative teaching for a patient who has colon cancer. The surgeon informed the patient that his entire large intestine and rectum will be removed. The nurse should explain the type of ostomy he will have is: Ileostomy ❖ There’s a high risk for fluid/electrolyte imbalance. Drink 2-3L per day. Can resume a regular, balanced diet gradually. Chew food thoroughly! Take enteric-coated meds cautiously and monitor for any meds undissolved ❖ Teaching: GERDS (REFLUX) Common disorder marked by backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms Diet: avoid offending foods, large meals, eating before bedtime. Consume 4-6 small meals, remain upright, fatty/fried foods, chocolate, caffeinated beverages, peppermint, spicy foods, tomatoes, citrus, alcohol. Lifestyle: avoid clothing that is tight on abdomen, lose weight, elevated bed of head. Teach promotion and prevention: maintaining weight below BMI of 30, stop smoking, limit/avoid alcohol and tobacco, eat low-fats. When clients take PPIs (Proton pump inhibitors): TEACH that long-term use puts clients at risk for fractures. When clients take antacids: TEACH to take antacids when acid secretion is the highest: 1-3 hrs after eating and at bedtime and to separate them from other meds by at least an hour. When taking Histamine2receptor antagonist: TEACH to take with meals and at bedtime, and to separate from antacids by at least an hour. When taking prokinetics like metoclopramide teach to report abnormal, involuntary movements. QUESTIONS: Nurse explains to patients with gastroesophageal reflux disease (GERD) that this disorder --- ds Often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus. → the acidic components of the stomach touching the inside of the esophagus are responsible for “heartburn”, cardinal symptom of GERD. Client with GERD has chronic cough. This symptom may be indicative of ----Aspiration of gastric contents. Which of the following instructions should nurse include in teaching plan for GERD ? --- Do not lie down for 2 hours after eating Client encouraged to follow high-protein, low-fat diet, & avoid irritating foods. Avoid foods that decrease esophageal sphincter pressure (fatty foods, chocolate, caffeine drinks, peppermint, & alcohol) ❖ Planning: Diverticulitis Complications: abscess formation, bleeding and peritonitis. Abdominal pain in the left lower quadrant, nausea/vomiting, fever, tachycardia. Cant have small seeds or nuts or anything that could get stuck in the pockets. Recommended fluid intake of 2 L per day. Food high in fiber. QUESTIONS: ❖ Nurse should teach a client with diverticulitis to integrate which of the following into a daily routine at home? refraining from straining & lifting activities. → clients w/ diverticulitis should refrain from lifting, straining or coughing that increases intra-abdominal pressure. Enemas are also contraindicated. ❖ Nursing care: high fiber and low fat, NPO with inpatient, suctioning with inpatient. ❖ Treatment: for acute: bed rest; for uncomplicated: bowel rest; for severe: NG decompression ❖ Treatment: antibiotics, analgesic, antispasmodic ❖ Barium enemas are contraindicated in diverticulitis because of risk for perforation. ❖ Avoid seeds that can block diverticulum! ❖ What are some nursing plans and interventions for diverticular disease: monitor I and O and bowel elimination; avoid constipation. Observe for complications, obstruction, peritonitis, hemorrhage, infection. ❖ Assessment: Common Bile Duct (Cholithiasis/Cholycystitis) Pain/tenderness RU, abdominal pain Pain with inspiration Pain radiates to right shoulder or back Physical assessment: jaundice, dark urine, clay-colored poop. Labs: high WBC, increased bilirubin Nutrition: low in fat, high in carb and protein. No fried chicken! Ideal body weight. ❖ Clinical Judgment: Medication Administration Rs. (right patient, right drug, right dose, right route, right time, right documentation, right reason) Look at blackbox warning ❖ Assessment: Appendicitis CBC will show increased WBC with an elevation of neutrophils An enema shouldnt be given because it can lead to perforation No laxatives Pain at mcburney's point (left side) tenderness rebound. ❖ Teaching: Cholelithiasis (formation of gallstones) Before surgery, teach that frequent turning, beep-breathing, and early ambulation can prevent post-op pneumonia. Explain that they may need an NG tube, drain, and suction may be needed if an early cholecystectomy is done. Avoid smoking, Avoid NSAIDs, aspirin, other OTCs and herbal meds b/c they can alter coagulation. Low fat diet (reduce dairy products, fried food, chocolate, nuts, gravies). Avoid gas-forming foods (beans, broccoli, cabbage, cauliflower) Promote weight loss. ❖ ❖ ❖ ❖ ❖ Assessment: EGD Endoscopic procedures that visualize the upper part of the GI tract for any gastric or duodenal disorders or inflammatory or infectious processes are suspected. Golytely: med to clean/prep colon before colonoscopy Assess adequate hydration, before, during and immediately after the procedure. Educate on how to maintain hydration. After Procedure: monitor vitals and respiratory status. Maintain open airways until they wake up Assessment: POST GI Surgery Postoperative nursing care for clients following appendectomy should include which of the following? Noting the first bowel movement after surgery. → Indicates normal peristalsis has returned. ❖ Implementation: Cholecystectomy (REMOVE GALLBLADDER) After the procedure, place the client in low Fowlers. Give IV fluids and NG suction to relieve abdominal distention. Teach incentive spirometers. Encourage a diet low in fat and high in carbs and protein. ❖ Assessment: GI ulcers Risk factor for peptic ulcers: H. Pylori infection, NSAID and corticosteroid use, severe stress Dull, gnawing pain or burning sensation at the midepigastrium or back Pain after eating bleeding ❖ Implementation: Paralytic Ileus Can occur due to the absence of GI peristaltic activity caused by abdominal surgery Nonmechanical block. Motor activity of the bowel is impaired. Monitor Bowel sounds Encourage ambulation Advance the diet as tolerated when bowel sounds or flatus are present The client can have an NG tube inserted to empty stomach contents ❖ Assessment: NG tube Check if the NG tube is properly placed by x-ray. pH testing acidic (4 or less is expected), residuals. Assess color of nasogastric tube drainage. Report dark “coffee-ground” or blood-streaked drainage to provider immediately QUESTION: Q- A nurse is preparing to instill an enteral feeding to a client who has an NG tube in place. Which of the following is the nurse's highest assessment priority before performing this procedure? A. Check how long the feeding container has been open. B. Verify the placement of the NG tube. C. Confirm that the client does not have diarrhea. D. Make sure the client is alert and oriented. ❖ Teaching: Gastritis causes : H. Pylori (most common), long term NSAIDS, smoking. The nurse and patient review foods and other substances to be avoided (e.g., spicy, irritating, or highly seasoned foods; caffeine; nicotine; alcohol). Consultation with a dietitian may be recommended Meds: antacids, H2 blockers, PPI’s ❖ Implementation: Gastric Lavage an orogastric or nasogastric tube is inserted both to aspirate gastric contents and to instill a rinsing solution into the stomach to dilute the toxic substance ❖ Assessment: Jaundice Jaundice: condition where the body tissues, including the sclerae and the skin, become tinged yellow or greenish-yellow, due to high bilirubin levels. Physical assessment finding of jaundice: cholecystitis & Cholelithiasis, pancreatitis. ❖ Clinical Judgment: Colonoscopy To visualize the rectum and the sigmoid, descending, transverse and ascending colon. Prep: Golytely Clear liquid diet (avoid red, purple, orange fluids). NPO after midnight. Post op: Maintain an open airway until the client is awake, increase fluid intake,notify provider of severe pain, rectal bleeding. ❖ Clinical Judgment: GI Bleeding Fecal occult blood test: stool sample collected and tested for blood, ova, and parasites (Giardia lamblia) and bacteria (C. Diff). Client presentation: GI bleeding, unexplained diarrhea Post-procedure: Interpretation of Findings: A positive finding for blood is indicative of GI bleeding (ulcer, colitis, cancer). QUESTION: Nurse should assess the patient being admitted with upper GI bleeding for which of the following?--- Decreased urine output, rapid respirations, tachycardia, thirst. → Clients experiencing upper GI bleeding is at risk for hypovolemic shock from blood loss. Clinical Judgment: H2 receptor Antagonist (H2RA) Ranitidine, famotidine ex of H2RA: decreases gastric acid output by blocking gastric histamine 2 receptors. Take with meals and at bedtime Separate dosages from antacids (1 hr. before or after taking antacid) QUESTION: Client is taking one daily dose of ranitidine (Zantac) at home to treat peptic ulcer. Client understands administration when client will take drug at which time?--- at bedtime → taken at bedtime to inhibit nocturnal secretion of acid ❖ Clinical Judgment NG Tube to remove fluid and gas from the upper GI tract by the process known as decompression. QUESTION: After a subtotal gastrectomy, the NG tube drainage will be what color for about 12-24 hours after surgery? --- Dark brown → indicated digested blood; 6-12 hrs drainage would contain bright red blood A client has a NG tube following a subtotal gastrectomy. The nurse should --- Monitor for nausea, vomiting, & abdominal distention → will indicate gas & secretions are accumulating within gastric pouch due to impaired peristalsis or edema & drainage system not working properly ❖ Clinical Judgment: Nutrition QUESTION: ❖ A client with ulcerative colitis has persistent diarrhea. He is thin & lost 12 lbs since exacerbation of his ulcerative colitis. Which of the following will be most effective in helping meet his nutritional needs?--- Total Parenteral Nutrition (intravenously) (TPN) → Food will be withheld from clients with severe symptoms of ulcerative colitis, start TPN. ❖ Clinical Judgment: Enema Barium Enema: Barium inserted into rectum and colon. Must be scheduled prior upper GI studies Contraindications: bowel perforation or obstruction, inflammatory disease Monitor elimination of contrast material Client should report abdominal fullness, pain or delay of return of brown stool. ❖ Clinical Judgment: Diverticular Disease (diverticulosis) NPO, NG suctioning, IV fluids and antibiotics, analgesics Low fiber diet, slowly advance to high fiber when inflammation subsides Avoid indigestible material (nuts, seeds) and alcohol. Drink plenty of fluids Hematocrit and Hgb: decreased ESR: Increased WBC: Increased Stool for occult blood: Can be positive ❖ Clinical Judgment: Fecal Occult blood No vitamin C, red meat, chicken, fish, no NSAIDS, no uncooked veggies interpretation: 3 repeats of positive guaiac FOBT confirms GI Bleeding, Positive finding for blood is indicative of GI Bleeding ❖ Clinical Judgment: Barium Swallow instruct clients to use cathartics (i.e. bisacodyl) to evacuate the barium from the GI post procedure. Failure to eliminate barium places clients at risk for fecal impaction. ❖ Clinical Judgment: Pancreatitis severe, constant, knifelike pain in the left upper quadrant, midepigastric and/or radiates to the back. Another majoring finding is cullen’s sign which is bruising around the belly button ↑serum amylase & lipase. (memory aid: in pancreatitis the “-ases” are high). ↑ wbc count, serum liver enzymes/bilirubin, and erythrocyte sedimentation rate. ↓ serum calcium, magnesium, and platelets. NPO: no food until pain free, when diet is resumed eat bland, high protein, low fat diet w/out stimulants (coffee), small frequent meals. No alcohol or smoking. Positioning client for comfort on fetal, side lying, head of bed elevated, sitting up, or leaning forward. PAIN MEDS ❖ Clinical Judgment: Medications for Peptic Ulcer Advice client to take antacid 1hr before taking H2 antagonist QUESTION: Client taking cimetidine (Tagamet) to treat hiatal hernia. Nurse should evaluate effectiveness in preventing the following? --- Esophagitis. → Tagamet is a histamine receptor antagonist that decreased quantity of gastric secretions ❖ Teaching: Colostomy Preprocedure- instruct client and a support person regarding care and management of an ostomy. Postprocedure- Empty the stoma ¼ to ½ full of drainage Stoma appearance should be pink and moist. Educate regarding dietary changes to manage flatus and odor. QUESTION: A nurse is completing a discharge teaching with a client who is 3 days post op following transverse colostomy. Which of the following should the nurse include in the teaching? A. Mucus will be present in stool for 5-7 days after surgery B. Expect 500-1000 mL of semi liquid stool after 2 weeks C. Stoma should be pink and moist D. Change the ostomy bag when it is ¾ full ❖ Teaching: Pain Management Which goal for the clients care should take priority during first days of hospitalization for an exacerbation of ulcerative colitis?--- Managing diarrhea → Diarrhea is primary symptom of ulcerative colitis & decreasing symptom of stools is the 1st goal of treatment. Client may receive antidiarrheal medicine, antispasmodic agents, bulk hydrophilic or anti-inflammatory drugs. Client with ulcerative colitis is following orders for bed rest with bathroom privileges. When evaluating effectiveness of level of activity, nurse determines if client has --- Reduced intestinal peristalsis. → bed rest is to reduce hypermotility of the colon. A client diagnosed with ulcerative colitis who has been placed on steroids asks nurse why steroids are prescribed. What should the nurse tell client?--Steroids are used in severe flare-ups because they decrease incidence of bleeding. Which of the following diets would be most appropriate for client with ulcerative colitis? --- High protein, low residue → should follow high protein, high calorie, low residue diet, avoiding high-residue food as whole-wheat grains, nuts, raw fruits/vegetables. Client had an exacerbation of ulcerative colitis with cramping & diarrhea persisting longer than 1 week. The nurse should assess for which complication?--- Hypokalemia → Excess diarrhea causes depletion of sodium & potassium as well as fluid. Should monitor for hypokalemia & hyponatremia. ❖ Clinical Judgment: Ulcerative Colitis ulcerative colitis include diarrhea, with mucus, pus, or blood; lower left quadrant abdominal pain; and cramping rectal pain. The bleeding may be mild or severe, and pallor, anemia, and fatigue result. The patient may have anorexia, weight loss, fever, vomiting, and dehydration, as well as cramping, rectal pain, and the passage of six or more liquid stools each day. Stool positive for blood Low hematocrit, hemoglobin, albumin potassium, magnesium, and calcium Elevated WBC, C-reactive proteins, Antineutrophil cytoplasmic antibody levels ❖ Clinical Judgment: Colostomy Post op:assess the fit of ostomy Assess peristomal skin integrity Apply skin barriers and creams. Evaluate stoma output, and empty when ¼ to ½ full, an assess for person to be able to perform ostomy care. ❖ Assessment: Peptic Ulcer QUESTIONS: ❖ The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? --- A rigid, board-like abdomen. → perforation of ulcer is a medical emergency! NOTIFY PHYSICIAN! Characterized by sudden, sharp, intolerable severe pain beginning in mid-epigastric area & spreading over abdomen ❖ Which assessment data support the client’s diagnosis of gastric ulcer?--- Complains of pain with ingestion of food & sleep. → client diagnosed with gastric ulcer has pain 30-60 mins after eating, while client with duodenal ulcer has pain during night often relieved by eating, pain occuring 1-3 hrs after meals. ❖ A client with peptic ulcer reports epigastric pain that frequently causes clients to take up during the night. The nurse should instruct client to do--- eat small frequent meals throughout day, obtain adequate rest to reduce stimulation, sit up for 1 hour when awakened, take all meds as prescribed ❖ Teaching: Chrons Disease Instruct clients who experience long or intense episodes that NPO and TPN help promote bowel rest. Instruct clients to eat high protein, high calorie, low fiber foods, and avoid caffeine and alcohol, as well as to take a multivitamin with iron. Educate regarding meals that small more frequent meals can reduce manifestations. Avoid smoking and cold food. QUESTION: Which of the following would be a priority focus of care for client experiencing exacerbation of Crohn’s disease? --- Promoting bowel rest → accomplished through decreasing activity, encouraging rest, & initially placing on NPO status while maintaining nutritional needs parenterally. ❖ Assessment: Acute Pancreatitis Labs Increase: amylase Lipase WBC glucose liver enzymes and bilirubin Decrease: platelets Hi studious student calcium magnesium ❖ Teaching: Nutrition (SATA) Nurse is developing care plan on client who had laryngectomy 3 days ago. Nurse should instruct to do with of the following to assure adequate nutrition?--- weigh weekly & report weight loss, when eating sit & lean slightly forward, check serum albumin regularly, administer enteral tube feedings as ordered. Client with major burn injury receives TPN. The expected outcome is to--Ensure adequate caloric & protein intake Developing a nutritional plan for child who needs to increase protein intake. Suggested foods?--- Cooked dry beans, peanut butter, & yogurt. Which of the following instructions are appropriate when teaching client in early stages of cirrhosis about nutritional needs?--- Adequate intake of protein is important to health & “I encourage you to eat small, frequent meals.” The nurse is caring for client with cirrhosis of the liver. To minimize effects of disorder, the nurse teaches client about foods high in thiamine. The nurse determines client has best understanding if client states intention to increase ---- Legumes → clients with cirrhosis need to consume foods high in thiamine; other good sources include nuts, whole-grain cereals, & pork The nurse is caring for client who is post-op following pelvic exenteration & HCP changes diet from NPO to clear liquids. The nurse should check which priority item before administering diet?---- Bowel sounds The nurse is monitoring client for early signs & symptoms of dumping syndrome. Which findings indicate this occurrence?--- Sweating & pallor → early s/s of dumping syndrome occur 5-30 minutes after eating Glaucoma: GENETICS LIFE-LONG MEDICATION, DISORDER NOT CURED. ONLY CONTROLLED Two Primary Types: Primary open-angle glaucoma: ❖ Most common, Silent type, Loss of peripheral vision (tunnel vision), Malfunction of drainage system, Halos around lights, elevated IOP. Primary angle-closure glaucoma: ❖ Rapid onset of elevated IOP, ocular emergency, colored halos around lights, pupils nonreactive to light, pain/nausea, photophobia. Educate clients about disease processes and early identification of glaucoma such as reduced vision & mild eye pain. Tonometry- measures IOP (reference range 10-21) ○ IOP is usually higher in the mornings. Initial action is to CHECK THE TIME the test was performed. Atropine sulfate is contraindicated in clients with glaucoma because it increases IOP. Mydriatics contraindicated as well due to it increasing IOP. Anticholinergics contraindicated. Medication Teaching: prescribed eye meds every 12 hours. Instill 1 drop in each eye twice daily. Wait 5-10 min. Between each drop if more than one is prescribed to prevent dilution. Avoid touching the tip of the bottle to the eye. Wash hands before & after use. Once drop is instilled, apply pressure using punctal occlusion technique (pressure on inner eye). Emergency treatment for primary angle-closure glaucoma, quickly decreases IOP: IV Mannitol. Client education: wear sunglasses. Report signs of infection (yellow/green drainage), avoid activities that increase IOP (bending over wasit, sneezing, coughing, sex, head hyperflexion, tight clothing). Do NOT lie on the operative side. Report nausea & pain (possible hemorrhage). Report any lid swelling, decreased vision, bleeding or discharge, sharp sudden pain & flashes of light or floating shapes, signs of detachment. Best vision not expected until 4-6 weeks. Questions: 1. A client was recently diagnosed with open angle glaucoma. What client teaching should the nurse provide? a. Avoid cold medicines that contain pseudoephedrine (dilatory effect on pupils can increase IOP), laser surgery can correct flow to aqueous humor, expect impaired vision at night, driving may be dangerous due to loss of peripheral vision. 2. d/c teaching for open angle glaucoma and prescribed pilocar (miotics) eye drops? a. wait an hour before driving after taking medication 3. What do you give for open-angle glaucoma and decreased aqueous humor production? a. beta-blocker (timolol(timoptic)) ← first line therapy for glaucoma 4. What med is used as an emergency treatment for angle-closure glaucoma to quickly decrease IOP? a. IV Mannitol 5. A client with glaucoma is to receive 3 gtt of acetazolamide (Diamox) in the left eye. What should a nurse do? a. have client look up while administering drops 6. A client treated for chronic open-angle glaucoma (COAG) for 5 yrs asks “how does glaucoma damage my eyesight?”. The nurse's reply should be based on knowledge that COAG: a. causes increased IOP 7. Which of the following should the nurse provide as part of the information to prepare the client for tonometry? a. Painless procedure with no adverse effects 8. The nurse observes clients instill eye drops. The client says “I just try to hit the middle of my eyeball so drops don't run out of my eye.” nurse explains this method may cause: a. corneal injury 9. Patients with acute angle-closure glaucoma reports using the following med. Which indicated further instruction needed a. Diphenhydramine (benadryl) → may result in blindness if used in AACG, do not give atropine, benadryl or Vistaril (hydroxyzine)-- they are mydriatics. 10. Nurse is providing instructions on clients who will be self-admin eye drops. To minimize systemic absorption of drops, a nurse instructs the client to? a. Occlude nasolacrimal duct with a finger after instilling the drops. Fundamentals EYE assessment: Test used to screen for presbyopia (impaired near vision or farsightedness): Rosenbaum eye chart. Ishihara test assess for: Color vision Vision loss risk factors: Age is the most significant Eye infection, inflammation or injury Brain tumor Client education: Quit smoking Limit alcohol intake Keep BP, blood glucose and cholesterol under control Eat foods rich in antioxidants, such as green leafy vegetables. Presbyopia: age-related loss of the eye’s ability to focus on close objects due to decreased elasticity of the lens. Cataracts: opacity of the lens, which blocks the entry of light rays into the eye. Glaucoma: Structural damage within the eye resulting from elevated pressure within the eye leading to blindness. Diabetic retinopathy: Noninflammatory changes in the eye’s blood vessels leading to blindness. Macular degeneration: Loss of central vision from deterioration of the center of the retina.