NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+, Exams of Nursing

Download NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ and more Exams Nursing in PDF only on Docsity! 1 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ Achlorhydria: Lack of HCL in digestive secretions of the stomach Antrectomy: Removal of the pyloric portion, lower third of the stomach (antrum) with anastomosis to the duodenum Bariatric: relating to obesity Dumping syndrome: physiologic response to rapid emptying of gastric contents into jejunum causing water to be pulled into instestine (osmotic pressure) resulting in nausea, weakness, sweating, palpitations, syncopy, diarrhea. Occurs in patients with partial gastrectomy and gastrojejunostomy. Dysphagia: difficulty swallowing Enteroclysis: fluoroscopic x-ray of the small intestine while barium liquid is infused through tube. Gastritis: inflammation of the stomach Helicobacter pylori: gram negative bacteria that colonizes the gastric mucosa and is involved in most cases of peptic ulcer disease and gastritis Hematemesis: vomiting of blood Hematochezia: bright, red bloody stools Melena: tarry or black stools – occult blood in stools Omentum: folds of peritoneum that surrounds the stomach and intestinal organs Peritoneum: membrane that lines abdomen wall and covers all abdominal organs Pyrosis: burning sensation in the stomach and the duodenum (heartburn) Steatorrhea: grey, fatty stools that are foul smelling. Can be seen with malabsorption syndromes. (Anti-obesity medication Orlistat – greasy stools as it decreases fat absorption) 2 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ GASTRITIS- Inflammation of the gastric mucosa either non-erosive or erosive. Non-erosive caused by an infection with Helicobacter pylori. Erosive is most often caused by long term use of non-steroidal anti-inflammatory drugs (NSAID), aspirin, spicy, hot foods, alcohol abuse and radiation. Gastritis may be associated with Achlorhydria (lack of HCL) can cause overgrowth of bad bacteria, or Hyperchlorhydria (too much HCL). Acute Gastritis: • Abdominal discomfort, headache, nausea, anorexia, vomiting, hiccupping. • Bleeding with erosive gastritis – blood in vomit, black tarry stools (melena) , red bloody stools (hematochezia) Chronic Gastritis: • Heartburn (pyrosis) , belching, nausea, vomiting • Common cause: Smoking – nicotine reduces the neutralization of gastric acid • Unable to absorb vitamin B12 because of diminished production of intrinsic factor thus leading to pernicious anemia Medical Management: • NPO or liquid diet, IV fluids, NGT, surgery • Reduce stress, avoid alcohol and NSAID’s and spicy foods • Antacids (Take one hour after meals) • Histamine -2 receptor antagonists (BEFORE MEALS and/or AT BEDTIME) o Famotidine (Pepcid) o Ranitidine (Zantac) • Proton pump inhibitors (BEFORE MEALS except Protonix is with meals) o Omeprazole (Prilosec) o Pantoprazole (Protonix) [delayed release tablet – take whole with or without meals – do not crush] o Lansoprazole (Prevacid) – can open and mix with applesauce Nursing Management: • Reduce anxiety • Promote optimal nutrition • Promote fluid balance (pt. needs at least 1.5 liters/1500 cc of fluid a day) • Relieve pain • Educate patient 5 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ o 5-fluorouracil (5-FU) o Cisplatin (Platinol) o Doxorubicin (Adriamycin) • Nursing Process o Assessment – diet history, weight loss, fullness, pain, smoking and alcohol history, familial history of stomach cancer, psychosocial questions about family support, assessment of abdomen for tenderness, masses, ascites. o Nursing Diagnosis ▪ Anxiety ▪ Imbalance nutrition ▪ Acute pain ▪ Deficient knowledge o Nursing Interventions ▪ Reduce anxiety and relieve pain ▪ Promote optimal nutrition/ prevent metabolic imbalances • Small frequent meals, high in calories and vitamins A, Vitamin C and iron. Fluids in-between meals, NOT with meals. Weight gain and maintenance is a goal. • If gastric surgery is done - Monitor for “dumping syndrome” which results in a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis cramping and diarrhea. (extracellular fluids go into the stomach and small intestine.) • If total gastrectomy is done- needs Vitamin B12 for rest of life (intrinsic factor, secreted by parietal stomach cells, binds with B12 in order to be absorbed by the ileum) Deficiency in B12 results in pernicious anemia develops. • Parenteral nutrition may be necessary • Prevent pulmonary complications such as atelectasis and pneumonia. Deep breathing, incentive spironmeter, early ambulation are imperative • Monitor blood work and I & O • Provide psychological support – let patient 6 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ verbalize, encourages patient to participate in decisions, offers emotional support and includes family members. 7 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ • Education about self-care & Support Services ie. Clergy, social workers, clinical nurse specialists. GASTROINTESTINAL UNIT 9 Management of Patients with Intestinal and Rectal Disorders Chapter 41 15 Edition GLOSSARY: Borborygmus: rumbling noise caused by the movement of gas through the intestines Diverticulitis: inflammation of a diverticulum from obstruction by decaying fecal matter resulting in abscess formation (High Fiber diet is recommended to prevent diverticulitis) Fissure: normal or abnormal fold, groove or crack in body tissue Gastrocolic reflex: peristaltic movements of the large bowel that are triggered by stomach distention Ileostomy: surgical opening into the ileum by means of a stoma to allow drainage of bowel contents Inflammatory Bowel Disease (IBD): group of chronic disorders (ulcerative colitis and Crohn’s disease) that result in inflammation and or ulceration of the bowel lining Irritable Bowel Syndrome (IBS): chronic functional disorder that affects the frequency of defecation and consistency of stool and is associated with no specific structural or biochemical alterations. Identify foods that trigger IBS. Kock pouch: type of ileal reservoir created surgically by making an internal pouch with a portion of the ileum and placing a nipple valve flush with the stoma Peritonitis: inflammation of the lining of the abdominal wall Tenesmus: ineffective and painful straining and urge to eliminate feces or urine Valsalva maneuver: forcible exhalation against a closed glottis followed by a rise in the intrathoracic pressure and subsequent possible rise in arterial pressure. 10 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ o Nursing management: relieve pain; prevent fluid volume deficit; reduce anxiety; prevent infection; optimal nutrition ▪ High fowlers after surgery (reduces tension on incision) ▪ NPO until bowel sounds return ▪ Morphine sulfate to relieve pain ▪ Can be discharged on day of surgery if temperature is WNL ▪ Discharge instructions: Make appt with surgeon to remove sutures on 5-7 day after surgery and incision care instruction is given • No heavy lifting – resume all activities in 2-4 weeks • Diverticular Disease – a diverticular is a saclike herniation of the lining of the bowel that extends through a defect in the muscle layer most commonly in the sigmoid colon. Diverticulosis is when multiple diverticula are present without inflammation. A low dietary fiber intake is considered a presdisposing factor and constipation. Diverticulitis result when food and bacteria retained in the diverticula produce infection and inflammation. This can lead to perforation or abscess formation. o S/S include bowel irregularity, bloating, progressing to cramping, narrow stools and constipation. Weakness, fatigue and anorexia are common. With diverticulitis, there is an onset of acute pain in the left lower quadrant with nausea, vomiting, fever and leukocytosis. Pain in LLQ when you sit down. Left untreated it can lead to peritonitis and sepsis. o Diverticulosis is diagnosed by colonoscopy. CT scan with contract if diverticulitis is suspected. (colonoscopy is contraindicated in diverticulitis as there is a risk of perforation) o Complications include peritonitis, abscess formation, fistulas and bleeding o Treatment for diverticulitis: antibiotics, analgesic medications, anti-spasmodic agents, bulk forming laxatives (psyllium), clear liquid diet, then a high fiber, low fat diet is recommended. For acute case of diverticulitis: The patient should be NPO, NGT, IV fluids, antibiotics IV- Metronidazole/aminoglycoside, (ampicillin/sulbactam Uasyn) [addition of sulbactam increases the 11 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ activity of ampicillin] or ticarcillin/clavulanate Timentin) , analgesics. o Surgical Management – if complications occur such perforation, peritonitis, hemorrhage or obstruction surgery is done. ▪ One Stage Resection: inflamed area is removed and an end to end anastomosis is completed ▪ Multiple Stage Procedure – anastomosis is not done, but resected end of bowel is brought out to the abdominal wall and the distal end is closed over or both ends (double barrel) is brought out to the abdominal wall. o Nursing Process: ▪ Assessment: description of pain, dietary habits, bowel habits, auscultation of bowel sounds, palpation of LLQ for pain and tenderness; vital signs. ▪ Nursing Interventions: Maintain normal elimination patterns; relieving pain, MORPHINE is contraindicated as it can increase pressure in the colon; monitoring for complications and promoting home and community based care; teaching the importance of adequate daily fluid intake of at least 3000 cc a day, consume a high fiber diet and avoid vegetables and fruits with seeds; avoid nuts and popcorn. • Peritonitis – inflammation of the peritoneum, which is a membrane lining the abdominal cavity. (Can be a complication of diverticulitis) o Common bacteria: Escherichia coli, Klebsiella, Proteus, Pseudomonas and Streptococcus o Can also result from trauma, perforation of ulcers, appendicitis o Diffuse constant pain, then localizes over site of pathogenic process, movement increases pain, abdomen is tender and distended, rebound tenderness and paralytic ileus may be present. o Increase in temperature, pulse and hypotension o WBC is elevated, and sepsis may ensue o Medical management includes fluids, colloids and 12 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ electrolyte replacement due to third spacing 15 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ occurring one after another. Bowel narrows due to inflammation, thickens because of muscular hypertrophy and fat deposits. o Because process is not transmural, it affects the inner lining only thus fistulas, obstruction and fissures are uncommon. o Clinical manifestations include bloody diarrhea 10-20 times a day, passage of mucus, LL quadrant pain, rectal bleeding. o Anorexia, weight loss, fever, vomiting, passage of 10-20 liquid bloody stools a day. o Extra-intestinal manifestations include skin lesions, eye lesions and join abnormalities and liver disease. o Assess patient for tachycardia, hypotension, fever and pallor o Stool positive for blood, low H & H, elevated WBC o Sigmoidoscopy/colonoscopy, barium enema are diagnostic o Complications include toxic megacolon, perforation and bleeding o Surgical options: colectomy, ileostomy Management of Chronic Inflammatory Bowel Disease • Treatment is aimed at reducing inflammation, suppressing inappropriate immune responses, providing rest for a diseased bowel, improve quality of life and prevent complications. o Nutritional Therapy – Oral fluids, low residue diet, high protein, high calorie with supplemental vitamin and iron replacement. IV therapy. Milk, cold foods, smoking are avoided as they increase intestinal motility o Pharmacologic Therapy – Sedatives. Anti-diarrheal and anti- peristaltic medications are given 30 minutes before meals. Aminosalicylates such as sulfasalazine (Azulfidine) are given for moderate inflammation. Antibiotics such as matronidazole (Flagyl) are used for secondary infections. Corticosteroids are used to treat severe disease. Be sure to monitor the patients glucose levels as steroids increase blood glucose levels. Immunomodulators such as azathioprine (Imuran), methotrexate (MTX), cyclosporine (Neoral) to alter the immune response. Newer biological therapies such as infliximab (Remicade), adalimumab (Humira). o Surgical Management – Surgery may be necessary when pharmacological measures do not relieve severe 16 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ symptoms. 17 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ 75% of patients with Crohn’s Disease will undergo surgery and 25% of patients with Ulcerative colitis will undergo surgery. ▪ Total Colectomy with Ileostomy ▪ Continent Ileostomy ▪ Restorative Protocolectomy with Ileal Pouch o Nursing Management – The Nursing Process of the Patient with Chronic Inflammatory Bowel Disease ▪ Assessment - obtain health history (pain, onset, duration; diarrhea, weight loss; family history of IBD; patterns of elimination; allergies food or milk; if lactose intolerant- must have frequent screening for osteoporosis. ▪ Nursing Diagnosis – Acute pain; deficient fluid volume; imbalanced nutrition; anxiety; ineffective coping; risk for impaired skin integrity and ineffective health management. ▪ Potential Complications – Electrolyte imbalance; cardiac dysrhythmias related to electrolyte imbalance; fluid volume loss due to bleeding; perforation of the bowel ▪ Planning & Goals – attainment of normal bowel elimination; relief of abdominal pain; prevention of fluid volume deficit; maintenance of optimal nutrition and weight gain; promotion of effective coping; absence of skin breakdown; increased knowledge about disease process. ▪ Nursing Interventions: • Maintain Normal Elimination Patterns • Relieving Pain – administer anticholinergic medications 30 minutes before meal to decrease intestinal motility • Maintaining Fluid Intake – Monitor I & O daily • Maintaining Optimal Nutrition – Patient will be on TPN for 1-2 weeks before initiating feedings, bland, low-residue, high protein, high calorie and high vitamin diet. • Promoting Rest • Reducing Anxiety • Enhancing Coping Measures 20 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ • Mechanical – an obstruction such as intussusceptions, tumors, neoplasms, stenosis, strictures, adhesions, abscesses • Functional – intestinal musculature cannot propel contents along bowel • Most occur in the small bowel Small Bowel Obstruction – Clinical Manifestations: crampy colicky pain; No passage of formed feces (diarrhea) , and vomiting occurs with potassium and sodium loss. Dehydration, thirst, drowsiness; acidosis from acute fluid loss. Diagnostic Findings: X-Ray; CAT scan; electrolyte studies. Medical Management: decompression of bowel with NGT; IV fluids; surgical treatment – laparoscopy and open laparotomy. Nursing Management: maintain function of NGT; assessing and measuring NGT output; assessing for fluid and electrolyte imbalances; assessing bowel sounds; maintaining fluid and electrolyte balance is a priority to monitor in patients with a small bowel obstruction. Large Bowel Obstruction – Adenocarcinoma tumors account for the majority Clinical Manifestations: differs from small bowel obstruction as the symptoms develop and progress slowly. Constipation may be only symptom for months. Cramping, weight loss, anorexia and abdomen becomes markedly distended; fecal vomiting; shock. Diagnostic Findings: X-Ray; CAT scan; MRI Medical Management: Restoration of intravascular volume; correction of electrolytes; NGT inserted; surgical resection; temporary or permanent colostomy. Nursing Management: Assess for worsening of intestinal obstruction; IV therapy; monitor electrolytes; comfort. COLORECTAL CANCER Third leading cause of cancer death. Hereditary (Family history) is a risk factor called Lynch Syndrome, other risk factors include: age, alcohol, cigarette smoking, obesity, history of gastrectomy and IBS and high fat, high protein and low residue diet. The most common initial sign associated with rectal colorectal cancer is a change in bowel habits followed by passage of blood. Testing stool for blood - REMEMBER: With FOBT (fecal occult blood testing) or guaiac test - 21 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ Vitamin C will cause a FALSE NEGATIVE with occult blood testing on stool Red meats, aspirin, NSAID’s, turnips and horseradish will cause a FALSE POSITIVE with occult blood testing on stool. (Current literature contradicts this) Quantitative fecal immunochemical tests are more accurate than guaiac testing and useful for patients who refuse invasive testing. Primarily adenocarcinoma. May start as a benign polyp and progress to cancer. • Clinical Manifestations: Symptoms depend on location of growth. Most common sign is change in bowel habits and then passage of blood. Also weight loss, anemia, fatigue and with right sided lesions dull abdominal pain and melena and with left sided lesions abdominal pain/ red blood. • Assessment and Diagnostic Findings – fecal occult blood, barium enema, colonoscopy. CEA – carcinoembryonic antigen studies are useful in assessing the progression of the disease. • Complications – partial or complete bowel obstruction, ulceration, perforation, peritonitis, sepsis, shock. • Medical Management – treatment depends on the stage and consists of surgery to remove tumor. Surgery, chemotherapy, radiation, immunotherapy. For patients with intestinal obstruction – surgery, IV fluids, NGT and if bleeding then blood transfusions. o Adjuvant Therapy: The standard adjuvant therapy for patients with Dukes’ class C or TNM (tumor, nodes, metastasis) is 5- Fluorouracil (5- F:U or Adrucil) plus leucovorin calcium (Wellcovorin) plus oxaliplatin (Eloxatin). Radiation therapy may be used to shrink tumor, to achieve better results from surgery, and reduce risk of recurrence. o Surgical Management: surgery is the main treatment for colon and rectal cancers. It may be curative or palliative. ▪ Segmental resection with anastomosis ▪ Abdominoperineal resection with sigmoid colostomy ▪ Temporary colostomy following segmental resection ▪ Permanent colostomy or ileostomy for palliation • Nursing Process – o Assessment: Obtain health history of elimination patterns, IBD, family history, current medications, dietary patterns, alcohol masses and tenderness. o Nursing Diagnosis: 22 NURS GASTROINTESTINAL UNIT 9 EXAM GUIDE WITH COMPLETE SOLUTIONS 2023 A+ ▪ Imbalanced nutrition ▪ Risk for fluid volume deficit ▪ Anxiety related to surgery and diagnosis ▪ Risk for ineffective self health maintenance ▪ Impaired skin integrity ▪ Disturbed body image o Problems/Potential Complications ▪ Infection/Peritonitis ▪ Obstruction/Perforation/Bleeding o Nursing Interventions: Preparing the patient for surgery building stamina with high calorie intake, low residue before surgery then full liquid diet 24-48 hours before surgery. Parenteral nutrition may be given. Antibiotics a day before surgery is initiated. The bowel is cleansed with laxatives, enemas and/or colonic irrigations prior to surgery and IV antibiotics given the morning of surgery (cefazolin (Ancef), and metronidazole (Flagyl). Monitors electrolytes, fluid volume, abdominal distention, pain or rigidity. Nurse assesses patient’s knowledge about diagnosis prognosis, surgical procedure and provides emotional support. ▪ Providing postoperative care • Assess for bowel sounds and returning peristalsis ▪ Maintaining optimal nutrition • Avoid foods that cause gas and order and high cellulose products (peanuts, celery, oranges, unpeeled fruit) ▪ Providing wound care • Assess for signs of bleeding, and temperature • Assess stoma- must be pink or red ▪ Managing/monitoring complications • Infection – check temperature and WBC’s • Rectal bleeding - reported immediately Monitor H& H • Abrupt change in abdominal pain to be reported • Change positions frequently, cough and deep breath and early ambulation prevent pulmonary complications ▪ Applying colostomy appliance • Colostomy begins to function in 3 – 6 days after surg. ▪ Irrigating colostomy (Except patients with radiation as perforation occur.)