Assessment of Digestive and Gastrointestinal Function Flashcards
(257 cards)
1
Q
What is the primary focus of quality improvement in healthcare systems?
A
To continuously improve the quality and safety of healthcare systems using data and improvement methods.
2
Q
What type of diet is often recommended for patients with IBD to reduce symptoms like diarrhea and weight loss?
A
A low-residue, high-protein, high-calorie, and high-vitamin diet.
3
Q
List five general categories of information to be gathered during assessment of digestive and gastrointestinal function.
A
- Health history 2. Medication history 3. Nutritional history 4. Family and social history 5. Examination of the abdomen
4
Q
Name five nursing concepts that are related to assessment of digestive and gastrointestinal function.
A
- Assessment 2. Elimination 3. Nutrition 4. Fluid and Electrolyte Balance 5. Teaching and Learning
5
Q
What is absorption in the context of gastrointestinal function?
A
Phase of the digestive process that occurs when small molecules, vitamins, and minerals pass through the walls of the small and large intestine and into the bloodstream.
6
Q
Define amylase.
A
An enzyme that aids in the digestion of starch.
7
Q
What factors extrinsic to the GI tract can interfere with its normal function?
A
Stress, anxiety, fatigue, and inadequate or abruptly changed dietary intake.
8
Q
Where is the stomach located?
A
In the left upper portion of the abdomen under the left lobe of the liver and the diaphragm, overlaying most of the pancreas.
9
Q
What are the four anatomic regions of the stomach?
A
- Cardia (entrance) 2. Fundus 3. Body 4. Pylorus (outlet)
10
Q
What is the function of the pyloric sphincter?
A
Controls the opening between the stomach and the small intestine.
11
Q
What is the primary function of the small intestine, and approximately how much surface area does it provide for this function?
A
Secretion and absorption, with approximately 70 m (230 feet) of surface area.
12
Q
List the three sections of the small intestine.
A
- Duodenum 2. Jejunum 3. Ileum
13
Q
What is the function of the ileocecal valve?
A
Controls the flow of digested material from the ileum into the cecal portion of the large intestine and prevents reflux of bacteria into the small intestine.
14
Q
What is the function of the common bile duct?
A
Allows for the passage of both bile and pancreatic secretions into the duodenum.
15
Q
List the segments of the large intestine.
A
- Ascending segment 2. Transverse segment 3. Descending segment 4. Sigmoid colon 5. Rectum 6. Anus
16
Q
What regulates the anal outlet?
A
A network of striated muscle that forms both the internal and the external anal sphincters.
17
Q
From which arteries and veins does the GI tract receive and return blood, respectively?
A
Arteries originating along the entire length of the thoracic and abdominal aorta and veins that return blood from the digestive organs and the spleen.
18
Q
Name the five large veins that compose the portal venous system.
A
- Superior mesenteric 2. Inferior mesenteric 3. Gastric 4. Splenic 5. Cystic
19
Q
What is the approximate percentage of total cardiac output that blood flow to the GI tract represents?
A
About 20%, which increases significantly after eating.
20
Q
List three major functions of the GI tract.
A
- Breakdown of food particles into the molecular form for digestion 2. Absorption into the bloodstream of small nutrient molecules produced by digestion 3. Elimination of undigested unabsorbed foodstuffs and other waste products
21
Q
What are the two main functions of gastric secretion?
A
To break down food into more absorbable components and to aid in the destruction of most ingested bacteria.
22
Q
What is the function of intrinsic factor, and where is it secreted?
A
Combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum; secreted by the gastric mucosa.
23
Q
What results from a lack of intrinsic factor?
A
Pernicious anemia.
24
Q
Name some enzymes that digest carbohydrates, their sources, and their digestive actions.
A
- Ptyalin (salivary amylase): Salivary glands, digests starch into dextrin, maltose, glucose * Amylase: Pancreas and intestinal mucosa, digests starch into dextrin, maltose, glucose * Maltase: Intestinal mucosa, digests maltose into glucose * Sucrase: Intestinal mucosa, digests sucrose into glucose, fructose * Lactase: Intestinal mucosa, digests lactose into glucose, galactose
25
Name some enzymes/secretions that digest protein, their sources, and their digestive actions.
* Pepsin: Gastric mucosa, digests protein into polypeptides * Trypsin: Pancreas, digests proteins and polypeptides into polypeptides
26
Name a secretion that digests fats, its source, and its digestive action.
* Bile: Liver and gallbladder, fat emulsification
27
What two types of contractions occur regularly in the small intestine?
Segmentation contractions and intestinal peristalsis.
28
Describe segmentation contractions.
Produce mixing waves that move the intestinal contents back and forth in a churning motion.
29
What do intestinal peristalsis contractions do?
Propels the contents of the small intestine toward the colon.
30
What are carbohydrates broken down into during digestion?
Disaccharides (e.g., sucrose, maltose, galactose) and monosaccharides (e.g., glucose, fructose).
31
What happens to ingested fats during digestion?
Become monoglycerides and fatty acids through emulsification.
32
How long does chyme typically stay in the small intestine?
3 to 6 hours.
33
What are villi and what is their function?
Small, fingerlike projections lining the entire intestine that function to produce digestive enzymes as well as to absorb nutrients.
34
Where does absorption begin, and how is it accomplished?
Begins in the jejunum and is accomplished by active transport and diffusion across the intestinal wall into the circulation.
35
Where are fats, proteins, carbohydrates, sodium, and chloride absorbed?
Jejunum.
36
Where are vitamin B12 and bile salts absorbed?
Ileum.
37
Where are magnesium, phosphate, and potassium absorbed?
Throughout the small intestine.
38
Name some stool characteristics that should be noted during a basic stool examination.
Consistency, color, and occult (not visible) blood.
39
What are some nursing concepts related to the management of patients with oral and esophageal disorders?
Nutrition, Communication, Self-perception, Coping.
40
Define stomatitis.
Inflammation of the oral mucosa.
41
What should the nurse instruct the patient to consult for antibiotic prescription and deep root scaling?
A dentist or periodontist.
42
What may be impaired by radical surgery for oral cancer, especially if the larynx is removed?
Verbal communication.
43
What should the nurse assess preoperatively regarding communication?
The patient’s ability to communicate in writing.
44
What should be provided postoperatively to patients who can use them to communicate?
Pen and paper.
45
What is obtained preoperatively and given after surgery to patients who cannot write so they may point to needed items?
A communication board with commonly used words or pictures.
46
What other electronic devices may also be options for facilitating communication?
Tablets or smartphones.
47
What kind of therapist benefits the interprofessional team for patients with oral cancer?
A speech therapist.
48
What other therapists might be consulted as needed for patients with oral cancer?
Physical and occupational therapists.
49
What does preoperative education address?
Interventions that cover the entire perioperative period.
50
During the informed consent process, what should the patient be made aware of?
Potential and actual risks and benefits of the procedure, Other treatment options, Projected outcome if the procedure is not done.
51
What patient expressions guide the nurse in providing support postoperatively?
Concerns, anxieties, and fears.
52
What might enhance the patient’s appetite?
Oral care before eating.
53
Why is oral care after eating important?
To prevent infection and dental caries.
54
Postoperatively, what are psychological nursing interventions aimed at?
Supporting the patient who has had a change in body image or has major concerns related to the prognosis.
55
What kind of adaptation is required after disfiguring surgery?
Psychological adaptation.
56
What are the social complications inherent after disfiguring surgery?
Swallowing and speech difficulties.
57
When is nasoduodenal or nasojejunal feeding indicated?
When the esophagus and stomach need to be bypassed, When the patient is at risk for aspiration.
58
For tube feedings longer than how long are gastrostomy or jejunostomy tubes preferred for medication or nutrition administration?
Longer than 4 weeks.
59
What is the osmolality of normal body fluids?
Approximately 300 mOsm/kg.
60
What may feeding formulas with high osmolality lead to?
Undesirable effects.
61
What symptoms may a patient experience when a concentrated high-osmolality solution enters the stomach too quickly or in large amounts?
Fullness, Nausea, Cramping, Dizziness, Diaphoresis.
62
What is osmotic diarrhea?
When water moves rapidly into the intestinal lumen from surrounding organs and the vascular compartment due to small intestine expansion.
63
What are fullness, nausea, cramping, dizziness, diaphoresis, and osmotic diarrhea collectively termed?
Dumping syndrome.
64
What can dumping syndrome lead to?
Dehydration, Hypotension, Tachycardia.
65
How can the small intestines adapt to a formula of high osmolality?
By initiating it at a low hourly rate and advancing it slowly.
66
What do bolus and intermittent drip tube feeding methods require?
Dividing the total daily feeding volume into 4 to 6 feeds throughout the day.
67
How are boluses given into the stomach?
Through a large (50-mL) syringe via gravity.
68
How quickly can bolus feedings be delivered?
As quickly as the patient can tolerate them, but they are initiated slowly and increased as tolerated.
69
With gravity feedings, what regulates the rate of flow?
Raising or lowering the syringe above the abdominal wall.
70
How often are intermittent gravity drip feedings administered?
Over 30 minutes or longer at designated intervals.
71
How does continuous feeding deliver nutrition?
Incrementally by slow infusion over long periods.
72
For what kind of patients are slow drip feedings recommended?
Critically ill patients, Patients at high risk for aspiration, Patients at risk for intolerance, Patients requiring small bowel feedings.
73
What do enteral feeding pumps control?
The delivery rate of the formula.
74
What features do feeding pumps have to signal issues such as an empty bag, low battery, or occlusion?
Alarms.
75
What factors need to be considered when administering tube feedings?
Temperature and volume of the feeding, Flow rate, Patient’s total fluid intake.
76
What schedule must be maintained for tube feedings?
The correct quantity and frequency of feedings.
77
Why must the nurse carefully monitor the drip rate?
To avoid administering fluids too rapidly.
78
If agency protocols include assessing gastric residual volume (GRV), research supports holding the feeding for how long if GRV is greater than 500 mL?
For 2 hours only.
79
When administering different types of medications through a tube, what method is used to ensure compatibility?
A bolus method.
80
When administering medications via tube, what is the tube flushed with before and after medication administration?
At least 15 mL of water.
81
After medication administration via tube, what size syringe is used to irrigate small-bore feeding tubes for continuous infusion?
A 20-mL or larger syringe.
82
What is a common location for Candida to develop and spread?
The area beneath the gastric tube external retention bolster.
83
After the first week of healing, how can buried bumper syndrome be prevented?
By rotating the gastric tube daily and moving it inward 2 to 10 cm at least once a week.
84
What does the nurse assess regarding the feeding tube in the home setting?
The patient’s level of knowledge and interest in learning about the tube.
85
What does the nurse encourage to facilitate self-care?
The patient’s participation in flushing the tube, administering medications, and tube feedings during hospitalization to establish a normal routine.
86
Define absorption.
The process where small molecules, vitamins, and minerals pass through the intestinal walls into the bloodstream.
87
Define anus.
The final section of the gastrointestinal (GI) tract; the outlet for waste.
88
Define esophagus.
A collapsible tube connecting the mouth to the stomach, allowing food to pass.
89
Define hydrochloric acid.
An acid secreted by the stomach to break down food and kill bacteria.
90
Define ingestion.
The process of taking food into the GI tract via the mouth and esophagus.
91
Define intrinsic factor.
A gastric secretion that enables vitamin B12 absorption.
92
What happens in the absence of intrinsic factor?
Vitamin B12 cannot be absorbed, leading to pernicious anemia.
93
Define large intestine.
The part of the GI tract where waste passes from the small intestine, and water absorption occurs.
94
What are the functions of the stomach?
Stores food, secretes digestive fluids, and propels chyme into the small intestine.
95
What is the capacity of the stomach?
Approximately 1500 mL.
96
What is the gastroesophageal junction?
The inlet to the stomach.
97
What are the four regions of the stomach?
Cardia, fundus, body, and pylorus.
98
What are the segments of the large intestine?
Ascending, transverse, descending, sigmoid colon, and rectum.
99
What completes the terminal portion of the large intestine?
The sigmoid colon, rectum, and anus.
100
What controls the anal outlet?
Internal and external anal sphincters.
101
Which arteries supply blood to the GI tract?
Branches from the thoracic and abdominal aorta.
102
Which veins return blood from the digestive organs?
The superior mesenteric, inferior mesenteric, gastric, splenic, and cystic veins.
103
Which vein returns blood from the small intestine and parts of the colon?
The superior mesenteric vein.
104
What percentage of cardiac output goes to the GI tract?
About 20%.
105
How does blood flow to the GI tract change after eating?
It increases significantly.
106
What are the major functions of the GI tract?
Food breakdown, nutrient absorption, and waste elimination.
107
What does the stomach secrete when food is present?
A highly acidic fluid.
108
What is the function of gastric secretion?
Breaks down food and destroys bacteria.
109
What is pepsin, and what does it do?
An enzyme that digests proteins by breaking them into polypeptides.
110
What does intrinsic factor do?
Enables vitamin B12 absorption in the ileum.
111
What enzymes digest carbohydrates?
Ptyalin (salivary amylase), amylase, maltase, sucrase, lactase.
112
What is the function of ptyalin?
Breaks down starch into dextrin, maltose, and glucose.
113
What is the function of amylase?
Breaks down starch and dextrin into maltose and glucose.
114
What is the function of maltase?
Breaks down maltose into glucose.
115
What is the function of sucrase?
Breaks down sucrose into glucose and fructose.
116
What is the function of lactase?
Breaks down lactose into glucose and galactose.
117
What are the major digestive enzymes and secretions that digest protein?
Pepsin, Trypsin.
118
What is the digestive action of pepsin?
Protein → polypeptides.
119
What is the digestive action of trypsin?
Proteins and polypeptides → polypeptides.
120
What digestive action is bile responsible for?
Fat emulsification.
121
What do segmentation contractions produce?
Mixing waves that move the intestinal contents back and forth in a churning motion.
122
What does intestinal peristalsis do?
Propels the contents of the small intestine toward the colon.
123
What stimulates segmentation contractions and intestinal peristalsis?
The presence of chyme.
124
What are carbohydrates broken down into?
Disaccharides (e.g., sucrose, maltose, galactose) and monosaccharides (e.g., glucose, fructose).
125
What is the major carbohydrate that tissue cells use as fuel?
Glucose.
126
What are proteins broken down into, and what do they provide?
Amino acids and peptides; a source of energy.
127
Ingested fats become what through emulsification?
Monoglycerides and fatty acids.
128
What findings might suggest an issue in the GI system?
Bulky, greasy, foamy stools with foul odor; light gray or clay-colored stool; stool with mucus threads or pus; small, dry, rock-hard masses occasionally streaked with blood; loose, watery stool possibly streaked with blood.
129
What information is gathered about past health, family, and social history when assessing the GI system?
Normal toothbrushing and flossing routine; frequency of dental visits; oral lesions or irritation; history of sore throat or bloody sputum; food-related discomfort; daily food intake; alcohol and tobacco use, including smokeless tobacco; use of dentures or partial plate.
130
What is functional constipation (FC)?
A persistent problem with defecation, characterized by decreased bowel movements, incomplete bowel emptying, or difficulty defecating.
131
What does the physical examination of the GI system include?
Assessment of the mouth, abdomen, and rectum.
132
What does the oral cavity examination begin with?
Inspection of the lips for moisture, hydration, color, texture, symmetry, and ulcerations or fissures.
133
What are normal findings when examining the lips?
Moist, pink, smooth, and symmetric lips.
134
What is inspected on the dorsum of the tongue?
Texture, color, and lesions.
135
What are normal findings on the dorsum of the tongue?
A thin white coat and large, vallate papillae in a “V” formation on the distal portion of the dorsum of the tongue.
136
How is further inspection of the ventral surface of the tongue and the floor of the mouth accomplished?
By asking the patient to touch the roof of the mouth with the tip of the tongue.
137
What are you assessing when a patient protrudes the tongue and moves it laterally?
To estimate the tongue’s size as well as its symmetry and strength (to assess the integrity of the 12th cranial nerve [hypoglossal nerve]).
138
What might a white or red plaque, lesions, ulcers, or nodules on the ventral surface of the tongue and floor of the mouth indicate?
Oral cancer.
139
Why is a complete assessment of the oral cavity essential?
Because many disorders, such as cancer, diabetes, and immunosuppressive conditions resulting from medication therapy or acquired immunodeficiency syndrome, may be manifested by changes in the oral cavity, including stomatitis.
140
How should the patient lie for inspection, auscultation, percussion, and palpation of the abdomen?
Supine with knees flexed slightly.
141
Auscultation always precedes what, and why?
Percussion and palpation, because they may alter sounds.
142
What is auscultation used for in an abdominal assessment?
To determine the character, location, and frequency of bowel sounds and to identify vascular sounds.
143
What is used to assess bowel sounds, and what are you listening for?
Use the diaphragm of the stethoscope for soft clicks and gurgling sounds.
144
How are bowel sounds designated?
As normal, hyperactive, hypoactive, or absent.
145
How long should the nurse auscultate to confirm the absence of bowel sounds?
For a minimum of 5 minutes; listening for at least 1 minute in each quadrant.
146
What is used to note any bruits in the aortic, renal, iliac, and femoral arteries?
The bell of the stethoscope.
147
What are friction rubs?
High pitched sounds heard over the liver and spleen during respiration.
148
What is borborygmus?
Stomach growling heard as a loud prolonged gurgle.
149
What is the purpose of GI diagnostic studies?
To confirm, rule out, stage, or diagnose various disease states, including cancer.
150
Where are the majority of GI tests and procedures performed?
On an outpatient basis in special settings designed for this purpose (e.g., endoscopy suite or GI laboratory).
151
What does preparation for many GI diagnostic studies include?
Either a clear liquid or low residue diet, fasting, ingestion of a liquid bowel preparation, the use of laxatives or enemas, and ingestion or injection of a contrast agent or a radiopaque dye.
152
Initial diagnostic tests begin with what?
Serum laboratory studies.
153
What serum laboratory studies are included in initial diagnostic tests?
CBC, complete metabolic panel, prothrombin time/partial thromboplastin time, triglycerides, liver function tests, amylase, and lipase; possibly, more specific studies such as carcinoembryonic antigen (CEA), cancer antigen (CA) 19-9, and alpha-fetoprotein.
154
When detected, what does CEA indicate?
That cancer is present, although not what type of cancer is present.
155
Besides serum laboratory studies, what is another basic diagnostic examination?
Examination of the stool.
156
What does basic examination of the stool include?
Inspecting the specimen for consistency, color, and occult (not visible) blood.
157
What additional stool studies require laboratory evaluation?
Fecal urobilinogen, fecal fat, nitrogen, Clostridium difficile, fecal leukocytes, calculation of stool osmolar gap, parasites, pathogens, food residues, and other substances.
158
What does a nurse instruct a patient to do before ultrasound testing and why?
To fast for 8 to 12 hours before ultrasound testing to decrease the amount of gas in the bowel.
159
If gallbladder studies are being performed, what should a patient do the evening before the test?
Eat a fat-free meal.
160
How long are patients who receive moderate sedation observed after ultrasound testing?
For about 1 hour to assess for level of consciousness, orientation, and ability to ambulate.
161
What should nurses assess when patients have a family history for digestive and gastrointestinal disorders?
For other cancers (e.g., endometrial, ovarian, kidney).
162
What patient assessments are specific to digestive and gastrointestinal disorders?
Ask about bowel pattern and color of stool; Assess if patient experiences episodes of abdominal cramping, diarrhea, or dehydration; Assess for unexplained weight loss; Identify intolerance to specific foods (e.g., gluten, high-fat foods, lactose); Assess for prior history of liver disorders; Assess for presence of other clinical conditions.
163
What is an upper GI fluoroscopy?
An upper GI fluoroscopy delineates the entire GI tract after the introduction of a contrast agent.
164
What does the GI series enable the examiner to detect or exclude?
Anatomic or functional disorders of the upper GI organs or sphincters.
165
What does the GI series aid in the diagnosis of?
Ulcers, varices, tumors, regional enteritis, and malabsorption syndromes.
166
What is a double-contrast method of examining the upper GI tract?
Involves administration of a thick barium suspension to outline the stomach and esophageal wall, after which tablets that release carbon dioxide in the presence of water are given.
167
What is enteroclysis?
A very detailed, double-contrast study of the entire small intestine that involves the continuous infusion (through a duodenal tube) of 500 to 1000 mL of a thin barium sulfate suspension; after this, methylcellulose is infused through the tube.
168
What should postprocedural patient education include after an upper GI study?
Information about increasing fluid intake, evaluating bowel movements for evacuation of barium, and noting increased number of bowel movements.
169
What does a CT scan provide?
Cross-sectional images of abdominal organs and structures.
170
What is CT a valuable tool for detecting and localizing?
Many inflammatory conditions in the colon, such as appendicitis, diverticulitis, regional enteritis, and ulcerative colitis, as well as evaluating the abdomen for diseases of the liver, spleen, kidney, pancreas, and pelvic organs, and structural abnormalities of the abdominal wall.
171
What does preprocedure patient education include for a CT scan?
NPO status 6 to 8 hours before the study and removal of all jewelry and other metals.
172
What can patients choose to do during an MRI to help with claustrophobia?
Wear a headset and listen to music or wear a blindfold during the procedure.
173
What do PET scans produce images of?
The body by detecting the radiation emitted from radioactive substances.
174
What does scintigraphy rely on?
The use of radioactive isotopes (i.e., technetium, iodine, indium) to reveal displaced anatomic structures, changes in organ size, and the presence of neoplasms or other focal lesions such as cysts or abscesses.
175
What does tagging of red blood cells and leukocytes define?
Areas of inflammation, abscess, blood loss, or neoplasm.
176
In EGD, how does the gastroenterologist view the GI tract?
Through a viewing lens and can obtain images through the scope to document findings.
177
What does PillCam ESO require?
That the patient swallows a capsule that travels by peristalsis through the small intestines.
178
What does the capsule in PillCam ESO contain?
An oxide metal silicon chip video camera, which transmits digital images of the GI mucosa to a data recorder that is worn on the patient’s waist.
179
What position is a patient in for a colonoscopy?
Lying on the left side with the legs drawn up toward the chest.
180
What can complications during and after a colonoscopy include?
Cardiac arrhythmias and respiratory depression resulting from the medications given, vasovagal reactions, and circulatory overload or hypotension resulting from overhydration or underhydration during bowel preparation.
181
What does postprocedure discomfort result from?
Instillation of air to expand the colon and insertion and movement of the scope during the procedure.
182
What does the success of colonoscopy depend on?
How well the colon is prepared.
183
What is the primary provider may prescribe for colon cleansing?
A laxative for two nights before the examination and a Fleet or saline enema until the return is clear the morning of the test.
184
What electrolyte lavage solutions are used for effective colon cleansing?
PEG electrolyte lavage solutions (GoLYTELY, CoLyte, and NuLYTELY).
185
What are the two current regimens for PEG electrolyte lavage solutions?
The nonsplit dose regimen, in which the entire solution is ingested the night before the procedure, or the split-dose regimen.
186
How well is the colon prepared?
The colon is prepared well.
187
What are the two current regimens for PEG electrolyte lavage solutions?
The nonsplit dose regimen, in which the entire solution is ingested the night before the procedure, or the split-dose regimen, in which half of the dose is ingested the night before and half is ingested the morning of the procedure, 3 hours prior to the scheduled test.
188
What does Tariq et al. (2019) report regarding bowel preparation with a split prep?
Improved bowel preparation and cleansing.
189
How is a sodium phosphate tablet (OsmoPrep, Visicol) dosed for colon cleansing prior to colonoscopy?
20 tablets (4 tablets every 15 minutes) with 8 oz of any clear liquid (water, any clear carbonated beverage, or juice) on the evening prior to the examination, and 12 tablets (taken in the same manner) on the morning of the examination.
190
What are side effects of the electrolyte solutions used for colon cleansing?
Nausea, bloating, cramps or abdominal fullness, fluid and electrolyte imbalance, and hypothermia.
191
What does the nurse advise the patient with diabetes to do to prepare for a colonoscopy?
Consult with their primary provider about medication adjustment to prevent hyperglycemia or hypoglycemia resulting from the dietary modifications required in preparing for the test.
192
What special precautions must be taken for some patients undergoing colonoscopy?
Implantable defibrillators and pacemakers are at high risk for malfunction if electrosurgical procedures (i.e., polypectomy) are performed in conjunction with colonoscopy.
193
For flexible scope procedures, what position does the patient assume?
A comfortable position on the left side with the right leg bent and placed anteriorly.
194
What is performed with small biting forceps introduced through the endoscope?
A biopsy.
195
If polyps are present during a flexible scope procedure, how may they be removed?
With a wire snare, which is used to grasp the pedicle, or stalk and an electrocoagulating current is then used to sever the polyp and prevent bleeding.
196
What methods are available for visualization of the small intestine?
Capsule endoscopy and double-balloon enteroscopy.
197
What is capsule endoscopy useful in the evaluation of?
Obscure GI bleeding.
198
The capsule used for a small bowel study allows for inspection of the small intestine without what?
Patient discomfort.
199
What is given subcutaneously to stimulate gastric secretions during a gastric acid stimulation test?
Histamine or pentagastrin.
200
What is monitored during a gastric acid stimulation test to detect hypotension?
The patient’s blood pressure and pulse.
201
What is measured in gastric specimens collected after injection during a gastric acid stimulation test?
The volume and pH of the specimen.
202
What is esophageal reflux of gastric acid evaluated by?
Ambulatory pH monitoring.
203
How long is the sensor in ambulatory pH monitoring worn while the patient continues usual daily activities?
For 24 hours.
204
What does the Bravo pH monitoring system offer?
The advantage of pH monitoring of the esophagus without the transnasal catheter.
205
How long are data collected for in the Bravo pH monitoring system?
Up to 96 hours and then downloaded and analyzed.
206
What is the accuracy of the Bravo pH monitoring system compared to other ambulatory pH monitoring methods?
Greater because the patient can eat normally and continue typical activities during the testing.
207
What should a nurse instruct a patient to do for an antibiotic prescription and deep root scaling?
Consult a dentist or periodontist.
208
What may a patient require before and after surgery to maintain adequate nutrition when managing oral and esophageal disorders?
Enteral (through the GI tract) or parenteral (intravenous [IV]) feedings.
209
In radical surgery for oral cancer, what communication ability should the nurse assess?
The patient’s ability to communicate in writing before surgery.
210
What is obtained preoperatively and given after surgery to patients who cannot write so that they may point to needed items?
A communication board with commonly used words or pictures.
211
What may also be options for facilitating communication?
Electronic devices, such as tablets or smartphones.
212
What are the major goals for the patient undergoing surgery for oral or esophageal disorders?
Increased knowledge of surgical procedure and treatment plan, maintenance of respiratory status, decreased pain, viability of the graft, maintenance of adequate intake of food and fluids, effective coping strategies (for patient and caregivers), effective communication, maintenance of shoulder and neck motion, and absence of complications.
213
Before surgery, what should the patient be informed about?
The nature and extent of the surgery and what to expect in the postoperative period.
214
What should preoperative education address?
Interventions that cover the entire perioperative period.
215
Preoperatively, what information is given to the patient and family?
Information about the planned surgery.
216
Postoperatively, what are psychological nursing interventions aimed at?
Supporting the patient who has had a change in body image or who has major concerns related to the prognosis.
217
What behavioral issues often directly relate to the underlying cause of head and neck cancer?
HPV infection status, alcohol, smoking.
218
What determines whether diet modification is necessary for a patient who can chew?
The patient’s chewing ability.
219
What may enhance the patient’s appetite, and what is important to prevent infection and dental caries?
Oral care before eating may enhance the patient’s appetite, and oral care after eating is important to prevent infection and dental caries.
220
What should be covered in education for a patient recovering from neck surgery?
Name the procedure that was performed and identify any permanent changes in anatomic structure or function as well as changes in communication, ADLs, IADLs, roles, body image, relationships, and spirituality; Identify modification of home environment, interventions, and strategies (e.g., utilizing durable medical equipment, employing a home health aide) used in safely adapting to changes in structure or function and promote effective recovery and rehabilitation; Describe ongoing therapeutic regimen, including diet and activities to perform (e.g., oral care, suctioning) and to limit or avoid (e.g., lifting weights, driving a car, contact sports).
221
What should the patient be able to state regarding medications after education?
The name, dose, side effects, frequency, and schedule for all medications.
222
What should the patient be able to describe regarding pain after education?
Approaches to controlling pain (e.g., take analgesics as prescribed; use nonpharmacologic interventions).
223
What are examples of local support groups for patients with oral disorders?
New Voice Club.
224
When is nasoduodenal or nasojejunal feeding indicated?
When the esophagus and stomach need to be bypassed or when the patient is at risk for aspiration.
225
For tube feedings longer than 4 weeks, what tubes are preferred for administration of medications or nutrition?
Gastrostomy or jejunostomy tubes.
226
Why is osmolality an important consideration for patients receiving tube feedings through the duodenum or jejunum?
Because feeding formulas with a high osmolality may lead to undesirable effects.
227
What is dumping syndrome?
When a concentrated solution of high osmolality entering the stomach is taken in quickly or in large amounts, the small intestines expand and water moves rapidly into the intestinal lumen from fluid surrounding the organs and the vascular compartment; The patient may have feelings of fullness, nausea, cramping, dizziness, diaphoresis, and osmotic diarrhea.
228
What can dumping syndrome lead to?
Dehydration, hypotension, and tachycardia.
229
What tube feeding methods are practical and inexpensive options for the patient receiving tube feedings who resides at home or in a long-term care facility?
Bolus and intermittent drip tube feeding methods.
230
How often is the total daily feeding volume divided into when using bolus infusions?
4 to 6 feeds throughout the day.
231
What assessment findings should nurses be alert for in patients receiving tube feedings?
Tube placement, patient’s position (head of bed elevated > 30 degrees), and formula flow rate; Patient’s ability to tolerate the formula; observe for fullness, bloating, distention, nausea, vomiting, and stool pattern; Clinical responses, as noted in laboratory findings (blood urea nitrogen, serum protein, prealbumin, electrolytes, kidney function, hemoglobin, hematocrit); Signs of dehydration (dry mucous membranes, thirst, decreased urine output); Amount of formula actually taken in by the patient; Elevated blood glucose level, decreased urinary output, sudden weight gain, and periorbital or dependent edema; Signs of infection (to avoid infection, replace any formula given by an open system every 4 to 8 hours with fresh formula; change tube feeding container and tubing every 24 hours); Signs of complications (if suspected, check gastric residual volume before each feeding or, in the case of continuous feedings, every 4 hours; return the aspirate to the stomach); Intake and output; Weekly weights; Recommendations made on dietitian consult.
232
When administering tube feedings, what factors are important to consider?
The temperature and volume of the feeding, the flow rate, and the patient’s total fluid intake.
233
What are some indicators of feeding tolerance that the nurse needs to consider?
Abdominal distention, patient reports of discomfort, vomiting, hypoactive bowel sounds, changes in passing flatus, and presence of diarrhea.
234
According to the most recent guidelines for assessment and provision of nutrition in the patient who is critically ill, what do they not advocate using to monitor tolerance of enteral feedings?
Gastric residual volumes (GRVs).
235
If agency protocols and policies include assessing GRV as part of routine care, research and guidelines support holding the feeding for 2 hours only if the GRV is greater than what?
500 mL.
236
When different types of medications are prescribed via a feeding tube, what method is used for administration?
A bolus method.
237
What is done before and after medication administration via feeding tube?
The tube is flushed with at least 15 mL of water before and at least 15 mL of water after medication administration (30 mL total).
238
When irrigating small-bore feeding tubes after administration of medications, what size syringe is used?
A 20-mL or larger syringe because the pressure generated by smaller syringes could rupture the tube.
239
What should guide the primary provider’s prescriptions regarding medication choices and route of delivery?
Nursing judgment is required to individualize care; institutional protocols and pharmacist input.
240
What strategies may help prevent some of the uncomfortable signs and symptoms of dumping syndrome related to tube feeding?
Slow the formula instillation rate to provide time for carbohydrates and electrolytes to be diluted; Administer feedings at room temperature, because temperature extremes stimulate peristalsis; Administer feeding by continuous drip (if tolerated) rather than by bolus, to prevent sudden distention of the intestine; Advise the patient to remain in semi-Fowler position for 1 hour after the feeding; this position prolongs intestinal transit time by decreasing the effect of gravity; Instill the minimal amount of water needed to flush the tubing before and after a feeding, because fluid given with a feeding increases intestinal transit time.
241
For the first week after insertion of a tube, interventions are focused on prevention of what?
Stomal tract infection and promotion of incisional healing.
242
What is the insertion site cleaned with daily and/or dressed with for the first week after tube insertion?
Cleaned with aseptic wound care daily and/or a glycerin hydrogel or glycogel dressing.
243
After approximately 1 week, how is the tube insertion site cleansed?
Twice a week with soap and water and left open to air.
244
After the first week of healing, what is a severe, but rare complication that can be prevented by rotating the gastric tube (not done with jejunostomy tubes) daily and moving the tube inward 2 to 10 cm at least once a week?
Buried bum.
245
What does diagnosis of a hiatal hernia typically confirmed by?
x-ray studies; barium swallow; esophagogastroduodenoscopy (EGD); esophageal manometry; or chest CT scan.
246
What does management for a hiatal hernia include?
Frequent, small feedings that can pass easily through the esophagus; The patient is advised not to recline for 1 hour after eating, to prevent reflux or movement of the hernia, and to elevate the head of the bed on 4- to 8-inch (10- to 20-cm) blocks to prevent the hernia from sliding upward.
247
What is the primary reason for surgical hernia repair?
To relieve GERD symptoms and not repair the hernia.
248
Chemical burns of the esophagus may also be caused by what?
Undissolved medications in the esophagus, or they may occur after swallowing of a battery, which may release a caustic alkaline.
249
What are patients with chemical burns of the esophagus monitored for?
Tracheoesophageal fistula, perforation of large vessels, mediastinitis, vocal cord paralysis, tracheal stenosis or tracheomalacia, aspiration pneumonia, empyema, lung abscess, pneumothorax, spondylodiscitis, and strictures.
250
Potential risk of gastric acid suppression from antacids is what?
Loss of protective flora and an increased risk of infection, especially Clostridium difficile.
251
In a nonemergency setting, what may reveal the nature of the esophageal disorder?
A complete health history.
252
What should nurses determine when taking a patient's history for an esophageal disorder?
Whether the patient appears emaciated and auscultates the patient’s chest to assess for pulmonary complications.
253
What are some nursing diagnoses based on assessment data for esophageal disorders?
Impaired nutritional intake associated with difficulty swallowing; Risk for aspiration associated with difficulty swallowing or tube feeding; Acute pain associated with difficulty swallowing, ingestion of an abrasive agent, tumor, or frequent episodes of gastric reflux; Lack of knowledge about the esophageal disorder, diagnostic studies, medical management, surgical intervention, and rehabilitation.
254
What are patients advised regarding antacid use?
That excessive use of over-the-counter antacids can cause rebound acidity and antacid use should be directed by the primary provider, who can recommend the daily, safe dose needed to neutralize gastric juices and prevent esophageal irritation.
255
In instances of trauma, what is more difficult because of the short time available and the circumstances of the injury?
The emotional and physical preparation for treatment.
256
What is important if outpatient procedures are performed with the use of moderate sedation?
Someone must be available to drive the patient home after the procedure.
257
What should patients at the completion of education be able to state regarding an esophageal disorder?
State the impact of the esophageal disorder and treatment on physiologic functioning, ADLs, IADLs, body image, roles, relationships, and spirituality; Identify modification of home environment, interventions, and strategies (e.g., utilizing durable medical equipment, employing a home health aide) used in safely adapting to changes in structure or function and promote effective recovery and rehabilitation; Describe ongoing therapeutic regimen, including diet and activities to perform (e.g., suctioning) and to limit or avoid (e.g., oral foods if NPO).
