GI # 1 high yield Flashcards by Hayden Bastion

enteral vs parenteral nutrition

Enteral Nutrition – nutritionally balanced liquid or foods delivered directly to the GI tract

Parenteral Nutrition – administration of nutrients directly into the bloodstream

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Nasally and Orally Placed Feeding Tubes vs Gastrostomy and Jejunostomy Tubes

NG tube 4 weeks or less

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Jejunostomy tubes are used for

chronic reflux to decrease risk for aspiration.

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5 ways to prevent enteral tube aspiration

evaluate all enterally-fed patients for risk,

verify tube position before use,

position patient with HOB > 30-45 degrees,

minimize time in supine position,

and follow agency protocol/orders for checking gastric residual volume

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what to monitor to pt with parenteral nurition

blood glucose - give insulin if indicated
weight
i and o

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how often is parenteral solution and tubing changed

q 24 hours

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complication of parenteral nutrition

refeeding syndrome - fluid retention and electrolyte imbalances, especially hypophosphatemia, hypokalemia, and hypomagnesemia

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2 highest risk complications of anorexia

renal failure and dysrhythmias

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4 supplements needed after Roux-en-Y Gastric Bypass (RYGB):

Multivitamin, iron, calcium, and B12 (cobalamin)

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nutriton after bariatric surgery

NPO then clear low sugar liquid
15-30ml every 15 min gradually increasing
low fat full liquid after 48 hrs
NO STRAWS
no meds bigger than m/m

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if pt has excessive pain or pain not relived by meds after baraitric surgery

check incision site for leaking

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HOB after bariatric surg

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nurse interventions after bariatric surg 3

I and O
early mobility/VTE prophylaxis
teach deep breathing/IS

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tx for metabolic syndrome

weight reduction and PA

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generalized weakness, sweating,
palpitations, and dizziness, abdominal cramps.

dumping syndrome - small feedings to prevent - usually last 1 hour after eating - pt should have a rest period after eating

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5 interventions for vomitting

NPO
IV fluids
for persistent vomitting, bowel obstruction or ileus- NG tube
BRAT
meds as ordered

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3 interventions for Upper gastro-intestinal endoscopy (EGD)

Evaluate for presence of a gag reflex prior to allowing PO intake (including meds) after test

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what to give patients after barium swallow

fiber and fluids

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education for GERD patient 5

sleeping/resting with HOB elevated,

not supine for 2-3 hours after eating,

avoiding constrictive clothing,

cigarette cessation

avoid alcohol, chocolate, mints, caffeine, and fatty foods

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main cause of PUD

hpylori

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treating h pylori infection

Antibiotics (clarithromycin, amoxicillin, and metronidazole are common) along with a PPI for 7-14 days

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gastric vs duodenal ulcer

Gastric ulcers – burning or gaseous pressure in the epigastrium, pain 1-2 hours after eating, if penetrating, increased discomfort with food

Duodenal ulcers – burning, cramping, pressure-like pain across mid-epigastrium and upper abdomen or back, 2-5 hours after eating, midmorning, midafternoon, and during the night. Pain relieved with food and antiacids – pain at night

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normal vs abnormal gastric contents

normal green yellow, abnormal is coffee grounds or red

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biggest complication and monitoring for PUD

bleeding - monitor BP, HR, Hgb, HCt, gastric contents

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3 signs of hemorrage from PUD

hypovolemia, dec Hgb/Hct, bright red gastric contents

sudden, severe pain, signs of peritonitis/sepsis

preforation from PUD

if NG tube isnt draining

ask provider for an xray

Postprandial Hypoglycemia

uncontrolled gastric emptying of fluid high in carbohydrate into the small intestine resulting in excess insulin and reflex hypoglycemia

Anastomosis Leak

break in the suture line allowing gastric or intestinal contents to enter the peritoneum

Pernicious Anemia

loss of intrinsic factor preventing cobalamin (B12) absorption

priority for vomitting red blood

IV site for fluids to prevent hypovolemic shock and for blood products

med for upper GI bleeding

PPI

preventing gastroenteritis

hand hygiene

intervention for prolonged diarrhea

stool culture

3 assessments for diarrhea

temp, dehydration, VS

biggest risk factor for cdiff diarrhea

abx use

IBS education 2

Address underlying psychological factors – stress eat low FODMAP foods *Foods to avoid – dairy containing lactose, wheat-based products, beans and lentils, artichokes, asparagus, onions, garlic, cabbage, broccoli, mushrooms, sweet corn, stone fruits

education about what s/s of crohns and ulcerative colitis look like

exacerbation and remission

ulcerative colitis complication and education

colorectal cancer - get screened

common complication of crohns

nutritional deficiencies

8 acute care for crohns and UC

monitor vital signs, assess and treat pain, I & O, monitor lab results (CBC, electrolytes), administer IV fluids as ordered, daily weight, assess abdomen, provide hygiene

diverticulosis teaching

high-fiber diet, fiber supplements/stool softeners, weight reduction (if overweight), physical activity, and avoiding things that increase intrabdominal pressure

diverticulitis home tx

clear liquids, rest, antibiotics, and analgesics

key to tx of acute adbominal pain

determining cause because it can be life threatening

pain with appendicitis

Pain may be dull initially, persists and settles in the right lower quadrant

2 dx test for appendicitis

CBC and CT abdominal scan

7 managements of after apendectomy

monitoring vital signs, advancing diet as tolerated post-operatively, early ambulation, abdominal assessment, tx of pain, surgical site assessment and care, monitoring for complications

pain with peritonitis

more pain with movement - pt may want fetal position

complication of periotonitis

hypovolemic shock so provide I Vfluids

small bowel obstruction symptom

vomitting

how to know how to tx bowel obstruction

location to determine manifestation

how to prevent CRC

Colonoscopy every 10 years starting at age 45 - if famililal hx, need more frequent screening

Illeostomy contents

liquid

focus of ostomy care

assessment, patient and caregiver teaching about ostomy care, and emotional support

teaching regarding drainage after ostomy

normal until peristalsis is normal

The nurse is providing teaching to a client about newly prescribed phentermine. The nurse knows that the client has correct understanding about the medication when the client makes which of the following statements?

i will monitor my BP regularly

A client tells the nurse that since starting orlistat they have experienced increased gas and diarrhea, especially after eating high-fat foods. What is the nurse’s best response to the client?

that is a SE when eating high fat foods

The nurse is administering ondansetron to a client. Which of the following side effects should the nurse monitor for after administration?

HA and fatigue

The nurse should include what information when providing teaching about omeprazole to a client with gastroesophageal reflux disease?

lowest dose for shortest duration

The nurse is administering sucralfate to a client diagnosed with peptic ulcer disease. The client asks the nurse how the medication works. What is the best response by the nurse?

protective barrier

The nurse is aware that famotidine works by which of the following methods?

blocks histamine

The nurse is caring for a client diagnosed with Clostridium difficile diarrhea. The nurse should question a medical prescription for which of the following medications?

loperamide

The nurse is administering polyethylene glycol to a client prior to a diagnostic procedure. The client asks how quickly the medication will work. What is the nurse’s best response?

1 hour

The nurse is caring for a client following gastric resection for gastric cancer. The client begins to complain about increasing discomfort and nausea and the nurse observes that the client’s NG tube has not drained any secretions for over 6 hours. What action should the nurse take first?

verify placement

2. The nurse is providing education to a client following gastric resection. What measures should the nurse teach the client to prevent dumping syndrome? SELECT ALL THAT APPLY. A. Avoid foods high in sugar and concentrated carbohydrates. B. Eat 3 larger meals a day. C. Eat foods that are high in fiber. D. Eat smaller, more frequent meals. E. Avoid foods that are high in protein.

A and D

3. The nurse is caring for a client following abdominal surgery. The client is complaining of abdominal pain. Which assessment findings would be consistent with a paralytic ileus?

absence of bowel sounds

complains of increased pain and feeling light-headed. On assessment, the nurse finds that his abdomen is firm and tense and he is diaphoretic and pale. 3. Which of the following actions in response to these findings is a priority:

check vitals, BP, HR, RR

2. What information does the nurse need to teach SP about adalimumab?

more susceptible to infection

priority for obstruction

NPO

An abdominal CT is ordered and shows a small bowel obstruction and stricture in the ileum. SP is taken to the OR for an emergency laparotomy. SP returns to the surgical unit post-operatively with a 5 cm abdominal incision and an ileostomy. 5. What are the initial assessment priorities for the nurse to make? (List 5)

Vital signs and O2 saturation every 15 minutes X 1 hour, then every 30 minutes X 1 hour, then hourly X 4. Assess surgical site (dressing for bleeding/drainage) and appearance of the ostomy. Recognize that once peristalsis returns, ostomy output will be liquid, constant, and of increased amount after eating. Assess and maintain NG tube (placement, output, function) and NPO status. Assess hydration status and I & O, frequent urine output assessment, administer IV fluid as ordered. Assess pain and administer analgesia as ordered.

priority asessment for ostomy

assessing pts thoughts about it

A patient is receiving peripheral parenteral nutrition. The solution is completed before the new solution arrives on the unit. The nurse gives

5% dextrose

6. A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply) a. hypokalemia. b. hypoglycemia. c. hypercalcemia. d. hypomagnesemia. e. hypophosphatemia.

ADE

6. A patient with extreme obesity has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse anticipates that the patient a. may have severe diarrhea early in the postoperative period. b. will not be allowed to ambulate for 1 to 2 days postoperatively. c. will require nasogastric suction until the drainage is pale yellow. d. may have limited amounts of oral liquids during the early postoperative period.

4. Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. “The best time to take an as-needed antacid is 1 to 3 hours after meals.” b. “A glass of warm milk at bedtime will decrease your discomfort at night.” c. “Do not chew gum; the excess saliva will cause you to secrete more acid.” d. “Limit your intake of foods

9. The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information about the importance of (select all that apply) a. limiting alcohol intake to 1 serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking drugs prescribed by the health care provider. e. taking all drugs 1 hour before mealtime to prevent further bleeding.

The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to

inc fluids

In planning care for the patient with Crohn’s disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn’s disease is that Crohn’s disease a. often results in toxic megacolon. b. causes fewer nutritional deficiencies than ulcerative colitis. c. often recurs after surgery, while ulcerative colitis is curable with a colectomy. d. is manifested by rectal bleeding and anemia more often than is ulcerative colitis.

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that

follow up colonoscopies

GI # 1 high yield Flashcards

(79 cards)