Flashcards in Learn Smart med/surg GI Deck (21)
P. w/ severe GERD to undergo an esophagoscopy. During teaching RN should state?
a. the procedure is needed to measure the presence of acid in the esophagus
b. esophagoscopy is useful in determining how well the lower part of your esophagus works.
c. you should discuss this procedure with your provider
d. an esophagoscopy helps to diagnose cancer
b. esophagoscopy is useful in determining the incompetence of the lower esophageal sphincter (LES) and the extend of infla, scarring, and presence of strictures. An Esophageal pH probe study measures acid in the esophagus.
abnormal reflux of GI contents (acid) into the esophagus most commonly caused by a relaxed/incompetent lower esophageal sphincter. The acid causes infla and ulceration, and even strictures over time. S&S include dyspepsia, regurgitation, coughing/hoarseness, water brash, dysphagia, odynophagia (painful swallowing), epigastric pain, retrosternal burning, belching (eructation), flatulence, nausea, and pharyngitis.
P. with bowel obstruction dvlps severe abd pain. WOTF indicates possible perforation?
a. elevated BP
b. hyperactive bowel sounds
c. rigid abdomen
d. emesis of undigested food
C. A rigid boardlike abdomen (along with pain, distention, and absent bowel sounds) indicates perforation. Hypotension, not hypert, occurs b/c of leaked circulating bld volume into the peritoneum. Emesis of food typically occurs with bowel obstruction.
P returns from PT and the RN notes the infusion pump for TPN has been turned off, after restarting the pump the RN should mon for?
a. htn and crackles
b. polydipsia and polyuria
c. fever and chills
d. shakiness and diaphoresis
d. shakiness and diaphoresis. Hypoglycemia can dvlp in ps who are suddenly withdrawn from TPN. (RN should also monitor for weakness, anxiety, confusion, and hunger).
The pt is not expected to have fluid overload, hyperglycemia, or infection.
A nurse is teaching a p with diverticulitis about preventing acute attacks and advises him to eat foods?
a. high in vit c
b. low in fat
c. high in fiber
d. low in calories
c. high in fiber. Diverticulitis develops from trapped food/bacteria in a diverticula. This occurs more often with low fiber diets and increased intracolonic pressure c/b straining with BMs. High fiber foods help to maintain GI motility.
WOTF statements should be included in a Hep B education program?
a. hep b vaccine is recommended for those traveling, esp. military personnel.
b. hep b immunization is given to infants and children.
c. Hep. B is acquired by eating fruits/vegies/shellfish or other contaminated foods.
d. Hep B can be prevented by using good personal hygiene habits and proper sanitization.
b. A Hep B vaccine is given as part of the standard childhood immunizations. It can be given as early as birth, and a second dose usually is given at 1-4 months. The Hep. B virus is spread by unprotected sex, needle sticks/sharing, maternal-fetal route and hemodialysis.
WOTF p S&S is expected in the early stages of Hep. A?
c. Dark urine
d. Pale feces
b. Anorexia is an early symptom of Hep. A. This virus is spread by the fecal-oral route, through contaminated food/fluids. Hep. A is typically not life-threatening, recovery is usually uneventful, but it can progress to severe liver damage and other manifestations.
P. is receiving enteral tube feedings continuously at 75ml/hr. WOTF observations by the RN at 0800 require intervention?
a. pitcher of water is sitting on p's bedside table.
b. the disposable feeding bag is from the previous day at 1000 and has 200ml of feeding left.
c. the p is lying on his right side with a visible dependent loop in the feeding tube.
d. the HOB is elevated 20 degrees.
d. The HOB should be elevated at least 30 degrees to help prevent regurgitation. Regarding the water, free water is essential to prevent hypertonic dehydration and the p needs 2000ml/day. Feeding bags should be changed every 24 hours, thus, observation b is okay.
P. post-splenectomy after MVA. WOTF care measures has highest priority?
a. monitoring for fever
b. encouraging early ambulation
c. promoting lung aeration
d. observing for hemorrhage
c. Promoting lung aeration. Postop abd. incision pain causes splinting and shallow breathing, leading to under aeration of the lower lobes. Slow/deep/relaxed breaths provide more lung expansion and O2 use, which prevents atelectasis.
Caring for p dxd with fulminant hepatic failure. WOTF procedures should RN prepare p for?
a. portacaval anastomosis
b. right liver lobectomy
c. liver transplant
d. transjugular intrahepatic portosystemic shunt
c. liver transplant- fulminant hepatic failure is most often c/b viral hepatitis and leads to hepatic encephalopathy within weeks of the onset of disease. Mortality is high even with treatment.
Unconscious p recovering from a closed-head injury following placement of a PEG tube. WOTF actions has highest priority?
a. Flush the PEG tube with water before and after each feeding
b. place the p in high-fowlers position during PEG feedings.
c. Cleanse the skin around the PEG tube site each shift
d. Aspirate the PEG tube prior to each feeding
b. High-folwer's position decreases the risk for aspiration
Caring for p. on a low-bacteria diet with oral selective bowel decontamination solution before liver transplant surgery. RN knows the p should avoid consuming?
a. fresh grapes
b. carbonated soda
c. hard-boiled eggs
d. mashed potatoes
a. fresh fruits with peels (grapes cherries berries) are CI'd b/c microbes can easily penetrate the skin. Fresh fruits that can be rinsed and peeled are allowed.
P. returned to unit after a laparoscopic cholecystectomy and c/o severe left shoulder pain. RN should recognize that this pain
a. is due to CO2 instilled into the abd.
b. is not r/t the surgery and should be investigated
c. may indicate a peritoneal tear
d. is r/t lying in one position for too long on the operating room table.
a. CO2 is used to inflate the abd during laparoscopic procedures. The gas can irritate the diaphragm and cause referred shoulder pain which disappears in 1-2 days. Mild analgesics and recumbent positioning alleviate this pain. A peritoneal tear would cause abd. pain and distention, fever, anorexia, and vomiting (peritonitis).
A nurse notes that bowel sounds have returned in a p. 3 days p/op gastroplasty for obesity. WOTF is appropriate to give first?
a. vanilla pudding
b. apple juice
c. diet ginger ale
d. water (clear liquids) should be given first. Carbonated bvgs should be avoided bc they can cause distention and pressure on internal sutures. The sugar in apple juice can cause diarrhea (hyperosmolar bolus).
P. w/ Laennec's cirrhosis and hepatic encephalopathy. P. denies alcohol use. WOTF enzyme tests will confirm alcohol use?
a. Gamma-glutamyl Transferase (GGT)
b. Alkaline phosphatase (ALP)
c. 5' Nucleotidase
d. Alanine aminotransferase (ALT)
a. GGT enzymes are more specific for the hepatobiliary system than ALP, which can be elevated in bone or liver disease. The GGT lvl is also raised by alcohol and hepatotoxic drugs and thus is useful to mon drug toxicity and alcohol abuse.
Caring for p scheduled to undergo a liver biopsy for suspected malignancy. WOTF should RN mon. prior to procedure?
b. serum albumin
d. Hgb and hct
a. Prothrombin time. Major complication following liver biopsy = hemorrhage. Along with the PT, the activated partial thrombroplastin time (aPTT) and platelet count should be monitored. Many ps w/ liver dysfunction have increased risk of bleeding bc the liver cells no longer function to make prothrombin and clotting factors from Vit. K.
Admission hx/axmt of p with an exacerbation of chronic pancreatitis. RN recognizes that WOTF findings is likely to cause chronic pancreatitis?
a. high-caloric diet
b. prior gi illnesses
c. tobacco use
d. alcohol usage
d. alcohol usage is the major cause of c. pancreatitis in the US. Long-tm alcohol use is toxic to pancreatic cells and leads to an increased amt of proteins in pancreatic secretions which can cause plugs and calculi within pancreatic ducts.
Education program to prevent hep A transmission, WOTF population groups likely to become infected?
a. children and young adults
b. older adults
c. infants and pregnant women
d. middle aged men
a. children and young adults are the two grps most affected by hep a
P. w/ esophageal varices and double balloon tamponade (sengstaken Blakemore tube). Hours later, p. is agitated and R=36/min and shallow. RN action?
a. advance the tube further into the p's nose
b. decrease the pressure in the esophageal tube
c. raise the HOB to high-fowler's
d. use scissors to cut the tubing in front of the nose guard.
d. the breathing problems are likely c/b a displaced esophageal balloon. Cutting the tubing relieves the obstruction.
P. scheduled to have an esophagogastroduodenoscopy (EGD). RN knows that purpose of procedure is to?
a. visualize colon polyps
b. sclerose esophageal varices
c. evaluate the ileum
d. determine the presence of free air in the abd.
b. An EGD is the direct visualization of the upper GI tract to detect the presence of bleeding esophageal varices, stomach irritation and ulceration, or duodenal ulceration and bleeding. A fiberoptic endoscope is inserted and can be used to cauterize varices to prevent further bleeding.