Med-Surg: GI, Hepatic, Pancreatic/4

Question 1

bariatric surgery indications

3

Answer 1

1. BMI >40
2. BMI > 35 with other diseases
3. repeated failure of nonsurgical weight reduction

Question 2

bari surgery - diet post op

Answer 2

liquids and pureed foods for first 6 weeks

Question 3

bari surgery post op care

6

Answer 3

1. # 1 airway
2. ensure abd binder in place
3. place in semi fowlers
4. ambulate asap, day of surgery
5. measure and compare abd girth
6. listen for bowel sounds

Question 4

bari surgery - feedings post op should be

2

Answer 4

1. six small feedings per day

2. begin with 1 oz cups of clear liquids

Question 5

dumping syndrome s/s

6

Answer 5

1. tachycardia
2. nausea
3. diarrhea
4. abd cramping
5. diaphoresis
6. anastomotic leak

Question 6

colostomy - avoid what foods

5

Answer 6

1. nuts
2. popcorn
3. celery
4. seeds
5. coconut

Question 7

colostomy - foods that can cause odor and gas

6

Answer 7

1. cruciferous veggies
2. asparagus
3. fish
4. eggs
5. garlic
6. beans

Question 8

cirrhosis contributing factors

4

Answer 8

1. alcoholism
2. postnecrotic
3. biliary disease
4. severe right sided HF

Question 9

cirrhosis mani. early

4

Answer 9

1. enlarged liver
2. jaundice
3. GI disturbances
4. weight loss

Question 10

cirrhosis mani. late

8

Answer 10

1. liver becomes smaller and nodular
2. splenomegaly
3. ascites
4. bleeding tendencies, decreased vit K and PT time, anemia
5. esophageal varices
6. pruritis of skin
7. clay colored stools; no bile in them
8. tea colored urine; bile in urine

Question 11

cirrhosis diet

Answer 11

high calorie, low protein (10-20 g/day), low fat, low sodium diet

Question 12

cirrhosis - sodium and fluid

Answer 12

limit

Question 13

lactulose

Answer 13

decreases ammonia levels in cirrhosis

Question 14

hep a route

Answer 14

fecal oral

Question 15

hep B route

Answer 15

blood

Question 16

hep C route

Answer 16

blood

Question 17

hep A mani.

2

Answer 17

1. mild

2. flu like

Question 18

hep B mani.

9

Answer 18

1. may be asymptomatic
2. RUQ pain
3. anorexia
4. NV
5. fatigue
6. febrile
7. dark urine
8. light colored stool
9. jaundice

Question 19

hep C mani.

3

Answer 19

1. most are asymp.
2. dx with blood testing
3. chronic inflammation progresses to cirrhosis

Question 20

hep A prevention

2

Answer 20

1. hand washing

2. vaccine ages 2+ (two doses 6-18 months apart)

Question 21

hep B prevention

2

Answer 21

1. vaccine infants and high risk populations

2. 3 doses over 6-month time

Question 22

hep C prevention

Answer 22

avoid high risk behaviors

Question 23

hep B and C tx

3

Answer 23

1. antiviral drugs
2. peginterferon alfa-2B
3. monitor kidney function

Question 24

cholecystitis

Answer 24

inflammation of gallbladder

Question 25

cholelithiasis

Answer 25

presence of stones in the gallbladder

Question 26

gallbladder disease CF | 5

Answer 26

1. more common in females 2. obesity 3. high fat diet 4. older adults 5. DM type 2

Question 27

gallbladder manif. | 7

Answer 27

1. sharp right upper quadrant, epigastric, or shoulder pain 2. NV after ingestion of high fat food 3. murphy's sign 4. flatulence 5. dyspepsia 6. dark urine 7. clay colored stool

Question 28

cholecystectomy post op | 4

Answer 28

1. may have T tube 1-2 weeks 2. monitor drainage, keep below level of GB 3. report drainage greater than 1000ml/day 4. never irrigate without order

Question 29

GB disease client education | 3

Answer 29

1. resume regular low fat diet 2. prevent dumping syndrome 3. care of T tube

Question 30

chronic pancreatitis CFs | 6

Answer 30

1. alcohol 2. gallstones 3. illegal drug use 4. infection 5. blunt abd trauma 6. operative manipulation and trauma

Question 31

pancreatitis manif. | 9

Answer 31

1. severe mid-epigastric or LUQ pain 2. pain intensifies after meals and when lying down 3. NV 4. weight loss 5. abd tenderness 6. ascites 7. elevated amylase and lipase 8. steatorrhea 9. Turner and Cullen's sign

Question 32

pancreatitis position of comfort

Answer 32

upright leaning forward

Question 33

pancreatitis - monitor for what electo

Answer 33

hypocalcemia and hypomag

Question 34

pancreatitis rx for pain that is contraindicated

Answer 34

meperidine

Question 35

client education for chronic pancreatitis | 3

Answer 35

1. take enzymes before meals and snacks 2. nutrition: high caloric needs, low fat 3. no alcohol

Question 36

pancreatic cancer dx procedures | 5

Answer 36

1. carcinoembryonic antigen (CEA) levels - normal is <2.5 nonsmokers, <5 smokers 2. elevated serum amylase and lipase 3. elevated alkaline phosphate and bilirubin 4. ERCP 5. US, CT scan