Gastrointestinal System4

Billy Ray A. Marcelo, BSN, RN Faculty Bataan Peninsula State University

Overview

Functions:

digestion  absorption  elimination 

Overview Accessory organs I. Salivary Gl&s - for mechanical digestion (amylase: ptyalin) Parotid (below & in front of ears) oSaliva produced- 1,200-1,500 ml/day Sublingual Submaxillary

Salivary Gl&s

MUMPS

Causative agent: Paramyxovirus Signs & Symptoms swollen parotid gl& dysphagia fever chills anorexia

MUMPS

MUMPS Signs & Symptoms

nausea & vomiting general body malaise weight loss

MUMPS Prevent Complications Male orchitis (puberty stage → sterility) virus attacks the sperms produced by Leydig cells at seminiferous tubules

Orchitis

MUMPS

Female vaginitis cervicitis oophoritis

MUMPS Nursing Management Strict respiratory isolation Administer meds as ordered Antipyretic Analgesic Antibiotics

MUMPS

Nursing Management Cool pack General liquid to soft diet

APPENDICITIS Inflammation

of Vermiform Appendix small structure extending from the cecum at the R iliac/inguinal region produces WBC during fetal life, ceases to function once baby is born

APPENDICITIS

APPENDICITIS

Predisposing Factors Microbial agents  Fecalith (undigested food particles)  Intestinal obstruction 

APPENDICITIS

Signs & Symptoms  (+) rebound tenderness & abdominal rigidity  Pain at the R iliac region  Position of comfort: side-lying with abdominal guarding & legs flexed

APPENDICITIS

Signs & Symptoms  Low grade fever  Anorexia, N/V, diarrhea, constipation  Late Sign tachycardia

APPENDICITIS (+) rebound tenderness at McBurney’ s point

APPENDICITIS

Diagnostic Procedure CBC- mild leukocytosis U/A- ↑ acetone

Surgery Appendectomy within 24-48 hrs

Pre-op Nursing Interventions: APPENDECTOMY Informed consent NPO, IVF, skin prep, NO ENEMA/LAXATIVES! NO RECTAL TEMP! NO HEAT APPLICATION! Position of comfort: R sidelying or semi-Fowler’s Ice packs for 20-30 mins qh Antipyretics & antibiotics as ordered

Pre-op Nursing Interventions: APPENDECTOMY

Monitor VS, I/O, pain level,bowel sounds N: 5-30X/min or q 5-15 sec, Listen to each quadrants for 5 mins Borborygmi- > 60 sounds/minhyperactive bowel WOF ruptured appendix & peritonitis

PERITONITIS  Peritoneum Lines

the abdominal cavity Forms the mesentery that supports the intestines & blood supply  Signs & Symptoms of Peritonitis ↑HR, ↑RR, ↑T & chills Pallor, restlessness Progressive abdominal distention & pain R guarding of the abdomen

PERITONITIS

Post-op Nursing Interventions: APPENDECTOMY

NPO until bowel function returned If appendix has ruptured, expect: Penrose drain (with profuse output for the 1st 12 hrs) Or opened incision to heal from the inside out

Post-op Nursing Interventions: APPENDECTOMY

Position: R side-lying or low Semi-Fowler’s with legs flexed (to facilitate drainage) Wound irrigation & dressing Antipyretics & antibiotics as ordered Monitor T, incision site for infection, Penrose drain output

LIVER

LIVER Largest

gl&, occupies most of the R hypochondriac region Weighs 3-4 lb (adult) Covered by fibrous capsule (capsule of Glisson)- makes the liver scarlet brown, transparent in nature

With

LIVER

R & L lobes Functional unit: liver lobules With canaliculi (receptacles of bile) produced by the hepatocytes Composed of sinusoids (“Processing Plant”) Lined with Mononuclear Phagocyte Sytem (Kuppfer Cells) which remove pathogens in the portal venous blood

Blood

LIVER

Supply Even if the liver receives 30% of CO/min., the portal system remains lowpressured

Blood

LIVER

Supply From Hepatic artery & Portal vein → Sinusoids (capillaries of the liver, carries admixture of venous & arterial blood → Provide both O2 & nutrients → Drains to Hepatic vein → IVC

LIVER Blood

Supply

LIVER

Functions  Produce BILE- to emulsify fats; gives color to urine (urobilinogen) & stool (stercobilinogen to stercobilin)

BILE Liver

LIVER

secretes 500- 1,000 ml of bile/day Composed of bilirubin, plasma electrolytes, water, bile salts, bicarbonate, cholesterol, FA & lecithin

FATE OF HEMOGLOBIN

Hemoglobin

Heme Globin Unconjugated Iron (Ferritin) acid Indirect Bilirubin (stored in liver) (Fat-soluble)

Amino pool

FATE OF HEMOGLOBIN

Unconjugated/Indirect Bilirubin (Fatsoluble) Attached to albumin Liver (with enzyme glucoronyl transferase) Conjugated/Direct Bilirubin (Watersoluble) Excreted in Bile Small Intestine Kidneys stercobilinogen to stercobilin urobilinogen

LIVER Hepatic Ducts Deliver bile to the gall bladder via cystic duct Deliver bile to the duodenum via common bile duct Common bile duct: with pancreatic duct at the ampulla of Vater Sphincter prevents reflux of intestinal contents into the common bile duct &

LIVER Functions Vitamin

ADEK synthesis Stores & filters blood (200-400 ml) Stores Vitamins A, D, B & iron Detoxifies drugs Destroys excess estrogen

LIVER

Functions Metabolize

macronutrients:  CHO  glycogenesis  glycogenolysis 

LIVER

Functions 

CHON synthesis of albumin & globulin Synthesis of prothrombin & fibrinogen Conversion of NH4 to urea

LIVER

Functions FATS

synthesis of cholesterol to neutral fats or triglycerides



LIVER DISORDER: CIRRHOSIS Chronic, progressive disease characterized by diffuse damage to cells with fibrosis & nodular regeneration Repeated destruction of hepatic cells causes formation of scar tissue

Types of Cirrhosis Postnecrotic Cirrhosis After

massive liver necrosis Cx of acute viral hepatitis or exposure to hepatotoxins Scar tissue destroys liver lobules & entire lobes

Types of Cirrhosis

Biliary Cirrhosis From

chronic biliary obstruction, bile stasis, inflammation resulting in severe obstructive jaundice

Types of Cirrhosis

Cardiac Cirrhosis Associated

with severe RSHF, resulting enlarged, edematous congested liver Anoxic liver→ cell necrosis & fibrosis

Types of Cirrhosis

Laennec’s Cirrhosis Alcohol-induced,

nutritional, portal Cellular necrosis→ scar tissue with fibrotic infiltration

LAENEC’S CIRRHOSIS

LIVER DISORDERS

Predisposing Factors Chronic alcoholism Malnutrition- primary reason for Laennec’s cirrhosis Viruses

LIVER DISORDERS Predisposing Factors Toxicity- CCl4 Hepatotoxic agents (Acetaminophen, Chlorpromazine, INH, Halothane)

LIVER DISORDERS Early

Signs & Symptoms Weakness & fatigue Anorexia, early am N/V, hematemesis, wt. loss Indigestion, Flatulence, Steatorrhea Abdominal pain/tenderness Jaundice/Icteric sclerae

LIVER DISORDERS Early

Signs & Symptoms Pruritus Palmar erythema Hepatomegaly ↓ bowel sounds Loss of axillary & pubic hair

LIVER DISORDERS Late

Signs & Symptoms

Hema

changes

Pancytopenia,

ecchymosis

Spider

petechiae,

angiomas/telangiectasi Caput medussae (abdomen) Endocrine changes Gynecomastia

Spider angioma & Caput medussae

LIVER DISORDERS Late

Signs & Symptoms GIT

changes Ascites, peripheral edema Bleeding esophageal varices

LIVER DISORDERS

Late Signs & Symptoms CNS changes: Asterixis

LIVER DISORDERS Late Signs & Symptoms Hepatic encephalopathy Asterixis (liver flap)-coarse, flapping h& tremors ↓ LOC headache, confusion, delirium Fetor hepaticus (fruity, musty breath odor of chronic liver disease)

LIVER DISORDERS Diagnostic Procedure Liver Enzymes ↑ SGPT/ALT(specific for liver disease) & SGOT (AST) ↑ Serum indirect bilirubin

LIVER DISORDERS Diagnostic Procedure ↑ Serum cholesterol & NH4  CBC- pancytopenia  Prolonged PT  Hepatic UTZ- fat necrosis of liver lobules 

LIVER DISORDERS Nursing Management

CBR, High Fowler’s position  Enteral feeding or TPN as ordered Diet: ↑Ca+2, Vit (B complex, A, C, K, folic acid & thiamine) & min, ↓ to moderate CHON & fats  Meticulous skin care 

LIVER DISORDERS

Nursing Management

Monitor neuroVS, I/O, e+ balance  Weight & abdominal girth OD  Reverse isolation  Restrict fluids & Na 

LIVER DISORDERS Nursing Management Prevent Complications ASCITES- fluid in peritoneal cavity Administer meds as ordered Loop Diuretic K+ supplements

LIVER DISORDERS

Nursing Management Prevent Complications ASCITES ↓ Na+ diet Assist in abdominal paracentesis

LIVER DISORDERS

Paracentesis: transabdominal removal of fluid from the peritoneal cavity for analysis Pre-op Informed consent Empty the bladder (to prevent puncture) Baseline wt, abdominal girth, VS Position: Upright (High Fowler’s) on the edge of the bed with back support & feet resting on a stool

LIVER DISORDERS

Paracentesis Post op Dry, sterile pressure dressing at insertion site, WOF bleeding Measure fluid collected, describe & record, label & send to lab for analysis Monitor VS, abdominal girth & wt WOF hypovolemia, e+ loss, encephalopathy, hematuria (bladder trauma)

LIVER DISORDERS

Nursing Management Prevent Complications Bleeding esophageal varices Administer meds as ordered Vitamin K Vasopressin (Pitressin) BT

LIVER DISORDERS

Nursing Management Bleeding esophageal varices NGT decompression via gastric lavage Monitor for NGT output

LIVER DISORDERS

Nursing Management Bleeding esophageal varices Assist in mechanical decompression (gastric intubation) Sengstaken Blakemore tube (Esphagogastric balloon tamponade) WOF hemorrhage Prepared at bedside: scissors

Sengstaken Blakemore tube

LIVER DISORDERS

Nursing Management

Prevent Complications Hepatic Encephalopathy: endstage hepatic failure characterized with altered LOC, neuro Sxs & neuromuscular disturbances Assist in mechanical ventilation Monitor VS, neuro VS

LIVER DISORDERS

Nursing Management Hepatic Encephalopathy Side rails up Administer meds as ordered Neomycin (Mycifradin): ↓NH4 production by N bacterial flora of the bowel Lactulose (Chronulac): promotes excretion of NH4 No sedatives, narcotics, barbiturates & hepatotoxic meds/substances

LIVER DISORDERS Nursing Management

Prevent Complications Hepatorenal syndrome: progressive renal failure associated with hepatic failure Sudden ↓ in U.O., ↑ serum BUN & Crea, ↓ urine Na excretion, ↑ urine osmolality

PANCREAS Located behind stomach As exocrine gland (80%) Secretes NaHCO3: neutralizes stomach’s contents entering the duodenum Secretes pancreatic juices: with enzymes for digesting macronutrients 

PANCREAS As

endocrine gland (20%) Islets of Langerhans- secretes insulin (hypogly) & glucagon (hypergly) Secretes Somatostatin: with hypogly effect

PANCREAS

PANCREATITIS Acute

or Chronic inflammation of pancreas leading to pancreatic edema, suppuration, necrosis & hemorrhage due to autodigestion Cause: activation of proteolytic pancreatic enzymes (Trypsin, Elastase, Lipases)

PANCREATITIS

PANCREATITIS



Predisposing Factors Alcoholism Hepatobiliary disorder (Cholelithiasis) Drugs toxic to pancreas: steroids, OCP, thiazide diuretics, Rentam (for AIDS), ASA Peptic ulcer disease

PANCREATITIS  Predisposing Factors Metabolic disorders 

hyperparathyroidism (hyperCa)  hyperlipidemia (obesity) Ischemic vascular disease

PANCREATITIS

Predisposing Factors ↑ Na+ intake Trauma Surgery Pancreatic Tumor Viral/Bacterial Infection





ACUTE PANCREATITIS

Signs & Symptoms Pain at midepigastric or LUQ radiating to the back, flank & substernal area with DOB, aggravated by eating a large fatty meal or an episode of heavy alcohol intake or lying in recumbent position Lasts for hours & days

ACUTE PANCREATITIS



Signs & Symptoms

↑ HR & T, ↓ BP to Shock  Shallow respiration  Anorexia, N/V, wt. loss  ↓ bowel sounds (paralytic ileus)  Indigestion/dyspepsia 



ACUTE PANCREATITIS

Signs & Symptoms

(+) Cullen’s signecchymosis at umbilicus  (+) Grey Turner’s signecchymosis at flank area  hypocalcemia (due to extensive lipolysis) 

Cullen’s Sign & Grey Turner’s Sign

ACUTE PANCREATITIS

Diagnostic Procedure ↑ WBC,

↑ Hct, ↑ bilirubin, ↑ alkaline phosphatase, ↑ urinary amylase, ↑ CBG ↓ serum Ca+2, Mg+2 Abdominal UTZ & CT scanenlarged pancreas Chest X-ray- pleural effusion

ACUTE PANCREATITIS

Diagnostic Procedure ↑ serum amylase (↑ 200 Somogyi units) & lipase (↑ 1.5 U/ml)

ACUTE PANCREATITIS

Nursing Management

NPO,

NGT to suction, TPN (with vit. & min.) as ordered  Cx: hyperglycemia, air embolism, infection If can eat: diet- ↑ CHO, ↑ CHON, ↓ fats

ACUTE PANCREATITIS

Nursing Management Administer meds as ordered Narcotic analgesic- Demerol (no Morphine & Codeine SO4- causes spasms of sphincter of Oddi aggravating pain) Antacids, H2 blockers: Ranitidine (to ↓ HCL production & prevent activation of pancreatic enzymes)

ACUTE PANCREATITIS Nursing Management Administer meds as ordered Anticholinergics (to ↓ vagal stimulation, ↓ GI motility, inhibit pancreatic enzyme secretion) Smooth muscle relaxant Vasodilators- NTG Calcium gluconate

ACUTE PANCREATITIS Nursing Management Assume comfortable position Knee-chest, fetal-like Stress

Management Technique: DBE, yoga

Prevent

Complications: chronic hemorrhage, septicemia



CHRONIC PANCREATITIS

Signs & Symptoms Abdominal pain & tenderness LUQ mass Steatorrhea Wt loss Muscle wasting Jaundice S/Sx of DM

CHRONIC PANCREATITIS

Nursing

Interventions Diet: limited fat & CHON, vit. & min. supplements, no heavy meals, no alcohol Administer meds as ordered Pancreatic

enzymes with meals Insulin & OHA to control DM

PANCREATITIS Health Teachings Importance

of avoiding alcohol Importance of follow-up care/visit with the MD Notify MD if acute abdominal pain, jaundice, clay-colored stools, steatorrhea or dark urine develops

GALL BLADDER

Receives

bile from the liver Stores, concentrates & releases bile to the common bile duct to the duodenum upon stimulation (presence of fatty foods)→ gall bladder contracts & sphincter of Oddi relaxes Common bile duct: joined cystic & hepatic ducts Sphincter of Oddi: guards the entrance into the duodenum

GALL BLADDER Cholecystitis-

gall bladder

inflammation Acute: caused by gallstones Chronic: r/t inefficient bile emptying & gall bladder muscle disease→ fibrotic & contracted gall bladder Acalculus: (-) gallstones, r/t bacterial invasion via the lymphatic or vascular systems Cholelithiasis- gallstones

GALL BLADDER

Predisposing Factors  High risk  Female, 40 years old, menopausal, obese



Cholelithiasis

GALL BLADDER Signs & Symptoms  Localized pain at RUQ, (+) mass  Epigastric pain radiating to scapula 2-4 hrs after taking heavy meal/fatty foods, persisting for 4-6 hrs, usually at night  Fatty intolerance, N/V, indigestion, belching, flatulence

GALL BLADDER Signs & Symptoms Guarding, rigidity & rebound tenderness Murphy’s sign: can’t take a deep breath when examiner’s finger’s are passed below the hepatic margin ↑ HR, ↑T, S/Sx of dehydration

GALL BLADDER Signs & Symptoms (Biliary Obstruction) Jaundice Dark orange & foamy urine Steatorrhea & clay-colored stools Pruritus Easy bruising

GALL BLADDER Diagnostic Procedures Cholecystography: to detect gall stones; to assess the ability of the gall bladder to fill, concentrate its contents, contract & empty Pre-op Ask for hx of allergies to iodine, seafood or dye Contrast dye may be given 10-12 hrs prior to test (evening before) NPO after giving of dye WOF anaphylactic reaction to dye

GALL BLADDER Diagnostic Procedures: Cholecystography Post-op Dysuria is common because the dye is excreted in the urine N diet is resumed: fatty meal enhances excretion of dye

GALL BLADDER Diagnostic Procedures Endoscopic retrograde cholangiopancreatography (ERCP): exam of the hepatobiliary system via endoscope inserted into the esophagus to the duodenum; multiple positions are required during the procedure to pass the endoscope

GALL BLADDER Diagnostic Procedure: ERCP Pre-op NPO X several hrs Sedation as ordered Post-op Monitor VS, return of gag reflex WOF perforation or infection

GALL BLADDER Diagnostic Procedures  Oral cholecystogram  Gall Bladder Series)- (+) gall stones  ↑ Serum alkaline phosphatase

GALL BLADDER

Nursing Management  Administer meds as ordered  Narcotic analgesic- Demerol (no Morphine & Codeine SO4)  Anticholinergics/ Antispasmodics to relax smooth muscles  Pro-Banthine  AtSO4  Anti-emetics

GALL BLADDER Nursing Management  Monitor V/S, bowel sounds  Small, frequent meals  Diet: ↑ CHO, ↑ CHON, ↓fats, no gas-forming foods  Meticulous skin care

GALL BLADDER

Non-Surgical Interventions Dissolution therapy (of cholesterol stones) Meds: Chenodeoxycholic acid (Chenodiol) or Ursodiol (Actigall) po Direct contact with repeated injections & aspirations of a dissolution agent via percutaneous cath

GALL BLADDER

Surgical Interventions under Exploration Laparoscopy/Peritoneoscopy: direct visualization of organs & structures within the abdomen using fiberscope; bx can be obtained Cholecystectomy: gall bladder removal Choledochotomy: common bile duct incision to remove stone

GALL BLADDER

Nursing Interventions: s/p Gall Bladder Surgery Coughing (splint the abdomen) & DBE, early ambulation NPO & NGT to suction, then progressive diet as ordered Administer meds as ordered Antiemetics Antipyretics Antibiotics

GALL BLADDER

Nursing Interventions: s/p Gall Bladder Surgery Monitor drainage from the T-tube Purpose: preserves the patency of the common bile duct & ensures bile drainage until edema resolves & bile is effectively draining into the duodenum

GALL BLADDER Nursing Interventions: s/p Gall Bladder Surgery Semi-Fowler’s position, drain system by gravity Avoid irrigation, aspiration or clamping the T-tube without MD’s orders

GALL BLADDER

Nursing Interventions: s/p Gall Bladder Surgery As ordered, clamp the T-tube before meals, WOF abdominal pain/distention, N/V, ↑T (if noted, unclamp the T-tube & notify MD) Monitor amount, color, consistency & odor of drainage Refer sudden ↑ in bile output Prevent skin irritation

ESOPHAGUS

Collapsible

muscular tube about 10 inches long Carries food from pharynx to the stomach

Gastroesophageal Reflux Disease (GERD)

or

Chalasia Backflow of gastric & duodenal contents into the esophagus

GERD

GERD Causes Incompetent

lower esophageal sphincter (LES) Pyloric stenosis Motility disorder Prolonged gastric intubation Ingestion of corrosive chemicals

GERD Causes Uremia Infections Mucosal

alterations Systemic disease (SLE)

Signs

GERD

& Symptoms (mimic those

of MI) Substernal pain (due to frequent regurgitation through gastroesophageal junction), aggravated by postural changes especially when in supine Dyspepsia Dysphagia Hypersalivation

GERD

Complications Pulmonary

aspiration

Esophagitis Esophageal

CA

ESOPHAGITIS Inflammation

of esophageal mucosa, most often results from GERD due to prolonged vomiting or an incompetent LES

ESOPHAGITIS 

Signs & Symptoms

precipitated

by ingestion of fatty foods & alcohol Heart burn Retrosternal discomfort Regurgitation of sour, bitter material

ESOPHAGITIS 

Signs & Symptoms

Dysphagia

for both solids & liquids (r/t permanent strictures) Bleeding→ IDA Nocturnal reflux (in upright or supine position or both)

GERD & ESOPHAGITIS Diagnostic Procedures pH in esophagus- 0.8- 2 Esophageal biopsy- (+) inflammatory changes



GERD & ESOPHAGITIS  Diagnostic

Procedure: GASTRIC

ANALYSIS Esophageal reflux of gastric acid may be done by ambulatory pH monitoring; a probe is placed just above the LES & connected to an external recording device; provides a computer analysis & graphic display of results

GERD & ESOPHAGITIS  Diagnostic

Procedure: GASTRIC

ANALYSIS Pre-op: NPO X 8-12 hrs, no tobacco & chewing gum X 6 hrs, hold meds that can stimulate gastric secretions X 1-2 days Post-op: Resume N activities, place gastric samples in ref if not tested within 4 hrs

GERD & ESOPHAGITIS



Diagnostic Procedures Upper GI study/series (Barium swallow): done under fluoroscopy after the pt drinks Barium SO4 Pre-op: NPO after 12 MN Post-op: Laxative as ordered, Force fluids, WOF passage of chalk-white stools (Barium can cause GI obstruction)

GERD & ESOPHAGITIS

Diagnostic Procedures Barium swallow- poorly distensible, shortened, stricture & or ulcerated esophagus Gastroesophageal scintiscan (X-ray to document amount of reflux)



GERD & ESOPHAGITIS

Nursing

Interventions Position: ↑ head of bed on 6 to 8-inch blocks Diet: ↓fat, ↑fiber Avoid caffeine, tobacco, carbonated drinks, eating & drinking 2hrs before HS No tight clothes

GERD & ESOPHAGITIS

Nursing

Interventions Administer as ordered Antacids,

H2 blockers, proton-pump inhibitors Prokinetic meds (to ↑ gastric emptying) No anticholinergic meds! (↓ gastric emptying)

MEDICAL MANAGEMENT 

Cholinergic Meds  Bethanecol – to ↑ esophageal tone & peristaltic activity  Metochlopramide (Reglan/Plasil)- to ↓ esophageal pressure by relaxing pyloric & duodenal segments, ↑ peristalsis without stimulating secretions

MEDICAL MANAGEMENT 

Cholinergic Meds  H2 blockers- to ↓ gastric acidity & pepsin secretion  Proton-pump inhibitors- ↓ gastric acidity  Antacids (Maalox)- to neutralize gastric acid between feedings

SURGICAL MANAGEMENT Nissen Fundoplication (under EL)  Creation of valve mechanism by wrapping the greater curvature of stomach (gastric fundus) around the LES  To create pressure & prevent backflow to esophagus



NISSEN FUNDOPLICATION

HIATAL HERNIA  or

Esophageal or Diaphragmatic Hernia  A portion of the stomach herniates through the weak muscles of the diaphragm & into the thorax

HIATAL HERNIA

HIATAL HERNIA





Aggravated by factors ↑ intraabdominal pressure: pregnancy, ascites, obesity, tumors, heavy lifting Cx: ulceration, hemorrhage, regurgitation, aspiration, strangulation, incarceration of the stomach in the chest with necrosis, peritonitis & mediastinitis

HIATAL HERNIA  Signs

& Symptoms

 Heartburn  Regurgitation

or vomiting

 Dysphagia  Feeling

of fullness

HIATAL HERNIA  Nursing, Medical & Surgical Interventions  Same as in GERD  Small frequent meals, minimal amount of fluids  Avoid reclining for 1 hr after eating

STOMACH

J - shape  Widest section of alimentary canal  With valves  Cardiac sphincter - between esophagus & stomach  Pyloric sphincter- between stomach & duodenum, olive-shape 

STOMACH 

Parts  Cardia  Fundus  Body  Antrum  Pylorus

STOMACH

STOMACH

Mucous

Glands Prevent autodigestion by providing alkaline protective covering

STOMACH

Cells  Chief/zymogenic cells  Gastric amylase digests CHO  Gastric lipase - digests fats  Pepsin - digests CHON  Rennin - digests milk products



STOMACH Parietal/Oxyntic cells  Produces Intrinsic Factor (glycoprotein) for reabsorption of Vit B12 for RBC maturation  Secretes HCl- aids in digestion



STOMACH

Endocrine cells (Gcells)  Stimulates gastrin (controls gastric acidity)



STOMACH

Functions  Mechanical & chemical digestion  Storage of food CHO & CHON: 2-3 hrs Fats: 3-4 hrs



GASTRITIS Inflammation

of the the stomach or gastric mucosa Causes of Acute Gastritis Ingestion of food with bacteria, fungi, virus Highly-seasoned/irritating food Overuse of NSAIDs Alcoholism Bile reflux Radiation therapy

GASTRITIS Signs & Symptoms: Acute Gastritis A/N/V Abdominal discomfort Headache Hiccuping

GASTRITIS Causes

of Chronic Gastritis Benign or malignant ulcers H. pylori bacteria Autoimmune diseases Diet, Meds Smoking & alcoholism Reflux

GASTRITIS Signs & Symptoms: Chronic Gastritis A/N/V Belching Heartburn after eating Sour taste in the mouth Vit. B12 deficiency

GASTRITIS  Nursing

Interventions NPO until Sx subside, then progressive diet WOF hemorrhagic gastritis & notify MD: hematemesis, ↑HR, ↓BP Avoid irritating/spicy/highly seasoned foods, caffeine, alcohol & nicotine Administer as ordered Antibiotics Bismuth salts (Pepto-Bismol) Vit B12 injections

PEPTIC ULCER Erosion/excoriation of mucosal & submucosal lining (extending to muscle) due to  Hypersecretion of acid pepsin  ↓ resistance of mucosal barrier to hyperacidity



PEPTIC ULCER

PEPTIC ULCER  Incidence Rate  M- 2-3 X higher risk  Low income, laborer  Predisposing Factors  Hereditary  Hx of gastritis  Emotional stress

PEPTIC ULCER

Predisposing Factors  Smoking  Alcoholism  Caffeine  Irregular Diet  Rapid Eating



PEPTIC ULCER

Predisposing Factors  Ulcerogenic drugs  ASA  Ibuprofen  Indomethacin  Phenylbutazones  Steroids



PEPTIC ULCER 

Predisposing Factors  Gastrin-producing tumors Zollinger-Ellison syndrome  Microbial invasion  Helicobacter pylori

PEPTIC ULCER Types

depending on: Severity Acute- affects submucosal & mucosal linings Chronic- affects deeper tissues → heals → scars

PEPTIC ULCER Types depending on: Location Stress ulcer Esophageal Gastric ulcer Duodenal ulcer- 90-95% less Bicarbonate

PEPTIC ULCER

Stress

Ulcer common among critically-ill pt

PEPTIC ULCER Stress Ulcer Curling’s Ulcer- due to trauma & major burns → hypovolemia → GIT ischemia → ↓ resistance of mucosal barrier to HCl acid secretion → ulceration

PEPTIC ULCER Stress

Ulcer Cushing’s Ulcer- due to head trauma/injury (e.g. CVA) → Vagal stimulation → hyperacidity → ulceration

PEPTIC ULCER GASTRIC VS. ULCER Antrum 30 mins- 1 or 2 hrs p.c. Epigastric pain (L midepigastric pain)

DUODENAL ULCER Duodenal bulb 2-3 or 4 hrs p.c. Mid-epigastric pain

PEPTIC ULCER GASTRIC VS. ULCER Gaseous pain & burning Not relieved by food/antacid N gastric acid secretion

DUODENAL ULCER Cramping & burning Relieved by food/antacid ↑ Gastric acid secretion

PEPTIC ULCER GASTRIC VS. DUODENAL ULCER ULCER Hematemesis Melena Weight loss Weight gain Stomach CA, Perforation, gastric pyloric obstruction, outlet obstruction, hemorrhage, perforation intractable disease 60 y/o & ↑

20 y/o & ↑

PEPTIC ULCER Diagnostic

Procedures Upper GI Fiberoscopy (Esophagogastroduodenoscopy ) After sedation, an endoscope is passed down the esophagus to view the gastric wall, sphincters & duodenum; tissue specimens can be obtained

Upper GI Fiberoscopy

PEPTIC ULCER  Diagnostic

Procedures: Esophagogastroduodenoscopy Pre-op NPO X 6-12 hrs Local anesthetic (spray or gargle) along with Midazolam IV (conscious sedation) AtSO4 IV (↓ secretions), Glucagon (to relax smooth muscles) Position: L-side lying (to drain secretions & easy access of endoscope) Prepare emergency equipment at bedside

PEPTIC ULCER  Diagnostic

Procedures: Esophagogastroduodenoscopy Post-op CBR until pt is alert NPO X 1-2 hrs (until gag reflex returns) Lozenges, saline gargles or oral analgesics can relive minor sore throat WOF perforation (pain, bleeding, dysphagia, ↑T)

PEPTIC ULCER Diagnostic Endoscopic

Procedures

exam- extent & depth of ulceration Stool- (+) occult blood Upper GI series (Barium swallow)- (+) ulceration

PEPTIC ULCER Diagnostic

Procedure: GASTRIC ANALYSIS (pH, apperance, vol.): after NGT insertion, the entire gastric contents are aspirated, specimens are collected q 15 mins X 1hr Histamine or Pentagastrin SQ (to stimulate gastric secretions, may produce a flushed feeling Pre & Post-op Care: See GERD

PEPTIC ULCER Nursing

Management Avoid smoking, NSAIDs Diet: bland, no caffeine & chocolate, no milk & its products, give crackers Adequate rest, reduce stress

PEPTIC ULCER Administer meds as ordered Antacids Maalox- combined with ↓ S/E than 2 antacids separately MAD- Mg containing antacid, S/E- diarrhea AAC- Al containing

PEPTIC ULCER Nursing

Management

Administer

meds as ordered H2 blockers Ranitidine (Zantac) Cimetidine (Tagamet) Famotidine (Pepsin)

PEPTIC ULCER Nursing

Management

Administer

meds as ordered Mucosal barrier protectants: creates a paste-like substance that coats the gastric mucosa Taken 1 hr a.c. Sucralfate Cytotec

PEPTIC ULCER Nursing Management Administer

meds as ordered Anticholinergics, Antispasmodics AtSO4, Buscopan Sedatives/Tranquilizer (Valium)

PEPTIC ULCER Nursing Assist

Management

in surgical procedures Vagotomy- prior to gastric surgery to ↓ hemorrhage Pyloroplasty: to ↓ obstruction, to ↑ gastric emptying

PEPTIC ULCER Nursing SUBTOTAL

Management

GASTRECTOMY Bilroth I (Gastroduodenostomy) Removal of 1/3 to ½ uppermost stomach & anastomosis of the gastric stump to the duodenum

PEPTIC ULCER Nursing SUBTOTAL

Management

GASTRECTOMY Bilroth II (Gastrojejunostomy) Removal of 2/3 of stomach duodenal walls & anastomosis of the gastric stump to the jejunum

SUBTOTAL GASTRECTOMY

PEPTIC ULCER Nursing

Management GASTRIC RESECTION or Antrectomy: removal of lower half of stomach TOTAL GASTRECTOMY Removal of the stomach & attachment of esophagus to the jejunum or duodenum (Esophagojejunostomy)

PEPTIC ULCER Nursing

Management Post-

op Monitor VS, I/O, bowel sound Fowler’s position NPO for 1-3 days, NGT to suction (don’t irrigate/remove NGT)

PEPTIC ULCER Nursing

Management Post-op Monitor NGT output Immediately post-op- bright red 12-16 hrs post-op- greenish > 24 hrs- tea-colored, dark red Progressive diet to 6 small, bland meals/day

PEPTIC ULCER Nursing

Post-op

Administer IVF

Management as ordered

& e+ Antibiotics Analgesics Anti-emetics

PEPTIC ULCER Nursing

Management Post-op Prevent Complications Bleeding → Hemorrhage → Shock Paralytic ileus Peritonitis

PEPTIC ULCER Nursing Management Post-op Prevent Complications Pernicious anemia Thrombophlebitis HypoK, Hypogly Dumping Syndome

DUMPING SYNDROME Rapid

emptying of hypertrophic food solution (chyme) from stomach to jejunum → hypovolemia

DUMPING SYNDROME Signs

& Symptoms (occur 30 mins p.c.) N/V

Abdominal

fullness, cramping Diaphoresis Palpitation, ↑ HR Weakness, dizziness Diarrhea Borborygmi

DUMPING SYNDROME Nursing Management

↓ CHO, ↑ fat, ↑ CHON Small, frequent meals (divided into 6 equal parts/day), no fluids with meals Avoid sugar, salt, chilled solution Pt lie flat for 30 mins p.c. Antispasmodics as ordered to ↓ gastric emptying Diet:

SMALL INTESTINE

SMALL INTESTINE

Divided

into: Duodenum (with openings of the bile & pancreatic ducts) Jejunum (8 ft long) Ileum (12 ft long) Terminates into the cecum Functions: digestion & absorption of ingested nutrients & water Alterations: Malabsorption Maldigestion

SMALL INTESTINE Pancreatic

intestinal juice enzymes Amylase: starch → maltose Maltase: maltose → glucose Lactase: lactose → galactose → glucose Sucrase: sucrose → fructose → glucose Nucleoses: nucleic acids → nucleotides Enterokinase: activates trypsinogen → trypsin

SMALL INTESTINE Disorders Vomiting,

diarrhea Gastroenteritis Malabsorption syndrome Cystic

Fibrosis (CF) Celiac Disease (Non-tropical sprue/Gluten Enteropathy) Tropical sprue Regional enteritis (Chron’s

CYSTIC FIBROSIS (CF) Or Mucoviscidosis or Fibrocystic disease of the Pancreas  Multisystem disorder  Incidence: most fatal genetic disease in Caucasians & Europeans 

CYSTIC FIBROSIS (CF) 

Genetic characteristics  Transmitted by autosomal recessive inheritance  Mutation on gene on Chromosome 7q31  Deletion of an AA resulting CF transmembrane conductance regulator (CFTR)

CYSTIC FIBROSIS (CF)

CYSTIC FIBROSIS (CF) 

Pathophysiology  CFTR: N located on cells of exocrine gl&s (lungs, liver, pancreas, intestines, sweat gl&s, RT) regulating electrolytes & water channels  In CF: inadequate sythesis of CFTR→ pores are lacking for release of electrolytes at cell surfaces→ affects Cltransport (↑ NaCl in sweat)

CYSTIC FIBROSIS (CF)

Pathophysiology  On stimulation: exocrine ducts release thick, viscous secreations causing plug → anatomical & physiologic changes



CYSTIC FIBROSIS (CF)

Characteristics  Pancreatic enzyme deficiency→ fat & Vit ADEK malabsorption



CYSTIC FIBROSIS (CF) Characteristics  Large volume of thick, viscous bronchial secretions → chronic pulmonary disease  ↑ NaCl in sweat



CYSTIC FIBROSIS (CF)

Signs & Symptoms  dry, repetitive cough followed by vomiting; thick, sticky sputum



CYSTIC FIBROSIS (CF)  Diagnostic Tests  Pilocarpine iontophoresis sweat test: simplest, most reliable method  N: <60mEq/L sweat Cl CXR: ↑ diameter of upper chest, overaerated lungs, fibrotic changes

CYSTIC FIBROSIS (CF)

Diagnostic Tests  Pancreatic deficiency: (-) trypsin  Fecal fat test: steatorrhea (+) 15-30 g fat/day



 N:

4 g fat/day

CYSTIC FIBROSIS (CF)  Management  Gene therapy  Respiratory:  Tobramycin

IV & aerosol: prevent P. aeruginosa  Coenzyme Q10,N-Acetylcystein: ↓mucus viscosity

CYSTIC FIBROSIS (CF)

Management: GI  Vit ADEK supplement  Ursodeoxycholic acid (UDCA): ↓bile viscosity



 Correct

steatorrhea

 Pancreatic

enzyme replacement therapy  Lecithin, Taurine, MCT

CHRON’S DISEASE Or Regional Enteritis Idiopathic, chronic, relapsing granulomatous inflammatory disease of the intestinal tract, affecting the terminal ileum or colon With periods of remissions & exacerbations

CHRON’S DISEASE

Predisposing

Factors  M=F, depressed & dependent  higher in members of Jewish race  familial

CHRON’S DISEASE

Predisposing

Factors onset- 15-20 y/o; peak- 55 & 60 y/o  common in US, Britain, Scandinavia

CHRON’S DISEASE

Causes

Infectious

(viruses, Pseudomonas spp., atypical mycobacteria) Immunologic

CHRON’S DISEASE

Causes

Psychosomatic Dietary

Hormonal Unknown

CHRON’S DISEASE Pathogenesis Lesions

in lymph nodes next to SI Obstruction of lymphatic drainage Lymphoid tissue hyperplasia & lymphedema Bowel thickening Bowel lumen narrowing Inflamed & ulcerated mucosa with grayish- white abscesses → fistula formation

CHRON’S DISEASE Complications intestinal

stenosis/stricture due to abscesses → obstruction Fistula development→ rupture → peritonitis

CHRON’S DISEASE Signs & Symptoms Cramplike & Colicky pain in RLQ p.c. Mild, intermittent diarrhea with mucus & pus (2-5 stools/day)- dominant feature Steatorrhea (+) occult blood in stool

CHRON’S DISEASE Signs

& Symptoms A/N/V, wt. loss, fever, anemia, malaise Dehydration & e+ imbalance, Malnutrition

CHRON’S DISEASE Diagnostic Procedures CBC- ↓ RBC, ↑ WBC Deranged Serum electrolytes ileum biopsy- (+) inflammatory changes Barium swallow- (+) String Sign Endoscopic exam- (+) skip lesions



CHRON’S DISEASE Nursing,

Medical Interventions Same as in ulcerative colitis Surgery is avoided as much as possible because recurrence of the disease process in the same region is likely to occur

LARGE INTESTINE About 5 ft long Absorbs water (1,800 to 3,000 ml) with few electrolytes, provides for the final water balance in the GIS Eliminates wastes Bacterial flora synthesize some B Vitamins & Vit. K

LARGE INTESTINE From cecum, colon (subdivided into ascending, transverse & descending), sigmoid, rectum & anus Ileoceccal valve: prevents backflow of LI contents to the ileum Anal sphincters: guard the anal canal

ULCERATIVE COLITIS Chronic

inflammatory disease of the mucous membranes of the colon Commonly begins in the rectum & spreads upward toward the cecum Bowel fills with bloody, mucoid secretion that produces a characteristic cramping pain, rectal urgency & diarrhea With

periods of remissions & exacerbations

ULCERATIVE COLITIS

ULCERATIVE COLITIS Predisposing Unknown

Factors

cause Genetic basis suggested Associated with viruses other microorganisms & autoimmunity Peak occurrence: 15-35 y/o Common among Whites than in other races

ULCERATIVE COLITIS Pathogenesis ACUTE PHASE edematous colon develop bleeding lesions & ulcers→ perforation CHRONIC PHASE ulcerations become scars→ ↓ elasticity→ malabsorption, bowel thickening, shortening & narrowing

ULCERATIVE COLITIS

Signs

& Symptoms Abdominal tenderness & cramping Severe bloody diarrhea with mucus Vit. K deficiency A/,

wt. loss, fever, anemia, malaise Dehydration & e+ imbalance, malnutrition

ULCERATIVE COLITIS Diagnostic

Procedures  CBC- ↓ RBC, ↑ WBC  ↓ Serum albumin  Deranged serum electrolytes ↑ serum alkaline phosphatase

ULCERATIVE COLITIS Diagnostic

Procedures Lower GI study/series (Barium enema)fluoroscopic & radiographic exam of LI after rectal instillation of Barium SO4, may be done with or without air Pre-op: ↓fiber diet X 1-2days, CL diet or laxative at pm, NPO after 12MN, cleansing enemas in am Post-op: Laxative as ordered, Force fluids, WOF passage of chalk-white stools (Barium can cause GI obstruction), Notify MD if no bowel mov’t within 2 days

ULCERATIVE COLITIS Diagnostic

Procedures Barium

enemasigmoidoscopic appearance of the mucosa  Colon Biopsy & culture to r/o carcinoma & bacterial diarrhea

ULCERATIVE COLITIS

Complications Intestinal

obstruction Dehydration Fluid & electrolyte imbalances Malabsorption Chronic IDA

ULCERATIVE COLITIS

Nursing

Interventions

CBR NPO,

IVF or TPN as ordered to progressive diet (CL to ↓fiber, ↑CHON, vit. & min.) Avoid gas-forming foods, milk products, wheat grains, nuts, raw fruits, vegetable, pepper, alcohol & caffeine

ULCERATIVE COLITIS Nursing Interventions Avoid smoking Monitor stool color, consistency, presence of blood WOF perforation, peritonitis & hemorrhage

ULCERATIVE COLITIS Nursing

Interventions

Administer

as ordered

Bulk-forming

agents: bran, psyllium, methylcellulose Antibiotics Corticosteroids Immunosuppressants

ULCERATIVE COLITIS Surgical

Interventions

Total

proctocolectomy with permanent ileostomy Curative,

removal of entire colon, rectum & anus with anal closure Terminal ileum at RLQ: with stoma

ULCERATIVE COLITIS Surgical Interventions Kock

(continent) ileostomy

Intraabdominal

pouch that stores feces constructed from the terminal ileum The pouch is connected to the stoma with nipplelike valve; the stoma is flush with the skin Cath. is used to empty the pouch, & a small dressing or adhesive bandage is worn over the stoma between

KOCK’S ILEOSTOMY

ULCERATIVE COLITIS

Surgical

Interventions Ileoanal reservoir A 2-stage procedure Involves excision of rectal mucosa, an abdominal colectomy, construction of a reservoir to the anal canal & temporary loop ileostomy The ileostomy is closed in 3-4 mos. after the capacity of the reservoir is increased

ILEOANAL RESERVOIR

ULCERATIVE COLITIS Surgical

Interventions Ileoanal anastomosis (Ileorectostomy) Does not require ileostomy Requires a large, compliant rectum A 12- to 15-cm rectal stump is left after the colon is removed, the SI is inserted into this rectal

COLO/ILEOSTOMY PRE-OP CARE Consult

with enterostomal therapist to identify optimal placement of ostomy Low-residue diet for 1-2 days pre-op Give intestinal antiseptics & antibiotics, laxatives & enemas as ordered

ILEOSTOMY POST-OP CARE Post-op

drainage: dark green to yellow (as the pt begins to eat) Expect liquid stool WOF dehydration & e+ imbalance Avoid suppositories through ileostomy

COLOSTOMY POST-OP CARE Apply

petroleum jelly over the stoma to keep it moist followed by dry sterile gauze if pouch system is not yet in place Monitor the stoma for size, unusual bleeding or necrotic tissue Monitor the stoma for color N: pink or red indicating ↓vascularity Pale: anemia, Violet/Blue/Black: compromised circulation

COLOSTOMY POST-OP CARE Check

pouch system for proper fit & leakage Ascending colon colostomy: expect liquid stool Transverse colon colostomy: expect loose to semiformed stool Descending colon: expect close to N stool Empty pouch when 1/3 full, remove feces from the skin Avoid gas/odor-forming foods

COLOSTOMY POST-OP CARE WOF

perineal wound infection (if present) Administer as ordered Analgesics & antibiotics Stoma irrigation

COLOSTOMY

COLOSTOMY APPLIANCE

COLOSTOMY IRRIGATION Enema

given through the stoma to stimulate bowel emptying Done at the same time each day, 1 hr p.c. by instilling 500-1000ml of lukewarm tap water through the stoma, allowing the water & stool to drain into a collection bag

COLOSTOMY IRRIGATION If

ambulatory: allow the pt sit on a toilet If bedridden: pt on side-lying position Hang the irrigation bag with its bottom at the level of the pt’s shoulder or higher Insert irrigation tube carefully Begin the flow of irrigation If cramping occurs, clamp the tubing; release it as cramping subsides Avoid frequent irrigations with water→ fluid & e+ imbalance

COLOSTOMY IRRIGATION

COLOSTOMY IRRIGATION

DIVERTICULOSIS & DIVERTICULITIS

DIVERTICULOSIS:

outpouching of herniation of the intestinal mucosa, can occur in any part of the intestine (most common in the sigmoid colon) DIVERTICULITIS- inflammation of one of the diverticula when these perforates→ peritonitis

DIVERTICULOSIS/DIVERTICULITIS

Signs

DIVERTICULOSIS & DIVERTICULITIS & Symptoms

LLQ

pain esp. when coughing, straining or lifting N/V, flatulence, ↑T Abdominal distention, cramps & tenderness Palpable, tender rectal mass Blood in stools

DIVERTICULOSIS & DIVERTICULITIS

Nursing

CBR

NPO

Interventions

then progressive diet as ordered Diet: If inflammation resolves- Soft, ↑fiber foods (whole grains), Force fluids If with inflammation: Avoid ↑fiber foods (can irritate the mucosa further

DIVERTICULOSIS & DIVERTICULITIS

Nursing

Interventions

Avoid

gas forming-foods, indigestible roughage, seeds or nuts (can be trapped in the diverticula & cause inflammation) Avoid any form of Valsalva maneuver WOF perforation, hemorrhage, fistulas & abscesses

DIVERTICULOSIS & DIVERTICULITIS Nursing Interventions Administer as ordered Antibiotics Analgesics Anticholinergics Small

amount of bran OD Bulk-forming laxatives

DIVERTICULOSIS & DIVERTICULITIS

Surgical

Interventions Colon resection with primary anastomosis Temporary or permanent colostomy (for ↑ bowel inflammation)

HEMORRHOIDS

Dilated

varicose veins of the anal canal, caused by portal HTN, straining, irritation, ↑venous or ↑abdominal pressure Internal: above the anal sphincter (can’t be seen on inspection of the perianal area) External: below the anal sphincter Prolapsed: can become thrombosed or inflammed

HEMORRHOIDS Signs & Symptoms Bright

red bleeding with defecation Rectal pain & itching

HEMORRHOIDS Nursing

Interventions Cold packs followed by Sitz bath as ordered Apply witch hazel soaks & topical anesthetics as ordered Stool softeners as ordered ↑fiber-diet, force fluids

HEMORRHOIDS Endoscopic procedures Sclerotherapy Endoscopic

ligation Surgical interventions Cryosurgery Hemorrhoidectomy

HEMORRHOIDS Post-op

Nursing Interventions Position: prone or side-lying Ice packs over dressing as ordered ↑fiber-diet, force fluids Stool softeners as ordered Limit sitting to short periods of time Sitz bath 3-4X/day as ordered WOF urinary retention

CGFNS/NCLEX Question

When

assessing a pt who underwent colostomy several months ago, a nurse would expect the stoma to appear

CGFNS/NCLEX Question

A. dry B. red C. edematous D. retracted

CGFNS/NCLEX Question Which

of the following statements would a nurse include in the pre-operative instructions for a pt who is scheduled for an ileostomy?

CGFNS/NCLEX Question A. “Your urine will be collected in a pouch subsequent to surgery.” B. “Your bowel will be visualized with a laparoscope during surgery.” C. “You will have a NGT in your nose after surgery.” D. “You can drink liquids within 24 hours following surgery.”

CGFNS/NCLEX Question Which

of the following assessment techniques should a nurse use to determine the appropriate placement of NGT?

CGFNS/NCLEX Question A. Aspirating drainage through the NGT B. Auscultating for bowel sounds C. Palpating over the epigastric region D. Inserting the open end of the NGT into water

CGFNS/NCLEX Question

A

RN would instruct a pt who had an ileostomy to avoid which of the following food?

CGFNS/NCLEX Question

A. potatoes B. beef C. popcorn D. yogurt

CGFNS/NCLEX Question

Which

of the following serum lab results would a nurse expect to identify in a pt who has pancreatitis?

CGFNS/NCLEX Question

A. ↓ cholesterol B. ↓ glucose C. ↑ amylase D. ↑ creatinine

CGFNS/NCLEX Question Which of the following questions would be most important for a nurse to ask when gathering data from a pt who is suspected of having acute pancreatitis?

CGFNS/NCLEX Question A. “Have you had a recent blood work-up?” B. “Do you have a hx of diabetes?” C. “When was your last bowel movement.” D. “How much alcohol do you drink in a week?”

CGFNS/NCLEX Question The nurse is caring for a pt with a dx of pancreatitis. All of the following meds are ordered for the pt. Which one should the nurse question?

CGFNS/NCLEX Question A. Meperidine HCl (Demerol) B. Morphine SO4 C. Propantheline Br (Pro-Banthine) D. Cimetidine (Tagamet)

CGFNS/NCLEX Question

The

nurse should teach a pt who has acute pancreatitis to avoid which of the following foods?

CGFNS/NCLEX Question A. Pasta & tomato juice B. Rice & green beans C. Steak & baked potato D. Bread & baked apple

CGFNS/NCLEX Question Which of the following factors, if noted in a pt’s hx, would indicate a predisposition for developing cholecystitis?

CGFNS/NCLEX Question

A. obesity B. hypertension C. depression D. childlessness

CGFNS/NCLEX Question A 10-y/o boy is admitted to the hospital with a hx of fever & RLQ abdominal pain. Which of the following comfort measures would be taken until a dx is made?

CGFNS/NCLEX Question A. maintain the child in recumbent position B. apply warm compress to the affected area C. obtain an order for an age appropriate analgesic D. distract the child with an age appropriate video

CGFNS/NCLEX Question When

a 12-year old child has a dx of appendicitis, which of the following manifestations would be most important for the RN to follow-up?

CGFNS/NCLEX Question A. tympanic temp of 101.2 F (38.4 C) B. absence of stool for 24 hrs C. nausea when exposed to food odors D. cessation of abdominal pain

CGFNS/NCLEX Question Which

of the following statements, if made by a pt who has gastroesophageal reflux disease (GERD), would support a nursing dx of Knowledge Deficit?

CGFNS/NCLEX Question A. “I will lie down for 30 minutes after meals.” B. “I will restrict spicy foods in my diet.” C. “I should sleep with the head of the bed elevated.” D. “I should decrease my intake of caffeine.”

CGFNS/NCLEX Question Which

of the following findings in a pt who has Chron’s disease would indicate that corticosteroid therapy has been effective?

CGFNS/NCLEX Question

A. expansion of muscle mass B. increase in the bulk of stool C. moon-like appearance of the face D. decreased complaints of abdominal pain

CGFNS/NCLEX Question Which

of the following explanations should a nurse give to a pt regarding the primary cause of peptic ulcer disease?

CGFNS/NCLEX Question A. “A spicy diet contributes to ulcer development.” B. “Seasonal changes are associated with ulcer disease.” C. “Executive job positions predispose people to ulcer formation.” D. “Infection with Helicobacter pylori causes ulcers.”

CGFNS/NCLEX Question The

nurse should monitor a pt who is receiving lactulose (Cephulac) for which of the following adverse side effects?

CGFNS/NCLEX Question

A. Diarrhea B. Petechiae C. Polyuria D. Flushing

CGFNS/NCLEX Question A

nurse should expect a Sengstaken Blakemore tube to be ordered for a pt who has bleeding esophageal varices in order to

CGFNS/NCLEX Question

A. cause vasoconstriction to the splenic artery B. ensure airway patency C. provide for enteral nutrition D. apply direct pressure to the area

CGFNS/NCLEX Question Which

of the following nursing measures would be most appropriate for a pt who has ascites?

CGFNS/NCLEX Question A. withholding fluids B. measuring abdominal girth C. encouraging ambulation D. monitoring for pedal edema