If your patient has hematemesis, what type of ulcer are they likely to have? If your patients pain occurs within one
hour of their meal, why type of ulcer is likely?
Hematemesis (bright red, brown, or black vomitus) and is most common in peptic ulcer disease (duodenal?).
Gastric ulcer pain occur 1 to 2 hours after meal; duodenal ulcers occur 2 to 4 hours after meal (944)
1. What complications are associated with peptic ulcers? What symptoms are associated with the complications?
Hemorrhage most common of PUD, Duodenal ulcers accounts for a greater percentage of upper GI bleeding than
gastric ulcers
Perforation Most lethal complication PUD, duodenal are more prevalent and perforate more often. Perforated
ulcer penetrates serosal surface with spillage of either gastric or duodenal contents into peritoneal cavity. Patient
experiences sudden, severe upper abdominal pain that spread throughout abdomen. Abdomen appears rigid and
boardlike to protect from further injury. RR shallow and rapid. HR tachy, pulse weak, bowel sounds absent.
Gastric outlet obstruction only occur with gastric ulcers, obstruction in distal stomach and duodenum is result of
edema, inflammation, or pylorospasm and fibrous scar tissue formation. PTs reports discomfort or pain worse toward
end of day as stomach fills and dilates, relief by belching or self-induced vomiting. Vomit often projectile, contain
food particles. Constipation occurs because of dehydration and diet intake secondary to anorexia. (945)
2. What are the nursing responsibilities associated with a/an EGD, ERCP or Colonoscopy?
Sign consent, preprep education, IV fluid, assess and monitor, discharged educaiton
3.
What color stools will a patient have if they are bleeding from an UGI site? If they are bleeding from a lower GI
site?
UGI Melena (black, tarry stools) indicates slow bleeding from an upper GI, the longer the passage of blood through
the intestines, the darker the stool color because of the breakdown of hemoglobin and release of iron (954)
LGI bright red, and maroon color
4.
What is the action of antacids? What are the nursing considerations associated with administering antacids? Which
antacids are associated with constipation? With diarrhea? (934)
Antacids use as adjunct therapy for PUD, gastric pH by neutralized the HCl acid and acid content of chyme
reaching duodenum. (e.g., aluminum hydroxide bind to bile salt that damaging affects on the mucosa).
Assess, location, duration, precipitating factors of gastric pain. Lab: monitor serum phosphate and calcium level,
may cause serum gastrin and serum phosphate , monitor pH of gastric secretion
5.
What is the action of Histamine-2 receptor antagonists? What are the two GI related side effects associated with this
class of drugs? What are two non-GI related side-effects? What are the nursing considerations associated with
administering H2- receptor antagonists?
Histamine (H2)-receptor antagonists Blocks action of histamine on H2-receptors to HCl acid secretion,
conversion of pepsinogen to pepsin, irritation of esophageal and gastric mucosa
Constipation, diarrhea
Headache, confusion, arrhythmias
Assess, epigastria/abdominal pain, occult blood in stool, Assess geriatric for confusion. Lab test: CBC, may serum
transaminases and creatinine
6.
HCl acid secretion by inhibiting proton pump (H+, K+, ATPase) responsible for secretion of H+, irritation of
esophageal and gastric mucosa. More effective than H2-receptor blockers in reducing gastric acid secretion and
promoting ulcer healing. Also used in combination with antibiotics to treat ulcers caused by H. pylori. Long term use
has been associated with bone density, chronic hypochlorhydria, risk of C. difficile, pneumonia
7.
8. If a patient is receiving antacids, H2-receptor antagonists, and sucralfate; when should they take each of the drugs?
9.
In the stomach the bacteria can survive a long time by colonizing gastric epithelial cells w/in mucosal layer. Bacteria
produce urease, which metabolizes urea-producing ammonium chloride and other damaging chemicals. Urease
activates immune response with both antibody production and release of inflammatory cytokines. H. pylori alters
gastric secretion and produces tissue damage, leading to PUD and influenced by genetics, environment, and diet.
942
SECTION 8 Problems of Ingestion, Digestion, Absorption, and Elimination
10. What drugs are used to treat H. pylori? (942)
T A B L E 42-13
Erosion
DRUG THERAPY
Duration
Eradication Rate
Triple-Drug Therapy
proton pump inhibitor (PPI)*
amoxicillin
clarithromycin (Biaxin)
Quadruple Therapy
PPI*
bismuth
tetracycline
metronidazole (Flagyl)
7-14 days
70%-85%
Acute
ulcer
Chronic
ulcer
Mucosa
Submucosa
10-14 days
85%
Muscularis
Serosa
Scarring
FIG. 42-9 Peptic ulcers, including an erosion, an acute ulcer, and a chronic
ulcer. Both the acute ulcer and the chronic ulcer may penetrate the entire
wall of the stomach.
12. and
What
are the Ifnursing
implications
for acute
a patient
post Gastric
Bypass procedure: diet, meds, care?
vomiting.
vomiting
accompanies
gastritis,
rest,
Dumping Syndrome direct result of surgical removal of large portion of stomach and pyloric sphincter. Normally
gastric chyme enters small intestine in small amounts. However, after surgery the stomach no longer has control over
amount of gastric chyme entering small intestine. A large bolus of hypertonic fluid enters intestine and results in fluid
being drawn into bowel lumen. This creates in plasma volume along with distention of bowel lumen and rapid
intestinal transit.
Early symptoms occurs w/in 15-30minutes after eating: feelings of generalized weakness, sweating, palpitations, and
dizziness due to sudden in plasma volume.
Abdominal cramps, borborygmi (audible abdominal sounds produced by hyperactive intestinal peristalsis), and urge
to defecate usually less than 1 hour after eating
Controlled by nutritional therapy. Divide meals into six small feedings to avoid overloading stomach and intestine at
mealtimes. Do not take fluids with meals but at least 30-45 minutes before or after meals to help prevent distention or
feeling of fullness. Avoid concentrated sweets (honey, sugar, jelly, jam, candies, sweet pastries, sweetened fruits)
because they sometimes cause dizziness, diarrhea, and sense of fullness. protein and fats to promote rebuilding of
body tissues and to meet energy needs. Meet, cheese, and eggs are specific foods to in diet. (949-950)
14. What medication (injection) might a patient need to be on for the rest of their life following a gastrectomy or gastric
bypass?
Pt requires cobalamin supplementation because intrinsic factor (normally made in stomach) is not available to bind
with cobalamin so that this vitamin can be absorbed in the ileum.
15. What are the risk factors associated with cholecystitis?
Cholecystitis inflammation of the gallbladder. Associated with obstruction caused by gallstones or biliary sludge.
Absence of obstruction occurs most frequently in older adults and in patients who are critically ill. Acalculous
cholecystitis is also associated with prolonged immobility and fasting, prolonged parenteral nutrition, and DM.
Bacteria reaching the gallbladder via the vascular or lymphatic route, or chemical irritants in the bile, can produce
cholecystitis.
Complications of choletlithiasis ad cholecystitis: gangrenous cholecystitis, subphrenic abscess, pancreatitis,
cholangitis (inflammation of biliary ducts), biliary cirrhosis, fistulas, and rupture of gallbladder which an produce
peritonitis
16. What symptoms are associated with biliary tract obstruction?
Pain usually located in left upper quadrant, but may be in midepigastrium. Commonly radiates to back because of
retroperitoneal location of pancreas. Sudden onset (severe, deep, piercing, and continuous or steady). Pain
aggravated by eating and frequent
17. Describe the tests commonly used to make a diagnosis of cholelithiasis.
Cholelithiasis stones in the gallbladder. Develops when balance that keeps cholesterol, bile salts, and calcium in
solution is altered so that substances precipitate caused by infection and disturbances in metabolism of cholesterol.
Ustrosonography is commonly used to diagnose gallstones. Lab tests reveal an increased WBC result of
inflammation. Direct and indirect bilirumbin levels are elevated, urinary bilirubin level elevated if obstructive process
present. If common bile duct obstructed, no bilirubin will reach small intestine to be converted to urobilinogen.
Alkaline phosphate, ALT, AST may elevated. Amylase if pancreatic involved (1038)
18. What foods stimulate the gallbladder to release bile?
Fat, bile salt will surround the fat particles and emulsify the fat
19. What complications are likely to occur in the patient with incision cholecystectomy?
Incisional (open) cholecystectomy removal of gallbladder through right subcostal incision. Postoperative care
focuses on adequate ventilation and prevention of respiratory complications (1040).
20. Describe the care of a patient with a T-tube. Why does a pt have a T-tube? How long will they have the T-tube?
If patient has T tube, maintain bile drainage and observe for T-tube functioning and drainage (1040). A T tube may be
inserted into common bile duct during surgery when common bile duct exploration is part of surgical procedure. This
ensures patency of duct until edema produced by trauma of exploring and probing duct subsided. It also allows excess
bile to drain while the small intestine is adjusting to receiving continuous flow of bile (1039).
21. Describe the pre-op and post-op care of the patient receiving a cholecystectomy? What tubes might they have postoperatively? Describe the function of a Penrose drain?
22. What diet instructions should be given to the patient with a cholecystectomy?
Instruct patient to have liquids for the rest of the day and eat light meals for a few days for laparoscopic procedure.
For Incisional, the patient will progress from liquids to regular diet once bowel sounds have returned. The amount of
fat in postoperative diet depends on patients tolerance of fat. A low-fat diet may be helpful if the flow of bile is
reduced (usually only in early postoperative period) or if patient is overweight. Sometimes the patient is instructed to
restrict fats for 4 to 6 weeks. Otherwise no special dietary instructions are needed other than to eat nutritious meals
and avoid excessive fat intake (1039)
23. What discharge instructions will you give to a patient following a laparoscopic cholecystectomy? (I.e. wound care,
showering, activity, when to call the physician)
24. Which type of nutritional supplement is preferred for a patient who has Altered Nutrition: Less than Required?
(Enteral or Parenteral?) Why?
Enteral nutrition (EN): EN may be ordered for patient who has functioning GI tract but unable to take any or enough
oral nourishment, or when it is unsafe to do so. EN is easily administered, safer, more physiologically efficient, and
typically less expensive than parenteral (PN). This question required more information as it stands, the best route
would be Enteral (EN) because it is less invasive. If more information were to state that pt is altered nutrition: less
than required r/t malabsorption of GI tract, than PN may be used. PN is usually indicated when GI tract cannot be
used for ingestion, digestion, and absorption of essential nutrients. PT sustain severe injury, surgery, or burns and
those who are malnourished due to medical treatment or disease processes have greatly increased nutritional needs
(903)
25. List two reasons a patient receiving only tube feedings (with no supplemental water) may develop dehydration.
26. What principles should be applied to safely administer a tube feeding?
27. What is the ultimate purpose of TPN?
28. What is the difference between PPN and TPN?
29. What complications are associated with TPN? What actions are used to avoid them?
30. What standards of care are indicated for the patient receiving TPN? What should be considered when controlling
glucose levels?
31. Considering osmotic and hydrostatic pressure, explain the pathophysiology of ascites.
32. Identify five important things to assess and include in your charting for the patient with cirrhosis.
33. What laboratory changes in liver enzymes, prothrombin time/INR, cholesterol, bilirubin and albumin are seen in
liver failure?
61. How does the nurse calculate NGT output when normal saline irrigation is used?