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

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)
o Saliva 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 side-lying 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/min-
hyperactive 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
LIVER
 With 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
LIVER
Blood Supply
Even if the liver receives
30% of CO/min., the portal
system remains low-
pressured
LIVER
Blood 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)
LIVER
BILE
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) Amino acid

Indirect Bilirubin (stored in liver) pool
(Fat-soluble)
FATE OF HEMOGLOBIN
Unconjugated/Indirect Bilirubin (Fat-soluble)
Attached to albumin
Liver (with enzyme glucoronyl transferase)
Conjugated/Direct Bilirubin (Water-soluble)

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 &
pancreatic 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
 gluconeogenesis
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
Chronic alcoholism
Malnutrition- primary
reason for Laennec’s
cirrhosis
Viruses
LIVER DISORDERS
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, petechiae,
ecchymosis
Spiderangiomas/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
Liver Enzymes
 SGPT/ALT(specific for
liver disease) & SGOT
(AST)
 Serum indirect bilirubin
LIVER DISORDERS
  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
ASCITES- fluid in peritoneal
cavity
Administer meds as ordered
Loop Diuretic
K+ supplements
LIVER DISORDERS
Nursing Management
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
Vitamin K
Vasopressin (Pitressin)
BT
LIVER DISORDERS
Nursing Management
NGT decompression via
gastric lavage
Monitor for NGT output
LIVER DISORDERS
Nursing Management
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
Hepatic Encephalopathy: end-stage
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
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
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
Metabolic disorders
 hyperparathyroidism
(hyperCa)
 hyperlipidemia (obesity)
Ischemic vascular disease
PANCREATITIS
 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
  HR & T,  BP to Shock
 Shallow respiration
 Anorexia, N/V, wt. loss
 bowel sounds (paralytic
ileus)
 Indigestion/dyspepsia
ACUTE PANCREATITIS
 (+) Cullen’s sign-
ecchymosis at umbilicus
 (+) Grey Turner’s sign-
ecchymosis at flank area
 hypocalcemia (due to
extensive lipolysis)
Cullen’s Sign & Grey Turner’s Sign
ACUTE PANCREATITIS
 WBC,  Hct,  bilirubin, 
alkaline phosphatase,  urinary
amylase,  CBG
 serum Ca+2, Mg+2
Abdominal UTZ & CT scan-
enlarged pancreas
Chest X-ray- pleural effusion
ACUTE PANCREATITIS
 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
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
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
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
 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
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
 Oral cholecystogram
 Gall Bladder Series)- (+)
gall stones
  Serum alkaline
phosphatase
GALL BLADDER
Nursing Management
 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
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)
GERD
 Signs & 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
precipitated by ingestion of
fatty foods & alcohol
Heart burn
Retrosternal discomfort
Regurgitation of sour, bitter
material
ESOPHAGITIS
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
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
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
Barium swallow- poorly
distensible, shortened,
stricture & or ulcerated
esophagus
Gastroesophageal scintiscan
(X-ray to document amount
of reflux)
GERD & ESOPHAGITIS
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
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
 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 (G-cells)
 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
 Hereditary
 Hx of gastritis
 Emotional stress
PEPTIC ULCER
 Smoking
 Alcoholism
 Caffeine
 Irregular Diet
 Rapid Eating
PEPTIC ULCER
 Ulcerogenic drugs
 ASA
 Ibuprofen
 Indomethacin
 Phenylbutazones
 Steroids
PEPTIC ULCER
 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
StressUlcer
Cushing’s Ulcer- due to head
trauma/injury (e.g. CVA) 
Vagal stimulation 
hyperacidity  ulceration
PEPTIC ULCER
GASTRIC VS. DUODENAL ULCER
ULCER
Antrum Duodenal bulb
30 mins- 1 or 2 hrs 2-3 or 4 hrs p.c.
p.c.
Epigastric pain Mid-epigastric pain
(L midepigastric pain)
PEPTIC ULCER
GASTRIC VS. DUODENAL
ULCER ULCER
Gaseous pain &
Cramping &
burning
burning
Not relieved by
food/antacid Relieved by
N gastric acid secretionfood/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
 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 Procedures
Endoscopic exam- extent
& depth of ulceration
Stool- (+) occult blood
Upper GI series (Barium
swallow)- (+) ulceration
PEPTIC ULCER
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
Antacids
Maalox- combined with  S/E
than 2 antacids separately
MAD- Mg containing antacid,
S/E- diarrhea
AAC- Al containing antacid,
S/E- constipation
PEPTIC ULCER
Administermeds as ordered
H2 blockers
Ranitidine (Zantac)
Cimetidine (Tagamet)
Famotidine (Pepsin)
PEPTIC ULCER
Mucosal barrier protectants:
creates a paste-like substance
that coats the gastric mucosa
Taken 1 hr a.c.
Sucralfate
Cytotec
PEPTIC ULCER
Anticholinergics,
Antispasmodics
AtSO4, Buscopan
Sedatives/Tranquilizer
(Valium)
PEPTIC ULCER
Assistin surgical procedures
Vagotomy- prior to gastric
surgery to  hemorrhage
Pyloroplasty: to 
obstruction, to  gastric
emptying
PEPTIC ULCER
SUBTOTAL GASTRECTOMY
Bilroth I (Gastroduodenostomy)
Removal of 1/3 to ½
uppermost stomach &
anastomosis of the gastric
stump to the duodenum
PEPTIC ULCER
SUBTOTAL 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
Post-op
IVF & e+
Antibiotics
Analgesics
Anti-emetics
PEPTIC ULCER
Prevent Complications
Bleeding  Hemorrhage
 Shock
Paralytic ileus
Peritonitis
PEPTIC ULCER
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
Diet:  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
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 Disease)
CYSTIC FIBROSIS (CF)
 Or Mucoviscidosis or Fibrocystic
disease of the Pancreas
 Multisystem disorder
 Incidence: most fatal genetic
disease in Caucasians &
Europeans
 Genetic characteristics
 Transmitted by autosomal
recessive inheritance
 Mutation on gene on Chromosome
7q31
 Deletion of an AA resulting CF
transmembrane conductance
regulator (CFTR)
 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 Cl-
transport ( NaCl in sweat)
 Pathophysiology
 On stimulation: exocrine
ducts release thick, viscous
secreations causing plug 
anatomical & physiologic
changes
 Characteristics
 Pancreatic enzyme
deficiency fat & Vit ADEK
malabsorption
 Characteristics
 Large volume of thick, viscous
bronchial secretions 
chronic pulmonary disease
  NaCl in sweat
 dry, repetitive cough followed
by vomiting; thick, sticky
sputum
 Diagnostic Tests
 Pilocarpine iontophoresis sweat
test: simplest, most reliable
method
 N: <60mEq/L sweat Cl-
 CXR:  diameter of upper chest,
overaerated lungs, fibrotic
changes
 Diagnostic Tests
 Pancreatic deficiency: (-)
trypsin
 Fecal fat test: steatorrhea (+)
15-30 g fat/day
 N: 4 g fat/day
 Management
 Gene therapy
 Respiratory:
 Tobramycin IV & aerosol:
prevent P. aeruginosa
 Coenzyme Q10,N-Acetylcystein:
mucus viscosity
 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 predisposition
CHRON’S DISEASE
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
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
 Withperiods of remissions &
exacerbations
ULCERATIVE COLITIS
ULCERATIVE COLITIS
Unknown 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
 CBC-  RBC,  WBC
  Serum albumin
 Deranged serum electrolytes
 serum alkaline phosphatase
ULCERATIVE COLITIS
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
Barium enema-
sigmoidoscopic 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
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
Avoid smoking
Monitor stool color,
consistency, presence of blood
WOF perforation, peritonitis &
hemorrhage
ULCERATIVE COLITIS
Bulk-forming agents: bran,
psyllium, methylcellulose
Antibiotics
Corticosteroids
Immunosuppressants
ULCERATIVE COLITIS
Surgical Interventions
Totalproctocolectomy with
permanent ileostomy
Curative, removal of entire
colon, rectum & anus with anal
closure
Terminal ileum at RLQ: with
stoma
ULCERATIVE COLITIS
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
emptyings
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 sleeve &
anastomosed
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
 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
WOF perineal wound infection (if

present)
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
 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
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
DIVERTICULOSIS &
DIVERTICULITIS
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
CBR
NPO 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
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
Antibiotics
Analgesics
Anticholinergics
Small amount of bran OD
Bulk-forming laxatives
DIVERTICULOSIS &
DIVERTICULITIS
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
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
A. dry
B. red
C. edematous
D. retracted
Which of the following

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

assessment techniques
should a nurse use to
determine the appropriate
placement of NGT?
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
A RN would instruct a pt
who had an ileostomy to
avoid which of the
following food?
A. potatoes
B. beef
C. popcorn
D. yogurt
serum lab results would a
nurse expect to identify in
a pt who has pancreatitis?
A.  cholesterol
B.  glucose
C.  amylase
D.  creatinine
questions would be most
important for a nurse to ask
when gathering data from a
pt who is suspected of
having acute pancreatitis?
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?”
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?
A. Meperidine HCl (Demerol)
B. Morphine SO4
C. Propantheline Br
(Pro-Banthine)
D. Cimetidine (Tagamet)
The nurse should teach
a pt who has acute
pancreatitis to avoid
which of the following
foods?
A. Pasta & tomato juice
B. Rice & green beans
C. Steak & baked potato
D. Bread & baked apple
factors, if noted in a pt’s
hx, would indicate a
predisposition for
developing cholecystitis?
A. obesity
B. hypertension
C. depression
D. childlessness
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?
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
When a 12-year old child

has a dx of appendicitis,
manifestations would be
most important for the RN
to follow-up?
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

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

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

explanations should a nurse
give to a pt regarding the
primary cause of peptic ulcer
disease?
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.”
The nurse should monitor

a pt who is receiving
lactulose (Cephulac) for
adverse side effects?
A. Diarrhea
B. Petechiae
C. Polyuria
D. Flushing
Anurse should expect a

Sengstaken Blakemore tube
to be ordered for a pt who
has bleeding esophageal
varices in order to
A. cause vasoconstriction to the
splenic artery
B. ensure airway patency
C. provide for enteral nutrition
D. apply direct pressure to the
area

nursing measures would be
most appropriate for a pt
who has ascites?
A. withholding fluids
B. measuring abdominal girth
C. encouraging ambulation
D. monitoring for pedal
edema

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

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