(58)The nurse and the dietitian are planning sample diet menus for the client who is experiencing dumping syndrome. Which sample meal is best for this client?
A. Chicken and rice
Chicken and rice is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products.
Not be allowed to have any mayonnaise and can have whole wheat bread only in very limited amounts.
Several small meals daily
Relatively high fat and protein content
Relatively low carbohydrate content
No milk, sweets, or sugars
Liquid between meals only
(58) The client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 lbs. of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client?
A. Ask the client if a change in flavor would make the supplement more palatable.
(58)The client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority?
B. Schedule of the client's follow-up examinations and x-ray assessments
Because recurrence of gastric cancer is common, it will be a priority for the client to have follow-up examinations and x-rays, so that a recurrence can be detected quickly.
(58)The client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response?
D. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop."
Crohn's disease may be an underlying disease process associated with gastritis, but it is not known to be a direct cause of the disease.
Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs.
Although Crohn's disease tends to run in families, gastritis is a symptom of other disease processes and is not a disease process in and of itself.
(58) The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response?
B. "These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen."
(58) The nurse is teaching the client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates correct understanding of the nurse's instruction?
A. "Small meals should be eaten about six times a day."
The client with chronic gastritis will need to take vitamin B12 shots only ifhe or she has pernicious anemia.
The client with chronic gastritis should notuse ibuprofen or aspirin.
(58) The client is exhibiting symptoms of gastritis. The nurse is assessing the client to determine whether the form of gastritis being experienced is acute or chronic. Which data are correlated with a diagnosis of chronic gastritis?
B. Treatment with radiation therapy
Treatment with radiation therapy is known to be associated with the development of chronic gastritis.
Anorexia, nausea, and vomiting are all symptoms of acutegastritis.
Corticosteroid use is associated with acutegastritis.
Hematemesis and anorexia are more likely to be symptoms of acutegastritis.
(58) The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which syndrome is most significant in determining whether the client's ulceration is duodenal as opposed to gastric in origin?
A. Pain occurs 1 1/2 to 3 hours after a meal, usually at night.
A key symptom characteristic of duodenalulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal.
Pain that is worsened with ingestion of food is a key feature of gastriculcers.
A malnourished appearance is a key feature of gastriculcers.
(58) A key symptom characteristic of AAA ulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal.
(58) Pain that is worsened with ingestion of food is a key feature of AAA ulcers.
(58) A malnourished appearance is a key feature of AAA ulcers.
(58) T/F: The client is a man older than 50 years. This fact is associated with gastric ulcers.
False: This is a finding that could apply to either type of ulcer: duodenal or gastric.
(58) The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority?
D. Starting a large-bore intravenous (IV)
A large-bore IV should be placed as requested, so that blood products can be administered.
(58) The nurse is teaching the client with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge?
A. "Nizatidine (Axid) needs to be taken three times a day to be effective."
Nizatidine (Axid) is most effective if administered twice daily.
(58) T/F: A dose of ranitidine (Zantac) at bedtime should decrease acid production throughout the night.
(58) T/F: Sucralfate (Carafate) should be taken 1 hour before and 3 hours after meals
False 1 and 2
(58) T/F: Because omeprazole (Prilosec) is a delayed-release capsule, it should be swallowed whole and not crushed.
(58) The nurse is monitoring the client with gastric cancer for signs and symptoms of upper GI bleeding. Which change in vital signs is most indicative of bleeding related to cancer?
B. Blood pressure from 140/90 to 110/70 mm Hg
A decrease in blood pressure is the most indicative sign of bleeding.
(58) The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority?
C. Administering intravenous (IV) fluids
Administration of IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding.
(58) The nurse has placed a nasogastric (NG) tube in the client who has overdosed to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response?
A. "Saline goes down the tube to help clean out your stomach."
Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents.
(58) The nurse is teaching the client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching?
C. "Ice cream can be eaten in moderation."
(58) The client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention?
A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician
Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician
(58) The client is an older woman diagnosed with Zollinger-Ellison syndrome. Which statement made by the client's family demonstrates correct understanding of the disorder?
A. "She may have to be treated with chemotherapy drugs."
The client may undergo treatment with chemotherapeutic agents to reduce the tumor before further treatment can commence.
It can be cured.
A familial tendency to develop Zollinger-Ellison syndrome has been noted.
The only way to cure Zollinger-Ellison syndrome is with surgery.
(58) T/F: Zollinger-Ellison syndrome is curable.
(58) The client with peptic ulcer disease (PUD) asks the nurse whether a maternal history of ovarian cancer will cause the client to develop gastric cancer. What is the nurse's best response?
A. "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing."
Although a diet high in pickled, salted, and processed foods does increase the risk for gastric cancer, a family history of specific types of cancer can also increase the risk.
(58) Which nursing action is best for the charge nurse to delegate to an experienced licensed practical nurse/vocational nurse (LPN/LVN)?
A. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis.
Re-taping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by licensed nursing staff.
(58) The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40, pulse 124, and respiratory rate 26. Which admission request will the nurse implement first?
C. Infuse lactated Ringer's solution at 200 mL/hr.
The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia.
Type and crossmatch for 4 units of packed red blood cells - Incorrect: This will need to be done, but the nurse's immediate concern is correcting the client's hypovolemia.
All options will need to be done. They are just not the priority.
(58) The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request will the nurse implement first?
C. Place nasogastric (NG) tube, and connect to suction.
To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis.
Antiembolism stockings will need to be applied to prevent thromboembolism, but the nurse's immediate priority is to minimize the risk for peritonitis.
All other options are appropriate, but they are not the priority.
(58) The nurse working during the day shift on the medical unit has just received report. Which client will the nurse plan to assess first?
D. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy
This client is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon should be notified immediately because the nasogastric tube may need irrigation or repositioning.
(58) The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil, Motrin, others) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client?
C. Misoprostol (Cytotec)
Misoprostol (Cytotec) is a prostaglandin analogue that protects against NSAID-induced ulcers. It is a "pain mediator", but in the stomach it protects the mucossal lining.
Bismuth subsalicylate (Pepto-Bismol) is an antidiarrheal drug that contains salicylates, which can cause bleeding and should be avoided in clients who have peptic ulcer disease (PUD).
Magnesium hydroxide (Maalox, Mylanta) is an antacid that may be used to neutralize stomach secretions but is not used specifically to help prevent NSAID-induced ulcers.
Metronidazole (Flagyl) is an antimicrobial agent used to treat Helicobacter pylori infection, i.e. H. pylori
Inflammationof the gastric mucosa
Lesionof the mucosal lining of the stomach or duodenum, and possibly the esophagus.
(58) A client who undergoes a gastric resection is at risk for developing dumping syndrome. The nurse monitors the client for:
Dumping syndrome is the rapid emptying of the gastric contents into the small intestine that occurs after gastric resection. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vasomotor disturbances such as dizziness, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.
(58) Gastritis definition and types
Inflammation of gastric (stomach) mucosa
can be caused by H. pylori as well as long-term NSAID use, and less common by staph, strep, and E. coli
Type A: inflammation of glands, fundus & body; and is assoc w/ antibodiesto parietal cells and intrinsic factor, so an autoimmune cause is likely.
Type B: (most common "chronic") usually glands of Antrum, but may be whole stomach and is caused by H. pylori.
Atrophic: most often seen in older adults and caused by exposure to toxins (e.g. benzene, lead), H. pylori, or autoimmune
(58) Zollinger–Ellison syndrome
caused by a non–beta islet cell, gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach to maximal activity, with consequent gastrointestinal mucosal ulceration.
ZES may occur sporadically or as part of an autosomal dominant familial syndrome called multiple endocrine neoplasia type 1 (MEN 1). The primary tumor is usually located in the pancreas, duodenum or abdominal lymph nodes, but ectopic locations have also been described (e.g., heart, ovary, gallbladder, liver, kidney).
(58) Differential Features of Gastric and Duodenal Ulcers
(58) Side effects: Flagyl
Consuming ethanol (alcohol) while taking metronidazole has long been thought to have a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), and shortness of breath.
(58) Med Info: Tetracycline
Not for renal Pt
Not for Kids under 8
Rpt severe nausea, vomoting, dizziness
(58) Meds for H. pylori
Some combo of:
flagyl, which cannot be taken with alcohol
(58) Tx of choice for Trichomonas
(58) Early and Late signs of Dumping Syndrome
It is: Gastric dumping syndrome, or rapid gastric emptying is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested.
"Early" dumping begins concurrently with or immediately succeeding ingestion of a meal.
Symptoms of early dumping include:
"Late" dumping happens one to three hours after eating.
Symptoms of late dumping include
(58) Nasogastric Tubes
Inform the patient about the procedure and its potential discomfort.
Position the patient with pillows behind the shoulders.
Lubricate the tube with a water-soluble lubricant.
Measure the length of the tube to be passed:
a. Measure from the bridge of the nose to the earlobe to the xiphoid process.
b. Indicate this length with a piece of tape on the tube.
Determine which nostril is more patent.
Encourage the patient to swallow or drink water if the level ofconsciousness and treatment plan permit.
Insert the tube:
a. Pass the tube gently into the nasopharynx. Ask the patient to swallow repeatedly while the tube is advanced.
b. If resistance is met, rotate the tube slowly, aiming downwardand toward the closer ear.
c. In the intubated or semiconscious patient, flex the headtoward the chest while passing the tube.
Withdraw the tube immediately if any change is noted in respiratory status.
Test for tube placement by using these techniques:
a. Obtain a sample of the gastric contents by aspirating with a 50-mL catheter-tipped syringe.
b. Test the pH of the gastric contents (should be between 1 and3.5).
c. Obtain a request for an x-ray study to confirm placement.
Connect the tube to suction at low pressure:
a. The Levin tube is connected to intermittent low suction.
b. The Salem sump or Anderson tube (has pigtail vent) is connected to continuous low suction.
Secure the tube to the patient's nose and to his or her gown:
a. Tie a slipknot around the tube with a rubber band.
b. Pin the rubber band to the gown.
Check intake and output every 4 hr or more often, as indicated.
Observe the patient for nausea, vomiting, abdominal fullness, ordistention.
If irrigation is indicated, use only a normal saline solution.
Observe the patient for alterations in fluid and electrolyte balance.
If indicated, instruct the patient about movement that will not dislodge the tube and cause nasal irritation.
Remove the tape securing the tube to the nose daily and PRN to clean skin; reapply tape.