GI & PHARM REVIEW

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1

Documentation upon assessment of patient with Diverticulitis

Pain in the LLQ and fever

2

Patient teaching for patient liver biopsy patient

Lie on the right side for 2 hrs

3

Minimize dumping syndrome for a gastrectomy client

Limit fluids taken with meals

4

Early sign and symptom of dumping syndrome

Sweating and pallor

5

Stool characteristic of Crohn's disease

Diarrhea

6

Which type of hepatitis contracted from contaminated food

Hepatitis A

7

Which medication is intraindicated for acute pancreatitis patient

Morphine sulfate. Can cause spasm in the sphincter of Oddi

8

What is intraindicated for hiatal hernia patient

Lying recumbent following meals

9

Patient with acute pancreatitis is complaint of pain, which position would aggrevate the pain.

Supine

10

Sign and symptom of viral hepatitis in hospital setting

Fatigue

11

Priority to include in plan of care to prevent infection of Hepatitis B client

Hepatitis B vaccine

12

Nursing intervention for loss of appetite of Hepatitis patient

Increase fluid intake

13

Sign of paralytic ileus of an acute pancreatitis patient with a history of alcoholism

Inability to pass flatus

14

Nursing intervention for Hepatitis patient with loss of appetite

Small and frequent meals

15

Risk factor for colorectal cancer

Personal history of ulcerative colitis or gastrointestinal polyps

16

Interventions for patient with acute pancreatitis

Administer antacids. Encourage coughing and deep breathing. Administer anticholinergics. Meperidine for pain

17

Patient with hepatic encephalopathy has serum ammonia level of 95 mcg/dL, receives treatment with lactulose syrup. Level changes to which for optimal response to the treatment?

40 mcg/dL

18

Diet for a asymtomatic diverticular disease patient

High fiber diet

19

Teaching for Hepatitis patient

Eat high-carbohydrate, low fat diet. Aovid alcohol and aspirin. Take the prescribed amount of vitamin K.

20

If an Miller-Abbot tube advanced 6 cm since it was place, what is the nursing intervention

Document finding in patient record

21

Assessment of Peptic ulcer includes

History of tarry black stools. History of alcohol abuse. History of gastric pain 2-4 hrs after meals

22

Sign which indicate possible liver damage

Pruritus

23

Nursing intervention for hepatitis patient to meet safety needs

Monitoring prothrombin and partial
thromboplastin values

24

Abnormal sign in client with hepatitis which are not normal

Confusion or drowsiness

25

Nurse intervention for client receving parenteral nutrition complaint of nausea, excessive thirst and increased frequency of voiding.

Capillary blood glucose level

26

Gastroscopy postoperative essential nursing intervention

Check gag reflex prior to giving oral fluid and food

27

Patient teaching of post operative barium enema patient

Take laxative until stool return to normal color

28

Sign and symtom of hiatal hernia

Difficult swallowing

29

Barium swallow patient preoperative instruction

NPO at midnight before the test

30

Misoprostol(Cytotec) and sucralfate(Carafate) work primarily for

Protect the gastric mucosa

31

Dietary for client with peptic ulcer disease

Eat anything as long as it does not aggravate or cause pain

32

Intervention postoperative upper gastrointestinal series patient

Laxative

33

Patient complains of frequent heartburn and regurgitation. Nurse assess for

Difficulty swallowing

34

Nursing intervention of a client with Sengstaken-Blakemore tube to prevent ulceration and necrosis of oral and nasal mucosa

Give frequent oral and nasal care

35

70 yrs old patient complaint of stomach pain 30 min to 1 hour after meal. Pain is relieved by vomiting.

History of alcolhol use, smoking and weight loss

36

Intervention for subtotal gastrectomy patient

Smaller, more frequent meals

37

NANDA Nursing diagnose of client with anorexia nervosa

Impaired nutritional status

38

Abnormal finding of an abdominal assessment, report to MD

Pulsation between the umbillicus and
pubis

39

Which factor is responsible for anemic of a chronic ulcerative colitis

Blood loss

40

What cause pernicious anemia that is part of client's health history?

Hemigastrectomy

41

Post gastrectomy client is at high risk for hyperglycemia related to dumping syndrome. Nurse must monitor for

Postprandial blood glucose readings

42

Nursing intervention for patient with pneumonia with history of bleeding esophageal varices

Constipation

43

Complications from acute pancreatitis

Alteration of comfort related to abdominal pain

44

Intervention to include for client with endoscopic retrograde cholangiopancreatoghrapy (ERCP)

NPO until gag reflex return

45

Risk associated with GERD in patient being scheduled for Nissen fundoplication

Aspiration r/t fistula formation between esophagus & trachea

46

Abnormal lab value for client with peptic ulcer

Hemoglobin 10.2 g/dL ( Normal level: 12-16 for female, 14-18 for male ). Indication of bleeding

47

Assessment for optimal response to medication of lactulose(Cephulac) for a hepatic encephalopathy client

Client previously oriented to person, now oriented X 3 (name, year,location)

48

Teaching for 20 yrs old viral hepatitis patient

Not going back to work right away. Close friends should be vaccinated. Condom should be use for sexual intercourse

49

Further teaching required for postprocedure of patient of a colonoscopy if patient stated:

OK to drive once patient is home for an hour

50

Diet for client scheduled for an oral cholecystography

Fat free

51

Medication intracondicated for client with acute gastritis

Ibuprofen ( cause ulceration of the esophagus, stomach, duodenum, or small intestine)

52

Sign of perforation of a peptic ulcer

Rigid, boardlike abdomen

53

Pyloroplasty treatment for peptic ulcer

An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from stomach to the duodenum

54

Vagotomy (peptic ulcer)

Reduces the stimulation of acid secretion

55

Chemical digestion

amylase for carbohydrates(starch)
proteases for protein
lipase for fats

56

Absorption

carbohydrate and fats by blood vessel villi
fats by lymphatic villi

57

Parts of the stomach

Fundus
Body
Pylorus

58

Hypothalamus (“Thermostat”)

Fluid balance, Appetite, Emotions, fear, pleasure, pain . symphatetic/ parasymphatetic. One center stimulates eating and another signals to stop eating

59

Nursing intervention for GI series (Barrium swallow /enema)

ensure all barium is expelled rectally

60

Gastroesophageal reflux disease-GERD

Backward flow of stomach acid into the
esophagus
Heartburn (pyrosis) 20 min to 2 hours after
eating. Regurgitation. Dysphagia or odynophagia
Eructation

61

Carcinoma of the esophagus

Malgnant epithelial neoplasm that has invaded the
esophagus.
– 90% are squamous cell carcinoma associated with
alcohol intake and tobacco use
– 6% are adenocarcinomas associated with reflux
esophagitis
Manifestations/assessment. Progressive dysphagia over a 6-month period. Sensation of food sticking in throat

62

Digestive system

Mouth: Beginning of digestion (Bolus)
Teeth: Bite, crush, and grind food
Salivary glands: Secrete saliva
Esophagus: Moves food from mouth to stomach
Stomach: Churn and mix (chyme) with gastric juices
Small intestine: Most digestion occurs here
Large intestine: Forms and expels feces
Rectum: Expels feces

63

Achalasia

Cardiac sphincter muscle of the stomach cannot relax.
S/S:Dysphagia , regurgitation of food
,substernal chest pain, loss of weight, weakness
poor skin turgor.
Treatment: Cardiomyectomy

64

Inflammation of the lining of the stomach (Acute Gastritis)

Fever; headache
Epigastric pain; nausea and vomiting
Coating of the tongue
Loss of appetite.
Intervention: NPO. NG tube. Monitor I/O

65

Gastric ulcers and duodenal ulcers

acid and pepsin imbalances. H.Pylori

66

NSG DX: Ineffective tissue perfusion

Breath test for H. Pylori.
Intervention: Tagamet/Zantac
Diet: High fat/carb.limit coffee. small meals. no alcohol/aspirin

67

Post Op Gastrectomy assessment

Dumping syndrome. Pernicious anemia. Iron anemia

68

Risk factors for stomach cancer

Common: adenocarciaoma (pyloric area)History of polyps. Pernicious anemia, Hypochlorhydria
,Gastrectomy,chronic gastriti, gastric ulcer
Diet high in salt, preservatives, and carbohydrates
Diet low in fresh fruits and vegetables

69

Ulcerative colitis

Diarrhea—pus and blood; 15 to 20 stools per day
Abdominal cramping
Involuntary leakage of stool

70

Post Op Ileostomy care for Ulcercolitis - with absence of resected bowel.

monitor skin for excoriation

71

Crohn's Disease

Chronic inflammation of the inestinal tract
S/S : Weakness; loss of appetite.Diarrhea: 3 to 4 daily; contain mucus and pus. Right lower abdominal pain
Steatorrhea. Anal fissures and/or fistulas

72

Appendicitis

Rebound tenderness over the right lower quadrant of
the abdomen (McBurney’s point)
Vomiting.Low-grade fever.Elevated WBC.
NPO. NI: Fluid & electrolyte

73

Nursing intervention for Diverticuitis

Encourage to express concern if not able to adjust to colostomy
Diet: high-fiber diet, Sulfa drugs, Antibiotics; analgesics

74

Peritonitis

Inflammation of the abdominal peritoneum
Bacterial contamination of the peritoneal cavity from fecal matter or chemical irritationSevere abdominal pain; nausea and vomiting
Abdomen is tympanic; absence of bowel sounds
Chills; weakness.Weak rapid pulse; fever; hypotension

75

Different types of external hernias ( incarceration and strangulation)

Incarcerated: intestine trapped
Strangulated: intestine tightly trapped (loss of blood flow)

76

Heptitis prevention in healthcare environment

Hepatitis B vaccine

77

NPO rationale for pancreatitis patient

Avoid stimulating pancreatic activity

78

Nursing intervention for pancreatitis focus

Pain therapy. Bed rest. Enteral feeding.

79

Care of T tube

No kink. Bag is below level of common bile duct or incisions.
Gauze roll under tube to prevent tension/pulling. Drainage=500 mL first 24 hr.Clamped 1-2 hr AC, unclamped 1-2 hr BC.

80

Complications post op cholecystectomy

jaundice, hemorrhage, inc. pulse, inc. exudate @ dressing site.

81

Sign of acute pancreatitis

Complaint severe pain at epigastric area radiating to the back , relieve by leaning forward. Jaundice if common bile duct is obstructed

82

Nursing intervention post op of liver cancer patient

sign of infection

83

Factors of pancreatitis

diabetes and smoking
cause: occlusion of pancreatic duct = ruptures, releasing enzymes which digest pancreas.

84

Protein restriction for Cirrhosis of the liver rationale

acute hepatic encephalophathy

85

Danger of Cirrhosis of the liver

hemorrhage from esophageal varices, hepatic encephalopathy and ascites.

86

Hand flapping tremors

S/S Cirrhosis of the liver disease - stretched arms, hyperextends wrists with fingers seperated. Rapid, irregular flexion + extension of the wrist

87

Intervention for patient post op paracentesis

signs of hypovolemia + electrolyte imbalances. Bleeding + drainage.

88

Priority of nursing interventions for hepatitis and cirrhosis of the liver

Relief of pruritus

89

Appendicitis interventions

NPO. Replace fluids + electrolytes. Monitor T/P/BP/R every hour. No heat apply = rupture.

90

Abdominal pain in epigastric or URQ, jaundice, anorexia, nausea + vomiting + extreme weakness

gallstone or gall bladder

91

Post op intervention of paralytic ileus (lack of intestinal peristalsis + bowel sounds)

Folwler position. Acess for bowel sounds. Breath deeply through nose + coughing.Continue nasointestinal suctioning until bowel activity returns.

92

S/S of cholecystitis

Cause: obstruction, gallstone or tumor.
nausea, vomiting, severe colicky pain in RUQ of abdoment, elevated leukocyte count, jaundice, clay colored stools caused by a lack of bile.

93

Sodium Bicarbonate antacids contraindicated in

patients with cardiovascular problems (hypertenstion, CHF, sodium-restricted diets)

94

Types of Antacids

aluminum carbonate (Basaljel), aluminum hydroxide (AltemaGEL, Alu-Tab), calcium carbonate (Tums, Mylanta), magnesia (MOM), magnesium oxide(Mag-Ox), sodium bicabonate (Bellans)

95

Emolient laxatives

Mineral oil (Kondremul Plain, Mikinol)

96

Order: 4 times a day

At meal times + before bed (0600, 1100,1400, 2000)

97

Optimal response for patient on omeprazole (Prilosec)

No symptom of heart burn

98

Zantac is given at

Once at bed time

99

Adverse reaction to Prevalin

...

100

Irritant/Stimulant Laxatives

sennosides (Exlax), bisacodyl (Ducolax)

101

CNS Adverse Reaction of cimetidine (Tagamet) in older clients

Confusion, dizziness increase risk for falls.

102

Stool softeners/Surfactants

docusate (Colace), lactulose (Cephulac/Chronulac), lubiprostone ( Amitiza)

103

Patient teaching for lansoprazole (Prevacid)

Swallow whole tablet (do not chew, crush ) 1 hr before meal

104

Order of loperamide (Imodium) PRN given

act on the muscle wall of the bowel to slow motility in treatment of chronic diarrhea associated with IBD.

105

calcium carbonate (antacid) drug/drug interaction

Decreasing absorbtion with digoxin, phynytoin, isoniazid
Decrease effectiveness of anti inflammatory properties

106

Proton Pump inhibitors

esomeprazole ( Nexium ), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole(Protonix), rabeprazole (Aciphex)

107

How to give magnesium nitrate PO

Chill to lessen the bad taste effect

108

dimenhydrinate (Dramamine) are given when?

1 hour before traveling

109

Medications to speed up gastric empty

Milk of Magnesia, GoLYTELY

110

Teaching for misoprostol

May cause spontaneous abortion, advise women of childbearing age to use a reliable contraceptive.

111

psyllium (Metamucil) teaching

Taken with water / right after preparation to reduce risk of obstruction of the esophagus, stomach, small intestine and colon

112

H2 receptor antatagonists (dine)

cimetidine (Tagamet) famotidine(Pepcid), nizatidine (Axid), ranitidine(Zantac)

113

dexpanthenol contraindication

Cautions in patients with heophilia, diabetes and cardiovascular disease, pregnancy and lactation

114

Optimal respond to calcium carbonate (antacid) treatment

No symtom of heart burn

115

Test drawn for jaundice

Billirubin

116

carbohydrate and proteins are broken down / absort where?

broken down in stomach, absorbed in small intestine

117

Anatomy of the stomach

Jejunum, liver, ileum, appendix, stomach, pancreas, tranverse colon, cecum, anus

118

Liver enzyme tests

...

119

Normal lab values of pathological condition of the liver

...

120

Contraindication intervention for unknown stomach pain

No heat application

121

Assessment of patient with total gastrectomy

Perninicious anemia and vitamin B12 absorbtion

122

Cirrhosis of the liver patient, vitamin K malabsorbed, what lab value is abnormal

prothrombin time and international normalized ratio