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Ma. Victoria J.

Recinto, BSN, RN,


USRN
Philippine General Hospital
University of the Philippines-Manila

Overview

Functions:

digestion
absorption
elimination

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

Salivary Glands

MUMPS
Causative agent:
Paramyxovirus
Signs & Symptoms
swollen parotid gland
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: sidelying with
abdominal
guarding & legs
flexed

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

APPENDICITIS

(+)
rebound
tenderne
ss at
McBurne
ys 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-Fowlers
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-Fowlers 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

gland, 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 natureb

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 5001,000 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 (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 &
pancreatic duct

LIVER

Functions
Vitamin

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

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

Laennecs Cirrhosis
Alcohol-induced,

nutritional, portal
Cellular necrosis scar
tissue with fibrotic
infiltration

LAENECS CIRRHOSIS

LIVER DISORDERS

Predisposing Factors
Chronic alcoholism
Malnutritionprimary reason for
Laennecs 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 hand 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 Fowlers 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 Fowlers)
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
stomachs contents entering
the duodenum
Secretes pancreatic juices:
with enzymes for digesting
macronutrients

PANCREAS
As endocrine gland (20%)
Islets of Langerhanssecretes 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

(+) Cullens signecchymosis at umbilicus


(+) Grey Turners signecchymosis at flank area
hypocalcemia (due to
extensive lipolysis)

Cullens Sign & Grey Turners


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 SO4causes 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
Murphys sign: cant take a
deep breath when examiners
fingers 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 Ttube
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-Fowlers position,
drain system by gravity
Avoid irrigation,
aspiration or clamping
the T-tube without MDs
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

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- 0.82
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

MEDICAL MANAGEMENT

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

SURGICAL MANAGEMENT

Nissen Fundoplication
(under EL)
Creation of valve
mechanism by
wrapping the greater
curvature of stomach
(gastric fundus) around
the LES

NISSEN FUNDOPLICATION

HIATAL HERNIA
or

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

HIATAL HERNIA

HIATAL HERNIA

Aggravated by factors
intraabdominal pressure:
pregnancy, ascites,
obesity, tumors, heavy
lifting
Cx: ulceration,
hemorrhage,
regurgitation, aspiration,
strangulation,
incarceration of the

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

STOMACH

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

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
Curlings Ulcer- due to
trauma & major burns
hypovolemia GIT
ischemia resistance of
mucosal barrier to HCl acid
secretion ulceration

PEPTIC ULCER
Stress

Ulcer
Cushings 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
(L midepigastric pain) 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 Management
Assist

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
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
Fowlers position
NPO for 1-3 days, NGT to
suction (dont
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

Management Post-op
Administer
IVF

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

SMALL INTESTINE
Disorders
Vomiting,

diarrhea
Gastroenteritis
Malabsorption syndrome
Cystic

Fibrosis (CF)
Celiac Disease (Non-tropical
sprue/Gluten Enteropathy)
Tropical sprue
Regional enteritis (Chrons

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 Cl- transport ( NaCl in

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,NAcetylcystein: mucus

CYSTIC FIBROSIS (CF)

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

Correct

steatorrhea

Pancreatic

enzyme
replacement therapy
Lecithin, Taurine, MCT

CHRONS 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

CHRONS DISEASE

Predisposing

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

CHRONS DISEASE

Predisposing

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

CHRONS DISEASE

Causes
Infectious

(viruses,
Pseudomonas spp.,
atypical
mycobacteria)
Immunologic

CHRONS DISEASE

Causes
Psychosomatic
Dietary

Hormonal
Unknown

CHRONS 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

CHRONS DISEASE
Complications
intestinal

stenosis/stricture due
to abscesses
obstruction
Fistula development
rupture peritonitis

CHRONS 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

CHRONS DISEASE
Signs

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

CHRONS DISEASE
Diagnostic

Procedures
CBC- RBC, WBC
Deranged Serum electrolytes
ileum biopsy- (+) inflammatory
changes
Barium swallow- (+) String
Sign
Endoscopic exam- (+) skip
lesions

CHRONS 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
movt 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

KOCKS 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 pts 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)
DIVERTICULITISinflammation 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 &

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 (cant 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 preoperative 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

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 pts
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
Chrons 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