Chapter 32 Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment, and Therapeutic Measures

Answers CHAPTER 32 GASTROINTESTINAL, HEPATOBILIARY, AND PANCREATIC SYSTEMS FUNCTION, ASSESSMENT, AND THERAPEUTIC MEASURES AUDIO CASE STUDY Grace and Enteral Feedings 1. Collects data on abdominal status—nausea or a full feeling, soft, flat, not distended. Changes and labels enteral tube-feeding administration set every 24 hours, practices appropriate hand hygiene, avoids contamination of feeding tube and feeding formula. 2. Measured the length of the tube and compared it to insertion measurement that was verified with x-ray. 3. Head of Mrs. Patel’s bed was elevated to 30 degrees to prevent aspiration. 4. Head of bed elevated to 30 to 45 degrees to prevent aspiration, appropriate patient hand hygiene practiced, and oral care administered four times daily to remove bacteria. FUNCTIONS OF THE GASTROINTESTINAL SYSTEM 1. esophageal 2. ileocecal 3. pyloric 4. small 5. stomach 6. large 7. small 8. esophagus 9. external 10. salivary 11. teeth, tongue 12. villi 13. rectum 14. bile 1 2 Chapter 32 Answers STRUCTURES OF THE GASTROINTESTINAL SYSTEM Tooth Oral Cavity Tongue Sublingual gland Submaxillary gland Parotid gland Esophagus Liver Lower esophageal sphincter Stomach Gallbladder Common bile duct Duodenum Pyloric sphincter (cut) Transverse colon(cut) Pancreas Ascending colon Jejunum Ileum Cecum Appendix Descending colon Sigmoid colon Rectum Anal canal VOCABULARY BOWEL PREPARATION 1. endoscope 2. bowel sounds 3. colonoscopy 4. gavage 5. impaction 6. occult 7. fluoroscope 8. steatorrhea 9. gastric analysis 10. gastroscopy Corrections are in boldface. LABORATORY TESTS 1. (5) 2. (4) 3. (2) 4. (1) 5. (3) A bowel preparation is required for several procedures that visualize the lower bowel. This preparation is important for effective test results. An incomplete bowel preparation may prevent the test from being done or cause the need for it to be repeated. This can result in the patient’s delayed discharge and increased costs. The patient usually receives a clear liquid diet 24 hours before the test. A laxative may be given. Enemas may be given the evening before and in the morning. Older or debilitated patients should be carefully monitored during the administration of multiple enemas, which can fatigue the patient and decrease electrolytes. In patients with bleeding or severe diarrhea, the bowel preparation may not be ordered by the health care provider. Chapter 32 PANCREAS 1. Trypsin 2. Lipase 3. Amylase LIVER 1. clay 2. clotting 3. radioactive 4. 2 5. bleeding CRITICAL THINKING 1. Explain the procedure to the patient and answer patient questions. 2. By comparing current exposed tube length with documented exposed tube length at insertion. 3. Head of bed up 30 to 45 degrees to prevent aspiration. 4. Label feeding. Ensure correct tube connection is made. Follow tubes back to their site of origin before making a connection to accurately identify the purpose of the tube. Use or advocate for use of ENFit connection tubing to help prevent tubing misconnections to prevent patient injury or death. 5. To carefully control the rate of the feeding and to help ensure the patient’s nutritional needs are met. 6. Provide patient’s free water needs. Consult dietitian. 7. Flush the tube at intervals and before and after administration of medications. Use 30 mL of water every 4 hours to routinely flush the tube. Sterile water may be desired, especially for immunocompromised people, to prevent infection from potentially contaminated tap water. Flushing the tube is done to prevent clogging, and it also provides free water, which counts toward the patient’s daily total free water needs. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. (1, 3, 4) are incorrect. 2. (2) is correct. (1, 3, 4) are incorrect. 3. (1) is correct. (2, 3) are incorrect. 4. (3) is correct. (1, 2) are incorrect. 5. (4) is correct. (1, 2, 3) are incorrect. 6. (1) is correct. (2, 3, 4) are incorrect. Answers 3 7. (3) is correct. Stool cultures must be collected using sterile technique so as not to introduce any pathogens into the specimen that would alter the test results. (1, 2, 4) can be done using clean technique. 8. (4) is correct. The chalky barium will cause the patient’s stool to look white for 1 to 3 days after the procedure. (1) is incorrect. Stools usually gradually return to a brown color. (2, 3) are not associated with the color of barium. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 9. (2) is correct. The gag reflex must return before the patient eats or drinks to prevent aspiration. (1) is incorrect. Keeping the patient nil per os (NPO) does not rest the vocal cords. (3) is incorrect. There is no reason to keep the throat dry after an esophagogastroduodenoscopy. (4) is incorrect. An absent gag reflex does not stimulate vomiting. 10. (3) is correct. A chest x-ray shows correct nasogastric tube placement and should always be done after initial nasogastric tube placement to verify placement is not in the lung. (1) is incorrect. Auscultation of bowel sounds does not confirm tube placement. (2) is incorrect. Nothing should be instilled into the tube prior to verifying tube placement with a chest x-ray. (4) is incorrect. A chest x-ray, not an abdominal x-ray, shows correct nasogastric tube placement. 11. (1) is correct. The lack of bowel sounds is documented as absent. (2, 3, 4) are incorrect. These would indicate there are some bowel sounds. 12. (1, 3, 5, 6) all require either clear visibility or they have a risk of aspiration. (2) is incorrect. A flat plate x-ray can be done with food in the stomach or feces in the bowel, which does not impair visibility of the structures and has no risk for aspiration. (4) is incorrect. It does not require being NPO. 13. (2, 5) are correct. Barium can produce constipation if it is not diluted; it is important the patient be taught to increase fluid intake after the procedure and that stool is normally white for up to 3 days post-procedure. (1) is incorrect. Dysphagia does not result from a barium swallow. (3) is incorrect. Barium can produce constipation, not diarrhea, if it is not diluted. (4) is incorrect. There should be no pain during or after a barium swallow. 4 Chapter 32 Answers 14. (1, 2, 3, 6) help ensure safe tubing connections for enteral feedings. (4) is incorrect. Only staff familiar with the patient should reconnect a disconnected tubing to prevent misconnection. (5) is incorrect. Route tubes/catheters with different purposes in standardized directions (intravenous lines routed toward the patient’s head; enteric lines routed toward the feet). 15. The area where the nurse would measure ascites.