Chapter 33 Nursing Care of Patients with Upper Gastrointestinal Disorders

Answers CHAPTER 33 NURSING CARE OF PATIENTS WITH UPPER GASTROINTESTINAL DISORDERS AUDIO CASE STUDY Darnell and Peptic Ulcer Disease 1. The bacteria called Helicobacter pylori, commonly referred to as “H. pylori.” 2. Burning, gnawing pain in the high-left epigastric region. Pain when food is eaten or 1 to 2 hours after eating. Anorexia, nausea, and vomiting also may occur. 3. The most effective treatment for H. pylori is triple therapy: two antibiotics to decrease bacterial resistance and a proton pump inhibitor (PPI) or H2-receptor antagonist. VOCABULARY 1. Helicobacter pylori 2. anorexia 3. gastritis 4. aphthous stomatitis 5. bariatric 6. steatorrhea 7. gastrectomy 8. obesity 9. hiatal hernia 10. gastrojejunostomy GASTRITIS 1. (1) 2. (2) 3. (1) 4. (3) 5. (2) 6. (1) 7. (3) 8. (1) PEPTIC ULCER DISEASE Corrections are in boldface. Most peptic ulcers are caused by the bacterium Helicobacter pylori. Peptic ulcers are commonly found in the duodenum. Symptoms of peptic ulcers include burning and a gnawing pain in the epigastric region. With a duodenal ulcer, there is pain and discomfort on an empty stomach, which may be relieved by ingesting food. Peptic ulcers can be cured. Medication treatment for peptic ulcers caused by H. pylori should include antibiotics as indicated. 1 2 Chapter 33 Answers GASTRECTOMY Vagus nerve Distal portion resected Stomach joined to jejunum Total resection of cancerous stomach Stomach joined to duodenum Esophagus Diaphragm Jejunum Duodenum CRITICAL THINKING 1. The nurse’s first action is to prevent Mrs. Sheffield from aspirating. The nurse maintains Mrs. Sheffield in a sidelying position, reminds her to remain in this position, and props her up with pillows so she does not aspirate. The nurse verifies that the nasogastric (NG) tube is patent and suction is working. 2. The next action is to take her vital signs. 3. The nurse believes that Mrs. Sheffield is in the early stages of hypovolemic shock (increased pulse and respirations, decreased temperature and blood pressure, and diaphoresis) and that her gastric bleeding needs to be stopped immediately. The nurse maintains the intermittent low-wall suction to remove the gastric output and thus prevent further gastric distention and vomiting. The nurse also maintains the intravenous (IV) fluids to compensate for the fluid loss. The nurse immediately notifies the health care provider of Mrs. Sheffield’s condition. 4. Report current vital signs; signs and symptoms, including diaphoresis, nausea, slightly and distended abdomen; intake and output, including vomitus (amount and color), nasogastric output (amount and color), IV (solution and rate), and urine output since return to the unit; and other data, such as the time Mrs. Sheffield returned from the perianesthesia care unit, her vital signs upon return to the unit, and other general pertinent data collected upon return to the unit. 5. Apply oxygen at 2 L/min via nasal cannula and reassure the patient that her condition is being closely monitored and that her HCP is taking her back to surgery to repair her abdomen. Ensure the laboratory work is done and review the results. Gather the equipment necessary to transport Mrs. Sheffield to surgery with oxygen, an emesis basin, and some extra blankets. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (1) is correct. Gastrectomy is the only effective treatment for gastric cancer. (2) is incorrect. Gastric stapling is a surgical treatment for obese patients. (3) is incorrect. Gastroplasty reduces the size of the stomach to treat morbid obesity. (4) is incorrect. Gastrorrhaphy is suturing of the stomach wall. 2. (1) is correct. A painless ulcer is common early in oral cancer. (2) is incorrect. White painful ulcers describe aphthous stomatitis (canker sore). (3) is incorrect. Feeling of fullness occurs with hiatal hernia or esophageal cancer. (4) is incorrect. Heartburn occurs with hiatal hernia. 3. (2) is correct. Esophageal dilation is performed to enlarge the esophagus and allow food to pass the obstruction caused by the tumor. (1) is incorrect. Gastrectomy is done for stomach cancer. (3, 4) are incorrect. Radical or modified neck dissection is performed for oral cancer that has metastasized to cervical lymph nodes. Chapter 33 REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 4. (4) is correct. Topical tetracycline can aid healing canker sores. (1) is incorrect. Oral care should be maintained. (2) is incorrect. Mouthwash could be painful. (3) is incorrect. Acyclovir, an antiviral, will not help heal a canker sore. 5. (1) is correct. Anorexia is a symptom of chronic gastritis type B. (2) is incorrect. Dysphagia is seen in gastroesophageal reflux disease. (3) is incorrect. Diarrhea is not a sign of chronic gastritis type B. (4) is incorrect. A feeling of fullness can occur in patients with dumping syndrome. 6. (1, 2, 4, 5) are correct. Diaphoresis and hypotension are common signs of hypovolemic shock. Restlessness and confusion are an indication of altered oxygenation, which accompanies shock. (3) is incorrect. The pulse would be weak and thready, not bounding. 7. (3) is correct. A low-fat diet is advised to decrease the fat content in the stool. (1) is incorrect. A soft diet does not address the patient’s problem of inadequate mixing of food with pancreatic and biliary secretions to digest fats; a low-fat diet would be more helpful for this. (2) is incorrect. A high-carbohydrate diet does not prevent fat from being introduced in the diet. (4) is incorrect. A pureed diet would not be helpful because it could contain fat. 8. (2, 4, 5) are correct. Diet management with calorie restrictions and eating healthy along with exercise are the first interventions used to promote weight loss in the obese patient because they are noninvasive. Also, monitoring the patient in a diet and exercise program gives the health care provider information about the patient’s metabolism, food preferences, food habits, rate of weight loss, and activity tolerances. (1, 3) would not be the initial treatment for weight loss. Counseling may be added to the treatment plan if needed. (6) is incorrect. A healthy, balanced diet, not fasting, would be recommended for weight loss. 9. (1) is correct. Eating small, frequent meals that can pass easily through the esophagus prevents the rapid filling of the stomach and thus heartburn and regurgitation. (2) is incorrect. The patient should avoid reclining for 1 hour after eating because reclining would promote reflux, not prevent it. (3) is incorrect. The patient should sleep in an elevated position to prevent reflux by raising the head of the bed on 6-inch blocks and using pillows. (4) is incorrect. Eating 3 hours or less before bedtime should be avoided so the stomach is empty to prevent reflux. 10. (4) is correct. Start the oxygen first. Use the Maslow hierarchy to help prioritize interventions. Oxygen Answers 3 administration will increase the amount of oxygen in the vascular system, thus increasing the oxygen to the tissues. (1) is incorrect. The intravenous bag should be hung next to help restore and maintain volume. (2) is incorrect. The laboratory can be called to draw blood for a complete blood count while other interventions are occurring. The complete blood count will give a hemoglobin level that will indicate oxygen-carrying capacity. (3) is incorrect. While the patient’s blood is being drawn and processed, insert the nasogastric tube, which will decompress the stomach, and keep the head of the bed up 30 to 45 degrees to prevent aspiration of any emesis. 11. (4) is correct. Foods that cause discomfort need to be identified so they can be avoided. (1) is incorrect. Large meals promote reflux, so small meals should be eaten. (2) is incorrect. Sleeping flat without pillows promotes reflux, so the patient should be elevated. (3) is incorrect. Lying down after each meal would promote reflux, so the patient should sit up for 2 hours after a meal. 12. (3) is correct. Fundoplication, in which the stomach fundus is wrapped around the lower part of the esophagus, is the most common surgical procedure performed for a hiatal hernia. If dysphagia occurs, the health care provider should be notified right away because the repair may be too tight, causing obstruction of the passage of food. (1, 2, 4) can be common after surgery, are not of a serious nature, and should have postop orders in place for intervention. 13. The area that is producing the coffee ground appearance of the patient’s vomit.