DIAGNOSTICS
Prior to a colonoscopy the client needs to undergo.. and the client must provide..
Colon/bowel cleansing and the client must provide informed consent
The patient diagnosed with GERD complains of regurgitation after eating large meals. After further investigation he stated he just likes to lay down after meals and does not like staying up. What can the nurse teach to prevent future episodes from occurring?
Try not to eat at least an hour or 2 before you go to bed.
No late night snacks.
What is a major complication for a patient diagnosed with ulcerative colitis ?
Hemorrhage due to rupture of bowel
Medication used to decrease elevated ammonia levels in patients with diagnosis of hepatic encephalopathy
Lactulose
Procedure used to remove fluid from the peritoneal cavity
Paracentesis
The provider suspects the patient has c. diff. what test can the nurse anticipate will be ordered?
Stool culture/exam
Causes/risk factors for peptic ulcer disease (PUD).
NSAID use- disrupts mucous barrier
H. pylori
GERD
A patient previously diagnosed with Crohn’s disease states he is going through an exacerbation period, what dietary changes should the nurse instruct the client to make until symptoms subside.
Decrease fiber
Increase protein, calories and fluids.
What education is important for a patient who has been prescribed with Metoclopramide (Reglan)
Patient should be educated to report to MD extrapyramidal symptoms such: erratic movements of tongue, lip smacking and muscle rigidity.
A client has been experiencing pain in the RLQ for 3 days and it’s becoming severe. Before heading to the ER he calls the nurse at his PCP office for advice and asks if he should apply a warm or cold compress to the area to help with pain. What is the nurse’s best response?
You should avoid a hot compress because it can cause the appendix to rupture. An ice pack is recommended as long as it's on for only 20 minutes at a time.
What test would NOT be performed if the patient is admitted to rule out a small bowel obstruction?
Barium swallow test
What are the three major complications of PUD?
Hemorrhage, perforation, gastric outlet obstruction.
The patient just underwent an MRI due to having RLQ pain for the last 2 days that was described as crampy and tender upon palpitation. The MRI revealed a cobblestone appearance of the intestine. What is the likely diagnosis?
Crohn's disease.
A patient newly diagnosed with GERD is prescribed famotidine (H2 receptor antagonist), what is this patient at risk for?
The patient is at risk of GI infections due to decreased stomach acid secretions.
A patient complains of sudden, severe mid epigastric pain/LUQ, nausea and vomiting along with a fever. When the nurse assesses the patient, she notices a bluish discoloration of the flank and umbilicus. What does the nurse anticipate as a possible diagnosis?
Pancreatitis
The patient is post-endoscopy and received a local anesthetic and sedative prior. The procedure went well and no complications occurred. What are the top 2 nursing priorities/assessments when this patient returns to the floor?
Respiratory function- return of gag reflex, airway is priority as this places patient at risk for aspiration.
Neurological function-patient is coming off of anesthesia.
The patient was just admitted with a diagnosis of gastritis, what are some educational points the nurse can implement/teach?
No laying down after meals
No NSAIDs, must find alternatives
No smoking
Limit fluid intake during meals
The patient presents to the ED with extreme dehydration and states they have been throwing up for the last 48hrs. Their last bowel movement was 3 days ago. What are the top 5 nursing priorities/orders that would be indicated/anticipated for this patient?
1)NPO- until we determine the cause allow GI to rest
2)IVF- isotonic
3)NGT
4)Monitor/ strict I& O's
5)Prevent aspiration
When is the best time of the day for the patient who is newly prescribed with Omeprazole to take this medication to maximize effectiveness?
The patient should take omeprazole 30 minutes prior to the first meal of the day.
A patient with a diagnosis of Cirrhosis is developing complications, as a result of portal hypertension there are increased esophageal varices, what are two major contraindications to avoid rupture and hemorrhage?
Straining when having a bowel movement
Insertion of a Nasogastric Tube.
A patient presented to the ER after being on a 4 day bender of extreme alcohol intake. The triage nurse suspects pancreatitis. What lab values would confirm this diagnosis?
Increase amylase, lipase, and WBC.
How do you differentiate between a upper and lower GI bleed?
Upper= vomiting bright red/coffee grounds
Lower= dark tarry stools
Patient complains of tenderness at McBurney's point upon palpitation and vitals show a low grade fever. When palpating the LLQ pain is felt in the RLQ. CBC reveals increased WBC's and increased C-reactive protein levels. What is the potential diagnosis?
Appendicitis
A patient is prescribed with antacids, when should the patient take this medication in regards to other medications for best effectiveness?
The patient should take antacids one hour before or two hours after other medications.
Patient presents with signs and symptoms of severe upper abdominal pain that radiates to the right shoulder blade and positive Murphy’s sign, what is the cause?
Cholecystitis