Worst Case Scenario
This is a sign
Name that condition
Food for thought
Who's on First?
100
Bernie just arrived 30 minutes ago after having an EGD. The tech reports that Bernie's temp is now 100.8. What is the priority intervention?
Assess the patient for signs of perforation:
sudden onset of abdominal pain
board-like abdomen
signs of shock
100
Periumbilical bruising
This is Cullen's Sign = Pancreatitis
100
Result of an incompetent lower esophageal sphincter.
GERD
100
The word to avoid, on a food label, to keep away from transfat
hydrogenated
100
Which patient do you administer Omeprazole (Prilosec) to first?
a. Barney who is NPO
b. Wilma who ordered from Uber Eats and the meal will be here in 30 min
c. Betty who ordered Jimmy Johns and it will be here in 5 minutes because they are freaky fast.
d. Fred who ate hospital food already because he couldn't wait.
b. Wilma. Proton pump inhibitors should be given 30min prior to the first bite of food for maximum benefit.
200
A family member brings in a McDonald's meal and the patient eats it despite being on NPO for a swallow study. What could happen besides the obvious choking?
Aspiration pneumonia
200
Melena
GI bleed (dark feces indicate "old blood" from the stomach as opposed to bright red blood from a hemorrhoid).
200
Sally has been hospitalized for 10 days in ICU with an NG tube in place on continuous suction. Her tube was removed today and she doesn't want to eat because she feels full and has epigastric tenderness with nausea. What condition might this be and why?
Gastritis due to the the breakdown of gastric mucosa secondary to NG on continuous suction. It would have been less traumatizing to the gastric mucosa if the NG was set to intermittent suction.
200
Rice and beans will give you all 9
Amino Acids
200
Who do you see first? A patient with
a. surgery planned for hiatal hernia
b. suspected gastric cancer who is NPO
c. PUD with sudden onset of acute stomach pain
d. fractured jaw 2 days ago requesting pain meds
c. acute onset of pain is a red flag.
d. keep pain from getting out of control
b. Ensure understanding of NPO for test
a. Reinforce pre-op and post op expectations
300
Reabsorbed bile irritates the gallbladder causing ischemia and infection leading to perforation and this.
Peritonitis which can lead to sepsis.
300
Bruising of the flanks
Turner's sign = seepage of blood stained exudates into tissue as a result of pancreatic enzyme actions
300
Disease characterized by an ulceration that penetrates the mucosal wall of the GI tract.
PUD
300
Too much of these can give you the thing you are trying to prevent
Fat soluable vitamins A D E K
300
Who do you see first? A patient who
a. Is eating lunch in High Fowler's
b. Has an NG and is resting with HOB at 30 degrees
c. Just had an EGD and is lying supine
d. Has GERD and is in chair after eating meal
c. Post EGD patients should be low Fowler's since this position relaxes abdominal muscles.
400
You have two patients:
Patient A has a blood sugar of 40mg/dl
Patient B has a blood sugar of 200mg/dl
which is the worst case scenario?
Patient A may go into coma, get some Dextrose STAT!
400
Hand spasm when blood pressure cuff is inflated
Trousseau's sign =secondary to hypocalcemia seen in pancreatitis.
400
Frank works at UPS pushing harbor freight (50 LB boxes) out of a 26 foot truck all night long. He denies heartburn when lying down but does complain of unstoppable hiccups at times and bloating and breathlessness after eating. Which hiatal hernia might this be?
Paraeophageal (Rolling) Hiatal Hernia 
sphincter still works so no GERD
400
When you take this medication, it is best to wait one hour before taking your other medications.
aluminum hydroxide (antacid). It would decrease the stomach acid therefore slowing the breakdown and absorption of your other medications.
400
Who do you see first? A patient
a. Has vomited 3 X in the past 2 hours
b. Has had second diarrhea stool after taking Milk of Magnesia
c. Reports heartburn after eating hot wings
d. Reports feeling sleepy after taking Reglan
a. The person at highest risk is the one whose current condition puts them at risk. This patient is loosing Potassium and other electrolytes. If the potassium drops too low, this can interfere with electrical activity of the heart.
500
Dobhoff feeding tube is inserted into the patient, but aspirate on pH strip turns blue. What does this mean?
Tube may be in the lung. Get an x-ray STAT.
Dobhoff's are very small and the patient may not cough when it is in their airway.
500
Kelly has a sore on her lower lip that doesn't seem to heal; it bleeds easily and appears to be a rough patch.
What might this be?
Oral cancer
500
Complication of GERD
Barrett's esophagus (strictures)
500
Tommy's breakfast consists of:
2 eggs scrambled
2 pieces of wheat bread toast
A small bowel of blueberries
1 cup of coffee
Which item may trigger his GERD?
Coffee = caffeine
Other triggers include
Tomatoes, alcohol, chocolate, and peppermint (Thanks Sonic)
500
Who do you see first? A patient who
a. is a recovering alcoholic on TPN, complaining of diarrhea
b. has dentures in and getting ready to go for an EGD
c. has just had their third BM after a Barium swallow
b. Dentures must be removed prior to an EGD
Slow rate of TPN if having diarrhea
Patients should have multiple BMs to rid the body of the Barium after a Barium swallow test.