Gut Instincts
True/False – it is important to get a person's travel history when considering their current GI issues
True
When an NG, G tube, or J tube should be flushed and with what amount
What is before and after medication administration, 30 mL
A patient on TPN after abdominal surgery needs careful monitoring. Which nursing intervention directly addresses a major risk of TPN therapy?
A. Assess for distention
B. Monitor blood glucose levels every 4 hours
C. Measure daily weights
D. Inspect the peripheral IV site for redness
Answer - B
The RN is supervising a student nurse in administering meds to a pt. with a NG tube. When would the RN intervene?
a.Student compares MAR with original RX
b.Student draws up 30ml sterile water bolus for flush
c.Student performs 3 checks of the medication names and dosages
d.Student crushes tablets and puts all meds in the same cup
Answer D - one med at a time!
Percent of body weight loss for initiating TPN
10%
A patient has just been extubated in the recovery unit after an oral cancer procedure. To promote spontaneous breathing and reduce discomfort, what action should the nurse take?
A. Place in semi-Fowler's or Fowler's position
B. Offer sips of water
C. Apply high-flow oxygen (15L)
D. Apply a warm compress to the neck
Answer A
Ms. D (bowel obstruction) reports feeling weak. She’s more confused compared with her baseline. The NG drainage container has a large amount of watery bile-colored fluid. What labs do you check first?
a.BUN and Creatinine levels
b.Platelet and WBC count
c.Na & K levels, & pH of blood
d.Bilirubin level, H & H
Answer C - Pt is dehydrated, possible Na and K imbalances (most likely LOW = confusion, weakness) - need pH of blood because what state is she possibly in?
Sign that a bowel obstruction has perforated
A. Abdominal cramping
B. Hyperactive bowel sounds
C. Abdominal distension
D. Rigid abdomen
What is D, rigid abdomen
The nurse is providing health promotion teaching to a group of middle-aged adults. At what age should average-risk individuals begin routine colonoscopy screening for colorectal cancer?
Answer - 45 years
45yo admitted to ER with severe abdominal pain – 102F, HR 120, Resp. 32, BP 82/54 – what intervention do you do first?
a.Infuse 1L LR over 30 min
b.Administer IV Toradol
c.Obtain a CT scan of abdomen
d.Draw a CBC
Answer A - Need to increase our BP! Hypovolemic shock. Use fluids first to increase BP, decrease HR, decrease RR
Name five risk factors (modifiable or non-modifiable) of colorectal cancer
Which signs are related to bowel perforation or peritonitis? Select all that apply
a.Guarding of abdomen
b.Increased temperature or chills
c.Progressive abdominal distention
d.Restlessness/Irritability
e.Tachycardia
f.Tachypnea
All of them!
Who do you see first?
a. 42yo acute gastritis – ongoing epigastric pain
b. 60yo n/v – dry oral mucosa & lethargy
c. 70yo hiatal hernia – heartburn
d. 53yo dumping syndrome – recent partial gastrectomy
Answer B - dehydrated!
Who should the new RN get? Select all that apply.
a.Ms. H ( Acute cholecystitis) – had a good night
b.Ms. D (bowel obstruction) – abd. Pain gradually improving
c.Ms. T (ulcerative colitis) – at risk for electrolyte imbalances – TPN/Central Line Mgmt.
d.Mr. A (appendectomy) – D/C home today
e.Mr. K (PEG-tube) – large family, overinvolved, ask a lot of ?’s, argue amongst themselves
f.Mr. R (acute pancreatitis) – confused and beligerant
Answers A, B, D - most stable, least complex
When taking a history for a patient with GI problems, what daily behavior warrants further assessment? Select all that apply.
a.Eats multiple servings of vegetables
b.Takes 800mg of ibuprofen for arthritic pain
c.Walks 30 minutes
d.Chews tobacco
e.Takes Senna to assist with BM’s
f.Listens to music to promote relaxation
Answer: B, D, E