GI CH 44-48

A nurse is teaching a client about bowel health promotion. Which interventions promote healthy bowel function?

Increase dietary fiber, exercise regularly, and increase fluid intake. These interventions improve peristalsis and help prevent constipation.

What is the function of peristalsis in the gastrointestinal tract?

Peristalsis is the rhythmic muscular movement that propels food through the alimentary canal. It may slow, stop, or increase with disease.

What is the alimentary canal?

The alimentary canal is the digestive tube extending from the mouth to the anus.

Which enzymes begin chemical digestion in the mouth, and what do they digest?

Salivary amylase begins carbohydrate digestion, and salivary lipase begins fat digestion.

A client receiving chemotherapy reports painful mouth ulcers. Why is this concerning?

Stomatitis can make eating difficult, leading to malnutrition and nutritional deficiencies.

What complications can occur from ill-fitting dentures?

Dentures may create a choking hazard, become swallowed, or obstruct the airway.

A newborn develops coughing, gagging, and aspiration during feeding. Which disorder should the nurse suspect?

Tracheoesophageal fistula (TEF), an abnormal connection between the trachea and esophagus that requires surgical repair.

What are the manifestations of esophageal atresia?

Food backup, gagging, vomiting, and swallowing difficulties.

Which foods commonly cause esophageal obstruction in children and older adults?

Children commonly choke on grapes and coins, while older adults frequently experience obstruction from steak or chicken.

What medication may be administered to relax the esophagus in a client with food impaction?

Glucagon may relax the esophageal smooth muscle and help relieve the obstruction.

What causes Barrett's esophagus?

Chronic gastroesophageal reflux disease (GERD) and tobacco smoke can cause precancerous changes in the esophageal lining.

Why are esophageal varices considered life-threatening?

Rupture can result in massive hemorrhage due to portal hypertension and liver cirrhosis.

What treatments are used for bleeding esophageal varices?

Ligation, cauterization, and vasoconstrictor injections such as epinephrine.

What is the function of the lower esophageal sphincter?

It prevents reflux of stomach contents back into the esophagus.

What are the functions of hydrochloric acid in the stomach?

Hydrochloric acid breaks down food and destroys many ingested bacteria.

Why is intrinsic factor important?

Intrinsic factor is necessary for vitamin B12 absorption. Deficiency can lead to pernicious anemia.

A client undergoes a gastrectomy. Which vitamin deficiency is the nurse most concerned about?

Vitamin B12 deficiency because part of the stomach responsible for intrinsic factor production may be removed.

A newborn has projectile vomiting after feedings. Which condition should the nurse suspect?

Pyloric stenosis, which occurs when the pyloric sphincter fails to open properly.

A client reports severe chest pain that mimics a myocardial infarction. Which gastrointestinal disorder should the nurse suspect?

Hiatal hernia.

What surgery is commonly performed to treat a hiatal hernia?

Nissen fundoplication, which wraps the stomach around the lower esophagus to prevent reflux.

Which section of the small intestine receives bile and pancreatic enzymes and begins nutrient absorption?

The duodenum receives bile and pancreatic enzymes and is the primary site where nutrient absorption begins.

Where does final digestion and absorption occur in the gastrointestinal tract?

Final digestion and absorption occur in the ileum.

What is the function of the ileocecal valve?

The ileocecal valve prevents backflow from the large intestine into the small intestine.

What are the four sections of the colon?

Ascending colon, transverse colon, descending colon, and sigmoid colon.

What happens to stool consistency as it moves through the large intestine?

Stool changes from liquid in the ascending colon to a formed mass in the descending and sigmoid colon.

A client cannot absorb nutrients through the duodenum after surgery. Which form of nutrition is indicated?

Total parenteral nutrition (TPN) administered through a central line.

What is the difference between enteral and parenteral nutrition?

Enteral nutrition uses the gastrointestinal tract, while parenteral nutrition bypasses the GI tract and is given intravenously.

What is peritonitis?

Peritonitis is an infection of the peritoneum that can become life-threatening.

What is the primary function of bile?

Bile emulsifies fats to aid in digestion and absorption.

Why do gallstones cause severe pain?

Gallstones are often sharp or jagged, causing pain when the gallbladder contracts to release bile.

What changes should a nurse teach a client to expect after a cholecystectomy?

Bile flows continuously into the duodenum, and stool color may temporarily change before returning to normal.

Name four important functions of the liver.

Produces bile, stores glycogen, synthesizes clotting factors, and detoxifies drugs.

Which fat-soluble vitamins are stored in the liver?

Vitamins A, D, E, and K.

What are the endocrine functions of the pancreas?

The pancreas secretes insulin and glucagon to regulate blood glucose.

What is the exocrine function of the pancreas?

The pancreas produces digestive enzymes and bicarbonate to digest nutrients and neutralize stomach acid.

Which age-related gastrointestinal changes increase the risk for constipation in older adults?

Decreased gastric secretions, decreased intestinal motility, and overuse of laxatives.

What teaching should the nurse provide after an upper GI series with barium?

Increase fluid intake to prevent constipation caused by barium.

What are the nursing priorities after an endoscopy (EGD)?

Monitor the gag reflex and assess for bleeding and perforation.

What laboratory value is most important to check before a liver biopsy?

Prothrombin time (PT/INR) because the liver produces clotting factors.

How should the nurse position a client after a liver biopsy?

Position the client on the right side with pressure under the ribs and monitor vital signs and pain closely.

What are common manifestations of anorexia related to GI disorders?

Loss of appetite, nausea, malnutrition, decreased protein and albumin levels, and electrolyte imbalances.

A client with persistent nausea and vomiting develops confusion and decreased level of consciousness. What electrolyte imbalance should the nurse suspect?

Hyponatremia (low sodium), which can cause confusion, disorientation, arrhythmias, and decreased LOC.

Which interventions are used to manage nausea and vomiting?

IV fluids, electrolyte replacement, antiemetics such as Zofran, ginger, and gradual introduction of foods using the BRAT diet.

What are the classic manifestations of GERD?

Epigastric burning, regurgitation, inflammation, and nocturnal aspiration.

Which foods should a client with a hiatal hernia or GERD avoid?

Chocolate, caffeine, spicy foods, and highly seasoned foods because they weaken the lower esophageal sphincter.

A client with peptic ulcer disease reports black stools and abdominal pain radiating to the back. What additional assessment finding supports peptic ulcer disease?

Chronic gastric inflammation and blood in the stool or vomit.

Which medications are commonly used to treat peptic ulcer disease caused by H. pylori?

Antibiotics such as amoxicillin, proton pump inhibitors (PPIs), and H2 blockers.

What symptoms are associated with dumping syndrome after gastrectomy?

Nausea, sweating, diarrhea, and abdominal pain after eating.

What teaching should the nurse provide to a client with dumping syndrome?

Avoid sitting upright after meals, limit sweets, avoid drinking fluids with meals, and eat small, frequent meals.

Why should a nurse avoid flushing or manipulating a nasogastric tube after a gastrectomy?

Manipulation can disrupt the surgical sutures and cause injury.

What nursing considerations are important for a client receiving TPN?

TPN requires a central line, frequent glucose monitoring, infection prevention, and gradual discontinuation to prevent hypoglycemia.

What assessment findings are expected in constipation?

Infrequent bowel movements, hard and dry stools, abdominal discomfort, and straining.

What complications can result from severe diarrhea?

Dehydration, electrolyte imbalances, vitamin deficiencies, and malnutrition.

What are common manifestations of irritable bowel syndrome (IBS)?

Mucus in the stool, abdominal distention, abdominal pain, diarrhea, constipation, or alternating bowel patterns.

Which medications may be prescribed to treat irritable bowel syndrome?

Antispasmodics such as hyoscyamine and dicyclomine, along with dietary and stress management.

Which portion of the GI tract is affected by Crohn disease?

Crohn disease can affect any part of the GI tract and involves full-thickness ulceration.

What diet is recommended during a Crohn disease flare-up?

A low-fat, low-fiber, high-protein diet to reduce symptoms and improve nutrition.

What serious complication is associated with ulcerative colitis?

Toxic megacolon, which is a life-threatening dilation of the colon.

What assessment findings are commonly seen in ulcerative colitis?

Bloody diarrhea, abdominal pain, dehydration, and anorexia.

What is the difference between an ileostomy and a colostomy?

An ileostomy is created from the small intestine (ileum), while a colostomy is created from the colon.