What teaching would you provide to a client with GERD?
Don't lie down for 2 hours after eating.
Following an X-ray (with barium contrast) of the patient's upper GI, what nursing measure would you take?
Give the patient a laxative to stimulate peristalsis (barium is constipating).
A patient with GERD complains of heartburn. Which food would you instruct the patient to eliminate from his diet?
Eliminate hot chocolate (because it's fatty, chocolate, and caffeinated).
A patient with GERD complains of a chronic cough. What potential complication does this signal?
Aspiration of stomach contents.
A patient with GERD is given urecholine. What adverse effects would you anticipate?
Urinary frequency, diarrhea, increased saliva, hypotension (this drug is a cholinergic...used to increase gastric emptying).
What diet changes would you recommend to decrease GERD?
Patient will decrease intake of fats; patient will eat small, frequent meals.
Patient has a sliding hernia that is causing reflux. What is a primary s/sx?
What are causes of a hiatal hernia?
Obesity (increased abd pressure); heavy lifting; pregnancy; old age.
Milk of Magnesia is given for the patient's hiatal hernia. What is an adverse effect of taking MOM for too long?
Patient underwent a gastrectomy. The OR nurse must report to the PACU nurse. What is the best way to report?
Use individualized, printed check list (these nurses are in two different places in the hospital, so face-to-face hand-off won't happen).
What is the recommended colon cancer screening for non-high-risk clients?
Annual fecal testing > age 50.
A patient with ulcerative colitis has had s/sx present for > 1 week. For what is patient at greatest risk?
Hypokalemia (lose K and Na in diarrhea).
Crohn's patient is admitted to the hospital with fever, abd pain, wt loss, and diarrhea. For what is he at greatest risk?
Patient admitted for a bowel obstruction and has N/V, abd pain, and cramping. List priority of nursing actions.
1. Assist with ambulation (to try to induce peristalsis)
2. Give Lactated Ringer's IV
3. NG tube
Crohn's patient is on TPN. What are the nursing responsibilities?
Weigh daily, monitor IV infusion rate hourly, tape all tubing securely, vitals q4hrs, CVC dressing change 1x per week (unless signs of infection, drainage, etc.).
What is the most appropriate diet for a patient with ulcerative colitis?
High protein, low residue.
Patient has C. diff. How does the nurse prevent it from spreading?
Wash hands with soap & water; wear protective clothing.
(Note: alcohol gel will NOT kill C. diff.)
You discover the patient's TPN is running at the wrong rate and is 2 hours behind schedule. The nursing action would be?
Patient had an abdominal peroneal ressection and his stitches have torn. What is your first action?
Cover the wound with sterile gauze wetted with NS.
What lab value would you expect to see in a patient with diverticulitis?
Elevated WBC count.