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GI QuestionsSmeltzer (Med-Surg)

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With what population would a nurse expect to prioritize oral care/anticipate problems with oral digestion?
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Immunocompromised, pts on antibiotics
Dysphagia: what cranial nerve has been affected?
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Glossopharyngeal nerve
Your patient aspirated his breakfast. How will you assess his swallowing ability?
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Can they swallow to command. Then try with h20
After your patient comes back to the floor after a barium swallow, your priority is what and why?
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Give MOM because of constipation.
What stimulates the esophagus?
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Liquid, sitting up, food
Your patient has a PMH of GERD, Pna, and COPD. He starts coughing, but says he can handle it without medication. What is your response?
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"GERD weakens your esophagus, so it's more likely to tear. That's why I would like to give you this cough suppressant to prevent the increased pressure."
Hiatal hernias are diagnosed by?
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Barium Swallow
What a S/Sx of a hiatial hernia?
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Heartburn about 30-40 min after meal (dilated LES) - better with food
Nursing care for a hiatal hernia revolves around?
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Education: Eat smaller meals, do not lay down after eating, sleep with the head of the bed up
T/F: You should stop your patient from vomiting because of the increased strain on the GI.
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False: Blood is an emetic (in nosebleeds, always tip head forward), so it's important to not suppress vomiting.
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You are working the 7-3 pm shift at a rural hospital. A young male arrives complaining of constant "heartburn." In questioning him, he reveals he played football for over 20 years. In light of his symptoms and history, you expect him to have?
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GERD. Those who have a weak LES, receive excessive injury (football), pregnant, or weight lifters (valsalva)
What would you expect the doctor to order to diagnose GERD?
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12-36 hr pH testing Esophageal mamometry (measure muscle tone)
What foods should a patient with GERD avoid?
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Foods that relax the LES: Fatty foods Caffeine Peppermint Caffeinated beverages Spicy foods Tomatoes/Citrus Alcohol
A patient with GERD asks if it's okay to go out to drink and party with the boys during Homecoming Weekend. Which is the best response? A) "Sure, you know your limits." B) "You should wait until the medication takes effect" C) "Large amounts of alcohol will relax your esophagus and will increase the occurrence and intensity of your GERD" D) "You should never drink alcohol with this disease"
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C
T/F: Patients with GERD can lay down after eating because of the work it takes to eat.
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False: There is no 'work' involved in eating for these patients. They should remain upright to decrease the pressure put upon their weakened LES.
Mrs. R.B has a PMH of GERD. She says she's just ordered a water bed and can't wait to use it. What is your concern?
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A water bed would be difficult to sleep on with blocks under her pillow - something which is important in patients with GERD.
Mrs. R.B will likely be prescribed _____ to neutralize acid and protect the mucosa, ____ to irreversibly decrease the amount of acid available, _____ to selectively block the h2 receptors, and ____ to promote motility.
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Antacids to neutralize, Protonix (PPI) to irreversibly stop, Zantac or Prilosec to selectively inhibit, and Reglan to increase
What is caffeine's role in GI disorders?
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Promotes gastrin and HCL
In gastritis, what are three possible causes of the inflammation?
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Atrophy of cells, less acid production, or thining of the walls
Which barium swallow would a doctor order for gastritis?
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Upper barium
  
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