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GI Questions 2Smeltzer (Med-Surg)

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Question Answer
There is always a risk for INFx when outside materials are introduced to the body cavity. Thus every 4 hours for 48 hours, the nurse must assess..?
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Temperature
How should a patient be positioned post paracentesis?
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On unaffected side for 1-2 hrs.
There is much documentation required after a procedure such as this. The nurse must document descriptions of the fluid removed, the insertion site, and other symptoms. Expand upon these answers.
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- Color, ordor, consistency, and amount of fluid removed - Any leakage at insertion site - S/Sx of hypovolemia or changes in mental status
A priority lab assessment following a paracentesis is:
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Albumin levels --> hypovolemia
After your patient had a paracentesis, you go to check his albumin levels. You see that they are very low. What are you worried about?
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In general, hypovolemia. However, this will eventually cause fluid retention and increased ascites and edema.
Prior to a paracentesis, your patient's vital signs are: Temp 37.2, BP 123/89, HR 80, RR 14. You go into his room after the procedure and find his BP has dropped to 100/68, HR increased to 100, RR 19. He is pale and diaphoretic. What do you suspect?
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Hypovolemia.
A rare but possible complication of paracentesis is bladder perforation. How can this be prevented and what signs should the nurse look for to recognize this?
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Have the patient void before the procedure. Telltale signs include hematuria, supra-pubic pain, low/no urine output, symptoms of cystitis, and fever. Notify immediately.
How much weight is 1 L equal to?
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1 kg (2.2 lbs)
After a paracentesis, you believe your patient is quickly becoming hypovolemic. After notifying the provider, what are your next actions?
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Initiating IV access for plasma expanders or volume replacement.
While assisting in a paracentesis, the patient begins to complain of N/V, his temperature increases, and his abd becomes painful. Upon palpitation, there is rigidity and rebound tenderness. What has happened?
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Perforation of the bowel with the needle
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There are two classic signs exhibited by patients with GERD. What are they?
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Retrosternal heartburn and regurgitation in relationship to eating or activities. *Symptoms usually occur 4-5 times a week on a consistent basis*
You're a nursing student on the floor of a busy hospital floor. You are educating a newly diagnosed 28 year old female on GERD. She says she really loves to party and hopes she'll still be able to do that. What things might you want to inquire about?
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- What does it mean to "party"? Does this include excessive amounts of alcohol? Also, what sort of outfits does she wear? Tight clothing around the midline can exacerbate GERD.
What is the point of a portal-system shunt and a ballon tamponade?
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A portal system shunt uses a balloon to enlarge the portal vein and a stent is put in. With a balloon tamponade, a ballon is inflated to compress the blood vessels, traction, then gradually released when bleeding stops.
Why would instilling normal saline be used to treat esophageal varices?
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The instillment of the 200 mL of NS is then suctioned out, causing vasoconstriction. Continued until return is clear.
If the client is bleeding from these varices (as evidenced by hematemesis, hypotension, tachycardia, melena), what are your nursing actions?
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Establish IV access, monitor vital signs/hematocrit, and type and cross match for possible transfusion.
Juline is admitted for esophageal varices. As her nurse, you would expect to see the doctor order what two drugs?
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1. Beta blockers: decrease the heart rate and the amount of hepatic venous pressure 2. Vasopressors to decrease portal INFLOW
Your patient returns to your floor after undergoing a gastrectomy with a laparoscopy. She routinely complains of gas pains and requests pain medications. Do you give them?
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Of course, if the patient states they are in pain, they should be given relief. However, many times these are gas pains and relieved by ambulation. Suggest ambulation first, then any medications PRN.
Samantha is a 67 year old female who will be going for a CAT scan. She states she hates fish cause it makes her itchy. Do you have any concerns with her leaving the floor?
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Yes, her statement may indicate she has an allergy to shellfish which could mean she will be allergic to the iodine.
Iris, your patient, just came up to the floor from the PACU. The nurse gives report and says the surgeon put an NG tube in. Twenty minutes later you notice the tube seems to be clogged. Is it okay to irrigate the tube?
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No. The surgeon placed it in its specific location for a reason, and your interventions could cause disruption of the sutures. Talk with the provider before irrigating or repositioning.
After a gastrectomy, the patient has hardly any stomach left. Although much of the absorption occurs in the SI, what supplements might this patient need?
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Vitamin b12, vitamin D, calcium, iron, and folate
If 30 minutes after eating, your patient (post op day 5 from abd surgery) complains of vertigo, and your assessment reveals tachycardia, diaphoresis, and palpitations - what might be the problem? What is your next action?
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These are indicators of early dumping syndrome. Instruct the client to lie down - this will slow the rate of movement.
  
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