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GI Questions 2Smeltzer (Med-Surg)

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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.
Excessive insulin release can cause dumping syndrome approximately 90 minutes to 3 hrs after eating. What s/sx would clue you into this?
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Abd distention/cramping, borboygmi, nausea Dizziness, diaphoresis, and confusion
Hoyt comes into your ER reporting constant pain 'around his stomach' and saying he's very bloated and having diarrhea. You hear hyperactive bowel sounds in his SI, but by his sigmoid colon there are hypoactive bowel sounds. What is your diagnosis?
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He may have a lower GI obstruction - somewhere within his LI. The clues are constant & diffuse pain, significant abd distention, and possible diarrhea around the impaction.
If the patient presented with intermittent, "colicky" pain and visible peristalsis, what other questions might you ask and why?
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Would inquire whether they were vomiting. Projectile, odorous vomiting usually occurs with a higher GI (small intestine) obstruction. This vomiting usually relieves the pain.
There are four main causes of non-mechanic ileus. Expand upon these four: - Neurogenic - Vascular - Electrolytes - Inflammation
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- Bowel manipulation during surgery/spinal fractures - Insufficient supply or mesenteric emboli - Hypokalemia - Sepsis or peritonitis
In a high obstruction, what will be the Acid-Base concern? With lower?
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A higher obstruction will result in metabolic alkalosis, so expect to see slow breathing to compensate. With lower obstructions, metabolic acidosis occurs, therefore the patient may exhibit deep rapid respirations (Kussmaul's)
Your patient has had an NG tube to continuous suction for 7 days now. What electrolyte are you closely monitoring?
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Potassium!
MacBeth is on your unit for a bowel obstruction. When you assess him in the morning, you find he reports pain that's "was here, then went away, but now it hurts all over." Furthermore, the patient has developed a fever, and palpitation reveals rebound tenderness. What is your concern?
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These findings indicate perforation. A rigid abd might indicate peritonitis.
The obstruction in appendicitis can cause hypoxemia which may lead to gangrene or perforation. Perforation causes ______
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formation of an abscess/peritonitis
T/F: Due to INFx, a patient with appendicitis will have a drastically increased WBC - >20,000
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False: Moderate elevations 10,000-18,000 with left shift. Anything greater than 20,000 indicate peritonitis.
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After assessing your patient Ian, you instinctively think he has appendicitis d/t his N/V, and rebound tenderness over McBurney's point. However, he states he has cramping pain all over. Does this change your opinion?
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It should not - those are early signs. The later sign is constant, intense lower right quadrant pain.
Because you think Ian has appendicitis you immediately _______ and ______ and position _______
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Make him NPO, IV fluids/access, and Semi-Fowler's to contain drainage in lower abd
Ian is in great pain now. He says he thinks he might just be really constipated and is asking for either a heating pad or laxatives. Can you help him with that?
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No, laxatives or a heating pad could cause perforation
With which complication will a patient have an NG tube? A surgical drain?
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NG tube with peritonitis. Perforation usually requires a surgical drain.
What s/sx indicate perforation following appendicitis? What is the Tx?
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*Fever of 101F/38.2C or higher* - Board-like abd - Acutely ill appearance - Decreased urine output/septicemia Administer broad spectrum antibiotics IV
One of your patients is going to surgery for appendicitis. As she is being moved she asks about what her huge scar will look like. What is your reply?
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"Instead of one large incision, there will be a couple little incisions which usually heal nicely."
  
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