Exam 2
Study Guide (Gastrointestinal and Integumentary)
Chapter 43
1. Effect of stress on the GI system
... [Show More] (SATA)
● Norepinephrine
■ Constipation, decreased motility and secretions, increased muscle tone of sphincters
● The nurse is performing an initial assessment of a patient reporting increased stomach acid related to stress. The nurse knows that the healthcare provider will want to consider the influence of what neuroregulator? Norepinephrine
● A patient has been experiencing significant psychosocial stress in recent weeks. The nurse is aware of the hormonal effects of stress, including norepinephrine release. Release of this substance would have what effect on the patients gastrointestinal function? SATA Decreased motility. Norepinephrine generally decreases GI motility and secretions, but increases muscle tone of sphincters.
● The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? "I have learned some relaxation strategies that decrease my stress."
● The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.
● Which of the following interventions are appropriate for clients with gastritis? SATA Use a calm approach to reduce anxiety. Discourage cigarette smoking. Notify the physician of indicators of hemorrhagic gastritis. Provide general education about how to prevent recurrences.
2. Malabsorption disorder (SATA)
■ The hallmarks of malabsorption syndrome from any cause are diarrhea or frequent, loose, bulky, foul-smelling stools that have increased fat content and are often grayish (steatorrhea).
■ Nutritional deficiencies, lack of vitamins/minerals.
■ Absorption occurs when small molecules, vitamins, and minerals pass through the walls of the small and large intestine and into the bloodstream. Elimination occurs after digestion and absorption when waste products are eliminated from the body.
■ Major Enzymes and Secretions:
● Chewing and swallowing: saliva, salivary amylase
● Gastric function: hydrochloric acid, pepsin, intrinsic factor
● Small intestine: amylase, lipase, trypsin, bile
Chapter 44
3. Client education for parenteral nutrition at home (SATA)
➢ Parenteral Nutrition
● A method to provide nutrients to the body by an IV route
● A complex mixture containing proteins, carbohydrates, fats, electrolytes, vitamins, trace minerals, and sterile water is administered in a single container
● The goals of parenteral nutrition are to improve nutritional status, establish a positive nitrogen balance, maintain muscle mass, promote weight maintenance or gain, and enhance the healing process
● May be delivered peripherally or via a central line, depending on the solution’s hypertonicity
Indications for Parenteral Nutrition:
● Intake is insufficient to maintain anabolic state
● Ability to ingest food orally or by tube is impaired
● Patient is not interested or is unwilling to ingest adequate nutrients
● The underlying medical condition precludes oral or tube feeding
● Preoperative and postoperative nutritional needs are prolonged
Nursing Process: The Care of the Patient Receiving Parenteral Nutrition Assessment
● Assist in identifying patients who are candidates for PN
○ Nutrition status; decreased oral intake >1 week
○ Weight loss 10% or more of usual wt
○ Muscle wasting, decreased tissue healing
○ Persistent N&V
● Hydration status
● Electrolytes
● Caloric intake
Nursing Process: The Care of the Patient Receiving Parenteral Nutrition Diagnoses
● Imbalanced nutrition
● Risk for infection
● Risk for imbalanced fluid volume
● Risk for activity intolerance
Purposes and Advantages of Enteral Feedings
➢ Meet nutritional requirements when oral intake is inadequate or not possible, and the
➢ GI tract is functioning
➢ Advantages
➢ Safe and cost effective
➢ Preserve GI integrity
➢ Preserve the normal sequence of intestinal and hepatic metabolism
➢ Maintain fat metabolism and lipoprotein synthesis
➢ Maintain normal insulin and glucagon ratios
4. Post-operative assessment for gastrostomy
➢ Nursing Care of the Patient With a Nasogastric, Nasoenteric, Gastrostomy, or
■ Jejunostomy Tube
■ Patient education and preparation
■ Tube insertion
■ Confirming placement
■ Clearing tube obstruction
■ Monitoring the patient
■ Maintaining tube function
■ Oral and nasal care
■ Monitoring, preventing, and managing complications
■ Tube removal
➢ Patient knowledge and ability to learn
➢ Self-care ability and support
➢ Skin condition
➢ Nutrition and fluid status
➢ Inspection of the tube
➢ Additional care:
● Meet nutritional needs
● Prevent infection: proper use of dressing; skin care around the tube; manipulation of the stabilizing disk to prevent skin breakdown
● Enhance body image
● Monitor for potential complications
A client is recovering Administers an initial bolus of 50 mL water
from percutaneous The first fluid nourishment may consist of water, saline, or 10% dextrose. This
endoscopic may be administered as a bolus of 30 to 60 mL. By the second day, formula
gastrostomy (PEG) tube feeding may begin. A gauze dressing is applied between the tube insertion site
placement. The nurse and the gastrostomy tube. The dressing is changed daily or as needed. The nurse gently manipulates the stabilizing disk daily to prevent skin breakdown.
5. Guidelines for administering parenteral nutrition
➢ Rebound hypoglycemia is a complication of parenteral nutrition caused by "feedings stopped too abruptly. Rebound hypoglycemia occurs when
the feedings are stopped too abruptly.
➢ The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). What actions would the nurse perform while the client receives PN? SATA. "Weigh the client every day. Check blood glucose level every 6 hours. Document intake and output. When a client is receiving PN through a central line, the nurse weighs the client daily, checks blood glucose level every 6 hours, and documents intake and output. These actions are to ensure the client is receiving optimal nutrition. The nurse also performs activities to prevent infection, such as covering the insertion site with a transparent dressing that is changed weekly and/or prn and using sterile technique during catheter site dressing changes."
➢ "The following appears on the medical record of a male patient rec [Show Less]