GI Disorders

Question 1

Liver biopsy steps (5)

Answer 1

• Get informed consent
• Assess coagulation studies
• NPO 8-10 hours before procedure
• Position on affected side to promote hemostasis
• Monitor for bleeding complications

Question 2

Paracentesis steps (9)

Answer 2

• Have patient void
• Get baseline vitals
• Position upright
• Give mild sedation
• Give prescribed IV fluids/albumin to restore fluid balance (4-6 L can be drained)
• Monitor vitals
• Record weight before/after procedure
• Measure abdominal girth before/after procedure
• Assess lab profile before/after procedure (albumin, amylase, protein, BUN, creatinine)

Question 3

Nasogastric tubes (2)

Answer 3

• Levin
• Salem sump

Question 4

Levin NG tube

Answer 4

Single lumen

Question 5

Salem sump

Answer 5

Double lumen

Question 6

Levin tube purpose

Answer 6

Decompress stomach

Question 7

Levin/salem sump nursing interventions (4)

Answer 7

• Elevate head of bed
• Verify placement
• Provide frequent mouth care
• Maintain NPO

Question 7

Salem sump tube purpose

Answer 7

Obtain specimens for analysis

Question 8

Miller-Abbott tube

Answer 8

Double lumen

Question 9

Miller-Abbott tube purpose

Answer 9

Small bowel suction

Question 10

Miller-Abbott nursing interventions (4)

Answer 10

• Reposition every hour
• Don’t tape tube to nose
• Monitor advancement of tube
• Assess color of gastric contents

Question 11

Sengstaken-Blakemore tube

Answer 11

Triple lumen

Question 12

Sengstaken-Blakemoore purposes

Answer 12

• Treatment of esophageal varices

Question 13

Sengstaken-Blakemoore nursing interventions (3)

Answer 13

• Monitor for respiratory distress
• Keep scissors at bedside
• Monitor for signs of shock

Question 14

Gastric pH

Answer 14

1.5-4

Question 15

Intestinal aspirate pH

Answer 15

6

Question 16

Respiratory aspirate pH

Answer 16

7 or higher

Question 17

Small bore NG tube steps (6)

Answer 17

• Use x-ray to verify placement
• Assess gastric pH before each feeding, every 4 hours for continuous feedings
• Maintain semi fowler’s while feeding is infusing
• Assess residual in stomach and reffed residual unless it exceeds the maximum
• Provide nose/mouth care
• Replace tube every 4 weeks

Question 18

Small bore NG tube inserted through skin nursing interventions (5)

Answer 18

• Obtain x-ray to determine placement
• Assess length of exposed tubing (tube migration)
• Assess placement prior to feeding using intestinal pH
• Maintain semi fowler’s position
• Assess residual (greater volume = upward migration)

Question 19

Percutaneous Endoscopic Gastrostomy (PEG) tube nursing interventions (5)

Answer 19

• Assess skin integrity
• Assess residual volume
• Feeding infuse slowly
• Flush with 30 ml warm water before/after feeding
• Maintain semi fowler’s 1-2 hours after feeding

Question 20

TPN nursing interventions (10)

Answer 20

• Confirm placement using x-ray
• Monitor central line insertion site for signs of local infection
• Strict surgical asepsis for dressing changes (every 72 hours)
• Change tubing and remaining TPN every 24 hours
• Monitor for signs of systemic infection
• Monitor glucose, electrolytes, fluid balance
• Prevent air embolism
• Use infusion pump
• Keep 10% dextrose/water available
• For patients receiving fat emulsions monitor for fat overload syndrome

Question 21

S/S of fat overload syndrome (4)

Answer 21

• Fever
• Increased triglycerides
• Clotting problems
• Multi-system organ failure

Question 22

Hepatitis A mode of transmission (3)

Answer 22

• Fecal oral
• Person to person
• Food/water contamination

Question 23

Hepatitis B mode of transmission (4)

Answer 23

• Unprotected sex
• Sharing needles
• Needle sticks
• Blood products, organ transplants before 1992

Question 24

Hepatitis C mode of transmission (4)

Answer 24

- Blood to blood - Illicit IV drug sharing - Unprotected sex - Blood products, organ transplant before 1992

Question 25

Hepatitis A manifestations (3)

Answer 25

- Mild - Flu-like s/s - Older age, chronic disease increase severity

Question 26

Hepatitis B manifestations (9)

Answer 26

- Asymptomatic - RUQ pain - Anorexia - N/V - Fatigue - Febrile - Dark urine - Light colored stool - Jaundice

Question 27

Hepatitis C manifestations (3)

Answer 27

- Asymptomatic - Diagnosed with blood test - Chronic inflammation progresses to cirrhosis

Question 28

Hepatitis A prevention (2)

Answer 28

- Hand washing - Vaccine for 2 years old and older 2 doses 6-18 months apartH

Question 29

Hepatitis B prevention (1)

Answer 29

- Vaccine for infants and high risk populations with 3 doses over 6 month period

Question 30

Hepatitis C prevention (1)

Answer 30

- Avoid high risk behaviors

Question 31

Hepatitis A treatment (2)

Answer 31

- Symptom specific - May change medications to give liver a break

Question 32

Hepatitis B/C treatment (3)

Answer 32

- Anti-viral meds - Give peginterferon alfa-2B (Pegintron) - Monitor kidney function