Gastrointestinal

 Gastrointestinal

Case Study:

Bruce Eggert, age 59 years, was brought to the ED with complaints of dizziness, dyspnea, restlessness, and anxiety.  Mr. Eggert currently works as an accountant for a large firm.  He is married and has two children living at home.  He reported a 2 day history of hematemesis with some bright red blood and large amounts of “coffee ground” emesis.  Mr. Eggert denied any recent or chronic illnesses and was unable to remember if anyone in his family had ever had problems with GI tract bleeding.  He did admit to drinking six to eight alcoholic beverages almost every day for the past 7 years.  Initial assessment revealed cool and clammy skin, a distended abdomen with hyperactive bowel sounds, and tachycardia. He is allergic to Codiene, Full Code, Ht: 59” WT 210lbs. Current vital signs and laboratory results are as follows:

BP – 92/60 mmHg HR – 120 bpm Respirations – 28 breaths/min

Temp – 36.9° C (98.3 °F oral) Ammonia 60 mcg/dl

Glucose – 87 mg/dl LDH – 500 U/L AST (SGOT) – 950 U/L

ALT (SGPT) – 1000 U/L Alkaline Phosphatase – 165 U/L

Total Bilirubin – 2.5 mg/dl Albumin – 2.3 g/dl

PT – 26 sec PTT – 85 sec

Three hours after arriving in the ED, Mr. Eggert was admitted to the ICU with an IV of NS.  Two units of PRBC’s were administered.  Twenty units of vasopressin (Pitresssin) in 100 ml of D5W were given IV over 20 minutes.  A continuous infusion of vasopressin at 0.4 units/min was then initiated.  Sublingual NTG was added to the medication regimen.  Diagnostic fiberoptic endoscopy, immediately preceded by a saline lavage, was scheduled for the following day.  Endoscopy revealed a large esophageal varix (1.5 cm) above the gastroesophageal junction.  Only a small amount of bright red blood was observed, so sclerotherapy was performed.  A solution of 5% ethanolamine oleate was given by intravariceal injection.  Mr. Eggert’s condition remained stable after sclerotherapy and he was transferred to a medical floor.  Subsequently sclerotherapy sessions were scheduled on a weekly basis for 4 weeks.

Answer the following questions in full sentences and typed.

1.  Define and discuss the pathophysiology of esophageal varices and portal hypertension.

2.  What do Mr. Eggert’s laboratory test results indicate about his current health status?  How do these support his diagnosis of portal hypertension and esophageal varices?

3.  Identify the relevant nursing diagnoses for Mr. Eggert while he is in the ICU.

5.  Identify the diagnostic procedures and nursing implications for esophageal varices.

HESI Review Questions

Please select the best answer for the following questions

1.  A client has a total gastrectomy.  The nurse explains to the client the need for long-term injections of which of the following vitamins?

____A.  Thiamine

____B.  Folic acid

____C.  Cyanocobalamin

____D.  Niacin

2.  The client who has ulcerative colitis is scheduled for an ileostomy.  When the client asks the nurse what to expect related to bowel function and care after surgery, what response should the nurse make?

____A.  “You will be able to have some control over your bowel movements.”

____B.  “The stoma will require that you wear a collection device all the time.”

____C.  “After the stoma heals, you can irrigate your bowel so you will not have to wear a 

                pouch.”

____D.  “The drainage will gradually become semisolid and formed.”

3.  The nurse is conducting dietary teaching with a client who has dumping syndrome.  The nurse encourages the client to avoid which of the foods that the client usually enjoys?

____A.  Eggs

____B.  Cheese

____C.  Fruit

____D.  Pork

4.  The client returning from a colonoscopy has been given a diagnosis of Crohn’s disease.  The oncoming shift nurse expects to note which of the following manifestations in the client?

____A.  Steatorrhea

____B.  Firm, rigid abdomen

____C.  Constipation

____D.  Enlarged hemorrhoids

5.  The nurse should evaluate results of which of the following laboratory tests for a client who has cirrhosis in order to plan for safe care?

____A.  Prothrombin time

____B.  Urinalysis

____C.  Serum lipase

____D.  Serum troponin

6.  The nurse is caring for a client with a history of alcoholism.  Which of the following findings would indicate that the client has possibly developed chronic pancreatitis?

____A.  Steady weight gain

____B.  Flank pain on left side only

____C.  Fatty stools

____D.  Excessive hunger

7.  A nurse is assigned to four clients who have been diagnosed with gastric ulcers.  Which one of these clients should the nurse conclude is most at risk to develop GI bleeding?

____A.  A 40-year-old client who is positive for Helicobacter pylori (H. pylori).

____B.  A 45-year-old client who drinks 4 ounces of alcohol a day.

____C.  A 70-year-old client who takes aspirin (Ecotrin) 81 mg daily to prevent coronary artery  

              disease.

____D.  A 30-year-old pregnant client who uses acetaminophen (Tylenol) as needed for 

              headaches.

8.  Which activities should a nurse, caring for a client with acute necrotizing pancreatitis, implement as part of a collaborative plan of care this client?  SELECT ALL THAT APPLY.

____A.  Administering 1,000 mL IV fluid bolus over 1 hour followed by IV fluids at 250 

                 mL/hour.

____B.  Initiating nasojejunal enteral feedings

____C.  Administering IV imipenem-cilastating (Primaxin) 500 mg every 6 hours.

____D.  Ambulating four times daily

____E.  Positioning on left side with head of bed elevated

____F.  Inserting a Foley catheter

9.  A nurse is caring for a client who is 6 hours post-open cholecystectomy.  The client’s T-tube drainage bag is empty, and the nurse notes slight jaundice of the sclera.  Which action by the nurse is most important?

____A.  Repositioning the client to promote T-tube drainage.

____B.  Notifying the surgeon about these findings.

____C.  Checking the client’s blood pressure immediately.

____D.  Recording the findings and continuing to monitor the client.

10.  A client is admitted to a hospital for medical treatment of acute diverticulitis.  A nurse should anticipate that this client’s treatment plan will include:  SELECT ALL THAT APPLY.

____A.  NPO status.

____B.  frequent ambulation.

____C.  antibiotics.

____D.  antiemetic medication.

____E.  deep breathing every 2 hours.