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Gastrointestinal

1. What are the two major functions of the pancreas?

endocrine-insulin. Exocrine-digestive enzymes.

2. What is the major cause of pancreatitis?

gall bladder disease and alcoholism

3. How can gallbladder disease cause pancreatitis?

a gallstone can block the pancreatic duct trapping the enzymes inside the pancreas.

4. List all of the symptoms of pancreatitis. (Explain WHY these occur)

a. Abdominal distention and ascites- losing fluid into the abdomen

b. Abdominal mass- a large pancreas
c. Rigid board-like abdomen- possible hemorrhage
d. Bruising- possible hemorrhage
e. Fever- inflammation
f. Jaundice- liver involvement
g. Hypotension- bleeding or ascites

5. Why do we give the pancreatitis client steroids?

to decrease inflammation of the pancreas

6. Why do we give the pancreatitis client anti-cholinergic drugs?

to dry secretions

7. Is it possible that a pancreatitis client might have to have insulin? Explain why.
yes because the pancreas is damaged, steroids and TPN

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8. What are the dietary changes needed for the pancreatitis client?
we want to ease them back into a diet, for a period of time they may receive TPN

9. What is cirrhosis?
Liver cells are destroyed and are replaced with connective and scar tissue; therefore the blood
pressure in the liver goes up and the client has portal hypertension.

10. When a client has cirrhosis, what happens to the blood pressure in their liver and what is the

proper term for this?

increased. Portal HTN

11. Explain the S/S of cirrhosis and explain why the client develops each symptom.
Firm, nodular liver-due to connective and scar tissue
Abdominal pain-liver capsule has been stretched
Chronic dyspepsia-GI tract is altered
Change in bowel habits-GI tract is altered
Ascites-liver is not producing albumin as it should; therefore we lose fluid out of the vascular space into
the abdomen
Increased ALT & AST-liver enzymes are increased because the liver is altered.

12. Why does the cirrhosis client sometimes develop hepatic encephalopathy and coma?
a buildup of ammonia

13. Your client is going to have a liver biopsy. What clotting studies should be checked? Please

explain why.
PT; PTT-One of the main functions of the liver is to help our blood to clot. After puncturing into
the liver there is a chance our blood may not clot as quickly as it should.

14. Why is it so important that vital signs be checked pre-liver biopsy?

we are worried about hemorrhage

15. How is a client positioned during a liver biopsy?

on their back with the right arm behind the head

16. How is a client positioned post-liver biopsy? Explain why.

on the right side to hold pressure

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17. Why does the client have to exhale and hold while the primary healthcare provider is

puncturing into the liver?

to get the diaphragm out of the way

18. Why are we worried about I & O and daily weights with the cirrhosis client?
because we have a client with a fluid volume problem due to the ascites

19. Why is rest so important with a cirrhosis client?

to rest the liver because toxins make you tired

20. Why are we worried about prevention of bleeding in the cirrhosis client?
because the liver is responsible for the production of clotting factors

21. Why do we measure the abdominal girth in the cirrhosis client and what will it tell us?
We are measuring the abdominal girth to see how much fluid the client is accumulating in their
abdomen. The more fluid the client accumulates in the abdomen indicates that the vascular volume is
going down

22. What is a paracentesis?

removal of fluid from the peritoneal cavity

23. When a client is having a paracentesis, what position do you put them in?
sit them up
24. Why is it so important that the paracentesis client void pre-procedure?
do not want to puncture the bladder

25. Why is it so important to monitor the vital signs pre- and post-paracentesis?
because you are worried about throwing the client into FVD

26. During a paracentesis, could the client could go into a fluid volume deficit or a fluid volume

excess?
deficit

27. Where is the first place that a cirrhosis client might develop jaundice?
sclera of the eyes

28. When jaundice gets to the skin, what is one of the major nursing diagnoses?
alteration in skin integrity

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29. Why do you have to avoid narcotics in any liver client?

Because the liver cannot metabolize narcotics so you can get a build up of narcotic effects and
depress the respirations

30. When a client has a liver disease, what should be done with protein in the diet?
decrease

31. Why does the liver client need a low-sodium diet?

to decrease ascites

32. What chemical builds up in the blood that causes a client to go into a hepatic coma?
ammonia

33. Why does the blood level of this chemical increase?

because the liver is unable to convert ammonia to urea

34. Explain symptoms of peptic ulcers.

burning pain in the mid epigastric area. The pain may go all the way through to the back and
heart burn or dyspepsia

35. What is the pre-procedure care of a gastroscopy? Explain what a client should expect if they

are going to have a gastroscopy.

NPO-pre, they will be sedated; a tube will be placed in the throat and through the esophagus
into the stomach.

36. When a client has a gastroscopy, they have to be NPO until their gag reflex returns. Why?
because we don’t want them to aspirate

37. What would be a major sign of perforation post-gastroscopy?

pain
38. Why do we give the peptic ulcer client antacids? What type of antacids would be the bestliquid

or tablet?
to decrease acid. Liquid to coat the stomach

39. Why do we give the client with peptic ulcer disease H-2 receptor antagonists? List some

examples.
to decrease acid. famotidine (Pepcid), ranitidine (Zantac

40. Why do we give the peptic ulcer client sucralfate?

to form a barrier over the wound so acid cannot get on the wound

41. Why is it important that the peptic ulcer client decrease stress?
because stress increases stomach acid

42. Why is it important that the peptic ulcer client stop smoking?
smoking increases stomach acid

43. Explain what you would teach a peptic ulcer client about diet.
eat what you tolerate but avoid extra spicy foods

44. What is the difference in a gastric ulcer and a duodenal ulcer?

the location

45. What is a hiatal hernia?

when part of the stomach moves up into the thoracic cavity

46. What are the major symptoms of a hiatal hernia?

heartburn, regurgitation, difficulty swallowing

47. What are the major nursing interventions for a client who has a hiatal hernia?
Sit up after meals and elevate the head of the bed. We are trying to keep the stomach down in
the abdominal cavity.

48. What is dumping syndrome?

When the stomach empties too rapidly after a gastrectomy, gastric bypass, or with gallbladder
disease

49. What can cause a client to get dumping syndrome?

gastrectomy, gastric bypass, faintness, weakness, cramping and diarrhea

50. What are the symptoms of dumping syndrome?

fullness, palpitations, faintness, weakness, cramping and diarrhea

51. What are the major nursing interventions for a client who has dumping syndrome?
lie back when eating then lie flat after meals, drink fluids between meals, do not drink fluids
with meals

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52. What is the difference in ulcerative colitis and Crohn’s disease?
ulcerative colitis is a large intestine disease. Crohn’s disease is a small intestine disease

53. What are the symptoms of ulcerative colitis and Crohn’s disease?
Diarrhea, rectal bleeding, weight loss, vomiting, cramping dehydration, blood in stool, anemia,
rebound tenderness and fever.

54. What is another name for Crohn’s disease?

regional enteritis

55. When a client has ulcerative colitis or Crohn’s disease, do they need a high-fiber or lowfiber

diet? Why?
low fiber diet because a high fiber diet would increase motility

56. Why does the client with ulcerative colitis or Crohn’s need to avoid cold foods and

smoking?
these will increase motility

57. Why does the client with ulcerative colitis or Crohn’s disease need steroids?
to decrease inflammation

58. When a client has an ileostomy, what will the drainage be like?
continuous liquid drainage

59. Why would an ileostomy client need to avoid rough foods or high-fiber foods?
these will increase motility and therefore make the client lose even more water

60. Why does the ileostomy client need Gatorade?

to replace fluid and electrolytes

61. Why is the ileostomy client at risk for kidney stones?

because they are always a little dehydrated

62. When a client has an ileostomy, what electrolyte are they losing a lot of?
potassium

63. Explain the nursing care for a colostomy.

bowel training and irrigation will be needed

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64. Why does a client develop appendicitis?

because the appendix fills with bowel contents and becomes inflamed and can rupture

65. Explain the major symptoms of appendicitis?

RLQ pain, elevated WBC, may have N/V and rebound tenderness

66. Why do we avoid giving enemas to a client who has appendicitis?

because we do not want to rupture the appendix
67. When a client has had any abdominal surgery, what is the position of choice and why?
elevate the HOB and to decrease stress on suture line