Silvestri: Comprehensive Review for the NCLEX-RN® Exam, 7th Edition

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Dumping Syndrome

Dumping syndrome describes a group of symptoms that occur after eating. It is believed to result
from rapid dumping of gastric contents into the small intestine, which causes fluid to shift into
the intestine.

To manage this syndrome, clients are encouraged to decrease the amount of food taken at each
sitting, eat in a semirecumbent position, eliminate ingesting fluids with meals, and avoid
consumption of high-carbohydrate meals.

If the NG tube needs to be repositioned, the nurse should call the surgeon, who would do this
repositioning under fluoroscopy.

Ulcerative Colitis

Clients with ulcerative colitis have bloody diarrhea, not steatorrhea

The diet for the client with ulcerative colitis should be low fiber (low residue).

Corn is high in fiber but can be very irritating to the intestines and should be avoided

Colostomy Care:

The client should be taught to include deodorizing foods in the diet, such as beet greens, parsley,
buttermilk, and yogurt.

For the first 4 to 6 weeks after colostomy formation, the client should consume a low-fiber diet.
After this period, the client should eat a high-carbohydrate, high-protein diet.

Peptic Ulcer Disease

Dietary modifications for the client with peptic ulcer disease include eliminating foods that can
cause irritation to the gastrointestinal (GI) tract. Items that should be eliminated or avoided
include highly spiced foods

The peristomal skin must receive meticulous cleansing because ileostomy drainage has more
enzymes and is more caustic to the skin than colostomy drainage.

Alcohol, caffeine, chocolate, and citrus fruits:

Should be avoided
Pancreatitis

The pain that is associated with acute pancreatitis is often severe, is located in the epigastric
region, and radiates to the back

Cold packs may be prescribed for comfort.

Nausea and vomiting are common presenting manifestations of acute pancreatitis. A hallmark
symptom is severe abdominal pain that is not relieved by vomiting.

Lipase, trypsin, and amylase are produced in the pancreas and aid in the digestion of fats,
starches, and proteins, respectively.

The client with pancreatitis needs to avoid alcohol, coffee and tea, spicy foods, and heavy meals,
which stimulate pancreatic secretions,

Pain with acute pancreatitis usually increases after vomiting because of an increase in intraductal
pressure caused by retching, which leads to further obstruction of the outflow of pancreatic
secretions. The pain is a steady and intense epigastric pain that radiates to the client's back and
flank

The exocrine pancreas produces digestive enzymes such as amylase, lipase, and trypsin

Lipase, trypsin, and amylase are produced in the pancreas and aid in the digestion of fats,
starches, and proteins, respectively.

Hepatitis

Clients should select a diet high in calories because energy is required for healing. Protein
increases the workload on the liver. Changes in bilirubin interfere with fat absorption, so low-fat
diets are better tolerated.

NG Tube Care

If the gastric residual is greater than 200 mL for 2 consecutive hours, the client may be
experiencing delayed gastric emptying.

A tube with a large lumen and an air vent is a Salem sump tube. A Dobbhoff weighted tube is a
type of feeding tube. A Sengstaken-Blakemore tube is used to control bleeding in the esophagus.
A tube with a single lumen is called a Levin tube

NG tubes are discontinued when normal function returns to the gastrointestinal (GI) tract.

All stomach contents are aspirated and measured before a tube feeding is administered.
Cirrhosis

Ascites is a problem because as more fluid is retained, it pushes up on the diaphragm, thereby
impairing the client's breathing patterns.

Lactulose is an osmotic laxative used to decrease ammonia levels, which are elevated in hepatic
encephalopathy

Appendicitis

Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may
cause a rupture with resultant peritonitis

Inflammatory Bowel Disease

Salicylate compounds, such as sulfasalazine, act by inhibiting prostaglandin synthesis and

reducing inflammation. The nurse teaches the client to take the medication with a full glass of
water and increase fluid intake throughout the day. The medication needs to be taken after meals
to reduce gastrointestinal irritation.

Five major classes of medications used to treat IBD are antimicrobials, corticosteroids,
aminosalicylates, biological and targeted therapy, and immunosuppressants

This medication binds with bile salts in the intestines to form a compound that is excreted in the
feces. The client should be instructed to mix the medication with 3 to 6 ounces of water, milk,
fruit juice, or soup. It should be administered before meals

Cholestyramine

To splint and provide pressure at the puncture site, the client is kept on the right side for a
minimum of 2 hours after a liver biopsy.

During the first 24 to 72 hours following surgery, mucus and serosanguineous drainage are
expected from the stoma.