Union University
School of Nursing – Germantown
NUR 425
Study Guide for Digestive and Gastrointestinal
Function and Disorders
Chapters 34-38
Outcomes and activities for Chapter 34
1.
Review the structure and function of the organs of the GI tract.
A. Draw the abdomen depicting the organs in the proper quadrants.
B. Identify the function of each of the organs of digestion.
2.
Explain the processes involved in the digestion, absorption,
and elimination of food products.
A.
3.
Identify major digestive enzymes, sources, and digestive
actions.
Describe assessment parameters and techniques used when
evaluating the GI tract.
A. Draw a torso and shade common sites of referred abdominal pain.
B. Discuss the order of the examination of the abdomen and give the
rationale.
4.
Describe preparation, education, and follow-up care for
patients undergoing the following diagnostic testing of the GI
tract.
A. Discuss how the nurse would prepare and educate patients for the
following tests and include nursing interventions post procedure.
1. Stool tests
2. Abdominal ultrasonography
3. Upper GI tract X-ray studies
4. Lower GI tract X-ray studies
5. CT
6. MRI
7. Esophagogastroduodenoscopy (EGD)
8. Colonoscopy
9. Gastric analysis, gastric acid stimulation test, & pH monitoring
Outcomes and activities for Chapter 35
5.
Synthesize nursing care of patients with conditions of the oral
cavity,
esophagus, and/or head and neck.
a. Compare and contrast the differences and nursing interventions for
parotits, sialadenitis, sialolithiasis.
b. Prioritize nursing interventions post radical neck dissection.
Case Study: Gastroesophageal Reflux
You are interviewing a patient in the medical clinic who has been treated in the clinic
previously for gastroesophageal reflux. He complains that his symptoms are worse but
that he has been taking his medications as prescribed. He states that he has tried many
different kinds of antacids but none of them are helping him. Describe how you would
continue to assess this patient to obtain the additional information that is needed.
Speculate regarding the different causes that may underlie this patient’s inability to obtain
relief. Assess patient for compliance with instructions to
a. Eat a low-fat, high-fiber diet
b. Avoid caffeine, tobacco, and carbonated beverages
c. Avoid eating or drinking two hours before bedtime
d. Maintain a normal body weight
e. Avoid tight clothes
f. Elevate the head of the bed on six- to eight-inch blocks
g. Determine whether the physician has prescribed antacids or if antacids may be
retarding absorption of medications
Case Study: Hiatal Hernia
Mrs. Montgomery, a 68-year-old African American woman, was diagnosed with an axial
hiatal hernia (reference page 977).
1.
The nurse knows that an axial, or sliding, hiatal hernia occurs when __________.
2.
Clinical manifestations of an axial hiatal hernia include
a.
Heartburn
b.
Regurgitation
c.
Dysphagia
d.
All of the above
3. When teaching Mrs. Montgomery about how to manage her condition, the nurse tells
Mrs. Montgomery to
a.
_________
b.
_________
c.
_________
4. Mrs. Montgomery asks the nurse to explain the difference between a hiatal hernia and
gastroesophageal reflux. The nurse explains that gastroesophageal reflux refers to the
________ .
5.
Diagnosis of a hiatal hernia is confirmed by
a.
X-ray studies
b.
Barium swallow
c.
Fluoroscopy
d.
All of the above
Outcomes and activities for Chapter 36
6.
Discuss the nursing management of the patient with an enteral
tube and feedings.
A.
Outline and discuss the specific method for determining nasogastric tube
placement. Discuss the research findings of Metheny et al. (1994, 1998,
2001) regarding accurate assessment of tube placement (reference pages
985–992).
B.
Discuss why the dumping syndrome occurs and what nursing measures
can be used to prevent its occurrence (reference pages 992 and Table 36–
3).
C.
Design a nursing care plan for a patient with a gastrostomy tube. Based on
the six nursing diagnoses listed on page 999, design three components of
the plan of care. Cluster related data to support your plan (reference pages
998–1001).
Write the number for the rationale/s from column A with the NG tubes in
column B. You may use more than 1 rationale if applicable.
A
1.Administration of meds/feedings
2.Intestinal aspiration/decompression
3.Obtain specimen for gastric contents
4.Fluid/gas removal from upper GI
5.Gastric lavage/toxin removal
6.Compress a bleeding site
_______
_______
_______
_______
_______
_______
_______
_______
B
Levin
orogastric
Sengstaken-Blakemore
Miller-Abbott
Salem sump
Dobbhoff
Harris
Cantor
Case Study: Tube Feeding
Mrs. McMillan, a 76-year old white woman, recently had abdominal surgery and is
receiving tube feedings (reference pages 985–998, Table 36–4).
1. Because Mrs. McMillan is receiving tube feedings, the nurse would expect her to
have which of the following tubes?
a. Cantor
b. SengstakenBlakemore tube
c. MillerAbbott tube
d. Dobbhoff tube
2. The nurse uses a combination of the following methods to confirm placement of Mrs.
McMillan’s feeding tube:
a. __________________________________________________________________
b. __________________________________________________________________
c. __________________________________________________________________
3. The choice of tube feeding formula is influenced by
a. __________________________________________________________________
b. __________________________________________________________________
4. List two nursing diagnoses appropriate for a patient receiving a tube feeding:
a. __________________________________________________________________
b. __________________________________________________________________
5. To ensure patency and to decrease the chance of bacterial growth, crusting, or
occlusion of Mrs. McMillan’s tube, the nurse administers 15 to 30 mL water in each
of the following instances:
a. __________________________________________________________________
b. __________________________________________________________________
c. __________________________________________________________________
d. __________________________________________________________________
6. A medication in an enteric-coated tablet form has been ordered for Mrs. McMillan.
The nurse would like to administer the medication via the feeding tube. To do so, the
nurse would need to
a. Crush the tablet and dissolve it in water
b. Open the tablet and pour the contents down the tube
c. Obtain an order for a change in form because the tablet cannot be crushed
d. Split the tablet and place it in the tube, followed by 30 mL water
Draw a PEG tube and outline the nursing care of a patient with a gastrostomy.
7.
8.
Identify nursing care related to patients receiving parenteral
feedings.
Discuss purposes and complications of enteral and parenteral
feedings. (You may need to refer to your pharm text to assist with answering
some items.)
A. Discuss establishing positive nitrogen balance.
B. Identify clinical indications for the use of PN.
C. Differentiate between PN and TPN as far as formulas and
advantages.
D. Identify components of PN and their purpose.
E. Discuss 4 methods of central administration of PN or TPN.
F. Identify 8 possible complications of PN, cause, and nursing
interventions (including collaborative interventions.
G. Identify 5-6 nursing interventions when caring for a patient
receiving PN.
Outcomes and activities for Chapter 37
9.
Synthesize the nursing care of patients with gastritis and
peptic ulcer
disease.
Compare and contrast the differences between acute and chronic gastritis
according to incidence, pathophysiology, clinical manifestations, and treatment
modalities (reference pages 858–860).
Complete the following chart by listing the major action and nursing considerations for
drugs used in peptic ulcer disease (reference pages 1015–1021 and Table 37–1).
Drug Classification
Magnesium-based antacids
Cimetidine
Ranitidine
Famotidine
Sucralfate
Misoprostol
Omeprazole
Action
Nursing Considerations
Complete the following chart by listing the description and comments for each gastric
operation for peptic ulcers (reference page 1017 and Table 37–3).
Operation
Vagotomy
Truncal vagotomy
Selective vagotomy
Pyloroplasty
Billroth I
Billroth II
Description
Comments
Outcomes and activities for Chapter 38.
10.
Compare regional enteritis and ulcerative colitis in regard to
etiology, clinical manifestations, diagnostic evaluation,
treatment, and nursing care.
Complete the following chart comparing regional enteritis and ulcerative
colitis.
Regional Colitis
Etiology
Clinical
Manifestations
Diagnostic
Evaluation
Treatment
Nursing Care
Ulcerative colitis
11.
Using the nursing process, synthesize care of the patient with
intestinal disorders, including irritable bowel syndrome,
appendicitis, diverticular disease, peritonitis, obstruction, and
an ostomy.
Match the physical complication listed in column II with its associated medical condition
listed in column I. An answer may be used more than once (reference page 1029).
Column I
Column II
1. ________ Constipation
a. Megacolon
2. ________ Appendicitis
b. Perforation
3. ________ Peritonitis
c. Evisceration
4. ________ Diverticulitis
d. Intestinal obstruction
5. ________ Abdominal hernia
6. ________ Colostomies
1. You are visiting a resident in an extended care facility. She complains that she has
had pain throughout her abdomen for the past day. She has not had a bowel
movement in four days and she complains of loss of appetite. Physical examination
reveals that her abdomen is distended and rigid, and that bowel sounds are absent.
Analyze these findings, indicate what you think possible causes may be, and explain
the actions you would take and why.
2. During a conversation with an elderly gentleman at a community center for senior
citizens, he tells you he cannot have a bowel movement without taking a laxative
each day. He asks if this is acceptable, given that he also takes “blood pressure
medicine, a heart pill, and aspirin” each day. Explain how you would advise this
patient and give the rationale behind your advice.
3. You are caring for a patient who has been treated medically for ulcerative colitis for
five years. The patient underwent a total colectomy and ileostomy yesterday. What
are the similarities and differences between the care of this patient and that of a
patient who had a colon resection and colostomy? Explain how you would meet the
emotional and health education needs of the patient with an ileostomy and those of
the patient with a colostomy.
Sources:
Smeltzer, S. & Bare, B. (2004). Brunner & Suddarth’s textbook of medicalsurgical nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Smeltzer, S. & Bare, B. (2004). Brunner & Suddarth’s Instructor Manual.
cc/2005