Q15 from the Study Guide

Ok, here is the information for Q15 - or what I could find. Some of the things I wasn't exactly sure where she was coming from with the question. Please correct me if you think I'm off track.
Again, I can send it to you in a Word Document if you prefer. Just let me know. :)

15. Gastrointestinal

a. Why is your pancreatitis client in NPO status?
To reduce pancreatic secretions (p. 1135)

b. Be able to identify the best nutritional intervention immediately post gastric surgery. When are you going to do your patient teaching for these clients? What will you do to intervene if post operative complications occur? What will you do to prevent complications?
Discharge planning and instruction should be started as soon as the immediate postoperative period is passed. Dietary instructions may be given by the dietitian and reinforced by the nursing staff. Because the stomach’s reservoir has been greatly diminished after gastric resection, the meal size must be reduced accordingly. The patient should be advised to eliminate drinking fluids with meals. Dry foods with a low-carbohydrate content and moderate protein and fat content are better tolerated initially. These dietary changes, with the incorporation of short rest periods after each meal, reduce the likelihood of dumping syndrome. Reassurance that following these dietary measures will result in cessation of these symptoms within a few months is essential to long-term compliance. (p.1141)

The most common postoperative complications from peptic ulcer surgery are (1) dumping syndrome, (2) postprandial hypoglycemia, and (3) bile reflux gastritis. (p.1040)

Postoperative care:
§ An NG tube is used to decompress the remaining portion of the stomach to decrease pressure on the suture line and to allow for resolution of edema and inflammation resulting from surgical trauma.
§ The gastric aspirate must me carefully observed for color, amount, and odor during the immediate postoperative period.
§ If the tube becomes clogged during this period, the health provider may order periodic irrigations with normal saline solution. It is essential that the NG suction is working and the tube remains patent so that accumulated gastric secretions do no put a strain on the anastomosis.
§ This can lead to distention of the remaining portion of the stomach and result in (1) rupture of the sutures, (2) leakage of gastric contents into the peritoneal cavity, (3) hemorrhage, and (4) possible abscess formation.
(p.1042-1043)

In case of dehiscence &/or evisceration: IMMEDIATELY grab a roll of gauze, lay it out over the wound, and pour normal saline over it. THEN, call for help. (per Shelba’s lecture)

c. How are you going to manage symptoms of Hepetitis in order to preserve function of the CNS, nutritional status, and skin integrity? When will the differing therapies for prevention or cure of these viral diseases work?
§ CNS is effected by elevated levels of ammonia. Administer lactulose to increase elimination of stool – the ammonia will pass with it.
§ Eat a large breakfast – increase protein intake.
§ Prevention: Vaccines – Hep A & B
§ There is no cure for Hepetitis - Medical care is supportive depending on symptoms experienced.
§ Gamma Globulin - Hep B
§ Interferon – Hep B & C
(Per Shelba’s lecure notes for GI)

d. What symptoms indicate clients experiencing cholelithiasis are developing complications?
Cholelithiasis may produce severe symptoms or none at all. The severity of symptoms depends on whether the stones are stationary or mobile and whether obstruction is present. The gall bladder spasms in response to the stone. This sometimes produces severe pain, which is termed biliary colic. The pain can be excruciating and accompanied by tachycardia, diaphoresis, and prostration. The severe pain may last up to an hour, and when it subsides there is residual tenderness in the RUQ. When total obstruction occurs, symptoms related to bile blockage are manifested – including: jaundice, foamy dark/amber urine, no urobilinogen in urine, clay-colored stools, pruritis, intolerance to fatty foods, bleeding tendencies, and steatorrhea.
Complications that occur include cholangitis, biliary cirrhosis, carcinoma, and peritonitis.
(p.1142 and box)

e. When the patient’s bladder is full, remember it is a bad idea to place a catheter in the abdominal cavity for any kind of tap!!