NCLEX Review about Bowel Disorders 6-8

NCLEX Review about Bowel Disorders

Situation: Mr. Greg, a 49 year old CEO is diagnosed as having ulcer disease.

6. Mr. Greg's ulcer perforates into the peritoneal cavity. To relieve the pain caused by perforation, Mr. Greg is most likely to:

a) lie on his left side
b) turn into his stomach
c) rigidly maintain the supine position
d) draw his knees up to his abdomen

7. Mr. Greg is placed on the bland diet and receives medications to decrease gastric acidity. Which medication reduces hydrochloride acid secretion?

a) cimetidine (tagamet)
b) sucralfate (carafets)
c) aluminum hydroxide (amphogel)
d) aspirin

8. Mr. Greg is scheduled for an upper GI series. Which intervention should the nurse perform after procedure?

a) testing stool for occult blood
b) give the patient a laxative
c) assessing for the gag reflex
d) administer double dose of antacids to prevent excessive HCL production




NCLEX REVIEW ABOUT BOWEL DISORDERS:
ANSWERS AND RATIONALE

6) D
- Ulcer is the ulceration of the mucosa and underlying structures of the upper gastrointestinal tract caused by conditions in which there is increased acidic gastric secretions or decrease mucus production. Common complication of peptic ulcer are perforation, hemorrhage and obstruction.

Perforation often occurs in duodenal ulcer. When it happens, gastric content is emptied into the peritoneal cavity causing peritonitis (gastric content is acidic, irritates peritoneal cavity and cause inflammation), bacterial septicemia (microorganism from stomach invade peritoneum and gain access to blood) and shock (from bleeding)

When ulcer perforates, the patient experiences sudden severe excruciating and stabbing pain at the epigastrium that spreads to the entire abdomen. The severe abdominal pain caused by perforated ulcer makes the patient assume the fetal position by drawing the knees up in an effort to lessen abdominal muscle tension with the hand clutching the abdomen. The abdominal area becomes tender and rigid.

On examination, the patient will also have a rigid boardlike abdomen with absent bowel sounds. Because after perforation peristalsis diminishes and the patient develops paralytic ileus.

7) A
- Medications for Ulcer

Histamine Receptor Antagonists - Block release of histamine, a hormone which stimulates HCL secretion.
It includes:

• Cimetidine (tagamet)
• Ranitidine (zantac) -side effect free
• Famotidine (pepcid) - given if patient develop adverse reaction with tagamet
• Nizatidine (axid) - newest and most expensive

Side Effects:

• diarrhea - instruct to increase fluids and take with meals
• abdominal cramps
• confusion, dizziness, weakness - avoid driving
• antiandrogenic effect in men: gynecomastia, low libido, impotence

Antacids - neutralizes HCL.
It includes:

• amphojel, alternaGEL, dialume, alucap
• aluminum hydroxide is the antacid of choice because:
  
• a) it neutralizes hydrochloric acid
• b) inhibit pepsin activity
• c) stimulate prostaglandin synthesis

Side Effects:

• constipating - advise to increase fluids
• if with sodium may cause edema
• decreases absorption of phosphate
• if antacid contains calcium, may cause hypercalcemia

Misoprostol (Cytotec) - the drug used for cancer prevention and given to patients on long term aspirin medication. Acts like prostaglandin.

Side Effects:

• crampy abdominal pain
• diarrhea
• contraindicated in pregnant women because it causes uterine contraction

Agents that coat the gastric mucosa such as sulcrafate and bismuth compounds form protective barriers to promote ulcer healing.


Antibiotics - to inhibit H. pylori

• Bismuth compounds - (Pepto-Bismul) - antibacterial effect
• amoxicillin or tetracycline
• metronidazole (flagyl, protostat)

8) B
- Upper GI series, also known as barium swallow, is the x-ray visualization of the esophagus, stomach, duodenum, and upper duodenum. It can detect 80% of peptic ulcers and is the first diagnostic procedure employed as it is also less costly and less invasive than gastroscopy.

• barium swallow - only esophagus is x-rayed
• low bowel series - only small intestines is x-rayed

The purpose of this test is to:

• examination of the structure, position, peristalsis and motility of organs
• detects malposition, tumors, ulceration, inflammation and abnormal anatomy

Preparation:

• tell patient barium is white and has chalky taste
• NPO 6 hours
• allow to swallow barium prepared in milk shake form
• entire tests is about 45 minutes
• films are taken at intervals

After Test:

• give patient laxative to prevent constipation (barium may become hard and difficult to expel)
• expect the stool to be whitish for the next 48-72 hours because of barium
• assess the abdomen for distention and constipation because barium is constipating. Absence of bowel sounds on auscultation may result in barium impaction.

  

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