Gastrointestinal Conditions - NCLEX-PN

The majority of liver infections are viral in nature. Hepatitis A, hepatitis B, and hepatitis C are the most frequent agents of infection, with hepatitis C being the leading cause of liver transplants. Bacterial infections in the liver most commonly take the form of an abscess. Fungal hepatitis and prion infection of the liver are not generally seen.

There are multiple viruses that can cause hepatitis other than hepatitis A, B, or C. Among these are Epstein-Barr virus, cytomegalovirus, and yellow fever.

While individuals with Celiac disease can certainly have gastritis, fistulas, and ulceration due to inflammation, the primary effect of Celiac disease is villous atrophy in the small intestine. Villi become blunted, leading to loss of ability to absorb nutrients, including minerals and fat-soluble vitamins.

While Crohn's disease can affect any part of the alimentary canal, the small intestine, particularly the terminal ileum, is the most common site of serosal inflammation.

The characteristic histological alteration seen in ulcerative colitis is the crypt abscess, in which inflammation causes loss of goblet cells due to neutrophilic exudate in glandular lumens. Granulomas, thickened mucosa, and skip lesions are all seen in Crohn's disease.

Calcium carbonate preparation is rapid-acting, releasing carbon dioxide in the stomach, causing belching and flatulence. Calcium carbonate is an antacid which reacts quicly with HCl to form CaCL2 and carbon dioxide.

Multiple therapies are required to treat Helicobacter Pylori infections. Colestipol is a bile acid sequestrant used to lower blood cholesterol, which is not used to treat Helicobacter Pylori infections ( a bacterium that colonizes the human stomach).

Portal hypertension causes proteins to move from the bloodstream into the lymphatics which cannot handle the excess and they leak into to abdominal cavity. The proteins causes an osmotic pressure pulling fluid into the space leading to ascites. Hypoalbuminemia will lead to decreased colloid oncotic pressure as well, also contributing to ascites.

Celiac disease is an autoimmune condition that is triggered by ingestion of gluten, a protein found in wheat, barley, and rye. A wheat-free diet is not sufficient for a patient with Celiac disease, as many other products contain elements of barley or rye and thus also contain gluten.

Oat, while often avoided by individuals with Celiac disease due to cross-contamination during processing, does not contain gluten. Whole dairy products are also generally gluten-free and considered safe for patients with Celiac disease.

Clostridium difficile (C. diff) is an infection caused by Clostridium difficile bacteria and requires contact precautions. Contact precautions state that nurses must wear gloves and a gown while caring for the patient. Nurses must also preform adequate hand hygiene before and after the use of gloves. Additionally, because C. diff infections are caused by spores, alcohol gel alone may not be sufficient to eliminate the bacteria. Current practice is the use of soap and water to cleanse hands. Afterwards, nurses may utilize alcohol-based hand gel. It is acceptable to place a C. diff patient in a semi-private room with another C. diff patient if private rooms are unavailable.

It is possible that this patient is suffering from a Clostridium difficile infection caused by bacteria. The presence of an underlying condition, increasing age, and antibiotic use are all risk factors for contracting Clostridium difficile. A stool sample is commonly used to test for the bacteria. Until the results are available, Carrie should place the patient under proper C. difficile contact precautions.

Helicobacter pylori or H. pylori is the bacterial cause of peptic ulcers. Staphylococcus aureus is a bacteria that frequently causes skin infections along with other conditions such as toxic shock syndrome. Streptococcus faecalis is responsible for many urinary tract infections and contracting Viridans streptococci may result in endocarditis. Treponema pallidum bacteria cause syphilis.

To prevent pain during a bowel movement post operatively, pain medication is often indicated to help make it more tolerable. Pain medications will need to be given post op and may contribute to constipation, but oral stool softeners and and a high fiber diet can help to avoid the constipation. Rectal suppositories and daily enemas are not needed. Bowel movements should not be delayed nor avoided in the post operative period.

This client is to be on contact precautions, the wearing of a mask is consistent with airborne precautions which is not necessary for C-diff. All other choices are appropriate for contact precautions.

Several foods can cause relaxation or irritation of the lower-esophageal sphincter. Alcohol, carbonated beverages, and chocolate are a few examples. Advise the patient to remain upright after meals, to utilize antacids when appropriate, and to practice a balanced diet.

Magnesium hydroxide is a strong base. It works by neutralizing the acid in the stomach, forming water and magnesium chloride. All other listed medications work to prevent the stomach from over-producing acid, rather than neutralizing the existing acid in the stomach.

Advanced age, female sex, obesity, alcohol use, frequent heavy lifting, pregnancy, gastrointestinal tumors, and smoking may increase an individual's risk for the development of a hiatal hernia. The correct scenario represents four risk factors.

Fowler’s position (head of bed (HOB) elevated 45 degrees) increases comfort, ventilation, circulation, and relieves pressure from the thorax. It would be best for this patient due to the pain experienced by the patient in the abdomen. Sims’ position (halfway between lateral and prone, upper arm flex, lower arm behind patient) is used when a patient is receiving an enema or an examination in the perineal area. Trendelenburg (HOB lowered, feet elevated) is used for patients with hypotension, as it promotes venous return. Reverse Trendelenburg (HOB elevated, feet lowered) is used to promote gastrointestinal problems by minimizing esophageal reflux. Side-lying (patient on side with top leg in front of bottom leg and hip/knee flexed) is used to relieve pressure from the sacrum and is often rotated with patients who are on bedrest.

The correct answer in this question is "Insert two large-bore peripheral IV's."

This is the correct answer because this patient is suffering from a suspected gastrointestinal bleed and based upon the report of the vital signs, he is hemodynamically unstable. In evaluating an emergency/trauma patient, the "ABC's" must be assessed (A= airway, B= breathing, C= circulation). In this patient's case, it is stated that he is responsive and breathing without any issues, indicating that his airway and breathing are both satisfactory. The next issue is his circulation. Given that he has a suspected bleed, and is tachycardic and hypotensive, it is likely that he is losing a significant amount of blood from his bleeding viscera. As such, he may need emergent, rapid fluid and/or blood product resuscitation. The best way to prepare for this immediately is to place two large bore peripheral IV lines, such that resuscitation can be provided through these lines while the rest of the workup and treatment continues. Any delay in placing these lines delays the fluid/blood resuscitation of the patient, which can be dangerous.

At this point, given that the patient has a protected airway and is breathing without issue, intubation would not be indicated. Should his airway or breathing status change, the need can be reassessed.

Administering hydromorphone, a potent opioid, may be necessary if the patient is in a significant amount of pain, but that would not be the most pressing initial concern given that he is hemodynamically unstable.

Administering warfarin, an anticoagulant, would be highly contraindicated in this patient, as he likely has an active gastrointestinal bleed and is hemodynamically unstable.

Administering lorazepam, a benzodiazepine, is not indicated in this hemodynamically unstable patient with a suspected gastrointestinal bleed. After stabilization and continued demonstration of airway protection, if the patient is anxious, this need can be reassessed.