NCLEX: Caring for the Client with Disorders of the Gastrointestinal System

Terms you’ll need to understand:
Ascites
Gastrinoma
Hepatomegaly
Malaise
Melena
Spleenomegaly
String sign (see Diagnosis of Crohn’s Disease)
Tetany

Nursing skills you’ll need to master:
Performing ostomy care
Assisting with a paracentesis

Ulcers
Ulcers are erosions that occur in the mucosal lining of the esophagus, stomach, or duodenum. Ulcers occur more frequently in men, post-menopausal women, those with a family history for ulcers, and those with type O blood.

Factors contributing to the development of ulcers include
- Irritants that increase the secretion of hydrochloric acid; nonsteroidal, anti-inflammatory drugs (NSAIDs) such as ibuprofen and Toradol; and steroids.
NSAIDs and steroids should be administered with meals or food.
- Stress
- H Pylori bacteria, which is treated with antibiotic therapy with doxycy- cline (tetracycline) or amoxicillin and metronidazole (Flagyl) and a bismuth salt.
- Gastrinomas

Types of Ulcers

An ulcer is referred to as duodenal, gastric, or esophageal depending on its location in the gastrointestinal system. The two most common locations for ulcers are the duodenum and gastric area. The clinical manifestations for these ulcers follow with differentiating characteristics that you will need to know for the exam.

Duodenal
Duodenal ulcers are erosions that occur on the mucosa of the duodenum.
These ulcers occur more frequently in people 30–60 years of age and occur more frequently than any other type of ulcer. The basic pathophysiology is a hypersecretion of stomach acid.
Unlike gastric ulcers, with duodenal ulcers, vomiting is uncommon. Clinical manifestations include
- Epigastric pain 2–3 hours after meals
- Pain that is relieved by food intake
- Melena

Gastric
When an erosion occurs in the gastric mucosa, the ulcer is classified as gastric. This type of ulcer usually occurs in people over 50 and accounts for about 15% of ulcers. The pathophysiology of gastric ulcers involves a normal or hyposecretion of stomach acid.
Clinical manifestations include
- Midepigastric pain occurring from 1/2 to 1 hour after meals
- Discomfort that is increased by food consumption
- Vomiting (this is common and provides some relief of pain)

Diagnostic Tools for Ulcers
Ulcers are diagnosed by the patient history and a diagnostic test. The preferred diagnostic tool is the endoscopy exam because it allows direct visualization and biopsies of the area. The following are the major exams used to diagnose an ulcer:
- Upper gastrointestinal (GI) studies
- Barium swallow
- Endoscopy exam
- Gastric analysis
- Biopsy

Treatment of Ulcers
The treatment of ulcers includes two potential paths. One path is the conservative path that includes treatment through dietary modifications and medications. Dietary modifications include avoiding highly seasoned or spicy foods, high fiber foods, caffeine, alcohol, smoking, and stress. The following highlights some medications used to treat ulcers:
- Antacids
- Antibiotics
- Histamine (H2 receptor) blockers
- Anticholinergics
- Antispasmodics
- Proton pump inhibitors
- Barrier drugs (for example, sucralfate [Carafate])

The second method of ulcer treatment involves surgery. The surgical procedure is a gastrectomy. Caring for a client who has had a gastrectomy includes assessment for
- Bleeding
- Shock
- Abdominal distention
In the first 12–24 hours, the nasogastric drainage should be small in amount but may be bright red in appearance. After 24 hours the drainage should turn darker in color and decrease further in amount.

Dumping Syndrome
Post-gastrectomy problems can include the dumping syndrome. This syndrome is caused due to rapid emptying of food from the stomach into the jejunum. Symptoms of dumping syndrome include
- Dizziness
- Pallor
- Nausea
- Vomiting
- Palpitations

Treatment for clients with dumping syndrome include the following:
- Decreased fluids with meals
- Decreased carbohydrate intake
- Small, frequent meals
- Resting in recumbent position after meals
- Medications, including sedatives and antispasmodics, such as bentyl and pro-banthine

Inflammatory Bowel Disorders
There are two major inflammatory bowel diseases: Crohn’s disease and ulcerative colitis. People 10–30 years of age have the greatest risk of developing these disorders. The causes are unknown, but these disorders can be triggered by agents such as pesticides, food additives, and radiation. A connection might also exist between a client’s allergies or immune system.

Crohn’s Disease (Regional Enteritis)
Crohn’s disease is an inflammation of segments of the bowel that leads to swelling, thickening, and abscess formation. The following lists symptoms associated with Crohn’s disease:
- Abdominal pain
- Diarrhea
- Cramping
- Weight loss
- Anemia
- Ulcer formation
The client will usually try to control some of the symptoms by not eating.

Diagnosis of Crohn’s
In diagnosing Crohn’s, you will see that barium studies reveal the presence of a string sign. A string sign is a narrowing of the lumen of the intestine that shows as such on the barium x-ray.

Treatment of Crohn’s
Treating clients with Crohn’s can involve several methods. Diet control, vitamins, medications, and surgery are possible treatments. The following highlights the treatment paths for Crohn’s you should understand for the exam:
- Low-residue diet
- Vitamin and iron supplements
- Medications, including the following:
- Sedatives
- Antidiarrheals
- Steroids
- Surgery for severe cases

Ulcerative Colitis
Ulcerative colitis is an inflammation of the colon and rectum. This disorder usually begins at the rectum and proceeds upward. This disease can result in systemic complications and a high mortality rate. The following highlights symptoms associated with ulcerative colitis that you should be aware of for the exam:
- Abdominal cramping
- Urgent defecation
- Vomiting
- Weight loss
- Fever
- Hypocalcemia
- Decreased iron absorption

Diagnosis of Ulcerative Colitis
Ulcerative colitis is diagnosed by exams that visualize the distal portion of the intestines. The two diagnostic tools that follow are valuable in distinguishing this disease from other conditions that have similar symptoms:
- Barium enema
- Sigmoidoscopy

Treatment of Ulcerative Colitis
People with ulcerative colitis are treated with options similar to those that were discussed with Crohn’s. Medications included in the following list emphasize additional drugs that the candidate needs to know for the exam:
- Anti-inflammatories
- Antibiotics

Diverticulitis
Diverticulum are sac-like outpouchings in the wall of the large intestine. The inflammation results from the trapping of food and bacteria in the diverticulum. This inflammation increases the risk of abscess formation and perforation.
Diverticulitis is more prevalent in elderly females who eat a diet containing seeds, nuts, and grains. The following list highlights symptoms of diverticulitis:
- Bowel irregularity
- Intervals of diarrhea
- Cramping pain in the left lower quadrant of the abdomen
- A low-grade fever

Diagnosis of Diverticulitis
Tools used to diagnose diverticulitis include a CBC that can reveal an elevation in white blood cells due to infection and sedimentation rate elevations that indicate inflammation. A CT scan can be a valuable tool if an abscess has occurred due to the diverticulitis. The following list highlights other exams that can demonstrate muscle thickness, narrowing of the colon, and direct visualization of the inflamed diverticulum:
- Barium studies
- Endoscopy exam
A barium enema would be contraindicated in clients with acute diverticulitis due to the possibility of perforation of the diverticulum.

Treatment of Diverticulitis
The paths used to treat diverticulitis depend on the severity of the problem.
Conservative treatment includes diet and medications. If the client’s symptoms do not improve or the client becomes acutely ill, surgery might be required. The following highlights the treatment options you need to be familiar with for the exam:
- Increased dietary intake of soft fiber foods
- Increase in fluid intake (2–3 liters per day) within cardiac limits
- Medications, including
- Antispasmodics
- Fiber laxatives
- Surgery (approximately 20% of clients with diverticulitis require surgical intervention due to hemorrhage, perforation, abscess formation, or bowel obstruction)

Diseases Associated with the Liver
The liver is a large internal organ. Liver function is complex and any dysfunction of this organ affects all body systems. Liver disorders are common and can result from substances that destroy the liver, such as alcohol (which causes pancreatitis and cirrhosis). These disorders can also result from a virus, such as hepatitis.

Hepatitis
Hepatitis is a viral infection of the liver. The five major types of hepatitis are known as hepatitis A, B, C, D, and E. Hepatitis A and E are similar in transmission: They have a fecal-oral route but are not chronic. Hepatitis B, C, and D have similar characteristics in that they are all transmitted by the same route—parenteral, perinatal, or sexual.
The following list gives you some important general management techniques for clients with forms of hepatitis:
- Bed rest for those with prodromal or icteric symptoms
- Small and frequent increased calorie meals
- Increased fluid intake (3000ml/day)
- Avoidance of drugs detoxified by the liver
- Cool baths and soothing lotions to treat pruritis
- Medications used for treating forms of hepatitis, including steroids and immunosuppressives
- Anti-inflammatory medications, such as Motrin and Advil

Hepatitis A
Hepatitis A is transmitted by the fecal-oral route. It can lead to an acute infection, but without the chronicity seen in other forms of the disease.
The symptoms of hepatitis A appear after an incubation period of 2–6 weeks.
Hepatitis A is usually limited to 1–3 weeks of duration. The following list gives you the symptoms of hepatitis A:
- Malaise
- Fever
- Jaundice
- Nausea
- Vomiting

Diagnosis of Hepatitis A
Diagnosing hepatitis A requires a stool specimen. This specimen can reveal the hepatitis A antigen for 7–10 days before the illness and 2–3 weeks after symptoms appear. HAV antibodies are found in the serum after symptoms appear.

Treatment of Hepatitis A
Treatment of hepatitis A includes many parameters. First, prevention of the transmission of hepatitis A is a key element. Obtaining the two-dose hepatitis vaccine (Havrix) is recommended for adults 18 years or older and is highly recommended for the following groups: homosexuals; people traveling to unsanitary, poor-hygiene countries or locations; and healthcare workers.
The second dose of the vaccine should be given 6–12 months after the first dose. Protection begins a few weeks after the first dose and can last for up to 20 years. Administration of the immune globulin should be administered within 2 weeks of exposure to boost antibody protection and provide 6–8 weeks of passive immunity. The following two medications are important treatment options to remember for the exam:
- Hepatitis vaccine (Havrix)
- Serum immune globulin for exposure to the disease
Remember that hepatitis A has no long-term effects and is not chronic.

Hepatitis B
Hepatitis B is transmitted through parenteral, perinatal, or sexual routes.
People at the greatest risk of hepatitis B include
- IV drug users
- Homosexual men
- Infants born to hepatitis B virus-infected mothers
- Healthcare workers

Hepatitis B symptoms closely resemble hepatitis A’s symptoms, but there is a much longer incubation period of 1–6 months. The following list gives you symptoms of hepatitis B that you will need to know for the exam:
- Malaise
- Fever
- Rash
- Jaundice
- Arthritis
- Abdominal pain
- Nausea

Diagnosis of Hepatitis B
In diagnosing hepatitis B, HBsAG can appear in the blood of infected clients for 1–10 weeks after exposure to the hepatitis B virus and for 2–8 weeks before the onset of symptoms. Clients who have HBsAg persist in serum for 6 or more months after an acute infection are considered to be carriers.

Treatment of Hepatitis B
When it comes to treating this problem, there are a lot of unknowns for hepatitis B—and for all other forms of hepatitis as well. However, treatments are available for hepatitis B, and the following lists the treatments you should be familiar with:
- Hepatitis B vaccine (Heptovax or Recombivax)—The hepatitis B vaccine is administered IM in three doses. The second and third doses are given 1 month and 6 months, respectively, after the first dose. Doses are given in the deltoid muscle in adults.

- Alpha interferon injections for chronic hepatitis B—This medication can cause a flu-like reaction 3–6 hours after administration. The drug is given as a regimen of 5 million units daily or 10 million units three times weekly for 4–6 months.
- Hepatitis B immune globulin (HBIG)—This gives passive immunity to hepatitis B for people who have been exposed to the hepatitis B virus but have never received the hepatitis vaccine.

Hepatitis C
Hepatitis C is transmitted through the same routes as hepatitis B (parenteral, perinatal, or sexual). Cases of viral hepatitis not classified as A, B, or D are given the classification of hepatitis C. The age group with the highest incidence of hepatitis C is 40–59 years of age. Hepatitis B and C are similar, but a chronic carrier state exists more often with hepatitis C. More people with hepatitis C progress to chronic liver disease, including cirrhosis and liver cancer, than any other type of hepatitis.
It is estimated that approximately 150,000 persons are infected with hepatitis C yearly, with most of that number being healthcare workers.

Symptoms of hepatitis C are similar to those of hepatitis B. Some say the symptoms are mild and variable. The reason there are so many people predicted to have hepatitis C is because of the lack of symptoms and vagueness.
Consequently, those infected often do not seek assistance. A great deal of people with hepatitis C are carriers of the disease but do not know they have it.

Diagnosis of Hepatitis C
Diagnosis of hepatitis C is confirmed by the presence of HCV (hepatitis C virus) in serum.

Treatment of Hepatitis C
The combination therapy used to treat hepatitis C (interferon and ribavirin) has been shown to produce positive results. Some clients experience complete remission from the drug regimen. These drugs are also used for relapses in the client’s condition. The following are important to keep in mind for the exam:

- No vaccine is available for hepatitis C.
- Medications for treating hepatitis C include a combination of alpha interferon and ribavirin.

Hepatitis D
Hepatitis D is a delta hepatitis that requires the HBV surface antigen for replication. Only people with hepatitis B are at risk for hepatitis D. The virus is common among IV drug users, hemodialysis clients, and clients who have received multiple blood transfusions. Symptoms are similar to hepatitis B, except the incubation period is 3–20 weeks. These clients are also more likely to develop chronic active hepatitis and cirrhosis.
Diagnosis of Hepatitis D
Hepatitis D is diagnosed by a laboratory test. The presence of anti-delta antibodies in the presence of HBAg will be revealed in the test results.
Treatment of Hepatitis D
Treatment of hepatitis D includes alpha interferon.

Hepatitis E
Hepatitis E (HEV) is transmitted by the fecal-oral route. Like hepatitis A, it is not a chronic condition and has been found to develop mostly in persons living in underdeveloped countries. Many outbreaks have occurred in areas where flooding and heavy rains have occurred.
Symptoms are similar to hepatitis A, and the incubation period for this hepatitis is 15–64 days.
Diagnosis of Hepatitis E
Diagnosis is made by the presence of anti-HEV in serum.

Treatment of Hepatitis E
There is currently no known treatment for hepatitis E. Prevention is accomplished by practicing good hygiene and hand washing techniques. Treatment with immune globulin after exposure has not been shown to be effective.

Prodromal Stage and Icteric Stage
Regardless of the type of hepatitis, clients experience symptoms associated with two stages: the prodromal stage and icteric stage. The prodromal stage of the hepatitis episode is the period of time when the client is exhibiting vague symptoms. This is the period when the patient’s bile is not being excreted as it should (signified by dark urine and clay-colored stools) and is collecting in the blood stream. When the bile has accumulated in the client’s blood, the icteric stage begins and the client starts to exhibit symptoms such as jaundice, pruritis, and elevated liver enzymes.
Prodromal stage symptoms last from a few days to 2 weeks and include
- Fatigue
- Malaise
- Anorexia
- Nausea
- Vomiting
- Fever
- Dark urine
- Clay-colored stools

Icteric stage symptoms occur 5–10 days after the prodromal stage begins and include
- Jaundice
- Pruritis
- Tenderness in the right upper quadrant of the abdomen
- Hepatomegaly
- Elevated liver enzymes

Cirrhosis
Cirrhosis is the scarring or fibrosis of the liver, which results in the distortion of the liver structure and vessels. The three types of cirrhosis are
- Laennec’s portal cirrhosis—This is the most common type, and it’s due to chronic alcoholism that produces scar tissue around the portal areas.
- Post-necrotic cirrhosis—This form of cirrhosis results from previous acute viral hepatitis and produces broad bands of scar tissue.
- Biliary cirrhosis—This results from chronic biliary obstruction and infection and produces scar tissue around the bile ducts.

The following lists symptoms of cirrhosis you should know for the exam:
- Jaundice
- Spleenomegaly and hepatomegaly
- Chronic indigestion
- Constipation or diarrhea
- Weight loss
- Ascites
- Edema
- Vitamin deficiencies of A, D, E, and K
- Changes in behavior, cognition, and speech
- Elevations in liver enzymes, BUN, and ammonia levels

Diagnosis of Cirrhosis
Liver functions are complex, requiring many diagnostic tests. These tests determine the extent of the cirrhosis, and the type of treatment depends on the condition of the liver. The candidate will need to know the following list of tests or exams important in diagnosing cirrhosis:
- Laboratory tests (liver enzymes, prothrombin time, and ammonia levels)
- Upper gastrointestinal x-ray
- CT scan
- Esophagogastroduodenoscopy (EGD)
- Liver biopsy

Treatment of Cirrhosis
The treatment regimen for clients with cirrhosis is based on the symptoms the client is exhibiting. For example, if the client is retaining fluids, diuretics are prescribed. Diet interventions include a diet to promote healing of liver tissue. The client would need increased calories, increased proteins, and low sodium food sources.
If the client is in end-stage failure, protein sources are restricted.

Medications prescribed for clients with cirrhosis include antacids for gastric distress that could lead to bleeding, diuretics for fluid and ascites, and cathartics and enemas to correct the pH in the bowel and rid the body of ammonia. Other treatments the candidate should know for the exam include:
- Teach the client to avoid alcohol and medications detoxified by the liver
- Heme-test all stools and vomitus
- Record weight
- Intake and output
- Measure abdominal girth daily
- Use small needles for injections and maintain pressure for 5 minutes after injections due to bleeding tendencies

Pancreatitis
Pancreatitis is an acute inflammation of the pancreas associated with auto digestion. Enzymes secreted by the pancreas (lipase, amylase, trypsin, and so on) destroy the tissue of the pancreas. Consistent alcohol intake for 5–10 years is the common causative factor in middle-aged men with pancreatitis.
The following list highlights some of the causes of pancreatitis:
- Biliary disease
- Alcoholism
- Bacterial or viral infections
- Blunt abdominal trauma
- Peptic ulcer disease
- Ischemic vascular disease
- Surgery on or near the pancreas
- Long-term use of steroids, thiazide diuretics, or oral contraceptives

The symptoms of pancreatitis a client might exhibit include
- Epigastric pain radiating to the back
- Nausea and vomiting
- Abdominal distention
- Elevated blood and urine glucose levels
- Elevated serum lipase and amylase levels
- Decreased serum calcium levels
- Elevated white blood cells
- Steatorrhea

Diagnosis of Pancreatitis
The nursing candidate should know that a diagnosis of acute pancreatitis is made by the clinical picture of the client and diagnostic tests. The major laboratory tests to diagnose this disorder are serum amylase and lipase. These tests will show an elevation with pancreatitis. More laboratory tests—for example, white blood cell counts and calcium, magnesium, and glucose levels—might also be done to determine a diagnosis. Other exams, x-rays, and endoscopic procedures that the candidate should know are included in the following list:
- 24-hour urine test
- MRI
- Endoscopic retrograde cholangiopancreatography (ERCP)

Treatment of Pancreatitis
The treatment modalities for the client with pancreatitis focus on relieving the client’s symptoms and preventing or treating complications. The client is kept NPO, in the acute episode, with administration of IV fluids to inhibit stimulation and secretion of pancreatic enzymes. A nasogastric tube is usually inserted to decrease abdominal distention, prevent vomiting, and prevent hydrochloric acid from entering the duodenum. Other forms of therapy utilized to treat these clients include
- Observe for signs of bleeding. To prevent excessive bleeding, use small- gauge needles for IM, IV, or subcutaneous injections and maintain pressure for 5 minutes after any injections have been given.
- Medications, including the following:
- Meperidine (Demerol)
- Cimetadine (Tagamet)
- Calcium gluconate
- Viokase
- Vitamins A, D, E, and K
- Antibiotics
- Insulin
- After oral feedings begin, the diet should be low fat and low protein and the client should avoid caffeine and alcohol.
- ABGs to detect early complications.

Cholecystitis/Cholelithiasis
Cholecystitis is inflammation of the gallbladder. Cholelithiasis occurs when gallstones are formed due to bile that is usually stored in the gallbladder hardening into stonelike material. Precipitates of cholesterol, bilirubin, and calcium produce gallstones.
Causes of gallbladder disease include a familial tendency for the development of this disease, but it can also be due to dietary habits. It is also associated with certain drugs, such as cholesterol lowering agents. People with diabetes, hemolytic blood disorders, and Crohn’s disease have a higher risk of development. An easy way to remember who usually develops gallstones is to remember these 4:

Fs of gallbladder disease:
- Female (sex)
- Forty (usual age)
- Fat (usually obese)
- Fertile (usually have children)

Symptoms of Cholecystitis
The symptoms that occur with cholecystitis are usually associated with pain.
The client might also exhibit jaundice of the skin, sclerae, and upper palate.
Clinical manifestations also include
- Abdominal pain in RUQ, especially after a fatty meal
- Abdominal distention

Symptoms of Cholethiasis
The client with gallbladder disease from gallstones can experience symptoms due to the disease of the gallbladder or by the stones blocking the flow of the bile from the gallbladder. The client might exhibit fullness and abdominal distention. Other symptoms the nurse might observe are as follows:
- Severe pain in the RUQ of abdomen (pain can radiate to the back and right shoulder)
- Nausea and vomiting
- Palpable mass in the abdomen

Treatment of Cholecystitis
Interventions for gallbladder inflammation and stones is supportive. The management might be for clients who might or might not have surgery after the acute episode.
Clients with cholecystitis might be treated conservatively or surgically.
Conservative treatment is directed toward the relief of inflammation of the gallbladder and eliminating pain. This goal is accomplished by placing the client NPO with IV fluids and NG suction. Pain relief is accomplished by administration of meperidine (Demerol).
Morphine is not given for pain because it can cause spasms of the sphincter of oddi.

Antibiotics are administered intravenously, especially if the client’s WBC count is elevated. When the client has improved, diet intake is reinstituted with a gradual introduction of low-fat liquids and a high-protein, highcarbohydrate diet. Foods allowed and foods to avoid for clients recovering from a gallbladder attack are included here:
- Foods allowed—Skim milk, cooked fruits, rice, tapioca, lean meats, mashed potatoes, nongas-forming vegetables, bread, coffee, and tea
- Foods to avoid—Eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol

Diagnosis of Cholecystitis/Cholethiasis
The following items are used to diagnose cholecystitis and cholethiasis:
- Abdominal x-ray
- Gallbladder ultrasound
- Choecystography using contrast media (telepague, cholografin, or oragrafin):
- The client is held NPO for 10–12 hours before x-ray.
- A laxative or cleansing enema is ordered the evening prior to x-ray.

Treatment of Cholethiasis
General treatments of cholethiasis include PO medication, lithotripsy procedures, and surgery. Small stones and radiolucent cholesterol stones can be treated with ursodeoxycholic acid (UDCA) or chenodeoxycholic acid (CDCA). These drugs are bile acids that can be used to dissolve the gallstones. It can take up to 2 years for the medication to work and is usually reserved for older clients who are not good surgical candidates.
Approximately one half of people who take these drugs have a recurrence of the stones after the medication is stopped.
Another form of treatment that can be used for clients with gallstones is lithotripsy. In this procedure, the client is placed in certain positions as repeated shock waves are directed at gallstones to cause them to fragment.
After the stones are broken into small pieces, they can then pass through the common bile duct easily, be retrieved by endoscopy, or be dissolved by the bile acid drugs mentioned previously. This procedure is done on an outpatient basis, and the client resumes a regular routine within 48 hours. The positioning of the client depends on the location of the stones. These positions are listed here:
- Stones in gallbladder = prone position
- Stones in common bile duct = supine position

The final type of treatment for gallstones is surgery. The surgeries that can be performed are laparoscopic (laser) and abdominal cholecystectomy.
Laparoscopic or laser surgery accounts for more than half of all cholecystectomies.
When this surgical procedure is used, a small incision or puncture wound is made through the abdominal wall. Other puncture wounds allow for the introduction of surgical instruments to remove the gallbladder and stones.
Laser surgery is usually performed as same-day surgery. Its advantages are less postoperative pain, decreased likelihood of paralytic illeus, and quicker resumption of preoperative activity.

The second type of procedure is the abdominal cholecystectomy. This procedure is reserved for those with large stones or with extensive involvement of the duct system. The surgical procedure involves ligation of the cystic duct and artery and removal of the gallbladder. Insertion of a penrose drain allows the drainage of serosanquinous fluid and bile into an absorbent dressing. If the common bile duct was manipulated, a T-tube is usually inserted in the duct to keep it open until swelling diminishes.

Food-Borne Illnesses
Food-borne illnesses commonly cause gastrointestinal problems in clients in the United States. These illnesses result when a person receives an infectious organism with the intake of food. The NCLEX® candidate needs to be prepared to answer questions relating directly to these diagnoses.

Food-Borne Illnesses


Part2


Diagnostic Tests for Review
Most of the diagnostic exams for the gastrointestinal system are directly related to the anatomical area needing visualization. Along with the usual routine exams—for example, CBC, urinalysis, and chest x-ray—the NCLEX® candidate should be knowledgeable of the preparation and care of clients receiving endoscopic exams. An example of special considerations for these exams is the need to assess the gag reflex before allowing oral intake after a gastroscopy procedure. The nurse candidate must also be aware of the risk of bleeding after a liver biopsy, as well as the possible breathing problems that can occur due to the sedation usually given for endoscopic exams. While reviewing these diagnostic exams, the candidate should be alert for information that would be an important part of nursing care:
- Barium enema
- Barium swallow
- Colonoscopy and sigmoidoscopy
- Endoscopic exams
- Gallbladder ultrasound
- Gastric analysis and biopsy
- Liver biopsy
- Liver panel blood tests
- pH motility studies
- Upper GI studies

Pharmacology for Review
An integral part of care to clients with gastrointestinal (GI) disorders is pharmacological intervention. These medications provide an improvement or cure of the clients’ GI problems. The NCLEX® candidate needs to focus on the classification of drugs in the following list. Most of these drugs are commonly given, which makes them more likely to be a part of the NCLEX® exam. When reviewing these drug classifications, the candidate should think about the common side and adverse effects associated with the classification, such as the GI upset and bleeding associated with NSAIDs:
- Antacids
- Antispasmodics
- Antivirals
- Cathartics
- Corticosteroids
- Cytoprotective
- Fiber laxatives
- Hepatitis vaccines
- Histamine receptor blockers
- Immunosuppressives
- Interferons
- Nonsteroidal anti-inflammatory drugs
- Proton pump inhibitors