CARE OFCLIENTS WITH PROBLEM IN
METABOLISM AND ENDOCRINE,
NUTRITION, AND GASTRO-INTERNAL,
PERCEPTION AND COORDINATION, (ACUTE AND CHRONIC)
BS NURSING / THIRD YEAR
STUDENT’S ACTIVITY SHEET
Session # 3 (2 hours and 30 minutes)
LESSON TITLE: IMPAIRED ESOPHAGEAL MOTILITY, Materials:
HIATAL HERNIA, GASTROESOPHAGEAL REFLUX
Book, pen and notebook, projector
DISEASE (GERD), AND PEPTIC ULCER DISEASE
References:
LEARNING OUTCOMES: Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K.
Upon completion of this lesson, the nursing student can: (2008). Brunner &Suddarth’s Textbook of
Medical-Surgical Nursing 11th Edition.
1. Enumerate the risk factors/causative agent/s.
Lippincott Williams &Wilkins
2. State common signs and symptoms.
3. Identify nursing interventions related to the disorder/s.
CANTARONA, JONAS T.
BSN-3 A6 MS-2
CHECK FOR UNDERSTANDING (15 minutes)
The instructor will ask the students to study and answer the case below.
Situation: Mrs. Dela Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and difficulty of swallowing.
1. Based from the symptoms presented, Nurse Melinda might suspect:
A. Esophagitis
B. Hiatal hernia
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C. GERD
D. Gastric Ulcer
ANSWER: C, GERD
RATIO: GERD is the backflow of gastric or duodenal contents into the esophagus caused by incompetent lower
esophageal sphincter. Pyrosis or heartburn, dyspepsia and dysphagia are cardinal symptoms.
2. What diagnostic test would confirm the type of problem Mrs. Cruz have?
A. barium enema
B. barium swallow
C. colonoscopy
D. lower GI series
ANSWER: B, barium swallow
RATIO: Barium swallow or upper GI series would confirm GERD. Endoscopy is another diagnostic test.
3. Mrs. Dela Cruz complained of pain and difficulty in swallowing. The terms are referred as:
A. Odynophagia
B. Dysphagia
C. Pyrosis
D. Dyspepsia
ANSWER: A, Odynophagia
RATIO: When difficulty of swallowing is accompanied with pain this is now referred as odynophagia. Dysphagia is difficulty
of swallowing alone.
4. To avoid acid reflux, Nurse Melinda should advice Mrs. Dela Cruz to avoid which type of diet?
A. cola, coffee and tea
B. high fat, carbonated and caffeinated beverages
C. beer and green tea
D. All of the above
ANSWER: B, high fat, carbonated and caffeinated beverages
RATIO: All are correct but option b is the best answer. In patients with GERD, this type of diet must be avoided to avoid
backflow of gastric contents. Excessive caffeine reduces the tone of lower esophageal sphincter. Test Taking Skills: look for
the umbrella effect
Situation: Nurse Marishka is the staff nurse assigned at the Emergency Department. During her shift, a patient was
rushed in the ED complaining of severe heartburn, vomiting and pain that radiates to the flank. The doctor suspects gastric
ulcer.
5. What other symptoms will validate the diagnosis of gastric ulcer?
A. right epigastric pain
B. pain occurs when stomach is empty
C. pain occurs immediately after meal
D. pain not relieved by vomiting
ANSWER: C, pain occurs immediately after meal
RATIO: In gastric ulcer food intake aggravates pain which usually occur ½ - 1 hour before meal or immediately during or
after food intake. Options a, b, c suggests duodenal ulcer.
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6. What diagnostic test would yield good visualization of the ulcer crater?
A. Endoscopy
B. Gastroscopy
C. Barium Swallow
D. Histology
ANSWER: A, Endoscopy
RATIO: Endoscopy determines bleeding, pain, difficulty swallowing, and a change in bowel habits. This would yield good
visualization of the ulcer crater.
7. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorgamisms?
A. E. coli
B. H. pylori
C. S. aureus
D. K. pnuemoniae
ANSWER: B, H. pylori
RATIO: Helicobacter pylori (H. pylori) is a bacteria responsible for most ulcers and many cases of chronic gastritis
(inflammation of the stomach). This organism can weaken the protective coating of the stomach and duodenum (first part of
the small intestines), allowing the damaging digestive juices to irritate the sensitive lining of these body parts.
8. She is for occult blood test; what specimen will you collect?
A. Blood
B. Urine
C. Stool
D. Gastric Juice
ANSWER: C, Stool
RATIO: Occult blood test or stool guiac test is a test that detects the presence of hidden (occult) blood in the stool (bowel
movement). The stool guaiac is the most common form of fecal occult blood test (FOBT) in use today. So stool specimen
will be collected.
9. What Diagnostic test will confirm Achalasia?
A. Barium Swallow
B. X- ray Studies
C. Manometry
D. BariumEnem
ANSWER:C,Manometry
RATIO: This test measures the rhythmic muscle contractions in your esophagus when you swallow, the coordination and
force exerted by the esophagus muscles, and how well your lower esophageal sphincter relaxes or opens during a swallow.
10. For Sliding Hiatal Hernia, all are clinical manifestations except:
A. Heartburn
B. Halitosis
C. Regurgitation
D. Dysphagia
ANSWER: B, Halitosis
RATIO: Halitosis is not part of the sliding hiatal manifestation
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