Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS363 - Practice of Nursing IV > Week 5: GI > Flashcards

Week 5: GI Flashcards

1
Q

Risk Factors for GI Disorders

A
  1. Family Hx
  2. Lifestyle - stress, poor diet, alcohol, tobacco, smoking can all lead to these disorders - many of the disorders are associated with lifestyle behaviors
  3. Domino Effect
  4. Previous abdominal surgeries or trauma
  5. Neurologic disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can GERD lead to?

A

Barret’s esophagus –> predisposition for esophageal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can chronic gastritis lead to?

A

Predisposition to gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can previous abdominal surgeries lead to?

A

Can lead to adhesions (development of scar tissue) which can lead to intestinal obstructions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neurological disorders like MS/Parkinsons can impair what?

A

Patient’s ability to: 1. Move and have peristalsis which impairs movement of waste products2. Chew and swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is GERD?

A

Backward movement of gastric or duodenal contents resulting in heartburnEpisodes occur more than 2 times a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the major cause of GERD?

A

Relaxation or weakness of LES (lower esophageal sphincter)

Obesity can also cause GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Things that Trigger LES Relaxation

A
  1. Fatty Food
  2. Caffeinated Beverages
  3. Carbonation
  4. Chocolate
  5. Milk
  6. Tobacco
  7. Alcohol
  8. Peppermint/Spearmint
  9. Progesterone during pregnancy
  10. Hormonal replacement in older women
  11. NG tube
  12. Medications: NSAIDS, Calcium Channel Blockers, Blood Pressure Meds, Nitroglycerine for chest pain
  13. Pyloric Stenosis
  14. Overeating or being overweight
  15. Eating right before bed or eating/sleeping in recumbent position
  16. Wearing tight clothing
  17. Mucosal irritants - tomato’s and citrus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should you do prior to laying down for the night when you have GERD?

A

Do not eat 3 hours prior to laying down Avoid laying supine if you do

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a classic symptom of GERD?

A

Waking up in the middle of the night feeling a pain in their throat or feeling heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical Manifestations of GERD

A
  1. Pyrosis
  2. Dyspepsia
  3. Sour Taste
  4. Hypersalivation - patients will clear throats & swallow more frequently
  5. Dysphagia
  6. Ordynophagia
  7. Eructation
  8. Fullness (even when eating a v small amount of food)
  9. Early Satiety
  10. Nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pyrosis

A

Burning in the esophagus / heartburnMay radiate to neck and jaw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dyspepsia

A

Indigestion that leads to pain in the upper abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dysphagia

A

difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ordynophagia

A

Painful swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Eructation

A

Belching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When do symptoms of GERD occur?

A

30 min - 2 hours after a meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When do symptoms worsen for GERD?

A

Worsen when lying down, bending over, or straining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should you assess when a patient comes in and complains of symptoms of GERD?

A

Need to determine if s/sx are caused from GERD or something else (ex: cardiac event)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some non-surgical interventions for GERD?

A
  1. Dont let the sphincters relax
    - Eat small meals
    - Explore weight loss options
    - Smoking cessation
    - Keeping HOB up at night
    - Avoid tight clothing
    - Avoid lying down after meals
  2. Promote gastric emptying and avoid gastric distention
  3. Watch those acidic foods
  4. Medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which medications help with GERD?

A
  1. Antacids - decrease overproduction of gastric acids2. Pepcid3. Proton pump inhibitors (PPIs) - provide long lasting reduction in amount of acid created by the stomach (ex: Prevacid, Prilosec)4. Prokinetic drugs - for those that have issues with delayed gastric emptying; increase motility/movement (ex: Reglan)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a surgical intervention for GERD?

A

Nissen Fundoplication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the procedure forNissen Fundoplication?

A

Takethe fundus and wrap it around the LES to reinforce the closing function of the sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the risks of surgery for Nissen Fundoplication?

A
  1. Hemorrhage, bleeding, infection
  2. Obstruction (If too tight)
  3. Short bouts of temporary dysphagia
  4. Bloating and gas buildup
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Does Nissen Fundoplication cure GERD?

A

No, patients still need to follow non-surgical recommendations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is Barretts Esophagus?

A

Occurs w/ prolonged GERD

Acid erodes lining of the esophagus and turns cells of esophagus to look like the lining of the intestines

Alterations can lead to esophageal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How is Barrett’s Esophagus diagnosed?

A

Via an endoscopy and biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is a Hiatal Hernia?

A

When the opening through the diaphragm where the esophagus passes becomes enlarged and part of upper stomach moves into lower portion of the thorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Risk Factors for Hiatal Hernias

A
  1. Age
  2. Obesity
  3. Women more at risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Concerns of Hiatal Hernias

A

Obstructions and Strangulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the two types of Hiatal Hernias?

A
  1. Sliding
  2. Rolling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Sliding Hiatal Hernia

A

Occur when the upper stomach, lower esophageal sphincter, and the gastroesophageal junction are displaced upward and they slide in and out of the thorax

Gastroesophageal junction is compromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Rolling Hiatal Hernia

A

Gastroesophageal junction remains in position

The stomach is pushed through the diaphragm and sits next to esophagus

The fundus rolls through the hiatus and into the thorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How does a Sliding Hiatal Hernia present?

A

Can be asymptomatic

GERD symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does a Rolling Hiatal Hernia present?

A

Can be asymptomatic

GERD symptoms

Breathlessness after eating

Chest pain that mimics angina

Feeling of suffocation

Worse lying down (SOB)

*Patients will complain of more respiratory symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which type of hiatal hernia has a higher risk for strangulation?

A

Rolling Hiatal Hernia

Piece of stomach can be strangulated - leading to higher risk for strangulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the s/s of strangulation with a hiatal hernia?

A
  1. Sudden pain in affective area
  2. Fever
  3. N/V
  4. SOB

This is a MEDICAL EMERGENCY!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Interventions for Hiatal Hernias

A

Similar to Non-Surgical Interventions for GERD

  1. Limit or eliminate foods that relax LES
  2. Promote gastric emptying or avoid gastric distention (this also helps prevent movement of the hernia)
  3. Limit or eliminated foods that add fuel to the acid fire d/t acidic content (tomato and citrus)
  4. Medications
  5. Sleep in low fowlers position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is gastritis?

A

When the lining of the stomach becomes inflamed or swollen - disrupted stomach lining

Over time the mucosa can erode due to this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Gastritis can be ___ or ___

A

acute or chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How long is acute gastritis compared to chronic gastritis?

A

Acute = few hours to days

Chronic = repeated exposure/recurrent episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the cause of non-erosive acute gastritis?

A

H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the cause of erosive Gastritis?

A

NSAIDS, Motrin, ASA, Alcohol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Why can H Pylori lead to pernicious anemia?

A

Chronic Gastritis can destroy the parietal cells of the stomach leading –> lack of intrinsic factor production which is needed for VitB12 absorption

Vit B12 is needed for RBC production, therefore anemia results

Patients may need lifelong supplementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What makes gastritis worse?

A
  1. Stress
  2. Caffeinated beverages
  3. Tobacco
  4. Spicy/highly seasoned foods
  5. NSAIDs
  6. Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are some s/s of acute gastritis?

A
  1. Anorexia
  2. Epigastric pain
  3. Hemtaemesis
  4. Hiccups
  5. Melena or hematochezia
  6. NV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are some s/s of chronic gastritis?

A
  1. Belching
  2. Early satiety
  3. Intolerance to fatty or spicy foods
  4. NV
  5. Pyrosis
  6. Sour taste in mouth
  7. Vague epigastric discomfort relieved by eating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How is gastritis diagnosed?

A

Via an upper endoscopy

Other orders may include fecal occult blood & CBC to monitor H&H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How is gastritis treated?

A

Treatment will typically be supportive, which may include:

  1. NG tube - so the stomach can rest and heal. It will be placed for decompression
  2. Medications - antacid, Pepcid, PPIs (Prilosec, Prevacid)
  3. If the patient is NPO, they are given parenteral nutrition (TPN)
  4. IV fluids
  5. Foods will be slowly introduced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the goals for patients hospitalized for gastritis?

A
  1. Relieving pain (abdominal)
  2. Promote fluid balance
  3. Reduce anxiety
  4. Promote optimal nutrition
  5. Educate about the disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Why is nutrition balance and fluid balance impaired with gastritis?

A

They become essentially NPO and are not consuming enough calories so they aren’t getting the food they need or are drinking and risk dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Interventions to Treat Chronic Gastritis

A
  1. If caused by H Pylori –> combo of antibiotics
  2. NSAIDS/Alcohol –> collaborate with health care team, educate patient, refer
  3. Smoking cessation
  4. Stress management
  5. Avoid trigger foods
    * focus on the mind-gut connection*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is Peptic Ulcer Disease (PUD)?

A

Sores in the lining of the GI system and these sores can erode the mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How do gastritis and PUD differ?

A

Gastritis only affects the stomach lining while peptic ulcers are localized sores that can erode past the mucosal layer at least half a centimeter (deeper than gastritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

A patient with H Pylori induced chronic gastritis is at high risk for developing ____?

A

PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the 4 locations peptic ulcers can be found?

A
  1. Duodenum
  2. Stomach
  3. Pylorus
  4. Esophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

___ is the most common location for a peptic ulcer, and ___ is the second most common

A

Duodenum; Stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Risk Factors for PUD

A
  1. Age (> 65 y/o)
  2. Genetics
  3. Stress
  4. NSAID use
  5. Diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Main Underlying Cause of PUD

A

H Pylori and Excessive secretion of hydrochloric acid by parietal cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the major symptom of PUD?

A

Dull, gnawing, burning pain in the mid epigastric area that can radiate into the back

due to radiation to the back rule out other potential causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are other symptoms of PUD?

A
  1. Pyrosis (heartburn)
  2. Vomiting
  3. Constipation
  4. Diarrhea
  5. Bloody stools, or emesis
    * If the bleeding is considerable, the patient may demonstrate s/s of anemia - monitor CBC, H&H
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How is PUD diagnosed?

A

Upper endoscopy to visualize the inflammation, ulcer, and lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Nursing Management and Interventions for PUD

A

Dietary Modification

Smoking cessation

Pharmacologic therapy

surgical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the drug regimen like for H Pylori infection

A

triple or quadruple therapy (with quadruple adding bismuth salts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the timing of pain like for PUD depending on if it is duodenal or gastric?

A

Duodenal (farther down so takes longer): 2-3 hours after a meal, occurs at night, relieved by food

Gastric: Immediately after a meal or 30-60 min after a meal, rarely at night, worse with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the stomach acid secretion like for PUD depending on if it is duodenal or gastric?

A

Duodenal - Hypersecretion

Gastric - Hypo or normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is weight change like with PUD depending on if it is duodenal or gastric and why?

A

Duodenal - Weight Gain - since food relieves the pain

Gastric - Weight Loss - since it becomes worse with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

4 Types of Surgical Interventions for PUD

A
  1. Vagotomy
  2. Pyloroplasty
  3. Biliroth I
  4. Biliroth II
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

When is surgical intervention for PUD done?

A

if the obstruction or perforation or ulcer wont heal over 12-16 weeks

70
Q

Vagotomy

A

Surgical Intervention for PUD

Involves severing the vagus nerve to decrease gastric acid making them less responsive to gastrin which can help prevent PUD

71
Q

Pyloroplasty

A

Surgical Intervention for PUD

widens the opening of the lower part of the stomach so contents pass easier into the duodenum

72
Q

Biliroth I (Gastroduodenostomy)

A

PUD Surgery

Lower portion of stomach (gastrin release area) and a small part of the duodenum and pylorus are removed and then what remains is resewn to the duodenum

Removes the pylorus so risk for dumping syndrome

73
Q

Biliroth II (Gastrojejunostomy)

A

PUD Surgery

Removes lower portion of stomach and connects it to the jejunum

Can have dumping syndrome here

74
Q

Nursing Dx for PUD

A

Pina

Fluid and Nutrition Balance

Anxiety

Home and Community Based Care

75
Q

What are some common complications of PUD

A

Hemorrhage

Perforation and Penetration

Gastric Outlet Obstruction

76
Q

___% of PUD pts hemorrhage and present with bloody stool or emesis

A

15%

77
Q

What does perforation and penetration with PUD cause

A

erode the serousa –> gastric contents leak into peritoneum (peritonitis) –> EMERGENCY

78
Q

When does gastric outlet obstruction from PUD occur

A

Area near pyloric sphincter is scarred and stenosed from healing ulcers over time meaning the sphincter cannot function right leading to scar tissue and obstruction

79
Q

T/F: Most pepetic ulcers result from infection with the gram negative bacteria H pylori which may be acquired through ingestion of food and water

A

True

80
Q

Currently the most commonly used therapy for peptic ulcers is a combination of ___, proton pump inhibitors, and bismuth salts that suppresses or eradicates H Pylori

A

Antibiotics

81
Q

Chronic Constipation

A

Fewer than 3 BMs weekly or hard, dry, small, and difficult to pass based on normal BM schedule

82
Q

Clinical manifestations of chronic constipation

A

straining

pain or pressure

sensation of incomplete evacuation

lumpy hard stools

fewer stools

83
Q

Causes of Chronic Constipation

A

diet - low fiber

holding in poop

inadequate fluid intake (<8 glasses)

being a couch potato / lack of exercise

too active leading to being too busy and forgetting or not having time to BM

medications: pain meds, chronic laxative use

Hypothyroidism and Spinal Cord Injuries

84
Q

Nursing Management for Chronic Constipation should focus on what

A

education and controlling any pain

85
Q

Ways to prevent constipation

A

high residue high fiber diet

making sure pt is consuming enough fluids unless contraindicated

exercising

diet

86
Q

Diarrhea

A

increased frequency of BM (more than 3 / day) and alternative consistency of the stool

87
Q

When is diarrhea considered chronic

A

when changed consistency and 3/day stools persist 2-3 weeks or more

88
Q

Clinical Manifestations of Diarrhea

A

Urgency

Perianal discomfort from frequency of BM and skin irritation around anus

abdominal cramping and distention

rumbling in the stomach or intestinal region

89
Q

Causes of Diarrhea

A

stool softeners

antibiotics

tube feedings

C Diff

diabetic neuropathy or pancreatic insufficiency

inflammation

90
Q

Complications of Diarrhea

A

dehydration!!

cardiac dysrhythmias

low potassium

skin irritation around anus

91
Q

What is nursing management of diarrhea focused on

A

Dehydration!!!

But also:

Lyte Balance
Skin Integrity
Accurate Health Hx
Exploring Diet and IV Hydration / Lyte Replacement

92
Q

Small bowel disorder leads to what stool characteristics

A

watery

93
Q

Large bowel disorders leads to what stool characteristics

A

loose, semi solid

94
Q

Malabsorption syndrome leads to what stool characteristics

A

voluminous, greasy

95
Q

Inflammatory disorders leads to what stool characteristics

A

blood, mucus, pus

96
Q

Pancreatic Insufficiency leads to what stool characteristics

A

oil droplets

97
Q

Diabetic neuropathy leads to what stool characteristics

A

nocturnal frequency

98
Q

C Diff leads to what stool characteristics

A

diarrhea, unexplained, and they are on antibiotics which can alter things

99
Q

Diarrhea is defined as the increased frequency of more than 3 bowel movements per day

A

true

100
Q

Inflammatory Bowel Disease (IBD)

A

A group of chronic disorders: Ulcerative colitis and Crohns disease

101
Q

Ulcerative colitis

A

IBD

recurrent ulcerations that affect the mucosa and submucosa layers of the colon and rectum (particularly the transcending and descending colon

ulcers are often continuous/contiguous and are connected to one another

102
Q

Crohn’s disease

A

IBD - AKA: Regional enteritis

Subacute and chronic inflammation of the GI tract that spreads deep into the tissue layers (deeper than UC) of the affected bowel tissue

Can happen anywhere mouth to anus but is typically found in the ileum and ascending colon

Has a cobblestone appearance because it does go deeper into the bowel layers

103
Q

IBD is most common in what age group

A

15-30 year olds

Young people!: HS Students, College Students, Young Adults

Some links to smoking and active smoking for UC but needs more research

104
Q

Location of UC v CD

A

UC - Colon

CD - Mouth to anus

105
Q

What are the lesions like in UC v CD

A

UC - Contiguous

CD - Cobblestone / Not contiguous

106
Q

What are the exacerbations like in UC v CD

A

UC - Exacerbations and remissions

CD - Prolonged bouts

107
Q

What is the diarrhea like in UC v CD

A

UC: More severe (10-20 bouts QD)

CD: Less severe (5-6 bouts of QD)

108
Q

Symptomology of UC v CD

A

UC: LLQ pain (where descending colon is), passage of mucus and pus, tenesmus (ineffective painful straining), rectal bleeding, anorexia

CD: RLQ crampy pain (ileum here), eating stimulates cramps, anorexia, steatorrhea, fever

109
Q

Bleeding of UC v CD

A

UC: Common and severe

CD : not common and mild

110
Q

Fistulas in UC v CD

A

UC: Rare

CD: Common

111
Q

Other Complications in UC v CD

A

UC - Perforation, Toxic Megacolon –> Bowel perforation

CD: Bowel obstruction, abscesses, colon cancer

112
Q

Surgery in UC v CD

A

UC: Curative (since removal can cure)

CD: Non curative (since it can be anywhere it cannot be cured)

113
Q

What sort of pharmacologic treatments are done for IBD

A

corticosteroids and antibiotics

114
Q

Big concern with IBD is ….

A

nutritional imbalance

the anorexia - IBD often underweight, malnutrition, malnourished - so its common (esp in CD) to see Parenteral nutrition - GI will need rest and anorexia

115
Q

Biggest complication concerns of IBD

A

electrolyte imbalance

cardiac dysrhythmias related to electrolyte imbalances

GI bleeding with fluid volume loss

perforation of the bowel

116
Q

Nursing Goals of IBD

A

bowel elimination

pain management

fluid volume

nutrition

fatigue

anxiety (v bad they are young)

coping

skin (frequent BM)

knowledge (deficit about IBD)

self health management

complications

117
Q

Nursing Interventions for IBD

A

Diet, activity and stressors - nutritional therapy

ready access to restroom

pain management

fluid volume and low residue diet –> low gas diet easy to digest

rest

anxiety and coping

skin

understanding and self care

118
Q

Irritable Bowel Syndrome (IBS)

A

chronic functional disorder associated with pain and disordered BMs

diagnosed s/s

119
Q

What differentiates IBD and IBS

A

IBD - the doctor can do an endoscopy and visually see the ulcers

IBS - functional disorders means there is no diagnostic finding on colonoscopy (scope shows nothing) - diagnosed based on s/s

120
Q

Clinical Manifestations of IBS

A

Disorder of frequency and consistency of stool - diarrhea to constipation back and abdominal pain/pain assoc with change in stool and stool appearance and frequency

121
Q

Interventions for IBS

A

Education

Dietary Habits

Chew and Dont Drink with Meals - Fluid cause distention

Stress Management

122
Q

T/F: The patient with IBS should select foods low in fiber in order to minimize intestinal irritation

A

False - want them to have high fiber foods

123
Q

In Crohn’s disease, the clusters of ulcerations on the intestinal mucosae have a ___ appearance

A

Cobblestone

124
Q

What are the 3 subclasses of Intestinal Obstructions be

A

Mechanical v functional

small bowel v large bowel

partial v complete

125
Q

Mechanical Intestinal Obstruction

A

Caused from pressure on the intestinal wall and the pressure leads to adhesions, intussusception, inguinal hernia, hernia, or tumor

126
Q

Functional Intestinal Obstruction

A

“Paralytic Obstruction”

When intestinal musculature cannot propel food, cannot do peristalsis, cannot propel weight

127
Q

Common causes for Intestinal Obstructions

A

Endocrine Disorders and Neurological Disorders

128
Q

What is the difference between partial and complete intestinal obstructions

A

Parial means only part of the movement is occluded; complete means nothing can move

129
Q

A patient with intestinal obstruction is at significant risk for what

A

fluid imbalance - critically imbalanced

We want to maintain the fluid and lyte balance, insert and NG tube as orders, and be NPO

130
Q

S/S of Intestinal Obstruction

A

Pain

May or may not have BM reported

potential mucus of blood in stool

abdomen distended!!!! (large and firm)

emesis

weakness

potential weight loss

131
Q

Nursing Interventions for Bowel Obstructions

A

IV fluids

NG tube decompression

fluid and lyte replacement

surgery - if tissue is strangulated

fix root cause - ex: hernia

anti nausea meads- not PO, IV or suppository’s

132
Q

T/F: Decompression of the bowel through a nasogastric tube is necessary for all patients with a small bowel obstruction

A

True - if the pt is obstructed they are getting an NG tube

133
Q

General Nursing Considerations Post GI Surgery

A
  1. Resuming enteral intake (PO) - get them back up and moving
  2. Dysphagia
  3. Gastric Retention
  4. Bile Reflux (when pylorus removed/broken)
  5. Dumping Syndrome (when pylorus removed/broken)
  6. Vit and Min Deficiencies
134
Q

Intestinal Diversion

A

Allows stool to leave the body when there is disease or injury

It is a pouch with a stoma that is from the wall of the colon or ileum v- brought to surface and fused with it

135
Q

Ostomy location depends on…

A

disease and condition location - depends on where in the GI system is affected

136
Q

What changes based on ostomy location

A

stool consistency

137
Q

Colostomies

A

Sigmoidostomy

Descending Colon Ostomy

Transverse Colon Ostomy

Ascending Colon Ostomy

138
Q

Ileostomy Stool

A

ostomy that bypasses the entire large intestine, so stools are liquid, frequently contain digestive enzymes, and must be pouched at all times

has lots of digestive enzymes so can be irritating to skin

139
Q

How do the colostomy stools compare

A

Sigmoid - stool may be more solid - water absorbed

Descending - semisolid, less solid than sigmoid

Transverse - more mushy than descending

Ascending - liquid stool

140
Q

Ileostomy byupasses what

A

colon, rectum, and anus

141
Q

Which ostomy has fewest complications

A

Ileostomy

142
Q

Colostomy

A

diverts colon to a stoma

143
Q

Ileoanal Reservoir

A

essentially a “new rectum”

large intestine removed but anus remains intact and disease free

colon like pouch from last several inches of ileum

stool collects and exits during bowel movement

144
Q

Continent Ileostomy (K Pouch)

A

For pts, with rectal or anal damage who do NOT want ostomy pouch

large intestine removed and a Kock pouch is made from the end of the ileum

effluent is then drained by inserting a catheter into a valve

145
Q

Ostomy Care education should include

A

basic assessments

size

strict I&O

effluent monitoring

skin care and pouch care

diet and medications

monitor and report increase or decrease of effluent, stomal swelling, abdominal cramping and distention

146
Q

When does effluent post ostomy surgery appear

A

not until 24-48 hours after surgery

147
Q

Nursing Dx for Ostomy Care

A

Disturbed body image

Risk for impaired skin integrity r/t to irritation of the peristomal skin by the effluent

Imbalanced nutrition: less than body requirements r/t avoidance of foods

Anxiety r/t to the loss of bowel control

Risk for deficient fluid volume

Sexual dysfxn

Deficient Knowledgeo

148
Q

Ostomy Irrigation

A

to stimulate emptying at scheduled times

note always in routine care but can help stop unplanned bowel movements or fecal drainage in social situations

gives pts control

149
Q

T/F: The pt with an ileostomy with a Kock Pouch will not need to use an external collection bag

A

True

150
Q

What is the main risk factor for esophageal cancer

A

barrets esophagus

151
Q

what gender is more likely to get esophageal cancer

A

men

152
Q

what race is more likely to get esophageal cancer

A

African American

153
Q

Risk factors for esophageal cancer

A

smoking

ETOH use

gender

age

comorbidities

154
Q

One of the number one complaints about esophageal cancer is what

A

dysphagia - trouble swallowing

sensation in throat or something is getting stuck

*also weight loss and weakness

155
Q

by the time esophageal cancer symptoms appear

A

the cancer has advanced

156
Q

Diagnostics for Esophageal Cancer

A

biopsy and endoscopy

157
Q

Treatments for Esophageal cancer

A

chemo

radiation

re-sectioning esophagus with part of small intestine

158
Q

What gender and races are more likely to get gastric cancer

A

men > women

native america, hispanic, african american > caucasian

159
Q

Risk Factors for Gastric Cancer

A

poor diet

smoking

alcohol use

gastritis

160
Q

How does gastric cancer present

A

clinical manifestations present like PUD

undiagnosed until CT scan

161
Q

Diagnostic for Gastric Cancer

A

CT Scan

162
Q

Treatments for Gastric Cancer

A

chemo and radiation - may be palliative not curative

total gastrectomy if it hasnt spread and is caught early

163
Q

Duodenal Tumors

A

Usually benign and diagnosed incidentally

present asymptomatic

if severe, intermittent pain and occult bleeding occurs

can be removed with surgery

164
Q

3rd most common cause of cancer death is via ____ cancer

A

colorectal

165
Q

chief sign for colorectal cancer

A

change in bowel habits!!!’

*second most common manifestation is blood in stool

166
Q

____ is the most prevalent cancer diagnosis in colorectal cancers

A

adenocarcinomas

167
Q

How is colorectal cancer diagnosed

A

via colonoscopy and biopsy

168
Q

Tenesmus

A

recurrent inclination to evacuate bowels - can be painful or spasming sensation

169
Q

Risk Factors for colorectal cancer

A

increasing age - >50 yo

family hx of colon cancer or polyps

high consumption of ETOH

cig smoking

obesity

hx of gastrectomy

hx of inflammatory bowel disease

high fat, high protein (with high intake of beef), low fiber

genital cancer (endometrial CA< ovarian CA) or breast CA (in women)

170
Q

S/S of Colorectal Cancer

A

Right Sided Lesions - Dull abdominal pain and melena

Left Sided Lesions - abdominal pain, cramping, narrowed stools, constipation, distention, bright red blood

Rectal lesion - tenesmus, rectal pain, feeling of incomplete evacuation after a BM. alternating constipation and diarrhea, bloody stool

171
Q

The etiology of cancer of the colon and rectum is predominantly (90%) ____, a malignancy arising from the epithelial lining of the intestine

A

adenocarcinoma

NURS363 - Practice of Nursing IV (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions