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ADN002 MED SURG > Week 3 GI Disorders > Flashcards

Week 3 GI Disorders Flashcards

1
Q

Functions of the Digestive Tract

A

Breakdown of food for digestion through mastication and peristalsis

Elimination of undigested foodstuffs and other waste products

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2
Q

Absorption of Nutrients

A

Produced by digestion into the blood stream

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3
Q

Digestion

A

Occurs when enzymes mix with ingested food and when proteins, fats, and sugars are broken down into their component molecules.

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4
Q

Phase of digestive process that occurs when small molecules, vitamins, and minerals, pass through the walls of the small intestine and large, and into the bloodstream

A

Absorption

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5
Q

Occurs after digestion when wastes are eliminated

A

Elimination

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6
Q

Bolus of food from stomach to small intestine

A

Chyme

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7
Q

Enzymes chewing and swallowing

A

Saliva and salivary amylase

Mixed and termed Bolus

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8
Q

Gastric function

A

Hydrochloric Acid, pepsin, gastrin, H+ ions, HCI acid, intrinsic factor

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9
Q

Small Intestine

A

Chyme- amylase, lipase, trypsin( pancreas), bile( gallbladder/liver)

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10
Q

Assessment Hx for GI

A

All information related to GI function

Psychosocial, spiritual, and cultural factors

Assess Knowledge, need for pt education, according to certain meds

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11
Q

Right Shoulder Pain

A

Liver/ gallbladder

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12
Q

Left Shoulder Pain

A

Spleen
Splenic rupture common in high impact trauma

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13
Q

Blood Pooling in dependent position

A

Ecchymosis

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14
Q

Bladder Rupture=

A

MVA

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15
Q

Epigastric Pain

A

Acid reflux
Pancreas and MI

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16
Q

Left arm and left jaw pain

A

MI

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17
Q

Cholecystitis =

A

Positive Murphys Sign

Acute cholecystitis

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18
Q

Positive Murphy Sign

A

Palpate gallbladder area medial to midclavicular line while the Pt is lying supine. Ask Pt to inhale deeply, which expands lungs and pushes gallbladder against examiner’s fingertips

Positive if pt. ceases inhaling due to pain

If not murphy can still have cholecystitis

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19
Q

MELD

A

Models for End Stage Liver Disease
Scoring liver transplant list higher the score more severe the liver disease

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20
Q

Child Pugh Score

A

Helps predict the risk of death in liver disease and suggest how aggressive the tx should be

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21
Q

RUQ Pain

A

Gallbladder
Cholecysitis
Hepatitis
Peptic Ulcer
Renal Pain
Pneumonia

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22
Q

RLQ Pain

A

Appendicitis
Intestinal Obstruction
Diverticulitis
Ectopic Pregnancy
Ovarian Cyst
Salpingitis
Endometriosis
Ureteral Calculi
Renal Pain

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23
Q

LUQ Pain

A

Gastritis
Pancreatitis
Splenomegaly
Renal Pain
MI
Pneumonia

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24
Q

LLQ Pain

A

Diverculitis
Intestinal Obstruction
Ovarian Cyst
Salpingitis
Ureteral Calculi
Renal Pain

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25
Q

Process of Peristalsis

A

Under control of nervous system

Contractions occur every 3-12 minutes

One third to one half of food waste is excreted in stool within 24 hours

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26
Q

Diagnostic Tests

A

Stool Specimen
Breath test- Detect H. Pylori
Abdominal Ultrasonography- advantage= no radiation; used for gallbladder, appendix, kidney stones, ectopic pregnancy
DNA Testing- Colon cancer, Lactose deficiency, IBS

Imaging Studies- CT, PET, MRI, scintigraphy
Upper GI tract- EGD
Lower GI Tract- Colonoscopy- fiberoptic

GI Motility- Barium Swallow- Fluoroscopy

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27
Q

How is colonoscopy performed?

A

Pt lying on left side with legs drawn up to the chest

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28
Q

Endoscopic Procedures

A

Endoscopy

Direct visualization of body’s interior through intestinal tract

Fiberoptic scope transmits light- clear image of internal tissue is directed back up the scope to the lens and eyepiece

Shows growth, strictures, ulcers, inflammatory disease

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29
Q

Why we use endoscopy?

A

Biopsy or excision of polyps or tumors
Dilate Structured areas
Localize and stop active hemorrhaging or bleeding
Remove or crush biliary stones

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30
Q

Common Types of Endoscopy

A

EGD
ERCP
Gastroscopy
Colonoscopy
Sigmoidoscopy

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31
Q

What is purpose of GI intubation?

A

Decompress the stomach
Lavage the stomach
Diagnose GI disorders
Administer Meds
Compress the bleeding site
Aspirate gastric contents for analysis

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32
Q

Levin and Gastrin Salem Sump are

A

NG tubes

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33
Q

Enteroflex and Nasoenteric are

A

Enteric tubes

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34
Q

Purposes and Advantages of Enteral Feedings

A

Meet nutritional requirements when oral intake is inadequate or not possible and the GI tract is functioning

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35
Q

Advantages of Enteral Feedings

A

Safe and cost effective
Preserve GI integrity
Preserve the normal sequence of intestinal and hepatic metabolism
Maintain Fat metabolism and lipoprotein Synthesis
Maintain Normal Insulin and glucagon ratios

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36
Q

Feedings longer than 4 weeks we use ?

A

Gastrostomy and jejunostomy preferred

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37
Q

Tubes

A

NG or Nasoenteric tubes

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38
Q

Methods of Feedings

A

Intermittent Bolus Feedings
Intermittent Gravity Drip
Continuous Infusion
Cyclic Feeding

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39
Q

Nursing Care of the Patient with a NG tube or any other Tubes

A

Pt education and preparation
Tube Insertion
Confirming Placement
Cleaning tube obstruction
Monitoring Pt
Maintaining Tube function
Oral and Nasal Care
Monitoring, preventing, and managing complications
Tube Removal

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40
Q

Caring for Pt receiving Enteral Feeding

A

Nutritional status and assessment
Factors or illnesses that increase metabolic needs
Digestive Tract Function
Renal Functions and Electrolyte Status
Medications and other theories that affect nutrition intake and function of the GI
Compare dietary prescription with Pt needs

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41
Q

Nursing Dx for Enteral Feedings

A

Risk for
Diarrhea
ineffective airway clearance
defecient fluid
ineffective coping
Deficient Knowledge

Imbalanced Nutrition

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42
Q

Maintain Nutrition Balance and Tube Function

A

Administer feeding at prescribed rate and to pt tolerance

Measure GRV before feedings and every 4-8 hours during continuous feedings

Administer water before and after each feeding and medication

And after checking residual flush with water

Every 4-6 hours and whenever the tube feeding is discontinued or interrupted

Do Not mix meds with feedings

Use a 30 ml or larger syringe
Why? smaller syringe creates too much pressure

Maintain delivery system as required. Avoid bacterial contamination and do not hang for more than 4 hours of feeding in an open system

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43
Q

How to reduce risk of aspiration for tube feedings

A

Elevate HOB at least 30- 45 degrees

Monitor residual volumes

X Ray Confirmation on initial placement before tube feedings.

44
Q

What is a TNA ?

A

Total Nutritional Admixture requires use of filter due to precipitates

45
Q

IVFE

A

Intravenous Fat Emulsions do NOT use filter

46
Q

Parenteral Nutrition

A

Method to provide nutrition to the body by IV route

Complex mixture containing proteins, carbs, fats, electrolytes, vitamins, trace minerals, and sterile water is administered in a single container

Goal is to improve nutritional status and to attain a positive nitrogen status

May be delivered peripherally or via a central line depending o solutions hypertonicity

47
Q

Indication for Parenteral Nutrition

A

Intake insufficient to maintain anabolic state
Ability to ingest food orally or by tube is impaired
Pt is not interested or unwilling to ingest nutrients
Underlying medical condition precludes oral or tube feeding
Preoperative and postoperative nutritional needs are prolonged

48
Q

Name Delivery Options for Parenteral Therapy

A

Peripheral Method

Central Method
Nontunneled catheter
PICC
Tunneled Central Catheter
Implanted Ports

49
Q

Assessment of Pt receiving Paternal Nutrition

A

Assist in identifying Pt for PN
Nutrition status
Hydration Status
Electrolytes
S/S of hypoglycemia or hyperglycemia - Monitor Blood Glucose

Assess for potential complications
VS, including Temperature every 4 hours or by protocol

50
Q

Pt with Parenteral Nutrition Nursing Dx

A

Imbalanced nutrition
Risk for Infection
Risk for excess or deficient Fluid volume
Risk for immobility
Risk of ineffective therapeutic regimen

51
Q

Collaborative Problems and Potential Complications

A

Pnemothorax
Clotted or displaced catheter
Sepsis
Hyperglycemia
Rebound Hyperglycemia
Fluid Overload

Always start PN slowly and advance gradually

52
Q

Prevention of Infection

A

Appropriate catheter and IV site care
Strict sterile technique for dressing changes
Wear mask when changing the dressing
Assess Insertion site
Assess for indications for infection
Proper IV tubing and tubing care

53
Q

What will prevent rebound hypoglycemia?

A

10% dextrose solution

54
Q

Maintaining Fluid Balance

A

Use Infusion pump. Flow rate should not be increased or decreased rapidly. If fluid out, hang 10%

Monitor fluid balance and electrolyte levels
I&O
Weights
Monitor blood glucose levels

55
Q

What are variables that influence Bowel Elimination?

A

Developmental Considerations
Daily Patterns
Food and fluid
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic Conditions
Medications
Diagnostic Studies
Surgery and Anesthesia

56
Q

Constipation

A

Abnormal infrequency or irregularity of defecation; any variation from normal habits may be a problem

57
Q

What causes constipation?

A

Meds
Chronic laxative Use
Weakness
immobility
Fatigue
Diet
Inability to create intra abdominal pressure
and lack of regular exercise

Increased risk in older age

58
Q

Perceived Constipation

A

Subjective problem in which the person’s elimination pattern is not consistent with what he or she believes is normal.

59
Q

Manifestations of constipation

A

Fewer than 3 BMs in a week
Abdominal Distention
Decreased Appetite
Headache
Fatigue
Indigestion
Sensation of incomplete evacuation
Straining at stool
Elimination of small volume, hard, dry stools

60
Q

Chronic Constipation is usually what?

A

Idiopathic

Further testing needed for severe, intractable constipation

61
Q

Assessment and Diagnostic Findings

A

Thorough History and Physical examination

Barium Enema, sigmoidoscopy, and stool testing

Defecography and colonic transit studies

MRI

62
Q

Defecogram

A

Useful for identifying rectal intussusception, rectocele, rectal prolapse, and animus.

63
Q

Special test that can be very important in helping to determine the cause of a patients symptoms of fecal incontinence or difficult defecating

A

Defecating Proctogram

64
Q

Part of intestine slides into an adjacent part of the intestine

A

Intussception

Often blocks fluids and food from passing through with the telescoping action.

Also cuts off blood supply to part of the intestine that is affected.

65
Q

Rectocele

A

Type of prolapse where the supportive wall of tissue between a woman’s rectum and vaginal wall weakens

66
Q

Rectal Prolapse

A

rectum slips out to external environment through Anus

67
Q

Anismus/ Dyssynergic Defecation

A

Failure of normal relaxation of pelvic floor muscles during attempted defecation- pelvic floor dysfunction

68
Q

Constipation Complications

A

HTN
Fecal Impacted
Fissures
Hemorrhoids
Megacolon

69
Q

Pt Learning Needs

A

Normal
Establishment of normal pattern
Variations of Bowel Patterns
Dietary Fiber and Fluid intake
Responding the urge to defecate
Exerciser and Activity
Laxative Use

70
Q

Soluble Fiber

A

Sticky when wet.
Oats

71
Q

Insoluble Fiber

A

Does not absorb water as much.

For example, celery in a glass of water, does not change.

72
Q

Laxatives that add mass, stimulate peristalsis and defecation. Must be taken with water to avoid obstruction. Most desirable for long term use

A

Bulk forming

Psyllium Preparations

73
Q

Decrease surface tension of the fecal mass to allow water and fat to penetrate into the stool by making it softer and easier to expel. Little true laxative effect.

A

Surfactant Laxatives

Docusate Sodium

74
Q

Laxatives that lubricate fecal mass and slow colonic absorption of water from fecal mass. Medications may interfere with the absorption of fat soluble vitamins and if aspirated may result in ?

A

Lubricant Laxatives

Mineral Oil and Fleets, Agoral Plain

Result in Lipid Aspiration Pneumonia

75
Q

Strongest and most abused laxatives

A

Stimulant Cathartics

Irritate GI mucosa, pull water into the colon, and stimulate peristalsis. Produce a watery stool and may lead to fluid and electrolyte, and acid base imbalances.

Ex; Biscodyl, Castor Oil, Glycerin, Senna

76
Q

Increase the osmotic pressure in the intestinal lumen, resulting in retention of water, which distends the bowel and stimulates peristalsis.

A

Saline Laxatives

Produce semifluid stool and may lead to fluid and electrolyte imbalances.

Ex: Magnesium Citrate, Milk of Mag, Miralax, Fleet, Phosphosoda, Fleets Enema

77
Q

To relieve constipation in pregnant women, elderly patient whose abdominal and perineal muscles have become weak and atrophied, children with megacolon, pt receiving drugs that decrease intestinal motility

A

Laxatives and Cathartics

78
Q

Laxatives and Cathartics

A

Prevent straining at stool in pt with CAD, HTN, Cerebrovascular disease, and hemorrhoids and other rectal conditions

79
Q

Empty bowel in preparation for bowel surgery or diagnostic procedures ( colonoscopy, barium enema)

Accelerate elimination of toxic substances from GI tract

Prevent absorption of intestinal ammonia in pt with hepatic encephalopathy - Lactulose

A

Indications for Use Laxatives and Cathartics

80
Q

Laxatives and Cathartics also used for…

A

Obtain a stool specimen for pathologic identification

Accelerate excretion of parasites after anthelminthic drugs have been administered

Reduce serum cholesterol levels ( psyllium products)

81
Q

Adverse Effects of Laxatives and Cathartics Psyllium or any fibers may result in what

A

Severe Gas or bloating

Common adverse effects of bisacodyl include abdominal pain and cramping, nausea, diarrhea, and weakness

82
Q

Miscellaneous Agents for Constipation

A

Lactulose- osmotic effect, pulling water into the colon and stimulates peristalsis. Also useful in treating encephalopathy by decreasing ammonia.

83
Q

Often given sodium polystyrene sulfonate in the tx of hyperK to aid in the expulsion of the potassium resin complex

A

Sorbitol

84
Q

Aids in treating chronic idiopathic constipation by increasing intestinal fluid secretion, stimulating intestinal motility, and defecation

A

Lubiprostone

85
Q

Increased frequency of BMs more than 3 a day, increased amount of stool, and altered consistency of stool( looseness)

A

Diarrhea

86
Q

Diarrhea is usually associated with

A

urgency, perianal discomfort, incontinence, or a combination of these factors

It may be acute or chronic

87
Q

What can cause diarrhea?

A

Infections
Meds
tube feeding
metabolic and endocrine disorders
Various disease processes

88
Q

Rumbling and gurgling sounds made with movement of fluid and gas in intestines

A

Borborygmus

89
Q

Feeling that you need to have a BM, even after you already have one

A

Tenesmus

90
Q

Manifestations of Diarrhea

A

Increased frequency and fluid of stools
Abdominal Cramps
Distention
Borborygmus
Painful Spasmodic contractions of anus
Tenesmus

91
Q

Assessment and Diagnostic Findings of Diarrhea

A

CBC- WBC infection
Serum Chemistries
Urinalysis
Stool Examination- C. Diff
Endoscopy or barium enema

92
Q

Possible complications of Diarrhea

A

Fluid and electrolyte imbalance
Dehydration
Cardiac Dysrhythmias

93
Q

Pt Learning Needs for Diarrhea

A

Recognition of need of medical Tx
Rest
Diet and Fluid intake
Avoid irritating foods
Perianal skin care
Medications
May need to avoid milk, fat, whole grains, fresh fruit, and veggies
Lactose intolerance

94
Q

What is used to treat moderate and severe diarrhea? What does it do?

A

Oral opioid diphenoxylate with atropine

Slows peristalsis by acting on the smooth muscles of the stomach

95
Q

Adverse Effects of Diphenoxylate with Atropine

A

Tachycardia, dizziness, flushing, nausea, vomiting, dry skin, and mucous membranes, and urinary retention

Hypotension and Respiratory depression have occurred with very large doses

96
Q

These salts have antibacterial and antiviral activity

A

Bismuth Salts

97
Q

Bismuth Subsalicylate also has what?

A

antisecretory and possible anti-inflammatory effects

98
Q

Ocetreotide Acetate

A

Synthetic form of somatostatin, hormone produced in the anterior pituitary gland and in the pancreas.

Decreases GI secretion and motility

99
Q

What can be given for gastric ulcers and GI bleed

A

PPIs

Octreotide also can be used for given GI bleed

100
Q

Polycarbophil and psyllium are most often used as what?

A

Bulk forming laxatives
Used for diarrhea to absorb toxins and water, and decreasing the fluidity of stools

101
Q

Pancreatin/ Pancreplipase

A

Used in deficiency of pancreatic enzymes and results in malabsorption of nutrients and steatorrhea which is a loose fatty stool

102
Q

This used to treat diarrhea due to bile salt accumulation in conditions such as Crohn’s disease or surgical incision of the ileum

A

Cholestyramine

Colestipol

103
Q

Selective 5HT3 receptor antagonist indicated in treating women with chronic severe diarrhea predominant in IBS that has not responded to conventional therapy

A

Alosetron

104
Q

Assessment of Diarrhea

A

Determine the duration
number of stools
Consistency, color, odor, any abnormal components

Try to determine the cause

With severe prolonged diarrhea, especially in young children and older adults.

Assess for dehydration, hypoK, and other fluid and electrolyte disorders

105
Q
A

ADN002 MED SURG (18 decks)

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