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NCLEX > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

pyloric sphincter

A

closes to keep food in the stomach, and opens to send food into the small intestine

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2
Q

small intestines

A

receive digestive enzymes from pancreas and liver, make food into chyme and absorb nutrients

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3
Q

liver functions

A

produce bile, albumin, cholesterol, converts glucose to glycogen for storage, converts ammonia to urea, metabolizes bilirubin in the breakdowns of RBCs, metabolizes drugs and toxins, produces clotting factors and regulates blood clotting

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4
Q

gallbladder

A

stores and releases bladder into small intestine

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5
Q

pancreas

A

regulates blood sugar, and produces and releases digestive enzymes; trypsin, amylase, lipase (released into duodenum)

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6
Q

Large Intestine

A

absorbs water and electrolytes, produces and absorbs vitamins, forms and propels feces toward rectum for elimination

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7
Q

TPN

A

delivered intravenously, contains dextrose, amino acids, and electrolytes; central line is preferred

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8
Q

TPN complications

A

infection, fluid overload hypo/hyper-glycemia, embolism

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9
Q

if TPN runs out and you don’t have anymore what should you do

A

do not turn off suddenly, give dextrose 10% at same rate the TPN was running

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10
Q

TPN bag and tubing is changed every

A

24 hours

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11
Q

ondansetron nursing consideration

A

administer slowly, fast push can cause QT prolongation and VT

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12
Q

antiulcer agents include

A

H2 receptor blockers, PPIs, antacids, GI protectant

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13
Q

Famotidine

A

H2 receptor antagonist (antihistamine); blocks release of histamine which blocks acid secretion; separate this class from other medications as they are likely to interact

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14
Q

Famotidine use

A

short term tx of gastric and duodenal ulcers, GERD, hypersecretion of stomach acid conditions, chronic NSAID use

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15
Q

Omeprazole

A

PPI; GERD and ulcers, decreases gastric acid production; administer 30-60 minutes, report black, tarry stools

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16
Q

sucralfate

A

aluminum hyroxide and sucrose; promotes healing of ulcers by providing a barrier over them, short term tx of duodenal or gastric ulcers, peptic esophagitis, NSAID/ASA induced GI damage

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17
Q

surcralfate nursing considerations

A

take on empty stomach 1 hr before meals or 2 hours after and at bedtime (usually taken 4 times a day), don’t give within 30 min of antacids as it decreases effectiveness, monitor BG in diabetics as it contains sucrose

can decrease availability of warfarin, digoxin, phenytoin, levothyroxine and classes of abx - separate these drugs from sucralfate for at least 2 hrs

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18
Q

NG tube measurement

A

nose to ear to xiphoid process

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19
Q

blakemore tube

A

inserted through nose down esophagus and into stomach with balloons that can be inflated to stop bleeding esophageal varices

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20
Q

blakemore tube nursing consideration

A

must keep a pair of scissors at bedside in case of emergency; if inflate balloon becomes dislodged it can compress the trachea and cause respiratory arrest; if happens cut balloon port to let air escape

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21
Q

hold feeds if gastric residual is greater than

A

500ml

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22
Q

esophageal varices

A

dilated submucosal veins in esophagus, can burst and bleed; caused by liver disease and alcoholism tx: blakemore tube and surgery

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23
Q

GERD what is it and tx and complications

A

acid refluxes from stomach into esophagus causing esophagitis Tx: sit upright after eating, eat small frequent meals, H2 blockers and PPIs, complication: Barrett’s esophagus

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24
Q

Gastritis

A

inflammatory disorder of gastric mucosa; acute gastritis is associated with H.pylori and NSAID use

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25
Q

gastritis S&S and tx

A

vague abdominal discomfort, epigastric tenderness, bleeding

tx: healing occurs spontaneously within a few days, no NSAIDs, H2 receptor blockers, PPIs, abx if cause is H. pylori

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26
Q

Barrett’s esophagus

A

reflux for extended period of time, acid has caused changes to cells of esophagus which are cancerous

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27
Q

Gastric ulcer S&S

A

pain 1-2 hrs after meals and gets worse when eating, abd pain aggravated by eating, vomiting, weight loss, hematemesis if hemorrhage occurs

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28
Q

Gastric ulcer tx

A

treat H.pylori infection with abx if this is the cause, reduce stomach acid with PPIs and H2 receptor blocks

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29
Q

duodenal ulcer S&S

A

pain 2-4 hrs after meals, food may relieve pain, weight gain, melena if hemorrhage occurs

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30
Q

duodenal ulcer tx

A

treat H.pylori infection with abx if this is the cause, reduce stomach acid with PPIs and H2 receptor blocks

31
Q

primary action of PPIs is to

A

increase stomach pH or decrease amount of acid in the stomach

32
Q

Crohn’s disease

A

inflammation and erosion of the ileum and anywhere throughout the small and large intestines; affects any part of digestive tract from mouth to anus, skip lesions

33
Q

ulcerative colitis

A

inflammation of large intestines, sigmoid colon and rectum, lesions are continuous (no skipped lesions) and are limited to the mucosa and are not transmural

34
Q

Diverticula

A

herniation of mucosa through the muscle layers of the colon wall

35
Q

diverticulosis

A

asymptomatic diverticular disease

36
Q

diverticulitis

A

inflammatory stage of diverticulosis

37
Q

possible causes of diverticular disease

A

decreased dietary fiber, abnormal neuromuscular function, alterations in intestinal motility, >60 yrs of age

38
Q

diverticula disease S&S

A

rebound tenderness, cramping, diarrhea, vomiting, dehydration, weight loss, rectal bleeding, bloody stools, anemia, fever

39
Q

diverticula disease tx

A

low fiber diet, avoid cold or hot foods, no smoking, antidiarrheals, abx, steroids, severe cases may require surgery and ostomy’s

40
Q

intestinal obstruction

A

any condition that prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the absence of an obstructing lesion

41
Q

small intestine obstruction S&S

A

colicky pains cause by intestinal distention followed by n/v

42
Q

large intestine obstruction S&S

A

hypogastric pain and abdominal pain

43
Q

Appendicitis

A

inflammation of appendix, begins as a dull steady periumbilical pain, pain progresses an localizes to RLQ, sudden relief of pain may indicate rupture

44
Q

Appendicitis S&S

A

RLQ pain, anorexia, increase temp and increased WBCs, nausea, McBurney’s and Psoas sign

45
Q

McBurney’s sign

A

indicated when there is significant pain upon palpation of this area in the RLQ

46
Q

Appendicitis tx

A

appendectomy; preop: no heat, position on right side low fowlers; postop: IV fluids, abx, pain management, NPO until return of bowel sounds, wound care

47
Q

pancreatitis

A

inflammation of the pancreas, number one cause is alcoholism; digestive enzyme activation inside pancreas causes autodigestion of the pancreas

48
Q

Pancreatitis S&S

A

pain (increases with eating), distention, ascites, abd mass, rigid abdomen, cullen’s sign, Gray turner’s sign, fever, n/v, jaundice, hypotension, increased WBCs and increase in serum lipase

49
Q

cullen’s sign

A

C shaped bruising above belly button

50
Q

turner’s sign

A

bruising along flank

51
Q

cholelithiasis

A

gallstones, hardened deposits of bile in gallbladder caused by hyperlipidemia or hyperbilirubinemia

52
Q

gallstone S&S and tx

A

sudden sharp RUQ pain, pain worsens and radiates to back and between shoulder blades, get worse at night or after fatty meal, n/v

tx: cholecystectomy

53
Q

cholecystitis

A

inflammation of gallbladder cause by infection, blocked bile duct, cholelithiasis

54
Q

rupture of appendix can lead to

A

peritonitis

55
Q

cholecystitis S&S and tx

A

fever, leukocytosis, rebound tenderness, and abdominal muscle guarding

tx: pain management, fluids, fasting, abx if indicated

56
Q

treatment for perforated gallbladder

A

immediate cholecystectomy

57
Q

hepatitis

A

inflammation of liver that can lead to cirrhosis, caused by different viral infections and severe cases can lead to hepatic coma/encephalopathy

58
Q

Hep A transmission, prevention, tx

A

contaminated food or water (fecal-oral)

vaccination, hygiene, sanitation

tx self limited

59
Q

hep B

A

contact with infected body fluids (blood, semen, vaginal fluids)

vaccination, blood screening, improved hygiene

acute: supportive, chronic: antiviral therapy

60
Q

hep C

A

contact with infected body fluids (IVDU, non sterilized medical equipment)

screening, sanitary environment, sterile needles

direct acting antivirals (DAAs)

61
Q

hep D

A

contact with infected body fluids; can only get HDV if already infected with HBV

blood screening, sanitary practices, HBV vaccine helps prevent HDV

62
Q

hep E

A

contaminated food or water (fecal - oral)

improved hand hygiene and sanitation

supportive tx

63
Q

chronic hepatitis includes

A

B, C, D

64
Q

Hepatic coma/encephalopathy

A

increased ammonia levels due to inflammation of liver and it not being able to convert it to urea so it builds up

65
Q

hepatic encephalopathy S&S

A

changes in LOC, neuromuscular disturbances, fetor (distinctive musty or sweet breath odor), sleep, mood, and speech problems

66
Q

hepatic encephalopathy risk factors

A

high protein diet, infection, hypovolemia, hypokalemia, constipation, GI bleeding, drugs

67
Q

hepatic encephalopathy tx

A

decrease ammonia - lactulose, abx, decrease protein in diet

decrease fluid retention - potassium sparing diuretics

avoid CNS depressants - can worse encephalopathy

68
Q

cirrhosis

A

chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue, liver cells destroyed and replaced with scar tissue, this impairs blood flow to liver causing portal htn

69
Q

causes of cirrhosis

A

alcoholism, hepatitis B, hepatitis C, diet

70
Q

cirrhosis S&S

A

palpable firm liver, ascites, edmea, abd pain, bloating, dyspepsia, poor appetite, spider angiomas, jaundice, low serum albumin, high serum liver enzymes ALT and AST, anemia

71
Q

anemia can occur in cirrhosis because

A

liver produces clotting factors, when not working properly becomes bleeding risk and bleeding/blood loss can lead to anemia

72
Q

cirrhosis tx

A

paracentesis, strict I&Os, daily weights, be careful with drug doses (liver cannot metabolize as well; especially with narcotics and acetaminophen), antacids, vitamins, diuretics, low protein and sodium diet, bleeding precautions, skin care

73
Q

avoid _____________ medication in liver pts

A

acetaminophen

74
Q

___________________ drugs can worsen encephalopathy

A

benzodiazepines and opioids

NCLEX (23 decks)

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