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Nursing Theory IV > GI > Flashcards

GI Flashcards

1
Q

Gastroenteritis: Assessment

A

Medical History
Med review (most meds can be constipating)
Diet history
Travel history (H2O)
Physical and abdominal assessment (distention, BP, skin, dehydration, cardiac

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2
Q

Gastroenteritis: Management

A 
Hand washing
Isolation (contact isolation)
Identify cause
F&E replacement (Na+, K+, Cl-, glucose)
Food safety measures (turkey)
Dietary management
*Don't give anti-diarrheals
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3
Q

Gastroenteritis: Medications

A

Antidiarrheals
Narcotic
Anticholinergic
Probiotics

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4
Q

Diarrhea

A

Risk for deficient fluid volume (Monitor I&O, BP; watch trends, hydration assessment, might have to do IV infusion; Ringer’s lactate)
Risk for impaired skin integrity (lots of nutrients, barrier creams, might have to sit in sits bath; avoid overuse of soaps)

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5
Q

Diarrhea: Evaluation

A 
Stool frequency
Nutritional status
Weight
Fluid volume status
Skin integrity
Monitor electrolytes
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6
Q

Diarrhea: Teaching

A

Teach causes and preventative measure
Infection control (isolate STAT if C.Diff)
Purification of water for travel
Fluid replacement
Chronic diarrhea (may be sign of chronic constipation)

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7
Q

Intestinal Obstruction: Assessment/ Management

A

Assess for bowel sounds (hypoactive; potential for blockage), distention
Assess for complications

Diagnostic tests
Gastric decompression
Surgery (take out the area where the obstruction is)

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8
Q

Intestinal Obstruction: Nursing Implementation

A

Monitor dehydration and electrolyte status closely
Strict intake and output (if nothing is going through- NPO)
NG tube care (always ensure proper placement)
IV fluids
Comfort measures and a quiet environment (High/semi fowlers)
Postop care same as for laparotomy

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9
Q

Intestinal Obstruction: Deficient Fluid Volume/ Ineffective Breathing Pattern

A

Monitor VS and CVP (Central venous pressure)
I&O, urine output, gastric output
Measure abdominal girth

Resp. rate, lung sounds
Resp. support

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10
Q

Intestinal Obstruction: Evaluation

A 
Abdominal girth
Bowel sounds
Pain
Tolerance
Fluid volume status
Potential complications
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11
Q

Colorectal Cancer

A

Colon cancer screening guidelines; for the individual at average risk, colonoscopy every 10 years (If polyps are seen during colonoscopy, screening becomes yearly)
Important hereditary condition; familial adenomatous polyposis (FAP) (if family member is diagnosed, you get screened 10 years before they were diagnosed)

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12
Q

Colorectal Cancer: Prognosis

A

Early detection, better prognosis
Depends on extent of timor invasion, cell type, degree of dysplasia, tumour genetics, presence or absence of metastasis
TNM classification used for metastasis

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13
Q

Colorectal Cancaer: Treatment

A

Surgical removal
Colostomy
Chemotherapy, radiation, or both

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14
Q

Colorectal Cancer: Assessment

A

Effects of the disease (not just pt. but whole family)
Treatment (depends on person. May be palliative surgery)
Clients ability to function and maintain ADLs

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15
Q

Colorectal Cancer: Nursing Implementation

A

Health Promotions: Screening, use of NSAIDs
Acute Interventions: Preop; Similar to care of a client undergoing laparotomy. Postop; After abdominal resection, 2 wounds and a stoma
Ambulatory and home care: Psychological support for client and family

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16
Q

Colorectal Cancer: Complications/ Management

A

Bowel obstruction
Perforation into neighbouring organs

Annual screening beginning at age 50
Diagnostic tests
Surgery
Adjunctive therapy (chemo)

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17
Q

Colorectal Cancer: Nursing care

A

Provide emotional support
Teaching
Surgical needs (RT hemicolectomy; LT hemicolectomy; Abd. - perineal resection; laproscopic colectomy; laproscopic)

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18
Q

Colorectal Cancer: Teaching

A 
Prevention
American Cancer Society recommendations
Regular health examinations
Tests and procedures
Ostomy care
Pain and symptom management
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19
Q

Colorectal Cancer: Nursing Diagnosis

A

Diarrhea or constipation
Acute pain
Fear
Ineffective coping

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20
Q

Colorectal Cancer: Planning

A

Goals include appropriate treatment, normal bowel pattern, good quality of life, relief of pain and promotion of comfort

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21
Q

Inflammatory Bowel Diease: Goals of Treatment

A 
Rest the bowel
Control inflammation
Combat infection
Correct malnutrition
Alleviate stress
Symptomatic relief
Improve quality of life
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22
Q

Inflammatory Bowel Disease: Planning

A

Experience a decrease in number and severity of acute exacerbations
Maintain normal fluid/electrolyte balance
Remain free from pain or discomfort
Comply with medical regimen
Improve QOL

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23
Q

Inflammatory Bowel Disease: Surgical Therapy

A

Procedures for chronic ulcerative colitis:
Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch)
Total protocolectomy with permanent ileostomy
Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch) or permanent ileostomy

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24
Q

Ulcerative Colitis and Crohn’s Disease: Managemetn

A 
Manage symptoms
Control disease process
Supportive care
Diagnostic tests
Medications
Dietary management
Surgery
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25
Q

Ulcerative Colitis: Treatment

A

Corticosteroids
Broad spectrum antibiotic
Salicylate analogs
Immunomodulating agents (Azathioprine; Mercaptopurine)
IV followed by oral cyclosporine for refractory
Infliximab (Remicade) for refractory

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26
Q

Crohn’s Disease: Treatment

A

Prednisone and sulfasalazine
Antibiotics: metronidazole
Azathioprine, 6-mercaptopurine, methotrexate, and biologic therapies (refractory)
Anti-tumor necrosis factor agents infliximab, adalimulab, and certolizumab (refractory)

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27
Q

Crohn’s Diease: Surgical therapy

A

75% will require surgery
Surgery produces remission, but high recurrence rate
Ileostomy

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28
Q

Colostomy or Ilostomy: Diagnosis

A 
Change in body image
Nutritional imbalance
Loss of sexuality
Possible dehydration
Diarrhea
Impaired skin integrity
Anxiety
Ineffective coping
Ineffective therapeutic regimen management
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29
Q

Ulcerative Colitis and Crohn’s Disease: Teaching

A 
Disease process, effects, stress
Treatment options
Medications
Complications, management
Diet
Nutritional supplements
Fluids
Exercise
Teaching for surgery
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30
Q

Malabsorption: Nursing Care

A

Effects on nutrition and bowel patterns
Nutritional status
Weight, fat fold measurements, lab data, dietary intake
Enteral feeding supplements as prescribed
I&O, daily weights, skin turgor, mucous membranes
Frequency stools
Medications
Skin care

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31
Q

Malabsorption: Management

A

Find and treat the cause

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32
Q

Malabsorption: Teaching

A 
Daily management 
Diet
Medication regime
Reading labels
Fluid intake
Exercise
Daily weights
Manifestations to report to physician
Dietician or counselor referrals
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33
Q

Malabsorption: Treatment

A

Gluten-free diet
Supplemental iron, folate, B12, fat soluble vitamins (A, D, E, K)
Oral corticosteroids or other immunomodulating agents for refractory

34
Q

Hiatus Hernia

A

Conservative therapy:
Lifestyle modifications
Elevation of bed 30 degrees
Use antacids and H2R blockers
Weight reduction, if overweight (reduce fats in diet, separate fluids from solids)
Surgical therapy (if lifestyle changes don’t work)

35
Q

Hiatal Hernia: Complicationa

A

Upper GI bleeding
Erosive esophagitis
If symptoms persist might need surgery
Management: Diagnosis made if able to reduce or manipulate; surgery

36
Q

Hernia

A

Risk for ineffective tissue perfusion: Gastrointestinal
- comfort measures
bowel sounds
signs of strangulation

37
Q

Hernia: Nursing Care/ Teaching

A

Preoperative assessment
Postoperative care

Risk factors
Surgical intervention
Pain management
Activity restrictions

38
Q

Nissen Fundoplication

A

Bring two sides of the stomach together and suture it
Risk of perforation
Have no decreased volume intake of stomach
Do not irrigate because it will cause too much pressure and dehiscence

39
Q

Peptic Ulcer Disease: Aim of treatment

A

decrease degree of gastric acidity
Enhance mucosal defense mechanisms
Minimize harmful effects on mucosa

40
Q

Peptic Ulcer Disease: Overall Goals

A

Comply with prescribed therapeutic regimen
Experience a reduction or absence of discomfort related to peptic ulcer disease
Exhibits no signs of GI complications
Have complete healing (no S&S)
Lifestyle changes to prevent recurrence

41
Q

Peptic Ulcer Disease: Medical regimen consists of:

A 
Adequate rest
Dietary modification (keep food diary; smaller more frequent meals)
Drug therapy
Elimination of smoking
Long-term follow-up care
42
Q

Peptic Ulcer Disease: Drug Therapy

A 
Antacids
H2R blockers
PPIs
Antibiotics (add probiotic; finish whole treatment)
Anticholinergics
Cytoprotective therapy
43
Q

Peptic Ulcer Disease: Drug Therapy

A

Antacids
Used as adjunct therapy for peptic ulcer disease
Increase gastric pH by neutralizing acid

Histamine-2 receptor blocks (H2R blockers)
Used to manage peptic ulcer disease
Block action of histamine on H2 receptors
- Decrease HCl acid secretion
- Decrease conversion of pepsinogen to pepsin
- Increase ulcer healing

44
Q

Peptic Ulcer Disease: Drug Therapy

A

Proton pump inhibitors (PPI)
Block ATPase enzyme that is important for secretion of HCl acid

Antibiotic therapy (High rate of recurrence if they don’t finish treatment)
Eradicate H. pylori infection
No single agents have been effective in eliminating H. pylori

45
Q

Peptic Ulcer Disease: Drug Therapy

A

Anticholinergic drugs
Occasionally ordered for treatment
Decrease cholinergic stimulation of HCl acid

Cytoprotective drug therapy
Used for short-term treatment of ulcers

Tricyclic antidepressants (help block acidity)

Serotonin reuptake inhibitors

46
Q

Peptic Ulcer Disease: Nutritional Therapy

A

Protein considered best neutralizing food
- Stimulates gastric secretions
Carbohydrates and fats at least stimulating to HCl acid secretion
- Do not neutralize well
Milk (often interferes with antibiotics) can neutralize gastric acidity and contains prostaglandins and growth factors
- Protects GI mucosa from injury

47
Q

Peptic Ulcer Disease: Acute Intervention

A

Patient generally complains of increased pain, N&V, and some bleeding
May be maintained on NPO status for a few days, have NG tube inserted, fluids replaced intravenously
Physical and emotional rest are conducive to ulcer healing

48
Q

Peptic Ulcer Disease: Acute Exacerbation

A

Treated with same regimen used for conservative therapy
Stuation is more serious because of possible complications of perforation, hemorrhage, gastric outlet obstruction
Accompanied by bleeding, increased pain and discomfort, N&V

49
Q

Peptic Ulcer Disease: Acute Exacerbation

A

Recurrent vomiting, gastric outlet obstruction

  • NG tube placed in stomach with intermittent suction for about 24-48 hours
  • F&E are replaced by IV infusion until patient is able to tolerate oral feedings without distress
50
Q

Peptic Ulcer Disease: Acute Exacerbation

A

Management is similar to that for upper GI bleeding
Blood or blood products may be administered
Careful monitoring of VS, I&O, lab studies, signs of impending shock

51
Q

Peptic Ulcer Disease: Acute Exacerbation

A

Endoscopic evaluation reveals degree of inflammation or bleeding and ulcer location
5-year follow-up program is recommended

52
Q

Peptic Ulcer Disease: Hemorrhage

A

Changes in VS, increase in amount and redness of aspirate signal massive upper GI bleeding
Increased amount of blood in gastric contents decrease pain because blood helps neutralize acidic gastric contents
Keep blood clots from obstructing NG tube

53
Q

Peptic Ulcer Disease: Perforation

A

Sudden, severe abd. pain unrelated in intensity and location to pain that brought client to hospital
Indicated by a rigid, board-like abd.
Severe generalized abd. and shoulder pain
Shallow, grunting respirations

54
Q

Peptic Ulcer Disease: Perforation

A

Immediate focus to stop spillage of gastric or duodenal contents into peritoneal cavity and restore blood volume
NG tube is placed into stomach
- Placement of tube as near to perforation site as possible facilitates decompression

55
Q

Peptic Ulcer Disease: Perforation

A

Circulating blood volume must be replaced with lactated Ringer’s and albumin solutions
Blood replacement in form of packed RBCs may be necessary
Central venous pressure line, in-dwelling urinary catheter should be inserted and monitored hourly

56
Q

Peptic Ulcer Disease: Gastric outlet obstruction

A

Can occur at any time
- Likely in clients whose ulcer is located close to pylorus
Gradual onset
Constant NG aspiration of stomach contents may relieve symptoms
Regular irrigation of NG tube

57
Q

Peptic Ulcer Disease: Gastric outlet obstruction

A

Decompress stomach
Correct any existing F&E imbalanced
Improve client’s general state of health
NG tube inserted in stomach, attached to continuous suction to remove excess fluids and undigested food particles

58
Q

Peptic Ulcer Disease: Gastric outlet obstruction

A

Continuous decompression allows:
- Stomach to regain its normal muscle tone
- Ulcer can begin to heal
- Inflammation and edema subside
When aspirate falls below 200 ml, within normal range, oral intake of clear liquids can begin

59
Q

Health Promotion

A

Identify patients at risk (high stress, elderly)
Early detection and decreased morbidity
Encourage clients to take ulcerogenic drugs with food or milk
Teach clients to report symptoms related to gastric irritation to health care provider

60
Q

Peptic Ulcer Disease: Surgical therapy

A
61
Q

Peptic Ulcer Disease: Surgical Procedures

A

Gastroduodenostomy (Bilroth I)
Gastrojejunostomy (Bilroth II)
Vagotomy
Pyloroplasty

62
Q

Peptic Ulcer Disease: Nutritional therapy

A 
Diet should consist of:
- Small, dry feedings daily
- Low in carbohydrates
- Restricted in sugars
- Moderate amounts of protein and fat
- 30 minutes of rest after each meal
Interventions are diet instruction, rest, and reassurance
63
Q

Appendicitis: Assessment

A

Location, severity, onset, duration, precipitating facors, and alleviating measures in relation to the pain
Previous abd. distress, chronic illnesses, surgeries; record allergies and medications
Temperature; abd. pain, distention, and tenderness; presence and characteristics of bowel sounds

64
Q

Appendicitis: Nursing Care/ Teaching

A 
Pain
Food
Fluids
Allergies
Medications

Preop teaching: turn, DB&C, pain management

65
Q

Appendicitis: Complications/ Management

A

Perforation

Prompt diagnosis and management to prevent perforation
Hospitalization, IV fluids, NPO until diagnosis confirmed
Diagnostic test
Surgery

66
Q

Appendicitis: Evaluation

A 
Teach wound/ incision care
Wound assessment instructions
Dressing changes
Hand washing
What to report to the physician
Activity restrictions
Driving, return to work
Home care nurses
67
Q

Peritonitis: Assessment

A

Monitor current status
Progress of recovery
Identify complications

68
Q

Peritonitis: Nursing Care

A 
Intensive nursing and medical interventions
Diagnostic tests
Intestinal decompression
Antibiotics
Surgery
69
Q

Peritonitis: Evaluation

A 
Pain level
Weight
Urine output
Documentation
Wound healing
70
Q

Peritonitis: Teaching

A 
Wound care, dressing changes
Needed supplies
Medications
S&S further infection
Activity restriction
71
Q

Hepatitis: Assess

A

Recent flulike symptoms
Medications
Changes in bowel habits, colour of feces and urine
Pain (RUQ)
Changes in colour of skin or sclera (jaundice)
Hx of vaccine
Known or possible exposure to Hep virus (travellers; A, B, C)

72
Q

Hepatitis: Overall goals

A

Relief of discomfort
Resumption of normal activities
Return to normal liver function without complications

73
Q

Hepatitis: Treatment

A

Most clients are not hospitalized
No cure so treatment is supportive
Client must rest in order to rest liver, promote cellular regeneration and prevent complications
Interferon injections

74
Q

Hepatitis: Drug Therapy

A 
No specific drug therapies
Supportive therapy:
- Antiemetics
- Diphenhydramine (Benadryl)
- Chloral hydrate
75
Q

Hepatitis: Prevention

A

Vaccines & immune globulin injections are available to prevent Hep A/B
Vaccines recommended for people at high risk
Immune globulin is used for post exposure prophylaxis, to prevent disease after known contact

76
Q

Hepatitis: Nursing Diagnoses

A

Risk for infection
Activity intolerance
Imbalanced nutrition: less than body requirements
Deficient knowledge r/t causes of hepatitis and modes of transmission

77
Q

Hepatitis: Risk for infection

A

Use standard precautions & meticulous hand washing
Hep A-contact isolation if decal incontinence is present
Encourage at risk clients to obtain Hep A or B immunizations

78
Q

Hepatitis: Activity Intolerance

A

Encourage client to rest as needed to relieve fatigue
Plan nsg activities that promote rest, allowing gradual resumption of activities
Provide or encourage diversional activities based on client’s interests
Encourage visitors to visit for short periods
Place frequently used items close by for easy reach

79
Q

Hepatitis: Imbalanced nutrition

A

Encourage diet high in carbs and calories, low in fat
Encourage eating more food when N&V are minimal
Give IV fluids if N&V present. Monitor F&E balance and assess for dehydration

80
Q

Hepatitis: Deficient knowledge

A

Assess clients knowledge about disease and modes of transmission
Instruct client with Hep B/C that a chronic form of the disease may develop and they will need monitoring once discharged
If drug or alcohol problem is identified, refer to appropriate persons
Teach client to modify sexual practices as directed

81
Q

Hepatitis: Teaching

A

Prevent spread of disease
Vaccination
No sharing personal items
No sexual activity until no longer infectious

Nursing Theory IV (12 decks)

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