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NCLEX > gastrointestinal > Flashcards

gastrointestinal Flashcards

1
Q

pancreatitis patho

A

autodigestion of the pancreas

function:
endocrine (insulin)
exocrine (digestive enzymes)

two types: acute and chronic

causes:
#1 gallbladder disease
#2 alcohol

**one system– when one part gets sick it’ll all get sick

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2
Q

pancreatitis s/s

A

pain (increases with eating)
abdominal distention/ascites (losing protein rich fluids like enzymes and blood in the abdomen)
abdominal mass (swollen pancreas)
rigid, board-like abdomen (bleeding that can lead to peritonitis)
bruising around umbilical area (Cullen’s sign)
bruising in the flank area (Grey-Turner’s sign)
fever (inflammation)
n/v
jaundice
hypotension (bleeding or ascites)

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3
Q

pancreatitis diagnosis

A 
*****serum lipase and amylase (digestive enzymes)
high WBC
high blood sugar
ALT/AST high
longer PT & aPTT (risk for bleeding)
high serum bilirubin
high h&h (dehydration)
low h&h (bleeding)
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4
Q

amylase normal levels

A

30-220

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5
Q

lipase normal levels

A

0-160

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6
Q

normal AST

A

0-35

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7
Q

normal ALT

A

10-36

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8
Q

pancreatitis treatment

A

control pain
decrease gastric secretions (NPO, NGT to suction)
bedrest
*****want the stomach dry and empty if anything gets in the body will want to make enzymes thats what is causing the pain

pain meds:
PCA narcotics
fentanyl patches

anticholinergics to dry the stomach:
benztropine
diphenoxylate

GI protectants:
pantoprazole
famotidine
antacids

maintain fluid and electrolytes

maintain nutritional status

insulin (pancreas is sick, TNA/TPN)

daily weights

eliminate alcohol

AA if that’s the cause

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9
Q

hemoglobin levels

A

male: 14-18
female: 12-16

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10
Q

hematocrit levels

A

male: 42-52
female: 37-37

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11
Q

***** if your liver is sick

A
  • ** worry about bleeding
  • ** decrease dose of meds
  • ** never give them acetaminophen (antidote is acetylcysteine)
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12
Q

4 major functions of the liver

A

detoxifying the body
helps the blood clot
liver helps metabolize (break down) drugs
synthesizes albumin

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13
Q

cirrhosis patho

A

liver cells destroyed and replaced with connective/scar tissue
alters circulation within the liver
BP in liver goes up (portal hypertension)

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14
Q

cirrhosis s/s

A 
firm, nodular liver
jaundice
abdominal pain (liver stretched)
***not normal to be able to palpate liver
chronic dyspepsia (GI upset)
change in bowel habits
ascites
splenomegaly
fatigue
peripheral edema
anemia
can progress to hepatic encephalopathy/coma (ammonia build up)
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15
Q

cirrhosis diagnostics

A

low serum albumin
high ALT/AST
ultrasound
CT/MRI

liver biopsy--confirms diagnosis
pre-procedure:
clotting studies pre-procedure (PT, INR, aPTT)
VS pre-procedure
supine w/ R arm behind the head
exhale and hold breath to get diaphragm out of the way
post procedure:
lie on R side
VS (worried about hemorrhage)

***if unsure why they’re swelling, ask for albumin levels

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16
Q

cirrhosis treatment

A 
antacids
vitamins
diuretics
no more alcohol 
i and o
weights
rest
bleeding precautions (no IM injections, no NSAIDs)
abdominal girth (ascites)
paracentesis:
remove fluid from the peritoneal cavity (ascites)
have them void
positing sitting up
VS (shocky clients BP goes down and pulse up)

monitor jaundice (good skin care)

  • **avoid narcotics (liver cannot metabolize drugs)
  • **diet (low protein, low Na)
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17
Q

hepatic coma patho

A

protein breaks down into ammonia
liver converts it to urea
urea is excreted through kidneys

when liver is impaired it cannot make the conversion, ammonia builds up in the blood and causes a decrease in LOC

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18
Q

hepatic coma s/s

A 
mental changes
motor issues
difficult to awaken
asterixis (liver flap-hand tremors)
handwriting changes
reflexes will decrease
EEG will be slow
fetor (breath smells like ammonia)
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19
Q

hepatic coma treatment

A

lactulose (decrease serum ammonia)
enemas
decrease protein in diet
monitor serum ammonia

20
Q

bleed esophageal varices patho

A

high bp in the liver (portal hypertension) forces collateral circulation to form in the stomach, esophagus, & rectum
no problem until it ruptures

21
Q

bleeding esophageal varices treatment

A 
replace blood
VS
monitor CVP
O2
Octreotide lowers BP in the liver
endoscopic sclerotherapy (banding)
esophageal variceal ligation (injects sclerosing agent into the varices)

balloon tamponade:
sengstaken-blakemore tube
used to stabilize severe hemorrhage
dont use more than 12 hours
used to hold pressure on bleeding varices
**if it gets caught, use scissors to cut the tube and pull out)

enemas to get rid of blood
lactulose (decreases ammonia)
saline lavage to get blood out of stomach

22
Q

peptic ulcer patho

A

common cause of GI bleeding
can be in esophagus, stomach, or duodenum
erosion is present

23
Q

peptic ulcer s/s

A

burning pain in mid-epigastric area/back

heartburn (dyspepsia)

24
Q

peptic ulcer diagnosis

A 
gastroscopy (EGD):
NPO pre procedure
sedated
NPO until gag reflex returns
watch for perforation by watching for pain, bleeding, or if they are having issues swallowing
upper GI: 
looks at esophagus and stomach with dye
NPO past midnight
***no smoking, chewing gum, or mints (smoking increases stomach motility which will affect test and increases stomach secretions which will increase the chance of aspiration)
*** remove nicotine patches
25
Q

peptic ulcer treatment

A

antacids (liquid to coat stomach) **take when the stomach is empty and at bedtime. when the stomach is empty acid can get on the ulcer so take antacids to protect the ulcer

PPI “prazole”
H2 antagonist (famotidine)
GI cocktail (donnatal, viscous llidocaine, mylanta II)
antibiotics for H. pylori (clarithromycin, amoxicillin, tetracycline, metronidazole)
Sucralfate forms a barrier over the wound so acid can’t get on the ulcer

26
Q

peptic ulcer teaching

A 
decrease stress
stop smoking
eat what you can tolerate 
avoid temp extremes and spicy foods
avoid caffeine
27
Q

two types of peptic ulcers

A 
gastric: 
malnourished
pain half hour to one hour after meals
food doesn't help
vomiting helps
vomits blood
duodenal:
appear well nourished
night time pain
pain 2-3hours after meals
food helps
blood in stools
28
Q

histal hernia patho

A

hole in diaphragm is too large so the stomach moves up into the thoracic cavity

cause: large abdomen (lose weight), congenital abnormalities, trauma, straining

29
Q

histal hernia s/s

A

heartburn
fullness after eating
regurgitation
dysphagia (difficulty swallowing)

30
Q

histal hernia treatment

A 
small frequent meals
sit up 1 hour after eating
elevate HOB
surgery
teach lifestyle changes 
healthy diet
31
Q

dumping syndrome patho

A

stomach empties quick after eating

client experiences uncomfortable to severe SE secondary to gastric bypass, gastrectomy, or gallbladder disease

32
Q

dumping syndrome s.s

A 
fullness
weakness
palpitations
cramping
faintness
diarrhea
33
Q

dumping syndrome treatment

A 
semi-recumbent with meals
lie down after meals on left side
no fluids with meals 
small frequent meals
avoid high carbs and electrolytes 9empty fast)

***recline and dine

  • **left side lying = leaves it in
  • ** right side lying = releases it
34
Q

ulcerative colitis and crohns patho

A

UC: ulcerative inflammatory disease, large intestine

Crohns: inflammation and erosion of the ileum (small intestine) but can be found in large intestine

35
Q

ulcerative colitis and crohns s/s

A 
diarrhea
rectal bleeding
vomiting
weight loss
cramping 
dehydration
blood in stools
anemia
rebound tenderness (push in, let go, and it hurts) means peritoneal inflammation
fever
36
Q

UC and crohns diagnostics

A

ct scan
mri

colonoscopy***
clear liquid diet 24 hours prior
NPO 6-8hours prior
avoid NSAIDs
laxatives or enemas until clear
polkyethylene glycol (better icy cold)
sedated
post:
watch for perforation
***Assume the worst 
pain and discomfort

barium enema:
BE or lower GI series
done if colonoscopy is incomplete

37
Q

UC and crohns treatment

A

diet:
low residue to limit GI motility to help save fluid
avoid cold foods and smoking

meds:
antibiotics
steroids (decrease inflammation)
biologics and immunodulators (infliximab, adalimumab)
aminosalicylates (decrease inflammation)– sulfasalazine, mesalamine

surgery:
UC
total colectomy, an ileostomy is formed
kock’s ileostomy or an illeal pouch anal anastomosis (no external bag, attaches to the rectum)

crohns:
try not to do surgery
remove only affected area
may end up with an ileostomy (ostomy in ileum) or colostomy (ostomy in colon)

38
Q

ileostomy post op care

A

liquid stool all the time
avoid foods hard to digest
Gatorade or electrolyte for summer
risk for kidney stones (dehydrated)

39
Q

colostomy care

A

water and nutrients are being absorbed and the stool is forming when waste moves through the colon

ascending and transverse (semi liquid stool)

descending or sigmoid (semi formed or formed)
need irrigation to give them some control regularly
irrigate after a meal same time everyday

anytime you give an enema and they cramp, stop the fluid lower the bad and/or check the temp of the fluid

40
Q

appendicitis patho

A

inflammed appendix

***worry about rupture (lay them on their R side if ruptured)

41
Q

appendicitis s/s

A

generalized pain and localizes in the lower R quadrant (mcburneys point)
rebound tenderness
n/v
anorexia

42
Q

appendicitis diagnostics

A

high WBC
ultrasound
ct
dont give enemas or laxatives (worried about rupture– perforation)

43
Q

appendicitis treatment

A

surgery

fowler’s position post op

44
Q

TPN/TNA nursing considerations

A 
***don't mix anything with it
keep refrigerated
warm for administration
let it sit a few minutes prior to hanging
central line needed
filter needed
nothing else should go through this line
daily weights
may need to take insulin
blood glucose monitoring q 6hours
check urine for ketones and glucose
mixture adjusted daily r/t electrolytes
can only be hung for 24 hours
change tubing with each new bag
needs to be on a pump
emphasize hand washing
****infection is huge complication
45
Q

assisting to insert a central line

A

have saline available for fluids (3 10ml)
don’t start fluids until positive confirmation by CXR
trandelenburg to distend veins
if air gets in: left side trandelenburg
***worry about air bubble

when changing to avoid air bubble:
clamp it off
walsalva
take a deep breath and hummmmm

xray done to check for placement and make sure they do not have a pneumothorax

position to take out central line: lie flat and apply pressure

NCLEX (17 decks)

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