Adult GI/GU Flashcards

Question

Polycystic Kidney Disease Nursing Management

Answer 1

- Monitor VS, Daily weight, I&O - Dietary Modification: Low potassium, phosphorus, protein, and sodium - Fluid restriction - Administer medications as directed Patient and Family Teaching - Immediately report clinical manifestations of infection!! - Dietary regimen - Medication adherence - Antihypertensives - Antibiotic regimen completion

Answer 2

- Acute, rapid loss** of renal function that, in most cases, is reversible** if addressed in a responsive and timely manner - Defined as azotemia** (an accumulation of nitrogenous waste products in the blood) - Oliguria** (urine output of <400 mL/day) may or may not be present - Patients without oliguria typically recover quicker

Answer 3

1. Prerenal: Caused by decreased blood flow to the kidneys (BEFORE kidneys) - Most common cause of AKI - Decreased blood flow to the kidney causes the kidney to activate the renin-angiotensin-aldosterone system - Result is low urine output and increased azotemia - Ex: Hypovolemia**, decreased cardiac output decreased peripheral vascular resistance and vascular obstruction 2. Intrarenal Causes: Direct damage to the renal parenchymal tissues, resulting in impaired nephron functioning (IN KIDNEYS) - Damage occurs as a result of prolonged ischemia, exposure to nephrotoxins (medications – ie., aminoglycoside antibiotics**, NSAIDs), contrast dye, hemoglobin released from hemolyzed RBCs, or myoglobin released from necrotic muscle cells - Acute glomerulonephritis** - Acute tubular necrosis (ATN)** 3. Postrenal Causes: caused by obstruction in the urinary tract below the kidneys (AFTER Kidneys) - Obstruction causes reflux of urine into the renal pelvis - Ex: urinary tract stones**, tumors, benign prostatic hypertrophy (BPH)

Answer 4

1. Initiating Phase - Begins with the precipitating event and continues until oliguria develops - Lasts hours to days 2. Oliguric Phase - Characterized by a urine output of <400mL/day that does not respond to fluid challenges or diuretics** - Lasts up to 14 days or longer (the longer it lasts, the poorer the prognosis) - Oliguria: <400 ml/day occurs within 1-7 days - Urinalysis: casts, RBCs, 3. Diuretic Phase - Occurs when the cause of the AKI has been corrected. - Urine output increases rapidly** (even up to 5L per day - Patient may experience dehydration and electrolyte imbalances because of the significant rapid fluid loss - Lasts 1-3 weeks 4. Recovery Phase begins as the kidneys return to normal function - Lasts from several months – 1 year

Answer 5

Signs of volume overload** due to decreased urine output - Edema - Pulmonary edema - Shortness of breath - Heart failure - JVD - Hypertension - Chest pain or pressure Anorexia and nausea Constipation or diarrhea Confusion Seizures Cues: Low BP, HR elevated, dizziness (lightheadedness), weakness, low urine output, HA, palpitations

Answer 6

CBC - Decreased H/H** CMP - Increased Potassium** - Increased Phosphorus** - Increased BUN** - Increased Creatinine** - Decreased Calcium** - Decreased Sodium ABG - Decreased pH (Metabolic acidosis)

Answer 7

Fluid overload Electrolyte imbalances - Hyperkalemia** - Can result in life-threatening dysrhythmias (V-fib, V-tach, asystole) - EKG Changes - Initial change is peaked T waves** Worsening hyperkalemia indicated by widening of the QRS complex, loss of the P wave, and presence of the sine wave

Answer 8

Stabilization of the myocardial cell membrane - Calcium chloride or Calcium gluconate** Intracellular movement of potassium *IV Glucose followed by IV Insulin** - Insulin facilitates movement of potassium - Glucose given first to avoid hypoglycemia (does nothing else) *Albuterol - Can help lower K+, drives it into cell *Bicarbonate** - Drives K+ into cell *Total body elimination of potassium - Kayexalate** - IV Lasix - Emergent hemodialysis (central line)

Answer 9

*Focuses on eliminating the cause, preventing complications, and assisting in recovery *Medications - Diuretics: to treat fluid overload *Nutrition - Adequate carbohydrate, protein, and fat intake - Sodium restriction - Potassium restriction *Dialysis - May be considered in the short term

Answer 10

- Monitor VS, I&O - Cardiac Monitoring: watch for EKG changes! - Manage fluid balance - Administer medications as directed - Position, ambulation, cough, and deep-breathing exercises - Monitor food intake Patient and Family Teaching - Cause and treatment of AKI - Avoid nephrotoxic meds

Answer 11

Progressive, irreversible loss of kidney function Etiology *Most common causes are diabetes and hypertension!! *Other risk factors - Hyperlipidemia - Smoking - Recreational drug use - Chronic NSAID use - Obesity - Glomerulonephritis - PKD - Lupus Pathophysiology - Characterized by slow increases in BUN and Creatinine; longer onset than AKI - Typically caused by a long-term disease or medical comorbidities - May be the result of poorly managed AKI

Answer 12

Alterations in sodium and fluid balance! - Hypertension - Heart failure - Pulmonary edema Altered potassium excretion! - Arrhythmias Impaired Metabolic Waste Elimination! - Uremia - Nausea/vomiting - Anorexia - Headache - Lethargy - Fatigue - Confusion - Seizures Due to altered calcium and phosphorus level! - Bone breakdown - Osteodystrophies Due to endocrine dysfunction! - Infertility - Amenorrhea - Hyperparathyroidism Due to decreased production of erythropoietin! - Chronic anemia Cues: SOB, weakness, N/V, low UOP, confusion, gained 10 lbs in 2 weeks, fatigue Resp: Kussmaul respirations (indicative of metabolic acidosis), crackles in lower lungs; Cardiac: S3; Abd: slightly distended; Extremities: 2+ edema

Answer 13

Lab Evaluation *CBC - Decreased H/H** *CMP - Decreased Sodium - Increased Potassium** - Increased Phosphate** - Decreased Calcium** - Decreased CO2 - Increased Creatinine** - Increased BUN** ABG - Decreased pH (acidosis) Urinalysis - Increased Urine protein Radiology Evaluation - Renal Ultrasound - Abdominal CT scan Diagnosis - Based on consistently elevated creatinine and decreased creatinine clearance - Stages of CKD: Based on GFR and Protein in the urine

Answer 14

Fluid Overload Electrolyte Imbalances Dysrhythmias Anemia Fragile bones – bones that fracture easily

Answer 15

Focuses on maintaining remaining kidney function and preventing complications *Hyperkalemia - Cleared via dialysis or by managing diet When acutely elevated, decreased with medication therapy (Same as AKI) *Hypertension - Target BP around 130/80 - Weight loss - Avoiding alcohol and smoking - Dietary modifications - Meds: Diuretics, Beta blockers, CCBs, ACE inhibitors, ARBs *Anemia - Target: Hgb 11-12 g/dL and Hct 33-36% - IV or SubQ Erythropoietin**: Watch for HTN - Oral iron supplements: Monitor for constipation and give stool softeners as needed - Blood transfusions: Only if patient is actively bleeding or is symptomatic** (dyspnea, fatigue, tachycardia, etc) *Dyslipidemia - Target: LDL <100 mg/dL, triglyceride <200 mg/dL - Medication: Statins** Renal Osteodystrophy - Manage phosphorus and calcium levels - Limit dietary phosphorus intake - Medication: Phosphate Binders** (ie., calcium acetate) *Must be administered with each meal* Monitor for constipation and give stool softeners as needed* Hypocalcemia - Vitamin D and Calcium supplementation Medication Management - Patients may have delayed or decreased elimination of medications - Dosages should be adjusted according to kidney function *Specific medications of concern: - Digoxin - Antibiotics (aminoglycosides, penicillin, tetracycline) - Pain medications - NSAIDs Nutrition - Protein restriction - Sodium restriction - Potassium restriction - Phosphorus restriction - Vitamin Supplements - Calcium - Vitamin D - Iron Renal Replacement Therapy - Hemodialysis** - Peritoneal Dialysis** Surgical Management - Renal Transplantation

Answer 16

- Monitor VS, daily weight, I&O - Cardiac monitoring - Administer medications as directed Nutrition management - Protein restriction - Sodium restriction - Potassium restriction - Phosphorus restriction - Vitamin Supplements - Calcium - Vitamin D - Iron Patient and Family Teaching - Disease process, progression, complications - DO NOT miss dialysis appointments - Dietary restrictions - Avoid nephrotoxic medications

Answer 17

*Evaluation of renal function. *Transplant recipient requires close attention because the immunosuppressive drug therapy used to prevent tissue rejection impairs healing and increases the risk for infection. *Assess urine output at least hourly during the first 48 hours. - An abrupt decrease in UOP may indicate complications such as rejection, acute tubular necrosis (ATN), thrombosis, or obstruction. *Urine color - Urine is pink or blood-tinged right after surgery - Gradually returns to normal over several days to several weeks - Obtain daily urine specimens for urinalysis, glucose measurement, the presence of acetone, specific gravity measurement, and culture *Monitor the patient's fluid status - Fluid overload can cause hypertension, heart failure, and pulmonary edema. - Evaluate fluid status by weighing daily, measuring blood pressure every 2 to 4 hours, and strict I & O’s.

Answer 18

HYPERACUTE REJECTION - Onset: Within 48 hours after surgery - Clinical Manifestations * Increased temperature * Increased blood pressure * Pain at transplant site - Treatment: Immediate removal of the transplanted kidney ACUTE REJECTION*** - Onset: 1 week - 2 years postop (Most common in first 2 weeks) - Clinical Manifestations * Oliguria or anuria * Temperature over 100° F (37.8° C) * Increased BP * Enlarged, tender kidney * Lethargy * Elevated serum creatinine, BUN, potassium levels * Fluid retention - Treatment: Increased doses of immunosuppressive drugs CHRONIC REJECTION - Onset: Occurs gradually during a period of months to years - Clinical Manifestations * Gradual increase in BUN and serum creatinine levels * Fluid retention * Changes in serum electrolyte levels * Fatigue - Treatment: Conservative management until dialysis is required

Answer 19

*Acute tubular necrosis (ATN) - Result of hypoxic damage when transplantation is delayed after kidneys have been harvested. - May need dialysis until adequate urine output returns and the BUN and creatinine levels normalize. - Often difficult to distinguish from acute rejection. *Thrombosis of the major renal blood vessels - May occur during the first 2 to 3 days after the transplant - A sudden decrease in UOP may signal impaired perfusion resulting from thrombosis. *Renal artery stenosis - May result in hypertension - The involved artery may be repaired surgically or by balloon angioplasty in the radiology department. *Infection

Answer 20

*Most common type: renal cell carcinoma *Occurs most often in males 50-70 years of age *African Americans and American Indians have slightly higher rates *Risk Factors - Cigarette/cigar/pipe smoking - Chewing tobacco - First degree relative diagnosis - Obesity - Hypertension - Exposure to certain substances (ie., asbestos, herbicides) Pathophysiology - Usually found in the cortex or pelvis of the kidney - Tumors compress underlying tissue which may lead to compromised renal functioning - Metastasis: Long bones, lungs, liver

Answer 21

- Most patients are asymptomatic early in the disease - Classic Triad: flank mass, flank pain, hematuria** - Weight loss - Fatigue - Hypertension - Fever not related to infection - Anemia Assess: Left CVA tenderness, palpable swelling in left flank

Answer 22

Radiology Evaluation - Ultrasound: used to differentiate between a solid mass, tumor, and cysts - CT scan - MRI Diagnosis - Several studies needed (including those above) - Renal biopsy - Robson’s System of Staging

Answer 23

Pain Reduced circulation/kidney perfusion ESRD Metastasis

Answer 24

Medical Management - Chemotherapy NOT effective** - Immunotherapy used to boost the immune system to aid in the destruction of cancer cells - Radiation therapy used as palliative treatment when metastasis is present Surgical Management - Typical treatment is a radical nephrectomy** - Removal of the kidney, adrenal gland, and surrounding tissues

Answer 25

*Monitor VS, I&O (including color and consistency or urine) *Pain management *Administer IV hydration/encourage PO hydration as directed *Care of any post-operative drains and wounds/incisions - Foley catheters - Stents - Nephrostomy tubes Patient and Family Teaching - Disease process, diagnostics, procedures - Medication use - Provide resources for counseling, support groups, financial concerns

Answer 26

*One of the most diagnosed cancers in men *Most cancers are localized *Higher rate in African Americans *Most diagnosed are > 65 years of age Other risk factors - Family history - Diets high in red meat and calcium - High BMI

Answer 27

*Usually asymptomatic in early stages *Symptoms vary on the basis of local or invasive disease *Digital rectal exam: enlarged prostate or nodules on prostate Local Disease Weak urinary stream - Urinary hesitancy - Sensation of incomplete emptying of bladder - Urinary urgency and frequency - Urge incontinence - UTI Invasive Disease - Hematuria - Dysuria - Perineal and suprapubic pain - Erectile dysfunction - Incontinence - Symptoms of renal failure - Hemospermia - blood in sperm - Rectal pain

Answer 28

Lab Evaluation - PSA**: Critical cut-off point is 4 ng/mL Radiology Evaluation - Used to detect tumors or masses outside the prostate - Ultrasound - CT - MRI - Bone scan Diagnosis - Prostate Biopsy - Need for biopsy is often determined based on the results of screening tools: digital rectal exam and PSA PSA and DRE can give a false-positive or a false-negative result. If prostate cancer is present, the PSA will detect it earlier than no screening at all. There is conflicting evidence that screening may reduce the risk of death. Abnormal screening results may result in biopsies, which are painful and can cause complications such as bleeding or infection. Treatment of prostate cancer can lead to complications such as erectile dysfunction, incontinence, and bowel problems. Immediate treatment of prostate cancer is not always necessary.

Answer 29

Radiation – Two Options *External beam aimed at tumor to reduce size *Brachytherapy** places radioactive seeds or pellets in the prostate - Must abstain from sex for 2 weeks and must use a condom after the 2-week period to prevent partner from radiation exposure Cryotherapy - Use of liquid nitrogen to freeze the prostate Ablative Hormone Therapy - Testosterone suppression** to prevent tumor growth - Often used in men whose cancer has metastasized to the lymph nodes or bones Used as adjuvant therapy to shrink the prostate before radiation treatment Chemotherapy - Usually reserved for advanced prostate cancer Surgical - Radical prostatectomy: Removal of prostate and seminal vesicles - Several techniques, but ALL usually result in impotence

Answer 30

Administer medications as directed Post-op surgical care - Aseptic wound care - Manage bladder irrigation - Medications as directed *Pain medication *Stool softeners *IV antibiotics Patient and Family Teaching - Disease process - If brachytherapy is used, sex safety - Signs of infection - Prevention

Answer 31

*Commonly seen in males 15-35 years old *Most often Caucasians *Favorable survival rate *Risk Factors - Brother with testicular cancer - Cryptorchidism (undescended testicles) - Down’s syndrome - Smoking Pathophysiology - May be localized or metastasized to other locations - Various types - Most common types: Seminoma: slow growing, Nonseminoma: grow and spread more quickly

Answer 32

- Usually present with a painless mass** (Self exams are important*) - Pain, swelling, or hardness in the scrotum - Other symptoms if metastasis is present (depends on location of metastasis)

Answer 33

Lab Evaluation *Tumor Markers - Alpha-fetoprotein - Human chorionic gonadotropin Radiology Evaluation - Ultrasound:* to differentiate from infection - CT and x-ray: to assist in staging Diagnosis - Based on combination of physical assessment, ultrasound, and lab results (tumor markers)

Answer 34

Surgical Management - ALL testicular cancers require surgical management** - Radical Orchiectomy: Removal of affected testicle, including blood supply, and surrounding lymph nodes - Usually have chemo after surgery Medical Management - Seminomas: post-surgery radiation and/or chemotherapy - Nonseminomas: chemotherapy after surgery

Answer 35

- Pain management - Monitor for infection - Aseptic wound care - Medications as directed -Patient and Family Teaching - Signs of infection - Sperm storage: encourage patient to bank sperm before treatment should the patient wish to preserve potential fertility - Self-exams - Follow-up/Surveillance for recurrence

Answer 36

Most prevalent causes: *Alcohol!! *Gallstone pancreatitis!! - Due to the presence of gallstones obstructing the bile duct or located near the area where the bile duct and pancreatic duct empty into the duodenum - More common in women than men - Incidence increases with each decade of life Other causes "I get smashed" - Idiopathic, gallstones, ethanol, trauma, steroid use, mumps, autoimmune, scorpion stings, hypercalcemia and hypertriglyceridemia, ERCP, drugs/meds Patho - Alcoholism and biliary tract association are most commonly associated - Pancreatic acinar cells are disrupted or injured, leading to leakage of pancreatic enzymes that activate prematurely and “auto digest” the pancreas - Trypsin and elastase break down the pancreatic tissue causing inflammation, edema, vascular damage, hemorrhage, necrosis, and fibrosis. - Lipase causes fat necrosis of the pancreatic cells - The fatty acids released during this process combine with ionized calcium leading to hypocalcemia - Release of inflammatory mediators into the bloodstream may cause injury to blood vessels and other organs (lungs, heart, kidneys) - Patients with hemorrhagic pancreatitis are critically ill and may die from irreversible shock

Answer 37

*Sudden onset severe epigastric pain (caused by edema, chemical irritation and inflammation of the peritoneum, and irritation/obstruction of the biliary tract) - Often radiates to the back, flank or shoulder blades - Sharp, deep pain - Worsens when lying flat, after vomiting, or after eating foods high in fat content *Nausea, vomiting and anorexia (caused by hypermotility or paralytic ileus) *Abdominal distension (caused by bowel hypermotility and accumulation of fluids in the peritoneal cavity) *Hypotension and shock (enzymes and kinins increase vascular permeability and dilate vessels) *Severe Pancreatitis: ascites, jaundice, palpable abdominal masses *Tetany (hypocalcemia) - Trousseau’s Sign: Inflation of a blood pressure cuff causes the fingers to go into carpal spasm - Chvostek’s Sign: tapping over the facial nerve leads to twitching of the face *Signs of severe Hemorrhagic Pancreatitis - Cullen’s Sign: Bluish discoloration around the umbilicus - Grey-Turner’s Sign: Bluish discoloration of the flanks

Answer 38

*CBC - WBC: Elevated (due to inflammation) *CMP Alcohol-Induced Pancreatitis - Calcium: Decreased (due to fat necrosis, hypoalbuminemia, and malnutrition) - Albumin: Decreased (due to poor nutrition) Gallstone Pancreatitis - AST: Elevated (Due to bile flow obstruction) - ALT: Elevated (common with gallstone pancreatitis) - Direct Bilirubin: Elevated (due to biliary obstruction) - Lactate Dehydrogenase (LDH) *Lipase/Amylase – Elevated

Answer 39

*Abdominal CT with Contrast - Gold standard for diagnosis pancreatic necrosis or fluid collections around the pancreas *Abdominal (RUQ) Ultrasound - To evaluate for the presence of gallstones Evaluation of the pancreas is often limited with this study *Abdominal MRI - Higher sensitivity than CT in evaluating early pancreatitis, but may not be feasible in a critically ill patient - Magnetic Resonance Cholangiopancreatography (MRCP): May be used to identify etiology (ie., common bile duct stone obstruction) *Endoscopic Retrograde Cholangiopancreatography (ERCP) - Combines radiology with endoscopy - May be used to remove CBD stones *Chest/Abdominal Xray - May show elevated of the left diaphragm or pleural effusion - Evaluate for ileus

Answer 40

*Requires TWO of the following three criteria: - Acute onset of persistent, severe epigastric pain that often radiates to the back** - Elevated Lipase or Amylase** (3x the upper limit of normal) - Findings of acute pancreatitis on diagnostic imaging *Ranson’s Criteria - Score >3 indicates severe pancreatitis

Answer 41

*Fluid Replacement - Aggressive fluid replacement with IV crystalloids at 5-10 mL/kg/hr - Increase to 20 mL/kg/hr for 8-12 hours if patient has hypotension or tachycardia - Patients who do not respond to fluid therapy alone may require vasopressors for BP support - Patients with hemorrhagic pancreatitis may require packed RBC transfusion *Electrolyte Replacement - Hypocalcemia, hypomagnesemia, hypokalemia *Nutrition Support - Maintain NPO status for the first 24 hours!! - NG tube placement may be necessary for patients with an ileus, severe gastric distension, and decreased LOC (to prevent aspiration) - Oral feeding can be initiated early IF pain there is no vomiting, pain is decreasing, and inflammatory markers are improving - Clear liquids initially, advancing to low residue, low fat, soft diet as tolerated - Initiate enteral nutrition if unable to tolerate oral diet (d/t pain and vomiting) by day 5 *Pain control is a PRIORITY!! - Pain increases the patient’s metabolism and thus increases pancreatic secretions - IV opioid analgesics as ordered - PCA Pumps *Pharmacological Management - Antiemetics for nausea and vomiting - Antibiotics typically not recommended* for the treatment of acute pancreatitis, no matter the type, may be used to treat secondary infections *Surgical Management - Surgery usually not indicated for acute pancreatitis - Surgical intervention may be necessary to treat the causes or complications of acute pancreatitis - Laparoscopic cholecystectomy to remove gallbladder/stones - Laparoscopy or CT guided percutaneous drainage of pseudocysts or abscess

Answer 42

*Monitor intake and output - Urinary output < 50 mL/hr is an early measure of hypovolemia!! *Monitor vital signs - Goals: SBP >100 mm Hg (without orthostatic decrease), MAP >60 mm Hg, HR <100 bpm!! *Assess skin color/temperature *Patients with severe disease may require monitoring of pulmonary artery pressure (goal 11-14 mm Hg)

Answer 43

*Monitor for signs of hypocalcemia - Prolonged QT interval - Tetany, Chvostek and Trousseau signs *Place patient on seizure precautions *Monitor serum albumin levels as true serum calcium can only be evaluated in comparison of albumin levels - If albumin is low, a serum IONIZED calcium level should be drawn OR the serum calcium level should be corrected using a clinical calculator *Administer calcium replacement as ordered *Monitor for calcium toxicity - Lethargy, nausea, shortened QT interval, decreased excitability of the nerves/muscles - Hypomagnesia may be present, replace as ordered

Answer 44

*Associated with cardiac dysrhythmias, muscle weakness, hypotension, decreased bowel sounds, irritability *Administer replacement as ordered - Must be diluted and administered via infusion pump!!

Answer 45

*Pulmonary - ARDS - Atelectasis, pneumonia, pleural effusion - Hypoxemia *Cardiovascular - Cardiac dysrhythmias - Hypovolemic shock - Myocardial depression *Gastrointestinal - GI bleeding - Pancreatic abscess - Pancreatic pseudocyst *Hematologic - Coagulation abnormalities - DIC *Renal - Acute renal failure - Azotemia (elevated BUN) - Oliguria (abnormally small amount of urine production)

Answer 46

*Educate about symptoms, disease progression, procedures, and interventions *Dietary Instructions - Small, frequent meals and vitamin supplements - Eat carbohydrate containing foods (less pancreatic stimulation) - Avoid fat and protein rich foods** *Avoid alcohol!! *Smoking cessation

Answer 47

Persistent inflammation, fibrosis, and loss of acinar and islet cells that is NOT REVERSIBLE *Most common cause is heavy, prolonged alcohol use (ie., five drinks daily for at least 5 years) - May initially present with acute pancreatitis, but have imaging evidence of chronic pancreatitis - Other cofactors including diet, genetic background or ethnicity and smoking likely contribute to development of chronic pancreatitis is heavy drinkers *Recurrent and severe acute pancreatitis (the other most common) - Severe acute pancreatitis (with necrosis), repeated attacks and those who continue to drink alcohol and smoke *Others: Smoking, hypertriglyceridemia, genetic, autoimmune, obstruction of pancreatic duct, idiopathic Patho *Changes to the pancreatic structure such as fibrosis, atrophy, and calcification lead to irreversible inflammation *These changes cause pancreatic insufficiency *Loss of exocrine function - Decreased pancreatic secretions - Malabsorption of fats ⇒ weight loss and muscle wasting - Malabsorption of protein ⇒ decreased levels of albumin ⇒ “starvation” edema of the extremities *Loss of endocrine function - Development of diabetes mellitus

Answer 48

Upper abdominal pain that may radiate to the back - Often constant and prevents normal activity - Exacerbated after eating or drinking (especially overeating or drinking alcohol) Nausea and vomiting Weight loss Diarrhea Pale or clay-colored stools Steatorrhea (greasy, foul-smelling stools)

Answer 49

CBC CMP - Increased Alkaline Phosphatase - Increased Bilirubin - Increased Glucose - Increased Lipase/Amylase Other Diagnostics - to visualize the pancreas - Abdominal CT - Abdominal ultrasound - ERCP Diagnosis *Should be suspected in patients with any of the following: - Chronic abdominal pain and/or a history of relapsing acute pancreatitis - Symptoms of pancreatic exocrine insufficiency - Diarrhea, steatorrhea, weight loss - Pancreatogenic diabetes - Visible damage on cross-sectional imaging: CT or MRI/MRCP - May be inconclusive, especially early in the clinical course *Endoscopic Ultrasound *Direct Pancreatic Function Testing

Answer 50

*Pain Control!! - Opioids usually required *IV Fluid Replacement *Other Medications - Electrolyte replacement as needed - Histamine blockers (ie., Pepcid) or Proton pump inhibitors (ie., Protonix) - Insulin therapy as needed - Pancreatic Enzyme Replacement Therapy (PERT): Provides amylase, lipase and protease. Used to treat malnutrition and malabsorption Nutritional Support - May require total parenteral nutrition (TPN) Patient and Family Education *Avoid alcohol!! *Avoid tobacco products *Medication education - Take prescribed pancreatic enzymes with food and a full glass of water - Do not chew pancreatic enzymes *Dietary considerations - Limit fat in the diet - Avoid intake of irritating foods and beverages (ie., coffee, caffeine) *Support group availability

Answer 51

*Because diagnosis often occurs late in the disease process, most patients have unresectable tumors!! *Majority are adenocarcinomas and develop in the exocrine portion of the pancreas - Most frequently found in the head of pancreas *Risk Factors - Cigarette smoking (smokers 2x as likely to develop pancreatic cancer) - Diets high in fat - High consumption of meat, fried foods, refined sugars, and nitrates - Patients with diabetes, chronic pancreatitis - Family history - Age over 60 years Often rapid growing, causing deterioration of both the endocrine and exocrine functions of the pancreas

Answer 52

*Usually vague and similar to other GI disorders!! *Often dependent upon the degree of pancreatic damage *Symptoms - Pain - Typically, dull pain in the epigastric area and back - Jaundice (due to obstruction of the bile duct) - Fatigue - Weight loss

Answer 53

Not specific for diagnosis, but may provide insight into pancreatic function *CBC *CMP - Increased Bilirubin - Increased LFTs - Increased Amylase and Lipase *Stool Testing - Fecal fat Radiologic Evaluation to determine presence of a mass *Ultrasound *CT Scan *MRI *ERCP Diagnosis *Definitive diagnosis made through biopsy - Collected by a fine-needle biopsy or excision biopsy through a laparotomy *Usually diagnosed late in the disease process, leading to high mortality rates

Answer 54

*Chemo and Radiation to improve long term survival *Surgical Intervention *Surgical resection of the tumor is potentially curative, however very few patients are candidates *Whipple Procedure!!! - Major resection of the pancreas, duodenum, stomach, and gallbladder *Nursing Management Post-Operative Management *Maintain NPO status *NG tube to low suction - NEVER manipulate the NGT postoperatively!! - NGTs should not be repositioned or irrigated or checked for placement. Doing so can cause a breakdown of the anastomotic site. If a patient removes his NGT, it is not to be replaced by the nursing staff. A member of the surgical team should be notified *Close glucose monitoring *Monitor post-op drainage tubes - Amount, color, consistency *Semi-fowlers position *Assess for potential surgical complications: - Diabetes: glucose monitoring - Hemorrhage: monitor VS, skin color, mental status - Wound infection: monitor VS, assess wounds for erythema, induration, drainage - Bowel obstruction: assess bowel sounds frequently, monitor stools - Intra-abdominal abscess: monitor VS, assess for severe pain

Answer 55

*Monitor vital signs, intake/output, weight - Glucose monitoring *Administer insulin as needed/directed *Monitor and treat pain as directed *Monitor for weight changes *Palliative care Patient and Family Education *Postoperative care *Medication regimens *Diet and nutrition - Use of prescribed dietary supplements *Signs and symptoms of hyper/hypoglycemia *Provide information on coping skills, support groups, palliative care

Answer 56

A chronic disease that causes cell destruction and fibrosis or scarring of hepatic tissues Causes * Infection (most common) - Hepatitis C**: leading cause of chronic hepatitis and cirrhosis *Alcohol-induced cirrhosis** *Other: biliary cirrosis, NASH, genetics, autoimmune disorder, hepatotoxins/medications, cardiac dysfunction (long term R-HF) Patho *Functional liver cells die, and damaged liver cells regenerate into nodules surrounded by fibrous tissue *Thick capillary networks form around these nodules, alternating blood flow *Alteration of blood flow results in Portal Hypertension (increase in the pressure in the veins that carry blood through the liver) and shunting of blood around the liver (bypassing the liver cells) *In a healthy liver, most blood flow occurs through the portal vein *In a cirrhotic liver, blood flow is dependent on the hepatic artery *Blood cannot freely flow from other organs (stomach, intestines, spleen, pancreas) through the portal vein because of blocked vessels (due to scarring and fibrosis) *Increased pressure leads to enlargement of the veins in the esophagus, skin of the abdomen, and veins in the rectum and anus *Leads to esophageal varices and gastric varices → Upper GI Bleeding Other pathophysiologic changes: *Ascites: Accumulation of protein-rich fluid in the abdominal cavity - Caused by increased hydrostatic pressure associated with portal hypertension *Coagulopathy** - Most of the coagulation cascade and fibrinolytic proteins are synthesized in the liver → liver disease negatively impacts the formation of clotting factors and coagulation mechanisms

Answer 57

*Shortness of breath – due to fluid overload/inability to lower diaphragm *Jaundice!! *Ascites - Increased abdominal girth!! - Abdominal pain and bloating *Increased Venous Pressure - Enlarged spleen - Spider angiomas - Hemorrhoids *Bleeding and/or bruising – due to increased venous pressure and coagulopathy *Pruritis (biliary cirrhosis – bile salts are retained and deposit on the skin) *Changes in mental status and motor function (hepatic encephalopathy)

Answer 58

Lab Evaluation *CBC - Decreased Platelets (Thrombocytopenia) *CMP - Increased Liver Enzymes (AST and ALT) - Increased Bilirubin - Increased Alkaline Phosphatase - Decreased Albumin - Decreased Sodium *Coagulation Studies - Increased PT - Increased aPTT *Elevated Serum Ammonia Level *Diagnosis - Abdominal Ultrasound: evaluate the liver parenchyma and to detect extrahepatic manifestations of cirrhosis - Liver Biopsy!: required to definitively confirm the diagnosis

Answer 59

*Bleeding *Hyponatremia *Hepatorenal Syndrome (HRS) - Rapid deterioration of kidney function because of altered blood flow to the kidneys - High mortality - Long-term treatment is liver transplantation *Spontaneous Bacterial Peritonitis (SBP) - Clinical manifestations: fever, abdominal pain, encephalopathy and/or acute hemodynamic decompensation - Diagnosis: confirmed with diagnostic paracentesis - Treatment: antibiotic therapy

Answer 60

Ascites Management *Fluid and Sodium Restriction *Paracentesis!: Invasive procedure to remove fluid from the abdominal cavity to ease symptoms and collect samples for lab analysis Portal Hypertension Management *Beta-blockers to lower systemic blood pressure *Control variceal bleeding - Variceal banding and sclerotherapy - Sengstaken-Blakemore Tube**: should not be left in place for more than 24 hours; keep scissors at the bedside for emergency use Surgical Management *Transjugular Intrahepatic Portosystemic Shunt (TIPS) - Goal is to decrease portal pressure *Liver Transplant

Answer 61

Assessment *Respiratory Status and Shortness of Breath *Vital Signs *Peripheral Edema *Abdominal Girth *Bleeding Gums, Ecchymosis, Petechiae, epistaxis *Skin, sclera, urine, and stool color *Mental status *Intake and Output *Daily Weight Interventions *Administer diuretics as directed *Electrolyte replacement as directed - Potassium - Magnesium - Phosphate *Restrict sodium and fluid intake *Restrict protein intake *Elevate head of the bed and legs *Administer blood products, Vitamin K and fresh frozen plasma as directed Patient/Family Education *Dietary Restrictions - Protein (low-protein diet reduces intestinal ammonia production) - Sodium (low-sodium diet reduces fluid build-up) - Limit to less than 2g of sodium per day - Fluid *Consume adequate calories, eating a well-balanced diet with plenty of fruits, vegetables, and whole grains *NO alcohol intake *Avoid medications that are metabolized in the liver (Acetaminophen) and OTC herbs and supplements *Need for care with hygiene - Soft toothbrushes, careful flossing, shaving, etc.

Answer 62

A spectrum of REVERSIBLE neuropsychiatric abnormalities *Main cause is the accumulation of ammonia** and toxins in the blood that are normally detoxified by the liver *Initiating factors - High-protein diet** - Infections - Hypovolemia - Hypokalemia - Constipation - GI Bleeding** - Drugs (diuretics, analgesics, narcotics, sedatives) Patho *As bacteria in the GI tract breakdown amines, amino acids, purines and urea, ammonia is produced *Ammonia is typically metabolized and cleared by the liver *In a unhealthy liver, ammonia clearance is decreased, leading to hyperammonemia *Once ammonia crosses the blood-brain barrier, it has multiple neurotoxic effects

Answer 63

*Disturbance in sleep pattern – insomnia and hypersomnia *Mood changes/impaired decision making *Slurred speech *Asterixis - flapping of the hands or arms (early sign) *Poor coordination *Confusion *Decreased level of consciousness *Coma 1) Pts have slurred speech, tremors, lethargy and euphoria, reversal of day and night sleep patterns, Asterixis, impaired writing, impaired decision making, poor coordination 2) Increased drowsiness, disorientation, inappropriate behavior, mood swings, agitation, Asterixis, fetor hepaticus (sweet fecal smell of the breath) 3) Severe confusion, difficult to awaken, slurred speech Asterixis, increased deep tendon reflexes, rigid extremities 4) Coma, nonresponsive to painful stimulus

Answer 64

Lab Evaluation *CMP - Elevated Liver Enzymes (AST and ALT) - ElevatedBilirubin - Elevated Alkaline Phosphatase - DecreasedPotassium - Decreased Sodium *Elevated Serum Ammonia Level Diagnosis *History and physical exam *EXCLUSION of other causes - Lab testing to rule out metabolic abnormality - CT scan of the brain to rule out other causes *Evaluation for precipitating causes - GI bleeding? Infection? Dehydration? *While ammonia levels are often elevated, it is NOT diagnostic - Ammonia does NOT have to be elevated in all patients with hepatic encephalopathy - Many other causes for elevated ammonia levels

Answer 65

Avoid protein overload!! *Encourage small, frequent meals Reduce bacterial production of ammonia *Lactulose!! - Prevents absorption of ammonia in the colon and promotes excretion - May decrease K+ levels *Neomycin - Broad spectrum antibiotic that destroys normal flora of bacteria in the GI tract - Decreases protein breakdown and production of ammonia *Restrict toxic medications - Opioids, sedatives, barbiturates *Prevent GI Bleeding - Blood cells are metabolized in the GI tract and increase ammonia *Supportive Care - Safety measures *Patient and Family Education - Educate patient and family on factors that may lead to hepatic encephalopathy - Educate on signs/symptoms of hepatic encephalopathy - Remember that initial signs may be very subtle

Answer 66

*Arterial hemorrhage resulting from an acute longitudinal tear in the GI mucosa *Usually occurs after episodes of forceful retching *Usually resolve spontaneously *Risk Factors - Chronic NSAID or aspirin use - Excessive alcohol intake

Answer 67

Increased portal venous pressure (“Portal Hypertension”) causes venous blood to be diverted from the liver to the systemic circulation by the development of connections to neighboring low-pressure veins - One of the most common sites for these collateral channels is the submucosa of the esophagus As these veins experience increased pressure, they become distended, the vessels enlarge, and varices develop (don’t always bleed, but when they do, it is profusely)

Answer 68

Usually, a medical emergency** because of massive upper GI blood loss *Hemodynamic instability and signs of shock Treatment priorities include hemodynamic stabilization and establishment of patent airway Diagnosis of the cause through endoscopy is a priority before definitive treatment can be started Treatment Measures *Somatostatin or Octreotide - Used to slow or stop bleeding; to stabilize patients before definitive treatment is performed - Given as a IV bolus of 25-100 mcg followed by an infusion of 25-50 mcg/h for 1-5 days - Monitor for hypo- and hyperglycemia!! *Vasopressin - Lowers portal pressure, but does not improve survival rates - Rarely used because of adverse effects *Endoscopic Procedures - Sclerotherapy - Endoscopic Band Ligation: rubber band is placed over the varix, resulting in thrombosis, sloughing and fibrosis of the varix *Transjugular Intrahepatic Portosystemic Shunt (TIPS) - Nonsurgical treatment for recurrent variceal bleeding after sclerotherapy - Stent is placed between the hepatic and portal veins to create a portosystemic shunt in the liver and decrease portal pressure *Esophagogastric Tamponade - Inflation of balloon ports applies pressure to the vessels supplying the varices to decrease blood flow and stop the bleeding - Sengstaken-Blakemore Tube

Answer 69

*Should not be in place for more than 24 hours *Has 3 lumina: one for gastric aspiration, one for inflation of the esophageal balloon and one for inflation of the gastric balloon *Normal inflation pressure of the esophageal balloon is 20-45 mm Hg Nursing Interventions for Sengstaken-Blakemore Tube *Monitor balloon lumen pressures and patency of system *Typical provider orders: - Deflate the balloon every 8-12 hours to decompress the esophagus and gastric mucosa and evaluate for bleeding - Deflate the esophageal balloon BEFORE the gastric balloon *Potential complications - Rupture of the gastric balloon, upward migration of the tube, and occlusion of the airway; esophageal rupture - In the event of any of the above, all lumina are cut and the tube is removed - Scissors should ALWAYS be kept at the patient’s bedside

Answer 70

*Intrabdominal Abscess - Collection of pus in the abdomen: May be caused by appendicitis, diverticulitis, perforated ulcer, injury to the bowel, or surgical complication *Spontaneous Peritonitis - Caused by infection of ascites (fluid in the peritoneal cavity) - Usually occurs from liver or kidney failure *Secondary Peritonitis - Caused by bacteria entering the peritoneum via the GI tract - Ruptured appendix, perforated colon, trauma - Bile leak into the lining of the abdominal cavity *Dialysis Associated - Peritoneal dialysis catheters allow foreign contaminants to enter the peritoneal cavity

Answer 71

*Response to inflammation/infection - Blood vessel dilation - Shunting of blood to the abdomen - Fluid shifted into the peritoneal cavity (third spacing) *Decrease in circulatory volume and eventually hypovolemic shock *Insufficient perfusion of the kidneys and eventually kidney failure with electrolyte imbalances *Life threatening progression**: - Peristalsis slows or stops - Bowels become distended with gas and fluid - Toxins and bacteria lead to septicemia - Respiratory problems from increased abdominal pressure against the diaphragm

Answer 72

- Severe pain** (often appearing out of proportion) - Rigid/board-like abdomen - Rebound tenderness** - Distended abdomen - Diminished bowel sounds - Fever - Tachycardia - Respiratory distress - Decreased urine output

Answer 73

Lab Evaluation *CBC - Elevated WBC** *CMP - Electrolyte abnormalities - Elevated BUN/Creatinine * Elevated Lactic Acid** * Radiologic Evaluation - Abdominal Xray - Abdominal CT scan - Ultrasound *Diagnosis - May be diagnosed based on physical assessment, lab, and radiology findings - Spontaneous and dialysis associated may be diagnosed based on lab evaluation of fluid obtained via paracentesis

Answer 74

*Nonsurgical Management - IV fluids** - IV antibiotics** - NG tube to decompress the stomach - NPO status - Surgical consultation *Surgical Management - Focuses on controlling contamination by removing foreign material and fluid from the peritoneal cavity - Usual approach is exploratory laparotomy** to remove or repair the inflamed or perforated organ - Prior to closing the abdominal cavity, the surgeon irrigates the peritoneum with antibiotic solutions

Answer 75

Administer fluids and antibiotics as directed Pain management Monitor for worsening of condition - Level of consciousness - Vital signs - Respiratory status I&O monitoring Post-surgical assessment interventions as indicated Patient and Family Education

Answer 76

Men > Women African Americans have the highest incidence and mortality Risk Factors *Personal or family history of colo-rectal cancer (first-degree relative) *History of adenomatous polyps *Family history of adenomatous polyposis, physical *IBS for 10 years or more *Physical inactivity *Obesity *Dietary - High fat diets - Consumption of red meat and processed meats - Inadequate intake of fruits and vegetables *Cigarette use *Alcohol use (>4 drinks per week) Patho *Most are adenocarcinomas *Metastasis can occur by direct extension to adjacent organs, through the lymphatic system or the blood stream *Most common site of metastasis is the liver - May also metastasize to the lungs, brain, bones, and adrenal glands

Answer 77

*Symptoms usually insidious in early stages *Unexplained weight loss and fatigue are often first symptoms!! *General symptoms - Change in bowel regularity and appearance - Blood in the stool** - Abdominal pain and/or distention - Sensation of pressure as with incomplete evacuation of bowel *Site specific symptoms - Ascending colon: Vague abdominal pain, change in bowel habits, anemia, fatigue - Transverse colon: Pain, symptoms of obstruction, change in bowel habits, anemia, fatigue - Descending colon: Pain, change in bowel habits, bright red blood in stool, symptoms of obstruction - Rectum: Blood in stool, change in bowel habits, rectal discomfort, feeling of incomplete evacuation

Answer 78

Lab Evaluation *CBC - Elevated WBC (secondary to inflammation of infection) - Decreased Hemoglobin and Hematocrit *CMP - To evaluate for electrolyte imbalances (particularly if there has been a change in stool) and - LFT abnormalities (concern for potential liver metastases) *Elevated CEA: treatment and screening purposes!! *Radiologic Evaluation - Abdominal CT scan - MRI - Abdominal xrays *Diagnosis - Colonoscopy is the gold standard for colorectal screening and diagnosis - Biopsies may be taking during procedure Polyps removed - Staging typically done using the TNM (tumor-node-metastasis) classification system

Answer 79

*Chemotherapy - Used as an adjunct to improve survival rates in patients whose tumors cannot be completely removed *Radiation - May be used preoperatively to reduce the size of the tumor - May also be used as a palliative measure *Surgical Management - Treatment usually involves surgery* to remove the affected portion of the colon - Goal is to remove the tumor and affected portion of the colon with proximal and distal margins of normal bowel - Need for temporary or permanent colostomy is dependent on location of tumor Nursing Management *Preoperative - Physical assessment, monitor lab values, assess current knowledge of disease, treatment plan, pre-/post-op care - Bowel prep (if ordered): To minimize bacterial growth and prevent contamination with feces during surgery; Example: GoLYTELY - Pre-op antibiotics as ordered - Ensure surgical consent is signed and witnessed Postoperative *Vitals signs at least every 4 hours *Monitor labs - Hemoglobin and Hematocrit: to assess for bleeding and/or nutritional deficits - WBC: to assess for infection or other complication *Assess for and treat nausea/vomiting - Patient may have NG tube *Monitor I&O *Assess ostomy if present *Monitor incision wounds for evidence of infection and/or bleeding *Pain control *Implement early ambulation *Coughing and deep breathing *Teaching - Methods to prevent post-op complications - Ostomy teaching if applicable - Consult wound/ostomy nurse

Answer 80

*Initial post-op evaluation - Slight bleeding may be present initially - May be slightly edematous at first, but this should gradually subside - Typically take 2-4 days postoperatively to function *Stoma evaluation - Stoma should be reddish pink and moist - Signs of ischemia (dark red, purple or black discoloration) or unusual bleeding should be reported immediately *Inspection of Stool - The further down the colon it is, the more formed the stool should be *Patient teaching - Consult wound/care ostomy nurse - Care of ostomy, needed supplies, potential complications - Self-care is more successful if teaching is completed prior to surgery - Only possible for planned surgeries - Will need to adjust teaching plan for emergent surgery/ostomy placement

Answer 81

Risk Factors - Diet - Foods with additives (smoked foods, pickled vegetables, salted fish and meat) - Dietary nitrates - Low gastric acidity: Atrophic gastritis, Pernicious anemia - Chronic inflammation of the stomach - High alcohol consumption - Smoking** - Family history - H pylori infection**

Answer 82

Often asymptomatic until late in the course and disease is advanced Symptoms are usually nonspecific – patients often initially treated for acid disease, making early detection difficult - Indigestion - Anorexia - Weight loss - Vague epigastric pain - Vomiting - Abdominal mass

Answer 83

Lab Evaluation *CBC - Decreased H/H *CMP - Elevated AST, ALT, Alkaline Phosphatase and Bilirubin (if liver metastases present) - Elevated CEA *Positive stool guaiac Diagnosis *Radiology Studies - Barium X-ray: Shows changes that suggest gastric cancer (tumor, filling defect, loss of flexibility) - Chest X-ray: To evaluate for metastasis - EGD: Visual examination of the lining of the esophagus, stomach, and upper duodenum Identifies cancer and helps rule out other diffuse gastric mucosal abnormalities. Used to obtain cells for biopsy - CT: Used to determine the spread of the cancer

Answer 84

*Radiation and chemotherapy not useful for primary treatment - Typically used for palliative purposes or to control metastases *Antiemetics (Zofran, Reglan, etc.) - Control nausea and vomiting (secondary to disease and treatment modalities) *Opioid analgesics *Vitamin Supplementation *Surgical Management - Gastric resection plus adjuvant chemotherapy/radiation may be effective for early stages *Complication: Dumping Syndrome!! - Alterations in gastric anatomy may cause rapid gastric emptying - Concentrated chyme (partially digested food) may enter the bowel too rapidly, causing abdominal distention, inappropriate gut hormone release and rapid glucose absorption

Answer 85

*Early Dumping Syndrome (15-30 minutes after a meal) Symptoms - Dizziness - Tachycardia - Pallor - Sweating - Diarrhea - Palpitations *Late Dumping Syndrome (1-3 hours after eating) Symptoms - Symptoms of hypoglycemia: weakness, sweating, dizziness *Treatment - Most cases respond well to dietary management - Frequent small meals that are high in protein and low in carbohydrates - Drinking fluids between meals instead of at mealtime - Reclining on left side after eating - Surgical intervention: reconstruction of the pylorus or a gastrojejunostomy

Answer 86

*A break in the mucosa extends through the entire mucosa and into the muscle layers, damaging blood vessels and causing hemorrhage or perforation into the GI wall *Duodenal and gastric ulcers are most common types and the most common cause of upper GI bleeding *Risk Factors - Alcohol consumption - H pylori infection - Chronic NSAID use - Smoking *Treatment - Standard Triple Therapy: PPI, amoxicillin, clarithromycin

Answer 87

*Acute form of peptic ulcer that often accompanies severe illness, systemic trauma, or neurological injury *Ischemia is primary etiology *Treatment - Antacids, histamine receptor (H2 receptor) antagonists, and PPIs - Patients at risk often receive PPI prophylaxis

Answer 88

*Hematemesis** (bloody vomitus that is bright red or has a coffee ground appearance) is the most common manifestation *Melena (shiny, black, foul-smelling stool) – results from the degradation of blood by the stomach acids and intestinal bacteria *Hematochezia (bright red blood) – usually a sign of lower GI bleeding, but may be present in massive upper GI bleeding *Epigastric pain or abdominal discomfort *Clinical signs of blood loss - Change in LOC - Cool, clammy skin - Decreased urinary output - Hypotension - Tachycardia

Answer 89

*CBC - Elevated WBC - Hemoglobin and Hematocrit: normal, then decreased - Platelets – initially elevated, then decreased *CMP - Sodium: decrease - Potassium: initially decreased, then increased - Glucose: often increased - Calcium: normal or decreased - BUN and Creatinine: Increased *PT and aPTT – often increased *Stool guaiac positive *Diagnosis - Endoscopy** is the procedure of choice for diagnosis and treatment - Usually not completed until patient is hemodynamically stable - Barium studies may be performed to define the presences of ulcers and sites of bleeding

Answer 90

*Hemodynamic Stabilization - Large-bore IV catheter and rapid fluid administration - Administration of blood and blood products - One unit of packed RBCs usually increases the Hemoglobin by 1 g/dL and the Hematocrit by 2-3% *Gastric Lavage - May be performed to reduce bleeding and to evaluate location of bleeding - Provides better visualization of the gastric fundus during endoscopy - Insert a large-bore NG tube and connect to suction - Instill 1000-2000 mL of room-temperature NS via the NGT and gently remove gastric contents by intermittent suction until clear - NGT may be removed post-procedure *Pharmacological Therapy - Antacids - Histamine antagonists (H2-receptor blockers - ie., Pepcid) - PPIs (ie., Protonix) - Mucosal barrier enhancers (Carafate, drink 30 min before meals and at night) - Antibiotics - Amoxicillin and Clarithromycin to treat H pylori infection

Answer 91

*Sclerotherapy – injection of necrotizing agent into the bleeding ulcer *Thermal Methods - Laser photocoagulation and electrocoagulation *Endo-clipping to provide hemostasis and prevent recurrence *Nursing Interventions during Endoscopy** - Maintain airway and monitor breathing - Assist in position patient in left lateral reverse Trendelenburg position

Answer 92

*Most common reason for emergency surgery is massive rebleeding within 8 hours of admission *Considered in patients who require more than 8 units of blood within a 24-hour period *Gastric resection or combined operations to restore GI continuity Postoperative Nursing Interventions!! *Prevent and monitor for complications - Fluid and electrolyte imbalances - Nausea, vomiting, diarrhea, or ileus *Provide adequate nutrition - TPN may be considered *Monitor for signs of wound infection *Monitor for signs of systemic infection *Pain control *Implement incentive spirometry and other pulmonary hygiene measures

Answer 93

Perforation of the gastric mucosa → Peritonitis - Abdominal tenderness - Abrupt onset of severe pain - Board-like abdomen - Leukocytosis - Presence of free air on xray - Absent bowel sounds

Answer 94

Maldigestion: failure of the chemical processes of digestion that take place in the intestinal lumen or at the brush border of the intestinal mucosa Malabsorption: failure of the intestinal mucosa to absorb (transport) the digested nutrients

Answer 95

- Chronic diarrhea** is a classic symptom (due to unabsorbed nutrients and fats) - Unintentional weight loss* - Steatorrhea (due to unabsorbed fats) - Bloating and flatus (↓ carbohydrate absorption) - Peripheral neuropathy (↓ Vitamin B1, B6, B12 absorption) - Bruising and purpura (↓ Vitamin K absorption) - Bone Pain (↓ Calcium and Vitamin D) - Edema (↓ protein absorption)

Answer 96

Nutrition Avoid triggers of malabsorption - Low fat diet for patients with gallbladder disease, steatorrhea, or cystic fibrosis - Lactose-free diet for lactose intolerant patients!! - Gluten-free diet for patients with celiac disease Nutritional Supplements -Targeted supplements for specific deficiency (ie., B-vitamin supplements) Drug Therapy - Antidiarrheals (Lomotil) and - - Anticholinergics (Bentyl) to inhibit gastric mobility - IV fluids to replace fluid losses from diarrhea - Antibiotics for problems involving bacterial overgrowth - Steroids sometimes given for inflammatory diseases (ie., Celiac disease and Crohn’s disease) Patient and Family Education - Identify and avoid triggers - Need for/use of supplements and medications

Adult GI/GU Flashcards

(120 cards)