Chapter 15 Gastrointestinal Diseases Flashcards
(143 cards)
0
Q
In this disease the teeth become loose and fall out because the support structures and the gums become diseased and unable to hold the teeth in place.
A
Periodontal disease
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Q
In this disease the bones become fragile, as do the teeth, since those are the two major storage areas for calcium.
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Osteoporosis
2
Q
Inflammation of the gums is called?
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Gingivitis
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Q
Gingivitis may cause pain and bleeding and may lead to what? The progressive loss of bone around the teeth.
A
Periodontitis
4
Q
What medication can cause an overgrowth of the gingivae causing gingivitis?
A
Dilantin or phenytoin
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Q
Nursing interventions to prevent and treat gingivitis and periodontitis include promoting what?
A
Good oral hygiene, regular dentist visits, and maintaining normal nutrition.
Prevention is the most important intervention.
6
Q
What is one of the most common causes of dysphagia in older adults?
A
It is usually the result of chronic acid reflux leading to Esophageal stricture. However it can also be a symptom of other more severe problems such as cancer, stroke. Also Parkinson’s disease.
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Q
This is the movement of stomach contents, Usually hydrochloric acid, back into the esophagus.
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Gastroesophageal reflux disease
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Q
Risk factors for esophageal reflux disease include?
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Obesity, and use of estrogen, nitroglycerin, and tobacco. Other causes include hiatal hernia, infections, and illnesses such as lupus.
9
Q
Symptoms of reflux disease include?
A
Acid taste in the back of the throat, heartburn, and in severe cases, chest pain. People often cannot tell the symptoms between cardiac and reflux disease and sometimes a trip to the emergency room for evaluation is necessary
10
Q
Chronic reflux causes?
A
Esophageal strictures. When strictures are present dysphagia begins to occur.
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Q
Common interventions for GERD Include?
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Avoiding large and high fat meals,
avoid lying down for three hours after eating,
and sleeping in bed with the head elevated approximately 8 inches.
12
Q
Common medications to treat GERD include?
A
Histamine blockers such as Zantac and Pepcid, or PPI’s such as omeprazole or protonix.
13
Q
Esophagitis is an inflammation of the esophagus caused by?
A
The most common cause includes gastroesophageal reflux and prolonged vomiting
14
Q
This Occurs when a part of the stomach protrudes through the Esophageal gastric junction. Part or all of the stomach and, in some cases the intestines may herniate up into the Esophagus.
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Hiatal hernia
15
Q
Common signs and symptoms of hiatal hernia include?
A
Dyspepsia, heartburn, indigestion, and dysphagia, in severe cases, severe retrosternal chest pain and gastric ulcer can occur.
16
Q
Risk factors for hiatal hernia include?
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Genetics and age-related changes in the esophageal wall.
17
Q
Diagnostics used to detect hiatal hernias include?
A
Chest x-ray, barium contrast studies, endoscopy, and 24 hour Esophageal pH monitoring.
18
Q
By age 60 what percentage of adults have hiatal hernias?
A
60%
19
Q
This condition is an inflammation of the gastric mucosa and comes in two forms acute and chronic.
A
Gastritis
20
Q
This type of gastritis is temporary inflammation, hemorrhage, or erosion of the gastric lining and can because by alcoholism aspirin use smoking, NSAIDs, and severe stress
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Acute gastritis
21
Q
This type of gastritis recurs over weeks or months and is caused by vitamin deficiency, chronic alcohol use, gastric mucosal atrophy, Chronic use of acid suppressive medications, and hiatal hernias.
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Chronic gastritis
22
Q
Chronic gastritis leads to what?
A
It leads to decreased gastric secretions which can eventually lead to deficiency of all B vitamins, peptic ulcer disease, or gastric cancer.
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Q
An imbalance between the effects of gastric acid and pepsin on the gastric and duodenal mucosa can cause an ulceration known as?
A
Peptic ulcer disease
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Common Causes of peptic ulcer disease include?
Helicobacter pylori infection
Overproduction of HCl in the stomach
Decreased resistance of gastric mucosa that can occur with the use of NSAIDs and in chronic gastritis
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Common treatment for H. Pylori is?
PPI's, clarithromycin plus amoxicillin.
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In gastric ulcers the amount of HCl is usually what?
Normal or reduced. The problem is with the increased diffusion of this acid back into the tissues, common symptoms of gastric ulcers include epigastric pain, some relief of pain with eating, nausea, vomiting, and weight loss.
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In duodenal ulcers the level of gastric acid is?
Increased, as is the rate of gastric acid release from the stomach into the duodenum. If acid is not buffered in the stomach before it is passed to the duodenum, the unbuffered acid will irritate the duodenum.
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Symptoms of duodenal Ulcers include?
Epigastric pain, pain that is relieved with foods and antacids, pain that is worse when the stomach is empty, and weight gain.
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Nursing interventions for older adults with PUD, peptic ulcer disease include lifestyle modification such as?
Smoking cessation, avoiding alcohol, avoiding aspirin, avoiding NSAIDs, reducing stress.
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Dietary changes that a patient may make to avoid PUD include?
Foods that irritate the stomach such as caffeine and alcohol and avoiding foods that cause symptoms to get worse.
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To reduce the likelihood of diverticulitis disease, a patient should eat a diet that is high in what?
Fiber, Most experts believe that a diet that is low in fiber is the main contributor to the increase of intraluminal pressure. When there is little stool volume, the intestinal muscles have to exert more force to propel the fecal matter through the colon, the end result is increased pressure.
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What percentage of older adults over age 85 have diverticular disease?
Two thirds.
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This is an inflammation or infection in and around a Diverticular sac, That is usually the result of trapped undigested food, stool, or bacteria in the sac.
Diverticulitis
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Common symptoms of diverticulitis include?
Change in bowel habits, lower left abdominal pain, constipation, and increased flatus, nausea, and vomiting. However, many older adults with diverticulitis may be afebrile and had minimal abdominal symptoms.
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A common laboratory findings in older patients with diverticulitis is?
Leukocytosis
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Treatment for diverticulitis includes?
Bowel rest, analgesics, antibiotics, and in severe cases, surgical resection.
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Nursing management for older adults with diverticular disease includes?
Prevention and elimination of constipation. A high fiber diet. Patients should be instructed on foods to avoid such as nuts, popcorn, corn, celery and other fresh uncooked vegetables. Adequate fluid intake is also important.
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This inflammation of the stomach or small intestine may be caused by bacteria, viruses, medications, ingestion of irritating foods or some type of allergic response.
Enteritis or gastroenteritis.
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This enteritis is causing parasite is found in a improperly cooked pork and game animals.
Trichinosis
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If your patient developed enteritis after traveling in a tropical part of the world were sanitation is poor, what parasite might you suspect?
Amoebae
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Occurs when a bacterium or virus invades the G.I. tract and produces a toxin that causes inflammation.
Acute enteritis
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Acute enteritis usually has increased fluid in the intestinal lumen along with increased intestinal motility resulting in what?
Massive loss of fluid and electrolytes. Other symptoms include abdominal cramping, diarrhea, and vomiting.
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Nursing assessment with suspected enteritis includes?
Recent foods eaten, symptoms, recent travel, recent use of antibiotics, and any new routine medications.
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The most important nursing intervention in patients with enteritis is?
Assessment and monitoring hydration status
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Common causes of constipation are?
Low fiber diet, medications, diabetes, thyroid disease, decreased bowel motility, mechanical obstruction, depression, functional issues, or overuse of laxatives
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Common medications that can cause constipation include?
Antacids, iron preparations, anticholinergics, calcium channel blockers, opiates, antidepressants, antipsychotics, barium sulfate, and anxiolytics.
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This type of medication used to treat constipation is known as a bulking agent and includes?
Bran, psyllium.
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Name an example of a surfactant used to treat constipation.
Colace or Ducosate
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This treatment for constipation is known as an emollient.
Mineral oil
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A saline cathartic used to treat constipation.
Milk of magnesia, magnesium citrate, sodium or potassium phosphate.
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Name a few stimulants used to treat constipation?
Cascara, castor oil, or bisacodyl
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Osmotic agents used to treat constipation include?
Lactulose, sorbitol, MiraLAX.
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Nurses should determine the cause of diarrhea by assessing what?
Onset, precipitating events, timing, other symptoms, recent dietary or medicine changes, recent antibiotic use, nocturnal diarrhea.
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Acute diarrhea is classified as what in Duration?
Less than two weeks
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Chronic diarrhea is classified as what duration?
Greater than four weeks.
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High morbidity and mortality rates in frail older adults in long-term care can because by what organism?
E. coli
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In older patients who have had recent oral or parenteral antibiotic use or any of several anti-neoplastic agents one may suspect what cause of diarrhea?
C-diff
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How many stools samples do you have to collect for c-diff?
Two
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Nursing interventions for patients with c-diff.
Place patient in isolation and wash hands with soap and water to remove spores. Hand sanitizers do not kill or remove spores.
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Treatment for C-diff includes?
Metronidazole 500 mg q 8 hours for 10-14 days. Vancomycin may be needed for severe cases or repeated occurrences.
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Patient teaching for patients with diarrhea include?
Eat a bland diet, and avoid the gas producing foods, vegetables, dairy, and spicy foods. It is safe to suggest clear liquids and the BRAT diet.(Bananas, rice, applesauce, and toast)
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Some common causes of fecal incontinence include?
Colorectal lesions, neurological diseases, laxative abuse, Fecal compaction, stress, chronic diarrhea, medications, Chronic constipation causing injured nerves, and decline in muscle tone related to aging
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Common treatments for fecal incontinence include?
Preventing constipation, biofeedback, adding fiber to the diet to provide bulk and prevent losing, antidiarrheals, and surgical intervention.
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Diagnostics that might be completed with a patient with fecal incontinence include?
Physical exam, anal manometry, sigmoidoscopy, or anal ultrasound.
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These are growths that protrude from the mucous membrane in the G.I. tract and most commonly occur in the rectosigmoid area.
Polyps
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This type of polyp is flat and broad and directly attached to intestinal mucosa.
Sessile polyps
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This type of polyp is balloon shaped and attached to the intestinal mucosa by a thin stem.
Pedunculated polyp
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The most common type of polyp that is nonmalignant and results from inflammation or abnormal growth of the mucosa.
Hyperplastic
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This type of polyp comes from epithelial proliferation and dysplasia. It is closely related to adenocarcinoma of the colon and rectum. Size is the main determining factor in malignancy, with larger polyps having more potential for malignancy.
Adenomatous polyp
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What are the symptoms of polyps?
For the most part, polyps have no symptoms and often are discovered during screening procedures such as colonoscopies. Occasionally, they will produce fright red-blooded in feces.
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What is the assessment and management for patients with polyps?
Monitor for changes and follow elimination patterns and any symptoms of blood in feces or onto the paper. Educate and reinforce the importance of colorectal cancer screening guidelines.
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Dilated veins in the mucous membranes inside or outside of the anus. They are related to varicose pains and are thought of as varicose veins in the rectum.
Hemorrhoids
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Predisposing factors for hemorrhoids include?
Constipation, low fiber diet, multiple pregnancies, liver disease, prolonged straining, irregular bowel habits, and increased intra-abdominal pressure.
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This type of hemorrhoid may cause bleeding with defecation. Dilated veins protrude into the anal and rectal canals were they become exposed. This exposure can cause pain, thrombus, ulcers, and frank red bleeding.
Internal hemorrhoids
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This type of hemorrhoid Can cause pain as well as itching and irritation. Sometimes palpable mass maybe seen or felt. Bleeding can occur if it is injured or ulcerated.
External hemorrhoids
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Nursing management for patients with hemorrhoids include?
Education about a high-fiber diet, That includes whole grains, legumes, fresh fruits, and vegetables. Adequate fluids, light exercise, and a regular toileting regimen.topical remedies such as Anusol or tucks pads may help. Sitz baths, Patient should be instructed to avoid constipation and straining with defecation.
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This occurs when there is a complete or partial blockage of the small or large intestine.
Bowel obstruction
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This type of bowel Obstruction is the most common and can be caused by tumor, adhesions, hernia, or volvulus.
Mechanical
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Is caused by part of the intestine twisting up on itself.
Volvulus. Although an uncommon cause of obstruction, when it does occur, it is more common in older adults because of weakening of the mesenteric ligaments.
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This type of bowel Obstruction occurs from decreased or absent peristalsis.
Non-mechanical bowel obstructions. The most common causes are neurological or vascular compromise. A paralytic ileum is an example of a neurologic obstruction and can occur in either the small or large bowel. Paralytic ileum is a common postoperative problem.
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Symptoms of bowel obstruction include?
Acute abdominal pain with cramping. Abdominal distention, hyperactive bowel sounds above the obstruction but no bowel sounds below the obstruction. Borborygmi (High-pitched sounds), Vomiting, and diarrhea,
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Possible complications of a bowel obstruction include?
Perforated bowel,. Peritonitis, hypovolemic shock, or septic shock.
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Nursing management of bowel obstruction in older adults focuses on what?
Hydration and comfort. Intravenous fluids and electrolytes should be given as ordered. You should monitor intake and output, urine specific gravity, and signs of volume overload or dehydration.
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Physical exam for patients with a bowel obstruction include?
Assess for bowel sounds, abdominal distention, vital signs, and urinary output.
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Esophageal , gastric, and Colorectal cancer account for what percentage of cancer deaths in The United States?
25%
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Risk factors for esophageal cancers include?
Cigarette smoking, heavy alcohol intake, and gastroesophageal reflux disease, specifically Barrett's esophagus
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Esophageal cancer presents with?
Progressive dysphagia and weight loss. Unfortunately individuals with esophageal cancer have the worst prognosis of all the G.I. malignancies.
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Gastric cancer develops slowly and often Is not diagnosed until late in the course of illness. What are the symptoms that usually present after the disease is advanced?
Weight loss, pain, vomiting, anorexia, dysphasia, and an abdominal mass. The prognosis is poor.
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Gastric cancers are usually what type of cancer?
Adenocarcinomas that occur as polypoid, ulcerative, or infiltrated disease. The ulcerative form is the most common and produces symptoms much like that of peptic ulcers.
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The most common type of G.I. malignancy and the third most common cause of death from cancer in both genders is?
Colorectal cancer
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Risk factors for colorectal cancer include?
Age & a low fiber, high fat, and high carbohydrate diet.
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Signs and symptoms of a tumor in the right lower colon include?
Symptoms are minimal as the stool is still liquid in this area of the colon. If present, the symptom is mild cramps. Anemia may be present. Right side lesions may cause malaise, weakness, and weight loss.
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Signs and symptoms of tumors in the left side of the colon include?
Melina, Diarrhea, constipation, and a feeling of incomplete evacuation.
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Nursing management for G.I. malignancies depend on stage and type of tumor for the most part. nurses should monitor patients for?
Weight loss and malnutrition. Small frequent meals that are high in protein and calories are most helpful. Use of supplements such as ensure or boost may be in order in some cases, tube feedings may be needed.
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The accessory organs of digestion and absorption, the gallbladder, pancreas, liver and biliary tree is known as?
Hepatobiliary system.
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Common illnesses of the heptobiliary system.
Cholelithiasis, colecystitis,pancreatitis, Hepatitis, cirrhosis of the liver, and carcinoma.
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When gallstones form in the gallbladder this is known as?
Cholelithiasis
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Colelithiasis is caused by?
The majority of gallstones are made of cholesterol, usually from increased saturation of cholesterol. This increased level may be accompanied by an increase Bilirubin from processes such as hemolysis. These two processes along with decreased emptying of the gallbladder cause collection of cholesterol crystals
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Risk factor for gallstones include?
Obesity, female gender, multiple pregnancies (^ estrogen), sedentary lifestyles, use of oral contraceptives, and advancing age.
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Symptoms of gallstones are?
In many individuals, gallstones are asymptomatic. Symptoms usually begin after a large, high-fat meal. Patient may have right upper quadrant abdominal pain that radiates up to the scapula. The pain may last several minutes to several hours
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Gallstones cause symptoms because of what?
Because they obstruct the common bile duct or cystic duct. Obstruction causes pressure and distention of the gallbladder.
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When the common bile duct is obstructed what happens?
Bile cannot get into the duodenum, as a result, the patient will become jaundiced and have clay colored stools. In addition obstruction of the common bile duct can cause biliary pain, pancreatitis, and or cholangitis.
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This is inflammation of the gallbladder from stones, and can be acute or chronic.
Cholecystitis
| Can occur for other reasons, such as obstruction from tumor or stricture, but gallstones are the most common etiology
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Nursing assessment of patients with gallbladder disease includes?
Assess for pain and other symptoms such as nausea and vomiting. Precipitating factors, such as a Large meal. Physical exam should focus on the abdomen, and they reveal tenderness in the right upper quadrant with or without jaundiced skin.
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Nursing management for patients with gallbladder disease include?
Providing pain relief and educating patients about the disease process. Patient should be given information about avoiding high-fat meals. Clear liquid diet may be in order until symptoms abate.
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Treatment options for patients with gallbladder disease include?
Surgery, medical therapy to dissolve the stones, and lithotripsy.
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Common causes of pancreatitis include?
Acute disease is related to alcohol or biliary tract disease.
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What happens during pancreatitis?
Activation of the pancreatic enzyme auto digest the organ. After the acute event, the pancreatic function returns to normal. Acute pancreatitis can be fatal.
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Chronic pancreatitis usually results from what?
Alcoholism. The etiology is not well understood any organ does not return to normal functioning state. The normal tissue is eventually replaced with scarred, fibrous tissue.
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Symptoms of pancreatitis include?
Severe epigastric pain and pain in the right upper quadrant of the abdomen, nausea, vomiting, and fever are common. Patients with chronic disease maybe week anorectic and jaundiced. Steatorrhea(Bulky, foul, fatty stools) are common later in the disease.
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Nursing assessment and management of pancreatitis includes?
Assessment includes obtaining a history of alcohol use or gallstones. Symptoms of abdominal pain should be documented. Nursing management centers on pain relief, maintenance of fluid and electrolyte status and prevention of complications. Prevention of recurrence is a priority. Referrals for alcohol treatment if necessary. Dietary counseling to reduce lipid levels.
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A global term that means inflammation of the liver. The most common etiologies are viruses, drugs, and alcohol.
Hepatitis
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Viral properties and mode of transmission for hepatitis A?
RNA a virus. Mode of transmission is fecal oral route, usually from contaminated food or water
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Viral properties and mode of transmission for hepatitis B
DNA virus. Blood and body fluids
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Viral properties and mode of transmission for hepatitis C.
Small RNA virus. Blood and body fluids.
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The most severe type of hepatitis is?
Hepatitis B
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The type of hepatitis that is most often chronic?
Hepatitis C, more than 50% incidence
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When he person contacts hepatitis how many Phases do they progress through?
Three. The prodromal phase, the icteric phase, and the convalescent phase.
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In this phase of hepatitis the patient will have malaise, fatigue, nausea and vomiting, anorexia, and low-grade fever. They may also have right upper quadrant pain. The patient may believe he or she has the flu.
Prodromal stage
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In this stage of hepatitis the patient will be jaundiced, have dark urine, pruritis and Clay colored stools.
Icteric stage
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In this phase of hepatitis the patient feels fully recovered. Jaundice and other symptoms begin to disappear.
Convalescent stage
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Assessment of patients with hepatitis should include?
Questions related to possible exposure, Recent travel, blood transfusion, and food intake. Physical assessment should include skin color in about a tenderness or organomegaly. Question patients about changes in energy level, appetite, and weight
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Nursing management for patients with hepatitis includes?
Teach patients that normal liver function takes 3 to 6 months. Teach ways to prevent spread of the virus. Also teach rest, a high calorie low-fat diet, & increased fluid intake. Jaundice will gradually abate, and urine and stool will return to normal color eventually. Over-the-counter medications for itching.
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Acetaminophen recommendations for healthy older adults
3000 mg in 24 hours. 2000 mg in 24 hours for frail older adults, or those who drink three or more alcoholic drinks every day.
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Name a couple of drugs that can cause liver damage in an unpredictable response, almost as if a person has a sensitivity to a drug. It is not related to dosage and occurs rarely and in a random fashion, and idiosyncratic response
Isoniazid INH, Methydopa, Anabolic steroids, & Oral contraceptives.
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The presentation of liver disease that is abrupt, with a short clinical course and the patient succumbs to the event unless liver transplantation occurs.
Fulminant hepatitis
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Refers to permanent and irreversible damage to the liver tissue. Normal liver tissue is replaced with scar like tissue that does not have the same working ability as normal liver tissue.
Cirrhosis
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The two most common causes of cirrhosis of the liver?
Steatohepatitis (Fatty liver from an obese state), and alcoholic hepatitis(laennec's cirrhosis)
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As liver tissues are damaged in cirrhosis, patients begin to show signs and symptoms such as?
Weakness, fatigue, disturb sleep, muscle cramps, and weight loss.
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Bleeding can occur in liver disease as a result of what?
Lack of clotting factors. The liver plays a pivotal role in producing clotting factors five, seven, nine, and 10, as well as fibrinogen and prothrombin.
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Other effects that can occur as cirrhosis progresses includes?
Bleeding, ascites, portal hypertension, and encephalopathy.
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Why do ascites occur in Cirrhosis ?
Because Serous fluid collects in the abdomen. The accumulation occurs as a result of insufficient amounts of albumin. When protein is lacking, plasma fluid escapes into the abdominal cavity. Increased venous pressure forces serous fluids out of the vessels into the abdomen and its periphery.
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This is an increased pressure in the portal vein and it's collateral vessels because of congestion in the liver.
Portal hypertension. Portal hypertension essentially causes blood to back up into areas such as the hemorrhoidal vessels, spleen, and small vessels that line the esophagus. Upper G.I. tract bleeding may occur from varices or Gastroduodenal ulcers
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This is the manifestation of the disease livers inefficient detoxification of waste products and toxins. One end product of protein metabolism is ammonia. Patients with rising blood ammonia levels will have mental status changes.
Encephalopathy. Patients with encephalopathy also can have muscle tremors, or asterixis.
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Patients with liver cirrhosis are susceptible to what?
Osteoporosis and osteomalacia, Secondary to malabsorption of electrolytes such as calcium and vitamin D.
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Nursing management for patients with liver cirrhosis focuses on what?
Preventing complications; skin care, reposition frequently. Position in semi Fowler's position because this position maximizes chest expansion and helps maintain oxygenation. Limit the number of venipunctures to minimize bleeding risk. Protein restricted diet. Mouth care and small bland meals.
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Pancreatic cancer affects individuals of what age and what sex most frequently?
Men ages 60 to 70.
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Pancreatic cancer is linked to what?
Alcohol abuse, high-fat diets, tobacco use, and chronic pancreatitis.
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As the tumor grows in pancreatic cancer the patient will experience what?
Jaundice as a result of pressure on the common bile duct. If the tumor encroaches on the celiac plexus patients will experience a deep, boring in, unrelenting pain in the abdomen. This cancer grows rapidly; 90% of the Cases have metastasized by the time of diagnosis
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This rare malignancy of the bile duct occurs in older patients who have previously been diagnosed with ulcerative colitis.
Cholangicarcinoma. This malignancy, it detected early enough is treated with radiation, chemotherapy, and liver resection to remove the tumor.
141
This rare biliary tract malignancy is usually thought to be related to chronic hepatitis B or C, but can also occur sporadically.
Hepatocellular carcinoma. Treatment is resection or organ transplantation if the tumor affects more than one lobe of the liver
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When liver cancer forms as a result of migration from a cancer in the lung, breast, kidney, or other G.I. cancers this is known as?
Metastatic liver disease. This disease usually indicates a terminal prognosis.
