Chapter 18 Gastrointestinal Alterations Flashcards Preview

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Flashcards in Chapter 18 Gastrointestinal Alterations Deck (23)
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1
Q

Anatomy and Physiology

  • Alimentary canal
  • Accessory organs
  • Gut wall
A
  • Gut wall
    1) Mucosa
    2) Gastric mucosal barrier
    3) Submucosa
2
Q

Anatomy and Physiology

- Oropharyngeal cavity

A
  • Oropharyngeal cavity
    • Mouth
    • Salivary glands
    • Pharynx
  • Esophagus
3
Q
  • Anatomy and Physiology
  • Stomach
  • Small intestine
A
  • Stomach
    • Cardia, fundus, body, and antrum
    • Gastric glands and pyloric glands
    • Hydrochloric acid (pH 0.8)
  • Small intestine
    • Duodenum, jejunum, and ileum
    • Digestion and absorption of foodstuff
    • Water, electrolyte, and vitamin absorption
4
Q

Anatomy and Physiology

  • Large intestine
  • Pancreas
  • Gallbladder
A
  • Large intestine
    • Ascending, transverse, descending, and rectum
    • Absorption of water and electrolytes
  • Pancreas
    • Exocrine = digestive enzymes
    • Endocrine = insulin and glucagon
  • Gallbladder
    • Bile
5
Q
  • Liver: 400 different functions
    -Liver vascular functions
    -Liver secretory function
    -Liver metabolic functions
    -
A
  • Receives 25% of cardiac output
  • Liver vascular functions
    • Blood storage
    • Filtration
  • Liver secretory function
    • Bile production
    • Bilirubin metabolism
  • Liver metabolic functions
    • Carbohydrate, fat, and protein
    • Clotting factors
    • Detoxification
    • Vitamin and mineral storage
6
Q

Blood Supply of the Gastrointestinal System

A
  • Splanchnic circulation

- Superior and inferior mesenteric and celiac arteries

7
Q

GI History

A
  • History of swallowing, digestive, and elimination problems
  • Nonspecific symptoms, such as anorexia and fatigue
  • Weight changes and diet
  • Pain assessment
  • Surgical procedures
  • Medications—prescription and over-the- counter
8
Q

GI Assessment

- Inspection

A
  • Skin color and texture
  • Symmetry and contour of abdomen
  • Masses and pulsation
  • Peristalsis and movement
9
Q
  • Auscultate before?
  • Percussion
  • Palpation
A
  • Auscultate before percussion and palpation
    • Auscultate for 5 minutes before determiningnabsence of bowel sounds
  • Percussion
  • Palpation
    • Last
    • Assess rebound tenderness, rigidity, and guarding
10
Q
Which assessment component is done last when assessing the abdomen?
A. Auscultation 
B. Inspection 
C. Palpation
D. Percussion
A

Palpation

11
Q

Acute Upper GI Bleeding
- Etiology
- Potential for?

A
  • Etiology
    • Peptic ulcer disease
    • Stress ulcer
    • Mallory-Weiss tear
    • Esophageal varices
  • Potential for hypovolemic shock
12
Q

Peptic Ulcer Disease

  • Duodenal versus?
  • Risk factors
A
  • Duodenal versus peptic
  • Risk factors
    • Smoking
    • Helicobacter pylori bacteria
    • Drugs: Nonsteroidal antiinflammatory drugs (NSAIDs), aminosalicylic acid (ASA), steroids
    • Alcohol
13
Q

Stress Ulcer

  • Ischemic—decreased blood flow
  • Cushing’s—
  • Prevention part of ICU “bundle” of care
A
  • Ischemic—decreased blood flow
    • Hemorrhage
    • Trauma
    • Burns (Curling’s ulcer)
  • Cushing’s—decreased blood flow and hypersecretion of acid
    • Head trauma
  • Prevention part of ICU “bundle” of care
    • Antacids or H2-receptor blocker medications
14
Q

Mallory-Weiss Tear

A
  • Arterial hemorrhage
    • Longitudinal tear
  • Forceful retching
  • Long-term NSAIDs or aspirin
  • Excessive alcohol
15
Q

Esophageal Varices

A
  • Portal hypertension
  • Veins become distended and varices develop
    • Esophagus
    • Upper portion of stomach
  • Tend to bleed easily
16
Q

Varices—Assessment

  • Blood loss
  • Symptoms of hypovolemia
  • Pain or discomfort
A
  • Blood loss
    • Color, amount, and consistency of emesis and stool
  • Symptoms of hypovolemia
    • Hypotension
    • Tachycardia
    • Dizziness
  • Pain or discomfort
17
Q
Nursing Assessment
- First priority is to assess blood loss 
 Vital signs
 Level of consciousness  Urine output
- Hyperactive bowel sounds
A
Nursing Assessment
 First priority is to assess blood loss  Vital signs
 Level of consciousness  Urine output
 Hyperactive bowel sounds
A B C D, then focused, then head to toe
18
Q

Nursing Assessment

  • First priority is to assess blood loss
  • Hyperactive bowel sounds
A
  • First priority is to assess blood loss
    • Vital signs
    • Level of consciousness
    • Urine output
  • Hyperactive bowel sounds
    • A B C D, then focused, then head to toe
19
Q

Laboratory Studies

  • Complete blood count (CBC)
  • Electrolyte imbalance
  • Increased blood urea nitrogen (BUN) and creatinine
A
  • Complete blood count (CBC)
    • Hemoglobin and hematocrit
    • White blood cell (WBC) count
    • Platelets
  • Electrolyte imbalance
  • Increased blood urea nitrogen (BUN) and creatinine
20
Q

Laboratory Studies

A
  • Liver function
  • Clotting profile
  • Ammonia levels
21
Q

Diagnostic Tests

  • Endoscopy
  • Barium studies
A
  • Endoscopy
    • Procedure of choice
    • Diagnosis and treatment of upper GI bleeding
  • Barium studies
    • Ulcers/bleeding, tumors
22
Q

Priority Treatment

  • Hemodynamic stabilization
  • Gastric lavage
A
  • Hemodynamic stabilization
    • Oxygen administration
    • Arterial pressure monitoring
    • Administration of fluids and/or blood products
    • Hematocrit may not reflect actual blood loss
  • Gastric lavage
    • Upper GI bleeding
    • May be done prior to endoscopy to provide better visualization of gastric fundus
23
Q

Pharmacological Therapy

A
  • Proton pump inhibitors
  • Antacids
  • H2-receptor blockers
  • Mucosal barrier enhancers
  • Antibiotics (Helicobacter pylori)