Final exam

Question 1

Gi assessment and Hx- what questions do you ask?

Answer 1

Diet recall, last BM, pain while eating, characteristics of pain, unintentional weight loss, alcohol, caffeine, allergies,N/V/D, family Hx, dyspepsia, abd pain, bloating, gas

Question 2

Gi assessment- prioritization of abnormal findings

Answer 2

Inspection- beginning in RUQ, discoloration, distension, pulsation, lesions, color
Auscultation- begin in RLQ, report bruit (aneurysm)
Palpation- organ sizes, masses, tenderness, guarding

Question 3

Age related GI changes

Answer 3

Peristalsis slows, sodium loss, decrease in gastric secretions, decrease in absorption

Question 4

Interventions for GI related age changes

Answer 4

Promote fluid intake, high fiber diet, exercise, encourage supplements and vitamins

Question 5

Prevention for GI related age changes

Answer 5

Encourage adequate fluid intake, fiber, exercise, small frequent meals, high nutrition foods

Question 6

4?

Question 7

Pt prep, education, indication, implications, post-procedure care for X-ray

Answer 7

Answer questions, stricture/obstruction confirmation, s/s of obstruction, no jewelry, belts, zippers, buttons, telemetry leads

Question 8

Pt prep, education, indication, implications, post-procedure care for Upper GI series

Answer 8

-Radiographic imaging of esophagus, stomach, intestinal tract barium swallow test
-Gastric ulcers, peristaltic disorders, Tumors, various, intestinal enlargements/constrictions
-NPO, avoid smoking or chewing gum,monitor elimination of contrast and report retention of contrast material (constipation) or diarrhea, stools will be white for 24-72 hours until barium clears
-assess client understanding of bowel prep, assess for contraindications for bowel prep i.e. perforation, obstruction, inflammatory Disease
-monitor elimination for contrast material and administer laxative as prescribed, encourage fluid intake

Question 9

Pt prep, education, indication, implications, post-procedure care for MRI(GI)

Answer 9

Look for obstructions/perforations,/blockages
Remove all metal and jewelry, lie still, monitor VS if sedated for anxiety

Question 10

Pt prep, education, indication, implications, post-procedure care for CT (w/ and w/o contrast- GI)

Answer 10

Visualization of blockages, tumors, obstructions, etc
Medication list->any react with contrast?
Stop metformin 48 hours before CT and resume when kidney function returns to normal, monitor VS and assess pt for contrast reactions, encourage fluid intake to flush contrast out

Question 11

Pt prep, education, indication, implications, post-procedure care for Abdominal ultrasound

Answer 11

Visualize ulcers, blockages, obstructions, abnormalities
Positioning and clothing removed in area, wipe off jelly from skin and answer all questions

Question 12

Pt prep, education, indication, implications, post-procedure care for Endoscopic ultrasound

Answer 12

NPO4-6 hours before, consent obtain, explore esophagus, stomach, and intestines
General anesthesia, airway management
Monitor VS for complications and maintain airway until pt conscious and able to support self.

Question 13

Pt prep, education, indication, implications, post-procedure care for EGD

Answer 13

Endoscope through mouth to duodenum to identify/treat areas of bleeding, dilate esophageal stricture, and diagnose gastric lesions/celiac disease
-topical anesthetic to suppress gag reflex, moderate sedation per IV, left-side laying with HOB up, NPO 6-8 hrs before, remove dentures prior, atropine to decrease secretions
-monitor VS and resp status, notify if bleeding, abd or chest pain, evidence of infection, withhold fluids until gag reflex returns, d/c IVF once oral fluids tolerated
-do not drive/use quipment 12-18 hr after procedure, use lozenges for sore throat, report s/s bleeding (melena,hematemesis)

Question 14

Pt prep, education, indication, implications, post-procedure care for ERCP

Answer 14

Endoscope through mouth to biliary tree via duodenum- visualization of biliary ducts,gall bladder, liver, pancreas.
-moderate seed at ion via IV and atropine to decrease secretions, initial semi-prone w/ repositioning throughout , NPO 6-8 hr before
-monitor VS and resp status, report signs of bleeding or abd/chest pain, infection. IVF until gag relfex returns- d/c IVF once oral fluids tolerated
-do not drive/operate machinery 12-18 hrs after procedure,use lozenges to ease sore throat

Question 15

Pt prep, education, indication, implications, post-procedure care for pH monitoring

Answer 15

Tube is inserted into the nares right above LES to monitor the pH, 24-48 hours of recording. Must record food and s/s.

Question 16

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for GERD

Answer 16

Dyspepsia,pyrosis, odynophagia,pain that occurs after eating lasts 20min-2 hr, increased flatus and eructation, pain relieved by sitting upright, drinking water or antacids, manifestations 4-5 times per week
-EGD,pH monitoring,esophageal manometry, barium swallow
-PPI(-prazole), H2 blockers(-tidine), antacids, prokinetics
-avoid citrus fruits, caffeine , carbonation, avoid large meals
-remain upright after eating, elevate HOB, avoid eating 2-3 hours before bedtime
-aspiration of gastric secretion, Barrett’s epithelium(premalignant) and esophageal adenocarcinoma

Question 17

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Hiatal hernia

Answer 17

Sliding: heartburn, reflux, CP, dysphagia, belching
Rolling:fullness after eating,sense of breathlessness/suffocation, CP, worsening of manifestations while reclining
-pharyngitis and inspiratory/expiratory wheeze
-barium swallow with fluoroscopy, EGD, CT of chest w/ contrast
PPI, antacids
-fundoplication, laparoscopic Nissan fundoplication
-volvulus, obstruction, strangulation, iron-deficiency anemia

Question 18

Volvulus

Answer 18

Twisting of the stomach or esophagus

Question 19

Strangulation

Answer 19

Paraesophageal hernia/rolling: compression of blood vessels to the herniated portion of the stomach

Question 20

Hiatal hernia: sliding vs paraesophageal

Answer 20

Sliding: portion of stomach and gastroesophageal junction moves above diaphragm
Paraesophageal (rolling): fungus of stomach moves above diaphragm, gastroesophageal junction remains below diaphragm

Question 21

What type of hernia is the most common?

Answer 21

Sliding

Question 22

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Esophageal tumors

Answer 22

Silent in beginning, persistent and progressive dysphagia(rapidly weeks to months), feeling of food stuck in throat, odynophagia (painful swallowing), hoarseness, chronic cough and hiccups, weight loss (more than 20 lb); Dx with EGD, PET scan; tx=nutrition/swallowing therapy with registered dietician, daily weights, HOB above 30, thickened liquids/soft diet; liquid supplements for calories , chemo and radiation to decrease tumor size, esophagectomy-> stop smoking several weeks b4, remain semi/high fowlers to support ventilation and reduce reflux and support chest drainage system , respiratory care-> TCDB Q hr,lung sounds Q 1 hr, intubated for 1st 16-24 hrs

Question 23

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Gastritis (acute)

Answer 23

Long-term NSAID use=acute gastritis and resolves within a few days; alcohol,caffeine,smoking, stress make it worse
Sudden onset, short duration, local irritation, severe s/s=pain, dyspepsia, hematemesis, melena
Dx=EGD
Tx=avoid alcohol and NSAID use, proper food prep(food poisoning), supportive-IVF and pain management , treat underlying cause

Question 24

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Gastritis (chronic)

Answer 24

White patchy parts of inflammation leading to damage over time, vitamin B-12 absorption issues(deficiencies), most commonly caused by H.Pylori, increased risk for gastric cancer
Autoimmune, pernicious anemia, H.Pylori
Long-term, diffuse and patchy
Few s/s unless ulceration->N/V, pain
Dx=EGD
Tx= treat underlying cause and meds->PPIs, H2 blockers, Antacids, Mucosal barrier agents (sucralfate and kerafate)

Question 25

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for PUD

Answer 25

GI mucosa can’t defend itself, most commonly H.Pylori infection S/s=epigastric tenderness and pain (sharp, burning, gnawing), dyspepsia(most commonly reported) Three types: duodenal, gastric, stress(ulcers) Perforation= peritonitis, rigid-board like abd, rebound tenderness, severe pain Complications= bleeding (vomiting bright red blood and coffee ground emesis, melena), pyloric obstruction (edema and inflammation), perforation Dx= blood labs, breath (urea), or stool (H. Pylori presence), EGD Tx=abx (amoxicillin and clarithromycin about 2 wks) and PPI, H2 blockers, antacids, bland foods surgery

Question 26

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Gastric cancer

Answer 26

Risks= H.Pylori, chronic gastritis, pernicious anemia, pickled foods, nitrates Early s/s= dyspepsia, abd discomfort, feeling of fullness, epigastric, back, or retrosternal pain(or asymptomatic) Advanced s/s= N/V, IDA,palpable mass, weakness/fatigue, weight loss, enlarged lymph nodes Tx= chemo, radiation, surgery (total/subtotal gastrectomy)

Question 27

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Dumping syndrome

Answer 27

Rapid passage of food into jejunum and drawing of fluid into jejunum causing abd distension Early s/s within 30 min of eating (vertigo, tachycardia, syncope, pallor, diaphoresis desire to lay down) Late s/s within 90 min-3 hrs of eating(ra;id entry of high CHO into jejunum=rise in glucose, then excessive insulin release, risk for hypoglycemia-dizziness, diaphroesis, confusion palpatations) Tx=avoid fluid with meals (inc gastric emptying), avoid high CHO/sugar intake, eat high-protein, high fat to avoid dumping, gastrectomy

Question 28

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for IBS

Answer 28

IBS-C. IBS-D, mixed Abd bloating/pain Cause unknown-> stress, diet, genetics, environment Hydrogen breath test(NPO, small amts of sugar given, samples taken over a few hours=bacterial overgrowth=hydrogen presence), blood tests normal Tx=30-40g/day fiber, increase fluid, consitpation=insoluble fiber (spinach, broccoli, brown rice, whole wheat) Diarrhea=soluble fiber (oats and beans), may need to take probiotic, regular meals, stress reduction, IBS-C=laxatives (Metamucil and Linaclotide)-psylllium hydrophilic muciloid IBS-D= antidiarrheals-loperamide (psyllium, alosetron)

Question 29

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Herniation

Answer 29

reducible or irreducible (incarcerated), strangulation=bowel and hernia twisted, blood supply cut off=ischmeia and obstructions->peritonints, sepsis, perforation; pt c/o N/V, pain, fever, s/s infection, tachycardia Can be epigastric, incisional, direct inguinal, indirect inguinal, umbilical, femoral Tx= truss (applies pressure to keep reducible hernia in place), herniorrphaphy and hernioplasty

Question 30

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Colorectal cancer

Question 31

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Intestinal obstructions

Question 32

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Polyps

Question 33

S/S, findings, labs, diagnostics, tx, care, education, meds, nutrition, complications, safety considerations for Hemorrhoids

Answer 33

Swollen, distended veins form increased abd pressure-striating, obesity, pregnancy Stops being symptomatic 3-5 days Bright red blood, itching Tx= supportive care (sitz baths, prevent increase abd pressure, increase fiber, fluids, stool softeners, topical anesthetics, anti-itch ointment) Hemorrhoidectomy—>clip and cauterize

Question 34

Interventions (pre and post), education, potential complications for Nissan fundoplication

Answer 34

If drugs dont work to treat hiatal hernia Fundus wrapped around and sutured to esophagus to prevent it form sliding, transthoracic/abdominal laparascopic (ideal) Pre- stop smoking, lose weight Post- avoid carbonation and raw veggies, s/s infection and bleeding, early ambulating, open respiratory status, elevate HOB at least 30 degrees, splint incision, IS, TCDB, NG tube (prevent wrap from narrowing esophagus), initial dark brown output from blood and normal after 8 hrs), clear liquid diet and advance as tolerated for 4-6 wks, fuller quicker, more frequent small meals dysphagia very common

Question 35

Interventions (pre and post), education, potential complications for Esophageal tumor surgery

Answer 35

Cardiovascular: pressure on posterior heart during surgery, s/s of fluid overload (A-Fib during) Wound management-s/s infection, monitor for leakage at anastomosis NG tube- dont aspirate residual-damages mucosal tissue easier, oral care, check placement, dont irrigate or reposition its for decompression, barium swallow 1 wk post op if leaks out, anastomotic leak, no leak=oral intake of fluids for two weeks and increase over time

Question 36

Interventions (pre and post), education, potential complications for Gastrectomy

Answer 36

Tx for ulcers, upper GI bleeding, gastric cancer and dumping syndrome Can be total or subtotal Complications:delayed gastric emptying (resolves within a week due to anastomosis edema) and malabsorption(decreased surface area to absorb) NPO 4-6 hours before, NG tube for decompression, clear liquid diet

Question 37

Interventions (pre and post), education, potential complications for Hernia repair

Question 38

Interventions (pre and post), education, potential complications for Colorectal cancer surgeries

Question 39

Interventions (pre and post), education, potential complications for Exploratory laparotomy

Question 40

Acid base issues for GI problems

Question 41

Lower GI diagnostics

Question 42

GI labs-indications and pt education

Answer 42

FOBT-bleeding in GI

Question 43

S/S, risk factors, findings, diagnostics, tx, care, education, meds, nutrition, complications/safety considerations for appendicitis

Answer 43

Appendectomy Peritonitis Bowel perforation Appendix perforation Caused by hard fecal matter blocking , pressure continues to build Can become septic Bursting=med emergency RLQ pain=most common s/s reported

Question 44

S/S, risk factors, findings, diagnostics, tx, care, education, meds, nutrition, complications/safety considerations for Peritonitis

Answer 44

abdominal surgery, appendicitis, bowel perforations, pancreatitis S/S= rigid-board like abdominal pain, fever, rebound tenderness blood cultures, CBC can become septic, perf bowel, pancreatitis

Question 45

S/S, risk factors, findings, diagnostics, tx, care, education, meds, nutrition, complications/safety considerations for Gastroenteritis

Answer 45

N/V, fever, anorexia, abd pain that worsens when eating -traveling outside of the country, surgery -electrolyte imbalances, dehydration, metabolic alkalosis/acidosis

Question 46

S/S, risk factors, findings, diagnostics, tx, care, education, meds, nutrition, complications/safety considerations for Ulcerative colitis

Question 47

S/S, risk factors, findings, diagnostics, tx, care, education, meds, nutrition, complications/safety considerations for Crohn’s disease

Question 48

S/S, risk factors, findings, diagnostics, tx, care, education, meds, nutrition, complications/safety considerations for Paralytic ileus

Question 49

S/S, risk factors, findings, diagnostics, tx, care, education, meds, nutrition, complications/safety considerations for Cholecystitis

Question 50

Care for colostomies

Answer 50

Skin integrity, stoma=red beefy and moist Change bag when 1/3-1/2 full, change whole set every week or when soiled Avoid stringy foods like celery that may cause clogs, stool will be more formed

Question 51

Care for ileostomies

Answer 51

Skin integrity, stoma=red beefy and moist Change bag when 1/3-1/2 full, change whole set every week or when soiled Avoid stringy foods like celery that may cause clogs, Stool more liquid

Question 52

Interventions (pre and post), education, potential complications for appendectomy

Question 53

Interventions (pre and post), education, potential complications for Colectomy

Question 54

Interventions (pre and post), education, potential complications for Colon resection

Question 55

S/S for complication(s) of appendectomy

Question 56

S/S for complication(s) of Colectomy

Question 57

S/S for complication(s) of Colon resection

Question 58

S/S for complication(s) of Cholecystectomy

Question 59

S/S for complication(s) of Appendicitis

Question 60

S/S for complication(s) of Peritonitis

Question 61

S/S for complication(s) of Gastroenteritis

Question 62

S/S for complication(s) of Ulcerative colitis

Question 63

S/S for complication(s) of Crohn’s disease

Question 64

S/S for complication(s) of Diverticular disease

Question 65

S/S for complication(s) of Paralytic ileus

Question 66

S/S for complication(s) of Cholecystitis

Question 67

S/S for complication(s) of Nissan fundoplication

Question 68

S/S for complication(s) of Esophageal tumor surgery

Question 69

S/S for complication(s) of Hernia repair

Question 70

S/S for complication(s) of Gastrectomy

Question 71

S/S for complication(s) of colorectal cancer surgeries

Question 72

S/S for complication(s) of Exploratory laparotomy