Gastrointestinal Flashcards
(95 cards)
1
Q
what is foodborne illness
A
food poisoning
common infective agents: staph aureus norovirus C. perfringens Salmonella botulism E. coli
2
Q
foodborne management
A
food safety and preparation
good hand hygiene
prevent transmission
monitor fluid volume deficit
discourage use of antidiarrheals
with e. coli infection
- monitor kidney function
with botulism poisoning
- monitor neuro status
3
Q
what is pernicious anemia
A
deficiency in production of RBCs because of lack of intrinsice factor
due to lack of intrinsic factor, vit B12 cant be absorbed
more frequently in Northern European descent and African Americans
4
Q
pernicious anemia manifestations
A
fatigue
weakness
dyspnea
pallor and palpitations
beefy red tongue
nausea
vomiting
anorexia
diarrhea
abdominal pain
paresthesia in hands and feet
- burning or prickling sensation
impaired coordination and balance
5
Q
pernicious anemia diagnostic studies
A
CBC
bone-marrow biopsy
low levels of gastric hydrochloric acid
Schilling test
- vit B12 absorption test
6
Q
pernicious anemia care
A
lifelong vit b12 therapy adeuqate dietary sources of vit B12 - clams - sardines - meat - fish - milk - cheese - eggs - fortified breakfast cereals
7
Q
pernicious anemia management
A
manage fatigue and activity intolerance
educat eclients
montitor for complications
will receive B12 injections weekly then monthly as maintenance
8
Q
what is peptic ulcer disease
A
occurs as the resut of erosion of GI mucosa by hydrochloric acid and pepsin
9
Q
risk factors of peptic ulcer disease
A
stress
H pylori
fam hx
use of aspirin
NSAIDs
steroids
caffeine
high alcohol intake
NSAIDs are responsible for majority of non H pylori peptic ulcers
10
Q
peptic ulcer disease manifestations
A
pain near epigastrum nausea vomiting bloody emesis - blood vomiting tarry stools - bloody stools
11
Q
peptic ulcer disease complications
A
hemorrhage
perforation
gastric outlet obstruction
12
Q
peptic ulcer disease diagnostic studies
A
upper endoscopy = most accurate diagnostic procedure
stool for occult blood may be evaluated, as well as complete blood count
13
Q
peptic ulcer disease care
A
NPO
NG tube
if acute GI bleeding, endoscopic therapy/hemostasis
srugery - if urgent
14
Q
peptic ulcer disease pharmacologic interventions
A
proton pump inhibitors:
- pantoprazole
- omeprazole
- lansoprazole
antiinfectives if H pylori
- clarithromycin
- metronidazole
H2 receptor antagonists
- cimetidine
- ranitidne
- famotidine
anticholinergics
- dicyclomine
antacids
- aluminum hydroxide
- aluminum magnesium combinations
- calcium carbonate
metoclopramide
cytoprotective
- sucralfate
- misoprostol
15
Q
peptic ulcer disease complementary health
A
licorice root cats claw goldenseal - little exvidence exists that support their efficacy
acupuncture
therapeutic massage
guided imagery
progressive relaxation
surgically severing vagus nerve (vagotomy) can help with gastric acid secretion
- for clients who do not respond to medical management
16
Q
what is GERD
A
syndrome, not a disease
17
Q
GERD manifestations
A
based on symptoms
increased by bending, stooping, lying down, or eating
usually relieved by antacids
nausea after eating is common
18
Q
GERD diagnostic studies
A
endoscopy
manometry studies
- to evaluate LES and esophageal mobility
scintigraphy
- assess gastric emptying
- used with radioactive tracer to obtain an image of a bodily organ or a record of its functioning
19
Q
GERD care
A
pharamacological interventions:
proton pump inhibitors:
- omeprazole
- lantoprazole
H2 receptor antagonists
- cimetidine
- ranitidine
- famotidine
OTC antacids
- pepto bismol
20
Q
GERD management
A
HOb elevated, esp after meals
avoid alte night eating
administration of PPI before first meal of the day
monitor aspiration and other complications
maintain fluid and electrolyte balances
avoid foods that acidic or gas-forming
incidence of GERD increases with age
21
Q
what is appendicitis
A
inflammation of the appendix
most common reason for emergency abdominal surgery
22
Q
appendicitiy manifestations
A
anorexia
nausea and vomiting
right lower quadrant pain
low grade fever
localized and rebound tenderness
23
Q
appendicitis diagnostic studies
A
physical exam
differential WBC count
urinalysis
- to rule out urinary conditions that mimic appendicitis
KUB
- kidneys, urter and bladder x ray
ultrasound of the abdomen
CT
24
Q
appendicitis care
A
immediate appendectomy
- any delay can lead to rupture and peritonitis
25
what is ulcerative colitis
begins in the rectum and extends to the distal colong
causes swelling, ulcerations and loss of function of the large intestine - colon
scarring produces narrowing, thickening and shortening of the colon
26
ulcerative colitis manifestations
bloody diarrhea ranging from 2-3 times/day to 10-20 times/day
stools may contain pus and mucus
left-sided abdominal pain
fever
weight loss
anemia
tachycardia
dehydration
impaired abrotpion of fat soluble, vitamins such as E and K
inflammation of the eyes
liver disease
27
ulcerative colitis diagnostic studies
CBC
stool for occult blood
stool culture
sigmoidoscopy or colonoscopy
28
ulcerative colitis care
goal of treatment:
- decreased diarrhea
- formed stool
- control of bowel movement
29
ulcerative colitis pharmacological interventions
prednisone
infliximab
dicyclomine
drug of choice = sulfasalazine
metronidazole
diphenoxylate
methotrexate
cyclosporine
loperamide
30
ulcerative colitis dietary restrictions
adhere to high calorie and high protein diet
low roughage
- whole grains
- nuts
- seeds
- legumes
- fruits
- veggies
NO milk products
31
ulcerative colitis surgical management
proctocolectomy
colectomy
ileostomy creation
32
ulcerativie colitis complications
increased risk of colon cancer
fluid and electrolytes imbalances
toxic megacolon
- extreme inflammation and distention of the colon
perforation
bleeding
hemorrhage
33
ulcerative colitis management
manage pain
maintain optimal fluid and nutritional intake
prevent fluid and/or electrolytes imbalances
support coping mechanisms
recognize complications
```
ileum = most distal part of the small intestine
ileus = obstruction in intestine
```
ilium = part of hipbone
34
what is crohns disease
results in swelling and dysfunction of intestinal tract
especially the small intesting
most frequent site if the distal ileum
inflammation involves all layers of the bowel wall
35
crohns disease manifestations
diarrhea with steatorrhea
no obvious blood or mucus in blood
abdominal pain located in right lower quadrant
fatigue
weight loss
dehydration
fever
```
extraintestinal manifestations:
arhtiritis
skin inflammations
kidney
gallstones
```
36
crohns disease diagnostic studies
stool for occult blood
stool culture
sigmoidoscopy
colonscopy
barium enema
37
crohns disease complications
obstructions from strictures
fistula formations
- abnormal made passage between organs
bowel perforation
infection
38
crohns disease care
rest
remaining NPO during exacerbation
TPN
diet high in calories and protein
low in roughage and fat
39
crohns disease pharmacological interventions
```
prednisone
hydrocortisone
azathioprine
methotrexate
cyclosporine
infliximumab
```
same as ulcerative colitis
surgery will not cure crohns disease but it may limit the damage
40
what is diverticular disease
inflammation of one or more diverticula
colon wall thicken and increases pressure in the bowel
stool and bacteria retained in the diverticula become
inflamed and small perforations begin to occur
- surrounding tissue becomes inflamed --> diverticulitis
41
contributing factors for diverticular disease
```
smoking
excessive alcohol consumption
constipation
obesity
diet low in fiber
```
42
Diverticular disease manifestations
frequently asymptomatic
crampy lower left abdominal pain
alternating constipation and diarrhea
```
low grade fever
chills
anorexia
nausea
leukocytosis
```
43
diverticular disease diagnostic studies
barium enema
CBC
urinalysis
stool for occult blood
flexible sigmoidoscopy
colonscopy
44
diverticular disease care
high fiber, high residue diet
pharmacologic interventions:
- bulk laxatives
- stool softeners
- anticholinergics
client with be NPO for 24-48 hours
low fiber diet will be implemented after 48 hours
bowel resection with temporary colostomy
majority of clients with diverticulosis have no symptoms
- typically during a routine colonoscopy
45
diverticular disease complications
abscess formation
perforation with peritonitis
- progressive pain in other quadrants of the abdomen
fistula
bowel obstruction or hemorrhage
46
diverticular disease management
weight reduction for obese clients
high fiber diet
fluit intake at least 2L/day
use of stool softeners
avoid intra-abodminal pressure
- straining during defecation
- vomiting
- ending
- heavy lifting
47
what is intestinal obstruction
partial or complete blockage of bowel that preents the contents of the intestine from passing through
abdomen becomes distended from accumulation of fluid, gas, and intestinal contents
48
intestinal obstruction manifestations
abdominal pain
distention
nausea and vomiting
- vomiting will be bile stained - (yellowish brown)
hypoxia
metabolic acidosis
bowel necrosis from impaired circulation
low fluid volume increases WBC, hgb, hct, BUN
49
intestinal obstruction diagnostic studies
upper GI and lowe GI series
abdominal X-ray: for air in the bowel
50
intestinal obstruction care
abdomen will be decompressed via NG tube
surgical bowel resection may also be necessary
51
intestinal obstruction complications
perforation
peritonitis
shock
strangulation of the bowel
52
intestinal obstruction management
manage pain, but avoid using morphine or codeine
measure abdominal girth
provide good oral care if client has NG tube
maintain fluid and electrolyte balance
53
risk factor for colorectal cancer
clear risk factor is age
- ulcerative colitis
- crohns
- genetic abnormalities
- colorectal polyps
- high fat/low fiber diet
- smoking
- alcohol consumptions
- sedentary lfiestyles
54
colorectal cancer manifestations
early stages: no symptoms
advance cases:
- rectal bleeding
- blood in stool
- changes in bowel habits
- lower abdominal pain/cramping
screening for early detection is critical for survival
55
colorectal cancer diagnostic studies
DRE
fecal occult blood test
proctoscopy/sigmoidoscopy
colonscopy
CT scan
56
colorectal cancer care
goal of surgical intervention:
- removing tumor
finding out if cancer has spread
- removing lymph node near the cancer
chemotherapy and targeted therapy often follow
57
colorectal cancer management
clients over age of 50 to have screning
- bowel cleansing will be necessary in order for client to be screened properly
NG tube
- monitor for bleeding or coffee ground aspirate
nausea and vomiting are common
- antiemetics can be administered as ordered
monitor fluid and electrolyte
monitor wound incision and drainage after surgery
some might feel phantom rectal pain
- normal and ubsides quickly
progress to a regular diet as tolerated
if no ostomy, teach how to manage bowel movement changes
58
what is hepatitis
liver becomes inflamed and Kupffer cells become enlarged
59
stages of hepatitis
pre-icteric (pre jaundice) or prodromal stage
- general flu like symptoms occur
iceteric stage
jaundice occurs
- although not all clients with hepatitis develop jaundice
post icteric stage or recovery stage
- client continues to have fatigue and malaise
hepatitis can lead to :
- swelling
- scarring of the liver (cirrhosis)
- cancer
60
non viral hepatitis
drug- induced= reaction to a drug due to hypersensitivity
toxic hepatitis caused by;
- ingestion
- inhalation
- inspection of certain chemicals that have a poisonous effect on liver
like carbon tetrachloride, chloroform, poisonous mushrooms
61
viral hepatitis
5 different viruses to cause viral hepatitis
Hep A: infectious heaptitis
b: serum hepatitis
c: most common form of viral hepatitis
d: found in IV drugs and carriers of hep B
E: similar to hep A
- found in people who live in countries with poor sanitation
diagnosed as either acute or chronic
62
hepatitis diagnostic studies
decreased serum albumin
increased ALP, ALT, AST
- initially elevated and may rise 1-2 weeks before jaundice is apparent and then decline
bilirubin above 2.5 mg
bromsulphalein excretion test elevated
decreased RBC
antigen tests
abnormal liver enzymes
Pt may be prolonged
clay colored stool, steatorrhea
liver biopsy
liver scan
63
hepatitis interventions
rest
bedrest during acute phase
encourage client to eat
administer antacids afte r meals
- do not give antacids at the same time as H2 receptor antagonists
- maintain gastric pH greater than 3.5
smokers may report distaste for/aversion to cigarettes
avoid OTc meds that contain aspirin or NSAIDs
aceptance
infection control
64
what is cirrhosis
irreversible, chronic progressive degeneration of teh liver
65
types of cirrhosis
laennecs (alcoholic): related to alcohol abuse
post necrotic cirrhosis:
- associated with viral hep or exposure to hepatotoxin
biliary: inflammation or obstruction of the gallbladder or bile duct
cardiac icrrhosis:
- associated with heart failure
66
cirrhosis manifestations
```
weakness
fatigue
weight loss
hepatomegaly
right upper quadrant
```
jaundice
pruritus
steatorrhea
clay colored stools
increased bilirubin in urine - dark colored urine
impaired aldosterone metabolism - edema
hypoglycemia
impaired strogen matbolism
- spider angiomas
- palmar erythema
impaired metabolism of protein, carb and fat
- absorbs less Vit K s o prolonged bleeding
- less proteins needed for clotting
- less plasma proteins leads to edema and ascites
67
cirrhosis diagnostic studies
increased ALT, AST, alkaline phosphatase
Pt
CBC
decreased cholesterol
serum bilirubin and urine bilirubin
ERCP to examine bile ducts
CT scan of liver
liver biopsy
68
cirrhosis care
steroids for post-necrotic cirrhosis
replace vitamins B and fat soluble vitamins
increased carbs
protein may be restricted
possible sodium restriction
2,000-3,000 calories daily
no alcohol
69
cirrhosis complications
portal hypertension
ascites
hepatomegaly
70
cirrhosis management
monitor for bleeding
promote adequate or optimal nutrition
avoid alcohol and other hepatotoxic agents
manage itching and maintain skin integrity
rest
```
assess for changes in LOC
monitor for fluid balance
- measure abdominal girth daily
- weigh daily
- measure intake and output
```
acetaminophen is safe when taken in recommended amounts
- should take no more than 3,900 mg total in a 24 hour period
71
what is ascites
accumulation of fluid in the peritoneum
72
ascites manifestations
abdominal distention
protruding umbilicus
dull sound on percussion of abdomen
bulging flank
dyspnea
73
ascites diagnostic studies
abdominal x-ray
CT scan
ultrasound
74
ascites care
```
pharamcological interventions:
- diuretics (spironolactone)
- Iv albumin
- paracentesis
- low sodium diet
- peritoneal venous shunt
this allows the drainage of fluid from peritoneum to superior vena cava
```
75
ascites management
monitor fluid balance
intake and output
daily weight
abdominal girth
skin turgor
restric fluids
monitor ineffective breathing patterns
semi-fowlers position
impaired skin integrtiy
administration of lactulose to reduce ammonia levels in the body is often titrated
76
what is hepatic encephalopathy
syndrome observed in clietns with late-stage cirrhosis
impaired ammonia metabolism leads to neurotoxins in blood and cerebral edema
ammonia is produced in the bowel by the action of bacteria on protein
- as a result, nitrogenous waste and neurotoxins increase
77
hepatic encephalopathy amnifestations
changes from level of consciousness from confusion to coma
changes in sleep pattern
memory loss
asterixis - flapping tremor
impaired handwriting
hyperventilation with respiratory alkalosis
fetor hepaticus - musty, sweet breath to client
78
hepatic encphalopathy diagnostic studies
serum ammonia level
| liver enzymes
79
hepatic encephalopathy care
antibiotics
- rifaximin
lactulose
- converts ammonia to ammonium
low protein diet
80
hepatic encephalopathy management
safety because treats can lead to falls and injury
uninterrupted rest periods
assess fluid and electrolyte balances andbody weight
monitor bowel changes
hepatic encephalopathy is a neuropsychiatric manifesation of late-stage liver disease
- caused by neurotoxis effects of elevated ammonia levels
81
what is acute pancreatitis
inflammation of the pancreas
82
acute pancreatitis manifesations
upper abdominal pain that radiates to the back
nausea
vomiting
tachycardia
slow and shallow respirations
swollen and tender abdomen
fever
complications
atelectasis
hypovolemia and shock
abscess
hemorrhage into retroperitoneal space
- produce bluish discoloration around umbilicus
83
risk factor of acute pancreatitis
```
heavy aclhol use
gallstones
drug ingestion
viral infection
trauma
```
84
acute pancreatitis diagnostic studies
```
labs
serum amylase
serum lipase
increase urinary amylase
CBC
- increased WBC, decreased Hgb and Hct
```
increased LDH and AST
hyperglycemia
```
hypocalcemica
chest x-ray
CT scan
ultrasound
ERCP
```
85
acute pancreatitis care
pharamcological intervention:
- meperidine
- morphine
- insulin
- calcium replacement
- anticholinergics
- H2 receptor antagonists
fluid maintenance to repvent shock
calcium replacement and decreasing stimulation to pancreas
NG tube
eat high in protein and carbs
low in fat if eating is allowed
86
acute pancreatitis management
manage pain
monitor fluid and electrolyte balance
alcohol is STRICTLY prohibited
monitor breathing patterns
monitor nutritional status
oral care when NPO
87
what is cholecystitis
inflammation of the gallbladder
usually due to gallstones
happens because common bile duct is obstructed by gallstone and bile cannot be excreted
- remaining bile distends and inflames the gall bladder
2 types:
- cholesterol (most common)
- pigment (unconjugated bilirubin)
88
risk factors of cholecystitis
age 40 or older
birth control pills
being 6-9 months postpartum
89
cholecystitis manifestations
colicky pain in right upper quadrant
possible radiation to right shoulder and back
indigestion after eating fatty foods
nausea
vomiting
jaundice
low grade fever
90
cholecystitis diagnostic studies
ERCP
ERCG
CBC
amylase lipase
serum bilirubin
ultrasound
91
cholecystitis care
rest
low fat diet
removal of stone in common duct by endoscopy
pharmacological interventions
- chenodiol
- urosdiol
side effects are diarrhea and hepatotoxicity
- analgesics
- replace vit K if bleeding is prolonged
extracorporeal shockwave lithotripsy
- may have heamturia after procedure, but not longer than 24 hours
choledocholithotomy
- remove or break up stones and place a T-tube in common bile duct
laparascopic laser cholescystectomy
cholescystectomy
92
cholecystitis management
vitals
restrict fatty foods in their diet
remember 6 F's of gallbladder disease:
- female
- fertile
- fat
- forty
- flatulent
- fair skin and hair
93
hemorrhoids care
1. pain relief
- NSAIDs and/or acetaminophen
- opioids can be prescribed initially but may worsen constipation
1-2 days post op
warm stiz baths
2. preventing constipation
- high fiber diet
- adequate fluid intake at least 50 ml/day
-stool softener like Docusate
oil retention enema may be used if constipation persists for 2-3 days
Pain is priority
94
Colostomy and ileostomy irrigation procedure
1. Fill with 500-1000mL of lukewarm water
2. Flush irrigation tubing and red lamp
3. Hang container on a hook or IV pole
4. Sit on toilet
5. Place irrigation sleeve over stoma
6. Extend sleeve into toilet
7. Place irrigation container approx 18-24 inches above stoma
8. Lubricate done tipped irrigator
9. Insert cone
10. Attach catheter gently into stoma and hold in place
11. Slowly open roller clamp, allow irrigation to flow for 5-10 min
12. Clamp if cramping occurs, until it subsides
13. Once desired amount is distilled, cone is removed and feces is allowed to drain through sleeve into toilet
95
Paracentesis procedure
Prior to a paracentesis,
- verify client received necessary information to give consent and witness informed consent
- instruct client to void to prevent puncturing bladder
- assess abdominal girth, weight and vitals
- place high Fowler’s or as upright as possible
NPO status is not required for paracentesis
Often performed at bedside
*remember, nurses cannot give informed consent. So just choose the answer that has verify that client got informed consent.
Don’t choose the one that says give informed consent
