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Flashcards in Gastrointestinal 2 Deck (269):
1

Discomfort in epigastric & back of throat with conscious desire to vomit

Nausea

2

Powerful ejection of gastric contents through mouth

Vomiting

3

N&V related to a disease

Pathogenic

4

N&V stemming from a disease treatment
Ex. Chemo

iatrogenic

5

N&V resulting from psychological state

psychogenic

6

vomiting is caused by what?

the stimulation the chemo-receptor trigger which stimulates the vomiting center in the medulla by some type of stimulus

7

vomiting can cause what kind of imbalance

metabolic alkalosis

8

diahrrea can cause what kind of imbalance

metabolic acidosis

9

what kind of nursing management should you do for a pt with N&V?

NPO until able to tolerate oral intake (once vomiting has stopped), HOB elevated to prevent aspiration, replace fluids/electrolytes, NG tube, mouth care, clean enviornment

10

what kind of electrolyte imbalance will happen with vomiting

hypokalemia

11

when is it best to give antiemetics

before vomiting starts

12

what kind of diet shuold be given to a pt with N&V

NPO, then effervescent fluids, bland foods, avoid fats

13

if a pt is post op what should you check for if your pt is vomiting

wound dehiscence

14

Rx's for N&V are?

zofran, phenergan, reglan, CNS depressents

15

Reglan Rx does what

increases gastric emptying

16

Zofran and phenergan Rx does what

given to prevent nausea

17

inflammation in gastric mucosa

gastritis

18

hematoemesis

blood in vomit

19

how is gastritis diagnosed

H. Pylori testing & EGD

20

S/Sx of gastritis

malaise, N&V, hematemesis, epigastric pain, dyspepsia

21

recurrent inflammation of gastric mucosa, chief & parietal cells malfunction & disappear

chronic gastritis

22

what is associated with gastric cancer

chronic gastritis

23

S/Sx of chronic gastritis

N&V, indigestion, epigastric pain not relieved with antacids

24

Tx for chronic gastritis

avoid irritants, bland diet, B12 injections for pernicious anemia

25

if you have bright red blood in vomit it is from what

arterial

26

if you have slower oozing, dark emesis it is from what

venous or capillary

27

melena

tarry stools, slow bleeding from UGI

28

how long after the bleeding stops can you have blood in your stools

2-3 days

29

hematochezia

bright red blood in stool

30

how long after bleeding stops can you have a positive quiac test

8 days

31

possible causes of upper GI bleeding

NSAIDS, asa, steroids, esophageal varices, ulcers, cancer, clotting disorders, leukemia

32

what test can you do to show active bleeding

bleeding scan

33

what diagnositc test can you have for an upper GI bleed

endoscopy, barium swallow, CT, bleeding scan

34

Mallory Weiss tear

tear in mucosa near esopagogastric junction, from severe vomiting

35

a pt with a dupdenal ulcer may exhibit what?

melena

36

what treatment would you provide for a pt with an active upper GI bleed

VS for shock, IV fluids (LR, blood), foley cath, NG tube (saline lavage to clear out blood), O2

37

what Rx's will help with a GI bleed

vasopressin, sandostatin, antacids, H2 blockers

38

an erosion of the GI mucosa resulting from digestive action of HCl and pepsin

peptic ulcer disease

39

where can peptic ulcer disease occur

any area of the GI tract but mostly inthe duodenum and stomach

40

difference between acute and chronic peptic ulcer disease

acute: superficial erosision minimal inflammation
chronic: erosiion through muscular layer, fibrosis & scar tissue form

41

peptic ulclers only develop in the presence of what

an acid enviornment and/or pepsin (begins the digestion of proteins) release

42

normal or increased acid secretinos/bile reflux duodenum

gastric ulcer

43

increased acid secretion from incrase parietal cell mass, hypersecretion occurs at unusually times (between meals & at night)

duodenal ulcer

44

S/Sx of peptic ulcer

burning/dnawing pain, pain worse on empty stomach, relieved by food but recurs within 3-4 hours, pain awakens patient at night (bc hypersecretion of acid)

45

Tx for peptic ulcer

physical and emotional rest, Rx, aviod stressors, nutritional therapy

46

what Rx neutralizes gastric acid

antacids

47

when should antacids be given

1-3 hours after meals & at bedtime

48

what Rx reduces HCl acid secretions by blocking the action of histamine on H2 blockers

H2 receptor antagonists (pepcid, zantac)

49

what Rx stops the secretion of HCl acid to raise pH of the stomach

proton pump inhibitor (protonix, prevacid, prilosec)

50

what Rx inhibits gastric secretions and decreases gastric motility (slows PNS)

anticholinergics

51

what is a side effect of anticholinergics

dry mouth, urinary retention

52

what Rx forms an adherent that covers the ulcer and protects from erosion

carafate

53

what Rx increases gastric motility & emptying (acid doest stay in contact with stomach as long)

reglan

54

Teaching for peptic ulcers

bland food, calm enviornment, no alcohol, ASA, stop smoking

55

what is the most common comlication of peptic ulcer disease

hemorrhage

56

what is the first sign of hemorrhage in peptic ulcer disease

hematemesis or melena

57

what is the most serious complication of peptic ulcer disease

perforation (hole)

58

involves spilling of gastroduodenal contents into peritoneal cavity causing peritonitis & septicemia

perforation of peptic ulcer

59

S/Sx of perforation

sudden onset of severe upper abdominal pain, rigid abd, absent bowel sounds, increase RR

60

Tx of performation

sugery, post op antibiotics

61

pt has ulcer located close to the pylorus, causes edema

gastric outlet obstruction

62

S/Sx of gastric outlet obstruction

abd pain which is releived by belching or self induced vomiting, vomit often contains food particles from days before

63

Tx for gastric outlet obstruction

surgery

64

Pronton pump inhibitors

reduce gastric acid secretions and promote ulcer healing

65

removal of 2/3rds of stomach and anastomosis of duodenum

billroth I

66

removal of 2/3rds of stomach and anastomosis of jejunum

billroth II

67

vagotomy

severing of vagus nerve, decreases gastric acid secretion

68

pyloroplasty

surgical enlargment of pyloric sphinctor to help with passage of contents from stomach to intestine

69

Post op gastric surgeries

DO NOT irrigate NG tube after surgery unless you have an order

70

how long post op of gastric surgery will you have bright red drainage

1-12 hours, return to mornal yellow green in 36 hours

71

rapid emptying of gastric contents into small intestines, occurs 15-30 minutes after meals

dumping syndrome

72

S/Sx of dumping syndrome

weakness, syncope, sweating, dizziness, cramps, diarrhea

73

Tx for dumping syndrome

small frequent meals, no fluids with meals (fluids will wash food through stomach quicker), no carbs

74

your pt has a loss of intrinsic factor

pernicious anemia

75

if your pt has pernicious anemia, what do they need

B12 shots once a month for life

76

what can occur after surgery on pylorus

alkaline reflux gastritis

77

what can be a side effect of dumping syndrome

postprndial hypoglycemia, due to release of excessive amounts of insulin into circulation

78

ulcer caused by generalized stress response resulting in decreased production of mucus and increased gastric acid secretions

curlings ulcer

79

gastric ulcer thats linked to intracranial pressure, stimulates vagal nerve, and increases gastric acid production, caused by trauma, operations or strokes

cushings ulcer

80

multiple small erosions caused by severe stress or trauma (burn pts)

stress ulcers

81

1st sign of stress ulcer

bleeding

82

Tx of stress ulcer

cautery or laser, if unable to control bleeding then surgery

83

what disease has severe peptic ulceration, gastric acid hypersecretion, elevated serum gastrin levels, and gastrinoma of pancreas or duodenum

Zollinger-Ellison syndrome

84

how is zollinger-ellison syndrome diagnosed

high serum gastrin levels, steatorrhea

85

Tx for zollinger-ellison

pancreatectomy (remove tumor), total or partial gastrectomy, H2 receptor antagonist

86

impairment of forward flow of intestinal contents caused by blockage

intestinal obstruction

87

where does intestinal obstruction mostly occur

ileum (narrowest part of small bowel)

88

what is the most common cause of small bowel obstruction

hernia

89

intestinal loop protrudes thru a weak segment of the abdominal wall

hernia

90

the slipping of one part of the intestine into another part just below it

intussusception

91

can hernias be life threatening?

yes they can cause necrosis of intestine

92

twisting of bowel on its self, twisted loop beomes strangulated

volvulus, EMERGENCY can occur within 6-12 hours

93

bezoar

foreign object stuck in bowel

94

what is key to prevent paralytic ileus 9neurogenic obstruction)

ambulation

95

in vascular obstruction what happens

occurs when the blood supply to bowel is disrupted, peristalsis stops and ischemia occurs quickly-its an EMERGENCY

96

S/Sx of obstruction

pain, abd distention, n&V

97

if you have a partial obstruction in your bowel what kind of stool will you have

liquid stool

98

if you have a complete obstruction in your bowel what kind of stool will you have

no stools

99

borborygmi

high pitched, tinkling sounds

100

during an intestinal obstruction what do your bowel sounds sound like

usually increase proximal to obstruction, within few hours, bowel becomes flassid & bowel sounds decrease

101

Dx of intestinal obstructions

increase of H&H, BUN (related to dehydration), decrease electrolytes, increase WBC

102

Tx of intestinal obstruction

surgical emergency, NPO, NG tube to relieve abd distention, fluid/electrolyte replacement, high mortality rate if not treated in 24 hours

103

what Rx do you want to avoid with a pt that has intestinal obstruction

morphine, bc causes spasms in large intestine

104

administration of nutrition thru tube inserted through stomach or small intestine (duodenum/jejunum)

enteral nutrition

105

who can not have enteral feedings

IBS, diverticulitis, bowel obstruction, GI hemmorhage

106

PEG tube is placed where

into the stomach

107

PEJ tube is placed where

jejunum (intraenteric)

108

are enteral feeding tubes prone to obstruction

yes when oral Rxs are not thoroughly crushed and dissolved in water

109

which feeding tube is used for an extended time period

PEG

110

when can feedings start

when bowel sounds are present

111

Aspiration precautions for enteral feeding tubes

assess placement of tube Q4hr & b4 meals by aspirating, assess for residual volumes b4 meals & Q4hrs, maintain semi fowlers 30-45 minutes after feeding, irrigate tube with H2O after feeding,

112

how is placement of enteral tubes checked

x ray

113

continous drip (enteral feedings)

16-24 hours/day
use pump for constant flow
less regurgitation
increase absorption, nutrients

114

intermittent drip (enteral feedings)

250-400 mL over 20-40 min 5-8 times/day
gravity or pump
allows freedom btwn meals

115

bolus (enteral feedings)

rapid administration
similar to 2-3 meals/day
250-400mL given over a few minutes
poorly tolerated

116

how long is a ready to hang set good for
(enteral feedings)

48 hours bc its a closed system

117

how long is a top fil set good for
(enteral feedings)

24 hours (bc its an open system)

118

what do you label with the enteral feedings

date and time when bag is hung

119

perititis

inflammation of salivary gland

120

when doing enteral feedings that else should you do for your pt

daily weights
I&O
frequent oral hygine to prevent perititis

121

what are NG tubes used for

decompress stomach or small intestine
admin of Rx or feedings
Tx of obstruction or bleeding site
obtain gastric contents for analysis
diagnose gastrointestinal motility or disease process

122

which NG tube is only to be used on intermittent suction

levine or single lumen

123

which NG tube decreases the chance of decompression of stomach and can be used on constant suction

salem, double lumen

124

how do you check the patency of a NG tube

aspiration or irrigation with saline

125

when irrigating an NG tube can you use water

NO saline only

126

how do you measure for an NG tube

nose to ear to xiphoid process

127

what should you lubricate the NG tube with

water soluble gel

128

when the NG tube reaches the nasopharynx what shouldyou instruct the pt to do

lower head slightly to close trachea and open esophagus, have pt swallow water to aid with tube advancing

129

what is the best way to confirm placement of NG tube

x ray

130

when removing NG tube what should you ask the pt to do

hold breath to close epiglottis, gently and steadily withdraw the tube

131

decompression of intestines in bowel obstruction

intestinal or nasoenteric tubes

132

who does the insertion of intestinal tubes

MD

133

when the MD has inserted an intestinal tube what must you instruct the pt to do

pt lie on right side for 2 hours, then supine with head elevated for 2 huors, then on left side for 2 hours, the tube is carried to the intstine by paristalsis

134

with the removal of the intestinal tube, what should you do

remove 1-2 inches at a time, if the tube has reached the ileocecal valve, cut tube at nose and it will be removed by peristalsis via the rectum (poop it out)

135

is irrigation of NG/intestinal tube included in I&O

yes

136

when gastic surgery can you irrigate without a MD order or manipulate the tube

NO

137

can you use lemon or glycerine swabs for oral care

NO

138

what labs are for dehydration

BUN

139

passage of frequent, loose, unformed stool

diarrhea

140

large volume diarrhea

excess fecal water

141

small volume diarrhea

without excess fecal water

142

chronic diarrhea

at least 4 weeks, can be life threatening from dehydration/electrolyte imbalance

143

Tx for diarrhea

replace fluid/electrolytes
Rxs to decrease motility

144

BRAT diet

banana, rice, apple sauce, toast

145

destroys bowels normal flora, permits overgrowth of c, diff

antibiotic related diarrhea

146

found in some pts who are taking antibiotics, whitish membrane form over damaged areas of bowel

pseudomembranous colitis

147

Dx of antibiotic related diarrhea

stool culture for c-diff

148

tx of antibiotic related diarrhea

dc antibiotics, admin intestinal flora modifiers (yogurt, buttermilk), Rx (vanc, flagyl

149

relaxation of external sphincter resulting in involuntary passage of stools

fecal incontinence

150

what fluid replaces body fluids

saline 0.9%, isotonic

151

what fluid has glucose, has few calories

dextrose, 170 calories

152

what fluid has electrolyte replacement, has no dextrose so has no calories

LR

153

what kind of diet should you give a pt with fecal incontinence

high fiber, high fluid diet

154

retention or delay of fecal material in colon results in dry, hard stools

constipation

155

What kind of diet should you give a pt with constipation

high fiber and increase fluids, avoid laxatives or enemas

156

bulk forming agents-laxitive

absorb water, stimulates peristalsis
metamucil, benefiber
24 hours

157

stimulant-laxitive

irritates colin wall to increase peristalsis
ex lax, correctol
12 hours

158

stool softeners-laxative

lubricates intestinal tract and softens stoll
colace, mineral oil
8-72 hours

159

saline and electrolytes-laxative

causes retention of fluid in intestinal lumen
golytely
15-30 minutes

160

which laxative is the most abused

stimulants
ex lax, correcctol

161

which laxative can cause kidney problems

saline and electrolytes
golytely

162

a sympton associated with tissue injury
ex. abscess or rupture in abd, bowel obstruction, peritonitis, ovarian cyst rupture

acute abdominal pain

163

TX of acute abd pain

ID & Tx cause
CT/ultrasound

164

acute inflammation of vermiform appendix of cecum

appendicitis

165

fecalith

stool is compacted in appendix

166

if you have a pt with RUQ pain, and positive mcBurneys point what might your pt have

appendicitis

167

pain felt when release of palpation

rebound tenderness

168

tenderness between umbilicus & right anteriosuperior spine

McBurneys point

169

when you suspect appendicitis what should you never do

apply heat to the abdomen (can cause rupture of appendix)

170

if your pt has appendicitis what should you monitor for

symptoms of peritonitis

171

inflammation of all or part of the surfaces of the abd cavity

peritonitis

172

peritonitis

when you have drainage fromperforated or infected area that leaks into abd cavity

173

S/Sx of peritonitis

increase RR, pain, rebound tenderness, muscle rigidity, abd distention, absent bowel sounds, fever, WBC elevated, hiccups (r/t irritated diaphragm)

174

what should be your focus with peritonitis

fluid and electrolyte balance

175

if you have a pt that is vomiting what shuold you do

NPO until vomiting has stopped

176

inflammaiton of stomach and intestinal tract (small bowel)

gastroenteritis

177

what are causes of gastroenteritis

bacteria, virus, parasite, food poisoning
transmitted by fecal-oral route

178

what things can cause gastroenteritis

not washing hands, shellfish

179

gastroenteritis of large bowel

dysentery

180

what should you consider with gastroenteritis

contact precautions, fluid electrolyte imbalance

181

chronic non infectious irritation caused by spasms of colon, no pathophysiologic changes in bowel

IBS (irritable bowel syndrome)

182

mannings criteria for IBS

abd pain relieved by defecation
abd pain associated with stool changes
abd distention
presence of mucus with stool passage

183

what is the most common symptom of IBS

intermittent crampy abd pain (lower quadrants)
due to spasms

184

what is the most common digestive disorder seen in clinical practice

IBS

185

what Rx is used to relieve pain in IBS

steroids

186

Nursing care for IBS

low residue diet, steroids, mild relaxants (valium, xanax), anticholinergics (bentyl)

187

anticholinergics

helps reduce spasms/cramping
Bentyl

188

Ulcerative colitis

slow progressive lesion, starts in rectum and progresses to sigmooid colon to descending colon.

189

S/Sx of ulcerative colitis

bloody, mucus diarrhea, LLQ colicky abd pain, fever, weakness, anemia
pt will have exacerbations and remisions

190

toxic megacolon

bowel becomes inflammed & distended (transverse colon)

191

fistulas

opening from one organ to another, one that is not supposed to be there
(usually with uterus, bladder or vagina. urine will look like stool in color)

192

Tx for ulcerative colitis

bowel rest, combat infection, correct dyhydration

193

diet for ulcerative colitis

high calorie, high protein, low reside, vit supplements

194

can surgery cure ulcerative colitis

yes

195

removal of entire colon and rectum with permanent ileostomy

proctocolectomy (for ulcerative colitis)

196

crohns disease

chronic, inflammatory area seperated by normal tissue (skip lesions), can affect all areas of GI tract, thickened cowel wall, cobblestone apperance

197

S/Sx of crohns disease

not often bloody, more pus and mucus, low grade fever, fistulas, intermittent diarrhea, crampy abd pain

198

Rx for crohns disease

steriods, nutritional management

199

is surgery curative for crohns disease

no, bc recurrence can occur in any area of bowel

200

projection of mucosal surface of the bowel lumen

polyps (are pre cancerous)

201

what type of polyp attaches to intestinal wall by stalk or stem

pedunculated

202

what type of polyp attaches directly to wall, flat , broad based

sessile

203

what type of polyp is larger, bleeds easily, premalignant

villous

204

how do we diagnose cancer in polyps

colonoscopy with biopsy

205

cancer of colon and rectum

3rd most common cancer, usually asymptomatic, metastasized to liver first, can have cancer for 8-10 years prior to diagnosis

206

if you have a left sided tumor to colon, what kind of symptoms will you have

obstruct flow of solid stool, have ribbon like stool, constipation, rectal bleeding, diarrhea alternating with constipation

207

hematachezia

rectal bleeding

208

if you have a right sided tumor to the colon what kind of symptoms will you have

less change in bowel habits, melena, dull abd pain, anorexia, malaise, pain is late sign

209

what is CT scan used for in cancer

staging

210

what blood test is able to detect cancer/tumors

CEA (carcinoembryonic antigen)
protein secreted by tumor cells measured in blood

211

resection or laparoscopic bowel resection

incision is made & proximal sigmoid is brought through abd wall as permenent colostomy

212

radiation is used for what

shrink tumor

213

chemotherapy is used for what

for control or palliation

214

pouchlike protrusions of intestinal mucosa

diverticulum

215

multiple diverticula exist

diverticulosis

216

inflammation of diverticulum

diverticulitis

217

diverticulitis results from what

obstruction of diverticula by a fecalith`

218

fecalith

hard stoney mass made of feces

219

S/Sx of diverticulitis

may be asymptomatic
LLQ pain,
N/V, occult bleeding, fever, WBC elevated

220

Dx of diverticulitis

barium enema, colonoscopy
no colonoscopy during an acute flair can cause peritonitis

221

Rx used for diverticulitis

anti cholinergic

222

abnormal protrusion of an organ, tissue or part of an organ through a structure that normally contains it.

hernia

223

reducible hernia is

can be pushed back in

224

irreducible (incarcerated) hernia

needs surgery, can decrease blood flow = tissue death

225

weakness in abd wall in inguinal canal, where spermatic cord or round ligament emerge

inguinal hernia

226

protrusion through femoral ring into femoral canal

fermoral hernia
strangulates easily

227

occurs due to weakness of rectus muscle or failure of umniliacl opening to close

umbilical hernia

228

occurs due to weakness in abd wall at site of prevous surgeries

incisional or ventral hernia

229

how do you assess for a hernia

have pt lay in supine position and ask pt to raise shoulders and head

230

Tx for hernias

conservative: wear external support
surgery: prevent strangulation or if it has alreay occured

231

herniorrhapy

hernia repair

232

hernioplasty

weak area reinforced with mesh, wire, facscia

233

Post op hernia repair

no coughing, avoid lifting or straining, watch for difficulty voiding, I&O

234

impaired uptake of essential nutrients leads to malnutrition and weight loss

malabsorption syndrome
ex. celiac disease, tropical sprue, nontropical sprue

235

what do villi do

increase surface area, increase absorption of nutrtients

236

anemia

due to decrease of absorption of neutrients (iron)

237

Tx for malabsorption syndrome

gluten free diet
no rye, barley, oats, wheat

238

deficiency in intestinal lactase results inhigh concentration of intra-luminal lactose

lactose intolerance

239

what OTC Rx helps with lactose intolerance

Lactaid

240

dilated varicose vein of rectum and anus

hemorrhoids

241

do internal hemorrhoids have pain

no pain

242

do external hemorrhoids have pain

very painful

243

causes of hemorrhoids

obesity, pregnance, portal HTN

244

Tx for hemorrhoids

I&D, ointments, sitx baths

245

post op hemorrhoids

watch for constipation, pain control, bleeding

246

thin tear or crack in anal mucosa

anal fissure

247

S/Sx of anal fissure

bleeding on defecation, pain, burning

248

inflammation of ano-rectum with localized infection & pus accumulation

ano-rectal abcess

249

S/Sx of ano-rectal abcess

throbbing pain when sitting

250

Tx of ano-rectal abcess

I&D with packing

251

hallow tract that leads from anal canal or rectum to perinanal skin, usually following a gland tract

ano-rectal fistula

252

S/Sx of ano-rectal fistula

pruritis, pain, odor

253

Tx for ano-rectal fistula

surgical repair
fistulectomy, fistulotomy

254

fistulectomy

surgery for superficial fistulas

255

fistulotomy

surgery for depper fistulas
area is opened & packed, heals by granulation

256

small tract under skin at saceral area

pilonidal sinus

257

pilonidal sinus

congenital, common in yound men, movement of buttock causes hair to penetrate skin=pilonidal cyst or abcess forms

258

Tx for pilonidal sinus

I&D, packing, wound left open to heal

259

Resulting from psychological state

Psychogenic

260

Vomiting is caused by?

Stimulation of CTZ which stimulates the vomiting center in medulla

261

Vomiting can cause?

Hypokalemia & metabolic alkalosis

262

Antiemetics work best when

Prior to vomiting

263

Inflammation of gastric mucosa

Gastritis

264

Rovsing sign

Palpation of LLQ causing pain to be felt in the RLQ

265

Pt with abd pain N&V, pt has bowel obstruction & abd mass. When listening to abd what would you hear

High pitched and hyperactive above area of obstruction

266

Side effect of reglan

Tremors

267

Pepcid is working correctly when what symptom is relieved

Epigastric pain

268

Phenergran has a side effect of

Dry mouth

269

What lab value would be used to indicate acute pancreatitis

Amylase