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NCLEX-RN (5) Adult Health > Gastrointestinal > Flashcards

Flashcards in Gastrointestinal Deck (121)
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1

What are the general signs and symptoms for a client with an upper gastrointestinal disorder?

  • nausea and vomiting
  • gastric reflux
  • upper abdominal pain
  • coffee-ground emesis (blood in the vomit)

 

2

What are the general signs and symptoms for a client with a lower gastrointestinal disorder?

  • lower abdominal pain and cramping
  • diarrhea
  • melena (blood in the stool)

 

3

What medications are given for nausea and vomiting?

Antiemetics:

  • ondansetron
  • metoclopramide
  • promethazine

 

4

What is the typical diet for a client with an acute gastrointestinal disorder with inflammation?

NPO (nothing by mouth) and IV fluids are started to prevent dehydration.

This is to decrease inflammation and preparation for possible surgery. 

5

What is the typical diet for a client going for a gastrointestinal procedure or test?

NPO (nothing by mouth) for at least 4-8 hours. Some clients are taught to have a clear liquid diet only the day before some diagnostic tests.

This is to clean out the bowels and decrease the risk of aspiration.

6
Describe:

Peritonitis

Immediate complication

Peritonitis is when the bowel perforates causing infection and eventually sepsis if not treated.

 

7

What are the characteristic signs and symptoms of peritonitis?

  • rigid, hard abdomen and pain
  • no bowel sounds/no flatus
  • temperature and chills
  • restlessness, tachycardia, and tachypnea

8
Interventions:

Peritonitis

  • IV antibiotics
  • drain any fluid - surgery/NG tube
  • possible surgery to repair perforation

9

What is an endoscopy?

An endoscopy is a test where a flexible tubing with a camera on the end is inserted into the nose or mouth to visualize the digestive tract.

10

What are the interventions for an endoscopy?

  • NPO for at least 4-6 hours
  • will be sedated
  • check for gag reflux afterward
  • assess for signs of perforation afterward

11

What is a barium test?

A barium test is when the client drinks barium or gets an enema with barium to visualize the GI tract

The barium is white and x-rays are taken while the barium is administered. 

12

What are the interventions before a barium swallow test?

Interventions before a barium test:

  • NPO for at least 8 hours
  • inform client that stools will be chalky white

13

What are the interventions after a barium test?

Goal is to prevent constipation: administer laxatives and increase fluids.

14

What is a capsule endoscopy procedure?

A capsule endoscopy procedure is when the client swallows a capsule that has a small camera in it to look for abnormalities in the intestines. The client wears a belt that records the images. 

Make sure the client is NPO 3 hours before and 3 hours after swallowing the capsule.

 

15

What is an endoscopic retrograde cholangiopancreatography (ERCP)?

An ERCP is a scope that is inserted into the esophagus to look at the liver, gall bladder, and bile ducts - the hepatobiliary system. 

Client will be getting dye, so assess for allergies.

16

What is a paracentesis?

A paracentesis is when a needle is used to get fluid out of the peritoneal cavity.

It's commonly done for clients with liver failure who have ascites.

17

What are the interventions before a paracentesis?

  1. obtain informed consent 
  2. get a set of vital signs and weight to assess for fluid shifts
  3. have client empty bladder to avoid puncture

18

What are the interventions after a paracentesis?

  • assess for shock and fluid and electrolyte imbalances
  • record output
  • get a sample and send to lab for analysis
  • monitor for pink or bloody urine due to possible bladder puncture

19

What is a liver biopsy?

A liver biopsy is when a needle is inserted through the skin into the liver to get a liver tissue sample for laboratory analysis.

 

20

What are the interventions before a liver biopsy?

  1. Assess PT, PTT, and platelets
    • if high, there is risk for bleeding and procedure may be held
  2. give a sedative
  3. place in a supine or left lateral to access the right side

21

What are the interventions after a liver biopsy?

Goal is to prevent bleeding:

  • assess for bleeding and peritonitis
  • place on right side for at least 2 hours
  • no coughing or straining
  • teach that there is no heaving lifting for at least 2 weeks

22

What is the most common reason a stool specimen is collected?

A stool specimen is collected to check for occult blood (blood that is not obvious to the naked eye).

 

23
Describe:

Gastroesophageal reflex disease (GERD or "reflux")

 

GERD is excess stomach acid that goes up the esophagus.

It is caused by excessive relaxation of the lower esophageal sphincter (LES).

 

24

Who is most at risk of getting GERD?

Clients with a hiatal hernia or clients who are overweight.

Both conditions increase intra-abdominal pressure pushing the acid back up.

 

25
Describe:

Hiatal hernia

A hiatal hernia is when a portion of the stomach herniates up through the diaphragm

It has the same symptoms of GERD and symptoms occur when laying down.

26

What are the severe complications of untreated GERD?

  1. Barrett's esophagus
    • The damaged lining of the esophagus gets replaced with precancerous cells.
  2. Esophageal stricture
    • The damaged lining of the esophagus gets replaced with scar tissue leading to difficulty swallowing.

27

What substances should a client with GERD avoid?

  • caffeinated drinks
  • chocolate
  • citrus fruits, tomatoes
  • smoking
  • peppermint
  • alcohol
  • fatty foods
  • large meals

These substances increase gastric acid production

28

What is the characteristic symptom of GERD?

dyspepsia (heartburn)

The epigastric pain is due to acid entering the esophagus. These symptoms typically get worse when the client bends over.

29

What other disease can the symptoms of severe GERD imitate?

The symptoms of GERD can imitate myocardial infarction.

Many clients will visit the ER thinking they are having a "heart attack" when it is actually GERD. It is important to rule out a severe cardiac issue first. 

30

What are the diagnostic tests for suspected GERD?

  • barium swallow to check for esophageal problems like hiatal hernia
  • upper endoscopy to look at the esophagus for abnormalities
  • pH monitoring exam for 24 hours (a scope is placed in the esophagus and the pH is monitored)

31
Teaching:

Lifestyle changes with GERD

Teaching for life-style changes with GERD:

  • Limit or avoid foods that cause esophageal irritation
  • Avoid smoking and drinking alcohol
  • Avoid large meals, especially before sleep
  • Sleep with the head of the bed elevated
  • Avoid constrictive clothing, bending over and heavy lifting

32
Medications:

GERD

  1. Antacids - ​neutralizes stomach acid
  2. H2 receptor blockers 
    • end in -dine
  3. Proton pump inhibitors (PPIs) - prevents stomach acid from forming
    • end in -prazole

33

What is the last resort treatment for a client with GERD?

The last step in treating GERD is fundoplication surgery.

The gastric fundus is wrapped around the sphincter area of the esophagus.

34
Describe:

Gastritis

Gastritis is inflammation of the stomach or gastric mucosa.

It is caused by many reasons. 

35
Cause:

Gastritis

Causes of gastritis are from irritation of the gastric mucosa:

  • infection (such as H. pylori)
  • spicy foods
  • overuse of aspirin or NSAIDs
  • alcohol and smoking
  • acid reflux
  • radiation

36
Signs and symptoms:

Gastritis

Upper GI symptoms:

  • abdominal discomfort
  • nausea/vomiting
  • acid reflux and burping

37

Which vitamin deficiency is associated with chronic gastritis? 

Chronic gastritis is commonly associated with vitamin B12 deficiency (which can result in anemia).

Healthy gastric mucosa is needed to absorb vitamin B12.

38
Interventions:

Gastritis

  • assess for bleeding
  • give small, bland meals during acute phase
  • treat the cause

39
Medications:

Gastritis

  1. to decrease acid secretion
    • antacids
    • H2-receptor blockers (famotidine)
    • proton-pump inhibitors (pantoprazole)
  2. antibiotics to treat H. pylori
  3. Vitamin B12 injections

40

What is the last resort treatment for gastritis?

Gastric resection (Billroth I procedure)

A part of the stomach is removed.

41
Describe:

Peptic ulcer disease

Peptic ulcer disease are ulcers anywhere from the esophagus to the duodenum. 

42

What is the major complication if gastritis or peptic ulcer disease isn't treated?

Perforation and bleeding

Assess for bleeding and provide interventions:

  • check vital signs
  • check hemoglobin and hematocrit
  • start IV fluids and give blood

43
Risk factors:

Peptic ulcer disease

Peptic ulcer disease risk factors are substances that irritate the mucosa:

  • infection of H. pylori
  • overuse of aspirin, NSAIDs, corticosteroids
  • alcohol and smoking
  • acid reflux
  • stress

44

What are the characteristic signs and symptoms of a gastric ulcer?

  • pain in the stomach 30 - 60 minutes after a meal
  • hematemesis (vomiting of blood)

45

What are the characteristic signs and symptoms for a duodenal ulcer?

  • pain in the stomach 1.5 - 3 hours after a meal and during the night
  • melena (blood in the stool)
  • pain is relieved by eating

46
Interventions:

Peptic ulcer

  • asses for bleeding
  • small, frequent and bland meals
  • treat the cause

47
Medications:

Peptic ulcers

Meds for peptic ulcer are to protect stomach:

  1. Take before meals:
    • mucosal barriers such as sucralfate or bismuth subsalicylate
    • proton pump inhibitors (omeprazole)
  2. H2 blockers (ranitidine) at bedtime
  3. antacids 2 hours after meals
  4. antibiotics for H. pylori

48
Teaching:

Gastritis and Peptic ulcer disease

Teach client to avoid substances that cause stomach irritation:

  • alcohol, caffeine, and chocolate
  • aspirin and NSAIDs
  • don't smoke and try to reduce stress - smoking and stress release gastric acid

49

What is the last resort treatment for peptic ulcers and gastritis if meds and lifestyle changes don't work?

Surgery to remove the stomach or part of the intestine including:

  • gastrectomy: removal of the entire stomach
  • gastric resection: removal of the lower half of stomach
  • gastroduodenostomy or gastrojejunostomy: removal of part of the stomach and then reconnected to the small intestine

50

What is a gastrectomy?

A gastrectomy is the removal of the entire stomach.

51

What is a gastroduodenostomy?

A gastroduodenostomy is a partial removal of the stomach with the remaining part connected to the duodenum.

Also called a Billroth I.

52

What is a gastrojejunostomy?

A gastrojejunostomy is a partial removal of the stomach with the remaining part connected to the jejunum.

Also called a Billroth II.

53

What is a pyloroplasty?

A pyloroplasty widens the pylorus (lower part of the stomach) to reduce obstruction.

This allows stomach content to empty into the small intestine.

 

54

What is Dumping syndrome?

Dumping syndrome can occur after gastric surgery where food leaves the stomach quickly due to lack of a stomach.

 

55
Signs and symptoms:

Dumping syndrome

Symptoms occur 10 - 30 minutes after a meal:

  1. nausea/vomiting/diarrhea/cramping/pain/diarrhea
  2. hot, sweaty, palpitations, dizzy
  3. pale, cold, clammy
    • due to fluid and electrolyte shifts
  4. borborygmi (loud bowel sounds)

56
Teaching:

Dumping syndrome

  1. eat a high-protein, high-fat, low-carb diet
    • may eat laying on left side because delays gastric emptying
  2. eat small meals and don't drink fluids with meals
  3. lie down after meals

This prevents food from metabolizing too quickly.

57

What is bariatric surgery?

Bariatric surgery is used with obese clients to reduce the size of the stomach by several different ways. 

Clients will need psychological interventions to agree to change their lifestyle and keep the weight off.

 

58

What is gastric banding?

Gastric banding is a type of bariatric surgery where a band is placed around the stomach to reduce its size.

 

59

What is a Roux-en-Y gastric bypass?

A Roux-en-Y gastric bypass is when a small pouch is created on the upper part of the stomach. Then the small intestine is directly connected to it.

60

What are the postoperative interventions after most gastric surgeries?

  • monitor vital signs for signs of hemorrhage and fluid and electrolyte imbalances
  • place in Fowler's position to promote drainage and comfort
  • keep client on NG tube suction
  • NPO status for 1 to 3 days until peristalsis returns

61

Why should the NG tube NOT be removed after a gastric surgery unless prescribed by the health care provider?

NG tube should NOT be removed as it might result in the disruption of the gastric sutures.

62

How should the diet progress after a client has had gastric surgery?

  • NPO 1 - 3 days
  • clear liquids
  • then full liquids as tolerated

After bariatric surgery, the client will be limited to liquids or pureed foods for 6 weeks.

63
Describe:

Cholecystitis

Cholecystitis is inflammation of the gallbladder, usually caused by gallstones. 

64

What are the characteristic signs and symptoms of cholecystitis?

  • epigastric pain that radiates to the right shoulder or scapula
  • pain in the right quadrant after a high-fat meal
  • Murphy's sign (can't take a deep breath when pressed on the right quadrant)

65

What is a biliary obstruction?

A biliary obstruction is when one of the ducts that carry bile from the liver to the intestine via the gallbladder becomes blocked. Gallstones can cause this.

If left untreated, this blockage can lead to sepsis.

66
Signs and symptoms:

Biliary obstruction

  1. from bilirubin in the blood
    • yellow skin (jaundice)
    • dark orange and foamy urine
  2. toxins getting on skin
    • itchy skin (pruritus)
  3. from bilirubin not entering the intestines
    • fat in feces (steatorrhea)
    • clay/pale-colored feces

67
Interventions:

Acute cholecystitis

Acute cholecystitis interventions focus on preventing nausea and vomiting:

  • NPO
  • NG tube decompression (suction)
  • antiemetics
  • analgesics

68

What diet should a client with chronic cholecystitis follow?

A diet consisting of small portions and low-fat meals.

69

What is a choledocholithotomy?

A choledocholithotomy is the removal of gallstones.

70

What is a cholecystectomy?

A cholecystectomy is the removal of the gall bladder.

"lap choly" is a common term that means removal of the gall bladder by laparoscopic surgery.

71

 What is a T-tube?

A T-tube is placed in the bile duct after a cholecystectomy to drain the bile while the edema subsides. 

72

What are the interventions​ for a T-tube?

Interventions for a T-tube:

  • semi-Fowler's and keep tube below level of gallbladder to help with drainage
  • monitor, empty and record output
  • avoid getting bile on skin - it's irritating
  • report to HCP for any sudden increase in drainage or signs of infection

73

What is done with the T-tube before meals?

The T-tube is clamped before meals so that the bile can be used for digesting food.

If the client gets abdominal discomfort or nausea/vomiting, unclamp the tube.

74
Describe:

Cirrhosis

Cirrhosis is liver damage usually caused by chronic alcohol use or Hepatitis C. The healthy tissue is replaced with scar tissue.

There are many complications associated with it because the liver has many functions. 

75

What are the major complications associated with cirrhosis?

  • ascites (fluid overload in the abdomen)
  • esophageal varices (bleeding)
  • coagulation problems (bleeding)
  • encephalopathy (confusion and coma)

 

76

What are the characteristic signs and symptoms of cirrhosis?

  • ascites/edema
  • jaundice
  • asterixis (coarse hand flapping)
  • fetor hepaticus (a fruity, musty breath)
  • high ammonia level

77
Interventions:

Ascites and cirrhosis

Focus on preventing fluid overload:

  • restrict fluids and sodium
  • diuretics
  • monitor intake and output
  • weight daily and abdominal girth
  • paracentesis

78
Interventions:

Bleeding and cirrhosis

  • monitor PT/INR and give vitamin K if bleeding
  • insert an NG tube with a balloon tamponade if has esophageal varices
  • administer blood products

79
Interventions:

Encephalopathy and cirrhosis

Focus on decreasing toxins in blood and monitoring for coma:

  • give lactulose to decrease ammonia levels in blood
  • fall precautions

80

What diet is recommended for a client with cirrhosis?

  1. if there are no ascites and no signs of an impending coma give a high protein diet with supplemental vitamins
    • B complex, vitamins A, C, and K, folic acid and thiamine
  2. if there are ascites and possible impending coma, give a low protein diet

Protein breaks down into ammonia.

81

Which medicines are avoided for clients with cirrhosis?

  • acetaminophen - it's hepatotoxic
  • sedatives - due to risk of coma

82
Describe:

Hepatitis A and E

Hepatitis A and E is an infection of the liver transmitted by the fecal-oral route and person-to-person contact.

Prevent by washing hands and foods thoroughly before eating.

83
Describe:

Hepatitis B, C, and D

Hepatitis B, C, and D is an infection of the liver transmitted by body fluids, especially the blood.

Prevent by having protected sex, no IV drug use, and not accidentally sticking self with a needle.

84
Symptoms:

Preicteric (1st) stage of hepatitis

"flu-like" symptoms:

  • fatigue
  • nausea/vomiting/diarrhea
  • headache and muscle aches
  • increased bilirubin

 

 

85
Symptoms:

Icteric (2nd) stage of hepatitis

Caused by increased bilirubin in the blood:

  • jaundice
  • dark or tea-colored urine
  • clay-colored stools
  • pruritis (itching)

 

 

86
Symptoms:

Posticteric (3rd) stage of hepatitis

Client starts to go back to normal:

  • jaundice decreases
  • urine and stool goes back to normal
  • minimal GI symptoms
  • bilirubin returns to normal

 

 

87

What are the diagnostic tests for hepatitis?

Client is positive for hepatitis if there are antibodies or antigens in the blood specific to the type.

Example: + for hepatitis A: HAV antibodies in blood

88

What are the complications for untreated Hepatitis?

  • cirrhosis
  • if pregnant: fetal death

89

What is the treatment if a client is suspected of having hepatitis A or hepatitis B?

Give immune globulin to prevent hepatitis from occurring.

Hepatitis B is the most common disease nurses get from accidentally sticking themselves with a dirty needle. 

90
Medications:

Hepatitis C

Antivirals

91
Treatment:

Hepatitis D

It is typically a mild disease and there is no specific treatment. 

Hepatitis D infection occurs with Hepatitis B.

92
Teaching:

Hepatitis

  • wash hands a lot!
  • don't share personal items, especially for hygiene
  • don't prepare food for others
  • no alcohol or acetaminophen and sedatives (bad for the liver)
  • no blood donation
  • small meals that are high carb and low fat

93
Describe:

Acute pancreatitis

Pancreatitis is inflammation of the pancreas usually caused by alcoholism or gallstones.

 

94

What are the characteristic signs and symptoms of acute pancreatitis?

  • mid-epigastric or left upper quadrant pain
  • pain aggravated by a fatty meal or alcohol
  • Cullen's sign
  • Turner's sign

95

What labs are elevated with acute pancreatitis?

  • amylase and lipase
  • white blood cell count
  • bilirubin

96
Interventions:

Acute pancreatitis

Focus on preventing release of enzymes that can damage the pancreas:

  • NPO and IV fluids
  • TPN if severely malnourished
  • possible NG tube for suction
  • Teach to not drink alcohol

97
Medications:

Acute pancreatitis

  1. Opioids
    • to decrease pain
  2. HReceptor blockers and proton pump inhibitors
    • to prevent increased acid and enzyme release

98
Describe:

Irritable bowel syndrome

Irritable bowel syndrome is chronic episodes of diarrhea and constipation.

The cause is unknown.

99
Interventions:

Irritable bowel syndrome

  • If client is experiencing diarrhea give antidiarrheals
  • if client is experiencing constipation increase fiber and fluids

100
Describe:

Ulcerative colitis

Ulcerative colitis is an inflammatory bowel disease that occurs in one portion of the colon.

It is an autoimmune disorder.

101

What is the characteristic symptom with ulcerative colitis?

Ulcerative colitis: severe diarrhea that may contain blood and mucus.

102
Describe:

Crohn's disease

Crohn's disease is an inflammatory bowel disease that can occur anywhere in the GI tract. 

The cause is unknown but thought to be autoimmune.

103

What is the characteristic symptom with Crohn's disease?

Diarrhea, which may contain mucus and pus.

104
Medications:

Ulcerative colitis and Crohn's disease

  • corticosteroids
  • immunosuppressants
  • antidiarrheals

Possible ostomy creation if medications don't work.

105

What is a colostomy and ileostomy?

A colostomy connects the colon to the abdominal wall.

An ileostomy connects the small intestine (ileum) to the abdominal wall.

These operations are done because the bowel may have to be rerouted through an artificially created hole (stoma) in the abdomen so that stool can still leave the body.

 

106

What is the difference in stool between a colostomy and an ileostomy?

A colostomy is made from the colon and puts out more solid stool.

An ileostomy is made from the small intestine and puts out more liquidy stool, putting the client at a higher risk of fluid and electrolyte imbalances.

107

What are the preoperative interventions for an ostomy (stoma)?

  • work with client to identify optimal placement of stoma (don't want it at the beltline)
  • address body concerns and feelings
  • antibiotics 1 hour before surgery

108

What are the post-operative interventions for a stoma?

  1. assess stoma
    • it should be pink or bright red and shiny
    • if pale or purple-black stoma notify HCP
  2. empty when bag is 1/3 full 
  3. don't let stool get on skin - it's irritating
  4. assess for fluid and electrolyte imbalances

Pale stoma indicates a low hemoglobin and hematocrit; purple-black stoma indicates that no blood is getting to it

 

109

What is a colostomy irrigation?

A colostomy irrigation is when an enema (warm tap water) is given through the stoma to stimulate a bowel movement.

Usually done around the same time each day, 1 hour after eating.

110
Describe:

Appendicitis

Appendicitis is inflammation of the appendix. It is usually caused by impacted stool.

If not treated, it can rupture causing peritonitis and sepsis.

111

What are the characteristic symptoms of appendicitis?

  • abdominal pain most intense at McBurney's point
  • laying in a side-lying position with legs flexed due to extreme pain.

112
Treatment:

Appendicitis

Appendectomy - removal of the appendix

113

What should NOT be placed on the abdomen for a client with appendicitis?

Never apply a heating pad; it can cause rupture of the appendix.

114
Describe:

Diverticulosis and Diverticulitis

Diverticulosis is an outpouching of the intestinal mucosa.

Diverticulitis is when that intestinal mucosa becomes inflamed from fecal matter getting impacted in the pouches (diverticula).

 

115

What is the characteristic symptom of diverticulitis?

Left lower quadrant pain that increases with straining.

116
Interventions:

Diverticulitis

  • NPO and analgesic until inflammation subsides
  • assess for perforation
  • possible colon resection and colostomy

117
Teaching:

Diverticulosis

  • eat a high fiber diet
  • drink 2500 - 3000 mL of fluids daily to prevent constipation
  • do not eat seeds, nuts, or popcorn since it can get trapped in the diverticula and cause inflammation
  • take bulk-forming laxatives

118
Describe:

Hemorrhoids

Hemorrhoids are dilated veins coming out of the anus.

They are caused by increased abdominal pressure or straining with bowel movements.

119

What is the characteristic symptom of hemorrhoids?

Bright red bleeding with bowel movements

120
Interventions:

Hemorrhoids

  • cold packs and witch hazel soaks to decrease inflammation
  • possible hemorrhoidectomy

121
Teaching:

Hemorrhoids

Focus on preventing constipation:

  • high fiber diet and fluids to prevent constipation and straining
  • stool softeners when needed