Gastrointestinal System (Exam One) Flashcards
(176 cards)
1
Q
Where does the absorption of nutrients and digestion take place?
A
Small intestine
2
Q
Where does the absorption of water and minerals take place?
A
Large intestine
3
Q
What does the oral cavity consist of?
A
- Teeth
- Tongue
- Salivary glands
4
Q
Where does digestion begin?
A
In the oral cavity
5
Q
What is the tongue made of? What nerve does it contain?
A
- Skeletal muscle
- Hypoglossal nerve
6
Q
What is the first step in swallowing?
A
Elevation of the tongue
7
Q
What are the only two digestive enzymes produced in the mouth?
A
- Amylase
- Linguinal Lipase
8
Q
Saliva is mostly made up of what?
A
Water
9
Q
What are the three pairs of salivary glands?
A
- Parotid
- Submandibular
- Sublingual
10
Q
What is the purpose of the esophagus? How is this done?
A
- Carries ingested items to the stomach
- Peristalsis propels food to the stomach
11
Q
What is the purpose of the lower esophageal sphincter (LES)?
A
- Allows food to enter the stomach
- Prevents backflow of food
12
Q
The lower esophageal sphincter is also known as what?
A
Cardiac sphincter
13
Q
List the parts of the stomach.
HINT: the CAR is FUN ‘til the BODY PILES
A
- Cardia
- Fundus
- Body
- Pylorus
14
Q
What is the main purpose of the stomach?
A
To store food for digestion
15
Q
Which cells secrete hydrochloric acid in the stomach?
A
Parietal cells
16
Q
What does the hydrochloric acid do within the stomach?
A
- Kills microorganisms
- Breaks down food
- Facilitates gastric enzyme activation
17
Q
When is gastric juice release?
A
At the sight or smell of food
18
Q
What are rugae?
A
- Folds on internal surface of stomach
- Provide extra surface area
- Allows stomach to stretch
19
Q
The stomach changes ingested food into what?
A
Chyme
20
Q
What is the pyloric sphincter responsible for?
A
Regulates the rate of stomach emptying into the small intestine
21
Q
What are the three portions of the small intestine?
A
- Duodenum
- Jejunum
- Ileum
22
Q
What ducts are in the duodenum?
A
- Common bile duct
- Pancreatic duct
23
Q
What is released by the pancreas release when chyme moves into the small intestine?
A
Bicarbonate
24
Q
What does bicarbonate do?
A
Protects the small intestine from the acidity of gastric contents
25
What are villi? What are villi responsible for? Where are they located?
- Small fingerlike projections
- Located in the small intestine
- Increase surface area and absorb nutrients
26
The large intestine is also known as what?
Colon
27
What is the purpose of the large intestine?
Forms and stores feces
28
What does the ileocecal valve do?
Prevents backup of fecal matter from the large intestine into the small intestine
29
What is the liver's role in digestion?
Produces bile
30
What is bile made of?
- Water
| - Bile salts
31
Bile flows out of the liver through which ducts?
Left and right hepatic ducts
32
What ducts form the common hepatic duct?
Left and right hepatic ducts
33
Which duct is connected to the gallbladder?
Cystic duct
34
Which two ducts form the common bile duct?
- Cystic duct
| - Common hepatic duct
35
What do bile salts do?
Break down fats in the small intestine
36
Explain hepatic portal circulation and how the liver detoxifies blood.
1. Liver receives oxygenated blood from the hepatic artery
1. Liver receives blood (high in nutrients, low in oxygen) from the abdominal organs and spleen via the hepatic portal vein
2. Liver filters out by-products from abdominal organs and spleen
3. By-products are excreted into the bile or the blood
4. Bile by-products enter the intestine and exit the body via the feces
4. Blood by-products are filtered out by the kidneys and exit the body via the urine
37
All blood enters the liver via the what?
Hepatic artery
38
All blood exits the liver via the what?
Hepatic portal vein
39
List the functions of the liver.
- Regulates the blood glucose level
- Regulates blood levels of non-essential amino acids
- Forms lipoproteins and cholesterol
- Produces albumin, clotting factors, and globulins
- Removes bacteria and foreign substances from the portal blood
- Forms bilirubin
- Storage for several vitamins and minerals
- Detoxification of harmful substances
- Coverts ammonia to urea
- Provides the body with active Vitamin D
40
Which organ is responsible for storing and concentrating bile until it is needed for digestion?
Gallbladder
41
Which hormone secreted when fatty foods need to be digested?
Cholecystokinin hormone
42
What does the hormone cholecystokinin do?
- Signals the gallbladder to contract
| - Forces bile into the duodenum
43
What happens to the GI system of older adults?
- Sense of taste decreases
- Teeth loss causes difficulty chewing
- Secretions of GI tract are decreased
- Peristalsis may decrease causing constipation
- Frequent indigestion
- Risk of colon and oral cancer increase
- Peridontal disease is more common
- Diverticula may form
- Hemorrhoids are more common
44
What is included in the physical exam for a patient with GI issues?
- BMI
- Dry, cracked lips
- Foul breath
- Color of gums
- Ill fitting dentures
- Abdomen inspection, auscultation and palpation
45
A BMI of 30 or higher is considered what?
Obese
46
A BMI of 40 or higher is considered what?
Morbidly obese
47
What will the nurse hear with normal bowel sounds?
- Soft clicks
| - Gurgles
48
What will the nurse hear with abnormal bowel sounds?
High-pitched tinkling sounds
49
What are hyperactive bowel sounds? What causes them?
- Rapid or increased sounds
- <5 seconds apart
- Caused by hunger or gastroenteritis
50
What are absent bowel sounds? What causes them? The nurse knows they should do what if the patients bowel sounds are absent?
- No sound at all for 5 minutes in each quadrant
- May indicate bowel disease or obstruction
- Can occur after anesthesia
- Report to provider!
51
What are hypoactive bowel sounds? What causes them?
- Infrequent sounds
- >15 seconds apart
- Can occur after abdominal surgery
52
What is jaundice? What causes jaundice? If a patient is jaundice, what color will their urine and stool be?
- Yellowing of skin and sclera
- Caused by excess bilirubin
- Urine will be dark colored
- Stools may be gray in color
53
What labs should be assessed in a patient with suspected liver problems?
- CBC
- Bilirubin
- Occult blood
- ALT, AST, ALP
- Albumin
- Ammonia
- Potassium
- Amylase
- Lipase
54
What is a normal bilirubin level?
< 1.0 mg/dL
55
What is the upper GI series (barium swallow) test?
- X-ray of the esophagus, stomach, duodenum, and jejunum
| - Patient drinks oral liquid contrast medium (barium) and x-rays are taken at timed intervals
56
What does the upper GI series detect?
- Strictures
- Ulcers
- Tumors
- Polyps
- Hiatal hernias
- Motility issues
57
What should the nurse monitor the patient for if they have had an upper GI series?
- Ensure patients clears the barium
- Constipation
- Chalky white stools
- Encourage plenty of foods
58
What education should the nurse provide to the patient before an upper GI series?
- Patient must be NPO for six hours prior to procedure
- No smoking prior to procedure
- Encourage plenty of foods
- Laxatives may be given
59
What is the a lower GI series (barium enema) test?
- Colon is filled with barium
| - X-rays are taken
60
What does the lower GI series detect?
- Tumors
- Diverticula
- Stenosis
- Obstructions
- Inflammation
- Ulcerative colitis
- Polyps
61
What education should the nurse provide to the patient before a lower GI series?
- Patient placed on low residue or clear liquid diet several days prior to the procedure
- Clear liquids 24 hours prior
- NPO 8 hours before the test
- Laxatives will be given prior to clear the bowel
- Encourage liquids
- Failure to clear the bowel will result in cancellation of test
62
What patient education should be provided to a patient who has an esophagogastroduodenoscopy ?
- NPO for 8 hours prior to test
| - Patient may have a sore throat for a few days
63
What should the nurse assess and monitor with an esophagogastroduodenoscopy?
- Dentures (think safety!)
- Assess for gag reflex
- NPO until gag reflex returns
- Monitor for perforation
- Monitor for pain, fever, abnormal vital signs, bleeding
64
What does the esophagogastroduodenoscopy assess?
- Visualizes the esophagus, stomach, duodenum
- Used to diagnose ulcers, cancer, bleeding
- Can obtain specimens via a biopsy
65
What should the nurse monitor the patient for if they have had an ERCP?
- Gag reflex
- NPO until gag reflex returns
- Vital signs
- Signs of reaction to contrast
- Assess for contrast dye allergy
66
What education must be provided for a patient undergoing a colonoscopy?
- Clear liquid diet evening prior to procedure
- Patient is NPO midnight prior to procedure
- Bowel must be clear for successful procedure!!
- Patient may experience gas and abdominal cramping afterwards
67
What should the nurse monitor for after a colonoscopy?
Rectal bleeding
68
When would a liver biopsy be needed?
When other diagnostic tests have not been successful in diagnosing a liver disease
69
What patient education should be provided prior to a liver biopsy?
- Patient will be on bedrest after procedure
- Avoid coughing and straining for 1 week
- Avoid exercise for 1 week
70
What should the nurse monitor after a liver biopsy?
- Vital signs
| - Bleeding
71
When is gastrointestinal decompression necessary?
When the stomach or small intestine becomes filled with air of fluid
72
What can be done to maintain the patency of an NG tube?
Irrigation
73
What is enteral nutrition?
Provides the patient with hydration and nutrition when oral intake is not possible
74
When is enteral nutrition most commonly used?
After GI surgery
75
Do you need an order from a physician for enteral nutrition?
Yes
76
How is gravity enteral feeding delivery?
- Place feeding above the level of the stomach
| - Feeding delivered by gravity
77
What are intermediate enteral feedings?
Feeding administered throughout the day and stopped at night
78
What is continuous enteral feeding?
Delivered 24 hours/day by a pump
79
What should the nurse monitor when a patient has enteral feedings?
- Feedings not being absorbed
- Abdominal distention
- Patient feels full
- Nausea
- Vomiting
80
What should the nurse do if the patient presents with any signs and symptoms of the enteral feeding not being absorbed?
- Stop the feeding
| - Contact the provider
81
What nursing management should be provided with enteral feedings?
- HOB at 30-45 degrees
- Use liquid medications when possible
- Make sure medications are safe to crush
- Use normal saline to irrigate
- Always check placement by x-ray and pH of gastric aspirate
82
How often should the nurse check the pH of gastric aspirate?
Every time a feeding is to be administered
83
What is parenteral nutrition?
Method of supplying nutrients via an IV route
84
When would parenteral nutrition be used?
Used for patients who cannot eat or absorb enough food through tube feeding formula or by mouth
85
What should the nurse check if a patient is receiving parenteral nutrition?
- Blood glucose
| - May require insulin
86
Parenteral nutrition has a high concentration of what?
Glucose
87
The feeling of nausea is _____ to each person.
Individualized
88
What interventions may the patient require if they suffer from nausea and vomiting?
- Provide odor free and clean environment
- Give antiemetic medications
- Provide oral care
- Monitor I&Os
- Daily weights
- Provide oral or IV fluids
- NG tube
- Turn on side to prevent aspiration
89
What should the nurse monitor regarding nausea and vomiting?
- Vital signs
- I&Os
- Dehydration
- Electrolytes
- Characteristics of vomit
- Monitor for signs of fluid overload
- Coffee ground emesis
90
What lab values may be elevated with nausea and vomiting?
- Increased hematocrit
- Increased sodium
- Increased pH
- Decreased potassium
91
What are the causes of anorexia?
- Medications
- Treatments
- Stress
- Emotional problems
- Infection
92
What are the nursing interventions and considerations regarding anorexia?
- Electrolyte imbalance
- Accurate documentation of I&O
- Patient has food available
- Access to preferred foods
93
Who is most at risk for anorexia nervosa?
- Females 12 to 18 years of age
| - Females who have low self esteem
94
What is anorexia nervosa?
Eating disorder where patients have a phobia of gaining weight or are afraid to lose control
95
What are the signs and symptoms of anorexia nervosa?
- Poor nutritional health
- Low BP and HR
- Heart and kidney failure
- Osteoporosis
- Muscle loss
- Vitamin/electrolyte imbalance
- Diabetes
- Constipation
- Cardiac arrhythmias
96
What is bulimia nervosa?
- Compulsive eating disorder with self induced vomiting
- Binging and purging
- Laxatives and exercise used to avoid weight gain
97
What are the signs and symptoms of bulimia nervosa?
- Similar to s/sx of anorexia nervosa
- Enamel erosion
- Teeth staining
- Patient spends large amounts of time in the bathroom
- Hypokalemia
- Hypocalcemia
98
What is obesity?
Occurs when caloric intake exceeds energy expenditure
99
Patients with obesity are at an increased risk for what?
- Atherosclerosis
- Gallbladder disease
- Heart disease
- Hypertension
- Sleep apnea
- Type 2 Diabetes
100
What are the nursing interventions related to obesity?
- Focus on education
- Healthy diet
- Exercise
- Calorie restriction
- Decrease stress
- Change concepts about food
- Join support group
101
Most obese patients have _____ issues.
Psychosocial
102
What are the different types of bariatric surgery?
- Laparoscopic adjustable gastric banding
- Sleeve gastronomy
- Roux-en-Y
103
What are the complications of bariatric surgery?
- Vomiting due to overeating
- Bloating
- Heartburn
- Staple disruption
- Obstruction
- Dumping syndrome
- Protein, vitamin, mineral deficiencies
- Compliance issues
- Band slipping
- Intestinal leakage
104
What postoperative care should be provided for bariatric surgery patients?
- NG tube
- HOB elevation
- Provide support to incision when coughing or sneezing
- Started on clear liquid diet
- Only small amounts of fluid at a time
105
What education should be provided to patients who have undergone bariatric surgery?
- Diet is very important
- Should be able to tolerate regular food 6 weeks post surgery
- Can not eat and drink at the same time
106
How long should a patient weight to have skin removal surgery after bariatric surgery?
1 year
107
Where is oral cancer usually found?
Pharynx
108
What are the signs and symptoms of oral cancer?
- Leukoplakia
- Painless or tender ulcers
- Oral sores that wont heal
- Difficulty chewing, swallowing, or speaking
- Swollen cervical lymph nodes
109
What are the treatment options for patients with oral cancer?
- Radiation
- Chemotherapy
- Surgery
- Radical or modified neck dissection
110
What is nursing care focused on for patients with oral cancer?
- Nutritional needs
- Airway management
- Pain management
- Education
- Stridor
- Avoid alcohol/tobacco use
111
Esophageal cancer is associated with the use of what?
Alcohol or tobacco
112
What is Barrett's esophagus?
Precancerous condition associated with esophageal cancer
113
What are the signs and symptoms of esophageal cancer?
- Progressive dysphagia
- Feeling of fullness
- Pain in the chest after eating
114
What are treatment options for esophageal cancer?
- Radiation
- Chemotherapy
- Surgery (most common)
115
When is esophageal cancer usually detected, late or early?
Late
116
What are the nursing interventions for a patient with esophageal cancer?
- Assess pain and provide pain medication
- Assess fluid intake
- Assess swallowing
- Daily weights
- Provide fluids
- Monitor IV nutrition and fluids
- Monitor vital signs
- Airway!!!
117
What is a hiatal hernia?
Occurs when the stomach slides up through the hiatus of the diaphragm
118
What are the risk factors associated with hiatal hernia?
- Smokers
- Obese patients
- Pregnant patients
- Lifting heavy objects
- Straining with bowel movement
119
Patients with a hiatal hernia also suffer from what?
GERD
120
What are the signs and symptoms of hiatal hernia?
- Pain
- Heartburn
- Feeling of fullness
- Reflux
121
What is the nursing management for patients with a hiatal hernia?
- Lifestyle modifications
| - Education patient on eating small meals, raise HOB, no reclining for one hour after meals
122
What is GERD?
Occurs when gastric contents reflux into the esophagus
123
What are the signs and symptoms of GERD?
- Heartburn
- Regurgitation
- Dysphagia
- Bleeding
124
What diagnostic tests are used to diagnose GERD?
- Barium swallow
- Esophagoscopy
- Esophagus pH
125
What are the complications associated with GERD?
- Esophagitis leading to Barretts esophagus
- Respiratory complications
- Asthma
- Aspiration
- Pneumonia
- Bronchospasm
- Laryngospasm
- Chronic bronchitis
126
What are the treatment options for GERD?
- Lifestyle changes
| - Avoid alcohol, chocolate, fatty foods, caffeinated soda
127
What drugs fall under the class of H2 Receptor Antagonists?
- Zantac
- Pepcid
- Tagamet
128
How do H2 Receptor Antagonists work?
Compete with histamine for H2 receptors on the stomach's parietal cells and depress production of hydrochloric acid
129
What drugs fall under the class of Proton Pump Inhibitors?
- Protonix
- Nexium
- Prilosec
130
How do Proton Pump Inhibitors work?
Irreversibly block the final step of acid production
131
What drugs fall under the class of Antacids?
- Tums
- Mylanta
- Maalox
132
How do Antacids work?
Neutralize stomach acid
133
What is a common side effect of frequent antacid use?
Constipation
134
Using Proton Pump Inhibitors long term can cause what?
C. diff
135
What is a mallory-weiss tear?
Longitudinal tear in the mucous membrane of the esophagus and stomach junction
136
What can cause a mallory-weiss tear?
- Sudden, powerful, prolonged force
- Vomiting excessively
- Seizures
- Coughing
137
What are the signs and symptoms of mallory-weiss tear?
- Result from bleeding
- Bright red, bloody emesis
- Bloody tar like stools
138
What should be avoided with mallory-weiss tears?
Alcohol
139
What are esophageal varices? What causes them?
- Dilated blood vessels in esophagus
| - Caused by portal hypertension
140
What happens if esophageal varices rupture?
Life-threatening, EMERGENCY!
141
What is the priority nursing goal with esophageal varices?
Prevent them from bleeding
142
What is gastritis?
- Chronic inflammation of the mucosa of the stomach
| - Can be acute, chronic, or stress induced
143
What are signs and symptoms of gastritis?
- Abdominal pain
- Nausea
- Anorexia
- Feeling of fullness
- Reflux
- Belching
- Hematemesis
144
What are the therapeutic measures for gastritis?
- Remove irritating substance
- Bland diet
- Eat small, frequent meals
145
What is peptic ulcer disease?
Erosion of the lining of the stomach, pylorus, duodenum or esophagus
146
Which portions of the GI tract are most at risk for peptic ulcer disease?
Those that are exposed to hydrochloric acid and pepsin
147
Where do peptic ulcers occur most often?
Duodenum
148
What is the main cause of peptic ulcer disease?
H. pylori bacteria
149
How is H. pylori transmitted?
- Oral-to-oral
| - Oral-to-fecal
150
Who is at an increased risk for peptic ulcer disease?
- People who smoke
| - People who frequently use NSAID's
151
What are signs and symptoms of peptic ulcer disease?
- Different types of pain
- Anorexia
- Nausea/vomiting
- Bleeding may occur (range from large hemorrhage to slow leak)
- Occult blood
152
What are some complications of peptic ulcer disease?
- Bleeding
- Perforation of stomach/duodenum wall
- Obstruction
- Perforated ulcer (emergency!)
153
What is the treatment for H. pyloric?
- Antibiotics
| - Proton Pump Inhibitor
154
Gastroduodenal contents spilling into the abdominal cavity resulting in inflammation is known as what?
Peritonitis
155
Peritonitis can lead to what?
- Septicemia
| - Hypovolemic shock
156
What nursing care should be provided for a patient with a perforated ulcer?
- IV fluids
- Insertion of NG tube
- Monitor VS
- Be prepared to give blood
- Manage pain
- Antibiotics
157
What is the key treatment option for perforated ulcers?
Rapid, appropriate surgical intervention
158
What is melena?
Black tarry stools containing digested blood
159
What are the signs and symptoms of a severe GI bleed?
- Hypotension
- Tachycardia
- Tachypnea
- Chills
- Palpitations
- Weak, thready pulse
- Hypovolemic shock
160
What are the nursing therapeutic measures for gastric bleeding?
- Patient NPO
- IV fluids
- HOB elevation
- Oxygen therapy
- Measure I&Os
- Medications
- Monitor changes in urine
- Monitor LOC changes
- Changes in color or mucous membranes
- Skin turgor
161
What is the most effective treatment of gastric cancer?
- Surgery (most effective)
- Chemotherapy
- Radiation
162
What portion of the stomach is removed in the Billroth I procedure? Where does it attach?
- Distal portion of the stomach removed
| - Stomach is attached to duodenum
163
What portion of the stomach is removed in the Billroth II procedure? Where does it attach?
- Greater portion of distal stomach is removed
| - Stomach is attached to jejunum
164
What is a total gastrectomy?
- Total removal of the stomach
| - Esophagus and jejunum are attached
165
What are the nursing interventions for postoperative gastric surgery?
- Pain management
- Assessment of incision
- Monitor vital signs
- Maintain NG tube
166
What is a complication of gastric surgery?
- Hemorrhage
- Gastric dumping
- Life-time supplements
- Pyloric obstruction
- Pernicious anemia
- Steatorrhea
167
What are the symptoms of hemorrhage?
- Restlessness
- Cold skin
- Increased pulse
- Decreased temperature
- Decreased blood pressure
- LOC changes
168
What is gastric dumping?
- Food enters jejunum rapidly and mixes with digestive juices improperly
- Causes fluids to become imbalanced
169
What are the symptoms of gastric dumping?
- Dizziness
- Tachycardia
- Fainting
- Sweating
- Nausea
- Diarrhea
- Abdominal cramping
170
What are the treatment options for gastric dumping? What patient education should be provided?
- Eat small frequent meals
- High protein, low fat, low sugar, low carb diet
- Do not drink fluids with meals
- Limit fluids to one hour prior to meals and two hours after a meal
171
What is pyloric obstruction?
Develops as a result of scar tissue or edema
172
Pernicious anemia causes a deficiency of which vitamin?
Vitamin B12
173
What will a patient with pernicious anemia require?
Lifelong Vitamin B12 injections
174
What is steatorrhea?
Presence of fat in stools
175
What are the characteristics of stool with steatorrhea?
- Foul smelling
- Oily
- Float
176
Should the esophagus be alkaline or acidic?
Alkaline
