Gastrointestinal System (Exam Two) Flashcards
(173 cards)
1
Q
What is constipation? Is it a symptom or a disease?
A
- Occurs when fecal matter is held in the rectal cavity longer than usual
- Rectal cavity may become insensitive to feces
- Constipation is a symptom
2
Q
Constipation that is severe and continues for a long period of time is referred to as what?
A
Obstipation
3
Q
Stool becomes much more difficult to pass after being in the rectal cavity for how many days?
A
Three days
4
Q
What medications may cause constipation?
A
- Narcotics
- Tranquilizers
- Antacids with aluminum
5
Q
What is the most common cause of constipation?
A
-Low intake of fiber and fluids
6
Q
What is done to prevent constipation?
A
- Exercise
- Fluid consumption
- High fiber diet
- Avoid chronic laxative use
7
Q
What are the signs and symptoms of constipation?
A
- Abdominal pain
- Indigestion
- Rectal pressure
- Feeling of incomplete emptying
- Intestinal rumbling
8
Q
What is fecal impaction? What medication may cause fecal impaction to worsen?
A
- Dry stools that cannot be passed
- Liquid waste may pass around the impaction causing liquid stool incontinence
- Anti-diarrheal medications
9
Q
What can happen if a patient with constipation uses laxatives long term?
A
- Atrophy of colon muscles
- Muscle thickening
- Fibrosis
10
Q
What is a fecaloma? What can it cause?
A
- Mass of very hard feces
- Causes bowel obstruction or perforation of the bowel
- Usually requires surgical intervention
11
Q
What can be used to treat constipation instead of laxatives?
A
- Psyllium medications (i.e. Metamucil)
- Stool softeners
12
Q
When should the nurse use enemas or laxatives for constipation treatment?
A
As last resort for severe constipation
13
Q
What is diarrhea? How is it classified
A
- Frequent loose or liquid stools
- Classified by more than three loose stools in 24 hours
14
Q
How long does acute diarrhea last?
A
1-2 weeks
15
Q
A patient who has diarrhea will present with what type of bowel sounds?
A
Hyperactive
16
Q
What is the most common cause of diarrhea?
A
- Bacterial infection (i.e. E. coli, C diff, Salmonella)
- Can also be caused by viruses (i.e. Rotavirus)
17
Q
What are the signs and symptoms of diarrhea?
A
- Frequent liquid stools
- Foul smell
- Blood or mucus
- Rapid onset
- N/V
- Abdominal cramping
- Weakness
- Dehydration
- Anorexia
18
Q
What diagnostic test should be completed to test for bacteria in the stool?
A
Stool culture
19
Q
What are the treatment options for diarrhea?
A
- Fluid replacement (oral or IV)
- Elimination diet
- Antibiotics
- Probiotics
- Medication (i.e. Lamotil)
20
Q
What is the appendix? What is appendicitis?
A
- Small finger-shaped appendage attached to cecum of large intestine
- Serves no purpose
- Inflammation of infection of appendix
21
Q
What are signs and symptoms of appendicitis?
A
- Fever
- Increase in WBC’s
- Pain in upper abdomen
- Pain in lower right quadrant (McBurney’s point)
- N/V
- Rebound tenderness
22
Q
Where would the nurse palpate to diagnose appendicitis?
A
- McBurney’s point
- Lower right quadrant
23
Q
What type of bowel sounds occur with appendicitis?
A
Normal bowel sounds
24
Q
It is common for the patient to do what for comfort during appendicitis pain?
A
Keep right leg flexed
25
What nursing management should be done for a patient with appendicitis?
- NPO
- Semi-fowlers position
- Apply ice
- IV antibiotics
- NG tube
- Monitor dressing/incision site
26
How is appendicitis treated?
Appendectomy
27
What can happen if heat is applied to appendix during appendicitis?
Appendix may rupture
28
What is peritonitis? What causes peritonitis?
- Inflammation of the peritoneal cavity
| - Anything that causes organ contents to be spilled into abdominal cavity
29
What are the signs and symptoms of peritonitis?
- Abdominal pain that worsens with movement
- Rebound tenderness
- Abdominal rigidity (hardness)
- N/V
- Bloating
- Hypovolemia
- Fever
- Sepsis
30
What type of bowel sounds are expected with peritonitis?
Hypoactive
31
What diagnostic tests are used to diagnose peritonitis?
- CT
- CBC
- Laboratory analysis
- Exploratory surgery
32
What is the normal range for WBC's? During peritonitis, WBC's are usually elevated above what?
- 5,000 to 10,000
| - Above 15,000
33
List therapeutic measures for a patient with peritonitis?
- NPO
- IV fluids/electrolytes
- NG tube
- Antibiotics
- Surgery may be required
- Wound drain
- Pain management
34
What are the complications of peritonitis?
- Intestinal obstruction
- Hypovolemia
- Septicemia
- Death if left untreated
35
What is a diverticulum/diverticula? What causes diverticulum to develop?
- Outpouching of bowel or mucous membrane
- Due to increased pressure in colon
- Due to weakness in bowel wall
36
What is diverticulosis? What can occur if food/particles get stuck in the diverticula?
- Presence of multiple diverticula with no inflammation
| - Can cause diverticulitis
37
What is diverticulitis?
Inflammation/infection of one or more diverticula
38
What are the signs and symptoms of diverticulosis?
No signs or symptoms present
39
What are the signs and symptoms of diverticulitis?
- Constipation or diarrhea
- Cramping in lower left quadrant
- Fever
- Fatigue
- Weakness
- Abdominal tenderness
40
Where does diverticulosis occur most commonly?
Sigmoid colon
41
What can cause diverticulosis?
- Chronic constipation
| - Insufficient dietary fiber intake
42
Who is most at risk for developing diverticulitis?
Older adults >60 years old
43
How is diverticulosis managed?
By preventing constipation
44
To allow the bowel to rest, patients with diverticulosis may require what?
- Surgical resection
| - Temporary ostomy bag
45
Patients with acute diverticulosis may require what?
Hospitalization for pain management and antibiotic therapy
46
What are dietary considerations for patients with diverticulosis?
- Foods high in fiber
- High fluid intake
- Unprocessed bran
- Low residue diet (low in nuts and seeds)
47
List examples of high fiber foods?
- Raisins
- Peas
- Prunes
48
What is Crohn's disease? What part of the digestive tract is affected by Crohn's disease?
- Chronic autoimmune inflammation of the bowel
- Lesions are mixed with healthy tissue
- Can affect any part of GI tract
- Occurs in remissions and exacerbations
49
What is the cause of Crohn's disease?
- Unknown
- Autoimmune
- Possibly genetic
50
Who is most at risk for Crohn's disease?
- Females
| - Smokers
51
What are the signs and symptoms of Crohn's disease?
- Cramping pain not relieved with bowel movement
- Weight loss
- Diarrhea
- Fluid/electrolyte imbalances
- Abdominal distention
- Fistulas
- Fissures
- Possible perforated intestine
52
What is commonly used to diagnose Crohn's disease? How is the diagnosis confirmed?
- Colonoscopy with biopsy
- Sigmoidoscopy with biopsy
- Confirmed by granulomas in the biopsy specimen
53
What foods can cause exacerbations of Crohn's disease?
- Dairy
- Fatty foods
- Fresh fruit and vegetables
- Spicy foods
- Caffeine
54
What is the goal of treatment for Crohn's disease?
- Reduce inflammation
- Focus on remission
- Manage diet and fluid intake
55
What medications are used to treat Crohn's disease?
- Aminosalicylates
- Biologics
- Corticosteroids
- Antidiarrheal medications
- Immunomodulators
- Antibiotics
- Vitamin supplements
56
What is ulcerative colitis?
- Chronic autoimmune inflammation of the bowel
- Lesions spread in continuous pattern
- Only occurs in the large colon and the rectum
57
What can cause ulcerative colitis exacerbations?
- Tobacco
- Radiation
- Food preservatives
- Diet
58
At what age(s) are Crohn's disease and ulcerative colitis generally diagnosed?
Between ages 15 and 30
59
What are the signs and symptoms of ulcerative colitis?
- Abdominal pain
- Rectal pain/bleeding
- Diarrhea
- Malabsorption
- Severe dehydration
- Urgency
- Anorexia
- Anemia
- Electrolyte imbalances
60
What lab might be elevated in a patient with ulcerative colitis?
C-reactive protein
61
What are the therapeutic measures for patients with ulcerative colitis?
- Diet
- Fluids
- Medications
- Surgery
62
What is the priority nursing concern for a patient experiencing an ulcerative colitis exacerbation?
- Replace fluids
| - Replace electrolytes
63
Can ulcerative colitis be cured?
- Yes
| - Entire colon must be removed
64
What is irritable bowel syndrome?
- Functional problem
- Disorder of intestinal mobility
- Colon randomly contracts causing constipation, diarrhea, or both
65
What are the signs and symptoms of irritable bowel syndrome?
- Gas
- Bloating
- Constipation
- Feeling of incomplete emptying
- Abdominal pain
- Mucus in stool
- Depression
- Anxiety
66
Irritable bowel syndrome is most common in?
- Females
| - Flare ups occur during menstrual cycle
67
A patient with irritable bowel syndrome may be placed on what kind of diet?
Low FODMAP diet
68
What are causes and risk factors for abdominal hernias?
- Coughing
- Heavy lifting
- Straining
- Obesity
- Pregnancy
- Poor wound healing
69
How are hernias classified?
By location
70
What is a reducible hernia?
Herniation that is easy to return to the abdominal cavity
71
What is an irreducible/incarcerated hernia?
Herniation that cannot be returned to the abdominal cavity
72
What should the nurse expect if an incarcerated hernia becomes strangulated?
Emergency surgery
73
What are the signs and symptoms of an incarcerated hernia?
- Pain at the site
- Vomiting
- Nausea
- Abdominal pain
74
What is a strangulated hernia?
Hernia that has decreased or no blood flow
75
What should the patient avoid after having a herniorrhaphy or hernioplasty?
Avoid heavy lifting for several weeks
76
What type of foods should be avoided in patients with celiac disease?
- Gluten
| - Wheat, barley, rye, grains
77
What type of foods should be avoided in patients with lactose intolerance?
Lactose
78
What is a mechanical small bowel obstruction?
Blockage occurs within the intestine
79
What is a non-mechanical small bowel obstruction?
Peristalsis is impaired because of neruomuscular condition
80
What is fecal vomiting?
Fecal matter is propelled upward
81
What type of bowel sounds are associated with a small bowel obstruction?
- High pitched tinkling
| - Absent
82
What are the therapeutic interventions for a patient with a small bowel obstruction?
- NPO
- NG tube
- Fluid/electrolyte replacement
- Medications
- Surgery
83
What are the different types of abdominal ostomies?
- Ileostomy
- Colostomy
- Urostomy
84
What type of patients are at greatest risk for dehydration?
Patients with ileoanal anastomosis
85
What is an ileoanal anastomosis?
- Connects illeum to anus
- No stoma needed
- Effluent is more liquified and mushy
86
Why might a patient with an ileoanal anastomosis have a temporary ileostomy or J-pouch?
- Allows everything to rest and heal
| - Can be reversed
87
Do patients with a J-pouch have a stoma?
No
88
Are patients with a J-pouch able to have regular bowel movements?
Yes
89
What happens with the effluent as the stoma is moved down the colon?
- Less liquid
| - More firm and formed
90
What education should be provided to a patient with a stoma in regards to diet?
- No chunks that can block stoma opening
- Avoid fluids that cause gas (i.e. cabbage, broccoli)
- Yogurt is helpful in reducing the smell
91
What does a normal stoma look like? What education should be provided to the patient?
- Pink to red in color
- Moist
- Watch for skin irritation due to drainage and seeping after surgery
- May have swelling for 2-3 weeks after surgery
92
What does a blueish, dusky stoma indicate? The nurse should anticipate doing what if this happens?
- Inadequate blood supply
| - Call HCP
93
What does a black stoma indicate?
Necrosis
94
What is hepatitis?
Inflammation of the liver resulting in loss of liver function
95
What are the causes of hepatitis? Which of these is the most common?
- Bacteria
- Viruses (most common)
- Drugs
- Alcohol
- Chemicals
96
Many patients born between _____ to _____ have been infected for as many as _____ years and did not know.
- 1945 to 1965
| - 20 years
97
What are the most common forms of hepatitis in the United States?
- Hep A
| - Hep B
98
How is Hepatitis A transmitted?
Fecal-oral route
99
How is Hepatitis B transmitted?
-Blood or body fluids (i.e. saliva, menstrual or vaginal fluid, contaminated equipment)
100
How is Hepatitis C transmitted?
- Blood transfusions
- IV drug use
- Unprotected sex
101
How is Hepatitis D transmitted?
- Blood or body fluids
| - Must be co-infected with Hepatitis B
102
How is Hepatitis E transmitted?
- Contaminated water
| - Raw or undercooked pork/venison
103
How do you prevent hepatitis?
- Good hand hygiene
- Avoid sharing personal hygiene items
- Avoid sharing needles
- Use condoms
- Vaccinations
104
When can an immunoglobulin be given for hepatitis?
After exposure
105
Describe Stage 1 of hepatitis?
- Known as prodromal/preicteric stage
- Occurs two weeks after exposure
- Lasts about one week
- Flu-like symptoms
106
Describe Stage 2 of hepatitis?
- Known as icteric stage
- Occurs 5 to 10 days after prodromal stage
- Lasts two to six weeks
- Flu-like symptoms
- Dark urine
- Enlarged and tender liver
- Jaundice
107
Describe Stage 3 of hepatitis?
- Known as convalescent stage
- Lasts two to six weeks
- Patient is considered recovered when liver function is back to normal
- Patient should avoid liver toxic substances for at least one year (i.e. alcohol)
108
What are the complications of hepatitis?
- Acute or chronic liver failure
- Chronic infection
- Increased risk of liver cancer
109
What labs will be elevated or decreased with hepatitis?
- Elevated liver enzymes
- Elevated bilirubin
- Prolonged PT
- Elevated ammonia
- Decreased albumin
110
Antivirals can be given for which forms of hepatitis?
- Hep B
| - Hep C
111
What should patients avoid if they are hepatotoxic?
- Alcohol
| - Drugs (i.e. Tylenol)
112
What is acute liver failure?
- Rare but serious failure of liver system
| - Can develop rapidly
113
What is the most common cause of acute liver failure?
Acetaminophen overdose
114
What can be given for acetaminophen overdose within one hour of the overdose?
Activated charcoal
115
What is the antidote for acetaminophen?
- N-acetylcysteine
| - Can prevent hepatotoxicity if given within 8 hours of overdose
116
How many milligrams of Tylenol is recommended for a daily dose?
3000mg/24 hours
117
What should the nurse educate the patient on if they have acute liver failure?
OTC medications that contain Tylenol
118
What are the signs and symptoms of acute liver failure?
- GI symtoms (initial symptom)
- Fatigue (initial symptom)
- Elevated liver enzymes
- Bleeding
- Hypoalbuminemia
- Abdominal distention
- Hypokalemia
- Blood glucose levels drop
- Reduced liver size
- Hepatic encephalopathy
- Jaundice
119
If left untreated, how high is the mortality rate for acute liver failure?
50%
120
What is the priority nursing concern with acute liver failure?
Support the airway
121
What medications can be given to decrease ammonia levels?
- Lactulose
| - Rifaxinim
122
What is cirrhosis?
Progressive, irreversible replacement of healthy liver tissue with scar tissue
123
Cirrhosis is more common in which gender?
Males
124
What is the most common cause of cirrhosis?
Alcohol abuse or misuse
125
Describe the characteristics of the liver during early stages of cirrhosis and late stages of cirrhosis?
- Early: enlarged liver
| - Late: shrink and develop grey scar tissue on the outside
126
What is ascites?
- Large amount of fluid build up in the abdominal cavity
| - Can cause respiratory distress
127
What are the causes of ascites?
- Low albumin
| - Portal hypertension
128
What are the treatment options for ascites?
- Fluid and sodium restriction
- Diuretics
- Albumin infusions
- Paracentesis
- Shunt
129
What nursing management will be provided to a patient with ascites?
- Monitor I&Os
- Monitor abdominal girth
- Monitor weight
130
What is portal hypertension?
- Elevated blood pressure in the portal vein
| - Blood backs up into surrounding vessels
131
What causes portal hypertension?
Obstructed blood flow from liver scarring
132
Portal hypertension can cause what?
- Caput medusae
- Rectal hemorrhoids
- Splenomegaly
- Esophageal varices
133
What is hepatic encephalopathy? What does it represent?
- Decline in brain function due to increased ammonia levels
| - Represents end stage liver failure
134
What are the stages of hepatic encephalopathy?
- Early
- Stupor/confusion
- Comatose
135
What is used to treat hepatic encephalopathy?
- Lactulose
| - Antibiotics
136
What are the symptoms of hepatic encephalopathy?
- Progressive confusion
- Asterixis
- Fector hepaticus
137
What is Wernicke-Korsakoff syndrome?
- Complication of alcohol induced liver disease
| - Deficiency in thiamine
138
Wernicke-Korsakoff syndrome can progress to what?
Korasakoff's psychosis
139
Can Korasakoff's psychosis be reversed?
- No
| - It can only be prevented
140
How is Wernicke-Korsakoff syndrome treated?
Oral or SQ thiamin
141
What nursing management should be provided for patients with cirrhosis?
- Daily weight
- Abdominal girth measurement
- Vital signs
- Respiratory status
- I&Os
- Lab values
- Low sodium diet
- Fluid restriction
- Oral care
- Monitor for bruising or bleeding
142
What digestive enzymes are secreted by the pancreas?
- Lipase
- Amylase
- Trypsin
143
What is acute pancreatitis?
- Inflammation of the pancreas
- Digestive enzymes active inside of the pancreas
- Pancreas begins to digest itself
144
What is secreted by the pancreatic duct to neutralize the acidity of stomach contents in the duodenum?
Sodium bicarbonate
145
What causes acute pancreatitis?
- Autodigestion of the pancreas
- Alcohol misuse
- Gallbladder disease
146
How is acute pancreatitis described?
Chemical burn to the organ
147
What are the signs and symptoms of acute pancreatitis?
- Severe pain (Epigastric or LUQ radiating to chest, back, flanks)
- Rigid abdomen
- Hypotension or shock
- Respiratory distress
- Low-grade fever
- Dry mucus membranes
- N/V
- Jaundice
148
What are the two signs of bleeding associated with acute pancreatitis?
- Turner's sign
| - Cullen's sign
149
What is Turner's sign?
Bleeding that causes bruising around flanks
150
What is Cullen's sign?
HINT: "C" = "C"ircle around bellybutton
Bleeding that causes bruising around bellybutton
151
How is acute pancreatitis diagnose?
- Abdominal pain
- Increased serum amylase
- Increases serum lipase
152
Acute pancreatitis is diagnosed when either serum amylase or serum lipase is how many times the normal amount?
Three times the normal amount
153
What are the treatment options for acute pancreatitis?
- IV fluids
- Pain management
- H2 antagonist
- NPO for period of time
- NG tube
- Antibiotics
- Electrolytes
- Insulin as needed
154
Why would a patient with acute pancreatitis have an NG tube with suction?
- To prevent the digestive enzymes from going to the small intestine
- Allows the pancreas to rest
155
Repetitive episode of acute pancreatitis can lead to what?
Chronic pancreatitis
156
How do gallstones cause acute pancreatitis?
Gallstones block the pancreatic duct and block the digestive enzymes from being released
157
Pancreatic cancer is the _____ leading cause of cancer related deaths in the United States.
Third
158
Who has the highest rate of contracting pancreatic cancer?
African American males
159
What are the risk factors of pancreatic cancer?
- Smoking
- Obesity
- Diabetes
- Exposure to chemicals
- Cirrhosis
- Chronic pancreatitis
- H. pylori infection
160
What are the signs and symptoms of pancreatic cancer?
- Often no signs or symptoms
| - May have overall weakness or not feel well
161
What is cholecystitis?
- Inflammation of the gallbladder
| - Can be acute or chronic
162
What causes acute cholecystitis? What can it lead to?
- Obstruction of the common bile duct leading to further inflammation and infection
- Can lead to rupture of gallbladder
163
Chronic cholecystitis causes the gallbladder to do what?
Become thick and hard
164
Cholelithiasis is what?
Gallstones
165
Cholelithiasis occur most frequently in what gender?
Females
166
What factors highly contribute to the development of cholelithiasis?
- Inactive lifestyle
| - High fat, high cholesterol diet
167
Most cholelithiasis are composed of what?
Cholesterol
168
Symptoms of cholelithiasis usually last how long?
- 1 to 3 hours
| - Follows intake of high fat meal
169
Obstruction of the common bile duct can cause what?
-Clay colored fatty stools
170
What is Murphy's sign?
- Specific to cholecystitis
- Patient takes in and holds a deep breath while palpating the right subcostal area
- Pain will cause an abrupt halt in inspiration
171
Treatment of acute cholecystitis focuses on what?
Pain management
172
High levels of bilirubin can cause what? What can the patient be given for this?
- Severe itching
| - Colestid or Questran
173
What type of education should the nurse provide to a patient with cholecystectomy?
- Diet!
- Low fat, low cholesterol
- Avoid greasy, high fatty food
