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Flashcards in GI Deck (129):
1

Acute inflammation of the vermiform appendix

Appendicitis

2

Where do patients with appendicitis have pain?

In the epigastic or periumbilical area

3

When do patients with appendicitis have nausea and vomiting?

After the abdominal pain

4

What are the signs of appendicitis?

Pain at McBurney's point and rebound tenderness

5

Why is appendicitis very difficult to diagnose?

Because it is a diagnosis of exclusion

6

Why should patients with appendicitis not be given laxatives?

They can cause perforation of the appendix

7

Why should patients with appendicitis not use heat for the pain?

Because heat causes the circulation in the appendix to increase, leading to inflammation and perforation

8

How should patients with appendicitis be positioned?

Semi-fowlers

9

What are the priorities when a patient comes into the ER with appendicitis?

Make that patient NPO and give IV fluids and electrolytes

10

How many mL of sterile fluid are normally in the peritoneal cavity to prevent friction?

50

11

Life threatening acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity, or peritoneum

Peritonitis

12

What does primary peritonitis indicate?

Peritoneum is infected via the bloodstream

13

What does secondary peritonitis indicate?

Contamination of the peritoneal cavity by bacteria or chemicals

14

Why does peritonitis have to be treated immediately?

To stop the shunting of blood to the area of inflammation and causing third spacing and hypovolemic shock

15

What are the signs of peritonitis?

Rigid, board like abdomen, pain, distention, high fever, tachycardia, dehydration, low urine output, hiccups, compromised respiratory status, nausea, vomiting, diminished bowel sounds, inability to pass flatus or feces, and anorexia

16

Why do hiccups occur with peritonitis?

Diaphragmatic irritation and increased white blood cells

17

How is peritonitis diagnosed?

Peritoneal lavage

18

How is peritonitis managed?

IV fluids, antibiotics, NG suctioning

19

What position do patients with peritonitis need to be in?

Semi-Fowlers

20

Widespread inflammation of mail the rectum and rectosigmoid colon, associated with periodic remissions and exacerbations

Ulcerative Colitis

21

Unpleasant and urgent senstation to deficate

Tenesmus

22

What is the poop of a patient with ulcerative colitis like?

10-20 bloody stools daily

23

What would the labs of a patient with ulcerative colitis be?

Decreased H&H, increased WBCs, c-reactive protein, increased erythrocyte sed, decreased electrolytes

24

What is the most definitive test for ulcerative colitis?

Colonoscopy

25

What are the drugs used to treat ulcerative colitis?

Glucocorticoid, antidiarrheal drugs, and Humira

26

What are the side effects of antidiarrheal drugs?

Colon dilation and toxic megacolon

27

What needs to be taught with Humira?

Watch for signs and symptoms of infection

28

What should patients with ulcerative colitis avoid?

Caffeine, pepper, alcohol, and smoking

29

What do patients with ostomies need to be taught?

Don't leave supplies in the car

30

What should a stoma look like?

Pinkish to cherry red

31

What are the nursing interventions for patients with ostomies?

Skin protection, monitor blood and fluid loss, and psychological care

32

Inflammatory disease of the small intestine and colon causing thickening of the bowel wall with deep ulcerations and fistulas

Crohn's Disease

33

What causes Crohn's?

Possibly genetic, immune, or environmental factors

34

What do patients with ulcerative colitis look like?

Very sickly

35

What is the poop of a Crohn's patient like?

5-6 loose stools daily

36

How do obstructions occur in Crohn's patients?

Inflammation and scarring from the fistulas cause a narrowing of the intestines

37

What is the priority for patients with fistulas with Crohn's disease?

Always protect the skin

38

What is the criteria for patients to have a wound vac?

They must be in a positive nitrogen balance

39

What would the bowel sounds of a patient with Crohn's be?

Hyperactive in all four quadrants

40

Where is the pain for patients with Crohn's?

Right lower quadrant

41

Why would patients with Crohn's be anemic?

Because they can't absorb intrinsic factor

42

What drugs can be used to treat Crohn's?

Flagyl, methotrexate, remicade and Humira

43

What does Flagyl do?

Fights infection in deep, dark places

44

What teaching needs to accompany taking Flagyl?

Don't drink

45

What does Methotrexate do?

It is an immunosuppressant that kills rapidly dividing cells

46

What does Humira do?

Immunosuppressant

47

What teaching needs to accompany Humira?

Stay away from crowds and report signs of infection

48

What is the priority for patients with Crohn's?

Nutritional management

49

What is the diagnostic test for Crohn's?

Biopsy

50

The presence of many abnormal pouch like herniation in the wall of the intestine

Diverticulitis

51

Where do patients with diverticulitis have pain?

Left lower quadrant

52

What are the signs of diverticulitis?

Abdominal distension, guarding, rebound tenderness, decreased BP, hypovolemia, low grade fever, and nausea

53

How is diverticulitis diagnosed?

Barium show

54

What are the primary interventions for patients with diverticulitis?

Drug therapy, nutritional therapy, and rest

55

What drugs are used for patients with diverticulitis?

Flagyl, cipro, anticholinergics, and analgesics

56

What needs to be avoided for patients with diverticulitis?

Avoid laxatives and enemas

57

What does a bowel prep do?

Cleansing and then neomycin

58

A lack of desire to eat despite physiologic stimuli that would normally produce hunger?

Anorexia

59

The forceful emptying of the stomach and intestinal contents through the mouth

Vomiting

60

What are the most common symptoms of nausea?

Hypersalivation and tachycardia

61

Nonproductive vomiting

Retching

62

What is projectile vomiting associated with?

Head injuries and and structural deficits

63

What elevated electrolyte causes constipation?

Calcium

64

A reflux of chyme from the stomach to the esophagus

GER

65

What is GERD caused by?

A loose lower esophageal sphincter

66

What is the hallmark of GERD?

Abdominal pain within 1 hour of eating

67

What cells heal erosions called by GERD?

Barrett's epithelium

68

How can GERD be treated?

Avoid food that irritates stomach, eat slowly, lose weight, sleep on right side

69

Name the protein pump inhibitors

Prilosec, pantoprazole, and Nexium

70

What is Nissen Fundiplication?

Using laproscopic surgery to reinforce the lower esophageal sphincter

71

What is the post op care for patients with nissen fundiplication?

Avoid foods and beverages that cause gas, NG tube

72

Chronic GI disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating

Irritable Bowel Syndrome

73

What are the clinical manifestations of IBS?

Abdominal pain relieved by defication or sleep with the sensation of incomplete bowel emptying

74

Where is the pain associated with IBS?

Left lower quadrant

75

What would the assessment of IBS patients reveal?

Normal weight, normal nutrition, normal fluid and electrolytes, and normal bowel sounds

76

What do patients with IBS need to be taught?

Don't abuse laxatives, don't delay the urge to deficate, increase fluids

77

What drugs are used to treat IBS?

Bulk forming laxatives, Bentyl, Ditropan, antidiarrheals, and Elavil

78

What teaching accompanies bulk forming laxatives?

Take at mealtimes with a glass of water

79

What is Bentyl used for?

Relieves cramps caused by smooth muscle spasms

80

What are the side effects of Bentyl?

Blurred vision, SOB, headache, drowsiness, and lack of sweatin

81

What is Ditropan used for?

It stops urge urinary incontinence

82

What is Elavil used for?

Relieves cramping

83

What are the side effects of Elavil?

Turns urine blue-green, constipation, dry mouth, and orthostatics

84

Unnaturally swollen or distended veins in the anorectal region

Hemorrhoids

85

How are hemorrhoids treated?

Preparation H, Rubber band treatment, diet high in fiber and fluids

86

What is the complications for hemorrhoids?

Bleeding

87

What is a nonmechanical intestine obstruction?

Paralytic Ileus

88

In what kind of obstruction are there borborygmi?

Mechanical Obstruction

89

In what kind of obstruction are there no bowel sounds?

Nonmechanical Obstruction

90

What is the hallmark of colorectal cancer?

Weight loss

91

Where is the most common place for colorectal cancer to occur?

In the exit of the rectum

92

What diet modifications can treat colorectal cancer?

Low fat, low carbs, high fiber

93

What is the most common sign of colorectal cancer?

Rectal bleeding

94

What is the diagnostic test for colorectal cancer?

Colonoscopy

95

What speeds up the return of bowel sounds and flatulence?

Ambulation

96

When can food be given post GI surgery?

After the gag reflex, bowel sounds, and flatulence returns

97

When do colostomy pouches need emptied?

When they are 1/3 - 1/2 full

98

Small growths in the intestinal tract that are covered with mucosa and are attached to the surface of the intestine

Polyps

99

What can polyps cause?

Bleeding, intestinal obstruction, and intussusception

100

What are 99% of peptic ulcers caused by?

H. Pylori

101

Ulcers characterized by high gastric acid secretion in the duodenum

Duodenal Ulcers

102

Break in the mucosa of the stomach

Gastric Ulcer

103

When do gastric ulcers cause pain?

Pain with an empty stomach

104

What causes stress ulcers?

Trauma, burns, head injuries, shock, or sepsis

105

What is the hallmark of stress ulcers?

Upper GI hemorrhage

106

When a patient is in shock, what can be done to prevent stress ulcers?

Start on tube feeds

107

What are Curling's ulcers caused by?

Burns

108

What are Cushing's ulcers caused by?

Head injury

109

What causes PUD?

NSAIDs, smoking, caffeine, Theophlylline and alcohol

110

How does Theophlylline cause ulcers?

It stimulates the HCL production

111

Where is the pain from gastric ulcers located?

Right upper quadrant

112

What is the most serious complication of ulcers?

Bleeding

113

What tests diagnose ulcers?

CBC and H&H, EGD

114

If a patient is hemorrhaging from an ulcer, what do you do?

Treat and prevent dehydration, stop the bleeding

115

What drug can be given to stop hemorrhaging?

Vasopressin

116

What are the three major complications that can occur from an ulcer?

Hemorrhage, Gastric Perforation, and Obstruction

117

What is the pharmacological treatment for ulcers?

Two antibiotics and a PPI

118

What does Carafate do?

Forms a viscid and stick gel and adheres to ulcer surfaces, forming a protective barrier

119

What teaching do patients on Carafate need?

Give on an empty stomach one hour before meals and at bed time

120

What surgical intervention can be used to treat PUD?

Vagotomy, antrectomy, or gastrectomy

121

What does a vagotomy do?

Eliminates the acid secreting stimulus to gastric cells and eliminates pain

122

What are the gastrectomy options?

Billroth 1 and 2

123

Patients with gastrectomy will develop what kind of anemia?

Pernicious or Folic Acid deficiency

124

What surgery is dumping syndrome associated with ?

Billroth 2

125

What is dumping syndrome?

Feeling like you will die after eating

126

How can dumping syndrome be avoided?

High protein, high fat and low carb diet, eat in recumbent position, avoid fluids, lie down after meals

127

What are the manifestations of a gastrojsjunocolic fistula?

Fecal vomiting

128

Why are protonix given to a patient experiencing a hemorrhage from PUD?

To protect the blood clot over the ulcer

129

What are the nursing interventions for PUD?

Pain, altered nutrition, and fluid volume deficit