gi

Question 1

acute pancreatitis causes x2

Answer 1

alcohol, gallbladder disease

Question 2

chronic pancreatitis #1 cause

Answer 2

alcohol

Question 3

ascites

Answer 3

losing protein rich fluids like enzymes and blood into the abdomen

Question 4

rigid board-like abdomen indicative of

Answer 4

bleeding that can lead to peritonitis

pain, inflammation, tenderness

Question 5

1 concern if liver is sick

Answer 5

bleeding

Question 6

4 major functions of the liver

Answer 6

detoxifying body
helps blood clot
metabolize drugs
synthesize albumin

Question 7

cirrhosis

Answer 7

liver cells destroyed and replaced with scar tissue

• altered circulation in liver
• hypertension

Question 8

when spleen is enlarged…

Answer 8

immune system is involved

Question 9

hepatic encephalopathy/coma

Answer 9

cirrhosis can progress to this

liver damaged = ammonia builds up = goes to brain = sedative

Question 10

paracentesis

Answer 10

removal of fluid from peritoneal cavity;
beware shock (removal of fluids)
- portal hypertension
- vessels to liver stretch
- no albumin to hold in fluid (liver damaged)
- fluid pools in potential space to relieve pressure

Question 11

give a liver client narcotics =

Answer 11

essentially double dosing them! liver can’t metabolize when sick.

Question 12

describe body metabolism of protein

Answer 12

protein = ammonia = liver converts to urea = kidneys excrete urea

Question 13

ammonia effect

Answer 13

sedation

Question 14

asterixis

Answer 14

“liver flap” - hand tremor

indicative of ammonia build up (hepatic coma)

Question 15

fetor

Answer 15

breath smells like ammonia (acetone-y, bottle of wine, fresh cut grass)

Question 16

hepatic coma

Answer 16

can result from ammonia build up due to liver’s inability to break it down to urea for excretion

Question 17

hepatic coma/ammonia build up s/s

Answer 17

mental changes/motor problems
asterixis, handwriting changes
fetor
bleeding

Question 18

hepatic coma tx

Answer 18

lactulose (pulls fluid, ammonia into GI tract and out via diarrhea)

cleansing enemas (get blood out because blood = protein)

decrease protein in diet

monitor serum ammonia

Question 19

bleeding esophageal varices

Answer 19

portal hypertension forces collateral circulation to form - usually no problem until rupture

Question 20

portal hypertension creates collateral circulation in x3

Answer 20

esophagus
stomach
rectum

Question 21

alcoholic client that is GI bleeding is usually

Answer 21

esophageal varices (portal hypertension collateral circulation)

Question 22

peptic ulcers

Answer 22

common cause of gi bleeding; erosion present
esophagus, stomach, duodenum

usually males

Question 23

smoking effect on gi

Answer 23

increases stomach motility, increases stomach secretions

Question 24

when do you take antacids?

Answer 24

when stomach is empty and at bedtime

Question 25

gastric ulcer

Answer 25

malnourished, pain is usually half hour to 1 hour after meals, food doesn't help but vomiting does, vomit blood

Question 26

duodenal ulcers

Answer 26

well-nourished, night time pain is common and 2-3 hours after meals, food helps, blood in stools

Question 27

hiatal hernia

Answer 27

hole in the diaphragm is too large so stomach moves up into thoracic cavity main cause: large abdomen; also - congenital, trauma, surgery

Question 28

dumping syndrome

Answer 28

stomach empties too quickly after eating = many uncomfortable side effects; usually s/t gastric bypass, gastrectomy, gall bladder disease

Question 29

ulcerative colitis

Answer 29

ulcerative inflammatory bowel disease - just the large intestine (colon)

Question 30

crohn's disease

Answer 30

aka "regional enteritis" - inflammation and erosion of ileum, but can be found anywhere in small or large intestines

Question 31

rebound tenderness indicative of

Answer 31

peritoneal inflammation (irritation) aka peritonitis

Question 32

diet for ulcerative colitis and crohn's

Answer 32

low fiber - trying to limit gi motility to help save fluid avoid cold/hot foods and smoking (all increase motility)

Question 33

ileostomy care nota bene x4

Answer 33

- drains liquid all the time; don't have to irrigate - avoid hard to digest and rough foods (increase motility) - gatorade in summer - at risk for kidney stones (always a little dehydrated)

Question 34

which types of colostomy do you irrigate?

Answer 34

descending and sigmoid (formed stools! - ascending and transverse = semi-liquid stool)

Question 35

best times to irrigate colostomy x2

Answer 35

same time every day | after meal

Question 36

if client cramps during enema... x2

Answer 36

lower bag (slow fluids), check fluid temp

Question 37

appendicitis

Answer 37

related to low fiber diet abdominal pain first, nausea/vomiting second do not give enemas or laxatives! (possible rupture)

Question 38

appendicitis: #1 worry

Answer 38

rupture!

Question 39

localized pain in McBurney's point indicative of

Answer 39

appendicitis | right lower quadrant

Question 40

position of choice after any major abdominal surgery

Answer 40

HOB up (relieves pressure on abdomen, decreases tension on suture line)

Question 41

position of choice pre major abdominal surgery

Answer 41

HOB up, right side (bowel content into one quadrant) fetal position okay (comfort)

Question 42

total parenteral nutrition nota bene x6

Answer 42

keep refrigerated but warm for administration central line, dedicated line only discontinue gradually (avoid hypoglycemia) hang for 24 hours max change tubing every bag always pump less than 42ml/hr

Question 43

most frequent complication of tpn

Answer 43

infection

Question 44

how to avoid getting air in line when changing tubing on central line

Answer 44

clamp | valsalva (deep breath and hum)

Question 45

pancreatitis treatment x6

Answer 45

control pain (decrease gastric secretions with NPO, NGT to suction, bed rest, meds) steroids (decrease inflammation) anticholinergics (dry) ppi, h2 antag, antacids maintain f/e balance, nutritional status, daily weight, no alcohol insulin (pancreas damaged, steroids suppress, tpn high in glucose)

Question 46

cirrhosis diet

Answer 46

``` decrease protein (avoid ammonia build up) low Na ```

Question 47

client teaching for peptic ulcers

Answer 47

decrease stress stop smoking eat what you tolerate (avoid super spicy, extreme temp, caffeine) follow for a year

Question 48

hiatal hernia treatment

Answer 48

``` small, frequent meals sit up 1 hour after eating elevate HOB surgery teach lifestyle changes, health diet ```

Question 49

lay on what side to keep food in the stomach?

Answer 49

left side (right side empties it)

Question 50

dumping syndrome treatment

Answer 50

``` semi-recumbent with meals (left side!) lie down after no fluids with meals (in between) small, frequent meals avoid high carbs and electrolytes (empty fast) ```