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GI Flashcards

1
Q

Gastroenteritis: Assessment

A

Medical History
Med review (most meds can be constipating)
Diet history
Travel history (H2O)
Physical and abdominal assessment (distention, BP, skin, dehydration, cardiac

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2
Q

Gastroenteritis: Management

A 
Hand washing
Isolation (contact isolation)
Identify cause
F&E replacement (Na+, K+, Cl-, glucose)
Food safety measures (turkey)
Dietary management
*Don't give anti-diarrheals
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3
Q

Gastroenteritis: Medications

A

Antidiarrheals
Narcotic
Anticholinergic
Probiotics

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4
Q

Diarrhea

A

Risk for deficient fluid volume (Monitor I&O, BP; watch trends, hydration assessment, might have to do IV infusion; Ringer’s lactate)
Risk for impaired skin integrity (lots of nutrients, barrier creams, might have to sit in sits bath; avoid overuse of soaps)

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5
Q

Diarrhea: Evaluation

A 
Stool frequency
Nutritional status
Weight
Fluid volume status
Skin integrity
Monitor electrolytes
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6
Q

Diarrhea: Teaching

A

Teach causes and preventative measure
Infection control (isolate STAT if C.Diff)
Purification of water for travel
Fluid replacement
Chronic diarrhea (may be sign of chronic constipation)

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7
Q

Intestinal Obstruction: Assessment/ Management

A

Assess for bowel sounds (hypoactive; potential for blockage), distention
Assess for complications

Diagnostic tests
Gastric decompression
Surgery (take out the area where the obstruction is)

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8
Q

Intestinal Obstruction: Nursing Implementation

A

Monitor dehydration and electrolyte status closely
Strict intake and output (if nothing is going through- NPO)
NG tube care (always ensure proper placement)
IV fluids
Comfort measures and a quiet environment (High/semi fowlers)
Postop care same as for laparotomy

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9
Q

Intestinal Obstruction: Deficient Fluid Volume/ Ineffective Breathing Pattern

A

Monitor VS and CVP (Central venous pressure)
I&O, urine output, gastric output
Measure abdominal girth

Resp. rate, lung sounds
Resp. support

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10
Q

Intestinal Obstruction: Evaluation

A 
Abdominal girth
Bowel sounds
Pain
Tolerance
Fluid volume status
Potential complications
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11
Q

Colorectal Cancer

A

Colon cancer screening guidelines; for the individual at average risk, colonoscopy every 10 years (If polyps are seen during colonoscopy, screening becomes yearly)
Important hereditary condition; familial adenomatous polyposis (FAP) (if family member is diagnosed, you get screened 10 years before they were diagnosed)

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12
Q

Colorectal Cancer: Prognosis

A

Early detection, better prognosis
Depends on extent of timor invasion, cell type, degree of dysplasia, tumour genetics, presence or absence of metastasis
TNM classification used for metastasis

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13
Q

Colorectal Cancaer: Treatment

A

Surgical removal
Colostomy
Chemotherapy, radiation, or both

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14
Q

Colorectal Cancer: Assessment

A

Effects of the disease (not just pt. but whole family)
Treatment (depends on person. May be palliative surgery)
Clients ability to function and maintain ADLs

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15
Q

Colorectal Cancer: Nursing Implementation

A

Health Promotions: Screening, use of NSAIDs
Acute Interventions: Preop; Similar to care of a client undergoing laparotomy. Postop; After abdominal resection, 2 wounds and a stoma
Ambulatory and home care: Psychological support for client and family

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16
Q

Colorectal Cancer: Complications/ Management

A

Bowel obstruction
Perforation into neighbouring organs

Annual screening beginning at age 50
Diagnostic tests
Surgery
Adjunctive therapy (chemo)

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17
Q

Colorectal Cancer: Nursing care

A

Provide emotional support
Teaching
Surgical needs (RT hemicolectomy; LT hemicolectomy; Abd. - perineal resection; laproscopic colectomy; laproscopic)

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18
Q

Colorectal Cancer: Teaching

A 
Prevention
American Cancer Society recommendations
Regular health examinations
Tests and procedures
Ostomy care
Pain and symptom management
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19
Q

Colorectal Cancer: Nursing Diagnosis

A

Diarrhea or constipation
Acute pain
Fear
Ineffective coping

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20
Q

Colorectal Cancer: Planning

A

Goals include appropriate treatment, normal bowel pattern, good quality of life, relief of pain and promotion of comfort

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21
Q

Inflammatory Bowel Diease: Goals of Treatment

A 
Rest the bowel
Control inflammation
Combat infection
Correct malnutrition
Alleviate stress
Symptomatic relief
Improve quality of life
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22
Q

Inflammatory Bowel Disease: Planning

A

Experience a decrease in number and severity of acute exacerbations
Maintain normal fluid/electrolyte balance
Remain free from pain or discomfort
Comply with medical regimen
Improve QOL

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23
Q

Inflammatory Bowel Disease: Surgical Therapy

A

Procedures for chronic ulcerative colitis:
Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch)
Total protocolectomy with permanent ileostomy
Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch) or permanent ileostomy

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24
Q

Ulcerative Colitis and Crohn’s Disease: Managemetn

A 
Manage symptoms
Control disease process
Supportive care
Diagnostic tests
Medications
Dietary management
Surgery
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25
Ulcerative Colitis: Treatment
Corticosteroids Broad spectrum antibiotic Salicylate analogs Immunomodulating agents (Azathioprine; Mercaptopurine) IV followed by oral cyclosporine for refractory Infliximab (Remicade) for refractory
26
Crohn's Disease: Treatment
Prednisone and sulfasalazine Antibiotics: metronidazole Azathioprine, 6-mercaptopurine, methotrexate, and biologic therapies (refractory) Anti-tumor necrosis factor agents infliximab, adalimulab, and certolizumab (refractory)
27
Crohn's Diease: Surgical therapy
75% will require surgery Surgery produces remission, but high recurrence rate Ileostomy
28
Colostomy or Ilostomy: Diagnosis
``` Change in body image Nutritional imbalance Loss of sexuality Possible dehydration Diarrhea Impaired skin integrity Anxiety Ineffective coping Ineffective therapeutic regimen management ```
29
Ulcerative Colitis and Crohn's Disease: Teaching
``` Disease process, effects, stress Treatment options Medications Complications, management Diet Nutritional supplements Fluids Exercise Teaching for surgery ```
30
Malabsorption: Nursing Care
Effects on nutrition and bowel patterns Nutritional status Weight, fat fold measurements, lab data, dietary intake Enteral feeding supplements as prescribed I&O, daily weights, skin turgor, mucous membranes Frequency stools Medications Skin care
31
Malabsorption: Management
Find and treat the cause
32
Malabsorption: Teaching
``` Daily management Diet Medication regime Reading labels Fluid intake Exercise Daily weights Manifestations to report to physician Dietician or counselor referrals ```
33
Malabsorption: Treatment
Gluten-free diet Supplemental iron, folate, B12, fat soluble vitamins (A, D, E, K) Oral corticosteroids or other immunomodulating agents for refractory
34
Hiatus Hernia
Conservative therapy: Lifestyle modifications Elevation of bed 30 degrees Use antacids and H2R blockers Weight reduction, if overweight (reduce fats in diet, separate fluids from solids) Surgical therapy (if lifestyle changes don't work)
35
Hiatal Hernia: Complicationa
Upper GI bleeding Erosive esophagitis If symptoms persist might need surgery Management: Diagnosis made if able to reduce or manipulate; surgery
36
Hernia
Risk for ineffective tissue perfusion: Gastrointestinal - comfort measures bowel sounds signs of strangulation
37
Hernia: Nursing Care/ Teaching
Preoperative assessment Postoperative care Risk factors Surgical intervention Pain management Activity restrictions
38
Nissen Fundoplication
Bring two sides of the stomach together and suture it Risk of perforation Have no decreased volume intake of stomach Do not irrigate because it will cause too much pressure and dehiscence
39
Peptic Ulcer Disease: Aim of treatment
decrease degree of gastric acidity Enhance mucosal defense mechanisms Minimize harmful effects on mucosa
40
Peptic Ulcer Disease: Overall Goals
Comply with prescribed therapeutic regimen Experience a reduction or absence of discomfort related to peptic ulcer disease Exhibits no signs of GI complications Have complete healing (no S&S) Lifestyle changes to prevent recurrence
41
Peptic Ulcer Disease: Medical regimen consists of:
``` Adequate rest Dietary modification (keep food diary; smaller more frequent meals) Drug therapy Elimination of smoking Long-term follow-up care ```
42
Peptic Ulcer Disease: Drug Therapy
``` Antacids H2R blockers PPIs Antibiotics (add probiotic; finish whole treatment) Anticholinergics Cytoprotective therapy ```
43
Peptic Ulcer Disease: Drug Therapy
Antacids Used as adjunct therapy for peptic ulcer disease Increase gastric pH by neutralizing acid Histamine-2 receptor blocks (H2R blockers) Used to manage peptic ulcer disease Block action of histamine on H2 receptors - Decrease HCl acid secretion - Decrease conversion of pepsinogen to pepsin - Increase ulcer healing
44
Peptic Ulcer Disease: Drug Therapy
Proton pump inhibitors (PPI) Block ATPase enzyme that is important for secretion of HCl acid Antibiotic therapy (High rate of recurrence if they don't finish treatment) Eradicate H. pylori infection No single agents have been effective in eliminating H. pylori
45
Peptic Ulcer Disease: Drug Therapy
Anticholinergic drugs Occasionally ordered for treatment Decrease cholinergic stimulation of HCl acid Cytoprotective drug therapy Used for short-term treatment of ulcers Tricyclic antidepressants (help block acidity) Serotonin reuptake inhibitors
46
Peptic Ulcer Disease: Nutritional Therapy
Protein considered best neutralizing food - Stimulates gastric secretions Carbohydrates and fats at least stimulating to HCl acid secretion - Do not neutralize well Milk (often interferes with antibiotics) can neutralize gastric acidity and contains prostaglandins and growth factors - Protects GI mucosa from injury
47
Peptic Ulcer Disease: Acute Intervention
Patient generally complains of increased pain, N&V, and some bleeding May be maintained on NPO status for a few days, have NG tube inserted, fluids replaced intravenously Physical and emotional rest are conducive to ulcer healing
48
Peptic Ulcer Disease: Acute Exacerbation
Treated with same regimen used for conservative therapy Stuation is more serious because of possible complications of perforation, hemorrhage, gastric outlet obstruction Accompanied by bleeding, increased pain and discomfort, N&V
49
Peptic Ulcer Disease: Acute Exacerbation
Recurrent vomiting, gastric outlet obstruction - NG tube placed in stomach with intermittent suction for about 24-48 hours - F&E are replaced by IV infusion until patient is able to tolerate oral feedings without distress
50
Peptic Ulcer Disease: Acute Exacerbation
Management is similar to that for upper GI bleeding Blood or blood products may be administered Careful monitoring of VS, I&O, lab studies, signs of impending shock
51
Peptic Ulcer Disease: Acute Exacerbation
Endoscopic evaluation reveals degree of inflammation or bleeding and ulcer location 5-year follow-up program is recommended
52
Peptic Ulcer Disease: Hemorrhage
Changes in VS, increase in amount and redness of aspirate signal massive upper GI bleeding Increased amount of blood in gastric contents decrease pain because blood helps neutralize acidic gastric contents Keep blood clots from obstructing NG tube
53
Peptic Ulcer Disease: Perforation
Sudden, severe abd. pain unrelated in intensity and location to pain that brought client to hospital Indicated by a rigid, board-like abd. Severe generalized abd. and shoulder pain Shallow, grunting respirations
54
Peptic Ulcer Disease: Perforation
Immediate focus to stop spillage of gastric or duodenal contents into peritoneal cavity and restore blood volume NG tube is placed into stomach - Placement of tube as near to perforation site as possible facilitates decompression
55
Peptic Ulcer Disease: Perforation
Circulating blood volume must be replaced with lactated Ringer's and albumin solutions Blood replacement in form of packed RBCs may be necessary Central venous pressure line, in-dwelling urinary catheter should be inserted and monitored hourly
56
Peptic Ulcer Disease: Gastric outlet obstruction
Can occur at any time - Likely in clients whose ulcer is located close to pylorus Gradual onset Constant NG aspiration of stomach contents may relieve symptoms Regular irrigation of NG tube
57
Peptic Ulcer Disease: Gastric outlet obstruction
Decompress stomach Correct any existing F&E imbalanced Improve client's general state of health NG tube inserted in stomach, attached to continuous suction to remove excess fluids and undigested food particles
58
Peptic Ulcer Disease: Gastric outlet obstruction
Continuous decompression allows: - Stomach to regain its normal muscle tone - Ulcer can begin to heal - Inflammation and edema subside When aspirate falls below 200 ml, within normal range, oral intake of clear liquids can begin
59
Health Promotion
Identify patients at risk (high stress, elderly) Early detection and decreased morbidity Encourage clients to take ulcerogenic drugs with food or milk Teach clients to report symptoms related to gastric irritation to health care provider
60
Peptic Ulcer Disease: Surgical therapy
61
Peptic Ulcer Disease: Surgical Procedures
Gastroduodenostomy (Bilroth I) Gastrojejunostomy (Bilroth II) Vagotomy Pyloroplasty
62
Peptic Ulcer Disease: Nutritional therapy
``` Diet should consist of: - Small, dry feedings daily - Low in carbohydrates - Restricted in sugars - Moderate amounts of protein and fat - 30 minutes of rest after each meal Interventions are diet instruction, rest, and reassurance ```
63
Appendicitis: Assessment
Location, severity, onset, duration, precipitating facors, and alleviating measures in relation to the pain Previous abd. distress, chronic illnesses, surgeries; record allergies and medications Temperature; abd. pain, distention, and tenderness; presence and characteristics of bowel sounds
64
Appendicitis: Nursing Care/ Teaching
``` Pain Food Fluids Allergies Medications ``` Preop teaching: turn, DB&C, pain management
65
Appendicitis: Complications/ Management
Perforation Prompt diagnosis and management to prevent perforation Hospitalization, IV fluids, NPO until diagnosis confirmed Diagnostic test Surgery
66
Appendicitis: Evaluation
``` Teach wound/ incision care Wound assessment instructions Dressing changes Hand washing What to report to the physician Activity restrictions Driving, return to work Home care nurses ```
67
Peritonitis: Assessment
Monitor current status Progress of recovery Identify complications
68
Peritonitis: Nursing Care
``` Intensive nursing and medical interventions Diagnostic tests Intestinal decompression Antibiotics Surgery ```
69
Peritonitis: Evaluation
``` Pain level Weight Urine output Documentation Wound healing ```
70
Peritonitis: Teaching
``` Wound care, dressing changes Needed supplies Medications S&S further infection Activity restriction ```
71
Hepatitis: Assess
Recent flulike symptoms Medications Changes in bowel habits, colour of feces and urine Pain (RUQ) Changes in colour of skin or sclera (jaundice) Hx of vaccine Known or possible exposure to Hep virus (travellers; A, B, C)
72
Hepatitis: Overall goals
Relief of discomfort Resumption of normal activities Return to normal liver function without complications
73
Hepatitis: Treatment
Most clients are not hospitalized No cure so treatment is supportive Client must rest in order to rest liver, promote cellular regeneration and prevent complications Interferon injections
74
Hepatitis: Drug Therapy
``` No specific drug therapies Supportive therapy: - Antiemetics - Diphenhydramine (Benadryl) - Chloral hydrate ```
75
Hepatitis: Prevention
Vaccines & immune globulin injections are available to prevent Hep A/B Vaccines recommended for people at high risk Immune globulin is used for post exposure prophylaxis, to prevent disease after known contact
76
Hepatitis: Nursing Diagnoses
Risk for infection Activity intolerance Imbalanced nutrition: less than body requirements Deficient knowledge r/t causes of hepatitis and modes of transmission
77
Hepatitis: Risk for infection
Use standard precautions & meticulous hand washing Hep A-contact isolation if decal incontinence is present Encourage at risk clients to obtain Hep A or B immunizations
78
Hepatitis: Activity Intolerance
Encourage client to rest as needed to relieve fatigue Plan nsg activities that promote rest, allowing gradual resumption of activities Provide or encourage diversional activities based on client's interests Encourage visitors to visit for short periods Place frequently used items close by for easy reach
79
Hepatitis: Imbalanced nutrition
Encourage diet high in carbs and calories, low in fat Encourage eating more food when N&V are minimal Give IV fluids if N&V present. Monitor F&E balance and assess for dehydration
80
Hepatitis: Deficient knowledge
Assess clients knowledge about disease and modes of transmission Instruct client with Hep B/C that a chronic form of the disease may develop and they will need monitoring once discharged If drug or alcohol problem is identified, refer to appropriate persons Teach client to modify sexual practices as directed
81
Hepatitis: Teaching
Prevent spread of disease Vaccination No sharing personal items No sexual activity until no longer infectious

Nursing Theory IV (12 decks)

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