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GI Flashcards

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1
Q

What is the most common type of hernias?

A

Sliding hernia

75-90% of all adult hernias

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2
Q

GERD

A

The result of an incompetent lower esophageal sphincter that allows regurgitation of acidic gastric contents into the esophagus

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3
Q

Signs and symptoms present with GERD

A

Heartburn after eating that radiates to arms and shoulders

Feeling of fullness and discomfort after eating

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4
Q

Positive diagnosis of GERD is determined by

A

Fluoroscopy or barium swallow, gastroscopy

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5
Q

Nursing interventions for GERD

A

Encourage small frequent meals
Eliminate foods that aggregate symptoms (caffeine, strawberries, and chocolate)
Encourage pt to sit up when eating and remain upright for at least 1 hour after eating
Stop eating 3 hours before bed
Elevate hob (semi folwers or fowler position)

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6
Q

Common drug class medications prescribed for GERD

A

h2 antagonists
Antacids (after meals)
Mucosal healing agents (at least 1 hour before meal)
Proton pump inhibitors (before meals)

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7
Q

Peptic ulcer disease

A

Ulceration that penetrates the mucosal wall of the GI Tract

Gastric ulcers
Duodenal ulcers (most common)
Esophageal ulcers

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8
Q

Cause of PUD

A

Cause of some is unknown

Most caused by bacterium called helicobacter pylori (h. Pylori)

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9
Q

Risk factors for PUD

A 
NSAIDS or corticosteroids 
Alcohol
Smoking
Stress or trauma 
Familial tendency 
Blood type O
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10
Q

Symptoms common to all types of ulcers are

A

Benching
Bloating
Epigastric pain radiating to the back (not associated with type of food eaten) and relieved by antacids

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11
Q

Presence and location of peptic ulcer is determined by

A

Esophagogastroduodenscopy (EGD)
Barium swallow
Gastric analysis indicating increased levels of stomach acid

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12
Q

Potential complications involving PUD

A

Hemorrhage
Perforation (requires surgery)
Obstruction

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13
Q

Nursing interventions with PUD

A

Determine symptoms onset and how they are relieved
Monitor color, quantity, and consistency of stoops and emesis, and test for occult blood.
Small freq meals, no bedtime snacks
Avoid caffeine
Teach client symptoms of GI bleeding
Teach cessation of smoking and stress reduction

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14
Q

What should we educate patients about dumping syndrome related to PUD post op surgery?

A

Occurs 5-30 mins after eating
Characterized by vertigo, syncope, sweating, pallor, tachycardia, hypotension

Eat small freq meals that are high in protein and fat and low in carbs

Exacerbated by consuming liquid with meals,
Helps by lying down after eating

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15
Q

Symptoms and clinical manifestations of GI bleed include

A 
Dark tarry stools 
Coffee ground emesis 
Bright red rectal bleeding 
Abdominal mass of bruit 
Fatigue 
Pallor
Severe abdominal pain (should be reported immediately bc it could denote perforation)

Decreased Bp, rapid pulse, cool extremities, increase respirations

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16
Q

Inflammatory bowel diseases include which two diseases

A

Chrons disease and ulcerative colitis

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17
Q

Chohns disease

A

Subacute, chronic inflammation extending throughout all layers of intestinal mucosa which has a cobblestone appearance of the GI mucosa with periods of remission interspersed with periods of exacerbation.

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18
Q

When does Crohn’s disease usually occur? (Life cycle wise)

A

Usually teenage/early adult

Has second peak in the 6th decade

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19
Q

Is there a cure for Crohn’s disease?

A

As of now no.
Treatment relies on medications to treat the acute inflammation and maintain a remission

Surgery is used in cases where medications are not working

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20
Q

Nursing assessment with Crohn’s disease

A

Abdominal pain that is unrelieved by pooping in the right lower quadrant.
Diarrhea, steatorrhea (fatty diarrheal stools), weight loss, anemia, malnutrition
Constant fluid loss
Low grade fever
Anorexia due to pain after eating

Perforation of intestine due to severe inflammation is a medical emergency

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21
Q

Nursing interventions Crohn’s disease

A

Determine bowel patterns and control diarrhea with diet and meds
Diet should be low fat, high protein and calories and no dairy
Avoid spicy foods, smoking, caffeine, pepper, alcohol and milk
Monitor Is and Os
Weigh at least twice weekly
If Ileostomy is performed teach stoma care

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22
Q

Ulcerative colitis

A

Disease that affects the superficial mucosa of the large intestines and rectum causing the vowel to eventually narrow, shorten, and thicken due to muscular hyper trophy

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23
Q

Nursing assessment of ulcerative colitis

A

Diarrhea
Abdominal pain and cramping
Intermittent tenesmus (anal contractions) and rectal bleeding
Liquid stools containing blood, mucus, and pus
Sometimes passes 10-20 stools per day
Weakness and fatigue
Anemia

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24
Q

Nursing interventions for ulcerative colitis

A

Determine bowel pattern and control diarrhea with diet and meds
Diet should be low fat, high in proteins and calories and no dairy
Avoid spicy foods, smoking, caffeine, pepper, alcohol, and milk
Monitor Is and Os
Weigh at least twice a week
If ileostomy is performed teach stoma care

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25
When giving opiate drugs with gastric conditions you should
Give with caution Assess for abdominal distention, abdominal pain, abdominal rigidity, s/s of shock, increased HR, decreased BP, These could indicate possible perforation or GI bleed
26
Diverticulosis
Bulging pouches in the GI wall which push the mucosa lining through the surrounding muscle Usually no discomfort and problem goes unnoticed unless seen on radiologic exam (prompted by other diagnosis)
27
Diverticulitis
Inflamed diverticula which may cause obstruction, infection, and hemorrhage
28
Nursing assessment for diverticula r diseases
Left lower quadrant pain Increased flatus Rectal bleeding Possible intestinal obstruction
29
Signs of intestinal obstruction
Constipation alternating with diarrhea Abdominal distention Anorexia Low grade fever
30
Diverticular diseases diet
High fiber and 3 L of fluids per day unless inflammation is present in which case patient is: Acute phase: NPO graduating to liquids Recovery phase: no fibers or foods that irritate the bowel Maintenance phase: high fiber diet with bulk forming laxatives to prevent pooling of foods in the pouches Avoid small poorly digested foods such as popcorn, nuts, seeds
31
Complications of diverticular diseases
Obstruction Peritonitis Hemorrhage Infection
32
Intestinal obstruction
Partial or compete blockage or intestinal flow (fluids, feces, gas) that occurs mostly in the small intestines
33
Nursing assessment for intestinal obstruction
Sudden onset of abdominal pain, tenderness, or guarding | Increased peristalsis when obstruction first occurs then peristalsis becomes absent when paralytic ileus occurs
34
Bowel sounds of intestinal obstruction
High pitched with early mechanical obstruction and diminish to absent with neurogenic or late mechanical obstructions
35
Types of intestinal obstructions
Mechanical- hernia, adhesions, tumors, diverticulitis, gallstones. (due to disorders outside the bowel caused by disorders within the bowel or by blockage of the linen in the intestine) Neurogenic- paralytic ileus (usually post op patients) or a spinal cord lesion Vascular- mesenteric artery occlusion
36
Nursing interventions with intestinal obstruction
Maintain client NPO with IV fluids and electrolyte therapy Monitor Is and Os Implement NG intubination- advance the tube every 1-2 hours and reposition client to assist with placement. Note amount, color, consistency, and odor of drainage when suctioning Assess abdomen regularly for distention, rigidity, and change in status with bowel sounds
37
How long should food and fluids be restricted when preparing for bowel surgery
8-10 hours
38
If the patient has a bowel obstruction or perforation what is a major contraindication?
Bowel cleansing
39
Colorectal cancer
Tumor occurring in colon 4th most common cancer in US 2nd leading cause of cancer deaths Highest incidence in people older than age 50 Diet high in fiber and low in fat foods may be factor in preventing colon cancer
40
Recommendations for early detection of colon cancer
Digital rectal exam (DRE) every year after 40 A stool blood test every year after 50 A colonoscopy every 10 years after age 50 in average risk clients (may be more often based on advice from physician)
41
What serum level is used to evaluate effectiveness of chemotherapy with colon cancer
Carcinoembryonic antigen (CEA) serum level
42
Nursing assessments for colon cancer
``` Rectal bleeding Change in bowel habits Sense of incomplete evacuation Abdominal pain, nausea, vomiting Weight loss, cachexia Abdominal distention or ascites History of polyps ```
43
Nursing interventions for colon cancer
Prepare client for surgery Prepare client for bowel preparation If colostomy has been performed teach stoma care High calorie high protein diet Promote prevention of constipation with high fiber diet
44
The more distal the stoma is the...
The greater the chance for incontinence
45
How often is stoma pouch system changed?
Every 3-7 days
46
How do you remove effluence from sides of stoma pouch?
Simple squirt bottle
47
When should pouches be emptied?
When they become 1/3 to 1/2 full
48
Defending colon colostomies should be irrigated and cleaned...
The same time every day Using warm water Wash around stoma with Luke warm water and mild soap
49
Odor control can be managed by
Diet
50
Cirrhosis
Degeneration of liver tissue causing enlargement, fibrosis, and scarring
51
Causes of cirrhosis
``` Chronic alcohol ingestion Viral hepatitis Exposure to hepatotoxins Infections Cogenital abnormalities Chronic right sided HF ```
52
Physical findings of patient with cirrhosis
``` Weakness, malaise Anorexia and weight loss Palpable liver (early), abdominal girth increases as liver enlarges Jaundice Fector helaticus (fruity or musty breath) Asterixis (hand flapping tremor) Mental/behavioral changes Bruising, erythema Dry skin Ascites Hematemis Palmar erythema (redness in palms of hands) ```
53
Clinical manifestations of jaundice
Yellow skin, sclera, or mucosal membranes (bilirubin in skin) Dark colored urine (bilirubin in urine) Chalky or clay colored stools (no bilirubin in stools)
54
What should you do in case an esophageal varices ruptures?
Insertion of esophagogastric balloon tamponade Vasopressors, vit K, coagulation factors, and blood transfusions
55
Laboratory findings in patients with cirrhosis
Elevated: bilirubin, AST, ALT, alkaline, phosphatase, PT, and ammonia Decreased: Hgb, Hct, electrolytes, and albumin
56
When ammonia is not broken down as usual in a damaged lover what does that mean for metabolism of drugs?
The metabolism of drugs is slowed down so they remain in the system longer
57
Complications of cirrhosis include
``` Ascites Edema Portal HtN Esophageal varices Encephalopathy Resp distress Coagulation defects ```
58
Nursing interventions for cirrhosis
Eliminate alcohol or causative agent Observe for mental status every 2 hours Avoid initiating bleeding (use small bore needles, avoid injections wheneve possible) Use electric razor, soft bristle tooth brush Check stools and emesis for frank and occult blood Prevent straining when pooping Avoid soap, rubbing alcohol, and perfumed products (drying skin) Apply moisturizing lotion frequently Monitor IO, abdominal girth, edema Restrict fluids to 1500 mls day
59
Diet for cirrhosis
Low sodium, potassium, fat High carb
60
Hepatitis
Widespread inflammation of liver cells, usually caused by virus
61
People high risk for contracting hepatitis
``` Homosexual males IV drug users Recent tattoos piercings Those living in crowded conditions Health care workers ```
62
Physical signs of hepatitis
Fatigue, malaise, weakness, Anorexia nausea and vomiting Jaundice, dark urine, clay colored stools Dull headaches, irritability, depression Abdominal tenderness in right upper quadrant Fever (hep A) Elevation of liver enzymes (ALT, AST, alkaline, phosphatase) bilirubin
63
Nursing interventions with hepatitis
Plan periods of rest for client High calorie, carb diet with moderate fats and proteins Serve small freq meals Provide vit supplements Provide foods client prefers Give antiemetic prior to eating
64
Pancreatitis
Non bacterial inflammation of the pancreas Can be chronic or acute Acute- occurs when there is digestion of the pancreas by its own enzymes (trypsin). Alcohol ingestion and biliary tract disease are major causes for acute Chronic- progressive, destructive disease that causes permanent dysfunction. Usually from log term alcohol use
65
Nursing assessment/ symptoms for acute pancreatitis
Severe mid epigastric pain radiating to back usually related to excess alcohol ingestion or a fatty meal Abdominal guarding, rigid, boarderlike abdomen and abdominal pain Nausea and vomiting Elevated temperature, tachycardia, decreased Bp, bluish discoloration of flanks Elevated amylase, lipase, and glucose levels
66
Nursing assessment/ symptoms for chronic pancreatitis
Continuous gnawing or burning abdominal pain Reoccurring attacks of severe upper abdominal and back pain Ascites Steatorrhea, and diarrhea Weight loss Jaundice, dark urine
67
Nursing interventions for acute pancreatic
Maintain NPO status Maintain NG tube to suction Have client lay on side with legs drawn up to chest Avoid alcohol, caffeine, fatty, and spicy foods Monitor for hypocalcemia Place in semi fowler to decrease pressure on diaphragm
68
Nursing interventions for chronic pancreatitis
Monitor stools | Client needs a bland low fat diet and needs to avoid rich foods, alcohol, and caffeine
69
Cholecystitis
Acute inflammation of the gallbladder
70
Cholelithiasis
Formation or presence of stones in gallbladder
71
Treatment for cbolecystitis
IV hydration Antibiotics Morphine
72
Treatment for cholelithiasis
Non surgical removal of stones by dissolution therapy, endoscopic retrograde chola giopancreatography (ERCP), and lithotripsy Cholecystectomy is used to remove stones through laparoscope
73
Nursing assessment for cholecystitis
Pain anorexia vomiting of flatulence precipitated by ingestion of fried, spicy, or fatty foods Fever elevated wbcs and other signs of infection Abdominal tenderness Jaundice and clay colored stools (blockage ) Elevated liver enzymes, bilirubin and WBCs
74
Nursing interventions for cholecystitis
``` Administer analgesic for pain Maintain NPO Maintain NG tube to suction Monitor IOs Monitor electrolytes Teach client to avoid spicy, fried, fatty foods and to reduce caloric intake if indicated ```
75
Hiatial hernia
Herniation of the esophagogastric junction and a portion of the stomach into the chest through the esophageal hiatus of the diaphragm

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