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Flashcards in GI Deck (58):
1

what are the functions of the pancreas?

endocrine- insulin
exocrine-disgestive enzymes

2

what is the causes for acute and chronic pancreatitis?

acute- 1. alcohol 2. gallbladder disease
chronic- alcohol
(alcohol destroys your gi tract!)

3

s/s of pancreatitis?

pain- increased with eating
abdominal distention/ascites
abdominal mass- swollen pancreas
rigid broad-like abdomen (this is peritonitis)
bleeding around the umbilical area (cullen's sign)
fever (inflammation)
N/V
jaundice (liver is involved)
hypotension (ascites or bleeding)

4

what lab value is most specific to pancreatitis?

amylase

5

normal lab value for amylase and lipase?

amylase= 30-220
lipase=0-110

6

Normal lab value for hemoglobin

male- 14-18
female 12-16

7

diagnosis for pancreatitis

-serum lipase and amylase UP
-WBCs UP
-Blood sugar UP
-ALT, AST-liver enzymes UP
-PT,PTT LONGER
-serum bilirubin UP
-hemoglobin could go UP or DOWN (up for bleeding and down for ascites)

8

patient with pancreatitis, keep the stomach ____.

empty and dry!!

9

tx for pancreatitis

-NPO (decrease GI secretions)
-pain meds
-steroids
-anticholinergics (to dry up)
-GI protectants
-maintain f&e imbalance
-maintain nutritional status---ease into diet
-insulin (pancreas is sick, TPN (full of sugar), steroids(makes blood sugar go up))
-daily weight
-eliminate alcohol
-refer to AA f this is the cause

10

anytime there is a liver problem, what chemical should you think of?!!

ammonia!

11

**if you liver is sick, your #1 concern is

bleeding

12

if you liver is sick, what should you do with the medication?

decrease the dose

13

never give ____ to people with liver problems. antidote?

acetaminophen
antidote is acetylcysteine

14

4 major functions of the liver

1. detoxify the body
2. helps the blood to clot
3. the liver helps to metabolize (break down) drugs
4. the liver synthesizes albumin

15

Cirrhosis:
liver cells are destroyed and are replaced with connective/scar tissue---alters the ____ within the liver---the BP in the liver goes ____, this is called ____.

circulation
UP
potal hypertension

16

s/s of cirrhosis

-firm, nodular liver
-abdominal pain -liver capsule has stretched
- chronic dyspepsia (gi upset)
- changes in bowel habits
- ascities
- splenomegaly (means immune has kicked in)
- decrease serum albumin
-increased ALT and AST
-anemia
-can progress to hepatic encephalopathy/ coma

17

when the spleen is involve, this mean

immune system is involved!!

18

what should you know with acetylcysteine

give with carb. drink
STINKS
come in a small vial

19

what does albumin do?

hold on to fluid in the vascular space. if NO albumin, fluid goes to peritoneal cavity as ascites

20

Liver biopsy:
-clotting studies pre-procedure: _____
-vital signs pre-procedure
-how do you position this client?
-exhale and hold ____. why?
-post-procedure: lie on ____ side. vital signs, worried about _____.

PT INR and aPTT
worried about hypotension
supine with right arm above bed
breath why? to get the diaphragm out of the way
lie on right side post op (to hold pressure!)
worry about hemorrage

21

ammonia can lead to ___. it acts as a ___.

COMA hepatic encephalopathy.
SEDATIVE

22

tx for cirrhosis

-antacids, vitamins, diuretics
-no alcohol
-i&o and daily weight
-rest (bc toxins are building in the body)
-prevent bleeding!
-measure abdominal girth (why? ascites)
-paracentesis
-monitor jaundice
-avoid narcotics
-diet

23

what diet should cirrhosis patient ?

decrease protein
low NA diet

24

Protein----breaks down to ___----the ___ converts ammonia to ___----___excrete the urea

ammonia
liver
urea
kidneys

25

asterixis

hand tremor
liver flap
(s/s of hepatic coma)

26

what is fetor?

breath smells like ammonia

27

tx hepatic coma

lactulose (decrease ammonia)
cleansing enemas
decrease protein
monitor serum ammonia

28

s/s hepatic coma

-minor mental changes/motor problems
-difficult to awake
-asterixis
-handwriting changes
-reflexes will decrease
-eeg slow
-fetor
-anything that increase ammonia level will aggravate this problem
-liver people tend to be GI bleeders!

29

what is the liver drug to think of?

lactulose (decrease ammonia)

30

high BP in the liver

portal HTN

31

when you see an alcholic client that is GI bleeding it is usually esophageal varies. usually no problem until ____.

rupture

32

tx for bleeding esophageal varies

replace blood
VS
CVP
Oxygen (any time someone is anemic, o2 is needed)
octreotide (lowers bp in the liver)
ballon tamponade
cleansing enemia to get rid of blood
lactulose
saline lavage to get blood out of the stomach

33

what is balloon tamponade?

to hold pressure on bleeding varices

it is an infrequently used emergency procedure that may be used to stabilize client with severe hemorrhage. it should not be used more then 12 hrs. many of the safety implications for the blakemore tube can be applied to other oropharynx or nasopharync tubes.

34

peptic ulcers:
common cause of ___.
can be in the ____.
mainly in females or males?

GI bleeding
esophagus, stomach, or duodenum
males but increasing in females
(erosion is present)

35

s/s of peptic ulcers

burning pain usually in the mid-epigastric area/back.
heartburn (dyspepsia)

erosion can lead to PAin!

36

gastroscopy (EGD,endoscopy): Sedated
NPO until what returns?
watch for?

gag reflex returns

watch for perforation by watching for pain, bleeding, or if they are having trouble swallowing.

37

tx for peptic ulcers

--medications
1.antacids (liquid to coat stomach)
2. proton pump inhibitors (decrease acid secretion) "zole" at the end; omeprazole
3. h2 antagonist
---client teaching
decrease stress, stop smoking, eat what you can tolerate, need to be followed for one year

38

when should a client with a peptic ulcer take an antacid?

take when stomach is empty and at bedtime--- when the stomach is empty. acid can get on ulcer... take antacid to protect ulcer

39

malnourished; pain is usually half hour to 1 hour after meals; food doesnt help, but vomitting does; vomit blood

what is this?

gastric ulcer

40

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

duodenal ulcer

pain with stomach empty
these are lower down than gastric

41

what is hiatal hernia?

this is when the hole in the diaphragm is too large so the stomach moves up into the thoracic cavity

--main cause is large abdomen
--other cause include- congenital abnormalities, surgery, trauma

42

s/s hiatal hernia?

heartburn
fullness after eating
regurgitation
dysphagia

43

tx hiatal hernia

small frequent meals
sit up 1 hour after eating
elevate HOB
surgery
teach lifestyle changes and healthy diet

44

the stomach empties too quickly after eating and the client experiences many uncomfortable to severe side effects.... usually secondary to _____.

dumping syndrome

gastric bypass
gastrectomy
gall bladder

45

lay on ____ to keep food in the stomach.
____= leaves in
____= releases it

left side
lying on left side
right side lying

46

tx for dumping syndome

-semi-recumbent with meals
-lie down after meals
-no fluid with meals
-meals should be small frequent rather than large
-avoid foods high in carbs and electrolyte( becuase they empty fast!)

47

ulcerative colitis is ulcerative inflammatory bowel disease that is just in___.

large intestines

48

post op for colonoscopy, you would watch for

perforation. we are going to assume the worst. the signs of perforation are pain or unusual discomfort

49

difference between koch's ileostomy and a j pouch

koch's - has a nipple valve that opens and closes to empty intestines

j pouch- removes the colon and attaches the ileum to the rectum ( no external bag)

50

if the colostomy is in the ascending and transverse you will have _____. if it is in the descending or sigmoid you will have _____.

which do you irrigate?
why?
best time to irrigate?

semi formed stools
semi formed or formed (because the fluid is almost gone)

descending and sigmoid
regularity
same time everyday, after a meal

51

anytime you are giving an enema, if the client starts to cramp, ____ the fluids, lower the bag and/or check the ___ of the fluid.

what side should the pt be on?

stop
temperature

turn the pt on the left side!!

52

what position should pt be in with feeding tube?

elevate the hob and always want them on their side.

53

appendicitis is related to a ____ fiber diet.
major symptom?

never give what to appendicitis client?

low
initially pain localizes in the right lower quadrant (mcburney's point)

abdominal pain 1st!! then n/v

NEVER GET ENEMAS or LAXATIVES; worry about perforation

54

when a pt with appendicitis waiting for surgery, what position should the client be in?

right side with hob elevated. so all the bowel content will settle in one area.

55

hyperalinmentation is aka __.

(tpn) total parenteral nutrition

56

should anything else go through the line for tpn?

no

57

glucose in urine---- need ___
ketone in urine---- need ____

insulin

fat; you should change recipe

58

what position sould the client be in for placement of a central line?

trendenlenburg left side