GI Flashcards
(126 cards)
1
Q
saliva enzylme
A
amylase (aids in digestion)
2
Q
job of lower esophageal (cardiac) sphincter
A
prevent reflux into esophagus
3
Q
job of pyloric sphincter
A
regulate rate of stomach emptying into small intestine
4
Q
job of intrinsic factor
A
absorption of b12
5
Q
job of hydrochloric acid
A
kills micros
breaks down food
gastric enzyme activation
6
Q
job of large intestine
A
absorbs water
eliminates waste
synthesis of vit b and vit k
7
Q
job of peritoneum
A
lines the abdominal cavity
8
Q
job of liver
A
remove bacteria in blood removes extra glucose and amino acids from blood makes glucose amino acids and fat digests fats carbs and protein stores and filters blood stores vitamins and iron
9
Q
job of gallbladder
A
stores and concentrates bile
10
Q
job of pancreas
A
secretes bicarb to neutralize stomach acid
secretes glucagon to raise blood sugar
secretes insulin
11
Q
barium swallow
A
pt drinks barium sulfate then an xray is used to look at the upper GI tract
12
Q
barium swallow pre procedure
A
NPO for 8 hrs prior to test
13
Q
barium swallow post procedure
A
laxative may be given
increase fluids to pass barium
monitor stools for passage of barium (may be chalky white for 24-72 hrs after)
14
Q
capsule endoscopy
A
patient swallows a small camera capsule; detects bleeding
15
Q
capsule endoscopy pre procedure
A
bowel prep
clear liquids evening before
NPO 3 hrs prior and 2-3 hrs after
16
Q
endoscopy
esophagogastroduodenoscopy
A
sedation required
endoscope goes down esophagus down to duodenum to obtain tissue samples
17
Q
endoscopy pre procedure
esophagogastroduodenoscopy
A
NPO 6-8 hrs prior local anesthetic and moderate sedation meds to reduce secretions and relax smooth muscle place patient on left side monitor airway
18
Q
endoscopy post procedure
esophagogastroduodenoscopy
A
monitor VS
NPO till gag reflex comes back
check for s/s perforation (pain, bleeding, elevated temp, difficulty swallowing)
bed rest till sedation wears off
lozenges, saline gargles, oral pain meds for sore throat (DO NOT GIVE IF GAG REFLEX HAS NOT BEEN ASSESSED)
19
Q
colonoscopy
A
endoscopy used to check out large intestine, biopsy and check for polps
place patient on left side with knees to chest
position can be changed during procedure to help scope pass through
20
Q
colonoscopy pre procedure
A
colon cleanse clear liquids day before (NO red orange purple liquids) talk to MD about meds to withhold NPO 4-6 hrs before hand moderate sedation muscle relaxers
21
Q
colonoscopy post procedure
A
monitor VS
bed rest till alert
check for s/s bowel perforation and peritonitis
passing gas, abdominal fullness, and cramping are expected
report bleeding to MD
22
Q
patients taking bowel cleanse prep and enemas are at risk for
A
fluid and electrolyte imbalance
23
Q
s/s bowel perforation and peritonitis
A
rigid boardlike abdomen n/v diminished bowel sounds decreased urine output hiccups guarding of abdomen increased temperature chills pallor abdominal distention abdominal pain restlessness tachycardia tachypnea
24
Q
endoscopic retrograde cholangiopancreatography
ERCP
A
exam of hepatobiliary system via endoscope through esophagus
25
endoscopic retrograde cholangiopancreatography
| (ERCP) monitoring
```
respiratory
central nervous system depression
hypotension
oversedation
vomiting
```
26
endoscopic retrograde cholangiopancreatography
| (ERCP) pre procedure
NPO 6-8 hrs
ask about contrast allergies
moderate sedation
27
endoscopic retrograde cholangiopancreatography
| (ERCP) post precedure
check VS
check gag reflex
check s/s perf or peritonitis
28
what need to be monitored after endoscopic procedures?
gag reflex
| if has not returned patient is at risk for aspiration
29
paracentesis
transabdominal removal of fluid from peritoneal cavity
30
paracentesis priority nursing actions
informed consent
obtain VS and weight
(weight before and after)
assist patient to void to move bladder out of the way
position patient upright and on edge of bed with back supported and feet on stool (or in fowlers position)
provide comfort and support
apply dressing to site of puncture
check blood pressure and pulse post procedure
weight patient post procedure
maintain bed rest
measure fluid removed
label and send fluid to lab
document event patients response and appearance and amount of fluid removed
31
paracentesis post procedure
dry sterile dressing
check for bleeding
measure abdominal girth and weight
check for hypovolemia electrolyte loss mental status changes or encephalopathy
check for hematuria
report to MD if urine is bloody pink or red
**rapid removal of fluid from abdominal cavity leads to decreased abdominal pressure causing vasodilation and can cause shock. monitor HR and BP closely
32
liver biopsy
needle inserted into abdominal wall to liver to get tissue samples
33
liver biopsy pre procedure
assess coagulation
give sedative
supine or left lateral position
34
liver biopsy post procedure
check VS
check for bleeding
check for peritonitis
bed rest for hours
place on right side with pillow under costal margin for 2 hrs to decrease bleeding
avoid coughing or straining
no heavy lifting or strenuous exercise for 1 wk
35
stool samples
24-72 hr collections must be refrigerated till taken to lab
| send to lab ASAP
36
GERD
backflow of gastric content (acid reflux)
37
GERD s/s
```
heartburn
epigastric pain
dyspepsia
nausea
regurg
pain and difficulty swallowing
hypersalivation
```
38
GERD care
```
avoid factors that cause acid reflux (chocolate, peppermint, coffee, fried or fatty foods, carbonated drinks, ETOH, smoking)
low fat high fiber diet
no eating or drinking 2 hrs before bed
no tight clothes
elevated HOB on 6-8 inch blocks
no anticholinergics
no NSAIDS/aspirin
taken antacids
```
39
gastritis
stomach inflammation caused by irritating foods, aspirin and NSAID overuse, increase ETOH intake, radiation, smoking, and H. PYLORI
40
gastritis s/s
```
hiccups
n/v
headache
reflux
abdominal discomfort
burping
south tast in mouth
vitamin b12 deficiency
```
41
gastritis care
decrease floods and fluids till s/s decrease
then ice chips given then clear liquids then food
check for hemorrhagic gastritis (hematemesis, tachycardia, hypotension) and report to MD
no spicy or highly seasoned food
no caffeine
no ETOH
no smoking
antibiotics for h.pylori
vitamin b12 injections
42
peptic ulcer disease
ulcers on upper GI
| can be gastric or duodenal
43
gastric ulcer disease s/s
gastric: gnawing sharp pain in or to the left of mid epigastric region that occurs 30-60 mins after a meal (food makes pain worse) hematemesis is common
44
gastric ulcer disease care
```
check VS and for bleeding
give small bland feeds
meds to decrease gastric acid
antacids
anticholinergics to reduce gastric motility
mucosal barrier s 1 hr before eating
```
45
gastric ulcer disease teaching
```
no ETOH
no caffeine
no chocolate
no smoking
no aspirin or NSAIDS
reduce stress
rest
```
46
gastric ulcer care during bleeding
```
check s/s of dehydration, shock, sepsis, respiratory insufficiency
maintain NPO
IVF
I&O
check H&H
give blood
```
47
peptic ulcer disease surgery
```
gastrectomy
vagotomy
castric resction
gastroduodenostomy
gastrojejunostomy
phyloroplasty
```
48
gastric ulcer surgery postop
```
check VS
fowlers position for comfort and drainage
increase fluids
I&O
assess bowel sounds
NG suction
NPO 1-3 days till peristalsis returns
progressive diet
check for complications (hemorrhage, dumping syndrome, hypoglycemia, diarrhea, vitamin b12 deficiency)
```
*AFTER GASTRIC SURGERY DO NOT IRRIGATE OR REMOVE NG TUNE UNLESS PRESCRIBED BECAUSE OF RISK FOR DISRUPTION OF GASTRIC SUTURES. CHECK PROPER FUNCTIONS OF NG TUBE TO PREVENT STRAIN ON ANASTOMOSIS SITE. CONTACT MD IS TUBE IS NOT FUNCTIONING CORRECTLY
49
duodenal ulcers s/s
duodenal: burning pain 1.5 to 3 hrs after meal and at night (wakes patient). melena is common. food decreases the pan
50
duodenal ulcers care
```
VS
small frequent bland meals
rest
no smoking
no alcohol
no caffeine
no aspirin
no NSAIDS
no steroids
antibiotics for h.pylori
antacids
```
51
dumping syndrome
rapid emptying of gastric contents
52
dumping syndrome s/s
```
occurs 30 mins after eating
n/v
abdominal fullness
abdominal cramps
diarrhea
palpitations
tachycardia
perspiration
weak
dizzy
borborygmi (loud gurgling sounds from hyperactive bowels)
```
53
dumping syndrome education
```
no sugar
no salt
no milk
high protein high fat low carb diet
eat small meals
no fluids with meals
lie down after meals
antispasmodic meds to delay gastric emptying
```
54
vitamin b12 deficiency
lack of absorption or lack of intake
55
vitamin b12 deficiency s/s
```
pallor
fatigue
weight loss
smooth beefy red tongue
jaundice
paresthesias of hangs and feet
gait and balance issues
```
56
vitamin b12 deficiency care
increase b12 in diet (green leafy veggies, citrus, dried beans, liver, nuts, organ meat, brewers yeast)
give vitamine b12 injections (weekly at first then monthly). injections are lifelong
57
bariatric surgery post op
clear liquids introduced slowly in 1 oz (30 ml) servings at a time once bowel sounds have returned
58
bariatric surgery patient teaching
```
no alcohol
no high protein
no high sugar or fat foods
eat slowly
chew food well
progressive diet
supplements needed
check for complications (dehydration persistent abdominal pain and n/v)
```
59
hiatal hernia
esophageal or diaphragmatic hernia
portion of stomach herniates through diaphragm and into thorax
caused by weakened diaphragm muscles
60
hiatal hernia s/s
```
heartburn
regurg
vomiting
dysphagia
feeling of being full
```
61
hiatal hernia care
```
surgery
small frequent meals
limit liquids with meals
do NOT recline for 1 hr after eating
NO anticholinergics
```
62
cholecystitis
gallbladder inflammation
63
cholelithiasis
acute inflammation with gallstones
64
cholecystitis s/s
```
n/v
indigestion
burping
farting
epigastric pain that radiates to right should or scapula
RUQ pain triggered by high fatty or large meals
guarding
rigidity and rebound tenderness
mass on RUQ
murphy's sign
elevated temp
tachycardia
dehydration
```
65
murphy's sign
can NOT take deep breath when examiners fingers are below hepatic margin because of too much pain
66
biliary obstruction
```
jaundice
dark orange and foamy urine
steatorrhea
clay colored feces
pruritus
```
67
cholecystitis care
```
NPO during n/v
NG decompression
antiemetics
pain meds
antispasmodics (anticholinergics)
eat small low fat meals
no gassy foods
surgery
```
68
cholecystectomy
removal of gallbladder
69
cholecystectomy post op care
```
check respiratory
cough and deep breath exercises
early ambulation
splinting abdomen to prevent discomfort when coughing
antiemetics
pain meds
NPO and NG tube suction
clear liquids then solids when tolerated
T-tube care if present
```
70
T Tube
preserves patency of bile duct
ensures drainage of bile until edema resolves
attached to gravity drainage bag
71
T Tube care
semi fowlers position
check output amount and color consistency and odor
report sudden increase in bile output
check for inflammation
protect skin from irritation
keep drain below level of gallbladder
report foul odor or purulent drainage
avoid irrigation aspiration or clamping of t tube without an order
clam tube before meal and observe for abdominal discomfort and distention n/v chills fever, unclamp is n/v occurs
72
cirrhosis
chronic progressive disease of the liver that causes destruction of hepatocytes
73
cirrhosis complications
```
portal hypertension
ascites
esophageal varices
coagulation defects
jaundice
encephalopathy
hepatorenal syndrome
```
74
portal hypertension
persistent increase in portal vein pressure caused by an obstruction
75
ascites
accumulation of fluid in peritoneal cavity
76
esophageal varices
fragile thin walled distended esophageal vein
77
portal encephalopathy
end stage hepatic failure characterized by altered levo of consciousness, neuro s/s, impaired thinking, and neuromuscular disturbances all caused by increased levels of ammonia
78
hepatorenal syndrom
progressive renal failure and hepatic failure
decreased urine output
increased BUN and creatinine
79
cirrhosis care
```
elevated HOB to decrease SOA
high protein diet with supplements (if patient is does not have ascites, edema, or s/s of coma)
restrict fluids and sodium
start NG feeds or TPN
diuretics
I&O
check electrolytes
daily weight
check abdominal girth
check for pre-coma state (tremors, delirium)
monitor for asterixis (coarse tremor that is rapid and non rhythmic = flapping of hands)
check for fector hepaticus (fruity musty breath)
gastric intubation
give blood
check coags
give lactulose to decrease pH ad production of ammonia
antibiotics
no opioids or sedative
NO ETOH
paracentesis
surgical shunting
```
80
how to measure abdominal girth
client is supine
bring tape measure around client and take measurement at level of umbilicus
mark abdomen along side of tape on patients flanks and midline to ensure that later measurement are taken at same place
81
esophageal varices
emergency of dilated veins in the esophagus
82
esophageal varices s/s
```
hematemesis
melena (dark sticky poop containing blood)
ascites
jaundice
hepatomegaly
splenomegaly
dilated abdominal veins
s/s shock
```
83
esophageal varices primary concern
RUPTURE!!
84
esophageal varices care
```
VS
elevate HOB
check for ortho hypotension
check lung sounds and for respiratory distress
give O2
check LOC
NPO
IVF
I&O
H&H
coag levels
give blood and clotting factors
NG tube
no vasovagal activities (give stool softener)
```
85
hepatitis
Hep A: fecal oral, contaminated food or liquids, poor hand washing
Hep B: blood and body fluids, sex, perinatal period, blood and body fluids via birthing process
Hep C: blood circulation
Hep D: if you have B you can get D
Hep E: same as hep A
86
hepatitis prevention
```
hand washing
needle precautions
safe sex
vaccines
treatment of water
```
87
hepatitis home care
handwashing
no sharing bathrooms
use your own washcloths, towels, drinking and eating utensils.
do not prepare food for other family members
no alcohol
no OTC meds (tylenol or sedatives)
increase activity gradually
consume small frequent meals
high carb low fat foods
no donating blood
normal contact as long as proper hygiene is maintained
no kissing or sex with hep B will test results are negative
88
pancreatitis
inflammation of pancreas
89
acute pancreatitis s/s
```
abdominal pain
sudden onset of pain mid epigastric or LUQ radiating to back
pain made worse with fatty meals alcohol or laying recumbent
abdominal tenderness
guarding
n/v
weight loss
absent or decreased bowel sounds
elevated WBC
elevated glucose
elevated bilirubin
elevated lipase and amylase
cullens sign (discoloration at belly button and abdomen)
turners sign (discoloration at flanks)
```
90
acute pancreatitis care
```
withhold food and fluids
IVF
parenteral nutition
supplements/vitamins/minerals
NG tube if vomiting or has obstruction or paralytic ileus
opiates for pain
no alcohol
report if having acute abdominal pain, jaundice, clay colored stool, or dark colored urine
```
91
chronic pancreatitis s/s
```
abdominal pain and tenderness
LUQ mass
steatorrhea
foul smelling stools
weight loss
muscle wasting
jaundice
s/s DM
```
92
chronic pancreatitis care
limit fat and protein
no heavy meals
no alcohol
vitamins and minerals to increase calories
pancreatic enzymes
give insulin or oral DM meds
report if increase steatorrhea abdominal distention or cramping or skin breakdown
93
irritable bowel syndrome (IBS)
chronic or recurrent diarrhea constipation and abdominal pain and bloating
cause is unknown but worse with stress and environment
94
irritable bowel syndrome (IBS) care
increase fiber
drink 8-10 cups fluids daily
meds depend on the s/s (laxative vs. antidiarrheals)
95
ulcerative colitis
ulcers and inflammation of the bowel that results in poor nutrition absorption
colon becomes edematous and develops bleeding lesions and ulcers that can lead to perforation
96
ulcerative colitis s/s
```
anorexia
weight loss
malaise
abdominal tenderness and cramping
severe diarrhea that contains blood and mucus
malnutrition
dehydration
electrolyte imbalance
anemia
vitamin K deficiency
```
97
ulcerative colitis care
NPO and give IVF with electrolytes (acute phase)
TPN
restrict activity to reduce intestinal activity
check bowel sounds
check stools for color consistency and blood
check for bowel perf peritonitis and hemorrhage
progressive diet from clear liquids to low fiber as tolerated
low fiber high protein with vitamins and iron supplements
no gassy foods
no milk
no whole wheat grains
no nuts
no raw fruits or veggies
no pepper
no alcohol
no caffeine
no smoking
98
ulcerative colitis surgery pre op care
diet restrictions: low fiber 1-2 day prior
antibiotics 1 hr prior
body image issues d/t ostomy
99
ulcerative colitis surgery post op care
stoma and ostomy care
check stoma for color and unusual bleeding
check for color changes in stoma
normal stoma should be pink to bright red and shiny
pale pink stoma means low H&H
purple black stoma meas circulation is cut off (report ASAP)
check that stool is liquid postop but should become more solid
ostomy at ascending colon is liquid stool
ostomy at transverse colon is loose to semiformed
ostomy at descending colon is close to normal
empty pouch at 1/3 full
skin care is priority
check for dehydration and electrolyte imbalance
give pain meds
no foods that cause gas
100
crohns disease
inflammatory disease that happens anywhere in the GI tract
thickening and scarring, narrowing lumen, fistulas, ulcers and abscesses
has remissions and exacerbation
101
crohns disease s/s
```
fever
cramplike and colicky pain after meals
diarrhea with mucus and pus
abdominal distention
anorexia
n/v
weight loss
anemia
dehydration
electrolyte imbalance
malnutrition
```
102
crohns disease care
NPO and give IVF with electrolytes (acute phase)
TPN
restrict activity to reduce intestinal activity
check bowel sounds
check stools for color consistency and blood
check for bowel perf peritonitis and hemorrhage
progressive diet from clear liquids to low fiber as tolerated
low fiber high protein with vitamins and iron supplements
no gassy foods
no milk
no whole wheat grains
no nuts
no raw fruits or veggies
no pepper
no alcohol
no caffeine
no smoking
103
appendicitis
inflammation of the appendix
104
appendicitis s.s
```
periumbilical pain that descends to RLQ
pain at McBurneys point
rebound tenderness
abdominal rigidity
low grade fever
elevated WBC
anorexia
n/v
side lying position with legs flexed
abdominal guarding
constipation or diarrhea
peritonitis is rupture occurs
```
105
appendectomy
surgical removal of appendix
106
appendectomy preop
NPO
IVF
check changes in pain (rupture)
check for s/s ruptured appendix and peritonitis
position right side lying or low to semi fowlers
check bowel sounds
ice pack to abdomen for 20-30 mins q 1 hr
antibitotics
NO LAXATIVE
NO ENEMA
NO HEAT TO ABDOMEN
107
appendectomy post op
```
check temp for s/s infection
NPO until bowel function returned
advance diet gradually as tolerated
drain will be placed if appendix ruptures or incision will be left open
profuse drainage for 1st 12 hrs is normal
position right side lying or low to semi fowlers with legs flexed
change dressing as prescribed
record type and amount of drainage
wound irrigation
NG suction
check patency of NG tube
give antibiotics and pain meds
```
108
diverticulosis and diverticulitis
diverticulosis: outpouching or herniation of intestine and can occur at any part of intestine (common in sigmoid colon)
diverticulitis: inflammation of 1 or more diverticula. results in abscess formation and perforations leading to peritonitis (lite on fiber)
109
diverticulosis and diverticulitis s/s
```
LLQ pain that increases with coughing straining or lifting
elevated temp
n/v
farting
cramplike pain
abdominal distention and tenderness
palpable tender rectal mass
bloody stool
```
110
diverticulosis and diverticulitis care
```
bed rest
NPO or clear liquids
introduce fiber gradually wheninflammation is gone
give antibiotics
give pain med
give anticholinergics
no lifting
no straining
no coughing
no bending
check for perforation hemorrhage fistulas and abscesses
increase fluids to 2500-3000 unless contraindicated
eat soft high fiber foods
NO HIGH FIBER WHEN INFLAMMATION OCCURS
no gassy foods
no foods with roughage seeds nurts or popcorn
small amount of bran daily
bulk forming laxative
temporary colostomy
```
111
hemorrhoids
dilated varicose vein of anal canal
112
hemorrhoids s/s
bright red bleeding with poops
rectal pain
rectal itching
113
hemorrhoids care
```
cold pack followed by sitz baths
witch hazel soaks
topical anesthetics
high fiber
increase fluids
stool softeners
```
114
hemorrhoids surgery post op care
```
prone or side lying position to prevent bleeds
icce pack over dressing
check urine retnetion
give stool softeners
increase fluids
high fiber
limit sitting
sitz baths 3-4x daily
```
115
antacids
chewing thoroughly and drink with water or milk
shake liquid before dispensing
allow 1 hr between antacid and other meds
116
proton pump inhibitors
end in -prazole
suppress gastric acid secretion
side effects: headaches, diarrhea, abdominal pain, nausea
117
meds to treat H. pylori
end in -prazole + antibiotics
| can use multiple at one time
118
bile acid sequestrants
start with cole or chole
| use cautiously with suspected bowel obstruction or constipation because it could make it worse
119
treating encephalopathy
lactulose
increases peristalsis and bowel evaucation
want ammonia 10-80
oral syrup or rectally
120
pancreatic enzyme replacement
pancrelipase
taken with ALL meals and snack
side effect: abdominal cramps, pain, n/v/d
121
treatment of chrons and ulcerative colitis
steroids
antimicrobials
immunomodulators
meds can decrease immune system increase blood sugar increase risk of infection
122
antiemetics
control vomiting and motion sickness
check VS, I&O, s/s dehydration, electrolytes
limit oral intake to clear liquids when pt is vomiting and nauseated.
can cause drowsiness so protect form injury
123
bulk forming laxatives
absorb water into feces and increase bulk
124
stimulant laxative
stimulate motility of large intestine
125
emollient laxatives
inhibit absorption of water
| used to avoid straining
126
osmotic laxative
attract water to produce bulk and stimulate peristalsis
