GI Bleed

Question 1

Upper Gastrointestinal Bleeding: Esophageal Origin

Answer 1

chronic esophagitis-GERD, irritating medications, alcohol, cigarettes, esophageal varices

Question 2

Upper Gastrointestinal Bleeding: Stomach and Duodenal Origin

Answer 2

Bleeding peptic ulcers caused by: NSAIDS, ASA, corticosteroids (irritate and disrupt mucosal barrier

Question 3

melena

Answer 3

Black tarry stools, indicative of an upper GI bleed

Question 4

small amounts of blood in gastric secretions

Answer 4

occult bleeding

Question 5

Diagnostics for a GI Bleed?

Answer 5

• Diagnosed by Endoscopy (EGD)
• Angiography
• CBC-low H/H
• BUN-elevated
• Electrolytes-loss of electrolytes through emesis/stool
• PT-increased risk for bleeding
• Liver enzymes
• ABG - monitor resp status
• Blood type/cross match-blood type
• Occult bleeding-assess stool/emesis
• UA-looking for dehydration

Question 6

Liver failure increases the risk of _________ (GI related).

Answer 6

esophageal varices

Question 7

Why would the BUN be elevated in a GI bleed?

Answer 7

due to blood proteins broken down by GI tract

Question 8

GI bleeds are diagnosed by?

Answer 8

Endoscopy (EGD)

Question 9

Nursing Assessments for a GI Bleed?

Answer 9

• Monitor VS q15-30 min
• Emphasis on ABC’s & early identification of Shock
• Assess LOC, BP, HR, peripheral pulses and perfusion, presence or absence of neck vein distension, abdominal assessment
• Frequent Resp, CV, GI, I&O assessments

Question 10

GI BLEED Treatment

Answer 10

• Patient is NPO
• Hydrate (Insert 2 large bore IV’s)
  
  • Isotonic crystalloid fluids (LR)
• Blood transfusions
  
  • Watch for fluid overload
  • Monitor urine output
• IV infusion or IV push Proton Pump Inhibitor (Protonix)

Question 11

1st line tx for GI bleed?

Answer 11

Endoscopic hemostasis - hopefully within 24hrs of the bleed

Question 12

Nursing Interventions: Teaching for GI Bleed

Answer 12

• Smoking cessation
• Avoid alcohol, stress, OTC drugs
• Medication adherence
• S/S of upper and lower GI bleed
• Side effects of medications (ASA, NSAIDS, COUMADIN)
  
  • Potential for bleeding even with low dose aspirin taken daily

Question 13

Inflammation and breakdown of the normal gastric mucosal barrier by HCL acid and pepsin

Answer 13

Gastritis

Question 14

Gastritis Caused by?

Answer 14

• Drugs-ASA, NSAIDS
• Diet-alcohol, spicy
• Microorganisms-H-Pylori
• Environmental-Smoking
• Pathophysiologic
  
  • hiatal hernia, stress
• Other- NG tube, EGD

Question 15

S/S of Acute Gastritis?

Answer 15

• anorexia
• N/V
• epigastric tenderness
• feelings of fullness
• hemorrhage is associated with alcohol and may be only symptom

Question 16

Gastritis is diagnosed by ?

Answer 16

endoscopy (EGD) with biopsy

Question 17

Treatment of Gastritis?

Answer 17

NPO, IVF, Possible NG Tube, PPI

Question 18

Nursing Interventions: Teaching for Gastritis?

Answer 18

• diet modification (Individualize)
• Decrease alcohol intake
• Smoking cessation
• Tx H-Pylori,

Question 19

Erosion of the GI mucosa from the digestive action of HCL acid and pepsin

Answer 19

Peptic Ulcer Disease (PUD)

Question 20

Peptic Ulcer Disease (PUD) is caused by?

Answer 20

• H. Pylori
• alcohol
• nicotine
• stress
• ASA & NSAIDS

Question 21

Manifestations of Duodenal Ulcers?

Answer 21

• Mid-epigastric pain may radiate to back
• Burning or cramping 2-5 hours after eating –relief obtained with antacids and food
• More common in men esp. 35 -45 age group

Question 22

Manifestations Gastric Ulcers

Answer 22

High epigastric dyspepsia occurring 1-2 hours after eating
Food aggrevated deep ulcers
More prevalent in women & older adults

Higher mortality rate

Question 23

Duodenal Ulcer Risk factors

Answer 23

• H. pylori
• alcohol
• smoking
• COPD
• Chronic Renal Failure

Question 24

Gastric Ulcer Risk factors

Answer 24

H. Pylori, bile reflux, smoking, medications

Question 25

Peptic Ulcer Disease is diagnosed by?

Answer 25

Endoscopy (EGD) with biopsy

Question 26

Diagnostics for Peptic Ulcer Disease?

Answer 26

- Barium Contrast Study - Lab test - CBC - H/H - Similar to GI bleed if hemorrhage or perforation present - WBC - Liver enzymes - Amylase - Stool Studies

Question 27

Nursing Interventions for Peptic Ulcer Disease?

Answer 27

- Advance diet as tolerated - start with clear liquids - Teach: - Avoid foods that cause gastric distress (spicy, acidic) - Alcohol and smoking cessation - Side effects of OTC medications - Drug therapy - Decrease stress - S/S of recurrence

Question 28

Drug therapy for Peptic Ulcer Disease?

Answer 28

- PPI or H2 receptor blockers, - antacids - antibiotics if H. Pylori present

Question 29

Complications of Peptic Ulcer Disease?

Answer 29

- Hemorrhage (most common) - Vomiting of blood, change in VS - Perforation (most lethal- may cause infection) - Gastric outlet obstruction

Question 30

Signs of perforation of a Peptic Ulcer?

Answer 30

- Sudden severe pain, - rigid abdomen - found with knees drawn in - grunting respirations

Question 31

Signs of a Gastric outlet obstruction with a Peptic Ucler?

Answer 31

N/V, abdominal distention despite having NG tube

Question 32

Treatment of PUD Complications: hemorrhage?

Answer 32

- NPO - IVF - Hemorrhage (if present) - Stop Bleeding - Restore blood volume

Question 33

Treatment of PUD Complications - Perforation (if present)?

Answer 33

- NPO - IVF - Stop bleeding - Surgical intervention - Restore blood volume - Antibiotics-delay OR to get antibiotics started

Question 34

Treatment of PUD Complication - Gastric outlet obstruction (if present)?

Answer 34

- NPO - IVF - NG to decompress stomach - Fluid and electrolytes

Question 35

partial removal of the lower 2/3 of the stomach

Answer 35

Gastrectomy

Question 36

severing of the vagus nerve

Answer 36

Vagotomy

Question 37

englargement of the pyloric sphincter

Answer 37

Pyloroplasty

Question 38

Vagotomy

Answer 38

- severing of the vagus nerve | - Decreases gastric acid secretion

Question 39

Gastrectomy

Answer 39

partial removal of the lower 2/3 of the stomach

Question 40

Pyloroplasty

Answer 40

englargement of the pyloric sphincter

Question 41

- Mid-epigastric pain may radiate to back - Burning or cramping 2-5 hours after eating –relief obtained with antacids and food - More common in men esp. 35 -45 age group

Answer 41

S/S of a duodenal ulcer

Question 42

- Sudden severe pain, rigid abdomen, found with knees drawn in, grunting respirations

Answer 42

signs of perforation of a Peptic Ulcer

Question 43

- High epigastric dyspepsia occurring 1-2 hours after eating - Food aggrevated deep ulcers - More prevalent in women & older adults - Higher mortality rate

Answer 43

Manifestations Gastric Ulcers