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NURS 3313 > GI Disorders > Flashcards

GI Disorders Flashcards

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1
Q

x-ray done using barium as a contrast agent; allows for a view of the stomach, esophagus, stomach, and small bowel

A

barium swallow study

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2
Q

A barium swallow study aids in the diagnosis of what disorders?

A

ulcers, varices, tumors, regional enteritis

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3
Q

Nursing Considerations of a Barium Swallow Study

A

pre-op:
- clear liquids the day before
- NPO after midnight
- hold PO meds
- insulin dosages may need to be adjusted

post-op:
- increase fluid intake after procedure
- monitor for constipation
- assess bowel sounds

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4
Q

Barium Enema Nursing Considerations

A

pre-op:
- bowel prep before procedure
- low residue diet 1-2 days
- clear liquids the day before
- laxatives of gloytely the night before
- NPO after midnight
- may have cleansing enemas until clear morning of test

post-op:
- inform pt they will have increase BMs
- increase fluids to help with elimination/constipation and possible obstruction

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5
Q

procedure that allows for clear x-ray of colon

A

Barium Enema

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6
Q

A barium enema is used to see what?

A

polyps, tumors, and lesions

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7
Q

A barium enema is contraindicated with what conditions?

A
  • active IBS
  • bowel perforation
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8
Q

Endoscopy Nursing Considerations

A

pre-procedure:
- NPO 8 hrs prior to procedure
- signed informed consent
- verify allergies
- sedation used

post-procedure:
- assess LOC
- NPO after until gag reflex returns
- check vitals
- monitor for signs of perforation

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9
Q

What are the major S/S of perforation after an endoscopy?

A
  • sudden onset of pain
  • may be throat or back pain
  • bleeding (inc. HR, dec. BP)
  • unusual difficulty swallowing
  • rapidly elevating temperature
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10
Q

procedure done to screen for colon cancer using a flexible fiber optic cable

A

colonoscopy

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11
Q

Colonoscopy Nursing Considerations

A

pre-procedure:
- golytely (most common prep)
- NPO past midnight

post-op:
- assess for s/s of bowel perforation

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12
Q

s/s of bowel perforation

A
  • rectal bleeding
  • sudden onset of abd pain
  • cramping
  • abd distension
  • fever
  • focal peritoneal signs (rebound, rigidity, guarding, pain, distension, N/V, paralytic ileus
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13
Q

GI disorder caused by gram-positive anaerobic bacteria that is associated with antibiotic use; can be community or hospital acquired

A

c. diff

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14
Q

Which antibiotics are most likely to cause c. diff?

A

cephalosporins, fluoroquinolones, levaquin, ciprofloxin, clindamycin

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15
Q

potential complications of c. diff

A
  • dehydration
  • electrolyte imbalances (potassium especially)
  • skin break down
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16
Q

S/S of c. diff

A

liquid stools, frequency, distention, rumbling noise in intestines, thirst, loss of appetite

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17
Q

C. diff nursing considerations

A
  • strict I/O
  • auscultate
  • palpate for tenderness
  • assess hydration status
  • assess perianal area
  • stool specimen
  • may be NPO

short term:
- avoid: bulky food, alcohol, dairy, fatty and fried foods
- monitor serum electrolytes

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18
Q

acute abdomen potential complications

A
  • peritonitis
  • sepsis
  • septic shock
  • death
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19
Q

localized or generalized inflammation of the peritoneum, usually bc of a bacterial infection

A

peritonitis

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20
Q

S/S of peritonitis

A
  • rebound tenderness
  • rigidity
  • guarding
  • severe pain
  • distention
  • N/V
  • paralytic ileus
  • absent bowel sounds
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21
Q

What usually causes a paralytic ileus?

A

surgery, narcotic pain med uses, peritonitis

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22
Q

condition with s/s of intestinal obstruction, but without a physical blockage

A

paralytic ileus

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23
Q

What is the immediate response of the intestinal tract to peritonitis?

A

paralytic ileus

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24
Q

Diagnosis tools for peritonitis

A
  • inc. WBC
  • H&H may drop (if bleeding occurs)
  • altered serum electrolytes
  • culture of abd blood and fluid
  • x-ray may show: air, fluid levels, distended bowel loops
  • ultrasound may show: abscess, fluid collection
  • CT scan
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25
Nursing Considerations for Peritonitis
- assess abdomen (placement of NG tube for gastric decompression) - fluid and electrolyte balance (strict I/O, daily weights) - vital signs q4h - nutritional support - comfort (N/V management) - pain management - post-op care
26
Peritonitis treatment options
- fluid and electrolyte replacement to prevent septic shock - surgery - drain fluid or abscess - NG suction - antibiotics - pain management - antiemetic
27
inflamed, infected appendix
appendicitis
28
What is the most common cause of acute abdomen in the U.S?
appendicitis
29
S/S of appendicitis
- vague, poorly localized periumbilical pain - anorexia - sharp RLQ pain (McBurney's Point) - increased WBC - low grade fever - nausea - rebound tenderness
30
Potential complications of Appendicitis
- gangrene - perforation - abscess formation
31
Nursing management of appendicitis
- pain relief - preventing dehydration - surgical site infection - maintaining skin integrity - preventing atelectasis - administering ordered antibiotics - monitor for peritonitis and septic shock - never use heat/heating pad
32
A NG tube sits where?
stomach
33
A NE tube sits where?
duodenum or jejunum
34
Gastrostomy and Jejunostomy tubes are ordered when?
Tube feedings lasting longer than 4 weeks
35
GI tube indications
- decompress the stomach - lavage the stomach - administer meds and feedings - compress a bleeding site - aspirate gastric contents for analysis
36
Potential GI tube complications
- fluid volume deficit - electrolyte imbalance
37
erosion of the mucosal lining and gastric, duodenal, and esophageal ulcers
peptic ulcer disease
38
What are the common causes of peptic ulcer disease?
- NSAIDs - H. pylori infection
39
Potential causes of stress ulcers
- burns - shock - sepsis - ventilator-dependence - trauma - after surgery
40
Which ulcer presents pain immediately after eating?
gastric ulcer
41
Which ulcer presents pain 2-3 hours after eating?
duodenal ulcer
42
Clinical manifestations of peptic ulcer disease
s/s of bleeding
43
Peptic Ulcer treatment
- antibiotics (if caused by H. pylori) - smoking cessation - avoiding caffeine and alcohol - eating regular meals
44
Peptic Ulcer Nursing Considerations
- monitor for hemorrhage - relieve pain - NG tube may be required - assess for signs of perforation
45
Intestinal obstructions most commonly occur where?
small intestine
46
What is the most common cause of intestinal obstruction?
surgical adhesion
47
inflammation or surgery leading to tissues bonding together
adhesion
48
types of mechanical obstructions
- hernias - tumors - carcinoma - stool impaction - gallstones - volvulus (twisted intestines) - foreign bodies
49
common causes of functional obstructions
- abd surgery - peritonitis - diabetes - pancreatitis - appendicitis - hypokalemia - narcotics - lumbar and thoracic fx
50
What is the initial symptom of an intestinal obstruction?
crampy, wavelike pain due to persistant peristalsis and vomiting
51
What are the clinical manifestations of an intestinal obstruction?
- N/V (eventually fecal matter) - abd pain and distension - unable to pass gas - obstipation - slow large bowel progression that may only manifest as constipation
52
What are teh common s/s of a bowel perforation?
- rectal bleeding - sudden onset abd pain - pain worsening suddenly - abd distension - fever - peritoneal signs (rebound, guarding, rigidity, etc) - inc HR and dec BP
53
Diagnostic tools for a bowel obstruction
x-ray and CT
54
Management of bowel obstruction
- NPO - NG tube insertion - IV fluids - K+ replacement - nutritional support - possible colonoscopy to untwist and decompress large bowel
55
What are the two kinds of inflammatory bowel disease?
- ulcerative colitis - crohn's disease
56
inflammation of the small and large intestines
Crohn's disease
57
inflammation and/or ulceration of the colon
ulcerative colitis
58
clinical manifestations of inflammatory bowel disease
- diarrhea - weight loss - abd pain - fever - fatigue
59
inflammatory bowel disease complications
- hemorrhage - strictures - perforation - abscesses - fistulas (Crohn's) - colonic dilation (toxic megacolon)
60
IBD dx studies
- Hx and physical exam - blood studies (CBC, WBC, serum electrolyte disorders, sed rate) - stool examination - stool cultures - CT scan
61
Crohn's vs Colitis Location
- crohn's : ileum, ascending colon - colitis: rectum, descending colon
62
Crohn's vs Colitis Bleeding
- crohn's: if it occurs, it is mild - colitis: severe
63
Crohn's vs Colitis Diarrhea
- crohn's: less severe - colitis: severe
64
Ulcerative Colitis Clinical Manifestations
- diarrhea with mucus (10-20 liquid stools/day) - diarrhea is severe and may be bloody - rectal bleeding - LLQ abd pain - pallor, anemia, fatigue - weight loss - electrolyte and fluid loss - symptoms range from mild to severe - remissions and relapses
65
ulcerative colitis complications
- hemorrhage - perforation - peritonitis - colon cancer
66
Crohn's Disease Clinical Manifestations
- diarrhea (up to 20x/day) - steatorrhea - dehydration - mild diarrhea (if it even occurs) - rapid weight loss - malabsorption - fever and fatigue - periods of remission and exacerbation
67
Crohn's Disease Complications
- small bowel obstruction - severe malnutrition - strictures and fistula - anal fissures - small bowel cancer - abscesses - peritonitits
68
Management of acute IBD exacerbations
- NPO - IV fluids and TPN - electrolyte replacement if needed
69
What should be done as an IBD exacerbation resolves?
- clear liquids -> full liquids - low-fiber, high protein, high calorie diet - vitamin and iron supplements - determine food triggers and avoid
70
What high fiber foods should be eliminated from someone's diet if they have IBD?
- whole grain breads - cereal - nuts - seeds - raw or dried fruits *eliminate dairy products*
71
What are the surgical options for ulcerative colitis?
- total proctocolectomy w/ permanent ileostomy this is a curative surgery!
72
What are the surgical options for crohn's?
- partial or complete colectomy with ileostomy not curative!
73
What is the patient goal post-op?
- promoting independence in caring for colostomy

NURS 3313 (8 decks)

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