GI Part 2 Flashcards
(48 cards)
What happens with a Hiatal Hernia?
What is the main cause of this? Other causes?
Part of the stomach pushed up through the diaphragm and into the thoracic cavity
Main cause is a large abdomen so we need to teach weight loss
Could be congenital anomalies, trauma, and surgery
S/S hiatal hernia
Heartburn
Regurgitation
Fullness after eating
Dysphagia
How are we going to treat a Hiatal Hernia—
What is the KEY*
How to eat meals?
What position is best?
Can surgery be done?
What to teach?
Key is to keep the stomach in the down position!!
Small frequent meals - big meals shove the stomach back up into the thorax
Sit up 1 hr after eating
Elevate HOB - May use blocks
Surgery can be done - fat person may cause the stomach to go right back up
Teach weight loss and healthy eating
What happens in Dumping Syndrome?
What can cause this?
The stomach empties too fast after eating
Secondary to gastric bypass, gastrectomy, or gallbladder disease
S/S of Dumping Syndrome
Fullness, cramping, diarrhea
Weakness, faintness
Palpitations
NCLEX TEST STRATEGY how positioning regarding food in the stomach**
*Lay on left side to keep the food in the stomach
Left side lying leaves it in
Right side lying releases it
How should we sit while eating with Dumping Syndrome?
What about afterwards?
Semi-Recumbent - lying back bit to keep the food in the stomach
Lie down after eating and on the LEFT side
What are things to keep in mind during meals for the Dumping Syndrome patient?
What kinds of foods to they avoid?
Drink BETWEEN meals, not during them
Small and frequent meals
Avoid foods high in carbs and electrolytes because these empty FAST!
Location in UC vs Crohn’s
Inflammation and erosion
UC: Large intestine/colon
Crohn’s: Sm int/Ileum, but can be anywhere in the sm AND lg intestine
S/S of UC and Crohn’s
Diarrhea, dehydration
Rectal bleeding, bloody stools, anemia
Cramping, rebound tenderness
Fever
Rebound tenderness: peritoneal inflammation
How do we diagnose UC and C?
CT (not as common)
Colonoscopy
Barium enema
Colonoscopy–
Diet pre-op?
Avoid what?
How to we clear the bowel?
What do they have to drink to empty the bladder? And what makes this easier? Can they use a straw?
Sedated?
POSTOP: watch for what?
Clear liquids for 12-24 hr
NPO 6-8 hr
Avoid NSAIDS - bleeding risk
Clear the bowel with laxatives and enema until clear (Watch for weakness)
Polyethylene glycol: Give anti-emetic, cold it better
NO STRAW! This causes them to swallow air and cause more GI upset
YES, they are sedated
Post-op: Perforation risk - signs include pain and unusual discomfort: especially if they didn’t have pain before
ASSUME THE WORST that sOMETHING BAD HAPPENED!
What kind of enema is done to diagnose UC and C?
Why would they do this?
Barium enema (BE, lower GI series)
Do this if the colonoscopy is incomplete
What kind of diet to give UC and C patient?
High or low fiber?
Avoid what? Why?
LOW fiber - we want to limit GI motility to help save fluid
Avoid foods that are cold, hot, or smoked because these can increase motility
What kind of medication are the UC and C patients going to get?
Anti-diarrheals
Antibiotics
Steroids
What to think about when giving antidiarrheals?
Only give these to patients with UC that have only mild symptoms because it doesn’t work well in severe cases
Surgery for UC
Ileostomy
Koch Pouch
J Pouch
Different between Koch pouch and J Pouch
Koch: Removes the colon and has as a nipple valve that opens and closes to empty the intestines - catheter to remove (continent)
J: Removes the colon and attaches the ileum to the rectum
Ileostomy vs Colostomy
Ileostomy: sm int/ileum
Entire colon with rectum and anus removed
Colostomy: lg int/colon
Rectum and anus removed and part of the colon
Surgery for Crohn’s
What’s the goal?
May have ileostomy or colostomy, depending on the area of intestine affected
Goal is to ONLY remove the affected area
We try to not even do surgery
Post-op ileostomy
When the the fluid draining? What are these patients at risk for? Do we have to irrigate it? What foods to avoid? why? What's good for summer?
Fluid is always draining - always a little dehydrated putting the patient at risk for kidney stones
Don’t need to irrigate
Avoid rough foods or foods that are hard to digest; we want increased motility
Gatorade and E replacements
What happens as waste moves through the colon?
Water and nutrients absorb in the body and stool is formed
Order of large intestine pieces?
Right: ascending
Transverse
Left: Descending
Sigmoid
Differences in stool!
Ascending/transverse:
Descending/sigmoid:
Ascending/transverse: semi-liquid
Descending/sigmoid: semi-formed or formed
*The further the ostomy, the more water is being drawn out
