Med Surg: Alterations in GI Function

Question 1

Why is a diet history good with GI assessment?

Answer 1

My explain symptoms or food triggers

Try to observe, may not tell truth

Food preferences: especially with dietary teaching

Anorexia

Question 2

What are the GI changes in the elderly?

Answer 2

Stomach: atrophy of tissues, gastric mucosa: cant break down food, intrinsitc factor decreases, decrease acid bacterial growth

Large Intestinge: decrease peristalisis, constipation, decrease sense to defacate, increases fiber

Pancreas: decrease blood flow to exocrine function, may not break down food, decaresase fat absorption, decrease ability to metabolize drugs and nutrients

Question 3

What are the S&S of pain?

Answer 3

P: precipitating or relieving factors

Q: quality or quantity

R: region or radiation, point to it, does it move, always there?

S: severity, is it better after intervention

T: timing, when starts, length, when first occurred, how often

Dysphagia: difficulty swallowing

Dyspepsia (indigestion): heart burn, chest pain, reflux, burning, nausea, belching

Anorexia: do have appetite

Appetite changes

Weight changes

N&V: hematemesis: characteristics, blood in vomit, color, old blood (coffee grounds)

Change in bowel habits

Presence of frank blood or tarry stools

Presence of abdominal distention or gas

Skin changes

Question 4

What are some skin changes that are S&S of GI changes?

Answer 4

Skin discoloration or rashes

Itching liver

Jaundice

Increased susceptibility to bruising and bleeding

Cullen’s sign

Question 5

What are lab tests for GI changes?

Answer 5

CBC: bleeding, change-anemia, inflammation/infection

Oncofetal antigens such as CEA: adenocarcinomas, Increase GI cancers, liver dysfunction, inflammation and bowel disease

Clotting factors

Electrolytes: diarrhea, vomitting

Liver enzymes and serum amylase and lipase

Bilirubin: increase obstruction gallbladder

Stool tests: fecal occult blood test, clostridium difficile

Question 6

What are diagnostic tests for GI changes?

Answer 6

review pre-procedure, procedure and post procedure care for each: selected tests discussed on next several slides

Abdominal x-ray films

Question 7

What is protocol for Upper Gastrointestinal Series and Small Bowel Series?

Answer 7

Before test: NPO for 8 hr prior, withold analgesics and anticholinergics for 24 hours

During test: client drink 16 ounces of barium, frequent position changes and rotating fluroscopy machiene

After test: encourage fluids to eliminate barium, administer mild laxative or stool softener, educate clinet that stools may be chalky white for 24-72 hours

Question 8

What is protocol for Barium Enema?

Answer 8

Before test: only clear liquids are given 12-24 hours before the test, NPO the night before, bowel cleansing protocol

During test: barium enema enhances radiographic visualization of the large intestine

After test: expel the barium, drink plenty of fluids, stool is chalky white for 24-72 hours

Question 9

What is the protocol for esophagogastroduodenoscopy?

Answer 9

Before: NPO for 6-8 hours before the procedure

During: conscious sedation, VS

After: VS every 30 minutes, NPO until gag reflex returns, throat discomfort possible for several days

Question 10

What is small bowel capsule enteroscopy?

Answer 10

Visualization of the small intestine

Only water for 8-10 hours before test

NPO for first 2 hour of the testing

Application of belt with sensors

Patient resumes normal activity

8 hours

Question 11

What is a colonoscopy?

Answer 11

Before: liquid diet for 24 hr before procedures, NPO for 6-8 hour prior, bowel clensing routine

During: conscious sedation, VS, may do biopsy or polypectomy, air may be inserted for visualization

After: VS every 15-30 minutes, is polypectomy or tissue biopsy, blood possible in stool, abdominal distention

Question 12

When is a nasogastric tube management necessary?

Answer 12

when need to keep normal secretions out of stomach when healing occurs

N+V, aspiration risk and stomach surgery

Question 13

What is gastric lavage and when is it necessary?

Answer 13

Instill something

GI bleed to control iced saline or tap water (more research with tap)

Alcoholic: gastritis or varicies

Question 14

What are the dysfunctions of the GI system?

Answer 14

Abnormalities of ingestion

motility

secretion

inflammation

Question 15

What are major symptoms of ingestion?

Answer 15

Anorexia

Dysphagia

Question 16

What are some nursing diagnosis for ingestion?

Answer 16

Altered oral mucous membranes

Risk for ineffective airway clerance

Risk for aspiration

Question 17

What is nonsurgical management of ingestion?

Answer 17

Airway management

Aspiration precautions

Question 18

What is gastroesophageal reflux disease?

Answer 18

Backward flow of GI content into esophagus

Risk for aspiration

The lower esophageal sphincter tone decreased or inappropriately relaxed

Question 19

What are clinical manifestations of GERD?

Answer 19

Dyspepsia/heartburn

Regurgitation and belching

Hypersalivation or water brash

Dysphagia

Question 20

What is the diagnostic assessment of GERD?

Answer 20

Esophageal pH monitoring (usualy pH in esophagus is 6-7)

Endoscopy-EGD

Question 21

What is the nonsurgical management of GERD?

Answer 21

Diet therapy: foods to improve sphincter tone and to avoid, stay away from previous foods used to improve tone, antacids

Cleint education: prevention, lifestyle changes, small frequent meals, limit alcohol, dont snakc before laying down, lock up HOB, eat slow, chew food, less constrictive clothing around middle, life with good body mechanics

Question 22

What are the major classes of drug therapy for GERD?

Answer 22

Antacids: Mylanta

Proton pump inhibitor: Prilosec

Histamine receptor antagonists: Zantac

Drugs that increase gastric emptying: Reglan

Question 23

What do antacids do?

Answer 23

Buffer gastric acid and prevent the formation of pepsin

Mixture of aluminum hydroxide and magnesium hydroxide

makes tissue less caustic

check other meds to see if interact with antacids

Question 24

Proton Pump Inhibitors

Answer 24

Prazoles provide effective, long-acting inhibition of gastric acid secretion

Omeprazole: Prilosec

Lansoprazole: Prevacid

Rabeprazole: Aciphex

Pantoprazole: Protonix

Esomeprazole: Nexium

Question 25

What are H2-Receptor Antagonists?

Answer 25

Drugs that block histamine-stimulated gastric secretion thus inhibiting gastric acid secretion rantidine: zantac famotidine: pepcid nizatidine: axid cimetidine: tagamet

Question 26

What are prokinetic drugs?

Answer 26

Drugs that increase gastric emptying like Metoclopramide (Reglan) Postop with paralytic ileus to stimulate parastalsis Entereg: prevent small bowel obstruction post-op peripherally acting opiod receptor antagonist

Question 27

What are abnormalities of motility?

Answer 27

can affect the esophagus, stomach or intestine normally provides for peristaltic activity controlled by the ANS often occurs at sphincter sites

Question 28

What is a Hiatal Hernia and the types?

Answer 28

Protrusion of the stomach through the esophageal hiatus of the diaphragm into the throax sliding hernia: up through esophagus rolling hernia: rolls to side, more dangerous

Question 29

What is the assessment for a hiatal hernia?

Answer 29

Heartburn Regurugitation and Belching Pain: may mimic cardiac Dysphagia Worsening symptoms after eating or when in recumbent positions

Question 30

What is nonsurgical management of hiatal hernia?

Answer 30

Drug therapy: drugs for GERD Diet therapy: same as GERD, dont eat before lie down, sit to rest, avoid foods that exacerbates symptoms Weight reduction: avoid smoking Elevate HOB Remain upright after eating Avoid straining and vigorous exercise Avoid tight clothing

Question 31

What is the surgical management of a hiatal hernia?

Answer 31

fundoplication most common Wrap stomach around esophagus to help hold down

Question 32

Post-op care of a hiatal hernia?

Answer 32

Nasogastric tube management: patent, secure, check placement every 4-8hours, orders, check drainage Complications Plan of care Discharge planning

Question 33

What is motility in the stomach?

Answer 33

Hypermotility: 2 to inflammation condition Pyloric stenosis (decreased gastric emptying): narrow, hard to move food to duodenum distention to abdomen and stomach Dumping syndrome: after part of stomach removed, gastric contents dumped prematurely, not adquately broken down and mixed with secretion, overdistends intestine

Question 34

What dumping syndrome?

Answer 34

Occurs following gastric surgery when part or all of the stomach is removed Occurs when gastric contents are rapidly "dumped" into the small intestine

Question 35

What is early and late signs in dumping syndrome?

Answer 35

Early symptoms: within 30 minutes of eating, shock like in nature, palpitataions, tachycardia, pale, diaphoretic shock Late signs: 90 minutes to 3 hours after eating, insulin response to high carbohydrate bolus in jejunum

Question 36

What is the management of dumping syndrome?

Answer 36

Small frequent meals Diet modication Rest between meal Nutritional deficiencies

Question 37

What is intestinal motility?

Answer 37

increased motility: usually inflammatory in nature Decreased motility

Question 38

What are the different types of decreased motility?

Answer 38

Non-mechanical: paralytic ileus Mechanical: constipation, obstruction (adhesions, abdominal herniation, bowel obstruction)

Question 39

What is a herniation?

Answer 39

Weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structire protrudes

Question 40

What are the types of abdominal hernias?

Answer 40

indirect inguinal direct inguinal umbilical incisional or ventral

Question 41

What is postoperative care of surgical management?

Answer 41

elevate scrotum to prevent and control swelling difficulties in voiding may occur avoid increases in intra-abdominal pressure: such as coughing post op, restrict lifting for 8-12 weeks post op

Question 42

What is bowel obstruction?

Answer 42

Mechanical or Non-mechanical obstruction Complete or incomplete Strangulated: compromised blood flow

Question 43

What are clinical manifestations of bowel obstruction?

Answer 43

Midabdominal pain or cramping Vomiting: with high obstructions Obstipations Seeping of liquid stool ABdominal distention Decreased to absent bowel sounds below the obstruction; hyperactive about

Question 44

What is the diagnostic assessment of bowel obstruction?

Answer 44

Radiographic assessment: x-rays, no lab test unless long term gas distention or normal Endoscopy: cautionwith perforation - risky with obstruction Computed tomography: CT or MRI helpful

Question 45

What is the nonsurgical management of bowel obstruction?

Answer 45

NPO Nasogastric tube placement Fluid and electrolyte replacement Pain management Drug therapy

Question 46

What is the surgical management of bowel obstruction?

Answer 46

Preoperative care Operative procedure: exploratory laparotomy to determine procedure Postopervative care: nasogastric tube in place, usual postop care for abdominal surgery