Med-Surg GI ATI Unit 7 Flashcards Preview

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Flashcards in Med-Surg GI ATI Unit 7 Deck (47):
1

what are the types of liver function tests and their values/implications

1) aspartate aminotransferase (AST) - 5-40units/L
- elevation occurs with hepatitis or cirrhosis
2) alanine aminotransferase (ALT) - 8-20 units/L; 3-35 IU/L
- elevation occurs with hepatitis or cirrhosis
3) alkaline phophatase (ALP) - 30-120 units/L; 30-85 IU/L
- elevation indicates liver damage
4) total bilirubin - 0.1 to 1.0 mg/dL
con jugated 0.1 to 0.3 mg/dL
- elevations indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder
5) albumin - 3.5 - 5.0 g/dL
- decrease may indicate hepatic disease

2

blood tests that have information on GI system

1. amylase - 56-90 IU/L
- elevation occurs with pancreatitis
2. lipase: 0-110
- same as amylase
3. less than 40 mcg/L
- elevated in liver cancer
4) ammonia 15-110 mcg/dL
- elevated in liver disease

3

urine bilirubin

- also known as urobilinogen, tests bilirubin in urin
- for suspected liver or biliary tract disorder

4

FOBT and stool samples for

1) C diff
2) parasites/ova
3) blood for GI bleeding (ulver, colitis, cancer)
4) vimentin gene - indicator of colorectal cancer

5

FOBT/stool sample to know

NAs
1) occult blood: card with guaiac; 3 samples required
2) for ova/parasites provide with collection cup

Education
- red meat/anticoag restriction
- for collection cup, need for refrigeration and time to lab

6

what do clients usually present with for endoscopy needed

1) anemia secondary to bleeding
2) ab discomfort
3) ab distention or mass

7

procedure for endoscopy

Pre
NAs:
a) consent form
b) vita sign/allergies
c) labs/hx

note...
- fluid/food restriction before
- meds don't do NSAIDs, warfarin, aspiring
- previous barium admin
- proper laxatives, flushes
- electrolyte/fluid status

8

endoscopic procedures

1) Colonoscopy: flexible fiber-optic scope throiugh anus to see rectum, sigmoid, and colon
- moderate sedation with midazolam (Versed) and opiate analgesics
- left-side with knees to chest
- bowel prep like bisacodyl (Dulcolax) and polyethylene glycol (GOLYTELY) laxitives; clear liquid diet (no red/purple/orange); NPO after midnight
Post: a) severe pain could be perforation or sign of hemorrhage 2) recetal bleeding 3) vital signs/rr 4) resume normal diet 5) increase fluid intake 6) possible flatulence b/c of air instillation during procedure

2) EGD (esophagogastroduedenoscopy): endoscope through mouth into esophagus, stomach, duodenum
- moderate sedation - top anesthetic
- left-side lying
- NPO 6-8 hr prep, remove dentures prior to procedure
- Postprocedure: monitor vital sign/rr; notify of bleeding or pain; WITHHOLD fluids until return of gag reflex

3) ERCP (endoscopic retrograde cholangiopancreatography): insertion of endoscope through mouth into biliary tree via duodenum, allows visualization of biliary ducts, gall bladder, liver, pancrea
- conscious sedation - topical anesthetic
- initially semi-prone with repositioning
- NPO 6-8 hr prior, removes dentures
- Post: vitals/RR; bleeding pain infection; withouhold fluids until return of gag reflex

4) sigmoidoscopy: scope shorter than colonscope, anus rectum sigmoid of colon
- no anesthesia required
- positioned on the left side
- Prep: bowel prep like laxatives; clear liquid diet; npo after midnight; avoid certain meds
- post: vitals/rr; rectal bleeding; resume diet normal; fluid intake; flatulence from air

9

Complications of endoscopic procedures

1) oversedation (difficult to arouse, poor rr, hypoxemia, tachycardia, elevated or low bp) - don't drive
2) hemorrhage: bleeding, cool/clammy skin, hypotension, tachycardia, dizziness, tachypnea
3) aspiration (dyspnea, tachypnea, tachycardia, advent breath sounds, fever)
4) perforation of GI tract: chest/ab pain, fever, nausea, vomitting, ab distention

10

GI series

- for assessing anatomic or funcitonal abnormalities
- drink barium or done with enema (makes stools white 24-72 hours after until clears)

11

what are GI therapeutic procedures

1) enteral feedings
2) total parenteral nutrition (TPN)
3) paracentesis
4) nasogastric decompression
5) bariatric surgeries
6) ostomies

12

Infor on enteral feedings

- can no longer take nutrition orally

Indications: intubated clients, pathologies that cause dysphagia or risk of aspiration, need supplementation

Presentation: malnutrition, aspiration pneumonia

Complications:
1)overfeeding and client can't digest fast enough resulting in ab distention, N/V
NAs
a) check residual q 4-6 hours
b) follow protocol for witholding excess residual volumes as directed (typically 100-200 mL)
c) withhold feeding as prescribed and resume at reduced rate per rx

2) diarrhea
NAs
a) slow rate of feeding/notify provider
b) confer with dietitian
c) provide skin care and protection

3) aspiration pneumonia
- can be secondary to aspiration of feeding: tube displacement primary cause of aspiration of feeding
NAs
a) stop feeding
b) turn client to side and suciton airway, O2
c) monitor vitals/temp
d) auscultate breath sound
e) notify provider/obtain chest xray prn

13

TPN overview

total parenteral nutrition
- hypertonic iv bolus solution, purpose of admin is to prevent or correct nutritional deficiencies and minimize AEs of malnourishment

a) usually through central line like tunneled triple lumen catheter or single/double lumen PICC line
b) standar iv bolus is less than or equal to 700 calories/day
c) partial pn or PPN is less hypertonic and for short-term admin in larger peripheral vein, usual dextrose concentration is less than 10% RISK INCLUDES PHLEBITIS

14

what are the basic guidelines when to initiate TPN

- weight loss of 7% body weight and NPO for 5 days or more
- hypermetabolic state

15

flow rate of TPN

usually adjusted up or down by 10% increments; NEVER abruptly stop TPN

16

what should you keep by the bedside when admin TPN via IV

- 10% dextrose solution in case it's unexpectedly ruined or next bag isn't available, will minimize risk of hypoglycemia

17

if an air bolus while admin TPN occurs what should you do?

clamp catheter immediately, put patient on left side to trap air, admin O2 and call provider

18

what's big with TPN?

infection risk, don't use anything else in this tube

19

what's a big risk for TPN?

gluid imbalance bc hyperosmotic solution (3-6x of blod)
a) assess lungs
b) monitor weight and I/O
c) controlled infusion pump use
d) don't speed up infusion to catch up
e) gradually increase don't abruptly stop

20

what is ascites? what can be used to treat it

an abnormal accumulation of protein-rich fluid in ab cavity prob from cirrhosis, results in ab girth and distention

- a paracentesis: resp distress determining factor (so client present with comprised lung expansion)

21

what are some things preprocedure for a paracentesis

- have client void/insert cather
- measure ab girth
- local anesthetics at insertion

22

how much is usually drained during a paracentesis

- 4-6 L of fluid by gravity, responsible for measuring drainage

23

if pressure is applied to dressing for several minutes after a paracentesis and there's still leakage

- put on a dry steril gauze dressing

24

post procedure for paracentesis

- measure and compare girth
- apply pressure
- monitor temp q4hrs for 48 hours
- assess I/O q4hrs
- admin meds like diuretics and K+ supplements if loop diuretic
- elevateHoB
- document color of drainage

25

complications of paracentesis

1) hypovolemia: peritoneal fluid contains large amounts of protein and can cause big drop in albumin levels (may need to admin albumin beforehand)
2) bladder perforation
- signs include hematuria, anuria, suprapubic pain, symptoms of cystitis, fever
3) peritonitis
- can result as injury of intestines during insertion (sharp constant ab pain, fever, nausea, vomitting, absent bowel sounds

26

indication for bariatric surgery

bmi greater than 40 or greater than 35 with comorbidities

27

what are some NAs for bariatric surgery

a) provide 6 meals a day when client can resume oral nutrients, observe for dumping syndrome (cramps, diarrhea, tachycardia, dizziness, fatigue)
b) apply ab binder to prevent dehiscence
c) monitor for leak of anastomosis (creasing back/shoulder/ab pain, restlessness, tachycardia, oliguria), EMERGENCY
d) NG tube usually there so look out for displacement
e) walk daily for at least 30 min

28

what's the restriction on liquid/pureed foods following bariatric surgery

not for first 6 weeks, volume usually no more than 1 cup, eat two servings of protein a day, only nutrition-dense foods

29

complications of bariatric surgery

1) dehydration
2) malabsorption/malnutrition

30

bowel sounds for paralytic ileus vs obstruction

ileus - absent; obstruction - high-pitched

31

indications for ileostomy vs colostomy

ileostomy: when entire colon must be removed due to disease like Crohn's

colostomy: portion of bowel must be removed eg for cancer, ischemic injury or requires rest for healing like with diverticulitis, trauma

32

Output descriptions for ileostomy, transverse colostomy and sigmoid colostomy

1) ileostomy
normal postop output: less than 1000mL/day; may be bile-colored and liquid
postop changes in output: after several days to weeks output will decrease to about 500-1000 mL/day; becomes more past-like as small intestine assumes absorptive function of large intestine
pattern: continuous output

2) transverse colostomy
a) normal: small, semi-liquid with some mucus 2-3 days after surgery
b) postop changes in output: after several days to weeks, output becomes more stool-like, semi-formed or formed
c) pattern: resumes pattern similar to preop

2) sigmoid
a) small to moderate amount of mucus with semi-formed stool 4-5 days after surgery
b) postop: after several days weeks, output resembles semi-formed stool
c) resumes patter similar to preop

33

ostomy NAs

- monitor for leakage
- assess skin integrity, stoma should be pink/red and moist
- apply skin barries and adhesive paste to peristomal skin and allow to dry
- empty bag when 1/4 to 1/2 full (powerpoint says 1/3)
- asses for fluid/electro imbalance especially with new ileostomy

34

client education for ostomy

- foods that cause odor: fish, eggs, asparagus, garlic, beans, dark green leafy veggies
- food that causes gas: dark green leafy veg, beer, carb beverages, dairy products, and corn
- YOGURT can be used to decrease gas
- ostomy with small intestine, client should avoid HIGH FIBER foods for first 2 months and chew food well, increase fluid intake,
- place breath mint in pouch for odors

35

complications with an ostomy

1) stomal ischemia/necrosis
- signs include pale pink or bluish/purple color and dry
NAs: obtain vital, o2 sat, lab results, notify provider

2) intestinal obstruction (hypoactive bowel sounds, distention, NV, ab pain)

36

types of meds for GERD

1) PPIs - prazoles rabeprazole (Aciphex) should wear sunscreen daily
2) Antacids: take 1-3hrs after eating and at bedtime
3) Histamine2 receptor antagonists: the tidines, longer effect than antacids, don't mix nizatidine (Axid) with begetable-based juices
4) prokineticsL metoclopramide hydrochloride (Reglan) increase motility of esophagus/stomach - monitor EPS side effects

37

what is the main risk factor for esophageal varices

portal hypertension

38

manifestations of varices

- hematemesis and melena

39

two types of peptic ulcers and differences

1) gastric ulcers: pain 30-60 min after meal ,rarely at night, pain exacerbated by ingestion of food
- left upper epigastrium pain

2) duodenal ulcer: 1.5-3 hrs after a meal, often at night, pain may be relieved by food or antacid
- right epigastrium pain

40

what should client eat to decrease dumping syndrome?

high-protein, high-fat, low-fiber, moderate to low carb diet

41

Route of transmission and risk factors for types of hepatitis

1) Hep A: fecal - oral; a) ingestion of contaminated food/water b) close personal contact with infected individual
2) Hep B: blood; a) unprotected sex with individual b) infants born to infected mothers c) contact with infected blood d) injection drug-users
3) hep C: blood a) drug abuse b) sexual
4) D: coinfection with hepatitis B a) injection drug users b) unprotected sex
5) E: fecal-oral; ingestion of contaminated food/water

42

symptoms of hepatitis

1) fatigue
2) decreased appetite with nausea
3) ab pain
4) joint pain
objective
5) fever
6) vomitting
7) dark-colored urine
8) clay-colored stool
9) jaundice

43

what are some lab values expected for hepatitis viral infections (esp ABC)

a) elevated alanine aminotransferase (expected between 3-35 IU/L or 8-20 units/L)
b) elevated aspartate aminotransferase (expected 5-40 units/L)
c) normal or elevated alkaline phosphatase (expected 30-120 units/L)
d) elevated total bilirubin levels (expected 0.1-1.0 mg/dL)

44

lab tests for hep A

1) presence of A virus antibodies indicates presence
2) presence of immunoglobulin M antibodies indicates inflammation in liver
3) immunoglobulin G indicates permanent immunity to hep A

45

lab test for hep B

a) B surface antigen indicates individual is infections
b) B surface antibody shoes recovery and immunity from HBV infection
c) hep B core antibody indicates previous or ongoing infection
d) IgM antibody to hep B core antigen indicates acute infectino
e) hep B e antigen mean virus is replicating
f) hep B e antibody is a predictor for long term clearance of virus

46

lab tests for hep D and E

- intrahepatic delta antigen indentifies infection
- or hep D virus antibodies

for E...
- presence of hep E virus antibodies

47

hepatitis types meds

A: vaccine, immunoglobulin for post exposure

B: acute infection just supportive; chronic then antiviral meds

C: combo with peginterferon and ribavirin (Vitazole)

D: sam as hep B

E: no meds just supportive