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Med Surge 1 > Test 5 Gastrointestinal Shi > Flashcards

Test 5 Gastrointestinal Shi Flashcards

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1
Q

Major enzymes and secretions

A

Chewing and swallowing: Saliva , salivary amylase
Gastric function: Hydrochloric acid , pepsin, intrinsic factor
Small Intestine: Amylase, lipase, trypsin, bile

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2
Q

Assessment of GI system

A

Dyspepsia (indigestion): Most common symptom of pt with GI dysfunction
Intestinal Gas: Bloating, distention, feeling full of gas, excesive flatulance as a symptom of food intolernce or gallbladder disease
Nausea and vomiting

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3
Q

What else should you check for when assessing the GI system?

A

Change in bowel habits and stool characteristics
* Can signal colonic dysfunction
* Constipation and diarrhea

Past health, family, and social history
* Oral Care and dental visits
* Lesions in mouth
* Discomfort with certain foods
* Use of alcohol and tobacco
* Dentures

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4
Q

What are some diagnostic tests for the GI system?

A

Stool tests
Breath test
Colonoscopy

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5
Q

Nursing interventions for GI diagnostic tests

A

Inform the doc for any medical conditions or abnormal lab values that can affect the procedure
Assess for adequate hydration before, during, and immediately after the procedure, and provide education about hydration
Provide instructions about postoperative care

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6
Q

Oral Cancer

A

Risk Factors: Tobacco use, Alcohol, HPV, head and neck cancer

Men twice as likely to get it

Lips, lateral tongue, floor of the mouth most affected

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7
Q

Manifestations of oral cancer

A

Early: Few or no sysmpotoms
* Painless sore or mass that does not heal ; indurated ulcer with raised edges
* May Bleed Easily and present with red or white patch

Later:
* Tenderness
* Difficulty chewing, swallowing, speaking
* Coughing up blood tinged sputum
* Enlarged cervical lymph nodes

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8
Q

Assessment and Medical management of patients with oral cancer

A

Health History
* Symptoms related to oral problems, hygiene, and dental care, use of tobacco, alcohol, nutrition
* Inspect and palpate the structures of the mouth and neck

Med Management
* Surgery
* Radiation
* Chemo

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9
Q

Nursing management of oral cancer

A

Promote mouth care
* Dental care before surgery or radiation therapy
* Frequent gentle brushing and flossing
* Encourage fluid intake related for dry mouth

Ensure adequate food and fluid intake
* Assess nutritional requirements
* Dietary consult

Support a positive self image
Minimuze pain
* Avoid hot or spicy foods or hard food

Prevent infection

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10
Q

Sliding Esophageal Hernia and Paraesophageal Hernia

A

Sliding Esophageal: Increased intra-abdominal pressure causes lower portion of the esophagus and upper portion of stomach to rise into chest

Paraesophageal Hernia: Increaed intra-abdominal pressure causes greater curvature of the stomach to slide through the esophageal hiatus so that the gastroesophageal junction is within the esophageal cavity ; entire stomach may hernaite over time

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11
Q

Nursing and interproffesional shi for the hernia type shi

A

Meds: PPI’s and H2 blockers
Surgical therapy
* Fundoplication: Fundus wrapped and sewed around esophagus below diaphragm

Elevate HOB
Provide dietary consuling to avoid reflux ; small frequent meals

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12
Q

What is GERD?

A

Backflow of gastric or duodenal contents into the esophagus that can cause mucosal injury
Excessive reflux may occur because of an incomplete lower esophageal sphincter, pyloric stenosis, hiatal hernia, motility disorder
Incidence: Increases with age, iriitable bowel syndrome and obstructive disorders (assma, COPD, fibrosis)

Risk Factors: Tobacco, coffee drinking, alcohol, gastric infectoin w H PYLORI

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13
Q

Management of GERD

A

Low fat diet
Avoid caffeine, tobacco, beer, milk,* foods containing peppermint or spearmint*, don’t eat or drink 2 hours before bedtime, elevate head of bed by at least 30 degrees

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14
Q

Advantages of enteral nutrition

A

Safe and cost effective
Preserve GI integrity
Maintain fat metabolism and lipoprotein synthesis
Maintain normal insulin and glucagon ratios

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15
Q

Assessment of patient recieving enteral feeding

A

Tube placement
Pt ability to tolerate formula and amount
Clinical Response
Signs of dehydration
Elevated glucose level
Signs of infection
Check gastric residual volume
I & O , weekly weights, dietician consult

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16
Q

Maintaining feeding equipment and nutritional balance

A

Administer water before and after each medication and feeding, every 4 to 6 hours, and whenever tube is discontinued or interrupted
Do not mix medications with feedings
Do not hang more than 4 to 8 hours of feeding in an open system to avoid bacterial contamination

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17
Q

Interventions for patient undergoing neck dissection

A

Maintain airway clearence
* Place in fowler position
* Encourage coughing and deep breathing

Providing wound care
* Monitor for excessive drainage
* Reinforce dressing as needed
* Dressing changed 2-5 days

Maintain adequate nutrition
* Encourage high density, high quality intake
* May need to be modified to liquid diet or soft pureed liquid foods

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18
Q

What is gastritis?

A

Disruption of mucosal barrier that normally protects the stomach tissue from digestive juices

Acute: Rapid onset caused by dietary indiscretion ; self limiting. Causes can be from medications, alc, bile reflux, radiation therapy. Ingestion of strong acid or alkali may cause serious complication

Chronic: Prolonged Inflammation, atrophy of gastric tissue. May be associated with some autoimmune diseases, dietary factors, meds, alc, smoking, or chronic reflux of pancreatic secretions or bile

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19
Q

Manifestations of gastritis

A

Acute: Epigastric pain, anorexia, hiccups, nausea, vomiting, Erosive gastritis can lead to melena, hematemesis or hematochezia

Chronic: Fatigue, pyrosis, belching, sour taste in mouth, halitosis, early satiety, anorexia. May have pernicious anemia due to malabsoprtion of B12

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20
Q

Medical and Nursing management of gastritis

A

Acute: Refrain from alc and food until symptoms subside
* IV fluids, nasogastric intubation, antacids, histamine 2 receptor agonists, PPI

Chronic: Modify diet, get rest, reduce stress, avoid alc and NSAIDS

Both
Reduce anxiety
Promote optimal nutrition
DIscourage caffeine and alc and smoking

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21
Q

Peptic Ulcer Disease

A

Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus
Associated w infection of H Pylori
RIsk factors: Excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alc, smoking, familial tendency

Manifestations: Dull gnawing pain or burning in midepigastrium ; heartburn and vomiting may occur

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22
Q

Assessment of pt with peptic ulcer disease

A

Hisotry of presenting signs
Dietary Hisotry
72 hour diet ; diary
Abdominal Assessment ; vital signs
Meds like NSAIDS
Signs of anemia or bleeding

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23
Q

Gastric Cancer

A

Indicence: More common in older mf’s (68) ; men; Hispanic, Black, Asian
Poor Prognosis
95% of gastric cancers are adenocarcinomas and lymph node involvment with metastatis occuring early
RIsk factors: Diet, chronic inflammation of stomach, H Pylori, pernicious anemia, smoking, achlorhydria, gastric ulcers, previous subtotal gastrectomy

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24
Q

Upper GI Bleed

A

Bleeding orignating from a source proximal to the ligament of Treitz esophagus, stomach, and duodenum)

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25
Upper GI bleed etiologies
Peptic Ulcer Disease: Most common Esophageal Varices: Most common with cirrhosis Gastritis and Gastropathy: Acute or chronic inflammation of stomach lining Mallory Weiss Tear: Tear at the gastroesophageal junction due to vomiting or retching Arteriovenous Malformations: Abnormal blood vessel formation that can lead to slow, intermittent bleeding Cancer Dieulafoy Lesion: Rare, large aberrent artery in stomach wall
26
Manifestations of upper GI bleed
Hematemesis: Bright red or coffee ground appearance Melena (Black, tarry stool) Hematochezia (fresh blood in stool): Rarely from an upper GI bleed, more so lower GI Hypovolemic Shock: Tachycardia, hypotension, altered mental status, cold, clammy skin due to significant blood lost Abdominal Pain: Common with PUD, gastritis, or ulcers Anemia
27
Diagnosis of UGIB
Physical exam and history: Use of alc, NSAIDS, liver disease Edoscopy Labs: CBC, coagulation studies, liver function tests Imaging
28
Interprofessional Management of UGIB
Resuscitation: IV fluids (NS, LR) Blood trasnfusion Oxygen PPI's: For PUD and Gastritis Octreotide: For esophageal varices Antibiotics Surgery
29
Nursing Management of UGIB
Assessment and monitoring: Vitals, check for anemia, monitor I and O and fluid balance Pain management Blood transfusion management Educate on lifestyle modifications: Avoid alc, smoking, NSAIDS
30
UGIB preventative strategies and patient education
Avoidance of NSAIDS and ALc H.Pylori treatment Stress Ulcer Prophylaxis Patient Education
31
Colorectal Cancer
Manifestations: Change in bowel habits, blood in stool , occult, tarry, tenesmus
32
Planning and goals for the patient with cancer of the colon or rectum
Optimum level of nutrition Maintain fluid and electrolytes Reduce anxiety
33
Constipation
Fewer than 3 bowel movements weekly or bowel movements that are hard, dry, small, or difficult to pass Causes: Meds, chronic laxative use, inability to increase intra abdominal pressure, diet, ignoring urge to defecate, lack of exercise Manifestations: Abdominal distention, pain, bloating Sensation of incomplete evacuation Straining at stool
34
Complications of constipation
Decreased cardiac output Fecal Impaction Hemorrhoids Fissures Rectal prolapse Megacolon
35
Diarrhea
Increased frequency of bowel movements (more than 3 per day) with altereed consistancy (increased liquidity) Usually associated with urgency, perianal discomfort, incontinence, or a combination of these facotrs May be acute, persistent, or chronic Causes: Infection, meds, tube feeding formulas, metabolic and endocrine disorders
36
Manifestations of Diarrhea
Increased frequency and fluid content of stools Abdominal Cramps Distention Borborygmus Anorexia and thirst Painful spasmodic contractions of anus Tenesmus
37
Complications of Diarrhea
Fluid and electrolyte imbalances Dehydration Cardiac dysrhythmias Chronic diarrhea can result in skin care issues related to irritant dermatitis
38
Patient learning needs for diarrhea
Recognition of need for medical treatment Rest Diet and fluid intake Avoid irritating foods: Caffeiene, carbonated drinks, very hot and cold foods Perianal skin care Meds Avoid milk, fat, whole grains, fresh fruit, vegetables , avoid lots of fiber
39
Fecal incontinence causes
Anal sphincter weakness Traumatic and nontrauma Neuropathies both peripheral and gernarlized Inflammation Disorders or pelvic floor Central nervous system disorders Diarrhea ; fecal impaction w overflow
40
Manifestations of fecal incontinence
Minor soiling Occasional surgery Loss of contro; COmplete incontinence
41
Irritible Bowel Syndrome
Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both More common in women Triggers: Chronic stress, sleep deprivation, surgery, infections, diverticulitis, some foods
42
Manifestations of IBS
Alteration in bowel patterns Pain Bloating Abdominal Distention
43
Malabsorption
Inability of the digestive systems to absorb one or more of the major vitamins, minerals, or nutrients COnditions * Mucosal disorders * Infectious diseases * Luminal DIsorders * Postoperative Malabsorption
44
Clinical Manifestations of malabsorption
Hallmark is diarrhea or frequent, loose, bulky, foul smelling stools, high fat content, and often grayish Symptoms similar to IBS Weight loss and vatimin and mineral dificiency
45
Assessment and Diagnostic Findings of malabsorption
Fat analysis Lactose tolerance tests D xylose absorption tests Schilling tests
46
Patient Learning for Malabsorption
Vitamin Replacement Dietary therapy Probiotics Consider fluid and electrolyte imbalance Risk for osteoperosis
47
Celiac Disease
Disorder of malabsorption caused by autoimmune response to consumption of products that contain the protein gluten Gluten most commonly found in wheat, barley, rhye, and other grains Women more common to get
48
Manifestations of celiac
Diarrhea Steatorrhea Abdomen pain Distntion Fart Weight loss
49
Management of celiac
Chronic, noncurable and lifelong No meds to treat Refrain from exposure to gluten
50
Appendicitis
Appendix gets inflammed and edematous as a result of becoming kinked or occluded by a fecalith or lymphoid hyperplasia Inflammatory Process increases intraluminal pressure, causing edema and obstruction of orifice
51
Nursing management of appendicitis
Relieve pain Prevent fluid deficit Prevent surgical site infection
52
Diverticular Disease
Diverticulosis: Multple diverticula without inflammation Diverticulitis: Infection and inflammation of diverticula Diverticular disease increases with age and is associated with low fiber diet DIagnosed by colonoscopy
53
Diverticulitis managemtent
Encourage fluid intake of at least 2 L per day Soft foods with increased fiber, such as cooked vegetables Individualized exercise program Bulk laxatives and stool softeners
54
Nursing management of intestinal obstruction
Maintain function of NG tube Assessing and measuring NG output Assess for fluid and electro imbalance Monitor nutritional status
55
Potential complications of parenteral nutrition
Pneumothorax Sepsis Hyperglycemia Rebound hypoglycemia FLuid overload
56
Collaborative problems and potential complications of patient with inflammatory bowel disease
Electrolyte imabalnce Cardiac dysrhhythmias GI bleed with fluid loss Perforation of bowels
57
Planning and Goals for patient with Inflammatory Bowel Disease
Attainment of normal bowel elimination patterns Relief of abdominal pain and cramping Prevention of fluid deficit Maintenance of optimal nutrition and weight Avoidance of fatigue Abscence of skin breakdown
58
Nursing Interventions for pt with inflammatory bowel disease
Identify relationship between diarrhea and food, activities, or emotional stressors Provide ready access to bathroom or commode Encourage bed rest to reduce peristalsis Administer medications as prescribed Record frequency, consitancy, character, and amount of stools Fluid deficit, I & O, daily weight Elemental feeddings that are high in protein and low in residue or PN may be needed
59
Hepatitis A
Trasmission: Fecal - oral route (contaminated food/ water) Course: Acute, self limiting Risk factors: Poor sanitiation, travel to endemic areas, close contact with infected individuals Prevention: Vaccine
60
Hepatitis B
Transmission: Bloodborne , sex, perinatal Course: Can be acute or chronic (Leading to cirrhosis and liver cancer) Risk Factors: Unprotected seggs, sharing needles, healthcare exposure, pernatal transmission Prevention: Vaccine
61
Hepatitis C
Transmission: Bloodborne (shared needles, transfusions) Course: Chronic in most caces leading to cirrhoses and liver cancer RIsk factors: Injection drug use , multiple sex partners, blood transfusions before 1992 Prevention: No vaccine but antiviral treatment works
62
Hepatitis D
Transmission: Bloodborne (only in hose effected with HBV) COurse: Severe, chronic, rapid progression to cirrhosis Risk Factors: Co infection with HBV Prevention: Hep B vaccine
63
Hepatitis E
Transmission: Fecal oral route (contaminated water) Coure: Acute, self limiting, more severe in preg women Risk factors: Poor sanitation, travel to endemic areas Prevention: No vaccine, proper sanitation, and water hygiene
64
Distinguishing the types of viral hepatitis
Acute vs chronic: HAV and HEV are usually acute. HBV, HCV, and HDV can lead to chronic infection Transmission Routes: Fecal oral: HAV, HEV. Blood borne: HBV, HCV, HDV Prevention: Vaccones for HAV and HBV. No vaccines for HCV, HDV, or HEV Risk for complications: Chronic liver disease, cirrhosis, liver cancer (HBV, HCV, HDV). Acute liver failure (HAV, HEV)
65
Manifestations of viral hepatitis
General: Jaundice, fatigue, malaise, abdomen pain, NV, dark urine, pale stools Specific to Type: * A: Often asymptomatic, mild flu like symptoms * B: May be no symptoms or present with jaundice and liver dysfunction * C: No symptoms until advanced liver disease * D: Severe, co infection with HBV * E: SImilar to A, but more severe in preg women in 3rd trimester
66
Diagnostic evaluation for Hep
Liver funciton tests: Elevated ALT, AST, and bilirubin
67
Acute interproffesional management of Hep
A: No antiviral treatment B: Antivirals C: Direct acting antivirals D: Antivirals E: Supportive care , resolves on its own
68
Chronic interproffesional management of hep
HBV and HCV need long term antiviral therapy Liver transplant
69
Nursing Management of Hep
Vital signs Monitor labs Symptom management Patient education * Low fat, high protein diet for liver health Medication adhereance

Med Surge 1 (12 decks)

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