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Week 10 TUES Flashcards

GI inflammation

1
Q

hematemsis

A

bloody vomit

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2
Q

occult blood

A

blood in stool via lab test

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3
Q

melena

A

dark, coffee ground , tarry stools

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4
Q

hematochezia

A

bright red stools

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5
Q

Upper GI bleeds are most likey caused by

A
  • peptic ulcer
  • tumors
  • stress ulcers
  • erosive gastritis
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6
Q

manifestations of upper gi bleed

A

melena and hematemsis
- depending on if blood was digested or not

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7
Q

Upper GI bleed diagnosis

A

hx and visualization w/ fiber optic endoscopy

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8
Q

treatment for upper gi bleed

A
  • ppis
  • sucralfate
  • antacid
  • eliminating foods that cause distress
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9
Q

prevention for upper gi bleeds

A
  • reduced or prevented if gastric pH level maintained above 4
  • ppi, sucralfate used for both treatment and prophylaxis
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10
Q

Acute lower GI bleeds are most common in what population?

A

Older adult population

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11
Q

causes of lower gi bleeds

A
  • diverticulosis
  • inflammatory bowel disease
  • neoplasms
  • ischemic bowel disease
  • rectal ulcers
  • ischemic colitis
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12
Q

Ischemic bowel disease is?

A

ischemia of the colon
- caused by interruption of colonic blood supply

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13
Q

Management of acute GI bleeding

A
  • assess the severity of blood loss
  • assist in determining cause of bleed
  • plan and implement treatment
  • provide supportive care
  • provide fluid replacement
  • monitor on going care and progression
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14
Q

GI bleed assessment

A
  • hgl and hct levels
  • increase BUN?
  • stool color and characteristics
  • abdominal assessment
  • where is bleed coming from
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15
Q

diagnosis for upper and lower gi bleed

A
  • upper; gastroenterologist> endoscopy
    -Lower; general surgeon/colorectal> colonoscopy
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16
Q

What is the primary goal of early management in hemodynamically unstable pt

A

resuscitation
- oxygen maintenance can provide tissues with oxygen
- think ABC’s

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17
Q

Interventions for a severe GI hemorrhage

A
  • vasopressin
  • somatostatin
  • octreotide drip
  • mechanical tamponade
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18
Q

management of shock

A
  • maintain adequate tissue perfusion and oxygenation
  • prevention of fluid volume deficit related to blood loss
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19
Q

optimization of hemodynamic status in a pt w/ a GI bleed

A
  • ensure open airway and administer supplemental oxygen
  • initiate continuous monitoring for cardia dysrhythmias
  • prepare for insertion of central venous or pulmonary artery catheter
  • prepare pt for emergent surgical intervention
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20
Q

What can cause a bowel obstruction?

A
  • mechanical issues
  • tumor
  • surgical issue
  • incarcerated hernia
  • paralytic ileus
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21
Q

Acute small bowel obstruction
etiologies

A
  • swallowed air major cause of distention
  • strangulation can progress to bowel ischemia, necrosis, perforation, and peritonitis
  • intestinal strangulation occurs when intestine becomes so twisted circulation is interrupted
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22
Q

Large bowel obstruction etiologies

A
  • neoplasms are most common
  • diverticulitis, stricture formation, and fecal impaction
  • paralytic ileus
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23
Q

Clinical findings in intestinal obstruction

A
  • abdominal dissention
  • cramping and periumbilicus pain that occurs in waves, with periods of comfort in between
  • vomiting, possibly profuse, soon follows onset of pain and is usually bilious
  • electrolyte imbalance and intraluminal loss(sweating) of fluids occur
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24
Q

treatment for acute intestinal obstruction

A
  • fluid resuscitation and stabilization of pt> intial therapy
  • board spectrum antibiotics
  • early surgical consult advised in high-risk pts
  • monitor for complications> sepsis
25
what is pancreatitis
inflammation of the pancreas - results in injury to the pancreas
26
what is acute pancreatitis
sudden onset of pancreatic inflammation
27
Mild acute pancreatitis
- short term - pancreatic edema and swelling - localized inflammation - no organ failure - no local or systemic complications - reversible - good prognosis
28
Moderate acute pancreatitis
- organ failure that resolves in 48 hrs (transient) and/ or - local or systemic complications w/out persistent organ failure
29
Severe acute pancreatitis
- longer duration - persistant single or multi organ failure - poor prognosis> associated with sepsis and multiple organ dysfunction
30
etiologies of acute pancreatitis
- gallstones - chronic alcohol abuse - medications - metabolic causes - idiopathic - complications of AIDs - genetic factors
31
Nursing assessment for a pt with acute pancreatitis
- pain assessment - focused hx - GI assessment - s/s of inflammation - skin assess> cullen/ grey sign - cardiovascular assess - watch electrolyte imbalances
32
diagnosing acute pancreatitis
- abdominal pain characteristics - serum amylase and or lipase more than 3 times the upper limit of normal - characteristic findings of acute pancreatitis on abdominal imaging - abdominal and chest x-ray -ct scan, ultrasound, MRI, image-guided aspiration biopsy
33
Supportive treatment for pancreatitis
- stabilze hemodynamic status - monitor BP - control pain - minimize pancreatic stimulation - provide psychosocial support - curative therapies> correct underlying problems and prevent/ treat complications
34
pancreatitis; whole body system complications
- cardiac output decreased - hypovolemia - oxygenation and gas exchange - acute epigastric or abdominal pain - n/v - impaired nutritional intake - increased risk for infection - anxiety> d/t pain - pt at increased risk for injury - electrolyte imbalance
35
Defining acute Liver failure
- life-threatening condition - coag abnormalities - INR greater than 1.5 - onset of encephalopathy in someone who has no previously known hepatic cirrhosis - duration less than 26 wks
36
Causes of liver failure
- drug induced ALF> acetaminophen - Viral infections> hepatitis', herpes - vasuclar> loss of blood supply - metabolic> hellp syndrome, reyes syndrome
37
Diagnosis for acute liver failure
labs; routine chemistry values, LFT, serum amylase and lipase, CBC, PT/INR, hepatitis serologies, autoimmune markers testing; CT scan or ultrasound
38
N-acetylcysteine therapy is for what diagnosis of ALF
acetaminophen toxicity
39
Acyclovir is for what diagnosis of ALF
HERPES SIMPLEX VIRUS
40
Complications of ALF
- hepatic encephalopathy - cerebral edema - coagulation abnormalities - hypoglycemia - metabolic abnormalities - infection - cardiopulmonary abnormalities - AKI
41
Asterixis
bilateral flapping tremor most often seen w/ dorsiflexion
42
What grade of hepatic encephalopathy can be reversible
grade 1
43
Treatment for severe hepatic encephalopathy
Lactulose
44
Ammonia levels are _____ with HE
High; toxic
45
What is cerebral edema
- life-threating complication of ALF - greatest concern is development of IICP and brain herniation - severity coorelates to severity of HE
46
coagulopathy w/ ALF
- INR greater than 1.5 due to livers inability to produce clotting factors - treatment; it k, rrp, plts
47
other complications related to ALF
- hypoglycemia and electrolyte imbalnces - infection - cardiopulmonary abnormalities - AKI
48
Factors that contribute to hepatic encephalopathy in chronic liver failure
- infections> throws balance off - high protein diet> excess protein is hard on the liver - worsening hepatic function - constipation - Azotemia> HIGH BUN - GI bleeds - Hypovolemia
49
Azotemia
high BUN
50
Ascites w/ liver failure
- abnormal collection of fluid in abdominal cavity - volume of ascites can be so large pt may develop abdominal compartment syndrome
51
Treatment for ascites
- albumin - paracentesis - pleurX drain
52
Nursing goals for liver failure
- determine and correct underlying cause of ALF - Prevent worsening of liver function - Support organ function until pt recovers or receives liver transplant - Promote stable hemodynamic and ventilatory status - Prevent or minimize secondary complication
53
Nursing assessment with liver failure
- Full HTT - neurologic; cognitive, muscular, neurosensory
54
Frequently occurring nursing interventions for Liver failure
- interventions to optimize airway, breathing, and oxygentation/ gas exchange - administer fluid resuscitation - initiation of mobility protocols to prevent complications of immobility - initiation of mobility protocols to prevent complication of immobility
55
nursing considerations/ management for liver failure
- administration of oral, entral, or parenteral nutrtion to meet metabolic demand - administer pharm and nonpharm measures to optimize comfort - monitor and prevent for infections
56
what organ absorbs food
small intestine
57
Upper GI bleed stool characteristic
black and tarry stools
58
what s/s would indicate a peptic ulcer rupture
severe abdominal pain
59
what electrolyte often is low after having spouts of diarrhea
potassium

Complex Care (26 decks)

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