1. inguinal 2. femoral 3. umbilical 4. incisional

week 5 GI Flashcards by Adrielle Jodoin

which three nursing concepts are affected by issues r/t elimination?

fluid and electrolyte balance, tissue integrity, and altered nutrition status

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describe an acute exacerbation of a chronic GI disorder

inflammation can flare up and abscesses can form in the mucosal lining of the GI tract causing infection

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what is a common psychological complication of elimination issues?

sleep deprivation and subsequent inability to cope

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which two specific GI assessments are part of recognizing cues of impaired elimination?

bowel sounds and monitoring of stools for frequency, amount, blood, etc

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what will i monitor the bloodwork for in impaired elimination?

dehydration and fluid/electrolyte balance

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why should i care about checking peripheral pulses and cap refill on a patient admitted with a GI disorder?

becuase they are at risk for dehydration and subsequent hemodynamic collapse

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aside from GI assessment and signs of dehydration/electrolyte issues, what two things willl i monitor for in a patient with inflammatory bowel disease?

perineal skin and coping skills/emotional status

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what are three interventions r/t tissue integrity in IBD?

keep skin clean and dry
apply barrier cream
monitor for infection

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describe symptoms of diverticulosis

likely asymptomatic, but may have crampy pain, constipation OR diarrhea

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what is the difference between diverticulosis and diverticulitis?

diverticulitis involves the diverticula becoming inflamed d/t retention of stool in pouches

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what might be the signs of diverticulitis?

edema, abscesses, perforations, peritonitis

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what are symptoms of diverticulitis

abdominal pain, tender lower left quadrant, fever/chills/nausea/anorexia (signs of infection)

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how do we diagnose diverticulitis?

ultrasound or CT scan

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6 complications of diverticulitis

perforation with peritonitis
abscess
fistula formation
bowel obstruction
urethral obstruction
bleeding

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what are 5 things we can do as treatment/monitoring with diverticulitis?

rest the bowel with NPO and iv fluids

consult dietition about low-fibre diets for mild flare-ups

monitor for infection

might need order for antibiotics for severe

pt may need surgery

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four types of hernia

inguinal
femoral
umbilical
incisional

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are hernias painful?

commonly, yes. pain can be reduced if hernia can be placed back into abdominal cavity

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what complication of hernias is an emergency?

strangulation- pt would have s&s of a bowel obstruction

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what three actions can be taken to treat hernia?

wearing a truss, surgical replair (herniorrhaphy) or surgical reinforcement of weakened fascia (hernioplasty)

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what is post-op care for hernia? (5)

-watch for bladder distension (I&Os)
-provide scrotal support
-deep breathing and turns
-splint incision
-position to reduce pressure in suture line

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what is different about post-hernia surgery compared to other surgery recoveries?

no coughing

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discharge teaching for hermorrhoidectomy (5 points)

narcotics for sphincter spasm
sitz baths 1-2 days post op
teach pt to change dressing
use stool softeners
take analgesics before a bm

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which three things precipitate peptic ulcers?

drugs, stress and H pylori bacteria

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what are the main differences between gastric and duodenal ulcers? (6)

-peak age: 50-70 for peptic, 20-50 for duo
-pain factors: food aggravates gastric, sooths duodenal
- nutritional status: only peptic tends to present as poorly nurished
-gastric secretions: decreased in gastric, increased in duo
-pain onset- this makes sense
- gastric heals with tx, duo often has remissions

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which labs will be ordered for suspected peptic ulcer?

H pylori in bllod, breath or stool, HGB and HCT (d/t bleeding)

which 2 Dx tools are used for peptic ulcer? which is the gold standard?

Esophagogastroduodenoscopy (gold standard), nuclear medicine scan which tests for bleeding

three complications of PUD

hemorrhage/upper GI bleed, Perforation and spillage into peritoneal space gastric outlet obstuction

4 signs of upper gi bleed (one late sign)

hematemesis or coffee ground tarry black stool abdominal pain eventual shock

how to intervene in GI bleed

treat like hypovolemic shock - frequent VS, O2, IV fluids, monitor I&Os, stools, emesis and labs

how do they stop a GI bleed?

epinephrine sclerosing needles (or glue), endoclips electrocoagulation probes

which 5 drugs are used along with other tx to control GI bleeds? (besides epinephrine given endoscopically)

Octreotide vasopressin antacids aluminum hydroxide PPIs H2 receptor blockers

pt with PUD has sudden, severe abdominal pain, rigid board-like abdomen with increasing distention. What complication is this?

perforation and spillage of gastric contents

what interventions do I do for PUD perforation?

monitor for and treat hypovolemic or septic shock (vitals! lactic acid, cbc, fluids), make sure they have an NG tube for decompression, give antibiotics and prepare them for surgery

if gastric mucosa is perforated, what shouuld I NOT do?

allow anything into their stomach either via PO intake or NG tube

pt with PUD has pain that progesses, swelling of upper abdomen, and starts projectile vomiting. what complication is this

gastric outlet obstruction

how do we treat gastric outlet obstruction?

decompress with NG tube (to prevent vomiting), IV fluid and electrolyte replacement (after they've vomited, and b.c they can't absorb fluids with intestines), and prep for surgery!

5 drugs for PUD (some repeat)

-H2 receptor blockers like famotidine, - PPI, antibiotics for h pylori (tetracycline, metronidazole), -cytoprotective (like pepto-bismol), - antacids

Fill in the blank: Discharge teaching for PUD - Dietary modifications: four triggers - stop _______ - two points about meds: - report this sign:

1. avoid spicy foods, acidic foods, caffeine, alcohol 2. smoking 3. avoid OTC meds, take prescribed meds as ordered 4. tarry stools, bloody emesis, increased pain

4 surgeries for PUD

gastroduodenostomy, gastrojejunostomy, vagotomy (severing of vagus nerve), pyloroplasty

what will a patient not have immediately after PUD surgery?

peristalsis

what will i want to auscultate regularely after GI surgery?

bowel sounds to check for return of peristalsis

what is a long-term complication of PUD surgery?

anemia d/t loss of blood and not eating

what kind of IV fluids are best for post PUD surgery?

ones with K+

what am I ensuring patency of after PUD surgery? what other care am i doing with this?

NG tube. decompressing, monitoring contents, removing after peristalsis returns

this complication happens after removal of large portion of stomach and pyloric sphincter and results in uncontrolled gastric emptying of a high carb bolus into small intestine

dumping syndrome

15 minutes after eating, PUD post-op pt feels dizzy and bloated. what is going on? how do i prevent this?

dumping syndrome. don't let them drink with meals, take small dry feedings, and low-carb diet

what is post-prandial hypoglycemia?

a varient/ complication of dumping syndrome where hyperglycemia causes ++ insulin release resulting in secondary hypoglycemia

what might happen after plyoric surgery?

bile reflux gastritis

pt has Anemia, Vague epigastric fullness, feelings of early satiety after meals, weight loss, dysphagia, dyspepsia what could this be?

adenocarcinoma of stomach wall

how would early stomach ca be treated? what about later stage?

laparoscopic surgery if tumor small enough, large may require total gastrectomy

waht is a patient at risk for following a total gastrectomy with esophagojejunostomy?

poor nutrition status, wt loss, vitamin deficiency, anemia, dumping syndrome, postprandial hypoglycemia

which labs are used to diagnose IBD? (5)

barium, fecal OBT, CBC, ESR and C-reactive protein (for inflammation), electrolytes

which IBD causes bloody diarhea?

ulcerative colitis

which IBD is cured with surgery?

Ulcerative collitis

Which IBD has FISTULAS?

Crohns

which IBD causes hemorrhage?

which IBD causes obstruction?

Crohns

which IBD causes perforation?

both

what are 3 extra-intestinal complications of IBD?

arthopathy, arthritis, skin issues (could also name thromboembolic events, occular manifestations, osteoporosis)

IBD patients require meticulous ___________ care

perianal

someone with a Hx of IBD brings their medications with them to the ER. what's in the bag?

Sulphasalazine (5-asa), prednisone, cyclosporine and/or infliximab, vitamins-iron suppliment, and diphenaxylate (antidiarrheal)

what would i advice an IBD patient about their diet?

Keep a food diary! identify triggers and avoid them (dairy is common) eat high calorie high protein low fat diet take suppliments low-fibre (residue)

what exercise do I need to teach my pt to do after surgery with an ileoanal reservoir?

kegels!

five ways bowel obstructions can happen

-adhesions -CA -hernia -paralytic ileus - anything that blocks (stool?)

this type of bowel obstruction has a rapid onset, colic, projectile vomiting frequent and early on.

small bowel

this type of obstruction presents with gramping, constipation, signnificant abd distension and has a gradual onset

large bowel

nursing care with bowel obstruction (NOT about digital decomp or laxatives) - name 6

abd assessment, -pain control - n/g care and decompression - nutrition/lytes, fluid replacement - prep for surgery - monitor for perforation

clinical manifestations of colerectal ca

change in elimination habits, gas pains, bloody stool

what does CEA measure?

presence of a fetal growth hormone which would indicate CA

what three things are colonoscopies used for?

diagnose CA, biopsy, remove polyps

what is a abdominal peritoneal resection

anus, rectum and sigmoid colon removed, proximal sigmoid brought through abdominal wall and permanent colostomy

describe incisions/wounds after AP resection

abd incision, perineal incision with drain, and stoma

what positioning consideration do i need to know for post AP resection

NO PRESSURE ON PERINEUM

assess stoma q __

8hrs

teach pt with a new stoma to report: (4)

fever, diarrhea, constipation, stoma problems

three big principles for ALL GI surgery

pain control, nausea, constipation

week 5 GI Flashcards

(76 cards)