Adult Health I - Gastrointestinal Flashcards
General Gastrointestinal Overview, Stomatitis, Oral Cancer, GERD, Hiatal Hernia, Gastritis, Peptic Ulcer Disease, Upper GI Bleed, Gastric Cancer
Changes with Aging
General Gastrointestinal
Stomach
* Gastric mucosa atrophy
* Decreased hydrochloric acid levels: Low B12 and Iron absorption, Bacteria proliferation
* Atrophic gastritis from bacteria proliferation
Intestines
* Decrease in peristalsis, nerve impulses and sensation to defecate: constipation and impaction
Pancreas
* Decrease in Lipase: Decreased fat absorption
* Fat in feces (stentorrhea): diarrhea and fluid/electrolyte imbalance
Liver
* Low hepatic cells, high fibrosis tissue
* Decreased protein synthesis: decreased drug metabolism
Complications are in bold
Interventions for Changes in Aging
General Gastrointestinal
Stomach: No spicy foods, Bland foods high in B12 and Iron, assess for epigastric pain
* Complication: Low B12 and Calcium
Intestines: 1500 mL of fluid, high fiber, increased activity
* Complication: Constipation, Impaction
Pancreas: Small, frequent meals, assess for diarrhea and dehydration
* Complication: Stentorrhea
Liver: Smaller dosages for drugs, assess for toxicity
* Complication: Drug toxicity
Nursing Assessment
General Gastrointestinal
Patient and Family History
Nutritional History
* Diet, Food allergies, Alcohol/Caffeine
* Appetite, Anorexia, Unintentional Weight Loss
* N/V, Swallowing, Indigestion, Heart Burn, Pain/Discomfort Eating, Change in Taste, Regurgitation
Bowel Health
* Quality, Quantity, Frequency, Sound
Skin Health Indication of poor liver function
* Discoloration, rash, itching, jaundice, easy bruising, easy bleeding
Note: Stress can exacerbate GI issues like Chron’s, IBS and Ulcerative Colitis
Decreased Labs
General Gastrointestinal
- ⇣ Albumin (3.5-5): Hepatic Disease, Liver
- ⇣ Potassium and Calcium: Malabsorption, Pancreatitis
- ⇣ Hemaglobin/Hematocrit: Anemia, GI Bleed
Increased Labs
General Gastrointestinal
- ⇡ Liver Function Tests: Cirrhosis, Hepatitis
- ⇡ Bilirubin: Biliary Obstruction, Liver Disease
- ⇡ Ammonia: Hepatic Disease, Bad Metabolism Function
- ⇡ Ca 19-9 and CEA: Specifically Colon Cancer
- ⇡ Amylase and Lipase: Pancreatitis
- ⇡ Prothrombin Time (PT): Liver Disease
- ⇡ WBC: Infection
- ✔︎ Stool Heme Test (gFOBT): Upper GI Bleed
Diagnostic Test: EGD
Government Name: esophagogastroduodenoscopy
Description: Visual of esophagus, gastric, duodenum
Preparation: NPO 6-8 hours, Hold anticoagulants, NSAIDS, Asprin and Ibuprofen
Operation: Moderate throat sedation, 20-30 minutes
Post-operation: TEST GAG REFLEX BEFORE EATING, Monitor Vital Signs, H/H, Bleeding, No heavy machinery
Diseases: Gastritis, Gastric Cancer, Upper GI Bleed
Diagnostic Test: Colonoscopy
Description: Endoscopic exam of the entire large intestine recommended for 50 year olds and up every 10 years
Preparation: Clear liquids the day before, NPO 4-6 hours prior, Avoid all bleeding drugs before, adequate bowel cleansing is important, should expect watery diarrhea
Operation: Moderate IV sedation, 30 minutes to 1 hour
Post-operation: Expected feeling of fullness, cramping and bloating that will pass with flatus, observe for perforation s/s (severe pain) and hemorrhage
Diseases: Colon Cancer
Diagnostic Test: ERCP
Government Name: Endoscopic retrograde cholangiopancreatography
Description: Visual and radiographic exam of the liver, gallbladder, bile ducts and pancreas used to diagnose and treat
Preparation:NPO 6-8 hours prior, Avoid all bleeding drugs before,uses radiopaque dye (iodine/shellfish)
Operation: Moderate IV sedation, 30 minutes to 2 hours
Post-operation: NPO UNTIL GAG REFLEX CHECKED, Prevent aspiation, assess for bleeding/pain indicating perforation, assess for gallbladder and pancreas inflammation (n/v, fever, elevated lipase)
Diseases: None of our prototypes
Diagnostic Test: Small Bowel Endoscopy
Description:
Preparation:
Operation:
Post-operation:
Diseases:
Stomatitis
Description, Causes, Risk Factors and Assessment Notes
Description: Oral cavity inflammation with painful ulcerations which can be either primary or secondary
Causes: Primary (Direct Trauma, Herpes Simplex, Allergies); Secondary (Opportunistic on immunocompromised people)
Risk Factors: Irritants (Tobbacco/Alcohol), Infection, Allergens causing ulcers, Vitamin Deficiency (B, Folate, Iron and Zinc), Systemic disease causing immunosuppression (Chemo, HIV/AIDS)
* Ulcerations causing bleeding and pathway for infection
Assessment Notes: Infections, Nutritional Changes, Oral Hygiene, Oral Trauma, Drug History, Extent of Disease in Mouth
* Non-Sterile Gloves, Insure Good Lighting, REPORT IF FAR BACK
Candida Albicans is an example of FUNGAL SECONDARY STOMATITIS
Stomatitis
Interventions and Drug Therapy
Interventions: Remove mouth accessories, Encouraging frequent oral hygiene (After meals/Every 2 hours), Using a soft toothbrush/gauze, Frequent rinsing (baking soda mix or saline; NO COMMERCIAL MOUTHWASH), AVOID alcohol and lemon/glycerin, Soft and Bland Foods
Drug Therapy:
* Pt. with Bacterial Infections get Antimicrobials (Tetracyline, Minocyline, Chlorhexidine)
* Pt. with Herpes Simplex get IV, Oral or Topical Acyclovir
* Pt. with Fungal Infections get Nystatin (Mycostatin)
* Pt. with Pain get Anesthetics (Orabase, Anbesol)
A patient with Candida Albicans would get MYOCSTATIN
Oral Cancer
Description, Causes, Risk Factors and Assessment Notes
Description:
* Squamous (most common): Red, raised, eroded leisons assosiated with smokers and alcohol use
* Basal: Asymptomatic scab with a pearly border associated with excessive light exposure
* Kaposi’s: Malignant, opportunistic raised purple nodule/plaque on hard palate (most common), gums, tongue or tonsils associated with AIDS
Causes: Alcohol/Tobacco, Excessive Light, HIV/AIDS
Risk Factors: Smoking, Excessive Light, Immunocompromised population
Assessment Notes: Bleeding, Poor appetite from dificulty chewing and swallowing, Unintended weight loss, Thick or absent saliva, Leisons, Lump in Cheek
BIOPSY is definitive method for diagnosis
Interventions: Avoid alcohol/glycerin, Hygiene and Open Airway
GERD
Description, Causes, Risk Factors and Assesment Notes
Description: Gastroesophageal Reflux (Disease), where secondary hyperemia and ulcerations can develop esophageal stricures
* Key Features: Dyspepsia (Indigestion), Pyrosis (Heartburn) and Regurgitation
Causes: Excessive relaxation of the lower espophageal sphincter
Risk Factors: H. pylori, Obesity, Hiatal Hernia, Gastric Distention
Assessment Notes: Check for consuption of chocolate, caffeine, citrius, tomatoes, mint, tabacco/alcohol, calcium channel blockers, nitrates, anti-cholinergics, elevated estrogen/progesterone, NG Tubes
GERD
Intervention, Treatment, Diagnostic Tests
Interventions: Nutritional Therapy (small, frequent meals), Lifestyle Changes, Drugs (H2RA, Antacids, Prokinetic Drugs and PPIs)
Treatment: Relieve esophogastritis, Prevent Barrett’s esophagus and prevent strictures
* Barrett’s is pre-malignant ulceration of the lower esophagus associated with chronic GERD and is a precursor to cancer
Diagnostic: pH Monitoring (most accurate), Barium Swallow and EGD
Hiatal Hernia
Description, Interventions, Diagnostic Testing, Post-Op Interventios
Description: The stomach protruding through the esophageal hiatus of the diaphram into the chest
* Sliding (up and down, most common): shows GERD s/s
* Large Rolling: more serious, strangled/obstructed, surgery preferred
Interventions: Antacids/PPIs and Laproscopic/Open Fundoplication
Diagnostic: Barrium Swallows with fluroscopy, EGD (sliding hernias)
Post-Op Treatment: Soft diet (7 days), Anti-Reflux, REPORT: FEVER (101), N/V, BLOATING/PAIN
