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
Gastritis
Description, Cause, Risk Factors, Assessment Notes
Description: Inflammation of the gastric mucosa with acute and chronic degrees
Causes:
* Acute: Irritant exposure (H. pylori, NSAIDS, caffeine, alcohol, corticosteroids, radiation);
* Chronic: Thinning of the lining, decreased B12, associated with gastric cancer (can be autoimmune or triggered; relieved by food)
Risk Factors: H. pylori, Long-term NSAIDs, Caffeine/Alcohol, Corticosteroids, Radiation, Corrosive substances
Assessment Notes:
* Acute: Rapid onset of epigastric pain/discomfort, N/V, indigestion, gastric hemmorrhage, hematemesis, heartburn
* Chronic: Vague epigastric pain relieved by food, N/V, anorexia, intolerance of fatty/spicy foods, PERNICIOUS ANEMIA (No B12 absorption)
Gastritis
Interventions, Drug Therapy, Diagnostic Tests
Interventions: Treat s/s, avoid irritants and spicy food, avoid smoking
Drug Therapy: PPIs, H2RAs, Antibiotic (H. pylori), Mucosal Barrier fortifier, Antacids
Diagnostics: EGD, H. pylori testing
Peptic Ulcers
Description, Causes, Complications, Assessment Notes
Description: Mucosal lesions of the stomach (gastric), duodenum (duodenal) and ulcers from stress; weakened mucosal defense from stomach acid and pepsin
Causes: H. pylori and NSAIDS
* Gastric: Near acid secreting mucosa; pain worsened by food
* Duodenal: Upper duodenum, pain relieved by food
* Stress: After acute medical crisis/trauma, uncommon
Complications: Hemmorrhage (Gastric), Perforation, Pyloric Obstruction, Intractable (Unresponsive) Disease
Assessment Notes: Indigestion, Epigastric Tenderness, N/V
Peptic Ulcers
Interventions, Diagnostic Testing
Interventions: Bland foods, no night eating, avoid irritants (tobacco, alcohol, caffeine), trying yoga/meditation, ELIMINATE H. PYLORI (PPI and 2 antibiotics, Bismuth/Pepto-Bismol)
Diagnostics: EGD, Serologic H. pylori tesing, Occult blood and Decreased H/H
Gastric Cancer
Description, Cause, Risk Factors, Assessment Notes
Description: Usually adrenocarcinomas
Risk Factors: Pernicious Anemia, H. pylori, ACHLORHYDRIA, Eating Processed Food/Salt, Gastric/Esophagus Surgery
Assessment Notes: Early Signs (Heartburn, Abdomin Discomfort); Late (Progressive Weight Loss, and N/V)
Gastric Cancer
Diagnostic Testing, Treatment
Diagnostics: EGD; CT, MRI and PET for disease planning
Treatment: Drugs, Chemo, Radiation, Total/Partial Gastrectomy, B12 Injections
Dumping Syndrome
Description, Causes, Assessment Notes, Treatment
Description: Rapid emptying of food into the small intestin
Causes: Gastrectomy
Assessment Notes: Early Signs (Vertigo, Tachycardia, Syncope, Sweating, Pallor, Palpitations, Confusions
Treatment: No Liquid with Meals, Small Meals, High proteins, High fat, low-moderate carbs
Drugs to Know
Gastrointestinal
- Antacids (Calcium Carbonate): Increases Gastric Content pH, Deactivates Pepsin
- H2RA (Famotidine): Decreased Secretions
- Mucosal Barrier Fortifier (Sucralfate): Stimulates Mucosal Protection
- Proton Pump Inhibitor (Pantoprazol): Prevents Ulcers
- Prokinetic (Metoclopramide): Increases Gastric Emptying
