Adult Health II Exam 3 (GI, Headaches, Seizures, Strokes) Flashcards
what are GI system serum blood tests and indications>
CBC, electrolytes, prothrombin, liver function tests
What are the different imaging studies for upper GI disorders?
Barium studies = x rays after ingesting radiographic opaque fluid
–Do not do if perforation is suspected!
Endoscopy = bx and gastric analysis
What is an esophagogastroduodenoscopy? How long NPO for?
EGS = procedure to visualize upper GI for ulcers, inflammation, GERD, cancer, dysphagia
NPO until gag reflex returns
What are 4 age changes in the GI system?
Constipation, hemorrhoids, pyrosis, tooth loss
What do the mucous glands do?
Mucous glands located in the mucosa and prevent autodigestion by secreting an alkaline protective covering.
What does HCL do?
Hydrochloric acid kills microorganisms, breaks down food into digestible particles, and supports an environment for gastric enzyme activation.
What does pepsin do?
Pepsin is a chief coenzyme in gastric juices, and converts proteins to proteases and peptones.
What treatment is indicated for pernicious anemia?
- -chronic gastritis—B12 injections for pernicious anemia
- -Intrinsic factor comes from parietal cells and is necessary for absorption of vitamin B12. Loss of parietal cells from chronic gastritis leads to pernicious anemia in patients.
what does gastrin do?
Gastrin controls gastric acidity.
What are the risks, prevention, assessments, diagnosis, s/sx and management of oral cancer?
Risks: smoking, ETOH
Dental visits should be 2x/year
Manifestations = leukoplakia (white patch), erythroplakia (red patch)
Dx = tissue exam/excisional bx
Treatment = radiation, chemo, glossectomy, radical neck dissection
What are the risks, prevention, assessments, diagnosis, s/sx and management of Esophageal cancer?
- -Can lead to barrett’s esophagus
- -Caused by alcohol, smoking, bad dental care
- -Manifestations = progressive dysphagia, odynophagia, hoarseness
- -Diagnosis = barium swallow; esophageal biopsy
- -Treatment = esophagectomy; esophagogastrostomy
What are the risks, prevention, assessments, diagnosis, s/sx and management of stomach cancer?
–risks = male, genetics, workers, japanese, h pylori, pickled nitrate foods, smoked foods
–s/sx = asymptomatic until late, dyspepsia, belching, feeling full all the time, atrophic glottis (pernicious anemia vitamin b12 deficiency beefy red tongue), bloody vomit, anemia, enlarged lymph nodes, ascites
–Diagnosis = endoscopic biopsy, barium x rays, CBC, CEA (carcinoembryonic antigen)
treatment =
–Medical = chemo, radiation (palliative), no treatment
–Surgical = partial/complete gastrectomy, can develop dumping syndrome
Complication w/partial: dumping syndrome (DS)
—Early: 30 min after eating, dizzy, tachycardia, sweating
—Late: 1.5-3 hr post eating, release of insulin → hypoglycemia
–To help with DS = lay down after eating, avoid liquids with foods, high protein, high fat, low carb diet, eat additional vit b12, Fe, K
What are the 2 types of hiatal hernias? Which is most common?
Type 1 = Sliding hiatal hernia
Type 2 = Paraesophageal (rolling) hiatal hernia
what is hiatal hernia conservative management?
AVOID obesity, pregnancy, coughing, lifting heavy, tight clothes
for hiatal hernias, what is Nissen fundoplication? Nursing considerations?
Surgery = nissen fundoplication ABCs Pain NGT output, small meals Walk around good Soft diet x1 week, anti reflux meds x1 month No driving 1 week
What are LES relaxers, aggravators, manifestations and dx? What is the gold standard for the GERD diagnosis?
- -GERD = Reflux from stomach → esophagus from failing esoph cardiac sphincter (LES), failing = achalasia
1. LES relaxers = NSAIDs, caffeine, alcohol, fatty foods, peppermint, progesterone, beta blockers, calcium channel blockers
2. LES aggravators = tight clothes, bending over, vomiting
What are GERD lifestyle mod and nutrition?
Avoid spicy foods, fatty fried foods, losing weight
What are meds for GERD?
Antacids, Histamine Blockers, Prokinetics, Proton Pump inhibitors
In PUD, what is a gastric ulcer vs a duodenal ulcer location, cause, s/sx, management and considerations?
–Gastric ulcers – from normal secretion, delayed emptying
Increased pain after eating
–Duodenal ulcers – from speeding up secretion and emptying
Decreased pain after eating
Increase in HCL secretion, h pylori found 80%, perforations likely
What are meds for PUD?
Antacids, H2 blockers, Mucosal barrier fortifiers, PPI, Prostaglandin analogs
What is surgery for PUD? Complications?
bilateral vagotomy, pyloroplasty, distal gastrectomy
–Complications = bleeding, leaking, diarrhea, gallstones, dumping syndrome, perforation
what are s/sx of perforation?
s/sx = rigid abdomen, pain, upper abd pain, fever, vomiting
What is H pylori and how treated? What complications can occur from this?
Gastric mucosal barrier is the protector, h pylori breaks down
- -Breakdown and hypersecretion of acid→ ulcer
- -Can lead to scarring (barrett’s esophagus) and CANCER
What are calculus causes and acalculous causes of cholecystitis?
–Calculus = From cholesterol stones (most common), pigmented stones (various materials), mixed stones (cholesterol/pigmented), stay in BG, migrate to cystic duct or CBD
–Acalculus = from biliary stasis, e oli, prolonged fasting, multiple trauma, Sickle cell disease, DM, long term TPN
What are diagnostics/labs for cholecystitis?
- -+ murphys
- -U/S 90% effective for dx, No barium prior to US
- -HIDA (hepatobiliary iminodiacetic acid scan), NPO prior
- -Labs = CRP (inflammation), bilirubin (jaundice), liver enzymes–AST, ALT; WBC
What are acute and chronic s/sx, nursing interventions, pt ed for cholecystitis?
–Acute = sx control, pain, NPO/NG/IVFs
focus on pain relief, analgesics, anticholinergics, opioids, antispasmodics, NSAIDs, antibiotics
–Chronic = cholestyramine (bile salt binder) for pruritus, oral agents used to dissolve stones
Ursodiol, chenodiol
--Nutrition Fat soluble vitamins ADEK Diet low in saturated fats Weight loss needed 6 small meals, keep gallbladder working Avoid fat, dairy, gassy foods
What are nursing care after laparoscopic cholecystectomy?
- -Cholecystectomy: removal of GB
- –Laparoscopic and MIS (NOTES)
1. Lap chole = less pain and complications, short stay, early week, ABCs and infection, steri strips will fall off in 10 day, ice/opioids for incision pain and ambulation for CO2 retention
2. MIS or NOTES = surgical approach through natural orifice–Mouth, vagina, rectum, can d/c want to give antiemetic (zofran) to prevent V/aspiration; Can go home same day, no surgical incision since through hole
nursing care after open cholecystectomy?
ABCs, ROI, drains (JP, T tube), report drainage more than 1000mL, nutrition (NG tube then ADAT), post cholecystectomy syndrome
