Chapter 38 / 39: Assessment of Digestive and GI function Flashcards
Digestions begins with ________ where food is broken down into small particles that can be swallowed and mixed with _____________ ________
chewing
digestive enzymes
Absorption is a MAJOR function of the ______ intestine — vitamins and minerals are absorbed, accomplished by _________ transport and _________ across intestinal walls into the circulation
small
active
diffusion
elimination is the phase of the digestive process that occurs after digestion and absorption when _______ products are eliminated from the body
waste
salivary amylase breaks down :
Pepsin breaks down:
intrinsic factor is needed to absorb _____
lipase breaks down:
trypsin breaks down :
Bile breaks down :
startches
protein
b12
fat
protein
fat
Chyme is broken down ________ and __________ acid
food
stomach
emulsification is the breakdown of ____
fat
peristalsis is the constriction of ________ muscles that promotes wavelike movement to push stomach contents _________
stomach
forward
Key parts of the GI system assessment
Health Hx
-pain, indigestion, gas, N/V, diarrhea, constipation, previous GI disease
What is included in the physical assessment of the GI system
Oral cavity
- lips, gums, tongue
Abdominal assessment (4 quad method) IAPP
Diagnostic studies and tests for GI
stool tests : ________ blood test (must be obtained on __x on different days to confirm blood occult)
Breath tests : __ ________ testing
________ and ________ tract study
GI ________ study
Endoscopic procedures
CBC
Coag studies ( to look for ________)
Culture
occult ,3
H. Pylori
Upper and Lower
motility
bleeding
Parotitis is the inflammation of the ________ gland. is the most ________ inflammation condition of salivary glands
parotid
common
what are some symptoms of parotitis?
Fever
chills
systemic signs of infection
what is the medical management of parotitis?
* adequate _____________/_______ intake
* good _______ care
* ______packs
* Stop meds that decrease ____________ (steroids, anti-inflammatory)
nutritional/ fluid
oral
cold
salivation
Sialasentitis is the inflammation of the ___________ glands - may be caused by:
* Dehydration
* ___________ therapy
* Stress
* Malnutrition
* salivary gland _________
* Improper _______ hygiene
salivary
radiation
calculi
oral
what are some signs and symptoms of sialadenitis
pain
swelling
purulent drainage
how do you treat/manage sialadentitis?
massage
hydration
warm compress
sialagogues ( anything that stimulates salivation)
Sialolithiasis are salivary _________ (stones)
calculi
What are the symptoms of salivary stones?
local sudden pain —relieved by gush of saliva
How are salivary stones managed/treated?
Sialendscopy ( standard treatment)
Lithotripsy
Neoplasms are salivary _________/________
tumors/growths
what are some risk factors of neoplasms?
* ___________ to the head and neck
* __________ age
* exposure to specific ____________ in the work environment
radiation
increased
carcinogens
how are neoplasms treated/managed?
radiation
chemo
surgery
What are some risk factors for oral cancer?
tobacco use
HPV infection
Alcohol
HX of head/neck cancer
what are early manifestations of oral cancer?
often few/no symptoms
painless mass/sore that doesn’t heal
Any lesion present for more than 2 weeks or does not heal should be examined and biopsied (TRUE OR FALSE)
True
what are some late manifestations of oral cancer?
complaints of soreness
difficulty swallowing, chewing, speaking
what are the treatments/Management for oral cancer?
surgical resection (removal)
Radiation therapy (localized)
Chemo (systemic)
_______ neck dissection is used the ________ - it removes lymph nodes, sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve
radical
most
_________ neck dissection removes structures such as lymph nodes and tumor
modified
some pre-op care for neck dissections include :
* assess _________ prep and _________
* make sure pt _____________ procedure and what they should _______ afterwards
physical and knowledge
understands, expect
some post-op care for neck dissection includes :
* assess for _____________ related to :
* airway and breathing
* infection
* Hemorrhage
* Other : _______ injury , ______ leak
complications
nerve, chyle
Nursing interventions for Neck dissection
* maintain _________ clearance
* ________ position
* deep __________
* assess and manage _____
*Maintain adequate ___________
airway
fowler
breathing
pain
nutrition
a _______ ________ is where the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the portion of the thorax
hiatal hernia
___________ and _______________ are the two main types of hiatal hernias
sliding and paraesophageal
sliding hiatal hernias occur when the upper _________ and the _________________ junction are displaced upward and slide in and out of the thorax
stomach
gastroesophageal
*** most common type
A paraesophageal hernia occurs when all or part of the stomach pushed through the __________ beside the ___________
diaphragm
esophagus
what are some signs and symptoms of sliding hiatal hernias?
heartburn
reflux
chest pain
**dysphagia
belching
**pyrosis
**regurgitation
** many pts are asymptomatic
what are some common signs and symptoms of paraesophageal hiatal hernias?
**hemorrhage
**obstruction
**volvulus
**strangulation feeling
fullness after eating
chest pain
what are some risk factors of hiatal hernias
high intake of _______ foods
_________ or ___________ right before bed
fatty
eating or drinking
management for hiatal hernias includes :
*frequent small _______
* pt is advised to not _______ for 1 hour after eating to prevent reflux/ movement of hernia
* PPIs : reduce ______ ____ by inhibiting cellular pump or gastric parietal cells necessary for gastric and acid secretion ( omeprazole , Panprozol )
* Antacids : _________ excess acid and increases LES pressure (TUMs, Pepcid) ** take 1-2 hours before eating
meals
recline
gastric acid
Neutralizes
GERD is a fairly common disorder marked by the backflow of _______ or duodenal contents into the esophagus
gastric
GERD may occur because of an incompetent lower esophageal ___________, pyloric _______, hiatal _______, or ________ disorder
Sphincter
stenosis
hernia
motility
common risk factors of GERD:
* _________ use
*__________ drinking
* _________ consumption
* increased ________
*sleep ____
* ________ age
* _________ infection w helicobacter pylori
tobacco
caffeine
alcohol
weight
apnea
increased
gastric
clinical manifestation of GERD include
* heartburn (may ________)
* ___________ at midline
*_______salivatio n (can mimic heart attack )
* Nocturnal - cough, wheeze, SOB, ______ sleep patterns
radiate
dyspepsia
hyper
disturbed
how do you treat/manage GERD?
* avoid esophageal _________
*lifestyle modifications — (_________, ______ ______)
* ________ HOB 30 degrees, assess lung sounds, prevent aspiration
*Nutritional diet - low ____ diet
Avoid caffeine, peppermint or spearmint, beer, milk, carbonated beverages
* Meds: PPIs and H2 receptors
irritants
smoking, losing weight
elevate
complications of GERD are:
* aspiration
esophagitis
** Barrett’s esophagus : ____________ cell _________
reversible, changes
what are some risk factors of esophageal cancer?
GERD
BE
nutritional deficiency
tobacco use
alcohol use
what are some clinical manifestations of esophageal cancer? ** feeling that food is not ___________ _________ or sensation of ________ ___ _________
* sore throat or __________
*Dysphagia
* Weight ______
* Choking and/or _____________
passing through, mass in throat
hoarseness
gain
regurgitation
what is some pre-op care for esophageal cancer? *______ calorie and _____ protein diet
* IV fluids _________/ chemotherapy
* Meticulous ______ care
high, high
radiation
oral
what is some post-op care for esophageal cancer? HOB elevated ___ degrees
_____ - no manipulation by RN; monitor for arrhythmias
When able to eat, diet as tolerated; risk for ___________ syndrome
30
NGT
Dumping
Delivering nutrition enterally is done to meet ___________ requirements when oral intake is inadequate or not possible, but GI tract is functioning
nutritional
what are some of the advantages of delivering nutrition enterally?
* _____ and ______ effective
* Preserve GI ___________
* Preserve _______ sequence of intestinal and hepatic metabolism
* Maintain fat _____________ and lipoprotein synthesis
* Maintain __________ insulin and glucagon ratios
safe and cost
integrity
normal
metabolism
normal
what are some of the most common complications of enteral nutrition ?
Overfeeding
reseeding syndrome
aspiration pneumonia
constipation
Diarrhea
reasons for tube feeding:
* pt cannot __________
* something in the ________ tract (mouth , throat ) needs to be bypassed
swallow
upper
What are some reasons to have a g tube or j-tube?
difficulty swallowing
difficulty digesting food
removal of part of the GI
