Exam 1 Review pt.5 Flashcards
SBFT is a procedure to visualize
oropharynx, esophagus, stomach, and small intestine
SBFT
Patient swallows contrast medium and assumes different positions on table
Films are taken every 30 minutes until medium reaches terminal ileum
SBFT: Nursing Implications
NPO x 8 hours before
Avoid smoking after midnight
Force fluids after to prevent constipation
Patient will have white stools
Indications for modified barium swallow
Dysphagia
Non-cardiac chest pain
Painful swallowing
Gastroesophageal reflux
Barium Enema
Enemas till clear and clear liquid the night before
NPO x 8 hours
Cathartics aftwards
White stool
Gastric Emptying Study
Done to assess stomach emptying
Patient eats egg containing radioactive metal and images are take at 0-1-2-4 hrs
When is a gastric emptying test done?
PUD
Ulcer
Diabetes
Gastric malignancies
Gastric Emptying Study: NSG consideration
Explain ingested substance are of no danger
Explain need to lie flat during scann
What procedure is done to visualize UGI tract
Esophagogastroduodenoscopy
Criteria for bariatric surgery
BMI > 40
BMI of 35 with severe medical complication
Restrictive bariatric surgery
Sleeve gastrectomy
Intragastric balloon
Combination restrictive malabsorptive
Roux-en- Y procedure
Bariatric Surgery: Post op care
NG-LWS
Enhance mobility
Pain management
Risk for infection / dehiscence
GERD complications
Esophagitis
Barretts esophagus
Cough
Bronchospasm
GERD diagnostic studies
Barium swallow
EGD
Before surgery to how is GERD treated
High dose PPI x 2 weeks as first step
GERD: Nutritional Therapy
Avoid fatty foods
Small frequent meals w/ no fluids
Avoid late night snacking (2-3hrs before)
Elevate HOB with 4-6 inches
Weight loss
Lifestyle modifications for GERD
Avoid triggers
Quit smoking = helps stregnthen LES
LINX device
Endoscopic procedure
Augments the LES with a ring made up of a serious of rare earht magnest
Fundoplication
Endoscopic or open procedure
Causes of PUD
H-pylori
Alcohol
Smoking
Family history
Stress (aggravate)
PUD: Diagnostic studies
EGD = most accurate diagnostic procedure
Urea breath or stool test
Biopsy of mucosa testing for urease
CBC
Stool for occult blood
PUD complications
HOP
Hemorrhage
Obstruction
Perforation (most lethal)
Surgical Option for PUD
Billroth 1 and Billroth 2
Dumping syndrome
Bolus of hypertonic food dumps into small intestines; manifestations are result of fluid quickly shifting out of plasma into GI tract
Dumping Syndrome Clinical Manifestations
Weakness - sweating - palpitations
Abdominal cramping
Borborygmi
Urge to defecate
Postprandial Hypoglycemia
Consequence of Dumping syndrome
Bolus of fluid high CHO results in hyperglycemia
Body release excessive amount of insulin which results in hypoglycemia
Dumping Syndrome: Nutrition
6 small meals / day
Fluids should not be taken with meal
Avoid sweets
High protein and fats encouraged
Rest after eating
Most common causes of upper GI bleed
Esophageal varices
Stomach and Duodenal ulcers
-h-pylori
-NSAIDS
UGI Bleed Nursing Interventions
Monitor VS closely
Asses for tense rigid board like abdomen
Monitor H&H and BUN
Establish large bore IV
NG to lavage
Crohns vs Ulcerative Colitis
Crohns:
-Anywhere from mouth to anus
-Terminal ileum
-Skip lesion and cobblestone appearance
Ulcerative Colitis:
-Starts in rectum and spread up
-Bleeding
TPN-Factoids
Lipid emulsion usually infused as separate solution
Needs a dedicated CV line
Start slowly and end slowly (pancreatic beta cells need time to adapt)
IBD complications
Hemorrhage
Strictures
Perforation
Sometimes surgery
Total Proctocolectomy and Ileal Anal Reservoir
IPAA
Two stage surgery
Large intestine removed
J pouch is formed
Most common surgery for U.C
Ulcerative Colitis Surgery Types
IPPA
Permanent ileostomy
Continent ileostomy
Colon Cancer RF
Diet high in red meat
Obesity
Physical inactivity
Alcohol
Long term smoking
Low intake fruits and veggies
Genetic / familial history of IBD
Three major types of ostomies
End
Loop
Double barrel stoma
End stoma
Divides bowel and bringing out the proximal end as single stoma
Distal portion:
-Surgically removed
-Oversewn and left in (hartmann’s pouch)
