Exam 2 Flashcards
1
Q
Major functions of the GI tract
A
Digestion: breakdown of food particles
Absorption: absorbing food into the blood stream at the small and large intestines
Elimination: follows absorption, eliminating undigested and unabsorbed materials
2
Q
Digestion in older patients
A
Difficulty chewing & swallowing
Higher risk for developing reflux & pyrosis (heartburn)
Food intolerance, malabsorption, decrease in B12 absorption
Less hydrochloric acid (vital in killing bacteria on food)
Decrease in digestive enzymes/secretion of digestive enzymes
Indigestion & constipation
Decrease in peristalsis
Decrease in muscle tone
Decrease in salivation/mucus
Fecal incontinence
3
Q
Major role of the mouth in digestion
A
Process of digestion begins here
Chewing & swallowing
Contains aliva & salivary amylase containing ptyalin which is aids in digestion
After food is swallowed the epiglottis moves to cover the tracheal opening so food is not aspirated
4
Q
Major role of the stomach in digestion
A
Contains hydrochloric acid, pepsin, and instrinsic factor which allows you to absorb B12 into your small intestines, cant absorb B12 with it, get it from stomach.
5
Q
Major role of the gallbladder in digestion
A
Contains bile, which helps to break down fat
6
Q
Major role of the pancreas in digestion
A
Contains glucagon - raises your blood sugar
Contains insulin - brings your blood sugar down
Contains amylase - breaks down carbohydrates
Contains lipase - breaks down lipids
Contains trypsin - breaks down proteins
7
Q
What should you collect regarding GI history
A
Pain Dyspepsia - upper abdominal discomfort with eating, indigestion Gas Nausea & vomiting Diarrhea & constipation Blood in stool Medications can alter color of stool Surgeries Appetite and eating patterns
8
Q
Components of the RUQ
A
Gallbladder
Right kidney
Liver
Head of pancreas
9
Q
Components of the LUQ
A
Left kidney
Pancreas body/tail
Stomach
Spleen
10
Q
Components of the RLQ
A
Appendix
11
Q
Components of the LLQ
A
Descending and sigmoid colon
**pain here is usually diverticulitis
12
Q
Describe the diagnostic test of a stool specimen
A
Examine for consistency, color, and blood
13
Q
Describe the diagnostic test for breath tests
A
Testing for h.pylori which causes ulcers in the stomach & duodenum
14
Q
Describe the diagnostic test for abdominal ultrasounds
A
Noninvasive, detects an enlarged gallbladder or pancreas, presence of gall stones, enlarged ovaries, ectopic pregnancies, or appendicitis
15
Q
Describe the diagnostic test for DNA testing
A
Identifies genetic risk factors
16
Q
Whats the difference between an upper and lower GI study
A
Upper- drink barium and xray how it travels through
Lower- barium sulfate as an enema and then xray
17
Q
Describe the diagnostic test for endoscopic procedures
A
Looking with a scope
18
Q
Disorder of the teeth: glue like gelatin substance that gets stuck on the teeth
A
Plaque
19
Q
Disorder of the teeth: cavities or decay
A
Dental caries
20
Q
Disorder of the teeth: abscess under the tooth that fills with pus, can be acute or chronic
A
Periapical abscess
21
Q
Disorder of the teeth: misalignment, genetic or trauma, sucking thumb
A
Malocclusion
22
Q
Disorder of teeth where gums grow over teeth is caused by what medicine
A
Dilantin for seizures
23
Q
What are the 3 temporomandibular disorders and how do you treat them
A
- myofascial pain (discomfort)
- internal derangement of joint (dislocation)
- degenerative joint disease (arthritis)
Treatment: ROM, NSAIDS, opioids, muscle relaxants, antidepressants, orthotics to relieve pressure, may need surgery
24
Q
What are the 2 disorders of the lips, mouth, and gums
A
Xerostomia: dry mouth
Stomatitis: irritation of oral mucosa
25
What is GERD?
Gastro esophageal reflux disorder
| -Inflamed loose floppy lower esophageal sphincter
26
Risk factors for GERD
obesity, pregnancy, smoker, hiatal hernias
27
Clinical manifestations with GERD
nocturnal coughing, pyrosis (another term for heartburn)
28
Complications with GERD
esophagitis, Barrett's esophagus (HCl coming up to burn the esophagus, risk for cancer
29
Diagnostic studies with GERD
Barium swallow
30
Interventions for people with GERD
lifstyle modifications such as not eating 2-3 hours before bed, small low fat meals, nutrition, drug, and endoscopic therapy
31
Medications to take with GERD
```
Antacids (tums)
H2 blockers (pepcid)
Proton pump inhibitors (Prizol)
avoid anticholinergics
avoid sympathomimetics
anything to speed up perstalsis
```
32
What is achalasia?
Opposite of GERD
Lower esophageal sphincter is too tight
Food blocks or gets blocked sometimes causing vomit
33
Signs and symptoms of achalasia?
```
Heart burn
Burning, teary eyes, uncomfortable
Reduced peristalsis in esophagus
Failure of esophageal sphincter to relax for swallowing
Pyrosis
Dysphagia- difficulty swallowing
Weight loss
Hypersalivation
```
34
Inflammation of gastric or stomach mucosa
Can be drug related: NSAIDs, h. pylori
Gastric mucosa membrane becomes edematous and hyperemic and undergoes superficial erosion
Will not get instrinsic factor with this
Gastritis
35
Prevention is key
Can be because of undercooked meat, unclean vegetables, human to human, unpasteurized milk
Can cause extreme or bloody diarrhea
Food poisoning
36
Purposes of GI intubation
```
Suction decompresses the stomach
Lavage the stomach
Diagnose GI disorders
Administer medications
Way of feeding
Treat obstruction
Compress a bleeding site
Aspirate gastric contents
```
37
Types of gastric tubes
Levin - single lumen
Sump salem - radiopaque, 2 lumen
Enteric - means farther into the stomach or intestines
38
Describe parenteral nutrition
Provides nutrients via IV
Goal is to better nutrition, wont cause weight loss
--proteins, carbs, fats, electrolytes,vitamins, trace minerals, sterile water
Parenteral needs to be sterile cuz its going in IV
Enteral goes directly in the stomach so it does not need to be sterile, just clean
39
Reasons for parenteral nutrition
Poor nutrition intake
Bowels not working right
Patient not willing to ingest food: anorexic
If you cant use tube feeding, can use TPN
Prolonged pre or post op nutritional needs
40
Advantages of enteral feeding
Meet nutritional requirements
Safe and cost effective
Preserve GI integrity
Preserve normal intestinal and hepatic metabolism
Maintain fat metabolism and lipoprotein synthesis
Maintain normal insulin and glucagon ratios
41
What are the 2 feeding tubes
Nasogastric or nasoenteral
| Gastrostomy or jejunostomy
42
What are 4 methods for tube feeding
Intermittent bolus feediing
Intermittent gravity drip
Continuous infusion
Cyclic feeding
43
Ways to reduce complications of feeding tubes
Right rate, method, and can they tolerate it?
Measure risidual more than 200mL
Water
Dont mix feeding tubes with medications
Dont hang feeding for longer than 4 hours
Diarrhea
Prevent dumping syndrome: feel like they have to go to the bathroom
Not cold: can cause cramping
HOB up to at least 30 degrees
44
Rapid onset of symptoms usually caused by dietary indiscretion, medications, alcohol, bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause serious complications – suicide attempt
Acute gastritis
45
Prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori, autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile.
Chronic gastritis
46
What are some manifestations (things that happen) when you have acute gastritis
```
Abdominal discomfort
Headache
Lassitude
N/V
Hiccupping
```
47
What are some manifestations (things that happen) when you have chronic gastritis
```
Epigastric discomfort
Anorexia
Heart burn after eating
Belching
Sour taste in mouth
N/V
Intolerance of some foods
Malabsorption of B12
```
48
What should you do to manage acute gastritis
No food/alcohol
| Neutralize strong acid or strong alkalytic agents
49
What should you do to manage chronic gastritis
```
Modify diet
Promote rest
Reduce stress
Avoid alcohol
Avoid NSAIDs
Meds
```
50
What diet works best for children with gastritis
```
BRAT
bananas
rice
applesauce
toast
```
51
What is a peptic ulcer?
Erosion of the mucus membrane due to H. pylori
52
What are risk factors of peptic ulcers
```
Too much stomach acid
Diet
NSAIDs
Alcohol
Smoking
Family history
```
53
Signs/symptoms of peptic ulcers
Dull gnawing pain/burning in mid epigastrium
Heart burn/vomiting
Melena (stool may be black & tar like, indicates upper GI bleed)
54
Treatments for peptic ulcers
```
Medications
Reduce stress
Regular schedule
Rest periods during the day
Stop smoking
No hot or cold foods
No meat
No alcohol
No coffee
Small meals
Occasionally surgery
```
55
What are 3 surgical procedures for stomach ulcers
Vagotomy - cut the vagus nerve
Pyloroplasty - transect nerves
Billroth 1 & 2 - cut and replace location
56
What is a hemorrhage and how do you manage it
Escape of blood from a ruptured vessel
-could be experiencing bleeding, shock, hematemesis, n/v, constipation, epigastric fullness, wt loss, anorexia
Treatment: IV fluids, NG tube, saline or water lavage, O2, treatment shock, vital signs, urine output-should be at least 30 mL/hr, endoscopic coagulation, surgical intervention, pyloric obstruction, electrolytes, balloon dilation
57
What is perforation and how do you manage it
When something goes through any of the anatomy in the stomach
Signs/symptoms: upper ab pain probably referred to as shoulder pain, vomiting, tender board like abdomen, shock
Have to go to surgery
58
What is bariatric surgery
Surgery used to induce wt loss in morbidly obese patients but has high health complications
Selection factors are based on body wt, pt history, failure to lose wt, absence of endocrine disorders, psychological stability, meds have failed
59
6 aspects of care for patients undergoing bariatric surgery
Pre op: evaluate and counsel
Post op: gastric surgery and obesity tissue
Post op diet: 6 small feeds/ day, 600-800 cal/ day
Psychosocial interventions
Follow up care
Education regarding long term effects
60
Constipation and its causes
Its infrequent and irregular, when you cant use the bathroom
Causes: occurs with older age, medications, chronic laxative use, weakness, immobility, fatigue, inability to increase intra-abdominal pressure, diet, ignoring urge to defecate, lack of regular exercise
61
Manifestations/things that occur with constipation
```
Less than 3 bowel movements a week
Distended
Not hungry
Headache
Tired
Indigestion
Straining
Hard, dry stool
```
62
Complications that can occur with constipation
```
Hemorrhage
Fecal impaction
Hemorrhoids
Fissures
Megacolon
```
63
Patient learning with constipation
Drink water and lots of fiber
Go when you have to go
Exercise
Laxatives
64
What is diarrhea and what causes it
When you have more than 3 stool a day and its lots of loose stool
Urgent perianal discomfort, incontinence
Cant be acute or chronic
Caused by infection, medications, tube feeding, metbolic or endocrine disorders, various disease processess
65
Manifestations that occur with diarrhea
```
Abdominal cramping
Distention
Anorexia
Thirst
Borborygmus
Tenesmus
```
66
Complications that occur with diarrhea
Fluid and electrolyte imbalance: losing vit, K?
Dehydration: causes muscle weakness, tingling, hypotension, drowsiness
Skin break down
Cardiac dysrhythmias
67
Patient teaching/learning with diarrhea
```
Rest
Diet and fluid intake
Avoid irritating food or drinks
Perianal skin care
Medications
Avoid milk, fat, whole grains, fresh fruit, and veggies
```
68
What is anemia
Low hemoglobin, low RBC
69
Term for not producing enough RBC
Hypoproliferative
70
Components of a great RBC
Iron
B12
Folic acid
71
Term for excess destruction of RBC
Hemolytic
72
The spleen in responsible for..
destruction of bad or old RBC
73
Manifestations that occur with anemia are all different depending on the anemia but most are...
```
Fatigue, weakness, malaise
Pallor or jaundice
Excess of bilirubin
Cardiac and respiratory problems: heart is enlarged, pumps too quickly, peripheral edema
Tongue changes
Nail changes: brittle, dry
Pica: craving things like dirt
Neurological problems: numbness
```
74
What to avoid with angular cheilosis
Hot things
Spicy things
Anything that can burn you or create a sore
75
What is angular cheilosis
inflammatory condition that occurs in 1 or both angles of the mouth. This condition typically presents with erythema, painful cracking, scaling, bleeding, and ulceration at the corners of the mouth.
76
What are complications of severe anemia
May develop heart failure: RR will increase
Angina: chest pain
Paresthesia
Confusion
77
Iron supplements can cause
Black or dark colored stool
Abd. cramping or pain
Feeling nauseous
78
Serum B12 levels allow you to look at what type of anemia? low B12 levels means this anemia which also looks the same as folic acid deficiency anemia
Schillings test with this anemia also..
Pernicious anemia
79
Decreased erythropoietin levels show what
kidney function
80
Ways to manage amenia
*Transfusion of RBC
*Immunosuppressive therapy
Manage causes of GI bleeds (more common in alcoholics)
Manage menstruation
Pregnant women need 30% more blood
Occult tests are used to look for hidden blood in stool
Look at tongue for beefy or redness
Are they taking any supplements
Are they getting enough B12, iron, folic acid?
Introduce nutrients into the system
--add fruits, vegetables, dairy
Look at extreme exercise
Look at alcohol intake
81
Term for when all cells are low
| -erythrocytes, leukocytes, thrombocytes
Pancytopenia
82
What is aplastic anemia
deficiency of all types of blood cells caused by failure of bone marrow development
marrow is being replaced by fat
immune attacks against marrow
83
Cause of aplastic anemia
Usually an unknown cause
| -could be because of sepsis or nasty infection, pregnancy, medications, chemical exposure, radiation
84
What is significant about a neutropenic diet with aplastic anemia
Eat fully cooked foods such as carrots rather than fresh carrots because they could still have bacteria on them
85
What is the most common anemia
Iron deficiency
-commonly due to blood loss
male (14-17 mg/dL)
female (12-16 mg/dL)
86
With anemia, you have to have healthy kidneys because..
Kidneys produce erythropoietin which is a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues
87
Symptoms of iron deficiency anemia
```
Tachycardia
Pallor
Fatigue
Glossitis
Cheilitis
```
88
Things that disrupt the absorption of iron
disorder of the duodenum
antacids
dairy with medication
tea, coffee
89
Ways to give iron
```
IM
IV
Iron dextran
Test dose
Z-track or air lock
```
90
Anemia consisting of folic acid deficiency and B12 deficiency
Takes years to see
Megaloblastic anemia
91
Causes of megaloblastic anemia
Disease of stomach, small bowel or pancreas, family history, history of immune disorders
92
Interventions for megaloblastic anemia
Folic acid 1mg/day
Vitamin B12
-both IM injections
93
What is sickle cell anemia
A defective hemoglobin molecule with a sickle shape
Cannot get oxygenated blood to that area of tissue
Damages every organ: kidneys, heart, eyes, brain (strokes)
Very painful and involves monthly blood transfusions
94
Monthly blood transfusion for sickle cell anemia where the blood is pulled out and the good blood is put back in
Aphoresis
95
Sickle cell anemia is inherited from..
African descent
Mediterranean
Middle east
Some eastern indians
96
Treatments for sickle cell anemia
Bone marrow expands in childhood
Peripheral bone marrow stem cell transplant
Hydroxyurea & arginine
Transfusions
Get enough fluids (dehydration causes stickiness and cant get the blood to move through smoothly)
Pain managements
--apsirin, NSAIDs, morphine, dilaudid, PCA, corticosteroids (inflammation)
97
What is the Frank Starling law
How much the heart is stretched-- the more blood the more stretch
98
What is the cause of varicose veins
Weak valves, because they don't stay closed and gravity moves the blood down instead of back up to the heart
99
What is coronary artery disease
Damage or disease in the heart's major blood vessels
100
What happens when an area of tissue is not getting oxygenated blood
It will die and become scar tissue meaning its not coming back and becomes very weak
101
Leading cause of death in US
Cardiovascular disease
102
Most common causes of cardiovascular disease
Atherosclerosis
| Coronary atherosclerosis
103
Abnormal accumulation of fat/ lipid deposits and fibrous tissue within arterial walls
Repeated arterial inflammation, wall injury
Atherosclerosis
104
blockage & narrowing of coronary vessels- reduce blood flow to myocardium
Coronary atherosclerosis
105
Risk factors of coronary artery disease
```
Increased lipids
Increased LDLs
Smoking
Diabetes
Obesity
Family history
Peripheral artery disease
Abdomenal aortic aneurysm
Hypertension
Metabolic syndrome
```
106
What are other things that can reduce blood flow to the heart
```
Vasospasm of coronary artery
Myocardial trauma
Congenital problem
Blood loss
Tachycardia
Thyrotoxicosis
Cocaine use
```
107
Nonmodifiable risk factors for atherosclerosis and peripheral vascular disorders
Age
Gender
Familial genetics
Genetics plays a huge role in CAD
108
What is PTCA
Percutaneous transluminal coronary angioplasty
| Through the skin, through the lumen, change the shape of the vessel
109
What is laser angioplasty
burning up the plaque with a laser
110
What is an atherectomy
cutting out the built up plaque
111
What can happen after PTCA
An MI can happen if the balloon is kept in there
Beware of bleeding
For blocked vessels a heart cath is typically done and surgery is a last minute thing
112
What is angina pectoris and how does it feel
Severe pain in the chest
Feels like a choking sensation
Will have an upset stomach
Heavy pressure like someone is sitting on their chest
113
What can cause angina pectoris?
```
When the blood glucose level is too high
With diabetes
Blood that is too sugary destroys nerves so a person wont be able to tell if they are having chest pain or a heart attack
Anxiety/stress
Heavy meals
Cold weather
Exertion
```
114
How do you treat chest pain
```
Have them lie down
MONA
-morphine
-oxygen
-nitroglycerin
-aspirin to put under their tongue
(sub-lingual gets into the blood stream faster)
```
115
What will occur with right sided heart failure
```
Back up of blood to the body
Dependent edema
JVD
Abdominal distention
--liver gets big, spleen gets full, gain weight
Hepatomegaly
Splenomegaly
Nausea
Anorexia
Increased blood pressure
```
116
What will occur with left sided heart failure
```
Pulmonary congestion
Crackles
Dyspnea
Tachypnea
Decreased blood to the body
Decreased pulse
Decreased blood pressure
```
117
What does pulmonary edema look like with left sided heart failure
gets really foamy and can turn pink
118
Interventions for heart failure
```
Vital signs
Diuretics (in the morning so they dont pee all night)
Space out activities
Low sodium diet
Head of bed up
Probably also giving oxygen
```
119
How do you recognize an ace inhibitor and whats its use
-pril
| used for HTN and CHF
120
How do you recognize a beta blocker and whats its use
-olol
slows down the heart
protects the heart from having another heart attack
also for hypertension
121
What are nitrates used for
Vasodilation to increase blood flow to the heart
122
How do you recognize anticoagulants and name a common one
-xaparin
| Levanox
123
How do you recognize calcium channel blockers
-dipine
124
What are statins
Good for your cholesterol, bad for your liver
| Lipitor (atorvastatin)
125
When you don’t have good blow flow into the peripheries
Wont be able to find a pulse where there is not good arterial blood flow
You will also not have hair in places that don’t have good arterial blood flow
Peripheral arterial insufficiency
126
What is intermittent claudication
If you have a patient that doesn't have good blood flow they will have to stop when they are walking from these muscle cramps
Some patients it wont bother for a long time
127
These occur in the feet, bony areas
Base of the foot – looks punched out, no active bleeding
Want a dangling position as well to increase the blood flow and if not it will be painful
Elevation will stop the blood flow causing the pain
Arterial leg ulcers
128
What is the difference between atherosclerosis and arteriosclerosis
ath-- plaque build up
| art-- no elasticity
129
What is peripheral arterial occlusive disease
Intermittent claudication
130
Ways to treat PAOD
```
Meds (aspirin, trental, cilostazole)
Stop smoking
Control weight
Reduce cholesterol
Surgeries: endarterectomy, bypass grafts
```
131
A bypass graft taken from small veins in legs
Femoral to popliteal bypass graft
132
What is Raynauds disease
An arterial disorder with intermittent claudication
Happens to younger women
Need to protect the fingers
Scleroderma -- hardening and contraction of skin and connective tissue
Turns white then turns blue then turns red
Can be caused by stress, smoking/tobacco, diet
133
Why should patients on anticoagulants avoid vitamin K
It stops anticoagulants from working because vitamin K helps your blood to clot
134
Who is at risk for venous thrombosis
People on BC
Post op
Smokers
135
What are venous leg ulcers
Occur on the inner leg between ankle and mid calf
There will be drainage at the base
Skin will be purple tan
Very irregular borderse
136
Ways to treat venous leg ulcers
```
Gradually increase activity
--the more you walk around the more blood you push back up to your heart
Promote blood flow
Diversional activities
Pain meds
Good hygiene and wound care
Legs up
Avoid trauma
Good nutrition
```
137
Lymph vessel that is inflamed or infected
Acute lymphangitis
138
What is lymphedema
Chronic swelling
Elephantitis is a type that the skin gets very thick and you can fix it
Furosemide for lymphedema or surgery
139
What is cellulitis
Inflamed or infected connective tissue
140
Vascular surgeon makes an incision in affected artery & removes plaque contained in artery's inner lining
Endarterectomy
141
What is CABG
Coronary artery bypass graft
142
What should be done after a CABG
```
Arterial line
Intake and output
CT scans
Fluids
Blood pressure
Check temperatures
Vitamin K
```
143
What renal injury should you watch for after cardiovascular surgeries
Kidney perfusion related to poor cardiac output
