Exam 2- Gastrointestinal Disorders Flashcards
The GI system consists of what?
- Smooth muscle
- Blood vessels
- Nerve tissue
Propels food through the tract
Peristalsis
The GI tract is a hollow tube that is how long?
25 inches
Accessory organs (5)
- Liver
- Gallbladder
- Pancreas
- Bile ducts
- Vasculature
What does the liver do?
Metabolism of carbohydrates and proteins
Detoxifies blood
Autonomic Nervous System actions
Parasympathetic
Increases activity
Vagus nerve
Which NS includes the vagus nerve?
Autonomic (Parasympathetic)
Sympathetic Nervous System action
Slows activity
Functions of the GI tract (3)
- Breakdown of food for digestion
- Absorption of nutrients
- Elimination of undigested food or other waste products
What is needed for a GI assessment?
Thorough history
- Current state of health (nausea, vomiting, constipation, indigestion, swallowing, pain, etc.)
- Previous health (past GI illness, ulcers, gallbladder disease, IBS, GERD, GI bleed, abdominal trauma)
- Medications
For a GI assessment, what meds do we need to assess for?
Food and drug allergies
NSAIDs
ASA
Antihypertensives
Laxatives
Dyspepsia
Discomfort associated with eating
During a physical GI assessment, what do we need to examine?
Mouth
Abdomen
Liver
Rectum
Anus
Skin
What lab studies do we need to evaluate for GI?
- CBC
- CMP
- PT/PTT
- Triglycerides
- Liver Function Panel
- Amylase, Lipase
Cancer specific studies (CEA, CA) - Stool tests
Stool tests
Cultures: leukocytes, parasites, C-Diff,
Occult blood testing, Immunologic studies
What patients do we use triglyceride lab evaluation for?
Patients who have a fatty liver
What patients do we use PT/PTT lab evaluation for?
For patients that we are concerned about bleeding as a potential concern
What patients do we use liver function panel lab evaluation for?
For patients with alcohol overuse or hepatitis
What do we avoid 72 hours prior to stool tests?
Red meat
Aspirin
NSAIDs
Horse radish
Why do we avoid red meat, aspirin, NSAIDs, horse radish prior to stool tests?
These could provide a false positive
GI diagnostic evaluation
- Abdominal Ultrasound
- Upper GI Tract study
- Lower GI Tract study
- CT, MRI, PET scans
- Endoscopic Evaluation
Which diagnostic evaluation is low coat and immediate results?
Abdominal ultrasound
Pre-op abdominal ultrasound guidelines
Fast 8-12 hours pre-procedure
Gallbladder studies: fat-free meal night before
In which diagnostics is a contrast used?
Upper GI
Lower GI
In upper GI study, what contrast is used?
Barium or hypaque
What does an upper GI study detect?
Detection of anatomic or functional disorders of upper GI organs
Pre-op guidelines for upper GI study
- Clear-liquid diet & bowel prep
- NPO midnight before exam, hold am PO meds
Which diagnostic used a barium instillation (barium enema)?
Lower GI Tract study
Contraindications for lower GI study (3)
Active inflammatory disease of colon
- Obstruction or suspected perforation
- Active GIB (may preclude enemas or laxative use)
Pre-op guidelines for lower GI study
- Low residue diet 1-2 days
- Clear liquids
- Laxative the evening before
- NPO after midnight
- Cleansing enema until clear am of test
Which diagnostic can be done with or without contrast?
CT, MRI, or PET scans
What do we evaluate before and after CT, MRI, or PET scans?
BUN
Do we identify allergies before diagnostics?
Yes
Endoscopic Evaluation
Upper GI (EGD)
Lower GI (Colonoscopy)
After using a contrast during a diagnostic, what do we do?
Administer Mucamyst before or after
Administer sodium bicarb
Increase IV fluids to flush contact out
Guidelines for Upper GI Endoscopy
- NPO 8 hours before test
- If emergency, suction stomach
- IV sedation for comfort
- Throat sprayed with local anesthetic (remove dentures or dental appliances)
Guidelines for post-procedure Upper GI Endoscopy
- Frequent VS, oxygen saturation, pain
- Gag-reflex return
- Flatus
- I’s&O’s
Diagnostic Tests
- Upper GI Endoscopy
- Lower GI Endoscopy
Guidelines for Lower GI Endoscopy (Colonoscopy)
- Bowel preparation (laxatives, enemas)
- Clear-liquid diet day before procedure
- Fast morning of test
- Explain procedure to pt
Guidelines for post-procedure Lower GI Endoscopy
- VS, oxygen saturation, pain
- Pt to report any blood in his stool
- Flatus
- Can eat in 1 hour
For patients who are in severe danger, like puking up blood, what do we do if we need immediate Upper Gi Endoscopy?
NG tube
Nursing roles for GI: Assessment
- Monitor labs (S/S infection, send specimens immediately to lab)
- Abdomen (rigid/soft, bowel sounds)
- Pain
- VS
- Fluid volume status (I/O, daily weight), mucous membranes, JVD)
- Bleeding
- Patient/family education (procedure, pre/post-op expectations)
If we suspect bleeding of GI during assessment, what else will we do?
We will also look in the stool or vomit, but also monitor CBC, PT, INR, platelets (clotting factors)
Drug therapy treatment for GI disorders (8)
- Antacids
- Digestants
- Proton pump inhibitors
- Anticholinergics
- Antidiarrheal agents
- Laxatives
- Emetics
- Antiemetics
Treatment for GI disorders
- Drug therapy
- Surgery
Surgery treatment for GI disorders (8)
- Esophageal surgery
- Gastric surgery
- Bowel surgery with ostomy
- Bowel resection and anastomosis
- Appendectomy
- Gallbladder surgery
- Liver resection or repair
- Trans jugular intrahepatic portosystemic shunt insertion (TIPS)
What is anastomosis?
Removing a portion of the bowel and sewing it back together
Nursing DX for patients with GI disorders (7)
- Pain
- Anxiety
- Fear
- Knowledge
- Skin integrity (severe diarrhea)
- Ineffective tissue perfusion
- Fluid/Electrolyte disorders
