Exam 3: Gastrointestinal Flashcards
Four mechanisms that cause ulcers
- Increased contact with HCl acid
- Increased contact with pepsin
- Decreased mucosal resistance
- H. pylori
Three patient behaviors that can cause ulcers
- Stress
- Smoking
- Meds (ASA, NSAIDs)
What does hematemesis look like?
Coffee grounds
Prep for an upper GI series (3)
- NPO
- 16 oz barium solution (chalky)
- Milk of magnesia to offset constipation caused by barium
Before a gastroscopy… (4)
- Patient is NPO
- Attain consent
- Monitor VS, O2 sat
- Administer IV and IV sedation
What do you watch for after a gastroscopy? What could this lead to?
Sudden abdominal pain–> could be perforation
Four sxs involved with perforation
- Profuse sweating
- Shallow breathing
- Hard abdomen
- Sudden abdominal pain
How long after an upper GI series or gastroscopy should patient be NPO?
Til gag reflex returns
What two labs do you check for a patient with an ulcer?
- WBC
- BUN
Six med categories for ulcer patient
- Antacids
- Cytroprotective
- Antispasmotic
- Histamine 2 agents
- Proton Pump inhibitors
- H. Pylori agents
3 antacids (ulcer)
Milk of magnesia
Mylanta
Maalox
Cytroprotective drug (ulcer)
Sucralfate (carafate)
Antispasmotic drug (ulcer)
Banthine
Histamine 2 Antagonists (ulcer) - 2
Cimetidine (Tagamet)
Zantac
Proton pump inhibitors (ulcer) - 4
Omeprazol (Prilosec)
Prevacid
Nexium
Protonix
3 H. Pylori agents
Prevacid
Amoxicillin
Bilaxin
______ has diarrheal effect and ______ has a constipation effect. Most antacids are both.
MAGNESIUM
ALUMINUM
Most antacids have a very high ______ content – especially ______.
SODIUM
AKLASELTZER
Mechanism of sucralfate
CYTROPROTECTIVE
Take it an hour before meals, it mixes with stomach acid and forms a paste that adheres to - and protects - the ulcer
Histamine 2 antagonists should not be given with…
antacids (they will slow H2 antagonist absorption)
Role of Histamine 2
Stimulates production of HCl acid (GI specific)
Function of a proton pump inhibitor
helps block acid production
Common H. Pylori treatment
- Proton pump inhibitor
- Two antibiotics
Before and after: Gastroduodenostomy (Bilroth 1)
Bottom half of stomach is removed
Top half of stomach is re-connected to duodenum
Before and after: Gastrojejunostomy (Bilroth 2)
Bottom half of stomach is removed
Top half of stomach is re-connected to jejunum
Before and after: Gastrectomy (total)
Stomach is removed, lower esophagus is attached to duodenum
Levine v. Salem Sump:
Levine is only one tube - intermittent suctioning required
Salem is two tubes - second tube must be connected to low pressure suction at all times
What vitamin do you give to patients after GI surgery?
Vitamin B12
_____ or ______ is associated with dumping syndrome
- Large meals or
- High amount of simple carbs
after a total gastrectomy
Prevention of dumping syndrome (2)
- Small frequent meals
- Lie down for a half hour after eating
(after total gastrectomy)
How dumping syndrome occurs with a large meal:
Food is hypertonic, so fluid enters the small bowel. There is not enough volume in the intravascular space, so the body sets off a vasomotor response
Vasomotor response for dumping syndrome (5)
- Tachycardia
- Palpitations
- Dizziness
- Weakness
- Hypotension
Hypoglycemic reaction for dumping syndrome (6)
- Tachycardia
- Palpitations
- Dizziness
- Weakness
- Diaphoresis
- Trembling
Early symptoms of colon cancer:
Absent or vague
Later symptoms of colon cancer (5)
- Melena
- Pain
- Change in bowel habits
- Anemia
- Anorexia / Weight loss
4 risk factors for colon cancer
- Family history
- Age (40+)
- Diet (fat, protein, simple carbs)
- Smoking
Five types of tests to detect / diagnose colon cancer
- Rectal exam for stool guiac tests sigmoidoscopy colonoscopy lower GI series CAT scan, MRI or Ultrasound
How often should a patient get a rectal exam for stool guiac tests?
Yearly
How often should a patient get a sigmoidoscopy?
every 5 years
How often should a patient get a colonoscopy?
every 10 years
Bowel prep before test or surgery
Diet
Low-residue diet for 1-2 days
Then clear fluids, laxatives, cleansing enema
NPO 8 hours prior to test surgery
What is given before bowel surgery to remove some of the bacteria?
Aminoglycosides
3 post-op nursing goals: Colostomies
#1: Help the patient cope #2: Prevent complications #3: Maintain nutrition
Potential complications after a colostomy (7)
- Paralytic ileus
- Bowel obstruction
- Peritonitis
- Wound infectoin
- Atelectasis
- Pneumonia
- Pain
What nutrition should be administered after…
- A colostomy?
- An ileostomy?
- Normal diet
- Low residue diet
Irrigating ostomies:
- Yes: 2
- No: 2
- NEVER: 1
Yes: Descending and sigmoid colostomy
No: Ascending and transverse colostomy
Never: Ileostomy
With a colostomy, the contents become _____ as you _____
more solid
travel closer to the end of the digestive system
Consistency of contents: Ileostomy
Liquid
What type of ostomies can have constipation
Sigmoid colostomies only
With what ostomy is food blockage possible?
ileostomy – CHEW a lot
Which ostomy has a normal diet?
Colostomy
Restrictions for ostomies (2)
No contact sports
No heavy lifting
Contraindicated to eat/ take with ileostomy (5)
- Laxatives
- Enteric coated pills
- Time release pills
- Fresh fruit
- Raw veggies or nuts
