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d-health promotion(former alteration) > exam 5- gi > Flashcards

exam 5- gi Flashcards

1
Q

GI System organs

A

mouth,

pharynx,

esophagus,

stomach,

small intestine,

large intestine,

liver,

gallbladder,

pancreas

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2
Q

Subjective data for gi system

A

focused or part of total health assessment –

nutrition, diet screening.

Dietary habits and history of gi symptoms,

normal weight,

any weight loss,

meds,

current health history,

socioeconomic status

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3
Q

Objective data-

A

physical assessment –

ht
weight,
bmi,
oral, abdominal assessment,
bowel sounds and last bowel movement, passing flatus

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4
Q

Barium Swallow/upper GI Series

look for
drink
observing
diet
cannot take
eliminate by
stool

Diagnostic Tests- Esophagus & Stomach

A

-looks for inflammation, ulcerations, hernia and polyps.

Pts drink 16-20 ounces of barium-

observing movement of barium contrast by bronchoscope.

diet may be altered a few days before.

Pts cannot take narcotics or anticholinergics 24 hrs before /

/ after study- eliminate barium by increasing fluids for 48 hrs,

stool may be light in color

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5
Q

Esophageal Acidity –
diagnoses
inserted
normal

Diagnostic Tests- Esophagus & Stomach

A

diagnoses lower esophageal sphincter issues and chronic reflux.

A catheter with a ph probe is inserted

normal is between 5-6

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6
Q

Gastric Emptying Studies

evaluates

Diagnostic Tests- Esophagus & Stomach

A

–evaluates ability of stomach to empty liquids or solid

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7
Q

MRI
identify
no
need

Diagnostic Tests- Esophagus & Stomach

A

–identify sources of bleeding,

no metal implants,

need to lay flat and still

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8
Q

EGD- esophagogastroduodenoscopy –

direct
looking
pts need
monitored
local
check

Diagnostic Tests- Esophagus & Stomach

A

direct visualization of esophagus, stomach, duodenum-

looking for polyps or ulcers,

pts need to be npo,

monitored for anesthetic care/

/ local anesthetic is used in the throat

check gag reflex prior to giving them anything

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9
Q

Barium Enema –

used to identify
contrast
colon must be
liquids prior
give what after
increase

Diagnostic Tests- Intestines

A

used to identify abnormalities of the colon or rectum,

contrast medium and rectal area is looked through scope,

colon must be clear of fecal content,

clear liquids prior ,

given laxatives and enemas after,

increase fluids

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10
Q

Colonoscopy -,

entire/looking
pts
liquids
taking/tolerating
if coming in
after education

Diagnostic Tests- Intestines

A

entire colon, looks for polyps, tumors, bleeding , strictures,

pts are npo

are clear liquids,

taking oral bowel prep, must be able to tolerate oral prep,

if coming in for n/v or gi complaints bowel prep may be challenging/

/ after procedure educate on abdominal cramping and flatus for a few hrs

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11
Q

Guaiac Fecal Occult Blood

checking

Diagnostic Tests- Intestines

A

– checking fecal matter for hidden blood

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12
Q

Stool Culture –

what looking at

Diagnostic Tests- Intestines

A

looking at form, consistency, color and odor

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13
Q

Lower GI Series –

drink
film
must tolerate
increase
change

Diagnostic Tests- Intestines

A

drink contrast medium,

films are taken and can be used with upper gi series or barium swallow,

must be able to tolerate bowel prep to get rid of fecal matter,

increase fluids

changes in stool color

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14
Q

Ultrasound –

what is it
checks

Diagnostic Tests- Gallbladder, Pancreas, Liver

A

high frequency sound waves that pass through the body structures

to check for abnormalities

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15
Q

Cholangiogram

contrast
evaluates

Diagnostic Tests- Gallbladder, Pancreas, Liver

A

–contrast medium is injected into the common bile duct

to evaluate filling

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16
Q

CT -

what is it
might need

Diagnostic Tests- Gallbladder, Pancreas, Liver

A

360 view of body structures,

might need oral contrast,

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17
Q

Endoscopic Retrograde Cholangiopancreatography (ERCP)-

visualizes
retrieves

Diagnostic Tests- Gallbladder, Pancreas, Liver

A

visualizes gi structures

, retrieves gallstones from bile duct and dilate structures

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18
Q

Magnetic Resonance Cholangiopancreatography (MRCP)-

non
evalautes
no
lie

Diagnostic Tests- Gallbladder, Pancreas, Liver

A

non invasive mri

evaluate biliary and pancreatic ducts

, no metal implants,

lie flat and still

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19
Q

Liver Biopsy –

rules out
monitor/no
pts
preop
check
needle
after biopsy

Diagnostic Tests- Gallbladder, Pancreas, Liver

A

used to rule out metastatic cancer, liver cirrhosis

, monitor anticoagulants prior, no aspirin and ibuprofen a week prior to biopsy,

pts are npo,

vitals preop,

check bleeding times,

needle is inserted into upper right quadrant,

after biopsy pts are laying on right side to maintain pressure

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20
Q

Stomatitis-

common
oral mucosa
mucosal lining

A

Common disorder of mouth

Inflammation, ulcers of the oral mucosa

Thin, fragile mucosal lining is damaged leading to significant pain and discomfort

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21
Q

Stomatitis-

causes

infections
t
i
nd
ca

A

Viral, bacterial or fungal infections,

trauma,

irritants,

nutritional deficiencies,

chemo agents

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22
Q

who’s at risk for Stomatitis-

A

immune compromised patients,

chemo pts,

frail elderly pts,

HIV,

corticosteroids

dentures

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23
Q

Stomatitis-

diagnosis
DV
C
sm
les

A

direct visualization and physical exam ,

cultures,

smears for systemic illness,

lesions spreading down into esophagus

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24
Q

Stomatitis-

manifestations-pain/inability

leads to

A

oral pain,

inability to eat, drink or swallow,

leads to complications of malnutrition and fluid and electrolyte imbalances ,

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25
Q

treatment
Oral hygiene

A

–soft toothbrush,

avoid alchhol based mouthwashe

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26
Q

medications Stomatitis-

Coating agent
contain
dont

A

-coat the mouth

Often contain lidocaine –

don’t want to swallow,

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27
Q
  • Fungal meds stomatitis

treats what
med+considerations
oral antifungl meds-

A

treat thrush or candidas

Nystatin- oral suspension//swish and swallow

Oral antifungals- fluconazole, ketoconazole

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28
Q

Medications- Viral

meds

stomatitis

A

Topical/oral antiviral –

acyclovir, valacyclovir

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29
Q

Stomatitis- type–Cold sore, Fever Blister

causes
manifestation
treatment

A

Causes–Herpes Simplex Virus

manifestations–Burning, vesicular lesion

treatment–Resolves on own
Antiviral - “cyclovir”

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30
Q

stomatitis type–Aphthous ulcer- Canker Sore

causes
manifestations
treatment

A

causes–unknown; herpes virus

manifestations- Shallow white/yellow erosions with red ring

treatement- Topical steroid, numbing agents

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31
Q

Candidiasis (thrush)- stomatitis

causes
manifestasions
treatments

A

causes–Candida Albicans

manifestations-White, curd-like patches

treatment-antifungals- nystatin, fluconazole, ketoconazole

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32
Q

Stomatitis- health promotions

identify
education(eliminate/if chemo/ )

A

Identify risk factors –oral care, poor denture use,

Educate –eliminate spicy/hot foods, if on chemo, avoid irritants like alcohol and tobacco

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33
Q

Priorities of Care

hygiene
maintain

A

Oral hygiene, prevention, treatment

Maintain adequate nutrition- hydration

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34
Q

GERD-

what is it
what results from

A

Backward flowing of gastric contents

Results from  relaxation of esophageal sphincter and increased pressure from stomach

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35
Q

GERD contributing factors

increased
p
hh
environmental

A

increased gastric volume and pressure

positioning

hiatal hernia

environmental/diet-smoking, alcohol, coffee, chocolate

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36
Q

GERD-

Manifestation
other manifestations

A

Heartburn –usually after meals, when bending over

Atypical chest pain, Sore throat , Hoarseness

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37
Q

gerd

complications of manifestations

A

Esophageal strictures, leading to dysphagia

Barrett’s esophagus –cell wall changes leading to cancer risk

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38
Q

GERD- Diagnosis

A

Barium Swallow; evaluate GI track

Upper endoscopy; direct visualization, Bx

Bernstein Test; Saline & acid solution mimicking symptoms

24-hour pH monitoring

Esophageal manometry; pressure measurement of sphincters & peristalsis

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39
Q

PPIs

drug
how work
before
do not
meds

GERD- Treatment

A

–drug of choice,

reduce acid secretion,

before meals,

do not crush, -

omeprazole and pantoprazole

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40
Q

H-2 Receptor Blockers –
how work
what meds

GERD- Treatment

A

reduce acidity of gastric juices.

Famotidine, rimantadine,

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41
Q

Anti-ulcer Agent –
how work
when take

GERD- Treatment

A

react with gastric acid to fomr thick coating or paste, coats damaged gastric tissues and promotes healing,

1hr before meals and bedtime,

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42
Q

antacids
how work
what med
when take

GERD- Treatment

A

buffer/neutralize gastric acids, relieve pain and prevent damage,

tums,

sperate 2 hrs from other meds

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43
Q

motility Agent-
how work
what med

GERD- Treatment

A

stimulate gi tract motility and gastric emptying,

metoclopramide/reglan

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44
Q

nutrition and lifestyle

GERD- Treatment

A

Ideal body weight & diet selection

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45
Q

surgery
how work

GERD- Treatment

A

Lap/Nissen Fundoplication

Increases pressure in lower esophagus , inhibiting reflux

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46
Q

health history
priority
education

GERD- Nursing Care

A

Heath history, symptoms- manifestations, what foods are irritants, positioning issues,

Priority- symptom relief

Educate; irritants to avoid –stay away from meds that irritate gi tract like aspirin and nsaids, naproxin

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47
Q

Hiatal Hernia-

A

portion of stomach that protrudes through diaphragm, increases with age

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48
Q

Hiatal Hernia-

manifestations

A

Reflux,

fullness,

chest pain,

dysphagia,

bleeding,

belching,

indigestion

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49
Q

Hiatal Hernia-
diagnosis

A

barium swallow

upper scope

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50
Q

Hiatal Hernia-

treatment-similar
surgery why
keys to prevention-(ideal, remain, no)

A

Similar to GERD

Surgery- if conservative treatment is unsuccessful

Keys to prevention
1-ideal body weight
2-remain upright for 2 hrs after eating
3- no eating before bedtime

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51
Q

Peptic Ulcer Disease-

what is
gi tract-where
results

A

Break in mucous lining of GI tract where is comes in contact with gastric juices

GI Tract- duodenum most common

Results in peptic ulcers

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52
Q

Peptic Ulcer Disease-

risk factors

A

asprin & NSAID use –inc risk of bleeding

Age, history of ulcers

Smoking

H. Pylori infection

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53
Q

Peptic ulcer disease manifestations

classis symptoms

A

pain (indigestion), epigastric, below sternum area

Pain-food-relief pattern- pain 2-3 hrs after meals and in middle of night which is relieved by eating

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54
Q

Peptic ulcer disease manifestations

vague symptoms

A

hemorrhage

obstruction

perforation

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55
Q

Peptic ulcer disease manifestations
Zollinger-Ellison Syndrome

what is it
what does/leads to

A

Gastrin secreting tumor-

hypersecretion of gastric acid leading to ulceration

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56
Q

Peptic Ulcer Disease- diagnosis

upper gi endoscopy-

fecal analysis

gastic analysis

A

Upper GI Endoscopy & biopsy- rule out ulcer and provides direct visualization of ulcers and surrounding tissues

Fecal Analysis-stool analysis and looking for h pylori

Gastric Analysis- for suspected seilinger Ellison syndrome,

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57
Q

Peptic Ulcer Disease- Treatment

therapy
discontinue
receptor-promote
__protectant +meds

A

Antibiotic Therapy- 14 days & PPI

Discontinuation of NSAIDs

PPIs & H2 receptor
PPI’s faster healing relief

Mucosa protectant
Sucralfate, bismuth compounds, antacids

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58
Q

Peptic Ulcer Disease-
Treatment Cont

nutriton
surgery

A

Nutrition
Balanced meals, regular intervals
No smoking -slow healing

Surgery
Needed due to complications of PUD –if hemorrhage , perforation or obstruction

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59
Q

Hemorrhage
goal
what does nurse do

Peptic Ulcer Disease- Complication Management

A

Goal restore circulation

NPO, PPI’s via IV, iv fluids, blood transfusion, ng tube

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60
Q

obstruction
due to
gastric decompression

Peptic Ulcer Disease- Complication Management

A

Due to repeated inflammation, healing, scarring, edema

Gastric decompression- ng tube, iv

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61
Q

Perforation-Peritonitis

risk
positioning
needs

Peptic Ulcer Disease- Complication Management

A

Risk contamination, treat with ng tube and antibiotics,

Positioning  semi fowlers so contaminates pool in lower abdomen/ pelvis

Surgery

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62
Q

Peptic Ulcer Disease-

health promotion-avoid

priorities in care

A

_avoid nsaids, aspirin

Priorities in care reducing discomfort, nutritional status, identifying and preventing compliacations

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63
Q

Gastritis-

what is
most often from
3 kinds

A

Inflammation of stomach lining

Most often from gastric irritants such as : aspirin, alcohol, caffeine or contaminated foods

Acute, Chronic, Erosive

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64
Q

acute gastritis
local
why is it
what causes

A

*Local irritant

*Acid and pepsin comes in contact with gastric tissues-

inflammation, irrigation, superficial erosion

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65
Q

acute gastritis manifestations

A

*Anorexia, N&V, melena, pain, hematemesis, shock

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66
Q

chronic gastritis overview

progressive
h
autoimmune

A

Progressive disorder, atrophy of gastric tissues

H. Pylori gastritis

Autoimmune gastritis- intrinsic factors affected, unable to absorb B 12- pernicious anemia

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67
Q

chronic gastritis

manifestations

A

Vague, asymptomatic

Fatigue & Anemia

68
Q

erosive gastritis overview

induced
ischemia
maintain

A

Erosive, stressed induced- trauma, shock, burns, head injury, major surgery

Ischemia of gastric tissue from massive vasoconstriction

Maintain pH with medications to prevent acid secretion

69
Q

erosive gastritis manifestations

A

Painless gastric bleeding couple days after stressor

70
Q

Gastritis- Diagnosis -why

h pylori
gastric analysis
hh rbc
b12
upper endoscope

A

H. Pylori Testing-source of inflammation

Gastric Analysis-gastric content

H&H, RBC-anemia

B 12 levels-perniscous anemia-unable to absorb b 12

Upper Endoscope-gastric mucosa

71
Q

medications

Gastritis- Treatment

A

PPIs,

H2 receptor blockers,

sucralfate,

antibiotics

72
Q

NPO status

slow intriduction
keep hydrated

Gastritis- Treatment

A

Slow introduction clears-full liquids-general

keep hydrated- iv fluids

73
Q

gastric lavage

why used
___via lavage
nursing considerations-do not

Gastritis- Treatment

A

Used with poisonous or corrosive ingestion

Dilution and removal via lavage

Nursing Considerations  do not induce vomiting, further damage could occur

74
Q

complementary therapy

Gastritis- Treatment

A

Herbal & aromatherapy-

chamomile tea, garlic, ginger, mint

75
Q

health promotion
assessment
priorities in care

gastritis nursing care

A

Health Promotion
Prevention, safe food preparation

Assessment
Health and history, symptoms, risk factors

Priorities in care
Pain management, healing of tissue, nutritional status

76
Q

Dumping Syndrome-

common complication following what

patho- quick/stimulated/ increased/ leading to

A

Common complication following gastrectomy or gastric bypass

patho
Quick food bolus, drawing fluid into duodenum

Peristalsis is stimulated

Intestinal motility is increased

Leading to dumping and
Systemic symptoms

77
Q

systemic symptoms

dumping syndrome

A

tachycardia,
hypotension,
flushing,
, diaphoresis
dizziness

78
Q

Dumping Syndrome-
management

meals
separate
rest in after

A

Small, frequent meals

Liquids and solids separate

Rest in recumbent/semi-recumbent 30-60 minutes after meals

79
Q

Pyloric Stenosis-

what is
what does it cause

A

Pyloric sphincter muscle doesn’t empty properly and is unable to pass fluid

causes projectile vomiting

80
Q

pyloric stenosis

assessment(4-6 weeks/ watch for)
treatment(/ww/s)

A

Assessment
4-6 weeks of age, vomiting after feedings, projectile vomiting
Watch for s/s of dehydration

Treatment
Watch & wait
Surgery

81
Q

Irritable Bowel Syndrome

aka
what looks like
manifestations

A

aka spastic bowels

Abdominal pain, bloating, constipation and/or diarrhea

Manifestations: change in bowel habits, frequency, form, passage of mucous

82
Q

Irritable Bowel Syndrome- Diagnosis

ss
gs
bs
be
b

A

Stools samples

, GI scope,

bowel series,

barium enema,

biopsy

83
Q

Irritable Bowel Syndrome- Treatment

meds

A

Bulk forming laxative-

Anticholinergic- reduce spastic bowel and decrease bowel motility

Anti-diarrhea-

Antidepressants- ssri or tricyclics

84
Q

Education for irritable bowel syndrome

additional
avoid

A

; dietary habits- additional fiber ,

avoid trigger foods like dairy, caffine and soda

85
Q

Appendicitis-

inflammation
obstruction
pressure leading to
perforation =

A

Inflammation of the appendix

obstruction of proximal lumen

Pressure builds, leading to inflammation, edema, infection

Perforation= peritonitis

86
Q

mcbunreys point Appendicitis-

tenderness
relief/release

A

Localized and rebound tenderness at “McBurney’s point”

relief of pain when direct palpitation followed by pain on release

87
Q

Appendicitis-
Diagnosis

treatment

surgery

A

Ultrasound, CT scan, WBC

Hydration, antibiotic therapy, pain medications PRN

surgery- appendectomy

88
Q

Gastroenteritis-

what is it
culprit
how do infectious organisms enter body

A

What is it? Inflammation of the stomach and small intestine

Culprit  bacteria, viruses, parasites or toxins

Infectious organisms enter body in contaminated food or water- food poisoning

89
Q

manifestations
Gastroenteritis-

A

Anorexia, n/v, abdominal pain, cramping, diarrhea

90
Q

complication-due to
how treat

gastroenteritis

A

Electrolyte imbalances due to vomiting

IV fluid - hydration stabilization

91
Q

Gastroenteritis- diagnosis

A

Labs,

stool samples,

lower GI Scope

92
Q

Gastroenteritis- treatment

meds- what types
nutrition-what give
gastric lavage-what does

A

Medications - Antibiotics, antidiarrheal

Nutrition
 fluid supplements, oral electrolytes,

Gastric Lavage
 washes out stomach and lining

93
Q

Inflammatory Bowel Disease-

two conditions

A

ulcerative colitis

Crohns

94
Q

Ulcerative Colitis

what is it

A

Chronic inflammatory bowel disorder of the mucosa and submucosa of distal colon and rectum

95
Q

Ulcerative Colitis

diarrhea->
ranges
cramping/releif

manifestations

A

Diarrhea  blood in mucus with abdominal pain

Ranges from mild-severe

Left lower quad cramping- relieved by defecation

96
Q

ulcerative colitis complications

TM
P
MH
CC

A

Toxic megacolon,

perforation,

massive hemorrhage,

colorectal cancer

97
Q

Chrons

what is it

A

Chronic, relapsing inflammatory process affecting GI tract (Ileum & Ascending colon)

98
Q

chrons manifestations

persistant
pain

A

persistent diarrhea, no blood or mucus

Right lower quad pain, periumbilical

99
Q

chrons complications

O
F
AF
M
CC

A

Obstruction,

fistulization,

abscess formation,

malabsorption,

colon cancer

100
Q

Ulcerative Colitis & Crohn’s-
inspection
stools
C__/H_
elevated
low

diagnosis

A

Inspection of bowel (Scope, barium x ray)

Stools examination  blood and mucus

CBC, H&H

Elevated Sedimentation rate & C-Reactive proteins

Low Albumin

101
Q

Ulcerative Colitis & Crohn’s-

meds
nutrition
surgery

A

Medications- steroids

Nutrition-
Fiber moderation- fiber contraindicated with intestinal strictures, inflammation and scaring

Surgery- colectomy, ostomy or illesotomy

102
Q

Ulcerative Colitis & Crohn’s-

Health Promotion-
educate
need
monitor
monitor

A

educate on need for supplemental vitamins

need to be on steroids for exacerbations

monitor weight and nutrition

monitor daily bowel movements

103
Q

Diverticular Disease

what is it
2 kinds

A

Outpouching of colon, occurring in rows- anywhere in intestinal tract

2 kinds-
Diverticulosis
Diverticulitis

104
Q

Diverticulosis

presence
complications

A

Presence of diverticula, often asymptomatic

Complications- Hemorrhage, diverticulitis

105
Q

Diverticulitis

inflammation
what settle
complications

A

Inflammation in and around the diverticula

Undigested food and bacteria settle

Complications:
Perforation-fever and pain complaints

105
Q

Diverticular Disease-Manifestations

pain
con/inc
other manifestations

A

Pain- left side, ranges from mild to severe

Constipation or increased stools

N/V, fever

106
Q

Diverticular Disease

complications

obs
form
hem
narrow

A

Bowel obstruction,

fistula formation,

hemorrhage

, bowel narrowing

107
Q

Diverticular Disease- diagnosis

enema
ray
oscopy
scan
labs

A

Barium Enema,

x rays,

sigmoidoscopy/colonoscopy

, CT scan

Labs- H&H, WBC’s, guaiac stool

108
Q

Diverticular Disease- Treatment

what meds
inc what
nutrition-high, avoid,bowel rest

A

Antibiotics

Hydration

Nutrition-
high fiber,
avoiding small seeds, shells, popcorn
bowel rest-slow gradual feeding

109
Q

surgery diverticular disease

treats
2 stage procedure

A

To treat peritonitis, hemorrhage, resection (

2- stage procedure) –temporary colosotmy

110
Q

Diverticular Disease-

education
assessment
priority

A

Education- diet

assessment- subjective/ objective- pain, history, bowel sounds, tenderness, blood stool

Priority preventing complications- pain and anxiety

111
Q

Malabsorption Syndromes-

condition

diseases of intestines

A

Condition where intestinal mucosa ineffectively absorbs nutrients

Diseases of intestines- Crohn’s, gastric bypass, celiac, lactose intolerant

112
Q

manifestations Malabsorption Syndromes-

A

Anorexia,

bloating,

weight loss,

weakness,

fatigue,

difficulty concentrating

113
Q

Polyps-

what is it

most/some

asymptomatic-how found

A

What is it?? –mass of tissue that arise from bowel wall

Most benign, some malignant

Asymptomatic found on routine screens or painless rectal bleeding

114
Q

complications with large polyps

o
p
sc

A

Obstruction,

pain

stool changes

115
Q

Colorectal Cancer-

what improves survival rate

what type of growth

no symptoms until when

A

Early diagnosis and treatment improved survival rate

No symptoms until advanced

Growth slow

116
Q

risk factors of colorectal cancer

A

Age,

polyps

, family history,

IBD,

radiation,

diet,

obesity,

smoking, alcohol use

117
Q

manifestations

advanced disease manifestations

complications

colorectal cancer

A

manifestations-Rectal bleeding, change in bowel habits

advanced disease manifestations-pain, anorexia, weight loss

complications-bowel obstruction and perofration

118
Q

Colorectal Cancer- Prevention

lifestyle habits(inc/dec/ healthy/ do what)

age 50

A

Lifestyle habits- inc vegetables, decrease red meat, healthy weight, exercise

At age 50; start screening measures

119
Q

colorectal cancer diagnosis

use what
use if suspected metastasis
what labs

A

gi Scope; tissue biopsy

Ct/ MRI- if suspected metastasis

labs; CBC, guaiac, Tumor marker

120
Q

Surgical Resection->

Laser photocoagulation->

colostomy placement reason

Colorectal Cancer- Surgery

A

Surgical Resection; lymph node is removed

Laser photocoagulation-light beam, to destroy tumor

Colostomy placement- diversion

121
Q

colostomy naming

line going left
junction of line to small intestine
upwards
side
down
by anus

Colorectal Cancer- Surgery

A

Colostomies take name of the portion of colon from which they come from

line going left- illeostomy

ceconstomy - junction of line to small intestion

ascending -upwards

transverse-side

descending-down

sigmoid-by anus

122
Q

Colostomy-

assessing
L/t
S-surrounding
O-consitency

A

Assess location and type of colostomy

Assess stoma, surrounding skin

Assess output- consistency of drainage depends on stoma location

123
Q

Colorectal Cancer- Radiation

used with
reduces
shrink

A

Used with surgical resection for tumors

Reduces recurrence of pelvic tumors

Shrink to allow for surgery

123
Q

Consistency changes –look up

Ascending

Transverse

Descending

Sigmoid

A

Ascending

Transverse

Descending

Sigmoid

124
Q

Colorectal Cancer- chemo

reduces

A

Reduces rate of tumor reoccurrence/ Metastasis

125
Q

Intestinal Obstructions-

what is it

mechanical obstructions (1/2/3)

Gas and fluid accumulation, distending the bowel- does what

A

what is it-Failure of intestinal contents to move through

mechanical obstructions
1-scars
2. adhesions
3. tumors or inflammatory obstruction

Gas and fluid accumulation, distending the bowel- compromises blood flow leads to necrosis

126
Q

Small Bowel Obstruction

caused by

A
  1. adhesions
  2. scar tissue
  3. hernia
127
Q

small bowel obstructions

manifestations

early /late on

A

Cramping,
n/v
fecal matter

, early on high pitched bowel sounds, later on silent bowels

128
Q

Small Bowel Obstruction- Complications

Hypo
pvent
nec
perf

A

Hypovolemia(/ic shock) renal insufficency

Pulmonary ventilation

Necrosis from Strangulation- no blood supply

Perforation - can lead to septic shock

129
Q

Large Bowel Obstruction

occurance
area

A

Less frequent occurrence;

sigmoid area- cancer of bowel

130
Q

manifestations of large bowel obstructions

normal manifestations

late signs-not common

what types of sounds

A

constipation , colicky abdominal pain

Deep, cramping; vomiting late sign- not all that common

High pitched, tinkling bowel sounds with rushes/gurgles

131
Q

complications of large bowel obstructions

colon dialation
->

A

Colon Dilation increasing pressure which impairs circulation and can lead to

Gangrene, perforation, peritonitis, diaphragm involvement

132
Q

Bowel Obstruction- Diagnosis

A

X ray, CT

Labs (WBC/ Electrolytes/ ABGs )

133
Q

Bowel Obstructions- Treatment

conservative treatment

decompresion
npo status
pain meds
ng
type of meds
dvt

A

Decompression- NG tube, IV fluids

NPO status  watch fluid status, urine output

Pain medications, nausea medications

NG- Collects unwanted fluid & gas while allowing bowels to rest

Antibiotics

DVT prevention -Ambulation

134
Q

Bowel Obstructions- Treatment surgery

required if

does what to treat

A

Required if conservative treatment fails, or complete obstruction, strangulation

Remove obstructing cause- treat the problem

135
Q

preop bowel surgery

marking

tube
perform

A

Marking of stoma site

NG tube placement and management

Perform bowel prep as ordered

136
Q

postop bowel surgery

monitor
assess
support
managing
complications

A

Monitor bowel sounds

Assess surgical site dressing and drainage-CHECK bleeding

Emotional Support  depression, loss of interst in actiivtes

Managing post-op problems- pain, gas pain, nausea

Complications- peritonitis

137
Q

Bowel Obstructions- Priorities

imbalances
treating
observe
managing problems
discharge education

A

Fluid and electrolyte imbalances

Treating infection

Observe dressing and drainage

Managing post-op problems- pain, gas pain, nausea  encourage ambulation

Discharge education- normal bowel movements

138
Q

Peritonitis-

inflammation
sterile
caused by

A

Inflammation of peritoneum

Sterile peritoneal cavity becomes contaminated

Caused by bacteria

139
Q

Abdomen/GI Symptoms

peritonitis

A

Pain

Tenderness with rebound

Board-like rigid abdomen

Diminished/absent bowel sounds

Distention

n/v

140
Q

Systemic Symptoms
peritonitis
f
t
t
r
c
o

A

Fever

Tachycardia

Tachypnea

Restlessness

Confusion

Oliguria

141
Q

Peritonitis- Treatment

meds
surgery
nutrition
decompression

A

Medications - (Antibiotics Pain control)

Surgery -(Identify cause of contamination and fix/ Peritoneal lavage )

Nutrition (IV fluids, parenteral nutrition)

Decompression
Ng tube- Relieve distention, promote bowel rest

142
Q

Hernias-

what is it

how classified/classifications

A

What is it?? Defect in abdominal wall that allows abdominal contents to protrude outwards

Classified by location
Inguinal, umbilical, incisional/ventral

143
Q

Inguinal hernia

males->
indirect->
direct->

A

Males; bulge/lump with lifting/strain, sometimes dull ache

Indirect- improper closure of the tract as the testes descend at birth

Direct- acquired from weakness of posterior inguinal wall

144
Q

umbilical hernia

women ->

enlarge/pain->

A

Women; Pregnancy and obesity

Enlarge steadily, sharp pain with coughing/straining

145
Q

incisional hernia

where at

what looks like

often

A

At previous surgical sites, or abd muscle tear

Bulge;

often asymptomatic

146
Q

hernia manifestations

abdominal contents

A

abdominal contents protrude through abdominal wall and form sac

147
Q

Reducible hernia:

abdominal contents
returns

A

abdominal contents move through sac with increased abdominal pressure

returns to abdominal cavity when pressure returns to normal

148
Q

complications of hernias

low risk w
incarcerated
obs/stra

A

Risk is low with reducible

Incarcerated- if contents can not be returned to abdominal cavity

Obstruction, strangulation (severe pain, distention, n/v,)

149
Q

Hernias- Treatment

exam
how treated
what looking for for nursing care

A

Physical examination

Treated with surgery
Suturing opening, put mesh inside

Nursing Care
History of symptoms, looking for bulge

150
Q

Hemorrhoids-

manifestations
diagnosis
meds do what

A

Manifestations pain, rectal bleeding

Diagnosis- Patient history, physical exam

Medications- to improve constipation, reduce straining

150
Q

Hemorrhoids- Treatment

Sclerotherapy

Hemorrhoidectomy

A

Sclerotherapy –chemical irritant injected to cause scarring

Hemorrhoidectomy –surgical removal

151
Q

Anorectal Surgery-

why sensitive

used for what

A

Sensitive- sensory nerves, painful procedure

Hemorrhoids, Anal Fissure, Anorectal Abscess, Anorectal Fistula

152
Q

nursing care anorectal surgery

what after stools
no what
observing what
returnof gi function
Dietary support/teaching
Limit pressure and positioning on surgical site

A

Sitz bath after stools

No rectal medications

Observe dressing/drainage

Return of GI function-start fluid intake

Dietary support/teaching-high fiber diet, and fluid intake

Limit pressure and positioning on surgical site -low head of bed, supine position, don’t elevate hob

153
Q

Cholecystitis-

what is it
acute obstruction
difference between Cholecystitis /Cholelithiasis

A

Inflammation of gallbladder

Acute obstruction of cystic duct by stone

Cholecystitis inflamttion of actual gall bladder

Cholelithiasis presence of stone

154
Q

Cholecystitis Manifestations

onset
temp
pain where

A

Abrupt onset,

low grade temp,

Right quad pain radiates to back, right shoulder/scapula

155
Q

chronic manifestations of Cholecystitis-

A

repeated bouts or gallbladder irritation

156
Q

Cholecystitis-

diagnosis

A

CBC, bilirubin, amylase & lipase

Ultrasound

X-ray

Gallbladder Scans

157
Q

Cholecystitis- meds

does what

meds

antibiotics usage

A

Reduce cholesterol content of stones; gradual dissolution

Ursodiol, chenodiol

Antibiotics- infection, reduce edema, inflammation

158
Q

Cholecystitis-

surgical Treatment

nutrition
dietary
avoid

A

Laparoscopic Cholecystectomy

Nutrition- Reduce food intake during attack

Dietary low texture diet that’s bland

Avoid obesity, hyperlipidemia, high cholesterol, high fat foods

159
Q

Hep a

trasmission

what else

A

Fecal-Oral-

contaminated food/ water/ shellfish/ direct contact with and infected person-sex

160
Q

Hep b

trasmission

what else

A

Blood/body fluids
Perinatal

High risk group, iv drug users, multiple sex partners, exposed to blood products-oral contraceptives do not provide protection

161
Q

Hep c

trasmission

what else

A

Blood/body fluids

Injection drug users is primary risk-asymptomatic long after exposure//hand hygiene and ppe for healthcare providers

162
Q

Hep d

trasmission

what else

A

Blood/body perinatal

Only causes infection in pts with hep b

163
Q

Hep e

trasmission

what else

A

Fecal Oral

Fecal contamination of water supply, oral contraceptives do not provde protection

164
Q

Hepatitis- Diagnosis

assessment
increase in what labs
presence of what
what kinda biopsy

A

Assessment –inflammation of liver

Labs; liver function tests
ALT, AST, ALP, Bilirubin -increase

Presence of antigens and antibodies

Liver biopsy

d-health promotion(former alteration) (10 decks)

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