Gastro Flashcards
- Pathophysiology:
a. The pancreas has two separate functions:
1) Endocrine-_______________
2) Exocrine-_______________ enzymes
b. Two types of pancreatitis:
1) Acute: #1 cause = ________________
#2 cause = gallbladder disease
2) Chronic: #1 cause = ______
- Pathophysiology:
a. The pancreas has two separate functions:
1) Endocrine-___insulin____________
2) Exocrine-_____digestive __________ enzymes
b. Two types of pancreatitis:
1) Acute: #1 cause = ____alcohol____________
#2 cause = gallbladder disease
2) Chronic: #1 cause = _alcohol_____
- Dx: increase ( 7) for pancreases
Sarah Want Billy And Pete Sent Home
a. Serum lipase and amylase
b. ALT, AST-liver enzymes _______
c. Serum bilirubin ______
d. H/H (Hemoglobin & Hematocrit) ___up or ____Down_______ • Why down ____bleeding_____________, up ___dehydration___________.
* **Please note that all normal ranges for blood test depend on the lab performing the test.
e. PT, PTT___prolong
f. WBCs
h. Bloodsugar___
a. Serum lipase and amylase are going to go up. These are the digestive enzymes they are trying to go to the small intestines but they can’t get there because there’s an occlusion so they sit in the pancreas so long that the blood absorbed them. Lipase is the one that is most specific in diagnosing pancreatitis
b. WBCs ___up
c. Blood sugar ___up so you could be a diabetic forever now because The pancreas is sick_!
d. ALT, ASTliver enzymes go up! Liver enzymes never go down there either normal or they go up
e. PT, PTT (prolong) if your liver is messed up the number one thing you going to be worry about is bleeding so your PT, PTT is going to be prolonged! So this means going to take longer for the blood to clot ! If your PT, PTT was shorter you will be at risk for a clot
f. Serum bilirubin is going to go up_
g. H/H (Hemoglobin & Hematocrit) _____up or ___down not at the same time
Why down ____bleeding__, up _____ dehydrated___.
Because your booties concentrating and concentrate my numbers go up
***Please note that all normal ranges for blood test depend on the lab performing the test. The values listed in this book are only to be used as a reference.
9S/S of pancreatitis
People and Apes read beautifully filled novels justifying hope
1.)Pain- Does the pain increase or decrease with eating. ____
2.)Abdominal distention/ascites (losing protein rich fluids like enzymes and blood into the abdomen) → ascites
3.)Abdominal mass-swollen________________________
4.)Rigid board-like abdomen (guarding or bleeding)
• What does it mean? Peritonitis ___
5.)Bruising around umbilical area___cullen___sign; flank area GrayTurner’s sign.
6.)Fever (inflammation)
7.)N/V
8.)Jaundice
9.)Hypotension =___ ________or_____________
1.)Pain- Does the pain increase or decrease with eating. ____Increase
2.)Abdominal distention/ascites (losing protein rich fluids like enzymes and blood into the abdomen) → ascites
3.)Abdominal mass-swollen__Pancreas______________________
4.)Rigid board-like abdomen (guarding or bleeding)
• What does it mean? Peritonitis ___
5.)Bruising around umbilical area___cullen___sign; flank area GrayTurner’s sign.
6.)Fever (inflammation)
7.)N/V
8.)Jaundice
9.)Hypotension =___Bleeding ________or ascities_____________
13 Tx for pancreatitis
Tx:
a. Goal: ___?
Tx:
a. Goal: Control pain
1) Decrease gastric secretions (____NPO_______, NGT to suction, bed rest) • Want the stomach empty and dry
2) Pain Medications:
• PCA narcotics morphine sulfate(Morphine®), hydromorphone
(Dilaudid®)
• Fentanyl patches(Duragesic®)
3) Steroids, why? _____Decrease inflammation_____________________________
4) Anticholinergics, why? _____ they dry you up________________
• Benztropine (Cogentin®), Diphenoxylate/Atropine (Lonox®)
5) Pantoprazole (Protonix®) (proton pump inhibitor)
6) Ranitidine HCI (Zantac®), Famotidine (Pepcid®) (H2 receptor antagonist)
7) Antacids
8) Maintain fluid and electrolyte balance
9) Maintain nutritional status → ease into a diet
10) InsulinWHY?
• ____ The pancreas is sick___l
• ____ steroids make your blood sugar go up
• ____________TPN
11) Dailyweights
12) Eliminatealcohol
13) RefertoAAifthisisthecause.
cirrhosis
What are Liver 4functions
Cirrhosis:
• Liver ____ detoxing ____________ the body.
• Helps your blood to ___Clot____________
• The liver helps to metabolize (break down) _____drugs _______.
• The liver synthesizes ( MAKES)____albumin ___
Pathophysiology of Cirrhosis
Pathophysiology:
• Liver cells are destroyed and are replaced with connective/scar tissue→ alters the __Circulation____________within the liver→ the BP in the liver goes _up____, this is called portal ___hypertension _________.
DX for Cirrhosis
what are the 4 Dx:
How do you confirm liver disease?
Be afraid of what when do a liver biopsy?
- Dx:
a. Ultrasound
b. CT, MRI
c. Liver biopsy-this is how you confirm liver disease! They are going to take a needle and stick it in your sick liver so be a afraid of bleeding
Liver biopsy
what are the preop interventions?
What position do we place the client in Post op ?
Vital signs, what are we worried about ?
c. Liver biopsy
• Clotting studies pre- PT and PTT
• Vital signs pre-procedure
• How do you position this client? __supine with right arm behind head ______________________
• Exhale and hold ____breathe_________________
Why? To get the __Diaphragm_______________out of the way.
• Post: Lie on ___right __________ side
Vital signs, worried about ______ hemorrhage________________________.
10 S/S of cirrhosis
Fran Always Calls Charlie And Says Dumb ignorant Crazy Answer’s
- )Abdominal pain – liver capsule has stretched
- )_________, nodular liver
- )Chronic dyspepsia(GI upset)
- )Change in ______bowel_______ habits
- )Ascites
- )Anemia
- ) increase ALT & AST
- )___decrease_______ serum albumin ___
- )Splenomegaly
- )Can progress to hepatic encephalopathy/coma
1._A firm\_\_\_\_\_\_\_, nodular liver 2 Abdominal pain – liver capsule has stretched 3.Chronic dyspepsia(GI upset) 4.Change in \_\_\_\_Bowel\_\_\_\_\_\_\_\_\_ habits 5.Ascites 6.Anemia 7.\_\_\_increase \_\_\_\_\_\_ ALT & AST 8.\_\_\_\_\_\_Decrease \_\_\_\_\_ serum albumin 9._ Splenomegaly 10. Can progress to hepatic encephalopathy/coma
10 TX For Cirrhosis
How do you position a patient for paracentesis and why?
What are we worry about the vital signs with a paracentesis?
- No more ____Alcohol_____ (don’t need more damage)
- Avoid _ narcotics_ - liver can’t metabolize drugs well when it’s sick
3.Prevent bleeding(bleeding precautions)
4.Monitor jaundice – good ___________ care
5.rest
6..I& and daily__weight_____(Anytime You Have Ascites You Have A Fluid
volume problem)
7..Measure abdominal girth, why? _____ascites
8.Paracentesis:
• Removal of fluid from the __ peritoneal_ cavity (ascites)
Have client void
Position _____upright -any position where they are sitting up to let all that fluid settled in one spot so the doctor can go in and get it ! If you lay them flat the fluid will go everywhere
• Vital signs-Vital signs anytime you’re putting fluids from the patient you worried about shock
With shocky clients the BP goes down and they pulse goes
9.Antacids, vitamins, diuretics
10.Diet:
Decrease protein
Low Na diet
Let’s Get Normal Straight First!
Protein→ Breaks down to _______→ The Liver converts ammonia to ___→ Kidneys excrete the _____
Let’s Get Normal Straight First!
Protein→ Breaks down to ammonia→ The Liver converts ammonia to urea→ Kidneys excrete the urea
Hepatic Coma:
- Pathophysiology:
a. When you eat protein, it transforms into ______________________, and the liver converts it to urea. Urea can be excreted through the kidneys without difficulty.
b. When the liver becomes impaired then it can’t make this conversion, so what chemical builds up in the blood? _________________________
c. WhatdoesthischemicaldototheLOC?_____________
Hepatic Coma:
- Pathophysiology:
a. When you eat protein, it transforms into __AMMONIA_________________, and the liver converts it to urea. Urea can be excreted through the kidneys without difficulty.
b. When the liver becomes impaired then it can’t make this conversion, so what chemical builds up in the blood? ______AMMONIA___________________
c. WhatdoesthischemicaldototheLOC?_____DOWN ________
8 S/S hepatic coma
S/S:hepatic coma
1.)Minor mental changes/motor problems
2.)Difficult to ___AROSE___________
3.)Asterixis - this is the flappy tremor of the hand .The teacher Probsbly referred to it as the liver flap
4.) ___hand writing ____changes
5.)decrease Reflexes
6.)EEG __SLOW
7.)What is Fetor? Breath smells like _____________.
Ammonia( it smells like acetone)like fingernail polish remover A very strong chemical smell_.
Anything that increases the ammonia level will aggravate the problem.
8.)Liver people tend to be GI bleeders.
Hepatic coma 4 treatments
______ (Lactulax®, Duphalac®) (decreases serum ammonia)
_______ enemas
_______Protein
in the diet Monitor serum __
Lactulose (Lactulax®, Duphalac®) (decreases serum ammonia)
Cleansing enemas
Decrease_______Protein
in the diet Monitor serum ammonia
Bleeding Esophageal Varices
Pathophysiology:
a. High BP in the liver (_ HTN) forces collateral circulation to form.
• This circulation forms in 3 different places→ esophagus ,stomach,, rectum b. When you see an alcoholic client that is GI bleeding it is usually esophageal
varices.
• Usually no problem until _______________
Pathophysiology:
a. High BP in the liver (_PORTAL HTN) forces collateral circulation to form.
• This circulation forms in 3 different places→ stomach, esophagus, rectum b. When you see an alcoholic client that is GI bleeding it is usually esophageal
varices.
• Usually no problem until _Ruptures
9 Tx for Bleeding Esophageal Varices
Tx:
1.) Replace blood
2.)VS
3.)CVP-central venous pressure - a direct measurement of the BP in the right atrium and vena cava.
4.)Oxygen (any time someone is Anemic, Oxygen is needed)
5.)Octreotide(Sandostatin®)lowersBPintheliver.
Good - it stops the bleeding
Bad - causes vasoconstriction of other parts of body. We don’t know what it’s got to constricted. It could constricted coronary arteries neck and Cause Rhythm changes
6.)Saline lavage to get blood out of stomach
7.)Cleansing enema to get rid of blood - blood causing ammonia levels to increase
8.)Lactulose (Neo-Fradin®) (decreases ammonia)
9.)Sengstaken- Blakemore Tube
esophagus & stomach ballon Purpose - to hold pressure on bleeding varices
.
Peptic Ulcers:
- Pathophysiology:
a. Common cause of GI ___________________________
b. Can be in the _____, ____, ______
c. Mainly in males or females?_____________________
d. ______ is present
Peptic Ulcers:
- Pathophysiology:
a. Common cause of GI _____GI BLEEDING____________
b. Can be in the esophagus, stomach, duodenum
c. Mainly in males
d. Erosion is present
- S/S: peptic ulcer
a. Burning _________ usually on the mid-epigastric area/back
b. Heartburn (dyspepsia)
- S/S:
A. Heartburn (dyspepsia)
B. Burning ___pain usually on the mid-epigastric area/back
Dx for peptic ulcers?
a.
What is the dx treatment do we use and
what are the nursing care ?
Describe a upper GI series ?
What is past midnight?
What must the pt avoid and what nut they remove for a upper GI test ?
How does smoking affect the test?
Dx:
a.
Gastroscopy (EGD, endoscopy):
1) Sedated
2) NPO pre
3) NPO until what returns? ___gag reflex
4) Watch for perforation by watching for _____pain_______, bleeding, or _________swallowing
Upper GI:
1) Looks at the esophagus and stomach with dye
2) NPO past midnight
3) No smoking, chewing gum, or mints. Remove the nicotine patch, too.
• Smoking ___increases stomach __________mortality which will affect the test and it increase__________ stomach __secretions
a. Describe a person with Gastric ulcers?
How long does the pain last with gastric ulcers ?
What causes pain and relief pain with gastric ulcers ?
What will they be vomiting ?
Classifications:
a. Gastric ulcers:
laboring person; malnourished,
pain is usually half hour to 1 hour after meals;
food , vomiting
does; vomit blood
Describe a person with Duodenal ulcers
When does the pain occur and How long does the pain last with Duodenal ulcers ?
What cause pain and relief pain with Duodenal ulcers ?
What is in the stool?
Duodenal ulcers:
executives; well-nourished;
night time pain is common and 2-3 hours after meals; _____food helps; blood in stools
Tx for peptic ulcers?
What do antacids do? When do you take them and why?
Sucralfate?
Tx:
a. Medications:
1) Antacids: Liquids or tablets? _______liquids (to ___coat the stomach) • Take when stomach is empty and at bedtime – when stomach is empty
acid can get on ulcer… take antacid to protect ulcer.
2) Proton Pump Inhibitors: (decrease acid secretions)
• Omeprazole (Prilosec®), Lansoprazole (Prevacid®), Pantoprazole (Protonix®), Esomeprazole (Nexium®)
3) H2 antagonist: Ranitidine (Zantac®), Famotidine (Pepcid®)
• GI Cocktail (donnatal, viscous lidocaine, Mylanta II®)
• Antibiotics for H. Pylori: Clarithromycin (Biaxin®), Amoxicillin (Amoxil®), Tetracycline (Panmycin®), Metronidazole (Flagyl®)
Sucralfate (Carafate®): forms a barrier over the wound so acid can’t get on the ulcer.
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