Gastroenterology Flashcards
What is a Miller-Abbott tube?
a tube that is used to relieve intestinal obstruction
How is a Miller-Abbott tube inserted?
through the nostril, the tube is passed through the stomach and into the small intestine
Intestinal tubes are often used for treatment of ________.
paralytic ileus
How often should a formula bag for tube feedings be changed?
every 4 hours
__________ are economical source rich in proteins.
Legumes
__________ destroys bacteria found in the mouth, reducing the change of infection.
Hydrogen peroxide
What is irritable bowel syndrome?
a condition marked by abdominal pain (often relieved by passage of stool or gas), constipation, diarrhea or both and the passage of mucus in stools.
Irritable bowel syndrom is often called __________.
Spastic bowel disease, no inflammation is present.
2 things to know about inguinal hernia:
- a bulge in the lower right quadrant
2. pain at the umbilicus radiating down the the groin
A classic symptom of hiatal hernia:
Reflux; awakening at night with heartburn
Suggestion for patient diagnosed with hiatal hernia:
- withhold food and fluids just before bed so food won’t slide (reflux) through the hernia, causing heartburn.
- tell pt not to lie down after eating
- elevate head when sleeping
Cystic fibrosis causes __________
deficiency in pancreatic enzymes that digest fats, carbohydrates and proteins. There is an impairment of intestinal absorption.
What kind of diet do you need for a patient with cystic fibrosis?
- High protein
- Low fat because it interferes with the absorption of other nutrients.
- High calorie diet
What is eructation?
the production of gas from the stomach; belching
What do you do if a patient has dry, parched (extremely dry) mouth and tongue?
the mouth should be rinsed with room temperature tap water before and after meals
Why do elderly clients need to increase their protein intake?
to slow down the degeneration process
What is a guaiac test?
it tests for unseen blood in the stool
________ increases the risk of GI bleeding.
Alcohol
What can lead to peritonitis?
bowel perforates as a result of increased intraluminal pressure within the gut, intestinal content are released into the peritoneum. Pt needs to prepare for emergency surgery.
What is pyorrhea?
the discharge of purulent matter
What can indicate pyorrhea?
red, swollen gums which is caused by improper cleaning and poor mouth hygiene.
What is polyethylene glycol-electrolyte (GoLYTELY)?
an osmotic laxative
3 things to prep for colonoscopy?
- ingest 4 liters of (GoLYTELY)
- After ingesting GoLYTELY, drink only water
- Tap water can be used to reconstitute the GoLYTELY powder
Why can’t you drink GoLYTELY solution cold?
Because it can cause hypothermia.
Bowel prep for colonoscopy and NPO status puts patient at risk for _________.
imbalances
4 things to know about suppository insertion:
- Pt must breath through the insertion to relax rectal muscles.
- Suppository should touch the wall the of the client’s rectum.
- Suppository should be inserted 3 to 4 inches into the patient’s rectum
- Lubricant should be applied to the tip of the suppository
What do you give for an aspirin overdose and why?
Charcoal, because it will absorb particles of salicylate.
When should charcoal be given for an aspirin overdose?
within 2 hours. It is important to know when pt last took aspirin.
What is diverticula?
an out pouching of the walls of the canal
Where and what kind of pain do you feel with diverticulitis?
Pain in the left lower quadrant. You feel a colicky pain.
How is diverticulitis relieved?
By the passage of stool or fart
Diverticulitis is associated with __________
deficiency of fiber
What kind of diet is needed for diverticulitis?
High fiber diet. Pt should take bulk laxative.
Food to avoid for pt’s with diverticulitis:
Seeds Nuts Corn Popcorn Cucumbers Tomatoes Figs Strawberries
C. dif requires what kind of precaution?
Contact precaution
C. dif causes __________
pseudomenbranous colitis
Diapered and incontinent its makes the pt _________ precaution.
contact, because of the fecal contamination potential
What foods contribute to gas production?
Onions, beans, chewing gum, skipping meals, drinking beers and cucumbers
3 things to know about a colostomy, sigmoid colostomy and ileostomy bag:
- Output from ileostomy needs to be measured
- Do not use moisturizers (emollient) because it prevents a good seal around the stoma
- Draining from ileostomy is very irritating to the skin
How often do you irrigate a sigmoid colostomy?
Not necessary more than once a day
How often do you change an ostomy bag?
At least once a week; which is a good time for the stoma to be closely inspected. However if the seal is loose or leaking it needs to be changed more frequently.
When can a patient with a colostomy resume activities?
After appropriate healing of the stoma or incision
If the stoma appears to be tight and there is a decreased amount of stool, what do you do?
Report is to the physician. It may indicate obstruction of the stoma stricture.
How often do you irrigate a colostomy?
At the same time everyday.
4 ways to eliminate odor in a colostomy bag:
- place a breath mint in the pouch
- place a commercially prepared deodorizer
- drinking
- eating crackers and yogurt
What is an ileal conduit?
a method of diverting the urinary flow by transplanting the ureter into a prepared and isolated segment of the ileum.
How do you clean the skin after an ileal conduit?
with soap and water, no antiseptic solution
What kind of drainage bad do you apply on an ileal conduit?
A close fitting drainage bag to avoid urine from contacting the skin
Can the contrast from GI studies interfere with other examination?
Yes
6 things that should be avoided in patients with peptic ulcer disease (PUD) and why?
- Diets rich in milk and cream because they stimulate acid secretions.
- Aspirin
- Motrin
- meat extracts
- alcohol
- caffeinated beverages
3 symptoms found in patients with peptic ulcer disease:
- dull pain
- gnawing pain
- burning in the midepigastrium
If a patient has peptic ulcer disease and is taking a histamine blocker (Cimetidine, Tagamet) then _______________ are not necessary.
small, frequent feedings
Patients with gastric ulcers may be ___________
malnourished because food may cause nausea and vomiting
When does pain occur in patients with gastric ulcers?
1/2 hour to 1 hour after meals
__________ makes pain from gastric ulcers worse.
Ingestion of food
When do patients with duodenal ulcers experience pain?
after meals
When do you get the pain when diagnosed with acute appendicitis?
In the right lower quadrant
Pain in appendicitis usually comes prior to _________
nausea and vomiting (McBurney’s Point)
5 things to do with a pt diagnosed with acute appendicitis:
- no heating pads, enemas or laxatives should be used
- hold analgesics to avoid blunting pain
- pt should be NPO
- place ice bag on abdomen
- place pt in Fowler’s position is post-op to decrease tension on the abdomen
Nausea and vomiting that comes prior to abdominal pain frequently indicates ________.
gastroenteritis
What happens when you frequently use nasal sprays for allergic symptoms?
it can result in vasoconstriction that causes atrophy of nasal membranes, resulting in nosebleeds
If the skin over the abdomen is taut and glistening it indicates….
ascites
How do you enhance swallowing efforts?
sitting before a meal allows for a rest period before eating which helps minimize fatigue and helps the pt’s desire to eat.
If a patient has difficulty swallowing avoid …
- peanut butter
2. and most milk products because they produce mucus
What is a Sengstaken-Blakemore esophagogastric tube used for?
it provides balloon tamponade to stop bleeding of esophageal varices
An infiltrated esophageal balloon can _______
obstruct airway
If there is airway obstruction with an infiltrated esophageal balloon what do you do?
use scissors to cut the tube’s balloon port
What do you assess on a patient with an esophagogastric tube?
Assess vitals signs for decreased blood pressure and elevated pulse. Ensure that the balloon pressure and volume is maintained.
Risk factors of colorectal cancer:
- being over 40
- history of ulcerative colitis
- a diet high in fat, high protein and low fiber/residue is a risk factor
Diet for ulcerative colitis:
High protein
High calorie
Low residue
What is a Levin tube?
An NG tube
3 things to know about NG tubes:
- tube feedings should be given at room temperature to minimize cramping.
- Clamp the proximal end of the feeding tube to prevent air from entering the stomach and loss of liquid
- prevent aspiration
What is a Salem Sump tube:
an NG tube
How do you know if a Salem Sump tube is working correctly?
if there is a hissing sound from the blue lumen tube, hissing sound is an indicative of air that is freely exiting the airway
What is the purpose of the hissing sound in a Salem Sump tube?
to provide continuous steady suction without pulling gastric mucosa
How can a nurse clear the air vent of the Salem sump tube?
by inserting 30 ml of air through it. Clearing the air vent will re-establish proper suction
If the tube is patent and draining does the tube need to be irrigated?
No
When can medication be administered through an NG tube?
after placement has been checked
How can a nurse check proper placement of an NG tube.
Check the PH (0 -4) of the content aspirated from the NG tube
What should the nurse do before aspirating fluids from an NG tube?
flush the NG tube with 30 ml of air
What is the best position that facilitates swallowing and the movement of the NG tube through the GI tract?
60 - 90 degrees fowler position
What is an Ewald tube?
an orogastric tube
What happens when inserting and Ewald tube?
gagging and vomiting can happen. Suction equipment is needed to reduce the risk of aspiration.
What is dumping syndrome?
a syndrome marked by sweating and weakness after eating; occurs in patients who have had gastric resections
3 things to prevent for patient with dumping syndrome:
- lying down for 30 min after meals
- drinking fluids between meals
- reduce intake of carbohydrates and fiber
Early manifestations of dumping syndrome:
the desire to lie down and vasomotor disturbances of syncope (90 - 3 hrs after eating)
When you have dumping syndrome, the undigested food is dumped into the __________
jejunum, resulting in distention, cramping, pain, diarrhea 15 - 30 min after eating, hypotension and diaphoresis
What is Billroth II?
gastrojejunostomy
What can occur after Billroth II?
dumping syndrome
1 thing to know about patients with Billroth II:
lying down or semi recumbent after eating is recommended to delay the gastric emptying process
Vomiting for 2 weeks can cause:
electrolyte imbalance and decrease cardiac output
Weight below 75% of ideal body weight is considered ___________
medically unstable
Progressive systemic sclerosis can cause
dysphagia and esophageal reflux
Foods to avoid when having progressive systemic sclerosis:
spicy foods
caffeine
alcohol
because they stimulate gastric secretions
Bulk forming laxatives:
Psyllium hydrophillic mucilloid
Metamucil
Name 3 bulk forming foods:
- Cereal
- Fresh fruit
- Vegetables
Why can’t Docusate Sodium (Colace) be used regularly?
Because of its laxative dependency, bowel damage and electrolyte imbalance
What kind of laxative is Docusate Sodium (Colace)?
Emollient (moisturizes) laxative of the fecal softener
What kind of laxative is Magnesium Hydroxide (milk of magnesia)?
A saline laxative that if used chronically can significantly alter electrolyte balance, causing dehydration and lead to dependence.
What is ulcerative colitis?
inflammation and ulceration of the colon and rectum.
What kind of diet should you follow with ulcerative colitis?
High calorie
High protein
Low fat
Low residue
What do you need to rest bowel on a pt with ulcerative colitis?
TPN
What is present is the stool of a pt with ulcerative colitis?
blood, pus and mucous, no fat
Symptoms of ulcerative colitis:
- Rectal bleeding
- Bloody diarrhea, 10 - 12 times per day
- Weight loss, dehydration and anemia
- Fistula formation is rare
Pilondial cyst is often found in the __________
sacrococcygeal region
Ecchymosis around the umbilicus or in either flank indicates __________
retroperitoneal bleeding
Anorexia nervosa has little to do with appetite and more to do with _____________
fear of obesity and losing control over food intake
2 signs of anorexia nervosa:
- they like to talk about and plan their meal
2. display marked preoccupation with food
What measures successful treatment is women with anorexia nervosa?
the return of their menstruation
Patient with GERD should not drink?
carbonated drinks because they cause increase pressure in the stomach
How should patients with GERD sleep?
on their left side with their head elevated 6 - 12 inches to prevent nighttime reflux
3 symptoms on acute epiglottis:
- Sitting upright to breath better
- Tongue protrusion increases pharyngeal movement
- Drooling caused by difficulty swallowing because of pain and excessive secretions
5 things to know about bowel sounds:
- No sounds heard in 3 to 5 min indicates intestinal obstruction
- 1 or 2 sounds heard in 2 min indicates decreased motility
- Normal bowel sounds are 5 - 30 per min
- Greater than 30 sounds per min indicates increased motility
- Pt will have a high pitch bowel sound above the area of obstruction; Pt will have absent or decreased bowel sounds below the obstruction
What do you monitor after a hemorrhoidectomy?
Urinary retention because of the closeness of the bladder to the surgical site and the occurrence of rectal spasms and anorectal tenderness; catheterize to empty bladder
What can you do to manage pain 12 hours after a hemorrhoidectomy?
sitz bath 3 to 4 four times per day
When can an evisceration occur?
after abdominal surgery
What do you do if an evisceration occurs?
intestines should be kept moist and covered with a soaked sterile dressing, soaked in sterile saline; pt should be placed in low fowler’s position; instruct pt not to cough
Why would you do a low fowler’s (head elevated 15 degrees) position if an evisceration occurs?
it reduces stress on suture lines; pt may also be placed supine with the hips and knees bent
What position would you put a pt with an appendectomy and why?
Elevate the head of the bed 30 - 45 degrees to reduce stress on suture line.
How is the best way to deep breath and cough after an appendectomy?
hold their incision and then cough, it dilates airway and expands the lung surface area
4 things to know about abdominal incisions:
- slight swelling is expected
- slight crusting is normal
- incision should not be red, it indicates infection
- incision line should be pink
Kale is a ___________
Cabbage
Good source of folate include:
- Green leafy vegetables
2 Legumes - Tomatoes
- Fruits such as oranges and cantaloupe
Milk is a good source of ______
Vitamin D
2 things to avoid when you have an acute inflammatory bowel disease:
- red wine - may exacerbate inflammatory condition
2. whole grain breads
What kind of diet is indicated during the acute phase of inflammatory bowel disease:
Low residue
High protein
High calorie
What is a low residue diet:
Foods with fiber are restricted
Low residue foods:
- Beef Bouillon
- Streamed white rice
- Strawberry gelatin
- Clear chicken broth
- 2 slices of white toast
- Apple sauce
- Apple juice
- Cottage cheese
- Crackers
What is celiac disease?
immunological intolerance to wheat products which lead to malabsorption, weight loss and diarrhea
1 things to know about celiac disease:
- Gluten free diet is needed, no wheats, rye, barley
What kind of diet should you follow with celiac disease?
High calories, high protein
Performing an enema is a standard, unchanging procedure that can be delegated to ___________
a nursing assistant. It is the nurse’s responsibility to described clear outcomes.
Observing returns after an enema is part of the task delegated and should be performed by _________
the nursing assistant
When should enemas be performed?
after breakfast to avoid potential nausea
Where should the irrigation bag be placed after an enema?
12 - 18 inches above the rectum
4 things to do with a pt with acute pancreatitis?
- daily weights, because of fluid and electrolyte imbalances
- assess intake and output
- skin turgor
- mucous membranes
___________ should be avoided if a pt has acute pancreatitis because of ____________.
Mereridine Sulfate (Demerol), because of potential toxicity
What do you do to decrease the secretion of secretin from the pancreas and decrease abdominal distention in a pt with acute pancreatitis?
pt should be NPO; nasogastric suctioning removes gastric secretions and decreased abdominal distention
What decreases the metabolic rate and the secretion of pancreatic enzymes in a pt with acute pancreatitis?
bed rest
Acute pancreatitis may cause:
- acute mid-abdominal pain
2. acute vomiting
Acute pancreatitis is associated with ______________
males between 40 -45 with history of heavy drinking and females between 50 -55 diagnosed with biliary disease
What kind of diet should be followed with a pt with acute pancreatitis?
Low fat, bland diet
Vitamin B12 is used for patients with _________
pernicious anemia
Liquid medication that contains Sorbitol (sweetening agent) that is given thru a gastric tube may cause____________
diarrhea if the pt is allergic to sorbitol
How can a pt that is disoriented and confused feed himself?
by getting cues from the nurse to eat; goal is for the client to feed himself
What position promotes gastric emptying while preventing aspiration?
lying of the right side with the head of the bed elevated.
How to prevent complications with a pt with an abdominal aortic aneurysm (AAA)?
pt should increase fluid intake and fiber to prevent constipation and the need for straining which may increase intraabdominal pressure and the risk for rupture
In regards to AAA, it’s all about …
not increasing intra-abdominal pressure
If a pt with AAA is showing signs of shock what do you do?
still maintain the client of bed rest and evaluate for a decreased in CVP readings with previous readings
When you have diarrhea you should consume ___________
only low residue diets; white bread and refined cereals are well tolerated
What can a mouth wash that is glycerin-based cause?
dehydration and irritation of the tissues
What can you do to an elderly pt with peripheral arterial insufficiency?
place a heating pad to the abdomen once a day will cause reflex vasodilation of the extremities
A stroke may occur up to _________ hours after the first one
72
What is a good way to assess a pt’s eating habits?
By telling the pt to have a food/feeling/thoughts action journal
4 signs of bleeding in the throat after a tonsillectomy:
- frequent swallowing
- increased pulse
- pallor
- vomiting bright red blood
* Assess when child awakes and is asleep
Hypokalemia can cause:
- Hypertension
- CHF
- Muscle weakness
- Lethargy
- Digitalis toxicity with frequent premature ventricular complexes
What do you do if a pt is vomiting all the time?
Do not give food. You must slowly put the pt on a bland diet as pt will need to be NPO
7 signs and symptoms of Crohn’s disease:
- 20 - 30 and 50 - 80 yrs olds are victims
- Steathorrhea is common
- Colicky abdominal pain after meals
- Diarrhea is rare
- Weight loss, anemia and dehydration occurs
- Fistula formation is common
- Ileum and right colon are affected
_________ can increase client’s nausea.
drinking too much fluids because it can over distend the stomach increasing nausea
