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NCLEX > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

what is foodborne illness

A

food poisoning

common infective agents:
staph aureus
norovirus
C. perfringens
Salmonella
botulism
E. coli
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2
Q

foodborne management

A

food safety and preparation
good hand hygiene

prevent transmission
monitor fluid volume deficit

discourage use of antidiarrheals

with e. coli infection
- monitor kidney function

with botulism poisoning
- monitor neuro status

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3
Q

what is pernicious anemia

A

deficiency in production of RBCs because of lack of intrinsice factor

due to lack of intrinsic factor, vit B12 cant be absorbed

more frequently in Northern European descent and African Americans

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4
Q

pernicious anemia manifestations

A

fatigue
weakness
dyspnea
pallor and palpitations

beefy red tongue
nausea
vomiting
anorexia

diarrhea
abdominal pain
paresthesia in hands and feet
- burning or prickling sensation

impaired coordination and balance

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5
Q

pernicious anemia diagnostic studies

A

CBC
bone-marrow biopsy

low levels of gastric hydrochloric acid
Schilling test
- vit B12 absorption test

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6
Q

pernicious anemia care

A 
lifelong vit b12 therapy
adeuqate dietary sources of vit B12
- clams
- sardines
- meat
- fish
- milk
- cheese
- eggs
- fortified breakfast cereals
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7
Q

pernicious anemia management

A

manage fatigue and activity intolerance
educat eclients

montitor for complications

will receive B12 injections weekly then monthly as maintenance

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8
Q

what is peptic ulcer disease

A

occurs as the resut of erosion of GI mucosa by hydrochloric acid and pepsin

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9
Q

risk factors of peptic ulcer disease

A

stress
H pylori
fam hx
use of aspirin

NSAIDs
steroids
caffeine
high alcohol intake

NSAIDs are responsible for majority of non H pylori peptic ulcers

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10
Q

peptic ulcer disease manifestations

A 
pain near epigastrum
nausea
vomiting
bloody emesis - blood vomiting
tarry stools - bloody stools
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11
Q

peptic ulcer disease complications

A

hemorrhage
perforation
gastric outlet obstruction

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12
Q

peptic ulcer disease diagnostic studies

A

upper endoscopy = most accurate diagnostic procedure

stool for occult blood may be evaluated, as well as complete blood count

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13
Q

peptic ulcer disease care

A

NPO
NG tube
if acute GI bleeding, endoscopic therapy/hemostasis
srugery - if urgent

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14
Q

peptic ulcer disease pharmacologic interventions

A

proton pump inhibitors:

  • pantoprazole
  • omeprazole
  • lansoprazole

antiinfectives if H pylori

  • clarithromycin
  • metronidazole

H2 receptor antagonists

  • cimetidine
  • ranitidne
  • famotidine

anticholinergics
- dicyclomine

antacids

  • aluminum hydroxide
  • aluminum magnesium combinations
  • calcium carbonate

metoclopramide

cytoprotective

  • sucralfate
  • misoprostol
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15
Q

peptic ulcer disease complementary health

A 
licorice
root
cats claw
goldenseal 
- little exvidence exists that support their efficacy

acupuncture
therapeutic massage
guided imagery
progressive relaxation

surgically severing vagus nerve (vagotomy) can help with gastric acid secretion
- for clients who do not respond to medical management

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16
Q

what is GERD

A

syndrome, not a disease

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17
Q

GERD manifestations

A

based on symptoms
increased by bending, stooping, lying down, or eating

usually relieved by antacids
nausea after eating is common

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18
Q

GERD diagnostic studies

A

endoscopy
manometry studies
- to evaluate LES and esophageal mobility

scintigraphy

  • assess gastric emptying
  • used with radioactive tracer to obtain an image of a bodily organ or a record of its functioning
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19
Q

GERD care

A

pharamacological interventions:
proton pump inhibitors:
- omeprazole
- lantoprazole

H2 receptor antagonists

  • cimetidine
  • ranitidine
  • famotidine

OTC antacids
- pepto bismol

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20
Q

GERD management

A

HOb elevated, esp after meals
avoid alte night eating

administration of PPI before first meal of the day

monitor aspiration and other complications

maintain fluid and electrolyte balances
avoid foods that acidic or gas-forming

incidence of GERD increases with age

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21
Q

what is appendicitis

A

inflammation of the appendix

most common reason for emergency abdominal surgery

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22
Q

appendicitiy manifestations

A

anorexia
nausea and vomiting
right lower quadrant pain
low grade fever

localized and rebound tenderness

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23
Q

appendicitis diagnostic studies

A

physical exam
differential WBC count

urinalysis
- to rule out urinary conditions that mimic appendicitis

KUB
- kidneys, urter and bladder x ray

ultrasound of the abdomen
CT

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24
Q

appendicitis care

A

immediate appendectomy

- any delay can lead to rupture and peritonitis

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25
Q

what is ulcerative colitis

A

begins in the rectum and extends to the distal colong

causes swelling, ulcerations and loss of function of the large intestine - colon

scarring produces narrowing, thickening and shortening of the colon

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26
Q

ulcerative colitis manifestations

A

bloody diarrhea ranging from 2-3 times/day to 10-20 times/day

stools may contain pus and mucus
left-sided abdominal pain

fever
weight loss
anemia

tachycardia
dehydration

impaired abrotpion of fat soluble, vitamins such as E and K

inflammation of the eyes
liver disease

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27
Q

ulcerative colitis diagnostic studies

A

CBC
stool for occult blood
stool culture
sigmoidoscopy or colonoscopy

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28
Q

ulcerative colitis care

A

goal of treatment:

  • decreased diarrhea
  • formed stool
  • control of bowel movement
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29
Q

ulcerative colitis pharmacological interventions

A

prednisone
infliximab
dicyclomine

drug of choice = sulfasalazine
metronidazole

diphenoxylate
methotrexate
cyclosporine
loperamide

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30
Q

ulcerative colitis dietary restrictions

A

adhere to high calorie and high protein diet

low roughage

  • whole grains
  • nuts
  • seeds
  • legumes
  • fruits
  • veggies

NO milk products

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31
Q

ulcerative colitis surgical management

A

proctocolectomy
colectomy
ileostomy creation

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32
Q

ulcerativie colitis complications

A

increased risk of colon cancer

fluid and electrolytes imbalances
toxic megacolon
- extreme inflammation and distention of the colon

perforation
bleeding
hemorrhage

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33
Q

ulcerative colitis management

A

manage pain
maintain optimal fluid and nutritional intake

prevent fluid and/or electrolytes imbalances

support coping mechanisms
recognize complications

ileum = most distal part of the small intestine
ileus = obstruction in intestine

ilium = part of hipbone

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34
Q

what is crohns disease

A

results in swelling and dysfunction of intestinal tract
especially the small intesting

most frequent site if the distal ileum

inflammation involves all layers of the bowel wall

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35
Q

crohns disease manifestations

A

diarrhea with steatorrhea
no obvious blood or mucus in blood

abdominal pain located in right lower quadrant
fatigue
weight loss

dehydration
fever

extraintestinal manifestations:
arhtiritis
skin inflammations
kidney 
gallstones
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36
Q

crohns disease diagnostic studies

A

stool for occult blood
stool culture

sigmoidoscopy
colonscopy
barium enema

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37
Q

crohns disease complications

A

obstructions from strictures
fistula formations
- abnormal made passage between organs

bowel perforation
infection

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38
Q

crohns disease care

A

rest
remaining NPO during exacerbation
TPN

diet high in calories and protein
low in roughage and fat

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39
Q

crohns disease pharmacological interventions

A 
prednisone
hydrocortisone
azathioprine
methotrexate
cyclosporine
infliximumab

same as ulcerative colitis

surgery will not cure crohns disease but it may limit the damage

40
Q

what is diverticular disease

A

inflammation of one or more diverticula

colon wall thicken and increases pressure in the bowel
stool and bacteria retained in the diverticula become
inflamed and small perforations begin to occur
- surrounding tissue becomes inflamed –> diverticulitis

41
Q

contributing factors for diverticular disease

A 
smoking
excessive alcohol consumption
constipation
obesity
diet low in fiber
42
Q

Diverticular disease manifestations

A

frequently asymptomatic
crampy lower left abdominal pain

alternating constipation and diarrhea

low grade fever
chills
anorexia
nausea
leukocytosis
43
Q

diverticular disease diagnostic studies

A

barium enema
CBC
urinalysis

stool for occult blood
flexible sigmoidoscopy
colonscopy

44
Q

diverticular disease care

A

high fiber, high residue diet

pharmacologic interventions:

  • bulk laxatives
  • stool softeners
  • anticholinergics

client with be NPO for 24-48 hours
low fiber diet will be implemented after 48 hours

bowel resection with temporary colostomy

majority of clients with diverticulosis have no symptoms
- typically during a routine colonoscopy

45
Q

diverticular disease complications

A

abscess formation
perforation with peritonitis
- progressive pain in other quadrants of the abdomen

fistula
bowel obstruction or hemorrhage

46
Q

diverticular disease management

A

weight reduction for obese clients
high fiber diet

fluit intake at least 2L/day
use of stool softeners

avoid intra-abodminal pressure

  • straining during defecation
  • vomiting
  • ending
  • heavy lifting
47
Q

what is intestinal obstruction

A

partial or complete blockage of bowel that preents the contents of the intestine from passing through

abdomen becomes distended from accumulation of fluid, gas, and intestinal contents

48
Q

intestinal obstruction manifestations

A

abdominal pain
distention
nausea and vomiting
- vomiting will be bile stained - (yellowish brown)

hypoxia
metabolic acidosis
bowel necrosis from impaired circulation

low fluid volume increases WBC, hgb, hct, BUN

49
Q

intestinal obstruction diagnostic studies

A

upper GI and lowe GI series

abdominal X-ray: for air in the bowel

50
Q

intestinal obstruction care

A

abdomen will be decompressed via NG tube

surgical bowel resection may also be necessary

51
Q

intestinal obstruction complications

A

perforation
peritonitis
shock
strangulation of the bowel

52
Q

intestinal obstruction management

A

manage pain, but avoid using morphine or codeine

measure abdominal girth

provide good oral care if client has NG tube
maintain fluid and electrolyte balance

53
Q

risk factor for colorectal cancer

A

clear risk factor is age

  • ulcerative colitis
  • crohns
  • genetic abnormalities
  • colorectal polyps
  • high fat/low fiber diet
  • smoking
  • alcohol consumptions
  • sedentary lfiestyles
54
Q

colorectal cancer manifestations

A

early stages: no symptoms

advance cases:

  • rectal bleeding
  • blood in stool
  • changes in bowel habits
  • lower abdominal pain/cramping

screening for early detection is critical for survival

55
Q

colorectal cancer diagnostic studies

A

DRE
fecal occult blood test

proctoscopy/sigmoidoscopy
colonscopy

CT scan

56
Q

colorectal cancer care

A

goal of surgical intervention:
- removing tumor
finding out if cancer has spread
- removing lymph node near the cancer

chemotherapy and targeted therapy often follow

57
Q

colorectal cancer management

A

clients over age of 50 to have screning
- bowel cleansing will be necessary in order for client to be screened properly

NG tube
- monitor for bleeding or coffee ground aspirate

nausea and vomiting are common
- antiemetics can be administered as ordered

monitor fluid and electrolyte
monitor wound incision and drainage after surgery

some might feel phantom rectal pain
- normal and ubsides quickly

progress to a regular diet as tolerated
if no ostomy, teach how to manage bowel movement changes

58
Q

what is hepatitis

A

liver becomes inflamed and Kupffer cells become enlarged

59
Q

stages of hepatitis

A

pre-icteric (pre jaundice) or prodromal stage
- general flu like symptoms occur

iceteric stage
jaundice occurs
- although not all clients with hepatitis develop jaundice

post icteric stage or recovery stage
- client continues to have fatigue and malaise

hepatitis can lead to :

  • swelling
  • scarring of the liver (cirrhosis)
  • cancer
60
Q

non viral hepatitis

A

drug- induced= reaction to a drug due to hypersensitivity

toxic hepatitis caused by;
- ingestion
- inhalation
- inspection of certain chemicals that have a poisonous effect on liver
like carbon tetrachloride, chloroform, poisonous mushrooms

61
Q

viral hepatitis

A

5 different viruses to cause viral hepatitis

Hep A: infectious heaptitis

b: serum hepatitis
c: most common form of viral hepatitis
d: found in IV drugs and carriers of hep B

E: similar to hep A
- found in people who live in countries with poor sanitation

diagnosed as either acute or chronic

62
Q

hepatitis diagnostic studies

A

decreased serum albumin
increased ALP, ALT, AST
- initially elevated and may rise 1-2 weeks before jaundice is apparent and then decline

bilirubin above 2.5 mg
bromsulphalein excretion test elevated
decreased RBC
antigen tests

abnormal liver enzymes
Pt may be prolonged

clay colored stool, steatorrhea
liver biopsy
liver scan

63
Q

hepatitis interventions

A

rest
bedrest during acute phase

encourage client to eat
administer antacids afte r meals
- do not give antacids at the same time as H2 receptor antagonists
- maintain gastric pH greater than 3.5

smokers may report distaste for/aversion to cigarettes
avoid OTc meds that contain aspirin or NSAIDs

aceptance
infection control

64
Q

what is cirrhosis

A

irreversible, chronic progressive degeneration of teh liver

65
Q

types of cirrhosis

A

laennecs (alcoholic): related to alcohol abuse

post necrotic cirrhosis:
- associated with viral hep or exposure to hepatotoxin

biliary: inflammation or obstruction of the gallbladder or bile duct

cardiac icrrhosis:
- associated with heart failure

66
Q

cirrhosis manifestations

A 
weakness
fatigue
weight loss
hepatomegaly
right upper quadrant

jaundice
pruritus
steatorrhea

clay colored stools
increased bilirubin in urine - dark colored urine
impaired aldosterone metabolism - edema

hypoglycemia
impaired strogen matbolism
- spider angiomas
- palmar erythema

impaired metabolism of protein, carb and fat

  • absorbs less Vit K s o prolonged bleeding
  • less proteins needed for clotting
  • less plasma proteins leads to edema and ascites
67
Q

cirrhosis diagnostic studies

A

increased ALT, AST, alkaline phosphatase
Pt
CBC
decreased cholesterol

serum bilirubin and urine bilirubin
ERCP to examine bile ducts

CT scan of liver
liver biopsy

68
Q

cirrhosis care

A

steroids for post-necrotic cirrhosis
replace vitamins B and fat soluble vitamins

increased carbs
protein may be restricted

possible sodium restriction
2,000-3,000 calories daily
no alcohol

69
Q

cirrhosis complications

A

portal hypertension
ascites
hepatomegaly

70
Q

cirrhosis management

A

monitor for bleeding
promote adequate or optimal nutrition

avoid alcohol and other hepatotoxic agents
manage itching and maintain skin integrity
rest

assess for changes in LOC
monitor for fluid balance
- measure abdominal girth daily
- weigh daily
- measure intake and output

acetaminophen is safe when taken in recommended amounts
- should take no more than 3,900 mg total in a 24 hour period

71
Q

what is ascites

A

accumulation of fluid in the peritoneum

72
Q

ascites manifestations

A

abdominal distention
protruding umbilicus

dull sound on percussion of abdomen
bulging flank
dyspnea

73
Q

ascites diagnostic studies

A

abdominal x-ray
CT scan
ultrasound

74
Q

ascites care

A 
pharamcological interventions:
- diuretics (spironolactone)
- Iv albumin
- paracentesis
- low sodium diet
- peritoneal venous shunt
this allows the drainage of fluid from peritoneum to superior vena cava
75
Q

ascites management

A

monitor fluid balance
intake and output
daily weight

abdominal girth
skin turgor

restric fluids
monitor ineffective breathing patterns
semi-fowlers position
impaired skin integrtiy

administration of lactulose to reduce ammonia levels in the body is often titrated

76
Q

what is hepatic encephalopathy

A

syndrome observed in clietns with late-stage cirrhosis

impaired ammonia metabolism leads to neurotoxins in blood and cerebral edema

ammonia is produced in the bowel by the action of bacteria on protein
- as a result, nitrogenous waste and neurotoxins increase

77
Q

hepatic encephalopathy amnifestations

A

changes from level of consciousness from confusion to coma
changes in sleep pattern

memory loss
asterixis - flapping tremor
impaired handwriting

hyperventilation with respiratory alkalosis

fetor hepaticus - musty, sweet breath to client

78
Q

hepatic encphalopathy diagnostic studies

A

serum ammonia level

liver enzymes

79
Q

hepatic encephalopathy care

A

antibiotics
- rifaximin

lactulose
- converts ammonia to ammonium

low protein diet

80
Q

hepatic encephalopathy management

A

safety because treats can lead to falls and injury

uninterrupted rest periods
assess fluid and electrolyte balances andbody weight

monitor bowel changes

hepatic encephalopathy is a neuropsychiatric manifesation of late-stage liver disease
- caused by neurotoxis effects of elevated ammonia levels

81
Q

what is acute pancreatitis

A

inflammation of the pancreas

82
Q

acute pancreatitis manifesations

A

upper abdominal pain that radiates to the back
nausea
vomiting
tachycardia

slow and shallow respirations
swollen and tender abdomen
fever

complications
atelectasis
hypovolemia and shock

abscess
hemorrhage into retroperitoneal space
- produce bluish discoloration around umbilicus

83
Q

risk factor of acute pancreatitis

A 
heavy aclhol use
gallstones
drug ingestion
viral infection
trauma
84
Q

acute pancreatitis diagnostic studies

A 
labs
serum amylase
serum lipase
increase urinary amylase
CBC
- increased WBC, decreased Hgb and Hct

increased LDH and AST
hyperglycemia

hypocalcemica
chest x-ray
CT scan
ultrasound
ERCP
85
Q

acute pancreatitis care

A

pharamcological intervention:

  • meperidine
  • morphine
  • insulin
  • calcium replacement
  • anticholinergics
  • H2 receptor antagonists

fluid maintenance to repvent shock
calcium replacement and decreasing stimulation to pancreas

NG tube
eat high in protein and carbs
low in fat if eating is allowed

86
Q

acute pancreatitis management

A

manage pain
monitor fluid and electrolyte balance

alcohol is STRICTLY prohibited
monitor breathing patterns

monitor nutritional status
oral care when NPO

87
Q

what is cholecystitis

A

inflammation of the gallbladder

usually due to gallstones

happens because common bile duct is obstructed by gallstone and bile cannot be excreted
- remaining bile distends and inflames the gall bladder

2 types:

  • cholesterol (most common)
  • pigment (unconjugated bilirubin)
88
Q

risk factors of cholecystitis

A

age 40 or older
birth control pills
being 6-9 months postpartum

89
Q

cholecystitis manifestations

A

colicky pain in right upper quadrant
possible radiation to right shoulder and back

indigestion after eating fatty foods
nausea
vomiting

jaundice
low grade fever

90
Q

cholecystitis diagnostic studies

A

ERCP
ERCG
CBC
amylase lipase

serum bilirubin
ultrasound

91
Q

cholecystitis care

A

rest
low fat diet
removal of stone in common duct by endoscopy

pharmacological interventions
- chenodiol
- urosdiol
side effects are diarrhea and hepatotoxicity

  • analgesics
  • replace vit K if bleeding is prolonged

extracorporeal shockwave lithotripsy
- may have heamturia after procedure, but not longer than 24 hours

choledocholithotomy
- remove or break up stones and place a T-tube in common bile duct

laparascopic laser cholescystectomy
cholescystectomy

92
Q

cholecystitis management

A

vitals
restrict fatty foods in their diet

remember 6 F’s of gallbladder disease:

  • female
  • fertile
  • fat
  • forty
  • flatulent
  • fair skin and hair
93
Q

hemorrhoids care

A
  1. pain relief
    - NSAIDs and/or acetaminophen
    - opioids can be prescribed initially but may worsen constipation
    1-2 days post op
    warm stiz baths
  2. preventing constipation
    - high fiber diet
    - adequate fluid intake at least 50 ml/day
    -stool softener like Docusate
    oil retention enema may be used if constipation persists for 2-3 days

Pain is priority

94
Q

Colostomy and ileostomy irrigation procedure

A
  1. Fill with 500-1000mL of lukewarm water
  2. Flush irrigation tubing and red lamp
  3. Hang container on a hook or IV pole
  4. Sit on toilet
  5. Place irrigation sleeve over stoma
  6. Extend sleeve into toilet
  7. Place irrigation container approx 18-24 inches above stoma
  8. Lubricate done tipped irrigator
  9. Insert cone
  10. Attach catheter gently into stoma and hold in place
  11. Slowly open roller clamp, allow irrigation to flow for 5-10 min
  12. Clamp if cramping occurs, until it subsides
  13. Once desired amount is distilled, cone is removed and feces is allowed to drain through sleeve into toilet
95
Q

Paracentesis procedure

A

Prior to a paracentesis,

  • verify client received necessary information to give consent and witness informed consent
  • instruct client to void to prevent puncturing bladder
  • assess abdominal girth, weight and vitals
  • place high Fowler’s or as upright as possible

NPO status is not required for paracentesis

Often performed at bedside

*remember, nurses cannot give informed consent. So just choose the answer that has verify that client got informed consent.
Don’t choose the one that says give informed consent

NCLEX (21 decks)

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