Gastrointestinal 2 Flashcards
Discomfort in epigastric & back of throat with conscious desire to vomit
Nausea
Powerful ejection of gastric contents through mouth
Vomiting
N&V related to a disease
Pathogenic
N&V stemming from a disease treatment
Ex. Chemo
iatrogenic
N&V resulting from psychological state
psychogenic
vomiting is caused by what?
the stimulation the chemo-receptor trigger which stimulates the vomiting center in the medulla by some type of stimulus
vomiting can cause what kind of imbalance
metabolic alkalosis
diahrrea can cause what kind of imbalance
metabolic acidosis
what kind of nursing management should you do for a pt with N&V?
NPO until able to tolerate oral intake (once vomiting has stopped), HOB elevated to prevent aspiration, replace fluids/electrolytes, NG tube, mouth care, clean enviornment
what kind of electrolyte imbalance will happen with vomiting
hypokalemia
when is it best to give antiemetics
before vomiting starts
what kind of diet shuold be given to a pt with N&V
NPO, then effervescent fluids, bland foods, avoid fats
if a pt is post op what should you check for if your pt is vomiting
wound dehiscence
Rx’s for N&V are?
zofran, phenergan, reglan, CNS depressents
Reglan Rx does what
increases gastric emptying
Zofran and phenergan Rx does what
given to prevent nausea
inflammation in gastric mucosa
gastritis
hematoemesis
blood in vomit
how is gastritis diagnosed
H. Pylori testing & EGD
S/Sx of gastritis
malaise, N&V, hematemesis, epigastric pain, dyspepsia
recurrent inflammation of gastric mucosa, chief & parietal cells malfunction & disappear
chronic gastritis
what is associated with gastric cancer
chronic gastritis
S/Sx of chronic gastritis
N&V, indigestion, epigastric pain not relieved with antacids
Tx for chronic gastritis
avoid irritants, bland diet, B12 injections for pernicious anemia
if you have bright red blood in vomit it is from what
arterial
if you have slower oozing, dark emesis it is from what
venous or capillary
melena
tarry stools, slow bleeding from UGI
how long after the bleeding stops can you have blood in your stools
2-3 days
hematochezia
bright red blood in stool
how long after bleeding stops can you have a positive quiac test
8 days
possible causes of upper GI bleeding
NSAIDS, asa, steroids, esophageal varices, ulcers, cancer, clotting disorders, leukemia
what test can you do to show active bleeding
bleeding scan
what diagnositc test can you have for an upper GI bleed
endoscopy, barium swallow, CT, bleeding scan
Mallory Weiss tear
tear in mucosa near esopagogastric junction, from severe vomiting
a pt with a dupdenal ulcer may exhibit what?
melena
what treatment would you provide for a pt with an active upper GI bleed
VS for shock, IV fluids (LR, blood), foley cath, NG tube (saline lavage to clear out blood), O2
what Rx’s will help with a GI bleed
vasopressin, sandostatin, antacids, H2 blockers
an erosion of the GI mucosa resulting from digestive action of HCl and pepsin
peptic ulcer disease
where can peptic ulcer disease occur
any area of the GI tract but mostly inthe duodenum and stomach
difference between acute and chronic peptic ulcer disease
acute: superficial erosision minimal inflammation
chronic: erosiion through muscular layer, fibrosis & scar tissue form
peptic ulclers only develop in the presence of what
an acid enviornment and/or pepsin (begins the digestion of proteins) release
normal or increased acid secretinos/bile reflux duodenum
gastric ulcer
increased acid secretion from incrase parietal cell mass, hypersecretion occurs at unusually times (between meals & at night)
duodenal ulcer
S/Sx of peptic ulcer
burning/dnawing pain, pain worse on empty stomach, relieved by food but recurs within 3-4 hours, pain awakens patient at night (bc hypersecretion of acid)
Tx for peptic ulcer
physical and emotional rest, Rx, aviod stressors, nutritional therapy
what Rx neutralizes gastric acid
antacids
when should antacids be given
1-3 hours after meals & at bedtime
what Rx reduces HCl acid secretions by blocking the action of histamine on H2 blockers
H2 receptor antagonists (pepcid, zantac)
what Rx stops the secretion of HCl acid to raise pH of the stomach
proton pump inhibitor (protonix, prevacid, prilosec)
what Rx inhibits gastric secretions and decreases gastric motility (slows PNS)
anticholinergics
what is a side effect of anticholinergics
dry mouth, urinary retention
what Rx forms an adherent that covers the ulcer and protects from erosion
carafate
what Rx increases gastric motility & emptying (acid doest stay in contact with stomach as long)
reglan
Teaching for peptic ulcers
bland food, calm enviornment, no alcohol, ASA, stop smoking
what is the most common comlication of peptic ulcer disease
hemorrhage
what is the first sign of hemorrhage in peptic ulcer disease
hematemesis or melena
what is the most serious complication of peptic ulcer disease
perforation (hole)
involves spilling of gastroduodenal contents into peritoneal cavity causing peritonitis & septicemia
perforation of peptic ulcer
S/Sx of perforation
sudden onset of severe upper abdominal pain, rigid abd, absent bowel sounds, increase RR
Tx of performation
sugery, post op antibiotics
pt has ulcer located close to the pylorus, causes edema
gastric outlet obstruction
S/Sx of gastric outlet obstruction
abd pain which is releived by belching or self induced vomiting, vomit often contains food particles from days before
Tx for gastric outlet obstruction
surgery
Pronton pump inhibitors
reduce gastric acid secretions and promote ulcer healing
removal of 2/3rds of stomach and anastomosis of duodenum
billroth I
removal of 2/3rds of stomach and anastomosis of jejunum
billroth II
vagotomy
severing of vagus nerve, decreases gastric acid secretion
pyloroplasty
surgical enlargment of pyloric sphinctor to help with passage of contents from stomach to intestine
Post op gastric surgeries
DO NOT irrigate NG tube after surgery unless you have an order
how long post op of gastric surgery will you have bright red drainage
1-12 hours, return to mornal yellow green in 36 hours
rapid emptying of gastric contents into small intestines, occurs 15-30 minutes after meals
dumping syndrome
S/Sx of dumping syndrome
weakness, syncope, sweating, dizziness, cramps, diarrhea
Tx for dumping syndrome
small frequent meals, no fluids with meals (fluids will wash food through stomach quicker), no carbs
your pt has a loss of intrinsic factor
pernicious anemia
if your pt has pernicious anemia, what do they need
B12 shots once a month for life
what can occur after surgery on pylorus
alkaline reflux gastritis
what can be a side effect of dumping syndrome
postprndial hypoglycemia, due to release of excessive amounts of insulin into circulation
ulcer caused by generalized stress response resulting in decreased production of mucus and increased gastric acid secretions
curlings ulcer
gastric ulcer thats linked to intracranial pressure, stimulates vagal nerve, and increases gastric acid production, caused by trauma, operations or strokes
cushings ulcer
multiple small erosions caused by severe stress or trauma (burn pts)
stress ulcers
1st sign of stress ulcer
bleeding
Tx of stress ulcer
cautery or laser, if unable to control bleeding then surgery
what disease has severe peptic ulceration, gastric acid hypersecretion, elevated serum gastrin levels, and gastrinoma of pancreas or duodenum
Zollinger-Ellison syndrome
how is zollinger-ellison syndrome diagnosed
high serum gastrin levels, steatorrhea
Tx for zollinger-ellison
pancreatectomy (remove tumor), total or partial gastrectomy, H2 receptor antagonist
impairment of forward flow of intestinal contents caused by blockage
intestinal obstruction
where does intestinal obstruction mostly occur
ileum (narrowest part of small bowel)
what is the most common cause of small bowel obstruction
hernia
intestinal loop protrudes thru a weak segment of the abdominal wall
hernia
the slipping of one part of the intestine into another part just below it
intussusception
can hernias be life threatening?
yes they can cause necrosis of intestine
twisting of bowel on its self, twisted loop beomes strangulated
volvulus, EMERGENCY can occur within 6-12 hours
bezoar
foreign object stuck in bowel
what is key to prevent paralytic ileus 9neurogenic obstruction)
ambulation
in vascular obstruction what happens
occurs when the blood supply to bowel is disrupted, peristalsis stops and ischemia occurs quickly-its an EMERGENCY
S/Sx of obstruction
pain, abd distention, n&V
if you have a partial obstruction in your bowel what kind of stool will you have
liquid stool
if you have a complete obstruction in your bowel what kind of stool will you have
no stools
borborygmi
high pitched, tinkling sounds
during an intestinal obstruction what do your bowel sounds sound like
usually increase proximal to obstruction, within few hours, bowel becomes flassid & bowel sounds decrease
Dx of intestinal obstructions
increase of H&H, BUN (related to dehydration), decrease electrolytes, increase WBC
Tx of intestinal obstruction
surgical emergency, NPO, NG tube to relieve abd distention, fluid/electrolyte replacement, high mortality rate if not treated in 24 hours
what Rx do you want to avoid with a pt that has intestinal obstruction
morphine, bc causes spasms in large intestine
administration of nutrition thru tube inserted through stomach or small intestine (duodenum/jejunum)
enteral nutrition
who can not have enteral feedings
IBS, diverticulitis, bowel obstruction, GI hemmorhage
PEG tube is placed where
into the stomach
PEJ tube is placed where
jejunum (intraenteric)
are enteral feeding tubes prone to obstruction
yes when oral Rxs are not thoroughly crushed and dissolved in water
which feeding tube is used for an extended time period
PEG
when can feedings start
when bowel sounds are present
Aspiration precautions for enteral feeding tubes
assess placement of tube Q4hr & b4 meals by aspirating, assess for residual volumes b4 meals & Q4hrs, maintain semi fowlers 30-45 minutes after feeding, irrigate tube with H2O after feeding,
how is placement of enteral tubes checked
x ray
continous drip (enteral feedings)
16-24 hours/day
use pump for constant flow
less regurgitation
increase absorption, nutrients
intermittent drip (enteral feedings)
250-400 mL over 20-40 min 5-8 times/day
gravity or pump
allows freedom btwn meals
bolus (enteral feedings)
rapid administration
similar to 2-3 meals/day
250-400mL given over a few minutes
poorly tolerated
how long is a ready to hang set good for
enteral feedings
48 hours bc its a closed system
how long is a top fil set good for
enteral feedings
24 hours (bc its an open system)
what do you label with the enteral feedings
date and time when bag is hung
perititis
inflammation of salivary gland
when doing enteral feedings that else should you do for your pt
daily weights
I&O
frequent oral hygine to prevent perititis
what are NG tubes used for
decompress stomach or small intestine admin of Rx or feedings Tx of obstruction or bleeding site obtain gastric contents for analysis diagnose gastrointestinal motility or disease process
which NG tube is only to be used on intermittent suction
levine or single lumen
which NG tube decreases the chance of decompression of stomach and can be used on constant suction
salem, double lumen
how do you check the patency of a NG tube
aspiration or irrigation with saline
when irrigating an NG tube can you use water
NO saline only
how do you measure for an NG tube
nose to ear to xiphoid process
what should you lubricate the NG tube with
water soluble gel
when the NG tube reaches the nasopharynx what shouldyou instruct the pt to do
lower head slightly to close trachea and open esophagus, have pt swallow water to aid with tube advancing
what is the best way to confirm placement of NG tube
x ray
when removing NG tube what should you ask the pt to do
hold breath to close epiglottis, gently and steadily withdraw the tube
decompression of intestines in bowel obstruction
intestinal or nasoenteric tubes
who does the insertion of intestinal tubes
MD
when the MD has inserted an intestinal tube what must you instruct the pt to do
pt lie on right side for 2 hours, then supine with head elevated for 2 huors, then on left side for 2 hours, the tube is carried to the intstine by paristalsis
with the removal of the intestinal tube, what should you do
remove 1-2 inches at a time, if the tube has reached the ileocecal valve, cut tube at nose and it will be removed by peristalsis via the rectum (poop it out)
is irrigation of NG/intestinal tube included in I&O
yes
when gastic surgery can you irrigate without a MD order or manipulate the tube
NO
can you use lemon or glycerine swabs for oral care
NO
what labs are for dehydration
BUN
passage of frequent, loose, unformed stool
diarrhea
large volume diarrhea
excess fecal water
small volume diarrhea
without excess fecal water
chronic diarrhea
at least 4 weeks, can be life threatening from dehydration/electrolyte imbalance
Tx for diarrhea
replace fluid/electrolytes
Rxs to decrease motility
BRAT diet
banana, rice, apple sauce, toast
destroys bowels normal flora, permits overgrowth of c, diff
antibiotic related diarrhea
found in some pts who are taking antibiotics, whitish membrane form over damaged areas of bowel
pseudomembranous colitis
Dx of antibiotic related diarrhea
stool culture for c-diff
tx of antibiotic related diarrhea
dc antibiotics, admin intestinal flora modifiers (yogurt, buttermilk), Rx (vanc, flagyl
relaxation of external sphincter resulting in involuntary passage of stools
fecal incontinence
what fluid replaces body fluids
saline 0.9%, isotonic
what fluid has glucose, has few calories
dextrose, 170 calories
what fluid has electrolyte replacement, has no dextrose so has no calories
LR
what kind of diet should you give a pt with fecal incontinence
high fiber, high fluid diet
retention or delay of fecal material in colon results in dry, hard stools
constipation
What kind of diet should you give a pt with constipation
high fiber and increase fluids, avoid laxatives or enemas
bulk forming agents-laxitive
absorb water, stimulates peristalsis
metamucil, benefiber
24 hours
stimulant-laxitive
irritates colin wall to increase peristalsis
ex lax, correctol
12 hours
stool softeners-laxative
lubricates intestinal tract and softens stoll
colace, mineral oil
8-72 hours
saline and electrolytes-laxative
causes retention of fluid in intestinal lumen
golytely
15-30 minutes
which laxative is the most abused
stimulants
ex lax, correcctol
which laxative can cause kidney problems
saline and electrolytes
golytely
a sympton associated with tissue injury
ex. abscess or rupture in abd, bowel obstruction, peritonitis, ovarian cyst rupture
acute abdominal pain
TX of acute abd pain
ID & Tx cause
CT/ultrasound
acute inflammation of vermiform appendix of cecum
appendicitis
fecalith
stool is compacted in appendix
if you have a pt with RUQ pain, and positive mcBurneys point what might your pt have
appendicitis
pain felt when release of palpation
rebound tenderness
tenderness between umbilicus & right anteriosuperior spine
McBurneys point
when you suspect appendicitis what should you never do
apply heat to the abdomen (can cause rupture of appendix)
if your pt has appendicitis what should you monitor for
symptoms of peritonitis
inflammation of all or part of the surfaces of the abd cavity
peritonitis
peritonitis
when you have drainage fromperforated or infected area that leaks into abd cavity
S/Sx of peritonitis
increase RR, pain, rebound tenderness, muscle rigidity, abd distention, absent bowel sounds, fever, WBC elevated, hiccups (r/t irritated diaphragm)
what should be your focus with peritonitis
fluid and electrolyte balance
if you have a pt that is vomiting what shuold you do
NPO until vomiting has stopped
inflammaiton of stomach and intestinal tract (small bowel)
gastroenteritis
what are causes of gastroenteritis
bacteria, virus, parasite, food poisoning
transmitted by fecal-oral route
what things can cause gastroenteritis
not washing hands, shellfish
gastroenteritis of large bowel
dysentery
what should you consider with gastroenteritis
contact precautions, fluid electrolyte imbalance
chronic non infectious irritation caused by spasms of colon, no pathophysiologic changes in bowel
IBS (irritable bowel syndrome)
mannings criteria for IBS
abd pain relieved by defecation
abd pain associated with stool changes
abd distention
presence of mucus with stool passage
what is the most common symptom of IBS
intermittent crampy abd pain (lower quadrants)
due to spasms
what is the most common digestive disorder seen in clinical practice
IBS
what Rx is used to relieve pain in IBS
steroids
Nursing care for IBS
low residue diet, steroids, mild relaxants (valium, xanax), anticholinergics (bentyl)
anticholinergics
helps reduce spasms/cramping
Bentyl
Ulcerative colitis
slow progressive lesion, starts in rectum and progresses to sigmooid colon to descending colon.
S/Sx of ulcerative colitis
bloody, mucus diarrhea, LLQ colicky abd pain, fever, weakness, anemia
pt will have exacerbations and remisions
toxic megacolon
bowel becomes inflammed & distended (transverse colon)
fistulas
opening from one organ to another, one that is not supposed to be there
(usually with uterus, bladder or vagina. urine will look like stool in color)
Tx for ulcerative colitis
bowel rest, combat infection, correct dyhydration
diet for ulcerative colitis
high calorie, high protein, low reside, vit supplements
can surgery cure ulcerative colitis
yes
removal of entire colon and rectum with permanent ileostomy
proctocolectomy (for ulcerative colitis)
crohns disease
chronic, inflammatory area seperated by normal tissue (skip lesions), can affect all areas of GI tract, thickened cowel wall, cobblestone apperance
S/Sx of crohns disease
not often bloody, more pus and mucus, low grade fever, fistulas, intermittent diarrhea, crampy abd pain
Rx for crohns disease
steriods, nutritional management
is surgery curative for crohns disease
no, bc recurrence can occur in any area of bowel
projection of mucosal surface of the bowel lumen
polyps (are pre cancerous)
what type of polyp attaches to intestinal wall by stalk or stem
pedunculated
what type of polyp attaches directly to wall, flat , broad based
sessile
what type of polyp is larger, bleeds easily, premalignant
villous
how do we diagnose cancer in polyps
colonoscopy with biopsy
cancer of colon and rectum
3rd most common cancer, usually asymptomatic, metastasized to liver first, can have cancer for 8-10 years prior to diagnosis
if you have a left sided tumor to colon, what kind of symptoms will you have
obstruct flow of solid stool, have ribbon like stool, constipation, rectal bleeding, diarrhea alternating with constipation
hematachezia
rectal bleeding
if you have a right sided tumor to the colon what kind of symptoms will you have
less change in bowel habits, melena, dull abd pain, anorexia, malaise, pain is late sign
what is CT scan used for in cancer
staging
what blood test is able to detect cancer/tumors
CEA (carcinoembryonic antigen)
protein secreted by tumor cells measured in blood
resection or laparoscopic bowel resection
incision is made & proximal sigmoid is brought through abd wall as permenent colostomy
radiation is used for what
shrink tumor
chemotherapy is used for what
for control or palliation
pouchlike protrusions of intestinal mucosa
diverticulum
multiple diverticula exist
diverticulosis
inflammation of diverticulum
diverticulitis
diverticulitis results from what
obstruction of diverticula by a fecalith`
fecalith
hard stoney mass made of feces
S/Sx of diverticulitis
may be asymptomatic
LLQ pain,
N/V, occult bleeding, fever, WBC elevated
Dx of diverticulitis
barium enema, colonoscopy
no colonoscopy during an acute flair can cause peritonitis
Rx used for diverticulitis
anti cholinergic
abnormal protrusion of an organ, tissue or part of an organ through a structure that normally contains it.
hernia
reducible hernia is
can be pushed back in
irreducible (incarcerated) hernia
needs surgery, can decrease blood flow = tissue death
weakness in abd wall in inguinal canal, where spermatic cord or round ligament emerge
inguinal hernia
protrusion through femoral ring into femoral canal
fermoral hernia
strangulates easily
occurs due to weakness of rectus muscle or failure of umniliacl opening to close
umbilical hernia
occurs due to weakness in abd wall at site of prevous surgeries
incisional or ventral hernia
how do you assess for a hernia
have pt lay in supine position and ask pt to raise shoulders and head
Tx for hernias
conservative: wear external support
surgery: prevent strangulation or if it has alreay occured
herniorrhapy
hernia repair
hernioplasty
weak area reinforced with mesh, wire, facscia
Post op hernia repair
no coughing, avoid lifting or straining, watch for difficulty voiding, I&O
impaired uptake of essential nutrients leads to malnutrition and weight loss
malabsorption syndrome
ex. celiac disease, tropical sprue, nontropical sprue
what do villi do
increase surface area, increase absorption of nutrtients
anemia
due to decrease of absorption of neutrients (iron)
Tx for malabsorption syndrome
gluten free diet
no rye, barley, oats, wheat
deficiency in intestinal lactase results inhigh concentration of intra-luminal lactose
lactose intolerance
what OTC Rx helps with lactose intolerance
Lactaid
dilated varicose vein of rectum and anus
hemorrhoids
do internal hemorrhoids have pain
no pain
do external hemorrhoids have pain
very painful
causes of hemorrhoids
obesity, pregnance, portal HTN
Tx for hemorrhoids
I&D, ointments, sitx baths
post op hemorrhoids
watch for constipation, pain control, bleeding
thin tear or crack in anal mucosa
anal fissure
S/Sx of anal fissure
bleeding on defecation, pain, burning
inflammation of ano-rectum with localized infection & pus accumulation
ano-rectal abcess
S/Sx of ano-rectal abcess
throbbing pain when sitting
Tx of ano-rectal abcess
I&D with packing
hallow tract that leads from anal canal or rectum to perinanal skin, usually following a gland tract
ano-rectal fistula
S/Sx of ano-rectal fistula
pruritis, pain, odor
Tx for ano-rectal fistula
surgical repair
fistulectomy, fistulotomy
fistulectomy
surgery for superficial fistulas
fistulotomy
surgery for depper fistulas
area is opened & packed, heals by granulation
small tract under skin at saceral area
pilonidal sinus
pilonidal sinus
congenital, common in yound men, movement of buttock causes hair to penetrate skin=pilonidal cyst or abcess forms
Tx for pilonidal sinus
I&D, packing, wound left open to heal
Resulting from psychological state
Psychogenic
Vomiting is caused by?
Stimulation of CTZ which stimulates the vomiting center in medulla
Vomiting can cause?
Hypokalemia & metabolic alkalosis
Antiemetics work best when
Prior to vomiting
Inflammation of gastric mucosa
Gastritis
Rovsing sign
Palpation of LLQ causing pain to be felt in the RLQ
Pt with abd pain N&V, pt has bowel obstruction & abd mass. When listening to abd what would you hear
High pitched and hyperactive above area of obstruction
Side effect of reglan
Tremors
Pepcid is working correctly when what symptom is relieved
Epigastric pain
Phenergran has a side effect of
Dry mouth
What lab value would be used to indicate acute pancreatitis
Amylase
