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Basic Med-Surg > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What should be assessed when looking for GI disorders?

A

History, appetite, weight, bowels, skin, bruising, bleeding, pain, nausea, vomiting, bloating, smoking, alcohol, caffeine, travel, meal patterns, cultural practices, drugs, medications, allergies.

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2
Q

Life-threatening, acute inflammation of lining of abdominal cavity. Etiology?

A

Peritonitis. Contamination of peritoneal cavity by bacteria or chemicals via the bloodstream or acute abdominal disorder.

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3
Q

Lab assessment for GI?

A

CBC, prothrombin time (PT), partial thromboplastin time (PTT), electrolytes, bilirubin, albumin, amylase, lipase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), ammonia, carbohydrate antigen (CA19-9), carcinoembyronic antigen (CEA)

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4
Q

S/s of peritonitis?

A

increased pulse and BP. Dehydration, pain, decreased bowel sounds, fever, N/V, anorexia, rebound tenderness, board-like abdomen, abdominal distention and rigidity, increased WBC.

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5
Q

Risk factors for peritonitis?

A

Abdominal surgery, ectopic pregnancy, perforation via trauma, ulcer, appendix rupturing, or diverticulum.

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6
Q

Nursing care and treatments for peritonitis?

A

IV’s, electrolytes, GI distention, decreased infection process. Prevent complications with immobility, pulmonary, fluid balance, surgery, X-rays, NPO, NG tube, central line, I+O, indwelling urinary cath, antibiotics, analgesics

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7
Q

What should be done before an endoscopic procedure?

A

It’s an invasive procedure. Consent and IV. Diet, stop blood thinners, colonoscopy, diet, bowel prep. Done with conscious sedation, not general anesthesia

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8
Q

What should be done after an endoscopic procedure?

A

Frequent vitals, safety, diet, education. Report abdominal pain, fever, unresolved N/V, bleeding.

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9
Q

Management of care post colonoscopy?`

A

Frequent vitals, diet. Assess for severe abdominal pain, fever, hypotension, tachycardia, altered mental states, rigid abdomen

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10
Q

Complications of endoscopic procedures?

A

Over-sedation, hemorrhage, aspiration, perforation

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11
Q

What findings indicate that the patient is over-sedated?

A

Bradypnea, change in LOC, excessive sedation (can’t wake the patient up), change in oxygen saturation, tachycardia.

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12
Q

What are antagonists for sedation?

A 
Naloxone HCL (Narcan) for opioid sedatives 
Flumazenil (Romazicon) for non-opioid
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13
Q

What findings indicate hemorrhaging?

A

Dizziness, tachypnea, frank bleeding, hypotension, tachycardia, cool and clammy skin, change in LOC

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14
Q

What findings indicate aspiration?

A

Tachypnea, crackles, dyspnea, tachycardia, fever

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15
Q

What findings indicate perforation?

A

Severe abdominal pain, fever, N/V, abdominal distention, rigid abdomen, altered bowel sounds

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16
Q

General patient education post-endoscopic procedures

A

No alcohol for at least 24 hours, no driving home, bleeding, discomfort, flatulence, diet, report s/s to HCP

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17
Q

Management of care of PN (parenteral nutrition)?

A

Monitor labs, central line, infusion pump, dedicated IV line, change PN bag q24hrs, independent double verification
Assess for fluid overload, infection, hyperglycemia

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18
Q

Cather inserted with tip sitting within the superior/inferior vena cava

A

Central venous access devices (CVAD)

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19
Q

Complications of PN?

A

Pneumothorax, embolism, sepsis

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20
Q

Things about nasogastric tubes?

A

Decompression, suction, GI rest, decreased tension on sutures, promotes healing, enteral feedings.

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21
Q

Nursing care for an NGT (nasogastric)?

A

Aspirate, auscultate, confirm placement, tape securely, skin, document, record, I+O

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22
Q

Complications of NGTs?

A

Fluid and electrolyte imbalance from loss of GI contents. Fluid volume deficits from loss of GI contents. Metabolic alkalosis from loss of stomach acids. Pneumonia from aspiration into lungs. Nasal discomfort and erosion (inspect the nares and nasal skin).

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23
Q

Risk factors for ulcer disease?

A

Genetics, GI surgery, h. pylori, drugs, hypersecretory states, stress, smoking, chronic disease, radiation therapy, alcohol ingestion

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24
Q

Gastric ulcer etiology?

A

H. pylori, increased gastric acid secretion, delayed gastric emptying, incompetent pyloric sphincter

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25
Q

Duodenal ulcer etiology?

A

H. pylori, increased gastric acid secretion, rapid rate of gastric emptying

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26
Q

S/s of ulcers?

A

May be asymptomatic. Fullness, pyrosis, hematemesis, nausea, distention, bloating, anorexia, weight loss, dyspepsia, pain

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27
Q

Drug therapy in ulcer treatment?

A

Relief from pain and discomfort. Eradicate H. pylori. Decreased gastric acidity. Enhance mucosal defenses. Heal ulcerations. Prevent recurrence.

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28
Q

Diet in ulcer treatment?

A

Eliminate or restrict foods that cause discomfort. It’s no longer thought that a bland diet assists with healing. Avoid alcohol and foods that cause irritation.

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29
Q

What should not be done to a nasogastric tube after gastric surgery?

A

No not manipulate, reposition, or irrigate NG tube after gastric surgery without a prescription from the practitioner

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30
Q

Early s/s of dumping syndrome?

A

5-30 minutes after eating. Weakness, faintness, palpitations, diaphoresis, fullness, discomfort, nausea.

31
Q

Late s/s of dumping syndrome?

A

Hunger, dizziness, diaphoresis, tachycardia, shakiness, anxiety, confusion, fluid and electrolyte imbalance

32
Q

Diet and pt education for a person with dumping syndrome?

A

High protein and fat, low carbs and fiber. Small, frequent meals. Avoid milk, sweets, and sugars. Eliminate caffeine and alcohol. Drink liquids 1 hr prior to and following meal. Lie flat after eating.

33
Q

S/s seen with a GI hemorrhage?

A

Pallor, confusion, decreased h/h, abdominal pain and distention, coffee ground emesis, black and tarry stools, hematemesis, frank bleeding, tachycardia, hypotension

34
Q

S/s seen with a perforated ulcer?

A

Rigid and board-like abdomen. Severe sudden, sharp pain. Possible change in LOC. S/s of bleeding and/or peritonitis

35
Q

Risk factors for cholecystitis/ cholelithiasis?

A

Obesity, rapid weight loss, prolonged fasting, diabetes, pregnancy, gender, age, high fat diet, family history, hormone replacement, birth control pills, crohn’s disease, gastric bypass surgery, culture

36
Q

S/s of cholecystitis?

A

Dyspepsia, flatulence. An intense, sudden onset pain after consuming high calorie fatty diet.

37
Q

S/s of cholelithiasis?

A

Fear, chills, pain

38
Q

S/s of choledocholithiasis?

A

Jaundice, pruritis, steatorrhea, dark urine, clay colored stools

39
Q

Labs seen in gallbladder disease? Other tests done?

A

Increased all of the following: WBC, bilirubin, amylase, lipase, AST, LDH, cholesterol.
Ultrasounds, hepatobiliary imnodiacetic acid (HIDA) scan

40
Q

How does a hernia form?

A

Congenital/acquired muscle weakness. Aging process. Increased intra-abdominal pressure from obesity, pregnancy, lifting heavy objects, coughing

41
Q

Complications of GERD?

A

Nighttime reflux, esophageal strictures, hemorrhage, pneumonia, mimics cardiac disease

42
Q

What is included in inflammatory bowel disease?

A

Ulcerative colitis, Crohn’s disease, diverticular disease

43
Q

Diagnosis of IBD?

A

History, physical, radiologic exams, colonoscopy

Labs have increased WBC and erythrocyte sedimentation rate (ESR). Electrolyte unbalances. Decreased h/h

44
Q

Pathophysiology of ulcerative colitis?

A

Remissions and exacerbations. Autoimmune component. Widespread, diffuse, continuous inflammatory process.

45
Q

Pathophysiology of Crohn’s disease?

A

Autoimmune component. Cobblestone appearance. Inflammatory, spotty, sporadic process that may occur anywhere along the GI tract but often involves the terminal ileum.

46
Q

What are the common s/s of CD and UC? What’s different

A

Abdominal cramping, distention, anorexia, weight loss, leukocytosis, anemia, electrolyte imbalances, fever, weakness, malaise, stool
UC is 10-20 diarrheal stools a day, whereas UC is 5-6

47
Q

Common complications of UC and CD?

A

Hemorrhage, perforation, access, nutritional deficiency, bowel obstruction. UC has toxic megacolon and the need for surgery is infrequent. The need for surgery for CD is frequent because fistulas and fissures are common.

48
Q

Non-surgical management of IBD?

A

Drug therapy, nutritional therapy, rest, psychosocial support

49
Q

Diet to treat IBD?

A

NPO initially, PN? Fluids, low residue, high protein and calorie diet. Some common restrictions are spicy food, alcohol, caffeine, dairy, raw fruits and veggies

50
Q

Indications for surgery for CD and UC?

A

Bowel perforation, hemorrhage, cell dysplasia and cancer, failure of medical therapy, toxic megacolon

51
Q

S/s of toxic megacolon?

A

Constipation, liquid fecal incontinence, abdominal distention, signs of bowel obstruction or perforation

52
Q

Diagnosing diverticular disease?

A

Upper Gi series, barium enema, CT of the abdomen, flat plate of abdomen, colonoscopy

53
Q

S/s of diverticulitis?

A

Pain, distention, nausea, vomiting, fever, chills, tachycardia, bleeding, leukocytosis, anemia, check stool for occult blood

54
Q

A specific part of the colon is cut and linked to the artificial opening that’s made through the abdominal wall.

A

Colostomy

55
Q

The ileum, the final section of the small intestine, is cut and connected to the artificial opening that’s made through the abdominal wall.

A

Ileostomy

56
Q

Normal post-op output for a colostomy?

A

Small to moderate amount of mucus with semi-fromed still 4-5 days post-op. Several days to a week’s output resembles semi-formed stool. The ostomy in the sigmoid colon will most resemble a pattern similar to pre-op.

57
Q

Normal post-op output for an ileostomy?

A

At risk for fluid volume deficits r/t large amounts of GI output. After several days to weeks the output will decrease to 500-1000 mL/day. Becomes more paste-like as small intestine assumes absorptive function of the large intestine. Continuous liquid output, the stool will initially be more liquid because the colon no longer exerts its function of liquid resorption.

58
Q

What nursing diagnoses can be given to a patient undergoing -ostomy surgery?

A

Knowledge deficit. Disturbed body image. Risk for skin impairment. Nutritional/fluid imbalance.

59
Q

Post-op nursing care for an -ostomy?

A

Prevent complications. Discharge teaching. Report bleeding and signs of ischemia at the stoma to the HCP. Assess coping and readiness to learn. NGT and diet. Fluids, electrolytes, labs.

60
Q

Complications of an -ostomy?

A

Bleeding. Fluid and electrolyte imbalances. Abscess formation. Peritonitis.

61
Q

Etiology of mechanical bowel obstruction?

A

Volvulus, tumors, hernia, fecal impactions, vascular disorders, emboli, arteriosclerotic heart disease, cancer, adhesions

62
Q

Etiology of non-mechanical bowel obstruction?

A

Paralytic ileum, neurogenic disorders, manipulation of bowel, vascular disorders, electrolyte imbalance, inflammatory response

63
Q

S/s of bowel obstruction in the small bowel?

A

Absence of sounds. Upper abd colicky, spasmodic intermittent pain, cramps. Upper abd distention. Nausea, profuse projectile vomiting. No BM. Severe fluid and electrolyte imbalance.

64
Q

S/s of obstruction in the large bowel?

A

Absence of sounds. Intermittent, defuse, poorly localized lower abd pain. Lower distention. Infrequent vomiting. Minimal F+E imbalance. May have diarrhea around an area of impaction or no BM.

65
Q

Diagnosis of BO (bowel obstruction)

A

Physical assessment, radiologic exams, endoscopic exams, lab tests

66
Q

Interventions for non-mechanical BO?

A

NPO/NGT. Iv fluids, pain management, activity, correct fluid and electrolyte imbalances, auscultate bowel sounds, pain, measure abdominal growth

67
Q

Interventions for mechanical BO?

A

Prepare for surgery. Surgery consists of relief/removal of the obstruction. Exploratory laparotomy.

68
Q

Complications of BO?

A

Dehydration, electrolyte imbalance, metabolic alkalosis or acidosis. Persistent vomiting. Loss of HCL from stomach. Alkaline fluids not being resrobed in the colon

69
Q

Diagnosis and complications of appendicitis?

A

Abdominal x-rays. Evaluate symptoms and labs, R/o other causes.
Complications include access, perforation, peritonitis

70
Q

Chronic condition with altered bowel habits (most often diarrhea) with exacerbation and remissions without changes to lining of bowel

A

Irritable bowel syndrome

71
Q

S/s of IBS?

A

Diarrhea or constipation, abd relieved by BM, abd boating, feeling of incomplete evacuation

72
Q

Treatment of IBS?

A

Health teaching, avoid problem stimulants dietary fiber and bulk, liquids, drug therapy, stress management

73
Q

Etiology of IBS?

A

Diverticular disease, gastric stimulants, smoking, NSAIDs, in creased fat nit he diet, milk allergy, psychiatric/mental health disorder, stress

Basic Med-Surg (11 decks)

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