Gastrointestinal Flashcards
Vomiting (Continuous) what will happen over time?
Low K,Na, Cl and will be at risk for Metabolic Alkalosis (HCl removed from the stomach)
When does vomiting happen?
Early morning, or after a meal
Where is the GI bleed? (Coffee ground)
old blood being metabolized
Where is the GI bleed? (Bright red)
Active bleeding
Where is the GI bleed (Yellow, green)
Bile being metabolized
What are the sign and symptoms of Dehydration?
Dry MM, low bp, high HR, LOC, low urine output, Delerium, skin turgor, dizzy, no JVD, pale and clammy
If the patient wanted no medications what non-pharmacology interventions could we do to stop vomiting and nausea
Peppermint oil, cold wash cloth, acupuncture, deep breathing, quiet room, and ginger ale.
How do we measure an NG tube
nose to ear lobe, ear lobe to xiphoid process.
When suctioning a patients stomach, too much suction can produce?
Metabolic alkalosis
in N/V what do we make sure to not give the patient (Drinks)
Never give them Hot or Cold liquids.
If the patient is vomiting too much and can’t keep things down what will we administer?
Normal saline with Dex5%( D5W)
What kind of food can we give a N/V patient?
sips and ice chips, carbs with no fat, cola ginger-ale, bland diet (apple sauce or toast).
True or False. if a patient is vomiting constantly he/she should be put as NPO
True.
What are some Nursing Diagnosis for N/V?
Fluid volume defect and Imbalanced Nutrition.
Why are Elderly people at high risk for aspiration?
low LOC, Regurgitation, low reflex, they can’t raise quickly when vomiting.
What are other things Elderly people are at risk for in N/V?
Increased risk due to sensitivity to antiemetic drugs, impaired renal function with fluid electrolyte imbalance.
where is the GI bleed? (melena)
Upper GI Tract. old blood and digestive.
How do you do a Guaiac Test?
test the developer and smear a stool on it, if its positive it will be blue, meaning positive for blood.
What are the causes of upper GI bleed?
Drug induced (NSAIDS), Severe vomiting (Malory Weiss Tear), Cancer, Tumor some place, Gastritis, Stress, Uclers, Corticosteroids.
50% of what Causes upper Gi bleeds?
Ulcers from H-Pylori
What are common drugs that cause Ulcers?
Excedrin, Alka Seltzer, and bufferin
NSAIDS, Aspirin, corticosteroids
In a GI Bleed what are the nursing outcomes?
1 Stop the bleeding, Maintain normal body fluids, Maintain or a return to hemodynamics (BP,HR), or a change in life style.
If a patient is bleeding into the abdominal cavity from GI tract what are signs of shock?
Narrow pulse pressure, Cool, clamy anxious, tremors, and the patient will feel impending doom.
Endoscopy (EGD) What are the preparations for this procedure?
We will need consent from Patient, maybe restrains on patients wrist, suction will be on, yonker, bite block on tube, before procedure we will get H&H, important to make sure the patient is sitting up (never lying down) fowlers semi fowlers. Oxygen on patient.
After the EGD what do we assess for?
Return of Gag-Reflex, Check swallowing and Vital signs.
what medication will they use to stop the bleeding?
Epinephrine.
What kind of medications will patient be on if the bleeding continues? (upper GI bleed)
(Weak to strongest) Antacid (H blockers), H2 blocker, Proton Pump inhibitor.
What are the signs and symptoms of GERD?
Pyrosis (heartburn)Very Common, Dyspepsia, Globus sensation (I feel something behind my throat), Regurgitation, Acidic stomach.
What are some complications patients will face with GERD?
Esophagitis, Barrets Esophagus (precursor to cancer), Respirator complications (aspiration), Esopageal strictures (food will get stuck from scars)
What treatments will you teach the patient about eating food with GERD?
NO alcohol, tobacco, chocolate, caffeine, or peppermint. No spicy foods, high fat foods, milk products, orange juice, or tomato sauce.
What are things we can teach the patient to prevent GERD?
raise the head of the bed, lose weight (lessen abdomen pressure), avoid late meals, no meals 3-4 hours before bedtime.
What are the nursing diagnosis for GERD?
Imbalanced Nutrition, Chronic pain, Anxiety, ineffective coping with body image
What is the first sign of Oral cancer?
leukoplakia (looks like a cancer sore)
What are nursing diagnosis associated with Oral Cancer?
Imbalanced nutrition, chronic pain, anxiety pain, ineffective coping related to body image (after surgery on face)
What is the first sign of Esophageal Cancer?
they can’t swallow, its very painful. (Meat) it can progress to not being able to swallow soft food, then liquids.
What Quality of life issues will we teach the patient?
The feeding tube they will lose weight, because not enough nutrients. Radiation, and Chemo is heavy on quality of life.
Culturally who is at risk for Esophageal Cancer?
African Americans, and Alaskan natives.
Hiatal Hernia signs and symptoms
will feel like a heart attack, heart burn, they may think its their Gallbladder, or an ulcer
What are the symptoms of Gastritis?
Very Painful, Anorexia, Nausea and Vomiting, Epigastric tenderness, Frank bleeding. could cause a bleeding Ulcer,
What causes Gastritis?
NSAIDS, Corticosteroids, Aspirin, Alcohol, Stress, Spicy foods, H-Pylori, burns, smoking, large hiatal hernia, uremia, sepsis, shock.
What are some complications of PUD?
Where will the patient feel pain?
high risk of Hemorrhage, perforate (gastric juices in the abdomen = sepsis) A peptic ulcer bleeding can radiate to shoulder pain or back.
What treatments will we teach patients with PUD?
Rest, Bland Diets (high carb and low fat), and stop smoking.
What is the dumping syndrome
Food will rush through the gut, high carbohydrate diets, patient may or may not have diarrhea. will have cramps, coliky pain.
When patients have an appendicitis where is the pain sign located?
McBurneys point. halfway between umbilicus and illiac crest
What is 1# risk with a ruptured Appendicitis?
Sepsis in the abdomen cavity
What are common causes of Intestinal Obstruction?
Adehsions (scar tissue bonding together creating obstruction), strangulated inguinal hernia (intestines bulge into inguinal), illeocecal inteception (a piece of intestine overlaps each other) messenteric artery occlusion, tumor, or twisting of intestine (bulbous)
Small intestinal obstruction s/s?
sudden and onset, nausea and vomiting comes quickly, its very painful, (could have bowl movements for short time), abdomen will be distended very quickly.
When a patient with small intestine obstruction is diagnoses will they be NPO?
Yes, and they will need an NG tube. it will help with nausea vomiting and distention.
What nursing assessments will we do on Small intestine obstruction?
Pain assessment, projectile vomiting (foul, fecal smell), Bowl sounds could be active or absent, patient will be distended because of food and/or gas. watch for Metabolic alkalosis
if a patient comes in with small intestine block due to bulbous or adhessions will surgery be performed right away?
No, sometimes it can fix on its own. let them rest.
Large intestine obstruction signs and symptoms?
hardly no vomiting (food further down gut), pain just cramping, happens gradually, patient will be able to pass stools but followed by constipation, hardly any Abdominal distention.
What causes Cirrohsis
Alcohol, Drugs, viral hepatitis (C), bile duct obstruction (stone tumor cancer)
Which Cirrohsis is the most common?
Alcohol, causes more fat cells to accumulate in liver, Pt when stop drinking the liver can take care of its self.
What is Laennec’s cirrhosis?
Alcoholics Cirrhosis. 50% of all cirrhosis cases, can reverse effects of fat cells on liver if Pt stops drinking.
What causes Post-necrotic cirrhosis?
Drugs and chemicals, scaring on the liver, causes of hepatitis C and or alcohol.
What causes Biliary Cirrhosis?
bile duct obstruction, or cell destruction around bile ducts
What will Biliary Cirrhosis cause?
obstruction causes a back flow of bile resulting in jaundice (more common in women over 30)
What are early signs of Cirrhosis
gradual disease (very slowly), anorexia don’t feel like eating, N/V, Flatulenece, Abdominal pain. Constipation. change in bowl habbits all early signs*
How do we diagnose Cirrhosis?
liver functions test such as: alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, low albumin, long PTT,
Why will you have decreased albumin in Cirrhosis
you are not obsorbing protein as you should and your liver is not functioning well enough to make albumin.
What other data can diagnose cirrhosis
portal hypertension (blood doesn’t flow and backs up to the liver) fluid begins to seep in peritoneum. high risk of bleeding.
What is Ascites
protein moves away from abdomen so fluid follows protein (accumulating in the gut) from the liver problems or pressure in the gut
What symptoms will you see with Ascites
Hypoalbuminemic huge abdomen (depending on state of cirrhosis) if they have trouble breathing may have to do paracentesis. Lasix would work, or albumin to pull fluid into vascular space. you will see increased aldosterone.
What treatments do we give patients with Ascites
Bedrest, restriction from Na, Diuretics, paracentesis will help the patient breath
Liver failure causes Hepatic Encephalopathy, what happens to the ammonia?
ammonia crosses BB, since the liver is damaged ammonia can’t be converted to urea to be excreted out.
What are the symptoms of HE?
Pt becomes confused, slurred speech, drunk mannerisms, yawning (continuous) hiccups, and pt can go into coma.
How do we treat patients with Hepatic.E
We want to reduce their ammonia, restrict the protien (when digested it will have ammonia biproduct) give patient lactulose (thick and clear they drink, pulls ammonia out) <–side effects diarrhea. Neomycin sulfate kills extra bacteria in gut that causes ammonia.
What are the late signs of HE
slurred speech, confused, hiccups, respirations, hallucinations, hyperactive reflexis.
What other symptoms will you see with cirrhosis?
petechiae, spider angiomas (liver is not making clotting factors) fowl breath (fecal smell) black tar stools or melena (slow bleeds no clotting factor), change of mental status. no estrogen or testosterone, and palmar erythema (clotting issues)
Hepatitis A transmision
Fecal-Oral
Hep B transmision
blood bourne transmision, sexual contact, needles, paranatal.
What are early signs of Hepatitis?
anorexia, nausea, vomiting, hepatomegaly, splenomegaly, abnormal LFT.
What would you teach a patient with hepatitis A
receive the single dose vaccine.
What are symptoms of Hep A
flu like symptoms, weight loss, aches and pain, itching (because of bile salts under the skin) palpable liver and spleen
What are the side effects of Interferon?
fatigue, no energy, flu like symptoms, irritability, insomnia, and depression.
What are the side effects of ribavirin
Anemia, fatigue, muscle pain, hemolytic.
which viral disease is responsible for liver cancer
Hepatitis C
What causes acute pancreatitis
Alcohol, gallstones, biliary tract disease, main problem is PAIN.
How do you diagnose Acute pancreatitis?
elevated serum amylase and lipase levels.
What will you teach the patient with acute pancreatitis?
Control what you eat (eating makes it worse) on bland diet (low fat) pain will be worse after eating, pain in ULQ, pain causes fetal position (draw knees up helps with pain), don’t produce insulin (will be dependent for a while)
Chronic pacreatitiswhat will you teach?
pain. watch what you eat, maybe you need pacreatic enzymes OTC, low fat high carb diets. no Alcohol. bile salts will absorb ADEK could be an issue.
What is cullen’s sign in Chronic Pancreatitis
bruising in abdomen.
What are the symptoms for Chronic Pancreatitis?
abdominal pain, anorexia, rapid and progressive weight loss, nausea, jaundice.
what is whipple procedure?
removal of pancrease and duodenum. removal of all the cancer in pancrease and doudenum.
