Gastrointestinal Flashcards
Describe the dietary changes expected of patients with liver cirrhosis.
Abstain from alcohol
High calorie diet, high carb, low fat
Do not restrict protein
Describe the medications to avoid when a person has liver cirrhosis.
Avoid hepatotoxic medications (Tylenol, Statins)
Avoid Aspirin and NSAIDs when portal HTN or varices are present (due to bleeding risk)
What activities should a patient with liver cirrhosis avoid?
Activities that increase intraabdominal pressure (straining, coughing, sneezing, vomiting, heavy lifting, tight clothing)
When should a patient with liver cirrhosis seek medication attention?
Presence of blood when vomiting
Bloody or black, tarry stools
Altered mental status (encephalopathy)
progressive, degenerative disease caused by destruction and subsequent disordered regeneration of the liver parenchyma
Liver cirrhosis
What is the typical protein intake recommended for patients with liver cirrhosis?
1.2-1.5g/kg
What two major issues are associated with hypomagnesia?
Ventricular arrhythmias - torsades the pointes
Neuromuscular excitability - similar to hypocalcemia (tremors, hyperactive reflex, positive Troussea and Chvostek, seizures)
What two complications are associated with hypercalcemia?
Constipation and polyuria (due to diuretic effect)
What type of history would be expected of a patient with hypomagnesia?
Alcohol abuse
inadequate nutritional intake
underlying GI or nephro issues
What is the action of misprostol?
Synthetic prostaglandin that protects against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration
Misoprostol is often prescribed in patients to prevent gastric ulcers in clients receiving long-term _______ therapy
NSAID
What medication type can often increase adverse effects of misoprostol?
What should be done in these instances?
Antacids can increase the adverse effects - e.g. diarrhea and dehydration
if antacids are required, clients should receive those that do not contain magnesium (e.g. Tums)
What are instructions for the use of misoprostol?
Take with food to reduce side effects (abdo pain, cramping, diarrhea)
The drug is pregnancy category X - must discontinue if suspected pregnancy (med used for labour induction)
What is the indication for the use of sodium polystyrene sulfonate?
(Kayexelate) Administered to clients with hyperkalemia
What is the MOA of sodium polystyrene sulfonate?
Kayexelate resin replaces sodium ions for potassium ions in the large intestine and promotes evacuation of potassium-rich stool, thereby lowering serum potassium
What is a major side effect of sodium polystyrene sulfonate?
Intestinal necrosis
What is the purpose of the administration of neomycin enema?
Reduces the number of bacteria in the intestine in preparation for colon surgery
The client with liver cirrhosis is at risk for developing this neurological condition.
hepatic encephalopathy
What conditions/factors can predispose an individual with cirrhosis to hepatic encephalopathy?
Hypokalemia, high protein intake, GI bleeding, constipation, hypovolemia, infection
Low albumin is often expected in liver failure, but what is the purpose of albumin transfusions in this popuation?
Albumin is infused to promote good diuresis when used in combination with furosemide
What are common lab abnormalities in liver failure?
low albumin, elevated INR and elevated AST/ALT
In the case of acute blood loss, what position is preferred?
Trendelemburg to promote blood perfusion to the brain and other vital organs
What is the best indicator that a client is responding to medical nutritional therapy?
weight gain
Why is serum albumin a poor indicator of acute change in nutritional status?
Albumin has a long half life; pre-albumin is preferred as it has a half-life of only 2 days and is quicker and more reliable
Why does pruritis develop in patients with liver disease?
What are they at risk for in this case?
Pruritis develops due to buildup of bile salts beneath the skin, placing them at risk for skin breakdown due to secondary edema
What is some teaching done to reduce the incidence of skin breakdown secondary to bile salt accumulation in liver disease?
Cut nails short wear cotton gloves and long-sleeved shirts baking soda baths calamine lotion cool, wet cloths bathe in tepid water (NOT HOT)
What medication is often prescribed to help with pruritis from liver disease?
What are important considerations for administration?
Cholestyramine (Questran)
- mixed with food (applesauce or applejuice) and given 1 hour AFTER all other medications
- increases bile salt excretion in feces
Describe the important considerations for Bolus enteral feeding for the following:
- Positioning
- Flushes
- GRV
- Symptoms of feeding intolerance
- pH
Elevate HOB to 30-40 degrees (semi-Fowler) and keep elevated for 30-60 minutes after (decrease aspiration risk)
Flush feeding tube before and after to keep tube patent
GRV is checked before - may be held if GRV >500mL
- (often not done anymore)
Intolerance - abdominal distension, nausea or vomiting
pH - <5 if gastric, a pH of 6+ requires X-ray confirmation of tube placement
Describe the dash diet for the following:
- Fat
- typical food types recommended
- Protein
- Carbs
- Fat-free or low-fat dairy
- fresh fruits and veggies, whole grains
- meats low in cholesterol (poultry and fish) and alternate protein sources (legumes)
- limit simple carbs and high sodium foods
What is the main concern following bariatric surgery?
What macronutrients are limited following surgery?
Dumping syndrome
Simple carbs limited
Balloon tamponade tube used to temporarily control bleeding from esophageal varices.
Sengstaken-Blakemore tube
What is the big risk with Senstaken-Blakemore tubes?
Airway obstruction
What precautions are taken with a Senstaken-Blakemore tube?
Scissors are kept at the bedside as a precaution in the event of airway obstruction
the nurse can emergently cut the tube for rapid balloon deflation and tube removal
What is the highest priority intervention for an actively vomiting client with cholelithiasis?
Maintenance of strict NPO status to prevent additional gallbladder stimulation
What treatments can be completed for an actively vomiting client with cholelithiasis?
Maintain strict NPO status - priority Promethazine suppository (promotes relief of nausea and vomiting and minimizes further fluid loss) Maintenance of fluid balance Insertion of an NG tube to low suction (provides gastric decompression, alleviates nausea and vomiting, and promotes bowel rest)
What are the appropriate ranges for LDL, total cholesterol and TGs?
LDL < 2.6
Total cholesterol < 5.2
TGs < 1.7
What is the normal range for ALT?
10-40 U/L
Vegans are at risk for which nutritional deficiency, and thus which condition?
Risk for B12 deficiency and thus megaloblastic anemia and neurological symptoms
Chronic B12 deficiency may lead to which neurological deficiencies?
Peripheral neuropathy (tingling and numbness) Neuromuscular impairment (gait issues, poor balance) Memory loss/dementia (in cases of severe/prolonged deficiencies)
What are examples of B12 fortified foods?
Cereals, grain products, soy and nut milks, meat substitutes
What is the mnemonic for the foods that Celiac disease patients must avoid?
BROW
- Barley, Rye, Oats, wheat
How rapid will symptomatic relief of GI symptoms occur after patients with Celiac remove gluten from their diets?
Dramatic relief within a few days of eliminating gluten
For a patient with an ascending colostomy, provide teaching for the following topics:
- Fluids
- Foods
- When to empty
- Irrigation
Fluids - 3L/day (unless contraindicated)
Food - eliminate foods that produce gas and odour (broccoli, cauliflower, dried beans, brussel sprouts)
Irrigation - stool produced in the ascending (And transverse) colon are semiliquid which eliminates the need for irrigation
Describe the imbalances (metabolic, blood panel, immune) that occur with liver cirrhosis.
Low serum albumin High serum ammonia Elevated INR/prolonged PT Increased bilirubin level Low platelets
Describe how low platelets affects a patient with cirrhosis.
Fluid overload (edema, ascites, weight gain)
Describe how high serum ammonia affects a patient with cirrhosis.
Hepatic encephalopathy (confusion, lethargy, asterixis, coma)
What is asterixis?
Tremor of hand when wrist is extended
Describe how elevated INR/prolonged PT, low platelets and increased bilirubin levels affects a patient with cirrhosis.
Elevated INR/prolonged PT + low platelets - petechia, bruising, bleeding
Increased bilirubin - jaundice, scleral ictus (scleral jaundice), itching
What is the mainstay of treatment for hepatic encephalopathy?
Lactulose to excrete ammonia in feces
What is the desired amount of BMs for a patient suffering from hepatic encephalopathy using lactulose?
2-3 soft BMs each day
What electrolytes are off balance for receding syndrome?
PPM - phosphorus, potassium, magnésium
What does octreatide do?
Reduces hepatic portal HTN (used for gastroesophageal varices
