Gastrointestinal Flashcards

1
Q

What is the function of the pancreas?

A

Endocrine produces insulin

exocrine produces digestive enzymes

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2
Q

Two types of causes of pancreatitis?

A

1 is the gallbladder

2 cause is alcohol

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3
Q

s/s of pancreatitis

A
pain
abd distention/ascites
abd mass - swollen pancreas
rigid guarding
brusing around umbilical area - cullen sign
fever
inflammation 
n/v
jaundice
hypotention
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4
Q

Diagnosis for pancreatitis

A
Serum lipase and amylase 
WBC up
Bs up
alt/ast up
pt att longer
serum bilirubin up
hemoglobin up / down depending if they are bleeding or dehydrated
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5
Q

Values for amylase

A

30-220

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6
Q

Txt for pancreatitis

A
*control pain
decrease gastric secretions by NPO, NG, Bed rest
Pain meds 
Anticholingeric why
benzotropine
gi protectants 
pantopraazole
ranitidine
antacids
maintain f/e 
diet
insulin why?
daily weights
eliminate alcohol
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7
Q

Liver functions

A

The liver detoxifies the body and helps with clotting, metabolizing drus, and synethesize albumin

SO your concern would be bleeding

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8
Q

Patho for Liver Cirrhosis

A

Liver cells are destroyed and replaced with scar tissue, which alters circulation making bp go up called portal HTN

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9
Q

S/s of Cirrhosis

A
Firm Nodular 
Abd pain 
Chronic dyspepsia
change in bowel
ascites
splenomeagly
decreased albumin
up ast/alt
anemia
can become hepatic encephalopathy

*never given tylenol with liver problems
antidote is mucomysst

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10
Q

Diagnosis of Cirrhosis

A
Ultrasound
Ct/ MRI
Biopsy of liver preprocedure - PT.INR/ aPTT 
VS
Supine with arm up and hold breath why?
Post Procedure 
Side lying why?
VS why? - hemorrhage
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11
Q

Txt of Cirrhosis

A
Antacids/vit/diuretics
no alcohol
i/o daily weights cause of ? 
Rest
Prevent bleeding 
Measure abdominal girth
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12
Q

Paracentisis for cirrhosis and

what diet?

A

Removes fluid from periotonial cavity
client should void, make the sit up, vs to ensure no shock. have a good skin care cause jaundice makes them itch, avoid narcotics. * Diet must be low in protein and low in sodium

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13
Q

Hepatic COMA

A

Protein broken down is amonia and liver converts it to urea and excreted through the kidney when liver is impaired this cant happen and amonia builds up, decreasing LOC.

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14
Q

S/s of Hepatic Coma

A
mental/motor changes
diffiult to wake
asterixis 
handwriting changes
eeg slow
fetor
things that will aggravate amonia 
and watch for potential to have GI bleed
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15
Q

Txt for hepatic coma and the diet they would be on

A

lactulose
enema
decrease protein
and monitor serum amonia

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16
Q

Bleeding Esophageal varicies

A

Portal HTN, occurs in stomach, esophagus and rectum
Alcoholic clients w/ GI usually has varicies
Only noteable when it bursts aka person is vomitting bright red

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17
Q

Txt for Varicies

A
Replace blood 
monitor vs 
cvp
oxygen because anemic
give octreotide which lowers bp
endoscopic sclerotherapy
esophageal ligation
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18
Q

What is a temporary fix for varicies?

A

Balloon tamponade that can only be utilized for 12 hrs because itll hold pressure in the bleeding varicies

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19
Q

What is peptic ulcers?

A

common cause of gi

erosion present occuring in the esophagus, stomach, duodenum

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20
Q

S/s of peptic ulcer

A

burning pain - epigastric

heart burn

21
Q

Diagnosis for peptic

A

gastroscopy- need to be npo, sedated

must wait till gag reflex returns and watching for pain/bleeding, trouble swallowing means - PERFORATION

22
Q

Diagnosis Upper GI

A

visual exam with a dye of the esophagus and stomach, NPO at midnight no smoking eating etc as it increases motility smoking also increases stomach secretions risking aspiration

23
Q

Meds for peptic ulcer

A
Antacids liquid why
proton pump -prazole
h2 antagonis - dine
GI cocktail
antibiotics 
Sucralfate - barrier over wound
24
Q

Client teaching for peptic ulcer

A

decrease stress

stop smoking and no irritants like spicy and caffiene

25
What is gastric ulcer
Happens to malnourished pain felt after half to 1 hr and vomitts blood
26
What is duodenal ulcers
Well nourshied pain at night 2-3 hrs after meal and food makes it feel better
27
What is hiatal hernia
A hole in diaphragm causing stomach to move into thoracic cavity. abdomen appears large - overweight.
28
s/s of hiatal hernia
heartburn fullness regurgitation dysphagia
29
Txt for hiatal hernia
Small freq meals, sit up 1hr with HOB surgery and teach healthy diet
30
what is dumping syndrome
emptying too quickly after eating and can be uncomfortable caused by gastric bypass , gasrectomy gall baldder disease
31
s/s dumping syndrome
``` fullness weakness palpitations cramping faintness diarrhea ```
32
Txt dumping syndrome
Semi-recumbent lie down with meals on left side no fluids with meals avoid food high in carbs and watch for electrolytes
33
Ulcerative Colitis
IBD in large intestine | Crohns, inflammation in ileum
34
S/s of ulcerative colitis
``` diarrhea rectal bleeding dehydration blood instool vomitting weight loss anemia rebound tenderness - peritoneal inflammation fever cramping ```
35
Diagnosis of Ulcerative Colitis
ct/mri ``` colonoscopy clear liquid diet 12-24 hrs NPO 6-8 hrs before avoid NSAIDS laxatives until clear polyethylene prep drinks icy cold no straw sedated for procedure watch for perforation such as pain or unusual abd discomfort. ``` -- barium enema
36
diet for ulcerative
low residue and avoid cold foods and smoking
37
meds for ulcerative
abx steriods biologics and immunomodulators aminosalicylates
38
surgery for ulcerative
total colectomy or kock illostomy no external pouch and empty intestines through nipple pouch IPAA removes colon and attaches to illeum and to the rectum
39
Crohns ( try not to do surgery)
remove only affected areas may end up with -ostomy ileostomy or colostomy
40
Post op care for illeostomy
drains liquid all the time no irrigation avoid foods hard to digest gatorade may be provided for electrolytes and they are at risk for kidney stones why?
41
Colostomy care
nutrients are absorbed as stool and forms. colostomy as and trans - sem liquid colos - des and sigmoid - semi formed or formed you irrigating the descending and signoid why irrigate for regularity
42
When is the best time to irrigate
same time after a meal | same principle as enema if cramp occurs stop fluid and lower bag check temp
43
Appendicitis
``` Inflammation of appendix worry about rupture generalized pain RLQ Rebound tenderness N/V starts with abd pain , na/vom anorexia ```
44
Diagnosis for appendicitis
WBC up ultrasound CT no enema
45
Pre and Post op for appendicitis
pre surg sit up on right side done by laparaoscope after surgery elevate hob
46
TPN Nursing Considerations
``` Refridgerate and warm for admin Central line, filter needed discontinue gradually hypo daily weights / start taking insulin and monitor q6hr check urine for glucose and ketones hung for 24hrs change tubing and new bag each day IV bag dark needs a pump watch for infection ```
47
Assisting primary healthcare provider with central line
Flush with saline Do not start fluids till confirmed CXR - ensures placement and prevent pnuemothorax Position trendelenburg for distended veins, if air goes put client on left side trendelenburg
48
How to avoid air getting in the line?
Clamp it | Valsalva