gastrointestinal Flashcards
pancreatitis patho
autodigestion of the pancreas
function:
endocrine (insulin)
exocrine (digestive enzymes)
two types: acute and chronic
causes: #1 gallbladder disease #2 alcohol
**one system– when one part gets sick it’ll all get sick
pancreatitis s/s
pain (increases with eating)
abdominal distention/ascites (losing protein rich fluids like enzymes and blood in the abdomen)
abdominal mass (swollen pancreas)
rigid, board-like abdomen (bleeding that can lead to peritonitis)
bruising around umbilical area (Cullen’s sign)
bruising in the flank area (Grey-Turner’s sign)
fever (inflammation)
n/v
jaundice
hypotension (bleeding or ascites)
pancreatitis diagnosis
*****serum lipase and amylase (digestive enzymes) high WBC high blood sugar ALT/AST high longer PT & aPTT (risk for bleeding) high serum bilirubin high h&h (dehydration) low h&h (bleeding)
amylase normal levels
30-220
lipase normal levels
0-160
normal AST
0-35
normal ALT
10-36
pancreatitis treatment
control pain
decrease gastric secretions (NPO, NGT to suction)
bedrest
*****want the stomach dry and empty if anything gets in the body will want to make enzymes thats what is causing the pain
pain meds:
PCA narcotics
fentanyl patches
anticholinergics to dry the stomach:
benztropine
diphenoxylate
GI protectants:
pantoprazole
famotidine
antacids
maintain fluid and electrolytes
maintain nutritional status
insulin (pancreas is sick, TNA/TPN)
daily weights
eliminate alcohol
AA if that’s the cause
hemoglobin levels
male: 14-18
female: 12-16
hematocrit levels
male: 42-52
female: 37-37
***** if your liver is sick
- ** worry about bleeding
- ** decrease dose of meds
- ** never give them acetaminophen (antidote is acetylcysteine)
4 major functions of the liver
detoxifying the body
helps the blood clot
liver helps metabolize (break down) drugs
synthesizes albumin
cirrhosis patho
liver cells destroyed and replaced with connective/scar tissue
alters circulation within the liver
BP in liver goes up (portal hypertension)
cirrhosis s/s
firm, nodular liver jaundice abdominal pain (liver stretched) ***not normal to be able to palpate liver chronic dyspepsia (GI upset) change in bowel habits ascites splenomegaly fatigue peripheral edema anemia can progress to hepatic encephalopathy/coma (ammonia build up)
cirrhosis diagnostics
low serum albumin
high ALT/AST
ultrasound
CT/MRI
liver biopsy--confirms diagnosis pre-procedure: clotting studies pre-procedure (PT, INR, aPTT) VS pre-procedure supine w/ R arm behind the head exhale and hold breath to get diaphragm out of the way post procedure: lie on R side VS (worried about hemorrhage)
***if unsure why they’re swelling, ask for albumin levels
cirrhosis treatment
antacids vitamins diuretics no more alcohol i and o weights rest bleeding precautions (no IM injections, no NSAIDs) abdominal girth (ascites) paracentesis: remove fluid from the peritoneal cavity (ascites) have them void positing sitting up VS (shocky clients BP goes down and pulse up)
monitor jaundice (good skin care)
- **avoid narcotics (liver cannot metabolize drugs)
- **diet (low protein, low Na)
hepatic coma patho
protein breaks down into ammonia
liver converts it to urea
urea is excreted through kidneys
when liver is impaired it cannot make the conversion, ammonia builds up in the blood and causes a decrease in LOC
hepatic coma s/s
mental changes motor issues difficult to awaken asterixis (liver flap-hand tremors) handwriting changes reflexes will decrease EEG will be slow fetor (breath smells like ammonia)
hepatic coma treatment
lactulose (decrease serum ammonia)
enemas
decrease protein in diet
monitor serum ammonia
bleed esophageal varices patho
high bp in the liver (portal hypertension) forces collateral circulation to form in the stomach, esophagus, & rectum
no problem until it ruptures
bleeding esophageal varices treatment
replace blood VS monitor CVP O2 Octreotide lowers BP in the liver endoscopic sclerotherapy (banding) esophageal variceal ligation (injects sclerosing agent into the varices)
balloon tamponade:
sengstaken-blakemore tube
used to stabilize severe hemorrhage
dont use more than 12 hours
used to hold pressure on bleeding varices
**if it gets caught, use scissors to cut the tube and pull out)
enemas to get rid of blood
lactulose (decreases ammonia)
saline lavage to get blood out of stomach
peptic ulcer patho
common cause of GI bleeding
can be in esophagus, stomach, or duodenum
erosion is present
peptic ulcer s/s
burning pain in mid-epigastric area/back
heartburn (dyspepsia)
peptic ulcer diagnosis
gastroscopy (EGD): NPO pre procedure sedated NPO until gag reflex returns watch for perforation by watching for pain, bleeding, or if they are having issues swallowing
upper GI: looks at esophagus and stomach with dye NPO past midnight ***no smoking, chewing gum, or mints (smoking increases stomach motility which will affect test and increases stomach secretions which will increase the chance of aspiration) *** remove nicotine patches
peptic ulcer treatment
antacids (liquid to coat stomach) **take when the stomach is empty and at bedtime. when the stomach is empty acid can get on the ulcer so take antacids to protect the ulcer
PPI “prazole”
H2 antagonist (famotidine)
GI cocktail (donnatal, viscous llidocaine, mylanta II)
antibiotics for H. pylori (clarithromycin, amoxicillin, tetracycline, metronidazole)
Sucralfate forms a barrier over the wound so acid can’t get on the ulcer
peptic ulcer teaching
decrease stress stop smoking eat what you can tolerate avoid temp extremes and spicy foods avoid caffeine
two types of peptic ulcers
gastric: malnourished pain half hour to one hour after meals food doesn't help vomiting helps vomits blood
duodenal: appear well nourished night time pain pain 2-3hours after meals food helps blood in stools
histal hernia patho
hole in diaphragm is too large so the stomach moves up into the thoracic cavity
cause: large abdomen (lose weight), congenital abnormalities, trauma, straining
histal hernia s/s
heartburn
fullness after eating
regurgitation
dysphagia (difficulty swallowing)
histal hernia treatment
small frequent meals sit up 1 hour after eating elevate HOB surgery teach lifestyle changes healthy diet
dumping syndrome patho
stomach empties quick after eating
client experiences uncomfortable to severe SE secondary to gastric bypass, gastrectomy, or gallbladder disease
dumping syndrome s.s
fullness weakness palpitations cramping faintness diarrhea
dumping syndrome treatment
semi-recumbent with meals lie down after meals on left side no fluids with meals small frequent meals avoid high carbs and electrolytes 9empty fast)
***recline and dine
- **left side lying = leaves it in
- ** right side lying = releases it
ulcerative colitis and crohns patho
UC: ulcerative inflammatory disease, large intestine
Crohns: inflammation and erosion of the ileum (small intestine) but can be found in large intestine
ulcerative colitis and crohns s/s
diarrhea rectal bleeding vomiting weight loss cramping dehydration blood in stools anemia rebound tenderness (push in, let go, and it hurts) means peritoneal inflammation fever
UC and crohns diagnostics
ct scan
mri
colonoscopy*** clear liquid diet 24 hours prior NPO 6-8hours prior avoid NSAIDs laxatives or enemas until clear polkyethylene glycol (better icy cold) sedated post: watch for perforation ***Assume the worst pain and discomfort
barium enema:
BE or lower GI series
done if colonoscopy is incomplete
UC and crohns treatment
diet:
low residue to limit GI motility to help save fluid
avoid cold foods and smoking
meds:
antibiotics
steroids (decrease inflammation)
biologics and immunodulators (infliximab, adalimumab)
aminosalicylates (decrease inflammation)– sulfasalazine, mesalamine
surgery:
UC
total colectomy, an ileostomy is formed
kock’s ileostomy or an illeal pouch anal anastomosis (no external bag, attaches to the rectum)
crohns:
try not to do surgery
remove only affected area
may end up with an ileostomy (ostomy in ileum) or colostomy (ostomy in colon)
ileostomy post op care
liquid stool all the time
avoid foods hard to digest
Gatorade or electrolyte for summer
risk for kidney stones (dehydrated)
colostomy care
water and nutrients are being absorbed and the stool is forming when waste moves through the colon
ascending and transverse (semi liquid stool)
descending or sigmoid (semi formed or formed)
need irrigation to give them some control regularly
irrigate after a meal same time everyday
anytime you give an enema and they cramp, stop the fluid lower the bad and/or check the temp of the fluid
appendicitis patho
inflammed appendix
***worry about rupture (lay them on their R side if ruptured)
appendicitis s/s
generalized pain and localizes in the lower R quadrant (mcburneys point)
rebound tenderness
n/v
anorexia
appendicitis diagnostics
high WBC
ultrasound
ct
dont give enemas or laxatives (worried about rupture– perforation)
appendicitis treatment
surgery
fowler’s position post op
TPN/TNA nursing considerations
***don't mix anything with it keep refrigerated warm for administration let it sit a few minutes prior to hanging central line needed filter needed nothing else should go through this line daily weights may need to take insulin blood glucose monitoring q 6hours check urine for ketones and glucose mixture adjusted daily r/t electrolytes can only be hung for 24 hours change tubing with each new bag needs to be on a pump emphasize hand washing ****infection is huge complication
assisting to insert a central line
have saline available for fluids (3 10ml)
don’t start fluids until positive confirmation by CXR
trandelenburg to distend veins
if air gets in: left side trandelenburg
***worry about air bubble
when changing to avoid air bubble:
clamp it off
walsalva
take a deep breath and hummmmm
xray done to check for placement and make sure they do not have a pneumothorax
position to take out central line: lie flat and apply pressure
