Gastrointestinal Flashcards
Complete an abdominal assessment with a focus on inspection and palpation.
- Inspection: stand on patient’s right side and look down over abdomen, observe contour, umbilicus, skin, any visible pulsations, hair distribution and demeanor. Shine a light across the abdomen to observe symmetry.
- Palpation: use 4 fingers close together and depress skin about 1 cm. Make a gentle rotary motion. Lift fingers between locations on the abdomen. Start in right lower quadrant and move into all 4 quadrants. Indicate that abdomen is soft, non-tender, no masses, guarding or rigidity.
State 5 teaching points to provide a patient recovering from Hepatitis.
Rest! Watch for bleeding, high calorie, high protein, high carb, low fat diet. Frequent meals, avoid alcohol and drugs, Avoid NSAIDS, hand hygiene, hepatitis vaccines, supportive therapy (antiemetics)
Complete an abdominal assessment with a focus on palpation for a patient with cirrhosis.
Using appropriate technique (knees bent, in supine/semi-fowlers) start in lower right quadrant, palpate in all 4 quadrants. Indicate that abdominal is often distended on palpation. Pain often noted in right upper quadrant of abdomen. May be able to palpate stool if patient is constipated.
Describe the similarities between cholelithiasis and cholecystitis.
Both have a risk factor of female gender, both cause radiating abdominal pain, both may require a surgical intervention to correct, obesity plays a role in both disease processes, both are more profound in elderly populations, both can result in immobility.
State 5 interventions in nursing management of cholecystitis and cholelithiasis.
Control infection, maintain fluid and electrolyte balance, NPO pre-operative, treat nausea and vomiting, low fat diet, antispasmodics, avoid heavy dairy intact, fried foods, pastries. Prepare for surgery, monitor for complications such as: pancreatitis, fistulas, rupture of gall bladder, peritonitis, etc.
Describe the post-icteric phase of Hepatitis.
Jaundice starts to disappear. This can last from weeks to months. Continues to suffer from malaise and severe fatigue. Enlarged liver lasts for several months.
What is ascites? What nursing assessments specifically assess for ascites?
Ascites happens with increased pressure in the portal system. Proteins and fluid move out of blood and into interstitial spaces. Fluid not drained by lymph system and fluid leaks into peritoneum.
Assessments: Shifting dullness and fluid wave test.
Explain the etiology of jaundice.
A yellowish discoloration of body tissues, related to abnormal metabolism/removal of bilirubin. It is a symptom, rather than a disease process. Usually first observed in the sclera and skin.
State how cirrhosis is diagnosed.
Blood work (elevated liver enzymes- ALP, ALT,), increased bilirubin, history and physical, coagulation factors, serum ammonia levels, renal panel- decreased protein, albumin, abdominal ultrasound and liver biopsy.
List 4 causes of cirrhosis of the liver.
Alcohol use (# 1 cause), obesity, genetics, autoimmune diseases, medications, drugs, toxins, infections, malnutrition.
Describe characteristics of cirrhosis of the liver.
Chronic, progressive disease. Diffuse fibrosis of the liver and formation of nodules. Leads to disorganized cell regeneration, abnormal blood vessels and bile tracts.
State 4 risk factors associated with Hepatitis C.
Recent incarceration, male gender, age (25-34), First nations nationality, IV drug use, overcrowded housing, low education level, low income.
State 4 clinical manifestations of cirrhosis.
RLQ pain, anorexia, constipation/diarrhea, weight loss, flatulence, splenomegaly, ascites, peripheral edema, lesions, pruritis, jaundice, tachycardia, vasodilation, electrolyte imbalance, water retention, coagulopathies.
State 4 priority nursing diagnoses for a patient with acute pancreatitis.
R/F pain, sepsis, shock, infection, bleeding, fluid imbalance, altered GI functioning, knowledge deficit.
Explain 5 clinical manifestations associated with acute pancreatitis.
Hypotension, jaundice, abdominal distention, crackles in lungs, cyanosis or greenish to yellow discoloration, internal bleeding, sudden pain, LUQ pain, febrile, pain worse when eating, tachycardia, absent bowel sounds, guarding on palpation.
What health teaching is needed upon discharge?
Rest periods Frequent small meals Use of antiemetics Proper hygiene (mouth care, hands) Avoid carbonated drinks, ginger, hot beverages and very cold beverages Prevention of transmission Monitor for signs of bleeding Monitor for signs of worsening liver function Avoid NSAIDS, Aspirin Medications and side effects
interventions to decrease the incidence of any form of Hepatitis
Teach proper hand hygiene
Teach proper sanitation and appropriate removal of waste
Encourage vaccinations and benefits associated
Private room in hospital for hepatitis with incontinence of stool or poor personal hygiene
Early screening for high risk patients
No sharing of razor blades, toothbrushes, etc.
Use of protection during sexual contact
Continuous follow up after exposure
Medication compliance
Use of disposable needles
subjective data
weight loss, personal habits, history, medications, exposure, recent incarcerations, recent travel, family history, drug use
objective data
Skin: color, rashes, jaundice, icteric sclera; Abdn: abdominal tenderness, stool characteristics, nausea and vomiting; Neuro: Orientation, fatigue, lethargy, malaise; Vital signs: Q4H
What are the risk factors/causes associated with cirrhosis of the liver?
Chronic hepatitis B and/or C, excessive alcohol intake, fatty liver disease,
autoimmune disease, inherited liver diseases, obesity.
. List the clinical manifestations associated with cirrhosis of the liver. Which
blood work findings are indicative of cirrhosis?
Clinical Manifestations: Ascites, jaundice, spider angiomas, purpura, bilirubinuria,
peripheral edema
Blood work: Elevated ALT, elevated AST, elevated bilirubin, decreased albumin,
increased PT/aPTT, elevated INR, decreased platelets.
