GASTROINTESTINAL I Flashcards
BILE
product of liver, emulsifies fat
stomach
food resevoir
small intestine
absorption, digestion
large intestine
A.K.A. the colon..it is wider than sm. intestine, H2O absorption
food goes from mouth to anus using
peristalsis
What effect does aging have on the GI system?
tooth enamel gets harder/brittle, taste sensation decreases, decreased stomach motility, slower fat absorption, decreased rectal wall elasticity, faulty vitamini absorption>gallstones
frequency of stools is the most important data to determine GI function
false…consistency is most reliable
fresh colored blood is usually coming from
lower GI tract
Low CBC levels could indicate
internal bleeding
an occult blood test finds
blood not visible to the naked eye
clay colored feces could result from
barium or bile
TRUE OR FALSE
barium is not the usual medium contrast for GI diagnostics
false, it is
what must happen to barium post-study?
it must be eliminated
PT reports they ate some toast and drank extra pulp orange juice the morning of their colonoscopy, the nurse recognizes this is a problem because
a clear liquid diet should be followed 24 hours pre-op…eating could cause vizualization issues with scope
left side knee up for
endoscopy
A PT has difficulty eating 6 hours post EGD and presents a 101.2 degree fever. The nurse should report this to the HCP but why?
these are signs of perforation post EGD, which is a esophogus/stomach scope
*other S/S: Hypotension, tachycardia, n/v, rapid HR
An expected outcome of EGD could be PT reporting
scratchy, itchy throat
TRUE OR FALSE
A PT with acute kidney issues is contraindicated in ERCP
TRUE
left side position for
colonoscopy
PTs should avoid what colored drinks
orange and red
A PT reports cramping 3 hours post colonoscopy. The nurse should
1. administer a narcotic
2. reassure PT this is normal post-procedure
3. Supply a laxative
2
the LPN should make sure PT avoids ________ prior to basal secretion test
antacids
PT education for valvular disorders (MVP, stenosis etc) should include
1.Be consistent with leafy greens consumption if perscribed warfarin
2. avoiding salt/sodium intake
3. Don’t take NSAIDs and ASAs (ibuprofen, aspirin)
all
A PT on ACE inhibitors should monitor their
BP…it is an afterload reducing med
Liver, gallbladder, pancreas are
Accessory organs of digestion produce or store digestive secretion
Liver
Hepatic portal circulation
Páncreas
•amylase—starch>maltose
•lipase—emulsified fats>fatty acids/monoglycerides
•trypsin—polypeptides to peptides
•bicarbonate juices
S/S of GI Alterations
•abdominal pain
•nausea/vomiting
•diarrhea
•constipation
Abdominal pain (etiology & assessment)
•common
•reasons: obstruction, peritonitis, altered motility, stress, lesions etc
•assess: onset, character, location, severity, interventions etc
Náusea & vomiting & prevention
•náusea—gotta vomit…drooling, weakness, hyper/hypotension, sweats
•vomit—emesis, stimulated by CTZ, rids body of harmful stuff
•hematemesis- bloody vomit, breath may smelly poopy
•prevent aspiration, monitor /correct fluid balances
Diarrhea
•reasons: meds, anxiety, infection, diet, laxative, malnutrition
•assess duration, amount, character, etc, fever present(?)
•maintain skin hygiene, anti-poop meds, fluid balance
Constipation (RAPDISS)
•Reason: meds, need fiber, need fluids, gastric stasis, immobility etc
•assess: bowel patterns, diet, lax use…treat with diet change/meds
•prevention: exercise, high fiber diet, fluids
•S/S—bloated abd., indigestion, rectal pressure, incomplete poop, hard poop, rumbling
•issues: impaction, ulcer, heart rupture from straining, megacolon
•dx: history & physical
•solutions: prevention, exercise, softeners
Physical assessment
•Ht./Wt.
•BMI (18.5-24.9)
•mouth (loose teeth)
•abdomen—look for jaundice etc, listen, feel (girth), tap (Dr.),
Diagnostic Testing
CBC, electrolytes, CEA (cancer), billirubin, liver/pancreatic enzymes
Stool Testing color
•tarry-upper GI bleed
•frank–near rectum
•occult —least invasive blood in poo test
Occult &Parasite Exam
•Occult–3 tests, meat free 72 hours pre exam…bleeding gums, food, meds can cause false +
•ova/parasite–3 tests, finds pathogens/bacteria, no urine allowed, specimen fresh & warm
Fecal fat/Stool Cultures
•fecal fat–24 hr collection, test for malabsorption, crohn’s, pancreas issue
•stool culture—finds pathogens
Barium Swallow
•aka upper GI series …view of esophagus, stomach, duo/jejunum with barium
•NPO 6-8 hrs pre midnight, laxative post test, poop watched for barium, monitor for constipation, drink 12 8 oz water post study
•test takes hours
Barium Enema
•aka low GI series … looks at where/how full/ is colon
•unclear bowels=cancel study
•contraindicated with colon disease/perforation/obstruction
•finds polyps, hernias, motility, tumors, stenosis, colitis, diverticula
•same stool watch as UGI..PT should report bloating /constipation/bleeding
•test takes 15 minutes
Endoscopy (pathophysiology)
•invasive, requires consent, direct visual/ ability to biopsy
•cauterize bleeding, remove polyps
Esophagogastroduodenoscopy
•see esophagus, stomach, duodenum
•finds cancer, bleeding, infection, biopsy/cyto specimens can be taken
•watch V.S., prevent aspiration
•RUQ pain, fever, chills—infection
Proctosigmoidoscopy
•lower GI scope…looks at colon, rectum , anus
•finds ulcers, punctures, hemorrhoids, polyps, can get specimens
•laxative pre, enema post
Colonoscopy (Pathophysiology)
•Can see the Lg intestine
•watch for hemorrhaging, severe pain
•blood in poop normal if stool specimen taken
Gastric analysis
•stomach secretion measurement
•finds duodenal ulcer, gastric carcinoma, pyloric or duodenal obstruction, pernicious anemia
•2 types of GA: Basal cell, gastric acid stimulation
Basal cell secretion test
•NPO post-midnight pre-test
•stomach contents collected 4x/hr
•GI acid tested for amount/acid
•too much hydrochloric acid=maybe peptic ulcer, too little=cancer or pernicious anemia
Gastric acid test
Measures amt of gastric acid for HR after SQ injection of a histamine
A PT with DVT post op is started in IV heparin. Which lab test will the nurse monitor?
- Prothrombin time
- International normalized ratio
- Partial thromboplastin time
3
Percutaneous Liver Biopsy
- identifies cancer, cirrhosis, hepatitis
- small sample from liver extracted by needle
- risk for bleeding
- CBC/ coagulation study pre-biopsy
- NPO 6-8 pre-biopsy
- AVOID COUGHING/STRAINING POST-BIOPSY
NG vs EG, G tube, and J tube
Ng is shorter term, the rest are longer-term use
Why would PT need a GI tube
- remove gas/fluid in stomach
- diagnose GI motility/sample for testing
- relieve/treat obstruction or bleeding
- nutrition, hydration, medication
- promote post-op healing
- remove toxic substances
if you pull back 100 mLs after a feeding, what should you do next
PT isnt getting full feed, STOP THE FEED, call dr
Enteral nutrition
- supplies PT with nutrition
- delivered into jejunum/duodenum
- free water needs can be calculated by a dietician
Gastro decompression
NG tube usually used, suction applied
parenteral nutrition/periphreal para.
- feed goes thru IV
- due to high dextrose lvl, accuchecks should be taken
- imporves nutrition, promotes healing, wt. gain
- PPN-used <10 days
Gastrointestinal Intubation
•tube for therapy/diagnostics
•gas & fluid removal
•diagnoses GI motility & gastric
secretion analysis
•relieves/treats obstructions or bleeding in tract
•provides nutrition, hydration, medication
•remove toxins (lavage)
salem sump
- most common
- vents, prevents excess suction
- do NOT plug off air vent
- used for decompression, lavages
•weighted, flexible feeding tube with stylets
Nasoenteric
- PT repositioned side to side for passage
- used to decompress sm. bowel in Un-operable PTs
nursing management for GI tube PT
- nare care, check mouth (lose teeth), elevate HOB, educated PT pre/post-op
- fluid balance, peristalsis presence
possible complication of GI tube
PERFORATION
What should a PT with GERD avoid?
eating large meals, lying down after eating, caffeine
why are antidepressants given for IBS PTs?
for hypercontractions
Liver needle biopsy summary
Watch for bleeding, limit movement, apply pressure, Pt should avoid coughing
True or false : NG tubes are usually permanent or long term
False, it is short term and temporary
Percutaneous Liver Biopsy
•needle used to get specimen to identify cancer, cirrhosis, hepatitis
•NPO 6-8 hours before test
•risk for bleeding
Endoscopic Retrograde Cholangiopancreatography
•ERCP allows visual of liver, gallbladder, & pancreas
•removes stone/tumor removal, bile duct stent placement can be used
•NPO 8 hrs pre-op
•Monitor for hypotension, tachy, high HR, rapid RUQ pain, n/v—these are perforation/pancreatitis signs
•call Dr
