GASTROINTESTINAL II Flashcards
Lower GI and issues
1
Q
Bulimia nervosa nursing care
A
- therpeutic intervention
- V.S.
- daily wt
- I/O monitoring
- electrolyte balance
- dysrhythmias
2
Q
Bulimia nervosa may cause:
1. teeth erosion and Calcium deficiency
2. Osteoporosis and brain cancer
3. Rectal discomfort and dry skin
A
1.
3
Q
SELECT ALL THAT APPLY
Stomatitis treatment includes which of the following? Select all that apply:
1. Treat with acycolvir
2. avoid brushing with toothpaste
3. avoid oral care altogether
4. avoid stressful situations if possible
A
1.,4.
4
Q
aphthous stomatitis cause ____ in the mouth but HSV-1 stomatitis causes ____ on the facial surface.
A
small, painful ulcers; sores/blisters on the face
apthous stomatits–treated with topical anesthetic, HSV-1–Treat with acyclovir
5
Q
Fundoplication
A
- surgery that prevents sliding
- used for Hiatal hernia/GERD PTs
- risk r/t aspiration if sutures are too tight
*
6
Q
Mallory-Weiss tear
A
- longitudinal mucous membrane tear of espohagus at stomach junction
- causes bright bloody emesis, black/tarry stools
- EGD and H&H used to diagnose
- self-healing, antiemetics/PPI meds, and alcohol avoidance used for intervention
7
Q
Hiatal hernias are present in most PTs with
- Mallory Weiss Tear
- A DVT
- Bulimia nervosa PTs
A
1
8
Q
Peptic Ulcer Disease
A
- GI lining erodes from H. pylori infection
- ulcers found in GI spots exposed to peptic acid/hydrochloric acid
- transmitted from oral-oral/oral-fecal
- gastric– abd. burning, gnawing pain getting worse 1-2 hrs after eating, risk for gastric cancer, malnurition, hematemesis … duodenal–abd. burning, pain 2-4 hrs after eating or at night, anorexia, n/v, bleeding
9
Q
Peptic Ulcer diagnostics and Therapy
A
- tests: urea breath test, immunoglobulin G antibody, biopsy, culture…monitor H&H
- triple H therapy,.2 antibiotics and a PPI/H2 antagonist, 14 day tx, bland diet
- perforated ulcer is a medical emergency
10
Q
Gastric Bariatric Surgery and S/S With Therapy Interventions
A
- for PTs when wt loss isn’t sufficient
- surgery goal is to restrict intake by limiting stomach’s capacity
- vomiting, mineral/protein deficiency, stomach secretions leak, incision site breakdown, gastric tissue erosion
- post-OP PT may have NG, clear liquid/full liquid diet, regular food can resume after 6 weeks
- monitor for distention… suture can pop
11
Q
Gastric bleeding
A
- from ulcer perforation, tumors, gastric surgery
- mild bleed can cause some weakness/sweating
-
serious bleed can cause hypovolemic shock-hypotension, weak/thready pulse, chills, palpitations, sweating, LOC change, fatigue
*
12
Q
Gastric Bleeding diagnostics and therapy
A
- test: endoscopy, low H&H
- therapy: treat shock: NPO, IV fluids, O2 therapy, NG tube, lígate bleeding vessels, meds to limit gastric acids
13
Q
Nursing care after gastric surgery
A
- monitor vitals and respiratory status
- monitor PTs with large incisions for pain
- control pain & monitor I/O
- NG tube care
- early ambulation
- abdominal status
- education
14
Q
Gastric surgery complications
A
- hemorrhage—restlessness, cool skin, increased pulse/respiration, decreased temp/BP, LOC change
- acute gas distensión— enlarged abdomen, epigastric pain, tachy, hypotension, hiccup/gas .. Report to DR
- dumping— dizziness, tachy, fainting, sweating, nausea, abdominal fullness .. monitor for hypoglycemia 2 hrs after eating
- nutritional problems—B12, folic acid deficiency, reduced calcium and vitamin d absorption, food coming in too fast=inadequate absorption
- pernicious anemia—vitamin B12 deficiency from intrinsic factor secretion reduction, lifelong supplements, monitor for anemia, weakness, sore tongue, GI upset, numbness/tingling
- steatorrhea— fat in stools, reduce fat intake
15
Q
Appendicitis
A
- appendix inflammation
- symptoms include fever, elevated WBC, general upper abdominal pain…pain localizes down to McBurney’s point within hrs
- CBC and US used to diagnose
- keep PT NPO, surgery ASAP unless there’s no perforation/peritonitis
- if there’s infection, surgery’s delayed until it’s cleared up via IV fluids & antibiotics
16
Q
Appendicitis complications
A
- perforation (fever, pain)
- abscess (pus, surgery delayed until it’s gone
- peritonitis
17
Q
Peritonitis
A
- peritoneum infection/inflammation
- organ perforations causes its contents to spill into peritoneum cavity
- abdominal pain /tenderness, rebound tenderness, abdominal rigidity, decreased peristalsis, n/v, fever, WBCs high, high HR,
- Xray, CT scan, paracentesis, explorative surgery used to diagnose
- NPO fluid/electrolyte replacement, NG tube, antibiotics, pain control, surgery and PN for severe PTs are used for therapy
- wound dehiscence/evisceration, intestinal obstruction, septicemia and hypovolemia can occur as complications
18
Q
Diverticulosis/Diverticulitis
A
- diverticulum —herniation/outpouch of bowel mucus membrane from increased colon pressure
- diverticulosis—multiple diverticula present with no inflammation
- diverticulitis— diverticulum inflammation/infection
- caused by chronic constipation and decreased fiber intake
19
Q
Diverticulosis/Diverticulitis symptoms, Diagnostics, and therapy
A
- diverticulosis usually asymptomatic; diverticulitis causes both constipation AND diarrhea
- signoidoscopy, colonoscopy used to diagnose
- acute diverticulitis calls for IV antibiotics/fluid, pain control, NG tube, NPO, surgery
- diet should be high fiber (slow increase) for diverticulosis…Nuts or foods with small seeds may need to be avoided
20
Q
PTs post-hernia surgery should avoid
A
Coughing
21
Q
Crohn’s Disease
A
- inflammatory bowel disease anywhere in GI tract
- can cause abdominal cramping unrelieved by pooping, wt. loss, fever, diarrhea, fluid/electrolyte imbalance
- bloodwork for anemia/infection/liver function, stool samples, low albumin from poor protein absorption, endoscopy with biopsy
- no cure but treatment controls inflammation using -“INE”drugs, anti diarrheal (Imodium), biologics (Humira), corticos (prednisone/methylprednisolone)
*
22
Q
Abdominal Hernias
A
- asymptomatic unless there’s bulging
- reducible (can go back in place…only 1 of them all that isnt irreducible), irreducible (can’t go back in place), incarcerated (from edema, GI flow interrupted), strangulated (blood/GI flow interrupted, bowel can die)
- no tx, observe hernia and support it, surgery for strangulated hernias
23
Q
Intestinal Obstruction
A
- partial/complete intestinal blockage
- symptoms include wave-like pain, n/v, bloody mucus from rectum, perstalsis reversal=fecal vomit/abd. distension
- mechanical– in the intestine (adhesions, hernia), nonmechanical– impaired peristalsis (ischemia, infection)
- H&H done for dx, radiography/CT for bowel loops,
- Keep PT NPO, NG tube compression, IV fluid and electrolyte replacement, bowel resection/tumor removal/adhesion release may be needed
24
Q
Lg Bowel Obstruction
A
- PT experiences constipation, lower abd. cramps, fecal vomit
- therapy includes enemas and manual disimpaction, surgery required for some blockages
25
Q
hemorrhoids
A
- enlarged veins in anal tissue
- prevent constipation, avoid straining, increase fluids, sitz bath, stool softeners
- surgeries: rubber band ligation, sclerotherapy, hemorrhoidectomy
26
Q
Anal Fissures/Anorectal Abscess
A
- anal fissure –cracks/ulcers in anal lining, associated with, Crohn’s/constipation, can cause pain during poop & bleeding, surgery of fissure may be needed
- anorectal abscess– pus in rectum, caused by staph/strep/ E. coli, causes fever/redness/ drainage, surgical incision for draining..dress or pack wound, sitz bath, keep area clean and dry
27
Q
Lower Gastric Bleed
A
- from diverticulitis, hemrrhoids, polyps etc
- symptoms include melena, hematochezia, nausea, sweating, hypotension from blood loss
- test PTs H&H, BUN may elevate from protein breakdown, ednoscopy, digital exam
- monitor stools and V.S. for hypovolemic shock signs
28
Q
Colorectal Cancer
A
- can occur anywhere in Lg Intetsine..starts in colon or rectum lining
- S/S vary based on location/tumor type…bowel habit chanages, bloody/mucousy stools, abd./rectal pain, wt. loss, anemia, obstruction
- screening highly suggested after 50.Y.O. ..colon/sigmoidoscopy w. biopsy, barium enema, CEA,
- complications include bleeding, obstruction, perforation, anastomosis leak, can spread to lymph system and liver
- therapy includes excising small, localized tumors, stent placement to keep colon open for function, radiation, chemotherapy
29
Q
Meds for Crohns
A
- Aminos–INE meds..azulfindine, asacol, olasAlazine
- diarrhea—IDE..Imodium, laxes
- biologics—MAD/MAB…adalimumad, inflixmab
- corticos—ONE meds…deltasone
