Gastrointestinal System Flashcards
Nasogastric tube
What
* Tube inserted in the nare that terminates in the stomach
Uses
* Enteral nutrition
* Decompression
* Medication administration
* Removal of stomach contents after an overdose
NG Insertion
1. Perform hand hygiene
2. Explain the procedure to the client
3. Measure from the nose of the client to the earlobe, then to the xiphoid
process. This is how deep you will insert the NG tube.
4. Mark the depth of insertion on the NG tube
5. Lubricate the tip of the tube.
6. Insert the tube to the nasopharynx, and ask the client to swallow and
tuck their chin to their chest.
7. Continue advancing the tube to the predetermined depth.
8. Secure the tube.
9. Verify placement of the NG tu
Placement verification
* Gold standard - x-ray visualization
* Aspiration of gastric contents
* Auscultation of air over the epigastrium
* Residuals
○ The amount of previous feed that remains in the
stomach at the time of your assessment
○ Typically checked as you are preparing to start
the next feed
○ If it is greater than 500 mL, the feed should be
held
Blakemore tube
What
* Tube inserted through the nose down the esophagus and into the stomach with balloons that can be inflated to stop bleeding esophageal varices
* Also called Sengstaken-Blakemore or Minnesota tube
* Puts pressure on bleeding esophageal varices to stop the bleeding
Nursing Must Know
* MUST KEEP A PAIR OF SCISSORS AT THE BEDSIDE IN CASE OF EMERGENCY
* If the gastric balloon becomes displaced it can compress the trachea and cause respiratory arrest. If that happens, cut the gastric balloon port to let the air escape and restore the client’s airway.
Esophageal Varices
What
* Dilated submucosal veins in the esophagus
* Can burst and bleed
* Life-threatening emergency
Causes
* Liver disease
* Alcoholism
Treatment
* Blakemore tube
Surgery
Gastroesophageal reflux disease (GERD)
What
* Acid refluxes from the stomach into the esophagus, causing esophagitis
* Conditions that increase abdominal pressure increase risk for GERD:
○ Vomiting
○ Coughing
○ Lifting
○ bending,
○ obesity
Treatment
* Sit upright after eating
* Small, frequent meals
* H2 blockers
* PPIs
Complication
Barrett’s esophagus
Gastritis
What
* Inflammatory disorder of the gastric mucosa
* Acute gastritis
○ Associated with Helicobacter pylori, nonsteroidal anti-inflammatory drugs (NSAIDs), drugs, chemicals
Clinical manifestations
* Vague abdominal discomfort, epigastric tenderness, and bleeding
Treatment
* Healing usually occurs spontaneously within a few days
* No more NSAIDS!
* H2 receptor blockers
* PPIs
* Antibiotics if due to H. pylori
Gastric ulcer
Cause
* H. Pylori
* Overuse of NSAIDs
Symptoms
* Pain 1-2 hours after meal
* Abdominal pain aggravated by eating
* Vomiting
* Weight loss
* Hematemesis if hemorrhage occurs
Treatment
* Treat H. Pylori infection
○ Antibiotics
* Reduce stomach acid
○ H2-receptor blocker
Proton pump inhibitor
Duodenal ulcer
Cause
* H. Pylori
* Overuse of NSAIDs
Symptoms
* Pain 2-4 hours after meals
* Food may relieve pain
* Weight gain
* Melena if hemorrhage occurs
Treatment
* Treat H. Pylori infection
○ Antibiotics
* Reduce stomach acid
○ H2-receptor blocker
Proton pump inhibitor
Crohn’s Disease
What
* Idiopathic inflammatory disorder
* Inflammation AND erosion of the ileum and
anywhere throughout the small and large intestines
* Affects any part of the digestive tract, from mouth to anus
* Difficult to differentiate from ulcerative colitis
Similar risk factors and causes
Ulcerative Colitis
What
* Inflammation of the large intestines
* Is a chronic inflammatory disease that causes
ulceration of the colonic mucosa
○ Sigmoid colon and rectum
* Is common in those 20 to 40 years of age or of Jewish descent
Suggested causes
* Infectious
* immunologic (anticolon antibodies)
* dietary, genetics
Pathophysiology
Lesions are continuous with no skipped lesions, are limited to the mucosa, and are not transmural
Diverticular Disease
Diverticula
* Herniation of mucosa through the muscle layers of the colon wall
Diverticulosis
* Asymptomatic diverticular disease
Diverticulitis
* Inflammatory stage of diverticulosis
Possible causes
* Decreased dietary fiber
* Abnormal neuromuscular function
* Alterations in intestinal motility
* >60 years of age
Assessment
* Rebound tenderness
* Cramping
* Diarrhea
* Vomiting
* Dehydration
* Weight loss
* Rectal bleeding
* Bloody stools
* Anemia
* Fever
Treatment
* Low fiber diet
* Avoid cold or hot foods
* No smoking
* Antidiarrheals
* Antibiotics
* Steroids
* In severe cases, may end up surgically removing affected portion of the
Intestines
○ Ileostomy
Colostomy
Intestinal obstruction
What
* Any condition that prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the absence of an obstructing lesion
Clinical manifestations
* Small intestine obstruction:
○ Colicky pains caused by intestinal distention, followed by nausea and vomiting
* Large intestine obstruction:
○ Hypogastric pain and abdominal distention
Appendicitis
What
* Inflammation of the appendix
* Most common age = 10 years
* Most common abdominal surgery in children
* Perforation more common in children
Pain
* Begins as dull, steady periumbilical pain
* Over 4-6 hours, pain progresses and localizes to right lower quadrant (RLQ)
* Sudden relief of pain may indicate appendix rupture (which can lead to peritonitis)
Assessment
* Pain RLQ
* Anorexia
* Inc temp & WBCs
* Nausea
* Signs (McBurnes, Psoas)
Treatment
* Appendectomy
* Pre-op
○ No heat - this can aggravate inflamed appendix and cause rupture
○ Position right side, low Fowler’s for comfort
* Post-op
○ IV Fluids
○ IV antibiotics
○ Pain management
○ NPO until return of bowel sounds
○ Wound care
Pancreatitis
What
* Inflammation of the pancreas
* No. 1 cause = alcoholism
Pathophysiology
* Digestive enzymes activate inside of the pancreas
* This causes autodigestion of the pancreas
Assessment
* Pain
○ Increases with eating due to increased enzymes
* Abdominal distention
* Ascites
* Abdominal mass
* Rigid abdomen
* Cullen’s sign: bruises above and below belly button
* Gray Turner’s sign: bruise on side
* Fever
* Nausea & vomiting
* Jaundice
* Hypotension
Labs
* Increased WBCs
* Increase serum lipase
Nursing Interventions
* Pain control (fentanyl, hydromorphone, morphine)
* Antispasmodic drugs to reduce gut motility
* NPO/NGT suction, TPN - pancreatic rest
* Calcium replacement d/t hypocalcemia
* Replace fluids and electrolytes (fluid shift)
* Elevated enzymes (check amylase & lipase)
* Antibiotics with fever
* Steroids - corticosteroids for acute attacks
Cholelithiasis
What
* Gallstones
* Hardened deposits of bile in the gallbladder
○ Can be the size of a grain of rice up to the size of a golf ball
Causes
* Hyperlipidemia
* Hyperbilirubinemia
Assessment
* Sudden, sharp RUQ abdominal pain
* Pain continues to get worse
○ Can radiate to back and between shoulder blades or R shoulder
○ Gets worse at night and or after a fatty meal
* Nausea
* Vomiting
Treatment
* Cholecystectomy
Cholecystitis
What
* Inflammation of the gallbladder
Causes
* Cholelithiasis, infection, blocked bile duct
Clinical manifestations
* Fever, leukocytosis, rebound tenderness, and abdominal muscle guarding
Treatment
* Pain control
* Replacement of fluids and electrolytes
* Fasting
* Antibiotic administration
* Perforated gallbladder: Immediate cholecystectomy
