Gastrointestinal System Flashcards
Endoscopy procedures
+ Colonoscopy, EGD, Sigmoidoscopy
COLONOSCOPY: Allows visualization of anus, rectum, sigmoid, descending, transverse, and ascending colon. Done under moderate sedation.
+ Bowel prep: polyethylene glycol, clear liquid diet, NPO after midnight.
EGD: Allows visualization of esophagus, stomach, and duodenum. Done under moderate sedation
+ Prep: NPO 6-8 hour before procedure.
SIGMOIDOSCOPY: Allows visualization of anus, rectum, and sigmoid colon. No anesthesia required.
+ Bowel prep: polyethylene glycol, clear liquid diet, NPO after midnight
Total Parenteral Nutrition (TPN)
+ Indications
+ Administration
+ Nursing Care
INDICATIONS: Malabsorption, hypermetabolic rate, chronic malnutrition, prolonged NPO.
ADMINISTRATION: Through central line (ex: PICC line)
NURSING CARE:
+ Gradually increase/decrease flow rate
+ Change tubing and bag every 24 hours
+ Use micron filter on tubing
+ Monitor I&Os, daily weights, electrolyte levels, blood glucose (every 4-6 hours for first 24 hours)
+ IF THE NEXT TPN BAG IS UNAVAILABLE, ADMINISTER 10% DEXTROSE IN WATER UNTIL IT ARRIVES
+ Do not use TPN line for other fluids or meds!
+ Monitor. central line insertion site for S&S of infection (erythema, pain, exudate)
Paracentesis:
+ What is it?
+ Indications
+ Nursing Care
PARACENTESIS: Insertion of needle through abdominal wall to remove fluid from peritoneal cavity.
INDICATIONS: Ascites (usually r/t cirrhosis) with respiratory distress.
NURSING CARE:
+ Have patient sign consent form, void before procedure.
+ Take VS, weight, abdominal girth circumference before and after procedure.
+ Monitor for hypovolemia (peritoneal fluid removed is high in protein, causing a fluid shift). Administer albumin as prescribed.
Nasogastric (NG) tubes
+ Indications
+ Nursing Care
NG TUBE INDICATIONS: Intestinal obstruction (symptoms: vomiting, abnormal bowel sounds, abdominal pain and distention).
NURSING CARE:
+ Assess bowel sounds, abdominal girth.
+ Monitor NG tube for displacement.
+ Assess nasal mucosa for breakdown, Provide oral care.
+ Monitor I&Os, electrolytes.
+ Encourage ambulation to increase peristalsis.
Gastroesophageal Reflux Disease (GERD):
+ What is it?
+ Risk factors
+ Symptoms
GERD: Gastric contents (including enzymes) back flow into esophagus causing pain and mucosal damage (esophagitis, Barrett’s epithelium).
RISK FACTORS: Obesity, smoking, alcohol use, older Age, pregnancy, ascites, hiatal hernia, supine position diet high in fatty/fried/spicy foods, caffeine, citrus fruits.
SYMPTOMS: \+ Dyspepsia (indigestion) \+ Throat irritation, bitter taste \+ Burning pain in esophagus. pain worsens when laying down, improves with sitting upright, \+ Chronic cough
Gastroesophageal Refulx Disease (GERD):
+ Medications
+ Surgery
+ Patient Education
MEDS:
+ antacids (take 1-3 hour after eating, 1 hour before/after meds).
+ H2 receptor antagonists (ex: ranitidine).
+ Proton Pump Inhibitors (ex: pantoprazole).
+ Prokinetics (ex: metoclopramide: accelerates gastric emptying, watch for symptoms of EPS).
SURGERY: Fundoplication (fungus of stomach is wrapped around esophagus).
PATIENT EDUCATION: \+ Avoid fatty/fried/spicy foods \+ Eat smaller meals \+ Remain upright after meals \+ Avoid tight-fitting clothing \+ Lose weight \+ Elevate HOB 6-8" with blocks \+ Sleep on right side
Peptic Ulcer Disease (PUD):
+ What is it?
+ Risk factors, S/S, Differences between gastric and duodenal ulcers
+ Diagnosis of PUD
PEPTIC ULCER DISEASE: Erosion in the stomach, esophagus or duodenum mucosa.
RISK FACTORS: H. PYLORI INFECTION, NSAID use, stress.
S/S: N/V, heartburn, bloating, bloody emesis or stools, pain:
+ GASTRIC ULCER: PAIN 30-60 MINUTES AFTER MEAL, WORSE IN DAY, WORSE WITH EATING.
+ DUODENAL ULCER: PAIN 1.5-3 HOUR AFTER A MEAL, WORSE IN NIGHT, BETTER W/EATING OR ANTACIDS.
DIAGNOSIS: Esophagogastroduodenoscopy (EGD)
Peptic Ulcer Disease:
+ Meds
+ Patient teaching
+ Complications
MEDS:
+ MULTIPLE antibiotics to prevent resistance (metronidazole, amoxicillin, clarithromycin, tetracycline).
+ H2 receptor antognist (ex: ranitidine)
+ PPI (ex: pantoprazole)
+ Antacids (take 1-3 hours after meals, 1 hour apart from other meds
+ Mucosal protectant (ex: sucralfate, given 1 hr before meals and at bedtime).
PATIENT TEACHING: Avoid acid-producing foods (milk, caffeine, spicy foods), avoid NSAIDS.
COMPLICATIONS: Perforation (resulting in hemorrhaging): Symptoms include severe epigastric pain, RIGID/BOARD-LIKE ABDOMEN, rebound tenderness, hypotension, tachycardia.
Irritable Bowel Syndrome (IBS)
+ What is it?
+ Patient teaching
+ Medications
IBS: An intestinal disorder causing abdominal pain, gas, diarrhea, and constipation.
PATIENT TEACHING: Avoid dairy, eggs, wheat products, alcohol, caffeine. Increase fiber intake (30-40 g/day) and fluid intake (2-3 L/day). Keep diary of food intake and bowel patterns.
Inflammatory Bowel Disease
+ Ulcerative Colitis
+ Crohn’s Disease
+ Diverticulitis
ULCERATIVE COLITIS: Inflammation of the colon, causing CONTINUOUS LESIONS.
+ SYMPTOMS: LLQ pain, fever, 15-20 LIQUID STOOLS/DAY, abdominal distention and pain, mucus/blood/pus in stools.
CROHN’S DISEASE: Inflammation and ulceration of the small intestine, causing SPORADIC LESIONS. Risk of fistulas.
+ SYMPTOMS: RLQ pain, fever, 5 LOOSE STOOLS/DAY, mucus/pus in stools, abdominal distention and pain, steatorrhea.
DIVERTICULITIS: Inflammation of diverticula (small pouches in the colon). Can perforate and cause peritonitis.
+ SYMPTOMS: LLQ pain, n/v, fever, chills.
Ulcerative Colitis and Crohn’s disease:
+ Labs, Risk factors, Meds, Nursing Care
LABS: Decreased Hct/Hbg and albumin. Increased ESR, CRP, WBC.
RISK FACTORS: Genetics, Caucasions, Jewish descent, stress, autoimmune disorders.
MEDS: 5-aminosalicylic acid (ex: sulfasalazine), corticosteroids (ex: prednisone), immunosuppressants (ex: cyclosporine), antidiarrheals (ex: loperamide).
NURSING CARE:
+ Monitor for signs of peritonitis (symptoms: n/v, rigid/board-like abdomen, rebound tenderness, fever, tachycardia).
+ Monitor I&Os, electrolytes (risk of hypokalemia).
+ Diet: NPO during exacerbations. Ongoing, eat foods high in protein and calories, low in fiber. Avoid caffeine, alcohol. Eat small frequent meals.
Diverticulitis:
+ Labs, Meds, Nursing Care
LABS: Decreased Hct/Hg, increased WBC
MEDS: Antibiotics (ex: Metronidazole), analgesics
NURING CARE:
+ DIET: NPO or clear liquid diet during exacerbations, then progress to low-fiber diet. Ongoing, eat high-fiber diet. Avoid seeds, nuts, popcorn.
+ Monitor for signs of peritonitis (symptoms: n/v rigid/board-like abdomen, rebound tenderness, fever, tachycardia.
Cholecystitis:
+ What is it?
+ Risk factors, Symptoms, Labs, Interventions
CHOLECYSTITIS: Inflammation of gallbladder. It is usually caused by cholelithiasis (i.e. gallstones). These gallstones block the cystic or common bile ducts and cause bile to back up into the gallbladder.
RISK FACTORS: Female, HIGH-FAT DIET, obesity, genetics, older age.
SYMPTOMS: RUQ pain (possible radiation to right shoulder), pain and n/v with ingestion of high-fat food, jaundice, clay-colored stools, steatorrhea, dark urine, pruritis, dyspepsia, gas.
LABS: Increased WBC, bilirubin (if bile duct blocked), amylase and lipase (if pancreases is involved), AST, and ALP (if common bile duct blocked).
INTERVENTIONS: Lithotripsy (to beak up gallstones), cholecystectomy (removal of gallbladder)
Cholecystectomy: \+ What is it? \+ Nursing care \+ Patient teaching \+ Complications
CHOLECYSTECTOMY: Removal of gallbladder. If done via laparoscopic approach, shoulder pain is EXPECTED (encourage ambulation to reduce free air pain). If done via open approach, T-tube may be placed in bile duct. Nursing care of T-tube:
+ Record drainage. >400ml expected in first 24 hours, then will gradually decrease. Drainage > 1000ml/day needs to be reported.
+ Empty drainage bag every 8 hours.
+ Clamp tube for 1-2 hours to assess for tolerance to eating prior to removal.
+ After removal, stools should return to brown color in about 1 week.
PATIENT TEACHING: Low fat diet, avoid gas-causing foods, loose weight.,
COMPLICATIONS: Pancreatitis, peritonitis r/t rupture of gallbladder.
Pancreatitis:
+ What is it?
+ Risk factors, S/S, Labs
PANCREATITIS: Autodigestion of the pancreas by pancreatic digestive enzymes that are prematurely activated before reaching the intestines.
RISK FACTORS: Bile tract disease, alcohol abuse, GI surgery, trauma, medication toxicity.
S/S: Sever LUQ or epigastric pain (radiating to the back or left shoulder), n/v, TURNER’S SIGN (ecchymosis on flanks), CULLEN’S SIGN (blue/grey discoloration around umbilicus), jaundice, ascites, tetany.
LABS: INCREASED AMYLASE, LIPASE, WBC, BILIRUBIN, GLUCOSE. DECREASED CALCIUM MAGNESIUM, PLATELETS.
