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Med surg 2 > GI > Flashcards

GI Flashcards

1
Q 
stoma colors 
rose to brick pink 
pale
blanching, dark red to purple
small blood
A

Rose- viable stoma mucosa
maybe anemia
inadequate blood supply
when touched is normal from high vascularity

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2
Q 
post op wound care stoma
2 risks 
when will the edema resolve 
gas and time 
ileostomy drainage and one thing about it 
one thing to watch 
who is most at risk for developing obstruction 
stools
teach 1 about anal 
teach about pain
A

fistula, delayed wound healing
6 weeks
2 weeks will go away
1500-1800ml/24 if small bowel is shortened may be more can decrease to 500ml a day
electrolytes na and k
corhns in 30 days
first0 4-6 then will lessen in 3-6 month
if manipulated- mucus-do kegals 4 weeks after
phantom pain

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3
Q

when do you empty a ostomy bag

A

1/3 full

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4
Q

how long does a drainable pouch last?

A

4-7 days

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5
Q

pouches for ostomy

A

transverse-dispose

sigmoid- drain or dispose

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6
Q

function after surgery

A

6-8 weeks normal no heavy lifting

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7
Q

illeostomy care 4

A

no regularity
drainable pouch
2-3 lt a day
susceptible obstruction

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8
Q

bile billy and ammonia

A

Bile salts aid in digestion by making cholesterol, fats, and fat-soluble vitamins easier to absorb from the intestine. Bilirubin is the main pigment in bile. Bilirubin is a waste product that is formed from hemoglobin (the protein that carries oxygen in the blood) and is excreted in bile.
Ammonia is protein breakdown that turns into urea in the liver and leaves

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9
Q

Acute liver failure causes

A

Acetaminophen and alcohol
Hep B
NSAIDS, Ionized TB drug, sulf drugs, anticonvulsants

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10
Q

ALD definition and Death complications

A

RAPID acute onset with hepatic encephalopathy without previous cirosis
Cerebral edema, herniation, brainstem compression

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11
Q

Manifestations of ALF

A

Rapid onset of severe dysfunction, Cognitive decline (FIRST), Jaundice, Ascites, Coag abnormalities-DIC and bleeding
GI bleeding, Fever with leukocytosis, thrombocytopenia, hypovolemia, Algeria, azotemia, increased urea and nitrogen in blood, edema, hypoglycemia, bacterial infection
respiratory failure
Metabolic acidosis, sepsis, organ failure

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12
Q

Treatment of ALF

A

Liver transplant, monitor hemodynamic status, tx amonia

HOB at 30, avoid stimulation, no pressure-valsalva

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13
Q

LAbs for ALF

A

Bilirubin, pt time, Enzymes, glucose, CBC. d dim, hand h platelet, tox levels, serum c, a antitryps, iron, ammonia, autoantibodies, acid base

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14
Q

Imaging for ALF

A

CT and MRI

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15
Q

Nursing care for ALF

A

Neuro Checks-ICP- Widening BP, Irregular respirations, bradycardia
Seizure precautions
avoid sedatives
skin and oral checks- fluids for kidneys
no aminoglycosides or NSAIDS
Hemodynamic, kid, glucose, electrolyes, acid base checks
Is and Os
Bleeding risks

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16
Q

Ducts order

A

Common bile duct, cystic duct, biliary duct, pancreatic duct

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17
Q

Acute pancreatitis def
women-
men-

A

Injury to pancreatic cells causes activation of the enzymes
W-gallstones M- Chronic alcohol use
BIl disease, trauma, infection, drugs, post op GI, surgery, smoking DM, hypertyglycerides
Mild-Edematous or interstital
Severe-necrotizing, dysfunction, necrosis, organ failure, sepsis

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18
Q

Manifestations of acute pancreatitis

A

Sudden inflam, edema, necrosis, hemorrhage, fat necrosis, vascular perm, smooth mm contractions, shock, ab pain in LUQ, and mid epi that radiates to shoulder and worse with food, N/V that dosent help pain, low fever, Hypotension, Jaundice, gry turners sign, cullens sign (eccymosis), Hyposctive or no bowel sounds, crackles,

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19
Q

Complications of acute pancreatitis

A

plural effusion, atelectasis, pneumonia, ARDS,
Emboli, DIC
Hypotension
hypocalcemia-Tetany
Pseudo cyst- from all the gunk
Ab pain, palpable mass, anorexia, NV, Perf, peritonitis
Abscess- infection of pseudocyst

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20
Q

S/S of peritonitis

A

Increased HR, BP, temp, stiff plap belly,

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21
Q

Labs for pancreatitis acute

A

Panc enzymes, hypoca+,

Liver, triglycerides, glucose, bilirubin,

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22
Q

Image for pancreatitis one consideration

A

Ultrasound, xray for lung changes, contrast, MRCP, ERCP-can make it worse

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23
Q

Care for pancreatitis acute

A

REST the pancreas
Agressive hydration for third spacing, pain management, decrease pan stimulation-NPO NGT, Tx shock, electrolytes, Watch rep for ARDS, watch hypogly, tetany,

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24
Q

SURG for pancreatitis acute

A

ERCP and choleystectomy

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25
Q

Drugs for pancreatitis acute

A

PPI, decrease acid to rest pancreas
Spasmolytics- hypoca
Anticholenergics- DONT DO WITH PER IL

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26
Q

Nutrition for acute pancreatitis

A 
NPO initially, Entera-1st( If intestines are not used they get infected)  or parenteral, watch Trigy if IV lipis were given
Small frequent feedings
high carbs-takes less energy
No alcohol 
Fat sol vitamins
Albumin- tx shock
Gluconate and lactated ringers
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27
Q

Chronic pancreatitis and about the two types

A

Irreversible structural damage to the pancreas. This includes fibrotic tissue, strictures, and calcification, Scaring, dilation, stones pass.
Obstructive- Gallstones that cause inflam of sphincter or odi-cancer of amp, duodenum, pancreas, or cystic fibrosis,
Non-obstructive- Inflam and sclerosis in head of pancreases and duct, alcohol abuse

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28
Q

manifestations of chronic pancreatitis

A

Swelling, mass, chronic ab pain, or no pain, mal absorption, weight loss, constipation, DM!, increase in cholesterol, heavy burning not relieves by food or antacids, mild jaundice, dark urine-from bile, Steatorrhea

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29
Q

Diagnostic for Chronic pancreatitis labs and image

A

Panc enzymes, bilirubin, alkaline phosphate, ERCP/MRCP, CT

STOOL-fat

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30
Q

Care for chronic vs panc

A

Increase in WBC, pain-TD, bland low fat diet, no smoking, alcohol, caffeine, panc enzyme replacement, bile salts, insulin or hypo agents, acid inhibiting drugs, antidepressants,

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31
Q

Surgery for Pancreatitis chronic

A

look up

32
Q

Education for chronic pan

A

diet control, pan enzymes, diabetes education, no alcohol, no smoking, watch for fat in poop, bland diet

33
Q

Gallbladder disease two types and risks

A

Cholelith-Stones
Cholecys- Inflam of gallbladder usually from cholelith
Balance of chole, bile salts, ca+, and Na+=precipitation
Infections or alterations in metab or chole or stasis
immobility, pregnancy, inflam or obstruction, lesions-all cause obstruction

34
Q

Manifestatons of choelith

A

Pain is severe-none, more pain when stone is moving or obstructing, may be in shoulder or scap, tachy, diaphoresis, tender RUQ pain,- 3-6 hours after meal or when laying down

35
Q

Manifestations of chole sis

A

fat intol, dyspepsia, heart burn, flatulence, inflam with leuko and fever, ab regidity

36
Q

Total gal stone obstruction symptoms

A

Jaundice, dark urine, clay stools, pruritus, intol of fat, bleeding tendencies, steatorrhea

37
Q

Complications of gal bladder disease

A

Cholesis, gangrenous, subphrenic abcess, pancreatitis, cholangitis, billiary ducts, fistulas, bil cirrhosis, perionitis, choledocholithiasis.

38
Q

Diagnostic for bil disease

A

Ultrasound, ERCP, Percutaneoustransoatichosdfkhjldf-Look that up

39
Q

Labs for bil

A

Increase WBC, Serum bili/urin bil

Increase liver enzymes, amalase-pancreatic

40
Q

Tx for bil

A

Conservative management, if gallstone symp-Cholecystectomy, ERCP with sphincterotomy, endocarp shock lithotrips-takes 1-2 hr and use salts,

41
Q

Tx for cholecycsitis

A

Pain control, NSAIDS, anticholenergics, antibiotics, choleystestomy, Fluids and electrolytes, NG tube in severe N/V,

42
Q

Surgical tx for choleitis

A

Laperascopic cholecystectomy- Removal through holes, minimal post pain, normal activity in 1 week, few complications, clear lq, same day discharge
or open- removal through right subcostal incision
t-tube-Inserted into the common bile duct,
ESWL

43
Q

s/s of complete bil obstruction

A

Steatorrhea, jaundice, dark amber urine, puritis, bleeding, intol to fat foods, clay colored stools

44
Q

esophageal cancer patho history and risks

A

Usually advanced disease by the time of diagnosis, it narrows the esophagus, Risks-Increase with age, BE, smoking, alcohol, Obestiy, abestos, cement dust, achalasia-delayed emtying, gerd, barrets

45
Q

Manifestatons of Esoph cancer

A 
Progressive dysphagia-meat, soft food, lq
Pain is latep substernal epigastric, back that increases with swallowing-even spit, 
Weight loss
Sore throat, choacking 
hoarseness\regur with blood tinged
Hemmorrhage-if trach
May cause obstruction
common metastasis to lungs and liver
46
Q

Diagnosis for esoph cancer

A

Endoscope biops
ultrasound
CT/MRI
Bronchoscopy

47
Q

Tx for Esoph cancer

A

Surg-esophagectomy-removal
esophagastromy -resection to stomach
esophagoenterostomy-resection to colon- lap or open
Photodynamic lasor therapy- no sun 3-6 weeks
Chemo and radiation

48
Q

Post of esoph cancer

A

Watch respiratory, pain control, Chest tube, TPN, Swallow study, HOB 30 and for 2hr after meal

49
Q

Surg risk for esoph cancer

A

DysR, anastomatic leaks, fistulas, edema, respiratory distres, dysruption of medial sternal lymph nodes

50
Q

Care for E cancer

A

Airway, respiratory, swallow B4 oral fluids, high fowlers, tube feeding tol, pain

51
Q

Stomach cancer patho history
rt
and associations

A

Adenocarcinoma of stomach wall usually spread by diagnosis
RT mucosal injury-Hpylori, autoimmune disorders, NSAIDS, tobacco
Association-smoked meats, salted fish/meats, pickled veggies

52
Q

Manifestations of stomach cancer

A

Weight loss, saticty- full fast, indigestion, ab pain, anemia-blood loss or pernicious , weak fatigue, SOB, OB positive stool, Acities=poor prognosis- seeding of cancer cells introperitoneal cavity and no cure

53
Q

Diagnosis for stomach cancer

and labs

A

Upper endoscopy and biopsy
CT/PET
Anemia, liver function, pancreatic function

54
Q

tx for stomach cancer

A

surgery
legions in fundus means full gastrectomy
biliroth 1 and 11 with vegotomy or pyloric re
monitor fluids, cuts vegas nerve so no acid, dumping syndrome-slow meals no sugar or fat
bile reflux gastritis- enzymes and acid go up too
chemo radiatin
HyperTN S/S

55
Q

Lower GI obstruction types

A

Mechanical- Detectable, commonly found in sm intestine, surgical adhesion-small intest and colorectal cancer-Large intest
non mechanical- Paralytic illeus, pseudo- acting like theres an obstruction- critically ill, trauma, burns. vascular- no blood to intestines- a fib, art obstruction, clots, heart valve issues, heart attack, congestive fail

56
Q

Types of lower gi obstruction

A

Adhesions, intessuseption, hernwas, tumors, volvus,

57
Q

Steps of lower obs

A

1.obstruction- build up fluid, gas, intestial contents-prox
Collapse- distal
2. Increase in bowel distension- reabsorption of fluids
3. increase pressure- cap perm, fluids into 3rd space
4. loss of blood volume
5, ischemic bowel no blood supply

58
Q

Sm in lower GI

A

Rapid onset

Early- Colckly, intermit ab pain, NV in large ammounts, projectile vom with bile, if long standing smells like poop

59
Q

Lg in obstruction s/s

A

Gradual onset, vom it rare, ab pain present but low grade, ab distention increased new onset of constipation and no flatulus

60
Q

diagnosis of bowel obstruction

Labs

A

x ray-ct scan
Sigmoidoscopy/colonoscopy
Increase in WBC, H and H, BUN and creatinine

61
Q

Tx for lower GI obstruction

When do you need surgery

A

conservative, NPO, rest, NG tube, IV fluids-NS or lac ringers, Pain control
if strangulated or tx not effective, May need colonosctomy or illiostomy

62
Q

What are the biggest concerns with Lrg bowel obstructions

A

Ischemia, peritinitous, sepsis

63
Q

Ostomy 2 things

A

Fluid increase with all but sigmoid

bowel regulation- can only occur with sigmoid

64
Q

Indications for the types of ostomys

A

ill-Ulcerative, chrons, injury, family polp, trauma, cancer
Assending and transverse- perf dive, trauma, rec-vag fistula, inop tumor
Sigmoid- Cancer at the rectom or seg, perf div, trauma.

65
Q

What is the non perm end stom called

A

Hartmanns pouch

66
Q

How long does the plastic place stay on the loop

A

7-10 days

67
Q

Stoma after post op normal

A

Dark pink/ red swollen beefy

68
Q

Hernias

A

Hiatal- stomach and esoph, gerd, reflux, end of sternum
Ventral-Below hiatal poke through ab wall
Umbilical-below ventrical from birht
Inguinal- crease below hip crease
Femoral-high up on femur

69
Q

What can hernias cause

A

Peritonitis, sepsis, hyposhoich, bowel reconstrus, ostomy placement ARDS

70
Q

Diverticulitis complications 1 to remember

A

Abcess

71
Q

risks for diverticulitis

A

Obesity, inactivity, smoking, alcohol use, NSAIDS increased fiber decreased carbs constipation

72
Q

Manifestations of dive losis

A

No symptoms, ab pain, bloating, flatulence, change in bowel, can lead to itis or bleeding.

73
Q

Manifestations of deverticulitis

and can lead to-

A

Pain in LLQ, distention, decreased or no bowel sounds, NV, infection- fever leukocytosis-shift to the left,
erosin and perf into peritoneum, localized abcess, bleeding can be extensive but stops spontaneously, strictures

74
Q

What is the gold standard for divertic test

A

ct with oral contrast

CBC, berium enema, cloonoscopy w. biopsy, blood culture, colonoscopy

75
Q

Care for divertic

A

Increase fiber to prevent,
high activity-prevent
Clear lq, bed rest, pain
Severe- Hospitalization (For when you can’t have PO Fluids, symptomatic of infection, or immunosuppressed.
NPO, Bed rest, IV fluids, antibiotics, watch infection, strict I and O NG on low,

76
Q

Surg for divertic indications

A

Reoccuring abcess or obstruction, resection , diverting colonostomy

77
Q

Teaching for diver

A

Increase fiber, increase fluids to 2 lt a day, no interab pressure, lose weight, stool softeners, anticholinergics

Med surg 2 (18 decks)

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