GI

Question 1

What is Diverticular Disease?

Answer 1

Diverticula=small outpouchings of the colon that occur in rows. “Fingerlike”, mostly in sigmoid
Inc with age
Cause: low fiber, refined diet

Question 2

What causes diverticula?

Answer 2

Formed when increased pressure in the bowel causes herniation of the bowel mucosa through the colon wall.
Bowel lumen narrowed due to hypertrophy of muscular tissue.

Question 3

Define diverticula, diverticulosis and diverticulitis.

Answer 3

Diverticula: the actual finger like outpouches
Diverticulosis: indicates the actual presence of diverticula
Diverticulitis: inflammation in and around diverticular sac.

Question 4

What are the manifestations of diverticular disease?

Answer 4

Pain, left sided, mild to severe, steady or cramping
Constipation vs inc defecation
N,V, low grade fever
Distended abd, mass in LLQ

Question 5

What are the complications of diverticular disease?

Answer 5

Abscess
Peritonitis
Hemorrhage
Bowel obstruction

Question 6

What are the diagnostic tests performed for diverticular disease?

Answer 6

Barium enema
X-rays=free air
Flexible sigmoidoscopy
Colonoscopy
CT scan-abscesses, inflammation
Labs: Guaiac, WBC

Question 7

What are the treatments for diverticular disease? (meds and diet)

Answer 7

Meds: metronidazole, ciprofloxacin, trimethoprim-sulfamethoxazole, rifaximin

Acute=IV antibiotics: cefoxitin, Piperacillin-tazobactum
IV fluids, NPO, TPN, surgery (peritonitis/abscess)
***Diet-high fiber, avoid seeds (AFTER bowel rest is completed)

Question 8

What is a bowel obstruction and what can cause it?

Answer 8

Result of something blocking part of the intestine (mechanical obstruction) or a failure of the intestine to work properly (paralytic ileus).
Causes: Diverticulosis, UC, Crohns, Colon Cancer

Question 9

What is the nursing care for bowel obstruction?

Answer 9

NPO
CT scan, abd scan 
NGT to suction 
Bowel rest
Surgery if unresolved by the above
Monitor for infection, perforation, jaundice

Question 10

When is Total Parenteral Nutrition used and how do you calculate it?

Answer 10

Used for longer term bowel rest
Must administer through CVAD
Monitor labs daily if inpt
Check glucose q 6 hrs
Calculate requirements for water (30 to 40 mL/kg/day), energy (30 to 45 kcal/kg/day, depending on energy expenditure), amino acids (1.0 to 2.0 g/kg/day, depending on the degree of catabolism), essential fatty acids, vitamins, and minerals.
Use a central venous catheter, with strict sterile technique for insertion and maintenance.
Monitor patients closely for complications (eg, related to central venous access, glucose levels, electrolyte and mineral levels, hepatic or gallbladder effects, volume, or lipid emulsions).

Question 11

What is GERD?

Answer 11

A weak LES allows backward movement of gastric contents into the esophagus
Results in mucosal injury in the esophagus
Increase occurrence with age
May also be a result of pyloric stenosis or a motility disorder

Question 12

What are the symptoms of GERD?

Answer 12

Burning sensation in esophagus, AKA Pyrosis
Regurgitation and sour tasting secretions
Dysphagia
Odynophagia
Chest pain
Chronic cough
Hoarseness

Question 13

Explain the nursing management of GERD.

Answer 13

TEACH! Lifestyle modifications
Eat low-fat, high-fiber diet
Avoid irritants such as spicy or acidic foods, alcohol, caffeine, and tobacco
Do not eat or drink 2 hours before bed
Elevate the HOB
Weight loss
Give medications as prescribed
If no improvement, prepare for surgical repair
Fundoplication—wrapping a portion of the gastric fundus around the sphincter of the esophagus

Question 14

What are some medications for GERD?

Answer 14

Antacids
H2 receptor antagonists
Proton pump inhibitors, or PPI

Question 15

What is peptic ulcer disease?

Answer 15

Effects 5-10% of population
May result in duodenal or gastric ulcers
Results from Helicobacter pylori, or H-Pylori, infection
Excessive secretion of hydrochloric acid diminishes the protective effects of mucus secretion

Question 16

What are common risk factors of PUD?

Answer 16

Altered gastric acid and serum gastrin levels
Tobacco and alcohol use
Over use of Aspirin, NSAIDs, and Corticosteriods
Genetic predisposition
May be psychosomatic (seen with chronic anxiety)
H Pylori

Question 17

What are assessment findings and symptoms for PUD?

Answer 17

Burning or aching pain—occurs 2-3hrs after meal
Pain is relieved by eating
Heartburn, nausea, or vomiting
GI bleed (may be slow or rapid loss)
Coffee ground emesis
Epigastric tenderness
Older adult
-Chest pain
-Dysphagia
-Weight loss
-Anemia

Question 18

What are the complications of PUD?

Answer 18

Upper GI bleed – erosion of the blood vessels
Obstruction-edema surrounds the ulcer
Perforated stomach
Gastric contents enter the peritoneum causing inflammation
infection

Question 19

What is the nursing management for PUD?

Answer 19

Diagnose with Endoscopy, urea breath test, fecal test for h pylori
Medication management
Monitor for complication
Smoking cessation
Regular meals
Avoid excess milk or creams as they are acid stimulants
Stress management and coping techniques

Question 20

What are the medications for PUD?

Answer 20

PPIs
H2 Receptor blockers
Abx (combo of metronidazole, amoxicillin, tetracycline)
Sucralfate
Bismuth
Antacids

Question 21

What is Gastritis?

Answer 21

Inflammation of the stomach
May be associated with chronic use of NSAIDs, corticosteroids, aspirin, alcohol, and caffeine
Acute vs Chronic
Page 1105 chart 55-2 comparison
Acute is more common, usually related to something ingested
Chronic is seen more with Age
-Common in people who smoke or consume alcohol
-Irreversible changes in the gastric mucosa
-May be contributed to H pylori bacteria

Question 22

What are the acute symptoms of gastritis?

Answer 22

Mild heartburn
Vomiting
Bleeding
Hematemesis
Sharp pain
anorexia

Question 23

What are the chronic symptoms of gastritis?

Answer 23

Heavy feeling after meals
Ulcer like epigastric pain (unrelieved by antacids)
Fatigue
Anemia

Question 24

What is the diagnosis for gastritis?

Answer 24

Urea breath test
Endoscopy
Monitoring lab values… Hgb, Hct, RBC, B12

Question 25

What is the treatment for gastritis?

Answer 25

PPI
H2 Receptor Blockers
Sucralfate
Metronidazole, amoxicillin, tetracycline (combo 2)
Acute requires GI rest
Gastric Lavage

Question 26

What is a hiatal hernia?

Answer 26

Part of the stomach protrudes through the esophageal hiatus of the diaphragm and enters the thoracic cavity
Incidence increases with age

Question 27

What are the symptoms of hiatal hernia?

Answer 27

Typically asymptomatic
Diagnosed with barium swallow study or endoscopy
When symptoms do occur it presents like GERD
Increased pain may be present when there is increased abdominal pressure or the hernia becomes incarcerated.

Question 28

What is the treatment for a hiatal hernia?

Answer 28

Symptom management same as GERD

If becomes incarcerated, surgical repair
Nissen fundoplication

Question 29

What is needed for a successful bariatric surgery?

Answer 29

Pay attention to dietary changes and teach the patient about nutritional needs post op.

Patient needs a nutrition consult and Psych evaluation prior to surgery to make sure they are prepared for the life long changes that will occur.

Good support system

Question 30

What is the nursing care for abdominal surgery?

Answer 30

May need to be NPO longer before surgery and have a bowel prep
No lifting
Splint incision
Delayed healing with obesity
May need to be on liquids longer post op
Loose clothing
Pain meds and constipation

Question 31

What are the advantages of laparoscopic bariatric procedures?

Answer 31

Small incision
 Minimally invasive
 Less pain
 Better cosmetic appearance
 Less risk of infection
 Shorter length of stay
 Lower mortality rate
 Fewer complications
 Requires expertise

Question 32

Describe a gastric bypass.

Answer 32

• laparoscopic
  Stomach resection-divided and separated, leaves 1 ounce stomach. Stomach left in place, but is
  not functional.
   Also malabsorption_bypass portion of the bowel and goes to small intestine
   Small pouch-small portions of food
   Limits ability to absorb calories
   Hormone changes: Ghrelin, GLP-1_dec hunger and improves diabetic control
   Hospital stay: longest track record of safety & success. Greatest effect on diabetes, cholesterol
  and heartburn. Highest weight loss: 65-80%
   Complication rate 3.2% (low) but highest rate. Risk for ulcers-poor choice for smokers, unable to
  take anti-inflammatory (nsaids)
   Higher incidence of vitamin and mineral def

Question 33

Describe a sleeve gastrectomy.

Answer 33

(Laparoscopic)
 Creates high pressure narrow sleeves. Half of abd is resected and removed-no bypass. Food is
absorbed normally.
 Restrictive only-not malabsoprtive
 Hormonal changes: removes ghrelin cells. Diminished hunger
 Short hospital stay
 Able to take NSAIDS
 Few vitamin deficiencies
 Avg weight loss 60-70%
 Complications 2.6%
 Not reversible, has a leak rate out of stapled abdomen, unproven durability beyond 5 years

Question 34

Describe a lap band.

Answer 34

Creates small pouch, no malabsorption, pressure of band appears to diminish hunger
 Fluid can be added/withdrawn from the band-adjustable. 
 Low complication rate
 Short hospital stay
 Can take NSAIDS
 Few vitamin deficiencies
 Can be removed
 Restrictive diet
 More office follow-up, q month x12
 Weight loss is less predictable, more gradual
 40%-50% weight loss, highly variable
 Not good for very obese (>BMI 50)