GI Flashcards by Ehna S

GI CHANGES WITH AGING Stomach

Atrophy of Gastric Mucosa
Decrease in hydrochloric acid levels
-Decreased absorption of iron and vitamin B12
-Proliferation of bacteria
-Atrophic gastritis occurs as a consequence of bacterial overgrowth

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What you need to assess as a nurse when it comes to older people STOMACH ?

Nursing Interventions

encourage BLAND foods high in Vitamins and IRON
Assess for EPIGASTRIC pain to detect GASTRITIS

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GI CHANGES WITH AGING Intestine

-Peristalsis decreases
-Nerve impulses are dulled
-Decreased sensation to defecate can result in postponement of bowel movements
**Leads to constipation and impaction

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What you need to assess as a nurse when it comes to older people INTESTINE ?

Nursing Interventions

-Encourage a high-fiber diet and 1500 mL of fluid intake daily (if not contraindicated)

-Encourage as much activity as tolerated

-These interventions increase the sensation of needing to defecate

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GI CHANGES WITH AGING Pancreas

Decreased lipase level results in decreased fat absorption and digestion

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What you need to assess as a nurse when it comes to older people PANCREAS ?

Nursing Interventions

-Encourage small, frequent meals
Helps prevent steatorrhea

-Assess for diarrhea and dehydration

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GI CHANGES WITH AGING Liver

-Depresses drug metabolism*** increase rf toxicity

**Leads to accumulation of drugs – possibly to toxic levels

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What you need to assess as a nurse when it comes to older people LIVER ?

Nursing Intervention

-Assess for adverse effects of medications, specifically drug toxicity

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ASSESSMENT History and Physical Assessment

Patient history
Nutrition history
Diet
food allergies
Anorexia
N/V
Changes in taste
Pain or difficulty swallowing
Abdominal pain or discomfort with eating
Dyspepsia – indigestion or heartburn
Unintentional weight loss
Alcohol and caffeine consumption

3.Family history and genetic risk

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ASSESSEMENTHistory and Physical Assessment

Change in bowel habits

Changes in the skin
discoloration or rashes, itching, jaundice, increased bruising, increased tendency to bleed

**Psychosocial assessment
Stress can exacerbate some gastrointestinal disorders

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Preparation for pt going to have EGD

1.NPO for 6-8 hours

2.avoid anticoagulants (rf bleeding), aspirin (rf bleeding ) , NSAIDS , antiplatelet meds several days before procedure

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How to educate patient about the procedure of EGD

Procedure:

1.Moderate sedation and lasts about 20-30 minutes – **we don’t put them completely in sleep. Deep sleep but they are still breathing.

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How to care for patient after EGD procedure

What are the priorities

Keep patient NPO until gag reflex returns ( airway issue if not )

Priority care :includes preventing aspiration and assess for any bleeding or pain that could indicate perforation

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Endoscopic retrograde cholangiopancreatography (ERCP)

Visual and radiographic exam of the liver, gallbladder, bile ducts, and pancreas

**Use radiopaque dye

Used to diagnose obstruction as well as treat obstructions

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How to prepare for Endoscopic retrograde cholangiopancreatography (ERCP)

NPO for 6-8 hours and typically

2.avoid anticoagulants as determined by provider

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How to explain the procedure of Endoscopic retrograde cholangiopancreatography (ERCP)

Procedure:

Moderate sedation and lasts 30 minutes to 2 hours

How to care for post op ERCP

Assess for gallbladder inflammation and pancreatitis- severe abdominal pain, nausea and vomiting, fever and elevated lipase

Abdominal computerized tomography (CT)

** drink dye and we will give IV

Barium enema in enema (upper)

X-ray of large intestine with use of barium

Magnetic resonance cholangiopancreatography (MRCP)

Pancrease looking but just being done as MRI

*Endoscopic exam of the entire large intestine

*Can be used to visually diagnose, biopsy and treat

Colonoscopy

*Endoscopic exam of the entire large intestine

*Can be used to visually diagnose, biopsy and treat

Colonoscopy

How to prepare for colonoscopy

*Clear liquids the day before

NPO 4-6 hours prior

Avoid aspirin, anticoagulants, and antiplatelet drugs for several days before

*Adequate bowel cleansing is essential
-Follow provider orders for oral and rectal preparation; Patient should be passing clear liquid prior to procedure ( 4 liters of liquid)

How to care for post op or educate patient after COLONOSCOPY

Observe for signs of perforation (severe pain) and hemorrhage

*perforation
*hemmorrage ( bleeding)

** if bowel perforate there will be infection / sepsis problem

cant drink colored drink because it can dye the bowel and think it’s a blood

GASTROESOPHAGEAL REFLUX DISEASE lots of q from gerd

**Most common cause of GERD is excessive relaxation of the lower esophageal sphincter (LES) - Allows reflux of gastric contents into the esophagus and exposure of the esophageal mucosa to acidic gastric contents

GASTROESOPHAGEAL REFLUXKey Features

Dyspepsia (indigestion) Regurgitation (may lead to aspiration or bronchitis)

GASTROESOPHAGEAL REFLUXDiagnostic Assessment Barium swallow:

Can not confirm GERD, but can be helpful when used in combination with other diagnostic procedures

Most accurate method of diagnosing GERD

pH monitoring examination: in esophagus

GASTROESOPHAGEAL REFLUX Purpose of Treatment

1) Prevent complications such as strictures or Barrett’s esophagus Barrett’s esophagus – pre malignant.can lead to esophageal csncer Ulceration of the lower esophagus Caused by exposure to acid and pepsin Change in mucosa secondary to tissue injury Considered premalignant and indicates an increased risk for cancer

GASTROESOPHAGEAL REFLUX Interventions

Nutrition therapy: Limit or eliminate foods that decrease LES pressure and that irritate inflamed tissue Peppermint Chocolate Alcohol Fatty foods (especially fried) Caffeine Carbonated beverages Restrict spicy and acidic foods Lifestyle changes *Do not snack in the evening, and do not eat 2-3 hours before going to bed *Eat slowly and chew food thoroughly *Elevate the HOB by 6 to 12 inches or elevate your head *If you are overweight, lose weight

GASTROESOPHAGEAL REFLUX Interventions

GASTROESOPHAGEAL REFLUXInterventions Drug therapy Primary purposes

-Inhibit gastric acid secretion -Accelerate gastric emptying -Protect the gastric mucosa

H2-receptor antagonists will suppress the gastric acid Blocks gastric secretions Long acting-less frequent dosing Less side effects

(famotidine - Pepcid, nizatidine - Axid)

Antacids- Buffering agent Increases LES pressure Given for occasional episodes not long term use

(Maalox, Mylanta)

Prokinetic drugs Increases gastric emptying Take before meals

metoclopramide-Reglan

Proton pump inhibitors will suppress the gsastric acid -Primary treatment for severe GERD -Suppress gastric acid secretion -Long acting-usually given once a day but can be increased to twice a day -Can interfere with calcium absorption and protein digestion -Reduces available calcium in bone

(omeprazole - Prilosec, pantoprazole – Protonix)

HIATAL HERNIA