GI Flashcards
Antibiotics: Metronidazole
Side effects
nausea and HA
Antibiotics: Metronidazole
Nurse Administration/Teachings
Avoid alcohol. (make violently ill)
Should not be taken during pregnancy
Teach must take all meds!
Antibiotics: Metronidazole most effective against
Most effective against H. pylori
– more than one antibiotic should be used.
Teach must take all meds!
Histamine Receptor Antagonist (H2 blocker) all end in
-ine
Ranitidine does what
suppress the secretion of gastric acid
- serious side effects are uncommon
PPI stands for
Proton pump inhibitors
PPI medication
pantoprazole
Pantoprazole does what
suppress secretion if gastric acid (most effective)
Which drug is most effective at suppressing gastric acid
Pantoprazole
Pantoprazole side effects
Diarrhea headaches
Pantoprazole ADR
Pt needs to take the lowest dose for the shortest time possible
Pantoprazole Nursing Administration
tablets cannot be crushed
Antiulcer drug
sucralfate
Sucralfate does what
Creates a protective barrier against acid
Sucralfate Nursing Admin.
Administer one hour before meals and bedtime
Antacid
Aluminum hydroxide
Aluminum hydroxide does what
Neutralize stomach acid
Ondansetron side effects
Headache and diarrhea
Aluminum hydroxide ADR
constipation
Aluminum hydroxide Nursing Admin.
Take with glass of water
Ondansetron Should not be given to pt with
long QT syndrome
Antiemetic drugs
Ondansetron, promethazine, dimenhydrinate
Ondansetron does what
prevent N/V
promethazine does what
decrease vomiting
promethazine side effects
Respiratory depression
Local tissue damage injection site grimacing, sticking out the tongue or smacking the lips
promethazine ADR
Respiratory depression
Local tissue damage injection site
dimenhydrinate does what
motion sickness
dimenhydrinate side effects
sedation
dry mouth
constipation
Bulk laxative
works over a few days
Bulk-forming laxative
psyllium and docusate sodium
psyllium does what
Acts fiber in the bowel increases bulk of fecal volume – therefore stimulates peristalsis
psyllium nursing admin.
work 1-3 days
full glass of water
prokinetic drug
metoclopramide by
- Increase upper GI motility and suppresses emesis
Docusate sodium does what
stool softener
Stimulant laxative works
almost immediately for surgery clean out
stimulant laxative (surgery)
bisacodyl
Bisacodyl does what
Increases the number of water/electrolytes within the intestinal lumen.
Antidiarrheal
- Diphenoxylate (Lomotil)
- Loperamide (Imodium)
- by decreasing intestinal motility
Bisacodyl Nursing Admin.
Acts within 6-12 hours after taking.
Need to teach pt about key factors to establishing good bowel habits and reducing laxative abuse
Fluid and Electrolyte
Intake and Absorption = Output
Fluid and Electrolyte Causes
exercise
diarrhea
vomiting
burns
major trauma
Fluid and Electrolyte Ques
dehydration
- electrolytes low (sodium and potassium)
skin turgor
heart rate
dry
Fluid and Electrolyte Labs
potassium
sodium
Dehydration =
Hyponatremia
Hypokalemia
priority of nursing care in Fluid and Electrolyte
Rehydration
and confirm the rehydration with labs
Excess Nutrition causes
CAD
Increase BP
stroke
fatty liver disease
sleep apnea
asthma
musculoskeletal disorder
some Ca
Deficit Nutrition causes
elderly
loss of appetite
environmental factors
Nutrition deficit Ques
no teeth
denture pain
Nutrition Nursing Interventions
PEG better placement
- GI continues to work
NG Tube feedings
TPN through Central Line = by passes GI system
Causes of elimination
meds (steroids cause constipation)
inflammatory conditions
infection condition
obstruction
What systems can be surgically done to help elimination problems?
colostomy
ileostomy
Causes of inflammation in GI
gastroenteritis
cirrhosis
diverticulitis
crohn’s disease
ulcerative colitis
Different types of Infections include
Hep A, B, C
C. diff
H. pylori
GERD
Gastroesophageal Reflux Disease
GERD S/S
VOMITING
BURNING IN NOSTRILS WHEN LYING DOWN
TASTE ACID
GERD Causes
pregnancy and obesity
GERD Nursing/Teaching
Dietary – get rid of acidity (coffee, black tea, alcohol, citrus, tomatoes, spice, chocolate, fatty foods)
-Bland DIET
SLEEP WITH HOB ELEVATED
WEIGHT LOSS
GERD Meds
H2 Blocker
Antacid
Prokinetic
Dysphagia
difficulty swallowing
Dysphagia causes
Parkinson’s, alzheimer’s, dementia, burns, inflammation, stroke
Dysphagia s/s
drooling, coughing while eating, gurgling, wt loss
Dysphagia nursing/teaching
Thickener diet
HOB 30 degrees at least 1 hour
help eat food
Dysphagia s/s could lead to if severe
aspiration pneumonia
What is a hiatal hernia?
Achalasia s/s
halitosis
belch
feeling of food stuck
Achalasia pathophysiology
Peristalsis of the lower 2/3 of the esophagus is absent. The exact causes is unknown. What is known is a lost in inhibitory neurons to the esophagus
Achalasia Teaching
sit up
Achalasia meds
Botox injection lasting 6 months
endoscopic dilation of the area
calcium channel blockers
Achalasia dx
Barium swallow
constipation s/s
stool hard and dry
constipation causes
meds
sedentary lifestyle
low fiber diet
dehydration
constipation dx test
x-ray
barium enema
Constipation Teachings
balanced diet
exercise
water with meds
Meds for Constipation
bulk-forming laxatives stool softeners (docusate sodium and psyllium)
IBS stands for
irritable bowel syndrome
Irritable bowel syndrome can have what type of stool
diarrhea or constipation
C.diff is a
bacterium that can cause diarrhea to life threatening inflammation of the colon
Causes of C.diff
found in environment (soil, air, water, feces, processed meat)
- commonly associated with health care
- passed in feces ar=nd spread to food, surfaces, objects when hand hygiene is poor
Tx for C.diff
antibiotic therapy
fecal transplant
Dx of C. diff. through
stool specimens
Symptomatic patients of C. diff need to be placed under what isolation
special contact
gown and gloves
Wash with soap and water
C.diff S/S
Fever
Blood or pus in the stool
Nausea
Dehydration
Loss of appetite
Weight loss
Swollen abdomen
Kidney failure
Increased WBC
dehydration
Diarrhea S/S
3+ loose stools a day
fever
N/V
muscle weakness
If a person has diarrhea, the nurse needs to get a good
health hx
**traveled outside of the country
**family members sick
**how was food made
**antibiotics
Lab work for diarrhea
stool culture
blood work
Causes of diarrhea
viruses
bacteria (c. diff)
e. coli
Diarrhea could lead to
hypovolemia, dysrhythmias due to loss of electrolytes
send them to telemetry
Diarrhea Interventions
sodium and potassium supplements
fluids
call light
skin breakdown
pericare
clean linens and pads
BLAND Diet
Meds for Diarrhea
antibiotics
(Bisacodyl) - antidiarrheal
IV fluids
If a patient has IBS they should use a
food diary
I&Os
EGD stands for
Esophagogastroduodenoscopy
EGD uses
propofol
or conscious sedation (versed and opioid)
https://www.youtube.com/watch?v=vItktDQo-mE
Colonoscopy
NPO past midnight
BLAND diet
stimulant laxative for prep
at 45
Hx then screening occurs when the other was dx if runs in family
https://www.youtube.com/watch?v=VBraB8Oe9Fk
Diverticular Disease
95% sigmoid colon
Saclike herniation of the lining of the bowel through a defect in the muscle layer.
Can happen anywhere in the bowel
Processed food
Diverticulum
saclike herniation of the lining of the bowel
Diverticulosis
multiple diverticula present NO inflammation/symptoms
Diverticulitis
infection/inflammation of the diverticulum
When do you use an NG Tube
when the pt needs to rest their stomach
no feedings only suction
Acute diverticulitis
: let the colon rest and decrease inflammation. Can be managed at home: clear liquid, bed rest, and analgesic.
Risk factors of Acute Diverticulitis
constipation
lack of fiber
obesity
smoking
inactivity
Meds for diverticulitis
antibiotics
PPI
Opioid pain
fluids NPO
don’t need feedings
S.S of diverticulitis
HIGH WBCs
vomiting
abd pain
fever
and chills
belly feels hard like washboard
Labs Dx for diverticulitis
colonoscopy
CT scan with contrast
Complications of diverticulitis
Peritonitis – inflammation of the peritoneum
Abscess
Perforation – will require a procedure that involves resection of the involved colon with primary anastomosis
Diverticulitis
hang antibiotics
NPO
NG TUBE
Surgery later to have affected intestine removed
possible colostomy temporary for 6 months to heal
Acute Pancreatitis Causes/Risk Factors
gallbladder disease (stone blockage)
chronic alcohol use
Pancreatitis in digestion
pancreases secrete high concentrations of bicarbonate which neutralizes the acid in the chyme
- secretes HCO3
Pancreas is made up of what parts
head
body
tail
Meds for Acute Pancreatitis
pain meds
PPI
Antispasmodics
Chronic Pancreatitis most common cause
alcohol abuse
Acute Pancreatitis
enzymes from gallstone blockage build up
Acute Pancreatitis S/S
sudden onset, pain, fever, n/v, jaundice, hypotension
Acute Pancreatitis Lab
serum amylases and lipase high
WBC
Urinary amylase
Acute Pancreatitis
NPO
NG Tube
Ivs with fluid
pain management
Acute Pancreatitis mortality
life-threatening.
Acute Pancreatitis Discharge Teachings
pt needs to understand the reason for Pancreatitis.
Understand the need to rest to recover
if alcohol is involved – find support
Peptic Ulcer Disease Risk Factors
H. pylori
long term use of NSAIDs
physical stress (physical stress alone can not cause ulcers, but impaired body due to server illness/trauma be prone to develop ulcers)
Can physical stress alone cause peptic ulcer disease?
no, with impaired body due to illness
Peptic Ulcer Disease S/S
Burning sensation between meal/ night, pain stop if you eat or take antacids, the pain comes and goes, bloating
Peptic Ulcer Disease Labs
urea breathing test - noninvasive dx
Biopsy from stomach lining by means of EGD (endoscopy)
CBC
stool (for blood) to determine H.pylori
Meds for peptic ulcer disease
Antibiotics for h. pylori
PPI (pantoprazole) - prevent ulcers
- lowest dose for a short time, possible for C.diff
Sucralfate (coats lining)
- 1 hour before meals and bedtime
H2 Blocker (Ranitidine)
Antacid (Aluminum hydroxide)
What is better to take than antacid for peptic ulcer disease?
Ranitidine
Complications of peptic ulcer disease
Hemorrhage
Perforation
Gastric Outlet Obstruction
Hemorrhage from peptic ulcer disease
low BP
increase hr
small over time and rapid vomiting and diarrhea
establish airway by sitting up
Blood test for (H&H)
Perforation
needle into balloon causes
leak gastric juice
leads to sepsis
Gastric Outlet Obstruction
inflammation at the small bowel sphincter causing nothing to empty
Peptic Ulcer Disease
BLAND diet
H.pylori = antibiotics
limit NSAIDs
moderate exercise
NG Tube to stretch and rest (only suction INT)
NPO
Monitor I&Os
IV
Oral Care
Hepatitis means
inflammation of the liver
Hep A mode of infection
oral to fecal contamination
Hep A Teaching
good handwashing
vaccination since 1995
Hep B infection through
mom to baby
needle sticks
body fluids - semen, vaginal secretions, and saliva
Hep B vaccinations are required starting at
birth (3 shots)
Hep C mode of infection
tattoos
IV drug abuse
sharing contaminated needles
high-risk sexual behavior
blood transfusion before 1992
The elderly need to be screened for what
Hep C
Hep C pathophysiology
15-20 year delay between infection and manifestations of liver damage . This poses a challenge for the health care providers.
Liver Failure
cirrhosis
Hep B or C
fatty liver disease
drug-induced hep
Liver Failure S/S
Liver enzymes abnormal
AST & ALT -Indictor of liver damage
Liver Function:
PT
Albumin
Bilirubin
Ammonia Level – Hepatic Encephalopathy
ascites
Drug-Induced Hepatitis caused by
Acetaminophen
Nonalcoholic fatty Liver Disease
This is disease is growing because of the increase in our population of obese adults and children
Main goal if dx with Nonalcoholic fatty Liver Disease
lose weight
Ascites
accumulation of serous fluid in the peritoneal or abdominal cavity (third spacing). The main cause is from cirrhosis of the liver. A paracentesis is a sterile procedure to withdraw fluid from the abdominal cavity
Ascites Interventions
Paracentesis
measure girth every shift and prn
daily wt
low sodium diet
diuretic meds
Monitor breathing and airway
Ammonia encephalopathy can cause
coma
- five lactulose to have massive BM and intubated with rectal tube
What are the 2 types of inflammatory bowel diseases?
Crohn’s
Ulcerative colitis
Does Crohn’s have a cure?
no
Crohn’s can occur where
most common
mouth to anus
most common distal ileum and proximal colon
Crohn’s is called a “skipping lesion” why?
occurs by transmural (goes through the entire wall) and can occur between healthy and disease bowels
What is common for active Crohn’s patients to have
fistulas
crohn’s pts develop mal-
absorption
(alveoli get sad and weak with inflammation and don’t absorb nutrients
S/S of Crohn’s
diarrhea
cramping
pain
wt loss
fever
fatigue
Main goal for treatment of Crohn’s
Rest bowel - TPN
Control inflammation
Combat infection
Correct malnutrition- imbalance nutrition: less than body requirements relate to decreased absorption and increased nutrient loss through diarrhea
Alleviate stress - difficult to cope with the life changes
Provide symptomatic relief
Improve quality of life (OSTOMY)
Crohn’s patient have what percentage of causing bowel obstructions easily?
60%
- TPN
Most pts with Crohn’s will have a bowel section due to
stricture, obstructions, bleeding and fistula
multiple surgeries because the disease will return
Inflammatory Bowel disease
chronic inflammation of the GI tract.
- periods of remission of symptoms and periods of exacerbation.
Inflammatory bowel disease occurs
usually occurs during the teen years and early adult years and after the age of 60 years. IBD is more common in families that have medical history of this disease in their family.
IBD is more common in
families that have a medical history of this disease in their family.
When caring for a pt during exacerbation
Monitor serum electrolytes, CBC
Vital Signs
S/S of dehydration due to diarrhea
Skin breakdown due to diarrhea
Accurate I&O making sure to observe for blood in the stool.
If a pt is unable to tolerate food, they may be placed on a
TPN
Ulcerative Colitis only occurs in the
colon
works from the anus and up
The inflammation from Ulcerative colitis occurs in the
mucosal layer
S/S of ulcerative colitis
bloody diarrhea (10+ stools a day)
cramping
pain
wt loss
fever
fatigue
anemia
anorexia
What is the cure for ulcerative colitis
total proctocolectomy
- colostomy for the rest of their life
The main goal of treatment for ulcerative colitis
Rest bowel - TPN
Control inflammation
Combat infection
Correct malnutrition- imbalanced nutrition: less than body requirements related to decreased absorption and increased nutrient loss through diarrhea
Alleviate stress - difficulty to cope with the life changes
Provide symptomatic relief
Improve the quality of life - colostomy
Cholecystitis means
inflammation of the gallbladder
Cholecystitis risk factors
more common in women over the age of 40, postmenopausal, sedentary lifestyle, obesity, familial tendency
Cholecystitis meds
pain meds, antiemetics, antibiotics
Cholecystitis s/s
pain and can be associated after eating high-fat meal, fever, jaundice, pain can be referred to right shoulder/scapula, n/v
Cholecystitis lab/dx test
ultrasonography, liver function test, serum bilirubin, WBC, HIDA scan
Cholecystitis Teaching and Interventions
Post-op antibiotics
teach no greasy foods
nausea raise HOB
pain - reposition
ERCP allows for
visualization of gallbladder, cystic duct, common hepatic duct, and common bile duct
TPN means
Nutrients are given directly into the bloodstream when the GI tract cannot be used for ingestion, digestion, and absorption
TPN is given through a
central line or a PICC
- can cause infection or hypoglycemic quickly)
TPN solutions are prepared by
pharmacist using strict aseptic techniques under a laminar flow hood
and customized to meet the needs of each pt individually
- nothing added or infused
Possible complications of TPN
infection
hypoglycemic
burns
intubation
pancreatitis
Patients on TPN with also be on a what based on high sugar
SSI
Enteral feeding devices include
PEG
Gastrostomy
Jejunostomy
Nasal
Enteral feedings are
feedings of nutritious directly into the GI tract
Enteral feedings are for pts with
anorexia
head/neck CA
critical illness
etc.
If feeding for extended time, what will be placed
G tube
Possible complications of enteral feedings
Aspiration/dislodgement of the tube is an important safety concern.
Intestinal obstruction in the small bowel 4 hallmark s/s
throw up fecal matter and pooping
n/v, cramps, pain, distention & constipation
Intestinal obstruction in s. intestine other s/s rather than hallmarks
fever
signs of dehydration
acutely ill
SBO - vomit content hint at where
LBO - change in bm
DECREASE FLATUS
Meds of intestinal obstruction
IV fluids
antiemetic
antibiotic therapy
pain meds
tYPES OF OBSTRUCTIONS MORE COMMON IN SBO
surgical adhesions
crohn’s
CA
tYPES OF OBSTRUCTIONS MORE COMMON IN LBO
colorectal cancer
Intestinal obstruction shows
Reduced or absent peristalsis.
Paralytic ileus – lack of peristalsis/bowel sounds. This can be from neuromuscular or vascular
Paralytic ileus –
ack of peristalsis/bowel sounds. This can be from neuromuscular or vascular disorder
Intestinal obstruction lab/tests/endoscopy
CT scan
abd x-ray
CBC
blood chemistry
Surgical adhesion
surgery on abdomen
like a rubber band suffocating the tissue that just needs to be released for the intestine to expand again
Interventions for intestinal obstruction
SBO - NG suction, fluid hydration, teach family NPO
Both - pain meds, fluids,
Pulling the NG Tube and getting a normal diet progressing
Pull NG Tube day after is ordered
- clamp for 2-5 hours
- give clear liquids and more based on the progression of the patients feelings
- if can’t keep it down NG tube does not have to be reinserted, just unclamp
