GI Flashcards
Acute inflammation of the vermiform appendix
Appendicitis
Where do patients with appendicitis have pain?
In the epigastic or periumbilical area
When do patients with appendicitis have nausea and vomiting?
After the abdominal pain
What are the signs of appendicitis?
Pain at McBurney’s point and rebound tenderness
Why is appendicitis very difficult to diagnose?
Because it is a diagnosis of exclusion
Why should patients with appendicitis not be given laxatives?
They can cause perforation of the appendix
Why should patients with appendicitis not use heat for the pain?
Because heat causes the circulation in the appendix to increase, leading to inflammation and perforation
How should patients with appendicitis be positioned?
Semi-fowlers
What are the priorities when a patient comes into the ER with appendicitis?
Make that patient NPO and give IV fluids and electrolytes
How many mL of sterile fluid are normally in the peritoneal cavity to prevent friction?
50
Life threatening acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity, or peritoneum
Peritonitis
What does primary peritonitis indicate?
Peritoneum is infected via the bloodstream
What does secondary peritonitis indicate?
Contamination of the peritoneal cavity by bacteria or chemicals
Why does peritonitis have to be treated immediately?
To stop the shunting of blood to the area of inflammation and causing third spacing and hypovolemic shock
What are the signs of peritonitis?
Rigid, board like abdomen, pain, distention, high fever, tachycardia, dehydration, low urine output, hiccups, compromised respiratory status, nausea, vomiting, diminished bowel sounds, inability to pass flatus or feces, and anorexia
Why do hiccups occur with peritonitis?
Diaphragmatic irritation and increased white blood cells
How is peritonitis diagnosed?
Peritoneal lavage
How is peritonitis managed?
IV fluids, antibiotics, NG suctioning
What position do patients with peritonitis need to be in?
Semi-Fowlers
Widespread inflammation of mail the rectum and rectosigmoid colon, associated with periodic remissions and exacerbations
Ulcerative Colitis
Unpleasant and urgent senstation to deficate
Tenesmus
What is the poop of a patient with ulcerative colitis like?
10-20 bloody stools daily
What would the labs of a patient with ulcerative colitis be?
Decreased H&H, increased WBCs, c-reactive protein, increased erythrocyte sed, decreased electrolytes
What is the most definitive test for ulcerative colitis?
Colonoscopy
What are the drugs used to treat ulcerative colitis?
Glucocorticoid, antidiarrheal drugs, and Humira
What are the side effects of antidiarrheal drugs?
Colon dilation and toxic megacolon
What needs to be taught with Humira?
Watch for signs and symptoms of infection
What should patients with ulcerative colitis avoid?
Caffeine, pepper, alcohol, and smoking
What do patients with ostomies need to be taught?
Don’t leave supplies in the car
What should a stoma look like?
Pinkish to cherry red
What are the nursing interventions for patients with ostomies?
Skin protection, monitor blood and fluid loss, and psychological care
Inflammatory disease of the small intestine and colon causing thickening of the bowel wall with deep ulcerations and fistulas
Crohn’s Disease
What causes Crohn’s?
Possibly genetic, immune, or environmental factors
What do patients with ulcerative colitis look like?
Very sickly
What is the poop of a Crohn’s patient like?
5-6 loose stools daily
How do obstructions occur in Crohn’s patients?
Inflammation and scarring from the fistulas cause a narrowing of the intestines
What is the priority for patients with fistulas with Crohn’s disease?
Always protect the skin
What is the criteria for patients to have a wound vac?
They must be in a positive nitrogen balance
What would the bowel sounds of a patient with Crohn’s be?
Hyperactive in all four quadrants
Where is the pain for patients with Crohn’s?
Right lower quadrant
Why would patients with Crohn’s be anemic?
Because they can’t absorb intrinsic factor
What drugs can be used to treat Crohn’s?
Flagyl, methotrexate, remicade and Humira
What does Flagyl do?
Fights infection in deep, dark places
What teaching needs to accompany taking Flagyl?
Don’t drink
What does Methotrexate do?
It is an immunosuppressant that kills rapidly dividing cells
What does Humira do?
Immunosuppressant
What teaching needs to accompany Humira?
Stay away from crowds and report signs of infection
What is the priority for patients with Crohn’s?
Nutritional management
What is the diagnostic test for Crohn’s?
Biopsy
The presence of many abnormal pouch like herniation in the wall of the intestine
Diverticulitis
Where do patients with diverticulitis have pain?
Left lower quadrant
What are the signs of diverticulitis?
Abdominal distension, guarding, rebound tenderness, decreased BP, hypovolemia, low grade fever, and nausea
How is diverticulitis diagnosed?
Barium show
What are the primary interventions for patients with diverticulitis?
Drug therapy, nutritional therapy, and rest
What drugs are used for patients with diverticulitis?
Flagyl, cipro, anticholinergics, and analgesics
What needs to be avoided for patients with diverticulitis?
Avoid laxatives and enemas
What does a bowel prep do?
Cleansing and then neomycin
A lack of desire to eat despite physiologic stimuli that would normally produce hunger?
Anorexia
The forceful emptying of the stomach and intestinal contents through the mouth
Vomiting
What are the most common symptoms of nausea?
Hypersalivation and tachycardia
Nonproductive vomiting
Retching
What is projectile vomiting associated with?
Head injuries and and structural deficits
What elevated electrolyte causes constipation?
Calcium
A reflux of chyme from the stomach to the esophagus
GER
What is GERD caused by?
A loose lower esophageal sphincter
What is the hallmark of GERD?
Abdominal pain within 1 hour of eating
What cells heal erosions called by GERD?
Barrett’s epithelium
How can GERD be treated?
Avoid food that irritates stomach, eat slowly, lose weight, sleep on right side
Name the protein pump inhibitors
Prilosec, pantoprazole, and Nexium
What is Nissen Fundiplication?
Using laproscopic surgery to reinforce the lower esophageal sphincter
What is the post op care for patients with nissen fundiplication?
Avoid foods and beverages that cause gas, NG tube
Chronic GI disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating
Irritable Bowel Syndrome
What are the clinical manifestations of IBS?
Abdominal pain relieved by defication or sleep with the sensation of incomplete bowel emptying
Where is the pain associated with IBS?
Left lower quadrant
What would the assessment of IBS patients reveal?
Normal weight, normal nutrition, normal fluid and electrolytes, and normal bowel sounds
What do patients with IBS need to be taught?
Don’t abuse laxatives, don’t delay the urge to deficate, increase fluids
What drugs are used to treat IBS?
Bulk forming laxatives, Bentyl, Ditropan, antidiarrheals, and Elavil
What teaching accompanies bulk forming laxatives?
Take at mealtimes with a glass of water
What is Bentyl used for?
Relieves cramps caused by smooth muscle spasms
What are the side effects of Bentyl?
Blurred vision, SOB, headache, drowsiness, and lack of sweatin
What is Ditropan used for?
It stops urge urinary incontinence
What is Elavil used for?
Relieves cramping
What are the side effects of Elavil?
Turns urine blue-green, constipation, dry mouth, and orthostatics
Unnaturally swollen or distended veins in the anorectal region
Hemorrhoids
How are hemorrhoids treated?
Preparation H, Rubber band treatment, diet high in fiber and fluids
What is the complications for hemorrhoids?
Bleeding
What is a nonmechanical intestine obstruction?
Paralytic Ileus
In what kind of obstruction are there borborygmi?
Mechanical Obstruction
In what kind of obstruction are there no bowel sounds?
Nonmechanical Obstruction
What is the hallmark of colorectal cancer?
Weight loss
Where is the most common place for colorectal cancer to occur?
In the exit of the rectum
What diet modifications can treat colorectal cancer?
Low fat, low carbs, high fiber
What is the most common sign of colorectal cancer?
Rectal bleeding
What is the diagnostic test for colorectal cancer?
Colonoscopy
What speeds up the return of bowel sounds and flatulence?
Ambulation
When can food be given post GI surgery?
After the gag reflex, bowel sounds, and flatulence returns
When do colostomy pouches need emptied?
When they are 1/3 - 1/2 full
Small growths in the intestinal tract that are covered with mucosa and are attached to the surface of the intestine
Polyps
What can polyps cause?
Bleeding, intestinal obstruction, and intussusception
What are 99% of peptic ulcers caused by?
H. Pylori
Ulcers characterized by high gastric acid secretion in the duodenum
Duodenal Ulcers
Break in the mucosa of the stomach
Gastric Ulcer
When do gastric ulcers cause pain?
Pain with an empty stomach
What causes stress ulcers?
Trauma, burns, head injuries, shock, or sepsis
What is the hallmark of stress ulcers?
Upper GI hemorrhage
When a patient is in shock, what can be done to prevent stress ulcers?
Start on tube feeds
What are Curling’s ulcers caused by?
Burns
What are Cushing’s ulcers caused by?
Head injury
What causes PUD?
NSAIDs, smoking, caffeine, Theophlylline and alcohol
How does Theophlylline cause ulcers?
It stimulates the HCL production
Where is the pain from gastric ulcers located?
Right upper quadrant
What is the most serious complication of ulcers?
Bleeding
What tests diagnose ulcers?
CBC and H&H, EGD
If a patient is hemorrhaging from an ulcer, what do you do?
Treat and prevent dehydration, stop the bleeding
What drug can be given to stop hemorrhaging?
Vasopressin
What are the three major complications that can occur from an ulcer?
Hemorrhage, Gastric Perforation, and Obstruction
What is the pharmacological treatment for ulcers?
Two antibiotics and a PPI
What does Carafate do?
Forms a viscid and stick gel and adheres to ulcer surfaces, forming a protective barrier
What teaching do patients on Carafate need?
Give on an empty stomach one hour before meals and at bed time
What surgical intervention can be used to treat PUD?
Vagotomy, antrectomy, or gastrectomy
What does a vagotomy do?
Eliminates the acid secreting stimulus to gastric cells and eliminates pain
What are the gastrectomy options?
Billroth 1 and 2
Patients with gastrectomy will develop what kind of anemia?
Pernicious or Folic Acid deficiency
What surgery is dumping syndrome associated with ?
Billroth 2
What is dumping syndrome?
Feeling like you will die after eating
How can dumping syndrome be avoided?
High protein, high fat and low carb diet, eat in recumbent position, avoid fluids, lie down after meals
What are the manifestations of a gastrojsjunocolic fistula?
Fecal vomiting
Why are protonix given to a patient experiencing a hemorrhage from PUD?
To protect the blood clot over the ulcer
What are the nursing interventions for PUD?
Pain, altered nutrition, and fluid volume deficit
