GI

Question 1

what causes esophageal varices

Answer 1

cirrhosis

Question 2

what is the cardinal sign of esophageal varices

Answer 2

elevated pressure in the veins

“portal htn” - portal veins

Question 3

eso varices are prone to

Answer 3

rupture

massive hemorrhage in the upper GI tract

Question 4

eso vraices bleeds can travel down to rectum

Answer 4

true

Question 5

tf- eso varices has a low mortality rate

Answer 5

false- high

Question 6

clinical manifestations of eso varices

Answer 6

hematemesis
melana
deterioration of mental status
s/s of shock

Question 7

what is melana

Answer 7

dark tarry stools

Question 8

deterioration of mental status from eso varices is due to what

Answer 8

blood toxicity

low brain perfusion with O2

Question 9

how is eso varices dx’d

Answer 9

endoscopy- possible interventional
CT
angiograms
x rays

Question 10

t/f- eso varices pt must be admitted to the ICU

Answer 10

true

Question 11

when treating eso varices, what do we monitor for

Answer 11

VS
volume status
elctrolytes

Question 12

explain how we maintain fluid volume in pt w/ eso varices

Answer 12

return lost blood with bank blood
do not overload
fluid bolus’

Question 13

what do meds do we administer for eso var

Answer 13

vasopressin
sandostatin
beta blockers

Question 14

vasopressin and sandostatin are both…

Answer 14

vasoconstrictors

Question 15

when are vasoconstrictors used in eso var?

Answer 15

acute bleeding situations

Question 16

when are beta blockers used for eso var pt?

Answer 16

after an acute event

Question 17

how is beta blockers admin for eso var pt?

Answer 17

iv

at a higher dose

Question 18

why are beta blockers given to eso var pt?

Answer 18

maintain bp

vasocontrictive effect

Question 19

how is hemorrhage controlled in the pt w/ eso var?

Answer 19

balloon tamponade
variceal banding therapy
transjugular Intrahepatic Portosystem Shunting(TIPS)

Question 20

how does a balloon tamponade

Answer 20

NG tube
balloon is inflated over the bleed
pressure is exerted to control the bleeding

Question 21

does a balloon tamponade completely obstruct the esophagus

Answer 21

yes

Question 22

how does variceal banding work

Answer 22

similar to balloon

rigid pressure on area of bleed

Question 23

t/f - variceal banding is an acute intervention

Answer 23

true

Question 24

how does TIPS work

Answer 24

supports drainage of portal venous blood
decreases pressure in the portal system
allows for better circulation from the liver

Question 25

the blakemore tube allows for what

Answer 25

gastric aspiration esoph aspiration gastric balloon inflation eso balloon inflation

Question 26

what do we assess the blakemore tube for

Answer 26

correct labels and fxs

Question 27

the blakemore tube requires what kind o monitoring

Answer 27

constant reassessment

Question 28

with a blakemore, th pt is always at risk for what

Answer 28

aspiration

Question 29

what do we assess in a pt with a blakemore tube?

Answer 29

resp assessment | abdominal assessment

Question 30

t/f- hepatic encephalopathy is a life threatening complication of liver disease

Answer 30

true

Question 31

hepatic enceph leads to ...

Answer 31

profound liver failure

Question 32

neuropsychiatric manifestations of hepatic failure

Answer 32

minor mental health changes- disheveled, unkempt | motor disturbances- arms/hands do a flapping gesture

Question 33

hepatic enceph is a/w

Answer 33

portal htn

Question 34

what happens patho when hepatic enceph occurs

Answer 34

shunting of blood from the portal venous system into the circ system (collateral circulation)

Question 35

clinical manifestations of hepatic enceph

Answer 35

confused unkempt alteration in mood, sleep

Question 36

pregression of hepatic enceph

Answer 36

``` become more and more difficult to awaken - obtunded to unresponsive disoriented coma seizures ```

Question 37

what will be ordered if mental status changes as a reuslt of hepat enceph

Answer 37

an EEG | - ordered and placed for 24 hrs

Question 38

what is the role of the pancreas

Answer 38

endocrine and aids in digestion

Question 39

pancreatic disease can occur in which parts

Answer 39

head body tail

Question 40

what is the problem with dx'ing and treating pancreatic cancer?

Answer 40

pts seek attention late in the disease process

Question 41

what s/s will pancreatic cancer patients present with

Answer 41

pain jaundice weight loss

Question 42

how do u dx pancreatic cancer

Answer 42

spiral ct | endoscopic procedures

Question 43

is total excision of the pancreas possible as an intervention

Answer 43

no

Question 44

how does pancreatic cancer metastasize?

Answer 44

liver lungs bone

Question 45

what palliative care do we give for pancreatic cancer

Answer 45

pain mgmt | nutritional - enteral, parenteral

Question 46

clinical manifestations of pancreatic cancers

Answer 46

``` obstruction of the common bile ducts jaundice clay colored stools dark urine pain ```

Question 47

medical mgmt of pancreatic cancer

Answer 47

pancreaticoduodenectomy | aka whipples procedure

Question 48

what is whipples procedure

Answer 48

removal of the gallbladder

Question 49

what else can be removed during whipples procedure

Answer 49

``` portions of the stomach duodenum proximal jejunum head of the pancreas distal common bile duct ```

Question 50

what procedure is needed for whipples procedure to be effective

Answer 50

re-enastomosis

Question 51

complications of whipples procedure

Answer 51

leakage/bleed GI complications infec

Question 52

nursing care after whipples procedure

Answer 52

``` pain mgmt iv fluid replacement nutritional monitor for bleeding diabetes ```

Question 53

what kind of nutrition is needed after a whipples procedure

Answer 53

distal jejunostomy or parenteral

Question 54

why might someone become diabetic after the whipples procedure?

Answer 54

islets of langerhans dont fx properly