gi Flashcards
acute pancreatitis causes x2
alcohol, gallbladder disease
chronic pancreatitis #1 cause
alcohol
ascites
losing protein rich fluids like enzymes and blood into the abdomen
rigid board-like abdomen indicative of
bleeding that can lead to peritonitis
pain, inflammation, tenderness
1 concern if liver is sick
bleeding
4 major functions of the liver
detoxifying body
helps blood clot
metabolize drugs
synthesize albumin
cirrhosis
liver cells destroyed and replaced with scar tissue
- altered circulation in liver
- hypertension
when spleen is enlarged…
immune system is involved
hepatic encephalopathy/coma
cirrhosis can progress to this
liver damaged = ammonia builds up = goes to brain = sedative
paracentesis
removal of fluid from peritoneal cavity;
beware shock (removal of fluids)
- portal hypertension
- vessels to liver stretch
- no albumin to hold in fluid (liver damaged)
- fluid pools in potential space to relieve pressure
give a liver client narcotics =
essentially double dosing them! liver can’t metabolize when sick.
describe body metabolism of protein
protein = ammonia = liver converts to urea = kidneys excrete urea
ammonia effect
sedation
asterixis
“liver flap” - hand tremor
indicative of ammonia build up (hepatic coma)
fetor
breath smells like ammonia (acetone-y, bottle of wine, fresh cut grass)
hepatic coma
can result from ammonia build up due to liver’s inability to break it down to urea for excretion
hepatic coma/ammonia build up s/s
mental changes/motor problems
asterixis, handwriting changes
fetor
bleeding
hepatic coma tx
lactulose (pulls fluid, ammonia into GI tract and out via diarrhea)
cleansing enemas (get blood out because blood = protein)
decrease protein in diet
monitor serum ammonia
bleeding esophageal varices
portal hypertension forces collateral circulation to form - usually no problem until rupture
portal hypertension creates collateral circulation in x3
esophagus
stomach
rectum
alcoholic client that is GI bleeding is usually
esophageal varices (portal hypertension collateral circulation)
peptic ulcers
common cause of gi bleeding; erosion present
esophagus, stomach, duodenum
usually males
smoking effect on gi
increases stomach motility, increases stomach secretions
when do you take antacids?
when stomach is empty and at bedtime
gastric ulcer
malnourished, pain is usually half hour to 1 hour after meals, food doesn’t help but vomiting does, vomit blood
duodenal ulcers
well-nourished, night time pain is common and 2-3 hours after meals, food helps, blood in stools
hiatal hernia
hole in the diaphragm is too large so stomach moves up into thoracic cavity
main cause: large abdomen; also - congenital, trauma, surgery
dumping syndrome
stomach empties too quickly after eating = many uncomfortable side effects;
usually s/t gastric bypass, gastrectomy, gall bladder disease
ulcerative colitis
ulcerative inflammatory bowel disease - just the large intestine (colon)
crohn’s disease
aka “regional enteritis” - inflammation and erosion of ileum, but can be found anywhere in small or large intestines
rebound tenderness indicative of
peritoneal inflammation (irritation) aka peritonitis
diet for ulcerative colitis and crohn’s
low fiber - trying to limit gi motility to help save fluid
avoid cold/hot foods and smoking (all increase motility)
ileostomy care nota bene x4
- drains liquid all the time; don’t have to irrigate
- avoid hard to digest and rough foods (increase motility)
- gatorade in summer
- at risk for kidney stones (always a little dehydrated)
which types of colostomy do you irrigate?
descending and sigmoid (formed stools! - ascending and transverse = semi-liquid stool)
best times to irrigate colostomy x2
same time every day
after meal
if client cramps during enema… x2
lower bag (slow fluids), check fluid temp
appendicitis
related to low fiber diet
abdominal pain first, nausea/vomiting second
do not give enemas or laxatives! (possible rupture)
appendicitis: #1 worry
rupture!
localized pain in McBurney’s point indicative of
appendicitis
right lower quadrant
position of choice after any major abdominal surgery
HOB up (relieves pressure on abdomen, decreases tension on suture line)
position of choice pre major abdominal surgery
HOB up, right side (bowel content into one quadrant)
fetal position okay (comfort)
total parenteral nutrition nota bene x6
keep refrigerated but warm for administration
central line, dedicated line only
discontinue gradually (avoid hypoglycemia)
hang for 24 hours max
change tubing every bag
always pump less than 42ml/hr
most frequent complication of tpn
infection
how to avoid getting air in line when changing tubing on central line
clamp
valsalva (deep breath and hum)
pancreatitis treatment x6
control pain (decrease gastric secretions with NPO, NGT to suction, bed rest, meds)
steroids (decrease inflammation)
anticholinergics (dry)
ppi, h2 antag, antacids
maintain f/e balance, nutritional status, daily weight, no alcohol
insulin (pancreas damaged, steroids suppress, tpn high in glucose)
cirrhosis diet
decrease protein (avoid ammonia build up) low Na
client teaching for peptic ulcers
decrease stress
stop smoking
eat what you tolerate (avoid super spicy, extreme temp, caffeine)
follow for a year
hiatal hernia treatment
small, frequent meals sit up 1 hour after eating elevate HOB surgery teach lifestyle changes, health diet
lay on what side to keep food in the stomach?
left side (right side empties it)
dumping syndrome treatment
semi-recumbent with meals (left side!) lie down after no fluids with meals (in between) small, frequent meals avoid high carbs and electrolytes (empty fast)
