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Hesi Study > GI > Flashcards

GI Flashcards

1
Q

What is the most common type of hernias?

A

Sliding hernia

75-90% of all adult hernias

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2
Q

GERD

A

The result of an incompetent lower esophageal sphincter that allows regurgitation of acidic gastric contents into the esophagus

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3
Q

Signs and symptoms present with GERD

A

Heartburn after eating that radiates to arms and shoulders

Feeling of fullness and discomfort after eating

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4
Q

Positive diagnosis of GERD is determined by

A

Fluoroscopy or barium swallow, gastroscopy

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5
Q

Nursing interventions for GERD

A

Encourage small frequent meals
Eliminate foods that aggregate symptoms (caffeine, strawberries, and chocolate)
Encourage pt to sit up when eating and remain upright for at least 1 hour after eating
Stop eating 3 hours before bed
Elevate hob (semi folwers or fowler position)

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6
Q

Common drug class medications prescribed for GERD

A

h2 antagonists
Antacids (after meals)
Mucosal healing agents (at least 1 hour before meal)
Proton pump inhibitors (before meals)

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7
Q

Peptic ulcer disease

A

Ulceration that penetrates the mucosal wall of the GI Tract

Gastric ulcers
Duodenal ulcers (most common)
Esophageal ulcers

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8
Q

Cause of PUD

A

Cause of some is unknown

Most caused by bacterium called helicobacter pylori (h. Pylori)

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9
Q

Risk factors for PUD

A 
NSAIDS or corticosteroids 
Alcohol
Smoking
Stress or trauma 
Familial tendency 
Blood type O
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10
Q

Symptoms common to all types of ulcers are

A

Benching
Bloating
Epigastric pain radiating to the back (not associated with type of food eaten) and relieved by antacids

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11
Q

Presence and location of peptic ulcer is determined by

A

Esophagogastroduodenscopy (EGD)
Barium swallow
Gastric analysis indicating increased levels of stomach acid

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12
Q

Potential complications involving PUD

A

Hemorrhage
Perforation (requires surgery)
Obstruction

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13
Q

Nursing interventions with PUD

A

Determine symptoms onset and how they are relieved
Monitor color, quantity, and consistency of stoops and emesis, and test for occult blood.
Small freq meals, no bedtime snacks
Avoid caffeine
Teach client symptoms of GI bleeding
Teach cessation of smoking and stress reduction

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14
Q

What should we educate patients about dumping syndrome related to PUD post op surgery?

A

Occurs 5-30 mins after eating
Characterized by vertigo, syncope, sweating, pallor, tachycardia, hypotension

Eat small freq meals that are high in protein and fat and low in carbs

Exacerbated by consuming liquid with meals,
Helps by lying down after eating

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15
Q

Symptoms and clinical manifestations of GI bleed include

A 
Dark tarry stools 
Coffee ground emesis 
Bright red rectal bleeding 
Abdominal mass of bruit 
Fatigue 
Pallor
Severe abdominal pain (should be reported immediately bc it could denote perforation)

Decreased Bp, rapid pulse, cool extremities, increase respirations

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16
Q

Inflammatory bowel diseases include which two diseases

A

Chrons disease and ulcerative colitis

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17
Q

Chohns disease

A

Subacute, chronic inflammation extending throughout all layers of intestinal mucosa which has a cobblestone appearance of the GI mucosa with periods of remission interspersed with periods of exacerbation.

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18
Q

When does Crohn’s disease usually occur? (Life cycle wise)

A

Usually teenage/early adult

Has second peak in the 6th decade

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19
Q

Is there a cure for Crohn’s disease?

A

As of now no.
Treatment relies on medications to treat the acute inflammation and maintain a remission

Surgery is used in cases where medications are not working

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20
Q

Nursing assessment with Crohn’s disease

A

Abdominal pain that is unrelieved by pooping in the right lower quadrant.
Diarrhea, steatorrhea (fatty diarrheal stools), weight loss, anemia, malnutrition
Constant fluid loss
Low grade fever
Anorexia due to pain after eating

Perforation of intestine due to severe inflammation is a medical emergency

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21
Q

Nursing interventions Crohn’s disease

A

Determine bowel patterns and control diarrhea with diet and meds
Diet should be low fat, high protein and calories and no dairy
Avoid spicy foods, smoking, caffeine, pepper, alcohol and milk
Monitor Is and Os
Weigh at least twice weekly
If Ileostomy is performed teach stoma care

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22
Q

Ulcerative colitis

A

Disease that affects the superficial mucosa of the large intestines and rectum causing the vowel to eventually narrow, shorten, and thicken due to muscular hyper trophy

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23
Q

Nursing assessment of ulcerative colitis

A

Diarrhea
Abdominal pain and cramping
Intermittent tenesmus (anal contractions) and rectal bleeding
Liquid stools containing blood, mucus, and pus
Sometimes passes 10-20 stools per day
Weakness and fatigue
Anemia

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24
Q

Nursing interventions for ulcerative colitis

A

Determine bowel pattern and control diarrhea with diet and meds
Diet should be low fat, high in proteins and calories and no dairy
Avoid spicy foods, smoking, caffeine, pepper, alcohol, and milk
Monitor Is and Os
Weigh at least twice a week
If ileostomy is performed teach stoma care

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25
Q

When giving opiate drugs with gastric conditions you should

A

Give with caution
Assess for abdominal distention, abdominal pain, abdominal rigidity, s/s of shock, increased HR, decreased BP,

These could indicate possible perforation or GI bleed

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26
Q

Diverticulosis

A

Bulging pouches in the GI wall which push the mucosa lining through the surrounding muscle

Usually no discomfort and problem goes unnoticed unless seen on radiologic exam (prompted by other diagnosis)

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27
Q

Diverticulitis

A

Inflamed diverticula which may cause obstruction, infection, and hemorrhage

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28
Q

Nursing assessment for diverticula r diseases

A

Left lower quadrant pain
Increased flatus
Rectal bleeding
Possible intestinal obstruction

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29
Q

Signs of intestinal obstruction

A

Constipation alternating with diarrhea
Abdominal distention
Anorexia
Low grade fever

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30
Q

Diverticular diseases diet

A

High fiber and 3 L of fluids per day unless inflammation is present in which case patient is:

Acute phase: NPO graduating to liquids
Recovery phase: no fibers or foods that irritate the bowel
Maintenance phase: high fiber diet with bulk forming laxatives to prevent pooling of foods in the pouches

Avoid small poorly digested foods such as popcorn, nuts, seeds

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31
Q

Complications of diverticular diseases

A

Obstruction
Peritonitis
Hemorrhage
Infection

32
Q

Intestinal obstruction

A

Partial or compete blockage or intestinal flow (fluids, feces, gas) that occurs mostly in the small intestines

33
Q

Nursing assessment for intestinal obstruction

A

Sudden onset of abdominal pain, tenderness, or guarding

Increased peristalsis when obstruction first occurs then peristalsis becomes absent when paralytic ileus occurs

34
Q

Bowel sounds of intestinal obstruction

A

High pitched with early mechanical obstruction and diminish to absent with neurogenic or late mechanical obstructions

35
Q

Types of intestinal obstructions

A

Mechanical- hernia, adhesions, tumors, diverticulitis, gallstones. (due to disorders outside the bowel caused by disorders within the bowel or by blockage of the linen in the intestine)

Neurogenic- paralytic ileus (usually post op patients) or a spinal cord lesion

Vascular- mesenteric artery occlusion

36
Q

Nursing interventions with intestinal obstruction

A

Maintain client NPO with IV fluids and electrolyte therapy
Monitor Is and Os
Implement NG intubination- advance the tube every 1-2 hours and reposition client to assist with placement. Note amount, color, consistency, and odor of drainage when suctioning
Assess abdomen regularly for distention, rigidity, and change in status with bowel sounds

37
Q

How long should food and fluids be restricted when preparing for bowel surgery

A

8-10 hours

38
Q

If the patient has a bowel obstruction or perforation what is a major contraindication?

A

Bowel cleansing

39
Q

Colorectal cancer

A

Tumor occurring in colon
4th most common cancer in US
2nd leading cause of cancer deaths
Highest incidence in people older than age 50

Diet high in fiber and low in fat foods may be factor in preventing colon cancer

40
Q

Recommendations for early detection of colon cancer

A

Digital rectal exam (DRE) every year after 40
A stool blood test every year after 50
A colonoscopy every 10 years after age 50 in average risk clients (may be more often based on advice from physician)

41
Q

What serum level is used to evaluate effectiveness of chemotherapy with colon cancer

A

Carcinoembryonic antigen (CEA) serum level

42
Q

Nursing assessments for colon cancer

A 
Rectal bleeding 
Change in bowel habits
Sense of incomplete evacuation 
Abdominal pain, nausea, vomiting 
Weight loss, cachexia 
Abdominal distention or ascites 
History of polyps
43
Q

Nursing interventions for colon cancer

A

Prepare client for surgery
Prepare client for bowel preparation
If colostomy has been performed teach stoma care
High calorie high protein diet
Promote prevention of constipation with high fiber diet

44
Q

The more distal the stoma is the…

A

The greater the chance for incontinence

45
Q

How often is stoma pouch system changed?

A

Every 3-7 days

46
Q

How do you remove effluence from sides of stoma pouch?

A

Simple squirt bottle

47
Q

When should pouches be emptied?

A

When they become 1/3 to 1/2 full

48
Q

Defending colon colostomies should be irrigated and cleaned…

A

The same time every day
Using warm water
Wash around stoma with Luke warm water and mild soap

49
Q

Odor control can be managed by

A

Diet

50
Q

Cirrhosis

A

Degeneration of liver tissue causing enlargement, fibrosis, and scarring

51
Q

Causes of cirrhosis

A 
Chronic alcohol ingestion 
Viral hepatitis 
Exposure to hepatotoxins
Infections
Cogenital abnormalities 
Chronic right sided HF
52
Q

Physical findings of patient with cirrhosis

A 
Weakness, malaise
Anorexia and weight loss 
Palpable liver (early), abdominal girth increases as liver enlarges 
Jaundice 
Fector helaticus (fruity or musty breath)
Asterixis (hand flapping tremor)
Mental/behavioral changes
Bruising, erythema 
Dry skin
Ascites
Hematemis
Palmar erythema (redness in palms of hands)
53
Q

Clinical manifestations of jaundice

A

Yellow skin, sclera, or mucosal membranes (bilirubin in skin)
Dark colored urine (bilirubin in urine)
Chalky or clay colored stools (no bilirubin in stools)

54
Q

What should you do in case an esophageal varices ruptures?

A

Insertion of esophagogastric balloon tamponade

Vasopressors, vit K, coagulation factors, and blood transfusions

55
Q

Laboratory findings in patients with cirrhosis

A

Elevated: bilirubin, AST, ALT, alkaline, phosphatase, PT, and ammonia

Decreased: Hgb, Hct, electrolytes, and albumin

56
Q

When ammonia is not broken down as usual in a damaged lover what does that mean for metabolism of drugs?

A

The metabolism of drugs is slowed down so they remain in the system longer

57
Q

Complications of cirrhosis include

A 
Ascites 
Edema
Portal HtN
Esophageal varices
Encephalopathy
Resp distress 
Coagulation defects
58
Q

Nursing interventions for cirrhosis

A

Eliminate alcohol or causative agent
Observe for mental status every 2 hours
Avoid initiating bleeding (use small bore needles, avoid injections wheneve possible)
Use electric razor, soft bristle tooth brush
Check stools and emesis for frank and occult blood
Prevent straining when pooping
Avoid soap, rubbing alcohol, and perfumed products (drying skin)
Apply moisturizing lotion frequently
Monitor IO, abdominal girth, edema
Restrict fluids to 1500 mls day

59
Q

Diet for cirrhosis

A

Low sodium, potassium, fat

High carb

60
Q

Hepatitis

A

Widespread inflammation of liver cells, usually caused by virus

61
Q

People high risk for contracting hepatitis

A 
Homosexual males 
IV drug users
Recent tattoos piercings 
Those living in crowded conditions
Health care workers
62
Q

Physical signs of hepatitis

A

Fatigue, malaise, weakness,
Anorexia nausea and vomiting
Jaundice, dark urine, clay colored stools
Dull headaches, irritability, depression
Abdominal tenderness in right upper quadrant
Fever (hep A)
Elevation of liver enzymes (ALT, AST, alkaline, phosphatase) bilirubin

63
Q

Nursing interventions with hepatitis

A

Plan periods of rest for client
High calorie, carb diet with moderate fats and proteins

Serve small freq meals
Provide vit supplements
Provide foods client prefers
Give antiemetic prior to eating

64
Q

Pancreatitis

A

Non bacterial inflammation of the pancreas

Can be chronic or acute
Acute- occurs when there is digestion of the pancreas by its own enzymes (trypsin). Alcohol ingestion and biliary tract disease are major causes for acute

Chronic- progressive, destructive disease that causes permanent dysfunction. Usually from log term alcohol use

65
Q

Nursing assessment/ symptoms for acute pancreatitis

A

Severe mid epigastric pain radiating to back usually related to excess alcohol ingestion or a fatty meal
Abdominal guarding, rigid, boarderlike abdomen and abdominal pain
Nausea and vomiting
Elevated temperature, tachycardia, decreased Bp, bluish discoloration of flanks
Elevated amylase, lipase, and glucose levels

66
Q

Nursing assessment/ symptoms for chronic pancreatitis

A

Continuous gnawing or burning abdominal pain
Reoccurring attacks of severe upper abdominal and back pain
Ascites
Steatorrhea, and diarrhea
Weight loss
Jaundice, dark urine

67
Q

Nursing interventions for acute pancreatic

A

Maintain NPO status
Maintain NG tube to suction
Have client lay on side with legs drawn up to chest
Avoid alcohol, caffeine, fatty, and spicy foods
Monitor for hypocalcemia
Place in semi fowler to decrease pressure on diaphragm

68
Q

Nursing interventions for chronic pancreatitis

A

Monitor stools

Client needs a bland low fat diet and needs to avoid rich foods, alcohol, and caffeine

69
Q

Cholecystitis

A

Acute inflammation of the gallbladder

70
Q

Cholelithiasis

A

Formation or presence of stones in gallbladder

71
Q

Treatment for cbolecystitis

A

IV hydration
Antibiotics
Morphine

72
Q

Treatment for cholelithiasis

A

Non surgical removal of stones by dissolution therapy, endoscopic retrograde chola giopancreatography (ERCP), and lithotripsy

Cholecystectomy is used to remove stones through laparoscope

73
Q

Nursing assessment for cholecystitis

A

Pain anorexia vomiting of flatulence precipitated by ingestion of fried, spicy, or fatty foods
Fever elevated wbcs and other signs of infection
Abdominal tenderness
Jaundice and clay colored stools (blockage )
Elevated liver enzymes, bilirubin and WBCs

74
Q

Nursing interventions for cholecystitis

A 
Administer analgesic for pain 
Maintain NPO
Maintain NG tube to suction 
Monitor IOs
Monitor electrolytes 
Teach client to avoid spicy, fried, fatty foods and to reduce caloric intake if indicated
75
Q

Hiatial hernia

A

Herniation of the esophagogastric junction and a portion of the stomach into the chest through the esophageal hiatus of the diaphragm

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