GI Flashcards
What is the most common type of hernias?
Sliding hernia
75-90% of all adult hernias
GERD
The result of an incompetent lower esophageal sphincter that allows regurgitation of acidic gastric contents into the esophagus
Signs and symptoms present with GERD
Heartburn after eating that radiates to arms and shoulders
Feeling of fullness and discomfort after eating
Positive diagnosis of GERD is determined by
Fluoroscopy or barium swallow, gastroscopy
Nursing interventions for GERD
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)
Common drug class medications prescribed for GERD
h2 antagonists
Antacids (after meals)
Mucosal healing agents (at least 1 hour before meal)
Proton pump inhibitors (before meals)
Peptic ulcer disease
Ulceration that penetrates the mucosal wall of the GI Tract
Gastric ulcers
Duodenal ulcers (most common)
Esophageal ulcers
Cause of PUD
Cause of some is unknown
Most caused by bacterium called helicobacter pylori (h. Pylori)
Risk factors for PUD
NSAIDS or corticosteroids Alcohol Smoking Stress or trauma Familial tendency Blood type O
Symptoms common to all types of ulcers are
Benching
Bloating
Epigastric pain radiating to the back (not associated with type of food eaten) and relieved by antacids
Presence and location of peptic ulcer is determined by
Esophagogastroduodenscopy (EGD)
Barium swallow
Gastric analysis indicating increased levels of stomach acid
Potential complications involving PUD
Hemorrhage
Perforation (requires surgery)
Obstruction
Nursing interventions with PUD
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
What should we educate patients about dumping syndrome related to PUD post op surgery?
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
Symptoms and clinical manifestations of GI bleed include
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
Inflammatory bowel diseases include which two diseases
Chrons disease and ulcerative colitis
Chohns disease
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.
When does Crohn’s disease usually occur? (Life cycle wise)
Usually teenage/early adult
Has second peak in the 6th decade
Is there a cure for Crohn’s disease?
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
Nursing assessment with Crohn’s disease
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
Nursing interventions Crohn’s disease
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
Ulcerative colitis
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
Nursing assessment of ulcerative colitis
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
Nursing interventions for ulcerative colitis
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
When giving opiate drugs with gastric conditions you should
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
Diverticulosis
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)
Diverticulitis
Inflamed diverticula which may cause obstruction, infection, and hemorrhage
Nursing assessment for diverticula r diseases
Left lower quadrant pain
Increased flatus
Rectal bleeding
Possible intestinal obstruction
Signs of intestinal obstruction
Constipation alternating with diarrhea
Abdominal distention
Anorexia
Low grade fever
Diverticular diseases diet
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
Complications of diverticular diseases
Obstruction
Peritonitis
Hemorrhage
Infection
Intestinal obstruction
Partial or compete blockage or intestinal flow (fluids, feces, gas) that occurs mostly in the small intestines
Nursing assessment for intestinal obstruction
Sudden onset of abdominal pain, tenderness, or guarding
Increased peristalsis when obstruction first occurs then peristalsis becomes absent when paralytic ileus occurs
Bowel sounds of intestinal obstruction
High pitched with early mechanical obstruction and diminish to absent with neurogenic or late mechanical obstructions
Types of intestinal obstructions
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
Nursing interventions with intestinal obstruction
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
How long should food and fluids be restricted when preparing for bowel surgery
8-10 hours
If the patient has a bowel obstruction or perforation what is a major contraindication?
Bowel cleansing
Colorectal cancer
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
Recommendations for early detection of colon cancer
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)
What serum level is used to evaluate effectiveness of chemotherapy with colon cancer
Carcinoembryonic antigen (CEA) serum level
Nursing assessments for colon cancer
Rectal bleeding Change in bowel habits Sense of incomplete evacuation Abdominal pain, nausea, vomiting Weight loss, cachexia Abdominal distention or ascites History of polyps
Nursing interventions for colon cancer
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
The more distal the stoma is the…
The greater the chance for incontinence
How often is stoma pouch system changed?
Every 3-7 days
How do you remove effluence from sides of stoma pouch?
Simple squirt bottle
When should pouches be emptied?
When they become 1/3 to 1/2 full
Defending colon colostomies should be irrigated and cleaned…
The same time every day
Using warm water
Wash around stoma with Luke warm water and mild soap
Odor control can be managed by
Diet
Cirrhosis
Degeneration of liver tissue causing enlargement, fibrosis, and scarring
Causes of cirrhosis
Chronic alcohol ingestion Viral hepatitis Exposure to hepatotoxins Infections Cogenital abnormalities Chronic right sided HF
Physical findings of patient with cirrhosis
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)
Clinical manifestations of jaundice
Yellow skin, sclera, or mucosal membranes (bilirubin in skin)
Dark colored urine (bilirubin in urine)
Chalky or clay colored stools (no bilirubin in stools)
What should you do in case an esophageal varices ruptures?
Insertion of esophagogastric balloon tamponade
Vasopressors, vit K, coagulation factors, and blood transfusions
Laboratory findings in patients with cirrhosis
Elevated: bilirubin, AST, ALT, alkaline, phosphatase, PT, and ammonia
Decreased: Hgb, Hct, electrolytes, and albumin
When ammonia is not broken down as usual in a damaged lover what does that mean for metabolism of drugs?
The metabolism of drugs is slowed down so they remain in the system longer
Complications of cirrhosis include
Ascites Edema Portal HtN Esophageal varices Encephalopathy Resp distress Coagulation defects
Nursing interventions for cirrhosis
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
Diet for cirrhosis
Low sodium, potassium, fat
High carb
Hepatitis
Widespread inflammation of liver cells, usually caused by virus
People high risk for contracting hepatitis
Homosexual males IV drug users Recent tattoos piercings Those living in crowded conditions Health care workers
Physical signs of hepatitis
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
Nursing interventions with hepatitis
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
Pancreatitis
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
Nursing assessment/ symptoms for acute pancreatitis
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
Nursing assessment/ symptoms for chronic pancreatitis
Continuous gnawing or burning abdominal pain
Reoccurring attacks of severe upper abdominal and back pain
Ascites
Steatorrhea, and diarrhea
Weight loss
Jaundice, dark urine
Nursing interventions for acute pancreatic
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
Nursing interventions for chronic pancreatitis
Monitor stools
Client needs a bland low fat diet and needs to avoid rich foods, alcohol, and caffeine
Cholecystitis
Acute inflammation of the gallbladder
Cholelithiasis
Formation or presence of stones in gallbladder
Treatment for cbolecystitis
IV hydration
Antibiotics
Morphine
Treatment for cholelithiasis
Non surgical removal of stones by dissolution therapy, endoscopic retrograde chola giopancreatography (ERCP), and lithotripsy
Cholecystectomy is used to remove stones through laparoscope
Nursing assessment for cholecystitis
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
Nursing interventions for cholecystitis
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
Hiatial hernia
Herniation of the esophagogastric junction and a portion of the stomach into the chest through the esophageal hiatus of the diaphragm
