GI Flashcards
saliva enzylme
amylase (aids in digestion)
job of lower esophageal (cardiac) sphincter
prevent reflux into esophagus
job of pyloric sphincter
regulate rate of stomach emptying into small intestine
job of intrinsic factor
absorption of b12
job of hydrochloric acid
kills micros
breaks down food
gastric enzyme activation
job of large intestine
absorbs water
eliminates waste
synthesis of vit b and vit k
job of peritoneum
lines the abdominal cavity
job of liver
remove bacteria in blood removes extra glucose and amino acids from blood makes glucose amino acids and fat digests fats carbs and protein stores and filters blood stores vitamins and iron
job of gallbladder
stores and concentrates bile
job of pancreas
secretes bicarb to neutralize stomach acid
secretes glucagon to raise blood sugar
secretes insulin
barium swallow
pt drinks barium sulfate then an xray is used to look at the upper GI tract
barium swallow pre procedure
NPO for 8 hrs prior to test
barium swallow post procedure
laxative may be given
increase fluids to pass barium
monitor stools for passage of barium (may be chalky white for 24-72 hrs after)
capsule endoscopy
patient swallows a small camera capsule; detects bleeding
capsule endoscopy pre procedure
bowel prep
clear liquids evening before
NPO 3 hrs prior and 2-3 hrs after
endoscopy
esophagogastroduodenoscopy
sedation required
endoscope goes down esophagus down to duodenum to obtain tissue samples
endoscopy pre procedure
esophagogastroduodenoscopy
NPO 6-8 hrs prior local anesthetic and moderate sedation meds to reduce secretions and relax smooth muscle place patient on left side monitor airway
endoscopy post procedure
esophagogastroduodenoscopy
monitor VS
NPO till gag reflex comes back
check for s/s perforation (pain, bleeding, elevated temp, difficulty swallowing)
bed rest till sedation wears off
lozenges, saline gargles, oral pain meds for sore throat (DO NOT GIVE IF GAG REFLEX HAS NOT BEEN ASSESSED)
colonoscopy
endoscopy used to check out large intestine, biopsy and check for polps
place patient on left side with knees to chest
position can be changed during procedure to help scope pass through
colonoscopy pre procedure
colon cleanse clear liquids day before (NO red orange purple liquids) talk to MD about meds to withhold NPO 4-6 hrs before hand moderate sedation muscle relaxers
colonoscopy post procedure
monitor VS
bed rest till alert
check for s/s bowel perforation and peritonitis
passing gas, abdominal fullness, and cramping are expected
report bleeding to MD
patients taking bowel cleanse prep and enemas are at risk for
fluid and electrolyte imbalance
s/s bowel perforation and peritonitis
rigid boardlike abdomen n/v diminished bowel sounds decreased urine output hiccups guarding of abdomen increased temperature chills pallor abdominal distention abdominal pain restlessness tachycardia tachypnea
endoscopic retrograde cholangiopancreatography
ERCP
exam of hepatobiliary system via endoscope through esophagus
endoscopic retrograde cholangiopancreatography
(ERCP) monitoring
respiratory central nervous system depression hypotension oversedation vomiting
endoscopic retrograde cholangiopancreatography
(ERCP) pre procedure
NPO 6-8 hrs
ask about contrast allergies
moderate sedation
endoscopic retrograde cholangiopancreatography
(ERCP) post precedure
check VS
check gag reflex
check s/s perf or peritonitis
what need to be monitored after endoscopic procedures?
gag reflex
if has not returned patient is at risk for aspiration
paracentesis
transabdominal removal of fluid from peritoneal cavity
paracentesis priority nursing actions
informed consent
obtain VS and weight
(weight before and after)
assist patient to void to move bladder out of the way
position patient upright and on edge of bed with back supported and feet on stool (or in fowlers position)
provide comfort and support
apply dressing to site of puncture
check blood pressure and pulse post procedure
weight patient post procedure
maintain bed rest
measure fluid removed
label and send fluid to lab
document event patients response and appearance and amount of fluid removed
paracentesis post procedure
dry sterile dressing
check for bleeding
measure abdominal girth and weight
check for hypovolemia electrolyte loss mental status changes or encephalopathy
check for hematuria
report to MD if urine is bloody pink or red
**rapid removal of fluid from abdominal cavity leads to decreased abdominal pressure causing vasodilation and can cause shock. monitor HR and BP closely
liver biopsy
needle inserted into abdominal wall to liver to get tissue samples
liver biopsy pre procedure
assess coagulation
give sedative
supine or left lateral position
liver biopsy post procedure
check VS
check for bleeding
check for peritonitis
bed rest for hours
place on right side with pillow under costal margin for 2 hrs to decrease bleeding
avoid coughing or straining
no heavy lifting or strenuous exercise for 1 wk
stool samples
24-72 hr collections must be refrigerated till taken to lab
send to lab ASAP
GERD
backflow of gastric content (acid reflux)
GERD s/s
heartburn epigastric pain dyspepsia nausea regurg pain and difficulty swallowing hypersalivation
GERD care
avoid factors that cause acid reflux (chocolate, peppermint, coffee, fried or fatty foods, carbonated drinks, ETOH, smoking) low fat high fiber diet no eating or drinking 2 hrs before bed no tight clothes elevated HOB on 6-8 inch blocks no anticholinergics no NSAIDS/aspirin taken antacids
gastritis
stomach inflammation caused by irritating foods, aspirin and NSAID overuse, increase ETOH intake, radiation, smoking, and H. PYLORI
gastritis s/s
hiccups n/v headache reflux abdominal discomfort burping south tast in mouth vitamin b12 deficiency
gastritis care
decrease floods and fluids till s/s decrease
then ice chips given then clear liquids then food
check for hemorrhagic gastritis (hematemesis, tachycardia, hypotension) and report to MD
no spicy or highly seasoned food
no caffeine
no ETOH
no smoking
antibiotics for h.pylori
vitamin b12 injections
peptic ulcer disease
ulcers on upper GI
can be gastric or duodenal
gastric ulcer disease s/s
gastric: gnawing sharp pain in or to the left of mid epigastric region that occurs 30-60 mins after a meal (food makes pain worse) hematemesis is common
gastric ulcer disease care
check VS and for bleeding give small bland feeds meds to decrease gastric acid antacids anticholinergics to reduce gastric motility mucosal barrier s 1 hr before eating
gastric ulcer disease teaching
no ETOH no caffeine no chocolate no smoking no aspirin or NSAIDS reduce stress rest
gastric ulcer care during bleeding
check s/s of dehydration, shock, sepsis, respiratory insufficiency maintain NPO IVF I&O check H&H give blood
peptic ulcer disease surgery
gastrectomy vagotomy castric resction gastroduodenostomy gastrojejunostomy phyloroplasty
gastric ulcer surgery postop
check VS fowlers position for comfort and drainage increase fluids I&O assess bowel sounds NG suction NPO 1-3 days till peristalsis returns progressive diet check for complications (hemorrhage, dumping syndrome, hypoglycemia, diarrhea, vitamin b12 deficiency)
*AFTER GASTRIC SURGERY DO NOT IRRIGATE OR REMOVE NG TUNE UNLESS PRESCRIBED BECAUSE OF RISK FOR DISRUPTION OF GASTRIC SUTURES. CHECK PROPER FUNCTIONS OF NG TUBE TO PREVENT STRAIN ON ANASTOMOSIS SITE. CONTACT MD IS TUBE IS NOT FUNCTIONING CORRECTLY
duodenal ulcers s/s
duodenal: burning pain 1.5 to 3 hrs after meal and at night (wakes patient). melena is common. food decreases the pan
duodenal ulcers care
VS small frequent bland meals rest no smoking no alcohol no caffeine no aspirin no NSAIDS no steroids antibiotics for h.pylori antacids
dumping syndrome
rapid emptying of gastric contents
dumping syndrome s/s
occurs 30 mins after eating n/v abdominal fullness abdominal cramps diarrhea palpitations tachycardia perspiration weak dizzy borborygmi (loud gurgling sounds from hyperactive bowels)
dumping syndrome education
no sugar no salt no milk high protein high fat low carb diet eat small meals no fluids with meals lie down after meals antispasmodic meds to delay gastric emptying
vitamin b12 deficiency
lack of absorption or lack of intake
vitamin b12 deficiency s/s
pallor fatigue weight loss smooth beefy red tongue jaundice paresthesias of hangs and feet gait and balance issues
vitamin b12 deficiency care
increase b12 in diet (green leafy veggies, citrus, dried beans, liver, nuts, organ meat, brewers yeast)
give vitamine b12 injections (weekly at first then monthly). injections are lifelong
bariatric surgery post op
clear liquids introduced slowly in 1 oz (30 ml) servings at a time once bowel sounds have returned
bariatric surgery patient teaching
no alcohol no high protein no high sugar or fat foods eat slowly chew food well progressive diet supplements needed check for complications (dehydration persistent abdominal pain and n/v)
hiatal hernia
esophageal or diaphragmatic hernia
portion of stomach herniates through diaphragm and into thorax
caused by weakened diaphragm muscles
hiatal hernia s/s
heartburn regurg vomiting dysphagia feeling of being full
hiatal hernia care
surgery small frequent meals limit liquids with meals do NOT recline for 1 hr after eating NO anticholinergics
cholecystitis
gallbladder inflammation
cholelithiasis
acute inflammation with gallstones
cholecystitis s/s
n/v indigestion burping farting epigastric pain that radiates to right should or scapula RUQ pain triggered by high fatty or large meals guarding rigidity and rebound tenderness mass on RUQ murphy's sign elevated temp tachycardia dehydration
murphy’s sign
can NOT take deep breath when examiners fingers are below hepatic margin because of too much pain
biliary obstruction
jaundice dark orange and foamy urine steatorrhea clay colored feces pruritus
cholecystitis care
NPO during n/v NG decompression antiemetics pain meds antispasmodics (anticholinergics) eat small low fat meals no gassy foods surgery
cholecystectomy
removal of gallbladder
cholecystectomy post op care
check respiratory cough and deep breath exercises early ambulation splinting abdomen to prevent discomfort when coughing antiemetics pain meds NPO and NG tube suction clear liquids then solids when tolerated T-tube care if present
T Tube
preserves patency of bile duct
ensures drainage of bile until edema resolves
attached to gravity drainage bag
T Tube care
semi fowlers position
check output amount and color consistency and odor
report sudden increase in bile output
check for inflammation
protect skin from irritation
keep drain below level of gallbladder
report foul odor or purulent drainage
avoid irrigation aspiration or clamping of t tube without an order
clam tube before meal and observe for abdominal discomfort and distention n/v chills fever, unclamp is n/v occurs
cirrhosis
chronic progressive disease of the liver that causes destruction of hepatocytes
cirrhosis complications
portal hypertension ascites esophageal varices coagulation defects jaundice encephalopathy hepatorenal syndrome
portal hypertension
persistent increase in portal vein pressure caused by an obstruction
ascites
accumulation of fluid in peritoneal cavity
esophageal varices
fragile thin walled distended esophageal vein
portal encephalopathy
end stage hepatic failure characterized by altered levo of consciousness, neuro s/s, impaired thinking, and neuromuscular disturbances all caused by increased levels of ammonia
hepatorenal syndrom
progressive renal failure and hepatic failure
decreased urine output
increased BUN and creatinine
cirrhosis care
elevated HOB to decrease SOA high protein diet with supplements (if patient is does not have ascites, edema, or s/s of coma) restrict fluids and sodium start NG feeds or TPN diuretics I&O check electrolytes daily weight check abdominal girth check for pre-coma state (tremors, delirium) monitor for asterixis (coarse tremor that is rapid and non rhythmic = flapping of hands) check for fector hepaticus (fruity musty breath) gastric intubation give blood check coags give lactulose to decrease pH ad production of ammonia antibiotics no opioids or sedative NO ETOH paracentesis surgical shunting
how to measure abdominal girth
client is supine
bring tape measure around client and take measurement at level of umbilicus
mark abdomen along side of tape on patients flanks and midline to ensure that later measurement are taken at same place
esophageal varices
emergency of dilated veins in the esophagus
esophageal varices s/s
hematemesis melena (dark sticky poop containing blood) ascites jaundice hepatomegaly splenomegaly dilated abdominal veins s/s shock
esophageal varices primary concern
RUPTURE!!
esophageal varices care
VS elevate HOB check for ortho hypotension check lung sounds and for respiratory distress give O2 check LOC NPO IVF I&O H&H coag levels give blood and clotting factors NG tube no vasovagal activities (give stool softener)
hepatitis
Hep A: fecal oral, contaminated food or liquids, poor hand washing
Hep B: blood and body fluids, sex, perinatal period, blood and body fluids via birthing process
Hep C: blood circulation
Hep D: if you have B you can get D
Hep E: same as hep A
hepatitis prevention
hand washing needle precautions safe sex vaccines treatment of water
hepatitis home care
handwashing
no sharing bathrooms
use your own washcloths, towels, drinking and eating utensils.
do not prepare food for other family members
no alcohol
no OTC meds (tylenol or sedatives)
increase activity gradually
consume small frequent meals
high carb low fat foods
no donating blood
normal contact as long as proper hygiene is maintained
no kissing or sex with hep B will test results are negative
pancreatitis
inflammation of pancreas
acute pancreatitis s/s
abdominal pain sudden onset of pain mid epigastric or LUQ radiating to back pain made worse with fatty meals alcohol or laying recumbent abdominal tenderness guarding n/v weight loss absent or decreased bowel sounds elevated WBC elevated glucose elevated bilirubin elevated lipase and amylase cullens sign (discoloration at belly button and abdomen) turners sign (discoloration at flanks)
acute pancreatitis care
withhold food and fluids IVF parenteral nutition supplements/vitamins/minerals NG tube if vomiting or has obstruction or paralytic ileus opiates for pain no alcohol report if having acute abdominal pain, jaundice, clay colored stool, or dark colored urine
chronic pancreatitis s/s
abdominal pain and tenderness LUQ mass steatorrhea foul smelling stools weight loss muscle wasting jaundice s/s DM
chronic pancreatitis care
limit fat and protein
no heavy meals
no alcohol
vitamins and minerals to increase calories
pancreatic enzymes
give insulin or oral DM meds
report if increase steatorrhea abdominal distention or cramping or skin breakdown
irritable bowel syndrome (IBS)
chronic or recurrent diarrhea constipation and abdominal pain and bloating
cause is unknown but worse with stress and environment
irritable bowel syndrome (IBS) care
increase fiber
drink 8-10 cups fluids daily
meds depend on the s/s (laxative vs. antidiarrheals)
ulcerative colitis
ulcers and inflammation of the bowel that results in poor nutrition absorption
colon becomes edematous and develops bleeding lesions and ulcers that can lead to perforation
ulcerative colitis s/s
anorexia weight loss malaise abdominal tenderness and cramping severe diarrhea that contains blood and mucus malnutrition dehydration electrolyte imbalance anemia vitamin K deficiency
ulcerative colitis care
NPO and give IVF with electrolytes (acute phase)
TPN
restrict activity to reduce intestinal activity
check bowel sounds
check stools for color consistency and blood
check for bowel perf peritonitis and hemorrhage
progressive diet from clear liquids to low fiber as tolerated
low fiber high protein with vitamins and iron supplements
no gassy foods
no milk
no whole wheat grains
no nuts
no raw fruits or veggies
no pepper
no alcohol
no caffeine
no smoking
ulcerative colitis surgery pre op care
diet restrictions: low fiber 1-2 day prior
antibiotics 1 hr prior
body image issues d/t ostomy
ulcerative colitis surgery post op care
stoma and ostomy care
check stoma for color and unusual bleeding
check for color changes in stoma
normal stoma should be pink to bright red and shiny
pale pink stoma means low H&H
purple black stoma meas circulation is cut off (report ASAP)
check that stool is liquid postop but should become more solid
ostomy at ascending colon is liquid stool
ostomy at transverse colon is loose to semiformed
ostomy at descending colon is close to normal
empty pouch at 1/3 full
skin care is priority
check for dehydration and electrolyte imbalance
give pain meds
no foods that cause gas
crohns disease
inflammatory disease that happens anywhere in the GI tract
thickening and scarring, narrowing lumen, fistulas, ulcers and abscesses
has remissions and exacerbation
crohns disease s/s
fever cramplike and colicky pain after meals diarrhea with mucus and pus abdominal distention anorexia n/v weight loss anemia dehydration electrolyte imbalance malnutrition
crohns disease care
NPO and give IVF with electrolytes (acute phase)
TPN
restrict activity to reduce intestinal activity
check bowel sounds
check stools for color consistency and blood
check for bowel perf peritonitis and hemorrhage
progressive diet from clear liquids to low fiber as tolerated
low fiber high protein with vitamins and iron supplements
no gassy foods
no milk
no whole wheat grains
no nuts
no raw fruits or veggies
no pepper
no alcohol
no caffeine
no smoking
appendicitis
inflammation of the appendix
appendicitis s.s
periumbilical pain that descends to RLQ pain at McBurneys point rebound tenderness abdominal rigidity low grade fever elevated WBC anorexia n/v side lying position with legs flexed abdominal guarding constipation or diarrhea peritonitis is rupture occurs
appendectomy
surgical removal of appendix
appendectomy preop
NPO
IVF
check changes in pain (rupture)
check for s/s ruptured appendix and peritonitis
position right side lying or low to semi fowlers
check bowel sounds
ice pack to abdomen for 20-30 mins q 1 hr
antibitotics
NO LAXATIVE
NO ENEMA
NO HEAT TO ABDOMEN
appendectomy post op
check temp for s/s infection NPO until bowel function returned advance diet gradually as tolerated drain will be placed if appendix ruptures or incision will be left open profuse drainage for 1st 12 hrs is normal position right side lying or low to semi fowlers with legs flexed change dressing as prescribed record type and amount of drainage wound irrigation NG suction check patency of NG tube give antibiotics and pain meds
diverticulosis and diverticulitis
diverticulosis: outpouching or herniation of intestine and can occur at any part of intestine (common in sigmoid colon)
diverticulitis: inflammation of 1 or more diverticula. results in abscess formation and perforations leading to peritonitis (lite on fiber)
diverticulosis and diverticulitis s/s
LLQ pain that increases with coughing straining or lifting elevated temp n/v farting cramplike pain abdominal distention and tenderness palpable tender rectal mass bloody stool
diverticulosis and diverticulitis care
bed rest NPO or clear liquids introduce fiber gradually wheninflammation is gone give antibiotics give pain med give anticholinergics no lifting no straining no coughing no bending check for perforation hemorrhage fistulas and abscesses increase fluids to 2500-3000 unless contraindicated eat soft high fiber foods NO HIGH FIBER WHEN INFLAMMATION OCCURS no gassy foods no foods with roughage seeds nurts or popcorn small amount of bran daily bulk forming laxative temporary colostomy
hemorrhoids
dilated varicose vein of anal canal
hemorrhoids s/s
bright red bleeding with poops
rectal pain
rectal itching
hemorrhoids care
cold pack followed by sitz baths witch hazel soaks topical anesthetics high fiber increase fluids stool softeners
hemorrhoids surgery post op care
prone or side lying position to prevent bleeds icce pack over dressing check urine retnetion give stool softeners increase fluids high fiber limit sitting sitz baths 3-4x daily
antacids
chewing thoroughly and drink with water or milk
shake liquid before dispensing
allow 1 hr between antacid and other meds
proton pump inhibitors
end in -prazole
suppress gastric acid secretion
side effects: headaches, diarrhea, abdominal pain, nausea
meds to treat H. pylori
end in -prazole + antibiotics
can use multiple at one time
bile acid sequestrants
start with cole or chole
use cautiously with suspected bowel obstruction or constipation because it could make it worse
treating encephalopathy
lactulose
increases peristalsis and bowel evaucation
want ammonia 10-80
oral syrup or rectally
pancreatic enzyme replacement
pancrelipase
taken with ALL meals and snack
side effect: abdominal cramps, pain, n/v/d
treatment of chrons and ulcerative colitis
steroids
antimicrobials
immunomodulators
meds can decrease immune system increase blood sugar increase risk of infection
antiemetics
control vomiting and motion sickness
check VS, I&O, s/s dehydration, electrolytes
limit oral intake to clear liquids when pt is vomiting and nauseated.
can cause drowsiness so protect form injury
bulk forming laxatives
absorb water into feces and increase bulk
stimulant laxative
stimulate motility of large intestine
emollient laxatives
inhibit absorption of water
used to avoid straining
osmotic laxative
attract water to produce bulk and stimulate peristalsis
