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GI Flashcards

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1
Q

saliva enzylme

A

amylase (aids in digestion)

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2
Q

job of lower esophageal (cardiac) sphincter

A

prevent reflux into esophagus

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3
Q

job of pyloric sphincter

A

regulate rate of stomach emptying into small intestine

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4
Q

job of intrinsic factor

A

absorption of b12

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5
Q

job of hydrochloric acid

A

kills micros
breaks down food
gastric enzyme activation

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6
Q

job of large intestine

A

absorbs water
eliminates waste
synthesis of vit b and vit k

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7
Q

job of peritoneum

A

lines the abdominal cavity

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8
Q

job of liver

A 
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
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9
Q

job of gallbladder

A

stores and concentrates bile

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10
Q

job of pancreas

A

secretes bicarb to neutralize stomach acid
secretes glucagon to raise blood sugar
secretes insulin

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11
Q

barium swallow

A

pt drinks barium sulfate then an xray is used to look at the upper GI tract

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12
Q

barium swallow pre procedure

A

NPO for 8 hrs prior to test

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13
Q

barium swallow post procedure

A

laxative may be given
increase fluids to pass barium
monitor stools for passage of barium (may be chalky white for 24-72 hrs after)

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14
Q

capsule endoscopy

A

patient swallows a small camera capsule; detects bleeding

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15
Q

capsule endoscopy pre procedure

A

bowel prep
clear liquids evening before
NPO 3 hrs prior and 2-3 hrs after

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16
Q

endoscopy

esophagogastroduodenoscopy

A

sedation required

endoscope goes down esophagus down to duodenum to obtain tissue samples

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17
Q

endoscopy pre procedure

esophagogastroduodenoscopy

A 
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
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18
Q

endoscopy post procedure

esophagogastroduodenoscopy

A

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)

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19
Q

colonoscopy

A

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

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20
Q

colonoscopy pre procedure

A 
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
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21
Q

colonoscopy post procedure

A

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

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22
Q

patients taking bowel cleanse prep and enemas are at risk for

A

fluid and electrolyte imbalance

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23
Q

s/s bowel perforation and peritonitis

A 
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
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24
Q

endoscopic retrograde cholangiopancreatography

ERCP

A

exam of hepatobiliary system via endoscope through esophagus

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25
Q

endoscopic retrograde cholangiopancreatography

(ERCP) monitoring

A 
respiratory 
central nervous system depression 
hypotension
oversedation
vomiting
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26
Q

endoscopic retrograde cholangiopancreatography

(ERCP) pre procedure

A

NPO 6-8 hrs
ask about contrast allergies
moderate sedation

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27
Q

endoscopic retrograde cholangiopancreatography

(ERCP) post precedure

A

check VS
check gag reflex
check s/s perf or peritonitis

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28
Q

what need to be monitored after endoscopic procedures?

A

gag reflex

if has not returned patient is at risk for aspiration

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29
Q

paracentesis

A

transabdominal removal of fluid from peritoneal cavity

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30
Q

paracentesis priority nursing actions

A

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

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31
Q

paracentesis post procedure

A

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

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32
Q

liver biopsy

A

needle inserted into abdominal wall to liver to get tissue samples

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33
Q

liver biopsy pre procedure

A

assess coagulation
give sedative
supine or left lateral position

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34
Q

liver biopsy post procedure

A

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

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35
Q

stool samples

A

24-72 hr collections must be refrigerated till taken to lab

send to lab ASAP

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36
Q

GERD

A

backflow of gastric content (acid reflux)

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37
Q

GERD s/s

A 
heartburn 
epigastric pain 
dyspepsia
nausea 
regurg
pain and difficulty swallowing
hypersalivation
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38
Q

GERD care

A 
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
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39
Q

gastritis

A

stomach inflammation caused by irritating foods, aspirin and NSAID overuse, increase ETOH intake, radiation, smoking, and H. PYLORI

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40
Q

gastritis s/s

A 
hiccups
n/v
headache
reflux 
abdominal discomfort 
burping 
south tast in mouth 
vitamin b12 deficiency
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41
Q

gastritis care

A

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

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42
Q

peptic ulcer disease

A

ulcers on upper GI

can be gastric or duodenal

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43
Q

gastric ulcer disease s/s

A

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

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44
Q

gastric ulcer disease care

A 
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
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45
Q

gastric ulcer disease teaching

A 
no ETOH
no caffeine
no chocolate
no smoking
no aspirin or NSAIDS
reduce stress 
rest
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46
Q

gastric ulcer care during bleeding

A 
check s/s of dehydration, shock, sepsis, respiratory insufficiency
maintain NPO
IVF
I&O
check H&H
give blood
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47
Q

peptic ulcer disease surgery

A 
gastrectomy
vagotomy
castric resction
gastroduodenostomy
gastrojejunostomy
phyloroplasty
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48
Q

gastric ulcer surgery postop

A 
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

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49
Q

duodenal ulcers s/s

A

duodenal: burning pain 1.5 to 3 hrs after meal and at night (wakes patient). melena is common. food decreases the pan

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50
Q

duodenal ulcers care

A 
VS
small frequent bland meals
rest
no smoking 
no alcohol
no caffeine
no aspirin 
no NSAIDS
no steroids 
 antibiotics for h.pylori
antacids
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51
Q

dumping syndrome

A

rapid emptying of gastric contents

52
Q

dumping syndrome s/s

A 
occurs 30 mins after eating 
n/v
abdominal fullness 
abdominal cramps
diarrhea
palpitations
tachycardia
perspiration
weak
dizzy
borborygmi (loud gurgling sounds from hyperactive bowels)
53
Q

dumping syndrome education

A 
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
54
Q

vitamin b12 deficiency

A

lack of absorption or lack of intake

55
Q

vitamin b12 deficiency s/s

A 
pallor
fatigue
weight loss
smooth beefy red tongue
jaundice
paresthesias of hangs and feet 
gait and balance issues
56
Q

vitamin b12 deficiency care

A

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

57
Q

bariatric surgery post op

A

clear liquids introduced slowly in 1 oz (30 ml) servings at a time once bowel sounds have returned

58
Q

bariatric surgery patient teaching

A 
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)
59
Q

hiatal hernia

A

esophageal or diaphragmatic hernia
portion of stomach herniates through diaphragm and into thorax
caused by weakened diaphragm muscles

60
Q

hiatal hernia s/s

A 
heartburn 
regurg
vomiting
dysphagia
feeling of being full
61
Q

hiatal hernia care

A 
surgery
small frequent meals 
limit liquids with meals 
do NOT recline for 1 hr after eating
NO anticholinergics
62
Q

cholecystitis

A

gallbladder inflammation

63
Q

cholelithiasis

A

acute inflammation with gallstones

64
Q

cholecystitis s/s

A 
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
65
Q

murphy’s sign

A

can NOT take deep breath when examiners fingers are below hepatic margin because of too much pain

66
Q

biliary obstruction

A 
jaundice
dark orange and foamy urine 
steatorrhea 
clay colored feces
pruritus
67
Q

cholecystitis care

A 
NPO during n/v
NG decompression 
antiemetics 
pain meds 
antispasmodics (anticholinergics)
eat small low fat meals 
no gassy foods 
surgery
68
Q

cholecystectomy

A

removal of gallbladder

69
Q

cholecystectomy post op care

A 
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
70
Q

T Tube

A

preserves patency of bile duct
ensures drainage of bile until edema resolves
attached to gravity drainage bag

71
Q

T Tube care

A

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

72
Q

cirrhosis

A

chronic progressive disease of the liver that causes destruction of hepatocytes

73
Q

cirrhosis complications

A 
portal hypertension 
ascites 
esophageal varices
coagulation defects
jaundice
encephalopathy 
hepatorenal syndrome
74
Q

portal hypertension

A

persistent increase in portal vein pressure caused by an obstruction

75
Q

ascites

A

accumulation of fluid in peritoneal cavity

76
Q

esophageal varices

A

fragile thin walled distended esophageal vein

77
Q

portal encephalopathy

A

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

78
Q

hepatorenal syndrom

A

progressive renal failure and hepatic failure

decreased urine output
increased BUN and creatinine

79
Q

cirrhosis care

A 
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
80
Q

how to measure abdominal girth

A

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

81
Q

esophageal varices

A

emergency of dilated veins in the esophagus

82
Q

esophageal varices s/s

A 
hematemesis 
melena (dark sticky poop containing blood)
ascites
jaundice
hepatomegaly
splenomegaly
dilated abdominal veins
s/s shock
83
Q

esophageal varices primary concern

A

RUPTURE!!

84
Q

esophageal varices care

A 
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)
85
Q

hepatitis

A

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

86
Q

hepatitis prevention

A 
hand washing 
needle precautions 
safe sex 
vaccines 
treatment of water
87
Q

hepatitis home care

A

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

88
Q

pancreatitis

A

inflammation of pancreas

89
Q

acute pancreatitis s/s

A 
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)
90
Q

acute pancreatitis care

A 
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
91
Q

chronic pancreatitis s/s

A 
abdominal pain and tenderness
LUQ mass
steatorrhea
foul smelling stools 
weight loss
 muscle wasting
jaundice
s/s DM
92
Q

chronic pancreatitis care

A

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

93
Q

irritable bowel syndrome (IBS)

A

chronic or recurrent diarrhea constipation and abdominal pain and bloating

cause is unknown but worse with stress and environment

94
Q

irritable bowel syndrome (IBS) care

A

increase fiber
drink 8-10 cups fluids daily
meds depend on the s/s (laxative vs. antidiarrheals)

95
Q

ulcerative colitis

A

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

96
Q

ulcerative colitis s/s

A 
anorexia
weight loss
malaise
abdominal tenderness and cramping 
severe diarrhea that contains blood and mucus
malnutrition
dehydration
electrolyte imbalance 
anemia 
vitamin K deficiency
97
Q

ulcerative colitis care

A

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

98
Q

ulcerative colitis surgery pre op care

A

diet restrictions: low fiber 1-2 day prior
antibiotics 1 hr prior
body image issues d/t ostomy

99
Q

ulcerative colitis surgery post op care

A

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

100
Q

crohns disease

A

inflammatory disease that happens anywhere in the GI tract

thickening and scarring, narrowing lumen, fistulas, ulcers and abscesses

has remissions and exacerbation

101
Q

crohns disease s/s

A 
fever 
cramplike and colicky pain after meals
diarrhea with mucus and pus 
abdominal distention
anorexia 
n/v
weight loss
anemia 
dehydration 
electrolyte imbalance 
malnutrition
102
Q

crohns disease care

A

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

103
Q

appendicitis

A

inflammation of the appendix

104
Q

appendicitis s.s

A 
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
105
Q

appendectomy

A

surgical removal of appendix

106
Q

appendectomy preop

A

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

107
Q

appendectomy post op

A 
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
108
Q

diverticulosis and diverticulitis

A

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)

109
Q

diverticulosis and diverticulitis s/s

A 
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
110
Q

diverticulosis and diverticulitis care

A 
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
111
Q

hemorrhoids

A

dilated varicose vein of anal canal

112
Q

hemorrhoids s/s

A

bright red bleeding with poops
rectal pain
rectal itching

113
Q

hemorrhoids care

A 
cold pack followed by sitz baths 
witch hazel soaks 
topical anesthetics 
high fiber 
increase fluids 
stool softeners
114
Q

hemorrhoids surgery post op care

A 
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
115
Q

antacids

A

chewing thoroughly and drink with water or milk
shake liquid before dispensing
allow 1 hr between antacid and other meds

116
Q

proton pump inhibitors

A

end in -prazole

suppress gastric acid secretion
side effects: headaches, diarrhea, abdominal pain, nausea

117
Q

meds to treat H. pylori

A

end in -prazole + antibiotics

can use multiple at one time

118
Q

bile acid sequestrants

A

start with cole or chole

use cautiously with suspected bowel obstruction or constipation because it could make it worse

119
Q

treating encephalopathy

A

lactulose

increases peristalsis and bowel evaucation
want ammonia 10-80
oral syrup or rectally

120
Q

pancreatic enzyme replacement

A

pancrelipase

taken with ALL meals and snack
side effect: abdominal cramps, pain, n/v/d

121
Q

treatment of chrons and ulcerative colitis

A

steroids
antimicrobials
immunomodulators

meds can decrease immune system increase blood sugar increase risk of infection

122
Q

antiemetics

A

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

123
Q

bulk forming laxatives

A

absorb water into feces and increase bulk

124
Q

stimulant laxative

A

stimulate motility of large intestine

125
Q

emollient laxatives

A

inhibit absorption of water

used to avoid straining

126
Q

osmotic laxative

A

attract water to produce bulk and stimulate peristalsis

NCLEX prep (12 decks)

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