GI Flashcards
Pancreatitis = auto-________ of the pancreas
Patho: _____ tissue or _____ stones occlude ______ duct so that ______ can’t get to the _____ intestine and are then activated in the ________ which digests it
Pancreatic enzymes are _______ and _______, lipase is more ______ for pancreatitis
Causes of acute = _______ (#1) and ________ disease (#2); Causes of chronic = _______ (#1)
S/S = pain that _______ with eating, rigid _______ = bleeding that can lead to _______, bruising around umbilicus = _____ sign or bruising around flank = ______ sign, abdominal mass = _______ pancreas, ascites due to losing ______ into _______, fever d/t ________, GI symptoms _____/_______, jaundice signals ______ involvement, ______ = bleeding or ascites
digestion
scar, gall, pancreatic enzymes, small pancreas lipase, amylase specific
ALCOHOL, gallbladder
ALCOHOL
increases, abdomen peritonitis Cullen's, Gray Turner's swollen fluid, abdomen, inflammation Nausea/Vomiting, liver HYPOTENSION
Diagnose pancreatitis with labs: lipase and amylase \_\_\_\_\_ WBCs \_\_\_\_\_\_ BG \_\_\_\_\_\_\_\_--could lead to \_\_\_\_\_\_\_ liver enzymes (ALT/AST) \_\_\_\_\_\_\_ PT, aPTT \_\_\_\_\_\_\_\_\_--watch for \_\_\_\_\_ Serum Bilirubin \_\_\_\_\_\_\_ H/H are \_\_\_\_\_ with dehydration or \_\_\_\_\_\_ with bleeding
Treat pancreatitis: _____ pain, keep stomach ____ and ____ via NPO, _____ suction, ______ rest, pain meds could be _____ narcotics or ______ patch
steroids will decrease _______–check _____ often d/t potential for _____ r/t ______ steroids
anticholinergics will ________ (benztropine and diphenoxylate/atropine)
GI protectants include pantoprazole–_______, ranitidine or famotidine–________, antacids, maintain fluid and _______ balance, maintain ______ status–ease into ____, possible _____; WHY give insulin: _______, ______, _______; daily ______, ELIMINATE _______, refer to ___ if cause is alcohol
increase increase increase, diabetes increase prolonged--bleeding! increase increased, decreased
control, empty dry, NG, bed PCA, fentanyl inflammation, BG Cushing's, excess dry you up
PPI H2 antagonists electrolyte, nutritional diet, TPN; pancreas not producing it steroids, TPN; weights, ALCOHOL AA
4 functions of the liver:
______ the body, help the blood to _____, metabolize _______, synthesize _______
If liver is sick, ______ is #1 concern
If liver is sick, _______ medication doses
NEVER GIVE __________ TO A LIVER PROBLEM PERSON, ANTIDOTE IS _______
detoxify, clot, drugs, albumin
BLEEDING
decrease
ACETAMINOPHEN
MUCOMYST (acetylcysteine)
Cirrhosis = liver cells are ______ and replaced with _____ which alters ______ in the liver, so _____ in liver goes up = ____________
_____ build up, causing ____ and decreased ____ so we need client to ______
S/S: ______, nodular liver, pain in the ______, chronic ______, CHANGE in ______ habits, ascites d/t ______ albumin so ______ leaks into abdomen, splenomegaly signals ________ involvement, ______ serum albumin, ______ AST/ALT, anemia, can progress to hepatic _______ or _____, _______ builds up–sedative effect
Dx: imaging studies–_____, _____, _____; liver ______
Liver Biopsy–clotting studies pre-procedure: ____, _____, ____, baseline ____, position client _____, with the ______ side up–arm up and _____ head; post-procedure, position client on _____ side, worry about ______, monitor _____
destroyed
scar tissue, circulation, BP
portal hypertension
toxins, malaise, energy, rest
firm, RUQ dyspepsia, bowel, decreased fluid immune system, decreased increased encephalopathy, coma, ammonia
ultrasound, CT, MRI, biopsy
PT, aPTT and INR, VS, supine
right, behind
right
hemorrhage, VS
Treatment for Cirrhosis includes NO MORE _______, vitamins, antacids and _____, I/O and daily ______, ____ d/t build up of toxins, prevent _____, measure _______ girth d/t _____
Paracentesis = removal of ______ from the ______ cavity, have the client _____–want them to have a small _____, position the client ________ so the fluid ____ in one area for _______ removal, vital signs: watch for shock = ______ BP, _____- HR because any time you _______ fluids the client could go into _____; good _____ care d/t itching from _____–____ skin, _____ nails; liver can’t _________ drugs when it’s sick so avoid _______; decrease ______ and ______ in diet
ALCOHOL
diuretics, weights, rest
bleeding, abdominal
ascites
fluid, peritoneal void bladder, sitting up, pools easier decreasing, increasing pull, shock skin, jaundice--dry, short metabolize narcotics, protein, sodium
1 treatment is ________ because it ______ serum ammonia, cleansing ____, decrease _____ in diet, monitor serum ______
Hepatic coma results from increased ______ levels–_____ breaks down into ammonia, normally by the liver, but when liver is ______, it cannot convert ammonia into _____ so the ammonia ______ and causes LOC to ____
difficult to ______, minor ______ changes, ______ changes–asterixis = _______ hands, _______ reflexes, ______ EEG, ammonia smell on breath = ____, decrease _______ in diet, liver people tend to be ___________
ammonia
protein
sick/incompetent
urea, builds up, decrease
arouse, mental, handwriting
shaking, decreased
slowed, fetor
PROTEIN, GI bleeders
LACTULOSE, decreases
enemas, PROTEIN
ammonia
Bleeding Esophageal Varices are caused by development of _______ circulation pathways d/t _______ hypertension–circulation forms in 3 places: ___, ____, ____; GI bleeding alcoholic client usually d/t ______, usually no problem until _______
Treatment: replace ______, monitor ____ including _____, oxygen d/t ______, ________ directly lowers BP in liver, balloon tamponade with ________ tube to hold _______ on the varices, cleansing _____ to remove ______, ______ to decrease ammonia, saline lavage to remove _____ from ______
collateral
portal, stomach
esophagus, rectum
varices, rupture
blood, VS CVP, anemia, OCREOTIDE Blakemore pressure, enema blood, LACTULOSE blood, stomach
Peptic Ulcers are a common cause of GI ______, can be found in the ______, _____ or _______; mainly in ______ (gender), ______ is present
S/S: burning ______ in _______ area, heartburn aka ______
Dx: EGD or Upper GI
with ______ client will be ______ pre-procedure, and will stay on NPO until return of ________; watch for _______ by assessing for pain, bleeding or trouble _______
upper GI involves ____, they’ll be _____ past midnight, NPO includes _______, no chewing ____ or _____; smoking _______ stomach motility and ________, affecting the test and risk of ________
Treated with meds like _______ antacids, PPIs, H2 antagonists, antibiotics for _______ and sucralfate which forms a _______ over wound
Teach the client to STOP ______ and decrease _______, eat what they can ______ but avoid _______ extremes and _____ foods, also avoid ______ because it is an irritant, they’ll be followed for ____ year
bleeding
stomach, esophagus, duodenum
males, erosion
pain, mid-epigastric
dyspepsia
EGD, NPO gag reflex perforation swallowing dye, NPO smoking, gum, mints increases, secretions aspiration
liquid
H. pylori
barrier
SMOKING, stress
tolerate, temperature
spicy, caffeine
one
Two types of ulcers:
GASTRIC appears in a _______ client, pain occurs ______ minutes-___ hour after meals, food doesn’t help, _____ does, blood in _______
DUODENAL appears in a ______-nourished client, _____ time pain is common and ______ hours after meals, eating _______, blood in _____
malnourished, 30
1, vomiting
vomit
well, night
2-3
helps, stool
Hiatal Hernia occurs because the hole in _______ is too large so the ____ moves up; mainly caused by large _____ r/t _____ pressure
S/S include ______ after eating, heartburn, regurgitation or _____, difficulty ______ or dysphagia
Treatment: keep stomach in _______ position via ______, frequent meals, sit up for _______ after eating, elevate _______; surgery possible, _____ weight, teach ______ changes and ______ diet
diaphragm
stomach
abdomen, increased
fullness
reflux, swallowing
down
small, one hour
HOB, lose
lifestyle, healthy
Dumping Syndrome occurs when the stomach ________ too ______ after meals, usually secondary to gastric _____, removal of stomach (_______), and _______ disease
S/S: 6
Treatment: eat in a _____-recumbent position, lie ______ after meals, no ____ with meals, small and ______ meals, avoid _____ carbs and ______ because they empty _____
Lay on ______ side to keep food in _____
_____ side lying = LEAVES it in
_____ side lying = RELEASES it
empties
fast
bypass, gastrectomy, gallbladder
fullness, weakness, palpitations, diarrhea, cramping, faint
semi
down, fluids
frequent, high, electrolytes
quickly
LEFT, stomach
LEFT
RIGHT
Ulcerative Colitis = only in ____ intestine
Crohn’s Disease = anywhere in ____ or ____ intestine
Both are ______ disorders
Many S/S: diarrhea, _____ bleeding, weight ____, vomiting, cramping, dehydration, blood in _____, anemia, _____ tenderness, fever
Rebound tenderness = peritoneal _________
Diagnosed with CT, Colonoscopy, Barium Enema
________ is most definitive for ______ (C for C)
12-24 hours pre-procedure = ______ liquid diet, 6-8 hours pre-procedure = ______, colon prep with ______, drink it really ______, with _____ straw, _____ oz q10 min, can give ______ before to minimize nausea
client will be ______ during procedure, watch for _______ by assessing for _____ or unusual _______
Treatment includes ______ fiber diet to limit GI ________ and avoid ______, and extremes of ______ in food because these all _____ motility; meds include antidiarrheals for ____ UC–not for severe cases, antibiotics, steroids to decrease _________; surgery will involve colectomy with ileostomy for UC–leaves _____ intestine or a J Pouch that comes with a ______ valve; try to avoid ______ with Crohn’s and if done, only remove _______ area–may end up with ______ or ______ depending on area affected
Post-op care for Ileostomy–will drain ________ all the time, don’t have to ______; avoid rough foods because they ______ motility, drink ______ in summer, at risk for _____ stones d/t ________
Post-op care for Colostomy–semi-liquid stool with _____ and ______, semi-formed/formed with _______ or ______; only irrigate the _____ or _______ d/t presence of more formed stools; we irrigate to promote _______, best time to irrigate is the ______ time _____ and _____ meals
Further down the stoma is, the more ______ the stool is
If patient complains of cramps during irrigation (or enema), ______, _____ the bag and/or check ______
During enema, position client on _____; for irrigation, position ______; for tube feeding position on _____ side for better stomach _____ and ______ HOB
large
small, large
inflammatory
rectal, loss
stools
rebound
inflammation
Colonoscopy, Crohn's clear NPO, go-lytely (polyethylene glycol) COLD, NO, 8 zofran sedated perforation, pain, discomfort
low motility, smoking, temperature increase MILD inflammation small nipple surgery affected, ileostomy colostomy
liquid
irrigate
increase, gatorade
kidney, dehydration
ascending transverse, descending sigmoid, sigmoid, descending regularity same, everyday, after
NORMAL
STOP, lower, temp
LEFT
wherever, RIGHT
emptying, elevate
Appendicitis is related to a \_\_\_\_\_ fiber diet #1 thing to worry about is \_\_\_\_\_\_ = leaking \_\_\_\_\_ contents, best position is \_\_\_\_\_\_\_ to isolate the contents
Initially, pain will be _________ but will eventually localize at _______ point; rebound _______ possible, GI 3: ___, ____, ____ and make sure to get a good _____ -abdominal pain 1st, N/V second–______ of symptoms)
Dx: WBC _______, ultrasound, CT, don’t give _____ or _____ because we’re worried about ______
Treated with ____ done with _____ unless perforated; post-op, position of choice is ______ slightly _____; keep ______ off the _____ line
LOW
Rupture, bowel
sitting up
generalized
McBurney’s, tenderness
N/V/A, history
timeline
increased, enemas
laxatives, perforation
surgery, laparoscopically
HOB, elevated
pressure, suture
TPN, don’t administer ______, needs to be put through a ______ line with a _____; this line is _____ to TPN. d/c gradually to avoid __________
Daily _____, may have to give ______, check ______ every 6 hours
Check urine for ______ and ______, remember ____ can’t leak through glomerulus unless there is ____ damage
Formula changes _____, so don’t _____, must change tubing ______ and has to be on a _____
Home TPN teaching: emphasize _______, most frequent complication is ______
cold
central, filter, dedicated
hypoglycemia
weights, insulin, BG
glucose, ketones, protein
kidney
daily, pre-mix
daily, pump
hand-washing
infection
When assisting provider with central line insertion, position client in ___________ to distend ______; do not start fluids until confirmation of _____ with ____ x-ray
If air gets in the line, position client on _____ side in _________
To avoid air getting in line during a tubing change, _____ it off, have client _______ to _______ intrathoracic pressure and take a deep ______ and HUMMM
X-ray done post-insertion to verify _____ and r/o ________
trendelenburg, veins
position, chest
LEFT
Trendeleburg
clamp
valsalva, increase
breath
placement
pneumothorax
