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GI Flashcards

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1
Q

Pancreatitis: This is

A

auto-digestion of the pancreas

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2
Q

Pancreatitis: The pancreas has 2 separate functions

A
  1. endocrine (insulin)|2. exocrine (digestive enzymes)
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3
Q

Pancreatitis: There are 2 types of pancreatitis

A
  1. acute|2. chronic
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4
Q

Pancreatitis: What is the #1 cause?

A

gallbladder disease

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5
Q

Pancreatitis: What is the #2 cause and why?

A

alcohol because it causes scar tissue to build up

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6
Q

Pancreatitis: Signs/Symptoms

A

-pain|-abdominal distention/ascites|-abdominal mass|-rigid/board-like abdomen (with guarding)|-Cullen’s sign|-Grey-Turner’s sign|-fever|-N/V|-jaundice|-hypotension

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7
Q

Pancreatitis Signs/Symptoms: Pain increases with

A

eating

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8
Q

Pancreatitis Signs/Symptoms: Abdominal distention and ascites occur because

A

losing protein rich fluids like enzymes and blood into the abdomen which lead to ascites

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9
Q

Pancreatitis Signs/Symptoms: Why would there be an abdominal mass?

A

because the pancreas is swollen

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10
Q

Pancreatitis Signs/Symptoms: What does it mean when the client has a rigid, board-like abdomen (with guarding)?

A

bleeding that can lead to peritonitis

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11
Q

Pancreatitis Signs/Symptoms: What is Cullen’s sign?

A

bruising around the umbilical area

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12
Q

Pancreatitis Signs/Symptoms: What is Grey-Turner’s sign?

A

bruising in the flank area

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13
Q

Pancreatitis Signs/Symptoms: Why does fever occur?

A

inflammation

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14
Q

Pancreatitis Signs/Symptoms: Why would jaundice occur?

A

liver involvement

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15
Q

Pancreatitis Signs/Symptoms: Why would hypotension occur?

A

bleeding or ascites

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16
Q

Pancreatitis Diagnosis: Labs will show

A

-increased serum lipase and amylase|-increased WBCs|-increased blood sugar|-increased ALT, AST (liver ezymes)|-longer PT and aPTT times|-increased serum bilirubin|-increased OR decreased hemoglobin & | hematocrit

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17
Q

Pancreatitis Diagnosis: What are the most specific diagnostic labs and why?

A

serum lipase and amylase because they aren’t being used so they go to the blood

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18
Q

Pancreatitis Diagnosis: Why would the serum bilirubin be increased?

A

the liver is affected

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19
Q

Pancreatitis Diagnosis: Why would the hemoglobin and hematocrit be increased?

A

dehydration

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20
Q

Pancreatitis Diagnosis: Why would the hemoglobin and hematocrit be decreased?

A

bleeding

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21
Q

Pancreatitis Diagnosis: Normal amylase values

A

30-220 U/L (SI)

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22
Q

Pancreatitis Diagnosis: Normal lipase values

A

0-160 U/L (SI)

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23
Q

Pancreatitis Diagnosis: Normal AST values

A

0-35 U/L (SI)

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24
Q

Pancreatitis Diagnosis: Normal ALT values

A

10-36 U/L (SI)

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25
Q

Pancreatitis Diagnosis: Normal hemoglobin values

A

Male: 14-18 g/dL|Female: 12-16 g/dL

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26
Q

Pancreatitis Diagnosis: Normal hematocrit values

A

Male: 42-52%|Female: 37-47%

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27
Q

Pancreatitis: Treatment Includes

A

-pain control|-pain medications|-anticholinergics|-GI protectants|-maintain fluid and electrolyte balance|-maintain nutritional status|-insulin|-daily weights|-eliminate alcohol|-refer to AA if needed

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28
Q

Pancreatitis Treatment: Goal is to

A

control pain

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29
Q

Pancreatitis Treatment: To control pain we want to

A

decrease gastric secretions

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30
Q

Pancreatitis Treatment: How do we decrease gastric secretions and why?

A

-NPO|-NGT to suction|-bed rest||We want the stomach EMPTY and DRY

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31
Q

TESTING STRATEGY: Client with pancreatitis =

A

keep stomach empty and dry

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32
Q

Pancreatitis Treatment: Pain medications include

A

-PCA narcotics|-fentanyl patches (Duragesic)

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33
Q

Pancreatitis Treatment: PCA narcotics include

A

-morphine sulfate (Morphine)|-hydromorphone (Dilaudid)

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34
Q

Pancreatitis Treatment: Why do we give anticholinergics?

A

dry them up

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35
Q

Pancreatitis Treatment: Anticholinergics include

A

-benztropine (Cogentin)|-diphenoxylate/atropine (Lonox)

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36
Q

Pancreatitis Treatment: GI Protectants include

A

-proton pump inhibitors|-H2 receptor antagonists|-antacids

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37
Q

Pancreatitis Treatment: Proton pump inhibitor given

A

pantoprazole (Protonix)

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38
Q

Pancreatitis Treatment: H2 receptor antagonists

A

-ranitidine HCl (Zantac)|-famotidine (Pepcid)|-cimetadine (Tagamet)

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39
Q

Pancreatitis Treatment: We need to maintain client’s nutritional status by

A

easing them into a diet

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40
Q

Pancreatitis Treatment: Why do we give insulin?

A

because the pancreas is sick and the patient is receiving TPN

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41
Q

TESTING STRATEGY: If your liver is sick, your #1 concern is

A

bleeding

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42
Q

TESTING STRATEGY: If your liver is sick, ________________ the dose of medications

A

decrease

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43
Q

Cirrhosis: 4 major functions of the liver

A
  1. detoxify the body|2. helps your blood to clot|3. the liver helps to metabolize (break down) drugs|4. the liver synthesizes albumin
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44
Q

Cirrhosis: This is when the liver cells are _______________ and are ________________________________. This alters the ____________________ within the liver and as a result, the ______________ in the liver goes _______ which is called _____________________________

A

destroyed; replaced with connective/scar tissue; blood flow; BP; up; portal hypertension

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45
Q

Cirrhosis: Signs/Symptoms include

A

-firm, nodular liver|-abdominal pain|-chronic dyspepsia|-change in bowel habits|-ascites|-splenomegaly|-decreased serum albumin|-increased ALT and AST|-anemia

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46
Q

Cirrhosis Signs/Symptoms: Why is there abdominal pain?

A

liver capsule has stretched

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47
Q

Cirrhosis Signs/Symptoms: What is chronic dyspepsia?

A

GI upset

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48
Q

Cirrhosis Signs/Symptoms: Why is there anemia?

A

bleeding

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49
Q

Cirrhosis Signs/Symptoms: Liver cirrhosis can progress to

A

hepatic encephalopathy/coma

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50
Q

Cirrhosis Signs/Symptoms: Why can liver cirrhosis progress to hepatic encephalopathy/coma?

A

because ammonia builds up in blood and acts as a sedative leading to coma

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51
Q

Cirrhosis: Diagnosis using

A

-ultrasound|-CT|-MRI|-liver biopsy (confirms diagnosis)

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52
Q

Cirrhosis Diagnosis: Before liver biopsy is performed, _______________ are taken and ________________________ are done and include _________________ because __________________________

A

VS; clotting studies; PT, INR, aPTT; they could bleed when the needle is removed

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53
Q

Cirrhosis Diagnosis: How do you position the client getting a liver biopsy?

A

supine with right arm behind head

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54
Q

Cirrhosis Diagnosis: During liver biopsy, have the client exhale and ____________ to ____________________________

A

hold breath; get the diaphragm out of the way

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55
Q

Cirrhosis Diagnosis: After the liver biopsy, have the client _______________________ to __________________

A

lie on their right side; hold pressure

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56
Q

Cirrhosis Diagnosis: After liver biopsy, take ________________ and watch for signs of ____________________

A

VS; hemorrhage

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57
Q

Cirrhosis: Treatment includes

A

-antacids, vitamins, diuretics|-NO more alcohol|-I&O and daily weights|-rest|-prevent bleeding (bleeding precautions)|-measure abdominal girth|-paracentesis|-monitor jaundice|-avoid narcotics|-diet

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58
Q

Cirrhosis Treatment: Why no more alcohol?

A

it will only cause further damage

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59
Q

Cirrhosis Treatment: Why do we take I’s & O’s and daily weights?

A

anytime you have ascites, you have a fluid volume problem

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60
Q

Cirrhosis Treatment: Why do we need clients to rest?

A

toxins building up

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61
Q

Cirrhosis Treatment: Why do we measure abdominal girth?

A

ascites

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62
Q

Cirrhosis Treatment: What is a paracentesis?

A

removal of fluid from the peritoneal cavity (ascites)

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63
Q

Cirrhosis Treatment: Prior to paracentesis, have client ____________ to _______________ and position them _______________ and take __________

A

void; decrease bladder size; in any position where they’re sitting up; VS

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64
Q

Cirrhosis Treatment: Regarding paracentesis, we take VS because

A

with “shocky” clients, the BP goes down and the pulse goes up

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65
Q

Cirrhosis Treatment: Because of jaundice, clients will need

A

good skin care because their skin will itch from the jaundice

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66
Q

Cirrhosis Treatment: Clients need to avoid narcotics because

A

liver can’t metabolize drugs well when it’s sick (same as double dosing)

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67
Q

TESTING STRATEGY: NEVER give _______________________ to people with liver problems

A

acetaminophen (can’t break it down)

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68
Q

TESTING STRATEGY: Antidote for acetaminophen (Tylenol) overdose is

A

acetylcysteine (Mucomyst) (it should be mixed with a carbonated drink)

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69
Q

TESTING STRATEGY: When the spleen is enlarged,

A

the immune system is involved

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70
Q

TESTING STRATEGY: Anytime you are pulling fluids,

A

you can throw clients into shock

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71
Q

Cirrhosis Treatment: A diet for this client will be ___________ in protein to prevent _______________ and __________ in sodium to ___________________

A

low; increased ammonia; low; help with ascites

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72
Q

TESTING STRATEGY: If you give a liver client narcotics,

A

it’s the same thing as double dosing them

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73
Q

Protein breaks down to ________________ and the ____________ converts _____________ to ____________ and then the ______________ excrete the __________

A

ammonia; liver; ammonia; urea; kidneys; urea

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74
Q

Hepatic Coma: When the liver becomes impaired, it can’t make the conversion of protein to ammonia to urea so, ___________________ and causes ___________________

A

ammonia builds up in the blood; the LOC to decrease

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75
Q

Hepatic Coma: Signs/Symptoms include

A

-minor mental changes/motor problems|-difficult to awake|-asterixis|-handwriting changes|-decreased reflexes|-slow EEG|-fetor|-GI bleeds can occur

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76
Q

Hepatic Coma Signs/Symptoms: What is asterixis?

A

liver flap

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77
Q

Hepatic Coma Signs/Symptoms: What may be the first sign of a liver problem?

A

handwriting changes

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78
Q

Hepatic Coma Signs/Symptoms: Why do reflexes decrease?

A

ammonia acts like a sedative

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79
Q

Hepatic Coma Signs/Symptoms: What is fetor?

A

breath smells like ammonia (acetone or wine)

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80
Q

Hepatic Coma Signs/Symptoms: Anything that increases the ammonia level will

A

aggravate the problem

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81
Q

Hepatic Coma Signs/Symptoms: Blood is

A

protein

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82
Q

Hepatic Coma: Treatment includes

A

-lactulose|-enemas|-decrease protein in the diet|-monitor serum ammonia

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83
Q

Hepatic Coma Treatment: Lactulose does what?

A

decreases serum ammonia

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84
Q

Hepatic Coma Treatment: Why are enemas given?

A

to get blood out of the GI tract

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85
Q

Hepatic Coma Treatment: How often does serum ammonia need to be monitored?

A

every day

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86
Q

Bleeding Esophageal Varices: Think

A

hemorrhoids

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87
Q

Bleeding Esophageal Varices: High BP in the liver (portal HTN) forces

A

collateral circulation to form

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88
Q

Bleeding Esophageal Varices: The collateral circulation that forms as a result of portal HTN forms in 3 different places

A
  1. stomach|2. esophagus|3. rectum
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89
Q

Bleeding Esophageal Varices: When you see an alcoholic client that is GI bleeding, it usually ___________________________ and are usually no problem until ________________

A

esophageal varices; rupture

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90
Q

Bleeding Esophageal Varices: Treatment includes

A

-replace fluids/blood|-monitor VS|-monitor CVP|-oxygen|-octreotide (Sandostatin)|-endoscopic sclerotherapy|-esophageal variceal ligation (EVL)|-balloon tamponade|-enemas|-lactulose|-saline lavage

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91
Q

Bleeding Esophageal Varices Treatment: Anytime someone is anemic,

A

oxygen is needed

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92
Q

Bleeding Esophageal Varices Treatment: What does octreotide (Sandostatin) do?

A

lowers BP in the liver

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93
Q

Bleeding Esophageal Varices Treatment: What are the most common procedures used for esophageal varices?

A

-endoscopic sclerotherapy|-esophageal variceal ligation

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94
Q

Bleeding Esophageal Varices Treatment: Endoscopic sclerotherapy is when

A

the primary healthcare provider injects a sclerosing agent into the varices via an endoscope

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95
Q

Bleeding Esophageal Varices Treatment: Esophageal variceal ligation (EVL) is

A

a banding procedure

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96
Q

Bleeding Esophageal Varices Treatment: Type of balloon tamponade tube

A

Sengstaken-Blakemore tube

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97
Q

Bleeding Esophageal Varices Treatment: Balloon tamponade is

A

an infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage

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98
Q

Bleeding Esophageal Varices Treatment: Balloon tamponade should NOT be used

A

more than 12 hours

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99
Q

Bleeding Esophageal Varices Treatment: Many of the safety implications for the Blakemore tube can be

A

applied to other oropharnyx or nasopharynx tubes

100
Q

Bleeding Esophageal Varices Treatment: What is the purpose of a balloon tamponade?

A

to hold pressure on bleeding varices

101
Q

Bleeding Esophageal Varices Treatment: Saline lavage is used to

A

get blood out of stomach

102
Q

Peptic Ulcers: They are the common cause of

A

GI bleeding

103
Q

Peptic Ulcers: They can be in the

A

-esophagus|-stomach|-duodenum

104
Q

Peptic Ulcers: What is present?

A

erosion

105
Q

Peptic Ulcers: Signs/Symptoms include

A

-burning pain usually in the mid-epigastric | area/back (gnawing sensation or hungry feeling | sometimes)|-heartburn (dyspepsia)

106
Q

Peptic Ulcers: Diagnosis includes

A

-gastroscopy (EGD)|-upper GI

107
Q

Peptic Ulcers Diagnosis: Pre-gastroscopy (EGD), the patient needs to be

A

-NPO|-sedated

108
Q

Peptic Ulcers Diagnosis: With a gastroscopy (EGD), how long is the patient NPO?

A

until their gag reflex returns

109
Q

Peptic Ulcers Diagnosis: During a gastroscopy (EGD), watch for perforation by watching for

A

-pain|-bleeding|-trouble swallowing

110
Q

Peptic Ulcers Diagnosis: Upper GI looks at

A

the esophagus and stomach with dye

111
Q

Peptic Ulcers Diagnosis: With an upper GI the client needs to be

A

NPO past midnight

112
Q

Peptic Ulcers Diagnosis: With an upper GI, NO

A

-smoking|-chewing gum|-mints

113
Q

Peptic Ulcers Diagnosis: Regarding an upper GI, smoking ________________ stomach motility which will _____________

A

increases; affect the test

114
Q

Peptic Ulcers Diagnosis: Regarding an upper GI, smoking ____________________ stomach secretions, which will ________________________

A

increases; increase the chance of aspiration

115
Q

Peptic Ulcers: Treatment includes

A

-antacids|-proton pump inhibitors|-H2 antagonists|-GI cocktail|-antibiotics for H. pylori|-sucralfate (Carafate)

116
Q

Peptic Ulcers Treatment: What form are the antacids given in and why?

A

liquid to coat stomach and protect ulcer

117
Q

Peptic Ulcers Treatment: When should antacids be given and why?

A

when the stomach is empty and at bedtime because when the stomach is empty acid can get on the ulcer so the antacid is taken when the stomach is empty to protect the ulcer

118
Q

Peptic Ulcers Treatment: Examples of proton pump inhibitors given

A

-pantoprazole (Protonix)|-esomeprazole (Nexium)|-omeprazole (Prilosec)|-lansoprazole (Prevacid)

119
Q

Peptic Ulcers Treatment: Examples of H2 antagonists given

A

-ranitidine (Zantac)|-famotidine (Pepcid)

120
Q

Peptic Ulcers Treatment: What is in a GI cocktail?

A

-donnatal|-viscous lidocaine|-Mylanta II

121
Q

Peptic Ulcers Treatment: Antibiotics for H. pylori include

A

-clarithromycin (Biaxin)|-amoxicillin (Amoxil)|-tetracycline (Panmycin)|-metronidazole (Flagyl)

122
Q

Peptic Ulcers Treatment: What does sucralfate (Carafate) do?

A

forms a barrier over the wound so acid can’t get on the ulcer

123
Q

Peptic Ulcers: Client teaching includes

A

-decrease stress|-stop smoking|-eat what you can tolerate|-need follow-up

124
Q

Peptic Ulcers Client Teaching: What foods should the client avoid?

A

-temperature extremes|-extra spicy foods|-caffeine (irritant)

125
Q

Peptic Ulcers Client Teaching: How long do they need a follow-up?

A

for 1 year

126
Q

Peptic Ulcers: Classifications

A

-gastric ulcers|-duodenal ulcers

127
Q

Peptic Ulcers Classifications - Gastric Ulcers: These patients appear

A

malnourished

128
Q

Peptic Ulcers Classifications - Gastric Ulcers: Pain is usually when?

A

half hour to 1 hour after meals

129
Q

Peptic Ulcers Classifications - Gastric Ulcers: Food __________________, but _________________ does

A

doesn’t help; vomiting

130
Q

Peptic Ulcers Classifications - Gastric Ulcers: What do these patient vomit?

A

blood

131
Q

Peptic Ulcers Classifications - Gastric Ulcers: What happens to the weight of these patients?

A

it decreases

132
Q

Peptic Ulcers Classifications - Duodenal Ulcers: These patients appear

A

well-nourished

133
Q

Peptic Ulcers Classifications - Duodenal Ulcers: When does pain occur?

A

nighttime pain is common and also occurs 2-3 hours after meals

134
Q

Peptic Ulcers Classifications - Duodenal Ulcers: What does food do?

A

it helps

135
Q

Peptic Ulcers Classifications - Duodenal Ulcers: There is blood in

A

stools

136
Q

Peptic Ulcers Classifications - Duodenal Ulcers: What happens to the weight of these patients?

A

it increases

137
Q

Hiatal Hernia: This is when

A

the hole in the diaphragm is too large, so the stomach moves up into the thoracic cavity

138
Q

Hiatal Hernia: Common cause is ________________ so ______________

A

a large abdomen; lose weight if overweight

139
Q

Hiatal Hernia: Other causes include

A

-congenital abnormalities|-trauma|-straining

140
Q

Hiatal Hernia: Signs/Symptoms include

A

-heartburn|-fullness after eating|-regurgitation|-dysphagia

141
Q

Hiatal Hernia: Treatment includes

A

-small frequent meals|-sit up 1 hour after eating|-elevate HOB|-surgery|-teach lifestyle changes and healthy diet

142
Q

Hiatal Hernia Treatment: We elevate the HOB and have the client sit up 1 hour after eating in order to

A

keep the stomach in the down position

143
Q

Dumping Syndrome: This is when

A

the stomach empties too quickly after eating and the client experiences many uncomfortable to severe side effects

144
Q

Dumping Syndrome: This is usually secondary to

A

-gastric bypass|-gastrestomy|-gallbladder disease

145
Q

Dumping Syndrome: Signs/Symptoms include

A

-fullness|-weakness|-palpitations|-cramping|-fainting|-diarrhea

146
Q

Dumping Syndrome: Treatment includes

A

-semi-recumbent with meals|-lie down after meals on L side|-no fluids with meals|-small and frequent meals rather than large|-avoid foods high in carbs and electrolytes

147
Q

Dumping Syndrome Treatment: When should the client drink fluids?

A

in between meals

148
Q

Dumping Syndrome Treatment: Why should the client avoid foods high in carbs and electrolytes?

A

because carbs and electrolytes empty fast

149
Q

TESTING STRATEGY: Left side lying = _______________________ and right side lying = ________________________

A

leaves it in; releases it

150
Q

Inflammatory Bowel Disease (IBD): Ulcerative Colitis is

A

ulcerative IBD JUST in the large intestine

151
Q

Inflammatory Bowel Disease (IBD): Crohn’s Disease is also called

A

regional enteritis

152
Q

Inflammatory Bowel Disease (IBD): Crohn’s Disease is

A

inflammation and erosion of the ileum (small intestines), but it can be found anywhere in the small or large intestines

153
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Signs/Symptoms are

A

-diarrhea|-rectal bleeding|-vomiting|-weight loss|-cramping|-dehydration|-blood in stools|-anemia|-rebound tenderness|-fever

154
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What is rebound tenderness?

A

when you push in and let go and then it hurts

155
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What does rebound tenderness indicate?

A

peritoneal inflammation

156
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Diagnosis using

A

-CT scan or MRI|-colonoscopy|-barium enema

157
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What is the most common test for diagnosing?

A

colonoscopy

158
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Client needs to be on a ___________________ diet for ______________ and also needs to be __________ for ___________________before colonoscopy

A

clear liquid; 12-24 hours; NPO; 6-8 hours

159
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: The client needs to avoid _____________ for ___________________ after colonoscopy because __________________

A

NSAIDS; several days; they could bleed

160
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Regarding colonoscopy, laxatives or enemas until

A

clear (not everyone can tolerate)

161
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What is given in addition to colonoscopy procedure?

A

polyethylene glycol (Go-Lytely)

162
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: To help your client drink a colon prep more easily, get it

A

icy cold

163
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: The client will be _______________________ for a colonoscopy

A

sedated

164
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Post colonoscopy, we need to watch for

A

perforation

165
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: The signs of perforation post colonoscopy are

A

-pain|-unusual discomfort

166
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: A barium enema is used for

A

BE or lower GI series

167
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: A barium enema is done if

A

colonoscopy is incomplete

168
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Treatment includes

A

-diet modifications|-medications|-surgery

169
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Diet should be __________ residue because we’re trying to _____________________________

A

low; limit GI motility to help save fluid

170
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Clients need to avoid ______________ foods and ______________ because they can _______________________

A

cold; smoking; increase motility

171
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Medications include

A

-antibiotics|-steroids|-biologics and immunomodulators|-aminosalicylates

172
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Steroids are used to

A

decrease inflammation

173
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Biologics interfere with the

A

immune response

174
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Examples of biologics used are

A

-infliximab (Remicade)|-adalimumab (Humira)

175
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Aminosalicylates used include

A

-sulfasalazine (Azulfidine)|-mesalamine (Asacol)

176
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Surgery for ulcerative colitis

A

-total colectomy|-Kock’s ileostomy or ileal pouch anal anastomosis | (IPAA)

177
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: Total colectomy is also known as _____________________ and it is when an ______________________________

A

proctocolectomy; ileostomy is formed

178
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: With a Kock’s ileostomy and an IPAA, there is NO

A

external bag

179
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: A Kock’s pouch has a ______________ that opens and closes to ________________________ using a catheter to empty

A

nipple valve; empty intestines

180
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: The IPAA procedure does what?

A

removes the colon and attaches the ileum to the rectum (take out the sick part & hook everything back up normally)

181
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: Which surgical procedure is most popular?

A

the IPAA

182
Q

Inflammatory Bowel Disease (IBD) - Crohn’s Disease: We try not to do

A

surgery

183
Q

Inflammatory Bowel Disease (IBD) - Crohn’s Disease: With surgery, remove only

A

the affected side

184
Q

Inflammatory Bowel Disease (IBD) - Crohn’s Disease: The client may end up with an ____________________ or a ____________________; it just depends ____________________

A

ileostomy; colostomy; on the area affected

185
Q

Inflammatory Bowel Disease (IBD) - Crohn’s Disease: An ostomy in the ileum is called an ________________________ and an ostomy in the colon is called a _______________________

A

ileostomy; colostomy

186
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op ileostomy care, we don’t have to irrigate ileostomies because

A

it’s going to drain liquid all the time

187
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op ileostomy care, clients need to avoid foods that are

A

hard to digest and rough foods because they increase motility

188
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op ileostomy care, clients should drink _______________________ or a similare electrolyte replacement drink in the summer because these patients are always ____________________

A

Gatorade; a little dehydrated, especially in the summer from sweating

189
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op ileostomy care, these clients are always at risk for ________________________ because they are always ______________________

A

kidney stones; a little dehydrated

190
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What happens as waste moves through the colon?

A

water and nutrients are being absorbed and the stool is forming

191
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, if in the ascending and transverse, the stools will be

A

semi-liquid

192
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, if in the descending or sigmoid, stools will be

A

semi-formed or formed

193
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, with which colostomy locations would you irrigate?

A

descending and sigmoid

194
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, why irrigate?

A

for regularity

195
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, when is the best time to irrigate?

A

-same time everyday (training bowel to empty)|-after a meal (more peristalsis)

196
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, the further down the colon the stoma is, the more ____________________________ because ________________ is being drawn out so the stool is more ______________

A

formed the stool is; water; normal

197
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, when irrigating, use the same principles as if

A

administering an enema (don’t need to turn them on L side)

198
Q

Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, anytime you are giving an enema, if the client starts to cramp,

A

stop the fluid, lower the bag and/or check the temperature of the fluid (same principles for irrigating stoma)

199
Q

Appendicitis: This is

A

inflammation of the appendix

200
Q

Appendicitis: Can be caused from

A

eating low fiber and junk food all the time

201
Q

Appendicitis: If appendix ruptures and patient is waiting for surgery, put them in what position?

A

sitting up on right side

202
Q

TESTING STRATEGY: #1 thing to worry about is

A

rupture

203
Q

Appendicitis: Signs/Symptom include

A

-generalized pain initially|-rebound tenderness|-N/V|-anorexia|-abdominal pain FIRST, then N/V

204
Q

Appendicitis Signs/Symptoms: The generalized pain eventually localizes in the

A

right lower quadrant (McBurney’s point)

205
Q

Appendicitis Signs/Symptoms: We need to get a good history on these patients because

A

they have abdominal pain FIRST and then N/V

206
Q

Appendicitis: Diagnosis involves

A

-elevated WBC|-ultrasound|-CT

207
Q

Appendicitis Diagnosis: Why do we use an ultrasound to diagnose?

A

can visualize an enlarged appendix

208
Q

Appendicitis Diagnosis: Do NOT give ______________________ because we are worried about _______________

A

enemas or laxatives; perforation

209
Q

Appendicitis: Treatment involves

A

surgery

210
Q

Appendicitis Treatment: Most surgery is done via ___________________ unless ______________________

A

laprascopy; perforated

211
Q

Appendicitis Treatment: After abdominal surgery, what is the position of choice and why?

A

elevate HOB because it decreases pressure on abdominal & suture lines

212
Q

TESTING STRATEGY: Never want ________________ on a suture line

A

pressure

213
Q

Total Nutrient Admixture (TNA) is AKA

A

total parenteral nutrition (TPN) or parenteral nutrition (PN)

214
Q

Total Parenteral Nutrition (TPN): Keep ___________________

A

refrigerated

215
Q

Total Parenteral Nutrition (TPN): ___________ for administration

A

Warm

216
Q

Total Parenteral Nutrition (TPN): Let it sit out for a few minutes prior to

A

hanging

217
Q

Total Parenteral Nutrition (TPN): What is needed to administer TPN and why?

A

central line because TPN is packed with particles and will eat up veins

218
Q

Total Parenteral Nutrition (TPN): What is needed on the line administering TPN?

A

a filter

219
Q

Total Parenteral Nutrition (TPN): The TPN is a ____________________ and therefore; _________________________

A

dedicated line; nothing else should go through this line

220
Q

Total Parenteral Nutrition (TPN): Discontinue _____________________ to avoid hypoglycemia

A

gradually

221
Q

Total Parenteral Nutrition (TPN): Take the client’s _______________ daily

A

weight

222
Q

Total Parenteral Nutrition (TPN): The client may have to start taking

A

insulin

223
Q

Total Parenteral Nutrition (TPN): These patients need blood glucose monitoring every

A

6 hours

224
Q

Total Parenteral Nutrition (TPN): Clients’ urine needs to be checked for

A

ketones and glucose

225
Q

Total Parenteral Nutrition (TPN): Why do these patients need their urine checked for ketone and glucose?

A

because if there are ketones it means they need more glucose cause they’re breaking down fat and if there is glucose they need insulin

226
Q

Total Parenteral Nutrition (TPN): Do NOT _______________ because the mixture is ________________________________ according to electrolytes

A

mix ahead; adjusted

227
Q

Total Parenteral Nutrition (TPN): Can only be hung for

A

24 hours

228
Q

Total Parenteral Nutrition (TPN): Change _________________ with each new bag

A

tubing

229
Q

Total Parenteral Nutrition (TPN): IV bag may be _____________________ to prevent chemical breakdown

A

covered with a dark bag

230
Q

Total Parenteral Nutrition (TPN): Needs to be on

A

a pump

231
Q

Total Parenteral Nutrition (TPN): With home TPN, emphasize

A

hand washing

232
Q

Total Parenteral Nutrition (TPN): Most frequent complication is

A

infection

233
Q

TESTING STRATEGY: Protein can’t leak through the glomerulus UNLESS

A

there is kidney damage (there should be NO protein in urine)

234
Q

Total Parenteral Nutrition (TPN): Clients requiring long-term enteral nutrition may require a

A

percutaneous feeding tube

235
Q

Total Parenteral Nutrition (TPN): A percutaneous feeding tube allows feeding to be

A

placed directly into the stomach

236
Q

Total Parenteral Nutrition (TPN): Initial insertion of a percutaneous feeding tube is performed by a __________________________ and requires the nurse to perform ________________________

A

gastroenterologist; standard post-op observations

237
Q

Total Parenteral Nutrition (TPN): Standard post-op observations involving insertion of a percutaneous feeding tube include

A

-bedrest x 6 hours|-VS with temperature|-LOC|-bleeding|-abdominal pain

238
Q

Total Parenteral Nutrition (TPN): Post-op care of a percutaneous feeding tube involves

A

-assess and clean site daily|-observing for tube deterioration|-observing for drainage|-observing for s/s of infection

239
Q

Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: Have ________________ available for ___________

A

saline; flush

240
Q

Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: Do NOT start fluids until

A

positive confirmation of placement by CXR

241
Q

Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: What position should the client be in and why?

A

Trendelenburg to distend veins

242
Q

Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: If air gets in the line what position do you put the client in?

A

left side, Trendelenburg

243
Q

Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: When an air embolus is suspected in the heart, the client may be

A

taken to the cath lab for removal of the air

244
Q

Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: When you are changing the tubing, how can you avoid getting air in the line?

A

-clamp it off|-Valsalva|-take a deep breath and HUMMMMMMMMM

245
Q

Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: Why is an x-ray done post-insertion?

A

-check for placement|-make sure client does not have a pneumothorax

246
Q

Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: When taking out a central line, client needs to _____________________ and then __________________________

A

lie flat and Valsalva to prevent air; cover with an occlusive dressing

NCLEX (4 decks)

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