GI Flashcards
Pancreatitis: This is
auto-digestion of the pancreas
Pancreatitis: The pancreas has 2 separate functions
- endocrine (insulin)|2. exocrine (digestive enzymes)
Pancreatitis: There are 2 types of pancreatitis
- acute|2. chronic
Pancreatitis: What is the #1 cause?
gallbladder disease
Pancreatitis: What is the #2 cause and why?
alcohol because it causes scar tissue to build up
Pancreatitis: Signs/Symptoms
-pain|-abdominal distention/ascites|-abdominal mass|-rigid/board-like abdomen (with guarding)|-Cullen’s sign|-Grey-Turner’s sign|-fever|-N/V|-jaundice|-hypotension
Pancreatitis Signs/Symptoms: Pain increases with
eating
Pancreatitis Signs/Symptoms: Abdominal distention and ascites occur because
losing protein rich fluids like enzymes and blood into the abdomen which lead to ascites
Pancreatitis Signs/Symptoms: Why would there be an abdominal mass?
because the pancreas is swollen
Pancreatitis Signs/Symptoms: What does it mean when the client has a rigid, board-like abdomen (with guarding)?
bleeding that can lead to peritonitis
Pancreatitis Signs/Symptoms: What is Cullen’s sign?
bruising around the umbilical area
Pancreatitis Signs/Symptoms: What is Grey-Turner’s sign?
bruising in the flank area
Pancreatitis Signs/Symptoms: Why does fever occur?
inflammation
Pancreatitis Signs/Symptoms: Why would jaundice occur?
liver involvement
Pancreatitis Signs/Symptoms: Why would hypotension occur?
bleeding or ascites
Pancreatitis Diagnosis: Labs will show
-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
Pancreatitis Diagnosis: What are the most specific diagnostic labs and why?
serum lipase and amylase because they aren’t being used so they go to the blood
Pancreatitis Diagnosis: Why would the serum bilirubin be increased?
the liver is affected
Pancreatitis Diagnosis: Why would the hemoglobin and hematocrit be increased?
dehydration
Pancreatitis Diagnosis: Why would the hemoglobin and hematocrit be decreased?
bleeding
Pancreatitis Diagnosis: Normal amylase values
30-220 U/L (SI)
Pancreatitis Diagnosis: Normal lipase values
0-160 U/L (SI)
Pancreatitis Diagnosis: Normal AST values
0-35 U/L (SI)
Pancreatitis Diagnosis: Normal ALT values
10-36 U/L (SI)
Pancreatitis Diagnosis: Normal hemoglobin values
Male: 14-18 g/dL|Female: 12-16 g/dL
Pancreatitis Diagnosis: Normal hematocrit values
Male: 42-52%|Female: 37-47%
Pancreatitis: Treatment Includes
-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
Pancreatitis Treatment: Goal is to
control pain
Pancreatitis Treatment: To control pain we want to
decrease gastric secretions
Pancreatitis Treatment: How do we decrease gastric secretions and why?
-NPO|-NGT to suction|-bed rest||We want the stomach EMPTY and DRY
TESTING STRATEGY: Client with pancreatitis =
keep stomach empty and dry
Pancreatitis Treatment: Pain medications include
-PCA narcotics|-fentanyl patches (Duragesic)
Pancreatitis Treatment: PCA narcotics include
-morphine sulfate (Morphine)|-hydromorphone (Dilaudid)
Pancreatitis Treatment: Why do we give anticholinergics?
dry them up
Pancreatitis Treatment: Anticholinergics include
-benztropine (Cogentin)|-diphenoxylate/atropine (Lonox)
Pancreatitis Treatment: GI Protectants include
-proton pump inhibitors|-H2 receptor antagonists|-antacids
Pancreatitis Treatment: Proton pump inhibitor given
pantoprazole (Protonix)
Pancreatitis Treatment: H2 receptor antagonists
-ranitidine HCl (Zantac)|-famotidine (Pepcid)|-cimetadine (Tagamet)
Pancreatitis Treatment: We need to maintain client’s nutritional status by
easing them into a diet
Pancreatitis Treatment: Why do we give insulin?
because the pancreas is sick and the patient is receiving TPN
TESTING STRATEGY: If your liver is sick, your #1 concern is
bleeding
TESTING STRATEGY: If your liver is sick, ________________ the dose of medications
decrease
Cirrhosis: 4 major functions of the liver
- detoxify the body|2. helps your blood to clot|3. the liver helps to metabolize (break down) drugs|4. the liver synthesizes albumin
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 _____________________________
destroyed; replaced with connective/scar tissue; blood flow; BP; up; portal hypertension
Cirrhosis: Signs/Symptoms include
-firm, nodular liver|-abdominal pain|-chronic dyspepsia|-change in bowel habits|-ascites|-splenomegaly|-decreased serum albumin|-increased ALT and AST|-anemia
Cirrhosis Signs/Symptoms: Why is there abdominal pain?
liver capsule has stretched
Cirrhosis Signs/Symptoms: What is chronic dyspepsia?
GI upset
Cirrhosis Signs/Symptoms: Why is there anemia?
bleeding
Cirrhosis Signs/Symptoms: Liver cirrhosis can progress to
hepatic encephalopathy/coma
Cirrhosis Signs/Symptoms: Why can liver cirrhosis progress to hepatic encephalopathy/coma?
because ammonia builds up in blood and acts as a sedative leading to coma
Cirrhosis: Diagnosis using
-ultrasound|-CT|-MRI|-liver biopsy (confirms diagnosis)
Cirrhosis Diagnosis: Before liver biopsy is performed, _______________ are taken and ________________________ are done and include _________________ because __________________________
VS; clotting studies; PT, INR, aPTT; they could bleed when the needle is removed
Cirrhosis Diagnosis: How do you position the client getting a liver biopsy?
supine with right arm behind head
Cirrhosis Diagnosis: During liver biopsy, have the client exhale and ____________ to ____________________________
hold breath; get the diaphragm out of the way
Cirrhosis Diagnosis: After the liver biopsy, have the client _______________________ to __________________
lie on their right side; hold pressure
Cirrhosis Diagnosis: After liver biopsy, take ________________ and watch for signs of ____________________
VS; hemorrhage
Cirrhosis: Treatment includes
-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
Cirrhosis Treatment: Why no more alcohol?
it will only cause further damage
Cirrhosis Treatment: Why do we take I’s & O’s and daily weights?
anytime you have ascites, you have a fluid volume problem
Cirrhosis Treatment: Why do we need clients to rest?
toxins building up
Cirrhosis Treatment: Why do we measure abdominal girth?
ascites
Cirrhosis Treatment: What is a paracentesis?
removal of fluid from the peritoneal cavity (ascites)
Cirrhosis Treatment: Prior to paracentesis, have client ____________ to _______________ and position them _______________ and take __________
void; decrease bladder size; in any position where they’re sitting up; VS
Cirrhosis Treatment: Regarding paracentesis, we take VS because
with “shocky” clients, the BP goes down and the pulse goes up
Cirrhosis Treatment: Because of jaundice, clients will need
good skin care because their skin will itch from the jaundice
Cirrhosis Treatment: Clients need to avoid narcotics because
liver can’t metabolize drugs well when it’s sick (same as double dosing)
TESTING STRATEGY: NEVER give _______________________ to people with liver problems
acetaminophen (can’t break it down)
TESTING STRATEGY: Antidote for acetaminophen (Tylenol) overdose is
acetylcysteine (Mucomyst) (it should be mixed with a carbonated drink)
TESTING STRATEGY: When the spleen is enlarged,
the immune system is involved
TESTING STRATEGY: Anytime you are pulling fluids,
you can throw clients into shock
Cirrhosis Treatment: A diet for this client will be ___________ in protein to prevent _______________ and __________ in sodium to ___________________
low; increased ammonia; low; help with ascites
TESTING STRATEGY: If you give a liver client narcotics,
it’s the same thing as double dosing them
Protein breaks down to ________________ and the ____________ converts _____________ to ____________ and then the ______________ excrete the __________
ammonia; liver; ammonia; urea; kidneys; urea
Hepatic Coma: When the liver becomes impaired, it can’t make the conversion of protein to ammonia to urea so, ___________________ and causes ___________________
ammonia builds up in the blood; the LOC to decrease
Hepatic Coma: Signs/Symptoms include
-minor mental changes/motor problems|-difficult to awake|-asterixis|-handwriting changes|-decreased reflexes|-slow EEG|-fetor|-GI bleeds can occur
Hepatic Coma Signs/Symptoms: What is asterixis?
liver flap
Hepatic Coma Signs/Symptoms: What may be the first sign of a liver problem?
handwriting changes
Hepatic Coma Signs/Symptoms: Why do reflexes decrease?
ammonia acts like a sedative
Hepatic Coma Signs/Symptoms: What is fetor?
breath smells like ammonia (acetone or wine)
Hepatic Coma Signs/Symptoms: Anything that increases the ammonia level will
aggravate the problem
Hepatic Coma Signs/Symptoms: Blood is
protein
Hepatic Coma: Treatment includes
-lactulose|-enemas|-decrease protein in the diet|-monitor serum ammonia
Hepatic Coma Treatment: Lactulose does what?
decreases serum ammonia
Hepatic Coma Treatment: Why are enemas given?
to get blood out of the GI tract
Hepatic Coma Treatment: How often does serum ammonia need to be monitored?
every day
Bleeding Esophageal Varices: Think
hemorrhoids
Bleeding Esophageal Varices: High BP in the liver (portal HTN) forces
collateral circulation to form
Bleeding Esophageal Varices: The collateral circulation that forms as a result of portal HTN forms in 3 different places
- stomach|2. esophagus|3. rectum
Bleeding Esophageal Varices: When you see an alcoholic client that is GI bleeding, it usually ___________________________ and are usually no problem until ________________
esophageal varices; rupture
Bleeding Esophageal Varices: Treatment includes
-replace fluids/blood|-monitor VS|-monitor CVP|-oxygen|-octreotide (Sandostatin)|-endoscopic sclerotherapy|-esophageal variceal ligation (EVL)|-balloon tamponade|-enemas|-lactulose|-saline lavage
Bleeding Esophageal Varices Treatment: Anytime someone is anemic,
oxygen is needed
Bleeding Esophageal Varices Treatment: What does octreotide (Sandostatin) do?
lowers BP in the liver
Bleeding Esophageal Varices Treatment: What are the most common procedures used for esophageal varices?
-endoscopic sclerotherapy|-esophageal variceal ligation
Bleeding Esophageal Varices Treatment: Endoscopic sclerotherapy is when
the primary healthcare provider injects a sclerosing agent into the varices via an endoscope
Bleeding Esophageal Varices Treatment: Esophageal variceal ligation (EVL) is
a banding procedure
Bleeding Esophageal Varices Treatment: Type of balloon tamponade tube
Sengstaken-Blakemore tube
Bleeding Esophageal Varices Treatment: Balloon tamponade is
an infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage
Bleeding Esophageal Varices Treatment: Balloon tamponade should NOT be used
more than 12 hours
Bleeding Esophageal Varices Treatment: Many of the safety implications for the Blakemore tube can be
applied to other oropharnyx or nasopharynx tubes
Bleeding Esophageal Varices Treatment: What is the purpose of a balloon tamponade?
to hold pressure on bleeding varices
Bleeding Esophageal Varices Treatment: Saline lavage is used to
get blood out of stomach
Peptic Ulcers: They are the common cause of
GI bleeding
Peptic Ulcers: They can be in the
-esophagus|-stomach|-duodenum
Peptic Ulcers: What is present?
erosion
Peptic Ulcers: Signs/Symptoms include
-burning pain usually in the mid-epigastric | area/back (gnawing sensation or hungry feeling | sometimes)|-heartburn (dyspepsia)
Peptic Ulcers: Diagnosis includes
-gastroscopy (EGD)|-upper GI
Peptic Ulcers Diagnosis: Pre-gastroscopy (EGD), the patient needs to be
-NPO|-sedated
Peptic Ulcers Diagnosis: With a gastroscopy (EGD), how long is the patient NPO?
until their gag reflex returns
Peptic Ulcers Diagnosis: During a gastroscopy (EGD), watch for perforation by watching for
-pain|-bleeding|-trouble swallowing
Peptic Ulcers Diagnosis: Upper GI looks at
the esophagus and stomach with dye
Peptic Ulcers Diagnosis: With an upper GI the client needs to be
NPO past midnight
Peptic Ulcers Diagnosis: With an upper GI, NO
-smoking|-chewing gum|-mints
Peptic Ulcers Diagnosis: Regarding an upper GI, smoking ________________ stomach motility which will _____________
increases; affect the test
Peptic Ulcers Diagnosis: Regarding an upper GI, smoking ____________________ stomach secretions, which will ________________________
increases; increase the chance of aspiration
Peptic Ulcers: Treatment includes
-antacids|-proton pump inhibitors|-H2 antagonists|-GI cocktail|-antibiotics for H. pylori|-sucralfate (Carafate)
Peptic Ulcers Treatment: What form are the antacids given in and why?
liquid to coat stomach and protect ulcer
Peptic Ulcers Treatment: When should antacids be given and why?
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
Peptic Ulcers Treatment: Examples of proton pump inhibitors given
-pantoprazole (Protonix)|-esomeprazole (Nexium)|-omeprazole (Prilosec)|-lansoprazole (Prevacid)
Peptic Ulcers Treatment: Examples of H2 antagonists given
-ranitidine (Zantac)|-famotidine (Pepcid)
Peptic Ulcers Treatment: What is in a GI cocktail?
-donnatal|-viscous lidocaine|-Mylanta II
Peptic Ulcers Treatment: Antibiotics for H. pylori include
-clarithromycin (Biaxin)|-amoxicillin (Amoxil)|-tetracycline (Panmycin)|-metronidazole (Flagyl)
Peptic Ulcers Treatment: What does sucralfate (Carafate) do?
forms a barrier over the wound so acid can’t get on the ulcer
Peptic Ulcers: Client teaching includes
-decrease stress|-stop smoking|-eat what you can tolerate|-need follow-up
Peptic Ulcers Client Teaching: What foods should the client avoid?
-temperature extremes|-extra spicy foods|-caffeine (irritant)
Peptic Ulcers Client Teaching: How long do they need a follow-up?
for 1 year
Peptic Ulcers: Classifications
-gastric ulcers|-duodenal ulcers
Peptic Ulcers Classifications - Gastric Ulcers: These patients appear
malnourished
Peptic Ulcers Classifications - Gastric Ulcers: Pain is usually when?
half hour to 1 hour after meals
Peptic Ulcers Classifications - Gastric Ulcers: Food __________________, but _________________ does
doesn’t help; vomiting
Peptic Ulcers Classifications - Gastric Ulcers: What do these patient vomit?
blood
Peptic Ulcers Classifications - Gastric Ulcers: What happens to the weight of these patients?
it decreases
Peptic Ulcers Classifications - Duodenal Ulcers: These patients appear
well-nourished
Peptic Ulcers Classifications - Duodenal Ulcers: When does pain occur?
nighttime pain is common and also occurs 2-3 hours after meals
Peptic Ulcers Classifications - Duodenal Ulcers: What does food do?
it helps
Peptic Ulcers Classifications - Duodenal Ulcers: There is blood in
stools
Peptic Ulcers Classifications - Duodenal Ulcers: What happens to the weight of these patients?
it increases
Hiatal Hernia: This is when
the hole in the diaphragm is too large, so the stomach moves up into the thoracic cavity
Hiatal Hernia: Common cause is ________________ so ______________
a large abdomen; lose weight if overweight
Hiatal Hernia: Other causes include
-congenital abnormalities|-trauma|-straining
Hiatal Hernia: Signs/Symptoms include
-heartburn|-fullness after eating|-regurgitation|-dysphagia
Hiatal Hernia: Treatment includes
-small frequent meals|-sit up 1 hour after eating|-elevate HOB|-surgery|-teach lifestyle changes and healthy diet
Hiatal Hernia Treatment: We elevate the HOB and have the client sit up 1 hour after eating in order to
keep the stomach in the down position
Dumping Syndrome: This is when
the stomach empties too quickly after eating and the client experiences many uncomfortable to severe side effects
Dumping Syndrome: This is usually secondary to
-gastric bypass|-gastrestomy|-gallbladder disease
Dumping Syndrome: Signs/Symptoms include
-fullness|-weakness|-palpitations|-cramping|-fainting|-diarrhea
Dumping Syndrome: Treatment includes
-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
Dumping Syndrome Treatment: When should the client drink fluids?
in between meals
Dumping Syndrome Treatment: Why should the client avoid foods high in carbs and electrolytes?
because carbs and electrolytes empty fast
TESTING STRATEGY: Left side lying = _______________________ and right side lying = ________________________
leaves it in; releases it
Inflammatory Bowel Disease (IBD): Ulcerative Colitis is
ulcerative IBD JUST in the large intestine
Inflammatory Bowel Disease (IBD): Crohn’s Disease is also called
regional enteritis
Inflammatory Bowel Disease (IBD): Crohn’s Disease is
inflammation and erosion of the ileum (small intestines), but it can be found anywhere in the small or large intestines
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Signs/Symptoms are
-diarrhea|-rectal bleeding|-vomiting|-weight loss|-cramping|-dehydration|-blood in stools|-anemia|-rebound tenderness|-fever
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What is rebound tenderness?
when you push in and let go and then it hurts
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What does rebound tenderness indicate?
peritoneal inflammation
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Diagnosis using
-CT scan or MRI|-colonoscopy|-barium enema
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What is the most common test for diagnosing?
colonoscopy
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
clear liquid; 12-24 hours; NPO; 6-8 hours
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: The client needs to avoid _____________ for ___________________ after colonoscopy because __________________
NSAIDS; several days; they could bleed
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Regarding colonoscopy, laxatives or enemas until
clear (not everyone can tolerate)
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What is given in addition to colonoscopy procedure?
polyethylene glycol (Go-Lytely)
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: To help your client drink a colon prep more easily, get it
icy cold
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: The client will be _______________________ for a colonoscopy
sedated
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Post colonoscopy, we need to watch for
perforation
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: The signs of perforation post colonoscopy are
-pain|-unusual discomfort
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: A barium enema is used for
BE or lower GI series
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: A barium enema is done if
colonoscopy is incomplete
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Treatment includes
-diet modifications|-medications|-surgery
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Diet should be __________ residue because we’re trying to _____________________________
low; limit GI motility to help save fluid
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Clients need to avoid ______________ foods and ______________ because they can _______________________
cold; smoking; increase motility
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Medications include
-antibiotics|-steroids|-biologics and immunomodulators|-aminosalicylates
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Steroids are used to
decrease inflammation
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Biologics interfere with the
immune response
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Examples of biologics used are
-infliximab (Remicade)|-adalimumab (Humira)
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Aminosalicylates used include
-sulfasalazine (Azulfidine)|-mesalamine (Asacol)
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: Surgery for ulcerative colitis
-total colectomy|-Kock’s ileostomy or ileal pouch anal anastomosis | (IPAA)
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: Total colectomy is also known as _____________________ and it is when an ______________________________
proctocolectomy; ileostomy is formed
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: With a Kock’s ileostomy and an IPAA, there is NO
external bag
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: A Kock’s pouch has a ______________ that opens and closes to ________________________ using a catheter to empty
nipple valve; empty intestines
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: The IPAA procedure does what?
removes the colon and attaches the ileum to the rectum (take out the sick part & hook everything back up normally)
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis: Which surgical procedure is most popular?
the IPAA
Inflammatory Bowel Disease (IBD) - Crohn’s Disease: We try not to do
surgery
Inflammatory Bowel Disease (IBD) - Crohn’s Disease: With surgery, remove only
the affected side
Inflammatory Bowel Disease (IBD) - Crohn’s Disease: The client may end up with an ____________________ or a ____________________; it just depends ____________________
ileostomy; colostomy; on the area affected
Inflammatory Bowel Disease (IBD) - Crohn’s Disease: An ostomy in the ileum is called an ________________________ and an ostomy in the colon is called a _______________________
ileostomy; colostomy
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op ileostomy care, we don’t have to irrigate ileostomies because
it’s going to drain liquid all the time
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op ileostomy care, clients need to avoid foods that are
hard to digest and rough foods because they increase motility
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 ____________________
Gatorade; a little dehydrated, especially in the summer from sweating
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 ______________________
kidney stones; a little dehydrated
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: What happens as waste moves through the colon?
water and nutrients are being absorbed and the stool is forming
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, if in the ascending and transverse, the stools will be
semi-liquid
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, if in the descending or sigmoid, stools will be
semi-formed or formed
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, with which colostomy locations would you irrigate?
descending and sigmoid
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, why irrigate?
for regularity
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, when is the best time to irrigate?
-same time everyday (training bowel to empty)|-after a meal (more peristalsis)
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 ______________
formed the stool is; water; normal
Inflammatory Bowel Disease (IBD) - Ulcerative Colitis & Crohn’s Disease: With post op colostomy care, when irrigating, use the same principles as if
administering an enema (don’t need to turn them on L side)
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,
stop the fluid, lower the bag and/or check the temperature of the fluid (same principles for irrigating stoma)
Appendicitis: This is
inflammation of the appendix
Appendicitis: Can be caused from
eating low fiber and junk food all the time
Appendicitis: If appendix ruptures and patient is waiting for surgery, put them in what position?
sitting up on right side
TESTING STRATEGY: #1 thing to worry about is
rupture
Appendicitis: Signs/Symptom include
-generalized pain initially|-rebound tenderness|-N/V|-anorexia|-abdominal pain FIRST, then N/V
Appendicitis Signs/Symptoms: The generalized pain eventually localizes in the
right lower quadrant (McBurney’s point)
Appendicitis Signs/Symptoms: We need to get a good history on these patients because
they have abdominal pain FIRST and then N/V
Appendicitis: Diagnosis involves
-elevated WBC|-ultrasound|-CT
Appendicitis Diagnosis: Why do we use an ultrasound to diagnose?
can visualize an enlarged appendix
Appendicitis Diagnosis: Do NOT give ______________________ because we are worried about _______________
enemas or laxatives; perforation
Appendicitis: Treatment involves
surgery
Appendicitis Treatment: Most surgery is done via ___________________ unless ______________________
laprascopy; perforated
Appendicitis Treatment: After abdominal surgery, what is the position of choice and why?
elevate HOB because it decreases pressure on abdominal & suture lines
TESTING STRATEGY: Never want ________________ on a suture line
pressure
Total Nutrient Admixture (TNA) is AKA
total parenteral nutrition (TPN) or parenteral nutrition (PN)
Total Parenteral Nutrition (TPN): Keep ___________________
refrigerated
Total Parenteral Nutrition (TPN): ___________ for administration
Warm
Total Parenteral Nutrition (TPN): Let it sit out for a few minutes prior to
hanging
Total Parenteral Nutrition (TPN): What is needed to administer TPN and why?
central line because TPN is packed with particles and will eat up veins
Total Parenteral Nutrition (TPN): What is needed on the line administering TPN?
a filter
Total Parenteral Nutrition (TPN): The TPN is a ____________________ and therefore; _________________________
dedicated line; nothing else should go through this line
Total Parenteral Nutrition (TPN): Discontinue _____________________ to avoid hypoglycemia
gradually
Total Parenteral Nutrition (TPN): Take the client’s _______________ daily
weight
Total Parenteral Nutrition (TPN): The client may have to start taking
insulin
Total Parenteral Nutrition (TPN): These patients need blood glucose monitoring every
6 hours
Total Parenteral Nutrition (TPN): Clients’ urine needs to be checked for
ketones and glucose
Total Parenteral Nutrition (TPN): Why do these patients need their urine checked for ketone and glucose?
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
Total Parenteral Nutrition (TPN): Do NOT _______________ because the mixture is ________________________________ according to electrolytes
mix ahead; adjusted
Total Parenteral Nutrition (TPN): Can only be hung for
24 hours
Total Parenteral Nutrition (TPN): Change _________________ with each new bag
tubing
Total Parenteral Nutrition (TPN): IV bag may be _____________________ to prevent chemical breakdown
covered with a dark bag
Total Parenteral Nutrition (TPN): Needs to be on
a pump
Total Parenteral Nutrition (TPN): With home TPN, emphasize
hand washing
Total Parenteral Nutrition (TPN): Most frequent complication is
infection
TESTING STRATEGY: Protein can’t leak through the glomerulus UNLESS
there is kidney damage (there should be NO protein in urine)
Total Parenteral Nutrition (TPN): Clients requiring long-term enteral nutrition may require a
percutaneous feeding tube
Total Parenteral Nutrition (TPN): A percutaneous feeding tube allows feeding to be
placed directly into the stomach
Total Parenteral Nutrition (TPN): Initial insertion of a percutaneous feeding tube is performed by a __________________________ and requires the nurse to perform ________________________
gastroenterologist; standard post-op observations
Total Parenteral Nutrition (TPN): Standard post-op observations involving insertion of a percutaneous feeding tube include
-bedrest x 6 hours|-VS with temperature|-LOC|-bleeding|-abdominal pain
Total Parenteral Nutrition (TPN): Post-op care of a percutaneous feeding tube involves
-assess and clean site daily|-observing for tube deterioration|-observing for drainage|-observing for s/s of infection
Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: Have ________________ available for ___________
saline; flush
Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: Do NOT start fluids until
positive confirmation of placement by CXR
Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: What position should the client be in and why?
Trendelenburg to distend veins
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?
left side, Trendelenburg
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
taken to the cath lab for removal of the air
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?
-clamp it off|-Valsalva|-take a deep breath and HUMMMMMMMMM
Total Parenteral Nutrition (TPN) - Assisting the Primary Healthcare Provider to Insert a Central Line: Why is an x-ray done post-insertion?
-check for placement|-make sure client does not have a pneumothorax
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 __________________________
lie flat and Valsalva to prevent air; cover with an occlusive dressing
