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Adult 1 Test 3 > GI > Flashcards

GI Flashcards

1
Q

What is parenteral nutrition?

A

Administration of nutrients by route other than GI tract (i.e., bloodstream)

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2
Q

Storage and labelling of parenteral nutrition includes?

A

Must be refrigerated until 30 minutes before use; made daily, only good for 24 hours

Must be labeled with nutrient content, all additives, time mixed, and date and time of expiration

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3
Q

What are common indicators for PN?

A
  1. Chronic severe diarrhea and vomiting
  2. Complicated surgery or trauma
  3. GI obstruction
  4. GI tract anomalies and fistulae
  5. Intractable diarrhea
  6. Severe anorexia nervosa
  7. Severe malabsorption
  8. Short bowel syndrome - Occurs when a patient has a problematic portion of bowel cut out, and problems reoccur a few years later. Pt has more cut out, and it again occurs later on. Repeating.
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4
Q

What are common metabolic problems associated with PN?

A
  1. Altered renal function
  2. Essential fatty acid deficiency
  3. Hyperglycemia, hypoglycemia - Check blood glucose via finger blood stick q4-6hrs
  4. Hyperlipidemia
  5. Liver dysfunction
  6. Refeeding syndrome - Electrolyte imbalances, Fluid imbalances which lead to edema
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5
Q

What is nursing management of PN?

A

Vital signs q4-8hrs

Daily weights

Blood glucose

  1. Sliding scale
  2. Check every 4-6 hrs

Electrolytes

BUN

CBC

Liver enzymes

Dressing change

  1. Per policy
  2. Site observation is key!!

Refeeding syndrome

Infusion pump must be used

  1. Need to periodically check volume infused
  2. Check more often than regular IV

Watch for infection and sepsis

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6
Q

What are S/S of infection and sepsis with PN? and interventions if suspected?

A

Local manifestations - Erythema, Tenderness, Exudate at catheter insertion site

Systemic - Fever, chills, Nausea/vomiting, Malaise

If suspected:

  • Blood and catheter cultures if infection suspected
  • X-ray: To check changes in pulmonary status
  • After PN therapy, daily dressing changes to infusion site until it fully heals (After catheter is removed)
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7
Q

BMI categories

A 
< 18.5 	Underweight
18.5-24.9  Normal weight
25.0-29.9  Overweight
>29.9  Obese
>40  Extreme Obesity
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8
Q

What are ways to assess obesity?

A

BMI
Waist circumference
Waist to hip ratio
body shape

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9
Q

Waist circumference measurements:

A

increased health risk if >40 in men and > 35 in women

Larger waist = increased heart disease

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10
Q

Waist to hip ratio

A

> 0.8 greater risk for health complications

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11
Q

Apple body shape is at risk for:

A

Heart disease
DM
Hypertension

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12
Q

Pear body shape is at risk for:

A

osteoporosis

varicose veins

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13
Q

All opportunities for patient education on obesity should stress (2), and should include (6).

A

healthy eating and exercise

  1. Meal planning
  2. Adequate fruits and vegetables to prevent constipation, meets vitamin A and C requirements
  3. Lean meat, fish, and eggs for protein and B-complex vitamins (B complex vitamins can be insufficient if diet has not carbs)
  4. Exercise
  5. Behavior modification
  6. Support groups
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14
Q

Bariatric surgery is used to treat ___.

A

extreme obesity. It is currently the only treatment found to have a successful and lasting impact for sustained weight loss

Criteria guidelines include:

  1. BMI ≥40 kg/m2 OR
  2. 35 with one or more significant co-morbidities (such as hypertension, DMII, HF, sleep apnea)

Not always covered by insurance; Screened for psychologic issues associated with poor outcomes (depression, binge eating disorder, drug/alcohol abuse)

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15
Q

The three broad categories of bariatric surgeries are:

A

restrictive (reduces size of stomach or amount allowed to enter the stomach),

malabsorptive (small intestine is shortened),

and a combo

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16
Q

Bariatric surgeries include:

A

Restrictive:

  1. Gastric banding
  2. Sleeve Gastrectomy
  3. Plication
  4. Intragastric Balloon

Combo:
5. Roux-en-Y Gastric Bypass (RYGB)

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17
Q

Gastric banding

A

restrictive surgery that limits the size of the stomach with an inflatable band, adjustable

  • Port is subcutaneous that can be inflated or deflated by fluid injection in provider’s office
  • Creates sense of fullness
  • Delays in stomach emptying
  • Can be modified or reversed later
18
Q

Sleeve Gastrectomy

A

restrictive surgery in which 75% of stomach is removed, leaving a sleeve-shaped stomach

  • Stomach function preserved
  • Eliminates hormones made in the stomach that stimulates hunger
  • Currently requires a surgical incision, research ongoing on laparoscopic approach
  • Leakage related to stapling or sutures possible
  • NOT reversible
19
Q

Plication

A

restrictive surgery in which a 2. sleeve is created by suturing rather than removing stomach

  • Minimally invasive surgery (compared to sleeve gastrectomy)
  • Involves folding stomach wall inward, reducing the stomach volume
  • Reversible
  • Requires hospital stay
  • Nausea common after procedure
  • Blockage may occur from swelling or fold too tight
20
Q

Intragastric Ballon

A

A restrictive procedure in which a balloon occupies space in the stomach

  • Natural anatomy of the stomach is not altered
  • Patients feel more full, appetite decreased
  • Less invasive, placed using - - Balloon filled with saline, varying amounts can be used (400-700 mL) –OR- nitrogen gas (newer)
  • Can only be left in for 6 months
21
Q

Roux-en-Y Gastric Bypass

A

a combination surgery in which a stomach pouch is created, connected to jejunum, rest of stomach and first part of small intestine bypassed

  • Food bypasses 90% of the stomach, duodenum, and a small segment of jejunum
  • **Most common bariatric procedure **
  • Excellent patient tolerance
  • Has low complication rates
22
Q

Possible complications of Roux-en-Y Gastric Bypass surgery:

A
  1. DUMPING SYNDROME
    - also called rapid gastric emptying
    - causing abdominal cramps and nausea and diarrhea, due to insulin surge, symptoms of hypoglycemia occur 2-3 hours later
    - Avoidance of sugary foods, small frequent meals and dietician referral can all help
  2. LEAK AT ANASTOMOSIS SITE - this is a concern for every stomach surgery procedure!
  3. ANEMIA
23
Q

Preoperative Care for a Bariatric surgery:

A

Patients will likely have comorbidities, so team approach

Nurse myst prepare the room!
1. Have room ready for patient before arrival
- Larger blood pressure cuff
- Larger gown
- Patient transfer equipment
- Wheelchair with removable arms
(Note: Don’t make a large pt uncomfortable by making them feel like you have to provide special accommodations “Oh, I need a larger bp cuff, let me get it!” :O )

  1. Wound infection – skin prep important
  2. Breathing - Coughing, Deep breathing, Turning - These are super important in obese patients to avoid pulmonary complications*
  3. Venous access -> Have an extra long catheter
  4. Mechanical ventilation
24
Q

Postoperative care for Bariatric Surgery:

A
  1. Close observation for complications
  2. Transfer with specially trained personnel
  3. Stabilize airway -
    * *Elevate HOB to 35-40 degrees**
  4. Adipose tissue problems
    - Anesthetic agents stored in adipose tissue, may be slower to wake and/or re-sedation possible
    - Excess adipose tissue compresses chest and abdomen which Causes CO2 retention
  5. Manage pain
  6. Diligent turning and ambulating
  7. Hypoxemia, pulmonary hypertension, polycythemia
  8. Risk for deep venous thrombosis (DVT)
    - TED hose and PCD devices should be put on at night or when pt is NOT moving around
  9. Infection, dehiscence, delayed healing
    - Nutrition is KEY!!
  10. Keep skin folds clean and dry to prevent bacterial or fungal infections
  11. Attentive to placement of NG tube
  12. Careful transition to new diet
25
Q

Post Bariatric Surgery diet is generally:

A 
High protein 
Low carbohydrates 
Low fats
Low roughage 
6 small feedings
Fluids not to be ingested with meals and <1000 ml/day
26
Q

What are later complications of bariatric surgery?

A 
Anemia 
Vitamin deficiencies 
Diarrhea 
Psychologic problems
Peptic ulcer formation
Dumping syndrome
Small bowel obstruction

*Long-term follow-up care important

27
Q

What is the order of a GI exam?

A 
Inspection
**Auscultation**
Percussion
Light palpation
deep palpation
28
Q

What is in the RLQ?

A 
Lower pole right kidney
Cecum and appendix
Portion ascending colon
Bladder
Right ovary and fallopian tube
Uterus if enlarged
Right spermatic cord
Right ureter
29
Q

What is in the RUQ?

A 
Liver and gallbladder
Pylorus
Duodenum
Head of pancreas
Right adrenal gland
Portion right kidney
Hepatic flexure of colon
Ascending and transverse colon
30
Q

What is in the LUQ?

A 
Left lobe of liver
Spleen
Stomach
Body of pancreas
Left adrenal gland
Portion of left kidney
Splenic flexure of colon
Transverse and descending colon
31
Q

What is in the LLQ?

A 
Lower pole left kidney
Sigmoid flexure
Descending colon
Bladder
Left ovary and fallopian tube
Left spermatic cord
Left ureter
32
Q

Upper GI/small bowel series

Barium Swallow

A
  1. Use: detect structural changes in the esophagus, stomach, duodenum / small intestine
  2. Prep: NPO
  3. Post: fluids/laxatives, monitorstool for passage of barium
33
Q

Lower GI Series

Barium Enema

A
  1. Use: detect anatomic changes in lower GI tract
  2. Prep: clear liquids, NPO, bowel prep (must have clear/empty bowel before procedure)
  3. Post: fluids/laxatives, monitor for passage of contrast
34
Q

Abdominal Ultrasound

A
  1. Use: detect solid masses, cysts, or abdominal ascites
  2. Prep: NPO 8-12 hrs
  3. Post: none
35
Q

Gallbladder ultrasound

A
  1. Use: detect masses, cysts, tumors or cirrhosis of liver or biliary tract
  2. Prep: NPO 8-12 hrs
  3. Post: none
36
Q

Esophagogastroduodenoscopy (EGD)

A
  1. Use: direct visualization of mucosa of esophagus & duodenum, can perform biopsy or sclerotherapy
  2. Prep: NPO 6-12 hrs, consent, preop meds, sedation
  3. Post: * NPO until gag returns, assess for bleeding if biopsy*
37
Q

Sigmoidoscopy

A
  1. Use: direct visualization of mucosa of colon to ileocecal valve vs rectum/sigmoid colon only
  2. Prep: clear liquid 1-2 days, bowel prep, NPO 8-12 hrs, consent, preop meds, sedation
  3. Post: assess rectal bleeding, signs of perforation, need to pass gas
    - Bowel blown up w/air to do scope ->NEED to pass that gas
    - Teach pt that to help with intestinal cramping: Pass gas!!,
    Move around (walk)

**1st sign of perforation is PAIN **

38
Q

Capsule endoscopy

A
  1. Use: images of stomach, small intestine
    a. Pt swallows pill size camera
  2. Prep: NPO 8-12 until 4 hours after swallow
  3. Post: patient passes capsule in bowel movement, images downloaded
39
Q

Percutaneous cholangiography

A
  1. Use: local anesthesia, liver entered with needle using fluoroscopy, inject contrast to assess hepatic & biliary duct filling
  2. Prep: NPO
  3. Post: Assess for bleeding or bile leakage
40
Q

Computerized tomography (CT) or magnetic resonance imaging (MRI)

A

Computerized tomography (CT scan)

  1. May require contrast dye
  2. Assess renal function and allergy to dye

Magnetic Resonance Imaging

  1. IV contrast may be used
  2. Use caution with metal implants (ie: pacemaker, joint replacements)
41
Q

What are common lab studies done for GI issues?

A 
Stool cultures
Fecal analysis
Occult blood
Liver function studies
Serum amylase     
Serum lipase
Ammonia levels
Serum protein levels

Adult 1 Test 3 (6 decks)

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