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NURS 370 - Final > GI Alterations > Flashcards

GI Alterations Flashcards

1
Q

What are some complications of hepatic cirrhosis?

A

Complications:
Bleeding/coagulation
Fluid volume excess
Ascites
Hepatic encephalopathy
Portal hypertension

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2
Q

What kind of pain do patients have with a GI bleed? (where is it coming from?)

A

-pain coming from GI tract (visceral = vague, can’t pinpoint)

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3
Q

What becomes chalk like when swallowed and uncomfortable to pass? (type of diagnostic test)

A

Barium swallow becomes almost chalk-like when swallowed, but if they don’t pass this within 24 hours, it become more concrete-like which is even more uncomfortable to pass

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4
Q

what are the 3 stages/classifications of liver deases leading to cirrhosis?

A

1.) hepatocellular: when the liver cells themselves are damaged or altered (e.g. scarring) – this is most common

2.) metabolic: metabolic condition that’s damaging the liver

3.) cholestatic: results of the obstructions from gallbladder (gallstones)

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5
Q

What is important for us to provide to patients with chronic pancratitis?

A

chronic pancreatitis: education is more important in chronic cases (esp. if they have alcoholism), educating on how to modify lifestyle

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6
Q

difference between acte and chronic pancreatitis?

A

-acute pancreatitis: one or even multiple cases of pancreatitis but then goes back to normal after and in between cases
-chronic pancreatitis: when scarring has occurred
-can develop secondary diabetes because of this

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7
Q

wjere do we most often see/what conditions do we most often see esopageals varies in?

A

most often seen with severe liver disease and portal hypertension

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8
Q

In blood what rises right away/is the indicator of pancreatits? What takes up to a day to start rising?

A

amylase rises right away – within hours (first indicator)
-lipase takes up to a day to start rising

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9
Q

purpose of the liver?

A

-converts ammonia to urea
-filters blood
-produces bile
-enzymes and clotting factors

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10
Q

Why do we have changes in LOC, restlessness, and anxiety as clinical manifestations of a GI bleed?

A

Due to changes in our blood flow

 -restlessness and anxiety can also cause changes in the liver
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11
Q

What is the role of the pancreas? (think ezyme,exocrine, and endocrine)

A

Pancreas role
-enzyme production in body

-exocrine: releases enzymes into GI tract which helps with digestion

-endocrine: releasing insulin into our bloodstream to control blood sugars

*pancreas cannot be replaced

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12
Q

Why do we run a type+screen/cross match for GI bleeds?

A

-type and screen/crossmatch to get blood ready

-Tells us the type of blood we need

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13
Q

causes of liver cirrhosis?

A

Causes
-fatty liver disease where we would see steatorrhea
-hepatitis
-normal liver tissue is replaced with cirrhotic tissue
-affects men 2x more than women
-between 40-60 years old

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14
Q

What is hepatic encephalopathy?

A

Hepatic encephalopathy (HE) is a reversible syndrome observed in patients with advanced liver dysfunction. The syndrome is characterized by a spectrum of neuropsychiatric abnormalities resulting from the accumulation of neurotoxic substances in the bloodstream (and ultimately in the brain)

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15
Q

What are esophageal varices? What are they caused by?

A

Dilated, tortuous veins located in the submucosa of the lower esophagus

Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow

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16
Q

What lab work do we use/run to diagnose liver cirrhosis?

A

Serum (albumin, serum globulin, alkaline phosphatase, AST, ALT, GGT, bilirubin, PTT)

CT or MRI

Biopsy

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17
Q

What is pancreatitis?

A

Pancreatitis is the redness and swelling (inflammation) of the pancreas. It may be sudden (acute) or ongoing (chronic).

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18
Q

WHy do we run/check electorylte levels for GI bleeds?

A

-electrolytes: fluid electrolyte imbalance (low electrolyte levels due to excess vomiting or diarrhea)

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19
Q

where does bleeding occur if you’re vomiting fank/fresh blood?

A

-vomiting fresh/frank blood?: bleeding occurs in top of throat

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20
Q

Clinical management for GI bleeds?

A

A: if they’re vomiting, make sure they’re positioned properly to keep airway patent, if actively bleeding, look at clearing out the blood
B: oxygen administration whether they need it or not, the body will be stressed in a GI bleed
C: IV fluids, blood

TPN if they can’t have stuff in their stomachs

-Oral hygiene: if they’re vomiting (cleaning out vomit, acid, and blood)

-foley catheter: monitor carefully ins and outs

21
Q

what does compensated Vs decomesntated liver mean?

A

-compensated means still working

-decompensated means no longer working

22
Q

what do we do post bioposy of hepatic cirrhosis? Why?

A

-when treating someone post biopsy, we’ve got them flat on their back because of the risk of bleeding since the liver has so vascular

23
Q

What diagnostic studies are typically ran for GI bleeds? (which is the “golden rule”?)

A

-Golden rule: endoscopy-colonoscopy since it’s both diagnosis and treatment

-Barium swallow becomes almost chalk-like when swallowed, but if they don’t pass this within 24 hours, it become more concrete-like which is even more uncomfortable to pass

CT

MRI

24
Q

With GI bleed what does what we see indicate? What does how much we see indicate?

A

-what we see indicates where it’s at, how much we see indicates severity

25
Q

Manifestations of hepatic cirrhosis?

A

Manifestations:
-jaundice (excess bile): feels irritable and itchy, yellow sclera and skin

-ascites: accumulation of fluid due to excess pressure on portal vein
-when would we do something about this?: when they have trouble breathing due to excess pressure on the diaphragm

-MSK breakdown

-might be able to palpate lover now due to hepatomegaly

-deterioration of LOC due to hepatic encephalopathy (due to higher ammonia levels)

-infection and peritonitis, varices, vitamin deficiencies, anemia, mental deterioration

26
Q

What are some nursing interventions we can provide on patients with a GI bleed?

Activity
Food / fluids
Elimination
Psychological
Pain management
Education

A

-activity will be low, going to be weak, could be anemic (lighter workload, lots of breaks)

-if vomiting and actively bleeding, there won’t be any eating

-bland diets when reintroducing food, no irritants (looking out for belching and gas to indicate irritation)
-looking out for spicy foods, acidic foods, greasy foods, and will likely need weight loss

-might present with change in bowel patterns

-pale, dry skin, poor turgor, want to rehydrate with fluids

-psychological: will likely be panicked, need reassurance and comfort

-pain coming from GI tract (visceral = vague, can’t pinpoint)

-education: provide based on cause and risk factors

27
Q

What is patient education based on in patients a with GI bleed?

A

-education: provide based on cause and risk factors

28
Q

healthy liver Vs fatty liver?

A

-health liver: pliable, soft

-fatty liver: getting denser, swollen, and hard

29
Q

Which structures are upper GI bleed involved in?

A

Esophagus, stomach duodenum

30
Q

What do we do/how do we treat and esophageal bleed?

A

insert tube and blow up tube to put pressure

31
Q

Where does bleeding occur if your vomiting what apears to be coffee grounds?

A

-vomiting coffee grounds?: bleeding has occurred as far as stomach

32
Q

What do they do/use to visualize and remove gallstone that can trigger pancreatits?

A

ERCP – Endoscopic Retrograde Cholangiopancreatography

-ERCP: this is what they use to visualize and remove gallstones which can then trigger pancreatitis

33
Q

What will a beta blocker do for esophageal varices?

A

-beta blocker: will decrease pressure on portal vein which will stop the pressure up into the esophagus

34
Q

What are some surgical interventions for esophageal varices?

A

Surgical intervention for esophageal varices:
1.) banding therapy: go in and clip off the bleed

2.) Transjugular Intrahepatic Portosystemic Shunting (TIPS): bypasses the liver which stops the pressure (keep in mind that you have now lost the ability for the liver to filter your blood, blood now bypasses the liver and goes straight into the vena cava)
-this is only a temporary treatment in the most severe cases when they are typically waiting for a transplant

Liver transplant: taking a lobe of the liver out of a donor since it can regenerate (doesn’t regrow another lobe, will stay one lobe now, but will grow to accommodate)

35
Q

where is bleeding occuring if you are passing frank red blood in stools?

A

-frank red blood in stools?: bleeding in colon or rectum

36
Q

Why do we need to provide reasurance+support for GI bleeds?

A

-reassurance and support: vomiting bright red blood can be very distressing

37
Q

What is used as an assessment tool and treatment tool for GI bleeds?

A

Endoscopy

38
Q

Why do we deteration of LOC with lover cirrhosis?

A

-deterioration of LOC due to hepatic encephalopathy (due to higher ammonia levels)

39
Q

management for acute pancreatitis?

A

-what would we do: strict NPO, start them on IV fluids, also give them painkillers
-longterm, these patients will also be on TPN to rest the pancreas

40
Q

What is hematemesis?

A

Vomiting blood

41
Q

Risk factors for GI bleed?

A

-alcoholics (damage to liver and damage to lining of the stomach (gastritis, ulceration, etc.)
-age (the older we are)
-medications that we take (e.g. NSAIDS, prednisones)
-past ulcers
-Crohn’s (lower GI bleed)
-if the liver isn’t functioning, our clotting factors are uncontrolled
-inflammatory bowel disease (Crohn’s and ulcerative colitis)
-diverticulitis
-hemorrhoids

42
Q

What is the biggest risk facotrs for pancratitis?

A

: biggest risk factors are either alcoholic or problems with gallbladder where gallstones that were released have now travelled into the pancreatic duct and clogged it
-medical management/treatment of gallstones can also trigger the pancreatic duct

43
Q

Why do we run liver function tests (LFTs) for Gi bleeds?

A

-LFTs: checking for cirrhosis, confirming potential cause, liver enzymes and ammonia would be high, albumin would be low (don’t need to worry about the specific LFT tests)

44
Q

What is melena?

A

blood in stool

45
Q

Why do we run a CBC and differential for GI bleeds? n

A

-CBC and diff: current status and severity of bleeding

46
Q

when do we treat/do something for ascites that’s associated with hepatic cirrhosis?

A

-(ascites: accumulation of fluid due to excess pressure on portal vein)

 *when would we do something about this?: when they have trouble breathing due to excess pressure on the diaphragm
47
Q

what secondary condition can be developed as a result of chrinic pancreatitis?

A

-can develop secondary diabetes because of this

48
Q

where is bleeding occuring if you are passing melena stools or tarry stools or occult stools?

A

bleeding in jejunum

NURS 370 - Final (7 decks)

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