GI and Nutrition Flashcards
Peg procedure
invasive
done under conscious sedation
-uses endoscopy and goes through the esophagus into the stomach
peg tube matures
in 1-2 weeks but not fully established until 4-6 weeks
peg early dislogment
less than 7 days requires srugical or endoscopic replacement
small bore nasointestinal tubes
used for short term enternal feedings and get clogged,kinged,coiled and disloged easily
refeeding syndrome
fatal
nutrtitional reb in malnoursihed clients (anorexia, chronic etoh)
dumping syndrome not seen in
anorxia
leukocytosis
high WBC
nursing consideration for refeeding syndrome
when the client recieves food, or IV fluids with glucose, it causes the insulin secretion to increase leading to K, phsophrous and mg to go into the cell .
-phosphours is the electrlyte that is the most deficient since it is used for energy so hypophosphatemia causes —> RESP failure and muscle weakness SO YOU NEED TO REPLACE ELECTRYLE
hypophosphatemia
seen in refeeding syndome
-muscle weakness and RESP FAILURE
inition of nutrition needs
electrolyte replacement or cardiopulmoary failure can occur
paralytic ileus
tempory paralysis or the bowel affecting bowel motility and perstalsis
signs and symtoms of paralytic ileus
- abdominal discomfort
- distension
- NV
Paralytic ileus risk factors
abdominal surgery
- periop meds ( anesthesia, analgesics)
- immobility (stroke)
Paralytic ileus nursing management
NPO to prevent further distention of the stomach and nausea (not even meds should be taken)
- NG to decompress
- IV fluid and electroylye (NS) to correct loses from NG suction
- NONNNNN opioid IV medications are fine but not OPIOID
colonscopy no stool
to see visual better during procedure
colonoscopy teaching
clear liquid the day before NPO 8-12 hours prior -bowel cleansing agent such as cathartic, enema, or glycol day before the test. - there is no smoking cessation -no abx needed before procedure
PUD risk factors
h pylori
-NSAIDS
PUD treatment
ABX
PPI
initial PUD treatment
7-14 days of triple-drug therapy with omeprazole (Prilosec), amoxicillin, and clarithromycin (Biaxin).
PUD should avoid
NSAIDSSSSS because they inhibiot prostaglandin synthesis, increase gi section and reduce integrity of mucosal barrier
lifestyle modifification for PUD
no spicy food, acidic foods, or black peper
- avoid etohm nsaids, caff, choco, tabacoo or anything that cause acid secretion
- reduce stress and get rest
complications of PUD
GI bleeding
- ortho hypotension
- melena
- perforation
signs of perforation
incaresed epigastric pain
- NV
- fever
celiac disease avoid
BROW
barley, rye, oats, wheat
how much weight is okay to lose per week and is realistic
1-2 lb
IBS caused by
aaltered intestinal motility
IBS signs
diahrea costipation or both abdominal pain stress
managing IBS
avoid has producing foods (banana, cabbage, onions) - no etoh or caff, no honey -no spices, =hot or cold food or drink -no dairy
IBS good diet
increase the fiber
bread, protein, and bland foods are tolerated (even though fiber is good be careful with beans)
hiatal hernia happens when
conditions increase intraabdominal pressure (preg, obseity, ascities, tumors, heavy lifting) and weaken the disphrah and allow a portion of the stomach to herniate through the diaphram
sliding hernia
portion of the upper stomach herniates through an opening in the diaphragm
paraesophageal hernia
MED EMERGENCY upper stomach folds into the esophagous
hiatal hernia signs
similar to gerd and is often ASYMTOMATIC
- heartburn
- dysphagia
- pain caused by intrabdominal pressure or supine position
hiatal hernia intervention
avoid high fat
and foods that decrease lower esphageal sphinter pressure such as choco, peppermint, caff, and tomatoes
-eat small meals
-decrease fluid intake during meals
-dont eat close to bedtime or night eating
-weight loss and smoking cessation
-dont lift or strain
- keep head 30 degrees using pillows under the bed
-dont use gridle or tight clothes because they increase intraabdominal pressure
bowel sounds are
intermittent every 5-15 seconds
-high pitched, gurgling sounds
cardiovascular bruit indicate
aterial narrowing or dilation
- swishing, humming, buzzing sounds
- not benign
any procdures that require bwe=owel anupulation causes
absent bowel sounds for 24-48 hours
to consider bowel sounds to be absent
must asculatate 2-5 mins in each quadrant
borborygmi
loud, gurgling sounds
-increased peristalisis, gastroenteritis, diarrhea, early phases of obstruction
high pitched gurgling sounds
normal
diverticula
saclike protrusions of the large intestines caused by intraluminal pressure (constipatoin)
pain in diverticulitis
LLQ
complication of diverticulitis
abscees formation and intestinal perforation
peritonitis
bleeding
peritonisits signs
progressive pain in other quadrants
- guarding
- rigidity
- rebound tenderness
poistion for peritionis
lie still because movements make pain worse and take shallow breaths
ammonia range
15-45
pt range
11-16
bilrubin
0.2-1.2
cirrhosis causes
scar tissues and nodules which decrease liver function
lactulose
osmotic laxative
lactulose therputic effect
produce 2-3 soft bowel movmeents each day
preventing risk of colorectal cancer
fiber
fiberrich foods have
low glycemic load and lower caloric density
- binds to chloesterol which reduces the chloesterol level
- reduces vasclar disese such as stroke and CAD
complication of the critically ill
stress ulcers
how to prevent stress ulcers
early initiation of enternal feedings
early initation of enternal feedings helps
help preserve the function of the gut mucosa,
- limit movement of bacteria from intestines to bloodstream
- prevents stress ulcers
enternal feedings are associated with
lower risk of infectious complications compared to TPN
ilnness related stress hyperglycemia (glucogenesis)
occur in enternal feedings and tpn
Appendicitis
results from the obstruction of fecal matter
-traps fluid and mcusus causing intraluminal pressure and inflammation resulting in SWELLING AND ISCHEMIA
Appendicitis complciation
peritonitis and sepsis
nursing intervention for Appendicitis
avoid things that increase intesstinal blood circultion and pressure
- DO NOT APPLY HEAT TO STOMACH SUCH AS HEATING PAD OR BLANKET BECAUSE IT can cause perforation
- give iv analygesia such as morphine
- NPO but give fluids
acute pancreattis complication
pancreatic abscees (need to be treated or spesis happens)
absecces formation signs
high fever
high wbc
abdominal pain
expected finding for pancreatitis
elevated blood glucose
pancreas pain
midepigastric burning abdominal pain radiating to the back
blood loss intervention
lower HOB and place client supine to maintain perfusion to the brain
cirrhosis findings
pruritis because if the build up of bile salts
-risk of skin breakdown because of edema
intervention for cirrrhosis itching
cut the nails short and wear cotton gloves
- long sleeve shirt to prevent injury from scratching
- use baking sodas , calamine lotion and cool wet cloths on skin
- TEMP EXTREMES SUCH AS HOT BATHS MAKE PRURITIS WORSE
cholestyramine (questran)
increases the excretion of bile salts in the deces and decreases pruritus
- can be mixed with food or juice and should be GIVEN ONE HOUR AFTER ALL OTHER MEDS
laproscopic uses what to see
co2 is used to inflate and expand abdominal cavity to allow insertion of instruments and better visualization of the abdominal organs
co2 use in laparoscopic can do
irratate the phrenic nerve and diaphragmn causing shallow breathing and pain to th right shoulder
nusing intervention after laparoscopic
AMBULATEE to get rid of the co2 and it helps improve breathing and decrease thromboemoblism risk
not routes of transmitting heb b
kissing
neezing
sharing utensils and drinks
and breastfeeding
transmission of hep b
parental
sexual contact
blood semen or vaginal secretions
Signs and symptoms of acute appendicitis
Pain: Continuous; begins in the periumbilical region and then moves to the right lower quadrant centering at McBurney’s point (one-third of the distance from the right anterior superior iliac spine to the umbilicus) (Option 3)
Gastrointestinal symptoms: Anorexia, nausea, and vomiting
Rebound tenderness and guarding
Clients with acute appendicitis attempt to decrease pain by
preventing intrabdominal pressure by avoiding coughing sneezing deep inhaltion and LYING STILL WITH RIGHT LEG FLEXED
burning pain in upper stomach
gastric or duodenal ulcers
LLQ pain
diverticultiis
RUQ
cholecysitics
ulcerative coltis complication
megacolon
megacolon signs
abdominal distention
bloody diarhea
fever
megcolon caused by
cronhs
ulcerative colitis
inflmmaotry bowel disease
c diff
upper gi bleeding caused by
gastroesophageal varciies and peptic ulcers
Variceal rupture commonly occurs due to
-sudden increase in portal venous pressure such as coughing ,straining, and vomiting and from machenical injury (chest ttruma and consudig sharp and hard foods)
small bowel obstriction
NV
colocky intermittent abdominal pain
abdominal distension
nursing management for sall bowel obstruction
NPO
NG
IV fluids
pain control
large bowel obstruction
gradual onset cramping abdminal pain abdominal distesion BASOLUTE constipation lack of flatus
pain during defecation
hemmorids
anal fissue
inflammation
BUT NOT SMALL BOWEL OBSTRUCTION
continous suction
decompress stomach if salem sump tube is in place
salem sump
dont check for residual volume because it is attached to continous suction for decompression and not being used to adm enternal feeding
inteventions for salem sump tube
semi flower poistion to prevent gastric reflux and prevent the tube from lying against the stomach
- mouth care every 4 ours
- turn off suction when ausaculatation so you dont mistaken bowel souunds
- inspect drainage system for patency (kinks or blackoages)
- keep airvent (blue pigtail) open and above level of stomach
air vent for salum
must remain open
- 10-20 ml of air can be injected into the airven if gastric contents reflux
- keep above clients abdomen level to prevnt reflux
vegans at risk for
b12 suff (cobalamin)
b12 supplied by
animal products
b12 def causes
megaloblastic anemia and neurological symtoms
mmeory loss
b12 def signs
peripheral neuropathy (tingling and numbess)
- neuromuscular impairment (gait prob and poor balance)
- memory loss and dementia
foods high in b12
cereals
grain products
soy and nut milks
meat substituates
dervitucla care
allow the colon to rest and inflammation resolves
- IV antibiotic (flagyl)
- NPO
- NG-
- iv fluids
- bed rest
avoid what in dervitcula
any procedure or treatment that increases intraabdominal pressure such as lifting, srtraining, coughing, bending
- treatments such as laxative and enema should be avoided
pancreatiis location
LUQ or mimdepigaastric and radiates to the back
pain managment in pacreatitis
worsens with lying flat and improves when leaning forward
-pain worse with high fat meal
clients are at risk for what with pancreatitis (3 things)
hypovolemia
resp distress (because of systemic inflammaotry response)
-hypocalcemia
lactase def
cheese and yogurt dont have much lactose and can be tolerated
- lactase def is not an immune reaction /allergy ti milk products. it is the def of the enzyme lactase and ability to digest lactose
- eating cheese or yogurt in moderation, and supplementing with lactase enzymes. Vitamin D and calcium supplementation is also recommended.
pancreatis mangemnt
SYMTOM MANAGEMENT NPO (ongestion of food will stimulate the exretion of pancreatic enzymes) - NG -pain mangment using hydropmorphone -IV fluids- to prevent hypovoemic shock
positioning for pancreatic
flex thetrunk and draw the knees up to abdomen to decrease tension on the abdomen
- semi
- side lying position with head elevated 45
easrliest indication of peritonitis in peritoneal dialysis
cloudy peritoneal
later signs: fever, abdominal pain, rebound tenderness
rebound tenderness detction
one hand into abdominal and quickly withdraw and if there is pain on the removal that indicates inflammation of the peritoneal cavity (peritnonitis)
managment periotneal
collect fluid from drainage bag for culture and sensitivity
-mointor glucose level
treatment of peronitnits in perotneal dialysis
culture of the fluid
bariatric surgery
reduces stomach capacity
Bariatric surgery post op diet
low in simple carbs and high in protein and fiber ebcause consumption of simple carbs can lead to dumping dusndrome
Bariatric surgery managment
small meals of clear lqiuid at first, then full liquid 24-48 hours after surgery, then solid foods later
best food for Bariatric surgery
cream soups, sugar free drinks, low sugar prtein shakes and diary foods
clear liquids
clear fat free brother, bouillon
- gelatin (jello)
- poiscples
- clear fruit juices (grape, apple_
- carbonated bev (sprite and ginger ale)
- coffee and tea
full lquid
clear liquids PLUS
- cream sops
- pudding
- custard
- cooked cerelas such as oatmeals and grits
- fruit juices
- icecream, frozen yogurt, sherbet, milkshakes
soft diet
clear, full liquids PLUS
- soups,
- finely dice meats, flaked fish
- pancakes
- buscuits
- muffins
- pasta, rice and mashed potatoes
- cooked or canned fruits and veg
- pb
- scambled eggs
patients undergoing paracentesis must be closely mointored for
hypotension since changes in abdominal pressure causes vasodilation
what is given after paracentesis sometimes and why
IV albumin to increase the intravasular fluid volume to prevent hypotension and tacycardia
asterixis is due to
elevated ammonia level
risk of colonscopy
perforation
signs of perforation
abdominal pain rebound ttenderness guarding abdomminal distention boardlike abdomen rectal bleeding
expected things after colonscopy
abdominal cramping
- stool might be watery for short time after procedure
- gas is fine because air was inflated into the colon during procedure
diarhhea
self-limiting and last ≤48 hours. Clients experiencing diarrhea that lasts >48 hours or accompanied by fever or bloody stools should be evaluated by a health care provider (HCP). The HCP will need to assess for dehydration and electrolyte imbalances and identify underlying causes of the diarrhea that may require further treatment (eg, Clostridium difficile).
management for diarrhea occuring more than 48 hours
rest, fluids, and acetaminophen
Loperamide (Imodium)
antidiarrheal. It slows peristalsis and subsequently increases fluid absorption. It should not be used more than 2 days or if fever is present as retention of bacteria or toxins inside the colon can make the process worse and cause toxic megacolon.
JP closed-wound surgical drain seen in pt after
abdominal or breast reconstruction surgery
purpose of JP closed-wound surgical drain
to prevent fluid buildup in closed space which can put tension on the suture line and compromise the integirty of the incision, increase the risk for infection, and decrease wound healing.
emptying JP
Perform hand hygiene as asepsis must be maintained to prevent the transmission of microorganisms even though there is less chance of bacteria entering the wound using a closed-wound drainage device (eg, JP, Hemovac) than an open-drain device (eg, Penrose
Pull the plug on the bulb to open the device and pour the drainage into a small, calibrated container (eg, plastic water cup, urine specimen container) as this facilitates recording accurate drainage output
3)
Empty the device every 4-12 hours unless it is 1/2 to 2/3 full before then because as the small capacity bulb (100 mL) fills, the amount of negative pressure in the bulb decreases (Option 1)
—Compress the empty bulb by squeezing it from side-to-side with 1 or 2 hands until it is totally collapsed. Although the reservoir can be collapsed by pressing the bottom towards the top, compressing the sides of the reservoir (bulb) is recommended as it is more effective in establishing negative pressure (Option 3)
—Clean the spout on the bulb with alcohol and replace the plug when it is totally collapsed to restore negative pressure (Option 4)
what must be maintined in JP
tube patency and negative pressure in the reservoir (bulb) must be maintained to provide adequate drainage.
Valsalva maneuver should be avoided in
-esophageal varcies/portal htn
-contrindicated in itraocular pressure and halucoma and recent eye surgery
clients recently diagnosed with increased intracranial pressure, stroke, or head injury as straining increases intra-abdominal and intrathoracic pressure, which raises the intracranial pressure
what is stimulated when bearing down
vagus nevrve this temporarily slows the heart and decreases cardiac output, leading to potential cardiac complications in clients with heart disease
The Valsalva maneuver is contraindicated in the client diagnosed with increased intracranial pressure, stroke, head injury, heart disease, glaucoma, eye surgery, abdominal surgery, and liver cirrhosis.
client diagnosed with increased intracranial pressure, stroke, head injury, heart disease, glaucoma, eye surgery, abdominal surgery, and liver cirrhosis.
hepatitis nutrtion
low fat, small, frequent meals to decrease nausea and promote intake in clients with anorexia. Anorexia is lowest in the morning; promote eating a larger breakfast (Option 1).
Provide oral care and avoid extremes in food temperature to increase appetite.
Promote water consumption (2500-3000 mL/day) and diets adequate in carbohydrates and calories.
Colorectal cancer occurs mainly in
adults over 50
risk factors of Colorectal cance
- hisotry of colon polyps
- fam hx
- IBD (crohns, ulcerative coloties)
- HX of other cancers
symtoms of Colorectal cance
-blood in stool
-abdominal disocmofrt
-anemia
-change in bowel habiots-unexmaplained weight loss due to impaired absoprtion
BUT SYMTOMS GO UNNOTICED BECAUSE IT IS PAINLESS AND NONSPECIFIC
testing coloreactal
occult blood test every year, colonoscopy every 10 years
Complications of diverticulitis include
abscess, fistula formation, intestinal obstruction, peritonitis, and sepsis.
cause of diverticulitis
chronic constpiation
Wound evisceration is
the protrusion of internal organs through the wall of an incision.
Wound evisceration is common in clients who
abdominal surgery, those with poor wound healing, and those who are obese.
nursing internvetions for Wound evisceration
STAY with client while calling for help
-notify hcp
-supplies should be brought to room by someone else
- cover would with sterile saline dressing
-low fowler postion with the knees bend so there is less pressure on the suture line
-
cirrhosis manesiftisations
elevated bukurybin causing juandice
- cogulation factors are increased such as INR, PT, APTT
- ammonia increased
- hypoalbuminea and this is why we see edema and ascities
- low soidum because of the large amt of water
hepatic encephalopathy
reversible
- complicaion of cirrhosis
- caused by increased ammonia lvl in the blood
slide
49,52,54
colostomy
creates an opening (stoma) in the abdomin to pass stool
bowel irrgation
Fill the irrigation container with 500-1000 mL of lukewarm water, flush irrigation tubing, and reclamp; hang the container on a hook or intravenous pole (Option 2)
Instruct the client to sit on the toilet, place the irrigation sleeve over the stoma, extend the sleeve into the toilet, and place the irrigation container approximately 18-24 inches above the stoma (Option 3)
Lubricate cone-tipped irrigator, insert cone and attached catheter gently into the stoma, and hold in place
Slowly open the roller clamp, allowing irrigation solution to flow for 5-10 minutes
Clamp the tubing if cramping occurs, until it subsides (Option 4)
Once the desired amount of solution is instilled, the cone is removed and feces is allowed to drain through the sleeve into the toilet
prupose of colostomy irrgation
allows client to create bowel regiment
why kind of tip in colosntmy irrgation
cone tip application to avoid damage to colonstomy
hemorrhoids
sitended inflamed veins in the anus/rectum
causes of hemorrhoids
increased anorectal pressure (straining to defecate, constipation).
Nursing management for the post-hemorrhoidectomy client includes the following:
Pain relief: Initially, pain is managed with pain medications, including nonsteroidal anti-inflammatory drugs (eg, ibuprofen) and/or acetaminophen; opioids can be prescribed initially but may worsen constipation. Beginning 1-2 days postoperatively, warm sitz baths are used as a means to relieve pain. Clients often dread their first bowel movement due to severe pain with defecation. Therefore, pain must be appropriately controlled to prevent further constipation (Option 2).
Preventing constipation: Encourage a high-fiber diet and adequate fluid intake (at least 1500 mL/day). Administer a stool softener such as docusate (Colace) as prescribed. An oil-retention enema may be used if constipation persists for 2-3 days (Option 1).
- warm sitz used 1-2 post op 2-3x daily
- pack the retum and apply t binder to hold the packing in place and thre dressing is removed 1-2 days postop unless lot of soaking is noted
