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GI and Nutrition Flashcards

1
Q

Peg procedure

A

invasive
done under conscious sedation
-uses endoscopy and goes through the esophagus into the stomach

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2
Q

peg tube matures

A

in 1-2 weeks but not fully established until 4-6 weeks

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3
Q

peg early dislogment

A

less than 7 days requires srugical or endoscopic replacement

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4
Q

small bore nasointestinal tubes

A

used for short term enternal feedings and get clogged,kinged,coiled and disloged easily

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5
Q

refeeding syndrome

A

fatal

nutrtitional reb in malnoursihed clients (anorexia, chronic etoh)

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6
Q

dumping syndrome not seen in

A

anorxia

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7
Q

leukocytosis

A

high WBC

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8
Q

nursing consideration for refeeding syndrome

A

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

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9
Q

hypophosphatemia

A

seen in refeeding syndome

-muscle weakness and RESP FAILURE

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10
Q

inition of nutrition needs

A

electrolyte replacement or cardiopulmoary failure can occur

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11
Q

paralytic ileus

A

tempory paralysis or the bowel affecting bowel motility and perstalsis

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12
Q

signs and symtoms of paralytic ileus

A
  • abdominal discomfort
  • distension
  • NV
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13
Q

Paralytic ileus risk factors

A

abdominal surgery

  • periop meds ( anesthesia, analgesics)
  • immobility (stroke)
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14
Q

Paralytic ileus nursing management

A

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
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15
Q

colonscopy no stool

A

to see visual better during procedure

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16
Q

colonoscopy teaching

A 
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
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17
Q

PUD risk factors

A

h pylori

-NSAIDS

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18
Q

PUD treatment

A

ABX

PPI

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19
Q

initial PUD treatment

A

7-14 days of triple-drug therapy with omeprazole (Prilosec), amoxicillin, and clarithromycin (Biaxin).

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20
Q

PUD should avoid

A

NSAIDSSSSS because they inhibiot prostaglandin synthesis, increase gi section and reduce integrity of mucosal barrier

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21
Q

lifestyle modifification for PUD

A

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
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22
Q

complications of PUD

A

GI bleeding

  • ortho hypotension
  • melena
  • perforation
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23
Q

signs of perforation

A

incaresed epigastric pain

  • NV
  • fever
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24
Q

celiac disease avoid

A

BROW

barley, rye, oats, wheat

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25
Q

how much weight is okay to lose per week and is realistic

A

1-2 lb

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26
Q

IBS caused by

A

aaltered intestinal motility

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27
Q

IBS signs

A 
diahrea 
costipation
or both
abdominal pain
stress
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28
Q

managing IBS

A 
avoid has producing foods (banana, cabbage, onions)
- no etoh or caff, 
no honey
-no spices,
=hot or cold food or drink
-no dairy
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29
Q

IBS good diet

A

increase the fiber

bread, protein, and bland foods are tolerated (even though fiber is good be careful with beans)

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30
Q

hiatal hernia happens when

A

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

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31
Q

sliding hernia

A

portion of the upper stomach herniates through an opening in the diaphragm

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32
Q

paraesophageal hernia

A

MED EMERGENCY upper stomach folds into the esophagous

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33
Q

hiatal hernia signs

A

similar to gerd and is often ASYMTOMATIC

  • heartburn
  • dysphagia
  • pain caused by intrabdominal pressure or supine position
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34
Q

hiatal hernia intervention

A

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

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35
Q

bowel sounds are

A

intermittent every 5-15 seconds

-high pitched, gurgling sounds

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36
Q

cardiovascular bruit indicate

A

aterial narrowing or dilation

  • swishing, humming, buzzing sounds
  • not benign
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37
Q

any procdures that require bwe=owel anupulation causes

A

absent bowel sounds for 24-48 hours

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38
Q

to consider bowel sounds to be absent

A

must asculatate 2-5 mins in each quadrant

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39
Q

borborygmi

A

loud, gurgling sounds

-increased peristalisis, gastroenteritis, diarrhea, early phases of obstruction

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40
Q

high pitched gurgling sounds

A

normal

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41
Q

diverticula

A

saclike protrusions of the large intestines caused by intraluminal pressure (constipatoin)

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42
Q

pain in diverticulitis

A

LLQ

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43
Q

complication of diverticulitis

A

abscees formation and intestinal perforation
peritonitis
bleeding

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44
Q

peritonisits signs

A

progressive pain in other quadrants

  • guarding
  • rigidity
  • rebound tenderness
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45
Q

poistion for peritionis

A

lie still because movements make pain worse and take shallow breaths

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46
Q

ammonia range

A

15-45

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47
Q

pt range

A

11-16

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48
Q

bilrubin

A

0.2-1.2

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49
Q

cirrhosis causes

A

scar tissues and nodules which decrease liver function

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50
Q

lactulose

A

osmotic laxative

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51
Q

lactulose therputic effect

A

produce 2-3 soft bowel movmeents each day

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52
Q

preventing risk of colorectal cancer

A

fiber

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53
Q

fiberrich foods have

A

low glycemic load and lower caloric density

  • binds to chloesterol which reduces the chloesterol level
  • reduces vasclar disese such as stroke and CAD
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54
Q

complication of the critically ill

A

stress ulcers

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55
Q

how to prevent stress ulcers

A

early initiation of enternal feedings

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56
Q

early initation of enternal feedings helps

A

help preserve the function of the gut mucosa,

  • limit movement of bacteria from intestines to bloodstream
  • prevents stress ulcers
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57
Q

enternal feedings are associated with

A

lower risk of infectious complications compared to TPN

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58
Q

ilnness related stress hyperglycemia (glucogenesis)

A

occur in enternal feedings and tpn

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59
Q

Appendicitis

A

results from the obstruction of fecal matter

-traps fluid and mcusus causing intraluminal pressure and inflammation resulting in SWELLING AND ISCHEMIA

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60
Q

Appendicitis complciation

A

peritonitis and sepsis

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61
Q

nursing intervention for Appendicitis

A

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
62
Q

acute pancreattis complication

A

pancreatic abscees (need to be treated or spesis happens)

63
Q

absecces formation signs

A

high fever
high wbc
abdominal pain

64
Q

expected finding for pancreatitis

A

elevated blood glucose

65
Q

pancreas pain

A

midepigastric burning abdominal pain radiating to the back

66
Q

blood loss intervention

A

lower HOB and place client supine to maintain perfusion to the brain

67
Q

cirrhosis findings

A

pruritis because if the build up of bile salts

-risk of skin breakdown because of edema

68
Q

intervention for cirrrhosis itching

A

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
69
Q

cholestyramine (questran)

A

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

70
Q

laproscopic uses what to see

A

co2 is used to inflate and expand abdominal cavity to allow insertion of instruments and better visualization of the abdominal organs

71
Q

co2 use in laparoscopic can do

A

irratate the phrenic nerve and diaphragmn causing shallow breathing and pain to th right shoulder

72
Q

nusing intervention after laparoscopic

A

AMBULATEE to get rid of the co2 and it helps improve breathing and decrease thromboemoblism risk

73
Q

not routes of transmitting heb b

A

kissing
neezing
sharing utensils and drinks
and breastfeeding

74
Q

transmission of hep b

A

parental
sexual contact
blood semen or vaginal secretions

75
Q

Signs and symptoms of acute appendicitis

A

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

76
Q

Clients with acute appendicitis attempt to decrease pain by

A

preventing intrabdominal pressure by avoiding coughing sneezing deep inhaltion and LYING STILL WITH RIGHT LEG FLEXED

77
Q

burning pain in upper stomach

A

gastric or duodenal ulcers

78
Q

LLQ pain

A

diverticultiis

79
Q

RUQ

A

cholecysitics

80
Q

ulcerative coltis complication

A

megacolon

81
Q

megacolon signs

A

abdominal distention
bloody diarhea
fever

82
Q

megcolon caused by

A

cronhs
ulcerative colitis
inflmmaotry bowel disease
c diff

83
Q

upper gi bleeding caused by

A

gastroesophageal varciies and peptic ulcers

84
Q

Variceal rupture commonly occurs due to

A

-sudden increase in portal venous pressure such as coughing ,straining, and vomiting and from machenical injury (chest ttruma and consudig sharp and hard foods)

85
Q

small bowel obstriction

A

NV
colocky intermittent abdominal pain
abdominal distension

86
Q

nursing management for sall bowel obstruction

A

NPO
NG
IV fluids
pain control

87
Q

large bowel obstruction

A 
gradual onset
cramping abdminal pain
abdominal distesion
BASOLUTE constipation
lack of flatus
88
Q

pain during defecation

A

hemmorids
anal fissue
inflammation
BUT NOT SMALL BOWEL OBSTRUCTION

89
Q

continous suction

A

decompress stomach if salem sump tube is in place

90
Q

salem sump

A

dont check for residual volume because it is attached to continous suction for decompression and not being used to adm enternal feeding

91
Q

inteventions for salem sump tube

A

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
92
Q

air vent for salum

A

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
93
Q

vegans at risk for

A

b12 suff (cobalamin)

94
Q

b12 supplied by

A

animal products

95
Q

b12 def causes

A

megaloblastic anemia and neurological symtoms

mmeory loss

96
Q

b12 def signs

A

peripheral neuropathy (tingling and numbess)

  • neuromuscular impairment (gait prob and poor balance)
  • memory loss and dementia
97
Q

foods high in b12

A

cereals
grain products
soy and nut milks
meat substituates

98
Q

dervitucla care

A

allow the colon to rest and inflammation resolves

  • IV antibiotic (flagyl)
  • NPO
  • NG-
  • iv fluids
  • bed rest
99
Q

avoid what in dervitcula

A

any procedure or treatment that increases intraabdominal pressure such as lifting, srtraining, coughing, bending
- treatments such as laxative and enema should be avoided

100
Q

pancreatiis location

A

LUQ or mimdepigaastric and radiates to the back

101
Q

pain managment in pacreatitis

A

worsens with lying flat and improves when leaning forward

-pain worse with high fat meal

102
Q

clients are at risk for what with pancreatitis (3 things)

A

hypovolemia
resp distress (because of systemic inflammaotry response)
-hypocalcemia

103
Q

lactase def

A

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.
104
Q

pancreatis mangemnt

A 
SYMTOM MANAGEMENT 
NPO (ongestion of food will stimulate the exretion of pancreatic enzymes)
- NG
-pain mangment using hydropmorphone
-IV fluids- to prevent hypovoemic shock
105
Q

positioning for pancreatic

A

flex thetrunk and draw the knees up to abdomen to decrease tension on the abdomen

  • semi
  • side lying position with head elevated 45
106
Q

easrliest indication of peritonitis in peritoneal dialysis

A

cloudy peritoneal

later signs: fever, abdominal pain, rebound tenderness

107
Q

rebound tenderness detction

A

one hand into abdominal and quickly withdraw and if there is pain on the removal that indicates inflammation of the peritoneal cavity (peritnonitis)

108
Q

managment periotneal

A

collect fluid from drainage bag for culture and sensitivity

-mointor glucose level

109
Q

treatment of peronitnits in perotneal dialysis

A

culture of the fluid

110
Q

bariatric surgery

A

reduces stomach capacity

111
Q

Bariatric surgery post op diet

A

low in simple carbs and high in protein and fiber ebcause consumption of simple carbs can lead to dumping dusndrome

112
Q

Bariatric surgery managment

A

small meals of clear lqiuid at first, then full liquid 24-48 hours after surgery, then solid foods later

113
Q

best food for Bariatric surgery

A

cream soups, sugar free drinks, low sugar prtein shakes and diary foods

114
Q

clear liquids

A

clear fat free brother, bouillon

  • gelatin (jello)
  • poiscples
  • clear fruit juices (grape, apple_
  • carbonated bev (sprite and ginger ale)
  • coffee and tea
115
Q

full lquid

A

clear liquids PLUS

  • cream sops
  • pudding
  • custard
  • cooked cerelas such as oatmeals and grits
  • fruit juices
  • icecream, frozen yogurt, sherbet, milkshakes
116
Q

soft diet

A

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
117
Q

patients undergoing paracentesis must be closely mointored for

A

hypotension since changes in abdominal pressure causes vasodilation

118
Q

what is given after paracentesis sometimes and why

A

IV albumin to increase the intravasular fluid volume to prevent hypotension and tacycardia

119
Q

asterixis is due to

A

elevated ammonia level

120
Q

risk of colonscopy

A

perforation

121
Q

signs of perforation

A 
abdominal pain
rebound ttenderness
guarding
abdomminal distention
boardlike abdomen
rectal bleeding
122
Q

expected things after colonscopy

A

abdominal cramping

  • stool might be watery for short time after procedure
  • gas is fine because air was inflated into the colon during procedure
123
Q

diarhhea

A

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).

124
Q

management for diarrhea occuring more than 48 hours

A

rest, fluids, and acetaminophen

125
Q

Loperamide (Imodium)

A

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.

126
Q

JP closed-wound surgical drain seen in pt after

A

abdominal or breast reconstruction surgery

127
Q

purpose of JP closed-wound surgical drain

A

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.

128
Q

emptying JP

A

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)

129
Q

what must be maintined in JP

A

tube patency and negative pressure in the reservoir (bulb) must be maintained to provide adequate drainage.

130
Q

Valsalva maneuver should be avoided in

A

-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

131
Q

what is stimulated when bearing down

A

vagus nevrve this temporarily slows the heart and decreases cardiac output, leading to potential cardiac complications in clients with heart disease

132
Q

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.

A

client diagnosed with increased intracranial pressure, stroke, head injury, heart disease, glaucoma, eye surgery, abdominal surgery, and liver cirrhosis.

133
Q

hepatitis nutrtion

A

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.

134
Q

Colorectal cancer occurs mainly in

A

adults over 50

135
Q

risk factors of Colorectal cance

A
  • hisotry of colon polyps
  • fam hx
  • IBD (crohns, ulcerative coloties)
  • HX of other cancers
136
Q

symtoms of Colorectal cance

A

-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

137
Q

testing coloreactal

A

occult blood test every year, colonoscopy every 10 years

138
Q

Complications of diverticulitis include

A

abscess, fistula formation, intestinal obstruction, peritonitis, and sepsis.

139
Q

cause of diverticulitis

A

chronic constpiation

140
Q

Wound evisceration is

A

the protrusion of internal organs through the wall of an incision.

141
Q

Wound evisceration is common in clients who

A

abdominal surgery, those with poor wound healing, and those who are obese.

142
Q

nursing internvetions for Wound evisceration

A

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
-

143
Q

cirrhosis manesiftisations

A

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
144
Q

hepatic encephalopathy

A

reversible

  • complicaion of cirrhosis
  • caused by increased ammonia lvl in the blood
145
Q

slide

A

49,52,54

146
Q

colostomy

A

creates an opening (stoma) in the abdomin to pass stool

147
Q

bowel irrgation

A

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

148
Q

prupose of colostomy irrgation

A

allows client to create bowel regiment

149
Q

why kind of tip in colosntmy irrgation

A

cone tip application to avoid damage to colonstomy

150
Q

hemorrhoids

A

sitended inflamed veins in the anus/rectum

151
Q

causes of hemorrhoids

A

increased anorectal pressure (straining to defecate, constipation).

152
Q

Nursing management for the post-hemorrhoidectomy client includes the following:

A

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

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