GI AP Feed UGI Flashcards
What is the best position to give enema?
left lateral d/t the positioning of sigmoid colon
What might happen is the vagal nerve is simulated?
decrease HR and BP
For what conditions is rectal temperature contraindicated?
Cardiac disease such as MI r/t risk of brady arrythmias, recent rectal, vaginal and prostate surgery r/t surgical incision
Liver function
Synthesis of glucose, protein & blood-clotting factors
Produces bile to digest and absorb fats
Should not be able to palpate
Kupffer cells
phagocyte bacteria that enters the liver
pancreas function
Endocrine: insulin, glucagon, somatostatin
Exocrine: secrete pancreatic enzymes into GI tract through pancreatic duct (amylase, lipase, trypsin)
Spleen function
Filters antigens from the blood
Removes old or abnormal RBCs
Responsible for the immune response to infection because it is rich with B and T lymphocytes
Gallbladder functions
Storage tank for bile
Bile salts emulsify fat in the distal ileum
What is bilirubin converted to
urobilinogen and either excreted in feces or returned to portal circulation where it is re-excreted into the bile
What happens when bile is impeded due to gall stones or tumor?
Biliruben does not enter the intestine
- jaundice
- Icterus
- Renal excretion of the bilirubin (dark color urine)
- —-> Frothy when agitated since bile is a soap
- Clay colored stools because bile is not entering the small intestine
- Pruritus
- —-> Bile salts are irritating to the skin
Gero: Oral cavity, pharynx, esophagus
Chewing swallowing
Reflux (heartburn)
Decreased peristalsis
Gero: Stomach, small intestine, large intestine
Gastric mucosal degeneration
Decreased HCL production
Decreased B12 absorption leads to anemia)
Loss of sphincter control
Gero: liver
Increased drug toxicity
Decrease phagocytosis by Kupffer cells
What are things you want to consider when performing an abdominal assessment?
Hepatoxic substances Pain Dyspepsia Gas N/V Bowel habirs Color/consistency (BM, emesis) Soft, flat, rounded/soft, rounded/firm Jaundice Ascites Vein enlargement
What order of business do we use when doing a physical examination of the abdomen?
Inspection
Auscultation
Percussion
Palpation
Cullen sign
Bruising around umbilicus
- often seen in pancreatitis
Murphy sign
Patient unable to take a deep breath when examiners fingers are pressed below the right costal margin
Blumberg sign
Rebound tenderness
– seen in peritonitis
Rectal examination is done when?
usually performed when someone has fecal impaction
Dx: stool
multiple dif. tests for stool
Dx: Breath
H. Pylori (bacteria that can invade stomach)
Dx: imaging - upper GI tract study - barium swallow
Barium becomes like concrete in the GI tract - it will discolor stool. Push fluids and stool softener after
can inject through ostomy or rectum as well as PO
Endoscopy
Direct visualization of structure through a lighted endoscope
Gastric pH and esophageal pH ranges?
Gastric pH: 1-2
Esophageal pH: 5-6
Bili total range
0.3-1
Direct bili range
0.1 - 0.04
What is something to consider for a liver biopsy?
Bleeding is a complication (because it is so vascular)
- monitor PT and PTT prior to make sure the client is not at a high risk for bleeding
- lay on right side after procedure
What are things we can consider for paracentesis?
Look at albumin on the fluid drained
Bleeding risk
Hypovolemic because there has been a fluid shift - alters afterload
Gastrointestinal intubation:
Decompresses the stomach
- relieves nausea
Can use to lavage the stomach and remove toxins if someone had an OD or ingestion of something bad
Medications and nutrition is inserted through this tube
Treat an obstruction
Gastrointestinal intubation contraindications
Head and facial trauma, esophageal varices or diverticula, history of alkali ingestion – needs to be places by provider or endoscopy
What are some things you would want to assess for gastrointestinal intubation?
suction setting, assess skin, tube in correct position and stays there, working correctly, color of contents you’re looking for
How much fluid does the GI system make in a day?
up to 1500ml/day
What should the suction be set on for decompression of the stomach (gastrointestinal intubation)?
Should be on low, intermittent suction (20-80 mmHg)
Eternal tube feed: post pyloric tubes
Tube that goes past stomach
- measure the tube and confirm placement via Xray. Secure the tube in place.
- medication and tube feeds go through this tube, so the tube can get clogged.
What is one of the most important things to remember for an enteral tube feed (post pyloric tube)?
Oral care - alters sensation, client not eating or drinking so mouth gets dry
What does it mean if you see coffee ground material with an enteral tube feed?
indication of bleeding
Why might someone get a enteral tube feed
Aspiration risk, not eating, surgery, unconscious
Residual
Amount of feeding left in the stomach after 4 hours
Dumping syndrome
can happen because feedings are highly concentrated
Enteral tube feeding: solution of specific strength
Desired strength x amount of desired solution = solute
(substance/concentrated liquid to be dissolved)
Amount of desired solution-solute = amount of liquid needed to dissolve substance (solvent)
EX: 1/3 strength Ensure 900ml by NG tube over 8 hr
1/3 X 900 mL=X
X= 900/3 x= 300mL (of the formula ensure)
900 mL- 300 mL= 600 mL (you would add 600 mL of water to the 300 mL of Ensure to get 1/3 strength formula
1/3 strength jevity, it is determined that either the patients caloric need is at such that they can’t tolerate 1 to 1 or they do not need 1 to 1 (maybe having too much diarrhea with full strength), so we give them a partial strength feeding concentration - NURSES mix these (mix the jevity with water)
EX: 1/3 strength Ensure 900ml by NG tube over 8 hr (rate does not matter for this) = substance to be dissolved
The answer to this is how much Jevity you add.
To determine how much water you mix in, you take the 900 and subtract the feeding (300) to get 600 (amount of water to mix)
What is something to remember when anything is going to be administered via enteral tube feed?
Flush before and after administration
Intake - output =
balance
Ex. 2300 mL in, 4500 mL out
2300-4500 = -2200mL (this is a negative balance)
What might be happening if the client has greater output than input?
if you have no other information on the client, then you must consider that the client could be hypovolemic
What must you do when you are irrigating and you are not told that the irrigation fluid is removed from the total output?
you have to subtract it
Gastrostomy (Gtube) - what?
Enteral therapy or decompression of stomach contents
What are complications of enteral therapy?
Diarrhea Nausea/vomiting Dumping syndrome Constipation Aspiration Tube displacement Obstruction Nasopharyngeal irritation Hyperglycemia Dehydration
Why is dehydration a potential complication of enteral therapy?
Hyperosmolar feedings with insufficient water intake
What are indicators of malnutrition?
Prealbumin less than 1.6
Albumin less than 3.5
Weight loss of 10% in 6 months, 5% in 3 months or BMI <18.5b
Parenteral nutrition (TPN): how should a formula with Dextrose greater than 10% be administered?
Any formula with Dextrose concentration > 10% must be administered through a central vein
Parenteral nutrition: what would you administer is the TPN is stopped for any reason related to hypoglycemia?
Dextrose 5 or 10%
What should you keep in mind when it comes to draw blood on someone who has parenteral nutrition?
Do not draw blood off the part where TPN is being administered
What medications can be given with TPN?
no medications given with TPN except insulin
What should the nurse do if there is a clotted catheter in someone who has TPN?
administer tPA
How would you administer parenteral nutrition (TPN)?
over 24 hours, through central line
what should the nurse watch for if the TPN is abruptly stopped
hypoglycemia
What should the nurse be aware of in regard to the contents of TPN?
The contents are high in glucose, so the client is at risk for hyperglycemia. It can be treated with sliding scale OR you can add insulin to the TPN.
What is the only kind of insulin you can add to the TPN
regular insulin
How should the nurse stop TPN
Titrate it down to decrease the risk of hypoglycemia
Things to ensure for tube feedings
HOB up
Rate
Tolerance
Complications
Things to ensure with TPN
Central line
complications
