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331 Quiz 2 > GI bleeds > Flashcards

GI bleeds Flashcards

1
Q

where should we be checking for upper GI bleeds

A
  • esophagus, stomach, and duodenum
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2
Q

where do we check for lower GI bleed

A
  • jejunum, large intestine, rectum
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3
Q

what are causes of upper GI bleeds

A
  • peptic ulcer
  • erosive esophagitis
  • varices
  • mallory-weiss syndrome
  • cancers
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4
Q

what is peptic ulcer disease (PUD)

A
  • eurosive GI mucosa resulting from digestive action of HCl and pepsin
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5
Q

chronic esophagitis (affects esophagus)

A
  • alcohol, smoking, or GERD causing irritation of the esophageal wall
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6
Q

mallory-weiss tear (affects esophagus)

A
  • severe retching and vomiting that leads to tearing of the esophageal wall
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7
Q

esophageal varices (affects esophagus)

A
  • secondary to liver cirrhosis
  • they are enlarged veins in the esophagus
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8
Q

what causes bleeds in stomach and duodenal

A
  • medications (ASA, ibuprofen, corticosteroids), alcohol, GERD
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9
Q

what are behvaioral issues that can cause mallory weiss tears

A
  • chronic alcoholism
  • bulimia nervosa
  • anorexia nervosa
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10
Q

pathological issues that can cause mallory-weiss syndrome

A
  • GERD
  • hiatal henia
  • chemo
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11
Q

what history can we collect to source the bleeding

A
  • PUD (history of H. pylori infection, NSIAD use, antithrombotic use)
  • history of liver disease, alcohol use
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12
Q

what are patient histories that will impact treatment for upper GI bleeds

A
  • anemia (heart pulmonary disease)
  • fluid overload (HF)
  • coagulopathies, thrombocytopenia
  • meds (NSAIDS, anticoagulants, antiplatelets)
    -blood transfusions
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13
Q

symptoms of Upper GI bleeds

A
  • nausea, vomitting, weight loss, thrist, diarrhea, black tarry stools, decreased UO, weakness, abd pain
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14
Q

cardiovascular signs for upper GI bleeds

A
  • tachy, weak pulse, ortho hypotension, slow cap refill
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15
Q

symptoms for severe bleedign for upper GI

A
  • ortho lightheadedness
  • confusion
  • angina
  • severe palpitations
  • cold/clammy extremities
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16
Q

whats a big risk factor that can occur with severe GI bleeds

A
  • hypovolemic shock
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17
Q

what laboratory tests need to be done for upper GI bleeds

A
  • CBC (hgb)
  • prothrombin time
  • renal profile (increased BUN, UGIB)
  • liver profile (increased AST, ALT)
  • ECG
  • troponins (increased)
  • know blood type
  • get vomit and stool sample
18
Q

diagnostic tests for upper GI bleeds

A
  • endoscopy (into mouth)
  • colonoscopy (in rectum)
19
Q

what should nurses do when GI bleed is being figured out or is found (7)

A
  • monitor ABCs
  • vitals/perfusion status
  • keep patient NPO
  • ensure IV lines 16 gauge
  • oxygen >94%
  • treat hypotesnion (bolus infusion crystalloids)
  • blood transfusion 1:1:1 ratio of RBCs, plasma, platelets
20
Q

pharmacological management of GI bleed

A
  • histamine 2 receptor blockers (zantac)
  • proton pump inhibitors (pantoprazole)
  • antacids
  • antibiotic therapy (treat H. pylori)
21
Q

what do histamine receptors do (zantac)

A
  • decrease HCl production
22
Q

what is acute pancreatitis

A
  • acute inflammation of the pancreas
  • auto digestion causes necrosis of endocrine and exocrine cells
23
Q

what are causes of acute pancreatitis

A
  • gallbladder gallstones
  • alcohol
24
Q

interstitial pancreatitis

A
  • mild inflammatory response
  • most common cause is gall stone and alcohol
  • quick onset and easy recovery
25
Q

necrotizing pancreatitis

A
  • life threatening muiltisystem disease
  • necrosis
  • infection/sepsis
  • ICU and long term hospitalization
  • high mortality rate
26
Q

signs and symptoms of acute pancreatitis

A
  • sudden onset
  • pain radiates to back and is epigastric pain - wprse when laying down
  • nausea/vomting
  • decreased bowel sounds
  • bruising bewteen last rib and ileac crest or umbilicus
27
Q

what happens to cardiac and respiratory during acute pacreatitis

A
  • vasodilation, hypotension
  • tachycardic
  • bronchoconstriction
28
Q

what lab results will we see with someone who has acute pancreatitis

A
  • hyperglycemic
  • serum amylase decreases
  • serum lipase elevated
  • US or CT abd
  • ERCP (endoscopic retrograde)
29
Q

nursing care for acute pancreatitis

A
  • rest pancreas
  • pain management
  • monitor for potenitial complications (AKI (volume depletion), resp distress (edema), infection)
30
Q

treatment for pancreatitis

A

maintian NPO
- IV hydration
- NG suction
- monitor BS
- nutrition
- pain managment (no morphine!!)

31
Q

what can cause acute liver failure

A
  • primary disease process (virus, autoimmune, alcohol, drugs, hepatitis)
  • chronic liver disease, cirrhosis
  • MOD (shock)
32
Q

labs for acute liver failure

A
  • coagulation greater than 1.5
  • altered mental state
  • encaphalopathy
  • illness
33
Q

complications that can arise with liver failure (6)

A
  • hepatic encephalopathy (brain)
  • portal hypotension
  • ensophageal varices
  • ascites
  • hepatorenal syndrome
  • infections
34
Q

how do rupture varices occur

A
  • coughing, vomiting, straining
  • bleeding will be a medical emergency
35
Q

what are signs and symptoms with acute liver failure (5)

A
  • cardio: pulmonary edema, hypotension
  • GI: nausea/vomitting, diarrhea, anorexia, ascites, hypoglycemia, abdominal pain
  • Hematologic: coagulation failed (bleeding)
  • pulmonary: tachypnea, crackles
  • integument: spider angioma, jaundice, edema
36
Q

how to manage hepatic encephalopathy

A
  • enema or laxative to have bowel movement
  • helps remove urea ammonia
37
Q

ascites management for liver failure

A
  • diuretics
  • sodium restriction
  • paracentisis
38
Q

hypoglycemia management for liver failure

A
  • monitor signs
  • administer IV dextrose
39
Q

metabolic abnormalities management

A
  • monitor and treat electrolyte imbalances
40
Q

how to manage gastrointestinal hemorrhage

A
  • vitamin K
  • oral antacids
  • frozen plasma, platelets
41
Q

management for cerebral edema

A
  • monitor ICP
  • administer IV mannitol
  • elevate head of bed

331 Quiz 2 (8 decks)

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