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MedSurg > GI Disorders: Alimentary Tract > Flashcards

GI Disorders: Alimentary Tract Flashcards

1
Q

GI transit time

A

~30 hours

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2
Q

GI assessment

A

Inspection, Auscultation, Percussion, Palpation

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3
Q

GI assessment: auscultation

A

Normal: low to high pitched gurgling, 5 to 30/min
Absent: must listen for 5 mins

  • Hypoactive: constipation r/t meds (anesthesia, opioids, anticholinergics), ileus
  • Hyperactive: inflammatory bowel disease, infection, meds
  • Bowel obstruction: early signs are hyperBS bc system trying to move it, late signs are hypoBS
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4
Q

GI assessment: ausculation using bell

A

Listen for low-pitched bruits = partial obstruction of vessel
- Don’t palpate area, notify provider

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5
Q

GI assessment: lab values for nutritional status

A
  • Albumin, prealbumin, transferrin
  • Prealbumin most accurate (16-30)
  • Transferrin bc role in iron binding and transport
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6
Q

Stomatitis

A

Inflammation & ulceration of mouth lining + other mucous membranes in GI tract

  • Secondary: result of infection in immunosuppressed pts
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7
Q

Stomatitis clinical manifestations

A
  • *Severe atypical chest pain
  • *Hemorrhage
  • *Aspiration pneumonia
  • *Morning hoarseness
  • Heartburn
  • Painful swallowing, regurgitation
  • Chronic cough, dental carries
  • Adult-onset asthma
  • Laryngitis, pharyngitis, bronchitis
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8
Q

Stomatitis medical management (prevention care)

A
  • Sodium bicarb + water or saline
  • Topical analgesics
  • Moisturizers
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9
Q

Sodium bicarb for stomatitis prevention

A
  • Swish and spit every 4 hours
  • Remove loose particles
  • Moisturizes
  • Thins oral mucous
  • Decrease acidity
  • Decreases yeast growth
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10
Q

Stomatitis risk factors

A
  • Viral, bacterial, fungal infections
  • Chemo / radiation therapy
  • Irritants (chew tobacco, alcohol, mouthwash)
  • Allergies (metal, meds, dental materials, foods)
  • Deficiencies (B vitamins, iron, folate, zinc)
  • Systemic diseases (eg. chronic kidney disease, IBD)
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11
Q

Stomatitis assessment

A
  • Vital signs (temp = infection, increased pulse and decreased BP d/t fluid volume deficit)
  • Pain
  • Oral mucosa: detailed description, erythema, ulcers, location
  • Nutrition
  • Weight
  • I&O: assess for fluid vol deficit
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12
Q

Stomatitis nursing interventions

A
  • Aspiration precaution: suction, HOB 45 elevate, topical analgesics
  • Med administration: antimicrobials, antivirals (acyclovir), antifungal (nystatin troche), viscous lidocaine
  • Water soluble lubricants for lips/mouth: reduce dryness and cracking
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13
Q

Stomatitis pt teaching

A
  • Mouth care post meals, using soft-bristled toothbrush
  • No alc-containing mouthwash or glycerin swabs d/t drying out
  • Dentures or other oral devices removed
  • Routine dental care
  • Saline mouthwashes every 4 hours
  • Choose diet accordingly: avoid hard salty acidic spicy foods, high protein to facilitate healing
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14
Q

Gastroesophageal reflux disease (GERD)

A

Retrograde flow of GI content into esophagus causing inflamm –> slows removal of stomach contents –> increased blood flow (hyperemia), ulcerations (erosions), minor bleeding in esophagus

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15
Q

GERD risk factors

A
  • *Hiatal hernia
  • Lower esophageal sphincter hypotension
  • Loss of esophageal motility
  • Increased states of gastric secretion (Zollinger-Ellison Synd)
  • Delayed emptying of gastric contents (diabetes)
  • Obesity, pregnancy, eating large meals
  • Ascites
  • Tight belts or girdles
  • NG tube
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16
Q

GERD clinical manifestations

A
  • *Heartburn (dyspepsia)
  • *Severe atypical substernal chest pain
  • *Regurgitation
  • *Dysphagia
  • *Aspiration pneumonia
  • *Morning hoarseness
  • Odynophagia (painful swallow)
  • Chronic cough
  • Laryngitis, pharyngiits, bronchitis
  • Dental carries
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17
Q

GERD complications

A
  • Barret’s esophagus
  • Strictures
  • Esophageal CA
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18
Q

GERD complication: Barrett’s esophagus

A
  • Squamous epithelium replaced w Barrett’s epithelium
  • More resistant to acid
  • High propensity for malignancy –> esophageal CA
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19
Q

GERD complication: Strictures

A
  • Scarring and fibrosis in esophagus
  • Secondary to healing process after acid exposure
  • Results in worsening dysphagia and sensation of food getting stuck
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20
Q

GERD complication: esophageal CA

A
  • Untreated GERD is risk factor
  • Smoking and alc
  • Barrett’s esophagus
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21
Q

GERD nursing assessment

A
  • Resp symptoms: aspiration, pneumonia, chronic cough, wheez
  • Regurgitation: aspiration if lying supine
  • *Severe atypical chest pain: caused by esophageal spasm, NEED to rule out cardiac origin
  • Hemorrhage
  • Dyspepsia, dysphagia, odynophagia
  • Eructation, flatulence, bloating
  • Nausea
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22
Q

GERD medical management

A
  • PPIs
  • H2 blockers
  • Prokinetics
  • Antacids
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23
Q

GERD nursing intervention

A
  • Meds
  • Pt positioning: lying on R side promotes gastric emptying
  • Elevate HOB
  • Small freq meals (decrease pressure and promote gastric emptying)
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24
Q

GERD pt teaching

A
  • Avoid smoking & alc
  • Avoid NSAIDS and ASA (aspirin)
  • Wait 2 hrs after eating before lie down
  • Limit certain foods (… peppermint, caffeine)
  • Med teaching
  • Maintain ideal body weight; weight reduction
  • Nonrestrictive clothing
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25
Q

Gastritis

A

Localized, intermittent inflamm of gastric mucosa

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26
Q

Acute gastritis cause

A
  • *Aspirin & NSAIDS
  • Chronic ingestion of irritating foods
  • Chemo & radiation
  • Poison
  • Major surgery, trauma, infections
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27
Q

Chronic gastritis causes

A
  • *H.Pylori
  • *NSAIDS
  • TB, alcohol, bile reflux
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28
Q

Acute gastritis clinical manifestations

A
  • (everything from chronic gastritis)
  • Dehydration
  • Loss of blood: pallor, tachy, hypotension
29
Q

Chronic gastritis clinical manifestations

A
  • Epigastric pain
  • N/V
  • Weight loss
  • Decreased appetite
  • Changes in stool color
30
Q

Gastritis medical management

A
  • Proton pump inhibitors
  • H2 receptor antagonists
  • Antacids
  • Sucralfate
  • Antacids + sulcralfate (NO solid mass)
  • *Vitamin B12 supplements (treat pernicious anemia)
  • Triple treatment for H Pylori
31
Q

Triple treatment for H Pylori

A

High eradication rate

  • PPI
  • Clarithromycin (abx)
  • Amoxicillin (abx)
32
Q

Gastritis nursing assessment

A
  • History/CC: heartburn, indigestion, N/V, dyspepsia, food poisoning
  • Vital signs: FVD (tachy, decreased BP)
  • Abd exam: skin, pallor, coolness, signs of dehydration
  • Peripheral pulses: weak pulses due to FVD
  • I&O: FVD from vomit or blood loss
33
Q

Gastritis nursing interventions

A
  • IV fluids & electrolyte administration per order
  • Meds: PPI, H2 receptor antagonists, antacids, sucralfate
  • N/V management
34
Q

Gastritis pt teaching

A
  • Report episodes of hematemesis (bright red blood or dark brown, coffee ground appearance)
  • Med adherence
  • Avoid foods irritant to gastric mucosa: alcohol, caffeine, NSAIDs, spicy foods
35
Q

Peptic Ulcer Disease risk factors

A
  • H. Pylori
  • NSAIDS
36
Q

PUD clinical manifestations

A

Gastric ulcer:
- *Exacerbated by eating
- *Little/no relief from antacids
- Epigastric pain

Duodenal ulcer:
- *Exacerbated by fasting
- *Improved w food/antacids
- Burning epigastric pain
- Pain that awakens ppl d/t nocturnal gastric secretions

37
Q

PUD medications

A
  • Antacids: neutralize acids
  • H2 receptor antags: decrease acid prod
  • PPI: block acid prod
  • Sucralfate: enhance mucosal defenses by binding to necrotic ulcer tiss & serving as barrier
38
Q

PUD diet management

A
  • Avoid dietary irritants: spices, alc, caffeine
  • Meal frequency: 6 small meals per day OR hourly meals
  • GI bleed –> NPO
  • *Smoking cessation: decreases healing, increase ulcer relapse
39
Q

PUD complications

A
  • *Gastric adenocarcinoma (H Pylori)
  • GI hemorrhage
  • Abd or intestinal infarction
  • Perforation & penetration into attached structures
  • Obstruction
  • Peritonitis
40
Q

PUD assessment

A
  • History: alc, aspirin, NSAID, diet, foods assoc
  • VS (tachy, hypotension, orthostatic)
  • Weight
  • Pain (left epigastric, rhythmic, referred to L shoulder)
  • Abd exam
41
Q

PUD nursing interventions

A
  • IV infusions and administer blood prods as ordered (Hgb < 7 or symptomatic)
  • Meds: PPIs before meals, antacids 1-3 hrs post meal
  • Prepare pt/family for upper endoscopy/EGD/surgery
  • Limit food after evening meal
  • Pain documentation
  • Assist w gastric lavage: irrigation via NG tube, removes irritating blood from gut, slows bleed
42
Q

PUD pt teaching

A
  • Med adherence: PPI, H2 receptor antag, antacids, avoid OTC meds for dyspepsia if taking prescription meds
  • Avoid eating w/in 2 hrs of bedtime
  • Avoid PUD risk factors: NSAID, alc, aspirin, spicy food
43
Q

Types of Hernias

A
  • Inguinal: intraabd fat/SI protrudes around inguinal canal
  • Indirect: congenital, inguinal doesn’t close after birth
  • Direct: connective tiss degen weakens muscles
  • Femoral: preset below inguinal ligament 40% present as incarcerated
  • Umbilical: omentum and fat incarcerates
  • Ventral (or incisional): prev abd surgeries, often midline incision in upper area
44
Q

Incarcerated/Strangulated hernia

A
  • Surgery is more extensive
  • May result in temp colostomy
45
Q

Reducible vs. Irreducible/Incarcerated hernia

A
  • Reducible: contents easily reenter the abd by lying down or gentle pressure
  • Incarcerated: contents can’t be placed back into abd cavity (medical emergency)
46
Q

Hernia nursing assessment

A
  • VS (temp: infection)
  • Pain
  • I&O
  • Surgical site (well approximated)
47
Q

Hernia

A

Protrusion of abd contents thru area of weakened muscle in abd wall

48
Q

Hernia nursing interventions

A
  • Deep breathing, early ambulation
  • Administer pain meds as needed; prescription for pain meds upon discharge
  • Ice pack to scrotum, elevate scrotum
  • Advance diet as ordered, clear liquids to solids
49
Q

Hernia pt teaching

A
  • Discourage cough, if necessary, splinting (squeeze pillow against abd during cof)
  • Avoid heavy lifting for several weeks
  • Pain management techniques
  • What to observe in surgical incision
50
Q

Diverticulitis

A

Small pouchlike protrusions/herniations occuring primarily in colon at weak areas of intestinal wall

51
Q

Diverticulitis risk factors

A
  • Low fiber, high-fat diet
  • Obesity and smoking
  • Increasing age and heredity
  • Meds (NSAID, Tylenol, Opiates, Corticosteroids)
52
Q

Diverticulitis clinical manifestations

A
  • Localized abd pain over involved area, usually sigmoid colon
  • Fever and leukocytosis
  • Diarrhea, constipation, bloating, flatus
  • *Older adult: change in mental status
53
Q

Diverticulosis vs. Diverticulitis

A
  • Diverticulosis: non-infected pouching
  • Diverticulitis: infected diverticula
54
Q

Diverticulitis nursing assessment

A
  • VS (fever = infection, tachy = FVD)
  • Pain local vs diffuse (*diffuse pain = rupture)
  • GI: bowel sound, character of stool
  • *Mental status in older adults
  • I&O
  • Serum K levels (NG tube loss)
55
Q

Diverticulitis nursing interventions

A
  • Administer IV fluids
  • Administer ordered abx
  • NG tube to low intermittent suction to decrease GI motility
  • Provide oral care d/t dryness from increased mouth breathing
56
Q

Diverticulitis pt teaching

A
  • Dietary recs: increased fiber and fluids
  • Avoid straining, bending, lifting
  • Weight reduction
  • Complete abx as ordered to avoid rebound infection
57
Q

Diverticulitis complications

A
  • *Perforation
  • *Peritonitis (as result of perforation)
  • *Sepsis
  • Bowel obstruction
  • Inflammation resulting in fistula formation (colon and pelvic organs)
58
Q

Inflammatory bowel disease

A

Broad term for similar chronic diseases of GI tract
- Crohn’s Disease
- Ulcerative Colitis (UC)

59
Q

IBD cancer risks

A
  • Crohn’s: Small bowel cancer, cholangiocarcinoma
  • UC: Colon cancer, cholangiocarcinoma
60
Q

Characteristics of Crohn’s

A
  • Affect mouth, anus, most commonly in terminal ileum, and then colon
  • Affect all layers of intestine: transmural
  • Loose, semiformed stool
  • 5-6 loose, non-bloody stool
  • Fistual, fissure, abscess, stricture: COMMON
  • Tenesmus (spasm of rectum): RARE
  • Fistulas, nutritional deficiencies
  • Recurrence at site of anastomoses
61
Q

Characteristics of ulcerative colitis

A
  • Colon, rectum. Begins in rectum and advances in continuous process to cecum
  • Mucosa and submucosa of colon
  • Freq watery stools w blood and mucuous
  • 10-20 liquid and bloody stools
  • Tenesmus: COMMON
  • Hemorrhage, nutritional deficiencies
  • Cure w colectomy
62
Q

IBD Psychosocial issues

A
  • Body image disturbance
  • Embarrassment
  • Depression and anxiety
  • Loss of independence
63
Q

Crohn’s & surgery

A

Removal of diseased bowel is not curative, disease often returns in another area of bowel

64
Q

What leads to surgery for UC?

A

Ineffective medical management or complications from medical management

65
Q

Surgical management of IBD

A
  • Total colectomy w ileal pouch anal anastomosis (IPAA): entire colon & rectum removed, pouch created to collect waste, person can defecate normally
  • Proctocolectomy w permanent ileostomy
66
Q

IBD nursing assess

A
  • History: freq diarrhea leading to extreme fluid loss and electrolyte abnormalities (hypokalemia)
  • VS: tachy, hypotension, low grade fever
  • Weight: decreased intake d/t fear of worsening sympts & malabsorp
  • I&O
  • Freq and characteristics of stool
  • Psychosocial support
  • Nutritional intake
67
Q

IBD nursing interventions

A
  • Administer IV fluids & supplemental potassium as ordered
  • EKG monitoring if significant hypokalemia
  • Administer blood products & abx as ordered
  • Small frequent meals (decrease intestinal motility)
  • Rest periods (decrease intestinal motility)
  • Pain management: positioning, medications, monitoring for side effects such as constipation
  • Skin care: freq diarrhea, presence of ostomy
68
Q

IBD pt teaching

A
  • Nutrition: vitamin supplements, reducing fat and fiber during exacerbations, fluids
  • Meds: schedule of meds, SEs, how they work & purpose
  • Regular provider follow up
  • Routine colonoscopy

MedSurg (15 decks)

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