GI disorders Flash Cards
What should be included in your general assessment of a patient?
history, medications, pain level, location, duration, diagnostic tests, fluid and electrolytes, CBC, physical exam, food intake, calories
What body parts should be included in physical exam of the GI?
mouth, abdomen, rectum (stool quality and vomitus)
What are risk factors that can cause GI problems?
peristalsis and nutrition problems, immobility, medications, dehydration, anorexia, age, infection
What are some common manifestations of GI disorders?
anorexia, n & v, vomiting, dysphagia, constipation, diarrhea, constipation, pain, bleeding
_____ is the feeling to vomit
nausea
What s/s will accompany nausea?
diaphoresis, increased salivation, pallor, tachycardia, dizziness, and faintness
True or false, nausea is defined as reverse peristalsis and relaxation of the esophageal sphincter
False, vomiting
What are 2 types of vomiting?
projectile and retching (dry heaves)
Your post-op patient Kim is experiencing severe vomiting. What would you included in your assessment?
Condition associated with N/V, amount, odor, content [undigested food, mucus, parasites, foreign bodies, and color (green, red, coffee grounds, black, brown)]
After your assessment of Kim (severe vomiting), what nursing interventions would you implement?
NPO, IV w/ electrolyte replacement, NG tube insertion, give antiemetic
What preventative measures can you implement to prevent your patient for vomiting?
give water first, then slowly give clear liquids, warm cola, continue to increase if no vomiting, advance dry toast, crackers, bland food as tolerated.
What foods should a patient avoid that stimulate peristalsis?
high fat foods, orange juice, caffeine, high fiber, extremely hot or cold fluids
True or False, Bowel movements can vary from three a day to three a week
TRUE
What are your nursing interventions for constipation?
assist physician tx underlying cause, encourage to eat HIGH fiber diet to increase the bulk, increase fluid intake, administer prescribed laxatives/stool softeners, and assist in relieving stress
What are your nursing interventions that diarrhea?
record the color, volume, frequency and consistency of stools; identify factors that cause or contribute to diarrhea; eliminate gas-producing and spicy foods; rest the bowel; record weight regularly; monitor skin; antidiarrheal medications
You are educating your patient who has had diarrhea for the past two days on the ideal diet he should eat. What do you encourage him to eat?
a low-fiber, high-protein, high-calorie diet
What are some common diagnostic tests for GI disorders?
gastric analysis, lab tests (serum & urine), x-rays, endoscopy
What are 5 endoscopy diagnostic procedures?
gastroscopy, EGD, ERCP, colonoscopy, sigmoidoscopy
What does ERCP stand for and what is it?
endoscopic retrograde cholangiopancreatography. Exam of the hepatobilary system performed via a flexible endoscope inserted into the esophagus.
What does EGD stand for and what is it?
Esophagogastroduodenoscopy. Test to examine the lining of the esophagus
True or False, a upper gastrointestinal fiberoscopy is the aspiration of gastric juice to measure pH, appearance, volume and contents
False, Gastric analysis
What do you educate your patient on Pre-test and post-test instructions for gastric analysis?
Pre-Test: NPO 8 hours, avoidance of stimulants, drug and smoking. Post-test: resume normal activities
True or False, the only nursing responsibility for x-rays is prep
TRUE
What are the nursing responsibilities for endoscopy, ERCP, and colonoscopy
preps (MD order), consents, conscious sedation, post procedure assessment
What is the difference between upper and lower GI tract barium studies?
Upper- client drinks barium and only fluoroscopy exam. Lower- barium enema administered and fluoroscopic & radiographic exam
You need to give your patient a bowel prep. What does that entail?
laxative 12-15 hours before the test and give the patient 4 liters/quarts of a special cleansing solution to clean out the colon
Name one medication for bowel cleansing
polyethylene glycol 3350 (GoLYTELY)
What are 2 laxatives used to cleanse the bowel?
mag citrate (Citroma) or senna (X-Prep)
What are 2 common orders before a GI diagnostic test?
Bowel Prep, Diet Orders (NPO or Clear liquids only)
Suzie has just came back from an upper GI fiberoscopy, what will you monitor her for?
Vomiting, reflux, difficulty swallowing, chest pain or heart burn, N & V, abdominal pain, diarrhea
What are some nursing dx for patients with some kind of feeding tube?
altered elimination, n & v, FVD, pain, discomfort, nutrition, malabsorption, metabolic, self care deficit-feeding, elimination, tissue integrity, skin integrity, risk of infection, risk of injury
Your GI patient is at risk for imbalanced nutrition, what are some interventions you will implement?
anticipate pain & nausea, monitor bowel sounds and elimination, I & O, arrange for feeds, encourage supplements, dietary consult and tube feeding
If you are taking care of a patient on TPN, PPN, or Lipids, what are 2 nursing intervention you will implement?
site and line care, glucose levels
What are the clinical manifestations of an esophageal tumor?
dysphagia, odynophagia, regurgitation, vomiting, foul breath, chronic hiccups, pulmonary complications, chronic cough, and hoarseness
A _______ is an ulceration in the ______ wall of the stomach, pylorus, duodenum or esophagus in portions accessible to _____ secretions.
A peptic ulcer is an ulceration in the mucosal wall of the stomach, pylorus, duodenum or esophagus in portions accessible to gastric secretions.
True or False, vascular occlusion causes localized necrosis and HCL backwash in peptic ulcers
TRUE
Melanie comes into the ER c/o epigastric pain, n & v, and coughing up blood. What would you expect she is suffering from?
Peptic Ulcer
What are your interventions during an active bleeding ulcer?
monitor vital signs closely, assess for signs of dehydration, hypovolemic shock, sepsis, and respiratory insufficiency, maintain NPO and administer IV fluid replacement, monitor I & O, monitor H & H, administer blood prn
What is the action of antacids?
elevate the level of the gastric contents
True or False, the action of histamine receptor antagonists is to increase acid production
False, the action is to decrease acid production
What is the action of proton pump inhibitors?
Provide effective, long-acting inhibition of gastric acid secretion
What is the action of prokinetic drugs?
increase gastric emptying and improve lower esophageal sphincter pressure and esophageal peristalsis
Cisapride is an example of what kind of drug?
prokinetic drug
What are the treatments of peptic ulcer?
decrease risk factors, drug therapy, surgery, manager complications: GI bleeding
What are drugs prescribed for a peptic ulcer?
Histamine 2 blockers, pepcid, antacids, prostaglandins, omperazole
What are common surgeries used to correct a peptic ulcer?
vagotomy, pyloroplasty, bilroth I Bilroth II (total gastric resection)
What are the nursing interventions for postop care of a peptic ulcer?
monitor VS, monitor NG tube, NPO until peristalsis, monitor for complications (dumping syndrome, reflux gastropathy, bleeding)
Constellation of vasomotor symptoms after eating is called what?
Dumping syndrome
You suspect your patient is hypovolemic, what nursing intervention will implement?
Monitor VS(including ortho BP) and observe for fluid loss from bleeding and vomiting, monitor serum electrolytes, insert 2 large-bore peripheral IV caths to replace fluid and blood loss,
What type of volume replacement would you expect for a hypovolemic patient?
isotonic crystalloid solution
True or False, gastric cancer patients may be asymptomatic, but indigestion and abdominal discomfort re the most common symptoms
TRUE
True or False, drug therapy in chemo of gastric cancer remains uncertain
TRUE
True or False, the use of radiation in gastric cancer is limited because the disease is often widely disseminated
TRUE
_______ is defined as the ______ inflammation of the ____ appendix—- the blind _____ attached to the _____ of the colon
Appendicitis is defined as the acute inflammation of the vermiform appendix—- the blind pouch attached to the cecum of the colon
True or False, flank pain is the initial symptoms of classic appendicitis?
False, epigastric or periumbilical abdominal pain
What are the 6 non-surgical interventions to tx appendicitis?
NPO, IV fluid, semi-fowlers, analgesics, no laxatives or enema, and no heat
What are your nursing interventions for our gastric cancer patient?
monitor VS, monitor H & H, monitor weight, assess nutritional status (encourage small, bland, easily digestible meals with vitamin and mineral supplementation), administer pain meds prn, get patient ready for chemo or surgery
True or False, when the appendix becomes inflamed or infected, rupture may occur within a matter of hours, leading to peritonitis and sepsis
TRUE
Where will the pain be the most painful in a patient with appendicitis?
McBurney’s Point
What are the post-op interventions of a patient that had an appendectomy?
monitor temp for s/s of infection, assess incision for signs of infection such as redness, swelling and pain, maintain NPO until bowel sounds have returned, change dressing prn, keep patient in semi-fowlers with legs flexed to promote drainage, administer antibiotics or pain meds prn
Would you expect a patient to have a Jackson Pratt or a Penrose drain post appendectomy rupture?
Penrose
What is Crohn’s Disease?
An inflammatory disease of the small intestine and/or colon
Which layer of the bowel is involved in Crohn’s disease?
all layers, mostly terminal ileum
What assessment findings would you anticipate in a patient with CD?
fever, abdominal distention, diarrhea, colicky abdominal pain, anorexia, n & v, weight loss, anemia
Name 4 classes of drugs used to treat CD
salicylate compounds, corticosteroids, immunosuppressive drugs, antidiarrheal drugs
True or False, the treatments for Crohn’s disease (CD) and ulcerative colitis (UC) are the same?
True, except surgery is prolonged in CD for as long as possible due to high change of disease reoccurring in same area
What are common nursing interventions for CD and UC?
maintain NPO during active phase, monitor for complications (severe bleeding, dehydration, electrolyte imbalance), monitor bowel sounds, stool and blood studies, restrict activities, administer fluids, electrolytes, TPN prn, administer meds
Which meds would you likely see ordered for patients with CD and UC?
anti-inflammatory, antibiotics, steroids, bulk forming agents, vitamin/iron supplements
What education would you give you patient on CD and UC?
avoid gas-forming foods, milk products and foods such as whole grains, nuts, RAW fruits and veggies (esp. spinach), pepper, alcohol, and caffeine
What’s the difference between diverticulosis and diverticulitis?
Diverticulosis is abnormal out-pouching of the intestinal mucosa occurring in any part of the LI most common in the sigmoid. Diverticulitis- inflammation of the diverticula that occurs from penetration of fecal matter through the thin walled diverticula
True or False, diverticulitis can result in local abscess formation and perforation
TRUE
What are the nursing interventions for diverticulosis and diverticulitis?
NPO, bed rest, admin antibiotics, analgesia, and antispasmodics, increase fluid intake and monitor for complications (perforation, hemorrhage, and fistula)
What is another name for nonmechanical obstruction?
paralytic ileus
What are the clinical manifestations of a mechanical obstruction?
midabdominal pain, vomiting, obstipation, diarrhea, alteration in bowel pattern and stool, abdominal distention, borborygmi, abdominal tenderness
What is obstipation?
a type of sever form of constipation
Constant diffuse discomfort, abdominal distention, decreased to absent bowel sounds, vomiting, and obstipation are all s/s of what GI disorder?
nonmechanical obstruction
Describe the nonsurgical management of GI obstructions
NPO, NG tube insertion, nasointestinal tubes, fluid and electrolyte replacement, pain management, drug therapy (broad spectrum antibiotics and sandostatin)
______ refers to the colon and the rectum, which together make up the large intestine
Colorectal
True or False, tx of colon cancer depends of the stage or extent of the disease
TRUE
Evelyn has rectal bleeding, change in stool texture, and labs show she is severely anemic. Upon palpation, you feel a mass in abdomen. What is her dx?
colorectal cancer
If your patient is at risk for metastasis cancer, what interventions do you implement?
tx based off Duke’s staging, radiation therapy, drug therapy (chemo after surgery, antiangiogenesis meds, monoclonal antibodies & colorectal tumor vaccine (in clinical trials)
What is the post op care of colorectal cancer patients?
colostomy and wound mgmt. and ng tube care
What are the s/s of bowel perforation and peritonitis?
guarding, increased fever and chills, pallor, abdominal distention & pain, restlessness, and tachycardia and tachypnea
What are the nursing colostomy care that you would implement?
monitor stoma for size and unusual bleeding or necrotic tissue, monitor for color changes, assess consistency of stool, and encourage client to avoid foods that cause gas and odor
Describe the different colors the stoma could be?
pale pink- low H & H levels, purple and black- compromised circulation (call MD asap), pink to bright red & shiny- normal stoma color
What are ostomy priorities?
elimination, stoma (cherry red), skin, self care, body image & sexuality
What are the s/s of cholestasis and cholelithiasis?
varies on size, movement, inflammation, degree of obstruction- biliary colic, n & v, upper abdominal discomfort, fever and chills
impacted stone in cystic duct, obstruction, inflammation, cholangitis, sepsis, sudden starvation and immobility are all causes of what?
cholecystitis
Acute abdominal pain midepigastric & RUQ, n & v, anorexia, fever, headache, leukocytosis, tachycardia, tachypnea, and intolerance of fatty foods are all s/s of what?
cholecystitis
What are common post-op care nursing interventions for postsurgical cholecystitis patients?
free air pain result of CO2 in abdomen, ambulation and educate pt. to return to activities in 1 to 3 weeks
Cholelithiasis
condition in which there are stones present in the gallbladder or biliary duct system
Nursing Management for Cholelthiasis
Medicate: Oral bile acids or disslovers, Analgesics (Morphine for pain), Questran for pruritis, Educate (diet). Patient should avoid high fat foods, lose wt.
Nursing Management for Cholecystitis
Medicate: Oral bile acids or disslovers, Antibiotics, antipyretics, Analgesics (Morphine for pain), Questran for pruritis, Educate (diet). Patient should avoid whole milk products, lose wt.
Nursing Dx for Cholecystitis
Pain, Impaired gas exchange, risk for infection
Green
bile from the duodenum
Brown
feces from the large intestines
Black or coffe ground
old blood
Bright red blood
New blood
