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Amy's Nursing 55 > GI: Esophageal & Stomach Disorders > Flashcards

GI: Esophageal & Stomach Disorders Flashcards

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0
Q

Define LES.

A

Lower esophageal sphincter; prevents reflux of gastric contents into the esophagus

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1
Q

Define UES.

A

Upper esophageal sphincter; prevents air into the esophagus during respiration

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2
Q

What happens if the LES is not functioning properly?

A

Possible development of gastric reflux, or GERD.

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3
Q

Which substances do parietal cells in the stomach secrete?

A

Hydrochloric acid and intrinsic factor

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4
Q

What happens if parietal cells are not secreting enough intrinsic factor?

A

The body is not able to absorb vitamin B12, and pernicious anemia develops

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5
Q

Which enzymes are secreted by exocrine glands in the pancreas? What function do they have?

A

Trypsin, chymotrypsin, amylase, lipase; aids in digestion of carbs, fats, proteins

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6
Q

Which vitamins and minerals are stored in the liver?

A

Iron, Mg, vitamins A/D/E/K

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7
Q

What purpose do Kupffer cells in the liver serve?

A

They engulf harmful bacteria, anemic red blood cells and detoxify harmful substances

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8
Q

Why are the elderly more at risk for drug toxicity?

A

Because they have decreased liver function, which results in decreased ability to detoxify harmful compounds

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9
Q

Which substances are secreted by the endocrine glands in the pancreas?

A

Glucagon (secreted by alpha cells) and insulin (secreted by beta cells)

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10
Q

What type of issue is commonly seen in patients with liver disorders?

A

Bleeding problems because the liver synthesizes prothrombin

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11
Q

What is the main function of the large intestine?

A

Absorption of water

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12
Q

What change is commonly seen in the older adult in relation to the stomach?

A

Decrease in hydrochloric acid and intrinsic factor, which leads to decreased absorption of iron and vitamin B12 (pernicious anemia) and may lead to proliferation of bacteria (gastritis)

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13
Q

What patient teaching would you provide for a patient with pernicious anemia? To prevent gastritis?

A

Encourage foods high in vitamins and iron; encourage bland foods

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14
Q

What patient teaching can you provide to older adults to prevent constipation?

A

Encourage a high fiber diet, 1500 mL of fluid intake daily, and activity as tolerated

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15
Q

What changes are commonly seen in older adults in relation to the pancreas?

A

Decreased lipase production, which may lead to steatorrhea

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16
Q

Define steatorrhea.

A

Fat in feces

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17
Q

What patient teaching can you provide to an older adult to prevent steatorrhea?

A

Encourage small, frequent feedings

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22
Q

What changes are commonly seen in older adults in relation to the large intestine?

A

Decreased peristalsis and sensation, which can lead to constipation and impaction

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23
Q

What are signs & symptoms commonly seen in a patient with GI problems?

A

Anorexia, dysphagia, dyspepsia, N&V, unintentional weight loss

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24
Q

Define PQRST.

A

Precipitating or palliative (What brings it on, makes it worse/better), quality or quantity (how severe, what kind of pain), region or radiation (location, does it go anywhere), severity (0-10), timing (when did it start, how long does it last, how often)

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25
Q

In what order is the abdomen assessed?

A

Inspection, auscultation, percussion, palpation

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26
Q

For which situations would you avoid palpating a patient’s abdomen?

A

If appendicitis or abdominal aneurysm is suspected

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27
Q

Which major organs are located in the RUQ?

A

Most of the liver, gallbladder, duodenum, pancreas (head), colon

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28
Q

Which major organs are located in the RLQ?

A

Cecum, appendix, right ureter, right ovary/fallopian tube

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29
Q

Which major organs are located in the midline of the abdomen?

A

Abdominal aorta, uterus (if enlarged), bladder (if distended)

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30
Q

Which major organs are located in the LUQ?

A

Liver (left lobe), stomach, spleen, pancreas (body/tail), colon

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31
Q

Which major organs are located in the LLQ?

A

Colon, left ureter, left ovary/fallopian tube

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32
Q

Define cullen’s sign.

A

Ecchymosis around the umbilicus; indication of intra-abdominal bleeding

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33
Q

How long do you need to listen for bowel sounds before determining that there are no bowel sounds?

A

5 minutes per quadrant

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34
Q

What is the most reliable method for assessing return of peristalsis after abdominal surgery?

A

To ask if he/she has passed gas within the past 8 hours of if stool was passed within the past 12-24 hours

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35
Q

Define borborygmus.

A

Bowel sounds

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36
Q

Define bruits.

A

Swooshing sounds; usually indicates presence of aneurysm

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37
Q

Define blumberg’s sign.

A

Rebound tenderness; usually a sign of appendicitis with unperforated appendix (pain goes away when appendix ruptures)

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38
Q

Which lab abnormalities may be seen in acute pancreatitis?

A

Elevated amylase, lipase

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39
Q

Which lab abnormalities may be seen in liver disorders?

A

Elevated ALT, AST; prolonged PT

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40
Q

Which lab abnormalities may be seen with vomiting and diarrhea?

A

Decreased sodium, potassium

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41
Q

Which lab abnormalities may be seen with malabsorption?

A

Decreased calcium

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42
Q

What patient teaching would you provide to a patient that will be submitting a Hemoccult (FOBT)?

A

Avoid raw fruits/vegetables, red meat and foods rich in vitamin C; anticoagulants and NSAIDs should be discontinued for 7 days prior

43
Q

Define DNA (ColoSure).

A

Stool test for detecting colorectal cancer

44
Q

Which lab tests are related to cancers of the GI tract?

A

CA 19-9, CEA

45
Q

What patient teaching would you provide prior to a barium swallow?

A

No food or liquids for 8 hours prior; avoid opioid analgesics and anticholinergics for 24 hours prior if possible

46
Q

What patient teaching would you provide to a patient after a barium swallow or barium enema?

A

Drink plenty of fluids (to prevent obstruction/impaction); stools may be chalky white until all barium is passed

47
Q

What patient teaching would you provide prior to an EGD?

A

NPO 6-8 hours prior; avoid anticoagulants, NSAIDs, and aspirin for several days prior

48
Q

What is the priority for care after an EGD?

A
  1. Prevent aspiration (NPO until gag reflex returns) 2. Monitor for signs of perforation, such as pain, bleeding, fever
49
Q

What type of bowel preparation should not be used on older adults prior to colonoscopy?

A

GoLYTELY; may cause excessive fluid and electrolyte loss

50
Q

What type of medication is kept on hand during a colonoscopy in case of vasovagal stimulation?

A

Atropine sulfate

51
Q

What are signs & symptoms are seen during a vasovagal response?

A

Bradycardia

52
Q

What are the first signs and symptoms that would be seen in a patient with a perforated bowel?

A

Increased heart rate, drop in BP

53
Q

Following colonoscopy, which assessment data is key before allowing food or fluids?

A

Check for passage of flatus

54
Q

What are the primary signs & symptoms of GERD?

A

Dyspepsia (heartburn) and regurgitation

55
Q

What signs & symptoms are likely to present in an older adult with GERD?

A

ENT infections and pulmonary problems (aspiration pneumonia, sleep apnea, asthma)

56
Q

What patient teaching would you provide for GERD?

A

Limit alcohol, fatty foods, carbonated beverages, caffeine, spicy/acidic foods; eat 4-6 small meals/day, eat slowly; eliminate NSAIDs, anticholinergics, nitrates, calcium channel blockers if possible

57
Q

What type of medications are used for treatment of GERD?

A

antacids, histamine blockers, proton pump inhibitors

58
Q

When should an antacid containing aluminum hydroxide or magnesium hydroxide be taken?

A

1 hour before meals, 2-3 hours after each meal, and at bedtime

59
Q

When should the antacid alginic acid and sodium bicarbonate (Gaviscon) be taken?

A

After meals and at bedtime

60
Q

What type of medications are Famotidine (Pepcid), Ranitidine (Zantac) and Nizatidine (Axid)?

A

Histamine blockers

61
Q

What is the therapeutic outcome of histamine blockers?

A

Reduction of gastric acid secretion

62
Q

What type of medications are Omeprazole (Prilosec), Rabeprazole (Aciphex), Pantoprazole (Protonix), and esomeprazole (Nexium)?

A

Proton pump inhibitors

63
Q

What is the therapeutic effect of proton pump inhibitors (PPIs)?

A

Reduction of gastric secretion

64
Q

What side effect do aluminum antacids produce?

A

Constipation

65
Q

What side effect do magnesium products produce?

A

Diarrhea

66
Q

What side effect do histamine blockers commonly produce?

A

Dysrhythmias

67
Q

What patient teaching would you provide to a patient who is prescribed PPIs?

A

Wear sunscreen; PPIs predispose pts to burns

68
Q

Which medications are contraindicated with PPIs?

A

Digoxin, iron salts

69
Q

What patient teaching would you provide to a patient after an endoscopic therapy?

A

Cl liq for 24 hours, then soft diet; avoid NSAIDS, aspirin for 10 days; avoidNG tubes for at least 1 month

70
Q

What signs & symptoms would be seen for a patient with a hiatal hernia?

A

Heartburn, regurgitation chest pain, feeling of fullness or dyspnea after eating

71
Q

Define odynophagia.

A

Painful swallowing

72
Q

What are the signs & symptoms of an esophageal tumor?

A

Persistent & progressive dysphagia, severe chest/abdominal pain, regurgitation, weight loss

73
Q

What patient teaching would you give to a patient who was just treated with the medication Photofrin?

A

Avoid exposure to sunlight for 1-3 months

74
Q

What is the best standard of practice for checking placement in NG tubes?

A

Check pH q4-8h and before the start of each tube feeding

75
Q

What is the priority of care postoperatively following a Laparoscopic Nissen Fundoplication?

A

Prevention of respiratory complications; elevate HOB at least 30 degrees, OOB asap, incentive spirometer, cough & deep breath with incision support

76
Q

How should weight be taken if to be taken daily?

A

At the same time each day, preferably before breakfast

77
Q

What is the best way to assess for fluid loss or gain?

A

Weight

78
Q

What is the ideal BMI range for adults?

A

18.5-25

79
Q

What is the ideal BMI range for older adults?

A

23-27

80
Q

Define Marasmus.

A

Form of protein-energy malnutrition (PEM); general calorie malnutrition in which body fat & protein are wasted

81
Q

Define Kwashiorkor.

A

Form of protein-energy malnutrition (PEM); lack of protein quantity & quality in the presence of adequate calories

82
Q

Which patients are at risk for acute PEM?

A

Patients suffering from infection, stress or injury

83
Q

Which patients are at risk for chronic PEM?

A

Patients who have cancer, end-stage kidney or liver disease, or chronic neurologic disease

84
Q

What is the preferred route for nutritional intake?

A

Gi Tract

85
Q

What signs & symptoms may be an indicator of refeeding syndrome?

A

Shallow respirations, weakness, acute confusion, seizures, increased bleeding tendencies

86
Q

What is the most reliable method to check placement of a feeding tube?

A

X-ray

87
Q

How often should residual volume be checked?

A

Q4-6h

88
Q

How often should feeding bags and tubing for TEN be changed?

A

Q24-48h

89
Q

How long is TEN product good for?

A

4 hours

90
Q

How long are refrigerated & open cans of TEN good for?

A

24 hours

91
Q

To prevent aspiration, the HOB should be kept to a minimum of 30 degrees for how long?

A

At least 1 hour

92
Q

What range should the pH be if fluid aspirated is gastric content?

A

0-4.0

93
Q

What range should the pH be if fluid aspirated is from the intestines?

A

7.0-8.0

94
Q

What range should the pH be if contents aspirated is from the lungs?

A

Above 6.0

95
Q

Which drugs will cause aspirated contents to be as high as 6.0?

A

H2 blockers such as Ranitidine (Zantac) or Famotidine (Pepcid)

96
Q

What signs & symptoms may indicate aspiration pneumonia?

A

Increasing temperature/pulse, diminishing breath sounds (especially in lower lobes), dyspnea, chest discomfort

97
Q

When should a tube feeding be held?

A

If the gastric residual volume is greater than 200 mL (or 100 mL depending on the facility) on 2 consecutive assessments

98
Q

What signs & symptoms may indicate fat overload syndrome (complication of IVFE)?

A

Fever, increased triglycerides, clotting problems, multi-system organ failure

99
Q

What signs & symptoms may indicate an anastomotic leak after a gastric bypass surgery?

A

Increasing back/shoulder/abdominal pain, restlessness, tachycardia, oliguria

100
Q

What signs & symptoms may indicate dumping syndrome?

A

Tachycardia, nausea, diarrhea, abdominal cramping

Amy's Nursing 55 (9 decks)

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