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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
Which major organs are located in the RLQ?
Cecum, appendix, right ureter, right ovary/fallopian tube
29
Which major organs are located in the midline of the abdomen?
Abdominal aorta, uterus (if enlarged), bladder (if distended)
30
Which major organs are located in the LUQ?
Liver (left lobe), stomach, spleen, pancreas (body/tail), colon
31
Which major organs are located in the LLQ?
Colon, left ureter, left ovary/fallopian tube
32
Define cullen's sign.
Ecchymosis around the umbilicus; indication of intra-abdominal bleeding
33
How long do you need to listen for bowel sounds before determining that there are no bowel sounds?
5 minutes per quadrant
34
What is the most reliable method for assessing return of peristalsis after abdominal surgery?
To ask if he/she has passed gas within the past 8 hours of if stool was passed within the past 12-24 hours
35
Define borborygmus.
Bowel sounds
36
Define bruits.
Swooshing sounds; usually indicates presence of aneurysm
37
Define blumberg's sign.
Rebound tenderness; usually a sign of appendicitis with unperforated appendix (pain goes away when appendix ruptures)
38
Which lab abnormalities may be seen in acute pancreatitis?
Elevated amylase, lipase
39
Which lab abnormalities may be seen in liver disorders?
Elevated ALT, AST; prolonged PT
40
Which lab abnormalities may be seen with vomiting and diarrhea?
Decreased sodium, potassium
41
Which lab abnormalities may be seen with malabsorption?
Decreased calcium
42
What patient teaching would you provide to a patient that will be submitting a Hemoccult (FOBT)?
Avoid raw fruits/vegetables, red meat and foods rich in vitamin C; anticoagulants and NSAIDs should be discontinued for 7 days prior
43
Define DNA (ColoSure).
Stool test for detecting colorectal cancer
44
Which lab tests are related to cancers of the GI tract?
CA 19-9, CEA
45
What patient teaching would you provide prior to a barium swallow?
No food or liquids for 8 hours prior; avoid opioid analgesics and anticholinergics for 24 hours prior if possible
46
What patient teaching would you provide to a patient after a barium swallow or barium enema?
Drink plenty of fluids (to prevent obstruction/impaction); stools may be chalky white until all barium is passed
47
What patient teaching would you provide prior to an EGD?
NPO 6-8 hours prior; avoid anticoagulants, NSAIDs, and aspirin for several days prior
48
What is the priority for care after an EGD?
1. Prevent aspiration (NPO until gag reflex returns) 2. Monitor for signs of perforation, such as pain, bleeding, fever
49
What type of bowel preparation should not be used on older adults prior to colonoscopy?
GoLYTELY; may cause excessive fluid and electrolyte loss
50
What type of medication is kept on hand during a colonoscopy in case of vasovagal stimulation?
Atropine sulfate
51
What are signs & symptoms are seen during a vasovagal response?
Bradycardia
52
What are the first signs and symptoms that would be seen in a patient with a perforated bowel?
Increased heart rate, drop in BP
53
Following colonoscopy, which assessment data is key before allowing food or fluids?
Check for passage of flatus
54
What are the primary signs & symptoms of GERD?
Dyspepsia (heartburn) and regurgitation
55
What signs & symptoms are likely to present in an older adult with GERD?
ENT infections and pulmonary problems (aspiration pneumonia, sleep apnea, asthma)
56
What patient teaching would you provide for GERD?
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
What type of medications are used for treatment of GERD?
antacids, histamine blockers, proton pump inhibitors
58
When should an antacid containing aluminum hydroxide or magnesium hydroxide be taken?
1 hour before meals, 2-3 hours after each meal, and at bedtime
59
When should the antacid alginic acid and sodium bicarbonate (Gaviscon) be taken?
After meals and at bedtime
60
What type of medications are Famotidine (Pepcid), Ranitidine (Zantac) and Nizatidine (Axid)?
Histamine blockers
61
What is the therapeutic outcome of histamine blockers?
Reduction of gastric acid secretion
62
What type of medications are Omeprazole (Prilosec), Rabeprazole (Aciphex), Pantoprazole (Protonix), and esomeprazole (Nexium)?
Proton pump inhibitors
63
What is the therapeutic effect of proton pump inhibitors (PPIs)?
Reduction of gastric secretion
64
What side effect do aluminum antacids produce?
Constipation
65
What side effect do magnesium products produce?
Diarrhea
66
What side effect do histamine blockers commonly produce?
Dysrhythmias
67
What patient teaching would you provide to a patient who is prescribed PPIs?
Wear sunscreen; PPIs predispose pts to burns
68
Which medications are contraindicated with PPIs?
Digoxin, iron salts
69
What patient teaching would you provide to a patient after an endoscopic therapy?
Cl liq for 24 hours, then soft diet; avoid NSAIDS, aspirin for 10 days; avoidNG tubes for at least 1 month
70
What signs & symptoms would be seen for a patient with a hiatal hernia?
Heartburn, regurgitation chest pain, feeling of fullness or dyspnea after eating
71
Define odynophagia.
Painful swallowing
72
What are the signs & symptoms of an esophageal tumor?
Persistent & progressive dysphagia, severe chest/abdominal pain, regurgitation, weight loss
73
What patient teaching would you give to a patient who was just treated with the medication Photofrin?
Avoid exposure to sunlight for 1-3 months
74
What is the best standard of practice for checking placement in NG tubes?
Check pH q4-8h and before the start of each tube feeding
75
What is the priority of care postoperatively following a Laparoscopic Nissen Fundoplication?
Prevention of respiratory complications; elevate HOB at least 30 degrees, OOB asap, incentive spirometer, cough & deep breath with incision support
76
How should weight be taken if to be taken daily?
At the same time each day, preferably before breakfast
77
What is the best way to assess for fluid loss or gain?
Weight
78
What is the ideal BMI range for adults?
18.5-25
79
What is the ideal BMI range for older adults?
23-27
80
Define Marasmus.
Form of protein-energy malnutrition (PEM); general calorie malnutrition in which body fat & protein are wasted
81
Define Kwashiorkor.
Form of protein-energy malnutrition (PEM); lack of protein quantity & quality in the presence of adequate calories
82
Which patients are at risk for acute PEM?
Patients suffering from infection, stress or injury
83
Which patients are at risk for chronic PEM?
Patients who have cancer, end-stage kidney or liver disease, or chronic neurologic disease
84
What is the preferred route for nutritional intake?
Gi Tract
85
What signs & symptoms may be an indicator of refeeding syndrome?
Shallow respirations, weakness, acute confusion, seizures, increased bleeding tendencies
86
What is the most reliable method to check placement of a feeding tube?
X-ray
87
How often should residual volume be checked?
Q4-6h
88
How often should feeding bags and tubing for TEN be changed?
Q24-48h
89
How long is TEN product good for?
4 hours
90
How long are refrigerated & open cans of TEN good for?
24 hours
91
To prevent aspiration, the HOB should be kept to a minimum of 30 degrees for how long?
At least 1 hour
92
What range should the pH be if fluid aspirated is gastric content?
0-4.0
93
What range should the pH be if fluid aspirated is from the intestines?
7.0-8.0
94
What range should the pH be if contents aspirated is from the lungs?
Above 6.0
95
Which drugs will cause aspirated contents to be as high as 6.0?
H2 blockers such as Ranitidine (Zantac) or Famotidine (Pepcid)
96
What signs & symptoms may indicate aspiration pneumonia?
Increasing temperature/pulse, diminishing breath sounds (especially in lower lobes), dyspnea, chest discomfort
97
When should a tube feeding be held?
If the gastric residual volume is greater than 200 mL (or 100 mL depending on the facility) on 2 consecutive assessments
98
What signs & symptoms may indicate fat overload syndrome (complication of IVFE)?
Fever, increased triglycerides, clotting problems, multi-system organ failure
99
What signs & symptoms may indicate an anastomotic leak after a gastric bypass surgery?
Increasing back/shoulder/abdominal pain, restlessness, tachycardia, oliguria
100
What signs & symptoms may indicate dumping syndrome?
Tachycardia, nausea, diarrhea, abdominal cramping

Amy's Nursing 55 (9 decks)

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