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Nursing 102 > GI exam #1 > Flashcards

GI exam #1 Flashcards

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1
Q

Purpose of the GI tract

A

to supply nutrients for use at the cellular level

  • meet nutritional needs
  • and eliminate waste
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2
Q

Process of the GI tract

A

1) ingestion
2) digestion
3) absorption
4) elimination

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3
Q

Ingestion

A

taking in food

-intake, chewing anddeglutition

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4
Q

digestion

A

molecules for absorption (into chyme)

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5
Q

absorption

A

transfer from GI tract to circulation

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6
Q

elimination

A

excretion of waste products of digestion

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7
Q

Components of GI tract

A

mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, anus,

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8
Q

Accessory organs to GI tract

A

teeth, tongue, salivary glands, liver, gallbladder, pancreas

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9
Q

Mucosa

A

innermost layer of GI tract

  • -Protects, secretes, absorbs
  • —lumen/ small intestines: form folds “villi” and increase absortive capacity (surface area)
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10
Q

Submucosa

A

contains blood and lymph vessles
—transports nutrients
(connective tissue)

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11
Q

Muscularis (muscular) layer

A

Smooth muscle fibers arranged in circular and longitudinal groups.
—-motility

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12
Q

Serosa (serous) layer

A

outer covering

—protection

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13
Q

Peritoneum

A

lines walls of entire abdominal cavity. Forms the peritoneal cavity

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14
Q

Two folds of peritoneum

A

Mesentary and Omentum

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15
Q

Mesentary

A

blood and lymph

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16
Q

Omentum

A

fat covering for protection

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17
Q

Blood supply of GI tract

A

aorta–>celiac artery–> superior and inferior mesenteric arteries

–superior and inferior mesenteric arteries supply small and large intestine
—venous blood draiing GI tract empties into portal vein - carries nutrient rich blood to liver
(25-30% total caridac output is going directly to GI tract. increases after eating. more blood to transport nutrients)

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18
Q

Mucous

A
  • from mouth to anus.

- protects and lubricates (only secretion in esophagus)

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19
Q

Digestive secretions

A
  • enzymes, hormones, digestive juices, bile, pancreatic juices
  • produced throughout GI w/ very specific functions
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20
Q

Peristalsis

A

wavelike movements

-stimulus is expansion of lumen of tract by food

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21
Q

Gastrocolic and duodenocolic reflex

A

leads to urge to poop after eating

particularly strong in the morning

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22
Q

Bacteria

A

normal component of GI tract. Essential for function. Major component of colon
-aids digestion (proteins) 10% of stool

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23
Q

Sympathetic

A

inhibits or decreases digestive actions. “slows down” S-S

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24
Q

Pararsympathetic impules

A

-increase GI activities “picks up”

P-P

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25
Q

Vagus nerve

A

cranial that innervates GI tract

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26
Q

Mouth

A 
Oral or buccal cavity
Functions: where digestion begins
1)mastication: mechanically reduces size of food particles and mixes with saliva. protects esphagus from trauma by decreasing size of particles
2) speech
3) expression
4) taste
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27
Q

Salivary Glands

A

parotid, submaxillary, sublingual

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28
Q

Salivary secretions

A

1000-1500 ml saliva produced daily

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29
Q

Amylase

A

begins digestion of starches

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30
Q

Pharynx

A

Nasopharynx, Oropharynx, laryngopharynx

  • -pharyngeal muscles regulate swallowing
  • -involuntary control
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31
Q

Act of swallowing (deglutition)

A

1) initiated voluntary (force food into pahrynx)
2) Involuntary (swallowing reflex)
3) transported by peristalsis to stomach

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32
Q

Esophagus

A

transports food to stomach
penetrates diaphragm thru esphageal hiatus
–no digestion, only mucous

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33
Q

Pharyngo-esophageal orn upper esophageal sphincter

A

allows food into esophagus

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34
Q

Gastro-esophageal or lower esophageal sphincter

A

allows food into the stomach

  • -prevents acid reflux
  • -between esophagus and stomach
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35
Q

How many seconds for food to pass into the stomach?

A

10 seconds

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36
Q

Stomach

A
  • mixes food with gastric secretions
  • -stores food until it can pass into small intestines
  • empties content at rate which digestion can occur
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37
Q

Gastric secretions

A

chemical liquification of ingested food

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38
Q

Gastrin

A

stimulates secretions of parietal and chief cells

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39
Q

Parietal cells

A

secrete HCL and intrinsic factor

decrease HCL?

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40
Q

Chief cells

A

produce pepsinogen–>pepsin–>protein digestion

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41
Q

Mucous neck cells

A

secrete alkaline mucous to lubricate and protect stomach from self-digestion

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42
Q

pyloric glands

A

secretes mucous

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43
Q

pyloric sphincter

A

between stomach and duodenum

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44
Q

Gastric emptying

A
  • controlled by nerve impulses, chyme, and hormonal effects
  • fats and duodenal chyme (high acid)= activate the enterogastric reflex= inhibits gastric motility and secretion
  • allows pancreatic juices time to neutralize in duodenum
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45
Q

Vagal stimulation….

A

increases emptying

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46
Q

Small intestine

A
  • major site for digestion and absorption

- major nutrients absorbed

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47
Q

Villi

A

increase surface area and enhance absorption of nutrients

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48
Q

Duodenum and jejunum absorb….

A

carbohydrates, amino acids, lipids, iron, and calcium

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49
Q

Ileum absorbs…

A

water, electrolytes, bile salts, vitamins

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50
Q

How much water does the ileum absorb per day?

A

8 Liters

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51
Q

Large intestines

A

absorb water and electrolytes

and store feces until elimination

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52
Q

Mass movements

A

strong peristaltic actions occur when colon becomes filled

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53
Q

Haustra

A

when peristalsis breaks chyme into large pockets

–extracts water and chyme becomes solid feces

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54
Q

Rectum

A

storage and expulsion of food

–connects sigmoid colon and anus

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55
Q

Internal sphincter

A
  • involuntary control.

- autonomic nerves makes area insensitive

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56
Q

External sphincter

A
  • voluntary control

- somatic nerves make area very sensitive

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57
Q

Defecation reflex

A

feces move into rectum–>stretches and causes distention–> activates parasympathetic nervous system–> relaxes sphincters–> constricts muscles –> forces feces out

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58
Q

Chronic constipation

A

Occurs when defecation reflex is ignored or inhibited regularly

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59
Q

Major functions of the liver

A
  • storage, protection, metabolism
  • bile production and secretion
  • carb metabolism
  • protein metabolism
  • formation of clotting factors
  • fat metabolism
  • vitamin and mineral storage
  • filtration/detoxification
  • blood storage
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60
Q

Kupffer cells

A

reticuloendothilial cells provide crucial filtering system
(part of the immune system)
—-phagocytically destroy old RBCs and remove bacteria from nlood

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61
Q

what supplies blood to the liver?

A

portal vein and hepatic artery

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62
Q

Portal vein supplies how much blood to the liver?

A

75%

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63
Q

Hepatic artery supplies…?

A

other 25% as oxygenated blood

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64
Q

Pancreas

A
  • neutralizes acid chyme (lipase and amylase)

- –enters the duodenum via the pancreatic duct to the common bile duct

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65
Q

Acini cells

A

secrete pancreatic juices

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66
Q

Cholecystokinin-pancreozymin

A

food ingestion stimulates secretion stored bile in GB

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67
Q

Gallbladder

A

stores and concentrates bile made in the liver

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68
Q

Bile

A

emulsifies fats

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69
Q

Common bile duct

A

carries bile and empties into duodenum at ampulla of vater

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70
Q

Bilirubin

A

pigment derived from breakdown of hemoglobin

*main component of bile

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71
Q

Urobilinogen

A

converted from bilirubin by bacteria

  • excreted in feces, giving brown color
  • reabsorbed and excreted via kidneys giving yellow color
72
Q

GI assessment

A
  • establish baselines ht, wt, stool patterns
  • chief complaint/present illness
  • age, gender, culture
  • PMH
  • family history
  • eating habits
73
Q

1st sign of GI problem

A

abdominal pain

74
Q

Abdominal assessment (4)

A

inspection, auscultation, percussion, palpation

75
Q

Inspection of abdomen

A
  • at eye level
  • note contour
  • note any pulsations
  • cullen’s sign
  • measure abdominal girth
76
Q

Cullen’s sign

A

bluish around umbilicus

-indication internal bleed

77
Q

Ausculation

A
  • listen in each quadrant 5-15 seonds

- turn NG tube off before listening

78
Q

Palpation

A
  • light palpation
  • muscle guarding
  • blumbergs sign
  • Mcburney’s point
  • DO NOT palpate any pulsations
79
Q

Blumberg’s sign

A
  • rebound tenderness

- classic sign of peritonitis

80
Q

McBurney’s point

A
  • between umbilicus and iliac crest

- pain = appendicitis

81
Q

Most specific indicator of liver damage

A

ALT

82
Q

Paracentesis

A
  • *void prior to procedure
  • may accidentally puncture bladder
  • removing fluid from the abdomen
83
Q

GI cocktail

A
  • determine difference between GERD and heart
  • lidocaine, donatal, and , malox
  • if pain goes away after cocktail = GERD
84
Q

Barium swallow/enema

A

upper and lower GI series

-lots of water and laxatives to pass through

85
Q

Liver biopsy

A

-needle inserted through abdominal wall into liver, sample removed for microscopic exam

86
Q

Potential complications of liver biopsy

A
  • hemorrhage (check PTT prior to)
  • chemical peritonitis from bile leak into abdomen
  • pneumothorax
87
Q

What MUST be done after liver biopsy?

A
  • ***place patient on right side for 2 hours after procedure

- monitor for hemorrhage

88
Q

What is an important nursing responsibility for nutritional problems

A

-providing education on a well balanced diet with nutritional supplementation and support

89
Q

Nutritional status is influenced by…

A
  • age/gender
  • health
  • religion/culture preferences
  • attitudes about food
  • financial staus
  • availability of food sources
90
Q

Hunger

A

uneasy or painful sensation cause by lack of food

91
Q

Hidden hunger

A

subclinical deficiencies but no obvious signs of undernutrition

92
Q

Food insecurity

A

lack of access to food to meet dietary needs

93
Q

Malnutrition is caused by…

A
  • insufficient diet
  • unbalanced diet
  • excessive diet
  • impaired absorption of nutrients
  • upper GI disorders (dysphagia, anorexia
94
Q

Malnutrition effects on the body…

A

-**weakens the immune system and causes delayed wound healing

  • impairs mental and physical health
  • slows thinking
  • stunts growth
  • vision problems
95
Q

Malnutrition

A

deficiency or excess of nutrients

96
Q

Under nutrition

A

state of poor nutrition from inadequate diet or diseases that affect appetite and utilization of food (chemo)

97
Q

Over nutrition

A

ingestion of more food than required for body needs

98
Q

Protein calorie malnutrition

A
  • most common form of malnutrition
  • from chronic or prolonged inadequate protein and or calorie intake
  • or from high metabolic protein and energy requirements
99
Q

Primary protein-calorie malnutrition

A

nutritional needs are not met

100
Q

Secondary protein calorie malnutrition

A
  • physiological cause unable to meet nutrition

- alteration or defect in ingestion, digestion, absorption or metabolism

101
Q

Catabolism

A

without needed proteins and calories, body fills its energy needs by breaking down stored proteins and fats

  • loss of muscle mass
  • weakness and fatigue
  • poor wound healing
  • death
102
Q

Kwashiokor

A

lack of protein quality and quantity. adequate calories.

-ascites due to lack of protein

103
Q

Marasmus

A

low protein and calories. leads to starvation and death
-calorie malnutrition in which body fat and proteins are wasted.
(muscle wasting)

104
Q

Starvation

A

-initially the body uses carbohydrates to meet metabolic needs, glycogen found in liver and muscles - totally depleted in 18 hours
-next proteins are converted to glucose (gluconeo)
within 5-9 days body fat is mobilized to supply energy
-once fat stores gone (4-6wks), body proteins (internal organs) become only source of energy

105
Q

Main signs of starvation

A
  • edema

- skin becomes dry and wrinkled (cells not getting fluid)

106
Q

Obvious signs of protein/calorie deficiency

A
  • skin = dry
  • eyes = sunken in
  • muscle wasting
  • CNS = slowed thinking and reflexes
  • decreased wound healing and delay in recovery
  • anemia
107
Q

Nutritional assessment: subjective data

A
  • dietary intake in last 24 hrs
  • food diary for at least 2 weeks
  • psychosocial factors
  • alcohol intake
  • medications
108
Q

Nutritional assessment: objective data

A
  • physical exam
  • ht and wt
  • body frame size
  • mid-arm circumference
  • skin fold thinkness
  • BMI
109
Q

Labs for nutritional assessment

A
  • serum vitamins
  • nitrogen balance
  • H&H
  • total lymphocyte count
  • serum iron
  • total protein
  • albumin (visceral protein depletion)
110
Q

Most specific indicator of malnutrition

A

pre-albumin

111
Q

Normal range for pre-albumin

A

anything above 20

112
Q

Expected outcomes for malnourished client

A
  • achieve wt gain (1-2 pounds a wk)
  • consumes specified number of calories/day
  • selects good food choices
  • eat 75% of food on tray
  • take rest periods of 30 mins
  • no evidence of infection
113
Q

Goal of treatment for malnourished patients

A

restore nutrition with diet high in calories and protein

prevents fatigue and infection

114
Q

Nursing interventions for malnourished patients

A

-**good mouth care
*-small frequent meals
-supplemental feedings
-vitamin supplements
- pain relief
if severe: correct fluid and electrolyte balance, treat infections, enteral feedings, TPN

115
Q

what may cause or exacerbate malnutrition?

A

hospitalization

  • -NPO, changed diet, bad food, stress and anxiety
  • prevention is important
  • identify patients at risk.
116
Q

Bariatric medicine

A

branch of medicine that deals with prevention, control, and treatment of obesity

  • excess fat or adipose tissue relative to lean body mass
  • 20% above normal body weight
117
Q

Pathophysiology of obesity

A

obesity results when calorie intake exceeds energy demands for a prolonged period of time and the body stores excess calories as fat

118
Q

Primary obesity

A

caused by excess calorie intake for metabolic demands

119
Q

Secondary obesity

A

congenital, chromosomal, or metabolic problems

120
Q

Hypertrophic obesity

A
  • increase in size of adipose cells.

- seen in adult onset obesity

121
Q

Hyperplastic obesity

A
  • increase in size and number of fat cells

- seen in younger age

122
Q

Android obesity

A
  • fat distributed over abdomen and upper body
  • apple shape
  • **greater risk for CV issues
123
Q

Gynecoid Obesity

A
  • fat distributed over the hips
  • pear body shape
  • better health prognosis but more difficult to lose weight
124
Q

Normal BMI

A

18.5-24.9

125
Q

Morbid obese BMI

A

41-45

126
Q

Super obese

A

> 50

127
Q

major complications of obesity

A

-cardiovascular, respiratory and musculoskeletal

susceptible to infections

128
Q

Major assessment question for obese patients

A

previous attempts at weight reduction

-what they tried and why they failed. find out what triggered them to fail

129
Q

Important objective assessment for obese patients

A

skin assessment –increase in infection. make sure clean and dry

130
Q

Plan for obese patients

A
  • modify eating patterns
  • participate in regular exercise (aquatherapy)
  • achieve weight loss at specified level
  • maintain wt loss ( 1-2 lbs/wk)
  • minimize or prevent health problems
131
Q

Treatment for obese patients

A

prevention is the best treatment.

  • educate on proper diet and eating habits
  • diet, nutrition therapy, drug therapy, behavioral management
132
Q

Best diet for obese patient

A

nutritionally balanced diet

133
Q

two categories of drugs approved by the FDA for obese patients

A
  • appetite suppressants

- decrease nutrient absorption (usually fat so fat soluble vits no absorbed- no clotting factor)

134
Q

Gastroplasty

A
  • gastric partitioning
  • stomach divided by surgery, stapling, or banding into small upper portion and large distal portion
  • -must modify dietary habits. easier than bypass
135
Q

Important post-op care after surgery for obese peeps

A

airway priority

complication: anastomotic leak is the most common (leak at the connection)

136
Q

Most common cause affecting teeth

A

tooth decay

137
Q

Primary cause of tooth decay

A

plaque

138
Q

poor dental hygiene can lead to…

A

heart disease, stroke, and cancer

139
Q

Risk factors for tooth decay

A
  • diet high in simple sugars
  • poor oral hygiene
  • poor health
  • familial tendency
140
Q

Best treatment for tooth decay

A

prevention!

frequent brushing and daily flossing

141
Q

Treatment once tooth decay has occurred

A
  • removal of decayed tooth
  • replacement with restorative barrier devices
  • tooth extraction
142
Q

Periodontal disease

A
  • inflammation of tissue that supports and surrounds tooth caused by bacterial plaque
  • many adults have some degree of periodontal disease= other health problems
  • most common cause on tooth loss in adults
143
Q

Periodontal disease is caused by

A

bacterial plaque

144
Q

Gingivitis

A

inflammation of gums causing separation from tooth surface

  • pockets form, collects bacteria, pus forms
  • gums recede, bone destruction, tooth loosens
145
Q

First sign of gingivitis

A

painless bleeding of gums with normal brushing

146
Q

Nursing responsibility for gingivitis

A

provide and teach meticulous mouth care

147
Q

Halitosis

A

bad breath

  • caused by dental caries, periodontal disease, other upper GI pathology
  • food particles between teeth or in esophagus decay and create odor
148
Q

what to treat with halitosis

A

underlying cause

149
Q

stomatitis

A

inflammation of the mouth

-sore mouth, decreased appetite problems - very painful

150
Q

glossitis

A

inflammation of the tongue

151
Q

Nursing interventions for stomatitis, glossitis, and gingivitis

A
  • *remove underlying cause
  • soft bland diet
  • avoid harsh substances
  • topical or systemic antibiotics
152
Q

Apthous ulcers

A

(canker sores) small painful ulcers on mouth and lips

tx: topical or systemic steroids (lidex,bland diet, soothing oral care). can go away on own.

153
Q

Herpes simplex (cold sores, fever blisters)

A

viral lesions appear as small vesicles or shallow ulcers on mouth, lips, edge of nose, or gums

tx: treat symptoms
steroids, antiseptic mouthwash, antiviral agent

154
Q

Vincent’s Gingivitis

A

(trench mouth)
acute necrotizing ulcerative gingivitis caused by bacteria present in mouth
-hourly mouthwashes (peroxide and water)
-antibiotics and analgesics

155
Q

Candidiasis

A

(yeast or thrush)
fungal infection by candida albicans
-pearly white, curdlike patches in mouth which reveal raw bleeding surface when rubbed
-causes: steroid use, antibiotics, suppressed immune system (ca or hiv), debilitated patients

156
Q

Nursing interventions for Cadidiasis

A
  • *good oral hygiene
  • bland diet
  • Nystatin suspension or troches or clotrimazole (teach patients to keep in mouth as long as possible)
157
Q

Acute Sialadenitis

A

inflammation of salivary glands caused by inactivity of gland
-most common is parotid gland

158
Q

Anyone that is NPO for a long time is at risk for…

A

developing acute sialadenitis

159
Q

Treatment for Acute Sialadenitis

A
  • good oral hygiene to decrease bacteria
  • keep patient well hydrated
  • stimulate secretions of glands (candy & gum)
160
Q

Calculi or Sialolithiasis

A

stones in salivary glands

  • most common in submaxillary, pain w/ chewing
  • tx by excision
161
Q

Salivary gland tumors

A
  • parotid gland: usually benign
  • submaxillary gland: usually malignant

spreads by lymphatic system, pain as tumor enlarges
tx: local excision

162
Q

Oral cancer

A
  • may occur anywhere in mouth

- RFs: poor oral hygiene, tobacco, alcohol, chronic irriation, over exposure to wind/sun

163
Q

Cancer of the tongue

A
  • **poor prognosis r/t extensive vascular and lymphatic supply
  • metastasizes early to cervical lymph nodes
  • usually already mets when diagnosed
164
Q

Kaposi’s sarcoma

A
  • HIV infection related

- red, purple or blue lesion on oral mucosa

165
Q

Treatment for oral cancer

A
  • mandibulectomy, glossectomy, resections of buccual mucosa and floor of mouth
  • speech therapy necessary
  • radical neck dissection
166
Q

Radical neck dissection

A

done to relieve pressure on trachea, esophagus, blood vessels and nerves
-removal of tissue from jaw bone to clavical

167
Q

Complications of RND

A
  • high rate of complications
  • airway obstruction
  • hemorrhage
  • aspiration
  • infection
  • skin flap necrosis
168
Q

Post-op care for RND

A

1-maintain airway

  • *emotional support and pre-op teaching is essential
  • oral hygiene, saliva management -oral suction
  • pain management
  • nutrition, wound care, communication
169
Q

GERD

A

gastroesophageal reflux disease
-syndrome that causes reflux of gastric and duodenal contents into espophagus = irritation and inflammation = esophagitis

170
Q

Etilology of GERD

A
  • increased abdominal pressure (obesity, ascites, preggo)
  • incompetent LES
  • Hiatal hernia is most common
171
Q

Most common cause of GERD

A

hiatal hernia

172
Q

Symptoms of GERD

A
  • dyspepsia
  • regurgitation
  • eructation and flatulence
  • bloating
  • dysphagia/odynophagia
  • chronic cough
173
Q

Treatment for GERD

A
  • **small frequent meals
  • **don’t lay down after eating
  • avoid triggering substances
  • No CATS
174
Q

Barrett’s esophagus

A

(precancerous)
cells change and tend to be malignant
-can cause regurgitation

175
Q

most common symptom of hiatal hernia

A

pyrosis and indigestion

Nursing 102 (11 decks)

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