Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Critical Care > GI exam 2 > Flashcards

GI exam 2 Flashcards

1
Q

acute pancreatitis

A

inflammation of pancreas
-can be mild / severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

mild acute pancreatitis

A

self limiting, no end organ dysfunction
-most fully recover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

severe acute pancreatitis

A

pts may develops SIRS and end-organ dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

acute pancreatitis risks

A

alcohol and gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

other acute pancreatitis risks

A

I GET SMASHED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

I GET SMASHED

A

idiopathic
gallstones
ethanol
trauma
steroid use
mumps
autoimmune
scorpion stings
hypercalcemia / hypertriglyceridemia
ECRP
drugs / meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

acute pancreatitis s/s

A

sudden onset severe EPIGASTRIC pain!!
-radiates to flank / back / shoulder
-sharp, deep pain
n/v - bloody??
abd distention
hypotension and shock
tetany (hypocalcemia)
-trousseau’s sign
-chvostek’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

chvostek’s sign

A

twitch of facial muscles when touching someones cheek

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

trousseau’s sign

A

involuntary contraction of wrist muscle when BP cuff is inflated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

severe hemorrhagic pancreatitis

A

from eroding blood vessels
-cullen’s sign
-grey-turner’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cullen’s sign

A

bluish discoloration around umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

grey turner’s sign

A

bluish discoloration of flanks
-must turn pt to see this!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

acute pancreatitis labs

A

CBC : wbc elevation
CMP : ast / alt elevation , direct bilirubin elevated, calcium decreased, albumin decreased
Lipase : elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

acute pancreatitis dx test

A

abdominal CT with contrast!!!
abd US
EKG
CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

acute pancreatitis US

A

look at gallbladder for dilated common bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

acute pancreatitis CT

A

confirming / viewing possible calcification in duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

acute pancreatitis dx

A
  1. acute onset on persistent , severe epigastric pain
  2. elevated lipase / amylase
  3. findings on dx imaging

** MUST have 2 OF 3 in order to have dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ranson’s criteria

A

score > 3 indicates severe pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ransons admission

A

> 55 years old
WBC > 16,000
LDH > 350
AST > 250
glucose > 200

**KNOW THIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ransons at 48 hours

A

hematocrit decrease > 10%
BUN increase > 5
Calcium < 8
PaO2 < 60
base deficit > 4
fluid sequestration > 6

**KNOW THIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

acute pancreatitis management

A

fluid replacement : IV crystalloids
electrolyte replacement : hypocalcemia, hypomagnesmia, hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

acute pancreatitis fluids

A

IV crystalloids at 5-10 ml / kg / hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

acute pancreatitis I / O

A

urinary output < 50 mL / hr is early sign of HYPOVOLEMIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

acute pancreatitis BP

A

systolic BP > 100
MAP > 60
HR < 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

hypocalcemia s/s

A

widened QT interval
tetany , chvostek , trousseau
seizure PRECAUTIONS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what lab to monitor with hypocalcemia…

A

albumin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

if potassium is needed for hypokalemia…

A

ALWAYS HANG POTASSIUM ON A PUMP

-no more than 20 mL / hr
-potassium burns going in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

acute pancreatitis patients must….

A

remain NPO for 24 hours!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

mild pancreatitis diet

A

oral feeding IF no vomiting / decreased pain / inflammatory markers improving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

severe pancreatitis diet

A

enteral nutrition if unable to tolerate oral diet by 5 days!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

acute pancreatitis comfort

A

PAIN MANAGEMENT is #1
-pain increase pts metabolism , IV opioids , PCA pump
antibiotics NOT recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

acute pancreatitis pulmonary complications

A

ARDS
atelectasis , pneumonia , pleural effusion
hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

acute pancreatitis cardiac complications

A

cardiac dysrhythmias
hypovolemic shock
myocardia depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

acute pancreatitis GI complications

A

GI bleeding
pancreatic abscess
pancreatic pseudocyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

acute pancreatitis hematologic complication

A

DIC
coagulation abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

acute pancreatitis renal complications

A

acute renal failure
elevated BUN
oliguria - low urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

acute pancreatitis education

A

diet : small frequent meals, eats carbs , AVOID FAT AND PROTEIN
no alcohol
no smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

acute pancreatitis improvement

A

lipase decreases and pain decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

acute pancreatitis might have this in place if caused by alcohol….

A

seizure precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

chronic pancreatitis

A

persistent inflammation , not reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

chronic pancreatitis risks

A

heavy alcohol use
recurrent / severe acute pancreatitis!!!!
smoking
genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

chronic pancreatitis s/s

A

-upper abd pain radiating to back : gets WORSE with eating / drinking (esp. alcohol)
-n/v
-weight loss
-pale / clay colored stool!!!
-steatorrhea (greasy , bad smelling stool)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

chronic pancreatitis labs

A

CBC
CMP :
-alkaline phosphate : increase
-bilirubin : increase
-glucose : increase
Lipase and amylase increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

chronic pancreatitis dx test

A

abd CT
abd US
ERCP

*visualize pancreas and verify structural changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

chronic pancreatitis diagnosis

A
  1. chronic abd pain , recurring acute pancreatitis
  2. diarrhea, steatorrhea, weight loss
  3. pancreatogenic diabetes
  4. visual damage on imaging!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

chronic pancreatitis pain control

A

opioids normally required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

chronic pancreatitis meds

A

IV fluids
electrolyte replacement
histamine blocker
PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

pancreatic enzyme replacement therapy (PERT)

A

provides amylase and protease
tx malnutrition and malabsorption
taken everytime pt eats

**Creon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

chronic pancreatitis education

A

NO alcohol
avoid tobacco
pancreatic enzyme meds
limit fat
avoid irritating foods / drinks
-coffee, caffeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

pancreatic enzyme education

A

take with food and FULL glass of water
DO NOT chew tablets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

chronic pancreatitis CT

A

will have MULTIPLE pancreatic calcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

pancreatic cancer

A

diagnosis often occurs late in disease process
-very rapid growing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

pancreatic cancer risks

A

smokers
diet high in fate
high meat consumption, fried food, refined sugar, nitrates
diabetes, chronic pancreatitis
family hx
> 60 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

pancreatic cancer s/s

A

VAGUE symptoms : present like all GI disorders
pain : dull and epigastric area
jaundice : bile duct obstruction
fatigue
weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

pancreatic cancer labs

A

not specific for dx but see how pancreas working:
CBC
CMP :
-lipase increase
-LFTs increase
-bilirubin increase
fecal fat in stool

56
Q

pancreatic cancer dx test

A

ultrasound
CT scan
MRI
ECRP

**determines mass

57
Q

pancreatic cancer definitive dx

A

made through biopsy

58
Q

pancreatic cancer management

A

chemo and radiation normally used palliatively because tumor is metastisized

59
Q

whipple procedure

A

major resection of pancreas / duodenum / stomach and gallbladder

-most pts not a canidate

60
Q

pancreatic cancer nursing mgmt

A

vitals and i / o , weight
glucose monitor
monitor and tx pain
monitor weight
palliative care

61
Q

whipple post op pancreatic cancer

A

1.maintain NPO
2. NG tube low suction
-NEVER MANIPULATE the NG post op
-call surgeon if it comes out
3. glucose monitor
4. post op drain tubes
5. semi-folwers
6. assess for surgical complications

62
Q

whipple complications post op

A

diabetes
hemorrhage
wound infection
bowel obstruction
intra-abdominal abscess

63
Q

pancreatic cancer education

A

post op care
medications
diet / nutrition : dietary supplements
s/s of hypo or hyperglycemia
coping skills / support groups / palliative care

64
Q

cirrhosis

A

chronic disease that causes scarring of hepatic tissue

-not reversible only delay progression

65
Q

cirrhosis causes

A

hepatitis C!!!
alcohol induced cirrhosis
smoking
NASH
autoimmune diseases
hepatotoxins / medications
former IV use

66
Q

cirrhosis s/s

A

SOB
jaundice!!!
increased abd girth!!!
abd pain / bloating
spider angioma
hemorrhoids
bleeding / bruising
pruritis
asterixis
hepatic encephalopathy

67
Q

cirrhosis patho changes

A
  1. ascites
  2. coagulopathy
68
Q

asterixis

A

flapping tremor of hand when the wrist is extended

69
Q

cirrhosis labs

A

CBC : decrease platelets
CMP :
-increase ast / alt
-increase bilirubin
-increase alkaline phosphate
-decrease albumin
-decrease sodium
Coags : increase PT / increase aPTT
Ammonia increase

70
Q

cirrhosis dx test

A

abd US : enlarged liver
CXR : elevated diaphragm
liver biopsy: definitive test, not always done r/t risks

71
Q

cirrhosis complications

A

bleeding
hyponatremia
hepatorenal syndrome
spontaneous bacterial peritonitis
hemorrhoids

72
Q

hepatorenal syndrome

A

rapid deterioration of kidneys

73
Q

spontaneous bacterial peritonitis

A

tx with antibiotics
fever, abd pain, encephalopathy

74
Q

cirrhosis management

A
  1. ascites management
  2. portal HTN mangement
75
Q

ascites management

A

paracentesis : invasive procedure to remove fluid from abdominal cavity

**both dx and tx

76
Q

portal hypertension management

A

Sengstaken - Blakemore Tube
-should not be left in place for more than 24 hours
-keep scissors at bedside for emergency use

77
Q

cirrhosis education

A

-low protein
-low sodium : < 2g / day
-no alcohol
-avoid meds metabolized in the liver : acetaminophen
-soft toothbrushes , careful flossing , shaving : bleeding precautions

78
Q

cirrhosis nursing management

A

administer diuretics
electrolyte replacement
restrict sodium / fluid intake
elevate head of bed / legs
administer blood products
vitamin K
FFP

79
Q

hepatic encephalopathy

A

spectrum of reversible abnormalities , main cause is AMMONIA and toxins in the blood

80
Q

hepatic encephalopathy causes

A

ammonia
high protein diet
hypokalemia
GI bleeding!!!
-hypovolemia
-constipation

81
Q

hepatic encephalopathy s/s

A

mood changes
slurred speech
asterixis
confusion
decreased LOC
-poor coordination
-coma
-disturbance in sleep

82
Q

hepatic encephalopathy labs

A

Ammonia increased
CMP :
-increased liver enzymes
-increased bilirubin
-increased alkaline phosphate
-decreased potassium

83
Q

hepatic encephalopathy dx

A

EXCLUSION of other causes
-labs
-CT to rule out cause

**elevated ammonia levels are NOT diagnostic alone

84
Q

hepatic encephalopathy management

A

avoid protein overload : small frequent meals
LACTULOSE : prevents ammonia absorption
NEOMYCIN : abx that kills normal flora of bacteria
POTASSIUM
prevent GI bleed
restrict toxic meds
-opioid
-sedatives
-barbituates

85
Q

hepatic encephalopathy education

A

factors that cause it
s/s
initial signs are subtle

86
Q

lactulose

A

given to decrease ammonia levels , should produce 2-3 soft stools per day

87
Q

variceal bleeding

A

MEDICAL EMERGENCY , caused by massive upper GI blood loss

88
Q

variceal bleeding priority

A

hemodynamic stability and establish a PATENT AIRWAY

-dx of cause is priority before treatment

89
Q

variceal tx

A

octreotide
vasopressin
endoscopic procedure
TIPS
esophagogastric tamponade

90
Q

octreotide

A

used to slow / stop bleeding
IV bolus followed by INFUSION
monitor for hypo / hyperglycemia!!!

91
Q

endoscopic procedure

A

sclerotherapy
endoscopic band ligation

92
Q

TIPS

A

nonsurgical treatment for recurrent variceal bleeding after sclerotherapy

93
Q

esophagogastric tamponade

A

inflation of balloon applies pressure to vessels stopping the bleeding

**sengstaken - blakemore tube

94
Q

Sengstaken Blakemore Tube

A

3 lumen
normal inflation 20-45 mmHg

**deflate balloon every 8-12 hours
deflate esophageal BEFORE gastric

95
Q

sengstaken blakemore tube complications

A

possible rupture
-all lumen are CUT and tube is removed
**KEEP SCISSORS at BEDSIDE

96
Q

esophageal varices priority actions

A
  1. PROTECT AIRWAY : prepare to intubate
  2. two large IVs
  3. rapid fluid bolus
    **blood products
97
Q

esophageal varices labs

A

CBC
CMP
coags
stool
type and cross : in case of infusion

98
Q

colon cancer risks

A
  1. family hx
  2. IBS for 10 or more years
  3. obesity
  4. dietary : high fat , red meats , processed
  5. cigarette use
  6. alcohol
99
Q

colon cancer s/s

A

unexplained weight loss / fatigue
change in bowel regularity
blood in stool!!!
abd pain / distention

100
Q

colon cancer labs

A

CBC : wbc increased
CMP : electrolyte imbalance
CEA : cancer specific lab

101
Q

colon cancer dx tests

A

abdominal CT
MRI
abd x-ray

102
Q

colon cancer colonoscopy

A

GOLD STANDARD for dx
-biopsy taken , polyps removed

103
Q

colon cancer management

A

chemotherapy
radiation
surgical!!! - remove affected portion

104
Q

colon cancer preop

A

physical assessment
bowel prep : laxative
pre-op abx
consent

105
Q

colon cancer postop

A

vitals every 4 hours
monitor labs : H and H / WBC
assess for n/v
monitor i/o
monitor incision
pain control
early ambulation
cough / deep breathe

106
Q

colon cancer teaching

A

prevent post op complications
ostomy teaching

107
Q

ostomy post op

A

slight bleeding initially
slightly swollen but should subside
2-4 days to function post op
return of flatulus

108
Q

stoma post op eval

A

reddish pink / moist
signs of ischemia

109
Q

stoma ischemia

A

dark red / purple
unusual bleeding

110
Q

transverse colostomy

A

semiliquid to semiformed stool

111
Q

ascending colostomy

A

semiliquid stool

112
Q

illeostomy

A

liquid to semiliquid stool

113
Q

sigmoid colostomy

A

formed stool

114
Q

descending colostomy

A

semiformed stool

115
Q

ostomy pt teaching

A

care of ostomy , supplies , complications
SELF CARE is more successful when done BEFORE the procedure

116
Q

peritonitis

A

inflammation / infection of membrane that lines abdominal cavity

117
Q

life threatening peritonitis

A
  1. peristalsis slows / stops
  2. bowels become distended
  3. toxins and bacteria –> sepsis
  4. respiratory problems from increased abd pressure
118
Q

peritonitis s/s

A

severe pain!!!
board like abd!!!
rebound tenderness!!
fever
decreased UO
diminished bowel sounds
resp distress

119
Q

peritonitis labs

A

CBC : wbc elevated
CMP :
-electrolytes abnormal
-increase BUN / creatinine
Lactic acid increase

120
Q

peritonitis dx tests

A

abd x-ray
abd CT scan
US

121
Q

peritonitis diagnosis

A

based on physical assessment, labs , radiology

122
Q

peritonitis nonsurgical mgmt

A

IV fluids
IV abx
NG tube : decompress stomach
NPO

123
Q

peritonitis surgical

A

focus on removing foreign material and fluid
EXPLORATORY LAPAROTOMY

124
Q

peritonitis nuring management

A

administer fluids and abx
pain management
monitor worsening condition
I/O
post surgical assessment

125
Q

peritonitis worsening

A

decreased LOC
vitals
respiratory status decreased

126
Q

“hot belly” is also known as….

A

peritonitis

127
Q

malabsorption syndrome

A

chronic diarrhea
wt loss
s/s depend on what nutrient is not reabsorbed

128
Q

malabsorption tx

A

antidiarrheal
IV fluids
antibiotics
steroids

129
Q

gastric cancer causes

A

H. pylori
Smoking
-atrophic gastritis

130
Q

gastric cancer s/s

A

most dx very late
-indigestion
-anorexia
-weight loss
-vague epigastric pain
-vomiting
-abd mass

131
Q

gastric cancer labs

A

CBC : H and H decreased
CMP : ALT / AST elevated
CEA : increased
GUAIAC POSITIVE

132
Q

gastric cancer dx

A

EGD : see esophagus , stomach , upper duodenum
CT
barium x-ray

133
Q

gastric cancer surgery

A

gastric resection + chemo

complication = dumping syndrome

134
Q

dumping syndrome

A

chyme enters bile too rapidly
early s/s
-dizziness
-tachycardia
-pallor
-sweating
-diarrhea
-palpitations

135
Q

dumping syndrome late s/s

A

hypoglycemia-
weakness
sweating
dizziness

136
Q

gastric cancer educations

A

small frequent meals, non irritating food
nutrition supplements

Critical Care (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions