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Nursing 102 > GI exam #2 > Flashcards

GI exam #2 Flashcards

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1
Q

What is the most common GI problem?

A

N&V

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2
Q

What are the 3 types of N&V

A
  1. pathogenic- R/T disease process
  2. iatrogenic- R/T disease Tx
  3. psychogenic- R/T psychological state (stress)
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3
Q

Patho of vomiting:

A

stimulation of chemo-receptor trigger zone (CTZ) which then stimulates the vomiting center (VC) in the medulla

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4
Q

Objective data of emesis:

A

color, consistency and amount

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5
Q

Tx for N&V:

A

NPO until able to tolerate oral intake
HOB elevated to prevent aspiration
replace fluid and electrolytes

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6
Q

Acid-base balance
vomiting leads to _______?
diarrhea leads to _______?

A 
vomiting = alkalosis
diarrhea = acidosis
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7
Q

What is gastritis?

A

Inflammation of the gastric mucosa

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8
Q

What causes gastritis?

A

long-term NSAID use

H. Pylori or other bacteria

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9
Q

Chronic gastritis is closely associated with development of _______.

A

Gastric CA

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10
Q

Chronic Gastritis

What is chronic duodenal reflux?

A

When the pyloric sphincter allows alkaline juices to leak into stomach

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11
Q

Chronic Gastritis

Introduction of alkaline juices into stomach destroy which 2 kinds of cells in the stomach?

A

Parietal and chief cells

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12
Q

Chronic Gastritis

What will develop if there is no intrinsic factor produced?

A

pernicious anemia b/c B12 cannot be absorbed

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13
Q

Chronic Gastritis

Why do antacids not relieve pain associated with chronic gastritis?

A

b/c problem is alkaline not acidotic.

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14
Q

melena?

A

dark and tarry stool

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15
Q

hematochezia?

A

bright red blood in stool

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16
Q

What are the 2 origins of upper GI bleeding?

A

arterial and venous

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17
Q

which type of upper GI bleeding is more severe?

A

arterial

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18
Q

Hematoemesis?

A

bloody vomit

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19
Q

What kind of bleeding does melena indicate?

A

slow, oozing bleed in upper GI tract

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20
Q

What kind of bleeding does hematochezia indicate?

A

bleeding in lower GI tract

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21
Q

What is the most important intervention for upper GI bleed?

A

maintain airway

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22
Q

What is a mallory-weiss tear?

A

tear in esophagus caused by severe, violent vomiting

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23
Q

Peptic Ulcer Disease

Are gastric secretions increased, normal or decreased with gastric ulcer?

A

normal to decreased

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24
Q

Peptic Ulcer Disease

Are gastric secretions increased, normal or decreased with duodenal ulcer?

A

increased

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25
Q

what is Peptic Ulcer Disease?

A

erosion of GI mucosa from digestive action of HCl & Pepsin

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26
Q

Peptic Ulcer Disease

Acute vs. Chronic

A

Acute- superficial erosion

Chronic- long duration, erosion though muscular layer

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27
Q

1 cause of Peptic Ulcers:

A

H. Pylori

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28
Q

Peptic Ulcer Disease

S/Sx:

A

Burning, gnawing pain that is worse on empty stomach. Relieved by food, but recurs when stomach empties again.

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29
Q

Peptic Ulcer Disease

Tx:

A

relieve pain, avoid stressors

physical & emotional REST

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30
Q

Peptic Ulcer Disease

Drug Therapy:

A 
Antacids
H2 receptor agonists
Proton pump inhibitors (PPI's)
anticholenergics
reglan (increase gastric motility)
sucralfate (coats ulcer, protects from erosion)
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31
Q

Peptic Ulcer Disease

action of antacids & when to admin?

A

antacids neutralize gastric acid. give 1-3 hours after meals & at bedtime

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32
Q

Peptic Ulcer Disease

action of H2 blockers?

A

reduce HCl acid secretions (Tagamet, Zantac, Pepcid)

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33
Q

Peptic Ulcer Disease

action of PPI’s?

A

stop secretion of HCl acid to raise pH of stomach (Protonix, Prilosec, Prevacid)

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34
Q

Peptic Ulcer Disease

action of Anticholinergics?

A

block SNS- so they slow everything down. inhibit gastric secretions, decrease gastric motility. high incidence of s/e: dry mouth, urinary retention

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35
Q

What is the most common complication of Peptic Ulcer Disease?

A

hemorrhage.

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36
Q

What is the most serious complication of Peptic Ulcer Disease?

A

perforation (high mortality)

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37
Q

Peptic Ulcer Disease Complications:

What happens when perforation occurs?

A

gastroduodenal contents spill into peritoneal cavity= peritonitis & septicemia

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38
Q

Peptic Ulcer Disease Complications:

S/sx of perforation?

A

sudden onset sever upper abd pain, rigid, boardlike abd, absent bowel sounds, rapid & shallow resp

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39
Q

Peptic Ulcer Disease Complications:

What is gastric outlet obstruction?

A

occurs when inflammation & edema around ulcer (primarily duodenal) result in narrowing of pyloric sphincter = food can’t escape stomach

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40
Q

Peptic Ulcer Disease

S/sx of gastric outlet obstruction:

A

long Hx of pain, belching, vomiting of undigested food, weight loss

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41
Q

Peptic Ulcer Disease

Tx of gastric outlet obstruction:

A

gastric decompression by large lumen NG tube, then surgery.

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42
Q

Gastric Surgery

gastrectomy?

A

partial removal of stomach (70-80%), anastomosis to either duodenum (Bilroth I) or jejunum (Bilroth II)

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43
Q

Gastric Surgery

Vagotomy?

A

severe vagus nerve to decrease gastric secretions

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44
Q

Gastric Surgery

Pyloroplasty?

A

enlargement of the pyloric sphincter

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45
Q

Gastric Surgery

Post-op drainage will be bright ___ for first __ hours. Then return to normal _____ color in __ hours.

A

bright red 1st 12 hours. yellow-green after 36 hours.

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46
Q

Gastric Surgery Complications

What is dumping syndrome?

A

rapid emptying of gastric contents into sm intestines.

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47
Q

Gastric Surgery Complications

dumping syndrome S/sx:

A

weakness, syncope, dizziness b/c of increased blood flow to GI tract to facilitate digestion

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48
Q

Gastric Surgery Complications

dumping syndrome interventions:

A

small, frequent meals
no fluids with meals
avoid concentrated sweets
REST after meals

49
Q

Gastric Surgery Complications

why pernicious anemia with complete gastrectomy?

A

b/c IF can no longer be produced= no B12 absorption, will need B12 injections for life

50
Q

What are features of Zollinger-Ellison syndrome?

A

Pancreatic islet cell tumors
severe upper GI ulcers
excessive gastric acid secretions
diarrhea

51
Q

What is steatorrhea?

A

fatty, greasy, foul-smelling stools

52
Q

Tx of Zollinger-Ellison Syndrome:

A

Surgery- total or partial gastrectomy

Pancreatectomy- to remove tumors

53
Q

S/sx of gastric CA:

A

indigestion, feeling of fullness, gastric discomfort, weight loss, dysphagia, anemia, weakness, pale

54
Q

Enteral Nutrition

Percutaneous Endoscopic Gastrostomy? PEG

A

feeding tube inserted directly into stomach

55
Q

Enteral Nutrition

Duodenostomy?

A

feeding tube inserted directly into duodenum

56
Q

Enteral Nutrition

Jejunostomy? PEJ

A

feeding tube inserted directly into jejunum

57
Q

Enteral Nutrition

indications:

A

Physiologic- Inability to swallow
Psychologic- Mental disorders that prevent intake of nutrition
Pathophysiologic- Diseases that affect nutrition

58
Q

Enteral Nutrition

who can NOT have enteral feedings?

A

post op for gastric surgery

people who need bowel rest

59
Q

Enteral Nutrition

Orogastric?

A

through mouth into stomach

60
Q

Enteral Nutrition

Nasogastric?

A

through nose into stomach

61
Q

Enteral Nutrition

Nasoenteric?

A

through nose into small bowel

62
Q

Enteral Nutrition

After placement, when can feedings begin?

A

When bowel sounds are present

63
Q

Enteral Nutrition

What is an incomplete supplement?

A

do not provide all nutritional needs. for pt who still eats, but not enough calories

64
Q

Enteral Nutrition

Optimental formulas?

A

partially broken down, for pt unable to digest foods and/or absorb nutrients

65
Q

Enteral Nutrition

What does SOB indicate?

A

aspiration

66
Q

How do you measure an NG tube for insertion?

A

from ear lobe to tip of nose to xiphoid process

67
Q

2 types of diarrhea?

A 
Large Volume (excess fecal water)
Small volume (without excess fecal water)
can also be acute or chronic
68
Q

What is ABX related diarrhea?

A

when ingestion of ABX leads to destruction of bowels normal flora, permits overgrowth of C. diff

69
Q

S/sx of C. diff

A

severe diarrhea, fever/chills, abd distention, crampy pain

70
Q

Dx of C. diff

A

stool culture

71
Q

Tx of C. diff

A

D/C ABX which caused, take diff ABX designed to kill C. diff (Vancomycin)

72
Q

What is fecal incontinence?

A

relaxation, loss of control of, external sphincter = involuntary passage of stools

73
Q

Laxatives:

action of bulk-forming agents:

A

absorbs water, stimulates peristalsis (increase fluids)

74
Q

Laxatives:

action of stimulants:

A

irritates colon wall to increase peristalsis

75
Q

Laxatives:

action of stool softeners:

A

lubricates intestinal tract & softens stool

76
Q

what is Appendicitis?

A

acute inflammation of the vermiform appendix

77
Q

Most common cause of appendicitis?

A

fecalith

78
Q

Appendicitis

S/sx

A

abd pain RLQ
low grade fever
rebound tenderness
McBurney’s Point

79
Q

Appendicitis

Tx

A

NO HEAT to abd

appendectomy

80
Q

What is the major complication of a ruptured appendix?

A

peritonitis

81
Q

What is peritonitis?

A

inflammation of all or part of parietal & visceral surfaces of abd cavity

82
Q

S/sx Periotonitis:

A

pain = most consistent symptom
rigid, board-like abd
N/V, absent bowel sounds
rapid, shallow respirations

83
Q

Tx Peritonitis:

A

IV ABX & Fluids

semi-fowlers

84
Q

What is gastroenteritis?

A

inflammation of the stomach AND intestinal tract

85
Q

Causes of gastroenteritis?

A

bacteria, virus, parasite, food poisoning

86
Q

How is gastroenteritis transmitted?

A

fecal-oral route

87
Q

S/sx of gastroenteritis:

A

N/V, Cramping, Diarrhea, Dehydration, fever

88
Q

Tx of gastroenteritis:

A

determine cause
fluid/electrolyte balance
NPO until vomiting stops
ABX if bacterial

89
Q

What is dysentery?

A

gastroenteritis of the large bowel

90
Q

What is IBS?

A

Irritable Bowel Syndrome, chronic, NON-infectious irritation caused by spasms of colon

91
Q

How do you diagnose IBS?

A

H&P- weight loss, abd pain

“Manning’s criteria”

92
Q

S/sx IBS:

A

intermittent crampy lower abd pain, diarrhea alternating with constipation

93
Q

What is ulcerative colitis?

A

progressive & continuous inflammation & ulceration of lg bowel. intestinal mucosa- hyperemic, edematous, ulcerated, bleeds

94
Q

Who does UC usually affect?

A

young females

95
Q

S/sx of UC:

A 
PROFUSE BLOODY, MUCOUSY DIARRHEA
LLQ abd pain
fever
tenesmus
weight loss
anorexia
anemia
96
Q

Tx of UC:

A

bowel rest, ABX, I&O, daily weights, alleviate stress, fluid & electrolytes. Surgery = Proctolectom (remove colon & rectum with permanent ileostomy)

97
Q

Tx of UC meds:

A

steroids, ABX, vitamins & iron

98
Q

Dx UC:

A

Colonoscopy

99
Q

What is Crohn’s disease?

A

chronic inflammation of the small & or large bowel

100
Q

Describe pattern of UC:

A

Starts distally and spreads in a continuous pattern up the colon

101
Q

Describe pattern of Crohn’s:

A

Occurs anywhere along the GI tract in skip lesions. segmental

102
Q

Depth of involvement Crohn’s vs UC:

A

Crohn’s: entire thickness of bowel

UC: mucosa and submucosa

103
Q

Bowel lumen size: Crohn’s vs UC:

A

Crohn’s narrow

UC: normal

104
Q

Malabsorption: Crohn’s vs UC:

A

Crohn’s common

UC rare

105
Q

Weightloss: Crohn’s vs UC:

A

Crohn’s: severe

UC: common

106
Q

Rectal bleeding: Crohn’s vs UC

A

Crohn’s: rare

UC: common

107
Q

Tenesmus: Crohn’s vs UC

A

crohns: rare
UC: severe

108
Q

steatorrhea: Crohn’s vs UC

A

Crohn’s common

UC: rare

109
Q

Carcinoma risk: Crohn’s vs UC

A

crohn’s: only slightly greater than general pop

UC: increased incidence

110
Q

What are polyps?

A

projection of mucosal surface of the bowel lumen can be benign or malignant

111
Q

What is familial polyposis?

A

genetic condition, entire bowel covered in polyps. Leads to colon CA always… will have entire bowel removed

112
Q

3 types of intestinal obstruction:

A
  1. Mechanical
  2. Neurogenic
  3. Vascular
113
Q

What is the most common form of small bowel obstruction?

A

adhesions

114
Q

What kind of intestinal obstruction is a hernia?

A

mechanical

115
Q

What is volvulus?

A

the twisting of bowel on itself, twisted loop becomes strangulated. mechanical

116
Q

what kind of bowel obstruction is paralytic ileus?

A

neurogenic

117
Q

what causes vascular obstruction?

A

blood supply to bowel is disrupted (emboli, athersclerosis)

118
Q

S/Sx intestinal obstruction:

A

abd distention, liquid stools if partial obstr.
no stools if complete obstr.
abd pain, increased bowel sounds proximal to obstruction

119
Q

What is borborygmi?

A

High pitched, screaming bowel sounds

Nursing 102 (9 decks)

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