GI/GU Flashcards
What is Appendicitis?
Inflammation of the appendix
Higher incidence of appendicitis in males occur in which age group?
10 to 14
Higher incidence of appendicitis in females occur in which age group?
15 to 19
What role does the appendix have?
Immune system, repopulating good bacteria into the colon.
What conditions increase the risk of appendicitis?
Males, Crohn’s Disease, gastroenteritis, cystic fibrosis, trauma, swallowed item, tumor
Describe the etiology of appendicitis
You have a blockage of the appendix leading to inflammation, increased pressure, restricted blood flow (leading to pain & tenderness in RLQ)
What happens if there is perforation (hole) to the appendix?
Bacteria and other fluids are released into the abdominal cavity, potentially leading to peritonitis.
Clinical manifestation of appendicitis
Periumbicular pain, N/V, anorexia, RLQ pain, rebound tenderness, pain on coughing/sneezing/deep inhalation, low grade fever
A person with appendicitis will position themselves…
Lie still, with right leg flexed
How do you dx appendicitis?
Increased WBC
Urinalysis r/o any GU conditions
CT scan or sonogram to confirm Dx
What is the medical management protocol for appendicitis?
Surgical removal of the appendix. If rupture, antibiotics, and IV fluids are given Q6-H prior to appendectomy to prevent dehydration and sepsis
GERD is a disorder of the (upper/middle/lower) esophageal sphincter
lower esophageal sphincter
GERD symptoms
heartburn, chest pain, dysphagia, water brash
Esophageal symptoms / clinical manifestations
Pyrosis (heart burn)
Regurgitation
Dysphagia (difficulty swallowing)
Odynophagia (painful swallowing)
Nausea
Extraesophageal symptoms / clinical manifestations
Chronic cough, angina, laryngitis, asthma/sob/pneumonia/bronchitis, pharyngitis, sinusitis, otitis media, sleep apnea, erosion of dental enamel
Barrett’s esophagus
Precancerous lesions of cancer
What are esophageal strictures?
The esophagus is scarred making it narrowed and inflamed
What are complications of GERD?
Reflux esophagitis, esophageal strictures, Barrett’s esophagus, Esophageal cancer
Reflux esophagitis
Erosion of the esophagus leading to ulcers near the stomach esophageal junction
Risk factors for GERD
Genetics, Hiatal hernia (factors related to motility), obesity, Zollinger-Ellison Syndrome, Hypercalcemia, Scleroderma & systemic sclerosis, NSAID use can lead to pyrosis
What is Zolinger-Ellison Syndrome?
Increased gastric acid release due to increased gastrin production
How does hypercalcemia influence GERD?
Increased gastrin production (larger calcium stores), which increases acidity
Why is Esophageal pH monitoring used? How is it used?
Used to diagnose GERD. It is a wired capsule inserted into the esophagus. The patient touches the button to record occurrence of symptoms and times of eating or lying down.
GOLD STANDARD
What do esophageal manometry or esophageal motility study assess?
The motor function of the upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES). It detects pressure changes; no sedation.
What is a barium swallow?
Patient swallows barium and tack it as it goes down the track
What is an EGD?
Esophageal-gastroduodenoscopy.
Patient is sedated, they scope and biopsy the esophagus, and stomach, and take a look at the structures.
What lifestyle modifications are taken to reduce GERD?
Exercise, diet ; and obesity can cause GERD
What medications are used to manage GERD?
PPI (proton pump inhibitor), omeprazole
H2 receptor blocker, famotidine
Sucralfate
Method of action for PPI (proton pump inhibitor), omeprazole
Reduce gastric acid secretion
Method of action for H2 receptor blocker, famotidine
Reduce gastric acid secretion (histamine blocker)
Method of action for Sucralfate
Help to heal and prevent damage of esophagus
Prevents absorption of other drugs
Nissen fundoplication
A surgical procedure where the esophageal sphincter is tightened up. Done laparoscopically.
When should the patient contact the provider immediately?
Having trouble swallowing
Food gets “stuck” when swallowing
Lose weight when you’re not trying to lose weight
Chest pain
Choke when you eat
Vomiting blood or having bloody stool.
Untreated UTIs can lead to..
pyelonephritis
Most common bacterial pathogen
E coli
What are the organs of the upper urinary system?
Kidney and ureters
What are the organs of the lower urinary system?
Urinary bladder and urethra
What are the diseases of the upper urinary system?
Pyelonephritis (inflammation of renal parenchyma)
What are the diseases of the lower urinary system?
Cystitis (inflammation of the bladder)
Urethritis (inflammation of the urethra)
Lower urinary tract infection symptoms
Burning
Discharge
Pelvic pressure
Lower abdominal discomfort
Pain with urination
Blood
Upper urinary tract infection symptoms
Fever
Chills
Flank pain
N/V
can also present w/ lower urinary tract symptoms
Lower urinary tract infection storage symptoms
Urinary frequency
Urgency
Incontinence
Nocturia
Nocturia enuresis
Clinical manifestations of Pyelonephritis
Upper back and flank pain, high fever, chills, N/V
Clinical manifestations of Cystitis
Pelvic pressure, lower abdomen discomfort, frequent, painful urination, blood in urine
Clinical manifestations of Urethritis
Burning with urination
Uncomplicated UTI
Occur in the urinary tract and only involve bladder
Complicated UTI
UTI + coexisting obstruction or other conditions
Patients with a complicated UTI are at risk for…
urosepsis, pyelonephritis and renal disease
Risk factors for UTI
Urinary stasis, foreign bodies, anatomic factors, immune response, functional disorders, others (pregnancy, multiple partners, nursing bladder, etc.)
What does a urine dipstick analyze?
Nitrated
WBCs
Leukocyte esterase (indicates pyuria)
Diagnosing UTI
Urine culture (clean catch)
Urinalysis
CT
Ultrasound
Dipstick
How do we treat a lower UTI?
Administer broad spectrum antibiotics (ciprofloxacin) for a short period of time.
Increase fluids.
Pain relief (Pyridium)
Perform urinalysis & culture
Medical management for acute pyelonephritis
Urine culture, antibiotics, force fluids, NSAIDs
T/F We get a urine culture after we start antibiotics
FALSE! We always get a culture before antibiotics
How does the nurse manage lower UTIs
Force fluids to flush out bacteria
Decrease irritants (coffee, caffeine, ETOH, citrus, chocolate, spicy food)
Pain control (heat to suprapubic area)
Drug therapy (antibiotic)
What do you educate the patient with a LUTI?
Encourage fluid intake
Nutrition
Pain control (non-pharm actions)
Drug therapy (complete full round of antibiotics)
What do you have to avoid to prevent a lower UTI?
Holding urine for long periods of time
Tight clothes which irritate the urethra
Deodorants or feminine products on genitalia
What do you promote to prevent a lower UTI?
Wipe front to back
Showers, not baths
Pee after sex
Cranberry juice w/o sugar or proanthocyanidin (reduce recurrent bladder infections)
When do you call provider for LUTI
Symptoms do not diminish
Fever, N/V, flank pain, increasing signs of infection of Upper UTI
What do you educate the patient with Pyelonephritis?
Same as LUTI + antibiotics for 14-21 days
Fever & pain management
If a patient is hospitalized what actions are done to manage Pyelonephritis?
Hydrate the patient via IVF, then force fluids when they can drink.
When should s/s resolve for pyelonephritis?
48 to 72 hours
Urosepsis can result if…
Bacteriuria and bacteremia are present
Renal calculi are more common in which gender?
Men
Why is renal calculi more prevalent in the Southeast and Southwest?
Because it is hot, therefore, you are more likely to be dehydrated
Kidney stones can be made of…
calcium oxalate, calcium phosphate, uric acid, etc.
Clinical manifestations of renal calculi
Sudden and extreme pain in the flank, back, or lower abdomen. N/V, groin pain, hard time sitting still, sharp pain, manifest with UTI
Renal colic
A clinical manifestation of renal calculi that describes shape, severe pain due to stretching/dilation/spasm of the ureter in response to the stone
How dow urine acidity affect renal calculi?
Lower pH, less soluble uric acid and cystine. **When not soluble, more likely to precipitate out
How do we diagnose renal calculi?
CT, Ultrasound, IVP (intravenous pyelogram), urinalysis, chem panel
How do we diagnose renal calculi in recurrent stone formers?
24 hour urine sample (measuring for calcium, phosphorus, magnesium, sodium, oxalate, sulfate, potassium, uric acid, and tidal volume)
With an acute event, how do we manage renal calculi?
Hope it will pass through. Stones less than 4 mm will pass on its own. Force fluids, manage pain, infection and obstruction
How do we evaluate the cause of the stone?
History of illness, nutrition, and exercise
Foods rich in calcium
Milk, dried fruits, nuts, beans
Foods rich in oxalate
Dark roughage, spinach, asparagus, cabbage, chocolate, tea
What is a lithotripsy
Extracorporeal shock waves are used to break stones into tiny pieces. Pain medicine and/or anesthesia.
What is the nurse role post-op for lithotripsy?
Monitor for hematuria, force fluids, and prevent infection. Sometimes a stent is left in place and removed after ~2 weeks.
How much fluids does a patient need to drink per day?
2L of fluid a day and 3L a day for active patients
What vital sign do you want to assess for a ruptured appendix?
Temperature (fever)
Post Op nursing interventions
Vital Signs
Clear liquid diet
GI assessment (bowel sounds)
IV and oral hydration
Ambulation (prevent clots & atelectasis)
Prevent infection
Flatulence (gas passage)
Incentive spirometer, cough, deep breathing exercise
Wound Care
Take ALL antibiotics
Who is at risk for UTI development and why?
a. individuals with a penis
b. tumor of the bladder
c. foley catheter
d. renal calculi
e. patient with dehydration
f. immunosuppressed patient
g. younger adult
h. underweight individual
a. individuals with a penis bc prostate issues
c. foley catheter (infection); we avoid by using purewick
d. renal calculi (blockage)
e. patient with dehydration (build up)
g. younger adult (hygiene & sexual activity)
f. immunosuppressed patient
h. underweight (malnutrition)
Most common UTI symptoms
Frequency & Pain!
What antibiotics do you give to a patient with acute pyelonephritis
Empiric –> Culture
14 to 21 days
Fluid
Manage fever
Monitor for new symptoms
acute pyelonephritis is what type of UTI? upper or lower
upper
What do you want to teach a patient to prevent a UTI?
Encourage fluid intake
Evaluate diet
Control pain
Drug therapy: complete all antibiotics
When to notify the provider
Cranberry juice
Void after intercourse
Shower vs Bath
Proper wiping
Avoid restrictive clothes
Avoid holding urine
Avoid scented products
Risk factors for renal calculi
Situations where there is high solute load (dehydration)
High acidity (diabetes)
Alkalinity (high pH, calcium, and phosphate)
Gastric bypass surgery (enhanced oxolates)
Most common stone (calcium oxalate)
Symptoms of renal calculi
Sudden lower back, groin, flank pain
Unable to sit still
Can be accompanied by UTI-fever/pain/chills
Diagnostic tests for renal calculi
- X-Ray
- Urinalysis
- Ultrasound
How do we manage/fix renal calculi?
Lithotripsy (sound waves)
Fluids (pass it on their own)
Patient teaching for renal calculi?
Pain medication
You have JR, a 28 year old male. He has a chief complaint of abdominal pain, nausea, and low-grade fever for 12 hours. What is the first step you do as the nurse?
Assessment (COLDSPA)
Look at their past medical history
Assess their vital signs
GI Nursing action post-op
Bowel sounds & Flatulence
Laproscopic
a minimally invasive surgical procedure that allows surgeons to examine and operate on organs in the abdomen and pelvis (Lateral)
