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NCLEX > GI Part 2 > Flashcards

GI Part 2 Flashcards

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1
Q

What happens with a Hiatal Hernia?

What is the main cause of this? Other causes?

A

Part of the stomach pushed up through the diaphragm and into the thoracic cavity

Main cause is a large abdomen so we need to teach weight loss

Could be congenital anomalies, trauma, and surgery

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2
Q

S/S hiatal hernia

A

Heartburn
Regurgitation
Fullness after eating
Dysphagia

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3
Q

How are we going to treat a Hiatal Hernia—

What is the KEY*
How to eat meals?
What position is best?

Can surgery be done?

What to teach?

A

Key is to keep the stomach in the down position!!

Small frequent meals - big meals shove the stomach back up into the thorax
Sit up 1 hr after eating
Elevate HOB - May use blocks

Surgery can be done - fat person may cause the stomach to go right back up

Teach weight loss and healthy eating

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4
Q

What happens in Dumping Syndrome?

What can cause this?

A

The stomach empties too fast after eating

Secondary to gastric bypass, gastrectomy, or gallbladder disease

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5
Q

S/S of Dumping Syndrome

A

Fullness, cramping, diarrhea
Weakness, faintness
Palpitations

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6
Q

NCLEX TEST STRATEGY how positioning regarding food in the stomach**

A

*Lay on left side to keep the food in the stomach

Left side lying leaves it in
Right side lying releases it

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7
Q

How should we sit while eating with Dumping Syndrome?

What about afterwards?

A

Semi-Recumbent - lying back bit to keep the food in the stomach

Lie down after eating and on the LEFT side

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8
Q

What are things to keep in mind during meals for the Dumping Syndrome patient?

What kinds of foods to they avoid?

A

Drink BETWEEN meals, not during them

Small and frequent meals

Avoid foods high in carbs and electrolytes because these empty FAST!

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9
Q

Location in UC vs Crohn’s

A

Inflammation and erosion

UC: Large intestine/colon
Crohn’s: Sm int/Ileum, but can be anywhere in the sm AND lg intestine

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10
Q

S/S of UC and Crohn’s

A

Diarrhea, dehydration
Rectal bleeding, bloody stools, anemia
Cramping, rebound tenderness
Fever

Rebound tenderness: peritoneal inflammation

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11
Q

How do we diagnose UC and C?

A

CT (not as common)
Colonoscopy
Barium enema

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12
Q

Colonoscopy–

Diet pre-op?
Avoid what?
How to we clear the bowel?

What do they have to drink to empty the bladder? And what makes this easier? Can they use a straw?

Sedated?

POSTOP: watch for what?

A

Clear liquids for 12-24 hr
NPO 6-8 hr

Avoid NSAIDS - bleeding risk

Clear the bowel with laxatives and enema until clear (Watch for weakness)

Polyethylene glycol: Give anti-emetic, cold it better
NO STRAW! This causes them to swallow air and cause more GI upset

YES, they are sedated

Post-op: Perforation risk - signs include pain and unusual discomfort: especially if they didn’t have pain before
ASSUME THE WORST that sOMETHING BAD HAPPENED!

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13
Q

What kind of enema is done to diagnose UC and C?

Why would they do this?

A

Barium enema (BE, lower GI series)

Do this if the colonoscopy is incomplete

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14
Q

What kind of diet to give UC and C patient?

High or low fiber?
Avoid what? Why?

A

LOW fiber - we want to limit GI motility to help save fluid

Avoid foods that are cold, hot, or smoked because these can increase motility

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15
Q

What kind of medication are the UC and C patients going to get?

A

Anti-diarrheals
Antibiotics
Steroids

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16
Q

What to think about when giving antidiarrheals?

A

Only give these to patients with UC that have only mild symptoms because it doesn’t work well in severe cases

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17
Q

Surgery for UC

A

Ileostomy

Koch Pouch
J Pouch

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18
Q

Different between Koch pouch and J Pouch

A

Koch: Removes the colon and has as a nipple valve that opens and closes to empty the intestines - catheter to remove (continent)

J: Removes the colon and attaches the ileum to the rectum

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19
Q

Ileostomy vs Colostomy

A

Ileostomy: sm int/ileum
Entire colon with rectum and anus removed

Colostomy: lg int/colon
Rectum and anus removed and part of the colon

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20
Q

Surgery for Crohn’s

What’s the goal?

A

May have ileostomy or colostomy, depending on the area of intestine affected

Goal is to ONLY remove the affected area

We try to not even do surgery

21
Q

Post-op ileostomy

When the the fluid draining?
What are these patients at risk for?
Do we have to irrigate it?
What foods to avoid? why?
What's good for summer?
A

Fluid is always draining - always a little dehydrated putting the patient at risk for kidney stones

Don’t need to irrigate

Avoid rough foods or foods that are hard to digest; we want increased motility

Gatorade and E replacements

22
Q

What happens as waste moves through the colon?

A

Water and nutrients absorb in the body and stool is formed

23
Q

Order of large intestine pieces?

A

Right: ascending
Transverse
Left: Descending
Sigmoid

24
Q

Differences in stool!

Ascending/transverse:
Descending/sigmoid:

A

Ascending/transverse: semi-liquid

Descending/sigmoid: semi-formed or formed

*The further the ostomy, the more water is being drawn out

25
Q

Which ostomys do you irrigate? Why?

A

Descending and Sigmoid

Irrigation promotes regularity because the stoma doesn’t have voluntary control and this way, patients can predict timing and gain more control

26
Q

What is the best time to irrigate an ostomy?

A

At the same time everyday and after a meal because there is more peristalsis

27
Q

Irrigating an enema using what same principles?

What if the patient starts cramping?

Position when giving an enema or suppository with a rectum?

A

Same principles as an enema!!

Stop the fluids, lower the bag, and/or check the temp of the fluid

Lay on LEFT side because this is like the natural flow of the intestines

Any position is okay with a stoma

28
Q

What is appendicitis usually related to?

NCLEX major concern!!

A

A low fiber diet

RUPTURE!

29
Q

S/S of Appendicitis

WHERE IS THIS PAIN?

What’s important Hx to note?

What might cause the inflammation?

A

Pain is generalized initially
MCBURNEY’S POINT!

Rebound tenderness
***HX Abdominal pain THEN N/V
Anorexia

*Inflammation may be due to in filling with bowel contents

30
Q

How do we diagnose appendicitis?

A

WBC ^
US shows large appendix
CT

31
Q

What do we NOT give an appendicitis patient?

A

Enemas or laxative! Worry about rupture!!

32
Q

Appendectomy

How is is usually done?
Position of choice?
Careful with what?

A

Laparoscopic
HOB elevated, right side
NEVER put pressure on a suture line!!

33
Q

Feeding tube w/ ensure q4: best position?

Check what when moving the patient all around?

A

Right side, HOB up
Helps stomach empty and not aspirate
Re-check the placement

34
Q

TPN temperature
Stored?
Administration?

A

Keep refrigerated

Warm for admin: let it sit out

35
Q

What is needed for TPN (Hyperalimentation) administration? Why?

Can we put other things in this line?

NCLEX ABOUT PROTEIN

A

Central line & a filter
This shit is packed with particles

NO!!!

Protein can’t leak through the glomerulus unless there is kidney damage!

36
Q

How do we stop TPN?

What might happen when it’s stopped?

A

Need to do it gradually to avoid hypoglycemia: this shit is packed with sugar

They may need to start taking insulin

37
Q

TPN how often to monitor blood sugar?

What else to monitor while on this?

A

Every 6 hours

Daily weight - may need to increase amount

38
Q

What do we need to check the TPN patient’s urine for?

A

Glucose and ketones:

Ketones = fat break down!! Need more fat in the TPN!

39
Q

How long can TPN be hung?
What do you have to do when you hang a new bag?
When should you mix it?

Do you need to recheck the solution ingredients?

A

24 hours
New bag = New tubing
Don’t pre-mix because it changes frequently depending on electrolytes

YES!!! Pharmacy could have messed up or sent an old bag!!

40
Q

TPN needs to be delivered how?

A

On a pump

May have dark bag around it to prevent chemical breakdown

41
Q

What do you need to emphasize at home?

Biggest frequent complication?

A

Hand-washing

Infection!

42
Q

When assisting a physician for a central line, have what available?

When can you start fluids?

A

Flushes for each port

Until positive CXR placement

43
Q

Position for central line insertion?

A

Trendelenburg and head turned away: want the veins to be distended

44
Q

What position do you put the patient in if air gets in the line?

A

LEFT SIDE TRENDELENBURG

May have to go to cath lab if an air embolus is suspected in the heart

45
Q

How can you avoid getting air in the central line?

A

Clamp it off

Valsalva: Take a deep breath and HUMMM to increase intrathoracic pressure

46
Q

What does the CXR also check for?

A

Pneumo

47
Q

What to tell the patient when you are removing the line

What position?

A

Lay flat and HUMMMM

Prevent air embolus and occlusive dressing

48
Q

FOODS TO AVOID

Dumping syndrome
UC & Chrons
Ileostomy

A

Dumping syndrome: Foods high in carbs and electrolytes
UC & Chrons: Hot, cold, smoked
Ileostomy: Rough food, hard to digest

NCLEX (23 decks)

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