GI Part 2 Flashcards
What happens with a Hiatal Hernia?
What is the main cause of this? Other causes?
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
S/S hiatal hernia
Heartburn
Regurgitation
Fullness after eating
Dysphagia
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?
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
What happens in Dumping Syndrome?
What can cause this?
The stomach empties too fast after eating
Secondary to gastric bypass, gastrectomy, or gallbladder disease
S/S of Dumping Syndrome
Fullness, cramping, diarrhea
Weakness, faintness
Palpitations
NCLEX TEST STRATEGY how positioning regarding food in the stomach**
*Lay on left side to keep the food in the stomach
Left side lying leaves it in
Right side lying releases it
How should we sit while eating with Dumping Syndrome?
What about afterwards?
Semi-Recumbent - lying back bit to keep the food in the stomach
Lie down after eating and on the LEFT side
What are things to keep in mind during meals for the Dumping Syndrome patient?
What kinds of foods to they avoid?
Drink BETWEEN meals, not during them
Small and frequent meals
Avoid foods high in carbs and electrolytes because these empty FAST!
Location in UC vs Crohn’s
Inflammation and erosion
UC: Large intestine/colon
Crohn’s: Sm int/Ileum, but can be anywhere in the sm AND lg intestine
S/S of UC and Crohn’s
Diarrhea, dehydration
Rectal bleeding, bloody stools, anemia
Cramping, rebound tenderness
Fever
Rebound tenderness: peritoneal inflammation
How do we diagnose UC and C?
CT (not as common)
Colonoscopy
Barium enema
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?
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!
What kind of enema is done to diagnose UC and C?
Why would they do this?
Barium enema (BE, lower GI series)
Do this if the colonoscopy is incomplete
What kind of diet to give UC and C patient?
High or low fiber?
Avoid what? Why?
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
What kind of medication are the UC and C patients going to get?
Anti-diarrheals
Antibiotics
Steroids
What to think about when giving antidiarrheals?
Only give these to patients with UC that have only mild symptoms because it doesn’t work well in severe cases
Surgery for UC
Ileostomy
Koch Pouch
J Pouch
Different between Koch pouch and J Pouch
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
Ileostomy vs Colostomy
Ileostomy: sm int/ileum
Entire colon with rectum and anus removed
Colostomy: lg int/colon
Rectum and anus removed and part of the colon
Surgery for Crohn’s
What’s the goal?
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
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?
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
What happens as waste moves through the colon?
Water and nutrients absorb in the body and stool is formed
Order of large intestine pieces?
Right: ascending
Transverse
Left: Descending
Sigmoid
Differences in stool!
Ascending/transverse:
Descending/sigmoid:
Ascending/transverse: semi-liquid
Descending/sigmoid: semi-formed or formed
*The further the ostomy, the more water is being drawn out
Which ostomys do you irrigate? Why?
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
What is the best time to irrigate an ostomy?
At the same time everyday and after a meal because there is more peristalsis
Irrigating an enema using what same principles?
What if the patient starts cramping?
Position when giving an enema or suppository with a rectum?
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
What is appendicitis usually related to?
NCLEX major concern!!
A low fiber diet
RUPTURE!
S/S of Appendicitis
WHERE IS THIS PAIN?
What’s important Hx to note?
What might cause the inflammation?
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
How do we diagnose appendicitis?
WBC ^
US shows large appendix
CT
What do we NOT give an appendicitis patient?
Enemas or laxative! Worry about rupture!!
Appendectomy
How is is usually done?
Position of choice?
Careful with what?
Laparoscopic
HOB elevated, right side
NEVER put pressure on a suture line!!
Feeding tube w/ ensure q4: best position?
Check what when moving the patient all around?
Right side, HOB up
Helps stomach empty and not aspirate
Re-check the placement
TPN temperature
Stored?
Administration?
Keep refrigerated
Warm for admin: let it sit out
What is needed for TPN (Hyperalimentation) administration? Why?
Can we put other things in this line?
NCLEX ABOUT PROTEIN
Central line & a filter
This shit is packed with particles
NO!!!
Protein can’t leak through the glomerulus unless there is kidney damage!
How do we stop TPN?
What might happen when it’s stopped?
Need to do it gradually to avoid hypoglycemia: this shit is packed with sugar
They may need to start taking insulin
TPN how often to monitor blood sugar?
What else to monitor while on this?
Every 6 hours
Daily weight - may need to increase amount
What do we need to check the TPN patient’s urine for?
Glucose and ketones:
Ketones = fat break down!! Need more fat in the TPN!
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?
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!!
TPN needs to be delivered how?
On a pump
May have dark bag around it to prevent chemical breakdown
What do you need to emphasize at home?
Biggest frequent complication?
Hand-washing
Infection!
When assisting a physician for a central line, have what available?
When can you start fluids?
Flushes for each port
Until positive CXR placement
Position for central line insertion?
Trendelenburg and head turned away: want the veins to be distended
What position do you put the patient in if air gets in the line?
LEFT SIDE TRENDELENBURG
May have to go to cath lab if an air embolus is suspected in the heart
How can you avoid getting air in the central line?
Clamp it off
Valsalva: Take a deep breath and HUMMM to increase intrathoracic pressure
What does the CXR also check for?
Pneumo
What to tell the patient when you are removing the line
What position?
Lay flat and HUMMMM
Prevent air embolus and occlusive dressing
FOODS TO AVOID
Dumping syndrome
UC & Chrons
Ileostomy
Dumping syndrome: Foods high in carbs and electrolytes
UC & Chrons: Hot, cold, smoked
Ileostomy: Rough food, hard to digest
