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Chronic Rehab > GI Part 3 > Flashcards

GI Part 3 Flashcards

1
Q

antiulcer drugs

A 
Tranquilizers
Anticholinergics
Antacids
H2 blockers
Proton pump inhibitors
Pepsin inhibitors
Prostaglandin E1 analog
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2
Q

Action:
Reduce vagal stimulation, decrease anxiety
Side effects/adverse reactions:
Edema, ataxia, confusion, agranulocytosis

A

tranquilizers

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3
Q

Action:
Inhibit acetylcholine and block histamine and HCl
Delay gastric emptying
Side effects/adverse reactions:
Dry mouth, dizziness, drowsiness, blurred vision
Palpitations, urinary retention, constipation

A

anticholinergics

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4
Q

Neutralize HCl and reduce pepsin activity

A

antacids

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5
Q

may cause Hypernatremia, water retention, metabolic alkalosis, acid rebound

A

sodium bicarbonate

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6
Q

may cause Acid rebound, hypercalcemia

A

calcium carbonate

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7
Q

may cause diarrhea

A

Magnesium hydroxide

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8
Q

may cause constipation

A

Aluminum hydroxide

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9
Q

Action:
Block H2 receptors of parietal cells in stomach to reduce gastric acid secretion
Promote healing of ulcer by eliminating cause

A

histamine blockers

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10
Q

side effects of histamine 2 blockers

A

Headaches, dizziness, constipation

Impotence, decreased libido, gynecomastia

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11
Q

assessment of histamine 2 blockers

A

Determine the patient’s pain, including type, duration, severity, frequency, and location.
Assess fluid and electrolyte imbalances, including intake and output.

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12
Q

nursing diagnosis of histamine 2 blockers

A

Pain, acute related to excess gastric secretion

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13
Q

plan for histamine 2 blockers

A

The patient’s abdominal pain will decrease after 1 to 2 weeks of drug therapy.

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14
Q 
Action:
Reduce gastric acid by inhibiting hydrogen/potassium ATPase
Side effects:
Headache, dizziness, edema
Diarrhea, abdominal pain, constipation
A

proton pump inhibitor

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15
Q

Action:
Combines with protein to form thick paste covering ulcer protecting ulcer from acid and pepsin
Side effects:
Constipation

A

pepsin inhibitors

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16
Q

when are pepsin inhibitors given

A

Given 30 minutes before meals and bedtime

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17
Q

assessment of pepsin inhibitors

A

Evaluate patient’s pain including severity, type, duration, and frequency.
Determine patient’s renal function.
Assess for fluid and electrolyte imbalances.

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18
Q

nursing diagnosis of pepsin inhibitors

A

Pain, acute related to excess gastric secretion

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19
Q

plan for pepsin inhibitors

A

The patient will have relief of abdominal pain after 1 to 2 weeks of antiulcer therapy.

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20
Q

nursing interventions for pepsin inhibitors

A

Administer drug on an empty stomach.
Increase fluids, dietary bulk, and exercise to relieve constipation.
Monitor patient for severe constipation.
Emphasize cessation of smoking.
Teach patient to avoid liquids and foods that can cause gastric irritation.

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21
Q

drug therapy goals for ulcers

A

Goals: Provide pain relief, eradicate H. pylori, heal ulcerations, prevent recurrence

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22
Q

how do you eliminate H pylori

A 
triple treatment 
Bismuth product (pepto-bismol) or a proton pump inhibitor and two antibiotics (metronidazole (Flagyl) and tetracycline or amoxicillin)
May have to take medications 4 x’s/day for 14 days and often they don’t complete the series
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23
Q

Suppress gastric acid secretion
Cause moderate decrease in pepsin secretion
Protect mucosa

A

prostaglandin analog

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24
Q

side effects of prostaglandin analog

A

Diarrhea, abdominal pain
Chills, shivering
Hyperthermia

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25
Q

sucralfate (Carafate) supplies a protect coating by forming a complex with proteins, binds with bile acids and pepsin, should be given on an empty stomach and not within 1 hour of eating or taking antacids

A

Mucosal Barrier fortifiers

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26
Q

antacid nursing interventions

A

Avoid administering antacids with oral drugs because antacids can delay their absorption.
Monitor electrolytes, urinary pH, calcium and phosphate levels.
Encourage patient to drink 2 oz of water after taking an antacid to ensure drug reaches stomach.
Antacids can interact with other drugs- tetracycline, dilantin, also may have a high sodium content
Take 2 hours after meals to reduce the H+ion load

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27
Q

potential nursing diagnoses for ulcers

A 
Risk of anemia
Pain and heartburn
Increased risk for aspiration
Anxiety/fear related to disease prognosis
Knowledge deficit
Hypovolemia
Risk for shock
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28
Q

Hypovolemia Management

A

Monitor vital signs and I&O, assess for bleeding and vomiting, monitor CBC
Fluid and electrolyte replacement is necessary, usually NSS or LR, may give PRBC’s or FFP
Watch for signs of shock

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29
Q

bleeding reduction

A

Monitor labs, insert and NGT to decompress the stomach, give an H2 blocker, may need gastric lavage

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30
Q

what can EGD do

A

cautery on the bleeding sites
inject a sclerosing agent with diluted epipherine
Laser therapy
Clip the bleeding vessel

31
Q

may be used to suppress gastric acid secretion on parietal and chief cells, vasoconstricts the splanchnic arteries which reduce hemorrhage

A

Somastatin Analogue

32
Q

nursing diagnoses for GI bleeding

A

Somastatin Analogue,

33
Q

laparoscopic to remove chronic gastric ulcer or treat hemorrhage, make several small incisions, may partially remove the stomach and/or vagotomy to control acid secretion

A

MIG

34
Q

creates a passage between the body of the stomach and jejunum, reduces motor activity in the pyloroduodenal area, diverts acid, a vagotomy may be done with it to decrease secretion

A

Gastroenterostomy

35
Q

widens the exit of the pylorus and empties the stomach

A

pyloroplasty

36
Q

Surgical management of GI Bleeding

A

MIG, pyloroplasty, gastroenterostomy

37
Q

nursing considerations for GI after surgery

A

VS
S&S infection
Dumping syndrome
Hypoglycemia

38
Q

vasomotor symptoms, rapid emptying of gastric contents into the small intestine, shifts fluid into the gut and cause abdominal distention, 30 min after eating have vertigo, tachycardia, syncope, sweating, pallor, palpitations. 90 min later have excessive amount of insulin released, this dizziness, palpitations, diaphoresis and confusion

A

dumping syndrome

39
Q

what should a patient eat after GI surgery

A

Should eat smaller amounts, take less liquid with food, high protein and fat, low CHO diet, sandostatin may be given and pectin with food

40
Q

what causes early dumping syndrome

A

Is a result of rapid emptying of gastric contents into the small intestine, which shifts fluid into the gut, resulting in abdominal distention

41
Q

when does early dumping syndrome occur

A

occurs within 30 minutes of eating

42
Q

when does late dumping syndrome occur

A

occurs 90 minutes to 3 hours after eating

43
Q

what causes late dumping sydrome

A

Caused by a release of an excessive amount of insulin release

44
Q

how do you manage dumping syndrome

A

Decrease the amount of food taken at one time
Eliminate liquids ingested with meals
Consume high protein, high fat, low carbohydrate diet
Pectin may help reduce severity of s/s(purified carbohydrate obtained from peel of citrus fruits or from apple pulp)
Somatostatin may be used in severe cases (inhibits the secretion of insulin and gastrin)

45
Q

bile reflux, when pylorus is bypassed, bile in stomach and have abdominal discomfort and vomiting

A

Reflux gastropathy

46
Q

usually resolves in 1 week, edema at the anastomosis or adhesions may occur, hypokalemia, hypoproteinemia and hyponatremia may also cause

A

Delayed gastric emptying

47
Q

duodenal loop is partially obstructed, pancreatic and biliary secretions fill the intestinal loop, it becomes distended painful contractions, bloating and pain 20-60 min after eating

A

afferent loop syndrome

48
Q

occurs in 5% of patients, may have ulcers at the anastomosis

A

recurrent ulceration

49
Q

symptoms of pernicious anemia

A

weak, anemic, atrophic glossitis- beefy shiny tongue

50
Q

nutritional management after GI surgery

A

Deficiencies of B12, folic acid and iron

51
Q

Failure of gastric parietal cells to produce Intrinsic factors
Beefy Red Tongue

A

pernicious anemia

52
Q

Most common digestive disorder

Chronic GI disorder, with chronic or recurrent diarrhea, constipation, abdominal pain and bloating

A

IBS

53
Q

symptoms of IBS

A

Spastic colon, impairment of the motor/sensory function

diarrhea alternating with constipation

54
Q

abdominal pain relieved by defection, abdominal distention, sensation of incomplete evacuation of stool, presence of mucus with the stool

A

manning criteria

55
Q

potential causes of IBS

A 
abnormal contraction of intestinal walls
GI infection
stress/anxiety/depression
peristalsis is irregular
overeating 
too much fat in diet
smoking
56
Q

diet therapy of IBS

A

limit caffeine, alcohol, beverages with sorbitol or fructose, take in fiber and bulk, 30-40 gm/day

57
Q

drug therapy for IBS

A 
Bulk forming laxatives (Metamucil) 
antidiarrheals (loperamide) 
anticholinergics (bentyl)
antidepressants (elavil) 
5-HT4 agonists(Zelnorm) for prokinetic activity, imitates serotonin to stimulate peristalsis
58
Q

nursing diagnoses for IBS

A

Constipation r/t low residue diet and stress

Diarrhea r/t increased motility of intestines

59
Q

Familial
95% are adenocarcinomas, most come from adenomatous polyps
2/3 occur in rectosigmoid region

A

colorectal cancer

60
Q

Can metastasize through blood and lymph, liver most common site with 15-30% spread there, can also go to the lungs, brain, bones and adrenals
May form fistulas into bladder and vagina

A

colorectal cancer

61
Q

what is a risk factor of colorectal cancer

A

age

62
Q

how do you stage colon cancer

A

American Joint Committee on Cancer

1-4

63
Q

manifestations of colorectal cancer

A

Rectal bleeding, anemia and change in stool
Gas pains, cramping or incomplete evacuation
Hematochezia- bright red blood when in rectum
Tumors can grow large when in upper abdomen, mostly liquid stool, more pain when in lower

64
Q

tests for colorectal cancer

A

stool for occult blood, CEA, barium enema, CT of abdomen

Colonoscopy or sigmoidoscopy

65
Q

lab assessment for colorectal cancer

A

CBC, elevated liver enzymes, +fecal occult blood test (Ensure that the patient is not on NSAIDS). Two separate stool samples should be tested on 3 consecutive days

66
Q

what may be elevated in people with colorectal cancer

A

CEA (carcinoembryonic antigen)

67
Q

Duke’s staging classification of colorectal cancer

A

A- tumor has penetrated into, but not through the bowel wall
B- tumor has penetrated through the bowel wall
C-tumor has penetrated through the bowel wall and there is lymph node involvement
D- tumor has metastasized to distant sites

68
Q

has not improved outcomes of colorectal cancer except in regional disease affecting the rectum

A

radiation therapy

69
Q

chemotherapy of colorectal therapy

A

Eloxatin, Camptosar, Avastin are also being used, along with monoclonal antibodies- cetuximab

70
Q

removal of tumor and lymph nodes

A

colon resection

71
Q

excision of the involved area of the colon with reanastomosis

A

Hemicolectomy

72
Q

removes sigmoid colon, rectum and anus, colostomy is performed

A

Abdominal perineal resection-

73
Q

colon removal

A

colectomy

74
Q

may be ascending, descending, sigmoid, transverse or double barreled

A

colostomies

Chronic Rehab (18 decks)

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