GI Part 3 Flashcards by Christina Stafstrom

antiulcer drugs

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

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

tranquilizers

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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

anticholinergics

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Neutralize HCl and reduce pepsin activity

antacids

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

sodium bicarbonate

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may cause Acid rebound, hypercalcemia

calcium carbonate

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may cause diarrhea

Magnesium hydroxide

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may cause constipation

Aluminum hydroxide

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

histamine blockers

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side effects of histamine 2 blockers

Headaches, dizziness, constipation

Impotence, decreased libido, gynecomastia

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assessment of histamine 2 blockers

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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nursing diagnosis of histamine 2 blockers

Pain, acute related to excess gastric secretion

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plan for histamine 2 blockers

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

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

proton pump inhibitor

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

pepsin inhibitors

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when are pepsin inhibitors given

Given 30 minutes before meals and bedtime

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assessment of pepsin inhibitors

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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nursing diagnosis of pepsin inhibitors

Pain, acute related to excess gastric secretion

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plan for pepsin inhibitors

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

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nursing interventions for pepsin inhibitors

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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drug therapy goals for ulcers

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

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how do you eliminate H pylori

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

prostaglandin analog

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side effects of prostaglandin analog

Diarrhea, abdominal pain
Chills, shivering
Hyperthermia

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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

Mucosal Barrier fortifiers

antacid nursing interventions

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

potential nursing diagnoses for ulcers

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

Hypovolemia Management

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

bleeding reduction

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

what can EGD do

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

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

Somastatin Analogue

nursing diagnoses for GI bleeding

Somastatin Analogue,

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

MIG

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

Gastroenterostomy

widens the exit of the pylorus and empties the stomach

pyloroplasty

Surgical management of GI Bleeding

MIG, pyloroplasty, gastroenterostomy

nursing considerations for GI after surgery

VS S&S infection Dumping syndrome Hypoglycemia

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

dumping syndrome

what should a patient eat after GI surgery

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

what causes early dumping syndrome

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

when does early dumping syndrome occur

occurs within 30 minutes of eating

when does late dumping syndrome occur

occurs 90 minutes to 3 hours after eating

what causes late dumping sydrome

Caused by a release of an excessive amount of insulin release

how do you manage dumping syndrome

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)

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

Reflux gastropathy

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

Delayed gastric emptying

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

afferent loop syndrome

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

recurrent ulceration

symptoms of pernicious anemia

weak, anemic, atrophic glossitis- beefy shiny tongue

nutritional management after GI surgery

Deficiencies of B12, folic acid and iron

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

pernicious anemia

Most common digestive disorder | Chronic GI disorder, with chronic or recurrent diarrhea, constipation, abdominal pain and bloating

IBS

symptoms of IBS

Spastic colon, impairment of the motor/sensory function | diarrhea alternating with constipation

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

manning criteria

potential causes of IBS

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

diet therapy of IBS

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

drug therapy for IBS

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

nursing diagnoses for IBS

Constipation r/t low residue diet and stress | Diarrhea r/t increased motility of intestines

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

colorectal cancer

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

colorectal cancer

what is a risk factor of colorectal cancer

age

how do you stage colon cancer

American Joint Committee on Cancer | 1-4

manifestations of colorectal cancer

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

tests for colorectal cancer

stool for occult blood, CEA, barium enema, CT of abdomen | Colonoscopy or sigmoidoscopy

lab assessment for colorectal cancer

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

what may be elevated in people with colorectal cancer

CEA (carcinoembryonic antigen)

Duke’s staging classification of colorectal cancer

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

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

radiation therapy

chemotherapy of colorectal therapy

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

removal of tumor and lymph nodes

colon resection

excision of the involved area of the colon with reanastomosis

Hemicolectomy

removes sigmoid colon, rectum and anus, colostomy is performed

Abdominal perineal resection-

colon removal

colectomy

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

colostomies