GI System Med Surg Flashcards
1
Q
What is a Proctosigmoidoscopy?
A
An Exam of the distal, sigmoid colon, rectum, and canal using a flexible type of endoscope (sigmoidoscope).
2
Q
What does a sigmoidoscopy Detect?
A
P-Puncture M-early stage Malignancies
L-Lacerations
A-abscess
T-Tumors
P-Polyps H-Hemorrhoids U-Ulcerations F-Fissures F-Fistulas
3
Q
Nursing Process Proctosigmoidoscopy? Pre-opt
A
Clean out Bowel
- NPO stat 8 hr before test
- Low residue diet 3 days before
- Clear liquids
- Laxative or Enema right before
- Possible Enema morning before
- WARNING bowel prep not given to PT’s with bleeding, or sever diarrhea
4
Q
Nursing Process Proctosigmoidoscopy? During Procedure
A
- Place PT in left lateral knee-chest position, to straighten colon.
- PT may feel pressure indicating a BM
- 1-2 pieces of intestinal tissue may be removed (biopsy).
- Rectal or sigmoid polyps removed with a snare.
- Electrocoagulating current is used to prevent/stop bleeding.
- Specimens labeled and sent to lab for immediate exam.
5
Q
Nursing Process Practosigmoidoscopy? Post-Opt
A
- PT rests in the supine position to prevent orthostatic hypotension.
- Assess for signs of heavy bleeding, perforation, pain, and fever.
6
Q
Liver Biopsy
A
Test used after less invasive test fail
Detects: Cancer, Cirrhosis, and Hepatitis
7
Q
Liver Biopsy Pre-opt
A
Give local Anesthetic, Ultrasound may be ordered to guide the needle as it makes the incision.
8
Q
Liver Biopsy During Procedure
A
Warning Procedure extremely vascular! Placing PT at risk for bleeding especially because liver disease hinders its ability to produce clotting factors.
- Nurse assists PT to their back or left side, they must hold very still.
- Patient should exhale and hold deep breath as needle is inserted
- After needle is removed (hold pressure on site for 5 minutes!!!)
- Then apply pressure dressing.
- PT lies on (right) side for 2 hrs to prevent bleeding
- Monitor vitals for signs of bleeding
- Avoid coughing, straining, excersise, or heavy lifting
- Analgesics offered for comfort as ordered
9
Q
Critical Thinking What labs related to Jaundice would be elevated? What other lab may be important after liver biopsy?
A
- Serum Bilirubin maybe elevated
2. Check coagulation studies and prothrombin levels for lack of clotting ability
10
Q
Define Appendicitis
A
Inflammation of the Appendix, which is a finger-like extension of the cecum.
11
Q
Signs & Symptoms of Appendicitis
A
Most Important! Fever, RLQ rebound tenderness, and Classic Symptom!!!! Pain between the umbilicus and iliac crest McBurney’s Point.
Also, look for! (Rovsings sign) pain in RLQ, when LLQ palpated. Abdominal muscular rigidity (gaurding)
Anorexia, Nausea, and Vommiting
Increased WBC’s
PT may keep right leg flexed for comfort, PT my experience extreme pain when leg straightened.
12
Q
Appendicitis Diagnostic Tests
A
CBC to reveal elevated leukocytes and neutrophils
CT and MRI to reveal enlarged in cecum area
13
Q
Appendicitis Therapeutic Measures
A
- PT NPO stat
- Apply Ice to pain site, WARNING (Never, Heat!!!!!) may rupture appendix. WARNING Avoid Laxatives & Enemas may cause or complicate a rupture
- Surgery is usually performed immediately unless perforation or peritonitis is suspected.
14
Q
Appendicitis RUPTURE!!!!!
A
- Start IV fluids/antibiotics to treat infection or peritonitis
- Surgery may or may not be done right away due to infection
- Orogastric or NG tube may be used for decompressing the stomach
- If infection presents radiologist may insert drain in the abdomen.
- Surgery may be postponed several weeks until the infection resolves
15
Q
Further Complications of Appendicitis
A
- Peritonitis
- Appendix Abscess, collection of puss separated by small bowel, peritoneal cavity, or omentum.
Treatments IV antibiotics and surgical drainage. Surgery can be done 6 weeks after abscess discovery.
16
Q
Crohns Disease VS Ulcerative Colitis
A
- Their both a form of IBD
- They are Both Autoimmune disorders (Where the body attacks itself)
- Both come with Exaberation of Symptoms followed by Remission of a period of no symptoms
17
Q
Crohns Disease, and Ulcerative Colitis Causes (Etiology)
A
S-Smoking F-Family occurrence S-Sepsis of infection E-Enviromental Agents S-Stress
Often diagnosed between ages 15-30
18
Q
Ulcerative Colitis Define?
A
Open sores only in (Large intestine & rectum)
19
Q
Ulcerative Colitis Signs & Symptoms
A
- Warning! Bleeding in inflamed colon, affecting superficial outer layer of GI tract.
- 5-10 bloody stools per day
- Decreased Hgb and Hct
- Rebound Tenderness
- Abdominal and rectal pain
- Rectal bleeding
- Fecal Urgency*
- Straining*
- Anorexia due to weight loss*
- Cramping, fatigue, fever, dehydration, vomiting
- Fluid/Electrolyte imbalance due to bloody diarrhea!!!!*
- Anemia, due to rectal bleeding!!!!*
- Inflammatory eye/liver disorder!!!!*
- Fissures, Fistulas, Abscesss (remember!!!!!!!!)
20
Q
Etiology or Causes Ulcerative Coloitis
A
- Infection or allergies
- Autoimmune response
- Pesticides, tobacco, food additives may exasperate symptoms.
- Heredity
21
Q
Complications caused by Ulcerative Colitis
A
- other inflammatory disorders
- Hemmorphage
- Toxic mega-colon
- Perforation, or Peritonitis
- Osteoporosis
- Increased risk of colorectal cancer
22
Q
Ulcerative Colitis Diagnostic tests
A
- History
- Physical exam, Labs!
- Stool exam to rule out bacteria or omeaba!!!!!!####
- Stool positive for blood
- Electrolyte depletion!!!!!*
- Loss of protons due to liver dysfunction, and malabsorption
- Colonoscopy full colon##!!!! (endoscopy)
- Sigmoidoscopy lower colon!!!!### (endoscopy)
- Biopsy (inflamed cells)!!!!!!###
- Barium enema, CT, MRI, Ultrasound!!!!!!!!!!!!!!###
- Luekocytescintigraphy noninvasive WBC’s tagged with radioactive material to detect inflammation and infection in the colon!!!!!!!!####
23
Q
Ulcerative Colitis Therapeutic Measures
A
- Educate PT to avoid food that exaberate or cause diarrhea or bloody diarrhea.
- Try foods in small amounts and eliminate offending foods
- Foods to avoid (avoid high fiber), spicy foods, coffee, and milk products.
- Fluids due to diarrhea to prevent dehydration
- Surgery considered for excessive bleeding, perforation, or toxic mega-colon
- Proctocolectomy with ileostomy is (curative)#
- Ileoanal pouch not curative (may cause pouchitis treated with antibiotics)
24
Q
Crohn’s disease and Ulcerative Colitis Nursing Interventions
A
- Pain scale 0-10
- Pain character (dull, cramping, burning)
- Give analgesics and others meds to relieve cramping
- Stool character, color, consistency, amount, frequency, and odor.
- Ensure quick safe bathroom access or commode
- control diarrhea and comfort
- Encourage bed rest
- keep the environment clean/odor free
- Teach PT to avoid dairy products
- Administer antidiareal meds
- encourage bedrest and to control peristalsis
- Teach Pt to avoid high fiber dairy product spicy food, and limit fresh fruit/veg, caffeine, alcohol, and nicotine which increase intestinal motility
- weight pt daily to determine fluid loss
- record I&O for fluid balance determination
- Give oral and IV fluids to maintain fluid balance
- Teach PT signs and symptoms of Dehydration
- Talk in calm confident manner listen to PT to relieve anxiety
- Keep perry area clean, dry, and use barrier cream
- Provide sitz bath to prevent excoriation, keep skin clean, promote comfort
- weigh weekly to detect wieght loss
- Give full liquid formula as ordered not the water down kind to prevent contamination.
- Maintain PN nutrition if pt cannot tolerate oral intake.
25
Critical Thinking Crohn Disease
What to ask PT?
1. Pain character
2. Bowel character
3. Nutrition stat
4. Nutrition stat
5. Anxiety
Nursing Dx
1. Acute pain due to peristalsis or abdominal cramping
2. Diarrhea related to the inflammatory process
3. Risk for deficient fluid volume related to diarrhea and insufficient fluid volume
4. Anxiety related to stool frequency, and treatment
5. Impaired stem integrity due to frequent stool loss
6. Less than body requirements related to malabsorption
7. Ineffective coping related to stool frequency
Communication
1. Hcp
2. Dietitian
3. Psychologist
4. RN
26
Crohns Disease Signs & Symptoms
Important Skip Lesions, no as much or no blood in stool, Deep inflamed tissue where skip lesions are including fissure, fistulas, and abscess. Classic sign Granulomas (bumps & lumps)
Malabsorption of nutrients
Most Common! crampy abdominal pain unrelieved by defecation, diarrhea possible to no blood, weight loss, fatigue. fatigue, fever, mouth sores. mild-severe
More Lack of eating, poor nutrient absorption resulting in weight loss or malnutrition, chronic diarrhea contributing to fluid deficit and electrolyte imbalance, Inflammatory symptoms outside GI in eyes, liver, bile ducts, skin, and joints
Physical or Psychological stress may = Exaberations
27
Crohns Disease Diagnostic tests
Anemia, infection, liver function test, low albumin, poor absorption of protein, stool infection, occult blood. Endoscopy (colonoscopy, sigmoidoscopy) with multiple biopsies of terminal ileum used diagnose Crohns disease.
capsule endoscopy
ultrasound to identify fistulas, areas of bleeding, double-balloon enteroscopy,
Crohns disease by granulomas in biopsy specimen
Imaging tests include CT, and MRE
28
Therapeutic Measures Crohns disease
No cure
try to maintain remission stage
1. treatment is individualized
2. Symptoms controlled by reducing intestinal inflammation
3. The Meds corticosteroids. Aminosalicylates-5, immunodialators, antibiotics, biological response modifiers
4. Surgery will not work due to reoccurrence in anywhere in GI
5. Surgery procedures include strictureplasty to widen areas of stricture, resection of an affected area with anastomies, colectomy with eleorectal anastomies, or proctolectomy with rectum, and colon ileostomy.
6. Healthy diet
7. Adequate fluid intake
8. Multivitamin anf mineral supplements
9. Foods to avoid spicy, fatty, dairy products, and limit fresh fruit and veggies.
29
Etiology or Causes Crohns Disease
```
Tends to occur in families
infection or environmental agents can trigger immune responce
Most often diagnosed between ages 15-30
occurs more often in women
Smoking increases risk
```
30
Liver Transplant Define
A liver replacement for patients with end-stage cirrhosis, hepatitis, biliary disease, metabolic disorders, or hepatic vein obstruction.
31
Post-opt Liver Transplant
After PT is placed on drugs to suppress immune responses and tissue rejection nurse should observe for
1. Pulse greater than 100 BP per min
2. Temp above 101 F (38) C
3. Right Upper Quadrant Pain
4. Increased Jaundice
5. Decreased bile from T-tube, or change in bile color
32
Labs to watch after Liver Transplant
Increased ALT & AST, Serum bilirubin, ALP, and PT
33
Liver Tranplant extras
Symptoms of acute tissue rejection occur between 4th and 10th post-opt days
PT who receives an organ transplant needs extended medical follow up
(Teach PT to report to HCP if infection, bleeding, or Right Upper Quadrant Pain occurs.)!
34
Zantac
Is an Antisecretory Agent or (H2) -Receptor Antagonist, its generic name is (ranitidine). It can be given in a single bedtime dose or 2 times daily once in the morning the other at night.
35
Omeprazole
Is a Proton Pump Inhibitor that can be used in combination with 2 antibiotics against H. Pylori infection.
36
GI Bleed Define
The most common cause of blood loss in the stomach, or intestines
