GI test Flashcards
Major Functions of the GI Tract
-Breakdown of food particles into molecular form for digestion.
-Absorption into bloodstream of small nutrient molecules produced by digestion.
-Elimination of undigested unabsorbed food stuffs and other waste products.
Enzymes that digest Carbohydrates
Amylase
Ptyalin, Maltase, Sucrase, and Lactase
Enzymes/Secretion that digest Proteins
Trypsin
Pepsin, Aminopeptidase, Dipeptidase, and Hydrochloric acid
Enzymes/Secretions that digest Fats
Pharyngeal lipase
Steapsin, Pancreatic Lipase, and bile
What could a removed or partially removed stomach lead to
no stomach no B12 absorbed. B12 leads to paraniscious (sp) anemia. Look at hg/hct
intrinsic factor does what
promotes B12 absorption
small intestine function
Secretion of mucous
Absorption of nutrients
Movement of nutrients into the bloodstream
barium swallow teaching
teach the patient after the barium swallow to increase fluids to facilitate evacuation of stool and barium (check for fluid restrictions first)
CEA and CA 19-9 test looks for
cancer markers
Xerostomia
dry mouth
signs of aging on GI system
Xerostomia – dry mouth
* Decreased appetite
* Decreased ability to taste
* Delayed emptying of the esophagus
* Decreased HCl acid secretion
Constipation
* Liver size decreased
* Gallbladder disease
* Risk for decreased food intake
Gastrointestinal Intubation Reasons
Decompress the stomach
Lavage the stomach
Diagnose GI disorders
Administer medications and feeding
To compress a bleeding site
To aspirate gastric contents for analysis
To remove gas and toxins from the stomach, to diagnose GI motility disorders
what to do with a moist PEG tube
If pt has a Peg tube and its all moist around the area be sure to call the doc and get an order for antifungal medication
Signs of aspiration
Increased respiration, decreased pulse ox, crackles in lungs. STOP tube feeding and call doc
Indication for PN
malabsorption. 7 days unable to eat
Assess for hypoglycemia
why to not slow PN rates
rebound hypoglycemia
Parotitis
inflammation of parotid gland
Sialadenitis
inflammation of the salivary glands
Sialolithiasis
inflammation of the salivary stones
Oral and Laryngeal Cancers risk factors
Tobacco
Alcohol
HPV
History of head and neck cancer
Being a man
May occur in any area, but lips, lateral tongue, and floor of the mouth are most frequently affected
Over age of 60
Radical Neck Dissection Surgery nursing shit
ABCs > bleeding > patient’s ability to communicate
Preform Allen Test (test ulnar artery to ensure the radial artery will be sufficient)
Normal output is 80-100 mL output- watch for large clots, milky white fluid (infection/Chyle fistula) and excessive bleeding
Chyle fistula
can lead to dehydration, third spacing, poor wound healing. Call doc
Nursing Care of the Patient With a Radical Neck Dissection
Assess vitals every 1-2 hours, unless critical then it becomes every 15
Bed of head at 30 degrees, avoid Vlasova maneuver
May need suction, do not suction near suture line.
If they get a muscle removed assess grip and blood flow (pale, dusky, cool)
GERD meal recommendation
small and frequent
Esophageal Varices
true medical emergency
Risk factors – alcoholism, fatty liver, cirrhosis
Signs & Symptoms – vomiting blood, black and tarry stools
Bilirubin
product of red blood cell breakdown
liver function tests
AST, ALT, GGT, GGTP, LDH
Alanine aminotransferase (ALT)
levels increase primarily in liver disorders; used to monitor the course of hepatitis, cirrhosis, the effects of treatments that may be toxic to the liver
Aspartate aminotransferase (AST)
not specific to liver diseases however levels of AST may be increased in cirrhosis, hepatitis, and liver cancer
Gamma-glutamyl transferase (GGT)
levels are associated with cholestasis; alcoholic liver disease
Fatty liver disease
Nonalcoholic fatty liver disease (NAFLD)
Nonalcoholic steatohepatitis (NASH)
Manifestations of Liver Disease
Jaundice
Portal hypertension
Ascites and varices
Hepatic encephalopathy or coma
Nutritional deficiencies
Pruritus
very itchy skin
s/s Hepatocellular jaundice
Mild or severely ill
Lack of appetite, nausea or vomiting, weight loss
Malaise, fatigue, weakness
Headache, chills, fever, infection
s/s Obstructive jaundice
Dark orange-brown urine, clay-colored stools
Dyspepsia and intolerance of fats, impaired digestion
Pruritus – very itchy
Portal Hypertension
Obstructed blood flow through the liver results in increased pressure throughout the portal venous system
Results in
Ascites and Esophageal varices
Treatment of Ascites
Low-sodium diet
Diuretics
Bed rest
Paracentesis
Administration of salt-poor albumin
Transjugular intrahepatic portosystemic shunt (TIPS)
Other methods: peritoneovenous shunt
goal with lactulose
3 soft bowel movements a day (actually super bad diarrhea)
Medical Management of Hepatic Encephalopathy
Discontinue sedatives, analgesics, and tranquilizers. HIGH RISK for safety issues
Eliminate precipitating cause
Lactulose to reduce serum ammonia levels
IV glucose to minimize protein catabolism
Protein restriction
Reduction of ammonia from GI tract by gastric suction, enemas, oral antibiotics
Nursing Management of Esophageal Varices
Maintain safe environment; prevent injury, bleeding and infection
Hepatitis A and E route s
oral fecal
Hepatitis B and C routes
blood
Hepatitis D risk factors
only people with B are in danger
Nonviral Hepatitis
drug induced
Manifestations Hep A
mild flu-like symptoms, low-grade fever, anorexia, later jaundice and dark urine, indigestion and epigastric distress, enlargement of liver and spleen
Hepatitis A prevention
Good handwashing, safe water, and proper sewage disposal
Vaccine
Immunoglobulin for contacts to provide passive immunity
Management of Hepatitis B
Vaccine: for persons at high risk, routine vaccination of infants
Passive immunization for those exposed
Standard precautions and infection control measures
Screening of blood and blood products
Cholelithiasis
gallstones
Medical Management of Cholelithiasis
ERCP - remove or break up
Dietary management
Medications: ursodeoxycholic acid and chenodeoxycholic acid
Laparoscopic cholecystectomy
Nonsurgical removal - Intracorporeal or extracorporeal lithotripsy
Acute Pancreatitis can lead to
Autodigestion from premature activation of enzymes
Primary factors:
Biliary tract disease EtOH
s/s pancreatitis
Sharp mid to LUQ pain, N/V, hypotension, tachycardia, jaundice, absent bowel sounds, low grade fever, tetany
Turner’s and Cullen’s Sign
Pancreatoduodenectomy (Whipple Procedure)
Removes gall bladder, part of stomach and part of common bile duct and duodenum
Erosive Gastritis
Mucosa isn’t just damaged, it is going almost down to the sub mucosa
Radiation therapy, meds, alcohol could be the cause
Manifestations of acute Gastritis
epigastric pain, dyspepsia, anorexia, hiccups, nausea, vomiting. Erosive gastritis can lead to melena, hematemesis, or hematochezia
Manifestations of chronic Gastritis
fatigue, pyrosis, belching, sour taste in the mouth, halitosis, early satiety, anorexia, nausea, and vomiting. May have pernicious anemia due to malabsorption of B12. Some are asymptomatic
Medical Management of Gastritis
Acute
Refrain from alcohol and food until symptoms subside
Supportive therapy: IV fluids, nasogastric intubation, antacids, histamine-2 receptor antagonists, proton pump inhibitors
Chronic
Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs
Pharmacologic therapy
Peptic Ulcer Disease is associated with what infection?
H. Pylori
risk factors for peptic ulcer disease
Risk factors include excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, stress, smoking, and familial tendency
rates of duodenal ulcers
Duodenal ulcers account for about 80% of all peptic ulcers. H. Pylori found in 90-95% of duodenal ulcers.
what to monitor for with peptic ulcer disease
Hemorrhage – look for vs changes
Perforation and penetration – sudden very hard and rigid abdomen (surgical emergency) s/s shock
Gastric outlet obstruction
perforation and penetration s/s
sudden hard and rigid abdomen
dumping syndrome
malabsorption of vitamins and minerals, might need supplemental vit b12
for dumping syndrome avoid fluid with meals, avoid high carb high sugar diets
can cause hyper then sudden hypoglycemia
what can perforation lead to
peritonitis (inflammation of abdominal lining)
dumping syndrome management
To delay stomach emptying and dumping syndrome, assume low Fowler position after meals; lie down for 20 to 30 minutes
Take antispasmodics as prescribed
Avoid fluid with meals
Gastroparesis causes
Problems with vagus nerve (cranial nerve X)
Nerve damage secondary to diabetes
Drugs that decrease gastric motility
constipation causes
medications, chronic laxative use, weakness, immobility, fatigue, inability to increase intra-abdominal pressure, diet, ignoring urge to defecate, and lack of regular exercise
complications of constipation
Decreased cardiac output – straining increases interthorasic pressure
Fecal impaction
Hemorrhoids
Fissures
Rectal prolapse
Megacolon
diarrhea causes
infections, medications, tube feeding formulas, malabsorption, metabolic and endocrine disorders, and various disease processes
diarrhea complications
Fluid and electrolyte imbalances
Dehydration
Cardiac dysrhythmias
Chronic diarrhea can result in skin care issues related to irritant dermatitis
c-diff
Patients receiving clindamycin, ampicillin, amoxacillin, cephalosporins are susceptable.
**Clostridium Difficile – can be transmitted nosocomially (highly contagious) – private room
Contact Precautions
Metronidazole (Flagyl), Vancomycin (PO)
Handwashing
Fecal Transplant – ew
Clinical Manifestations of Malabsorption
Hallmark finding is diarrhea or frequent, loose, bulky, foul-smelling stools, high-fat content and often grayish
Symptoms similar to irritable bowel syndrome
Manifested by weight loss and vitamin and mineral deficiency
Diverticular Disease
Diverticular disease increases with age and is associated with a low-fiber diet
Diverticulum: sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer
May occur anywhere in the intestine but most common in the sigmoid colon
Diverticulosis: multiple diverticula without inflammation
Diverticulitis: infection and inflammation of diverticula
Crohn’s disease
subacute chronic inflammation of the GI tract. Can have remission and exacerbation. Can have bits inflamed, cobblestone pattern. Very rarely have bloody stools
Ulcerative colitis
can have exacerbation and remission. Have abd cramps, bloody diarrhea, starts in the rectum and spreads up the colon.
Ulcerative colitis location
begins in rectum and spreads toward the cecum
crohn’s disease location
most often in the terminal ilium with patchy involvement through all layers of the bowel
ulcerative colitis peak incidence at age
15-25 yr and 55-65 yr
crohn’s disease peak incidence at age
15-40
ulcerative colitis number of stools
10-20 liquid bloody stools per day
crohn’s disease number of stools
5-6 soft, loose stools per day, non-bloody
complications of ulcerative colitis
hemorrhage, nutritional deficiencies
crohn’s disease complications
fistulas (common), nutritional deficiencies
ulcerative colitis need for surgery?
infrequent
crohn’s disease need for surgery?
frequent
