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GI WKS Flashcards

1
Q

Which gastrointestinal changes occur in older adults? (Select all that apply.)
A. Increased hydrochloric acid secretion
B. Decreased absorption of iron and vitamin B12
C. Decreased peristalsis may cause constipation
D.Increased cholesterol synthesis
E. Decreased lipase with decreased fat absorption and digestion
F. Decreased liver enzyme activity depresses drug metabolism

A

Answer: B, C, E, F
Rationale: liver cells sclerosis so will be decreased in fat absorption
As age things get worse
Decreased hydrochloric acid secretion and cholesterol synthesis (cells sclerose in liver)
More constipation and more prone incontinence
Higher risk for sterrhoea - fatty stools
Much higher risk for toxicity - liver and GI - and decreased functioning in kidneys (filter less)

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2
Q

Atrophy of Gastric Mucosa
Decrease in hydrochloric acid levels
Decrease in the number and size of hepatic cells and increase in fibrous tissue
Distension and dilation of pancreatic ducts
Calcification of pancreatic vessels and a decrease in lipase production
Peristalsis decreases and intestinal nerve impulses dulled
Decreased sensation to defecate can result in postponement of bowel movements

A

GI changes with aging

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3
Q

Decreased absorption of iron and vitamin B12
Proliferation/more of bacteria
Atrophic gastritis occurs as a consequence of bacterial overgrowth

A

Decrease in hydrochloric acid levels

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4
Q

Leads to decreased protein synthesis and changes in liver enzymes
Depresses drug metabolism - increased risk toxicity

A

Decrease in the number and size of hepatic cells and increase in fibrous tissue

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5
Q

Decreased lipase level results in decreased fat absorption and digestion
Excess fat in the feces (steatorrhea)occurs because of decreased fat digestion

A

Calcification of pancreatic vessels and a decrease in lipase production

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6
Q

Leads to constipation and impaction and incontinence

A

Decreased sensation to defecate can result in postponement of bowel movements

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7
Q

Encourage bland foods high in vitamins and iron - risk for irrational; risk for malnutrition with decreased absorption
Assess for epigastric pain to detect gastritis
Assess for adverse effects of medications, specifically drug toxicity; adjust doses
Encourage small, frequent meals
Assess for diarrhea and dehydration
Encourage a high-fiber diet and 1500 mL of fluid intake daily - facilitate peristalisis
Encourage as much activity as tolerated

A

GI changes with aging interventions

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8
Q

Helps prevent steatorrhea

A

Encourage small, frequent meals

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9
Q

These interventions increase the sensation of needing to defecate

A

Encourage as much activity as tolerated

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10
Q

Visual exam/scope of the esophagus, stomach, duodenum with use of fiberoptic scope
Visual scope of esophagus, gastric, duodenum

A

What type of exam is the EGD and what does it evaluate? - EGD

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11
Q

NPO for 6-8 hours and avoid anticoagulants, aspirin, platelet meds, NSAIDS several days before procedure - not want to give anything that increases bleeding
NPO, hold anticoags, ibuprofen, aspirin, NSAIDS

A

Preparation for the procedure: - EGD

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12
Q

conscious/Moderate sedation – not completely under but sedation under enough where amnesia and pain medication where deep sleep but breathing on own
Numb throat
sedation/anesthesia
numb throat

A

What is done to minimize discomfort during the procedure? - EGD

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13
Q

Keep patient NPO until gag reflex returns
monitor for bleeding;
Hbg and Hct;
frequent VS (BP down; HR up);
Gag reflex before eating or drinking
Check airway

A

Post procedure care: - EGD

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14
Q

Priority care includes preventing aspiration and assess for any bleeding or pain that could indicate perforation
Priority for care is to monitor for complications: aspiration, bleeding, ABCs
Can have perforation so watch for signs of this

A

What is the priorities for post procedure? - EGD

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15
Q

Someone to drive them home

A

If discharged the same day, what precaution should be taken? - EGD

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16
Q

The nurse is caring for a patient scheduled for a colonoscopy in three days after discharge. What does the nurse teach the patient about preparations for this diagnostic test? (Select all that apply.)
A. “Take only clear liquids the day before the procedure.”
B. “You may drink red, orange, or purple beverages the day before the test.”
C. “Avoid aspirin, anticoagulants, or antiplatelet medications for several days before the procedure.”
D. “You will have watery diarrhea shortly after taking the medication prescribed for cleansing the bowel.”
E. “You will have an IV placed to receive medication to help you relax during the procedure.”

A

Answer: A, C, D, E
Clear liquids - easier bowel prep
Red, orange, purple - dye bowel to think something going on
You will have watery diarrhea shortly after taking the medication prescribed for cleansing the bowel - goal and want to completely clean them out
IV placed - conscious/full sedation

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17
Q

What is the goal of the bowel preparation?

A

Clear liquid BM, so able to visualize colon

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18
Q

Bleeding; Perforation (concerned about infection - peritonitis [rigid boardlike abdomen] and infection/sepsis quickly); AB - considered since under anesthesia so take VS

A

What should the nurse monitor for post procedure?

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19
Q

Endoscopic exam of the entire large intestine
Baseline test should be done at age 50 and every 10 years if norm
Preparation:
Procedure: Moderate sedation and procedure lasts 30-60 minutes
Post procedure:

A

Colonoscopy

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20
Q

Can be used to visually diagnose, biopsy and treat

A

Endoscopic exam of the entire large intestine - Colonoscopy

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21
Q

Clear liquids the day before
NPO 4-6 hours prior
Avoid aspirin, anticoagulants, and antiplatelet drugs for several days before
Adequate bowel cleansing is essential
Follow provider orders for oral and rectal preparation; Patient should be passing clear liquid prior to procedure

A

Preparation: - Colonoscopy

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22
Q

Observe for signs of perforation (severe pain) and hemorrhage
Feelings of fullness and cramping are expected - air gets into bowel
Fluids are permitted after the patient passes flatus to indicate that peristalsis has returned

A

Post procedure: - Colonoscopy

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23
Q

Visual and radiographic exam of the liver, gallbladder, bile ducts, and pancreas - back and look in all areas
Use radiopaque dye
Used to diagnose obstruction as well as treat obstructions
Preparation: NPO for 6-8 hours and typically avoid anticoagulants as determined by provider - sim to EGD
Procedure: Moderate sedation and lasts 30 minutes to 2 hours
Post procedure:

A

Endoscopic retrogrand cholangiopancreatography (ERCP)

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24
Q

Keep patient NPO until gag reflex returns
Priority care includes preventing aspiration and assess for any bleeding or pain that could indicate perforation
Assess for gallbladder inflammation and pancreatitis - pancreatic inflammation - acute onset of severe abdominal pain, nausea and vomiting, fever and elevated lipase

A

Post procedure: - Endoscopic retrogrand cholangiopancreatography (ERCP)

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25
Q

Abdominal x-ray
Acute abdominal series
Abdominal computerized tomography (CT) - unique: DYE GIVEN PO AND IV
Abdominal magnetic resonance imaging (MRI)
Upper GI series (Barium Swallow)
Small bowel follow-through
Barium enema
Magnetic resonance cholangiopancreatography (MRCP)

A

Imaging tests

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26
Q

Can identify tumors, strictures and obstructions

A

Abdominal x-ray

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27
Q

Includes chest x-ray, supine and upright abdominal x-ray

A

Acute abdominal series

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28
Q

X-ray from mouth to duodenojejunal junctions with use of barium
Or through NG tube
Gives better pics

A

Upper GI series (Barium Swallow)

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29
Q

Extension of the upper GI x-ray with use of barium
Gives better pics

A

Small bowel follow-through

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30
Q

X-ray of large intestine with use of barium
Gives better pics

A

Barium enema

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31
Q

Looking at pancreas, bile duct, gallbladder, liver area - done via MRI

A

Magnetic resonance cholangiopancreatography (MRCP)

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32
Q

Diet
Elimination patterns
Psychosocial
Family history
Physical assessment
Symptoms

A

Other assessments when there are GI issues

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33
Q

Big one; huge impacts on GI tract

A

Diet

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34
Q

Stress - certain things are exacerbated by stress

A

Psychosocial

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35
Q

Bowel sounds
Abdomen - stomach shape, firm, soft
Stool

A

Physical assessment

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36
Q

Nausea and vomiting, diarrhea
Pyrosis - heartburn
Abd pain
Regurgitation
Constipation

A

Symptoms

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37
Q

is a type of secondary stomatitis. Long-term antibiotic therapy destroys other normal flora and allows it to overgrow.

A

Candida albicans - like opportunistic infection

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38
Q

Fungal - white patches on tongue; sometimes redness and inflammation if really bad

A

What type of infection is this?

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39
Q

immunocompromised

A

What might put a patient at risk for this type of infection?

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40
Q

Oral care, soft brushes, mycostatin, bland food, don’t use commercial mouthwashes
Remove dentures - irritation worse
Oral hygiene imp
Mouth clean
Painful and uncomfy - may use swabs to clean mouth
Avoid things with acid/anything with alcohol - painful and not want cause further irritation
Always swab mouth with: nystatin

A

What nursing interventions should be included in the care of the patient?

41
Q

lower esophageal sphincter, which allows the reflux of gastric contents into the esophagus and exposure of the esophageal mucosa to acidic gastric contents. Not staying tight enough so refluxing acid into esophagus which not meant to be exposed to that low pH - irritating to mucosa and causes symp and eats away at lining

A

Most common cause of GERD is excessive relaxation of the

42
Q

dyspepsia (indigestion), pyrosis (heartburn) and regurgitation

A

Key features of GERD are:

43
Q

spicy or acidic foods
supine position (will happen a lot at night); positioning - easier to reflux up
Chocolate
Foods that cause excessive relaxation of LES
large meals - stomachs full push on LES

A

What can aggravate GERD?

44
Q

Barium swallow - do Xray after
EGD
pH - in esophagus and if matches esophagus then have GERD

A

How is it diagnosed?

45
Q

Which statements about Barrett’s esophagus are accurate? (Select all that apply.)
A. It is considered to be a premalignant condition
B. It is associated with excessive intake of fresh fruits and vegetables
C. It results from exposure to acid and pepsin
D. Is associated with an increased risk for cancer in patients with prolonged GERD
E. Is an ulceration of the lower esophagus

A

Answer: A, C, D, E
Chronic GERD not treated well acid mutates cells and makes it premalignant cells in lower part esophagus and can lead to esophageal cancer; goal treat GERD so not at risk for Barrett’s

46
Q

Diet: avoid spicy food - further irritate; avoid food that decrease the LES pressure (peppermint, chocolate, alcohol, fatty foods, carbonation, caffeine-coffee, citrus, tomato)
Eliminate tobacco - stop smoking
Frequent small meals 4-6 times a day
Elevate HOB at night
Remain upright after meals
Lose weight - overweight higher risk because all about pressure on LES
Avoid snacks before bed or eating right before bed
Remain upright for 1-2 hours after meals
Alcohol, chocolate put them at risk
Eat slowly and chew thoroughly
Don’t wear constrictive clothing pushing on LES
Avoid heavy lifting, straining and working in a bent over position
Chew antacids thoroughly and follow with a glass of water

A

What patient teaching about health promotion and lifestyle changes should the nurse provide to a patient with GERD?

47
Q

Medication adherence
Decrease symptoms/exacerbations - help pain: heartburn/pain
Treat esophageal irritation/esophagitis
Prevent chronic GERD complications: Barrett’s esophagus and strictures and esophageal cancer

A

Goals of treatment for GERD include what?

48
Q

Antacids-neutralize gastric acids; buffer acid not as much acid refluxing up
H2 antagonists and Proton pump inhibitors-decrease/suppress gastric acid secretions
Prokinetic-increase gastric emptying; moves things through GI tract faster; not as commonly used

A

What medications will we use to help reduce symp?

49
Q

asymptomatic, but some may have daily symptoms similar to those with GERD.
Protrusion of stomach up through esophageal hiatus that runs through diaphragm; if present, which not supposed be, protrudes up will have reflux so have sim s/s; not have tight LES

A

Many patients with hiatal hernia are

50
Q

GERD; provider typically prescribes antacids and PPIs.

A

Nonsurgical interventions are similar to those for

51
Q

Protrusion of the stomach through the esophagus hiatus of the diaphragm into the chest
Asymptomatic or symptoms similar to those with GERD
Diagnostic testing
Interventions

A

Hiatal hernia

52
Q

Barium swallow study with fluoroscopy is the most specific diagnostic test
EGD may be performed to visualize sliding hernias

A

Diagnostic testing - Hiatal hernia

53
Q

Provider typically prescribes antacids and a PPI

A

Nonsurgical Interventions - Hiatal hernia

54
Q

Can do where pull stomach down and suture it to keep below diaphragm
Hard recovery so not done often
Only done if strangulated

A

surgical Interventions - Hiatal hernia

55
Q

Inflammation of gastric mucosa or submucosa after exposure to local irritants or other causes - stomach lining exposed to something that causes irritation; irritation of stomach lining by med/bacteria
Etiology/risk factors:

A

Gastritis

56
Q

If the stomach muscle is affected, hemorrhage could occur
Chronic gastritis

A

Inflammation of gastric mucosa or submucosa after exposure to local irritants or other causes - stomach lining exposed to something that causes irritation; irritation of stomach lining by med/bacteria - Gastritis

57
Q

Long period time
Walls and lining of the stomach thin and atrophy
Intrinsic factor (critical for absorption of vitamin B12) is lost - not produced
Vitamin B12 stores are depleted, pernicious anemia results - anemia related not enough IF to make enough RBCs
Amount and concentration of acid in stomach secretions gradually decrease
Associated with increased risk for gastric cancer

A

Chronic gastritis

58
Q

Helicobacter pylori (gram-negative bacterium)
Long-term NSAID use
Diet: alcohol; coffee; caffeine - LOT
Corticosteroids
Radiation therapy for cancer to certain area
Accidental or intentional ingestion of corrosive substances/toxic

A

Etiology/risk factors: - Gastritis

59
Q

Rapid onset of epigastric pain
nausea/vomiting
dyspepsia (indigestion);
pyrosis (heartburn)
gastric hemorrhage - not common; can lead to this so watch for this
Hematemesis - not common; can lead to this so watch for this

A

Key features of acute gastritis may include:

60
Q

Eliminate the causative factors
Avoid foods that can irritate gastric lining further (spicy foods)
Avoid smoking
Manage stress
Medications:

A

Interventions for gastritis may include:

61
Q

NSAIDS; steroids; caffeine; alcohol; H.pylori

A

Eliminate the causative factors - Interventions for gastritis may include:

62
Q

PPIs; H2 antagonists; antibiotic for Hpylori; Mucosal barrier fortifier; antacids; B12 injections if had sig pernicious anemia
Decrease acid secretion - PPIs; H2 antagonist; santacids
Barriers - given before meals to coat lining stomachs

A

Medications: - Interventions for gastritis may include:

63
Q

Chronic gastritis can lead to pernicious anemia-atrophy of stomach lining leads to decrease in absorption of vitamin B12

A

What is a complication of chronic gastritis?

64
Q

Vague report of epigastric pain that is relieved by food
Anorexia
Nausea or vomiting
Intolerance of fatty and spicy foods
Pernicious anemia

A

Symptoms of chronic gastritis

65
Q

Which types of ulcers are included in peptic ulcer disease (Select all that apply.)
A. Esophageal ulcers
B. Gastric ulcers
C. Pressure ulcers
D. Duodenal ulcers
E. Stress ulcers

A

Answer: B, D, E

66
Q

Mucosal lesion of the stomach or duodenum - gastritis getting worse; open sore in GI tract
Occurs when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin
3 types of ulcers
Most gastric and duodenal ulcers are caused by H. pylori infection

A

Peptic ulcer disease

67
Q

Gastric
Duodenal
Stress

A

3 types of ulcers

68
Q

Develop in the antrum of the stomach near acid-secreting mucosa

A

Gastric

69
Q

Develop in the upper portion of the duodenum

A

Duodenal

70
Q

Occur after an acute medical crisis or trauma
Uncommon

A

Stress

71
Q

Can be undiagnosed in older adults because of vague symptoms associated with physiologic changes of aging and comorbidities that mask dyspepsia
Test for it - do via EGD and breath test

A

Most gastric and duodenal ulcers are caused by H. pylori infection

72
Q

Hemorrhage:
Perforation:
Pyloric obstruction:
Intractable disease:

A

Ms. Kim is a 55-year-old woman with a history of peptic ulcer disease (PUD). Her past medical history is otherwise unremarkable. She has been experiencing little relief with the medication prescribed for her during last month’s visit. She tells the nurse that she experiences pain within 2 hours of ingesting food. What complications are possible with ulcers?

73
Q

more common in gastric ulcers
life threatening
symptoms-vomiting blood (hematemesis)-look coffee ground emesis; sharp and sudden epigastric or abdominal pain; bloody or black stools
GI bleeding and perforation most common
Best way check via EGD = see if have bleeding
Frank looking blood
Will test stools

A

Hemorrhage:

74
Q

life threatening
symptoms-sharp sudden pain with board like abdomen (peritonitis)
Ulcer eroded enough to where perforated full linings through bowel and stomach
Rigid, boardlike abd; address quickly
Die quickly from sepsis

A

Perforation:

75
Q

scarring from chronic irritation
symptoms-abdominal bloating and nausea vomiting
More with chronic; scar due to consist irritation

A

Pyloric obstruction:

76
Q

does not respond to conservative treatment
Meds not working

A

Intractable disease:

77
Q

NSAIDS and H Pylori

A

The etiology of peptic ulcers is associated primarily with

78
Q

Dyspepsia (indigestion): Most common symptom; Described as sharp, burning, or gnawing pain
Epigastric tenderness - Most common symptom
N/V

A

Physical assessment/clinical manifestations: - PUD

79
Q

Esophogastroduodenoscopy (EGD)
Nuclear medicine scan to test for bleeding
Serologic testing for H. pylori antibodies
Breath test
Decreased hemoglobin and hematocrit, if bleeding
Stool may be positive for occult blood, if bleeding

A

Diagnostic testing: - PUD

80
Q

Allow mucosa to heal
Avoid eating at night
Avoid triggers: tobacco, caffeine and alcohol
Try CAM therapies to reduce stress
Mucosal barrier before eat
Eliminate H. pylori infection

A

Besides drug therapy, what additional teaching information will you give to Ms. Kim upon discharge?

81
Q

bland diet
avoid foods that irritate-spicy, citrus

A

Allow mucosa to heal

82
Q

Yoga, meditation, etc

A

Try CAM therapies to reduce stress

83
Q

PPI triple therapy
PPI quadruple therapy

A

Eliminate H. pylori infection

84
Q

PPI
Two antibiotics

A

PPI triple therapy

85
Q

PPI
Any two antibiotics as above
Bismuth (Pepto-Bismol)

A

PPI quadruple therapy

86
Q

Low H/H

A

GI bleed

87
Q

High AST/ALT
Low Albumin
High Ammonia
High Bilirubin
High Alkaline phosphatase

A

Liver disease (ex: hepatitis, cirrhosis)

88
Q

High Amylase
High Lipase

A

Pancreatitis

89
Q

Present Ova and Parasites

A

Parasitic infection

90
Q

High Bilirubin
High Alkaline phosphatase

A

Biliary obstruction

91
Q

Increased/High WBC

A

Cholecystitis - inflammation of gallbladder

92
Q

High CA 19-9
High CEA

A

GI cancers

93
Q

Low K; lose electrolytes during this

A

Vomiting, gastric suctioning, diarrhea

94
Q

increases pH of gastric contents by deactivating pepsin/buffer

A

Antacids (ex. Calcium carbonate; Maalox)

95
Q

decreases gastric acid secretions

A

H2 antagonists (ex. Famotidine)

96
Q

binds with bile acids and pepsin to protect stomach mucosa
Coating on stomach
stimulates mucosal protection
may cause the stools to be discolored black

A

Mucosal barrier fortifier (ex. Sucralfate)

97
Q

Decrease gastric acid secretion

A

Proton pump inhibitors (PPI) (ex. Pantoprazole)

98
Q

Increases gastric emptying

A

Prokinetic (ex. Metoclopramide)

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