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Adults 1 > GIGI > Flashcards

GIGI Flashcards

1
Q

GI disorders

A

gastroesophageal disease (GERD), pyloric stenosis, barret’s esophagus, gastritis, peptic ulcer disease, dumping syndrome, constipation, diarrhea, crohns disease, ulcerative colitis, diverticulitis/diverticulosis, appendicitis, pancreatitis

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2
Q

GERD

A

backflow of gastric and duodenal contents into the esophagus; caused by incompetent lower esophageal sphincter, pyloric stenosis, motility disorder

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3
Q

causes of lower esophageal sphincter weakening

A

overeating regularly- u=increased pressure on LES, smoking- increases acidity, drinking alcohol- relaxes LES muscles, specific medications, certain acidic foods- citrus, tomatoes, coffee, chocolate, fried food, fatty meals, carbonation

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4
Q

meds that cause weakening of LES

A

progestins, nitrates, beta blockers, calcium channel blockers, dopamine agonists, anticholinergics

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5
Q

GERD assessment

A

heartburn, cough, regurgitation, dysphagia, laryngitis, chest pain (may mimic MI); obtain HX and info about diet

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6
Q

GERD interventions

A

avoid food triggers, GERD friendly diet- smaller more frequent meals high in fiber alkaline and fluids, elevate HOB and encourage sitting up for 30 min following meal, medications- proton pump inhibitors and H2 receptor blockers, monitor for aspiration

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7
Q

pyloric stenosis

A

thickening/swelling of the pylorus; common in children but rare in adults; congenital in children and secondary in adults; causing back up and fullness in stomach

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8
Q

causes of pyloric stenosis in adults

A

ulcers, cancer, adhesions after abdominal surgery

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9
Q

pyloric stenosis assessment

A

dyspepsia (epigastric pain), nausea, regurgitation, odynophagia (pain when swallowing), hypersalivation

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10
Q

pyloric stenosis interventions

A

avoid foods that increase LES pressure or esophageal irritation, low fat high fiber diet, avoid eating 2 hours before bed, elevated HOB, avoid anticholinergics and NSAIDs, take prescribed meds- antacids, H2 receptor antagonists, PPIs, prokinetic medications; extreme cases may require endoscopic dilation or pyloroplasty (widening)

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11
Q

Barrett’s esophagus

A

normal lining of esophagus is damaged by acid reflux and thickens and reddens; presence of metaplasia causes increased risk of esophageal cancer; long-term effect of gerd

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12
Q

H. pykori

A

type of bacteria that infects stomach and duodenum causing inflammation; no symptoms present unless complicated by something else; main cause of peptic ulcer disease and chronic gastritis

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13
Q

gastritis

A

inflammation of the stomach or gastric mucosa; can be acute or chronic

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14
Q

acute gastritis causes

A

ingestion of food contaminated with disease-causing microorganisms, food that is irritating or too highly seasoned, overuse of ASA/NSAIDs/corticosteroids, alcohol, bile reflux, radiation therapy

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15
Q

chronic gastritis causes

A

benign or malignant ulcers, H. pylori, autoimmune diseases, dietary factors, medications, alcohol, smoking, reflux

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16
Q

gastritis assessment

A
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17
Q

gastritis interventions

A
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18
Q

peptic ulcer disease

A

ulceration in mucosal wall of stomach, pylorus, duodenum, or esophagus in portion accessible to gastric secretions; erosion can extend through muscle to peritoneum; usually occurs alone and in people aged 30-60

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19
Q

gastric ulcers

A

ulceration of the mucosal lining that extends to the submucosal layer of the stomach

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20
Q

duodenal ulcers

A

break in the mucosa of the duodenum

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21
Q

risk factors for developing gastric/duodenal ulcers

A

stress, smoking, use of corticosteroids, NSAIDs, alcohol, hx of gastritis, family hx of gastric ulcers, infection with H. pylori

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22
Q

complications with ulcers

A

hemorrhage, perforation, pyloric obstruction

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23
Q

gastric ulcer assessment

A

gnawing sharp pain; left to mid epigastric region; occurs during or 30-60 minutes after eating; hematemesis

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24
Q

duodenal ulcer assessment

A

burning pain; mid-epigastric region; occurs 1.5-3 hours following a meal and during the night; melena; pain relieved by eating

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25
Q

interventions for peptic ulcer disease

A

monitor VS for signs of bleeding, small frequent bland meals, H2 receptor agonist or PPI to decrease gastric acid secretion, antacids to neutralize secretions, mucosal barrier protectants 1 hr before meal, prostaglandins for protecting and antisecretory actions, avoid alcohol caffeine chocolate smoking NSAIDs

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26
Q

peptic ulcer disease active bleeding interventions

A

monitor VS for dehydration, hypovolemic shock (tachy, hypoten., hypotherm.), respiratory compromise; maintain NPO status and give fluids; monitor Hgb and hematocrit; admin meds to vasoconstrict and reduce bleeding

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27
Q

peptic ulcer disease surgical interventions

A

gastroduodenostomy/billroth I- partial gastrectomy and remaining segment connected to duodenum; gastrojejunostomy/billroth II- partial gastrectomy and remaining segment is connected to jejunum; total gastrectomy- removal of the stomach and attach esophagus to jejunum or duodenum; pyloroplasty- enlargement of pylorus to prevent/decrease pyloric obstructing increasing gastric emptying

28
Q

dumping syndromeq

A

rapid emptying of gastric contents into the small intestine following a gastric resection

29
Q

constipation

A

less than 3 bowel movements per week; caused by surgery, chronic laxative, immobility, diet, ignoring urge, lack of exercise

30
Q

diarrhea

A

over 3 bowel movements per day; can be acute, persistent, or chronic; caused by infections, meds, tube feeds, endocrine and metabolic disorders, IBS

31
Q

irritable bowel syndrome

A

chronic recurrent diarrhea, constipation, and/or abdominal bloating/pain; idiopathic but can be triggered by environmental, stress, hormonal, or genetic

32
Q

IBS assessment

A

alterations in bowel patterns, pain, bloating, distention

33
Q

IBS interventions

A

increase dietary fiber, drink 8-10 cups of liquid per day, exercise, sleep, med therapy

34
Q

ulcerative colitis

A

large intestine and rectum are affected; migrates in continuous pattern; inner layer of intestinal lining; cure is colectomy with ileostomy

35
Q

crohns disease

A

cobblestone appearance of distal ileum and ascending colon mainly but can affect entire all intestines; edematous bleeding lesions and ulcers; entire bowel wall; there is no cure but can be managed

36
Q

crohns disease vs ulcerative colitis

A

crohns disease is patchy inflammation throughout small and large bowel; UC is continuous and uniform inflammation in the large bowel

37
Q

crohsn disease assessment

A

fever; cram like colicky pain in RLQ after meals that does not relieve with BM; chronic diarrhea with mucus and pus; abdominal distention; tenderness; anorexia, N/V; dehydration; weight loss; anemia; malnutrition; electrolyte imbalance

38
Q

UC assessment

A

anorexia causing weight loss malnutrition and dehydration; electrolyte imbalance; vitamin K deficiency; malaise; abdominal tenderness in LLQ with cramping; severe diarrhea with blood and mucus; anemia

39
Q

diagnostics testing for UC

A

imagine- CT scan, MRI, abdominal x-ray, colonoscopy with biopsies, ultrasound; labs- CBC, WBC, ESR/CRP, low albumin, electrolyte imbalance

40
Q

interventions for crohns/UC

A

NPO, fluids IV, lectrolytes, parenteral nutrition, restrict movement to reduce intestinal activity, monitor BS/tenderness/cramping, monitor stools, administration of meds- salicylate/corticosteroids/antibx/immunosuppressants/antidiarrheals, avoid gas forming foods/whole wheat grains/nuts/raw fruits/veg./alcohol/smoking

41
Q

crohns disease and UC surgical interventions

A

restorative proctocolectomy with ileal pouch anal anastomosis: removal of entire colon and rectum but keeps anal sphincter; total proctocolectomy with permanent ileostomy: removes all the large intestine and small intestine through and opening

42
Q

stoma care

A

want bright beefy red stoma; pale pink is sign of low Hgb; purplish/black is sign of compromised circulation

43
Q

diverticulosis

A

outpouching herniation of the intestinal mucosa and/or all layers without inflammation; can occur in any part of intestine but mostly in sigmoid colon

44
Q

diverticulitis

A

inflammation of 1 or more diverticula that occurs from penetration of fecal matter through thin-walled diverticula; result in local abscess formation and perforation; perforated diverticula can progress to intra-abdominal perforation with generalized peritonitis; usually left lower quadrant

45
Q

diverticulosis/diverticulitis assessment

A

LLQ abdominal pain increasing with coughing, straining, and lifting; flatulence; cramp-like pain; abdominal distention and tenderness; palpable tender rectal mass may be present; blood in stools; elevated temp.; N/V

46
Q

diverticulitis/diverticulosis inteventions

A

bed rest, NPO with clear liquids; introductiNon of fiber containing diet gradually once inflammation resolves; admin antibx/analgesics/anticholinergics; refrain from strenuous activities (lifiting coughing);

47
Q

NG tubes

A

decompress stomach by removing fluids and gas; administration of meds to those unable to swallow; prove nutrition by acting as feeding tube; can be used to irrigate stomach and remove toxins; can feed as bolus (30-60 min q3-6 hours), continuous, or cyclical (8-16 hours overnight)

48
Q

admin of tube feeds

A

high fowlers, assess bowel sounds and hold if absent; assess tube placement via aspirating and check pH; warm feed to room temp.; maintain upright position for 30 min following bolus feed; flush with 30-50mL after feeding and then clamp 30-60 min after; tubing changed q24 hours

49
Q

parental nutrition

A

is used as a last resort for supplying nutrients; supplies nutrients via veins and can be partial or total; supplies fats carbs and proteins; prevent fat and muscle protein from being broken down; is a hypertonic saline d/t ihgh glucose and amino acids

50
Q

indications for admin of parenteral nutrition

A

dysfunctional or non-functional GI tract that cannot process nutrients; not enough oral nutrition; multiple GI surgeries or trauma; intolerance to enteral feeding; used when need to heal bowel; no other nutritional alternatives available

51
Q

PPN

A

admin though large distal vein either standard PIV or midline/PICC or subclavian or IJ/EJ

52
Q

TPN

A

continuous administration over 24 hours or cyclical overnight through central vein/PICC; must infuse via pump; admin D10W when TPN runs dry and waiting for new bag; watch for sclerosis, phlebitis, swelling; moitor glucose

53
Q

when discontinuing TPN

A

need evaluation by nutritionist; gradually decrease flow for 1-2 hours while increasing oral intake; change IV dressing after removal until healed; encourage PO nutrition; record IO, weight, lab results of electrolytes and glucose levels

54
Q

Parenteral nutrition interventions

A

validated by 2 RNs to ensure proper prescribed components; IV meds and blood not given through PN lines; blood can be drawn from central line but need to be stopped; monitor PT and PTT if receiving anticoags; monitor BGL, monitor for refeeding syndrome (rapid drop in K, Mg, and Phosph.), monitor central line infection; monitor liver/kidney function; refrigerate PN and admin within 24 hours

55
Q

appendicitis

A

most common cause of acute abdomen in US; leading reason for emergency abdominal surgery; common ages are 10-30; higher incidence in men; familiar predisposition

56
Q

diagnosing appendicitis

A

elevated WBC, elevated C-reactive proteins within 12 hours and may normalize after 24 hours; CT or ultrasound for confirmation; UA to rule out UTI or renal calculi

57
Q

appendicitis assessment

A

initial- vague dull poorly localized periumbilical pain, anorexia/loss of appetite; progression- pain shift to RLQ and is sharp and localized, nausea with low grade fever

58
Q

physical findingsing of appendicitis

A

local tenderness at McBurneys point on pressure (RLG 1/3 way from anterior iliac spine to umbilicus), rebound tenderness, rovisings sign (LLQ palpation causes RLQ pain)

59
Q

appendicitis complication

A

ruptured appendix is emergency and can cause spread of infection and bacteria

60
Q

appendicitis interventions

A

immediate surgery; pain relief, fluid balance, anxiety reduction; infection prevention, atelectasis, skin issues; optimal nutrition; high fowlers; discharge instructions for wound care

61
Q

pancreatitis

A

self-digestion by pancreatic enzymes; gallstone obstruct flow of pancreatic juice activating the enzymes; enzyme act. leads to vasodilation, increased permeability, necrosis, erosion, hemorrhage

62
Q

causes of pancreatitis

A

infections, mumps complications, trauma, peptic ulcers, vascular issues, HLD, hypercalcemia, alcohol, tobacco, hereditary

63
Q

interstitial edematous pancreatitis

A

mild common form characterized by gland enlargement due to edema; minimal organ dysfunction that resolves in 6 months; risk of shock, fluid electrolyte imbalance, sepsis

64
Q

necrotizing pancreatitis

A

severe rare form with tissue necrosis in or around pancreas; enzymes damage blood vessels leading to bleeding and thrombosis; necrosis may extend retroperitoneal; can cause organ failure

65
Q

acute pancreatitis assessment

A

severe abdominal pain that radiates to back that is aggravated by meals and unrelieved by antacids; abdominal guarding; rigid abdomen if peritonitis, bruising in flank (turners sign) or umbilicus (Cullens sign); n/v, fever, jaundice; hypotension, tachycardia, cyanosis, cold skin, resp. distress, hypoxia, AKI, hypocalcemia, hyperglycemia, coag issues

66
Q

chronic pancreatitis manifestation

A

recurring severe abdominal pain and back pain, attacks become more frequent severe and longer, weight loss d/t decreased intake and malabsorption, frothy foul smelling diarrhea, calcification of gland and formation of calcium stones

67
Q

diagnosis acute pancreatitis

A

2 of 3 following- upper abdominal pain hx, amylasee/lipase elevation, typical imaging

Adults 1 (10 decks)

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