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MedSurg > Lecture 5.1 - GI > Flashcards

Lecture 5.1 - GI Flashcards

1
Q

What kind of TPN is better for patients on fluid restrictions?

A

Those with higher percentages (10-30%) of fat emulsion provide large numbers of calories in relatively small amounts of fluid.

Note that fat emulsions are contraindicated in patients with hyperlipidemia.

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2
Q

What are the two kind of parenteral nutrition administration?

A

Peripheral and Central
–> PPN contains fewer nutrients and is less hypertonic (800mmol/L). Still poses risk for phlebitis or fluid overload.

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3
Q

What is refeeding syndrome?

A

Fluid retention and low phosphate, Mg, K.

Can occur any time a malnourished pt starts aggressive nutritional support.

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4
Q

What is Barrett’s esophagus?

A

When the normal squamous epithelium of the esophagus becomes replaced with columnar epithelium from the stomach.

Associated with repeated episodes of GERD.

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5
Q

What are the clinical manifestations of GERD?

A

Hx of heartburn, regurgitation, dyspnea or coughing.

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6
Q

What are some complications of GERD?

A

–> Esophagitis
–>Barrett’s esophagus.

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7
Q

Repeated esophagitis might lead to…

A

Scar tissue formation (esophageal stricture) that may result in dysphagia.

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8
Q

What is the purpose of diagnostic studied for GERD? What diagnostic studied are used?

A

TO determine the cause, such a a hiatal hernia.
–> Barium swallow
–> Endoscopy
–> Biopsy
–> pH tests

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9
Q

How can GERD be managed?

A

Lifestyle modifications
–> Avoid diet and medication factors that exacerbate (high fat, milk, spicy). High protein, low fat.
–> Avoid meals before bed.
–> Avoid smoking

Medication:
–> PPI, H2-blockers, antacids

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10
Q

What is the difference between a sliding and rolling esophageal hernia?

A

A sliding hernia involves the stomach sliding partially above the diaphragm into the thoracic cavity

A rolling hernia involves the esophagogastric junction remaining in normal position, but fundus rolls up through diaphragm forming a pocket beside the esophagus.

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11
Q

What is achalasia?

A

Absence of peristalsis in the lower 2/3rds of the esophagus.

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12
Q

What is gastritis?

A

Inflammation of the gastric mucosa
May be:
–> Acute/Chronic
–> Diffuse/Localized

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13
Q

Which medications can cause gastritis?

A

ASA, corticosteroids, NSAIDs

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14
Q

Which dietary factors can cause gastritis?

A

Alcohol and spicy food

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15
Q

Which microorganisms can cause gastritis?

A

–> H. pylori (Acquired in Childhood)
–> Species of salmonella
–> Species of staphylococcus

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16
Q

What are the three subtypes of gastritis?

A

1 - autoimmune (body and fundus)
2 - Diffuse antral (Antrum)
3 - Multifocal (diffuse throughout)

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17
Q

Anorexia, N&V, epigastric tenderness, and a feeling of fullness are associated with what condition?

A

Acute gastritis.

Chronic gastritis has similar manifestations, but may also be accompanied with a loss of intrinsic factor –> B12 deficiency –> Pernicious anemia

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18
Q

What stomach condition should you be aware of in those with chronic alcoholism?

A

Hemorrhage is commonly associated

Chronic gastritis –> B12 deficiency

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19
Q

What diagnostic studies are used to diagnose acute gastritis?

A

–> Hx of drugs and alcohol
–> Endoscopy w biopsy for definitive diagnosis

Breath, urine, serum (gold standard), stool and biopsy tests are available to test for H. Pylori.

–> CBC for anemia (B12/hemorrhage)
–> Stools for occult blood

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20
Q

How is acute gastritis managed?

A

Eliminating cause and preventing future exacerbation is main goal

Plan of Care
–> bed rest
–> NPO
–> IV Fluids + antiemetics

For severe acute gastritis an NG tube may be placed to keep stomach empty and free from noxious stimuli. Check VS frequently or hemorrhage is considered likely.

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21
Q

How is chronic gastritis treated?

A

Focus is on evaluating and eliminating specific cause.

Plan of Care:
–> Antibiotics (if indicated)
–> Cobalamin if necessary. Discussion about future supplementation

Future plan:
–> six small meals a day followed by antacid
–> Smoking cessation
–> Monitor Ca if taking calcium rich antacids

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22
Q

What is Zofran?

A

Ondansetron
–>52 blocker (antiemetic)

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22
Q

What should you be aware of for patients with excessive vomiting?

A

HypoK

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23
Q

What is gravol?

A

Dimenhydrinate
–>Antihistamine for &V

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24
Q

What is Stemetil?

A

Prochlorperazine
–> D2 blocker that also has anticholinergic and antihistaminic effects - used as antiemetic and antisecretory in gastritis

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25
Q

Upper GI bleeds are more common in which demographic?

A

Older women –> Most likely d/t NSAID use to treat arthritic pain

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26
Q

A massive GI bleed is considered how much blood?

A

1500 ml

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27
Q

Most upper GI bleeds originate where?

A

50% are in stomach and duodenal origin

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28
Q

What is melena?

A

Black tarry stool with foul acidic smell - associated with upper GI bleed

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29
Q

What percentages of upper GI bleeds spontaneously resolve? What must we do to ensure treatment for those that do not?

A

80-85% resolve spontaneously

Perform bowel assessment, integ/resp/CDV and frequent VS to monitor.
Basically a H2T for perfusion and signs of major hemorrhage.

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30
Q

A rigid abdomen is a hallmark of which condition?

A

Peritonitis

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31
Q

What diagnostic studies must be done for an upper GI bleed?

A

Serum for CBC, lytes, BGL, clotting factors (PTT,PT/INR), ABGs, T&C in anticipation for transfusion.

Urinalysis for blood in urine.

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32
Q

What is the purpose of a type and hold test?

A

To determine blood type and antibodies

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33
Q

What is the purpose of a type and cross test?

A

To determine how many units of blood should be prepared.

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34
Q

What diagnostic studies can be used to determine the etiology of acute abdominal pain?

A

A complete history and physical examination including rectal and pelvic exams.
–> CBC
–> Urinalysis
–> X-ray
–> ECG

Consider pregnancy test for anatomical females.

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35
Q

What are the overall goals to establish during the planning phase for a patient with acute abd pain?

A

1 - Resolution of the underlying process
2 - Relief of pain
3 - Freedom from complications
4 - Normal nutritional status

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36
Q

What goals should be established in the planning phase with a patient with acute infectious diarrhea?

A

1 - Not transmit microorganism
2 - Cease having diarrhea and resume normal bowel patterns
3 - Have normal fluid, lute, and acid-base balance
4 - Normal nutritional intake
5 - Have no perianal breakdown

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37
Q

What goals should be established in the planning phase for a patient with constipation?

A

1 - Increase dietary intake of fiber and fluids
2 - Have passage of soft, formed stools
3 - Not have any complications such as bleeding hemorrhoids.

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38
Q

What are the goals established during the planning phase for a patient with fecal incontinence?

A

1 - Have normal bowel control
2 - Maintain perianal skin integrity
3 - Not suffer any self-esteem issues resulting from problems with bowel control

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39
Q

What interventions should be considered for a patient with acute abdominal pain?

A

–> Need for pre and postoperative care
–> Potential nasogastric tube
–> Need for ambulatory and home care.

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40
Q

Bowel inflammation, peritonitis, obstruction and inflammation can lead to which major complications?

A

Septic and hypovolemic shock

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41
Q

Which bowel sounds are considered hyperactive, hypoactive, and absent?

A

Normal bowel sounds should be between 5-30 a minute. Anything out of this range is abnormal

Listen for a full 3 minutes to determine if sounds are absent.

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42
Q

What is laparoscopic surgery?

A

Minimally invasive abd surgery, access usually acquired through umbilicus.

43
Q

How soon post-op is an NG tube removed?

A

24-72 hours - once peristalsis returns

44
Q

When an NGT is first placed for drainage after surgery, what kind of drainage should be expected?

A

May be dark brown to red for first 12 hours, then change to light yellow or green which is indicative of bile.

45
Q

What is appendicitis? What usually causes it?

A

Inflammation of the appendix resulting in occlusion and edema, venous engorgement, invasion by bacteria and gangrene and perforation.

Most commonly, the occlusion is accumulates feces.

46
Q

A patient presents with periumbilical pain and anorexia, N&V. The pain eventually shifts to localize at McBurney’s point. The patient finds it most comfortable to lie supine with the right leg flexed.

What is likely wrong with this patient?

A

Appendicitis.

47
Q

What are potential complications of appendicitis?

A

–> Perforation
–> Peritonitis
–> Abscesses

48
Q

What diagnostic tests are often used for appendicitis?

A

Complete history and examination - abd assessment

–> WBC
–> Urinalysis

49
Q

How should the nurse manage appendicitis?

A

Ensure patient is NPO in case surgery is needed
–> Provide pain control
–> Observe for evidence of peritonitis

Local application of heat is not advised.

50
Q

What is Zantac?

A

Ranitidine
–>H2 blocker to prevent acid secretion in stomach

51
Q

What are clinical manifestations of peritonitis?

A

Abd pain, rebound tenderness, muscular rigidity and spasm.

52
Q

What diagnostic studies are used for peritonitis?

A

–> CBC for WBCs
–> Peritoneal aspiration
–> X-ray
–> Ct or ultrasound may also be used

53
Q

What are some important goals during the planning phase for a patient with peritonitis?

A

1 - Resolution of inflammation
2 - Relief of pain
3 - Freedom from complications (hypovolemic/septic shock)
4 - Normal nutritional status

54
Q

What is gastroenteritis? What are some clinical manifestations?

A

Inflammation of the mucosa of the stomach and small intestine
–> Fever, elevated WBCs, blood and mucous in stool

55
Q

What are the two kinds of inflammatory bowel disease?

A

Crohn’s and Ulcerative Colitis

56
Q

What is ulcerative colitis? What ages does it peak? Where in the colon does it effect?

A

Inflammation and ulceration of the rectum and colon wherein the mucosa becomes edematous with multiple abscesses developing in submucosa. Alternatives between exacerbations and remissions. Often leads to malnutrition of vitamins –> IDA
–> Peaks between ages 15-25 or 60-80
–> Starts is rectum and moved proximally along colon

57
Q

What is a mild/moderate/severe exacerbation of UC?

A

Mild
–> 1-2 semi formed stool with small amount of blood daily

Moderate
–> 4-5 BMs a day with increased bleeding, fever, lethargy, malaise, anorexia

Severe
–> 10-20 BMs a day with weight loss of 10% of body weight, anemia, tachycardia, dehydration.

58
Q

What are potential complications of UC?

A

–> Hemorrhage
–> Perforation
–> Toxic megacolon
–> Colon dilation
–> Cancer is diagnosed 10+ years ago

59
Q

What is toxic megacolon?

A

Extensive dilation and paralysis of the colon

60
Q

What is colonic dilation?

A

Dilation that occurs as a result of severe acute inflammation
of the entire colon wall. Most common in the transverse colon.

61
Q

What diagnostic studied are used for UC?

A

Cultures:
CBC, lytes
Stool for C&S - C-Diff

Imaging:
Colonoscopy
Barium enema

62
Q

What treatment options (large categories) are available for people with UC?

A

Drug therapy, surgery

63
Q

What are the interprofessional goals of treatment for UC?

A

1 - Rest the bowel
2 - Control the inflammation
3 - Manage fluids and nutrition
4 - Manage patient stress
5 - Provide education about the disease and treatment
6 - Provide symptomatic relief

64
Q

What drug therapy is used to treat UC and Crohn’s?

A

Antimicrobial
–> Metronidazole (flagyl)

5-ASA
–> Sulphasalazine for colon inflammation

Corticosteroids
–> Inflammation

Antidiarrheal
–> Loperamide (Imodium) / Diphenoxylate (Lomotil)

Immunosuppressant
–> Azathioprine (Imuran)

Immunomodulators
–> Infliximab (Remicade) / Adalimumab (Humira)

Vitamins
–> Iron for IDA

65
Q

What is Flagyl?

A

Metronidazole
–> Antimicrobial used for UC & Crohn’s

66
Q

What is sulphasalazine?

A

5-ASA used for inflammation in UC & Crohn’s

67
Q

What is Imodium?

A

Loperamide
–> Antidiarrheal

68
Q

What is Lomotil?

A

Diphenoxylate
–> Antidiarrheal

69
Q

What is Imuran?

A

Azathioprine
–> Immunosuppressant used in IBD

70
Q

What is Remicade and Humira?

A

Infliximab & adalimumab respectively
–> Immunomodulators used in IBD

71
Q

Which surgeries are available for people with IBD?

A

–> Total proctocolectomy with Permanent Ileostomy
–> Total proctocolectomy with Ileoanal reservoir

72
Q

What is a proctocolectomy?

A

Surgical removal of the colon, rectum and anus.

73
Q

What diet is recommended for UC?

A

A high calorie, low residue diet with vitamin supplements.

Low Residue: Low in fiber and limit of 2 cups daily of milk.
Cooked cereals are recommended and eggs all ways but fried are better.

74
Q

What is Crohn’s disease? Which demographics are affected?

A

A chronic IBD that can affect any part of the GI tract, from mouth to anus. Involves skip-lesions and abscesses and fistulas that may communicate with the bowel, skin, bladder, rectum or vagina.

Occurs most often in Jewish and upper-middle-class urban populations. Canada has one of the highest incidences in the world.

75
Q

Crohn’s is associated with elevated what?

A

TNF-alpha levels

76
Q

A patient presents with non-bloody diarrhea, abdominal pain and distension, fever and fatigue.
They have a history of weight loss, dehydration, electrolyte imbalance, anemia, and umbilical pain.

Auscultation reveals hypermobility.
What might be the issue with the patient?

A

Classic Crohn’s manifestations.

77
Q

How can Crohn’s be diagnosed?

A

Hx and physical exam

Imaging: colon/sigmoidoscopy, biopsy, barium studies.

78
Q

What diet is recommended for those with Crohn’s?

A

High cal, high vitamine, high protein, low residue and dairy free.

79
Q

What is the major difference between treatment of Crohn’s and UC?

A

Crohn’s cannot be permanently cured through surgery.

80
Q

Fish oil might be useful in the treatment of what?

A

Crohn’s

81
Q

What is Celiac disease? Who does it primary effect?

A

Autoimmune response that leads to damage to small intestinal mucosa upon ingestion of wheat, barley, and rye (gluten that released prolamine peptides when partially digested)
–> Most common in people with European ancestry

82
Q

Which three factors are necessary for celiac disease to develop?

A
  1. Genetic predisposition
  2. Gluten ingestion
  3. Immune-mediated response
83
Q

A patient presents with foul-smelling stool, steatorrhea, flatulence, abd distention and symptoms of malnutrition.
They also have decreased bone density.
What might be the issue?

A

Celiac

84
Q

What diagnostic studied can diagnose celiac?

A

Imaging looking for flat mucosa and loss of villi, looking at lytes and markers for malnutrition

85
Q

Celiac disease is also associated with…

A

Other autoimmune disorders
–> DM1, thyroid disease, rheumatoid arthritis.

86
Q

What usually causes mechanical obstruction of the small intestine? What about the large intestine?

A

Small: Adhesions, hernias, neoplasms

Large: Cancer, diverticular disease

87
Q

What are some causes for nonmechanical intestinal obstruction?

A

Neuromuscular or vascular disorders, paralytic ileus

88
Q

A patient presents with rapid onset colicky and cramp like abdominal pain. They are vomiting frequently and copiously, but are still passing bowel movements. What might be wrong?

A

Small intestine obstruction - BMs will stop after a short time

89
Q

A patient presents with gradually worse low-grade cramping in their abdomen and is constipated. Their abdomen is greatly distended. What might be the problem?

A

Large intestine obstruction - vomiting would be a late manifestation

90
Q

Which diagnostic studied are used with a bowel obstruction?

A

X-ray/Ct scan

CBC, WBCs, lytes

91
Q

What kind of care should the nurse expect for a person with an intestinal obstruction?

A

NG tube for decompression, IV fluids, TPN, and surgery.

92
Q

What is considered excessive loss through NG tube?

A

> 500-1000 ml/24 hours.

93
Q

What are the different kinds of ostomies?

A

Ileostomy
–> Ileum brought through wall

Colostomy
–> Colon brought through wall

End Stoma
–> Surgically dividing the bowel and bringing the proximal end out as a single stoma

Loop Stoma
–> Brings a loop of bowel to the surface to provide route for fecal diversion. Usually temporary

Doubled-Barreled Stoma
–> When both the proximal and distal ends are brought through the wall as separate stomas. Usually temporary

94
Q

What is Hartmann’s pouch?

A

When the distal bowel after a stoma is oversewn rather than removed.

95
Q

Bowel regulation with stomas is possible for which area of the colon?

A

The sigmoid, where stools will be formed and therefore extra fluid intake will not be required.

96
Q

What is a diverticulum?

A

An outpouching of the colon

97
Q

What is diverticulitis?

A

When outpouching become inflamed

98
Q

What is diverticulosis?

A

Multiple non-inflamed diverticula

99
Q

Which demographic is most affected by diverticulitis/losis?

A

Adults aged 85+

100
Q

What causes diverticulosis?

A

Fiber deficiency causes narrowing lumen, faecalis, and high intestinal lumen pressure

101
Q

Diverticulitis causes increased risk of…

A

perforation with peritonitis

102
Q

A patient presents with cramping in the LLQ relieved by flatus and has alternating bouts of constipation and diarrhea. What might be the issue?

A

Diverticulosis

Acute diverticulitis might also cause fever, N&V, anorexia, and elevated WBC

103
Q

How is diverticulitis/losis tested for?

A

Hx and physican exam

Testing for occult blood, sigmoid/colonoscopy, barium, CT w contrast

CBC, blood culture

104
Q

What diet can help diverticulosis/litis?

A

High fiber diet during non-symptomatic periods, bulk laxatives, stool softeners, broad spectrum antibiotics po.

105
Q

What is metamucil?

A

Psyllium hydrophilic mucilloid
–> Bulk laxative recommended for diverticulitis/losis

106
Q

What is the goal of treatment for acute diverticulitis?

A

To allow the colon to rest and the inflammation to subside.

MedSurg (13 decks)

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