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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
–>5-HT 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
What is Stemetil?
Prochlorperazine --> D2 blocker that also has anticholinergic and antihistaminic effects - used as antiemetic and antisecretory in gastritis
25
Upper GI bleeds are more common in which demographic?
Older women --> Most likely d/t NSAID use to treat arthritic pain
26
A massive GI bleed is considered how much blood?
1500 ml
27
Most upper GI bleeds originate where?
50% are in stomach and duodenal origin
28
What is melena?
Black tarry stool with foul acidic smell - associated with upper GI bleed
29
What percentages of upper GI bleeds spontaneously resolve? What must we do to ensure treatment for those that do not?
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.
30
A rigid abdomen is a hallmark of which condition?
Peritonitis
31
What diagnostic studies must be done for an upper GI bleed?
Serum for CBC, lytes, BGL, clotting factors (PTT,PT/INR), ABGs, T&C in anticipation for transfusion. Urinalysis for blood in urine.
32
What is the purpose of a type and hold test?
To determine blood type and antibodies
33
What is the purpose of a type and cross test?
To determine how many units of blood should be prepared.
34
What diagnostic studies can be used to determine the etiology of acute abdominal pain?
A complete history and physical examination including rectal and pelvic exams. --> CBC --> Urinalysis --> X-ray --> ECG Consider pregnancy test for anatomical females.
35
What are the overall goals to establish during the planning phase for a patient with acute abd pain?
1 - Resolution of the underlying process 2 - Relief of pain 3 - Freedom from complications 4 - Normal nutritional status
36
What goals should be established in the planning phase with a patient with acute infectious diarrhea?
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
37
What goals should be established in the planning phase for a patient with constipation?
1 - Increase dietary intake of fiber and fluids 2 - Have passage of soft, formed stools 3 - Not have any complications such as bleeding hemorrhoids.
38
What are the goals established during the planning phase for a patient with fecal incontinence?
1 - Have normal bowel control 2 - Maintain perianal skin integrity 3 - Not suffer any self-esteem issues resulting from problems with bowel control
39
What interventions should be considered for a patient with acute abdominal pain?
--> Need for pre and postoperative care --> Potential nasogastric tube --> Need for ambulatory and home care.
40
Bowel inflammation, peritonitis, obstruction and inflammation can lead to which major complications?
Septic and hypovolemic shock
41
Which bowel sounds are considered hyperactive, hypoactive, and absent?
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.
42
What is laparoscopic surgery?
Minimally invasive abd surgery, access usually acquired through umbilicus.
43
How soon post-op is an NG tube removed?
24-72 hours - once peristalsis returns
44
When an NGT is first placed for drainage after surgery, what kind of drainage should be expected?
May be dark brown to red for first 12 hours, then change to light yellow or green which is indicative of bile.
45
What is appendicitis? What usually causes it?
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
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?
Appendicitis.
47
What are potential complications of appendicitis?
--> Perforation --> Peritonitis --> Abscesses
48
What diagnostic tests are often used for appendicitis?
Complete history and examination - abd assessment --> WBC --> Urinalysis
49
How should the nurse manage appendicitis?
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
What is Zantac?
Ranitidine -->H2 blocker to prevent acid secretion in stomach
51
What are clinical manifestations of peritonitis?
Abd pain, rebound tenderness, muscular rigidity and spasm.
52
What diagnostic studies are used for peritonitis?
--> CBC for WBCs --> Peritoneal aspiration --> X-ray --> Ct or ultrasound may also be used
53
What are some important goals during the planning phase for a patient with peritonitis?
1 - Resolution of inflammation 2 - Relief of pain 3 - Freedom from complications (hypovolemic/septic shock) 4 - Normal nutritional status
54
What is gastroenteritis? What are some clinical manifestations?
Inflammation of the mucosa of the stomach and small intestine --> Fever, elevated WBCs, blood and mucous in stool
55
What are the two kinds of inflammatory bowel disease?
Crohn's and Ulcerative Colitis
56
What is ulcerative colitis? What ages does it peak? Where in the colon does it effect?
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
What is a mild/moderate/severe exacerbation of UC?
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
What are potential complications of UC?
--> Hemorrhage --> Perforation --> Toxic megacolon --> Colon dilation --> Cancer is diagnosed 10+ years ago
59
What is toxic megacolon?
Extensive dilation and paralysis of the colon
60
What is colonic dilation?
Dilation that occurs as a result of severe acute inflammation of the entire colon wall. Most common in the transverse colon.
61
What diagnostic studied are used for UC?
Cultures: CBC, lytes Stool for C&S - C-Diff Imaging: Colonoscopy Barium enema
62
What treatment options (large categories) are available for people with UC?
Drug therapy, surgery
63
What are the interprofessional goals of treatment for UC?
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
What drug therapy is used to treat UC and Crohn's?
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
What is Flagyl?
Metronidazole --> Antimicrobial used for UC & Crohn's
66
What is sulphasalazine?
5-ASA used for inflammation in UC & Crohn's
67
What is Imodium?
Loperamide --> Antidiarrheal
68
What is Lomotil?
Diphenoxylate --> Antidiarrheal
69
What is Imuran?
Azathioprine --> Immunosuppressant used in IBD
70
What is Remicade and Humira?
Infliximab & adalimumab respectively --> Immunomodulators used in IBD
71
Which surgeries are available for people with IBD?
--> Total proctocolectomy with Permanent Ileostomy --> Total proctocolectomy with Ileoanal reservoir
72
What is a proctocolectomy?
Surgical removal of the colon, rectum and anus.
73
What diet is recommended for UC?
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
What is Crohn's disease? Which demographics are affected?
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
Crohn's is associated with elevated what?
TNF-alpha levels
76
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?
Classic Crohn's manifestations.
77
How can Crohn's be diagnosed?
Hx and physical exam Imaging: colon/sigmoidoscopy, biopsy, barium studies.
78
What diet is recommended for those with Crohn's?
High cal, high vitamine, high protein, low residue and dairy free.
79
What is the major difference between treatment of Crohn's and UC?
Crohn's cannot be permanently cured through surgery.
80
Fish oil might be useful in the treatment of what?
Crohn's
81
What is Celiac disease? Who does it primary effect?
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
Which three factors are necessary for celiac disease to develop?
1. Genetic predisposition 2. Gluten ingestion 3. Immune-mediated response
83
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?
Celiac
84
What diagnostic studied can diagnose celiac?
Imaging looking for flat mucosa and loss of villi, looking at lytes and markers for malnutrition
85
Celiac disease is also associated with...
Other autoimmune disorders --> DM1, thyroid disease, rheumatoid arthritis.
86
What usually causes mechanical obstruction of the small intestine? What about the large intestine?
Small: Adhesions, hernias, neoplasms Large: Cancer, diverticular disease
87
What are some causes for nonmechanical intestinal obstruction?
Neuromuscular or vascular disorders, paralytic ileus
88
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?
Small intestine obstruction - BMs will stop after a short time
89
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?
Large intestine obstruction - vomiting would be a late manifestation
90
Which diagnostic studied are used with a bowel obstruction?
X-ray/Ct scan CBC, WBCs, lytes
91
What kind of care should the nurse expect for a person with an intestinal obstruction?
NG tube for decompression, IV fluids, TPN, and surgery.
92
What is considered excessive loss through NG tube?
>500-1000 ml/24 hours.
93
What are the different kinds of ostomies?
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
What is Hartmann's pouch?
When the distal bowel after a stoma is oversewn rather than removed.
95
Bowel regulation with stomas is possible for which area of the colon?
The sigmoid, where stools will be formed and therefore extra fluid intake will not be required.
96
What is a diverticulum?
An outpouching of the colon
97
What is diverticulitis?
When outpouching become inflamed
98
What is diverticulosis?
Multiple non-inflamed diverticula
99
Which demographic is most affected by diverticulitis/losis?
Adults aged 85+
100
What causes diverticulosis?
Fiber deficiency causes narrowing lumen, faecalis, and high intestinal lumen pressure
101
Diverticulitis causes increased risk of...
perforation with peritonitis
102
A patient presents with cramping in the LLQ relieved by flatus and has alternating bouts of constipation and diarrhea. What might be the issue?
Diverticulosis Acute diverticulitis might also cause fever, N&V, anorexia, and elevated WBC
103
How is diverticulitis/losis tested for?
Hx and physican exam Testing for occult blood, sigmoid/colonoscopy, barium, CT w contrast CBC, blood culture
104
What diet can help diverticulosis/litis?
High fiber diet during non-symptomatic periods, bulk laxatives, stool softeners, broad spectrum antibiotics po.
105
What is metamucil?
Psyllium hydrophilic mucilloid --> Bulk laxative recommended for diverticulitis/losis
106
What is the goal of treatment for acute diverticulitis?
To allow the colon to rest and the inflammation to subside.

MedSurg (14 decks)

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