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Med Surg Test 6: Renal/GI > Med Surg: Alterations in GI Function > Flashcards

Med Surg: Alterations in GI Function Flashcards

1
Q

Why is a diet history good with GI assessment?

A

My explain symptoms or food triggers

Try to observe, may not tell truth

Food preferences: especially with dietary teaching

Anorexia

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2
Q

What are the GI changes in the elderly?

A

Stomach: atrophy of tissues, gastric mucosa: cant break down food, intrinsitc factor decreases, decrease acid bacterial growth

Large Intestinge: decrease peristalisis, constipation, decrease sense to defacate, increases fiber

Pancreas: decrease blood flow to exocrine function, may not break down food, decaresase fat absorption, decrease ability to metabolize drugs and nutrients

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3
Q

What are the S&S of pain?

A

P: precipitating or relieving factors

Q: quality or quantity

R: region or radiation, point to it, does it move, always there?

S: severity, is it better after intervention

T: timing, when starts, length, when first occurred, how often

Dysphagia: difficulty swallowing

Dyspepsia (indigestion): heart burn, chest pain, reflux, burning, nausea, belching

Anorexia: do have appetite

Appetite changes

Weight changes

N&V: hematemesis: characteristics, blood in vomit, color, old blood (coffee grounds)

Change in bowel habits

Presence of frank blood or tarry stools

Presence of abdominal distention or gas

Skin changes

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4
Q

What are some skin changes that are S&S of GI changes?

A

Skin discoloration or rashes

Itching liver

Jaundice

Increased susceptibility to bruising and bleeding

Cullen’s sign

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5
Q

What are lab tests for GI changes?

A

CBC: bleeding, change-anemia, inflammation/infection

Oncofetal antigens such as CEA: adenocarcinomas, Increase GI cancers, liver dysfunction, inflammation and bowel disease

Clotting factors

Electrolytes: diarrhea, vomitting

Liver enzymes and serum amylase and lipase

Bilirubin: increase obstruction gallbladder

Stool tests: fecal occult blood test, clostridium difficile

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6
Q

What are diagnostic tests for GI changes?

A

review pre-procedure, procedure and post procedure care for each: selected tests discussed on next several slides

Abdominal x-ray films

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7
Q

What is protocol for Upper Gastrointestinal Series and Small Bowel Series?

A

Before test: NPO for 8 hr prior, withold analgesics and anticholinergics for 24 hours

During test: client drink 16 ounces of barium, frequent position changes and rotating fluroscopy machiene

After test: encourage fluids to eliminate barium, administer mild laxative or stool softener, educate clinet that stools may be chalky white for 24-72 hours

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8
Q

What is protocol for Barium Enema?

A

Before test: only clear liquids are given 12-24 hours before the test, NPO the night before, bowel cleansing protocol

During test: barium enema enhances radiographic visualization of the large intestine

After test: expel the barium, drink plenty of fluids, stool is chalky white for 24-72 hours

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9
Q

What is the protocol for esophagogastroduodenoscopy?

A

Before: NPO for 6-8 hours before the procedure

During: conscious sedation, VS

After: VS every 30 minutes, NPO until gag reflex returns, throat discomfort possible for several days

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10
Q

What is small bowel capsule enteroscopy?

A

Visualization of the small intestine

Only water for 8-10 hours before test

NPO for first 2 hour of the testing

Application of belt with sensors

Patient resumes normal activity

8 hours

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11
Q

What is a colonoscopy?

A

Before: liquid diet for 24 hr before procedures, NPO for 6-8 hour prior, bowel clensing routine

During: conscious sedation, VS, may do biopsy or polypectomy, air may be inserted for visualization

After: VS every 15-30 minutes, is polypectomy or tissue biopsy, blood possible in stool, abdominal distention

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12
Q

When is a nasogastric tube management necessary?

A

when need to keep normal secretions out of stomach when healing occurs

N+V, aspiration risk and stomach surgery

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13
Q

What is gastric lavage and when is it necessary?

A

Instill something

GI bleed to control iced saline or tap water (more research with tap)

Alcoholic: gastritis or varicies

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14
Q

What are the dysfunctions of the GI system?

A

Abnormalities of ingestion

motility

secretion

inflammation

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15
Q

What are major symptoms of ingestion?

A

Anorexia

Dysphagia

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16
Q

What are some nursing diagnosis for ingestion?

A

Altered oral mucous membranes

Risk for ineffective airway clerance

Risk for aspiration

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17
Q

What is nonsurgical management of ingestion?

A

Airway management

Aspiration precautions

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18
Q

What is gastroesophageal reflux disease?

A

Backward flow of GI content into esophagus

Risk for aspiration

The lower esophageal sphincter tone decreased or inappropriately relaxed

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19
Q

What are clinical manifestations of GERD?

A

Dyspepsia/heartburn

Regurgitation and belching

Hypersalivation or water brash

Dysphagia

20
Q

What is the diagnostic assessment of GERD?

A

Esophageal pH monitoring (usualy pH in esophagus is 6-7)

Endoscopy-EGD

21
Q

What is the nonsurgical management of GERD?

A

Diet therapy: foods to improve sphincter tone and to avoid, stay away from previous foods used to improve tone, antacids

Cleint education: prevention, lifestyle changes, small frequent meals, limit alcohol, dont snakc before laying down, lock up HOB, eat slow, chew food, less constrictive clothing around middle, life with good body mechanics

22
Q

What are the major classes of drug therapy for GERD?

A

Antacids: Mylanta

Proton pump inhibitor: Prilosec

Histamine receptor antagonists: Zantac

Drugs that increase gastric emptying: Reglan

23
Q

What do antacids do?

A

Buffer gastric acid and prevent the formation of pepsin

Mixture of aluminum hydroxide and magnesium hydroxide

makes tissue less caustic

check other meds to see if interact with antacids

24
Q

Proton Pump Inhibitors

A

Prazoles provide effective, long-acting inhibition of gastric acid secretion

Omeprazole: Prilosec

Lansoprazole: Prevacid

Rabeprazole: Aciphex

Pantoprazole: Protonix

Esomeprazole: Nexium

25
Q

What are H2-Receptor Antagonists?

A

Drugs that block histamine-stimulated gastric secretion thus inhibiting gastric acid secretion

rantidine: zantac
famotidine: pepcid
nizatidine: axid
cimetidine: tagamet

26
Q

What are prokinetic drugs?

A

Drugs that increase gastric emptying like Metoclopramide (Reglan)

Postop with paralytic ileus to stimulate parastalsis

Entereg: prevent small bowel obstruction post-op peripherally acting opiod receptor antagonist

27
Q

What are abnormalities of motility?

A

can affect the esophagus, stomach or intestine

normally provides for peristaltic activity

controlled by the ANS

often occurs at sphincter sites

28
Q

What is a Hiatal Hernia and the types?

A

Protrusion of the stomach through the esophageal hiatus of the diaphragm into the throax

sliding hernia: up through esophagus

rolling hernia: rolls to side, more dangerous

29
Q

What is the assessment for a hiatal hernia?

A

Heartburn

Regurugitation and Belching

Pain: may mimic cardiac

Dysphagia

Worsening symptoms after eating or when in recumbent positions

30
Q

What is nonsurgical management of hiatal hernia?

A

Drug therapy: drugs for GERD

Diet therapy: same as GERD, dont eat before lie down, sit to rest, avoid foods that exacerbates symptoms

Weight reduction: avoid smoking

Elevate HOB

Remain upright after eating

Avoid straining and vigorous exercise

Avoid tight clothing

31
Q

What is the surgical management of a hiatal hernia?

A

fundoplication most common

Wrap stomach around esophagus to help hold down

32
Q

Post-op care of a hiatal hernia?

A

Nasogastric tube management: patent, secure, check placement every 4-8hours, orders, check drainage

Complications

Plan of care

Discharge planning

33
Q

What is motility in the stomach?

A

Hypermotility: 2 to inflammation condition

Pyloric stenosis (decreased gastric emptying): narrow, hard to move food to duodenum distention to abdomen and stomach

Dumping syndrome: after part of stomach removed, gastric contents dumped prematurely, not adquately broken down and mixed with secretion, overdistends intestine

34
Q

What dumping syndrome?

A

Occurs following gastric surgery when part or all of the stomach is removed

Occurs when gastric contents are rapidly “dumped” into the small intestine

35
Q

What is early and late signs in dumping syndrome?

A

Early symptoms: within 30 minutes of eating, shock like in nature, palpitataions, tachycardia, pale, diaphoretic shock

Late signs: 90 minutes to 3 hours after eating, insulin response to high carbohydrate bolus in jejunum

36
Q

What is the management of dumping syndrome?

A

Small frequent meals

Diet modication

Rest between meal

Nutritional deficiencies

37
Q

What is intestinal motility?

A

increased motility: usually inflammatory in nature

Decreased motility

38
Q

What are the different types of decreased motility?

A

Non-mechanical: paralytic ileus

Mechanical: constipation, obstruction (adhesions, abdominal herniation, bowel obstruction)

39
Q

What is a herniation?

A

Weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structire protrudes

40
Q

What are the types of abdominal hernias?

A

indirect inguinal

direct inguinal

umbilical

incisional or ventral

41
Q

What is postoperative care of surgical management?

A

elevate scrotum to prevent and control swelling

difficulties in voiding may occur

avoid increases in intra-abdominal pressure: such as coughing post op, restrict lifting for 8-12 weeks post op

42
Q

What is bowel obstruction?

A

Mechanical or Non-mechanical obstruction

Complete or incomplete

Strangulated: compromised blood flow

43
Q

What are clinical manifestations of bowel obstruction?

A

Midabdominal pain or cramping

Vomiting: with high obstructions

Obstipations

Seeping of liquid stool

ABdominal distention

Decreased to absent bowel sounds below the obstruction; hyperactive about

44
Q

What is the diagnostic assessment of bowel obstruction?

A

Radiographic assessment: x-rays, no lab test unless long term gas distention or normal

Endoscopy: cautionwith perforation - risky with obstruction

Computed tomography: CT or MRI helpful

45
Q

What is the nonsurgical management of bowel obstruction?

A

NPO

Nasogastric tube placement

Fluid and electrolyte replacement

Pain management

Drug therapy

46
Q

What is the surgical management of bowel obstruction?

A

Preoperative care

Operative procedure: exploratory laparotomy to determine procedure

Postopervative care: nasogastric tube in place, usual postop care for abdominal surgery

47
Q
A

Med Surg Test 6: Renal/GI (6 decks)

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