Med Surg: Alterations in GI Function Flashcards
Why is a diet history good with GI assessment?
My explain symptoms or food triggers
Try to observe, may not tell truth
Food preferences: especially with dietary teaching
Anorexia
What are the GI changes in the elderly?
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
What are the S&S of pain?
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
What are some skin changes that are S&S of GI changes?
Skin discoloration or rashes
Itching liver
Jaundice
Increased susceptibility to bruising and bleeding
Cullen’s sign
What are lab tests for GI changes?
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
What are diagnostic tests for GI changes?
review pre-procedure, procedure and post procedure care for each: selected tests discussed on next several slides
Abdominal x-ray films
What is protocol for Upper Gastrointestinal Series and Small Bowel Series?
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
What is protocol for Barium Enema?
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
What is the protocol for esophagogastroduodenoscopy?
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
What is small bowel capsule enteroscopy?
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
What is a colonoscopy?
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
When is a nasogastric tube management necessary?
when need to keep normal secretions out of stomach when healing occurs
N+V, aspiration risk and stomach surgery
What is gastric lavage and when is it necessary?
Instill something
GI bleed to control iced saline or tap water (more research with tap)
Alcoholic: gastritis or varicies
What are the dysfunctions of the GI system?
Abnormalities of ingestion
motility
secretion
inflammation
What are major symptoms of ingestion?
Anorexia
Dysphagia
What are some nursing diagnosis for ingestion?
Altered oral mucous membranes
Risk for ineffective airway clerance
Risk for aspiration
What is nonsurgical management of ingestion?
Airway management
Aspiration precautions
What is gastroesophageal reflux disease?
Backward flow of GI content into esophagus
Risk for aspiration
The lower esophageal sphincter tone decreased or inappropriately relaxed
What are clinical manifestations of GERD?
Dyspepsia/heartburn
Regurgitation and belching
Hypersalivation or water brash
Dysphagia
What is the diagnostic assessment of GERD?
Esophageal pH monitoring (usualy pH in esophagus is 6-7)
Endoscopy-EGD
What is the nonsurgical management of GERD?
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
What are the major classes of drug therapy for GERD?
Antacids: Mylanta
Proton pump inhibitor: Prilosec
Histamine receptor antagonists: Zantac
Drugs that increase gastric emptying: Reglan
What do antacids do?
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
Proton Pump Inhibitors
Prazoles provide effective, long-acting inhibition of gastric acid secretion
Omeprazole: Prilosec
Lansoprazole: Prevacid
Rabeprazole: Aciphex
Pantoprazole: Protonix
Esomeprazole: Nexium
What are H2-Receptor Antagonists?
Drugs that block histamine-stimulated gastric secretion thus inhibiting gastric acid secretion
rantidine: zantac
famotidine: pepcid
nizatidine: axid
cimetidine: tagamet
What are prokinetic drugs?
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
What are abnormalities of motility?
can affect the esophagus, stomach or intestine
normally provides for peristaltic activity
controlled by the ANS
often occurs at sphincter sites
What is a Hiatal Hernia and the types?
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
What is the assessment for a hiatal hernia?
Heartburn
Regurugitation and Belching
Pain: may mimic cardiac
Dysphagia
Worsening symptoms after eating or when in recumbent positions
What is nonsurgical management of hiatal hernia?
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
What is the surgical management of a hiatal hernia?
fundoplication most common
Wrap stomach around esophagus to help hold down
Post-op care of a hiatal hernia?
Nasogastric tube management: patent, secure, check placement every 4-8hours, orders, check drainage
Complications
Plan of care
Discharge planning
What is motility in the stomach?
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
What dumping syndrome?
Occurs following gastric surgery when part or all of the stomach is removed
Occurs when gastric contents are rapidly “dumped” into the small intestine
What is early and late signs in dumping syndrome?
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
What is the management of dumping syndrome?
Small frequent meals
Diet modication
Rest between meal
Nutritional deficiencies
What is intestinal motility?
increased motility: usually inflammatory in nature
Decreased motility
What are the different types of decreased motility?
Non-mechanical: paralytic ileus
Mechanical: constipation, obstruction (adhesions, abdominal herniation, bowel obstruction)
What is a herniation?
Weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structire protrudes
What are the types of abdominal hernias?
indirect inguinal
direct inguinal
umbilical
incisional or ventral
What is postoperative care of surgical management?
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
What is bowel obstruction?
Mechanical or Non-mechanical obstruction
Complete or incomplete
Strangulated: compromised blood flow
What are clinical manifestations of bowel obstruction?
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
What is the diagnostic assessment of bowel obstruction?
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
What is the nonsurgical management of bowel obstruction?
NPO
Nasogastric tube placement
Fluid and electrolyte replacement
Pain management
Drug therapy
What is the surgical management of bowel obstruction?
Preoperative care
Operative procedure: exploratory laparotomy to determine procedure
Postopervative care: nasogastric tube in place, usual postop care for abdominal surgery
