Med-Surg: GI, Hepatic, Pancreatic/2 Flashcards
GERD contributing factors
6
- older
- obese
- smoking
- heavy alcohol use
- ingestion of very large meals
- obstructive sleep apnea
GERD manifestations
8
- dyspepsia (indigestion)
- regurgitation
- eructation
- flatulence
- coughing, hoarseness, wheezing
- water brash
- dysphagia
- odynophagia
GERD - limit or avoid foods that decrease LES pressure
6
- chocolate
- caffeine
- fried/fatty foods
- alcohol
- carbonated beverages
- spicy/acidic foods
GERD - teach (diet)
4
- dietary changes
- eat 4-6 small meals/day
- eat slowly and chew thoroughly
- eating nothing for at least 3 hours before bed
GERD - interventions
5
- diet
- elevate HOB 6-12 inches
- sleep on right side
- manage weight
- wear loose fitting clothes
GERD histamine blockers
2
famotidine
ranitidine
hiatal hernia
portion of the stomach protrudes through the esophageal hiatus of the diaphragm into the chest
hiatal hernia contributing factors
5
- high fat diet
- caffeinated drinks
- tobacco products
- meds (CCBs, anticholinergics, nitrates)
- obesity
hiatal hernia manifestations
8
- regurgitation
- persistent heartburn or dysphagia
- belching
- epigastric pain
- dysphagia
- breathlessness or feeling suffocated after eating
- chest pain that mimics angina
- symptoms worsen after a meal or when supine
hiatal hernia interventions
7
- prepare for barium swallow with fluoroscopy
- assess diet
- small freq meals
- avoid eating 3 hrs before bed
- sit upright 1-2 hour after meal
- avoid straining
- wear loose fitting clothes
PUD has a high risk for
perforation and bleeding
PUD contributing factors
9
- NSAIDs
- corticosteroids
- h. pylori infection
- uncontrolled stress
- stress
- caffeine
- alcohol
- type O blood
- ages 40-60
PUD manifestations
5
- dyspepsia
- dull, gnawing, burning, midepigastric and/or back pain with localized tenderness
- worsen with empty stomach
- relief with antacids
- decreased h and h
PUD dietary teaching
3
- avoid very cold and very hot foods
- eat 3 regular meals/day
- avoid caffeine, alcohol, decaffeinated coffee, milk, cream
PUD meds triple therapy
10-14 days - two antibiotics plus one PPI:
metronidazole or amoxicillin and clarithromycin plus PPI
PUD quad therapy adds what
bismuth salts
PUD meds - general
7
- antibiotics
- mucosal healing agents
- stool softeners
- antacids
- histamine receptor antagonists
- prokinetic agents
- PPIs
IBS
chronic disorder with recurrent diarrhea, constipation, and/or abd pain and bloating
IBS risk - diet, gender
high fat diet
female gender
IBS manifestations
7
- weight loss
- fatigue and malaise
- erratic bowel patterns
- abd pain relieved by defecation
- abd distention
- mucus with passage of stool
- colicky abd with diffuse tenderness
abd pain relieved by defecation
IBS
colickly abd with diffuse tenderness
IBS
IBS - nursing interventions
4
- encourage a diet high in fiber
- encourage regular exercise
- stress reduction
- eat at regular times
psyllium
bulk agent for IBS
IBS complementary agents
3
- peppermint oil
- artichoke leaf extract
- caraway oil
IBS and IBD
IBD inflammatory bowel disease is a more severe, autoimmune disorder and includes Crohn’s disease and UC
IBS stands for
irritable bowel syndrome
Crohn’s disease
inflammation of GI tract that extends through all layers; can occur anywhere in GI tract; most common in distal/terminal ileum; cobblestone appearance of ulcers that are separated by normal tissue
CD contributing factors
6
- family history
- jewish ancestry
- bacterial infection
- smoking
- 15-40
- living in urban area
abd pain in RLQ that doesn’t relieve with defication
CD
CD manifestations
10
- abd pain RLQ, not relieved by defecation
- pain aggravated by eating
- low grade fever
- diarrhea, steatorrhea
- weight loss
- formation of fistulas
- usually no bleeding
- leukocytosis
- string sign on x ray
- low H/H, high ESR
IBD: CD or UC - no bleeding usually
CD
IBD: CD or UC - cobblestone
CD
IBD: CD or UC - through all layers
CD
CD nursing interventions
4
- promote rest
- record stools
- monitor/prevent fluid deficit
- nutrition - high calorie, high protein, low fiber, no diary
CD complications
5
- intestinal obstruction
- perianal disease
- fluid electrolyte imbalances
- malnutrition
- fistulas, abscess
UC
recurrent ulcerative and inflammatory disease of the superficial mucosa of the colon. usually begins in rectum and spreads proximally through the entire colon. characterized by contiguous ulcers
UC contributing factors
7
- family hx
- jewish ancestry
- isotretinoin/accutane use
- female 15-25
- males 55-65
- white
- low fiber diet
UC manifestations
9
- liquid, bloody stool (10-20 per day)
- low grade fever
- abd distention along colon
- high pitched bowel sounds
- LLQ pain
- anorexia, weight loss
- vomiting, dehydration
- sensation of urgent need to defecate
- hypocalcemia, anemia
IBD: CD or UC - liquid, blood stools
UC
IBD: CD or UC - 10 to 20 stools/day
UC
IBD: CD or UC -high pitched bowel sounds
UC
IBD: CD or UC - LLQ pain
UC
IBD: CD or UC - hypocalcemia
UC
IBD: CD or UC - sensation of urgent need to defecate
UC
what helps differentiate CD and UC
bleeding is common in UC
UC nursing interventions 4 -promote -monitor -maintain -monitor
- promote rest
- monitor stool
- maintain NPO during acute phase
- monitor for dehydration
UC diet mgmt
2
- increase oral fluids
2. low residue, high calorie, high protein diet
UC intervention - administer
2
- multivitamins
2. supplemental iron
