Mod G GI Study Guide

Question 1

Why is it important to take a good health history?

Answer 1

a. Know about prior problems
b. Nutritional status, eating and bowel habits
c. Socioeconomic status
d. Meds they’re on to avoid contraindicated medications

Question 2

Why is it important to specifically know about their current problem?

Answer 2

e. Know breakdown of problem
f. When did it start, how long does it last, S&S, alleviating factors
g. Pain levels, what kind, where is it, quality
h. Changes in bowel or nutrition habits - do certain foods make it worse, bowels changed?

Question 3

What type of physical assessment do you do with GI problems?

Answer 3

i. Start with mouth; look for sores, bleeding
j. Check throat for redness, swelling, causes of swallowing problems
k. Bad breath could be regurgitation problems
l. Abdomen next, all 4 quadrants; inspect, auscultate, percuss, palpate. Looking for tenderness, abnormalities, obstructions, masses

Question 4

What are you looking for when you do a physical assessment of the GI?

Answer 4

m. Pulsating mass - Don’t touch, could be an abdominal aortic abscess.
n. Any abnormalities, pain, etc

Question 5

What type of GI diagnostic tests might be ordered? For what?

Answer 5

o. Check for infection: CBC for WBC, platelet, H&H count
p. Vomiting or diarrhea, check electrolytes: BMP or CMP
q. Jaundice suspected: Check liver enzymes, bilirubin or ammonia levels.
r. Check urine for amylase or uribilogen
s. Check stool samples for occult blood, C Diff or parasites
t. Radiological: CT scan, abdominal x-ray, MRI

Question 6

What is an EGD? What are the needs post procedure? Possible complications?

Answer 6

u. Scope that goes down the throat to look for problems.
v. Post op needs: Prevent aspiration, nothing to eat or drink until gag reflex returns.
w. Possible complication: If something is perforated by EGD, patient will have continuing sharp pains in upper chest & shoulder post-op. Immediate surgery.

Question 7

When can they advance from NPO?

Answer 7

When gag reflex returns.

Question 8

What is a colonoscopy? What are the needs post procedure? Possible complications?

Answer 8

y. Scope into the rectum to look at the colon.
z. Bright red blood: upper GI bleed, dark red blood: lower GI bleed.
aa. Post op needs: Pass flatulence or have bowel movement, watch for signs of perforation (continuing abdominal pain or hemorrhaging).

Question 9

What does an ERCP look for?

Answer 9

1

Question 10

What is stomatitis? Causes? Complications? Treatment?

Answer 10

bb. Irritation or inflammation of the mouth & oral mucosa
cc. Primary: caused by herpes (non infectious)
dd. Secondary: caused by infectious virus, fungi or bacteria, or chemo & radiation
ee. Complications: causes nutritional status, can obstruct airway
ff. Treatment: Antibiotics; if fungus, swish and swallow lidocane solution; perform mouth care frequently

Question 11

What is Candida Albicans? Treatment?

Answer 11

gg. Thrush, fungus infection
hh. Caused by: overuse of antibiotics
i. Babies can get it from yeast, from nursing
ii. Treatment: Oral lidocane solution

Question 12

What is leukoplakia? Erythroplakia?

Answer 12

: Benign white patching or lesions in mouth

ii. Caused by: prolonged irritation of mouth, bad dentures, broken teeth, biting cheeks, oral tobacco use
iii. May be early sign of HIV
kk. Erythroplakia: Flat red patch on roof of mouth, biopsy to diagnose.

Question 13

What is the difference between squamous and basal cell oral cancers? Causes of both?

Answer 13

mm. Squamous cell: 90% of all cancers. Appears on buccal mucosa, tongue, etc
iv. Slow growing - caused by tobacco, alcohol, gum disease, age.
nn. Basal cell: Raised scab on lips
v. Caused by: excessive exposure to sunlight

Question 14

What is Karposi’s sarcoma?

Answer 14

oo. Purple lesions, usually seen on hard palate; lesion on blood vessels.
pp. Most commonly seen in AIDS patients.

Question 15

What are the treatment for oral cancer?

Answer 15

qq. Maintain airway
rr. Steroids and antibiotics
ss. Aspiration precautions
tt. Chemo or radiation therapy
uu. Keep mouth moist, use a sponge for oral treatments; rinse with sodium bicarbonate or warm salt water.
vv. No alcohol or mouthwash, or hard bristle brushes.
ww. Surgical removal
vi. Concerns: airway clearance, nutrition, self-image problems

Question 16

With mandibular fractures, what needs to be watched?

Answer 16

xx. Airway

yy. Nutrition

Question 17

What is GERD? S/S? Complications? Treatment?

Answer 17

zz. Gastro esophageal reflux disease
aaa. Caused by a back flow of gastrointestinal contents into esophagus
bbb. Signs & symptoms: heartburn, chest pain, bad breath, pneumonia r/t aspiration
ccc. Complications: aspiration, erosion of esophagus (if long term), can lead to ulceration, varices, etc.
ddd. Treatment: Proton pump inhibitors, sleeping with head of bed raised, eating small frequent meals, avoid eating before bed; If extensive, surgical procedures, from treating ulcers to removing esophagus.

Question 18

What meds are used? What does each do?

Answer 18

eee. Proton pump inhibitors, #1 treatment for long term GERD: Protonix,
vii. Watch Calcium levels, long-term use can cause low calcium and fractures.
fff. Histamine receptors to reduce gastric acid production: Zantac, Tagament,
ggg. Antacid to neutralize acid: Mylanta, Maalox, baking soda.
hhh. Prokinetic drugs, help accelerate gastric contents: Reglan

Question 19

What are the two types of hiatal hernias? S/S? Complications? Treatment?

Answer 19

iii. Rolling and sliding
jjj. Rolling is worse, because it can become strangulated
kkk. Signs and symptoms: Heartburn, regurgitation, pain, dysphagia, full feeling after eating with rolling hernia, suffocating feeling, symptoms worsen with laying down
lll. Nonsurgical treament: same as GERD.
mmm. Surgical treatment: weight loss beforehand, education about drains that will be in place after: NG tube, chest tube.
nnn. Post op: Airway, pain control, prevent complications (look for infection, drainage), nutrition because they can’t eat until heals.

Question 20

What is most important about esophageal tumors? S/S? Complications? Treatment?

Answer 20

ooo. Airway is most important.
ppp. Esophageal tumors are usually fatal
qqq. Signs & symptoms: Dysphagia, weight loss, regurgitation, bad breath; if progressed into laryngeal area, hoarseness.
rrr. Level of dysphagia = level of disease process.
sss. Nonsurgical treatment: Nutritional support, swallowing therapy, chemo or radiation, dilation of esophagus.
ttt. Surgical: Esophagectomy, removal of part or all of esophagus.

Question 21

What are esophageal diverticula? Treatment?

Answer 21

uuu. Sacs of herniation on esophageal wall
vvv. Signs and symptoms: dysphagia, regurgitation, halitosis, coughing at night.
www. Complications: high risk for perforation
xxx. Nonsurgical treatment: Positioning. Teach to eat small, frequent meals, raise head of bed, stay upright while eating, no exercising after eating,
yyy. Surgical treatment: remove sacs; teach about NG tube.

Question 22

What causes esophageal varices? S/S? Complications? Treatment?

Answer 22

zzz. Break down mucus in esophagus; makes veins susceptible to harsh substances.
aaaa. #1 cause is alcohol abuse.
bbbb. Signs & symptoms: bright red vomit, decrease in H&H.
cccc. Complications: risk for massive, uncontrolled bleeding.
dddd. Nonsurgical treatment: Vasoconstrictors, such as Terlipressin, somatostatin, Enderall which is beta-blocker and prevents bleeding.
eeee. Surgical treatment: band or inject varices, balloon therapy to control massive bleeding.

Question 23

What causes gastritis? How is it managed?

Answer 23

ffff. Inflammation of gastric mucosa.
gggg. Treatment: treat symptoms, remove causes of gastritis. Bland diet; small frequent meals; stay away from spicy, acidic foods; avoid caffeine; PPIs and antibiotics.

Question 24

What is done in gastric decompression?

Answer 24

hhhh. NG tube to remove gas or secretions from stomach

iiii. Help minimize vomiting and aspiration.

Question 25

What is PUD?

Answer 25

jjjj. Peptic ulcer disease

Question 26

What are the 3 types? How are they treated? Complications?

Answer 26

kkkk. Gastric: in the stomach.
llll. Duodenal: in intestines.
mmmm. Stress: Caused by medical crisis or trauma.
nnnn. Treatment: treat symptoms.
viii. Bleeding: give blood
ix. Perforation: surgery

Question 27

What type drugs are used in treatment? How are they given?

Answer 27

oooo. PPI, antibiotics, flagulent amoxicilin, antacids, H2 antagonists such as Zantac.
pppp. Carafate used to coat mucosal lining and ulcer, prevents further irritation. Taken 1 hour before meals and at bedtime.

Question 28

What are the 4 types of food poisoning? Causes?

Answer 28

qqqq. Staph: caused by contaminated meat or dairy; also transmitted by humans.
rrrr. E coli: Eating meat contaminated with animal feces.
ssss. Botulism: improperly canned foods.
tttt. Salmonella: contaminated foods or drinks. Can be transmitted fecal-oral.

Question 29

What are the S/S of each type of food poisoning?

Answer 29

uuuu. Staph: abrupt nausea & vomiting, diarrhea without fever.
vvvv. E coli: abrupt nausea & vomiting, abdominal cramping, diarrhea with fever.
wwww. Botulism: Nausea & vomiting, diarrhea, weakness progressing to paralysis. Complication: airway.
xxxx. Salmonella: Fever, nausea & vomiting, abdominal cramping, diarrhea lasting 3-5 days.

Question 30

Complications of each type of food poisoning?

Answer 30

yyyy. Watch out for botulism, because it affects airway.
zzzz. Dehydration, fluid volume deficit.
aaaaa. Electrolytes off.

Question 31

Treatment of each type of food poisoning?

Answer 31

bbbbb. Staph: give IV fluids for dehydration. No drugs used.
ccccc. E coli: IV fluids, antidiarrheal drugs.
ddddd. Botulism: IV fluids, antitoxin if patient isn’t hypersensitive, stomach lavage (flushing with water) to get rid of anything in system. Ventilation in extreme cases because of paralysis.
eeeee. Salmonella: treat symptoms.
x. If with bacteremia, treat with ampicillin or cipro.

Question 32

What is the lap band? Nursing care?

Answer 32

fffff. Adjustable band filled with saline; section off a part of stomach.
ggggg. Nursing care: teach to eat small portions, start out on clear liquids and work up, watch for erosion at band site, outpatient surgery.

Question 33

What is a Roux-en Y? Nursing care? Complications? Nutritional changes?

Answer 33

hhhhh. Gastric bypass: surgically resection the stomach, attach small intestine to new stomach.
iiiii. Nursing care: same as lap band.
jjjjj. Teach about nutritional changes - malabsorption problems
kkkkk. Complications: dumping syndrome, nausea and vomiting, perforation.
lllll. Know about nutritional changes; no blood thinners

Question 34

What type of drains might you see with GI surgeries? What care should be done?

Answer 34

1

Question 35

What care should be done to incision sites?

Answer 35

1

Question 36

What care is done for NG tubes? If they are placed by surgery, what is the main concern?

Answer 36

1

Question 37

Always assess complications for simple outcomes first, before calling MD!

Answer 37

1