Module 3 Gastrointestinal System Flashcards
Trace the pathway of food through the digestive system.
Mouth, esophagus, lower esophageal sphincter, stomach, pyloric sphincter, duodenum, jejunum, ileum, large intestine, rectum, and anus. Remember that the duodenum, jejunum, and ileum are all parts of the small intestine.
The pyloric sphincter is between the stomach and the duodenum. True or false?
True
The nurse understands that the gallbladder is located in this quadrant of the abdomen?
Right upper quadrant
The nurse understands that the liver is located in this quadrant of the abdomen?
Right upper quadrant
The nurse understands that the pancreas is located predominately in this quadrant of the abdomen.
Left upper quadrant
The spleen is located predominately in this quadrant of the abdomen?
Left upper quadrant
The appendix is located in this quadrant of the abdomen?
Right lower quadrant
The rectum is located in this quadrant of the abdomen?
Left lower quadrant
The nurse understands that breakdown of food begins in the mouth with this enzyme present in a person’s saliva?
Amylase
State the three functions of the saliva.
- Buffer to protect the oral mucosa
- Saliva contains ptyalin and amylase, which initiate the digestion of dietary starches.
- Antibacterial action to help keep the mouth clean
List the major gastrointestinal hormones.
Cholecystokinin (CCK), Secretin, and Gastrin
Describe the function of Cholecystokinin (CCK). How would the patient be affected if CCK is deficient?
CCK stimulates contraction of the gall bladder, stimulates secretion of pancreatic enzymes, slows gastric emptying, and inhibits food intake. Therefore if CCK is deficient or not being released appropriately then the person would have a larger appetite and less control over their food intake.
Describe the function of secretin. How would the patient be affected if secretin is deficient?
Secretin stimulates secretion of bicarbonate-containing solution by the pancreas and liver. Remember bicarb is a buffer so if secretin is deficient the person will have ulcers form from the increased acid levels not being reduced appropriately.
Describe the function of gastrin. How would the patient be affected if gastrin is deficient?
Gastrin stimulates secretion of gastric aid and pepsinogen, increases gastric blood flow, stimulates gastric smooth muscle contraction, and stimulates growth of the gastric, small intestine, and colon mucosa. Therefore if gastrin is deficient then the absorption of nutrients will be significantly reduced because acid levels will be decreased, blood flow for absorption will be decreased, and food will not move through the GI tract efficiently.
The nurse is assigned to care for a client with c-diff during her shift. Prior to entering the clients room the nurse understands that all clients with c-diff have these two things in common?
These patients all have copious amounts of foul smelling, watery diarrhea and a history of broad spectrum antibiotic usage.
The nurse understands that c-diff is highly contagious and is easily transferred from patient to patient. The nurse understands that hand hygiene can prevent infections from spreading. How should the nurse perform hand hygiene after caring for a patient with c-diff?
The nurse should only** wash her hands with soap and water. The nurse should **never use alcohol based hand sanitizer since this will not kill the c-diff spores.
List common symptoms associated with appendicitis.
Abrupt onset with pain originally at the epigastric or periumbilical that then localizes to the lower right quadrant. Nausea, vomiting, RLQ tenderness, rebound tenderness, elevated WBC count, and fever.
List potential complications of appendicitis?
Perforation (rupture), peritonitis, sepsis, localized periappendiceal abscess formation
What is the treatment for appendicitis?
Treatment for appendicitis is surgery.
The nurse is caring for a patient with appendicitis. The patient reports that the right lower quadrant pain has suddenly been relieved. What should the nurse suspect has happened?
The nurse should expect the appendix has ruptured.
A client has symptoms of belching, nausea, burning pain in the chest, dry cough, and heartburn. The physician has dx with client with GERD. What medication treatment should should the nurse anticipate in this patient?
The nurse should anticipate antacids and proton pump inhibitors (PPI’s).
The nurse understands that this sphincter is weak in patients with a diagnosis of GERD?
Lower esophageal sphincter
The nurse is caring for an infant with severe projectile vomiting, weight loss, constipation, fatigue, excessive hunger, and a lump in abdomen. The physician tells the patient’s parents that the child has pyloric stenosis and failure to thrive. The parents begin to cry after the physician leaves and asks what they did wrong and why their infant is not gaining weight? The nurse says …
The nurse says that pyloric stenosis is a condition in which the opening between the stomach and small intestine (duodenum) thickens. This thickening will prevent food from entering the small intestine where most of the nutrients are absorbed. This means that no matter how much you feed your child the child will vomit the food up because it cannot move through the intestines. This is not your fault. You did nothing wrong, the cause of this disorder is unknown. Your child will need surgical correction of the problem.
The nurse understands that peptic ulcer disease (PUD) is an ulceration that develops in the stomach lining or duodenum from exposure to the acidic stomach acid. What medications place patient’s at a higher risk of PUD?
Aspirin and NSAIDs. Particularly susceptible when NSAIDs are taken with warfarin and/or corticosteroid medications.
What are the primary complications of peptic ulcer disease (PUD) and what is the preferred treatment of PUD?
Hemorrhage and perforation are the primary complications of PUD. The preferred treatment is PPI’s (proton pump inhibitors).
The nurse understands that PUD can be the result of H. pylori gastritis. How is H. pylori gastritis contracted and what is the preferred treatment?
H. pylori are small, curved, or spiral shaped, gram-negative rods (proteobacteria) that can colonize the mucus-secreting epithelial cells of the stomach. Exact cause is unknown. May be passed by saliva, fecal matter, and contaminated food / water. Treatment is antibiotics or bismuth salts in combination with PPI’s.
The nurse recognizes that understanding Crohn’s disease is very important in the education of the new graduate nurse who is working on the gastroenterology floor. When assessing for understanding the new graduate should state that Crohn’s disease is defined as ______ and the characteristic features include ______.
Crohn’s disease causes recurrent, granulomatous type of inflammatory response that can affect any area of the GI tract. The characteristic feature of this disease is the sharply demarcated, granulomatous lesions surrounded by normal-appearing mucosal tissue. Symptoms will depend on the lesion location. Most common symptoms include: diarrhea, abdominal pain, weight loss, fluid / electrolyte disorders, malaise, and low-grade fever which can be confused with other disorders. Symptoms specific to Crohn’s disease include a client experiencing tender red bumps on the shins, ankles, and occasionally arms and the client may complain of pain or stiffness in joints related to arthritis or arthralgia.
There is a cure for Crohn’s disease. (True or False)
False
The nurse would describe ulcerative colitis as the following to a group of nursing students?
Ulcerative colitis is a nonspecific inflammatory condition of the colon that leads to the formation of pinpoint hemorrhages which in time develop into crypt abscesses. These lesions may become necrotic and ulcerate. Limited to the mucosa and submucosa and is confined to the rectum and colon. Inflammatory process is continuous rather than skipping areas
List common symptoms of ulcerative colitis.
Ulcerative colitis is a relapsing disorder with periods of diarrhea. Stool will frequently appear with blood and/or mucus. Other symptoms include: abdominal cramping, fecal incontinence, anorexia, weakness, dehydration, tachycardia, abdominal distention/tenderness, and fatigue.
Irritable bowel disease (irritable bowel syndrome) is a functional GI disorder characterized by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities which affect the large intestine. The nurse understands that symptoms of this disorder will include?
Abdominal pain, bloating, abdominal distention, constipation, diarrhea, or alterations between periods of diarrhea and constipation. Frequent stools (more than 3x a day), stool can be hard, lumpy, loose, or watery. May strain, experience urgency, or feeling of incomplete evacuation.
What would the nurse anticipate as symptoms and causes of malabsorption?
The nurse understands that causes of malabsorption include infection, medications, small intestine surgery, and disorders like celiac disease. Symptoms of malabsorption include diarrhea, flatulence, distension, abdominal pain, ascites, weakness, muscle wasting, weight loss, steatorrhea stools (fatty, bulky, yellow-gray, malodorous stools), easy bruising, bleeding, vitamin K deficiency, vitamin deficiencies, bone pain, fractures, tetany, macrocytic anemia, and glossitis.
A 22 year old male patient reports diarrhea with small amounts of blood and large amounts of mucus present. The episodes of diarrhea are intermittent and includes abdominal cramping with some incontinence of stool. What disease do you suspect?
Ulcerative colitis would be expected. When assessing this question you will notice that many of the symptoms are non-specific and could be associate with multiple GI disorders. The condition is noted as intermittent so it is relapsing which is a clue. Another clue is the blood and mucus in the stools which is characteristic of ulcerative colitis because remember that UC results in pinpoint hemorrhages which may ulcerate in time.
Describe the disease process of cholelithiasis and cholecystitis as if you are describing it to a patient.
Cholelithiasis means that you have gallstones in your gallbladder. The gallbladder’s job is to store and concentrate bile which is used to digest fats in the diet as the food moves through the small intestine. Cholecystitis means that your gallbladder is inflamed most often as a result of a gallstone blocking the tube that leads from the gallbladder to the small intestine. Gallstones are most often made of cholesterol that you intake in your diet.
Explain what diet modifications the nurse would recommend to a patient with cholecystitis before and after surgery is completed.
The nurse should recommend a diet that is low fat, low cholesterol, and low triglyceride to a client dx with cholecystitis. After surgery many patients will want to eat high fat meals again. The nurse should advise that pain will occur after gallbladder removal when the patient eats high fat meals because the bile is needed to breakdown lipids (fats). Now that the gallbladder is removed bile which is normally concentrated and held in the gallbladder will drain more continuously and produce a laxative like effect when the client eat high fat meals. So the client will still have symptoms of pain, gas, and diarrhea post surgery with the ingestion of high fat meals.
What is the normal level of total bilirubin for an adult client?
0.3 to 1.2 mg/dL this level may vary slightly depending on what ranges your lab utilizes. Remember that a high level of bilirubin would make the nurse anticipate the patient will have jaundice.
Describe pancreatitis.
Pancreatitis is an inflammation of the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. In acute pancreatitis the inflammation is brought on by premature activation of pancreatic enzymes and is reversible.
List potential causes of pancreatitis.
Potential causes of pancreatitis include gallstones, ETOH, hyperlipidemia, infections, cystic fibrosis, diabetes, medications, abdominal trauma or surgery.
The nurse is caring for a client with acute pancreatitis and knows that lab testing can be utilized as a part of the diagnosis of pancreatitis. What lab results would indicate acute pancreatitis?
Elevated serum amylase and lipase three or more times the upper limit of normal,
The nurse anticipates what treatment plan to be ordered by the physician in acute pancreatitis?
Acute pancreatitis treatment includes IV fluids, nasogastric tube insertion, and NPO (nothing by mouth). The patient will also require pain relief and electrolyte replacement.
It is appropriate to give a patient with symptoms of nausea, vomiting, diarrhea, fever, and jaundice who has a diagnosis of hepatitis A an antibiotic for treatment of their condition. (True or false).
False. Hepatitis A is a viral infection and therefore an antibiotic will not treat the infection.
You know a patient with a recent diagnosis of hepatitis A understands their disease process when they say “I should have stopped using IV drugs and I would not have contracted this disease.” (True or false)
False. Hepatitis A is contracted by the fecal oral route.
Medications, toxins, alcohol, drugs, and the hepatitis viruses are all possible causes of hepatitis.
TRUE False
True
The nurse is explaining cirrhosis to a patient and states that this diagnosis best described as?
Cirrhosis is the end-stage of chronic liver disease, in which much of the functional liver tissue has been replaced by fibrous tissue. Common causes include alcohol, viral hepatitis, toxic reactions to drugs/chemicals, biliary obstruction, hemochromatosis, Wilson disease, and NAFLD (Nonalcoholic fatty liver disease).
The nurse understands that portal hypertension is an elevated pressure in the portal venous system. The portal vein is a major vein that leads to the liver. Symptoms of portal hypertension the nurse should anticipate would include?
Symptoms of portal hypertension include GI bleeding with black, tarry stools or blood in the stools. Vomiting blood. Ascites and confusion. Remember portal hypertension is the result of many different disease processes so all symptoms of underlying cause may be present in these patients as well.
What treatment would the nurse anticipate in a client dx with portal hypertension?
Treatment would include treating any underlying condition. Treat bleeding. Medications may include beta blockers (propranolol) and lactulose to reduce ammonia. A low sodium diet would be recommended. Surgical treatment would include transjugular intrahepatic portosystemic shunt, distal splenorenal shunt, liver transplant, and ascites fluid drainage (paracentesis).
The nurse understands that liver failure is the most severe consequence of liver disease. This occurs either suddenly or gradually depending on cause. The nurse knows possible causes of liver failure include?
Causes include a reaction to a medication, high doses of acetaminophen or paracetamol, hepatitis infection, alcohol abuse, and advanced fatty liver. Sudden fulminant hepatitis which is a sudden damage to the liver such as with overdoses of medications like Tylenol.
In a client diagnosed with liver failure the nurse would anticipate symptoms to include:
Sweet odor on breath, jaundice, RUQ pain, ascites, nausea, vomiting, malaise, confusion, sleepiness, deficiency in fat-soluble vitamins, fatty stools, gynecomastia, menstrual irregularities, spider angiomas, and tremors. Fulminant hepatitis - symptoms include elevated ammonia levels, convulsions, confusion, a flapping tremor, and coma.
List potential complications of liver failure.
Potential complications of liver failure include liver cirrhosis, cancer of liver, liver failure, hepatic encephalopathy, portal hypertension, glomerulonephritis, and death.
