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NURADN 28 > Module 5 Upper GI > Flashcards

Module 5 Upper GI Flashcards

1
Q

How long does the GI tract extend? What are the main functions?

A

•30 feet

•The main function is to supply nutrients to body cells by:
–Ingestion
-digestion
-absorption
-elimination

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2
Q

How much cardiac output does the G.I. tract and accessory organs receive during rest and during eating?

A

GI tract and accessory organs receive 25-30% of cardiac output at rest, and 35% or more after eating.

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3
Q

What changes occur related to the G.I. system as people age?

A

•LES delayed emptying /muscle weakness (sphincter problems/Gerd)
• slower peristalsis (constipation)
•slowed metabolism with food & medication
• decreased hunger and thirst
• incontinence (dysfunction of anal sphincter)
• difficulty chewing (no teeth or dentures)
• lose taste buds or sense of smell
• can’t shop or cook for themselves
• liver enzymes change

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4
Q

What subjective data can you gather from a patient about the G.I. system?

A

•PMH (pertinent history how it’s affecting them (constipation, diarrhea)

•Medications (are the meds they’re on causing these problems? Polypharmacy?) 

•Health Management (Active? Fiber? Stool softeners? Past procedures? Lactose intolerance? Gerd with spicy food? Have they traveled lately?- stomach bug)

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5
Q

What objective data can you gather from a patient about the G.I. system?

A

Physical exam:
•inspect
•auscultate (normal: 5-35 bowel sounds a minute, soft, non-tender)
• palpation (have pt as flat as tolerable, empty bladder, assess for hemorrhoids and anal sphincter tone)

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6
Q

What would be considered abnormal findings during your assessment of the G.I. system?

A

•Firm tender abdomen
•discoloration, lesions, scars, masses, not symmetrical
• assessed for hemorrhoids, bleeding, assessed for anal sphincter tone

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7
Q

What is the correct way to auscultate the patient’s abdomen?

A

RLQ, RUQ, LUQ, LLQ

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8
Q

What are the 8 Diagnostic studies we can perform for upper GI problems?

A

■EGD
■Ultrasound
■CT Scan
■MRI
■ERCP- Endoscopic retrograde cholangiopancreatography)
■Upper GI/Barium Swallow
■Capsule endoscopy
■Biopsy

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9
Q

Which diagnostic would be run 1st, 2nd?

A
  1. Ultrasound (size, condition, and configuration of organs)
  2. MRI (can see lesions, where the bleed is, cancers, may or may not use contrast)
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10
Q

What is a Barium Swallow?

A

The Pt will be NPO, given contrast and then x-rays are taken

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11
Q

What is a ERCP?

A

Endoscopic retrograde cholangiopancreatography

Fiber optic camera scope sent into the duodenum and can look/place a stent into the bile duct of liver/pancreas

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12
Q

What is a capsule endoscopy?

A

The Pt will swallow and digest a capsule that has a camera in it. Through it’s way out of the body it can take up to 50,000 pictures to try to determine where to problem is in the GI tract.

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13
Q

What is in a CBC?

A

•RBC
• H & H (levels important for bleed!)
•WBC (levels important for infection!)
•platelets

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14
Q

What is in a metabolic panel?

A

•Glucose

•electrolytes (levels important to see absorption)

• Albumin (levels important for nutritional status. Keeps fluid in the bloodstream instead of tissues)

•BUN/ Creatinine (levels important for kidney function & hydration status)

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15
Q

What are liver function tests? (LFTs)

A

AST (1-36)
ALT (12-78)

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16
Q

What is Bilirubin?

A

A waste product to be excreted.
It’s A molecule formed from the breakdown of RBC. Bilirubin has a yellow pigment and when it builds up, Pt’s present jaundice (yellow)

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17
Q

What are the two pancreatic studies?

A

Amylase
Lipase

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18
Q

What are clotting factors studies?

A

Pt
PTT
Vitamin K
All help with coagulation of blood to form clots to stop a bleed.

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19
Q

What to triglycerides look at?

A

Cholesterol levels

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20
Q

What is an occult study and how
Is it done?

A

A stool study is a diagnostic that determines if there is blood in the stool sample.

A Dr. will perform a digital anal exam and do a stool smear on a specialized paper that reacts when blood in the stool is confirmed.

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21
Q

When the sympathetic/parasympathetic systems of the GI get activated, What are the S/S of gastroenteritis?

A

•infection*
•MI (back pain, nausea)*
•motion sickness*
•migraines
•chemo/medications
•acid reflux
•pregnancy
•food poisoning
•stress/fear
•Alcohol
Can all cause N/V

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22
Q

Where is the control for vomiting?

A

Located in the medulla portion of the brain activates the signal to throw up.

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23
Q

What are the Specific S/S of sympathetic GI nervous system?

A

•increased HR
•pupil dilation
•tachypnea

24
Q

What are the specific s/s for parasympathetic GI system?

A

•Increased saliva
•LES relaxed (increased acid reflux and GI motility)

25
Q

What are the 3 drugs we need to know for this section (GI PT2)

A

•Meclizine (Antivert)
•ondansetron (Zofran)
•Metoclopramide (Reglan)

26
Q

Nursing management of N/V problems

A

•medication (IV push reglan, zofran for n/v)
•nutrition (oral is the best way to rehydrate a Pt if able, then IV fluid)
•treat underlying cause
•Alternative Tx (Elevated rest to avoid GERD, BRAT diet, no spicy food, ginger OIL & peppermint OIL helps with upset, acupuncture)
•gerontological considerations (higher risk for dehydration/F&E imbalance)

  • be careful in renal Pt’s with sports drinks they can’t filter the electrolytes and end up with an imbalance)
    •BRAT = Bananas, rice, applesauce, toast
27
Q

What is GERD?

A

Gastroesophageal Reflux Disease:
GERD/heartburn
■Chronic condition
■Usually due to a weak or damaged LES (lower esophageal sphincter)
■causes (meds/NSAIDs, spicy/fatty food, caffeine/alcohol, aging/sphincter weakness, nicotine, obese Pt’s, overeating, laying down after meals)
■Dx: (try meds 1st then if they don’t work do these)
Upper GI endoscopy, barium swallow, ph monitoring, gastric emptying study.

28
Q

Manifestations of GERD?

A

■Persistent mild symptoms or mod-severe
■Heartburn is the most common symptom (mild epigastric pain)
■Chest pain (angina)
■Dyspepsia & regurgitation (pain centered in upper abdomen, big problem in the elderly because of delayed gastric emptying)
■Other symptoms:
abnormal pain/bloating, coughing, wheezing/dyspnea, sore throat/feeling of lump in your throat
■always do least-most invasive. Try meds before procedures

29
Q

Drug therapy for GERD (3 classes!)

A

•PPIs (1st line for esophagitis, prevents movement of hydrogen ions (protons) out of the parietal cell into the stomach, thereby blocks gastric acid secretion.)
•protonix (PPI)

•Histamine (H2) Receptor Blockers: block the action of histamine on the H2 receptors to “decrease acid secretion.”
•Famotidine (Pepcid) take 30 mins before meals

Risks: osteoporosis, risk for possible c-diff

•Antacids: used with or without PPI’s/H2.
–Magnesium hydroxide (watch in renal Pt’s or with elevated mag level)
–Aluminum hydroxide
–Be cautious with elderly( kidney/liver problems, polypharmacy)
–Check interactions with other home meds**

30
Q

Nursing management of GERD

A

■Teach patient about diet and eating small frequent meals
■Tell patient not to lay down for 2-3 hours after eating
■Elevate HOB to sleep (promote gastric emptying)
■Medication education
■Caregiver education (they might do the shopping/cooking they need to know!)

31
Q

Surgical Therapy for GERD, complications?

A

■Antireflux surgery: to reduce reflux by enhancing integrity of the LES
–Nissan and Toupet fundoplication
■Complications: splenic injury, infection
■Linx Reflux Management System
■Endoscopic therapy: mucosal resection and ablation
*edema of mouth/esophagus after surgery is normal for days-month. If longer then call HCP

32
Q

What is a hiatal hernia?

A

Two types: sliding and paraesophageal (rolling- medical emergency)
■A herniation of part of the stomach into the esophagus through and opening (hiatus) in the diaphragm
■Common in older adults and more common in women
■Causes:
–structural changes
–factors increasing intraabdominal pressure (weightlifters, obesity, pregnancy, tumor, ascites)

33
Q

What are the different types of hiatal hernias?

A

■Sliding
■Paraoesophageal or rolling: Medical emergency tissue gets cut off from blood/oxygen supply and necrosis can happen

34
Q

Clinical manifestations of Hiatal Hernias? Diagnostics?

A

■Symptoms are similar to GERD

■complications: GERD, esophagitis, hemorrhage from erosion, stenosis, ulcerations of herniated part, strangulation of hernia, regurgitation with tracheal aspirations

Diagnostic Studies:
■Barium swallow
■Endoscopy

35
Q

Nursing management of Hiatal Hernias?

A

Also Similar to GERD- goal is to reduce intraabdominal pressure
■Surgical approaches (not tested on different ones)
■Gerontological Considerations: kyphosis, girdles, may develop before they know what’s going on because their symptoms are less noticeable)

36
Q

What medications create extra acidity and weakening of LES? test

A

•NSAIDs
•K+ (potassium)
•Antidepressants
•calcium channel blockers

37
Q

What is PUD? (Overview of slide!)

A

Peptic ulcer Disease: Characterized by erosion of the GI mucosa caused by digestive action of HCL acid and pepsin. Can be acute or chronic * (chronic can burn through esophageal wall)
■Gastric and duodenal present differently
–Gastric more common in women, 50-60 y.o., increased cancer risk, pain 1-2 hours after food. (Shorter time to get to irritated portion)

–Duodenal more common in men, 34-45 y.o., no increased cancer risk, pain 2-5 hours after (longer time to get to this point for s/s)

38
Q

What are the causes of Peptic Ulcer Disease?

A

■Helicobacter Pylori (H.pylori)
-however just because a Pt has the bacteria doesn’t mean they automatically also have PUD
-Transmitted possibly by fecal-oral or oral-oral from family
■Medication induced (NSAIDs)
■Lifestyle (alcohol, caffeine, smoking, stress, spicy food)
■Comorbidities(mainly for duodenal ulcers): COPD, cirrhosis, pancreatitis, hyperparathyroidism, CKD

39
Q

What are the clinical manifestations of PUD?

A

■Gastric Ulcers: pain 1-2 hrs after eating (geriatric risk “silent PUD”)
–Sometimes goes unnoticed until ulcer has eroded through mucosa and pain is present with all ingestion.
■Duodenal Ulcers: 2-5hrs after eating
–Described as “burning” or “cramping”.
■Both types may cause bloating, n&V, and early fullness

40
Q

What are the diagnostic studies for PUD?

A

■Barium swallow
■Endoscopy (most accurate/can take biopsy /test secretions for H.pylori)(looks at stomach, esophagus, duodenum)
■Biopsy of mucosa to test for urease (Urea is a biproduct of H.pylori)
■Lab tests (elevated gastrin, CBC:H&H/WBC, liver enzyme:ast/alt, kidney panel/amylase/Lipase, stool study dark color)

41
Q

Drug therapy for PUD? Test

A

•Reduce secretions AND tx H.pylori
•always treat the cause (h.pylori is causing the ulcers!)
•2 rounds of 14 day regimen of triple med therapy :
-amoxicillin
-clarithromycin (biaxin)
-metronidazole (Flagyl)
-tetracycline
-PPI
•H2 receptor blockers, antacids, misoprostol, tricyclic antidepressants

42
Q

Complications of PUD: Hemorrhage

A

Most common complication
■S&S:
–Bloody or black tarry stool
–Coffee ground emesis
–Shock
1. Increased HR/BP
2. BP drop d/t hypovolemia
3. Weak, thready pulse, increased RR

43
Q

Complications of PUD: Perforation (hole)

A

Highest risk with large penetrating duodenal ulcers
■S&S: sudden severe upper abdominal pain that quickly spreads throughout abdomen
–Radiates to back and shoulders
–Abdomen is rigid and board-like (painful)
–Bowel sounds absent (sympathetic response)
-antacids will no longer help, problem is too advanced. Bile, stomach acid, food, saliva is all leaking out into peritoneal cavity**

44
Q

Complications of PUD: Gastric outlet Obstruction

A

medical emergency

■Causes from acute or chronic issues
■S&S: edema, pylo spasms, pain relieved by burping or vomiting, constipation
■Tx: decompress stomach (NG tube) for days
–Correct F&E imbalances (K+ low)
–Balloon dilation/stent/scar tissue removal
–Pain management
–Possible PPI (block secretions) or h2 receptor blocker

45
Q

Nutritional Therapy for PUD?

A

■No caffeine
■No alcohol
■**Eliminate foods that cause symptoms! **(specific for each Pt)
■Hot and spicy foods (may irritate some but not others)
■Carbonated drinks
■Acidy foods such as tomatoes
■Meat extract (broth)
■Supplement with vitamin B-12

46
Q

Surgical Therapy for PUD?

A

■Try meds and lifestyle changes first surgery is last resort **
■Vagotomy: cutting a branch of the vagus nerve
■Pyloroplasty: surgical incision into the pyloris or sphincter where stomach empties to duodenum
■Same post-op tx for perioperative
NPO, (to decrease gastric secretions)
PPI (protonix)
Slowly increase food (ice chips, then clear liquid diet etc)

47
Q

Nursing considerations for PUD?

A

■Overall goals:
–Adhere to the prescribed therapeutic regimen (antibiotic regimen)
–Reduce pain
–Prevent complications
–Nutritional therapy (teach caregiver!)
–Lifestyle change education
■Labs (H&H- bleeding important for post-op. WBC-infection)
■Tx complications: h.pylori, medications (specifically NSAIDs)

48
Q

What is dumping syndrome?

A

Complication after surgical removal of a large part of the stomach and pyloric sphincter
■Symptoms: Generalized weakness, dizziness, diaphoresis, tachycardia, abdominal cramping, self-limiting, epigastric fullness
-occurs 15 min after eating

■Tell patient to rest after eating, may reduce the incidence

49
Q

What is Gastritis?

A

•common GI Issue

Inflammation of the gastric mucosa
■Risk factors:
–Meds (ASA, corticosteroids, biphosphonate, iron, digitalis, NSAIDs)
–Diet/Lifestyle
–Microorganisms (stomach bug)
–Diseases (Burns, crohn’s sepsis)
–Procedures (EGD, NG Tube)

50
Q

Clinical manifestations of Gastritis and diagnostic studies?

A

■Acute Gastritis S&S:
–anorexia, nausea & vomiting, epigastric tenderness, feeling of fullness
■Chronic Gastritis S&S: might be asymptomatic
–same as acute but longer lasting
■Dx: hx, endoscopy with biopsy

51
Q

Nursing management for Gastritis?

A

Treat the cause! (Treat the bleed, infection or bacteria!)
■Life style change
■Tx pain (not w/NSAIDs)
■6 small feedings a day
■Need a lot of nutritional help
■Reduce stress

52
Q

Explain Upper GI Bleed

A

■Locations: esophagus, stomach, duodenum. (Severity depends on location)
■Causes? (NSAIDs, H.Pylori)
■S&S: may be sudden obvious bleeding or insidious occult bleeding
■Diagnostic Studies: endoscopy, CBC, PT, BUN, Liver panel(broken down proteins gets stuck in kidney ducts/can’t filter out), ABG’s, type and cross match (blood transfusions)

Bleeds can be capillary, venous, arterial (worst one)

53
Q

Explain Mallory-Weiss Tear

A

Mucosal tear at GE junction
(Other causes: alcohol, chronic vomiting, EGD procedure irritation)
■Controlled by endoscopic coagulation or heater therapy
■Hypertonic-saline epinephrine-Trying to constrict blood vessels, helps with platelet aggregation

54
Q

Nursing Considerations for GI Bleeds?

A

■Massive bleed is considered >1500ml of blood or 25% of intravascular blood volume
■VS q 15-30 mins
■I&O, fluid volume deficit problems
■Abdominal assessment (firm/board-like, NO bowel sounds cause: sympathetic GI nervous system)
■NG (decompress secretions/gases)
■Assess stools
■IV fluids (isotonic fluids, PRBC, FFP
•peripheral perfusion: cap refill, therapy pulses, decreased output(look @kidney’s), cyanosis

•book table page 919

55
Q

Drug Therapy for GI Bleed

A

IV PUSH
■PPI’s
■Antiacids (PO/ NG)
■IV fluids (isotonic)
■Blood/FFP (fresh frozen plasma)
■Abx

56
Q

Endoscopy/ Surgical Therapy for GI Bleed?

A

Endoscopy is 1st line treatment
■Technique used is based on severity and MD
–Clips or bands
–Thermal ablation
–Injection with epinephrine
■Surgery

NURADN 28 (12 decks)

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