MS TEST 2 part 2 Flashcards
obstructed common bile duct will be monitored for:
Steatorrhea
Purpose of bile?
break down fat
After a Billroth II pt is dizzy, weak, has palpitations, what should nurse tell pt to do?
Lie down for 30 min after eating
H- pyori treated with
omeprazole, amox, clarithromycin
Age for most upper GI bleed?
60% over 65
severity of UGI bleed depends on origin
Venous-lower pressure easier to stop capillary - almost miniscule, inflammatory process arterial- worst- high pressure hard to stop
Types of UGI Bleeding
hematemesis- coffee grounds or fresh bright red Melena- black tarry stools due to iron- causes by digestion of blood.
occult bleed
detected by Guiac test can be tested in stool, vomitus, GI secretions
Melena
the longer the passage of blood thru the intestines the darker the stool color (caused by Hgb/release of iron)
Mucosa irritating drugs
Aspirin, NSAIDS, corticosteroids, alcohol, anti-platelets , cigarettes
What causes most peptic ulcer disease? Hint (80% of cases!)
80% r/t H Pylori or drug use (NSAIDS)
Polyps
changes in tissues- can lead to cancer
Stress related mucosal disease
instigates sympathetic nervous system that pulls perfusion away from GI causing thinning of the tissues
Endoscopy
primary tool for locating source of bleeding
How is lavage done?
drop NG tube- instill 100CC ROOM TEMP water then pull liquid out= if pink there is blood
Type of lavage on unconscious pt?
tube goes thru mouth
Hgb
actual measurement of RBC
Hct
percentage of whatever qty Hgb (so it won’t decrease if pt losing blood)
Mallory-Weiss tear
tear in esophageal tissue from forceful repeated emesis = will actively bleed until we run endoscope down and try to stop bleeding
portal vein
vein at top of liver
gastric varices
like a varicose vein but on esophagus
Goal of endoscopic hemostasis therapy
achieve coagulation or thrombosis in bleeding artery (stop flow of blood)
How do we stop flow of blood using hemostasis therapy?
thermal heat to try to cauterize, laser, cryotherapy
Goal of drug therapy for bleeding
decrease bleeding decrease HC acid secretion Neutraliize HCl acid that is present
coumadin antidote
vit K
antidote for heparin
protamine sulfate
What is the drug therapy for bleeding due to ulceration?
Epinephrine = produces tissue edema= pressure on bleeding source (usually combines with other therapy)
Sandostatin (octreotide) or somastatin
used for upper GI bleed - reduces blood flow to the GI organs and acid secretion
S/SX GI bleed pt (same as for shock)
Low BP Rapid weak pulse Increased thirst cold clammy skin restlessness / anxiety (won’t be able to perfuse tissues) altered LOC
urine specific gravity value
normal (1.005-1.025)
if NG tube is inserted:
keep in proper position (GI aspirate should be acidic) +make sure not in the lung+ observe aspirate for blood effectiveness of gastric lavage is questionable
DT symptoms
agitation uncontrolled shaking sweating vivid hallucinations
black tarry stools are caused by:
occur with slow bleeding from stomach
IBD inflammatory bowel disease
Chrohn’s ulcerative colitis
IBD
periods of remission/exacerbation exact cause unknown no “real” cure
ulcerative colitis
prob of colon and rectum
Chrohn’s disease
upper small bowel - autoimmune disease - trigger- inflammatory mediators diet , hygeine, stress, smoking, NSAIDS, genetics
Chrohn’s sX
diarhhea bloody stool weight loss (no absorptioin) abdominal pain fatigue
GI tract complications of IBD
hemorrahge strictures perforation=peritonitis fistulas
**peritonitis sx
pain high fever rigid boardlike hard washboard ab
Chrohn’s Symptoms
cramping , diarrhea, rectal bleeding , fever, weight loss especially if small bowel is involved since it absorbs nutrients. inflammation involves entire bowel wall
colitis
disease of mucosal layer of colon and rectum
colitis symptoms
fever rapid weight loss >10% anemia dehydration tachycardia
colitis labs
CBC, WBC, serum electrolyte levels serum protein ESR (sed rate= watch to see how long it takes blood to separate) C reactive protein stool culture - pus, blood, mucus WBC, RBC imaging studies (KUB) kidney, urinary, bladder endoscopy
colitis goal of treatment
rest the bowel control inflammation (steroids?) combat infection correct malnutrition (remember- they need to rest bowel= NPO!) alleviate stress relieve symptoms improve quality of life
drug therapy colitis
corticosteroids antimicrobials aminosalicylates immunosuppressant biologic targeted therapy = (Humira?) goals of drug treatment are to induce and maintain remission
colitis nutritional therapy
avoid bulk in diet avoid large bulky meals, cereal, grains= give good protein sources may be NPO or only allowed to have liquids - no lactose
meds contributing to nutritional prob for colitis pt
sulfasalazine corticosteroids
**different diets NEED TO LOOK UP!!! TEST ???
clear liquids to full
colitis diet
high protein , low bulk
***Irritable bowel syndrome (IBS)
is a functional GI disorder characterized by abdominal pain and altered bowel habits in the absence of a specific and unique organic pathology. intermittent abdominal pain or discomfort stool pattern irregularities. Symptoms may occur for years more frequent among women
IBS
The predominant clinical manifestations are altered bowel habits, abdominal pain and abdominal distention often people with PTSD, depression, anxiety, panic disorder
Prob NOT associated with IBS
NOT IBS- look at other issues if these symptoms are present : anemia fever persistent diarrhea rectal bleeding severe constipation weight loss basically a diagnosis is made by exclusion
pancreatitis most common in?
middle age people african american
pain from pancreatitis caused by
basically pancrease digesting itself autodigestion of pancreas
most common causes for bowel obstruction
The most common are adhesions, hernias, cancers, and certain medicines
types of bowel obstruction
mechanical - something physically blocking it non mechanical- tissues not working right to get adequate blood supply to muscle for peristalsis pseudo-mechanical
bowel obstructions
accumulation of intestinal contents proximal to obstruction = reduced fluid absorption increased cap permeability third spacing
lower intestine bowel obstruction
no gas abdominal distension new onset constipation normal bowel sounds until late in the game
small bowel obstruction
colicky ab pain very light to absent bowel sounds n/v abdominal distension fecal odor to breath fecal emesis LATER.. decresed flatus, constipation
how to diagnose bowel obstruction
pt history physical exam imaging endoscopy lab study
. An 85-year-old woman seen in the primary care provider’s office for a well check complains of difficulty swallowing. What common effect of aging should the nurse assess for as a possible cause?
XEROSTOMIA
The nurse is assessing a 50-year-old woman admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient?
high pitched sound on abdominal auscultation
. A 62-year-old woman patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient’s health history and is most concerned if the patient makes which statement?
my tongue swells when I eat shrimp
The nurse cares for a 34-year-old woman after bariatric surgery. The nurse determines that discharge teaching related to diet is successful if the patient makes which statement?
A. “A high protein diet that is low in carbohydrates and fat will prevent diarrhea.”
The nurse identifies that which patient is at highest risk for developing colon cancer?
. A 32-year-old female with a 12-year history of ulcerative colitis
The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit?
Left upper abdominal pain
What questions should we ask when gathering health history for GI pt?
• Describe any measures used to treat GI symptoms such as diarrhea or vomiting. • Do you smoke?* Do you drink alcohol?* • Are you exposed to any chemicals on a regular basis?* Have you been exposed in the past?* • Have you recently traveled outside the United States?*
What questions would we ask during a nutritional assessment?
• Describe your usual daily food and fluid intake. • Do you take any supplemental vitamins or minerals?* • Have you experienced any changes in appetite or food tolerance?* • Has there been a weight change in the past 6-12 mo?* • Are you allergic to any foods?*
what questions would we ask a GI pt regarding elimination?
• Describe the frequency and time of day you have bowel movements. What is the consistency of the bowel movement? • Do you use laxatives or enemas?* If so, how often? • Have there been any recent changes in your bowel pattern?* • Describe any skin problems caused by GI problems. • Do you need any assistive equipment, such as ostomy equipment, raised toilet seat, commode?
What questions might we ask a GI pt regarding sleep?
Do you experience any difficulty sleeping because of a GI problem?* • Are you awakened by symptoms such as gas, abdominal pain, diarrhea, or heartburn?*
