NHI exam 4 Flashcards
**Barium swallow– upper gi
-esopagus, stomach and small intestine - swallowing down into stomach- 30 min -white chalky liquid- can turn to concrete w no h20 -low residual diet 48 hrs prior -tap enema evening before - no food, fluids, smoking 8 hrs prior - no meds that affect bowel motility 24 hrs prior -test takes several hours -increase fluid intake 24 hr after to avacuate barium -may need laxative- milk of mag -stool will be chalky white up to 72 hrs
* Barium enema– lower GI
- used to ID polyps, tumors, structures of colon **-Rectal - client requested to turn side to side -before -verify signed consent - liquids only day before/ NPO 8hrs -laxatives,enamas as ordered night before and morning of
***EGD– esophagogastric duodenoscopy– upper GI
-before npo 8 hrs before, knowledge deficit– sedation used, remove dentures, eyewear, jewelry hairpins, pt teaching before is critical -AFTER monitor for complications: bleeding abd pain dyspnea dysphagia belching, NPO untl gag and swallow reflexes return-throat numbing, saliva draining (semi fowlers w/ head side to side), sore throat- hoarsness normal- warm saline goggles,s/s of complications to report- coughing up blood, no gag return, pt wont remember what you say, teach after with family
* Colonoscopy
-rectum, colon,cecum , and ileocecal valve - before: consent form (invasive), NPO 8-12 hrs and clear liquids day before, bowel prep– BIGGEST thing, expain procedure (no time prep no fun), client teaching, sedation used, scope inserted through the anus, air may be instilled during procedure (gas normal), report abd pain, fever, bleeding or purulent discharge, avoid heavy lifting for 7 days, avoid high fiber foods for 1-2 days.
Gastric analysis
-insertion of NG tube into stomach to obtain sample of fluid for analysis of acidity (between 1-4) -food or fluids 8-12 hrs before -no smoking or antacids
**Stomatitis- viral thrush ( herpes simplex)
-S/S– depending on type, herpes- clustered lesions; thrush– painful white patches -TX– topical anestetics: oragel, viscous lidocaine (liquid) deadens mouth, ambesol; topical antifungals: nystatin: swish and spit or swish and swallow, clotrimazole; antiviral agent:zovirax -Nursing care: assess for mouth lesions, wear gloves; implement mouth care- soft, lukewarm or cool food/ fluids,straws; evaluate: effectiveness of interventions, food intake comfort and healing, discharge instructions
* Cancer of oral cavity
- S/s: Asymptomatic (early) leukoplakia (white patches in mouth) sore on lip doesnt heal, erythroplakia (slightly raised red patch that bleeds easily when scraped);;;; Later– difficulty chewing, swallowing, edema , numbbess, earache/faceache/toothache - Causes: lips– pipe, exposure to sun/wind;;; mouth/ pharynx– tobacco, smoke, ETOH - Nursing care:Airway– ^ HOB/ monitor resp, trach care suction, drains/ support head; nutrition: small, frequent meals, eternal feedings; communication: pen/paper, call bell- Go to room (can’t talk) - Medical management– lip cure: rate high–lip wedge;;mouth/tounge–60%metastatize;; pharynx– radical neck
*GERD
-S/S: burning & pressure behind sternum, regurgitation -causes: backward flow of stomach acid into the esophagus -Nursing care: focuses on teaching: diet- small meals, low fat/caffiene/alcohol, REMAIN UPRIGHT 3 HRS AFTER EATING, eat slow;; Lifestyle– no smoking, ^HOB for sleeping - Pt teaching: stop smoking, avoid irritating foods (spicy,acidic) avoid large meals **** no lying down for 3-4 hr after eating & raise HOB - Meds: H2 receptor blockers(otc) tagamet, pepcid, axid, zantac;;; Proton pump inhib– nexium, protonix, prevacidk aciphex (prilosec is now available OTC);; antacids– tums;; sucralafate–protective barrier
Hiatal Hernia
-S/S: sliding– part of the stomach slides through the opening of the diaphgram when the client reclines and moves back into place when the client stands;; Paraesophageal– part of the stomach protrudes through the opening beside the esophagus -Nursing care:abd surgery, thoracic surgery, -Interdiciniplary care: medical, life style, and pharmacologic interventios used for GERD -If hernia becomes trapped, impairing blood flow, surgery may be necessary.
Esophageal cancer
- Cause: 90% assoc w/ alcohol use/smoking -S/s: dysphasia (mild feeling of discomfort when swallowing–food sticks, resorts to liquids- cant swallow, weight loss, regurgitation, blood loss) - TX: esophagogastrectomy— resp status– aspiration, splint incision (TCDB) NPO h20 small frequent meals, teach TPN -Interdiciniplary care: palliative, esophageal dilation, radiation, TPN, endoscopic, laser surgery
**Gastroenteritis
- Cause: food poisoning, -S/S: Gi– anorexia,abd pain, cramping, N/v, borborygmi (growling of stomach) diarrhea;;; General— malaise, weakness, dry skin, mucous membranes, orth hypotension, tachycardia, ^ temp -Nursing care: Client teaching– fluid replacement, good hand washing, washing of linens & clothing, food/water safety measures -Tx: identify cause, manage s/s, prevent complications, stool specimen;;; F&E balance replacement– oral glucose (electrolyte solution in SM-Sips, IV) antidiarhheal, antiemetics, carafate(coat stomach)
*Gastritis
-acute: aspirin, alcohol, certain bacteria -chronic: progressive irreversible, elderly, chronic alcoholics, smokers -acute– anorexia, n/v, abdpain,hematemesis, melana -stress- s/t shock, trauma, or surgery usually no s/s until severe bleeding -Nursing care: assessment– foods, fluids, meds taken, VS bowel sounds, tenderness, labs, monitor stool;; initially bland diet;; Goal–maintain sufficient fluid vol, assess mucous membranes, skin tugor, i&o
*Peptic ulcer disease
-Cause: benign pancreatic ulcers, NSAIDS aspirin’ -Types & s/s of PUD:: 1. Hemmorrhagne- eroding through blood vessel, distension in stomach, vomiting, vomiting blood , ^ resp, decreased bp/pulse; Iv solutions whole blood endoscopy, vasoconstrictor agent. 2. Perforation– eroding through stomach wall. gastric contents emptying in abd cavity, peritonitis, infection, abd distention, fever, pain, NPO Iv fluids, NG tube, fowlers. 3. obstruction– edema/ inflammation, distension cramping, decreased bowel sounds, nausea, diarhhea thats watery, NG tube endoscopy, surgery -s/s PUD—Epigastric pain: gnawing , burning hunger likeheart burn indigestion, happens when stomach empty– 2-3 hrs after meals or at night, may radiate to the back, relieved by eating -Nursing care– uncomplicated PUD: discomfort fo the disease and effects on nutrition, acute bleed: restoring blood vol and cardiac output -Interdisciniplary care– Goal– neutralize acid and decrease hypermobility- neutralize stomach, diet–no spicy or high salt,lifestyle– small freq. meals, weight control, bed w/ full stomach,;; -Meds: Antacids– before meals, H2 receptor antagonist- decreases acidity (zantac);; proton pump inhib– Prilosec;; mucosal healing agents– befoer meals (carafate) antibiotic therapy -Surgical tx: vagotomy– lower gastric secretions;;; phioroplasty– drainage of gastric secretions;;; Gastrojejunostomy– bypass duodenom;; gastroduodenostomy– remove bad part of stomach;;; ***gastrectomy– stomach removed (bleeding, pernicious anemia, dumping syndrome- 5-10min after eat decreased BP;; PT TEACHING— small freq meals, no liquids w/ meals,protiens and fats, decreased carbs, lie down 30-60 min after meals, nutritional deficiencies -post op: #1 airway, breathing (#5) o2 resp? #2 circulation- cap refill, BP #3 LOC– awake? who where? need to know #4 system review- everything should still be working ^ also, focus GI, i&o, VS CNS - Nursing care cklist for surgery— Before: provide routine preop care and teaching;; AFTER assess position and patency of NG tybe to low suction, assess color amount odor, bowel sounds and abd girth, IV fluids- I&o, resume oral food abnd fluids as ordered, discharge planning and teaching.
Bowel disorders ** Diarrhea
-S/s– several large watery stools -complications: freq small stools containing blood mucus pus– report HCP stat, water and electrolyte imbalance due to being lost in stool– dehydration, hypovolemic shock, elec. imbalance - Risk factors– dehydration, impaired skin integ, -Nursing care: VS, orth Bp, P (fall safety), nutritional/hydration status, observation abd, inspect feces color consistency blood mucus fat -pt teaching– handwashing, fluid intake -gatorade–, food intake not vital, preventitive measures, causes of diarrhea, prevent spread, no spicy food (irritates)
Bowel disorders- Constipation
-s/s 2 or less bowel movements per week or requires straining - risk factors: impation, obstruction, fluid imbalance -nursing care: prevention, education; pattern of defecation; diet fluid intakeactivity; abd shape & girth, digital exam if impaction; ^ fluids to 2500 ml/day, warm fluids; fiber privacy; bulk forming agents are the only safe laxatives for long term use. they ^ bulk of feces and draw h20 into bowel to soften in. 6-8 glasses water/day.
Bowel disorders- IBS
- Cause: unknown, stress, increases symptoms’ -Physical and phychological– diet, bulk forming agent (metaqmucil) meds, psycho. support, abd pain/ disturbed defecation -Nursing care:Secondary condition– Teach how to live with IBS, symptoms are real r/t stress/anxiety, dietary influences, notify HCP if s/s change;;; Assess– stool specimen (relieve symptoms)…upper GI series barium enema
Inflamm disorders– Appendicitis
- s/s generalize/ upper abd pain # 1 SYMPTOM, pain gradually localized in RLQ and is aggravated by moving, walking or coughing 2hr-2days, rebound pain noted at mcburneys point, low grade fever, n/v anorexia -Nursing care: description of pain, food and fluid intake, informed consent -monitor: s/s perforation, sudden relief of pain, VS, ^ P/R, cound indicate perforation, maintain fluids-IV, wound care, s/s infection, activity restrictions -Diagnostics: WBC ^, ultrasound, NPO, appendectomy, no heat -stages: simple–intact; gangrenous- necrosis; perforated– ruptured
Peritonitis
-cause: fluid shift, s/t perforated ulcer, appendix, traumatic injury, contamination -s/s– Acute abd: severe pain, tenderness w/ rebound, BOARDLIKE RIGIDITY ABD, no bowel sounds, progressive distension, anorexia, n/v;;; Systemic– fever tachycardia, tachypnea, restlessness, oliguria -Nursing care: painm anxiety/coping, mental status, vs–hourly, output q 1-2 hrs, drainage, intake, weight, abdominal girth, psychologic– sit with client -Complications: dehydration, risk infection -Management– Home health: intestinal decompression– ng suction (low suction still have bowel sounds, to assess turn off), fowlers with o2, antibiotics, laparotomy w/ peritoneal lavage, JP drain, close abd with mesh.
