NURS 343 GI test Flashcards
1
Q
most common upper GI problem
A
GERD
2
Q
GERD results when
A
defenses of the lower esophagus are overwhelmed by reflux of gastric contents into the esophagus
3
Q
most common cause of GERD
A
hiatal hernia
4
Q
other causes of GERD
A
allergic esophagitis, decrease gastric emptying, obesity, pregnancy, cigarette
5
Q
clinical manifestations of GERD
A
heartburn, dyspepsia, regurgitation, non cardiac chest pain, some respiratory symptoms
6
Q
hiatal hernia
A
stomach pushing up at the diaphragm
7
Q
GERD is directly related to
A
esophagus cancer
8
Q
complications of GERD
A
esophagitis and Barrett’s esophagus
9
Q
Barrett’s esophagus
A
changes to tissue of the esophagus that resembles the lining of the intestine
10
Q
diagnostics for GERD
A
EGD - esophagogaatroduodenoscopy, esophagram barium swallow, physical, or biopsy
11
Q
treatment of GERD
A
medications: H2 receptor blockers, PPIs, cholinergic, antacids, motility enhancers
12
Q
diet for GERD
A
decrease high fat food, fluids in between meals, and avoid smoking, caffeine, acidic stuff
13
Q
patient teaching for GERD
A
avoid smoking, food triggers, gas forming or reflux inducing food, acid foods, and eat small frequent meals, and elevate HOB at night
14
Q
surgical procedures for GERD
A
laparoscopic - Nissen and toupet fundoplications
15
Q
goal of surgical procedures for GERD
A
reduce reflux by enhancing the integrity of the LES
16
Q
when do you result to surgery with GERD
A
when conservative therapy fails, medication intolerance, Barrett metaplasia…
17
Q
Nursing Management of postoperative fundoplication patients
A
Thorough assessment monitoring for postop complications.
Administer PPI before the first meal of the day.
Administer antiemetics PRN
Assess and administer pain medications
NPO until peristalsis returns, then clears and slowly advance
Out of bed ASAP and regular ambulation
Record I&O’s
Ongoing teaching and preparation for discharge
18
Q
main causes of peptic ulcers
A
aspirin and NSAIDs
19
Q
other causes of peptic ulcer
A
alcohol stress smoking
20
Q
mortality is higher in which ulcers
A
gastric ulcers
21
Q
gastric ulcer pain
A
burning gassy pain felt high in epigastric 1-2 hours after meal
22
Q
duodenal ulcer pain
A
burning crampy upper abdominal pain usually 2-5 hours post meal
23
Q
peptic ulcer disease complications
A
hemorrhage, perforation, gastric outlet obstruction
24
Q
most deadly complication of peptic ulcer disease
A
perforation especially if gastric ulcer and is very painful
25
gastric outlet obstruction
obstruction that results in edema, inflammation, scar tissue, or pylorospasm
26
peptic ulcer disease management
discontinue NSAIDs, treat h. pylori if present, possible surgery, PPIs or H2 blockers
27
labs for peptic ulcer disease
CBC with diff, CMP focus on liver, serum amylase, stool cultures, H&H
28
gallbladder does what
holds the bile that goes into the intestines and helps with digestion
29
cholelithiasis
stones in the gallbladder
30
cholelithiasis is more frequent in
women over 40 and in pregnancy
31
cholecystitis
inflammation of the gallbladder can be from gallstones or biliary sludge
32
cholecystitis is most commonly associated with
obstruction and can be acute or chronic
33
cholelithiasis occurs when
the balance of cholesterol, bile salts, and calcium in solution are altered
34
bile flow decreases from
immobility, pregnancy, and inflammation or obstructive lesion of biliary system
35
gallbladder disease risk factors
living in a developed country (diet), FFFF (fat, female, fertile, forty), estrogen therapy, sedentary lifestyle, familial tendency, high in native Americans
36
initial clinical manifestations of gallbladder disease
indigestion, right upper quadrant pain, acute pain, V/N
37
total gallbladder obstruction clinical manifestations
jaundice, dark amber urine, clay color stools, pruritus, intolerance of fatty food
38
complications of cholecystitis
gangrenous cholescystis, infection, pancreatitis, common bile duct stone, rupture, carcinoma
39
diagnostics for gallstone
ultrasound - NPO 8-12 hours prior, ERCP - NPO 8 hours prior
40
ERCP
Endoscopic retrograde cholangio-pancreatography
41
labs for gallstones
elevated WBC, elevated direct and indirect bilirubin, AST and ALT might be elevated
42
if ultrasounds is negative for gallstone diagnostic what is usually next
HIDA scan - cholescintigraphy
43
medical treatment for gallstones
NPO, medications, gastric decompression with BG tube, ERCP, surgery
44
medications for treatment of gallstones
pain control - morphine and toradol, antibiotics, antiemetics for N/V, IV fluids, atropine for anticholinergic effect
45
treatment of choice for gallstones
laparoscopic cholecystectomy
46
laparoscopic cholecystectomy
removal of gallbladder through one of the four puncture holes. minimally invasive and can usually discharge on the same day
47
main complication of laparoscopic cholecystectomy
injury to the common bile duct. also a risk for intestinal perforation
48
open cholecystectomy
removal of gallbladder through right subcostal incision and T-tube inserted into the common bile duct which allows bile to drain
49
when is open cholecystectomy usually done
when suspect or confirmed gallbladder cancer, patients with cirrhosis, pregnant patient
50
nurse should be monitoring for what after a cholecystectomy
monitor for complications such as laprascopic, infection, bleeding, bile leakage, injury/perforation
51
laprascopic
shoulder pain from irritation of phrenic nerve and diaphragm due to retained CO2
52
how can you increase comfort for pt with laprascopic
Sims position
53
nursing care after cholecystectomy
pain management, encourage ambulation and turn cough and deep breath, observe for jaundice, treatment for N/V
54
patient education after cholecystectomy
clear liquids first and advance diet as tolerated, smaller meals, fat intake will depend on tolerance, and take fat soluble vitamins
55
#1 and #2 causes of pancreatitis
```
#1 - gallbladder disease
#2 - alcohol
```
56
other causes of pancreatitis
smoking, abd trauma, medications, infection, tumor
57
clinical manifestations of acute pancreatitis
pain - epigastric and radiating to back left flank and shoulder, N/V, low grade fever, hypotension, tachycardia, jaundice, paralytic ileus, tetany
58
acute pancreatitis pain gets worse
when lying down or while eating and after alcohol or high fat foods
59
tetany
involuntary contraction of muscles - hypocalcemia
60
paralytic ileus
absent or decreased bowel sounds
61
acute pancreatitis diagnostic studies
blood test, abdominal ultrasound, x-ray, CT scan, possible ERCP
62
blood test for acute pancreatitis
amylase and lipase will be elevated, elevated glucose, low calcium, increase triglycerides
63
nursing care during acute pancreatitis
relieve pain, prevent shock, reduce pancreatic secretions, fluid electrolytes, prevent infection, treat underlying cause if possible
64
medications during acute pancreatitis
morphine for pain, antibiotic, H2 blocker, PPI, pancreatic enzyme, oxygen, possible ERCP
65
acute pancreatitis patient NPO until
pain free
66
what can help with N/V and gastric distention
NG tube suctioning
67
pancreatitis diet
when pain subsides advance slowly starting with clears and advance to bland low fat diet. avoid caffeine smoking and alcohol
68
position for comfort during pancreatitis
fetal, side-lying, HOB elevated, sitting up leaning forward
69
monitor what during pancreatitis
blood glucose and give insulin as ordered. monitor hydration status
70
A 71-year-old female patient comes to the ER complaining of “coffee-ground” emesis. The nurse will anticipate preparing this patient for:
endoscopy
71
most common reason for emergency abdominal surgery
appendicitis
72
appendicitis is most common in
males between 10-30
73
acute appendicitis clinical manifestations
periumbilical abdominal pain followed by anorexia, n/v, low grade fever
74
pain of appendicitis will eventually localize to
right lower quadrant - McBurneys point
75
appendicitis will show what signs
peritoneal
76
labs you want to look at with appendicitis
CBC with differential which will often show left shift, UA, BMP, HCG
77
is a CT or MRI preferred with appendicitis
CT
78
inflammatory bowel disease
chronic autoimmune inflammation of the GI tract
79
two classifications of inflammatory bowel disease
ulcerative colitis and crohns
80
crohns lesions are most common in the
distal ileum
81
ulcerative colitis happens in the
rectosigmoid colon and rectum
82
ulcerative colitis usually begins in the
rectum and spreads to the entire colon
83
crohns manifestations
diarrhea, abd pain, cramping, weight loss
84
ulcerative colitis
bloody stools, left lower quadrant pain, diarrhea, weight loss not as common as crohns
85
crohns complication
hemorrhage, obstruction, F&E imbalance, fistula
86
ulcerative colitis complication
increased risk of colorectal cancer, perforation, bleeding, vomiting, toxic megacolon
87
assessment of inflammatory bowel disease
hydration, nutritional status, amount and character of stools
88
diagnostics of inflammatory bowel disease
stool cultures, ct scan, colonoscopy with biopsy
89
goals of treatment for inflammatory bowel disease
NPO to rest the bowel, control inflammation, combat infection, improve quality of life
90
medications for inflammatory bowel disease
5-aminosalicylates, antimicrobials, corticosteroids, immunosuppresents
91
inflammatory bowel disease pt need to be supplemented with
iron and B 12
92
B12 med called
cobalabin
93
avoid what foods with inflammatory bowel disease
lactose, high fat, cold foods and high fiber foods
94
inflammatory bowel disease nursing dx
diarrhea related bowel inflammation, imbalanced nutrition, and ineffective coping related to chronic disease
95
risk factors of colorectal cancer
history of IBD, DM, smoking, alcohol, obesity, consuming more than 7 servings a week of red meat, family history, and KRAS gene mutation
96
clinical manifestations of colorectal cancer
iron deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits
97
late signs of CRC
abdominal mass, ascites, hepatomegaly
98
diagnostics of CRC
colonoscopy, CT, CEA lab, H&P including family history
99
screening tests over 50 when CRC suspected
flexible sigmoidoscopy q5, colonoscopy q 10, CT colonography, fecal occult blood test yearly
100
treatment for CRC
surgery, radiation, chemo
101
post op ileostomy complications
F&E imbalance, hemorrhage, SBO, dehydration
102
SBO
small bowel obstruction
103
management ileostomy
assess Bowel sounds, stoma viability, and drainage every 4 hours
104
nursing care for ileostomy patient
pouch, emotional support, diet
105
what types of questions do you want to ask patients
open ended questions
106
diverticulum is most common in
the sigmoid colon
107
diverticulum extend into the
muscle
108
when diverticulum become inflamed
the condition is called diverticulitis
109
diverticulitis clinical manifestations
abdominal pain usually in left lower quadrant, fever, N/V
110
diverticulitis lab
elevated WBCs with left shift
111
risk factors for diverticulitis
older adults, usually over 60 with western diets
112
diagnostic tests for diverticulitis
CT scan, H&P, check stool, barium enema
113
complications of diverticulitis
bleeding, infection, perforation
114
peritonitis
Inflammation of the membrane lining the abdominal wall and covering the abdominal organs
115
management of diverticulitis
clear liquids and low bulk until inflammation resolved, antibiotics, IV fluid during bowel rest
116
what antibiotic do pt with diverticulitis usually get
flagyl
117
patient teaching for pt with diverticulitis
liquid diet until diverticulitis resolved then high fiber diet avoid seeds, nuts, popcorn
118
nursing diagnosis for diverticulitis
acute or chronic pain, knowledge deficient, impaired tissue integrity
