objective 5: GI alterations Flashcards by Kaitlyn Dominie

upper GI

mouth to proximal

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lower GI

distal duodenum to anus

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accessory components

liver, gallbladder, pancreas

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what are factors that promote optimal GI functioning?

Intact oral cavity and oesophagus
Smooth lining of small and large intestine
Adequate perfusion of mesenteric arteries (nutrients and oxygen).
Smooth muscle contraction facilitating gut motility/ peristalsis
Functioning accessory components to facilitate the release of digestive enzymes
Functioning villa to absorb the nutrients in small intestine
Excretion of residual waste to form feces
Bacteria to breakdown residual waste
Functioning colon to reabsorb water

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what are the diagnostic tests?

blood tests
stool tests
abdominal ultrasound
imaging studies
CT, MRI, PET
endoscopy

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is a type of X-ray that allows part of the body to be studied in motion and recorded on a video monitor to detect abnormalities in the size, shape, position or functioning of upper/lower GI.

fluroscopy

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X-ray examination of
the esophagus. Approximate time: 1 hour.

barium swallow

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X-ray examination of the stomach.
Approximate time: 1 to 1-1/2 hours.

upper GI series

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X-ray examination of the small
intestine (small bowel). Approximate time: 2 to 4 hours.

sm bowel series

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X-ray examination of the large intestine
(colon). Barium is introduced gradually into the colon by a
rectal tube. Approximate time: 1 to 1-1/2 hours

barium enema

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what is the LPNs role in diagnostic testing?

Order entry into computer
Complete pretest orders
* NPO
* IV access
* Teaching (client/family)
Client optimize (vitals, BW, meds)
Documentation
* Consent/forms
Report
Head to toe assessments (monitoring return of GI and renal
function).
* IV check
* Vitals, ABC, pain
Orders (post procedure protocol)
Family update

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what are nursing interventions common to GI alterations?

Monitoring and encouraging sufficient nutritional intake respecting the diet restrictions ordered.
Monitoring F/E balance (minimal fluid intake 1.5 L/day unless contraindication, U/O 30 ml/hr)
Monitoring complications: bleeding, dumping syndrome, bloating, ileus, perforation, infection
Minimizing pain and discomfort: modifying diet (different for each disorder) and evaluate response
Monitoring for alterations in bowel patterns and stool characteristics
Symptom management (Nausea, Vomiting, Diarrhea, Constipation)
Preparation for and recovery from diagnostic procedures/surgeries
Education:
Medications, treatments, self care regimes including lifestyle changes
Identification and avoidance of irritants (smoking, alcohol, caffeine, NSAIDs)
Promotion of rest and reduction of stress
Importance of keeping follow up appointments with HCP

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Most common manifestation of GI diseases
is the feeling (subjective data)
is the forceful evacuation of partially digested food and
secretions: know types

nausea and vomiting

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what are the consequences of persistent emesis?

tachycardia, tachypnea and diaphoresis
severe electrolyte imbalances, loss of extracellular fluid
volume, decreased plasma volume and eventually circulatory
failure
Can cause metabolic acidosis
Bleeding: coffee grounds or bright blood
Risk of pulmonary aspiration aspiration pneumonia

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what are the upper GI alterations?

Hiatal Hernia
Gastroesophageal
Reflux Disease
Gastritis
Peptic Ulcer Disease
Upper GI Bleeding

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Protrusion of part of the stomach through
the esophageal hiatus of the diaphragm into
the thorax
More common in women and older adults
Contributing factors: congenital weakness,
multiple pregnancies, obesity, aging (loss of
muscle tone)

hiatal hernia

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fundus is
displaced upward forming a pocket
alongside the esophagus

paraoesophageal hernia

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stomach slides
up into thoracic cavity when supine and
then goes back down when upright

sliding hernia

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A back flow of gastric or duodenal
content from the esophagus
* Some degree of reflux is normal
* Excessive reflux is the result of an
incompetent lower esophageal
sphincter (LES), pyloric stenosis,
motility disorders
* Incidence increases with aging
* No single cause

GERD

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Inflammation of the gastric
mucosa
Most common problems
affecting stomach
May be acute or chronic;
diffuse or local
Chronic gastritis occurs over
time and can be caused by H.
pylori bacterial infection

gastritis

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Can be gastric, duodenal or esophageal
A hollowed out area like an erosion forms in
the mucosal wall
Acute or chronic

peptic ulcer disease

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severe bleed has no time to mix
with gastric juice or be digested in the
intestine therefore is bright red:
* Hematemesis (blood in vomit)
* Hematochezia: Bright red blood per rectum (BRBPR)

acute upper GI bleed

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bleeding has an
opportunity to interact with gastric juice
or be digested
* Melena (black, tarry and foul-smelling stools or
dark-colored stools)
* Coffee Ground Emesis – vomiting of blood altered
by stomach acids and enzymes.

chronic (slower) upper GI bleed

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what are the lower GI alterations?

Irritable Bowel
Syndrome
Peritonitis
Inflammatory Bowel
Disease
Intestinal
Obstruction
Diverticular
Disorders

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Abnormal infrequency, irregularity of defecation, abnormal hardening, decrease in stool volume, retention of stool for a prolonged period with a sense of incomplete evacuation

constipation

Increased frequency of BM (>3/day), increased amount of stool >200 ml/d and increase liquidity of stool

diarrhea

* Chronic functional motility disorder primarily affecting the colon. Clients experience intermittent and recurrent abdominal pain, diarrhea and/or constipation and/or both * There is no evidence of inflammation or tissue changes in the intestinal mucosa * Intestinal motility seems to be underlying problem

IBS

* Localized or generalized inflammatory process of the peritoneum. * Acute and chronic forms * Usually caused by bacteria from GI tract or with women because of the reproductive orders (E. Coli, Klebsiella, Proteus, Pseudomonas, Streptococcus)

peritonitis

* Autoimmune disease, idiopathic inflammation and ulceration * Chronic illness characterized by exacerbations & remissions

inflammatory bowel disease

low colon and rectum

ulcerative colitis

ileum and ascending colon, but technically can occur anywhere along the entire GI tract

Crohn's disease

Partial or complete obstruction of small or large bowel * Two processes can impede bowel content flow:  Mechanical obstruction  Functional obstruction

intestinal obstruction

pressure exertion from tumor, IBD, diverticulitis, volvulus or from abscess/strictures/ adhesions

mechanical obstruction

intestinal musculature cannot propel bowel contents (neurological disorder, manipulation during surgery, paralytic ileus)

functional obstruction

is a saclike herniation of the lining of the bowel that extend through a defect in the muscle layer

diverticulum

can occur anywhere in the small intestine but most commonly in sigmoid colon

diverticula

Multiple diverticula with no inflammation -

diverticulosis

Inflamed of infected diverticula

diverticulitis

* Small bowel brought to skin surface and attached to replaceable fecal collection device * May be permanent or temporary * Loose large amount of fluid (1-2 L), no control of emptying

ileostomy

* Large bowel brought to skin surface and attached to replaceable fecal collection device * May be permanent or temporary * Named according to where in the bowel it is formed. May be created in the ascending, transverse, descending or sigmoid areas of the colon * Consistency of fecal material depends on location (e.g., sigmoid-formed; ascending- liquid)

colostomy

what does lower GI bleeds cause?

diverticular disease IBD tumors colon polyps hemorrhoids anal fissures proctitis

Noncancerous (benign) or cancerous tumors of the esophagus, stomach, colon or rectum can weaken the lining of the digestive tract and cause bleeding.

tumors

Small clumps of cells that form on the lining of your colon can cause bleeding. Most are harmless, but some might be cancerous or can become cancerous if not removed

colon polyps

These are swollen veins in your anus or lower rectum, similar to varicose veins

hemorrhoids

These are small tears in the lining of the anus.

anal fissures

Inflammation of the lining of the rectum can cause rectal bleeding.

proctitis

black, tarry and foul- smelling stools or dark-colored stools from cecum

melena

Bright red blood per rectum (BRBPR

hematochezla

* Inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum

appendicitis

stones in the gallbladder

cholelithiais

inflammation of the gallbladder

cholecystitis

- shock waves to break stones (in water tank), pieces removed by endoscopy

lithotripsy

a yellowish or greenish yellow discoloration of body tissues, results when the concentration of bilirubin in the blood becomes abnormally increased. * symptom rather than a disease * Hyperbilirubinemia * first observed in the sclera and later in the skin

jaundice

a systemic viral infection that causes necrosis and inflammation of liver cells with characteristic symptoms and cellular and biochemical changes

viral hepatitis

toxin- and drug- induced

nonviral hepatitis

Diffuse pathological process, characterized by scar tissue and conversion of normal liver structure to abnormal nodules

cirrhosis

occurs when liver cells attempt to regenerate but in an unorganized way

fibrosis

* An acute inflammatory process of the pancreas * Serious disorder

acute pancreatitis

* Is a continuous, prolonged inflammatory process of the pancreas. The pancreas becomes progressively destroyed as it is replaced with fibrotic tissues. Strictures and calcifications may also occur in the pancreas

chronic pancreatitis

Cancer may occur on the lips or anywhere within the mouth

oral cancer

* malignant neoplasm of the esophagus * two main types: squamous cell carcinoma and adenocarcinoma

esophageal cancer

* Adenocarcinoma of the stomach wall * More prevalent in men of lower socioeconomic class, primarily in urban areas * Usually begins with a nonspecific mucosal injury as a result of aging, autoimmunity, or repeated exposure to irritants such as bile, anti- inflammatory agents, or alcohol

gastric cancer

is the entry of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract * It often occurs from secretions in the oral pharynx or reflux of gastric content entering the throat and going down the trachea

aspiration

* Also known as tube feeding * Nutrition delivered through the GI tract distal to the oral cavity via a tube, catheter or stoma * For patient’s with functioning GI tract, but unable to take in enough orally * Wide variety of enteral formulas, with specific ones for patients with different diseases (diabetics, liver disease, etc.) * Infused via intermittent or continuous pump, or by gravity or bolus by syinge

enteral nutrition

* Refers to the administration of nutrients by a route other than the GI tract (e.g., the bloodstream) * Customized to meet individual need for each patient * Used when GI tract cannot be used for ingestion, digestion, or absorption of essential nutrients * Pharmacy prepares the solution based on dietician and physician orders * Can be administered through central or peripheral veins

parenteral nutrition