Test #1 Flashcards
what is achalasia
When the LES cannot relax causing food / fluid to build up
what are complications of achalasia
- distention of the esophagus leading to risk for aspiration
- GERD
- halitosis (foul breath)
- malnutrition leading to weight loss, weakness and poor skin turgor
s/s of achalasia
- dysphagia= most common
- substernal chest pain- usually after eating
- regurgitation/ nocturnal regurgitation
- halitosis (foul breath)
- inability to burp
- gerd
why would you expect someone with achalasia to have weight loss
because they are not adequately digesting food because it cannot enter the stomach therefore the pt is losing nutrition and hydration
what causes achalasia
nerve degeneration esophageal dilation d/t food backed up hypertrophy of the sphincter can be viral or genetic. unknown
what kind of tests can we do if we suspect achalasia
- Upper GI barium- to see how the fluid moves through the GI track
- esophageal manometry
- EGD
what does an esophageal manometry look for
it checks the pressure on the esophageal sphincter
what does a pt need to do prior to having an EGD
NPO for 8 hrs prior
have the procedure explained by the MD
consent signed
what kind of sedation is given when an EGD is performed
usually a benzodiazepine such as Versed (antianxiety agent/sedative hypnotic)
what kind of medications are given for achalasia
smooth muscle relaxants such as anticholinergics, nitrates(smooth muscle relaxants), calcium channel blockers
or botulism injections to the LES
what are the invasive procedures for achalasia treatment
Dilation of the cardiac sphincter (can end up causing problems with reflux)
Heller Myotomy- surgical incision and release the muscle around the LES (can end up causing problems with reflux)
POEM- the heller myotomy except it is done laparoscopically
what is gastritis
chronic or acute inflammation of the stomach d/t breakdown of the protective barrier
what happens to the stomach lining with gastritis
the breakdown in the protective layer of the stomach.
-when the barrier is broken, HCL and pepsin secrete into the tissue and cause edema, disruption of capillary walls and can cause hemorrhage.
what are some causes of gastritis
NSAIDS, aspirin and corticosteroids (inhibit the synthesis of prostaglandins)
alcohol use- increases HCL production
H pylori
radiation exposure
stress
what contributes to the protective layer of the stomach
-prostaglandins
manifestations of Gastritis
Heartburn
epigastric pain
anorexia
nausea
what is a complication of chronic gastritis
Pernicious anemia because the parietal cells are lost d/t atrophy and thus less IF is being secreted = less b12 absorption
What types of test would you do for a pt with gastritis
EGD/bx
H Pylori
cbc w/ IF
guaic stool
how do we treat gastritis
eliminate cause if known (i.e.: meds)
- NG tube for bowel rest
- PPIs (omeprazole)
- H2 blockers(ranitidine)
- antacids
- Abx (for H pylori infection)
complications of acute/chronic gastritis
ulcer formation
hemorrhage d/t ulceration
increased risk for stomach cancer d/t cells changing
What is Gerd
reflux of the gastric contents into the esophagus d/t incompetent LES
what puts pts at greater risk for GERD
- Incompetant LES
- food- caffeine, chocolate, peppermint
- Medications- anticholinergics(cause relaxation of the sphincter)
- smoking
- hiatal hernia
- obesity/increased abd pressure
s/s of GERD
- heartburn
- dyspepsia
- regurgitation- hot bitter sour liquid into throat or mouth
- respiratory sis (coughing, wheezing, dyspepsia, aspiration)
- chest pain burning squeezing or radiating to the back
what type of diagnostic tests would you suggest for a pt with GERD
-Endoscopy w/ bx (good is assessing the LES competence and the degree of inflammation
(bx to determine carcinoma from barrette and degree of dysplasia)
- pH monitoring- to determine the pH in the lower esophagus
- manometry- measure the LES pressure and motility
- Upper GI barium to see how the GI system is working
what are complications of GERD
- Esophagitis
- Barretts esophagitis
- respiratory compromise (aspiration, bronchospasm, cough,)
what is barretts esophagus
breakdown of tissue outside the esophageal sphincter. the cells begin to change and become precancerous
what are some medications that can be used to treat GERD
- PPIs
- H2 blockers
- prokinetic agents
- sulcrafate
- cholinergic
- antacids
- aluminum and magnesium
- Prostaglandins (cytotec)
what are the PPIs that can aid with GERD
dexilant nexus prevacid omeprazole pantoprozole
how do PPIs work
Inhibit the H+K+-atpase pump (responsible for gastric acid secretion)
thus decreasing HCL secretion
what are side effects of PPIs
HA Abd pain N&V diarrhea flatus
how do H2 blockers work
blocks the H2 receptors that way histamine cannot bind and thus decreasing the HCL secretion
what are the H2 blocker meds
Tagamet
Pepcid
nizatidine
ranitidine
Side effects of H2 blockers
HA
abd pain
diarrhea
constipation
what type of lifestyle changes should a pt make with GERD
- smaller more frequent meals throughout the day
- do not lay down for 2-3 hours after eating
- avoid triggering factos
- lose weight
- loose clothing around mid section
what types of surgery can be performed for GERD
LINX reflux management
(magnet around the LES that will act as the sphincter
What are the two types of hiatal hernias
sliding (most common- stomach slides up above diaphragm and back down)
-rolling (funds rolls through diaphragm and stays- causes risk for strangulation)
what diagnostic tests can you perform for hiatal hernia
- upper GI barium swallow
- EGD
what are s/s of a hiatal hernia
- Heartburn
- dyspepsia
- regurgitation
- pain
what contributes to the cause of a hiatal hernia
- weakening of the muscles of the diaphragm
- aging
- increasing abdominal pressure
- obesity
- pregnancy
- ascites
- heavy lifting
what are complications of a hiatal hernia
GERD esophagitis hemorrhage (from erosion- from gerd) stenosis ulceration of of herniated portion regurgitation strangulation
how do you treat hiatal hernias as a nurse
- decrease intra abdominal pressure
- avoid drugs and diets that effect the LES
- avoid late means/ before bed meals
- sleep at a 45 degree angle
- medications to relieve sxs such as PPIs or H2 blockers
- avoid carbonated beverages
prevent problems with gastric reflux
what are surgical options for hiatal hernias
Lap nissen- take the fundus of the stomach and wrap it around the LES - enhancing the function
Toupet fundoplication= only goes 270 degrees around the LES
what is peptic ulcer disease
erosion of the GI mucosa resulting from HCL and pepsin
a loss in balance of the stomach protective and agressive mechanisms
it can occur in any portion of the GI tract.
what determines the classification of PUD
the degree and duration of mucosal involvement
what tests are done for PUD
Endoscopy (most accurate)
biopsy to test for H pylori
labs- H&H
barium tests- to diagnose gastric outlet obstruction or for ulcer detection
risk factors for peptic ulcer disease
H pylori stress alcohol smoking medications- NSAIDS aspirin, corticosteroid, anticoags coffee (caffeine and decaffeinated) genetics
what are signs and symptoms of PUD
burning, gnawing pain
- in the stomach- shortly after meals
- in the duodenum - 2-3 hrs PC
dyspepsia
hematemesis
melena
coffee ground emesis
what should you do for a patient with PUD
- make them NPO for bowel rest
- IVF usually with 2 large bore IVs
- NG tube for bowel rest
- medications
- if pt still is not recouping, possible blood transfusion
help pt ID the cause and eliminate it. teach them to avoid foods that irritate it and cessation of smoking drinking and avoid stress
what are the complications that can arise from PUD
- Hemorrhage
- peforation
- gastric outlet obstruction- ( in chronic pud pts, scarring and tissue remodeling can lead to this)
what are signs of perforation
*signs are usually sudden* sever upper abd pain spreading to the back rigid/board like abdomen shallow/rapid breathing tachycardia weak pulse melena N&V hemataemesis
what are some medications used for PUD
- Antacids- neutralize the stomach acid
- sucralfate-coats lining of stomach
- H2 blockers- blocks histamine receptors = decreased acid production (ranitidine)
- PPIs- inhibits active enzymes in parietal cells = decreased acid production (omeprazole)
- Metoclopramide (pro kinetic agent)- increases gastric emptying
- antibiotics - for H Pylori infection
what is a gastric outlet obstruction
an obstruction at the distal end of the stomach resulting in edema, inflammation, scar tissue formation
what surgeries can be done for PUD
- Partial gastrectomy
- vagotomy (clips vagus nerve and limits stimulation)
- pyloroplasty (dilates the pyloric sphincter)
what are the 2 partial gastrectomy surgeries
- Billroth I (gastroduodenostomy)- remove part of the stomach and connect it with the duodenum
- BIllroth II- (gastrojejunostomy)- remove part of the stomach and connect it with the jejunum
what is the primary goal of treatment for a pt with an upper GI bleed
find the source of the bleeding
what are causes of upper GI bleeds
gastritis
ulcer
cancer
medications
what diagnostic tests should you run for a pt with suspected or known UGI bleed
- frequent H&H q4-6 hrs
- upper GI- may be emergent- to find source of bleed
- guiac stool
- frequent vitals
- labs-cbc, bun, electrolytes, pt ptt. liver enzymes ABG
what are clinical manifestations of a pt with a UGI bleed
- fatigue
- pain
- dyspepsia
- hemataemesis
- melena
-if sudden or massive bleed, pt may experience anxiety restlessness change in LOC tacky dyspneic tachypnea cool clammy skin nausea (signs of shock!)
why is a BUN helpful in a GI bleed
because during significant hemorrhage, blood proteins are broken down by GI tract bacteria resulting in an elevated BUN
also
elevated BUN levels may indicate renal hypo perfusion or renal disease
what treatment will a pt with an UGI bleed get
- frequent vital signs
- frequent H&H
- neuro checks for altered LOC
- oxygenation
- multiple large bore IVs- for fluid and blood
- NG tube for bowel rest
- fluid replacement and blood if needed
PPI or H2 blocker via IVP/infusion
sandostatin - IV infusion– will decrease blood flow to the gi tract and decrease acid secretion
(chronic bleed will need psi sucralfate and iron supp)
what does your pt need to be educated about after gastric surgery
-they may need to be on B12 for the rest of their life d/t there is not enough IF to absorb the b12
(they are at risk for pernicious anemia)
-they may experience dumping syndrome which causes pain, discomfort nausea and epigastric fullness, dizziness
what type of diet should someone have after gastric surgery
-low carb
high protein
high fat
what is rebound pain
the pt does not feel pain on palpation but feels pain after you lift your hands after palpation
what can cause appendicitis
obstruction, stricture
– the fecal matter gets trapped and becomes a harbor for bacterial growth
what are manifestations of appendicitis
rebound RLQ pain guarding/knees drawn up anorexia, vomiting fever constipation/bloating/diarrhea
what diagnostic tests can be done for appendicitis
observe pain pattern
abdominal assessment (mcburneys point)
labs- cbc may be elevated, ua to r/o GU problems that can mimic appendicitis, CT or US to confirm, hcg for females to r/o pregnancy
what are complications of appendicitis
- ileus
- perforation- can lead to peritonitis (fatal)
- shock
what are nursing interventions for a pt that comes in with appendicitis
- NPO- prep for sx
- treat for pain- only with diagnosis
- IV fluids and Abx to prep for sx
- monitor for worsening
- surgical consult
what happens when a laxative is given to a pt with appendicitis
-it increases peristalsis therefore it can cause the inflamed appendix to rupture
what does post op care of a lap appy consist of
- abx for 48hrs
- ambulation
- anti emetics
- monitor for flatus
- advance diet as tolerated
- monitor for s/s of peritonitis
signs and symptoms of peritonitis
- Severe bd pain-tenderness over involved area
- abdominal distention or rigidity
- N&V
- tympanic abd-(air inside)
- rebound tenderness
- hypotension
- fever/chills
- weak rapid pulse
- tachypnea d/t distention
- weakness
what diagnostic tests are done for pertonitis
- labs- abc to determine abc count and hemoconcentration
- abd xray- determine bowel loops for paralytic ileus or free air if perforation has occured
- US/CT to detect abscess or ascites
what are complications of peritonitis
- if care is delayed it can lead to
- septic shock
- hypovolemic shock
- paralytic ileus
- acute respiratory distress syndrome
what is the treatment for a pt with peritonitis
- NPO and NG tube to decrease gastric distention and to decrease further leakage of bowel contents
- IVF to replace lost fluids and to have access for ABX
- analgesics for comfort
- I&O to determine replacement therapy
- anti emetics to control nausea
- Monitor patient closely
what surgery is performed for a pt with pertonitis
-Laparotomy
find the cause and repair the damage, drain purulent fluid and flush with abx solution
what is crohns disease
a chronic incurable inflammatory bowel disease
- mostly occurs in the ileum
- consists of inflamed lesions with spaces of healthy tissue
-an inapropriate sustained response to their own GI response
what can develop with crohns disease
deep fissures that can lead to fistulas and abscesses
as well as
altered nutrition r/t unable to absorb a lot of the nutrients d/t those lesions
what are risk factors for developing crohns
-diet (refined sugars, saturated fats, meats), hygiene, stress, smoking and NSAIDS
(increase susceptibility by influencing the environment of the bacteria and immune system),
genetic factors (heredity, gender, age, family)
altered immune system
signs and symptoms of crohns disase
- episodes of diarrhea and and pain
- steatorrhea (oily with odor)
- anorexia, N&V
- malabsorption leading to weight loss, anemia, fatigue
- rectal bleeding
(anemia d/t decrease in production of RBC d/t not enough nutrients to make RBC)
what is ulcerative colitis
an auto immune inflammatory disease of the colon consisting of inflammation and ulcerations in the mucosal layer (it does NOT extend through all bowel wall layers)
what are s/s of UC
- 4-20 stools/day
- watery diarrhea w/ poss blood and pus
- abd cramping
- weight loss- d/t chronic water loss
- involuntary leakage of stool
what diagnostic tests are used for IBD
- colonoscopy for differentiation
- biopsy
- CT/MRI/ transabd US/ sm bowel follow through, BE
- labs-cbc, cmp, albumin (r/t poor nutrition), ESR, CRP,
- stool culture to look for blood/pus
capsule endoscopy - For Crohns Only
what type of nutritional tx will a pt require with IBD
- may need enteral, parenteral or vitamins for Crohns
- manage weight loss and dehydration for Colits
- may need dietary consult to have diet with adequate nutrition and not cause exacerbation
what types of meds are used for Tx of crohns and UC
- Sulfasalazine- anti inflammatory
- immune suppressors- given to retain remission
- Corticosteroids- used to achieve remission
- abx
- anti diarrheals
- pain meds
- anti emetics
immune suppressors have delayed action so they are not good for acute flare ups. Steroids should be used in an acute situation
what are nursing interventions for Crohns and Colitis
- bowel rest- poss NPO
- control inflammation & infection and nutrition
- Monitor I&O
- teach pt to avoid triggers and minimize stress
- provide symptom releif
what foods do you want to avoid with UC
cabbage sprouts capsicum radish raw salads okra brocoli raw onions
what are complications of IBD
Toxic megacolon- colonic dilation- at risk for perforation
Bowel obstructions
difference between Diverticulosis and diverticulitis
- osis= pockets/outpouches in colon
- itis= inflammation of one or more of those outpouchings
usually occurs in the area where blood vessels penetrate the colon wall
what are causes of diverticulosis/itis
weakening of the bowel wall and increased intraluminal pressure
which can be associated with age, prior sx, decreased fiber intake (causing hardening of stool making it harder to move increasing pressure weakening walls)
what are complications of diverticulitis
Perforation
peritonitis
abscess
scarring
what are signs and symptoms of diverticulitis
mostly asymptomatic but can show as LLQ and pain change in bowel habits diarrhea/constipation bloating flatulence
what diagnostic tests can be used for suspected diverticulitis
- colonoscopy
- XR
- CT
- MRI
- Labs-cbc for infection, crp
- stool
what is the treatment for diverticulitis
- bowel rest-NPO w/ IV hydration
- education for pt on dietary modifications
- –high fiber, no seeds, find the aggravating factor
- medications (abx, stool softness, anticholinergics, laxatives)
- NG w/ low intermittent suction
- surgery- colon resection or poss temp colostomy
what can be the cause of a bowel obstruction
- Mechanical
- -adhesion/stricture
- -intussusception (bowel slips into itself)
- -volvulus- (twisting of the bowel)
- -cancer
- -hernia
- Non Mechanical
- -Paralytic ileus
what are complications of a bowel obstructoin
- ileus
- perforation
- necrotic bowel
what diagnostic studies can be done to diagnose bowel obstruction
- CT scan
- abd xr
- poss endoscopy, sigmoidoscopy, colonoscopy
- labs (elevated CBC can indicate strangulation, elevated hct may refelct hemoconcentration, decreased H&H = bleeding or strangulation, electrolytes bun and creat to assess dehydration, abg to monitor metabolic alkalosis)
clinical manifestations of a pt with a bowel obstruction
- severe abdominal pain
- N&V
- sweating
- anxiety
- restlessness
- abd distention
- constipation
- lack of flatus
- hyperactive/hypoactive bowel sounds
what is the treatment for bowel obstruction
NPO status and NG tube for decompression IV fluids- NS or LR (isotonic), + electrolyte replacement anti emetics pain control abx- prophylactically -TPN if pt NPO for extended time **monitor for worsening condition** Consult with surgeon (sx will be required for mechanical obstruction)
NO laxatives in bowel obstruction
how is colon cancer preventable
colon cancer begins as a polyp of the tissues in the colon and rectum. These are seen via colonoscopy. Identified early enough it can be prevented
what are risk factors for colon cancer
- Genetic
- ethnicity (african americans, men, red meat, processed meat, low fiber, obesity, alcohol, smoking, IBD, age)
what are clinical manifestations of colon cancer
-vague in the beginning and do not show symptoms until the disease is advanced. when they do appear they include -rectal bleeding, -anemia -abdominal pain -weight loss
what are ways to decrease the risk of developing colon cacner
high fiber diet, no processed meat, no smoking/drinking
increase fruit and veggies
-long term use of NSAIDS can decrease risk
what are the warning signs of colon cancer
- change in bowel elimination
- blood in the stool
- rectal/abdominal pain
- change in character of stool
- sensation of incomplete emptying
what are the diagnostic tests for colon cancer
- colonoscopy (q10yrs)
- sigmoidoscopy (q5yrs)
- BE (q5yrs)
- CT, MRI, US- to detect metastasis)
- labs (fecal occult blood test, CEA, serum iron, LFTs/coag studies, cbc to check for anemia)
what is treatment for colon cancer
- bowel prep for surgery - colectomy, colostomy, colon resection
- chemo
- radiation
what type of post op care would a bowel surgery pt need
- dressing changes (sterile)
- NG tube and Strict NPO
- -diet to be progressed after flatus
- AMBULATE!!!!!!!!!!!!!!!!!!!!!!!!!
- maintain fluid volume status
- Strict I&O
- drain care if there is one
