Unit 7 - A

Question 1

What are the organs making up the GI tract?
When does digestion begin?

Answer 1

Mouth, esophagus, stomach, small & large intestine, rectum, anus. Liver, pancreas, gallbladder.
Digestion begins before food enters the mouth.

Question 2

Define the terms ingestion & digestion/absorption

Answer 2

Ingestion: Intake of food.
Digestion & Absorption: Happens in the stomach and small intestine.

Question 3

What is the function of the pancreas?

Answer 3

Neutralizes acidity of chyme.
Aids in digestion of fats/carbohydrates/proteins.

Question 4

What is the function of the liver?

Answer 4

Makes bile.
Helps convert ammonia to urea.

Question 5

What is the function of bile and where is it made/stored?

Answer 5

Bile aids in breakdown of fats.
Made in liver, stored in gallbladder.

Question 6

What is the function of the small intestine and villi?

Answer 6

Uptake of nutrients to the bloodstream.

Villi:
Increase surface area for absorption.

Question 7

What is the function of the large intestine?

Answer 7

• Absorption of water & electrolytes.
• Formation & expulsion of feces.
• Secretes mucus for lubrication & protection of mucosal lining.
• Synthesize vitamin K & some B vitamins.
• Final breakdown of undigested proteins.

Question 8

What controls peristalsis?

Answer 8

Under control of nervous system:
Parasympathetic - stimulates
Sympathetic - inhibits

Question 8

What is the general make-up of feces?

Answer 8

75% water
Bacteria
Unabsorbed minerals
Undigested foodstuffs
Bile pigments
Epithelial cells

Question 9

How would you assess the GI tract?

Answer 9

Inspection, auscultation, palpation.
Observe contour/masses/scars/distention.
Listen for 30s-5min in all quadrants.
Listen for bowel sounds - absent, hypo-, normo-, hyper-
Identify flatus.

Question 10

How would you examine the anus/rectum?

Answer 10

Inspect for lesions, ulcers, fissures, inflammation/external hemorrhoids.
Inspect for skin irritation.

Question 11

How would you assess the pt. elimination patterns? (UARPB)

Answer 11

Ask: UARPB
Usual pattern
Aids
Recent changes
Problems
Bowel diversion

Question 12

What affects bowel elimination?

DALMS

Answer 12

Daily patterns
Amount of food & fluid
Level of activity
Medication
Surgery

Question 13

What are the effects of aging on the GI system?

Answer 13

Xerostomia (Dry mouth)
Decreased appetite
Delayed emptying of esophagus
Decreased HCI secretion

Question 14

What diagnostic studies can be performed on the GI system?

Answer 14

-Stool collection/culture
-Direct Visualization:
* EGD
*Colonoscopy
*ERCP
-Indirect Visualization:
*UGI
*Barium Edema
*MRI/CT Scan

Question 15

What does a liver biopsy do and what liver function lab tests can you do? What are the normal values of the lab tests?

Answer 15

-Direct pressure against liver.
-Liver enzymes: ALP (30-120U/L) / ALT (12-78U/L) / AST (0-37U/L)
-Proteins: T. Protein(6.4-8.2g/dL), Albumin(3.2-4.7g/dL), Globulin(2.3-3.5g.dL).
-Bilirubin: Total (<1.1mg/dL). Direct (0-0.30mg/dL).

Question 16

Define nausea and anorexia.

Answer 16

-Feeling of discomfort/desire to vomit.
-Fear of gaining weight.

Question 17

Define vomiting.

Answer 17

Forceful ejection of ingested food & secretions.

Question 18

What can you do to prevent nausea & vomiting?

Answer 18

-Give IV fluid/ electrolytes and glucose.
-Use NG tube.
-Use advance DAT.

Question 19

What is a nasogastric (NG) tube and what does it do?

Answer 19

-Allows the GI tract to rest before/after surgery.
-It’s inserted to monitor for GI bleeding.
-Must clamp when giving medications.
-You must verify placement.

Question 20

Define the terms aspiration & dysphagia. What do you give a pt. with dysphagia?

Answer 20

-Inhalation of foreign material.
- Difficulty swallowing: Give thickened liquids.

Question 21

What must you do when giving enteral nutrition (tube feedings)?

Answer 21

-You must perform an X RAY.
-Place HOB over 30º to avoid aspiration.

Question 22

What is diarrhea? What is it caused by?
Define acute vs chronic diarrhea.

Answer 22

Anything more than 3 stools/day.
Acute: Less than 14 days.
Chronic: More than 30 days.
Caused by bacteria.

Question 23

What are some nonpharmacologic interventions for diarrhea?

Answer 23

• Give clear liquids.
  -Give oral solutions such as gatorade & pedialyte.
• Give IV electrolytes.

Question 24

What are the nursing interventions for pt. with diarrhea?

Answer 24

-Answer call lights.
-Remove cause of diarrhea.
-Monitor region around the anus.

Question 25

What is C. Difficile? What are its risk factors?

Answer 25

-Watery diarrhea, fever, anorexia, nausea, and abd pain.
- It is a hospital acquired infection.
-Risk factors:
* Abx, chemo, and immunosuppressive drugs.

Question 26

Antidiarrheals: Diphenoxylate & Loperamide; what do they do?

Answer 26

-Decrease hypermotility
-Can cause CNS/respiratory depression, & physical dependance.

Question 27

Adsorbents: Bismuth subsalicylate
What do they do?
What are their side effects?

Answer 27

-Coat GI tract wall.

S/E:
Dizziness/drowsiness, abd pain, constipation.

Question 28

What are the characteristics of constipation?

Answer 28

-Less than 4 stools/week.
-Straining
-Hard, dry, difficult to pass stools.
-Incomplete evacuation

Question 29

What are the risk factors for constipation?

LDEC

Answer 29

-Low fiber/fluid intake
-Decreased physical activity
-Emotions/pain
-Constipating medications

Question 30

What foods have a laxative effect?

Answer 30

Fruits, vegetables, bran, chocolate, alcohol, coffee.

Question 31

What foods have a gass-producing effect?

Answer 31

Onions, cabbage, beans, cauliflower.

Question 32

What foods increase the chance for constipation to occur?

Answer 32

Cheese, lean meat, eggs, pasta.

Question 33

What are some nonpharmacologic measures to prevent constipation?

Answer 33

-High fiber diet
-Increased water intake
-Position knees above hips
-Exercise

Question 34

What are some pharmacologic measures to prevent constipation? Any side effects?

Answer 34

Give Laxatives such as:

-Osmotic (saline)
-Stimulant (irritants)
-Bulk-forming
-Emollient (stool softeners)

S/E:
N.V.D./cramping, flatulence

Give Enemas

Question 35

What are some laxative contraindications?

Answer 35

-Undiagnosed abd pain

-Inflammatory GI disorders

-Bowel obstruction

-Spastic bowel (IBS)

-Pregnancy

Question 36

What types of enemas can you give?

Answer 36

-Cleansing
-Retention
-Large volume
-Small volume

Question 37

What do bulk-forming laxatives do?

Answer 37

-Absorb water into the intestine and increase fecal bulk.

-Results usually occur 8-24hrs

-Insufficient water intake can cause drug to solidify and cause an obstruction

Question 38

What do emollients (stool softeners) do?

Answer 38

-Lowers surface tension inside intestines

-Promotes water accumulation in intestine and stool

-Prevents constipation

-Decreases straining

Question 39

What do stimulant laxatives do?

Answer 39

-Increases peristalsis by irritating sensory nerve endings in intestinal mucosa

-Produces watery stools

-PO: within 6-8 hrs. PR: 15-60 mins.

-Used to empty bowel prior to diagnostic study

Question 40

What do osmotic laxatives include and do?

Answer 40

Include:
-Salts/saline products
-Lactulose
-Glycerin

-Pulls water into colon and feces, increasing bulk and peristalsis

-Monitor electrolytes to avoid imbalance

Question 41

What can cause fecal incontinence?

Answer 41

-Constipation/fecal impaction

-Trauma

-Caffeine/dairy products/insoluble fiber veggies

Question 42

What types of ostomies can you put?

Answer 42

-Sigmoid

-Descending

-Transverse

-Ascending

-Ileostomy

Question 43

What is the stool consistency from ostomies?

Answer 43

-Ileostomy allows liquid fecal content

-Colostomy allows formed feces content

Question 44

What are the types of ostomy appearances?

Answer 44

-Normal: Dark pink/red, moist, rounded.

-Pale: Indicates severe anemia.

-Eroded: May lead to a flush stoma.

Question 45

What are esophageal & gastric varices? Any risks? Medications?

Answer 45

-Similar to hemorrhoids but in the esophagus and stomach.

-High risk for internal bleeding when inserting NG tubes.

-Medications: Somatostatin analog.