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Med Surg > Upper GI > Flashcards

Upper GI Flashcards

1
Q

What is included in the post procedure care for a UGI/LGI series?

A

Laxative and fluids
Report constipation
Scheduling!!
SBFT (small bowel follow through)

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2
Q

What is included in post procedure care after an esophagogastroduodenoscopy (EGD)?

A

Check gag reflex
Pt will probably have sore throat
Monitor for complications:
- Perforation
- Hemorrhage
- Infection

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3
Q

What is an Endoscopic Retrograde CholangioPancreatography (ERCP)?

A

Visualizes the liver, gallbladder, bile ducts, and pancreas

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4
Q

What does the post procedure care include after an ERCP?

A

Monitor vital signs
Check for gag reflex
Monitor for complications:
- Pancreatitis
- Perforation
- Hemorrhage
- Infection

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5
Q

What is included in post procedure care after an endoscopy (colonoscopy or Procto/Sigmoidoscopy)?

A

Monitor vital signs
Monitor for pain, bleeding
Monitor for complications:
- Perforation
- Hemorrhage
- Infection

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6
Q

Diet for after bariatric surgery

A

Post op:
Begin with small amts of liquids (30 mL ever 2 hours)
Diet is progressive, 6 small meals per day

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7
Q

Possible complications after bariatric surgery

A

Pulmonary complications
Vomiting is common
Anemia: vitamin deficiencies
Anastomosis leaks (drainage)
Wound infections

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8
Q

What is dumping syndrome?

A

Cluster of symptoms that can occur following eating food.
Food enters small intestine too rapidly, causing fluid shifts in the gut.
This causes abdominal distention
(Is often related to the amount of sugar in the food)

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9
Q

Cause of early dumping (w.in 30 min of eating)

A

Stomach can’t control amount of chyme passing into small intestine
Large fluid bolus of hypertonic fluid enters intestine
Fluid is drawn into bowel lumen, causing decrease in plasma volume, bowel distention, and rapid intestinal transit
(Decreased plasma volume)

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10
Q

S/S of early dumping

A

Generalized weakness, perspiration
Palpitations, tachycardia, hypotension, syncope, dizziness, flushing
Abdominal cramping/pain, borborygmi, urge to defecate
(Usually lasts less than 1 hour)

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11
Q

What causes later dumping (2 hrs after eating)?

A

Too much insulin being released in response to an increase in blood sugar from carbs entering into the jejunum (secondary hypoglycemia)

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12
Q

S/S of later dumping

A

Hypoglycemia
Perspiration
Hunger
Weakness
Confusion
Tremor
Tachycardia
Anxiety

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13
Q

Pt teaching for management of dumping syndrome

A

Do not drink liquids with meals
Eat 5-6 small meals per day
High protein, low fat
Low to moderate carb intake
Lie down after meals to decrease peristalsis
Wait 1 hour after meals to drink fluids

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14
Q

Risk factors for GERD

A

Fatty foods, caffeine, chocolate, nicotine
Drugs: beta blockers, CCB, morphine, Anticholinergics, nitrates, Valium (Benzos)
Obesity
Smoking
Hiatal hernia

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15
Q

Pt teaching for nutritional therapy for GERD

A

Avoid foods that decrease LES pressure or irritate esophagus
Small, frequent meals
Avoid late evening meals
Drink fluids between meals
Chewing gum and oral lozenges is ok

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16
Q

Diagnostic tests done for GERD

A

Ambulatory esophageal pH monitoring
Endoscopy

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17
Q

Interventions for pts with GERD

A

Diet: restrict spicy/acid/fatty foods
4-6 low fat small meals
Avoid carbonated beverages
Avoid evening snacks / 2-3 hrs before sleep
Chew thoroughly, eat slowly

Elevate HOB on 4-6 inch blocks
Quit smoking, limit alcohol
Remain upright for 2-3 hrs after eating
Weight loss

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18
Q

After someone has diagnostic studies for a hiatal hernia or GERD, what is the post treatment care?

A

Force fluids to flush the contract out
Let pt know stool will be dark and chalky

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19
Q

What is Nissan fundoplication?

A

A surgery to correct GERD that tightens the junction between the esophagus and stomach
(Pt would have conservative tx first, and then would have the surgery if no relief)

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20
Q

Med treatment for helicobacter pylori

A

PPI (proton pump inhibitors) and antibiotics (Flagyl, *tetracycline)

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21
Q

Characteristics of gastric ulcers

A

High mortality
*High epigastric pain
*Occurs 30-60 min after eating
*Not relieved by food
*Hematemesis = bright red blood or coffee grounds
*Weight loss

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22
Q

Complications from gastric ulcers

A

*Hemorrhage (more likely to happen than with duodenal ulcers)
Perforation
Peritonitis

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23
Q

Characteristics of duodenal ulcers

A

High morbidity
*Mid-epigastric pain (lower than gastric ulcers)
*Occurs 2-4 hours after eating and at bedtime (when stomach is empty)
*Relieved by food
*Melena (dark, tarry stools)
*Weight stays stable
*low risk of malignancy

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24
Q

Complications of duodenal ulcers

A

*Perforation (more likely than gastric ulcers)
Hemorrhage
Peritonitis

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25
Q

Ages of people who typically get duodenal ulcers vs gastric ulcers

A

Duodenal = younger than gastric (any age, but 35-45 more common)

26
Q

Diagnostic studies for H. Pylori

A

Endoscopy (*EGD) = direct visualization
*Noninvasive H. Pylori: serology, stool, breath test
Labs: CBC, liver enzymes, serum amylase

27
Q

Symptoms of peritonitis

A

Sudden, severe upper abdominal pain - quickly spreads throughout abdomen
Pain radiates to back
*Rigid, board-like abdominal muscles
N/V
*No bowel sounds (as infection worsens)
**This is an emergency - can be fatal if no intervention

28
Q

What are the surgical interventions for PUD?

A

Bilroth I: cut off portion of diseased stomach and connect to duodenum
Bilroth II: cut off portion of stomach and connect to jejunum

29
Q

Post op management for PUD surgery

A

NPO
NGT: to decompress stomach (suck fluid out)
Return of GI function? (If pt can pass gas/stool)
B-12 (parenteral) for life b/c cant absorb orally anymore

30
Q

Nursing consideration for antacids

A

No antacids should be given within 1 hour of taking other meds b.c it will decrease their efficacy

31
Q

Common side effects of Mg antacids

A

Diarrhea
Renal failure
Ng+ toxicity
(No constipation)

32
Q

Side effects of Al antacids

A

Constipation
Low phosphorous

33
Q

Side effects of CaCo3 antacids

A

Constipation

34
Q

Side effects of NaHCO3 antacids

A

Fluid retention
Alkalosis
Constipation

35
Q

Function of H2 antagonists

A

Decrease gastric acid secretionby blocking histamine receptor in parietal cells

36
Q

Most common type of H2 antagonist

A

Famotidine (Pepcid)

37
Q

Use of H2 antagonists

A

PUD
GERD
H. Pylori ulcers

38
Q

Side effects of H2 antagonists

A

Confusion
Dizziness (elderly)
Diarrhea
Monitor for bleeding

39
Q

Patient teaching for H2 antagonists

A

Avoid smoking, aspirin, NSAIDs, and alcohol

40
Q

What are PPI (proton pump inhibitors) used for?

A

PUD
GERD

41
Q

Function of PPIs

A

Antisecretory agents
Cause irreversible inhibition of enzyme producing gastric acid
Suppresses gastric acid production

42
Q

Most common type of PPI

A

Pantoprazole (Protonix)

43
Q

Side effects of PPI

A

HA
Dizziness
Diarrhea
Decreased Ca+ absorption = bone fracture with long term tx
Thrombophlebitis at IV site

44
Q

Pt teaching for PPIs

A

Avoid smoking, alcohol, aspirin, and NSAIDs

45
Q

What are prokinetis used for?

A

GERD
Diabetic gastroparesis
Post-op motility

46
Q

Function of prokinetics

A

Promote gastric emptying
Reduce risk of gastric acid reflux
By increasing action of acetylcholine, causing increased GI motility and increases esophageal sphincter tone

47
Q

Side effects of prokinetics

A

Extrapyramidal effects:
- tardive dyskensia
Sedation
Diarrhea
Hypoglycemia

48
Q

Contraindications for prokinetics

A

GI obstruction/perforation

49
Q

Most common type of prokinetic

A

Metoclopramide (Reglan)

50
Q

Most common type of antiflatulant

A

Simethicone (Mylicon)

51
Q

Function of Simethicone

A

Relieves excessive gas by changing surface tension of gas bubbles, allowing them to stick together and pass through belching or flatulence

52
Q

Nursing considerations for Simethicone

A

Shake suspension
Monitor bowel sounds
Have pt walk and avoid gas producing foods

53
Q

Most common prostaglandin/Cytoprotective

A

Misoprostol (cytotec)

54
Q

Use of misoprostol (Cytotec)

A

Prevent PUD in Long term NSAID administration (Ex: rheumatoid arthritis)
Accelerates ulcer healing
Acts as a prostaglandin in GI tract to increase protective mucosal barrier of gastric lining

55
Q

Side effects of misoprostol (cytotec)

A

Diarrhea

56
Q

Nursing considerations for misoprostol (Cytotec)

A

Avoid mg containing antacids (b.c misoprostol already causes diarrhea)
Take with meals and at sleep

57
Q

What are anti ulcer/mucosal barrier fortifiers/cytoprotectives used for?

A

Duodenal ulcers

58
Q

anti ulcer/mucosal barrier fortifiers/cytoprotective drug name

A

Sucralfate (Carafate)

59
Q

Function of sucralfate (carafate)

A

Duodenal ulcers
Forms viscous sticky gel that adheres to ulcer crater, creating a protein barrier lasting up to 6 hours
Accelerates ulcer healing

60
Q

Side effects of sucralfate

A

Constipation
Decreases absorption of digoxin, warfarin, and phenytoin

61
Q

Nursing considerations for sucralfate

A

Increase fluids and fiber
Give 1 hr before or 2 hrs after meals
Do not give within 30 min of other meds or antacids

Med Surg (12 decks)

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