Upper GI Flashcards
What is included in the post procedure care for a UGI/LGI series?
Laxative and fluids
Report constipation
Scheduling!!
SBFT (small bowel follow through)
What is included in post procedure care after an esophagogastroduodenoscopy (EGD)?
Check gag reflex
Pt will probably have sore throat
Monitor for complications:
- Perforation
- Hemorrhage
- Infection
What is an Endoscopic Retrograde CholangioPancreatography (ERCP)?
Visualizes the liver, gallbladder, bile ducts, and pancreas
What does the post procedure care include after an ERCP?
Monitor vital signs
Check for gag reflex
Monitor for complications:
- Pancreatitis
- Perforation
- Hemorrhage
- Infection
What is included in post procedure care after an endoscopy (colonoscopy or Procto/Sigmoidoscopy)?
Monitor vital signs
Monitor for pain, bleeding
Monitor for complications:
- Perforation
- Hemorrhage
- Infection
Diet for after bariatric surgery
Post op:
Begin with small amts of liquids (30 mL ever 2 hours)
Diet is progressive, 6 small meals per day
Possible complications after bariatric surgery
Pulmonary complications
Vomiting is common
Anemia: vitamin deficiencies
Anastomosis leaks (drainage)
Wound infections
What is dumping syndrome?
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)
Cause of early dumping (w.in 30 min of eating)
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)
S/S of early dumping
Generalized weakness, perspiration
Palpitations, tachycardia, hypotension, syncope, dizziness, flushing
Abdominal cramping/pain, borborygmi, urge to defecate
(Usually lasts less than 1 hour)
What causes later dumping (2 hrs after eating)?
Too much insulin being released in response to an increase in blood sugar from carbs entering into the jejunum (secondary hypoglycemia)
S/S of later dumping
Hypoglycemia
Perspiration
Hunger
Weakness
Confusion
Tremor
Tachycardia
Anxiety
Pt teaching for management of dumping syndrome
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
Risk factors for GERD
Fatty foods, caffeine, chocolate, nicotine
Drugs: beta blockers, CCB, morphine, Anticholinergics, nitrates, Valium (Benzos)
Obesity
Smoking
Hiatal hernia
Pt teaching for nutritional therapy for GERD
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
Diagnostic tests done for GERD
Ambulatory esophageal pH monitoring
Endoscopy
Interventions for pts with GERD
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
After someone has diagnostic studies for a hiatal hernia or GERD, what is the post treatment care?
Force fluids to flush the contract out
Let pt know stool will be dark and chalky
What is Nissan fundoplication?
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)
Med treatment for helicobacter pylori
PPI (proton pump inhibitors) and antibiotics (Flagyl, *tetracycline)
Characteristics of gastric ulcers
High mortality
*High epigastric pain
*Occurs 30-60 min after eating
*Not relieved by food
*Hematemesis = bright red blood or coffee grounds
*Weight loss
Complications from gastric ulcers
*Hemorrhage (more likely to happen than with duodenal ulcers)
Perforation
Peritonitis
Characteristics of duodenal ulcers
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
Complications of duodenal ulcers
*Perforation (more likely than gastric ulcers)
Hemorrhage
Peritonitis
Ages of people who typically get duodenal ulcers vs gastric ulcers
Duodenal = younger than gastric (any age, but 35-45 more common)
Diagnostic studies for H. Pylori
Endoscopy (*EGD) = direct visualization
*Noninvasive H. Pylori: serology, stool, breath test
Labs: CBC, liver enzymes, serum amylase
Symptoms of peritonitis
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
What are the surgical interventions for PUD?
Bilroth I: cut off portion of diseased stomach and connect to duodenum
Bilroth II: cut off portion of stomach and connect to jejunum
Post op management for PUD surgery
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
Nursing consideration for antacids
No antacids should be given within 1 hour of taking other meds b.c it will decrease their efficacy
Common side effects of Mg antacids
Diarrhea
Renal failure
Ng+ toxicity
(No constipation)
Side effects of Al antacids
Constipation
Low phosphorous
Side effects of CaCo3 antacids
Constipation
Side effects of NaHCO3 antacids
Fluid retention
Alkalosis
Constipation
Function of H2 antagonists
Decrease gastric acid secretionby blocking histamine receptor in parietal cells
Most common type of H2 antagonist
Famotidine (Pepcid)
Use of H2 antagonists
PUD
GERD
H. Pylori ulcers
Side effects of H2 antagonists
Confusion
Dizziness (elderly)
Diarrhea
Monitor for bleeding
Patient teaching for H2 antagonists
Avoid smoking, aspirin, NSAIDs, and alcohol
What are PPI (proton pump inhibitors) used for?
PUD
GERD
Function of PPIs
Antisecretory agents
Cause irreversible inhibition of enzyme producing gastric acid
Suppresses gastric acid production
Most common type of PPI
Pantoprazole (Protonix)
Side effects of PPI
HA
Dizziness
Diarrhea
Decreased Ca+ absorption = bone fracture with long term tx
Thrombophlebitis at IV site
Pt teaching for PPIs
Avoid smoking, alcohol, aspirin, and NSAIDs
What are prokinetis used for?
GERD
Diabetic gastroparesis
Post-op motility
Function of prokinetics
Promote gastric emptying
Reduce risk of gastric acid reflux
By increasing action of acetylcholine, causing increased GI motility and increases esophageal sphincter tone
Side effects of prokinetics
Extrapyramidal effects:
- tardive dyskensia
Sedation
Diarrhea
Hypoglycemia
Contraindications for prokinetics
GI obstruction/perforation
Most common type of prokinetic
Metoclopramide (Reglan)
Most common type of antiflatulant
Simethicone (Mylicon)
Function of Simethicone
Relieves excessive gas by changing surface tension of gas bubbles, allowing them to stick together and pass through belching or flatulence
Nursing considerations for Simethicone
Shake suspension
Monitor bowel sounds
Have pt walk and avoid gas producing foods
Most common prostaglandin/Cytoprotective
Misoprostol (cytotec)
Use of misoprostol (Cytotec)
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
Side effects of misoprostol (cytotec)
Diarrhea
Nursing considerations for misoprostol (Cytotec)
Avoid mg containing antacids (b.c misoprostol already causes diarrhea)
Take with meals and at sleep
What are anti ulcer/mucosal barrier fortifiers/cytoprotectives used for?
Duodenal ulcers
anti ulcer/mucosal barrier fortifiers/cytoprotective drug name
Sucralfate (Carafate)
Function of sucralfate (carafate)
Duodenal ulcers
Forms viscous sticky gel that adheres to ulcer crater, creating a protein barrier lasting up to 6 hours
Accelerates ulcer healing
Side effects of sucralfate
Constipation
Decreases absorption of digoxin, warfarin, and phenytoin
Nursing considerations for sucralfate
Increase fluids and fiber
Give 1 hr before or 2 hrs after meals
Do not give within 30 min of other meds or antacids
