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Adult Health Nursing I > Upper GI > Flashcards

Upper GI Flashcards

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1
Q

Abdominal Examination

A

Inspect, Auscultate, Palpate, Percuss

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2
Q

Diagnostic Tests

A

Breath tests

DNA testing

Blood work

Endoscopic procedures

Radiology

Gastric analysis

Stool specimen/stool analysis

Ultrasound

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3
Q

Esophagogastroduodenoscopy

A

Scope looking at the esophagus, stomach, and duodenum

Patient must be NPO for at least 8 hours prior

Hold medications

Local anesthetic used to numb the oropharynx

Midazolam used for conscious sedation

Need to take vital signs before and after, especially temperature (elevated temperature indicates perforation)

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4
Q

Colonoscopy

A

Need a signed consent

NPO for at least 8 hours prior and a bowel prep is necessary (GoLYTEly)

General anesthesia or conscious sedation

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5
Q

Radiology

A

UGI: barium swallow

LGI: barium enema

Swallow study

CT-MRI with or without contrast

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6
Q

Gastric Analysis

A

Sampling the stomach acid

NPO for 8-12 hours prior

NG tube is placed and gastric contents are withdrawn

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7
Q

Occult Blood Tests

A

Best if patient hasn’t had a lot of red meat, turnips, aspirin, NSAIDs for 72 hours prior to exam

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8
Q

Ultrasound

A

Noninvasive

NPO for 8-12 hours prior

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9
Q

Treatments for Obstructions

A

Open the passage

Use of tubes, surgeries

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10
Q

Treatments for Itis-Osis

A

Medications

Organ rest (NPO)

Nutritional alterations

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11
Q

Treatments for Ulcerations

A

Stop the bleeding using medications or surgery

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12
Q

General Nursing Diagnoses

A

Pain: acute or chronic

Altered nutrition

Altered bowel elimination

Altered skin integrity, risk for

Potential for infection

Health care maintenance

Altered breathing patterns

Complication: Hemorrhage

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13
Q

Oral Cancer Risk Factors

A

Tobacco, alcohol, HPV

Increased incidence in men, persons older than 40 years old, and African Americans

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14
Q

Manifestations of Oral Cancer

A

Painless mass or sore that does not heal

Any lesion present for more than 2 weeks or that does not heal should be examined and biopsied

Later manifestations include tenderness, difficulty chewing or swallowing or speaking, coughing up blood-tinged sputum, enlarged cervical lymph nodes

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15
Q

Medical Management of Oral Cancer

A

Surgical resection

Radiation therapy

Chemotherapy

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16
Q

Care of Impaired Oral Mucous Membranes

A

Preventative oral care

Dental care before surgery or radiation therapy

Frequent gentle brushing or flossing

Patient education related to oral hygiene

Encourage fluid intake to reduce dry mouth

Use of synthetic saliva

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17
Q

Care for Imbalanced Nutrition

A

Assess nutritional requirements and dietary patterns

Assess patient preferences

Calorie count

Dietary consult

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18
Q

Maintaining an Airway

A

Frequent assessment

Place in Fowler’s position

Encourage coughing and deep breathing

If patient has tracheostomy, provide tracheostomy care as required

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19
Q

Nutrition for Radical Neck Dissection

A

Assess nutritional state before surgery and intervene early

Encourage high-density, high-quality intake

Provide oral care before and after eating

Diet may need to be modified to liquid diet or to soft, pureed, and liquid foods

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20
Q

Disorders of the Esophagus

A 
Dysphagia/Achalasia
Foreign Bodies
GERD
Hiatal hernia
Perforation
Cancer
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21
Q

GERD Etiology and Pathophysiology

A

Results when defenses of the lower esophagus are overwhelmed

Caused by anything that decreases esophageal clearance (decreased peristalsis) or anything that decreases gastric emptying

Risk factors include smoking, obesity, hiatal hernias

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22
Q

Symptoms of GERD

A

Heartburn (pyrosis)

Dyspepsia (pain, discomfort, pressure; often mistaken as a heart attack)

Regurgitation

Difficulty swallowing

Hypersalivation

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23
Q

Complications of GERD

A

Esophagitis

Barrett’s esophagus (precancerous lesion)

Respiratory complications (higher risk of aspiration)

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24
Q

Diagnostic Studies for GERD

A

History and PE

Barium swallow

Upper GI endoscopy

Biopsy and cytologic specimens

Esophageal manometric studies

Radionuclide tests

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25
Q

Lifestyle Modifications for GERD

A

Avoid triggers, tight clothes

Elevate the head of the bed

Quit smoking

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26
Q

Nutritional Therapy for GERD

A

Avoid caffeine, alcohol, orange juice, tomatoes, milk, chocolate, peppermint, spearmint, carbonated beverages

Eat a low-fat diet; small, frequent meals

Remain upright for 2-3 hours after eating

Maintain a healthy weight

27
Q

Drug Therapy for GERD

A

Histamine (H2) Receptor Blockers (Cimetidine, Famotidine, Ranitidine, Nizatidine): typically given at bedtime

PPIs (Omeprazole, Lansoprazole, Esomeprazole): given before the first meal of the day, preferably on an empty stomach

Antacids: neutralize the stomach acid, recommended 1 and 3 hours after meals, and before bed

Cholinergics (Bethanecol): increases pressure of lower esophageal sphincter to help it close and stay closed

Prokinetic (Dromperidone, Metaclopramide): helps moves things through the stomach

28
Q

Nissen Fundoplication

A

Fundus of stomach is wrapped around lower portion of esophagus

29
Q

Hiatal Hernia

A

Occurs when part of the stomach herniates through the diaphragm into the chest cavity

Symptoms and treatment are similar to GERD

30
Q

Disorders of the Stomach

A

Gastritis (inflammation of the stomach lining)

Peptic Ulcer Disease

Bariatric Surgery

31
Q

Acute Gastritis

A

Rapid onset of symptoms usually caused by dietary indiscretion

May also be caused by medications, alcohol, bile reflux, and radiation therapy

Manifested by abdominal discomfort, headache, lassitude, nausea, vomiting, and hiccuping

32
Q

Chronic Gastritis

A

Prolonged inflammation due to benign or malignant ulcers of the stomach or by H. pylori

May be associated with autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux

Manifested by epigastric discomfort, anorexia, heartburn after eating, belching, sour taste in the mouth, nausea/vomiting, and intolerance of some foods. May have a B12 deficiency

33
Q

Nursing Care of Gastritis

A

Goals include reduced anxiety, avoidance of irritating foods, adequate intake of nutrients, maintenance of fluid balance, increased awareness of dietary management, and relief of pain

34
Q

Medical Management of Acute Gastritis

A

Refrain from alcohol and food until symptoms subside

If due to strong acid or alkali treatment to neutralize the agent, avoid emetics and lavage

Supportive therapy

35
Q

Medical Management of Chronic Gastritis

A

Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs

Pharmacologic therapy

36
Q

Peptic Ulcer Disease

A

Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus

Risk factors include excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency

Dull gnawing pain or burning in the epigastrium

37
Q

Potential Complications of PUD

A

Hemorrhage

Perforation

Penetration

Pyloric obstruction

38
Q

Nursing Care of PUD

A

Relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications

39
Q

Pharmacological Treatment of H. Pylori

A

PPI, Amoxicillin, Clarithromycin (7-14 day course)

PPI, Bismuth, Tetracycline, Metronidazole/Flagyl (10-14 day course)

Avoid aspirin, NSAIDs, and alcohol

40
Q

Patient Education of PUD

A

Misoprostol (Cytotec) is a prostaglandin that is cytoprotective and has antisecretory properties, but should not be taken if pregnant due to teratogenic effects

Avoid triggering foods

Check with physician if generic forms are desired

Take medications exactly as prescribed

41
Q

Management of Hemorrhage Due to PUD

A

Assess for evidence of bleeding, hematemesis or melena, and symptoms of shock/impending shock and anemia

Treatment includes IV fluids, NG lavage, oxygen, monitoring VS and UO

May require endoscopic coagulation or surgical intervention

42
Q

Management of Pyloric Obstruction

A

Symptoms include nausea and vomiting, constipation, epigastric fullness, anorexia, and weight loss

Insert NG tube to decompress the stomach, provide IV fluids and electrolytes

Balloon dilation or surgery may be required

43
Q

Management of Perforation or Penetration

A

Signs include severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board-like abdomen, and symptoms of shock or impending shock

Patient requires immediate surgery

44
Q

Obesity

A

BMI above 30

Increased risk for disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life

45
Q

Potential Complications of Bariatric Surgery

A

Hemorrhage

Bile reflux

Dumping syndrome

Dysphagia

Bowel or gastric outlet obstruction

46
Q

Dumping Syndrome

A

Food passes rapidly into the intestines, resulting in diarrhea

Occurs shortly after eating; patient experiences weakness, faint, palpitations, sweating, stomach cramps, urge to defecate

Need small meals, low carbs, no fluids with meals, and recline/lay down 20-30 minutes after meals

47
Q

Risk Factors for Gastric Cancer

A

Diet, chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, previous subtotal gastrectomy, and genetics

48
Q

Manifestations of Gastric Cancer

A

Pain (relieved by antacids), dyspepsia, early satiety, weight loss, abdominal pain, loss or decrease in appetite, bloating after meals, nausea, and vomiting

Diagnosis is often late

49
Q

Optimal Nutrition for Bariatric Surgery

A

Small, frequent meals of non-irritating foods

Provide foods high in calories and vitamins A and C and iron

Six small feedings low in carbohydrates and sugar, with fluids between meals

50
Q

Prevention of Complications following Bariatric Surgery

A

Gastric Retention may require reinstatement of NPO and NG suction (low-pressure)

Bile Reflux: cholestyramine binds with bile acid

Malabsorption of Vitamins and Minerals requires supplementation of iron and other nutrients including B12

Steatorrhea: reduce fat intake and administer loperamide

51
Q

Delivery Options for Enteral Nutrition

A

Continuous infusion by pump

Intermittent by gravity

Intermittent bolus by syringe

Cyclic feedings by infusion pump

52
Q

Nasogastric and Nasointestinal Tubes

A

Radiopaque

Decreased likelihood of regurgitation and aspiration when placed in the intestine

Can be dislodged by vomiting or coughing

Can be knotted/kinked in the GI tract

53
Q

Gastrostomy and Jejunostomy Tubes

A

May be placed in those needing tube feedings for an extended period of time (patient must have intact, unobstructed GI tract)

Can be placed surgically, radiologically, or endoscopically

54
Q

Placing an Enteral Tube

A

Feedings can be started when bowel sounds are present, usually 24 hours after placement

Immediately after insertion, tube length from insertion site to distal end should be measured and recorded

Tube should be marked at skin insertion site and insertion length should be checked regularly

HOB 30-45 degrees, tube must be irrigated with water before/after each feeding

Placement should be checked every 8 hours, aspiration of stomach contents (pH < 5)

55
Q

Complications of Enteral Nutrition

A

Vomiting

Diarrhea

Constipation

Dehydration

56
Q

Complications of Gastrostomy or Jejunostomy Feedings

A

Skin irritation

Pulling out of tube

57
Q

Gerontologic Considerations for Enteral Feedings

A

More vulnerable to complications with fluid and electrolyte balances, glucose intolerance, decreased ability to handle large volumes, and increased risk of aspiration

58
Q

Composition of Parenteral Nutrition

A

Base solutions contain dextrose and protein in the form of amino acids

Prescribed electrolytes, vitamins, and trace elements are added to customize

IV fat emulsion is added

59
Q

Methods of Parenteral Nutrition Administration

A

Central parenteral nutrition through catheter whose tip lies in superior vena cava

Subclavian or jugular vein

60
Q

Complications of Parenteral Nutrition

A

Refeeding syndrome

Metabolic problems (increased blood sugars)

Mechanical problems

Infection and septicemia

61
Q

Refeeding Syndrome

A

Characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia)

62
Q

Nursing Management of Parenteral Nutrition

A

Vital signs every 4-8 hours

Daily weights/I&O

Blood glucose (check initially every 4-6 hours)

Electrolytes/BUN/CBC

Liver enzymes

Dressing changes

63
Q

Manifestations of Infection and Septicemia

A

Erythema/tenderness

Exudate at catheter insertion site

Fever, chills

Nausea/vomiting

Malaise

Adult Health Nursing I (22 decks)

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