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Adult Health Nursing I > Upper GI > Flashcards

Upper GI Flashcards

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NG tube is placed and gastric contents are withdrawn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
Lifestyle Modifications for GERD
Avoid triggers, tight clothes Elevate the head of the bed Quit smoking
26
Nutritional Therapy for GERD
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
Drug Therapy for GERD
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
Nissen Fundoplication
Fundus of stomach is wrapped around lower portion of esophagus
29
Hiatal Hernia
Occurs when part of the stomach herniates through the diaphragm into the chest cavity Symptoms and treatment are similar to GERD
30
Disorders of the Stomach
Gastritis (inflammation of the stomach lining) Peptic Ulcer Disease Bariatric Surgery
31
Acute Gastritis
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
Chronic Gastritis
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
Nursing Care of Gastritis
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
Medical Management of Acute Gastritis
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
Medical Management of Chronic Gastritis
Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs Pharmacologic therapy
36
Peptic Ulcer Disease
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
Potential Complications of PUD
Hemorrhage Perforation Penetration Pyloric obstruction
38
Nursing Care of PUD
Relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications
39
Pharmacological Treatment of H. Pylori
PPI, Amoxicillin, Clarithromycin (7-14 day course) PPI, Bismuth, Tetracycline, Metronidazole/Flagyl (10-14 day course) Avoid aspirin, NSAIDs, and alcohol
40
Patient Education of PUD
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
Management of Hemorrhage Due to PUD
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
Management of Pyloric Obstruction
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
Management of Perforation or Penetration
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
Obesity
BMI above 30 Increased risk for disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life
45
Potential Complications of Bariatric Surgery
Hemorrhage Bile reflux Dumping syndrome Dysphagia Bowel or gastric outlet obstruction
46
Dumping Syndrome
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
Risk Factors for Gastric Cancer
Diet, chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, previous subtotal gastrectomy, and genetics
48
Manifestations of Gastric Cancer
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
Optimal Nutrition for Bariatric Surgery
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
Prevention of Complications following Bariatric Surgery
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
Delivery Options for Enteral Nutrition
Continuous infusion by pump Intermittent by gravity Intermittent bolus by syringe Cyclic feedings by infusion pump
52
Nasogastric and Nasointestinal Tubes
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
Gastrostomy and Jejunostomy Tubes
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
Placing an Enteral Tube
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
Complications of Enteral Nutrition
Vomiting Diarrhea Constipation Dehydration
56
Complications of Gastrostomy or Jejunostomy Feedings
Skin irritation Pulling out of tube
57
Gerontologic Considerations for Enteral Feedings
More vulnerable to complications with fluid and electrolyte balances, glucose intolerance, decreased ability to handle large volumes, and increased risk of aspiration
58
Composition of Parenteral Nutrition
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
Methods of Parenteral Nutrition Administration
Central parenteral nutrition through catheter whose tip lies in superior vena cava Subclavian or jugular vein
60
Complications of Parenteral Nutrition
Refeeding syndrome Metabolic problems (increased blood sugars) Mechanical problems Infection and septicemia
61
Refeeding Syndrome
Characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia)
62
Nursing Management of Parenteral Nutrition
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
Manifestations of Infection and Septicemia
Erythema/tenderness Exudate at catheter insertion site Fever, chills Nausea/vomiting Malaise

Adult Health Nursing I (22 decks)

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