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NURB 3130 > Upper GI Disorders > Flashcards

Upper GI Disorders Flashcards

1
Q

GI Imaging

A
  • allows to see abnormalities in esophagus & stomach
  • monitor for constipation afterwards
  • no eating or smoking the day before
  • informed consent
  • assess allergies
  • stool may be chalky and white due to barium taken before surgery
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2
Q

upper gi endoscopy

A
  • anesthetic agent (propofol, benzos)
  • intraop: monitor vitals
  • post procedure: gag reflux
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3
Q

lower gi colonoscopy

A
  • anesthetic agent
  • preop: med given to clear intestines
  • air injected so may have pain postop (ambulate to expel)
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4
Q

contributing factors to dental caries

A
  • malnutrtion
  • poor oral hygiene
  • dry mouth
  • genetics
  • dental plaque
  • bad water
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5
Q

manifestations of dental caries

A
  • halitosis
  • tooth pain
  • erosion
  • discoloring of teeth
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6
Q

dental caries interventions

A
  • good nutrition and hygiene

- visit dentist regularly

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7
Q

salivary gland, oral mucosa, and pharyngeal disorders contributing factors

A
  • tobacco
  • etoh
  • aging
  • dehydration
  • radiation
  • stress
  • malnutrition
  • poor oral hygiene
  • immunosuppression
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8
Q

salivary gland, oral mucosa, and pharyngeal disorders manifestations

A
  • pain, cheesy white plaques (candidiasis)
  • inflammation/redness
  • persistent, painful oral lesion that won’t heal
  • xerostomia (dry mouth)
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9
Q

salivary gland, oral mucosa, and pharyngeal disorders nursing implications

A
  • good oral hygiene
  • good nutrition
  • monitor swallowing
  • comfort measures for pain
  • monitor for infection
  • promote positive self image
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10
Q

conditions that may require enteral therapy

A
  • alcoholism
  • choronic depression
  • anorexia nervosa
  • cancer therapy
  • coma
  • covalescent care
  • debilitation
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11
Q

open system for feedings

A
  • avoid bacterial contamination
  • don’t hang for more than 4-8 hours
  • bag & tubing needs to be changed every 24 hours
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12
Q

closed system

A
  • prefilled and sterile
  • must be ran through controlled system
  • hang 24-48 hours at room temperature
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13
Q

continuous via pump (NG)

A
  • measure residual volume every 4 hours

- frequent abdominal assessment

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14
Q

bolus/intermittent by gravity (PEG)

A

-check residuals before every feeding

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15
Q

prior to admin feedings

A
  • elevate HOB

- verify proper placement (x ray, tape placement, gastric pH)

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16
Q

assessing tolerance of enteral feedings

A
  • response to feedings
  • labs: albumin, electrolytes
  • mucous membranes
  • urinary output
  • weight
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17
Q

assess of pt on enteral feedings

A
  • s/s of dehydration
  • amount of formula taken in by pt
  • increase bs levels, decrease UO, sudden weight gain, & edema
  • s/s of infection and complications
  • I&O
  • weekly weights
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18
Q

high residual

A
  • 2 hours of feeding or 100-150 mls

- stop feeding, notify dr, allow stomach to empty & try again, assess abdomen for bowel sounds or gas

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19
Q

potential complications of enteral feedings

A
  • constipation
  • diarrhea
  • gas/bloating/cramping
  • tube displacement
  • dehydration and azotemia
  • refeeding syndrome
  • n/v
  • aspiration pneumonia
  • nasopharyngeal irritation
  • tube obstruction
  • hyperglycemia
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20
Q

preventing dumping syndrome

A
  • slow formula
  • admin feedings at room temp by continuous drip if tolerated
  • remain in semi fowler’s for 1 hour after feeding
  • use minimal amount of water to flush before and after
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21
Q

hiatal hernia

A
  • opening in diaphragm where esophagus normally passes is enlarged
  • part of stomach moves up into lower portion of thorax
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22
Q

contributing factors of hiatal hernia

A
  • high fat diet
  • caffeinated beverages
  • tobacco products
  • obesity
  • meds: anticholinergics, nitrates, ccb
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23
Q

manifestations of hiatal hernia

A
  • persistent heartburn & dysphagia
  • regurgitation
  • belching
  • epigastric pain
  • chest pain that mimics angina
  • feeling of suffocation after eating
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24
Q

hiatal hernia diagnostics

A
  • barium swallow

- egd

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25
Q

hiatal hernia nursing interventions

A
  • educate of barrium seallow
  • diet hx
  • smaller, frequent meals
  • sit up after meals
  • don’t eat atleast 3 hours before bed time
  • elevate HOB
  • try weight loss
  • loose clothing
  • drink more when eating
  • monitor for complications (gi bleeding, barret esophagus, chronic cough, pulmonary fibrosis)
26
Q

perforation

A
  • hole in esophagus

- results from several causes

27
Q

manifestations of perforation

A
  • severe retrosternal pain with dysphagia
  • infection
  • fever
  • leukocytosis
  • severe hypotension
28
Q

diagnostics for perforation

A
  • barium swallow
  • esophagram
  • CT
29
Q

perforation treatments

A
  • npo
  • iv fluids
  • abx
  • close monitoring in icu
  • prep for surgical repair or esophagostomy
30
Q

postop implications for perforations

A
  • npo 7 days
  • en/pn
  • abx
  • repeat esophagram verifying no leaks or ileus
31
Q

gerd

A
  • les problem, backflow of gastric or duodenal contents into esophagus
  • possible esophageal mucosal injury
32
Q

contributing factors to gerd

A
  • large, late meals
  • elderly
  • obesity
  • stress
  • smoke
  • heavy etoh
  • osa
33
Q

gerd manifestations

A
  • pyrosis
  • regurgitation
  • dyspepsia
  • hypersalivation
  • pulmonary problems
  • hoarseness, difficulty swallowing, sore throat
  • chest pain that mimics angina
34
Q

gerd complications

A
  • dental erosion
  • ulcerations in pharynx/esophagus: esophageal metaplasia & barrett’s esophagus (precancerous lesion)
  • laryngeal damage
  • esophageal strictures
  • adenocarcinoma
  • pulmonary: cough, bronchospasm, laryngospasm; potential for asthma, bronchitis & pneumonia
35
Q

gerd management

A
  • no chocolate, caffeine, etoh, smoking, carbonated beverages, fried, fatty
  • small meals
  • no eating atleast 3 hours before bed time
  • weight management
  • stress reduction
  • loose clothing
  • keep hob elevated
  • admin meds
  • endoscopy
36
Q

gerd drug therapy

A
  • ppi
  • h2 receptor blockers
  • antacids
  • antiulcer, protectants,
  • cholineric
  • prokinetic drugs
37
Q

gerd surgical therapy

A

nissen fundoplication

38
Q

barrett esophagus

A
  • alteration in esophageal lining caused by reflux

- only known precursor to esophageal adenocarcinoma

39
Q

barrett esophagus manifestations

A

gerd sx with frequent heartburn

40
Q

barrett esophagus diagnostics

A
  • egd with reddened esophageal lining

- biopsies with evidence of dysplasia

41
Q

barrett esophagus management

A
  • depends on stage of dx

- close monitoring: biopsy, PPI

42
Q

gastritis

A
  • inflammation of the gastric mucosa from the breakdown in gastric mucosal barrier
  • stomach tissue unprotected from autodigestion by HCl acid and pepsin
  • results in tissue edema and possible hemorrhage
43
Q

drugs that can cause gastritis

A
  • NSAIDs

- corticosteroids

44
Q

diets that can cause gastrits

A
  • etoh

- spicy foods

45
Q

microorganism that causes gastritis

A

h. pylori

46
Q

enviornmental factors that can cause h. pylori

A
  • smoking
  • radiation
  • renal failure
  • sepsis
  • stress
47
Q

manifestations of gastritis

A
  • hiccups
  • full when eating
  • errosive: hemorrhage, occult bleeding
48
Q

manifestations of chronic gastritis

A
  • pyrosis

- fatigue

49
Q

gastritis diagnostics

A
  • ednoscopy with biopsy and histologic exam
  • cbc
  • diagnostics to detect h. pylori
50
Q

acute gastritis supportive care

A
  • npo
  • iv fluids
  • rest
  • antiemetics
  • no etoh or NSAIDs
  • NG tube (observe for bleeding)
  • promote fluid balance, monitor electorlytes
  • advance liquids as tolerated, no caffeine
  • offer smoking cessation measures
51
Q

PUD contributing factors

A
  • h. pylori
  • nsaid, corticosteroids
  • stress
  • smoking, etoh
  • caffeine
  • age 40-50
  • type o blood
  • familial tendency
  • lifestyle factors
52
Q

pud manifestations

A
  • dyspepsia
  • bloated
  • belch
  • vomiting undigested food w/out nausea
  • melena
  • decreased hgb, hct
  • midgastric or back pain
  • sx worse with empty stomach
  • relief with antacid
53
Q

pud diagnostics

A

-egd with biopsy
-chest x-ray
-stool specimen
-barium contrast
-cbc/h&h
-

54
Q

pud interventions

A
  • smoke/etoh cessation
  • dietary modifications: same as other, and no milk
  • surgery: pyloroplasty, vagotomy, antrectomy
55
Q

pud drug therapy

A
  • h2r blockers
  • ppi
  • antacids
  • anticholinergics
  • abx: kills h. pylori, treatment lasts 7-14 days
  • sucralfate, misoprostol
56
Q

pud complications

A
  • hemorrhage

- perforation

57
Q

interventions for pud related hemorrhage

A
  • monitor for hypovolemic shock

- stabilize until can get pt to surgery or endoscopy lab- fluids and blood products

58
Q

pud perforation

A
  • duodenal more prevalent
  • can cause peritonitis
  • bacterial peritonitis can occur rapidly, small ones heal themselves, large ones require immediate surgical closure
59
Q

manifestations of pud peritonitis

A
  • sudden, dramatic,s severe generalized abdomen and shoulder pain
  • rigid, board like abdomen
  • keep knees drawn up
  • tachycardia, weak pulse; shallow, grunting, rapid respirations
  • absent bowel sounds, n/v
  • hypovolemic due to third spacing
60
Q

treating pud peritonitis

A
  • notify hcp
  • frequent vitals, q 15-30 min
  • stop all ng, oral feedings, drugs
  • continue/increase iv fluids
  • ng tube, continuous suction
  • restore volume: lr, albumin, prbc
  • foley, hourly i&o
  • broad spectrum abx
  • pain meds
  • surgery (open or laprascopic)

NURB 3130 (7 decks)

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