Week 9 Study Guide Flashcards
55 Chapter Terms
Liver
- Produces bile acids for digestion
- Processes medications, ETOH, and toxins (most important)
- Stores vitamins A, B12, D and ferritin
- Aids in carbohydrate metabolism, blood plasma proteins, protein metabolism
- Aging causes the liver to have less activity R/T decrease in number of liver cells and liver enzyme activity -> that causes slower or worse processing of medications, ETOH, and toxins; less bile acid for digestion; slower/worse metabolism of carbs and proteins
Lab Values/ Liver
- ALT, AST: increased levels indicate damage to the liver
- Albumin, pre-albumin: decreased levels indicate either damage to liver of lack of nutrition
- Bilirubin: increased levels indicate either damage to liver or breakdown of RBCs
- PT/PTT: liver makes clotting factors. Increased levels indicate liver damage or anticoagulant medication use
Pancreas
- Produces insulin and glucagon
- Produces pancreatic enzymes to aid digestion
Lab Values/ Pancreas
- Amylase, Lipase: pancreatic enzymes => elevated levels indicate pancreatitis
- Insulin, blood glucose: associated with blood sugar & cellular metabolism.
GI Assessment - History
- broad, general, open-ended questions followed by specific follow-up questions to obtain details
- social (smoking, ATOH, dietary practices), medical (known GI issues, medications), and surgical history
- Table55.2 PG. 1259
- Pain, vitals, and unintended weight changes
Abdominal Assessment - Inspection
- Inspect mouth and skin of abdomen for color, lesions, striae, scars, shape and contour
Abnormal findings:
- Teeth damage, bleeding, lesions on the mouth -> can indicate poor nutrition or oral cancer
- Bulging masses on abdomen -> can indicate tumors or hernias
- Bulging, PULSING, masses on abdomen -> can indicate an aortic aneurysm. DO NOT TOUCH, GET DOC QUICKLY
- YELLOW SKIN (jaundice) -> LIVER DISEASE/DAMAGE
- BLUE/PURPLE COLORING AROUND UMBILICUS (Cullen’s sign) -> intraabdominal bleeding
Abdominal Assessment - Auscultate
- Listen to all 4 quadrants
- Listen for several minutes before concluding “absent” bowel sounds
- Auscultate prior to percussion and palpation because that can impact bowel sounds, make them more active than they would otherwise be
Abnormal Findings:
- Hypoactive sounds: caused by opioids, anesthetics, anticholinergic meds, constipation
- Absent sounds: BIG PROBLEM. Indicate ileus or bowel obstruction
- Hyperactive sounds: caused by cholinergic medications, inflammatory bowel disorders
Abdominal Assessment - Percussion
- percuss abdomen in clockwise pattern
- Should have a sound called tympany - drumlike
- Liver and stomach will have dull sound
Abnormal findings:
- Dull sounds over intestinal tract: fecal matter, accumulation (ascites)
Abdominal Assessment - Palpation
- Palpate LIGHTLY
- Note any masses, tenderness, pain (do not palpate any pulsing masses)
- Deep palpation and hooking techniques is used to measure patient’s liver for hepatomegaly (DONE BY THE PROVIDER)
ABNORMAL FINDINGS:
-spleen should not be palpable. If it is, it will be in the LUQ*
-Liver shouldn’t be palpable on light palpation- if it is, it will extend past ribs on RUQ, RLQ
- Mass: can be a tumor, aneurysm, or hernia
- Right abdomen: pain, guarding, or peritonitis
Diagnostics / Barium Studies
- X- rays combined with barium, which is radiopaque
- Taking multiple x-rays allows us to watch the path of the barium through GI tract. *we can note any structural issues throughout (strictures of esophagus, ulceration in stomach, obstructions, polyps)
- We can also note the speed of movement in the GI tract
*Barium is a dry, white, chalky powder that is mixed with water
Diagnostics / CT Scans
-CTs with contrast use an iodine-based contrast medium *Contrast medium provides better visualization of the area
- Make sure you ask about IODINE, SEAFOOD & SHELLFISH because of potential cross-reactivity
*BUT there is not a high percentage of issues with iodine allergies.
Diagnostic / Endoscopy
- Putting the tube with a camera and equipment up/down the GI tract to visualize the area and do procedures
- Complications include: risk of perforation
*S&S of perforation: VS changes to HR and BP related to potential bleeding, high temp related to peritonitis, OBVIOUS RED BLOOD IN STOOLS, TARRU BLACK STOOLS - Endoscopic Retrograde Cholangiopancreatograpy (ERCP) visualizes the pancreatic and bile ducts. CAN CAUSE PANCREATITIS IN ADDITION TO RISKS OF PERFORATION
CH. 56 Terms
Stomatitis
- Irritation and inflammation of the oral cavity
- Associated with chemotherapy and radiation for cancer *Can be caused by viral, bacterial, or fungal infections **Can be caused by irritants like alcohol, tobacco, alcohol containing mouthwash
- Presents as ulcerations and inflammation of the oral cavity
- Causes problems with nutrition and fluid status
- Nursing management: monitor I&O, weight, fluid & nutrition status, meds as ordered, keep lips and mouth moist, aspiration precautions if lidocaine is being used: raise head of bed, high protein food choices while discouraging salty, spicy, acidic, sharp-edged foods, mouth care after meals, no alcohol mouth wash, remove dentures, saline mouth rinse q4 hrs, high protein foods, avoid acidic spicy foods.
*PRIMARY: painful ulcers, herpes simplex, and traumatic ulcers
*SECONDARY: Viral, bacterial, or fungal
Hiatal Hernias
- Part of the stomach herniates above the diaphragm
- 95%= sliding type, 5%= rolling type
-
Risk Factors: obesity, pregnancy, tobacco, western diet (low in fiber)
-S&S: heartburn, regurgitation, dysphagia, chest pain, belching, GERD; can have very little symptoms - Can eventually cause Barrett’s Esophagus- precancerous state
- Obesity can cause an increase of abdominal pressure
MANAGEMENT:
-Medications: Proton Pump Inhibitors (PPIs), Histamine receptor antagonists (H2 blockers), antacid tablets - Lifestyle changes: avoid caffeine, spicy food, fatty food, ETOH, smoking, NSAIDs and aspirin *Don’t lie down until >2hrs. past meals and don’t snack at night **Reduce weight (CANNOT BURP)
- Surgical treatment: Nissen Fundoplication
*Portion of stomach protrudes upward through esophageal hiatus
*Type 1- widened and enlarge just above
*Type 2- pouch to the side
Gastroesophageal Reflux Disease (GERD)
- Retrograde “reversed” flow of GI contents into esophagus
*I.E. stomach acid and digestive juices leave stomach and visit the esophagus - Results: inflammation of the esophagus
- Risk Factors: hiatal hernia, obesity, ETOH, pregnancy, big meals
- S&S: heartburn, regurgitation, dysphagia, chest pain, belching ** More sever: aspiration pneumonia, hemorrhage
- Eventually can cause Barrett’s Esophagus - precancerous state
~Management:
- Medications: PPI’s, H2 blockers, antacid tablets
- Lifestyle changes: avoid caffeine, spicy food, fatty food, ETOH, smoking, NSAIDS, aspirin *Do not lie down until >2hrs. past meals and don’t snack at night, reduce weight
- Surgical treatment: Nissen Fundoplication
Aspiration Pneumonia
- food or liquid is breathed into the airways or lungs, instead of being swallowed
- Aspiration pneumonia is why we do GI prophylaxis with PPIs or H2 blockers for post-surgical, ICU, and burn patients
Oral & Esophageal Cancer
- Development of cancer on the lips, mouth, oral cavity, or esophagus
- Risk Factors: smoking, ETOH, HPV, poor oral hygiene
- S&S: few early symptoms -> severe: bleeding, ulcerated areas, dysphagia, mouth odor, weight loss, swallowing issues
MANAGEMENT: treated like any other cancers. Due to location, big risk for AIRWAY COMPROMISE and nutritional issues.
Oral & Esophageal Trauma
- Significant sores to the face, mouth, or esophagus
- Risk Factors: GETTING OLDER AND FALLING DOWN, MVAs, altercations, etc
- S&S depends on location/severity of injury: lots of bleeding because the areas are highly vascularized
- Biggest concerns: AIRWAY & BREATHING; stridor, increased RR, SoB, decreased o2 stats, change in LoC
MANAGEMENT:
- Surgical stabilization of broken bones
- Possible for jaw to be wired shut; WIRE CUTTERS W/ PATIENT AT ALL TIMES in case of emergency
Tracheostomy
- May be necessary due to oral or esophageal trauma or cancer
PRIORITY INTERVENTIONS: - KEEP HoB ELEVATED, never below 30 degrees
- Suction frequently
- Call light with patient
- Humidify the o2 the patient is receiving
- Keep emergency tracheostomy kit in room -> losing a fresh trach is a medical emergency - get help immediately
GI Prophylaxis
- Surgery, ICU stays, burns, long-term illnesses case stress on patients which can increase stomach acid production and lead to GERD, ulcers, and even aspiration pneumonia
- To combat this, we provide GI prophylaxis - a PPI like Prilosec, Nexium or Protonix to reduce stomach acid production during hospitalizations
CH 57 Terms
Gastritis
- Acute Gastritis: hours- days of gastric inflammation
*Causes: irritating foods, ETOH, NSAIDS. aspirin overuse, endotoxins from bacteria, body trauma. like burns or surgery - Chronic Gastritis: prolonged, persistent, or intermittent gastric inflammation
*Causes: H. PYLORI INFECTION, autoimmune gastritis, atrophic gastritis
-S&S: EPIGASTRIC PAIN, N/V/D, weight loss, decreased appetite, ->Sever cases: GI bleeding, dehydration
Treatment: Relieve the symptoms, remove the cause
- GI rest then slowly reintroduce foods
- Medications like PPIs, H2 Blockers, antacids, carafate
- Treat H. Pylori with ABX
Gastroenteritis
- Self-limiting illness of the stomach and small intestine “classic stomach flu”
- Causes: infectious agents/viruses, or bacteria (*salmonella, shigella, camplyobacter, E.Coli, Clostridium
- S&S: N/V/D, anorexia, abdominal pain, abdominal distention and in severe cases dehydration
~Treatment: relive the symptoms, remove the cause, treat present dehydration
**GI rest then slowly reintroduce foods, medications (PPIs, H2 blockers, antacids, carafate), IV fluids- oral rehydration
Peptic Ulcer Disease (PUD)
- Ulcerations of the GI tract
- Gastric (20%), triggered or worsened by eating, alleviated by fasting
- Duodenal (80%), triggered or worsened by fasting, alleviated by eating
-Most common cause is H. Pylori -Other causes: NSAIDS, ETOH, smoking, aspirin
-S&S: EPIGASTRIC PAIN that may radiate to R shoulder or back. Pain noted lasts weeks or months. Many things cause epigastric pain (factors into diagnostics, reoccurrence becomes part of out diagnostic criteria)
~Treatment: symptom management, ulcer healing, prevention of ulcer reoccurrence - Treat H. Pylori with ABX
- Medications: PPIs, H2 blockers, antacids, Carafate, CYTOTEC (causes abortions)
- Diet/lifestyle changes: smaller meals, avoid irritants like ETOH, smoking, caffeine, spicy/acidic foods
- ## If untreated: GI bleeds that may require surgical intervention
Gastric Cancer
-Cancer of the GI tract
- S&S: asymptomatic at 1st, symptoms will be nonspecific and vague (indigestion, anorexia, weight loss, vague epigastric pain, vomiting,
** an abnormal mass may be noted when/if tumors get large enough
-Treatment: remove cancer surgically if possible, radiation and chemotherapy to kill remaining cancerous cells. Manage symptoms while doing so
*Surgery to resect the stomach/GI, issues include absorption of nutrients - issues like iron-deficiency anemia, Vitamin B-12 deficiency anemia, poor nutrition status shown by low levels of albumin and pre-albumin
MEDICATION REVIEW
-PPIs: Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix) = blocks acid production in the stomach ( takes hours to days to reach full effect)
-H2 blockers: Famotidine (Pepcid), Cimetidine (Tagamet), Nizatidine (Axid) = blocks acid production in the stomach (works faster bot does not last long)
-Carafate (Sucralfate): forms a physical barrier or coating over the stomach to protect it from acid
-Misoprostol (Cytotec): reduces gastric acid production & physically protects the stomach but…
-NSAIDS, aspirin: not great for stomach, damage stomach lining.
-Antacids: neutralize stomach acid via a chemical reaction (antacids are basic, so neutralize the acids in stomach)
