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GI
Question | Answer |
---|---|
routes of nutritional supplements | 1. liquid whole food/ by mouth 2. feeding tube 3. tpn or ppn |
types of feeding tubes | nasogastric, esophogostomy, gastrostomy, jejunostomy nasoduodenal, nasojejunal, Dobnoff |
can you check residual in jujuneum? | no |
NSAIDS | interfere with prostiglandins |
why does aspirin irritate the stomach? | first it works in the blood and then it works by interefering with prostiglandins. |
how do prostiglandins affect the stomach? | protect the mucous lining of the stomach and cut down on acid |
effects of aging on th GI tract | mouth, digestive enzymes (HCI acid, IF, Pepsin, Lipase, Trypsinogen, Amylase, Bile and sucrase), motility, musculoskeletal, socio-economic. |
What potential effects does NSAIDS have on the body? | GI upset and bleeding |
coated aspirin | has no benefit |
x-ray | looking for free air, shows if system has a leak, this is normally a medical emergency |
complication of barium studies | constipation, may need MOM to get rid of barium |
Nursing implications for upper GI study | 1. Keep pt NPO for 8-12 hrs. before procedure 2. prevent contrast mediums impaction |
Nursing implications for Barium | 1.administer laxatives & enemas untill colon is clear 2. cl diet evening before procedure |
Nursing implications for upper GI Endoscopy | 1.NPO for 8 hrs 2. make sure consent is signed |
Nursing implications for colonoscopy | bowel prep, sedation will be given, cl 1-3 days before procedure,will inject air tell pt it will be uncomfortable and to pass the air. |
Nursing implications for proctosigmoidoscopy | 1. enema evening before & morning of procedure 2. explain that knee-chest position may br necessary |
Nursing implications for gastric analysis | 1. NPO for 8-12 hrs. 2. ensure no smoking day of procedure |
Nursing implications for stool hemoccult | 1. place smear of stool on both areas of card2. apply 2 drops of developer to each area and the control area 3. avoid NSAIDS, red meat, broccili for 3 days (could effect the results) |
Nursing implications for liver biopsy | 1. check coagulation status 2. ensure informed consent is signed. |
Nursing implications for abd ultrasound | schedule test before upper GI or brium enemas 2. client may need bowel cleansing |
Nursing implications for liver/ spleen scan | 1. explain non-invasive nature of test with only a trace of radio-activity 2.explain client will lie still while camera moves over abd. |
Nursing implications for MRI | npo for 6 hrs. before procedure. 2 metal and pregnancy contrindicated |
Nursing implications for oral cholecystogram | 1. assess for iodine allergy 2. npo after dye |
pepsin | enzyme that breaks down protein in the stomach |
lipase | pancreatic enzyme that breaks down fats into fatty acids and glycerol |
cystokinin | hormone that stimulates bile flow into the duodenum |
stomach | where fat digestion begins |
ptyalin | enzyme in the mouth that breaks down starches |
mouth | where carb break down begins |
amylase | enzyme that breaks down maltose, lactose, and sucrose |
gingivitis | inflammation of the gums |
dysphagia | difficulty swallowing |
hematemesis | vomiting blood |
emesis | vomiting |
hepatomegly | liver enlargement |
ascites | fluid within abd cavity |
candidiasis | white, curd like fungal lesions |
hemorrhoids | thrombosed veins in rectum and anus |
melena | black, tarry stool |
leukoplakia | thickened white patches |
dyspepsia | heartburn, indigestion |
rebound tenderness | sudden pain when fingers withdraw from abdominal palpation |
the majority of blood supply to the liver is from the | portal vein |
purpose of procedure: oral cholecystogram | x-ray of gallbladder after contrast medium allows visualization of gallbladder and duct system |
purpose of procedure: barium swallow | fluoroscopy with contrast medium to diagnos structural sbnormalities of esophagus, stomach,duodenal bulb |
purpose of procedure: colonoscopy | allows direct visualization of colon up to ileocecal valve. |
purpose of procedure: ultrasound | use of high frequency sound waves to detect viruses, stones, tumors |
purpose of procedure: fecal analysis | specimen analyzed of fat, blood, parasites |
purpose of procedure: liver/spleen scan | injection of radionuclide to record distributionin liver and spleen. |
purpose of procedure: serum amylase | blood tested for pancreatic enzyme |
purpose of procedure: CT scan | x-ray of gallbladder exposures at different depths to detect biliary tract, liver, pancreatic disorders. |
Why do you need to be NPO for ultrasound? | keep gallbladder from contracting |
types of contrast | iv and oral |
nursing implications for contrast | check allergies to shellfish and iodine, check orders for contrast or no contrast, check BUN and creatine (can kidneys clear this contrast) |
Nursing implications for EGD | pt must sign permit, npo for 8 hrs, concerned about gag reflex returning, VS every 15 mins, wait 1 hr to eat |
best test for colon cancer | colonoscopy |
how do you get colon cancer | genetic: you make the polyp because you have the gene to make it. |
who should tell the pt when to have a colonoscopy? | only the dr |
colorectal canser risks | 1. genetic predispostion 2. african americans 3. family hx 4.H/O CA 5. Age 6. bowel disease 7. diet 8. medications 9. lifestyle |
GI Drugs | Antacids, H2 blockers, PPI (stop production of acid) |
antacids | Rolaids, Tums, MOM |
H2 Blockers | Pepsid, Tagament |
PIP | Nexium, Previcid, Prilosec |
S/S of polyp | caliber of stool change, occult blood, CEA lab |
GERD | acid and pepsin reflux |
factors of GERD | esophageal motility, defective mucousal barrier, gastric emptying, stomach contents move up, |
prediposing factors for GERD | Age, poor nutrition,obestiy,ascites, tumors,heavey lifting, forced recumbant position. |
GERD S/S | heartburn, pain, dyspepsia, hoarsness, microaspiration |
GERD treatment | Anti-secretory, antacids, cytorotective, prokinetic |
GERD lifestyle changes | HOB on 6 in blocks, diet, decrease intra-abd pressure |
complications of GERD | severe reflux esophagitis ( inflammation, erosion, fibrosis) and pre-cancerous metaplasia ( lining starts to change to be more like that of the stomach) |
GERD surgical unterventions | fundiplication (wrap top of stomach and suture it creating a false sphinter) and stretta procedure (creates more scar tissue to tighten up the sphincter) |
Gastritis causes | 1. drugs 2. lifestyle 3. H. Pylori (know to cause stomach cancer |
S/S of Gastritis | Anorexia, N&V, Epigastric tenderness, fullness, Macrocytic anemia |
Gastritis diagnosis | endoscopy, IF testing. CBC, Electrolytes, Liver profile. Urine and stool sample |
Peptic ulcer: Gatric S/S | 1-2 hrs PC pressure and pain, burning gaseous |
Peptic ulcer: Duodenal | 2-4 hrs PC Sleep disturbance, pressure and pain, Burning, cramp like back pain |
80% of ulcers are in? | duodenum |
complication of ulcers | hemorrhage, perforation |
Bleed from upper GI? | black |
Bleed from lower GI? | red |
treatment for perforation | surgery, emergent |
Gastroduodenostomy | Billroth I- removal of distal 2/3 stomch w/ anastomosis to duodenum |
gastrojejunostomy | Billroth II- removal of distal 2/3 stomach w/ anastomosis to jejunum |
Vagotomy | selective ligation of vagus nerve eliminates stimulus for HCI |
Dumping sydrome | occurs after surgery, goes away on it's own, a sudden decrease in plasma volume occuring after eating. S/S sweating , palpation, pain, abd cramps |
Blood that has begun to be digested by gastric secretions willl appear? | coffee ground |
Feosol | (iron) will turn stools black. |
S/S of GI hemorrage or perforation | Hypotension, tachycardia, tachypnea |
fluid movement in the dumping syndrome is a function of | osmosis |
Most common surgery | Appendectomy |
Appendisitis S/S | Pain RLQ, Starts at periumbilical and then moves to McBurney's point (RLQ at hip line), positive Rovsing's sign, N&V, Anorexia, decreased motility, Neutrophilia, and fever |
Rovsing's sign | pressure on the L and feels pain on the right |
Hernia | protrusion of organ or structure through an opening or defect or weak spot |
types of hernias | hiatus, ventral, umbilical, inguinal, femoral |
direct inguinal hernia | from normal stressures of life |
indirect inguinal hernia | canal didn't close |
strangulated hernia | blood supply is cut off, emergency surgery situation |
incarcerated | hernia is trapped outside peritoneal cavity |
reducible hernia | hernia moves vack into peritoneal cavity |
diverticulosis S/S | generally on the left side, caused by constipation and straining. asymptomatic, cramp-like pain, alternating BM, bloating |
diverticulosis diagnosis | CT, CBC, FOBT, BE, Colonscopy |
diverticulosis treatment | diet hydrtion, medication (bulk laxative, anticholinergics), decreased intra-abdominal pressure. |
diverticulitis S/S | pain on l side, guarding, LLQ Mass, inflammatory response, |
diverticulitis complications | abcess, peritonitis, fistula. obstruction, bleeding, |
diverticulitis treatment | NGT, IVF, Antibiotics, Analgesics, progressive diet and ambulation; surgery (bowel resection) |
types of bowel obstruction: | adhesion, strangulated, ilialsecal intussusception , Intussusception from polyp,mesenteric occlusion, neoplam (tumor), volvulus of sigmoid colon (twisting, paralytic |