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med surg III
unit 1 GI system
| Question | Answer |
|---|---|
| upper GI tract begins | at mouth ends at jejunum |
| lower GI tract begins | at ileum ends at anus |
| accessory structures of GI system | peritoneum, liver, gall bladder, pancreas |
| primary functions of GI system | digestion, distribution of food |
| GI assessment physical exam | general appearance, skin color, turgor, cracks in mouth, inflammation, sores, bowel sounds, girth, tenderness in abdomen |
| old blood emesis | looks like coffee grounds |
| new blood emesis | bright red |
| after vomiting bright red blood, first intervention | turn pt on side, notify charge nurse or MD, prepare for NGT |
| vitals drop after vomiting blood, what next? | lay pt flat, head flat, no pillow, feet elevated on 2 pillows, monitor VS q5 min |
| check placement of NGT how? | 10-20 ml of air, aspiration, litmus paper, ph should be around 4 |
| lab values for pt on coumadin | PT, INR, norms are PT: 10-14, INR: 2-3 |
| s/s of perforated ulcer | sharp, sudden onset of intense burning pain, N/V of bright red blood |
| s/s of gastric ulcer | burning pain upper gastric area 1-2 hrs after meals |
| what order do you assess the abdomen | inspect, auscultate, percuss, palpate |
| sphincter between esophagus and stomach | cardiac sphincter |
| sphincter between stomach and small intestine | pyloric sphincter |
| digestion occurs | small intestine |
| classification of tagamet and it's purpose | anti-secretory drug, decrease hydrochloric acid production |
| s/s of PUD | burning gnawing, abd. pain after eating |
| complications of PUD | hemorrhage, perforation, peritonitis, pyloric obstruction |
| what is gastritis | inflammation of the lining of the stomach, acute or chronic |
| causes of gastritis | H. pylori,spicy food, etoh, reflux |
| complications of chronic gastritis | hemorrhage is most serious, and pernicious anemia |
| subtotal gastrectomy consists of | part of distal portion of stomach removed, anastamosed to duodenum |
| NI for subtotal gastrectomy | assessment, pain control, antiemetics, monitor wt |
| vagotomy consists of | branch of vagus nerve that supplies stomach is severed, decreases stimulation of gastric secretions |
| NI for vagotomy | assessment, pain control, antiemetics, mon. wt |
| complications of gastrectomy and vagotomy | feeling of fullness, diarrhea, dumping syndrome,BP falls, dizziness, diaphoretic, cramps, hyperactive bowel sounds, urge to defecate |
| what is peritonitis | infection of the peritoneum |
| causes of peritonitis | perforated peptic ulcer, perforated bowel, perforated appendix, lack of surgical asepsis, GSW, stab wound |
| complications of peritonitis | paralytic ileus due to lack of peristalsis, sepsis, death |
| what is an upper GI series | diagnostic test to see abnormalities in stomach and esophagus, & evaluate for aspiration- barium swallow |
| diagnostic endoscopic procedures to examine lower GI tract | colonoscopy, proctoscopy, sigmoidoscopy |
| s/s of perforation | fever, abd. pain, distention, rectal bleeding |
| lab test that determines residual bowel cancer after surgery | carcinoembryonic antigen- CEA |
| late s/s of bowel cancer | obstruction of bowel, thin ribbon-like stools |
| pernicious anemia, malabsorption is an impairment of what | vit b12, folic acid, iron, calcium, vit d absorption |
| vit b12 is necessary for production of what | RBC's, supplement c b12 injections |
| low intermittent suction | prevents damage to stomach lining |
| purpose of TPN | bypasses digestive tract, delivering nutrition directly into bloodstream |
| labs to be monitored while on TPN | blood glucose levels- TPN mixed c d10w or higher abnormally raises glucose levels, may need to admin. insulin |
| points to remember while caring for pt on TPN | admin into central circulation, use sterile tech., inspect site for signs of infection, monitor flow rate, must be on a pump, can lead to circulatory overload, label TPN lines, nothing except lipids can infuse c TPN, must hang d10w if TPN empties |
| s/s of appendicitis | pain around umbilicus, rebound pain c palpation, elevated temp, N/V, elevated WBC, pain c tapping bottom of heel, relief of pain c right leg flexion |
| complications c appendicitis | rupture causing peritonitis- s/s- absence of bowel sounds, increased pulse, temp, N/V, rigid abd., shock |
| meds that contribute to constipation | opiod analgesics, over use of laxatives |
| what is diverticulosis | small sac like pouches in the intestinal wall called diverticula that herniate outward |
| cause of diverticulosis | lack of fiber, age, constipation, obesity, stress |
| s/s of diverticulosis | often asymptomatic, may reprt rectal bleeding, pain in left lower abd, N/V, change in bowel habits, urinary problems |
| diagnostic tests for diverticulosis, or diverticulitis | stool tested, abd CT, barium enema, colonoscopy |
| ulcerative colitis | usually occurs in adulthood, inflammation of intestinal lining, begins in rectum, moves upward |
| crohn's disease | can occur anytime, fom infancy to adulthood, inflammation of intestinal lining, can occur anywhere in intestinal tract |
| complications of inflammatory bowel disease | hemorrhage, obstruction, perforation, abscesses, fistulas, megacolon |
| tx for crohn's and ulcerative colitis | drugs , diet, rest, ATB for crohn's, low roughage diet, no milk, IV fluids or TPN, surgery |
| what is an ileostomy | opening in the ileum, the distal portion of the small intestine, |
| when is ileostomy necessary | when entire colon must be bypassed due to cancer, IBD, congenital defects or bowel trauma |
| type of stools c ileostomy or colostomy | ileum is liquid, colostomy may be liquid, semi-solid, or solid |
| normal stoma's look like | new- beefy red, healed- rosy red, impaired circulation- pale, bluish, black, call DR immed |
| highest priority after ileostomy/ colostomy surgery | abc's, vs, assess stoma/abd for bleeding, assess NGT, assess IV fluids, rite fluid, rite rate |
Created by:
echilders
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