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GI walkabout


explain difference btwn NG tube and Nasoenteric tube.. Inserted through the nasopharynx into the stomach, the duodenum or jejunum. In special cases, through the mouth over the tongue (anatomic or physiologic reasons).Nasoenteric Tubes used for decompression and allowed to go to small intestine by peristalsis
is there a specific diet w pt with gerd? Avoid diet high in fats, etoh, caffeine, stress/smoking, chocolate,peppermint, tomato. Milk increases gastric acid secretion. eat small meals
how does the nurse confirm placement of a ng tube There are two ways of confirming the tube’s position currently recommended. These are by pH test and X-ray. Other methods can be inaccurate and should not be used. on xr The tip of the tube can be seen as a white radio-opaque line, below diaphragm, L side
construct a gi diet plan. high fiber, veggies, fruits, low fat, low etoh.
compare stool characteristics w pt who has ascending, transverse and descending colostomy. ascending- mostly fluid. transverse- semi fluid. descending-mostly formed stool
what emergency does rebound tenderness indicate peritoneal inflammation.
compare dietary needs and situational uses for parenteral nutrition, tube feedings vs TPN NG tube (enteral nut.) used for short term feed probs.used when pt cant take in enough oral nutr.If extended time, gasto tube or jejuno tube delivers into jejunum.
when is a persons stool clay colored, and urine dark? f the stool is pale or appears clay-like, it indicates there is no bile reaching the small intestines and it reflects a possible obstruction or problem in its production and transport. originates in GB. Bad bile ducts/liver can produce dark urine.
describe s/sx one might see w internal bleeding low bp, hi HR, dizzy, pain, coffee ground or bright red emesis, black tarry stools.
when is Carafate given in relationship to meals Take sucralfate on an empty stomach, at least 1 hour before or 2 hours after a meal.
Sx for Crohn's disease Crohns: Inflammation may occur anywhere along the digestive tract, may occur in patches, RLQ pain, ulcers can go thru whole bowel wall.Abdominal pain, cramping or swelling Anemia Fever,GI bleed,Joint Pain,Malabsorption,diarrhea,ulcers,vomit Weight loss
tx for Crohn's ABX, corticosteroid, immunosuppresant, physical, emotional rest. TPN, surgery
tx for U.C. (ulcerative colitis) ABX, aminosalicylates, corticosteroid, anticholinergics, antidiarrheal. If severe, TPN, and surgery
Crohns affects any part of GI tract, from ____to ____. mouth, anus.
Which one is most often seen in the terminal ileum, jejunum, and colon? Crohn's
sx for u.c. usually begins in rectum, sigmoid and spread up colon. bloody diarrhea, abd pain, fever, anorexia, malaise. continuous lesion pattern.
diet for U.C. LOW roughage, NO MILK/PRODUCTS
diet for Crohn's HIGH calorie,vitamin, protein. NO MILK.
explain emotional and physical care of pt with IBS psychological and physical stressors over a lifetime may contribute to the disease. anxiety, depression, PTSD are common comorbidities. high fiber diet w no milk products.
explain pre/post care of esophagogastroduodenoscopy, and cholangiopancreatography... EGD pre: NPO 8hrs, consent signed, preop meds, explain anesthetic spray in throat and sedation. Post: NPO until gag reflex returns. ERCP pre: same except for spray. Post: VS, check for signs of perforation/infection. Pancreatitis common complication.
explain tell tale sx of peritonitis... abd pain, bloat, fever, n/v, LOA, diarrhea, LOW URINE OUTPUT,THIRST, cant pass gas, fatigue.
assessment data the nurse looks for when assessing a NG tube head of bed at 30-45*, patency of tube (flush w 30ml water Q4H), verify tube position w XR, evaluate pt for risk of aspiration.
describe a healthy stoma No evidence of erythema, rash, ulceration or inflammation in the surrounding skin, stoma should be above skin level
what class of medications is contraindicated w PUD? nSAIDS AND ASA
most common H2 blockers and PPI rx'd H2, Tagamet and Pepcid. PPI prevacid and Prilosec.
what does PPI do PPI decrease HCl acid secretion by inhibiting proton pump mechanism responsible for production/secretion of H+ ion. Promotes healing!!
what do H2 blockers do block action of histamine on H2 receptors, reducing HCl acid secretion
Carafate is a cyto_______ drug. protective
Cholinergic drugs improve _____ emptying in supine position, and increase ______ emptying esophageal, gastric
what mechanism does cholinergics exhibit that will improve esophageal emptying and improve gastric emptying INCREASE LES PRESSURE
Most common cause of GERD incompetent LES (lower esophageal sphincter)
Why are hospital pt prescribed H2 blockers and PPI? to prevent ulcers.
explain to your pt what a hiatal hernia is. A hiatal hernia occurs when the upper part of your stomach bulges through your diaphragm into your esophagus, from a weak lower esophageal sphincter.
what self care strategies taught for a person w gerd avoid factors that aggravate sx, maintain diet, stop smoking, don't do milk/eat late at night.
Define "otomy" surgical excision of, to cut out
if milk makes GERD feel better why isn't it rx for ulcers? it increases gastric acid secretion.
differentiate btwn gastric and duodenal ulcers, include tx. duodenal- 80% OF ALL PEPTIC ULCERS, common 35-45 yo. H pylori in 90% of all cases. etoh,copd,smoking,liver,pancreas dx all risk factors.
gastric ulcers.. less common than duodenal in west countries. women >50 common. tx is rest, stress mgmt, npo, ng suction, iv fluid, blood trans prn, drug therapy
compare and contrast dietary needs of a person in acute diverticulitis and chronic diverticulitis Colon rest for acute diverticulitis. NPO, Iv fluids, liquid diet. Diverticulosis is high fiber diet. (Itis is acute, osis is dx/condition)
what is patho of jaundice? When concentration of bilirubin in blood is abnormally high, it turns skin yellow/orange.
how do aluminum and magnesium antacids differ? Aluminum antacids: constipation, hypercalcemia, hypophosphatemia. Magnesium: diarrhea, hypermagnesmia
how high is bed w person w tube feeding 30-45*
define itis- Omg. duh.
Lifestyle mods for GERD avoid food,drugs, etoh that trigger it. stop smoking, lose weight if obese to reduce intraabdominal pressure.
Lifestyle mods for Hiatal Hernia no etoh, smoking, wt control, loose clothing, avoid lift/straining, elevate head of bed.
Lifestyle mods for PUD Avoid etoh, caffeine, milk, and any other gastric secretion producers, decrease stress. no smoking
why are antibiotics often for PUD H pylori is typically present in PUD and needs tx w a/b therapy.
why is immodium avail otc but lomotil is not? because lomotil is considered an opioid and abuse and physical dependence may occur
what are fiber requirements for avg man? woman? man- 38g, woman 25g
which comes first allergies or consent? allergies, because it is part of the pt med hx.
explain collaborative care for someone w IBD rest bowel, control inflammation, combat infection, correct malnutrition, alleviate stress, pain control, improve quality of life.
who might present malnourished, person w crohn's or UC? Crohn's b/c it can affect the whole gi tract. if it affects the part of tract that absorbs nutrients, malnourishment can occur. UC is usually found in sigmoid/rectum, and food already digested by then.
if crohn's and UC are autoimmune diseases, what self care would you ensure your pt understands? decrease stress, avoid sick people, med compliance
how do aminosalicylates work in tx of IBD? decrease GI inflammation thru direct contact w bowel mucosa
what is function of NG tube w post op GI surgical pt used to decompress remaining portion of stomach to decrease pressure on suture line and to allow for resolution of edema and inflammation resulting from surgical trauma
take apart the word, cholecystectomy chole (bile/gall), cyst (bladder), ectomy (surgical removal of)
ABG will show an ______ state if the bowel obstruction is high in the small intestine where gastric acid is secreted. alkalotic
If the obstruction is lower where base solutions are secreted the blood will be _____ . acidic
_______ cancer is the 4th most common cancer in US, 2nd leading cause of cancer related death in US colorectal
peristomal skin is prone to breakdown by ______. enzymes
are antacids taken before or after a meal? why after 1-3 hrs, because that is when Hcl acid produced
when do you take carafate? an hour before meals
which gi drug interferes with tetracycline, phenytoin, digoxin, cimetidine Carafate
when do you take PPI? before meals
which med class typically given as prophylaxis in hosp for prevention of ulcers? H2 blockers, ranitidine (zantac), famotidine (pepcid)
List four nursing interventions for the client with hiatal hernia Sit up while eating and for one hour after eating. Eat frequent small meals; eliminate foods that are problematic.
List three categories of medications used in the treatment of PUD. Antacids, hisamine-2 receptor blockers, musosal healing agents, proton pump inhibitors
List the symptoms of upper and lower GI bleeding Upper GI: melena, hematemesis, tarry stools; lower GI: bloody stools, tarry stools, common to both: tarry stools
What bowel sound disruptions occur with an intestinal obstruction? NOn-mechanical obstruction (eg: paralytic ileus) will have NO bowel sounds. with MECHANICAL obstruction, Very high-pitched bowel sounds may be a sign of early bowel obstruction.
List four nursing interventions for postoperative care of a client with colostomy Irrigate daily at same time (to get bowels working on a schedule), use warm water, wash around stoma with mild soap and water with each bag change, ensure pending extends at least 1/8 in around stoma.
List five symptoms indicative of colon cancer Rectal bleeding, change in bowel habits, sense of incomplete evacuation, abdominal pain with nausea, weight loss.
Surgical adhesions (scars), hernias, and tumors are examples of ________ bowel obstruction. mechanical
Paralytic ileus, periotinits, appendicitis, pancreatitis are examples of __________ obstruction non-mechanical
will a diverticulitis pt have fiber in diet while in the 'recovery' phase? maintenance phase? no, yes
Created by: scynba36