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3rd Quarter : 4
GI
| Question | Answer |
|---|---|
| What are the 3 phases of digestion? | Cephalic, Gastric, Intestinal. |
| What occurs in the the Cephalic phase of digestion? | Sight/smell of food stimulates the Vagus nerve to send impulses to the GI tract, which causes an increase in secretions and an increase in motility. |
| What happens in the Gastric phase of digestion? | Distention, decreased acidity, and peptides cause hormonal (gastrin & nerve (vagus) stimulation. |
| What does Gastrin do? | Activates parietal cells to increase secretion and increase motility. |
| What occurs in the Intestinal phase of digestion? | Distention, increased acidity, increased osmolarity of chyme stimulates 5 cells to release Secretin. |
| What does Secretin do? | Decreases acid production and decreases motility. |
| What is the purpose of saliva? | To: lubricate/moisten, neutralize acid, antibacterial properties, release Amylase. |
| What do proteins do in the GI system? | Buffer acid. Stimulate gastrin secretion, which increases acid secretion by parietal cells. |
| What does the esophagus do? | Transport food. Prevent reflux. |
| How does food move through the esophagus? | Via peristaltic waves. |
| UES innervation. | By excitatory impulses. Receives 0 inhibitory impulses. |
| Esophageal sphincters remain: | Closed between swallows. (In a state of tonic contraction) |
| LES innervation. | Receives both inhibitory & excitatory impulses. |
| LES inhibitory factors. | Hormones, chemicals (nicotine, peppermint, tea, coffee, fatty acids), & gastric distension. |
| What effect do peppermint, nicotine, hormones and gastric distension have on the LES? | They cause the LES to open, causing reflux. |
| LES is comprised of: | 1. Internal LES2. External LES3. Oblique muscles of stomach (form flap d/t 90 degree angle). |
| Functions of the stomach. | Store food. Form chyme. Meter food out slowly. |
| Pacemaker area. | Body of stomach. Action potentials generate movement through gap junctions. Frequency stays the same, force changes with neural & hormonal stimuli. |
| Body of stomach contains: | 75% of gastric glands. A billion parietal cells. Chief cells. Mucus |
| What do parietal cells secrete? | HCl & intrinsic factor. |
| What do chief cells secrete? | Pepsinogen. |
| Pepsinogen is converted to? | Pepsin, in the presence of HCL. |
| What causes Pepsin to be inactivate? | pH of 7. |
| What is the residual volume of the stomach? | 50 mL. |
| How much can the stomach hold? | Up to 1000 mL. |
| Secretions of the antrum. | Gastrin. Mucus. Pepsinogen. |
| What causes the pylori sphincter to close? | Muscle contraction of antrum. |
| Where does starch digestion begin? | In the mouth. |
| What destroys Amylase? | Acid in the stomach. |
| What is the digestive result of protein? | Peptide fragments. |
| What is the only essential element? | Intrinsic factor. |
| Why does B12 need Intrinsic Factor? | B12 is large and charged. It needs to be bound to Intrinsic Factor in order to be absorbed in the ileum. |
| What are the 3 lines of defense in the Gastric Mucosal Barrier? | Mucus. Epithelial tight junctions. Microvascular system. |
| What action does the mucus take in the gastric mucosal barrier? | A bicarbonate layer of gel that impedes ion diffusion. |
| What is the purpose of the epithelial tight junctions in the gastric mucosal layer? | To secrete mucus. Also capable of fast repair. |
| What is the purpose of the microvascular system in the gastric mucosal layer? | Contribution of HCO3 and prostaglandins. |
| Basal acid secretion follows a circadian rhythm. When is it highest? | It is highest in the night and lowest in the morning. |
| Where are Brunner's glands? | In the Duodenum. |
| What is the importance of the pyloric sphincter? | Regurgitation of bile salts could damage the stomach. Leakage of gastric acid could damage the duodenum. |
| _____ is 10" long, a portal for chyme, bile, and pancreatic enzymes. | The duodenum. |
| This is activated by amino acids and fatty acids. | Cholecystokinin (CCK). |
| What does CCK do? | Regulates gallbladder contraction. Relaxes the Sphincter of Oddi. Regulates pancreatic secretions. Potentiates Secretin. |
| Prosecretin is activated to? | Secretin, by acid chyme. |
| What does secretin do? | Stimulates the pancreas to secrete HCO3. |
| For optimal absorption in the SI, how does movement occur? | Chyme is moved back and forth over short distances. |
| What does intestinal mucosa produce from the crypts of Lieberkuhn? | 2000 mL of serous fluid that acts as a vehicle for absorption. |
| A disruption in motility, or damage to the surface area of the SI affects... | absorption of nutrients. |
| Motility is increased by ______ . | Inflammatory processes |
| Motilitly is decreased by _______ . | Surgical manipulation. |
| How much fluid is absorbed from the SI? | 80% |
| How often do enteroctyes turn over? | Q 72h. |
| Enterocytes: | Are capable of repairing damage. Little cancer in SI. Are susceptible to damage by chemo/radiation. |
| What do Brush Border's enzymes do? | Complete carbohydrate digestion. Complete protein digestion. |
| What does the colon do? | Secretes mucus. Stores & concentrates chyme by absorbing Na and H2O. |
| What is the purpose of bacteria in the colon? | To synthesize Vit K, and aid in synthesis of some B vitamins. Break down undigested carbs. Deanimate amino acids to form ammonia. |
| How is urea formed? | Ammonia is converted in the liver to form urea. |
| What controls GI function? | The enteric nervous system in the GI tract. |
| Does the parasympathetic system decrease/increase motility and secretion? | Increase. |
| Does the sympathetic system decrease/increase motility and secretion? | Decrease. |
| What type of muscle is in the esophagus? | Smooth and skeletal. |
| What does Gastrin do? | Causes the parietal cells to secrete HCl and intrinsic factor. |
| What is the purpose of gastric mucus? | Protect the stomach lining and lubricate. |
| What is produced for every hydrogen ion that is secreted into the lumen? | HCO3, which serves to maintain a neutral pH along the epithelial membrane. |
| What does it mean when you say that NSAIDS, ETOH, and bile salts are lipid soluble? | It means they can penetrate the lipid soluble layer and damage the gastric mucosa. |
| What do prostaglandins do in the GI system? | Improve blood flow. Increase HCO3 secretion. Enhance mucus production. |
| What effect do NSAIDS have on prostaglandins? | Decrease. |
| What digestive enzymes in the pancrease are stimulated by CCK? | Amylase. Lipase. Trypsin. |
| Contraction of the gallbladder causes the secretion of? | Bile. |
| Teniae coli are what? | Three bands of longitudinal muscle in the colon. |
| When the teniae coli constrict, the colon gathers into pouches called _______ . | Haustra. |
| This is probably the most common GI disorder. | GERD |
| What causes GERD? | Improper closure of the LES. |
| What are contributing factors to GERD? | Obesity, Fat, Peppermint, Peppers, Tomato Sauce, ETOH, Nicotine, Caffeine |
| What causes the painful burning sensation associated with GERD? | Acid that refluxes and touches the lining of the esophagus. |
| Is nausea common or uncommon with GERD? | Uncommon. |
| The most important factor in GERD? | An incompetent LES. |
| What are symptoms of GERD? | Pyrosis, Regurgitation, Strictures, Barrett's esophagus, Extra-esophageal effects |
| What is Barret's esophagus? | The growth of stomach lining into the esophagus. It is a precancerous condition. |
| Which test needs to be done last in a series of GI tests? | Barium swallow. |
| What diagnostic tests are used for GERD? | Barium swallow, EGD, 24h pH |
| What lifestyle changes are indicated for GERD? | Remain upright for 3h after eating. Eat 6 small meals per day. |
| Medications used to treat GERD. | Antacids, Foaming agents, H2 blockers, PPIs |
| What surgery may be used to treat GERD if medications fail? | Nissan Fundoplication. |
| What is a hiatal hernia? | Herniation of part of stomach into the thoracic cavity through the esophageal hiatus in the diaphragm. |
| What is Gastritis? | Inflammation of the gastric mucosa. |
| Name two types of gastritis. | Acute Chronic |
| What causes acute gastritis? | Dietary toxins, ETOH, ASA |
| What are symptoms of acute gastritis? | N/V |
| How is acute gastritis diagnosed? | GI series, Endoscopy |
| What causes chronic gastritis? | Autoimmune disorders, H. Pylori, Chemical agents |
| What happens in chronic gastritis? | Atrophy of gastric mucosa results in a loss of function, diminished acid secretion, and pernicious anemia. |
| Peptic ulcers, varices, and gastritis occur in this type of GI bleed. | Upper GI bleed. |
| Malignancy and diverticulitis occur in this type of GI bleed. | Lower GI bleed. |
| Often, GI bleeds are this. | Intermittent |
| 75-80% of these stop spontaneously. | GI bleeds. |
| How does a GIB present? | Suddenly, with s/sx of hypovolemic shock. |
| What are symptoms of a GIB? | Hematemesis, Coffee ground emesis, Hematochezia, Melena, Occult bleed |
| What color indicates a positive guiaic? | Blue. |
| Nursing actions for a GIB. | VS, Stabilize or call a code. Monitor: H&H, PT, PTT, BUN. Insert NGT. Prep for colon/endoscopy. Give IV fluids. Instruct patient to lay down. |
| How will the H&H appear with a GIB? | Normal, patients bleed whole blood. |
| Peptic ulcer disease (PUD) is characterized by? | Exacerbations & remission. |
| What causes most ulcers? | H. Pylori |
| How does H. Pylori cause an ulcer? | By secreting urease, and producing toxins. |
| Gastric ulcers | Higher mortality, Occur in older people, 50-70% from H. Pylori, NSAIDs and ETOH the remainder |
| Duodenal ulcers | 80% of ulcers, Lower mortality, Age 35-45, Male, H. Pylori causes 90%, Remainder NSAIDs and stress |
| How does stress contribute to an ulcer? | By increasing HCl and decreasing HCO3. |
| Food aggravates this type of ulcer. | Gastric |
| No food aggravates this type of ulcer. | Duodenal |
| What are 3 major complications of an ulcer? | Hemorrhage, Perforation, Obstruction |
| What is Zollinger-Ellison syndrome? | It is rare and is caused by a gastrin-secreting tumor. |
| Peptic Ulcer Disease diagnosis. | History, Labs, Radiologic Imaging, ENDOSCOPY |
| Treatments for PUD. | Dual antibiotics, PPI, H2 receptor antagonists, Bismuth, Sucralfate, Antacids |
| These decrease acid. | PPIs, H2 receptor antagonists |
| These heal & protect. | Bismuth, Sucralfate |
| When is Sucralfate given? | Before food. |
| In PUD what is the goal of surgery? | To decrease acid-secreting ability. |
| Why is there an NGT during Post-op of PUD surgery? | To decompress the stomach, To prevent stress to suture lines |
| What is important to remember when caring for a patient with an NGT? | Never reposition or irrigate unless specifically ordered by a surgeon. |
| What color will the drainage be from an NGT? | Initially dark brown, Within 8h yellowish-green |
| How often should you check for proper tube placement of an NGT? | Q 4-8h |
| How should an NGT be anchored? | To nose and gown. |
| What type of suction is used with an NGT? | LIS (low intermittent suction) |
| How much saline is used to irrigate an NGT? | 10-20 mL |
| What complications may result from PUD surgery? | Dumping syndrome, Malabsorption, B12 deficiency |
| Early Dumping Syndrome. | 15-30 min after meals, Fluid shift into gut lumen-plasma V decrease-intestinal distention |
| Late Dumping Syndrome. | 90min- 3h after meals, Hypoglycemia d/t excess insulin |
| To avoid dumping syndrome & postprandial hypoglycemia: | Eat six small meals, No fluids with meals, Avoid concentrated sweets, Increase protein and fat. Short rest period after meals |
| Inflammatory Bowel Disease is characterized by: | Chronic, recurrent inflammation, Diarrhea, Weight loss |
| Where does Crohn's usually begin? | The ileum. |
| Where does Ulcerative colitis usually begin? | The rectum. |
| Which has skip lesions, Crohn's or Ulcerative colitis? | Crohn's. |
| Which has a cobblestone appearance, Crohns or Ulcerative colitis? | Crohn's. |
| What are the symptoms of Crohn's? | Nutritional deficiencies, Electrolyte disorders, Weight loss, Pain, Diarrhea, Low grade fever |
| Diagnosis of Crohn's disease. | Sigmoidoscopy, Stool Cultures, Radiologic contrast studies, CT scan |
| Treatment of Crohn's. | Corticosteroids, 5-ASA, Flagyl, Infliximab (Remicaid), Nutritional therapy, Surgery, Anti-immune drugs |
| Continuous erythema and ulceration occurs in? | Ulcerative colitis. |
| What are the symptoms of Ulcerative Colitis? | Profuse diarrhea with blood and mucus, Weakness Fatigue, Anemia, Dehydration |
| Diagnosis of Ulcerative colitis. | CBC, WBC, lytes, stool culture, colonoscopy, sigmoidoscopy, double contrast barium enema |
| Treatment of Ulcerative colitis | DietCrohn's medsSurgery |
| This bacteria is anaerobic, gram positive, and spore forming. | C. Difficile |
| What are two types of C. Diff colitis? | Hospital acquired Opportunistic |
| What do broad spectrum antibiotics do to the GI system? | Alter normal bowel flora. |
| How is C. Diff transmitted? | Antibiotic use, Low resistance, Fecal-oral route |
| C. Diff diagnosis | Diarrhea longer than 48h-stool culture-microscopic exam |
| Pseudomembranous colitis | Severe C. Diff infection, Adherent inflammatory membrane overlying areas of injury. |
| C. Diff treatment | Stop antibiotics (some patients)Vancomycin, Flagyl, Probiotics |
| Why do we avoid antidiarrheals with C. Diff? | They delay the clearance of the toxin. |
| Does alcohol gel kill C. diff spores? | No. |
| How do we prevent transmission of C. Diff? | Good hand-washingIsolation |
| Diverticulosis | Mucosal layer herniates thruough teniae coli from increase in intraluminal P d/t V of colonic contents. |
| Symptoms of diverticulosis. | Asymptomatic to lower abdominal discomfort.Change in bowel habits.BloatingGas |
| The Wonder Bread Disease. | Diverticulosis. |
| Diagnosis of diverticulosis. | Barium Enemax-rayCT scanUS |
| Treatment of diverticulosis. | High fiber diet. |
| Diverticulitis | Inflamed diverticulum. |
| Symptoms of diverticulitis. | LLQ cramping pain, N/V, F, Increased WBC, stool changes |
| Diagnosis of diverticulitis. | x-ray, ct scan, US |
| Why is barium enema avoided with diverticulitis? | Risk of peritonitis. |
| Treatment of diverticulitis. | Antibiotics,NPO-CL,Heat,Surgery. |
| Two types of bowel obstruction are.... | Mechanical and Paralytic. |
| Hernias and adhesions are examples of? | Mechanical bowel obstruction. |
| Medications, infections, and surgery are examples of? | Paralytic bowel obstruction. |
| What is the #1 cause of bowel obstruction? | Adhesions |
| What is the #2 cause of bowel obstruction? | Hernia |
| Obstruction leads to... | Abdominal distension. Loss of fluid and electrolytes. Atony. |
| Symptoms of bowel obstruction. | Pain, constipation, distention, vomiting. |
| Diagnosis of bowel obstruction. | H&P, x-ray (reveals air-fille bowel). |
| Treatment of bowel obstruction. | Decompression with NGT to suction. Correct electrolyte imbalances. Surgery. |
| When do s/sx of colon cancer appear? | Not until late in the disease. |
| Diagnosis of colon cancer. | H&P, colonoscopy, digital rectal exam, CT, US, barium enema. |
| Treatment of colon cancer. | Surgery, radiation, chemotherapy. |
| Prevention of colon cancer? | Age 40+, annual rectal examAge 50+, add annual guiac, flexible sigmoidoscopy every 3-5 years. |
| Positive guiac? | Get a colonoscopy. |
| What is a bowel resection? | An excision of colon containing tumor, leaving an area of clean margins. |
| What type of line is used for TPN? | A central line with filter to catch precipitates. |
| How to prep for a bowel resection. | CL for 1-2 days prior. NPO after midnight. Antibiotics, enemas, laxatives, and GoLytely. |
| What to watch a stoma for. | Necrotic tissue. Unusual bleeding. Dull color. |
| What you want to see in a stoma. | Beefy red color, edema. |
| How soon will bowel function return after a bowel resection? | In 72 hours. |
| Where will rebound tenderness be with appendicitis? | RLQ (McBurney's point) |
| What are symptoms of appendicitis? | RLQ pain, low-grade F, high WBC (>10,000), N/V |
| What complications can occur from appendicitis? | Peritonitis, abscess formation, and septicemia. |
| What causes peritonitis? | Bacteria or chemical irritant. |
| Symptoms of peritonitis. | N/V, pain, rigid board-like abdomen. |
| Treatment of peritonitis. | Antibiotics, fluid and electrolytes, NGT to suction, NPO, Surgery to correct cause. |
| What rate does TPN run at? | 60-80 mL/h |
| Where do you put meds in, when running TPN? | Below the filter. |
| Why is TPN given via a central line? | Hypertonicity. |
| What to monitor for while giving TPN. | Blood glucose, electrolytes, BUN (high amino acid content), infection d/t central line. |
| What does bile do? | Emulsifies fats. ADEK. |
| Bilirubin is a waste product of this. | RBC |
| Bilirubin is not soluble in this. | Fluid |
| Bilirubin needs to be bound to this. | Albumin |
| Bilirubin goes here for conjugation. | The liver. |
| This gives feces and urine it's color. | Bilirubin. |
| Total Bilirubin | 0.1 - 1.2 |
| Prehepatic jaundice | Hemolytic reaction, disorder of RBC |
| Intrahepatic jaundice | Liver damage, drugs. |
| Posthepatic jaundice | Disorders of bile duct, cholelithiasis. |
| LFTs | ALT & AST |
| Which LFT is specific to the liver? | ALT |
| Hepatitis is the inflammation of? | Liver cells, from infection of hepatitis viruses. |
| Symptoms of hepatitis. | RUQ pain, jaundice, malaise, anorexia, nausea, chills, F, elevated AST & ALT. |
| How are Hepatitis A&E transmitted? | Oral-fecal route. |
| How are Hepatitis B,C,D transmitted? | Bodily fluids. |
| Which hepatitis can product a carrier state? | B or C. |
| Hepatitis treatment. | Bedrest, nutritional support, gradual progressive ambulation. |
| How long can there be shedding of the hepatitis virus before a serologic marker is present? | 2 weeks |
| Hepatitis A | Don't usually die. |
| Hepatitis B | Can be fatal. |
| Hepatitis C | 75% are healthy carriers. Can cause liver cancer and cirrhosis. |
| Cholelithiasis | Gallstones |
| Gallstones are more common in.... | Women d/t estrogen |
| Gallstones form d/t.... | Abnormal bile, stasis of bile, cholecystitis. |
| Symptoms of cholelithiasis. | Indigestion, biliary colic, jaundice. |
| Why is morphine not given for biliary colic? | Causes spasms at sphincter of oddi. |
| What is used to visualize the biliary tree? | ERCP |
| Diagnosis of cholelithiasis. | ERCP, US, cholescintigraphy. |
| Treatment of cholelithiasis. | Gallbladder removal. |
| Which patients need an open cholecystectomy? | Those who have undergone extensive abdominal surgery. Those with severe, acute, cholecystitis. Obese patients. |
| What is the purpose of a T tube? | To ensure patency of bile duct. |
| Post op care of T tube. | Keep below gallbladder. output 400 mL + a day. Never irrigate, aspirate, clamp tube without physician order. |
| Cholecystitis | Gallbladder edema |
| Cholecystitis manifestations. | Biliary colic, increased WBCs, increased LFTs,increased bilirubin, jaundice (if stone in CBD) |
| Cholecystitis diagnosis. | CBC, LFT, US. |
| Increased Alkaline phosphatase indicates? | Inflammation in biliary tree. |
| What happens if activated pancreatic enzymes leak into body of pancreas? | They can autodigest it. |
| What causes most cases of acute pancreatitis? | Alcohol abuse or a gallstone lodged in duct. |
| Symptoms of acute pancreatitis. | SEVERE epigastric & abdominal PAIN radiating to back, abdominal distension/hypoactive bowel, F, shock symptoms, mild jaundice. |
| Diagnosis of acute pancreatitis. | Elevated amylase, elevated lipase, elevated WBCs, hyperglycemia, hypocalcemia, x-ray, CT SCAN. |
| Amylase level | 53 - 123 |
| BUN level | 8 - 25 |
| ALT level | 8 - 20 |
| AST level | 5 - 40 |
| Treatment of acute pancratitis. | Put the pancreas to rest! Antibiotics, pain meds, NPO, NGT to suction, fluid and electrolytes. |
| Complications of pancreatitis. | ARDS, pseudocyst. |
| Chronic pancreatitis | Episodic pancreatitis characterized by progressive destruction of pancreas usually r/t alcoholism. |
| Symptoms of chronic pancreatitis. | Pain, N/V, gas, anorexia, deficiencies of endocrine and exocrine function leading to malabsorption. |
| Treatment of chronic pancreatitis. | Pancreatic enzymes, insulin, low-fat diet, pain meds, pain may necessitat surgery. |
| UGI with SBFT | NPO for 8h before. Hold anticholinergics or narcotics for 24h before. Drink a lot of fluid to expel barium. Stools will be chalky white for 24-72h |
| Barium enema | CL 12-24h before. NPO after midnight. GoLytely. Hold barium. |
| FOBT | Save all stool. Guiac blue = positive. |
| EGD | NPO after midnight. Conscious sedation. Remove dentures. IV access. Lying on left side. NPO until gag reflex returns. |
| ERCP | NPO after midnight. IV access. Ask if allergic to iodine, dye or shellfish. NPO until gag returns. ASSESS FOR PANCREATITIS. |
| Colonoscopy | CL 24h before. NPO after midnight. GoLytely the evening before. Conscious sedation on left side, knees up. |
| How is GoLytely administered? | 8oz q 15 minutes until gone. DO NOT DILUTE. |
| Atropine is to be ready during a colonoscopy, why? | In the event the patient becomes bradycardic from vasovagal response. |
| What antibiotics are used to treat H. Pylori? | Clarithromycin and Flagyl (Metronidazole). |
| Considerations while taking Flagyl (Metronidazole). | D/C if CNS s/sx develop. NO ETOH. |
| Clarithromycin is what type of antibiotic? | Broad spectrum. |
| Sulfasalazine (Azulfidine) | Anti-inflammatory GI agent. Used in Crohn's and Ulcerative Colitis. |
| How does Sulfasalazine (Azulfidine) work? | It is converted by intestinal flora into 5-ASA compound. Acts locally to produce an anti-inflammatory effect. May inhibit prostaglandins & suppress migration of inflammatory cells. |
| Infliximab (Remicade) is what type of drug? | Tumor necrosis factor modifier. |
| What is Infliximab (Remicade) used for? | Crohn's |
| How does Infliximab (Remicade) work? | Monoclonal antibody binds to TNF cytokine, prevent it's action. Reduce infiltration of inflammatory cells to damaged area of intestine. |
| When hanging an IV with Infliximab (Remicade) it is important to remember... | It is incompatible with PVC tubing & bags. |
| Why should you stop Infliximab (Remicade)? | For hemodynamic instability/fever/chills/SOB. |
| Sucralfate (Carafate) | Anti-ulcer agent. |
| How does Sucralfate (Carafate) work? | It reacts with gastric acid to form a paste that sticks to and protects damages mucosa. |
| What is a side effect of Sucralfate (carafate)? | It causes dose dependent diarrhea. |
| When should Sucralfate (carafate) be administered? | 1h AC & HS. |
| H2 Receptor antagonists | Famotidine (pepcid), Ranitidine (zantac), Cimetidine (tagamet). |
| Antacids can be given with? | Famotidine (pepcid). |
| Antacids must be given 2h before/after administration of? | Ranitidine (zantac), Cimetidine (tagamet). |
| How do H2 receptor antagonists work? | They inhibit hitamine action at H2 receptor site on parietal cell, blocking gastric acid secretion. By raising stomach pH, indirectly reduces pepsin secretion. |
| Pancrelipase | Pancreatic enzyme replacement. (protease, lipase, amylase) |
| Important to remember with Pancrelipase. | Take with meals & snacks. Enteric coated (do not crush/chew). |
| Proton Pump Inhibitors (PPIs) | Pantoprazole (protonix), Omeprazole (prilosec). |
| How do PPIs work? | They decrease acid secretion by inhibiting the H, K, ATPase pump in parietal cells. |
| When should PPIs be administered. | Before breakfast. |
| Antiemetics | Metoclopramide (reglan), Promethazine (phenergan). |
| Metoclopramide (reglan) | Also a GI stimulant. Accelerates gastric emptying & intestinal transit time. Extrapyramidal side effects. |
| Promethazine (phenergan) | Depresses CTZ in medulla. IV dilute with 10 mL NS, give slowly. Monitor for excess sedation. |
| Which antiemetic needs to be diluted? | Promethazine (phenergan). IV dilute with 10mL NS and give slowly. |
| What can patients with a gastric ulcer eat? | Most foods, as long as it doesn't bother their stomach. |
| Why is an NGT inserted for a possible bowel obstruction? | It removes fluid and air from the stomach. |
| What is the primary initial symptom of a perforated duodenal ulcer? | Pain. |
| After a laproscopic cholecystectomy a patient is instructed to eat a low fat diet, what is importatn to know? | The patient may not need to remain on the low fat diet for long. |
| Pernicious anemia results from a lack of B12, which organ absorbs B12? | The ileum. |
| What food is good for breakfast with a GERD patient? | NON-FAT milk. |
| Pancrelipase should decrease the amount of what in the stool? | Fat. |
| Is gastric mucosa resistant to HCL? | Yes |
| What is the first consideration of a newly diagnosed C. Diff patient? | Are they taking any antibiotics? |
| Pain in GERD is expected to radiate to... | the throat. |
| Acute pancreatitis nursing actions. | Patient may need drain/stent. Closely monitor pulse ox and ABGs. NGT to suction to relieve N/V. |
| What is typically seen with both ulcerative colitis and crohn's? | Weight loss. |
| Symptoms of a rolling/paraesophageal hernia. | Feel really full. SOB. |
| When inserting an NGT, instruct the patient to: | Swallow, tuck their chin. |
| What should you do with the NGT when inserting? | Rotate 180 degrees. |
| EGD is used to visualize the: | Stomach and duodenum. |
| How soon will a patient have a bowel movement after their first dose of GoLytely? | Within 1h. |
| Why is the incidence of cancer in the SI so low? | Cells are turned over q 4 days. |
| The lower esophageal sphincter relaxes with ingestion of: | Caffeine, ETOH, fat. |
| Where is Vitamin K synthesized? | Large intestine. |
| What kind of diet is given do a person with dieverticulosis? | High fiber diet. |
| What is a classic sign of perforation? | Shoulder tip pain & abdominal pain. |
| Stomach contraction is inhibited by: | Secretin |
| Ascending colostomy | Done for right-sided tumors. |
| Transverse (double-barreled) colostomy | Often used in emergencies such as intestinal obstruction or perforation. 2 stomas. |
| Metamucil | 1-2 T q morning |
| MOM | 30 mL HS, hold if creatinine > 3.0 |
| Docusate | 250 mg BID |
| Bisacodyl | 1-2 tabs q morning, or suppository HS. |
| Lovenox SQ | DVT prevention |
| How is blood supplied to the GI tract? | Abdominal aorta. |
| How do nutrients get to the liver? | Via drainage from the gastric and splenic veins. |
| GI function is controlled by: | The enteric nervous system in the GI tract. |
| Myenteric plexus controls: | Motility. |
| Submucosal plexus controls: | Motility, secretion, absorption. |
| Prostaglandins do this to blood flow. | Improve it. |
| Sliding hiatal hernia. | The most common. D/t weak anchors of esophageal junction to diaphragm. |
| Rolling hiatal hernia. | Pouch of stomach herniated beside junction through hiatus. These can strangulate. Feel full after eating. SOB. |
| Albumin | 3.1 - 4.3 |
| Protein | 6.0 - 8.0 |
| Glucose | 80 - 120 |
| Alkaline Phosphatase | 42 - 128 units/L to 30 - 85 IU/L |
Created by:
NataschAnn
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