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GI final 2
| Question | Answer |
|---|---|
| Chapter 43: Nursing Management | Lower Gastrointestinal Problems |
| DIARRHEA | defined as an increase in stool frequency or volume, and an increase in the looseness of stool. |
| Diarrhea | can result from alterations in gastrointestinal motility, increased secretion, and decreased absorption. |
| Diarrhea | All cases of acute diarrhea should be considered infectious until the cause is known. |
| Diarrhea | Patients receiving antibiotics (e.g., clindamycin [Cleocin], ampicillin, amoxicillin, cephalosporin) are susceptible to Clostridium difficile (C. difficile), which is a serious bacterial infection. |
| FECAL INCONTINENCE | Risk factors include constipation, diarrhea, obstetric trauma, and fecal impaction. |
| Fecal incontinence | the involuntary passage of stool, occurs when the normal structures that maintain continence are disrupted. |
| Fecal incontinence | Prevention and treatment of fecal incontinence may be managed by implementing a bowel training program. |
| CONSTIPATION | The overall goals are that the patient with constipation is to increase dietary intake of fiber and fluids; increase physical activity; have the passage of soft, formed stools; and not have any complications, such as bleeding hemorrhoids. |
| Constipation | defined as a decrease in the frequency of bowel movements from what is “normal” for the individual; hard, difficult-to-pass stools; a decrease in stool volume; and/or retention of feces in the rectum. |
| Constipation | An important role of the nurse is teaching the patient the importance of dietary measures to prevent constipation. |
| Acute abdominal pain | is a symptom of many different types of tissue injury and can arise from damage to abdominal or pelvic organs and blood vessels. |
| Acute abdominal pain | Pain is the most common symptom of an acute abdominal problem. |
| Acute abdominal pain | The goal of management of the patient with acute abdominal pain is to identify and treat the cause and monitor and treat complications, especially shock. |
| Acute abdominal pain | Bowel sounds that are diminished or absent in a quadrant may indicate a complete bowel obstruction, acute peritonitis, or paralytic ileus. |
| Acute abdominal pain | Expected outcomes for the pt include resolution of cause of acute abdominal pain; relief of abdominal pain and discomfort; freedom from complications (especially hypovolemic shock and septicemia); and normal fluid, electrolyte, and nutritional status. |
| Common causes of chronic abdominal pain | include irritable bowel syndrome (IBS), diverticulitis, peptic ulcer disease, chronic pancreatitis, hepatitis, cholecystitis, pelvic inflammatory disease, and vascular insufficiency. |
| Acute abdominal pain | The abdominal pain or discomfort associated with IBS is most likely due to increased visceral sensitivity. |
| ABDOMINAL TRAUMA | Blunt trauma commonly occurs with motor vehicle accidents and falls and may not be obvious because it does not leave an open wound. |
| ABDOMINAL TRAUMA | Common injuries of the abdomen include lacerated liver, ruptured spleen, pancreatic trauma, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel tears, renal injury, and stomach or intestine rupture. |
| Appendicitis | results in distention, venous engorgement, and the accumulation of mucus and bacteria, which can lead to gangrene and perforation. |
| Appendicitis | typically begins with periumbilical pain, followed by anorexia, nausea, and vomiting. The pain is persistent and continuous, eventually shifting to the right lower quadrant and localizing at McBurney’s point. |
| Appendicitis | Until a health care provider sees the patient, nothing should be taken by mouth (NPO) to ensure that the stomach is empty in the event that surgery is needed. |
| Peritonitis | results from a localized or generalized inflammatory process of the peritoneum. |
| Peritonitis | Assessment of the patient’s abdominal pain, including the location, is important and may help in determining the cause of peritonitis. |
| Gastroenteritis | is an inflammation of the mucosa of the stomach and small intestine. |
| Gastroenteritis | Clinical manifestations include nausea, vomiting, diarrhea, abdominal cramping, and distention. Most cases are self-limiting and do not require hospitalization. |
| Gastroenteritis | If the causative agent is identified, appropriate antibiotic and antimicrobial drugs are given. |
| Gastroenteritis | Symptomatic nursing care is given for nausea, vomiting, and diarrhea. |
| Inflammatory bowel disease | Crohn’s disease and ulcerative colitis are immunologically related disorders |
| Inflammatory bowel disease | characterized by mild to severe acute exacerbations that occur at unpredictable intervals over many years. |
| Inflammatory bowel disease Ulcerative colitis | usually starts in the rectum and moves in a continual fashion toward the cecum. Although there is sometimes mild inflammation in the terminal ileum, ulcerative colitis is a disease of the colon and rectum. |
| Inflammatory bowel disease Crohn’s disease | can occur anywhere in GI tract from mouth to anus, but occurs most commonly in terminal ileum & colon. inflammation involves all layers of the bowel wall with segments of normal bowel occurring between diseased portions, the so-called “skip lesions.” |
| Inflammatory bowel disease With Crohn’s disease | diarrhea & colicky abdominal pain are common symptoms.If small intestine is involved, weight loss occurs due to malabsorption. patients may have systemic symptoms such as fever. primary symptoms of ulcerative colitis are bloody diarrhea & abdominal pain |
| The goals of treatment for IBD | include rest the bowel, control the inflammation, combat infection, correct malnutrition, alleviate stress, provide symptomatic relief, and improve quality of life. |
| Inflammatory bowel disease Nutritional problems | are especially common with Crohn’s disease when the terminal ileum is involved. |
| The following five major classes of medications are used to treat IBD: | Aminosalicylates, Antimicrobials, Corticosteroids, Immunosuppressants, Biologic therapy |
| Surgery is indicated if the patient with IBD | fails to respond to treatment; exacerbations are frequent and debilitating; massive bleeding, perforation, strictures, and/or obstruction occur; tissue changes suggest that dysplasia is occurring; or carcinoma develops. |
| During an acute exacerbation of IBD | nursing care is focused on hemodynamic stability, pain control, fluid and electrolyte balance, and nutritional support. |
| Inflammatory bowel disease | Nurses and other team members can assist patients to accept the chronicity of IBD and learn strategies to cope with its recurrent, unpredictable nature. |
| The causes of intestinal obstruction | can be classified as mechanical or nonmechanical. |
| Intestinal obstruction | can be a life-threatening problem. |
| Intestinal obstruction | Cancer is the most common cause of large bowel obstruction, followed by volvulus and diverticular disease. |
| Intestinal obstruction | Emergency surgery is performed if the bowel is strangulated, but many bowel obstructions resolve with conservative treatment. |
| With a bowel obstruction | there is retention of fluid in the intestine and peritoneal cavity, which can result in a severe reduction in circulating blood volume and lead to hypotension and hypovolemic shock. |
| Adenomatous polyps | are characterized by neoplastic changes in the epithelium and are closely linked to colorectal adenocarcinoma. |
| Familial adenomatous polyposis (FAP) | is the most common hereditary polyp disease. |
| Colorectal cancer | is the third most common form of cancer and the second leading cause of cancer-related deaths in the United States. |
| Colorectal cancer | Most people with colorectal cancer have hematochezia (passage of blood through rectum) or melena (black, tarry stools), abdominal pain, and/or changes in bowel habits. |
| Colorectal cancer | Am Cancer Society recommends that person who has no established risk factors should have fecal occult blood test or fecal immunochemical test yearly, double-contrast enema every 5 yrs,sigmoidoscopy every 5 ys,colonoscopy every 10 yrs starting at age 50. |
| Colonoscopy | is the gold standard for colorectal cancer screening. |
| Surgery for a rectal cancer | may include an abdominal-perineal resection. Potential complications of abdominal-perineal resection include delayed wound healing, hemorrhage, persistent perineal sinus tracts, infections, and urinary tract and sexual dysfunctions. |
| Chemotherapy | is used both as an adjuvant therapy following colon resection and as primary treatment for nonresectable colorectal cancer. |
| The goals for the patient with colorectal cancer | include normal bowel elimination patterns, quality of life appropriate to disease progression, relief of pain, and feelings of comfort and well-being. |
| Colorectal cancer | Psychologic support for the patient and family is important. The recovery period is long, and the cancer could return. |
| An ostomy | is used when the normal elimination route is no longer possible. |
| The two major aspects of nursing care for the patient undergoing ostomy surgery are | (1) emotional support as the patient copes with a radical change in body image, and (2) patient teaching about the many aspects of stoma care and the ostomy. |
| Bowel preparations are used to empty the intestines before surgery | to decrease the chance of a postoperative infection caused by bacteria in the feces. |
| Postoperative nursing care | includes assessment of the stoma and provision of an appropriate pouching system that protects the skin and contains drainage and odor. |
| The patient should be able to | perform a pouch change, provide appropriate skin care, control odor, care for the stoma, and identify signs and symptoms of complications. |
| Colostomy irrigations | are used to stimulate emptying of the colon in order to achieve a regular bowel pattern. If control is achieved, there should be little or no spillage between irrigations. |
| The patient with an ileostomy | should be observed for signs and symptoms of fluid and electrolyte imbalance, particularly potassium, sodium, and fluid deficits. |
| Bowel surgery | can disrupt nerve and vascular supply to the genitals. Radiation therapy, chemotherapy, and medications can also alter sexual function. |
| Concerns of people with stomas | include the ability to resume sexual activity, altering clothing styles, the effect on daily activities, sleeping while wearing a pouch, passing gas, the presence of odor, cleanliness, and deciding when or if to tell others about the stoma. |
| Diverticular disease | covers a spectrum from asymptomatic, uncomplicated diverticulosis to diverticulitis with complications such as perforation, abscess, fistula, and bleeding. |
| Diverticular disease | is a common disorder that affects 5% of the U.S. population by age 40 years and 50% by age 80 years. |
| The majority of patients with diverticular disease | are asymptomatic. |
| Symptomatic diverticular disease | can be further broken down into the following: |
| Diverticulitis | (inflammation of the diverticuli) |
| Complications of diverticulitis | include perforation with peritonitis. |
| A high-fiber diet, mainly from fruits and vegetables, and decreased intake of fat and red meat are | recommended for preventing diverticular disease. |
| A hernia | is a protrusion of a viscus through an abnormal opening or a weakened area in the wall of the cavity in which it is normally contained. |
| If the hernia becomes strangulated | the patient will experience severe pain and symptoms of a bowel obstruction, such as vomiting, cramping abdominal pain, and distention. |
| Malabsorption | results from impaired absorption of fats, carbohydrates, proteins, minerals, and vitamins. |
| Causes of malabsorption include the following: | Biochemical or enzyme deficiencies, Bacterial proliferation, Disruption of small intestine mucosa, Disturbed lymphatic and vascular circulation, Surface area loss |
| Three factors necessary for the development of celiac disease (gluten intolerance) | are genetic predisposition, gluten ingestion, and an immune-mediated response. |
| Early diagnosis and treatment of celiac disease | can prevent complications such as cancer (e.g., intestinal lymphoma), osteoporosis, and possibly other autoimmune diseases. |
| Celiac disease | is treated with lifelong avoidance of dietary gluten. Wheat, barley, oats, and rye products must be avoided. |
| The symptoms of lactose intolerance | include bloating, flatulence, cramping abdominal pain, and diarrhea. They usually occur within 30 minutes to several hours after drinking a glass of milk or ingesting a milk product. |
| lactose intolerance | Treatment consists of eliminating lactose from the diet by avoiding milk and milk products and/or replacement of lactase with commercially available preparations. |
| Short bowel syndrome (SBS) | results from surgical resection, congenital defect, or disease-related loss of absorption. |
| SBS | is characterized by failure to maintain protein-energy, fluid, electrolyte and micronutrient balances on a standard diet. |
| The length and portions of small bowel resected | are associated with the number and severity of symptoms. Short bowel syndrome is characterized by failure to maintain protein-energy, fluid, electrolyte, and micronutrient balances on a standard diet. |
| Hemorrhoids | dilated veins,internal(above internal sphincter)/external(outside external sphincter)teaching to prevent constipation,avoid prolonged standing/sitting,proper use of OTC,need to seek med care for severe symp(excessive pain&bleeding,prolapsed hemorrhoids) |
| An anal fissure | is a skin ulcer or a crack in the lining of the anal wall that is caused by trauma, local infection, or inflammation. |
| A pilonidal sinus | is a small tract under the skin between the buttocks in the sacrococcygeal area. Nursing care for the patient with a pilonidal cyst or abscess includes warm, moist heat applications. |
| Chapter 42: Nursing Management: | Upper Gastrointestinal Problems |
| Nausea and vomiting | are found in a wide variety of gastrointestinal (GI) disorders. |
| found in conditions that are unrelated to GI disease,including preg,infectious diseases,CNS disorders(meningitis), CV probs(MI),metabolic disorders(diabetes), side effects of drugs (e.g., chemotherapy, opioids), and psychologic factors (e.g., fear). | Nausea and vomiting |
| Vomiting | can occur when the GI tract becomes overly irritated, excited, or distended. |
| Vomiting | It can be a protective mechanism to rid the body of spoiled or irritating foods and liquids. |
| Pulmonary aspiration | is a concern when vomiting occurs in the patient who is elderly, is unconscious, or has other conditions that impair the gag reflex. |
| Vomiting | The color of the emesis aids in identifying the presence and source of bleeding. |
| Drugs that control nausea and vomiting | include anticholinergics (e.g., scopolamine), antihistamines (e.g., promethazine [Phenergan]), phenothiazines (e.g., chlorpromazine [Thorazine], prochlorperazine [Compazine]), and butyrophenones (e.g., droperidol [Inapsine]). |
| The patient with severe or prolonged vomiting | is at risk for dehydration and acid-base and electrolyte imbalances. The patient may require intravenous (IV) fluid therapy with electrolyte and glucose replacement until able to tolerate oral intake. |
| The mortality rate for upper GI bleeding | remains at 6% to 10% despite advances in intensive care, hemodynamic monitoring, and endoscopy. |
| The severity of bleeding | depends on whether the origin is venous, capillary, or arterial. |
| Bleeding ulcers | account for 50% of the cases of upper GI bleeding. |
| Drugs that are cause of upper GI bleeding | such as aspirin, nonsteroidal antiinflammatory agents, and corticosteroids are a major. |
| upper GI bleeding | Although approximately 80% to 85% of patients who have massive hemorrhage spontaneously stop bleeding, the cause must be identified and treatment initiated immediately. |
| upper GI bleeding The immediate physical examination | includes systemic evaluation of pt’s condition w/ emphasis on BP,rate &character of pulse, peripheral perfusion w/capillary refill, and observation for the presence or absence of neck vein distention. Vital signs are monitored every 15 to 30 minutes. |
| The goal of endoscopic hemostasis | is to coagulate or thrombose the bleeding artery. Several techniques are used including thermal (heat) probe, multipolar and bipolar electrocoagulation probe, argon plasma coagulation, and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. |
| The patient undergoing vasopressin therapy | is closely monitored for its myocardial, visceral, and peripheral ischemic side effects. |
| The nursing assessment for the patient with upper GI bleeding | includes the patient’s level of consciousness, vital signs, appearance of neck veins, skin color, and capillary refill. The abdomen is checked for distention, guarding, and peristalsis. |
| The patient who requires regular administration | of ulcerogenic drugs, such as aspirin, corticosteroids, or NSAIDs, needs instruction regarding the potential adverse effects related to GI bleeding. |
| During the acute bleeding phase | an accurate intake and output record is essential so that the patient’s hydration status can be assessed. |
| upper GI bleeding Once fluid replacement has been initiated | , the older adult or the patient with a history of cardiovascular problems is observed closely for signs of fluid overload. |
| The majority of upper GI bleeding episodes | cease spontaneously, even without intervention. Monitoring the patient’s laboratory studies enables the nurse to estimate the effectiveness of therapy. |
| upper GI bleeding | The patient and family are taught how to avoid future bleeding episodes. Ulcer disease, drug or alcohol abuse, and liver and respiratory diseases |
| May be specific mouth diseases | , or they may occur in the presence of systemic disorders such as leukemia or vitamin deficiency. |
| The patient who is immunosuppressed (e.g., patient with acquired immunodeficiency syndrome or receiving chemotherapy) | is most susceptible to oral infections. The patient on oral corticosteroid inhaler treatment for asthma is also at risk. |
| Management of oral infections and inflammation | is focused on identification of the cause, elimination of infection, provision of comfort measures, and maintenance of nutritional intake. |
| ORAL (OR OROPHARYNGEAL) CANCER | May occur on the lips or anywhere within the mouth (e.g., tongue, floor of the mouth, buccal mucosa, hard palate, soft palate, pharyngeal walls, tonsils). |
| ORAL (OR OROPHARYNGEAL) CANCER | Head and neck squamous cell carcinoma is an umbrella term for cancers of the oral cavity, pharynx, and larynx. Accounts for 90% of malignant oral tumors. |
| The overall goals are that the patient with carcinoma of the oral cavity will | (1) have a patent airway, (2) be able to communicate, (3) have adequate nutritional intake to promote wound healing, and (4) have relief of pain and discomfort. |
| gastroesophageal reflux disease (GERD). | There is no one single cause. It can occur when there is reflux of acidic gastric contents into the esophagus. |
| gastroesophageal reflux disease (GERD). Predisposing conditions | include hiatal hernia, incompetent lower esophageal sphincter, decreased esophageal clearance (ability to clear liquids or food from the esophagus into the stomach) resulting from impaired esophageal motility, and decreased gastric emptying. |
| A complication of GERD | is Barrett’s esophagus (esophageal metaplasia), which is considered a precancerous lesion that increases the patient’s risk for esophageal cancer. |
| Most patients with GERD | can be successfully managed by lifestyle modifications and drug therapy. |
| Drug therapy for GERD | is focused on improving LES function, increasing esophageal clearance, decreasing volume and acidity of reflux, and protecting the esophageal mucosa. |
| Because of the link between GERD and Barrett’s esophagus, | patients are instructed to see their health care provider if symptoms persist. |
| The two most common types of hiatal hernia | are sliding and paraesophageal (rolling). |
| Factors that predispose to hiatal hernia development include | inc intraabdominal pressure,including obesity, pregnancy, ascites, tumors, tight girdles, intense physical exertion, heavy lifting on continual basis. Other factors are inc age, trauma, poor nutrition, forced recumbent position(prolonged bed rest). |
| Two important risk factors for esophageal cancer | are smoking and excessive alcohol intake. |
| Gastritis | occurs as the result of a breakdown in the normal gastric mucosal barrier. |
| Gastritis | Drugs such as aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), digitalis, and alendronate (Fosamax) have direct irritating effects on the gastric mucosa. Dietary indiscretions can also result in acute gastritis. |
| The symptoms of acute gastritis | include anorexia, nausea and vomiting, epigastric tenderness, and a feeling of fullness. |
| peptic ulcer disease (PUD) | Gastric and duodenal ulcers, are different in their etiology and incidence. |
| Duodenal ulcers | are more common than gastric ulcers. |
| The organism Helicobacter pylori | is found in the majority of patients with PUD. |
| Alcohol, nicotine, and drugs such as aspirin and nonsteroidal antiinflammatory drugs play a role in | gastric ulcer development. |
| The three major complications of chronic PUD | are hemorrhage, perforation, and gastric outlet obstruction. All are considered emergency situations and are initially treated conservatively. |
| Endoscopy is the most commonly used procedure for | diagnosis of PUD. |
| Treatment of PUD | includes adequate rest, dietary modifications, drug therapy, elimination of smoking, and long-term follow-up care. The aim is to decrease gastric acidity, enhance mucosal defense mechanisms, and minimize the harmful effects on the mucosa. |
| The drugs most commonly used to treat PUD | are histamine (H2)-receptor blockers, proton pump inhibitors, and antacids. Antibiotics are employed to eradicate H. pylori infection. |
| The immediate focus of management of a patient with a perforation | is to stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume. |
| The aim of therapy for gastric outlet obstruction is | to decompress the stomach, correct any existing fluid and electrolyte imbalances, and improve the patient’s general state of health. |
| Overall goals for the patient with PUD | include compliance with the prescribed therapeutic regimen, reduction or absence of discomfort, no signs of GI complications, healing of the ulcer, and appropriate lifestyle changes to prevent recurrence. |
| Surgical procedures for PUD | include partial gastrectomy, vagotomy, and/or pyloroplasty. |
| Stomach (gastric) cancers | often spread to adjacent organs before any distressing symptoms occur. |
| The nursing role in the early detection of stomach cancer | is focused on identification of the patient at risk because of specific disorders such as pernicious anemia and achlorhydria. |
| E. coli O157:H7O157:H7 | It is the organism most commonly associated with food-borne illness. |
| E. coli O157:H7O157:H7 | It is found primarily in undercooked meats, such as hamburger, roast beef, ham, and turkey. |
| Chapter 44: Nursing Management: | Liver, Pancreas, and Biliary Tract Problems |
| Jaundice | a yellowish discoloration of body tissues, results from an alteration in normal bilirubin metabolism or flow of bile into the hepatic or biliary duct systems. |
| The three types of jaundice | are hemolytic, hepatocellular, and obstructive. |
| Hemolytic (prehepatic) jaundice | is due to an increased breakdown of red blood cells (RBCs), which produces an increased amount of unconjugated bilirubin in the blood. |
| Hepatocellular (hepatic) jaundice | results from the liver’s altered ability to take up bilirubin from the blood or to conjugate or excrete it. |
| Obstructive (posthepatic) jaundice | is due to decreased or obstructed flow of bile through the liver or biliary duct system. |
| Hepatitis | is an inflammation of the liver. Viral hepatitis is the most common cause of hepatitis. The types of viral hepatitis are A, B, C, D, E, and G. |
| Hepatitis A | HAV is an RNA virus that is transmitted through the fecal-oral route. |
| The mode of transmission of HAV | is mainly transmitted by ingestion of food or liquid infected with the virus and rarely parenteral. |
| Clinical manifestations: | Many pts w/hep have no symp.Symp of acute phase include malaise, anorexia, fatigue, nausea, occasional vomiting, and abdominal (right upper quadrant) discomfort. Physical examination may reveal hepatomegaly, lymphadenopathy, and sometimes splenomegaly. |
| Both hepatitis A vaccine and immune globulin (IG) | are used for prevention of hepatitis A. |
| Wilson’s disease | is a progressive, familial, terminal neurologic disease accompanied by chronic liver disease leading to cirrhosis. |
| Wilson’s disease | It is associated with increased storage of copper. |
| Acute pancreatitis | is an acute inflammatory process of the pancreas. The primary etiologic factors are biliary tract disease (most common cause in women) and alcoholism (most common cause in men). |
| Acute pancreatitis | Abdominal pain usually located in the left upper quadrant is the predominant symptom. Other manifestations include nausea, vomiting, hypotension, tachycardia, and jaundice. |
| Two significant local complications of acute pancreatitis | are pseudocyst and abscess. |
| A pancreatic pseudocyst | is a cavity continuous with or surrounding the outside of the pancreas. |
| The primary diagnostic tests for acute pancreatitis | are serum amylase and lipase. |
| Objectives of collaborative care for acute pancreatitis | include relief of pain; prevention or alleviation of shock; reduction of pancreatic secretions; control of fluid and electrolyte imbalances; prevention or treatment of infections; and removal of the precipitating cause. |
| Acute pancreatitis | Because hypocalcemia can also occur, the nurse must observe for symptoms of tetany, such as jerking, irritability, and muscular twitching. |
| Chronic pancreatitis | is a continuous, prolonged, inflammatory, and fibrosing process of the pancreas. The pancreas becomes progressively destroyed as it is replaced with fibrotic tissue. Strictures and calcifications may also occur in the pancreas. |
| Clinical manifestations of chronic pancreatitis | include abdominal pain, symptoms of pancreatic insufficiency, including malabsorption with weight loss, constipation, mild jaundice with dark urine, steatorrhea, and diabetes mellitus. |
| Measures used to control the pancreatic insufficiency | include diet, pancreatic enzyme replacement, and control of the diabetes. |
| The majority of pancreatic cancers | have metastasized at the time of diagnosis. The signs and symptoms of pancreatic cancer are often similar to those of chronic pancreatitis. |
| Transabdominal ultrasound and CT scan are the most commonly | used diagnostic imaging techniques for pancreatic diseases, including cancer. |
| Surgery provides the most effective treatment of cancer of the pancreas | ; however, only 15% to 20% of patients have resectable tumors. |
| The most common disorder of the biliary system is | cholelithiasis (stones in the gallbladder). |
| Cholecystitis (inflammation of the gallbladder) | is usually associated with cholelithiasis. |
| Ultrasonography is commonly used to | diagnose gallstones. |
| Medical dissolution therapy | is recommended for patients with small radiolucent stones who are mildly symptomatic and are poor surgical risks. |
| Cholelithiasis develops when | the balance that keeps cholesterol, bile salts, and calcium in solution is altered and precipitation occurs. Ultrasonography is commonly used to diagnose gallstones. |
| Initial symptoms of acute cholecystitis | include indigestion and pain and tenderness in the right upper quadrant. |
| Complications of cholecystitis include | gangrenous cholecystitis, subphrenic abscess, pancreatitis, cholangitis (inflammation of biliary ducts), biliary cirrhosis, fistulas, and rupture of the gallbladder, which can produce bile peritonitis. |
| Postoperative nursing care following a laparoscopic cholecystectomy includes | monitoring for complications such as bleeding, making the patient comfortable, and preparing the patient for discharge. |
| The nurse should assume responsibility for | recognition of predisposing factors of gallbladder disease in general health screening. |
| Chapter 39: Nursing Assessment: | Gastrointestinal System |
| The main function of the gastrointestinal (GI) system | is to supply nutrients to body cells. |
| The GI tract | is innervated by the autonomic nervous system. The parasympathetic system is mainly excitatory, and the sympathetic system is mainly inhibitory. |
| The two types of movement of the GI tract | are mixing (segmentation) and propulsion (peristalsis). |
| The secretions of the GI system consist of | enzymes and hormones for digestion, mucus to provide protection and lubrication, water, and electrolytes. |
| Mouth: | consists of the lips and oral (buccal) cavity. |
| The main function of saliva | is to lubricate and soften the food mass, thus facilitating swallowing. |
| Pharynx: | a musculomembranous tube that is divided into the nasopharynx, oropharynx, and laryngeal pharynx. |
| Esophagus: | A hollow, muscular tube that receives food from the pharynx and moves it to the stomach by peristaltic contractions. |
| Lower esophageal sphincter (LES) | at the distal end remains contracted except during swallowing, belching, or vomiting. |
| Stomach: | The functions are to store food, mix the food with gastric secretions, and empty contents into the small intestine at a rate at which digestion can occur. |
| The secretion of HCl acid | makes gastric juice acidic. |
| Intrinsic factor promotes | cobalamin absorption in the small intestine. |
| Small intestine: | two primary functions are digestion and absorption. |
| Large intestine: | The four parts are (1) the cecum and appendix; (2) the colon (ascending, transverse, descending, sigmoid colon); (3) the rectum; and (4) the anus. |
| The most important function of the large intestine | is the absorption of water and electrolytes. |
| Liver: | Hepatocytes are the functional unit of the liver. Is essential for life. It functions in the manufacture, storage, transformation, and excretion of a number of substances involved in metabolism. |
| Biliary tract: | Consists of the gallbladder and the duct system. |
| Bile is produced | in the liver and stored in the gallbladder. |
| Bile consists of | bilirubin, water, cholesterol, bile salts, electrolytes, and phospholipids. |
| Pancreas: The exocrine function of | the pancreas contributes to digestion. |
| Pancreas: The endocrine function | occurs in the islets of Langerhans, whose beta cells secrete insulin; alpha cells secrete glucagon; and delta cells secrete somatostatin. |
| Aging causes | changes in the functional ability of the GI system. |
| Xerostomia | (decreased saliva production) or dry mouth is common. |
| Aging causes | Taste buds decrease, the sense of smell diminishes, and salivary secretions diminish, which can lead to a decrease in appetite. |
| Although constipation is a common complaint of elderly patients, | age-related changes in colonic secretion or motility have not been consistently shown. |
| The liver size decreases | after 50 years of age, but liver function tests remain within normal ranges. There is decreased ability to metabolize drugs and hormones. |
| Important health information: the patient is asked about | abdominal pain, nausea and vomiting, diarrhea, constipation, abdominal distention, jaundice, anemia, heartburn, dyspepsia, changes in appetite, hematemesis, food intolerance or allergies, excessive gas, bloating, melena, hemorrhoids, or rectal bleeding. |
| ASSESSMENT Subjective data: The patient is asked about | (1) history or existence of diseases such as gastritis, hepatitis, colitis, gallbladder disease, peptic ulcer, cancer, or hernias; (2) weight history; (3) past and current use of medications and prior hospitalizations for GI problems. |
| ASSESSMENT Subjective data: | Many chemicals and drugs are potentially hepatotoxic and result in significant patient harm unless monitored closely. |
| ASSESSMENT Objective data: | Anthropometric measurements (height, weight, skinfold thickness) and blood studies (e.g., serum protein, albumin, hemoglobin) may be performed. |
| ASSESSMENT Physical examination | Mouth. The lips are inspected for symmetry, color, and size. The lips, tongue, and buccal mucosa are observed for lesions, ulcers, fissures, and pigmentation. |
| ASSESSMENT Physical examination | Abdomen. The skin is assessed for changes (color, texture, scars, striae, dilated veins, rashes, lesions), symmetry, contour, observable masses, and movement. |
| ASSESSMENT Physical examination | Auscultation of the four quadrants of the abdomen includes listening for increased or decreased bowel sounds and vascular sounds. |
| ASSESSMENT Physical examination | Percussion of the abdomen is done to determine the presence of distention, fluid, and masses. The nurse lightly percusses all four quadrants of the abdomen. |
| ASSESSMENT Physical examination | Light palpation is used to detect tenderness or cutaneous hypersensitivity, muscular resistance, masses, and swelling. |
| ASSESSMENT Physical examination | Deep palpation is used to delineate abdominal organs and masses. Rebound tenderness indicates peritoneal inflammation. |
| ASSESSMENT Physical examination | During inspiration the liver edge should feel firm, sharp, and smooth. The surface and contour and any tenderness are described. |
| ASSESSMENT Physical examination | The spleen is normally not palpable. If palpable, manual compression of an enlarged spleen may cause it to rupture. |
| ASSESSMENT Physical examination | The perianal and anal areas should be inspected for color, texture, lumps, rashes, scars, erythema, fissures, and external hemorrhoids. |
| Many of the diagnostic procedures of the GI system | require measures to cleanse the GI tract, as well as the use of a contrast medium or a radiopaque tracer. |
| An upper GI series | with small bowel follow-through provides visualization of the esophagus, stomach, and small intestine. |
| A lower GI series (barium enema) x-ray examination | is done to detect abnormalities in the colon. |
| Ultrasonography | is used to show the size and configuration of organs. |
| Virtual colonoscopy | combines computed tomography (CT) scanning or magnetic resonance imaging (MRI). |
| Endoscopy | refers to the direct visualization of a body structure through a lighted fiberoptic instrument. |
| Retrograde cholangiopancreatography (ERCP) | is an endoscopic procedure that visualizes the pancreatic, hepatic, and common bile ducts. |
| Endoscopy of the GI tract | is often done with biopsy and cytologic studies. A complication of GI endoscopy is perforation. |
| Capsule endoscopy | is a noninvasive approach to visualize the GI tract. |
| Liver biopsy | is performed to obtain tissue for diagnosis of fibrosis, cirrhosis, and neoplasms. |
| Liver function tests reflect | hepatic disease and function. |
| Chapter 40: Nursing Management: | Nutritional Problems |
| Good nutrition | in the absence of any underlying disease process results from the ingestion of a balanced diet. |
| The MyPyramid (formerly the Food Guide Pyramid) consists of food groups that | are presented in proportions appropriate for a healthy diet, including grains, vegetables, fruits, oils, milk, and meat and beans. |
| The National Research Council recommends | that at least half of the body’s energy needs should come from carbohydrates, especially complex carbohydrates. |
| The Dietary Guidelines for Americans 2005 from Healthy People 2010 recommends | that people reduce their fat intake to 20% to 35% of their total daily caloric intake. |
| An average adult requires | an estimated 20 to 35 calories per kilogram of body weight per day, leaning toward the higher end if the person is critically ill or very active and the lower end if the person is sedentary. |
| The recommended daily protein intake | is 0.8 to 1 g/kg of body weight. |
| Vegetarians can | have vitamin or protein deficiencies unless their diets are well planned. |
| Culture, personal preferences, socioeconomic status, and religious preferences | can influence food choices. |
| The nurse should include | cultural and ethnic considerations when assessing the patient’s diet history and implementing interventions that require dietary changes. |
| Malnutrition | is common in hospitalized patients. |
| With starvation, the body initially | uses carbohydrates (glycogen) rather than fat and protein to meet metabolic needs. Once carbohydrate stores are depleted, protein begins to be converted to glucose for energy. |
| Factors that contribute to malnutrition | include socioeconomic status, cultural influences, psychologic disorders, medical conditions, and medical treatments. |
| Regardless of the cause of the illness, most sick persons | have increased nutritional needs. |
| Each degree of temperature increase on the Fahrenheit scale | raises the basal metabolic rate (BMR) by about 7%. |
| Prolonged illness, major surgery, sepsis, draining wounds, burns, hemorrhage, fractures, and immobilization | can all contribute to malnutrition. |
| On physical examination, the most obvious clinical signs of inadequate protein and calorie intake | are apparent in the skin, eyes, mouth, muscles, and the central nervous system. |
| The malnourished person | is more susceptible to all types of infection. |
| Across all settings of care delivery, the nurse must | be aware of the nutritional status of the patient. |
| The protein and calorie intake required in the malnourished patient | depends on the cause of the malnutrition, the treatment being employed, and other stressors affecting the patient. |
| The older patient is at risk for nutritional problems due to the following factors: | Changes in the oral cavity, Changes in digestion and motility, Changes in the endocrine system, Changes in the musculoskeletal system, Decreases in vision and hearing |
| High-calorie oral supplements | may be used in the patient whose nutritional intake is deficient. |
| Tube feeding (also known as enteral nutrition) | may be ordered for the patient who has a functioning GI tract but is unable to take any or enough oral nourishment. |
| A gastrostomy tube | may be used for a patient who requires tube feedings over an extended time. |
| The most accurate assessment for correct tube placement | is by x-ray visualization. |
| Parenteral nutrition (PN) | is used to meet the patient’s nutritional needs and to allow growth of new body tissue. |
| All parenteral nutrition solutions | should be prepared by a pharmacist or a trained technician using strict aseptic techniques under a laminar flow hood. |
| Complications of parenteral nutrition include | infectious, metabolic, and mechanical problems. |
| Chapter 41: Nursing Management: | Obesity |
| Obesity | is the most common nutritional problem, affecting almost one third of the population. |
| Approximately 13% of Americans have a body mass index (BMI) | greater than 35 kg/m2. |
| Obesity | is the second leading cause of preventable disease in the United States, after smoking. |
| The cause of obesity involves | significant genetic/biologic susceptibility factors that are highly influenced by environmental and psychosocial factors. |
| The degree to which a patient is classified as underweight, healthy (normal) weight, overweight, or obese | is assessed by using a BMI chart. |
| Individuals with fat located primarily in the abdominal area (apple-shaped body) | are at a greater risk for obesity-related complications than those whose fat is primarily located in the upper legs (pear-shaped body). |
| Complications or risk factors related to obesity include the following: | CVdisease M/F,Severe obesity w/sleep apnea&obesity/hypoventilation synd.T2 diabetes;80% obese.OA due to trauma to weight-bearing joints&gout.GERD,gallstones,&nonalcoholic steatohepatitis (NASH).Breast,endometrial,ovarian,&cervical CA is inc in obese F |
| When patients who are obese have surgery, | they are likely to suffer from other comorbidities, including diabetes,altered cardiorespiratory function,abnormal metabolic function,hemostasis,&atherosclerosis that place them at risk for complications |
| Measurements used with the obese person may include | skinfold thickness, height, weight, and BMI. |
| The overall goals for the obese patient include the following: | Modifying eating patterns, Participating in a regular physical activity program, Achieving weight loss to a specified level, Maintaining weight loss at a specified level, Minimizing or preventing health problems related to obesity |
| Obesity | is considered a chronic condition that necessitates day-to-day attention to lose weight and maintain weight loss. |
| Persons on low-calorie and very-low-calorie diets | need frequent professional monitoring because the severe energy restriction places them at risk for multiple nutrient deficiencies. |
| Restricted food intake | is a cornerstone for any weight loss or maintenance program. |
| Motivation | is an essential ingredient for successful achievement of weight loss. |
| Exercise | is an important part of a weight control program. Should be done daily, preferably 30 minutes to an hour a day. |
| Useful basic techniques for behavioral modification include | self-monitoring, stimulus control, and rewards. |
| Drugs approved for weight loss can be classified into two categories, including those that decrease the following: | Food intake by reducing appetite or increasing satiety (sense of feeling full after eating) &Nutrient absorption |
| Bariatric surgery | is currently the only treatment that has been found to have a successful and lasting impact for sustained weight loss for severely obese individuals. |
| Bariatric surgery | Wound infection is one of the most common complications after surgery. Early ambulation following surgery is important for the obese patient. |
| Bariatric surgery | Late complications following bariatric surgery include anemia, vitamin deficiencies, diarrhea, and psychiatric problems. |
| Obesity in older adults | can exacerbate age-related declines in physical function and lead to frailty and disability. |
| Metabolic syndrome | is a collection of risk factors that increase an individual’s chance of developing cardiovascular disease and diabetes mellitus. |
| Lifestyle therapies | are the first-line interventions to reduce the risk factors for metabolic syndrome. |
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