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GI M6

GI review plus nclex

QuestionAnswer
The largest glandular organ in the body, which functions as an accessory organ of digestion, is the Liver
Digestion begins__? in the mouth where food is chewed and saliva begins the breakdown of starches
define:Digestion the physical and chemical breakdown of food into absorbable substances and is completed in the small intestines
Discribe digestion in the small intestines -Carbohydrates are hydrolyzed to monosaccharides -Fats to fatty acids -Proteins into amino acids
enzymes used in digestion ptyalin, pepsin, trypsin, lipase, protease, and amylase
Where is each enzyme produce? ptyalin(amylase)found in the mouths saliva;produce by the adrenal gland Pepsin found in the stomach Trypsin is a protease produced by pancrease
most common clinical sign of infection Diarrhea
Primary diagnostic Tests Stool culture
Crohn’s Disease a form of irritable bowel disease (IBD) that causes inflamation of the digestive tract. Usualy occurs in the terminal ileum but can occur any where in the digestive tract
Crohn’s Disease Clinical Manifestations The principal symptoms are diarrhea and abdominal pain. Diarrhea is usually non-bloody. Weight loss, malnutrition, dehydration,electrolyte imbalances, amnemia, increased peristalsis and pain
crohn's disease assessment Assess stools for mucus and pus (this disease does not cause blood in the stools). Fever and anemia are complications to be aware of. Anal fissures and fistulas are common.
Fitst line Drugs to manage Crohn's disease Antiinflammatory agents (Sulfasalazine) are indicated for mild to moderate cases. Corticosteroids (Prednisone) are administered for more severe cases of Crohn's disease.
Three ANTIANXIETY Medications Ativan, Valium, Librium
CORTICOSTEROID (Prednisone) Check the -?-- level on a regular basis for all patients receiving corticosteroids blood glucose
Patient will be taking bismuth subsalicylate (Pepto-Bismol) to control his diarrhea. When reviewing the patient’s other ordered medications, the nurse recognizes that which of the following medications will interact significantly with the Pepto-Bismol? a. **digoxin (Lanoxin)** b. Antacids c. acetaminophen (Tylenol) d. Tricyclic antidepressants
Anticholinergic Examples atropine (Atro-Pen). ) bradyarrythmia( difenoxin/atropine (Motofen) diphenoxylate / atropine (Lomotil) ipratropium (Atrovent HFA) propantheline (Pro-Banthine) scopolamine (Transderm-Scop) trimethobenzamide (Benzacot) glycopyrrolate (Robinul)
What is the action/purpose of Anticholinergics? The purpose of ancholinergics is to reduce motility and decrease the amount of acid secreted by the stomach
Which of the following medications is most effective in preventing motion sickness? Serotonin antagonists Phenothiazines Corticosteroids Anticholinergics**
INTESTINAL OBSTRUCTIONS Mechanical Adhesions Incarcerated Hernias Tumor impacted feces Intussusception (telescoping) Volvulus (twisted bowels) Strictures High fiber residue
INTESTINAL OBSTRUCTIONS Non-mechanical Neuromuscular eg. Paralytic ileus (lack of persistalsis and bowel sounds) Vascular disorders (rare) eg. Due to emboli, atherosclerosis of mesenteric arteries
Which intestinal obstruction require prompt medical attention? For patients not requiring surgery monitor Fluids and electrolytes Function of tubes used to decompress and relieve abdomen Administer analgesic prn Ambulate these patients to help “wake-up” their ileus.
Define: VOLVULUS (twisting of bowel onto itself) Strictures of inflammatory bowel DZ Residues from foods high in fiber: 1- Coconut 2- Fruit pulp
Most obstructions Occur where? occur in the ileum, which is the narrowest segment of the small intestine
. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: a. increased intracranial pressure. b. * decreased urine output.* c. bradycardia. d. hypertension.
A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? Answer B. For a colonoscopy, the nurse initially should position the client on the left side with knees bent to allow proper visualization of the large intestine.
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Gastric ulcer Answer B. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: Answer: For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger *spasms of the sphincter of Oddi* (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas.
Fistulotomy opening of the fistula tract, incising the fistula with a partial anus division.
Fistulectomy removal of the fistula tract
What are hemorrhoids? Varicosities (dilated veins) that may occur inside or outside the anal sphincter.
Pathology hemorrhoids Repeated increased pressure and obstructed blood flow causes permanent dilation to occur.
Etiology hemorrhoids Etiological factors include straining at stool with increased intraabdominal and hemorrhoidal venous pressures.
Disorders of the mouth Cold sores, Canker sores, Aphthous Ulcers,mucositis, Dental decay
Dental decay action of bacteria on carbohydrates in mouth producing acid which eroids tooth enamel
Ulcers symptoms Pain limiting drinking, eating, talking, and hygiene.
Dental Assessment check for any abnormalities to include: sores, cracks, lesions to lip, color, moisture, halitosis,ulcerations
Candidiasis= Thrush Etiology/Patho Thrush and moniliasis--infection caused by fungus Candida.
What is Candida? Candida is a normal flora of the mucous membranses of the mouth, intestinal tract, vagina and skin of healthy people
Candidiasis commonly seen __?__ commonly seen in new born infants after being infected passing through the birth canal; patients with leukemia, DM, ABX, steroids
Medical management for candidiasis Nystatin (infants), amphotericin B, buccal tablets, 1/2 strength hydrogen peroxide/saline rinses -Nystatin vaginal tables for candida vaginal infection
candidiasis nursing interventions -Adults: eat soft foods and use soft-bristled toothbrush. -Pain: topical anesthetic for mouth dental caries and Candidiasis
three drugs used to treat cadidiasis amphotericin B deoxycholate (Fungizone). nystatin (Mycostatin). ketoconazole (Nizoral).
amphotericin B/Fungizone Side Effects/Adverse Reactions: CNS: headache. CV: hypotension. GI: diarrhea, nausea, vomiting. GU: nephrotoxicity. F&E: hypokalemia.
Nystatin (Mycostatin) side effects/ adverse reactions GI: D/N/V. Derm: contact dermatitis
Ketoconazole (Nizoral) side effects/ adverse reactions CNS: dizziness, drowsiness. EENT: photophobia. GI: drug-induced hepatitis, n/v/d. GU: decreased male libido, menstrual irregularities.
Endoscopy with biopsy Esophagitis is confirmed by the upper endoscopy. Endoscopy also used to evaluate severity of esophagitis and r/o cancer.
Given for moderate to severe cases of GERD. ___?__is a drug that increases ____?__ without simulating secretions Reglan / peristalsis
What is Fundoplication? Fundoplication is performed by Wrapping the gastric fundus around the lower esophagus and suturing it is in place. (makes the stomach opening smaller)
What are the techniques that may be used in performing fundoplication? laparoscipic, thoracic or open abdominal
What is Achalasia? cardiospasm
Achalasia/ (Cause/contributing factors) Cause: unknown. Contributing factor: *decrease motility of lower esophagus *absence of peristalsis *dilation of lower portion Can cause disruption to the normal neuromuscular activity of the stomach
Achalasia primary clinical manifistation difficulty swollowing and the sensation of food sticky to roof of mouth
The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? Answer (Anticholinergic drugs). Paregoric has an additive effect of constipation when used with anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren’t known to interact with paregoric
A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: Answer(increasing fluid intake to prevent dehydration). Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake.
Ileostomy an opening from the ileum through the abdominal wall.
DX tests for Achalasia Radiologic studies Esophageal manometry Barium swallow with esophagoscopy
Radiologic studies Radiologic studies-esophageal dilation above the narrowing at the cardio esophageal junction can easily be detected.
Esophageal manometry Esophageal manometry done to verify the absence of primary peristalsis.
Barium swallow with esophagoscopy Barium swallow with esophagoscopy can be used to confirm the diagnosis
Ileoanal reservoir is also called___? ileoanal anastomosis
What is a conventional ileostomy? the entire colon and rectum are removed.
What is a Colostomy? an opening between the colon and the abdominal wall.
what is preformed more often, loop or double-barrel colostomies? Loop colostomies are performed more often than double-barrel colostomies as temporary procedures
A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:__?__ Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn’t radiate to the shoulder..
True or False. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A. True
True or False. Eructation and constipation are common in gallbladder disease. True
True or False. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers. True
Achalasia Nursing Interventions Drink fluids with meals to increase the peristalsis movement to the lower esophageal spincter.
Ascending Colostomy fecal material is liquid to semi-liquid requiring frequent emptying to keep the patient dry and to control odor.
Transverse Colostomy fecal material is semiformed. This location of the stoma is more manageable when irrigated daily to reduce the number of bowel movements and to help eliminate odor.
Descending Colostomy fecal material is semiformed to formed.
Sigmoid Colostomy fecal material is formed. Stool that is semi-solid is more manageable than a liquid stool. A scheduled daily irrigation can establish regularity and help the patient achieve control
What laboratory finding is the primary diagnostic indicator for pancreatitis? Answer(Elevated serum lipase). Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. ; the AST, in relation to liver dysfunction
True or false. A client’s BUN is typically decreased in relation to renal dysfunction False. It increases
A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note__?__ Answer: Yellow Sclerae*. Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber.
Circumoral pallor and black, tarry stools don’t occur in common bile duct obstruction; they are signs of ___ and ____, respectively. hypoxia, GI bleeding
Achlorhydria Abnormal condition characterized by the absence of hydrochloric acid in the gastric secretions
Anastomosis Surgical joining of two ducts or blood vessels to allow flow from one to the other
Cachexia General ill health and malnutrition marked by weakness and emaciation; usually associated with a serious disease, such as cancer
Carcinoembryonic antigen (CEA)- Oncofetal glycoprotein antigen found in colonic adenocarcinoma and other cancers; also found in nonmalignant conditions.
Dehiscence Partial or complete separation of the wound edges
Dysphagia Difficulty in swallowing
Evisceration- State in which the patient’s viscera protrude through a disrupted wound (internal organs of the body)
VOLVULUS Twisting of the bowel on itself, causing intestinal obstruction
Tenesmus Ineffective and painful straining with defecation
Stoma Combining form meaning a mouth or opening
Steatorrhea Excessive fat in the feces
Remission A decrease in the severity of a disease or any of its symptoms
Pathognomonic Sign or symptom specific to a disease condition
Occult blood- Blood that is hidden or obscured from view
Lumen- Space within an artery, vein, intestine, or tube
Melena Abnormal, black tarry stool containing digested blood
Hematemesis- Vomiting blood
Exacerbation An increase in the seriousness of a disease or disorder; marked by greater intensity in the signs or symptoms of the patient being treated; common in IBD
LEUKOPLAKIA Symptoms -Difficulty chewing, swallowing or speaking -Edema, numbness, or loss of feeling in any part of the mouth - Earache, facial pain and toothache
Leukoplakia A white firmly attached patch in the mouth or tongue, mucosa, lips or buccal mucosa - Can be malignant or benign - Small percentage develops into squamous cell carcinoma - Ages 50-70 (more common in men)
Intussusception Infolding of one segment of the intestine into the lumen of another segment; occurs in children
What are the diagnostic Test for Upper GI Study A series of X-rays of the lower esophagus, stomach, and duodenum Barium sulfate is used as contrast medium
What is an Upper GI Study used to detect? An UGI series is used to detect any abnormal conditions of the upper GI tract, any tumors, or other ulcerative lesions
Because the small intestine needs bile only a few times a day, bile is stored and concentrated in the____?___ Gallbladder
Although food is digested through the alimentary canal, up to 90% of digestion is accomplished in the___?__ small intestine
The exit from the stomach is called the__?__ pyloric sphincter
The intrinsic factor is a gastric secretion necessary for the intestinal absorption of vitamin: B12
Which organ manufactures heparin, prothrombin, and fibrinogen? Liver
Paralyitic (adynamic) ileus is a functional intestinal obstruction that results from:? electrolyte imbalance, postabdominal surgery, or acute inflammatory reactions.
To prepare the patient for endoscopic examination of the upper GI tract, the patient's pharynx is anesthetized with lidocaine. Nursing intervention for postendoscopic examination include: ? keeping the patient NPO until gag reflex returns
A 35-year old man has been admitted with a diagnosis of peptic ulcer. Which drugs are most commonly used in these patients to decrease acid secretions? Tagament and Zantac
A patient is scheduled in the morning for a hemicolectomy for removal of a cancerous tumor of the ascending colon. the physician has ordered intestinal antibiotics for her preoperatively to: ? reduce the bacteria content of the colon
Why is a NG tube inserted? To keep the stomach empty until peristalsis resumes after a general anesthetic or any condition that interferes with peristalsis.
A recently approved medication for the reatment of Crohn's disease, infliximab (Remicade), is classified as which typ of drug? Monoclonal antibody
A 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory report that indicates a serum amylase level of_?__ 300units/L
A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. What full liquid item will the nurse offer to the client? Custard
The nurse should instruct the client to do what just before removing the tube? Take and hold a deep breath
What is the common causes of gastric disorders? alcohol, tobacoco, aspirin, and antinflammatory agents.
When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: Decreased urine output
Created by: ninja3lake