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Upper GI System
Adult 1 GI site Group 1 Mr. Justice (Tamara, Anissa)
| Question | Answer |
|---|---|
| Esophageal varices are | Swollen, twisted veins |
| Peristalsis | Muscular wave-like movement that transports food through the digestive system |
| Amylase | Enzyme to digest starch |
| What are the 4 main functions of the GI system? | Ingestion & Propulsion of food, Digestion, Absorption, Elimination |
| Villi | Finger-like folds of the small intestines; they increase the surface for absorption |
| Which is the only organ in the body that has both endocrine and exocrine functions? | Pancreas |
| What is the exocrine function of the pancreas? | Contributes to the process of digestion – secretes pancreatic enzymes |
| What nerve is involved in “bearing down” to have a bowel movement? | Vagus Nerve |
| What are the functions of the liver? | Metabolic function (metabolisms), Bile synthesis, Storage of glucose in form of glycogen, Break down of old RBC’s, WBC’s, and bacteria |
| What is a paraesophageal (rolling) hernia? | The esophagogastric junction remains in the normal position, but the fundus and greater curvature of the stomach roll up through the diaphragm forming a pocket alongside the esophagus |
| Ulcer | Sore or lesion |
| Dyspepsia | Burning or indigestion |
| Hernia | Bulge or nodule in abdomen, usually appearing on straining |
| Hemorrhoids | Thromboses veins in rectum and anus |
| Fissure | Ulceration in the anal canal |
| What do you assess for pain r/t GERD? | When does it occur, Location, Duration, Intensity, Quality |
| Nursing considerations after small bowel series? | Encourage fluids to get rid of barium , Monitor BM – may be whitish d/t barium, Be observant for constipation, Stool softeners and laxatives as ordered |
| What are some non-invasive diagnostic tests? | Abdominal Ultrasound, CT scan, MRI-MRCP, Gastric emptying |
| EGD (Esophagogastroduodenoscopy) | Insertion of flexible tube into esophagus through the stomach and into the duodenum of the small intestines, Performed under MAC (monitored anesthesia care) – “Twilight sleep”, Pt. able to communicate if needed, Can be done outside of OR |
| Purpose of EGD | To assess for sites of bleeding, Identify ulcerations/lesions, Detect strictures, masses or tears, Repair of acute bleed, Biopsy |
| Invasive Diagnostics can also be used to: | Remove gall stones obstructing bile duct, (if distal), Dilate strictures, Biopsy tumors, Diagnose pseudocysts |
| Lab Work | Serum Bilirubin, Serum amylase & lipase, CBC (H & H), Platelets, WBC’s, BMP/CMP |
| Dumping Syndrome | Occurs when food is dumped out of stomach quickly such as after gastric stapling or resection of stomach |
| A 68 year old patient awakens at night with heartburn & belching. The nurse recognizes that these symptoms may occur when there is abnormal relaxation of the | lower esophageal sphincter |
| A patient returns to the nursing unit following an EGD. During postprocedure care, it is most important for the nurse to | keep the patient NPO until the gag reflex returns |
| While the nurse is obtaining a history from a patient, an OTC medication that the patient uses that the nurse recognizes as significant to liver disorders is | acetaminophen |
| A patient with difficulty swallowing is started on continuous tube feedings of a full-strength formula at 100ml/hr. The patient has 6 diarrhea stools for the first day. The action that is most appropriate for the nurse to take first is | slow the feeding flow rate |
| A patient with chronic GERD is experiencing increasing discomfort. During assessment of pt's current management of the problem, the nurse determines that further teaching is needed when the patient states | I try to keep my diet low in fat, and I eat small meals throughout the day anad at bedtime |
| When teaching a pt. with GERD about recommended dietary modifications, the nurse explains foods that decrease lower esophageal spincter pressure and should be avoided include | coffee, tea and chocolate |
| Upper GI assesses for | Structural abnormalities in the esophagus, stomach, & duodenum |
| Nrsg. Considerations for barium tests | encourage fluids, Monitor BM |
| Monitor BM after barium tests for | whitish color, constipation |
| Abd Ultrasound assesses for | cysts, abscesses, stones of gallbladder or kidney, masses or tumors |
| Types of Non- invasive Diagnositics | Abdominal US, CT scan, MRI/MRCP, and gastric emptying |
| NPO status with most GI tests | NPO after midnight prior to the test |
| EGD assess for | sites of bleeding, identifies ulcerations/lesions, detects strictures, masses or tears, repair of acute bleeding, biopsy |
| How is an EGD performed | Under MAC, "twilight sleep", pt. able to communicate if needed, can be done outside the OR |
| Where does the flexible tube go for an EGD | into the esophagus through the stomach and into the duodenum of the small intestine |
| Liver functions tests include | Urobilinogen, serum protein, ammonia levels, serum enzymes |
| If ammonia level is elevated, patient will show s/s of | confusion |
| What electrolyte is usually elevated in malnutrition? | potassium |
| Anemia is reflected in what lab values | RBC Hgb |
| What function must a person have for gastric & enteral feedings to be effective? | Bowel sounds; Normal GI tract functioning |
| What situations require use of enteral (duodenal or jejunal) feeding? | If NPO for longperiod; need to bypass stomach due to disease,surgery,trauma,or lack of emptying;any sit. where need more nutrition than able to retain orally(chem,rad,burns,dysphagia),at risk for aspiration,anorexia, orofacial fx ,head/neck surg |
| What should the nurse be assessing while first introducing fluid into the GI tract? | What face for signs of aspiration |
| Dumping Syndrome occurs... | when food is dumped out of the stomach quickly such as after gastric stapling or resection of the stomach |
| Avoid dumping syndrom with gastric feedings by: | start with more dilute feeding & increase concentration as tolerates; if symptoms occur, get orders for more dilute concentration; lie down after bolus feeding in case have BP drop, etc., |
| How do you maintain patency of gastric feeding tube | irrigate with 30-50cmL (or ordered amt) before and after administering anything through tube; Usuall receive 250-500mL/shift of water |
| Feedings should hang no longer than? | 24 hours |
| Thrush | caused by candida albicans, white "milk curd" appearing lesions on mouth and tongue, can cause significant soreness leading to poor oral intake |
| Tx of thrush | Nystatin or Amphotericin B |
| Stomatitis | similar to thrush, prominent in CA patients, pallative care can be included with Nystatin if needed |
| What should you do with suction when performing abd assessments | turn it off - remember to turn it back on after |
| What is GERD | syndrome that results in backward flow of gastric contents into esophagus; over time can lead to erosive esophagitis if untreated |
| What relieves pyrosis (heartburn) | milk, antacids & water (milk feels better, but inc. HCl production makes it worse) |
| How do you diagnose GERD? | Hx, endoscopy (shows edema & erosion), Ambulatory pH monitoring |
| Complications of GERD | esophageal stricture from scar tissue, Barrett's esophagus, aspiration pneumonia |
| Treatment of GERD | Life style changes, Diet changes, avoid nicotine because it decreases bicarbonate prod., loose weight if obese, do not eat in pm, upright for 2 hours after eating, elevate HOB 6-8 inches |
| What foods should a GERD patient avoid that cause decrease LES pressure | chocolate, peppermint, caffeine, onions, fatty foods, alcohol |
| What foods should GERD patients avoid that cause inc. acid production | milk, caffeine |
| When should a patient with GERD take an antacid | 1-2 hours after meals and qhs |
| What do antacids do | neutralize acid |
| Types of antacids | Aluminum hydroxide, Mg hydroxide, Calcium carbonate, Sodium bicarbonate |
| S/S of hiatal hernia | Same as GERD, Belching, possible GI bleed, |
| Dx of Hiatal Hernia | barium swallow, endoscopy, CXR |
| Complication of Hiatal Hernias | esophagitis, aspiration, strangulation or incarceration |
| Tx of Hiatal Hernias | usually conservative (almost same as GERD), eating small meals, weight control, avoid tight constrictive clothing |
| Medications for Hiatal Hernias | Antacids for reflux |
| Surgery for Hiatal Hernias | Nissen Fundoplication; Angelchik prosthesis |
| Dysphagia results from | tumors (intrisic or extrinsic), strictures, diverticular herniations, Neuro disorders: stroke, head/spinal cord injury, Parkinsons, Achalasia |
| Tx of dysphagia | dependent on underlying cause |
| Gastritis | Inflammatory disorder of the stomach |
| Acute gastritis | med or chem related; self healing; minimal damage to mucosal lining |
| Chronic gastritis | usually in elderly; thins and degenerates stomach wall; |
| S/S of Gastritis | Vague; Fullness, N/V, anorexia, epigastric pain |
| Dx of gastritis | Gastroscopy, Bx, Gastric secretion evaluation |
| Tx of gastritis | small meals, soft/bland diet, avoid alcohol & aspirin, take B12 supplement |
| Peptic Ulcer Disease | erosion of the mucous membrane of the GI tract from digestive action of HCl & pepsin |
| Sites of peptic ulcers | esophagus, gastric, duodenal (most common) |
| S/S of peptic ulcers | gnawing epigastric pain with pain -food relief patterns, may radiate to back, relieved by antacids, worse when lean forward, worse when stomach empty |
| Dx of peptic ulcers | barium swallow, endoscopy, gastrin level studies, H.pylori detection |
| Complication of ulcers | hemmorhage, large vessel bleed, obstruction, perforation |
| S/S of a small vessel bleed from an ulcer | occult blood in stool, anemia, fatigue |
| S/S of a large vessel bleed from an ulcer | hematemesis, tarry stool, coffee-ground emesis - Emergency call PCP |
| S/S from an obstruction associated with ulcers | loud peristalsis with large visible waves, pain worse as eats more, vomit contains food long after eating, belching or vomiting dec. pain |
| Tx of an obstruction r/t ulcers | NG tube for decompression, f/e replacement, surgery to open pyloric sphincter |
| S/S of a perforation with ulcers | rigid abd., sever abd pain, pain radiating to R shoulder, absent bowel sounds, signs of shock |
| Tx of ulcers | relieve pain, heal ulcer, prevent complications, educate in lifestyle changes |
| Medications for ulcers | Antacids, Proton Pump Inhibitors, Histamine receptor blockers, Cytoprotective agents |
| What s/s occur with dumping syndrome | hypotension, sweating, weakness & palpitations occur |
| Measures to avoid dumping syndrome | avoid simple sugars & CHO, diet higher in protein & fats, avoid liquids with meals, small freq meals, lie down after meals for safety |
Created by:
okrecota
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