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Upper GI System

Adult 1 GI site Group 1 Mr. Justice (Tamara, Anissa)

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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