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Adult Health > GI AHII > Flashcards

GI AHII Flashcards

1
Q

signs of bowel perforation and peritonities

A

guarding of the abdomen, increased fever and chills, pallor, progressive abdominal distention and abd pain, restlessness, tachycardia and tachypnea

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2
Q

What do you monitor following an endoscopic procedure?

A

return of gag reflex before giving the client any oral substance

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3
Q

pyloric obstruction

A

n/v/c, epigastric fullness, anorexia, and (late) weight loss
insert NG tube to decompress the stomach, provide IV fluids and electrolytes
balloon dilation or surgery may be required

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4
Q

management of perforation or penetration-move fast! This is an EMERGENCY

A

signs include severe upper abd pain that may be referred to the shoulder, vomiting, and collapse, tender, board-like abd, and symptoms of shock. Patient requires immediate surgery.

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5
Q

Priority Nursing Actions r/t paracentesis

A

consent
VS/weight
have the client void
position client upright
assist HCP, monitor VS, and provide comfort
apply a dressing to the site of puncture
monitor VS, weight, and maintain bedrest
measure amt of fluid removed
label and send fluid to the lab for analysis
tell client to alert HCP if urine becomes bloody, pink, or red

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6
Q

What complication may result following paracentesis?

A

the rapid removal of fluid from the abd cavity during paracentesis leads to decreased abd pressure, which can cause vasodilation and resultant shock; monitor for hypovolemia, electrolyte loss, mental status changes, and encephalopathy

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7
Q

What do you look at before a liver biospy?

A

coag panels

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8
Q

how is the client positioned during a liver biospy?

A

note that the client is placed supine or left lateral position during the procedure to expose the right side of the upper abdomen

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9
Q

What do you do for your patient following a liver biospy?

A

assess VS
monitor biopsy site for bleeding
monitor for peritonitis (guarding, fever/chillls, pallor, abd distention/pain, restlessness, tachys)
maintain bed rest for several hours
place client on right side with a pillow under the costal margin to decrease the risk of hemorrhage, and instruct the client to avoid coughing or straining.
instruct the client to avoid heavy lifting and strenuous exercise for 1 week

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10
Q

What does an increase in cholesterol, amylase, and lipase levels indicate?

A

pancreatitis or biliary obstruction

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11
Q

gnawing, sharp pain in r to the left of the mid0epigastric region occurs 30-60 mins after a meal (food ingestion accentuates the pain). Hematemesis is more common than melena

A

gastric ulcer

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12
Q

burning pain occurs in the mid-epigastric area 1.5-3 hrs after a meal and during the night (often awakens the client) Melena is more common than hematemesis. Pain is often relieved by the ingestion of food

A

duodenal ulcer

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13
Q

Why perform a vagotomy?

A

this is a surgical division of the vagus never to eliminate the vagal impulses that stimulate hydrochloric acid secretion in the stomach

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14
Q

Do you irrigate NG tube after gastric surgery?

A

following gastric surgery, do not irrigate or remove the NG tube unless specifically prescribed bc of the risk for disruption of the gastric sutures. Monitor closely to ensure proper functioning of the NG tube to prevent strain on the anastomosis site. Contact HCP if the tube is not functioning properly.

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15
Q

Dumping syndrome

A

the rapid emptying of the gastric contents into the small intestine that occurs following gastric resection. symptoms occur within 30 mis of eating: n/v/d, abd fullness/cramping, palpitations/tachycardia, perspiration, weakness and dizziness Borborygmi (loud gurgles indicating hyperperistalsis)

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16
Q

what do you teach a patient with dumping syndrome?

A

avoid sugar, salt, and milk
eat a high-protein, high-fat, low carb diet
eat small meals and avoids consuming fluids with meals
lie down after meals
take antispasmodic medications as prescribed to delay gastric emptying

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17
Q

What are surgical concerns for obese clients?

A

Obese clients are at increased risk for pulmonary and thromboembolic complications and death

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18
Q

Murphy’s sign

A

cannot take a deep breath when the examiner’s fingers are passed below the hepatic margin bc of pain–>cholecystitis

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19
Q

dark orange and foamy urine

A

biliary obstruction

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20
Q

fecal vomiting

A

intestinal obstruction

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21
Q

care of a T tube

A

a T tube is placed after surgical exploration of the common bile duct. The tube preserves the patency of the duct and ensures drainage of bile until edema resolves and bile is effectively draining into the duodenum. A gravity drainage bag is attached to T-tube to collect the drainage.
place pt in semi fowlers to facilitate drainage
monitor drainage output; expect 500-100mL/day
avoid irrigation, aspiration, or clamping of the T-tube wo a HCP prescription

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22
Q 
glucose metabolsim
ammonia conversion
protein metabolism
fat metabolim
vit and iron storage
A

liver fxn

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23
Q

fetor hepaticus

A

a fruity, musty breath odor of severe chronic liver disease

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24
Q

asterixis

A

Asterixis is a flapping tremor of the hand that is an early sign of hepatic encephalopathy.

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25
Q

Cullens sign

Turners sign

A

discoloration of the abdomen and periumbilical area
bluish discoloration of the flanks
both indicate pancreatitis

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26
Q

interventions for acute pancreatitis

A

NPO
pain meds like meperidine
fetal positioning or side lying with HOB 45 degrees
turn, cough, deep breath due to susceptibility to respiratory infects due to pain assoc w breathing
antacids or anticholinergics may be prescribed to suppress gi secretions

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27
Q

nonbloody diarrhea of usually not more than four or five stools/day.

A

crohn’s disease

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28
Q

Profuse bright red hematemesis

A

arterial blood that has not been in contact with gastric secretions (esophageal or oral bleeding)

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29
Q

coffee-ground emesis

A

blood that has been in stomach awhile and reacted with gastric secretions

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30
Q

melena

A

slow bleeding from upper GI that has passed through GI tract and been digested

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31
Q

Occult blood

A

positive guaic stool test or NG aspirate

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32
Q

A patient is admitted to the ED with profuse bright red hematemesis. During the initial care of the patient, the nurse’s first priority is to

a) est two IV sites with large-gauge catheters
b) perform a nursing assessment of the patient’s status
c) obtain a thorough health history to assist in determining the cause of the bleeding
d) perform a gastric lavage with cool tap water in prep for endoscopic exam

A

b) although all the interventions may be indicated when a patient has an upper gi bleed, the first priority nursing intervention is to perform an assessment of the patient’s condition, with emphasis on BP, pulse, and peripheral perfusion to determine the presence of hypovolemic shock

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33
Q

The nurse recognizes that an agent that is used to decrease GI bleeding and decrease gastric acid secretions is

A

octreotide (Sandostatin):

34
Q

How do we use Misoprostol?

A

Misoprostol is used to protect gastric mucosa in pts who must take NSAIDs for other conditions bc it inhibits acid secretion stimulated by NSAIDs

35
Q

produces the enzyme urease–>PUD

A

h pylori

36
Q

decreases the rate of mucous cell renewal–>PUD

A

corticosteriods

37
Q

inhibits the synthesis of mucus and prostaglandins–>PUD

A

asa and nsaids

38
Q

increases the secretion of hcl–>PUD

A

alcohol

39
Q

Why NG tube for an acute PUD exacerbation?

A

remove stimulation for HCL and pepsin secretion by keeping stomach empty

40
Q

why NG tube for peritonitis?

A

stop spillage of GI contents into peritoneal cavity

41
Q

why NG tube for gastric outlet obstruction?

A

remove excess fluids and undigested food from stomach

42
Q

used to treat pts with verified H. pylori

A

amoxicillin/clarithromycin/omeprazole

43
Q

decreases gastric acid secretion by blockng ATPase enzyme

A

omeprazole (Prilosec)

44
Q

If you find your patient with an acute exacerbation of PUD doubled up in bed with shallow, grunting respirations, what might you suspect?

A

abdominal pain that causes the knees to be drawn up and shallow, grunting respirations in a patient with PUD are characteristic of perforation. Assess VS and abd before notifying HCP

45
Q

removal of distal two thirds of stomach with anastomosis to duodenum

A

billroth I

46
Q

removal of distal two thirds of stomach with anastomosis to jejunm

A

billroth II

47
Q

often performed with a vagotomy to increase gastric emptying

A

pyloroplasty

48
Q

this type of gastritis is associated with an increased risk of stomach cancer

A

autoimmune atrophic gastritis

49
Q

ulcerative colitis

A

The signs and symptoms of ulcerative colitis include diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia, not hypercalcemia. Because of the loss of blood, clients with ulcerative colitis commonly have decreased hemoglobin and hematocrit levels. Strictures and fistulas are more commonly seen in Crohn’s disease than in ulcerative colitis. Clients with ulcerative colitis have bloody diarrhea, not steatorrhea (fatty, frothy, foul-smelling stools).

50
Q

stages of viral hepatitis

A

There are three stages associated with viral hepatitis. The first (preicteric) stage includes flulike symptoms only. The second (icteric) stage includes the appearance of jaundice and associated symptoms such as elevated bilirubin levels, dark or tea-colored urine, and clay-colored stools. The third (posticteric) stage occurs when the jaundice decreases and the colors of the urine and stool return to norma

51
Q

dumping syndrome patient teachings

A

The client at risk for dumping syndrome should be instructed to maintain a low Fowler’s position while eating and lie down for at least 30 minutes after eating. The client also should be told that small, frequent meals are best and to avoid liquids with meals. Avoiding high-carbohydrate food sources also will assist in minimizing dumping syndrome

52
Q

colostomy dietary instructions

A

For the first 4 to 6 weeks after colostomy formation, the client should consume a low-fiber diet. After this period, the client should eat a high-carbohydrate, high-protein diet. The client also is instructed to add new foods, including those with fiber, one at a time to determine tolerance to that food.

53
Q

A Sengstaken-Blakemore tube

A

A Sengstaken-Blakemore tube may be used in a client with a diagnosis of cirrhosis with ruptured esophageal varices if other treatment measures are unsuccessful. The tube has an esophageal and a gastric balloon. The esophageal balloon exerts pressure on the ruptured esophageal varices and stops the bleeding. The gastric balloon holds the tube in the correct position and prevents migration of the esophageal balloon, which could harm the client.

54
Q

what are signs and symptoms of portal htn?

A

Clinical signs and symptoms of portal hypertension are similar to those of heart failure and include jugular vein distention, lung crackles, and decreased perfusion to all organs. Initially the client may have hypertension, flushed skin, and a bounding pulse.

55
Q

Are laxatives prescribed to relieve pain r/t appendicitis? Why or why not?

A

Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant peritonitis.

56
Q

Where is the appendix?

A

The appendix, sometimes referred to as the vermiform appendix, is attached to the apex of the cecum. The other locations listed are incorrect.

57
Q

A client is admitted to the hospital with severe weight loss after extreme dieting. The nurse plans care, knowing that which physiological processes occur in the prolonged absence of adequate food intake?

A

Gluconeogenesis is the production of glucose for energy from protein and fat stores in the body. This can occur with extreme dieting and also with diabetes mellitus. Glycogenolysis is the production of glucose from glycogen stores in the liver. Lactic acidosis occurs with excess production of lactic acid resulting from anaerobic metabolism. The body normally burns glucose for energy.

58
Q

what does rebound tenderness of the abdomen indicate?

A

peritonitis-tell the HCP

59
Q

Which ailment is more likely to wake a person due to pain: gastric ulcer or duodenal ulcer?

A

Gastric ulcer pain often occurs in the upper epigastrium, with localization to the left of the midline, and may be exacerbated by intake of food. The pain occurs 30 to 60 minutes after a meal and rarely occurs at night. Duodenal ulcer pain is usually located to the right of the epigastrium. The pain associated with a duodenal ulcer occurs 90 minutes to 3 hours after eating and often awakens the client at night.

60
Q

Lactulose

A

decreases ammonia formation by decreasing absorption of ammonia from bowel to treat pt with hepatic encephalopathy

61
Q

neomycin

A

decreases ammonia by decreasing bacteria flora that make ammonia to treat pt with hepatic encephalopathy

62
Q

eliminating blood from GI tract to treat hepatic encephalopathy

A

decreases ammonia by removing RBCs as source of protein to bacteria

63
Q

dietary considerations for cirrhosis

A

high-calorie, high-carb diet with moderate to low fat. Patients with cirrhosis are at risk for edema and ascites and their sodium intake should be limited.

64
Q

when do you take pancreatic enzymes?

A

with meals

65
Q

pancreatitis is associated with _______ while pancreatic cancer is associated with______

A

alcohol is associated with pancreatitis, but not with pancreatic cancer. Instead, pancreatic cancer is associated with cigarette smoking

66
Q

what are most gall stones made of ?

A

cholesterol

67
Q

obstructive jaundice occurs when gallstones obstruct the ____

A

common bile duct

68
Q

If a gallstone blocks the cystic duct, the patient will have symptoms of ______

A

biliary colic

69
Q

family history of gallbladder disease, multiparous female, obesity, age over 40, use of estrogen or oral contraceptives

A

cholethiasis

70
Q

obstruction of the common bile duct prevents bile drainage into the duodenum, with congestion of bile in the liver and subsequent absorption into the blood

A

jaundice

71
Q

absence of bile in the intestine

A

clay colored stools

72
Q

soluble bili in the blood excreted into the urine

A

dark urine

73
Q

absence of bile salts in duodenum, preventing fat emulsion and digestion

A

steatorrhea

74
Q

contraction of the inflamed gallbladder and obstructed ducts, stimulated by cholecystokinin when fats enter the duodenum

A

pain with fatty food intake

75
Q

hepatitis caused by a DNA virus

A

Hep b

76
Q

IV drugs is greatest method of transmission of this hep

A

hep c

77
Q

exists only with hep B

A

Hep D

78
Q

the systematic effects of viral hep are caused primarily by

A

activation of the complement system by antigen-antibody complexes

79
Q

during the incubation period of viral hep, the nurse would expect the patient to report

A

anorexia and RUQ discomfort

80
Q

scarring and nodular changes in liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein

A

portal hypertension

81
Q

development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension

A

esophageal varices

Adult Health (18 decks)

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