GI - Unit 1 PPT (Part 1) Flashcards Preview

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Flashcards in GI - Unit 1 PPT (Part 1) Deck (82)
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1
Q

Bruit - def

A

Swooshing sound

2
Q

What OTC really predispose the patient to GI Bleeding?

A

Advil

3
Q

How large is the small intestine? Large Intestine?

A
Small = 20ft
Large = 5ft
4
Q

What are some questions we might like to ask a patient who comes in with GI problems?

A

GI Problem history, meds, normal GI habits, PQRST of pain, labs= electrolytes, vitals, fecal/cbc/ast/alt, cea, CA19, etc.

5
Q

What does the parasympathetic nervous system do for the GI System?

A

It increases parastalsis!

6
Q

What does the sympathetic nervous system do for the GI sysmte?

A

It decreases parastalsis!

7
Q

What does the hypothalamus do?

A

It signals hunger when levels are low (like glucose, etc) When stimulated, it empties stomach, lowers body temp, decreased BS, etc. It’s inhibited by stomach distension, increased body temp, etc

8
Q

What’s all part of the abdominal assessment?

A

Inspect - look for size, scars, distension
Light palpation - pain, Nausea, rigidity, etc.
Bowel Sounds - assess 1-2 minutes each quad.

9
Q

What’s borborygmi?

A

Hyperactive bowel sounds.

10
Q

N/V - What’s part of the physical assessment?

A

Weakness, pallor, perspiration, increased HR & resp.

11
Q

N/V - Is there a Fluid & Electrolyte volume deficit?

A

Yes!

12
Q

With N/V, what diet should they follow? Should they have anything by mouth?

A

They should do a bland diet with fluids…….they should be NPO though, if needed.

13
Q

Anti-emetics - What are some?

A

Promethazine (Phenergan), Ondansetron (Zofran), etc.

14
Q

What’s the first choice anti-emetic?

A

Ondansetron (Zofran) - It’s a seritonin receptor antagonist?

15
Q

What do we assess for diarrhea?

A

Assess the stool character,causes, F/E volume deficit, etc.

16
Q

What are some meds for diarrhea?

A

Imodium, Lomotil

17
Q

Constipation - when is it common?

A

Common in elderly, after OR, prolonged inactivity, GI diseases, misuse of laxatives, enemas, etc.

18
Q

How do we treat constipation?

A

Restore/maintain normal bowel habits, increase fluids, fiber, etc.

19
Q

With a lower GI Barium Enema - what can’t the patient have?

A

No anti-cholinergics and narcotics before!

20
Q

With an Upper GI (EGD, Esophagogastroduodenoscopy) what happens? How long are they NPO before?

A

NPO 6-8 hours before. They are sedated and the tube is placed. They are put on their left side.

21
Q

With an EGD, what is one big nursing intervention we have to do?

A

Since they will have their throat numbed, we need to make sure they have a gag-reflex and such BEFORE they can eat. They also can’t drive themselves home.

22
Q

Squamous Cell Caner - type of cancer of the _____ is related to smoking and excessive alcohol.

A

Esophagus.

23
Q

Stomach Ulcer - how does it appear?

A

Clean and benign appearing.

24
Q

What are diverticuli?

A

Pockets that project away from the bowel.

25
Q

With a fecal test, what should we tell patients to do before?

A

Watch how much meat, vitamin C, raw fruit/veggies they eat.

26
Q

How do we prevent oral infections like stomatitis, thrush, herpes, etc?

A

Avoid trauma, irritating foods, tobacco, alcohol, reduce stress.

27
Q

What are some meds to treat oral infections?

A

Nystatin, Diflucan and Zovirax (Antiviral)

28
Q

What is erythroplakia?

A

A pre-cancerous velvety red patch on the tongue.

29
Q

Thrush - easy to remove from tongue. T/F?

A

FALSE

30
Q

Leukoplakia - def

A

white, smoker’s patch - you can scrape it off. Usually it’s benign and can come with oral cancer, AIDS, etc.

31
Q

What is one of the best ways to prevent squamous cell oral cancer?

A

NO TOBACCO

32
Q

With patients who have had oral surgery/tumor removal, etc..should we worry about airway clearance?

A

YES

33
Q

What is dysphagia?

A

Difficulty swallowing

34
Q

What could be a cause of dysphagia?

A

Hiatal hernia, CVA, obstruction, tumor, etc.

35
Q

Achalasia - def

A

absence of paristalsis

36
Q

Esophagitis - what could cause it?

A

Sliding hietal hernia, tumors, chemo meds, reflux, gastric ulcers.

37
Q

How do we treat a stricture (the narrowing of the esophagus)?

A

Balloon (pneumatic) dilation of the lower esophagus

38
Q

What are esophageal neoplasms?

A

Tumors in the esophagus. Most are malignant.

39
Q

What are symptoms of esophageal neoplasms? What causes them?

A

Pain, difficulty swallowing, weight loss, hallitosis, hiccuping, etc.
Caused by GERD, etc.

40
Q

How do we diagnose esophageal neoplasms?

A

Endoscopy, CT, MRI

41
Q

How do we treat esophageal neoplasms?

A

Chemo, radiation, Esophagogastrectomy (remove part of the esophagus, stomach)

42
Q

how do we care for a patient who has just been surgically treated for esophageal neoplasms? Do we move the NG?

A

IV, PCA, 02, drains, NG, Tube feedings, etc. DO NOT MOVE THE NG!

43
Q

Adenocarcinoma’s - where are they located in the esophagus?

A

Lower third of the esophagus - caused by GERD.

44
Q

Squamous Cell Esophageal Cancer - where in the esophagus?

A

Upper 2 Thirds, caused by smoking and alcohol.

45
Q

For an esophagogoastrostomy or colon interposition..which is more common? What do we do as nurses?

A

The harder one to say haha.

Monitor weight, among all the other usual shit. haha.

46
Q

What is GERD?

A

Gastroesophageal Reflux Disease

47
Q

How do we diagnose GERD?

A

Endoscopy, BA swallow, esophageal manometry.

48
Q

What causes GERD?

A

Hiatal Hernia (LES becomes weak)

49
Q

How do we prevent GERD?

A

Reduce weight, low fat diet, no smoking, no caffeine, no alcohol

50
Q

What puts you at risk for GERD?

A

Weight, age, sleep apnea, NG for >4 days, etc.

51
Q

What type of diet should someone with GERD be on?

A

Low fat diet, no alcohol/caffeine/peppermint/chocolate/spicy and high acid foods, etc.

52
Q

Should someone with gerd eat right before bed?

A

NO

53
Q

should someone with GERD eat just a few big meals per day?

A

No, they should eat small meals frequently throughout the day and drink lots of water!

54
Q

What happens with a sliding hernia?

A

Part of stomach slides through the opening above the diaphragm.

55
Q

What happens with a rolling hernia?

A

The fundus of stomach herniates through diaphragm alongside the esophagus!

56
Q

What are symptoms of a hiatal hernia?

A

Heartburn, regurgitation, chest pain, dysphagia, belching, occult bleeding, etc.

57
Q

How we do diagnose a Hiatal Hernia?

A

Endoscopy, BA Swallow

58
Q

For a hernia, what are the diet and meds like?

A

Same as for GERD

59
Q

After surgery for a hernia, what should we have the patient do? Should they cough?

A

Turn and deep breathe…DO NOT COUGH

60
Q

What is gastritis?

A

Inflammation of the gastric mucosa

61
Q

What should patients with gastritis avoid?

A

Irritants, contaminated food.

62
Q

How do we diagnose gastritis?

A

Gastroscopy, biopsy, gastric analysis, etc.

63
Q

What should be included in a gastritis diet?

A

NPO and slowly advanced diet.

64
Q

What is PUD?

A

Peptic Ulcer Disease

65
Q

What are symptoms of PUD?

A

Pain (chest), heartburn, N/V.

66
Q

What are some complications of PUD?

A

Hemorrhage, perforation, pyloric obstruction, recurrent symptoms.

67
Q

Peptic ulcers occur __% of the time in the duodenum.

A

80%

68
Q

What usually causes duodenal ulcers?

A

H. pylori

69
Q

What contributes to PUD?

A

Increased acid and pepsin, impaired mucosal barrier, irritants (smoking, asa, caffeine, steroids, alcohol), hereditary factors, COPD, STRESSSSSSSSSS, etc.

70
Q

What are symptoms of stress PUD?

A

Pain, improvement after eating, chest pain, dysphagia, etc.

71
Q

What are some surgical treatment for PUD?

A

Billroth 1&2

72
Q

Billroth 1 (Gastroduodenostomy) - What happens?

A

Remove fundus and pyloric area of stomach.

73
Q

Billroth 2 (Gastrojejeunostomy) - What happens?

A

Top & lower part of stomach removed and duodenum removed. More invasive - can cause dumping syndrome!

74
Q

What are vagotomies and pyloroplasties for PUD?

A

Vag - cut or remove parts of the vagus nerve.

Pyloroplasty - they cut the pyloric sphincter and sew it together the opposite way.

75
Q

How do we treat h. pylori infections?

A

Bismuth OR prilosec, flagyl, amoxicillin or tetracycline.

76
Q

What is dumping syndrome?

A

It’s a vasomotor thing - symptoms occur after eating. Caused by rapid emptying of gastric contents into small intestine. Can occur well after surgery. It causes a fluid shift in the gut. This leads to abdominal distension, N/V 30-90 minutes after eating.

77
Q

How do we manage dumping syndrome?

A

Low carb, high fat diet. Decrease fluids. Eat smaller meals and have veggies, no milk, sweets, etc.

78
Q

What are some gastric OR post-op meds?

A

Morphine, antibiotics like flagyl, histamine H2 Blockers, gastric acid pump inhibitior, autonomic NS stimulants, antiemetics, opioid receptor anatgonist, etc.

79
Q

What is an adenocarcinoma?

A

Tumors in the gastric system…..can be removed (which they need to be!)

80
Q

What is the size of stomach for someone who has had a gastric bypass surgery?

A

30CC!!!!!

81
Q

What are some of the issues with gastric bypass patients?

A

They have to stick to small meals and begin clear liquids 24 hours after surgery. Compliance and teaching are huge here!

82
Q

What are huge gastric surgery complications - like the number 1!!!

A

Respiratory problems!