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157 Cards in this Set
- Front
- Back
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What does the parasympathetic NS do to the GI? |
* Has cholinergic effects * Acetylcholine is released * Increases GI motility * SLUDGE * Heart rate decreases * BP goes down |
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What does SLUDGE stand for? |
Salivation Lacrimation (tears) Urination Digestion Gastric emptying Emesis |
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What does the sympathetic NS do to the GI? |
* Speeds things up in the cardiac system * Decreases GI motility * Increases HR & BP |
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What is the celiac axis and what does it do? |
*Left gastric artery, common hepatic artery and splenic artery. *Perfuses the lower esophagus,stomach, duodenum, gallbladder and liver (upper) |
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What does the superior mesenteric artery do? |
–Perfuses the small intestine,ascending and transverse colon(middle) |
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What does the inferior mesenteric artery do? |
–Perfuses the descendingcolon, sigmoid colon and rectum (bottom) |
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Describe portal circulation. |
Bloodfrom the GI tract, spleen and pancreas travels to liver by way of the “portalvein” before entering the hepatic vein then inferior vena cava |
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What causes portal hypertension? |
* Compression * occlusion * Liver disease (most associated with cirrhosis) |
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What kind of ulcer is the most common? |
Duodenal because of all the activity and functions |
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What is the subjective data of a GI history assessment? |
* Pain (onset & duration) * Location (know the landmarks) * Any N/V/D * Color of any vomitus or odor * Does the pain radiate to the back * stools (character & color) * Any prolonged use of NSAIDs? |
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What past medical history would you explore for a patient with GI issue? |
•AAA(abdominal aortic aneurism) •Oldsurgeries(colostomy?) •Trauma •Hepatitis •Pancreatitis(once, more likely to get it again) |
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**How do you perform an assessment on a GI patient? In what order and why? |
1. Inspection (check symmetry, masses, hernias, scars and dilated veins 2. Auscultation (start in lower right quadrant - listen for bowel sounds for up to 2 min if necessary) 3. Percussion (locates organs and air) 4. Palpation (to identify size of organs or abnormal masses - palpate pain area last) |
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What is rebound tenderness? |
When pain is felt AFTER hand is removed during palpation. Often is a symptom of an infection of the peritoneum. |
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How often are normal bowel sounds heard? |
5-15 seconds |
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How long do you listen for bowel sounds if you don't hear them? |
2 minutes |
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Which area of the abdomen should be palpated last? |
The painful area. |
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What is in the right upper quadrant of the abdomen? |
* Liver * Gallbladder * Pylorus * Duodenum * Head of the pancreas * Portions of the ascending and transverse colon |
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What is in the left upper quadrant of the abdomen? |
* Left liver lobe * Stomach * Spleen * Body of the pancreas * Portions of the transverse and descending colon |
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What is in the left lower quadrant of the abdomen? |
* Sigmoid colon * Portion of the descending colon |
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What is in the right lower quadrant of the abdomen? |
* Cecum * Appendix * Portion of the ascending colon |
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What is it called when the liver enzymes are elevated due to liver disease? (hint: doesn't have to do with a car) |
Transaminitis |
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If in liver enzyme tests, the AST is double the ALT, what is most likely the reason? |
Alcoholic liver disease |
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What is bilirubin? |
* bile pigment that causes yellow discoloration of the skin and eyes called jaundice * formed from the breakdown of a substance in red blood cells |
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What is albumin? |
isa major protein which is produced by the liver. Decreased in Liver disease. |
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What can the ammonia level do to a person with liver disease? |
Causes mental status changes AKA Hepatic encephalopathy. Lactulose can help by bringing in water and displacing the ammonia. |
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What are the most common diagnostic tests for problems with the abdomen? |
* Kidney, Ureter, Bladder (KUB x-ray) shows the lower GI tract * Upper and Lower GI series, Barium Swallow (drinks milky white stuff to show up in xray) * Paracentesis - Fine needle aspiration of fluid in the peritoneal cavity * Abdominal Ultrasound (looking for fluid) * Abdominal CT scan * MRI * Endoscopy - camera down throat * Colonoscopy - camera up butt * Endoscopic Cholangiopancreatictography (ECRP) - endoscopy of gall bladder and pancreas |
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Name the antacids |
* Tums * Rolaids * Milk of Magnesia (MOM) |
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Name the Histamine 2 receptor site antagonists |
* Tagamet * Zantac * Pepcid (Important to give to GI bleed patients because acid can irritate the bleed site) |
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Name the Proton pump inhibitors. |
* Protonix * Prilosec * Nexium * Prevacid |
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What are pancreatic enzymes given to a patient for? |
To replace the enzymatic activity of the pancreas (Mostly for CF patients). They are pancrease and Ultrase |
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How do antidiarrheals work? |
Kaopectate, Pepto Bismol and immodium work by slowing the GI motility |
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Name the stool softener |
Colace |
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What are the bulk forming agents for laxatives? |
* Citrucel * Metamucil |
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What is the bowel cleansing agent? |
Go Lytely |
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What is the hyperosmolality laxative agent and how does it work? |
Lactulose. Works by drawing water into the colon and preventing absorption of ammonia into the colon. |
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What are the stimulant laxatives and how do they work? |
* Dulcolax * Senna * Ex-Lax (They increase peristalasis) |
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What is the softener that's also a stimulant? |
Glycerin |
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What are the anti-emetics and how do they work? |
* Tigan * Reglan * Zofran * Compazine (Increases gastric motility so won't get nauseous) |
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What are the nasoenteral feeding tubes? How long do they stay in? |
* Nasogastric (NG) tube (nose to stomach) * Orogastric (OG) tube (mouth to stomach) * 4 to 6 weeks |
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What are the enterostomal feeding tubes? How long do they stay in? |
* Gastrostomy tube - right into the stomach * Percutaneous endoscopic gastrostomy (PEG) * Jejunostomy tube - directly into the jejunum |
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**What is necessary with a feeding tube? |
To always check for placement before placing anything in it, to make sure it's not in the lungs. Can listen with a stethoscope and place air in the tube and listen for the whoosh of air. |
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Why is a continuous feeding more beneficial than other types of feedings when using a feeding tube? |
Lowest risk of aspiration |
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**What are the complications of enteral nutrition? |
* N/V * Diarrhea (#1 complication) * Bloating * Constipation * Clogged tubes * Aspiration (if residuals are too high) |
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What are the different kinds of enteral feedings? |
* Continuous feedings (24 hours) * Bolus feedings (up to 400cc 5-6 x day) * Intermittent feedings (slow drip 300-400cc 4-6 x day over 30 min) * Cyclic feedings (Total daily nutrition overnight - not good for patients with GERD) |
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What are the 2 types of parenteral nutrition? |
* Total Parenteral Nutrition (TPN - through a PICC) - given ONLY through a large central vein * Peripheral Parenteral Nutrition (PPN) |
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What does a bag of TPN consist of? |
* Carbohydrates, dextrose & glucose (15-40%) * Amino Acids & Protein (3-14%) * Lipids (some places hang separately 10, 20 or 30%) |
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How is a TPN bag prepared? |
* Nutritionist ordered * Prepared by a pharmacist by strict aseptic technique * Some items may be added by pharmacist like heparin, insulin or electrolytes |
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What are the complications of TPN? |
* Hyperglycemia * Fatty Liver Disease |
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What are the common GI disorders? |
* GI Bleeds * Bowel obstruction * Pancreatitis * Hepatitis & Cirrhosis * Aortic Abdominal Aneurism (AAA) |
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Where does an upper GI bleed occur? How is it found? |
* esophagus * stomach * duodenum * Endoscopy |
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Where does a lower GI bleed occur? How is it found? |
* Jejunum * ileum * colon * rectum * Colonoscopy |
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Where does a peptic ulcer occur? |
* Gastric * Duodenal |
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What causes 90% of peptic ulcers? |
H. Pilori |
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What causes bowel obstructions? |
* adhesions * scar tissue * hernias * masses * Crohn's disease * surgical ileus |
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How many bowel obstructions are typically in the small bowel? |
60-75% |
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Where is the most common site affected in a large bowel obstruction? |
The sigmoid colon (where diverticulosis happens) |
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**What are the symptoms of a bowel obstruction? |
* abdominal distention * Pain * Decreased GI motility * May have diarrhea (stool leaking around obstruction) * Severe pain and vomiting a late sign |
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What is the treatment for a bowel obstruction? |
* IV fluids * Oxygen * Pressors * NG tube (get out some air to relieve pressure) * Belly labs & films (CT, KUB) |
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What is the surgical treatment of a bowel obstruction? |
* Small bowel - laparoscopic lysis, reduction of volvus, or bowel resection * Large bowel - bowel resection or laparoscopic decompression |
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What is a volvulus? |
A twisting of the bowel on itself |
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What is pancreatitis caused by? |
* Gallbladder Disease - Can be caused by a gall stone blocking the sphincter of oddi. (More common in women) * Alcohol abuse (More common in men) |
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What are the symptoms of pancreatitis? |
* Pain (epigastric pain following big meals) * Elevated amylase and lipase |
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Why is history important for pancreatitis? |
Once they've had it, they're likely to get it again |
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What are the different complications that can occur with pancreatitis? |
* Increased fluid & inflammation which can lead to cysts, abscesses or GI bleed * Pulmonary issues like atelectasis due to shallow breathing and pleural effusion which can lead to ARDS * Cardiovascular issues like hemorrhagic or septic shock, prone to DIC * Renal failure secondary to shock * metabolic acidosis |
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What is the treatment for pancreatitis? |
* Hemodynamic monitoring * Correct & replace fluids, electrolytes, blood, albumin * NG tube - patient NPO * Diet low in fat, high in protein & carbs |
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What is hepatitis? |
Inflammation of the liver. Can be acute or chronic. |
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What are the causes of non-infectious hepatitis? |
* Excessive alcohol * Autoimmune disorders * Metabolic or vascular disorders |
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What are the causes of infectious (viral) hepatitis? |
A - food borne B - sexual contact C - needles, sex D - won't get unless you have B E - contaminated food, water or uncooked meat (rare) |
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What is cirrhosis? |
An inflamed, fatty liver, caused primarily by alcoholism. Can lead to liver failure |
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**What is hepatic encephalopathy? |
A state of mental functioning as a result of the inability of the liver to remove ammonia and other toxins from the blood. Lactulose can remove ammonia from the blood. |
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What are the symptoms of cirrhosis? |
* Severely malnourished * jaundiced * ascites * Severely abnormal bleeding times |
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What are the conditions that can lead to liver failure? |
* Hepatitis * Cirrhosis * Pancreatitis * Gallbladder Disease |
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Describe an Abdominal Aortic Aneurism |
* Can develop over time. Less than 5cm, watch. * Over 5cm, need surgical repair. * Antihypertensives can help keep it from rupturing. * A classic sign of an impending rupture stabbing abdominal pain radiating to the back with HTN and tachycardia. If ruptures, prognosis is not good. |
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What is the difference between the parietal pleura and the visceral pleura? |
* Parietal pleura lines the chest wall * visceral pleura lines the lung parenchyma |
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What is in the mediastinum? |
–Containsthe heart, esophagus, great vessels |
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Where does the end of an ET tube sit? |
Just above the bronchi bifurcation called the Carina. |
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What is the only vein with deoxygenated blood? |
Pulmonary Vein |
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What is anything that clogs the alveoli called? |
A shunt (even pneumonia) |
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What is respiratory diffusion? |
Gas exchange. Movement of CO2 and O2 between the alveoli and the capillaries. |
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What is respiratory transport or perfusion? |
–Movementof O2 from the alveoli to the cells –Movementof CO2 from the cells to the alveoli–(problemshere is called “dead space” – pulmonary embolism) problem with blood flow |
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What is respiratory ventilation? |
Inhale/ exhale. Movement of air between the alveoli and atmosphere |
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What can hinder the process of ventilation? |
* Impeding movement of the diaphragm (ascites, trauma) * Airway resistance (asthma) |
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What is alveolar dead space? |
alveoli that are ventilated but not perfused, and where, as a result, no gas exchange can occur |
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What are PFTs? |
* Pulmonary Function Tests * Examines the body’s ability to move air in and out of alveoli for gas exchange/diffusion. Examines total lung capacity. |
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What is tidal volume? |
the volume of air inhaled and exhaled with each breath. Can be manipulated with mechanical ventilation |
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**What should be discussed on a respiratory history? |
* Dyspnea - When did it start? What makes it better or worse? * Chest pain - need to figure out if it's respiratory or cardiac (are they congested?). Is there more pain on inhalation? Is the pain relieved with nitro? Is it exertional? * Is there sputum production with a cough? Yellow or green means bacterial. Over 3 months of cough with sputum means chronic bronchitis * Family history * Social/ working history - smoke? environmental exposure? |
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What is Kussmaul breathing? |
* Rapid and labored breathing. * Normal with diabetic ketoacidosis (not enough bicarb - too much acid) |
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What is Cheyne-Stokes breathing? |
Breathing with periods of apnea. Seen in end of life, drug OD, Increased ICP, Severe CHF |
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What should be done first during a respiratory physical exam? |
Always look first: * Is the respiratory rate fast or slow (tachypnea may mean fever) * Labored breathing (accessory muscles used?) * Cyanosis of skin, lips or fingers (late sign of hypoxia) * barrel chested? * chest expansion equal? (pneumothorax?) * Trachea Midline (tension pneumothorax?) * Chest deformities or scars? |
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What is crepitus or subcutaneous emphysema? |
* Pockets of air under the skin * secondary to a traumatic injury/ pneumothorax * small pockets of alveoli that burst secondary to too much PEEP |
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What are the lung sounds? |
* Clear * Diminished (COPD, pneumonia) * Wheezes (asthma) * Rhonchi (coarse breath sounds - pneumonia) * Rales, fine or coarse (crackles - fluid accumulation) * Stridor (life threatening) |
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What is SaO2? |
O2 level in the blood (O2 combined with hemoglobin) |
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What is PaO2? |
Partial pressure of oxygen in the blood (O2 dissolved in the plasma) |
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What is a friction rub and what does it signify? |
Grating sound heard more with inspiration than expiration resulting from the visceral and parietal pleura rubbing against each other. Can be seen in pleurisy, pneumothorax and pleural effusion. |
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What is the normal range for serum pH? What if it's above or below? |
7.35 - 7.45 Below is acidosis Above is alkalosis |
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What is the normal range for CO2? What if it is above or below? |
35 - 45 Below is alkalosis Above is acidosis |
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What is the normal range for bicarb (HCO3)? What if it is above or below? |
22-26 Above is alkalosis Below is acidosis |
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What mnemonic helps with analyzing ABGs? |
ROME Respiratory Opposite Metabolic Equal |
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What are some causes of respiratory acidosis? |
* Hypoventilation (too sedated) * CNS depression (from narcotics) * Pneumothorax * COPD |
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What are some causes of respiratory alkalosis? |
* Hyperventilating * Anxiety * Fever |
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What are some causes of metabolic acidosis? |
* Diarrhea * Diabetic Ketoacidosis * Aspirin overdose * Rhabdomyolysis (causes renal failure) |
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What are some causes of metabolic alkalosis? |
* vomiting * too much drainage with an NG tube * Ingestion of too many antacids |
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What are the respiratory diagnostic tests? |
* Chest X-ray * Ventilation-perfusion scan * Pulmonary Function test * Bronchoscopy * Thoracentesis * Sputum Culture |
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**What are the pulmonary treatments to improve bronchial hygiene? |
* Cough and deep breathing (prevents atelectasis, keeps secretions moving & prevents pneumonia) * Chest physiotherapy (position of bad lung up, good lung down, postural drainage - trendelenburg or reverse trendelenburg, or percussion/ vibration) |
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Which mask delivers the highest amount of O2 before intubation? |
Non-rebreather mask |
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**Why are COPD patients called "CO2 retainers"? |
COPD patients live at higher levels of CO2, so if they are given high levels of oxygen, their body recognizes it as too much oxygen and it may knock out their drive to breathe. If O2 is bumped up, (an already high) CO2 is also bumped up and high CO2 levels can cause respiratory arrest. |
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What is a cricoid? |
An emergency cut in the throat to aid in breathing |
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When would a nasopharyngeal airway be used instead of an oropharyngeal airway? |
An NPA is used in unconscious patients where the tongue relaxes and would block a passage for an oropharyngeal airway. |
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What is empyema? |
Pus in the pleural space. Would be removed with a chest tube |
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What kinds of chest tubes are there and what are they called? |
* Wet system - Ocean * Dry system - Oasis |
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What is a hemothorax? |
Blood in the pleural cavity (trauma) |
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What is a pneumothorax? |
Air in the pleural space |
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What is a tension pneumothorax? |
Tracheadeviates away to one side, pressure will build up in the chest, decreasedcardiac output, decreased veinous return from the heart. Needle in the chest is needed to relieve pressure |
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**What are the modes of ventilation? |
* Assist-control or CMV (full support) * Synchronized intermittent mandatory ventilation (Pt. can breathe in addition RR set) * Continuous Positive airway pressure (CPAP - used to wean off vent) * Bilevel PAP - same as CPAP but not as invasive |
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**What are the pressure modes added to modes of ventilation? |
* Pressure support ventilation (PSV) - helps with inhalation, spontaneous breaths. Adjustable and used to augment breaths * Positive end-expiratory pressure (PEEP) - extra pressure with exhalation with a pt. still dependent on vent. Can cause low BP and high ICP |
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**What settings are located on a ventilator? |
* Tidal volume * Respiratory rate * FiO2 * Pressure limit |
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What is pleural effusion? |
•Accumulation of pleural fluid secondary to increased fluid formation |
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What are the symptoms of pleural effusion? |
* SOB * chest pain * tachypnea * hypoxemia |
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When is a thoracentesis needed? |
when effusion is more than 1 cm |
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What can a thoracentesis cause? |
A pneumothorax |
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What are the nursing interventions regarding ventilation? |
* Suction patient frequently * keep patient sedated * monitor pulmonary status * monitor ABGs * After insertion of ETT, listen to LS - if not left LS, it may be in the R mainstem * get a CXR to confirm |
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What are the complications of mechanical ventilation? |
* aspiration (need HOB at 30 degrees) * pneumothorax (may need a chest tube) * barotrauma (collapsed alveolar due to pressure changes during inspiration) * Ventilator associated pneumonia (VAP) * Decreased cardiac output (secondary to increased pulmonary pressure, too much PEEP = increased pulmonary HTN affecting decreased venous return |
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**What kind of nutritional needs are required for patients on mechanical ventilation? |
* extra protein * extra calories |
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What are the symptoms of pneumonia? |
* fever * diminished LS * tachycardic * congested * May be hypoxic |
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What is the management of pneumonia? |
* antibiotics * bronchodilators * steroids * O2 * nutrition * hydration (easier to expectorate) * rest |
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How is pneumonia diagnosed? |
* CXR (Every day or every other day during illness) * sputum culture * CBC * blood cultures |
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What is the 6th leading cause of death? |
pneumonia |
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What is the #1 reason for a pleural effusion? |
CHF |
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What is a pulmonary embolism? |
* Part of a deep veinthrombosis that has traveled and lodged in the pulmonary arteries. * A result of a DVT |
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What are the symptoms of a PE? |
* SOB * hypoxic * anxious * tachycardic * hypotensive |
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How is a PE diagnosed? |
* Serum D-dimer (clotting series) * chest CT * VQ scan or pulmonary angiogram |
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How is a PE managed? |
Anticoagulation. Heparin or Lovenox at first then PO coumadin for approximately 6 months |
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How are DVTs prevented? |
* anticoagulation * Teds elastic stockings * SCDs |
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**What are the anticoagulation studies? |
* PT (Prothrombin Time) * PTT (Partial Prothrombin Time) or APTT * INR (International Normalized Ratio |
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**What is the goal of the anticoagulated patient? |
To be 2X greater than normal ranges |
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**What are the symptoms of COPD? |
* Central cyanosis * barrel chested * Low SATs (80's not uncommon) * Diminished LSs or wheezes * Smoking history |
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**What is the non-pharmacologic management of the COPD patient? |
* Low O2 * education * drug therapy * nutrition * exercise |
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**What is the pharmacological management of the COPD patient? |
* Bronchodilators (albuterol) * Steroids |
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What is chronic bronchitis? |
Chronicbronchitis is an inflammation of the main airways in the lungs that continuesfor a long period or keeps coming back. Categorized in text as a productivecough. (more than 3 months per year) |
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What are the symptoms of chronic bronchitis? |
* cough that produces sputum * SOB * frequent respiratory infections that worsen symptoms * wheezing * continues for more than 3 months of the year |
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What is the management of chronic bronchitis? |
There is no cure curefor chronic bronchitis. The goal of treatment is to relieve symptoms andprevent complications. * antibiotics * bronchodilators |
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What is asthma? |
•A chronicinflammatory disease of the airways•Airway hyperresponsiveness to various stimuli•Variable airwayobstruction •Resolvesspontaneously or after using a bronchodilator |
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What are the symptoms of asthma? |
* wheezing * hypoxic |
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What are the diagnostic tests for asthma? |
* CXR * PFT |
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What is the management of asthma? |
* Bronchodilators * steroids * education to prevent exacerbation and optimize pharmacotherapy * know triggers (animals, dust, mold, etc) |
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Describe ARDS (Acute respiratory distress syndrome) |
* Caused by direct or indirect pulmonary injury (near drowning, aspiration, shock, DIC) * first sign is flash pulmonary edema (pink frothy sputum) * There is diffusealveolar-capillary membrane damage that increases membrane permeability. Thisleads to improper gas exchange, hypoxemia and pulmonary edema
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What are the diagnostic studies for ARDS? |
•Blood cultures •Blood gas •CXR •Lung compliance will be poor, airway resistance,and pressure •Keep prone 16-18 hours a day for lungcompliance, allowed a little higher CO2 (permissive hypercapnia), medically paralyze them and sedatethem •Put on a lot of PEEP |
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*In an LFT, if elevated Alkaline Phosphatase is found. What is likely the cause? |
Alcoholic Liver Disease |
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What is sclerotherapy? |
variceal ligation |
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**If a patient came in with chest pain and had more pain on inhalation, what is the cause of the chest pain and what else would you expect to see? |
The patient would have a pneumothorax and there would be no breath sounds on the affected side. |
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**What are normal O2 sats? |
93-99% |
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**When is a pulse oximeter not reliable? |
* On a patient in shock * On a patient in cardiac arrest * patient with poor perfusion |
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What is FiO2? |
The amount of O2 being received by patient. |
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What is the difference between SpO2 and SaO2? |
SpO2 is saturation measured by pulse oximetry - it is an indirect measurement SpA2 is O2 saturation in the blood - a direct measurement |
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Why should people who are hyperventilating breathe into a paper bag? |
Because by hyperventilating they are taking in too much oxygen. By breathing into a paper bag, they rebreathe some of their own CO2 |
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What's a VAP bundle? |
Ventilator associated pneumonia prophylaxis * HOB 30 degrees * PPIs * good oral care |
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**Why do COPD patients need nutritional counseling? |
* malnutrition is present in 50% of COPD patients admitted to the hospital * malnutrition results in wasting of respiratory muscles * a nutritional assessment is required to address the nutrition needs of the patient and restore the muscle strenght |
