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110 Cards in this Set
- Front
- Back
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What are the major GI changes with aging?
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increased prevalence of atrophic gastritis and achlorhydria, liver is less efficient at metabolizing drugs and repair, diverticuli more common, reduced peristalsis which increases risk for constipation
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What is gastroesophageal reflux disease (GERD)?
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backward flow of GI contents into the esophagus
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What are the s/s of GERD?
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pyrosis, dyspepsia, regurgitation, dysphagia, odynophagia, hypersalivation, esophagitis
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How is GERD managed?
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low fat diet, no caffeine, tobacco, beer, milk, foods containing peppermint/spearmint, carbonated beverages, no eating or drinking 2 hours before bedtime, elevate HOB
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What is gastroenteritis?
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increase in frequency and water content of stools as a result of inflammation of the mucous membranes of the stomach and intestinal tract
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What are the s/s of gastroenteritis?
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diarrhea, n/v, dehydration
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Interventions for gastroenteritis:
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fluid replacement, electrolyte replacement, antibiotics, skin care
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What is peptic ulce disease (PUD)?
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erosion of the mm forms an excatvation in the stomach, pyloris, duodenum or esophagus
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What is PUD associated with?
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H. pylori
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What are the risk factors for PUD?
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excessive secretion of stomach acid, diet, chronic use of NSAIDs, ETOH, smoking, genetics
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What are the s/s of PUD?
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dull, gnawing pain or burning in the mid-epigastrium, heartburn, vomiting
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Treatment for PUD
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medications, lifestyle changes and occasionally surgery
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Crohn's disease
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onset is insidious, prolonged, usually occurs in the ileum and ascending colon, subacute and chronic
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What are the s/s of Crohn's disease?
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prominent RLQ abdominal pain, diarrhea unrelieved by defecation, nutritional defecits, steatorrhea, anorexia, wt loss
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What is common in Crohn's disease that is not common in ulcerative colitis?
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abcesses, fistulas and fissures
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What are some complications of Crohn's disease?
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intestinal obstruction, stricture formation, perianal disease, malnutrition, fluid and electrolyte imbalances, fistula and abcess formation
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Ulcerative colitis
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onset is usually exacerbations and remissions, recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum, bleeding common and severe
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What are the s/s of ulcerative colitis?
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diarrhea, passage of mucus and pus, LLQ abdominal pain, intermittent tenesmus, rectal bleeding
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What are complications of ulcerative colitis?
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toxic megacolon, perforation and bleeding
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Interventions for IBD:
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maintaining normal elimination patterns, relieve pain, maintain fluid intake, maintain optimal nutrition (low-residue, high protein, high calorie), promote rest, reduce anxiety, prevent skin breakdown
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How many types of pancreatitis are there?
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2-acute and chronic
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What is acute pancreatitis?
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when the pancreatic duct becomes obstructed and enzymes back up into the pancreatic duct, causing auto digestion and inflammation of the pancreas. Can be a medical emergency
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What is chronic pancreatitis?
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progressive inflammatory disorder with destruction of the pancreas, cells are replaced by fibrous tissue and pressure within the pancreas increases
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What are s/s of acute pancreatitis?
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severe abd pain, pt appears acutely ill, abd guarding, n/v, fever, jaundice, confusion, agitation, ecchymosis in the flank/umbilical area, resp distress, hypoxia, renal failure, hypovolemia, shock
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What are the s/s of chronic pancreatitis?
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recurrent attacks of sever upper abdominal and back pain with vomiting, wt loss, steatorrhea
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What are the major goals for the patient with acute pancreatitis?
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relief of pain and discomfort, improved resp function, improve nutritional status, maintain skin integrity, absence of complications
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How do we relieve pain and discomfort for the patient with pancreatitis?
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pain meds, NG suction to relieve nausea and distention, freq oral care, bed rest
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What is cholecystitis?
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acute inflammation of the gallbladder
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What are the 2 types of cholecystitis?
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Calculous and Acalculous
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Calculous cholecystitis
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90% of all acute cholecystitis, gallbladder stone obstructs bile outflow
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Acalculous cholecystitis
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occurs after major surgical procedures, severe trauma, or burns
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Wha tis cholelithiasis?
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calculi/gallstones
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What are risk factors fr cholelithiasis?
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obesity, women, freq changes in wt, rapid wt loss, DM, CF, estrogen therapy
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What are s/s of cholelithiasis?
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may have no or minimal symptoms and may be acute or chronic, epigastric distress, fullness, abd distention, distress after eating a fatty meal, fever, palpable abd mass, biliary colic, jaundice
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Management of cholelithiasis:
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laparascopic cholecystectomy, dietary management, medications such as ursodeoxycholic acid and chenodeoxycholic acid, nonsurgical removal
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What are post-op care interventions for gallbladder surgery?
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low Fowler's position, may have NG, NPO until bowel sounds return, soft low fat diet, care of biliary drainage, administer pain meds, promote ambulation, TCDB, splinting
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What is viral hepatitis?
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systemic viral infection that causes necrosis and inflammation of liver cells with characteristic syptoms and cellular and biochemical changes
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How is hepatitis A transmitted?
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fecal-oral route
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How is HAV spread?
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primarily by poor hygiene, hand to mouth contact, close contact or through food and fluids
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HAV s/s
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mild flu-like symptoms, low grade fever, anorexia, later jaundice and dark urine, indigestion, epigastric distress, enlargement of liver and spleen
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How do you prevent HAV?
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good hand washing, safe water and proper sewage disposal
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Is there a vaccine for HAV?
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yes, HAV
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Management for HAV
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bed rest during acute phase, nutritional support, immunoglobulin for contacts to provide passive immunity
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How is Hepatitis B transmitted?
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blood, saliva, semen, vaginal secretions, breaks in skin
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HBV is the worldwide cause of?
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cirrhosis and liver cancer
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What are the risk factors for HBV?
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frequent exposure to blood, blood products, or other bodily fluids, health care workers, hemodialysis, male homosexual and bisexual activity, IV drug use, close contact with carrier, multiple sex partners, receipt of blood or blood products
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Manifestations of HBV
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similar to HAV but incubation period is longer
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How do you prevent HBV?
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vaccination for people at high risk and routine for infants, passive immunization for those exposed, standard precautions/infection control measure, screening of blood and blood products
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Medications for chronic hepatitis type B
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alpha interferon, lamividine (Epivir) and adefovir (Hepsera)
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How is Hepatitis C transmitted?
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blood, sexual contact
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Hepatitis C
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most common cause of blood-borne infection, causes 1/3 cases of liver cancer and the most common reason for liver transplant
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What are the risk factors for Hepatitis C?
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recipient of blood products or organ transplant before 1992, health care and public safety workers, children born to women infected with HCV, past/current illicit IV drug use, past tx with chronic hemodialysis, multiple sex partners
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Management of HCV
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prevention, screening of blood, prevention of needlesticks, same measures to reduce spread of HBV, avoid ETOH and meds that effect liver
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HCV medications
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interferon, ribavirin (Rebetol)
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Who is at risk for Hepatitis D?
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only those with Hep B are at risk
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Hepatitis E
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transmitted by fecal-oral route and resemble Hep A and is self-limited with an abrupt onset
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What are the types of hepatic cirrhosis?
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alcoholic, postnecrotic, biliary
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Manifestations of cirrhosis:
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liver enlargement, portal obstruction, ascites, gastrointestinal varices, edema, vitamin deficiency, anemia, mental deterioation
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Assessment of pt with cirrhosis of the liver:
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focus on onset of symptoms and hx, ETOH use/abuse, dietary intake and nutritional status, exposure to toxic agents and drugs, assess mental status, ability to carry on ADLs, monitor s/s r/t disease including indicators for bleeding, fluid volume changes and labs
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Interventions for pt with cirrhosis of liver:
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rest, positioning for resp effeciency, I&O, encourage eating, small freq meals, freq position changes, gentle skin care
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diverticulum
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sac-like herniation of the lining of the bowel that extend through a defect in the muscle layer
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diverticulosis
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multiple diverticual are present without inflammation or symptoms
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diverticulitis
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infection and inflammation of diverticula
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How is diverticular disease usually diagnosed?
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colonoscopy
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s/s of diverticulitis
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mild or severe pain in LLQ, n/v, fever, chills, leukocytosis
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What are the complications of diverticultitis?
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perforation, peritonitis, abscess formation, bleeding
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s/s of small bowel obstruction:
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pain, bloody stools, vomiting, changing of intestinal waves, abd distention
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How is small bowel obstruction diagnosed?
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abd x-ray, CT, CBC
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Medical management of SBO
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decompression, surgery
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nursing management of SBO
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maintain patency of NG tube
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s/s large bowel obstruction
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constipation, altered stool shape, visible intestine
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How is LBO diagnosed?
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abd x-ray, CT, MRI
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Medical management of LBO
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colonoscopy, rectal tube, colostomy
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Dilated portions of veins in the anal canal
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Hemorrhoids
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What are the causes of hemorrhoids?
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child birth, straining, shearing
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s/s of hemorrhoids
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itching, pain, bright red bleeding
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treatment for hemorrhoids:
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good hygiene, high residue diet, increase fluid intake, warm compresses, sitz baths, surgery
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What are the risk factors for esophageal cancer?
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ETOH, tobacco use, GERD (Barratt's Esophagus), hot liquids, hot foods, poor oral hygiene
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s/s of esophageal cx
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ulcerated lesions, dysphagia, mass sensation, painful swallowing, foul breath, hiccups
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How is esophageal cx diagnosed?
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EGD with biopsy
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Medical management of esophageal cx
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surgery, chemo, radiation, palliative
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nursing management of esophageal cx
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nutritional status, post op status
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The third most common cause of cancer death in the U.S.
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colorectal cancer
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s/s of colorectal cancer:
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change in bowel habits, blood in stool-occult, tarry, bleeding, tenesmus, symptoms of obstruction, pain, feeling of incomplete evacuation
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interventions for colon cancer
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prepare for surgery, emotional support, provide post op care, maintain optimal nutrition, provide wound care, monitor and manage complications, remove and apply colostomy appliance
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Primary liver tumors
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few cancers originate in the liver, usually associated with hep B and C, hepatocellular carcinome (HCC)
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liver metastasis
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liver is a freq site of metastatic cancer
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s/s liver cancer
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pain (dull continuous ache in RUQ, epigastrium or back), wt loss, loss of strength, anorexia, anemia, jaundice, ascites
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nonsurgical management of liver cancer
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underlying cirrhosis increases risk of surgery, palliative, radiation, chemo, percutaneous biliary drainage
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surgical management
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treatment of choice for HCC if confined to one lobe and liver function is adequate
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Antacids
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Mylanta, Maalox
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indications for antacids
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indigestion, GERD, heartburn
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action of antacids
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neutralizes gastric acid
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lab consideration antacids
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increases Ca
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teaching antacid
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do not take with 2 hours of other meds
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sucralfate
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Carafate
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indications for sucralfate
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ulcers, GERD, stomatitis
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action of sucralfate
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coats ulcers and helps with healing
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teaching for sucralfate
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administer on empty stomach, one hour before meals and bedtime
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H2 receptor antangonists
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Tagament, Pepcid, Zantac
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indication for H2 receptor antag.
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GERD, ulcers, heartburn, indigestion, sour stomach
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action of H2 receptor antag
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inhibition of gastric acid secretion
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teaching for H2 receptor antag
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take with meats and bedtime
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Proton pump inhibitors
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Protonix, Aciphex, Prilosec
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indications for PPI
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GERD, heartburn, preventative for stress ulcers
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actions for PPI
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diminished accumulation of acid
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lab consideration for PPI
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may cause abnormal liver function tests
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Antidiarrheals
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Pepto-Bismol, Lomotil, Imodium
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indications for antidiarrheals
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control of diarrhea
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actions for antidiarrheals
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slow intestinal motility
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