Med/surg Exam #2 - Gi System & Drugs

Front 1

What is reverse peristalsis?

Back 1

Vomiting

Front 2

Functions of the GI tract?

Back 2

Motility
Secretions (saliva, mucous,
digestive enzymes, acids)
Ingestion (mouth, esophagus)
Digestion & Absorption
(stomach, small intestine,
large intestine)
Excretion (rectum & anus)

Front 3

What influences motility?

Back 3

Stretching of the GI tract, neurotransmitters, hormones and drugs

Front 4

What causes vomiting?

Back 4

Stimulants to the medulla trigger receptors in the stomach & duodenum or by activating the chemoreceptor trigger zone (CTZ) in the brain

Front 5

What do salivary glands secrete?

Back 5

Saliva

Front 6

What do goblet cells secrete?

Back 6

Mucous

Front 7

What do parietal cells secrete?

Back 7

HCl

Front 8

What do chief cells secrete?

Back 8

Pepsinogen

Front 9

What do enteroendocrine cells secrete?

Back 9

Gastrin
Histamine
Endorphins
Serotonin
Cholescystokinin
Somatostatin

Front 10

What is one of the main things the colon does?

Back 10

Absorb H2O

Front 11

The rate of gastric emptying must match the duodenal buffering ability or what may happen?

Back 11

acid may damage duodenal mucosa

Front 12

What prevents regurgitation of duodenal contents into the stomach?

Back 12

Pylorus

Front 13

What happens if a person has no intrinsic factor?

Back 13

They can't absorb Vit B-12 and can get pernicious anemia

Front 14

Colonic Secretions?

Back 14

Electrolyte solution - bicarbonate to neutralize acidic chyme

Mucous - protect colon mucosa from acidic solution

Front 15

What is the timing from ingestion to cecum?

Back 15

4 hrs

Front 16

What is the timing from cecum to evacuation?

Back 16

12 hrs

Front 17

1/4 of fecal material stays in rectum for how long?

Back 17

3 days

Front 18

What are the local gastrointestinal reflexes that STIMULATE movement?

Back 18

gastroenteric reflex
gastrocolic reflex
duodenal-colic reflex

Front 19

What are the local gastrointestinal reflexes that INHIBIT movement?

Back 19

Ileogastric reflex
intestinal-intestinal reflex
peritoneointestinal reflex
renointestinal reflex
vesicointestinal reflex
somatointestinal reflex

Front 20

How is swallowing stimulated?

Back 20

By food bolus stimulating pressure receptors in the back of the throat & pharynx. It then sends impulses to medulla.

Front 21

How can the nurse stimulate the swallowing reflex in a pt?

Back 21

By temperature change or textured foods (icing the tongue w/ an ice cube or popsicle, ice chips)

Front 22

Effects of aging on digestion?

Back 22

* Altered ability to chew r/t loss of teeth, ill-fitting dentures, gingivitis (sore gums)
*Loss of senses of smell & taste (everything tastes bland)
*Decreased peristalsis in esophagus
*Gastroesophageal reflux (acid goes up into esoph)
*Decreased gastric secretions (*Slowed intestinal peristalsis
*Lowered glucose tolerance (might lead to diarrhea)
*Reduction in appetite & thirst sensation (get dehydrated easily)
*Loss of appetite assoc w/ depression & loneliness
*Physical handicaps (can't cook nutritious foods anymore)
*Low income
*Malnutrition
*Increased risk for drug-nutrient interactions

Gas

Front 23

Screening & assessment of nutritional health?

Back 23

List foods & beverages over 24 hrs, Food Guide Pyramid, Dietary Reference Intakes, Recommended Daily Allowance, Weight: same, gain, loss

Front 24

Symptoms seen w/ GI problems

Back 24

N/V (#1 chief complaint on admission)
Indigestion
Abdominal Pain
Weight & appetite change
Diarrhea
Constipation

Front 25

Which is more accurate for anthropometric measures: Body Mass Index or Skin Fold Tests

Back 25

BMI

Front 26

Body Mass Index

Back 26

A method for determining the ideal body weight of an individual

Front 27

Formula BMI?

Back 27

Weight (kg)/Height (m2)

Front 28

What lab tests are run to assess nutritional status?

Back 28

Nutritional Anemias (iron deficiency anemia is the most common cause of anemias in the world)

Serum Proteins

Nitrogen Balance (if too much nitrogen, not getting enough protein)

Fecal Analysis

Front 29

Flat plate of the abdomen

Back 29

X-ray of the abdomen

Uses: abnormal gas or fluid collections, strictures

Front 30

Barium Swallow of Upper GI Series

Back 30

Permits radiological visualization of the esophagus, stomach, duodenum and jejunum

Requires fasting 6-8 hours

Front 31

Nursing Assessment after barium swallow?

Back 31

Assess abdomen for distention

Observe stool to determine whether the barium has been eliminated

Front 32

How long should the nurse keep pt on NPO status after barium swallow?

Back 32

Until somone (speech therapist, radiologist, MD) has evaluated the test results

Front 33

After barrium swallow, what is the nurse looking for regarding the stool?

Back 33

Stool will be white initially and will return to its normal brown within 72 hours. If not, contact physician!

Front 34

After barium swallow, distended abdomen and constipation could indicate?

Back 34

Barium impaction. Notify the physician immediately!

Front 35

Indications for EGD?

Back 35

Direct visualization of GI tract; detect abnormalities

Front 36

Patient Care Pre and Post EGD?

Back 36

To reduce risk of aspiration, pt should be in left lateral position for procedure

Front 37

How long to withhold fluids from pt after EGD?

Back 37

Until local anesthesia wears off and GAG REFLEX returns

Front 38

Main indication for colonoscopy?

Back 38

Screening for cancer or pre-cancer conditions; remove polyps and take biopsies

Front 39

Pre-procedure for EGD?

Back 39

Clear liquids
Colon cleansings

Front 40

Major causes of dental decay?

Back 40

Plaque
Tobacco Use

Front 41

Periodontal Dz caused by?

Back 41

Plaque; Bacterial colonization

Front 42

Candidiasis seen in?

Back 42

Immunosuppressed pts (AIDS pts, transplant pts)

Front 43

Premalignant tumors of the oral cavity?

Back 43

Leukoplasia
Erythroplakia

Front 44

Malignant tumors of the oral cavity usually assoc w/ ?

Back 44

Alcohol and tobacco abuse
Ingestion of smoked meats

Front 45

Leukoplakia and Erythroplakia?

Back 45

Precancerous lesions

Result from chronic irritation of the mucosa

Physical, chemical or thermal factors

Front 46

Nursing care of the surgical pt w/ malignant tumors of oral cavity?

Back 46

Most important thing is to MAINTAIN AIRWAY!

Wound Care
Monitor for Bleeding
Assess communication
Assess nutrition (oral, enteral or parenteral)

May have PEG Tube. Can't use NG tube

Front 47

Dysphagia

Back 47

Difficulty swallowing

Front 48

What causes dysphagia?

Back 48

mechanical obstructions
cardiovascular abnormalities
neurologic diseases (CVA)

Front 49

What is the nursing consideration that is important in pt w/ dysphagia?

Back 49

Place pt in High Fowler's position.

Have pt tilt chin toward chest (flexion) to swallow (chin tuck technique)

Also place food in "good side" not affected by stroke and rub side of neck to stimulate

Front 50

Achalasia

Back 50

A disorder characterized by progressively increasing dysphagia.

Narrowing of esophagus
Great difficulty in swallowing
Expression of "something stuck in my throat"
Commonly occurs in people in their 20's and 30's
Equal in men and women

Front 51

Achalasia Etiology and Risk Factors?

Back 51

No known cause, idiopathic

Front 52

Achalasia Pathophysiology?

Back 52

Impaired motility of lower 2/3 of esophagus

Front 53

Clinical Manifestations of Achalasia?

Back 53

Dysphagia
Substernal pain
Difficulty of food passing through LES
Exacerbated by URI, emotional disturbance, overeating and pregnancy

Front 54

Achalasia Medical Management?

Back 54

Esophageal dilation w/ Bougie dilators

Front 55

Medical Management of Hiatal Hernia?

Back 55

Same as GERD

Front 56

Surgical Management of Hiatal Hernia?

Back 56

Nisson Fundiplication

Front 57

Teaching for Pt w/ Hiatal Hernia ?

Back 57

-Eat small, frequent meals, chew slowly
-Drink adequate fluids
-Increase dietary protein
-Avoid extreme hot and cold foods
-Do not eat 3 hrs before retiring
-Elevate HOB 6-8" during sleep
-Sit up at least 30 mins after eating
-Avoid lifting, straining, bending, and tight or constrictive clothing
-Avoid tobacco, salicylates (aspirin) and NSAIDS (ibuprofen)

Front 58

Esophageal disorders

Back 58

Regurgitation: ejection of small amounts of gastric content w/o nausea

Pain (odynophagia): pain occurs throughout the day and can be confused w/ angina

Heartburn (Pyrosis), Indigestion, Dyspepsia: Symptoms relieved by standing or eructating

Front 59

Diverticulum

Back 59

Outpouching of the esophagus due to weakened area or trauma

Risk for infection due to food being trapped in the diverticulum

Diagnosed w/ barrium swallow

Front 60

Gastroeophageal Reflux Disease (GERD)

Back 60

Backward flow of gastric contents into esophagus. Leads to gradual breakdown of the esophageal mucosa & causes reflex esophagitis

Front 61

Cause of GERD?

Back 61

Inappropriate relaxation of the LES (lower esophageal sphincter)

Front 62

GERD treatment ?

Back 62

Diagnose w/ EGD

Decrease reflex w/ Meds: PPIs (proton pump inhibitors) Nexium, Protonix

Decrease Reflux w/ lifestyle & diet changes

Front 63

Pt teaching for GERD ?

Back 63

-Eat small frequent meals
-Drink adequate fluids
-Eat slowly, chew thoroughly
-Avoid fatty foods, milk, chocolate, mints, caffeine, carbonated drinks, citrus fruits and juices, tomato products, pepper seasoning, and alcohol
-Avoid extreme hot or cold foods, spices
-Lose weight
-Avoid eating 3 hrs before retiring
-Elevate HOB
-Avoid tobacco, salicylates and phenylbutazone

Front 64

Esophageal Cancer Etiology and Risk Factors ?

Back 64

3 times more in men than women
Higher in AAs and Asians than white men
Cause unknown
Heaving smoking
Nutritional deficiencies
Ingestion of alcohol, hot foods, and hot drinks
Contaminants in soil & food
Ingestion of smoked meats or meats cooked over very high heat
Irritation from GERD, hiatal hernia or achalasia

Front 65

Esophageal Cancer Clinical Manifestations ?

Back 65

Dysphagia or Odynophagia

Dysphagia becomes constant

Front 66

Esophageal Varices

Back 66

Dilation of the esophagogastric veins.

Result from portal hypertension. Portal venous blood pressure increases cause esophageal veins to swell and distend. A MEDICAL EMERGENCY when they rupture.

Can be caused from alcoholism

Front 67

Oral Feeding Swallowing Techniques for pts w/ dysphagia ?

Back 67

Go Slow
Raise bed to High Fowler's position (90 degrees)
Place food in unaffected side of mouth
When food reaches the pharynx, pt should tilt chin down to decrease the risk of aspiration. COVERS up the tracheal opening
Massaging throat on affected side helps stimulate tactile areas & initiate swallowing.

Have SUCTION AVAILABLE - and HAVE IT SET UP BEFORE THEY BEGIN EATING!!

Front 68

Indications for Enteral Feeding ?

Back 68

Neurologic & Psychiatric
Oropharyngeal & Esophageal Surgeries
AIDS
Burn Pts
Chemotherapy
Radiation therapy

Front 69

Reasons for GI Intubation ?

Back 69

Decompress Stomach
Lavage (for OD)
Dx GI motility
Administer meds
Administer feedings
Treat obstruction
Compress a bleeding site
Aspirate gastric contents for analysis

Front 70

Types of Enteral Feedings ?

Back 70

Oral
Nasogastric
Nasoduodenal
Nasojejunal
Gastrostomy
Juejunostomy

Front 71

NG tube insertion steps

Back 71

Wash hands/don gloves
Examine nostril; select most patent
Establish cue w/ pt to use to stop you momentarily
Measure from tip of nose to earlobe to xiphoid process. Mark the tube.
Coil end to soften
Lubricate tube & insert through nostril to back of throat.
Aim tube toward back of throat and down.
Have pt swallow sips of water to assist tube insertion (Remember upper 1/3 of esophagus is voluntary muscle)
Tape the tube in place

Front 72

Most COMMON way nurses verify placement of NG tube

Back 72

Auscultation of air introduced via syringe into the tube (will hear gurgle)

Front 73

Most ACCURATE method for NURSES to check placement of NG tube?

Back 73

pH test of aspirate

Front 74

Most ACCURATE method to check placement of NG tube ?

Back 74

Radiography - most accurate, BUT requires physician's order

Front 75

Signs NG tube placement is incorrect and could be going into lungs ?

Back 75

Coughing, choking or cyanosis

Front 76

Assessment of NG tube ?

Back 76

Pain
Change in secretions (bright red blood is bad)
metabolic alkalosis (can be from suctioning)
Monitor potassium levels (can be decreased and cause cardiac problems)

Front 77

Methods of Administration for Enteral Feedings ?

Back 77

Bolus
Intermittent
Continuous

Front 78

Less aspiration risk with which method of administration of enteral feeding ?

Back 78

Continuous

Front 79

Bolus ?

Back 79

300-500 ml several times/day in 60 ml increments over 10-15 mins

Front 80

Intermittent ?

Back 80

Formula is placed in a gravity bag & dripped in over 30-60 mins

Front 81

Continuous Feeding?

Back 81

Feeding administered via infusion pump over 24 hrs ranging from 50-150 ml.

Less gastric distention and aspiration

Front 82

Benefits of Enteral Nutrition ?

Back 82

Maintain & support gut
integrity & function
Prevent atrophy of gut mucosa
Reduction of infectious
complications
Reduced cost
SAFER ADMINISTRATION

Front 83

Enteral Nutrition Contraindicated for ?

Back 83

Intestinal obstruction
Paralytic Ileus
Severe pseudo-obstruction
Severe diarrhea
intestinal ischemia
Fistulas or tumor of proximal
GI tract
Acute, severe pancreatitis
Malabsorption syndrome

Front 84

How long can an open system of enteral feeding hang?

Back 84

Only 4 hours

Front 85

Closed system of enteral feeding?

Back 85

Change 24-48 hours

Front 86

Nursing intervention to maintain enteral access ?

Back 86

Flush according to protocol or change pt's position

Front 87

Can enteric-coated or time-released tablets or capsules be crushed to be administered via enteral feeding tube?

Back 87

No

Front 88

When administering meds via enteral feeding tube it's important to do what ?

Back 88

Flush tube with 30 mls of water before & after giving each medication

Front 89

Goals of Tube Feeding ?

Back 89

Nutritional Balance
Normal Bowel Elimination
Reduced risk of aspiration
Adequate hydration
Individual Coping
Knowledge & skill in self care
Prevention of complications, eg aspiration!

Front 90

When providing meds via suction and feeding tubes ?

Back 90

If tube is on suction, clamp tube before administering med and leave clamped for 30 minutes

Front 91

Indications for Parenteral Nutrition ?

Back 91

Used when pt cannot be fed orally or by tube feeding or when the GI tract is not functional

Front 92

Parenteral Nutrition

Back 92

Peripheral: when using less than 10 days

Central venous (subclavian, PICC line): when needed for long term

Front 93

TPN (total parenteral nutrition) contents ?

Back 93

Carbohydrates
Fat Emulsions
Amino Acids
Fluid, Electrolytes, Vitamins, Trace Elements

Front 94

Parenteral Nutrition Clinical Indications ?

Back 94

Malabsorptive syndrome
Severe prolonged radiation enteritis
Motility disorders
Intestinal Obstruction
Perioperative nutrition for severe malnutrition
Critically ill pt when enteral therapy is CI

Front 95

Nursing Management for Parenteral Nutrition?

Back 95

Assessment of:

Infusion bag for correct ingredients
Appearance of solution (no precipitate!)
Condition of the venous access site (irritation?)
Monitor blood glucose levels
Rate of infusion (if too fast, can cause fluid overload)
Reactions to the solution

Front 96

Complications of Parenteral Nutrition ?

Back 96

Bacterial Growth
Risk for infection
D/C feedings too rapidly: hypoglycemia
Displacement of tube

Front 97

Digestive Disorders ?

Back 97

Gastritis
Peptic Ulcer Disease
Gastric Cancer

Front 98

Clinical Manifestations of Gastrointestinal Disorders

Back 98

Pain
Anorexia
N/V
Bleeding (ulcer gets eroded)
Belching & Flatulence
Indigestion

Front 99

Gastritis (Acute)

Etiology and Risk Factors

Back 99

Ingestion of corrosive, erosive or infectious substance

Front 100

Clinical Manifestations of Acute Gastritis

Back 100

It is severe
N/V
tenderness
cramping
belching
diarrhea develops w/i 5 hrs if cause is contaminated food

Front 101

Gastritis (Chronic)

Back 101

Three forms:

Superficial: reddened edematous mucousa

Atrophic: occurs in all layers of stomach (usually seen w/ gastric ulcer or cancer)

Hypertrophic: produces a dull & nodular mucosa (esp. in elderly)

Front 102

Chronic Gastritis

Etiology & Risk Factors

Back 102

Helicobacter pylori bacteria (causes 90% of peptic ulcers)

Gastric surgery

Front 103

Peptic Ulcer Disease

Back 103

Three Types:

Duodenal ulcers - highest incidence; hyper secretion of acid; rapid emptying of stomach
Gastric ulcers -

Stress-induced and Drug induced - frequently called stress ulcers or stress erosive gastritis. Can occur after an acute medical crisis; severe trauma or major illness; ingestion of a drug (aspirin, NSAIDS, steroids, alcohol; severe burns; sepsis or shock

Front 104

Peptic Ulcer Disease

Clinical Manifestations

Back 104

Aching, burning, cramp-like, gnawing

Front 105

Difference between GASTRIC ulcer and DUODENAL ulcer?

Back 105

In gastric ulcer, food may CAUSE pain and vomiting may RELIEVE the pain

In duodenal ulcer, there is pain with EMPTY STOMACH and it is RELIEVED by eating

Front 106

N/V occur more with which type of ulcer?

Back 106

Gastric

Front 107

Pt teaching with peptic ulcer disease ?

Back 107

*Understand the cause of the ulcer
*Healing is rapid when irritating effect is removed
*Understand what must be done to lessen the stimulation
*Eliminate the irritating substance from diet
*Understand the imp of continuing the med until healing complete (may be after pain has been relieved)
****Recognize that once the maintenance therapy stops, the ulcer MAY RECUR
**Use acetaminophen instead of aspirin

Front 108

What is dumping syndrome ?

Back 108

Rapid emptying of the stomach contents into the small intestine

Front 109

Dumping syndrome characterized by what ?

Back 109

Diaphoresis, weakness, palpitations, syncope and possibly diarrhea.

Early symptoms occur 5-30 mins. after meals

Front 110

Management of dumping syndrome ?

Back 110

-Decrease amount of food at each meal
-High protein, high fat, low carb, dry diet
-Remain in semi-Fowler's position for 1 hr after feeding
-Avoid fluids 1 hr before & 2 hrs after meals
-Medications: Sedatives and antispasmodic agents to delay emptying

Tube feeding: instill the minimal amount of water needed to flush the tubing before and after feeding

Front 111

What is the main thing to know about gastric cancer?

Back 111

There are no clinical manifestations in the early stages.

Pain usually from METASTASIS

Front 112

Viral and Bacterial Infections - Gastroenteritis

Symptoms

Back 112

Diarrhea, abdominal pain, cramping, vomiting, fever, anorexia, distention,

Causes: contaminated food and water

Front 113

Gastroenteritis Transmission ?

Back 113

Oral-fecal route: person to person and ingestion of contaminated food

Common sources: eggs (Salmonella), undercooked meats (e. coli), food poisoning: (staphylococcus aureus)

Front 114

Appendicitis - Etiology and Risk Factors

Back 114

A fecalith (fecal calculus or stone) that occludes the lumen of appendix

Kinking of appendix

Swelling of bowel wall

Fibrous conditions in the bowel wall

External occlusion of the bowel by adhesions

Front 115

Clinical Manifestations of Appendicitis ?

Back 115

Classic symptoms: begins w/ acute abd pain that comes in waves. Then becomes steady.

Starts in epigastrium or periumbilical region then shift to RIGHT LOWER QUADRANT.

Pt guards area by lying still & drawing the legs up to relieve tension of the abd muscles.

Front 116

IMPORTANT to know about Appendicitis ?

Back 116

Pt may feel she/he needs a laxative.
*** TAKING A LAXATIVE MAY LEAD TO RUPTURE***

Front 117

Is there medical treatment for appendicitis?

Back 117

No, only surgical management which is an appendectomy

Front 118

What is the nursing care for a pt pre-op for appendicitis?

Back 118

Keep pt NPO in case they are rushed to surgery

Withhold pain meds (they may mask symptoms)

Start IV infusion

Front 119

Peritonitis - Etiology and Risk Factors ?

Back 119

Major source of inflammation is from the GI tract

Normal flora of intestine when it enters the sterile peritoneal cavity (e. coli most common)

Ruptured gallbladder, perforated peptic ulcer, penetrating wounds

Front 120

Peritonitis Clinical Manifestations ?

Back 120

Pain localized or generalized
Shallow respirations
Rigidity of abd muscles
Pain that increases w/ pressure or motion
N/V
Absence of bowel sounds
WBC elevated
X-ray shows edema and free air or fluid in the abd cavity

Front 121

Complications of Peritonitis ?

Back 121

ARDS (Adult respiratory distress symptoms)

Sepsis and shock

Front 122

With sepsis....

Back 122

Closely monitor fluid balance (assess VS, bowel sounds (make sure they HAVE bowel sounds!), urine output, skin turgor, weight.

Front 123

Signs of sepsis that should be immediately reported....?

Back 123

Drop or rise in temp

Drop in BP

Front 124

Inflammatory Bowel Disease (IBD) - Two Types

Back 124

Crohn's Disease

Ulcerative Colitis

Front 125

In Crohn's....the pain is

Back 125

aggravated by walking, sitting and defecation

Front 126

In ulcerative colitis.....the pain is ?

Back 126

There is tenderness in the left lower quadrant, guarding and abd distention

Front 127

Crohn's is......

Back 127

transmural (goes thru all 3 layers)

Front 128

Ulcerative colitis involves....

Back 128

only the mucosa and submucosa

Front 129

Crohn's is....

Back 129

considered an autoimmune disease

Front 130

Ulcerative colitis is.....

Back 130

Bacterial in origin

Front 131

Crohn's is....

Back 131

relapsing; develops discontinuously

Front 132

Ulcerative colitis....

Back 132

spans entire length of colon

Front 133

Crohn's is most common in

Back 133

the terminal ileum

Front 134

Ulcerative colitis starts....

Back 134

in the rectum and distal colon, spreading upward

Front 135

Crohn's - Clinical Manifestations

Back 135

Diarrhea (less severe than Ulcerative Colitis)
Stool soft or semi liquid
Urgency to expel stool may awaken pt at night
Malabsorption assoc w/ steatorrhea may develop

Front 136

Ulcerative Colitis - Clinical Manifestions

Back 136

Predominant manifestation is rectal bleeding (because it starts in the rectum)

Liquid stools w/ tenesmus and may contain blood, mucus and pus

May have 20+ stools a day

Tenderness in left lower quadrant, guarding and abdominal distention

Emotional stress, physical exertion, respiratory infections and over fatigue may cause an attack

Front 137

Surgical Treatment for Ulcerative Colitis ?

Back 137

Surgery is the only cure

Front 138

Surgical Treatment for Crohn's Disease ?

Back 138

Surgery for complications only

Front 139

What would make you notify MD immediately in assessing post-op stoma?

Back 139

If stoma becomes pale, dusty or cyanotic (means it's not getting blood flow; tissue could become necrotic and fall back into abdomen)

Front 140

Foods that reduce odor with an ostomy ?

Back 140

Spinach, yogurt and buttermilk

Front 141

Foods to avoid with an ostomy ?

Back 141

eggs, fish, onions, cabbage and some greens

Front 142

How should skin be cared for in pt w/ ostomy?

Back 142

Should be washed and rinsed with each changing of pouch

Front 143

What foods could block stoma and should be avoided?

Back 143

Mushrooms and nuts

Front 144

What is a polyp ?

Back 144

A mass of tissue that protrudes into the lumen of the bowel

Front 145

Polyps can be classified as.....

Back 145

Neoplastic (ie, adenomas and carcinomas)

Non-neoplastic (ie, mucosal and hyperplastic)

Front 146

Benign tumor types

Back 146

Sessile
Pedunculated

Front 147

Polyps are dangerous because....

Back 147

they can mask the presence of a malignant tumor

they may serve as the focus for bowel obstruction or intussusceptions

Front 148

Average age of onset for cancer of the small bowel ...?

Back 148

53-58 years

Front 149

What is the most common GI cancer......?

Back 149

Colorectal cancer

Front 150

Colorectal Cancer

Etiology and Risk Factors ?

Back 150

Low-residue, high-fat and highly refined foods

Genetic mutations

DIET is the MAJOR factor

Front 151

Percentage of adematous polyps that develop into colorectal cancer....?

Back 151

95%

****This is why colonoscopies are so important!****

Front 152

Clinical manifestations of colorectal cancer......?

Back 152

Rectal bleeding
Change in bowel habits
Abdominal Pain
Weight Loss
Anemia
Anorexia
Tumors

Front 153

Hernias -- Etiology ?

Back 153

Muscle weakness
Poor wound healing after
abdominal surgery
Umbilical hernias occur more in obese or pregnant pts

**All associated w/ heavy lifting and straining

Front 154

Reducible hernia

Back 154

Contents of hernia can be replaced in the abdomen

Front 155

Incarcerated (irreducible) hernia

Back 155

Contents of the sac cannot be reduced or replaced by manipulation

Front 156

Strangulated hernia

Back 156

Pressure from the hernia ring muscle cuts off the blood supply to the herniated segment of bowel

Front 157

Diverticular Disease - Etiology ?

Back 157

Low fiber diet

Front 158

Diverticulitis

Back 158

Undigested food blocks the diverticulum, leading to a decrease in blood supply to the area and predisposing the bowel to infection

Front 159

Treatment for Diverticular Disease ?

Back 159

Strict adherence to a high-fiber diet;

Prevention of constipation

Surgery is indicated when complications occur, hemorrhage, obstruction, abscesses and perforation

Front 160

Bowel Obstructions ?

Back 160

Partial or complete impairment of the forward flow of intestinal contents

Front 161

Intestinal obstruction has a high mortality rate if not diagnosed and treated within ____ ?

Back 161

24 hrs

Front 162

Bowel obstructions lead to local changes of ______ ?

Back 162

loss of fluids, electrolytes and plasma
bacterial proliferation
perforation

Front 163

Bowel obstruction - systemic effects are _____ ?

Back 163

Reduction in extracellular fluid
Reduction in circulating blood volume
Toxemia
Peritonitis

Can lead to sepsis - temp will go up or down and BP wil go down

Front 164

What is the most GI disorder in the western world?

Back 164

Irritable Bowel Syndrome

Front 165

Irritable Bowel Syndrome - Etiology and Risk Factors ?

Back 165

Diets high in fat, fresh fruits, gas-producing foods, carbonated beverages and alcohol

Smoking, lactose intolerant, high stress, problems w/ sleep and rest

Front 166

Irritable Bowel Syndrome - Clinical Manifestations ?

Back 166

Abdominal Pain
Altered Bowel Function
Constipation or diarrhea
Hypersecretion of colonic
mucus, dyspeptic manifestations (flatulence)
Nausea
Anorexia
Anxiety or Depression

Front 167

With anorexia, medical management must include treatment of ______________ ?

Back 167

Psychological as well as nutritional components

Front 168

Anorexia Nervosa

Back 168

A condition of self-generated weight loss; usually seen in adolescent girls and young women; preoccupation w/ personal body weight and appearance

Front 169

Bulimia Nervosa

Back 169

Less serious than anorexia nervosa; pts maintain nearly normal weight. Go through periods of binging and vomiting, or taking laxatives.

Bulimia is usually done in secret and is a form of depression

Front 170

Acid-Controlling Drugs

Back 170

Antacids
H2 Antagonists
Proton Pump Inhibitors
Suracalfate (does not affect HCl. Coats and protects the gastric mucosa)

Front 171

Roles of Hydrochloride Acid

Back 171

*Maintains the pH of the stomach at pH 1-4
*Helps digest food
*Aids in body's defense against microbials

Front 172

Three Primary Cells of the Gastric Gland and what they secrete.....?

Back 172

Parietal Cells - HCl
Mucoid Cells - Mucous
Chief Cells - Pepsinogen

Front 173

Parietal Cell Receptors

Back 173

Acetylcholine (Ach)
Histamine
Gastrin

*When the parietal cell receptors are occupied (w/ Ach, Histamine, Gastrin), the parietal cell will secrete HCl

When the parietal cell receptors are blocked, HCl secretion is decreased

Front 174

Drug Cautions of Acid-Controlling Drugs

Back 174

Monitor for electrolyte disturbances; monitor for drug-drug interactions.

Front 175

Should antacids be given before or after the administration of other drugs?

Back 175

1-2 hours before or after

Front 176

If pt takes too much antacid, they become.....______?

Back 176

Alkalotic

Front 177

What are some harmful stimulants of hydrochloric acid?

Back 177

Large, fatty meals
Consumption of excessive amounts of alcohol
Emotional stress

Front 178

What do H2 Antagonists do ?

Back 178

The H2 blockers compete w/ histamine for binding sites on the surface of parietal cells

Front 179

_______ is the most popular drug for treatment of many acid-related disorders and why?

Back 179

Tagamet

Patient acceptance
Safety profile
Very few side effects

Front 180

Problems may occur with H2 Blockers and __________ ?

Back 180

Theophylline (taken for respiratory distress)
Warfarin
Lidocaine
Phenytoin

Front 181

___________ decreases the effectiveness of H2 blockers

Back 181

Smoking

Front 182

H2 antagonists should be taken ______ hrs BEFORE antacids

Back 182

1

Front 183

Proton Pump Inhibitors - Mechanism of Action

Back 183

Irreversibly bind to the H+/K+ ATPase

Prevents the movement of H+ ions out of the parietal cell into the stomach

Blocks ALL gastric acid secretion from the parietal cells

Front 184

_____ is the only proton pump inhibitor that can be administered IV in hospital?

Back 184

Protonix (pantoprazole)

Front 185

Proton pump inhibitors are the most ideal drug for hypersecretion of acid because _________ ?

Back 185

its effects are confined to the parietal cells; NO systemic effects

Front 186

How is Helicobacter pylori treated ?

Back 186

with Prilosec and Prevacid

Front 187

Aluminum Antacids

Back 187

AlternaGEL - constipating

Front 188

Magnesium Antacids

Back 188

Milk of Magnesia, Maalox, Mylanta - usually combined with Al to counteract the diarrhea side effect

Front 189

Calcium carbonate Antacids

Back 189

Oystercal, Tums - may result in kidney stones, constipation , rebound hyperacidity

Front 190

Sodium bicarbonate Antacids

Back 190

Highly soluble with a quick onset but a short duration. May lead to metabolic alkalosis

Front 191

Stomach is very ________. If there is a break in the mucosal barrier and acid can get to the epithelial cells, it causes burning

Back 191

acidic

Front 192

Patient Teaching for Aluminum Antacids

Back 192

Increase fluids, fiber and exercise

Front 193

Patient Teaching for Magnesium Antacids

Back 193

Causes a laxative effect (diarrhea)

Can lead to DEPENDENCY

Caution in pts w/ renal failure. Kidney cannot excrete Mg and this leads to TOXICITY

Front 194

What drugs are combinations of Al & Mg ?

Back 194

Gaviscon, Maalox, Mylanta, Di-Gel

Front 195

Patient Teaching for Calcium Antacids

Back 195

Can be constipating
Causes rebound hyperacidity
Can lead to kidney stones

Front 196

Patient Teaching for Sodium bicarbonate Antacids

Back 196

Quick onset with short duration

May lead to metabolic alkalosis

Front 197

Other Patient Teaching with Antacids

Back 197

*Always take as prescribed
and take before meals
*Be sure that chewable
tablets are well chewed
*Do not open, chew, or crush
capsules
*Give all antacids w/ at least 8
oz of water to enhance
absorption

Front 198

If an antacid causes an INCREASE in abdominal pain, what should the pt do?

Back 198

Contact the physician

Front 199

When should Tagamet be given ?

Back 199

With meals and if antacids are also given, they should be given 1 hour before or after the Tagamet

Front 200

Antipeptic Agent: Sucralfate (Carafate)

Back 200

Cytoprotective. Binds to the base of ulcers and erosions. Does not inhibit acid secretions like the others.

Almost no systemic toxicity

Most common side effect - constipation and nausea

Front 201

Carafate may impair absorption of ________ (drug-drug interaction)

Back 201

Tetracycline

Front 202

Prostaglandin

Back 202

Misoprostol (Cytotec)

Use: Prevention of NSAID-induced ulcers in adults at high risk for development of gastric ulcers.

Front 203

________ (_________) cannot be given to pregnant women

Back 203

Prostaglandins (Carafate).

It is an abortifacient.

Front 204

Saliva substitute

Back 204

MouthKote, Salivart.

Helps in conditions that cause dry mouth: stroke, radiation therapy, chemotherapy. Not absorbed systemically

Most Common Adverse Effect - Electrolyte absorption leading to increased levels of magnesium, sodium or potassium

Front 205

Pancrelipase

Back 205

Creon, Pancrease - Aid in digestion & absorption of fats, proteins, and carbohydrates, conditions that result in a lack of pancrelipase. Not absorbed systemically

Front 206

Purpose of Laxatives ?

Back 206

--Relief of constipation
--Prep for GI procedures

Front 207

Constipation

Back 207

Abnormally infrequent and difficult passage of feces through the lower GI tract

Front 208

________ are among the most commonly misused OTC medications.

Back 208

Laxatives

Front 209

Causes of constipation

Back 209

- Metabolic & endocrine d/o's (diabetes mellitus, hypothyroidism)
- Neurogenic d/o's (Parkinson's, spinal cord injury)

Front 210

What drugs have constipating adverse effects?

Back 210

Opiates, calcium channel blockers

Front 211

_____% of Americans eat 5 servings of fruits & vegetables a day

Back 211

11%

Front 212

How does lifestyle contribute to constipation ?

Back 212

Poor bowel habits
Diet
Lack of physical exercise
psychological (won't have BM except at home; withholding BM if psych disorders)

Front 213

Stimulant Laxatives

Back 213

- Results in increased peristalsis, increased fluid in the colon, increased bulk

Front 214

Which type of laxative class is most likely to cause dependence ?

Back 214

Stimulant laxatives

Front 215

Bulk-forming Laxatives

Back 215

Composed of water-retaining natural and synthetic cellulose derivatives

Front 216

Main danger for bulk-forming laxatives (ESP. w/ the elderly)

Back 216

Take with liberal amounts of water to prevent esophageal obstruction and/or fecal impaction

Front 217

Stimulant Laxative Prototype

Back 217

Ducolax (bisacodyl)

Front 218

Emollient Laxatives

Back 218

- By lubricating the fecal material and intestinal walls they prevent water from leaking out of the intestines which softens and expands the stool

Prototype - Mineral Oil

Front 219

How long should mineral oil enema stay in body to be most effective ?

Back 219

1 hour at least

Front 220

Hyperosmotic Laxatives

Back 220

- Increase fecal water content
- Results in distention, increased peristalsis and evacuation
- Site of action limited to large intestine

Lactulose (Chronulac, Duphalac, Enulose)
Polyethylene glycol (GoLytely, CoLyte)

Front 221

Which adverse effect is common to ALL classes of laxatives ?

Back 221

Electrolyte imbalances

Front 222

When are laxatives contraindicated ?

Back 222

- Acute surgical abdomen
- Appendicitis symptoms (right lower quadrant)
- Fecal impaction
- Intestinal obstructions
- Undiagnosed abdominal pain

Front 223

Important pt teaching for laxatives ?

Back 223

Swallow tablets whole with at least 8 oz of H2O

Front 224

Long-term use of laxatives or cathartics often results in_______?

Back 224

Decreased bowel tone and may lead to dependency

Front 225

______ increases emptying of the stomach; increases GI secretions and motility. Does not cause diarrhea or stimulate the intestines

Back 225

metoclopramide (Reglan)

Front 226

Reglan is used to ______

Back 226

empty stomach rapidly eg, emergency surgency

Front 227

Acute diarrhea has _____

Back 227

sudden onset, lasts for 3 days to 2 weeks

Front 228

Chronic diarrhea lasts _____

Back 228

for over 3-4 weeks and is associated w/ fever, loss of appetite, N/V, weight reduction and chronic weakness

Front 229

Side effect of Reglan ?

Back 229

Tardive Dyskinesia

Front 230

Anti-Diarrheal Categories

Back 230

1. Adsorbents
2. Anticholinergics
3. Opiates
4. Intestinal flora modifiers

Front 231

Adsorbent anti-diarrheals

Back 231

- coat walls of GI tract
- cause constipation, dark stools and black tongue

Prototype: Bismuth subsalicylate (Pepto-Bismol)

Front 232

Anticholinergic anti-diarrheals

Back 232

- Decrease peristalsis and the muscular tone of the intestine. Can cause urinary retention

Prototype: Atropine

Front 233

Intestinal Flora Modifier anti-diarrheals

Back 233

Products obtained from bacterial cultures

- Most comon: Lactobacillus acidophilus

Front 234

Opiate anti-diarrheals

Back 234

- Decrease bowel motility
- May cause constipation
- Causes drowsiness

Prototype: loperamide (Imodium)