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106 Cards in this Set

  • Front
  • Back
breakdown of food
digestion
transfer of food products into circulation
absorption
excreting the waste products of digestion
elimination
taking in food
ingestion
two types of secretion of GI tract:
mucous
digestive
This type of secretion is produced throughout entire length of GI tract. The purpose is to protect and lubricate walls of GI tract
mucous secretions
This type of secretion in produced in the mouth, stomach, duodenum and jejunum. It's when enzymes and lytes break down ingested food so it may be absorbed.
digestive secretions
Ingestion of materials can be: (3)
oral
enteral
parental
Physical and chemical breakdown of food into absorbable substances
digestion
facilitated by the timely movement of food thru the various organs and secretion of specific enzymes
absorption
Major hormones assoc. with digestion:
gastrin
secretin
cholecystokinin
gastric inhibitory peptide
__________:contraction of gallbladder, relax sphincter of Oddi, increasing bile into duodenum, release of pancreatic digestive enzymes
cholecystokinin
inhibits gastric acid secretion and gastric motility
gastric inhibitory peptide
gastric acid secretion, increased motility, LES tone
gastrin
inhibits gastric motility, acid secretion and pancreatic bicarb secretion
secretin
Pacreozymin is secreted where?
by duodenum
If someone has dumping syndrome, what nutrient should they NOT get?
carbohydrate
Nutrients: (6)
carbs
fats
proteins
vits
minerals
water
who will usually be deficient in nutrients?
elderly
-Building and maintaining body tissue
-furnishing energy
-regulating body processes

all functions of what?
nutrients
We can only use feeding tube if:
they have functioning GI tract
Two types of supplemental nutrition::
high calorie oral feedings
tube feeding
whats 2 examples of a high calorie oral feeding?
milk shake
commercial products (ensure)
________ are safer and less expensive then parenteral
tube feeding
Indicators of potential nutritional problems:
-clear liq/full liq
-Iv fluids
-NPO
-Decreased intake of diet or tube feedings
-weight 20% above or below IBW
-alterations in chewing, swallowing, producing saliva, taste or small
-dx cva or ca
who should we consult is we have indicator of potential nutritional probs
dietician
What lab data is important when looking at nutrition?
alb
transferring
prealb
nitrogen balance
cbc
lytes
bun
creatining
oncofetalantigens
cea
normal alb level:
3-5
normal transferrin level:
220-430
normal prealb level:
20-40
if serum alb is increased:
hepatic disease
if deficiency in iron:
can't absorb food
serum creatinine shows:
dehydration
look at total lymph count for:
signs of infection
transferrin will be diminished in:
chronic illnesses
The elderly undergo the following effects of aging regarding the mouth:
1. loss/decay of teeth
2.decreased
3.decreased
4.decreased
2. taste buds
3. sense of small/taste
4. volume of saliva
The elderly undergo the following effects of aging regarding the esophagus:
1. decreased
2. increased
1. peristalsis (gags)
2. reflux
The elderly undergo the following effects of aging regarding the stomach:
1. atrophy of
2. decreased _____,_____,______
1. gastric mucosa
2. acid secretion, gastric bld flow, absorption
DETERMINE
D
E
T
E
R
M
I
N
E
disease they have
eating poorly
tooth loss/mouth pain
economic hardship
reduced social contact
multiple meds
involuntary wt loss/gain
needs assis. in self care
elderly >80
What's the no. 1 thing ppl dont tell u?
economic hardship
when doing a symptom assessment remember Pqrst
palliation, provocatin
quality
radiation
severity
timing
what 4 things are included in physical assess?
inspectin
auscultation
percussian
palpation
There are several diganostic studies in the upper gi series:
barium swallow
endoscopy
gastric emptying studies
gastric pH
gastric analysis
h pylori
cbc
lytes
bun
creat
abg's
This involves observing the movement of a contrast medium thru the esophagus and into the stomach by means of a fluroscopy and xray exam. It's used to identify esophageal and stomach disorders
barium swallow
Diagnostic procedure commonly used in GI evaluation:
abd xray
kub
contrast studies
endoscopic procedures
radionuclide scintigraphy
ABG'S:
pH
7.35-7.45
ABG'S: PCO2
35-45mmHG
ABG'S: HCO3
22-26mEq/L
ABG'S: PO2
80-100 mm HG
ABG'S: O2 sat
95-100%
substance that can donate a hydrogen ion H+
acid
Power of the H expresses the acidity or alkalinity of a solutions hydrogen ion concentration
pH
substance that can accpet hydrogen ion
base or alkali
acid condition of bld ph <7.35
acidemia
alkaloid condition of bld pH >7.45
alkalemia
ph less then 7.35
hco3 less then 22
PCO2 normal
metabolic acidosis
name some causes of met acidosis:
shock, drug poisoning/od
severe diarrhea
diamox therapy
dehyration
ammonium cl administration
diabetic ketoacidosis
renal tubular necrosis
utererosigmoidostomy
renal failure, pancreatic drainage
To treat met acidosis:
1. correct ______
2. consider ______ replacement
3. monitor:
4. watch for ______
1. fluid/lyte imbalance
2. bicarb
3.i&o
4. cardiac arrhythmias
Ph ^ 7.45

HCO3 ^
met alkalosis
this syndrome is produced by condidtions that result in reflux of fastric secretions into the esophagus
GERD
what is GERD throught to be caused by?
dysfunction of LES (lower esophageal sphicter)
burning, tight sensations from lower sternum progressing to jaw or throat. also c/o excessive salivation
heartburn (pyrosis)
what is heartburn (pyrosis) relieved by?
milk
alkaline substances
water
The following pulmonary symptoms may be seen with Gerd
wheezing
coughing
dyspnea (2ndary to microaspiration of gastric contents)
The following otolaryngologic symptoms may be seen with gerd
hoarseness
sore throat
choking
the following may be gastric symptoms of gerd:
bloating
n/v
step 1 for Gerd:EDUCATE!!
-Avoid what type of foods?
high in fat or cholesterol
step 1 for Gerd: teach to eat how many meals/day?
4-6 small meals
step 1 for Gerd: elevate
head of bed
step 1 for Gerd: avoid CCCCC
caffeine
coffee
cigs
chocolate
constrictive clothing
Step one for Gerd: acoid heavy lifting, ____ or working in ____________
straining
bent over position
Step 1 for GERD: avoid drugs that you have to take with food like:
ASA, NSAIDS
Step 1 for GERD: tell client they really need to
lose wt
Step 2/3 GERD: add following meds:
oral H2 blocker
omeprazole (prilosec)
proton pump inhibitor
anti ulcer
antacid
If no relief of GERD in steps 2 or 3, go to step 4: add _________ (_____) and consider surgical antireflux therapy
metoclopramide
reglan
When should reglan be given in regards to meals?
30-60mins before meal
what are s/e's of reglan?
hallucinations
ataxia
GER and GERD in children: Ger differs from gerd in that ger is gastric relux :
without injury
when does GER become GERD?
when complications such as failure to thrive, bleeding or dysphagia develop
GERD in children is associated with resp sx such as:

(they can't tell you they have heartburn)
apnea
bronchospasm
laryngospasm
pneumonia
what is now thought to be the common cause of GER in children?
transient relaxation of the LES (lower esophageal sphincter
Look for + what with GER?
h pylori
sx of GER in infants:
spitting up
regurgitation
vomiting
excessive crying, irritability, arching of back, stiffening, wt loss, failure to thrive, resp probs (cough wheez stridor) gagging, choking following feeding, hematemesis, melena, anemia
sx of GER in children:
heartburn
abd pain
non cardiac chest pain
chronic cough
dysphagia
nocturnal asthma
recurrent pneumonia
Nursing care for infants with GERD:
1. feed with
2. position?
1. thickened formula c rice cereal
2. head elevated, prone or left side position
Nursing care for infants with GERD: gerd worsens with
supine position
Herniation of a portion of the stomach into the esophagus thru an opening in the diaphragm
hiatal hernia
2 other names for hiatal hernia
esophageal
diaphragmatic
who is hiatal hernia most common in?
elderly
women
two types of hiatal hernia
sliding/rolling
rolling hiatal hernia is aka
paraesophageal
this is when part of the stomach 'slides' into thoracic cavity in supine position and back when upright. It is the most common type.
sliding hernia
fundus and greater curvature of stomach roll up thru diaphragm, forming pocket alongside esophagus
rolling/paraesophageal hernia
what are some precipitating factors for hiatal hernia in adults?
obesity
pregnancy
ascites
tumors
tight corsets
kyphosis
intense physical exertion
continual heavy lifting, belts
what are the symptoms of hiatal hernia in adults like?
same sx as gerd, gi bleeding
sx of hiatal hernia in infants in children:
same sx as GERD
what is the most common type of repair for hiatal hernia?
nissen
someone with hiatal hernia should have what kind of diet?
high protein
low fat
tell someone with hiatal hernia to avoid what 4 things?
smoking
caffeine
etoh
tight clothing at waist
teach someone with hiatal hernia this about eating:
small freq. meals/feedings
Client teaching: hiatal hernia: do not lie down for __-__ hrs after meals, sleep with
2-3 head elevated
What lab test is most valuable in determining nutritional status of an elderly client?
prealb
to have a tube feeding (PEG), the requirements must include:
functioning gi tract
client is bloating, several day hx of vomiting, most as risk for:
metabolic alkalosis
c/o burning sensation in throat, dysphagia, cough, most important hx to obtain is:
diet hx
wt loss/gain
if someone just underwent surgery to repair hiatal hernai (nissen) what type of diet should they have
soft, no veggies, no carb drink, sm freq meals