N30_Gi

Front 1

1. S/S that preceded vomiting:

Back 1

increased salivation, sweating, tachycardia and pallor

Front 2

2. if patient is vomiting

Back 2

– increased risk for aspiration – place left or right side. If pt had surgery – assess gag reflex

Front 3

3. recurrent vomiting of undigested food

Back 3

– problem with pyloric area of stomach

Front 4

4. steatorrhea - =

Back 4

fatty diarrhea (greasy and stinky) indicates malabsorption (Crohn’s disease). fatty diarrhea. Food is not digested/absorbed. Marked by frequent, bulky, greasy loose stools with a foul odor. This is often seen in malabsorption problems/syndromes such as celiac disease, cystic fibrosis where fat is not absorbed.

Front 5

5. constipation –

Back 5

high reside diet (high fiber diet) [veggies, whole grains, brans cereals, fruits with pupl, brown rice]

Front 6

6. diarrhea

Back 6

– low residue diet (protein, liquids, BRAT)

Front 7

7. fecal impaction –

Back 7

watery diarrhea, which masks constipation. Do not give laxatives

Front 8

8. always assess stools and ask pt about their normal bowel habits

Back 8

True

Front 9

9. vomiting – metabolic alkalosis
severe vomiting – metabolic acidosis

Back 9

true

Front 10

when to administer anti-emetic

Back 10

10. anti-emetics should be administered 30min – 1 hr before surgery or anything that you know will cause N/V

Front 11

why Do not give Reglan to a patient with N/D

Back 11

because it will increase peristalsis

Front 12

12. bulk forming laxative =

Back 12

Metamucil (drink water or will give you constipation)

Front 13

13. H2 receptors blocker =

Back 13

Tagamet, Zantac, Pepcid. Decrease gastric acid. Give with meals. S/E = headache, diarrhea, and fatigue. It blocks the first stimuli and working within hour but only up to 12 hrs

Front 14

14. PPI – proton pump inhibitors:

Back 14

Prilosec, prevacid, Protonix, nexium. Give 30 mins before meals. Decrease production of acid by blocking the enzyme in the wall of the stomach. Blocks final step (delayed onset but works longer compared to H2 blocker, onset 24 hrs but last for 3 days)

Front 15

15. antacids –

Back 15

Calcium Carbonate, Maalox, Mylanta, TUMS, Gelusil – increase ph in stomach to 3 to 4. they cause constipation.

Front 16

16. anti-emetics –

Back 16

Dramamine (Scopolamine), campazine, zofran, vistroril. Blocks histamine and acetylcholine receptors. Cancer/pregnant – Ondansentron, metoclopramide (Reglan)

Front 17

17. stool softener –

Back 17

colace (docusate) – decrease absorption of H2O in lower intestine

Front 18

18. anti-diarrhea

Back 18

– Imodium, Paragoric, Lomotil. Sulfazine – suppress inflammatory process

Front 19

19. anti-cholinergic

Back 19

– praventin (anti-spasmodic)

Front 20

20. imuran –

Back 20

immunosuppressant drugs for Crohn’s disease

Front 21

21. flagyl –

Back 21

drug for food poisoning

Front 22

22. zitromax, biaxin

Back 22

– antibacterial that are irritating to the stomach

Front 23

23. burning pain –

Back 23

ulcers and inflammatory problems

Front 24

dull pain

Back 24

– liver disease

Front 25

Cramping pain

Back 25

– intestinal

Front 26

colicky pain

Back 26

– obstruction (gallstones)

Front 27

24. RUQ –

Back 27

liver, gallbladder, duodenum (gallstones)

Front 28

25. RLQ –

Back 28

cecum, appendix, ovary (appendicitis, Crohns)

Front 29

26. LUQ –

Back 29

stomach, spleen, pancreas

Front 30

27. LLQ –

Back 30

sigmoid colon (ulcerative colitis, diverticular)

Front 31

28. Stool samples should go to Lab ASAP (should be warm)

Back 31

true

Front 32

29. Barium study –

Back 32

are you allergic to shellfish/contrast

Front 33

30. Barium study – NIC: prevent constipation by forcing fluids and giving laxatives. Retained barium = fecal obstruction (s/s watery diarrhea)

Back 33

true

Front 34

31. Pre-barium :

Back 34

NPO, bowel cleansing or enemas

Front 35

32. post-barium:

Back 35

poop will be white 2-3days

Front 36

33. post-barium –

Back 36

get patient to the bathroom, they may be very weak, think safety

Front 37

34. ultrasound –

Back 37

dx gallstones

Front 38

35. CAT scans –

Back 38

are you allergic to shellfish/iodine

Front 39

36. no smoking or caffeine before gastric analysis test

Back 39

true

Front 40

37. biopsy –

Back 40

worry about bleeding

Front 41

38. endoscopy: offer anesthetic spray, saline gargle or lozenge if that have sore throat after. No food until gag reflex returns (tongue blade to pharynx)

Back 41

true

Front 42

39. ERCP is another type of endoscopy but it looks at bile duct and pancreas. Pre/post op same as endoscopy

Back 42

true

Front 43

40. colonoscopy –

Back 43

bowel cleanse before, enema after. Monitor for abd pain, rectal bleeding and fever

Front 44

41. sigmoidoscopy – knee chest position

Back 44

t

Front 45

42. gastritis – erosion of mucosal layer, vascular congestion, edema, bleed, hypovolemia

Back 45

t

Front 46

43. gastritis – give sucrafate (carafate)

Back 46

true - ulcer meds

Front 47

44. chronic gastritis – atrophy of gastric glands

Back 47

true

Front 48

cute gastritis – rest the stomach (clear liquids and progress diet)

Back 48

t

Front 49

46. duodenal ulcer

Back 49

– hunger ulcer. Eating relieves pain. Pain in the middle of the night

Front 50

47. gastric ulcers

Back 50

– pain after a meal. Eating makes It worse. No pain at bedtime

Front 51

48. gastric ulcers – hemorrhage – give vasopressin

Back 51

true

Front 52

49. treatment for hemorrhage (ulcers):

Back 52

vasopressin, blood transfusion, ice, saline lavage, arterial immobilization

Front 53

50. miller abbot tubes

Back 53

– for decompression

Front 54

51. salem sump tubes

Back 54

– for decompression – blue port is kept above the patients waist/midline

Front 55

52. if someone has NG tube for decompression

Back 55

– they should have IV with K replacement. Always intermittent sunction

Front 56

53. Levine tubes

Back 56

– for lavage (to wash out) and gavage (to feed)

Front 57

54. sengstaken-blackmore tubes

Back 57

are for compression (bleeding ulcers or esophageal varices)

Front 58

55. #1 concern post-op = F/E imbalances

Back 58

true

Front 59

56. if someone has an NG tube – we introduce liquids when bowel sounds return

Back 59

t

Front 60

57. never allow someone to lay down after a meal b/c it interferes with clearing the esophagus

Back 60

true but to avoid dumping syndrome, tell to patient to lie down after 30 mins of eating

Front 61

58. GERD pain can mimic a heart attack or angina (retrosternal or substernal pain). Give an antacid

Back 61

true. difference, maalox, mylanta alleviate pain

Front 62

59. chronic gastritis –

Back 62

can lead to stomach cancer

Front 63

60. stomach cancer

Back 63

– have them describe dietary changes, their symptoms and any weight loss

Front 64

61. stomach CA – will resemble s/s peptic ulcer disease

Back 64

t

Front 65

62. stomach ca – NIC: allow patient to express feelings

Back 65

t

Front 66

63. IBD may be due to anticolon antibodies (interleukin/cytokine) in the blood

Back 66

t

Front 67

64. with IBD – have exacerbations and remissions (Ulcerative Colitis)

Back 67

t

Front 68

65. Pts with IBD – if on TPN for nutrition

Back 68

t

Front 69

66. the main goal of IBD – nutritional status – not to stop the diarrhea

Back 69

t

Front 70

67. you don’t give aspirin to pt with IBD

Back 70

t

Front 71

68. IBD – bland foods

Back 71

t

Front 72

69. pts with IBD – can end up with anemia bec of bleeding disorders

Back 72

t

Front 73

anti-inflammatory for IBD

Back 73

70. sulfasalazine –

Front 74

nursing care for IBD

Back 74

71. IBD – reduce stress and rest the bowels

Front 75

BD diet

Back 75

– high protein, vitamin and calories, decrease fat, low residue diet/fiber

Front 76

73. Diverticular disease – low residue diet during exacerbation/ high residue diet in remission

Back 76

t

Front 77

74. diverticular disease – sulfa drugs and Abx

Back 77

t

Front 78

75. hiatal hernia – portion of the stomach is protruding through the opening of the diaphragm

Back 78

t

Front 79

76. strangulated hermia – cut off blood supply. Surgery STAT

Back 79

t

Front 80

77. post abd. Surgery interventions

Back 80

: 1) encourage deep breathing/not coughing, 2) splint abdomen with pillow, 3) activity restrictions – keep intraabdominal pressure low, 4) wound care

Front 81

78. if evisceration or dehiscence occurs, pack the wound with NS and gauze and get them to OR

Back 81

true

Front 82

79. classics S/S of appendicitis

Back 82

1) pain in RLQ @McBurneys point, 2) increased temp, 3) rebound tenderness, 4) inability to lift R leg, 5) urge to defecate or pass gas but pain isn’t relieved

Front 83

80. if you suspect appendicitis

Back 83

– anticipate surgery (NPO) and start pre-op check list

Front 84

81. NG tube – if pt has abd distention, you should suspect that the tube has lost potency:

Back 84

1) check patency (aspirate), 2) measure abd girth

Front 85

82. Gastroenteritis: 1) viral intubation is 8-10 hrs, 2) bacterial intubation is 1-10 days

Back 85

t

Front 86

83. gastroenteritis – obtain stool specimen for C&S

Back 86

t

Front 87

84. NIC gastroenteritis

Back 87

1) monitor/tx dehydration and replace F/E, 2) enteric precautions, 3) NPO to rest bowel 4) bed rest

Front 88

85. amoxicillin is the meds for septicemia

Back 88

t

Front 89

86. irrigate NG tube with NS, this is how you check patency:

Back 89

1) assess placement by injectiong 10-50cc of air and auscultate, 2) inject 30cc of NS, 3) aspirate GI contents. Note: if nothing comes out, check for kinks, reposition patient, then inject 20cc of air and aspirate again

Front 90

87. irrigate with NS because it’s isotonic and prevents electrolyte imbalances

Back 90

t

Front 91

88. check residual for patients on tube feedings

Back 91

t

Front 92

89. tube feedings should always start at ½ strength, mix with sterile water

Back 92

t

Front 93

90. definite way to check tube placement = x-ray. After, check placement with 30cc of air

Back 93

t

Front 94

91. meds through GT or peg – each med with 10cc of sterile water, flush with 60cc at the end

Back 94

t

Front 95

92. cant use a peg tube for 24 hrs

Back 95

t, make sure there is bowel sound in 4 quadrants before removing NG tube

Front 96

93. liver produces bile for digestion. The gallbladder stores the bile

Back 96

t

Front 97

94. GI cells live for 1 day, that is why we never discard the residual, you always puts it back

Back 97

t

Front 98

95. functions of the liver:

Back 98

1) produces bile for digestion, 2) stores vitamins and mineral – K, 3) engulfs and destroys bacteria, 4) detoxifies chemical drugs, and EToh, 5) breaks down amino acids to make albumin and prothrombin, 6) convert ammonia to urea – BUN, 7) synthesis plasma proteins, 8) releases glycogens PRN and synthesis/beaks down fatty acids

Front 99

96. decreased liver function

Back 99

– increased toxicity

Front 100

97. GI assessment :

Back 100

1) inspect, 2) auscultate 3) percuss 4) palpate – light then deep

Front 101

98. the overall goal for a patient with IBD is to maintain/improve nutrition

Back 101

t

Front 102

99. small or large intestine obstruction can lead to peritonitis

Back 102

t

Front 103

100. S/S of small intestine obstruction:

Back 103

vomiting of stomach contents 1st, then bile, then feces. There is major abdominal distention. We put in an NG tube for decompression. They may go to surgery

Front 104

101. with obstruction: you can remove the NG tube when bowel sounds return

Back 104

t

Front 105

102. give a zits bath to patient with ulcerative colitis and hemorrhoids. It promotes comfort

Back 105

t

Front 106

103. TPN and PPN (IBD) accuchecks q6h, never DC abruptly – they need to be weaned off, hang D10 if bag runs dry

Back 106

t

Front 107

104. irrigate colostomy bag with tepid water

Back 107

t

Front 108

105. irrigate G-tube or PEG with sterile water

Back 108

t

Front 109

106. electrolyte imbalances with diarrhea

Back 109

– hypocalcemia, paralytic ileus, muscle weakness, absent BS, cardiac

Front 110

107. hypokalemia – increased ammonium levels. Hepatic encephalopathy. That is why we give aldactone in cirrhosis

Back 110

t

Front 111

108. bilirubin in urine = gallstones

Back 111

t

Front 112

109. give carafate (sulcrafate) for ulcer ac and hs

Back 112

t

Front 113

110. give sulfasalazine (for bowel inflammation) 2 hrs before meals

Back 113

t

Front 114

111. continent colostomy – cannot regulate bowels

Back 114

t

Front 115

112. to get someone to look at colostomy for 1st time – have them look at pictures

Back 115

t

Front 116

113. is someone has had diarrhea for 2 days

Back 116

– assess stool 1st. what are their regular habits? Not Gatorade

Front 117

114. hep A – give glucose not insulin

Back 117

t

Front 118

115. if irrigating a colostomy and the person starts to cramp –

Back 118

stop the infusion (not shift position)