Nclex Review Gastrointestinal

Front 1

Antacids

Back 1

neutralize acid and have a protective action on the stomach.

Front 2

When do you give antacids

Back 2

one to two hours before or after other medications and with eight ounces of water unless contraindicated.

Front 3

Giving antacids with other meds may result in

Back 3

less effectiveness of the other drugs due to binding effects.

Front 4

Antacid medications are

Back 4

Aluminum carbonate (Basaljel), Aluminum hydroxide gel (Amphojel), Aluminum and magnesium combos (Maalox, Mylanta) Calcium Carbonate (Tums), Magnesium hydroxide (Milk of Magnesia), Magnesium oxide (Mag-Ox), Hydroxymagnesium aluminate (Riopan), Sodium bicarbonate

Front 5

Lab effects of antacids

Back 5

electrolyte imbalances

Front 6

H – 2 blockers do what

Back 6

reduce acid in the stomach by blocking the acid producing cells

Front 7

H – 2 blockers should not be taken

Back 7

within one hour of other medications

Front 8

H – 2 blocker meds are

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Cimetiding (Tagamet), Famotidine ( Pepsid), Nizatidine (Axid), Ranitidine (Zantac)

Front 9

H 2 blocker meds tend to end in

Back 9

tidine

Front 10

Lab effects of H-2 blockers are

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Inc. BUN, Creatinine and LFTs. Decreased WBC, RBC, and platelets

Front 11

Proton pump inhibitors do what

Back 11

prevent the acid producing pump from working in the stomach.

Front 12

If a client is on a drug that teats gastric acid production then other meds may be

Back 12

irritating to their stomach.

Front 13

Drug of choice for pain if pt. is on proton pump inhibitors

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Acetaminophen (Tylenol), due to it not being irritating. Ibuprofen (Motrin) can be irritating.

Front 14

Proton Pump Inhibitor meds are

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Omeprazole(Prilosec), Pantpraazole (Protonix), Lansoprazole (Prevacid), Esokeprazole (Nexium), Rabeprazole (Aciphex)

Front 15

Proton Pump Inhibitor tend to end in

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prazole

Front 16

Lab effects of Proton Pump inhibitors

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Dec. WBC, RBC and platelets

Front 17

Antiemetics do what

Back 17

block the chemicals and the pathways to the brain which cause nausea.

Front 18

Side effects of antiemetics are

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dizziness, dowsiness and disorientation.

Front 19

Neuroleptic agents can cause

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extrapyramidal symptoms, hypotension and tachycardia.

Front 20

Antiemetic medications

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Prochlorperazine (Compazine), Perphenazine (Trilafon), Chlorpromazine (Thorazine), Promethazine (Phenergan)

Front 21

The prokinetic agent, metoclopramide (Reglan,Maxolon,Octamide) can cause

Back 21

hypotension and tachycardia.

Front 22

For nausea give fluids at

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room temperature or cold, NOT hot fluids.

Front 23

Additional antiemetic meds are

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Dronabinol (Marinol), Meclizine (Antivert), Odansetron (Zofran), Scopolaminem (Transderm-Scop).

Front 24

Antiflatuents

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Simethicone (Gas-X, Mylicon)

Front 25

Antidiarrheal adsorbents do what

Back 25

coat the intestinal wall and bind with causative bacteria and toxins to eliminate them from the GI tract through the stool.

Front 26

Anticholinergics and opioids do what to the GI

Back 26

decrease peristalsis and the intestinal muscle tone.

Front 27

Bacterial replacement agents help to

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reestablish the normal flora in the bowel and suppress the growth of diarrhea causing bacteria.

Front 28

Antidiarrheal meds are

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Attapulgite (Kaopectate),
Belladone alkaloids (Donnatol),
Bismuth subsalicylate (Pepto-bismol),
Diphenoxylate with atropine (Lomotil),
Kaolin and pectin with opium (Parepectolin),
Kaolin and pectin (Kaodene),
Lactobacillius acidophilus (Bacid, Lactinex),
Loperamide (Imodium),
Methycellulose (Citrucel),
Psyllium (Fiberall)

Front 29

Bulk forming laxatives do not give you

Back 29

diarrhea with their use.

Front 30

Bulk forming laxatives are

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Methylcellulose (Citrucel), Psyllium (Metamucil, Fiberall)

Front 31

Emollient (lubricant) laxatives

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help to decrease the surface tension of the stool and provide lubrication for easier passage.

Front 32

Emollient laxatives are

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Mineral oil (Agoral plain, Fleet Mineral Oil enema), Ducosate salts (Surfak, Colace, Dialose), Milk of Mag and mineral oil (Haley’s M-O)

Front 33

Hyperosmotic laxatives may do what

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inc. risk of fluid and electrolyte imbalances.

Front 34

Hyperosmotic laxatives are

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Polyethylene glycol (CoLyte, GoLytely), Lactulose (Chronulac, Duphalac, Enulose), Polyethylene glycol (MiraLax), Glycerin (Fleet Babylax, Glycerin, Sani-Supp).

Front 35

Saline laxatives are

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Magnesium citrate, Milk of Mag, Epsom salts, Haley’s M-O, Fleet Physpho-Soda, Fleet enema.

Front 36

Stimulant laxatives do what

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stimulate the nerves of the intestines resulting in an increase of peristalsis.

Front 37

Stimulant laxatives are

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Bisacodyl (Ducolax), Cascara sagrada Senna (Senokayot, Senolax), Aloe (casanthrol), Ex-Lax, Castor oil.

Front 38

Pancreatitis

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inflammation and autodigestion of the pancrease. Any enlargement of the pancrease causes the peritoneum to stretch tightly.

Front 39

Symptoms of pancreatitis

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acute pain in retroperitoneal area. Pain worsens when walking or lying flat. Steatorrhea can be present.

Front 40

Reduce symptoms of pancreatitis by have client

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sitting up or leaning forward to reduce pain

Front 41

Most common cause of Chronic calcifying pancreatitis

Back 41

Alcohol use

Front 42

Pancreatitis TX

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Demerol is the pain med of choice. NPO, IV fluids, H-2 blockers.

Front 43

Dietary Do’s for Pancreatitis

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Eat small frequent meals, High protein, Low fat, Moderate to high Carbs.

Front 44

Dietary Don’ts for Pancreatitis

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No ETOH, No coffee or tea, No spicy foods, No heavy meals

Front 45

Pancreatic cancer

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may need to remove head of pancreas, the stomach, the distal end of the duodenum and the spleen.

Front 46

Surgical procedure is called

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Pancreaticoduodenectomy (Whipple Procedure)

Front 47

After Whipple, the blood sugar may

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increase

Front 48

Esophageal cancer is usually found

Back 48

late in the course of the disease.

Front 49

Esophageal CA pt is at risk for

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malnutrition and enemia due to dysphagia. (Barrett’s Esophagus)

Front 50

Gastric cancer is usually diagnosed

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late due to nonspecific symptom

Front 51

Gastric CA is more likely to metastasize to

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the liver and lung

Front 52

Subtotal gastrectomy

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bile still flows into the duodenum

Front 53

Billroth I

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upperportion of stomach (pylorus) is removed. Lower stomach to duodenum

Front 54

Billroth II

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lower portion of stomach is removed. Upper stomach to duodenum

Front 55

Total gastrectomy

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Esophagojejunostomy, the entire stomach and duodenum is removed. Esophagus to jejunum.

Front 56

In a esophagojejunostomy

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the thoracic cavity is entered and pt. must have a chest tube afterwards.

Front 57

In gastric surgeries expect

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NG tube for all pts. Small amounts of bleeding in first 12 hours. Do not irrigate unless ordered. Dumping syndrome may develop.

Front 58

Dumping syndrome is

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when gastric contents dump too quickly into the duodenum usually after surgery or tube feeding. Goes in the right direction just too fast.

Front 59

Symptoms of Dumping syndrome are

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diarrhea, rigid abdomen and pain. Blood sugar depletes.

Front 60

Nursing interventions in dumping syndrome

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eat small frequent meals, decrease HOB for one hour after meal to make stomach empty slower. Drink fluids between meals and reduce carb intake.

Front 61

GERD and hiatal hernia

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regurgitation of acid into the esophagus. May be due to weakening of the esophageal sphincter and/or because the upper part of the stomach has herniated through the diaphragm.

Front 62

Interventions for GERD and hiatal hernia

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elevate HOB for 30-60 minutes after eating. Put bed on 4-6 inch blocks to decrease tracheal aspiration

Front 63

Dietary do’s for GERD

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small frequent meals, high protein, low fat, moderate to high carbohydrates, increase fluids with meals.

Front 64

Dietary don’ts for GERD

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No caffeine, No fruit juice except apple and No tomatoes

Front 65

Colorectal Cancer signs

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rectal bleeding and change in bowel habits

Front 66

Presurgical intervention

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give Antibiotics to decrease bacterial count in the GI tract

Front 67

Screening guidelines for colorectal CA

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DRE every year 40, OB every year after 50, Scope every 3-5 years after 50, based on physician recommendation.

Front 68

Dietary guidelines by the American Cancer Society to help prevent Colorectal CA

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Cruceferous vegetables from the cabbage family, Increased fiber intake, maintain average weight, eat less animal fat.

Front 69

Gastritis

Back 69

inflammation of the gastric mucosa of the stomach which can be acute or chronic.

Front 70

Chronic gastritis can lead to

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atrophy of the stomach.

Front 71

Stomach atrophy can lead to

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low levels of intrinsic factor,k which leads to the inability to absorb B12.

Front 72

Lack of B12 or absorption of B12 can lead to

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Pernicious anemia

Front 73

Ulcerative colitis

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bloody stools, a form of inflammatory bowel disease in which ulcers occur in the large intestines. Not considered to be autoimmune. Genetically linked. Anemia is present due to bleeding.

Front 74

Symptoms of ulcerative colitis

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gradual onset of diarrhea mixed with blood. Anemia. Serious complications include gangrene and toxic megacolon.

Front 75

Colectomy

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removal of the colon is occasionally necessary and it can be a cure

Front 76

Instruct patient to eat

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low residue foods that produce less fecal waste and decrease bowel contents. Protein promotes healing. Avoid spicy foods.

Front 77

Crohn’s disease

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form of inflammatory bowel disease which can affect any part of the GI system from the mouth to the anus.

Front 78

Characteristics of Crohn’s

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inflammation areas in between areas of normal lining in between known as skip lesions. Autoimmune disease that is genetically linked. Surgery is NOT a cure for Crohn’s.

Front 79

Think of Crohn’s as cobblestone because

Back 79

it extends through the bowel wall and has cobblestone appearance.

Front 80

Clinical manifestations of Crohn’s

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abdominal pain, diarrhea, constipation, vomiting, weight loss or weight gain.

Front 81

Extracolonic complications of Crohn’s

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skin rashes, arthritis, inflammation of the eye.

Front 82

Irritable bowel syndrome

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functional bowel disorder characterized by abdominal pain, bloating and alternating constipation and diarrhea. Pain is unrelated to meals or activity and is usually relieved with defecation.

Front 83

Diverticulosis

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presence of pouches in the wall of the intestines. Due to weakening of the wall due to aging.

Front 84

Diverticulitis

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inflammation of the pouches leading to pain and potential perforation of the bowel.

Front 85

Diverticulitis is common in what population

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the elderly

Front 86

Diverticulitis pain is typically located where

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LLQ, lower left quadrant, Sigmoid colon area.

Front 87

Dietary considerations for Diverticulitis Acute phase

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NPO then liquids

Front 88

Dietary for Diverticulitis Recover phase

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no fiber or foods that irritate the bowel.

Front 89

Dietary for Diverticulitis Maintenance phase

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high fiber diet with bulk forming laxative to prevent pooling of foods in the pouches where they can become inflamed. Increase fluids to 3 liters per day. Decreased fluids puts patient at risk for constipation.

Front 90

Inguinal hernia

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is a protrusion of the abdominal cavity contents through the inguinal canal.

Front 91

Inguinal hernias can become

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incarcerated or strangulated

Front 92

Problems after surgery for hernia repair include

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voiding problems and scrotum frequently swells after surgery.

Front 93

Cholecystitis

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inflammation of the gallbladder usually due to gallstones blocking the ducts.

Front 94

Risk factors for Cholecystitis

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Fair, Fat, 40, Fertile, Female

Front 95

Lab effects of Cholecystitis

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Inc. ALP, AST, Total and direct bilirubin. Increased WBC during attack.

Front 96

Non surgical management of cholecystitis

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low fat diet, medications for pain and clotting if required. Decompression of the stomach via NG tube.

Front 97

Surgical management of cholecystitis

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Lithotripsy and Cholecystectomy.

Front 98

Hepatitis

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inflammatory cells in the liver tissue resulting in injury to the liver.

Front 99

Acute hepatitis

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last less than 6 months

Front 100

Chronic hepatitis

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lasts longer and persists for more than six months

Front 101

Hepatitis causative factors

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viruses, toxins such as alcohol, other infections or from an autoimmune process.

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Most common type of Hepatitis

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Type A. Needs contact precautions and thorough hand washing.

Front 103

Lab effects of Hepatitis

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Inc. ALT, ALP, AST, Total and indirect bilirubin

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Bilirubin effects on skin

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yellow skin, yellow sclera of the eyes and mucous membranes

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Bilirubin in the urine

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dark colored urine

Front 106

Absence of bilirubin in stools

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chalky or clay colored stools. Impaired absorption of Vitamin K because it is fat soluble and needs the bile.

Front 107

Other manifestations of Hepatitis

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Nausea, typically later in day, Fatigue is a major problem. Depression is not uncommon.

Front 108

Danger signs that Hepatitis is worsening include

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lethargy, bleeding an fluid retention.

Front 109

Diet for Hepatitis should be

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high in calories and carbohydrates to promote healing. Low fat diets are better tolerated due to changes in fat absorption.

Front 110

Cirrhosis and hepatic failure

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widespread nodules in the liver combined with fibrosis most often caused by hepatitis C and alcoholism.

Front 111

Hepatic failure

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broad term used to describe the failure of the liber to perform essential functions due to disease of the organ or acute injury unrelated to liver disorders.

Front 112

Lab effects of Cirrhosis and hepatic failure

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Inc. LFT, ammonia, PT and INR, Decreased total protein, albumin and platelets.

Front 113

Clinical manifestations include

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ascities, fetor hepaticus, vascular lesions.

Front 114

Ascities is

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enlarged liver places pressure on the portal system causing inc. hydrostatic pressure

Front 115

Fetor hepaticus is

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breath odor of chronic liver disease caused by the liver’s inability to detoxify mercaptan from the breakdown of protein.

Front 116

Vascular lesions are

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spider angiomas and telangiectasis on the hands and face.

Front 117

Hepatic encephalopathy

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confusion caused by liver impairment and accumulations of toxins in the brain. If portal hypertension is present, the blood from the intestines is not able to be filtered by the liver. Ammonia level increase.

Front 118

Clinical manifestations of Hepatic encephalopathy

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impaired cognition and confusion, Decreased LOC and coma, neuromuscular disturbances, Asterixis (Liver flap), muscle tremor associated with toxins in the blood and Cerebral edema.

Front 119

Causes of increasing ammonia levels in clients with cirrhosis

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inc. protein, infection, hypovolemia, hypokalemia, GI bleeding.

Front 120

Ways to decrease ammonia levels

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restrict protein in the diet, neomycin to reduce bacterial action in the bowel which leads to a dec. in ammonia. Lactulose also given to reduce level (lactulose makes the pH more acidic and ammonia moves out. It can cause nausea)

Front 121

Esophageal varices

Back 121

dilated veins in the esophagus which are at risk for bleeding.

Front 122

Esophageal varices occurs as a results of

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high pressure in the liver.

Front 123

To decrease esophageal varices

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avoid anything that increases intra-abdominal pressure such as straining, coughing, sneezing and bending over.

Front 124

In order to stop bleeding associated with esophageal varices

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use a Blakemore-Sengstaken tube or direct injection of vasopressors to stop bleeding.

Front 125

Triple lumen tube used to

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compress esophageal varices with a balloon.

Front 126

First lumen of triple lumen is

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esophageal compression balloon

Front 127

Second lumen of triple lumen is

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stomach compression balloom

Front 128

Third lumen of triple lumen is

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decompression of the stomach (NG tube)

Front 129

In order to remove fluid from ascities

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paracentesis frequently needed

Front 130

Peritoneovenous shunts such as LaVeen and Denver may be indicted for

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long term drainage of fluids.

Front 131

Additional needs in esophageal varices

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Vitamin K due to inability of liver to produce sufficient amounts. Blood transfusions due to blood loss. Supplemental albumin due to levels being low.

Front 132

Dietary considerations for esophageal varices

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restrict sodium and possibly fluids. Diet should have carbs to maintain weight and rebuild tissue but not enough protein to cause encephalopathy. Total daily caloric intake should be 2,000 – 3,000 kCals.

Front 133

Peptic Ulcer disease

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erosion of the lining of the stomach or duodenum. Will heal with medical treatment

Front 134

Pain in peptic ulcer disease

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described as gnawing, burning or craming epigastric or boring pain in the back.

Front 135

Eating considerations with peptic ulcers

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eat smaller portions of food to keep the gastric secretions neutralizied.

Front 136

Water intake in peptic ulcer disease

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should be 2,000 mls daily

Front 137

Stress and ulcers

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stress can cause exacerbations. Teach stress reduction methods. Encourage those with a family hx of ulcers to be screened..

Front 138

Symptoms of gastric ulcers

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burning left epigastric pain, weight loss, food aggravates pain, no pain at HS.

Front 139

Symptoms of duodenal ulcers

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right epigastric pain, weight gain, eating decreases pain, Pain 2-4 hours after meals. Pain at HS

Front 140

Stress (Curling’s) ulcer

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ulcers due to decreased perfusion to the mucosa due to vasoconstriction.

Front 141

Peritonitis

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infection of the peritoneal cavity due to contamination of the contents of an organ into the cavity.

Front 142

Risk factors for peritonitis

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Perforation from trauma, ulcer, appendix and diverticulum, Previous abdominal surgery with possible fistula formation, Ectopic pregnancy, Giving opiates which decreases motility. A distended intestinal wall accompanied by dec. motility may lead to perforation.

Front 143

Clinical manifestations of peritonitis

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anorexia, nausea and vomiting, dehydration, decreased or absent bowel sounds, rigid abdomen, increased pulse and BP.

Front 144

Nursing interventions in peritonitis

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maintain fluid and electrolyte balances, NG to suction to decompress bowel, antibiotics, semi-fowler’s position, prevent complications of immobility.

Front 145

Labs and diagnostics of GI

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colonoscopy, gastroscopy, oral chlolecystogram, Upper GI series, CT scan of abdomen, Liver biopsy, Endoscopic retrograde cholangiopancreatography (ERCP)

Front 146

Colonoscopy

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lie on left side

Front 147

Gastroscopy

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monitor for abdominal distention

Front 148

Oral cholecystogram

Back 148

iodine containing material is used. Excreted by liver and concentrated in the gallbladder. The normal gallbladder fills with contrast medium. If gallstones present, they appear as shadows on the radiograph. Monitor for GI complaints after such as pain, nausea, and vomiting., Can resume usual diet once GI function has returned.

Front 149

Upper GI series and barium swallow

Back 149

Takes 5-6 hours, series of x-rays follow the barium through the GI tract. Enemas and laxatives are not giving in prep of the procedure. Give a laxative after is barium used due to it causing constipation. The client will be NPO before test.

Front 150

CT scan of the abdomen

Back 150

if a liver study, will get an IV contrast.

Front 151

Liver biopsy

Back 151

small amount of bile colored draining may occur in some clients, will low in the dorsal recumbent position during procedure. Position client on right side after procedure.

Front 152

Endoscopic retrograde cholangiopancreatography (ERCP)

Back 152

scope is placed into gallbladder, stones are crushes and left to pass on their own, takes about 1 hour to perform, IV sedation is given, back of throat is sprayed, pt. may feel sick after procedure

Front 153

Clinical correlations of the GI tracts

Back 153

normally loses 100-200 ml of fluid daily, Filters up to 8 liters a day thus making it possible to lose very large amounts of fluid if vomiting and diarrhea occur.

Front 154

Miller-Abbott tube or Cantor tube

Back 154

mercury weighted nasoenteric tube used to decompress the bowel in an obstruction

Front 155

Miller-Abbott tube is inserted by

Back 155

a physician with the client in high fowlers position to decrease risk of aspiration. Client is then to lie on right side in order to facilitate movement of the tube from the stomach to the intestines.

Front 156

NG tube and tube feeding, how do you check placements

Back 156

prior to feeding and via X-ray

Front 157

If NG tube becomes clogged you should

Back 157

aspirate and then flush with warm water.

Front 158

If client gags during procedures with NG tube have them

Back 158

take deep breaths

Front 159

After an open cholecystectomy the client will have

Back 159

an NG tube

Front 160

In clients with abdominal pain it is common for them to have

Back 160

NG tube and IV. Narcotics may or may not be given

Front 161

When removing NG tube have the client

Back 161

take a deep breath and hold it.

Front 162

How often to you check for residual with a continuous feed

Back 162

every 4 hours and before every feed if on intermittent.

Front 163

When would you hold a feed

Back 163

if the residual is greater than 100 mls

Front 164

How often do you change bag and tubing

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completely changed every 24 hours with tube feeds.

Front 165

If on long term tube feedings client may need

Back 165

2 – 4 liters a day of fluid and adequate fiber to maintain regularity

Front 166

When on low intermittent suction the maximum should be

Back 166

25 mm

Front 167

When giving enemas to clear bowel how many would you give

Back 167

no more than 3

Front 168

If client has colostomy or stoma

Back 168

stoma appearance should be evaluated,.

Front 169

When apply the bag to a stoma

Back 169

cut the appliance 1/8 inch larger than the stoma. Stoma adhesive is good to use.

Front 170

How often should you empty a colostomy bag

Back 170

when one-third to one-half full.

Front 171

If a sigmoid resection with a colostomy is done the pt

Back 171

may not need to wear a bag due to sold feces.

Front 172

In general the diet of patient that has had a colostomy

Back 172

does not change. Just watch for gas and odor-forming foods.

Front 173

Foods that help eliminate odors from colostomy include

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yogurt, buttermilkd, spinach, beet greens and parsley.

Front 174

Foods that cause odors in colostomy include

Back 174

alcohol, beans, turnips, radishes, asparagus, onions, cucumbers, mushrooms, cabbage, eggs, fish, broccoli.

Front 175

For a pt. with a T-tube

Back 175

cleanse around the site to prevent skin breakdown, do not irrigate, expect to drain 300 – 500 mls of bile in the first day after cholecystectomy.

Front 176

After a spleenectomy the client is as risk for

Back 176

inadequate lung aeration due to pain and decreased expansion.

Front 177

The two types of surgery that are the most painful are

Back 177

Thoracic and abdominal surgeries