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215 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What med do you use for endoscopy?
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valium
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What's most imp NI post op endoscopy?
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Assess gag reflex
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What kind of colostomy can be self-regulated by pt?
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descending colonostomy
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What are 3 bad parts of getting an ileostomy?
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1. prone to dehydration
2. ADEK deficiency 3. greater chance of excoriation |
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With what type of ostomy are you prone to dehydration & ADEK deficiency?
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ileostomy
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What GI drug can cause Tardive Dyskinesia?
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Reglan
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What's a psych s/e of Reglan?
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tardive dyskinesia
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Tagament - uses? x3
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duodenal ulcer,
ulcer prophylaxis, GERD |
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Tagement - s/e? x5
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dizzy,
HA, agitation, thrombocytopenia, gynecomastia |
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Tagament - NI?
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Take w/ food,
assess for gynecomastia, breast pain, impotence, avoid alcohol, take 1 hour before or 2 hours after antacids |
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What do the chemicals Secretin and cholecystokinin do to the esophagus?
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v pressure in LES
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If you suspect hiatal hernia, what do you want to be sure to r/o? x3
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peptic ulcer, angina, gallbladder disease
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What are 3 drugs that ^ LES pressure?
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Urecholine, Propulsid, Reglan
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What do the following drugs do that's in common?:
Urecholine, Propulsid, Reglan |
^ LES pressure
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What's are two elements to the proper diet for GERD?
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high protein,
low fat |
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Why use Reglan for GERD?
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^ LES pressure
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^ or v LES pressure:
secretin? |
decrease
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^ or v LES pressure:
cholecystokinin |
decrease
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^ or v LES pressure:
theophylline |
decrease
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^ or v LES pressure:
valium |
decrease
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^ or v LES pressure:
morphine |
decrease
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^ or v LES pressure:
B-adrenergic blockers |
decrease
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^ or v LES pressure:
Calcium channel blockers |
decrease
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^ or v LES pressure:
Nitrates |
decrease
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^ or v LES pressure:
Urecholine |
increase
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^ or v LES pressure:
propulsid |
increase
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^ or v LES pressure:
reglan |
increase
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^ or v LES pressure:
fat |
decrease
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^ or v LES pressure:
chocolate |
decrease
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What are foods to avoid r/t GERD?
h |
"CATNAP"
Chocolate, caffeine Alcohol Theobromine, tea Nicotine Anticholinergics Progesterone, Peppermint |
"CATNAP"
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What are two drugs that don't effect LES directly used for GERD? (one general, one specific)
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Antacids,
Tagament |
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When do you give antacids for GERD during the day? x3
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1 hr after meals,
bedtime, prn |
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What's the following describe?:
absence of peristalsis in the lower 2/3 of esophagus? |
achalasia
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What's a common GI disorder that people show up w/ at the ED thinking it's an MI?
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achalasia
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What are four clinical manifestations of ACHALASIA?
h |
- dysphagia, gradual onset
- wt loss - substernal CP - Regurg of esophageal |
- eating
- wt - pain - night |
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When is regurg worse r/t achalasia?
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at night
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What kind of diet for achalasia?
x2 |
semi-soft,
bland |
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What can pt w/ achalasia do at meals to help? x2
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drink fluids,
use Valsalva's |
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What's the following describe?:
outpouching of esoph above the upper esoph sphincter? |
Zenker's diverticulum
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What are 2 risk factors of esoph diverticulum?
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1. regurg'd material aspirated into lungs
2. enlarged diverticulum my obstruct esophageal |
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Assessment for esoph diverticulum?
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- pain on swallow
- regurg - gurgling sound over diverticulum - cough - foul breath - wt loss, weakness, anemia |
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What esoph disorder might you have pain on swallow?
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esophageal diverticulum,
Zenker's diverticulum |
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What GI disorder might you have if gurgling noise over esophagus?
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esophageal diverticulum,
Zenker's diverticulum |
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How do you dx esophageal diverticulum, Zenker's diverticulum?
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barium swallow (upper GI series)
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What does the following describe?:
progressive dysphagia, regurg, foul breath & taste, coughing and pneumonitis form aspirated fluids |
esoph cancer
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What pathology predisposes to esophageal cancer?
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achalasia
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Achalasia predisposes to what disease?
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esoph CA
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What are 3 dx tests for esoph CA?
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barium swallow,
biopsy w/ endoscopy, CT scan |
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If po nutrition poss, what's good before surgery for esoph CA?
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high protein,
high calorie |
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What 3 elements of nsg care pre op for esoph CA esoph?
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1. improve nutritional status
2. oral hygiene 3. admin antibiotics |
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What's post op diet for esoph CA surgery?
x4 |
clear, soft, bland diet;
small feedings |
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What do you HAVE to do before po anything post surgery?
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Auscultate bowel sounds and
Gag reflex |
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What are two things to assess for post esoph CA surgery?
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1. signs of intolerance
2. leakage of feeding into mediastinum |
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What are 2 signs of intolerance post esoph CA surgery?
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vomiting,
gastric distention |
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What are sym of leakage of feeding into mediastinum r/t esoph CA surgery? x3
h |
pain,
^ temp, dyspnea |
all things you could find on regular head-to-toe ass?
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What are 5 high risk dietary habits for gastric CA?
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smoked,
highly salted (poss w/ nitrates), spicy foods; antiinflammatory agents, alcohol |
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What pathology predisposes to gastric CA the most?
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pernicious anemia
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What does pernicious anemia predispose to?
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gastric CA
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Pernicious anemia - 7 sym?
h |
weakness, sore tongue, paresthesia, DNV, cardiac failure
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strength,
mouth, CNS, GI x3, unique other sys affected |
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With what GI disorder in this unit might you get a sore tongue?
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pernicious anemia
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What's the one disorder from the first packet that has the sym of DIARRHEA?
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pernicious anemia
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What's the one disorder in this unit that you might see paresthesia?
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pernicious anemia
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With what GI disorder in this unit might you get CARDIAC FAILURE?
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pernicious anemia
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Gastric CA, what are clinical manifestations associated with specifically?
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location of the mass
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What set of sym is general for gastric CA?
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obstruction sym
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What are 2 sym r/t esophagogastric junction tumors?
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progressive dysphagia,
wt. loss |
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What are 4 early signs of CA of pylorus?
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mimic sym of peptic ulcer;
epigastic pain, NV |
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What 5 later signs of CA of pylorus?
h |
early satiety,
anorexia, NV, constipation |
all have to do with GI directly and are r/t eating in general
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1. What is a sym of gastric CA that often goes unnoticed until later signs appear?
2. What can that lead to? 3. If it's way more noticeable, how can it manifest? x2 |
1. occult bleeding,
2. can lead to anemia 3. massive hematemesis or melena |
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What is one risk factor for colorectal CA?
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polyps
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What can polyps be a precursor for?
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colorectal CA
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What are 3 factors or conditions that can lead to colorectal CA (not polyps)?
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ulcerative colitis > 10 yrs,
Crohn's disease, dietary factors |
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What are three dietary factors that can lead to colorectal CA?
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high saturated fat,
lots of meat, low in fiber |
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What are 4 clinical manifestations of colorectal ca (not r/t elimination patterns)?
h |
significant blood loss,
anemia, weakness, (all right-sided) obstruction (left-sided) |
x3 have to do with blood,
x1 is causes many other problems |
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What are 3 sym of rectal ca that pt could notice at home r/t elimination patterns (not habits)?
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1. alternating diarrhea & constipation
2. incomplete emptying 3. constant fecal urgency |
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What are 3 warning signs for colorectal cancer?
h |
rectal bleeding,
cramping abdominal pain, change in bowel habits |
x2 butt
x1 belly |
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If pt presents w/ the following, what could you suspect?:
rectal bleeding, cramping abdominal pain, change in bowel habits |
colorectal ca
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What could you suspect if pt presents w/ fecal urgency?
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rectal ca
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What are two GI disorders that might present alternating diarrhea & constipation?
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colorectal ca,
celiac disease |
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If receiving radiation for colorectal ca, what do you want to avoid taking?
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Pepto Bismol (conc radiation)
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When is Pepto Bismol contraindicated r/t GI disorders?
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if receiving radiation for colorectal ca
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What foods do you encourage for client w/ diarrhea r/t pelvic radiation?
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pasta, rice, cheese, dairy products
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What do you want to document r/t changing bowel habits in colorectal ca?
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volume and consistency of stools
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What are two risk factors r/t pancreatic ca?
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smoking,
high fat diets |
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To what disease do smoking and high fat diets predispose?
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pancreatic ca
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What are early sym of pancreatic ca?
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mild and non-specific
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What are 5 (now 7) sym of late pancreatic ca?
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"JAWBONE"
Jaundice Abdominal pain Weight loss Back pain Obstruction of biliary Not eating (anorexia Extra tired |
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What's the diet for pt w/ pancreatic ca?
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low-fat
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If pt has back and abdominal pain and is jaundiced, what could you suspect?
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pancreatic ca
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What are 2 empirical s/s r/t hyperglycemia?
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polydipsia,
polyuria |
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What with you have to admin if pt underwent pancreatic resection?
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pancreatic enzymes
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What is the name of obstructions caused by issues with muscles in the bowels, not a px blockage?
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functional obstruction
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What is the name of obstructions that are actual px blocks in the intestines?
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mechanical obstruction
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What is a functional obstruction?
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neuromuscular or vascular disorder
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What is a mechanical obstruction?
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occlusion of bowel lumen
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What are 10 sym of bowel obstructions?
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"OVERINFLATED"
Obstipation Vomiting E Rock hard abdomen Inability to fart Nausea Fecal vomiting Lacks peristalsis Abdominal pain Tinkling bowel sounds E Distention |
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What's the following describe?
blood supply to lower part of jejunum and ileum is interrupted. Intestine walls thicken and turn edematous, reddened, black and gangrenous |
mesenteric vascular occlusion
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What causes gangrene in the intestines?
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mesenteric vascular occlusion
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What's the basic definition for mesenteric vascular occlusion?
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blood supply loss leads to inflamed or gangrenous intestine
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What could an acute, sharp pain between xiphoid and umbilicus w/ absence of bowel sounds indicate?
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sudden occlusion r/t mesenteric vascular occlusion
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What are sym r/t partial blockage in mesenteric vascular occlusion?
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crampy and colicky pain after eating
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What are the 5 sym of sudden mesenteric vascular occlusion?
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"SANDE"
Sharp pain between xiphoid & umbilicus, Absent BS NV Distended abd Elev WBC |
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What is a life-threatening nsg dx if pt has severe abdominal distention unrelated to GI sys?
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ineffective breathing pattern
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What is a systemic risk r/t mesenteric vascular occlusion?
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septicemia
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What is are 4 nsg dx r/t mesenteric vascular occlusion?
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pain,
fluid volume deficit, altered tissue perfusion, ineffective breathing pattern |
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What are two conditions to assess r/t fluid volume deficit in mesenteric vascular occlusion?
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hypovolemia,
electrolyte imbalance |
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What is the po alimentation status of pt with full mesenteric vascular occlusion?
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NPO, not even ice chips
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What are three serious conditions to assess for when tissue perfusion is altered r/t mesenteric vascular occlusion?
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intestinal ischemia,
perforation, septicemia |
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What GI disorder could you suspect if GI pt is going into hypovolemic shock?
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mesenteric vascular occlusion r/t 3rd spacing
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What are 6 s/s r/t septicemia in mesenteric vascular occlusion?
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"THe FLAT"
Tachycardia, tachypnea Hypotension, Fever Leukocytosis Abdominal pain Tender & distended abdomen |
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What must pt do after herniorrhaphy before they can go home?
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void
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How long must pt avoid heavy lifting, pulling or pushing r/t herniorrhaphy?
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6 wks
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TCDB, which one can't a post hernia surgery pt do?
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cough
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What are 3 disease that leave pt prone to lactase deficiency?
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celiac, crohn's, ulcerative colitis
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Post esoph surgery, if pt presents w/ pain, pyrosis, dyspnea, what could you suspect?
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leakage of feeding into mediastinum
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If pt presents s/s of leakage of feeding into mediastinum post esoph surgery, what do you want to be sure to rule out?
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peritonitis
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If pt presents w/ pyrosis, if not GERD, what coud it be?
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axial (sliding) hernia
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What are 4 s/s of axial (sliding) hernia?
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pyrosis,
regurgitation, dysphagia, or asymptomatic |
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What are two s/s of paraesophageal hernia?
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asymptomatic, or
pt experiences fullness after eating |
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What complications can occur r/t paraesophageal hernia? x3
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hemorrhage,
obstruction, strangulation |
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What's Rx for Zenker's Diverticulum?
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surgery
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What are 7 sym of celiac sprue?
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Abdominal distention
Bloating Steatorrhea E N T Malabsorption I N Deficiency of Vit B, D, K E Diarrhea w/ alternating constipation Loss of weight Y *Now you can't eat wheat ABSENTMINDEDLY anymore* |
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Pt must avoid all grains, except what 2 r/t celiac sprue?
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corn and rice
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What are 2 forms of ca that untreated celiac disease can be associated with?
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lymphoma and carcinoma of the
small intestine |
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What should you teach pt to look for after barium tests?
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white or pink stool
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What's priority NI after barium tests?
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avoid constipation
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5-Flourouracil, use cautiously in: x4
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renal & hepatic impairment,
infections, edema, ascites |
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5-Flourouracil, assess for s/s of:
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toxicity
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What are 2 key signs r/t toxicity with 5 Flourouracil?
How long can that take to show up? |
stomatitis and diarrhea,
may take 1 to 3 weeks to show |
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5-Flourouracil, CNS s/e: x1
H |
acute cerebellar syndrome
(super dizzy) |
Flourourourourourouracil... Woaw I'm getting dizzy.
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Super dizzy (acute cerebellar syndrome) - assoc w/?
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5-Flourouracil
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If pt develops stomatitis and diarrhea 3 weeks after chemo, what drug would you suspect?
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5-Flourouracil
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5-Flourouracil, hematopoeitic s/e: x2
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leukopenia, thrombocytopenia
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5-Flourouracil, GI s/e: x1
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GI bleeding
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What are 2 drug interactions for 5-Flourouracil?
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leucovorin calcium,
live virus vaccines |
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What is priority nsg ass r/t erlotinib (Tarceva)?
H |
respiratory assessment
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Think of the lung issues you'd have if you had loads of TAR in your lungs from smoking.
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What drug might cause interstitial lung disease?
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erlotinib (Tarceva)
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For what ca is 5-Flourouracil used?
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colorectal ca
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What is the colorectal cancer drug we have to know?
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5-Flourouracil
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What are the two Pancreatic Cancer Meds?
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Tarceva,
Gemzar |
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What drug could put pt into bronchospasm?
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Gemzar
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What system is at risk with Gemzar (besides immune and resp)?
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renal
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Gemzar - assoc w/ what unique sym?
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hemolytic uremic syndrome
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hemolytic uremic syndrome - assoc w/?
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Gemzar
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What is particular nsg imp r/t Gemzar?
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monitor temp esp during 1st 12 hours of tx
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What are 3 life-threatening s/e of Taxotere?
h |
cardiac tamponade,
pulmonary edema, bronchospasm |
Picture your W-2s and 1099s filling up thoracic cavity and your lungs seizing
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What count to you want to know prior to admin of Taxotere?
What range is contraindicated? |
neutrophil count
< 1,500 cells/mm3 |
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What drug may cause cardiomyopathy or CHF, more common in children?
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Adriamycin
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What's the sys most threatened by s/e of Adriamycin? x1
Examples? x3 |
cardiovascular:
arrhythmias, cardiomyopathy, heart failure |
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r/t gastrectomy, from where and what drainage may you see indicating septicemia?
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gastic fluid thru
sump or penrose drain |
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What are 5 ways to monitor hemodynamic status r/t gastrectomy?
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Swan-Ganz or
CVP reading, UO, BP, P |
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There are two syndromes that can follow a gastrecomy:
what's the earlier one? what's the later one? |
early: postprandial dumping syndrome
later: reactive hypoglycemia |
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what are signs of postprandial dumping syndrome r/t gastrectomy?
h |
sweating, DNV, weakness
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picture being in the old west, hung on a "post" at high noon... you'd prob be sweaty and weak and have DNV
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What are 4 dietary interventions rt postprandial dumping syndrome?
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1. small feedings
2. low CHO 3. high fat 4. high protein |
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What are two drugs might you admin for postprandial dumping synd? (general category & specific)
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Sandostatin,
anticholinergic drugs |
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For what is Sandostatin ordered?
What's it do? |
postprandial dumping syndrome,
alters intestinal motility and v hormonal response to distention |
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For what are anticholinergics ordered r/t gastrectomy?
What do they do? |
postprandial dumping syndrome,
reduce intestinal motility |
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If client has reactive hypo glycemia, what kind of food regimen might they be put on?
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meals: high protein, low CHO
between meals: glucose foods |
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What is a resulting & expected pathology from total gastrectomy?
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pernicious anemia
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When do you want to avoid fluids during meals?
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w/ diarrhea r/t gastrectomy
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When oral feedings are initiated after gastrectomy, what do you monitor for r/t compromised nutrient absorption?
h |
diarrhea, nausea, flatulence, cramping, anorexia
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similar to IBS
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If there is evidence of malabsorption after gastrectomy, what is your next move?
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collaborate w/ DR, dietician, client
to dev plan for short bowel syndrome |
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What are 5 s/s of short bowel syndrome?
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steatorrhea,
wt. loss, malabsorption, malnutrition, F&E imbalance |
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What do you suspect if the following occurs post gastrectomy?
steatorrhea, wt loss, malabsorption, malnutrition, F&E imbalance |
short bowel syndrome
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When is TPN indicated?
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when client cannot get adeq oral nutrition w/in 7 days
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What 6 things does TPN contain?
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water,
glucose, amino acids, vitamins, electrolytes, calories |
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Where are 3 places you can stick TPN w/ glucose?
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subclavian vein,
internal jugular vein, PICC |
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What's PICC stand for?
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peripherally inserted central catheter
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What are 2 things not put into line used for TPN?
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lipids,
meds |
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What are 3 TPN catheter insertion complications?
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pneumothorax,
hemothorax, hydrothorax |
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What are 5 common s/s of TPN catheter insertion complications?
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CP,
v breath sounds, shallow rapid respirations, dyspnea, cyanosis |
ouch
breathing related x3 color |
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If you note backache during TPN tx, what could you suspect?
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infection
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If you note flushed face during TPN tx, what could you suspect?
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infection
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What's a complication r/t TPN infusion in the first 48 hours?
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refeeding syndrome
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What's refeeding syndrome?
(who gets it? what happens to them? when's it happen?) |
clients on TPN that are malnourished during first 48 hours
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What are 4 conditions r/t refeeding syndrome?
h |
hypophosphatemia,
hypomagnesemia, hypocalcemia, hyponatremia |
refeed the hungry hungry hypos
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How many calories are in TPN?
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1 calorie/cc
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What % of TPN can be glucose?
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15-40%
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What % of TPN can be amino acids?
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4%
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If during TPN, you note the following, what's it imply:
chest pain |
cath insertion complications
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If during TPN, you note the following, what's it imply:
v breath sounds |
cath insertion complications
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If during TPN, you note the following, what's it imply:
shallow rapid resp |
cath insertion complications
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If during TPN, you note the following, what's it imply:
dyspnea |
cath insertion complications
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If during TPN, you note the following, what's it imply:
cyanosis |
cath insertion complications
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If during TPN, you note the following, what's it imply:
chills |
infection
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If during TPN, you note the following, what's it imply:
fever |
infection
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If during TPN, you note the following, what's it imply:
malaise |
infection
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If during TPN, you note the following, what's it imply:
HA x2 |
infection or hyperglycemia
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If during TPN, you note the following, what's it imply:
flushed face |
infection
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If during TPN, you note the following, what's it imply:
backache |
infection
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If during TPN, you note the following, what's it imply:
hypotension |
infection
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If during TPN, you note the following, what's it imply:
resp depression or failure x2 h |
refeeding syndrome, specifically
hypophosphatemia |
The tween couldn't breath b/c she was so excited about getting her new baby PHAT jacket
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If during TPN, you note the following, what's it imply:
lethargy x2 h |
refeeding syndrome, specifically
hyponatremia |
"I'm too lazy to pass the damn salt"
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If during TPN, you note the following, what's it imply:
confusion x5 |
refeeding syndrome, and all the electr's
hyponatremia, hypocalcemia, hypomagnesemia, hypophosphatemia |
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If during TPN, you note the following, what's it imply:
weakness |
refeeding syndrome,
hyperglycemia, hypophosphatemia |
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If during TPN, you note the following, what's it imply:
cardiac arrest |
refeeding syndrome
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What are 4 categories of complications r/t TPN?
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1. Cath insertion complications
2. Infection 3. Refeeding syndrome 4. Metabolic complications |
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How can you avoid refeeding syndrome? x3
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start TPN slow,
1000 cal / 1st 24 hours, monitor serum electrolytes |
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When would you remove catheter during TPN tx?
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if s/s of infection
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Protein r/t TPN - check what?
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kidney function (BUN/creat)
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1. What's the implication if during TPN client presents: nausea, weakness, polydipsia, polyuria, HA
2. What are 2 NI? |
1. May only be transient hyperglycemic state at start of tx
2. slow infusion rate & admin insulin |
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During TPN, presents fatty liver syndrome, NI?
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cyclic TPN as ordered
(cycle lipids then dextrose TPN) |
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What conditions put pt at risk for rise in serum triglyceride & cholesterol r/t TPN?
NI? |
AIDS & cardiac conditions,
v fat emulsion |
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What are s/s hyponatremia r/t TPN tx?
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"CLAC"
Confusion Lethargy Abdominal... ...Cramps |
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What are s/s hypocalcemia r/t TPN tx?
h |
"IMPACT"
I Muscle cramps Paresthesia A Convulsions, confusion Tetany, tachycardia *Think of the impact of a big dinosaur bone hitting you in the head |
*Think of the impact of a big dinosaur bone hitting you in the head
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During TPN tx, what could you suspect if:
nausea |
hyperglycemia
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During TPN tx, what could you suspect if:
tachycardia x2 |
hypocalcemia,
hypomagnesemia |
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During TPN tx, what could you suspect if:
abdominal cramps |
hyponatremia
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During TPN tx, what could you suspect if:
tetany |
hypocalcemia
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During TPN tx, what could you suspect if:
muscle cramps |
hypocalcemia
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During TPN tx, what could you suspect if:
muscle spasms |
hypomagnesemia
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During TPN tx, what could you suspect if:
tremors |
hypomagnesemia
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During TPN tx, what could you suspect if:
paresthesia x2 |
hypocalcemia,
hypophosphatemia |
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TPN, what size filter if no fat?
what size if yes fat? |
no fat: 0.22 micron
fat: 1.2 micron |
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What are 2 GI disorders that might cause steatorrhea?
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celiac disease,
short bowel syndrome |
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