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215 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
What med do you use for endoscopy?
valium
What's most imp NI post op endoscopy?
Assess gag reflex
What kind of colostomy can be self-regulated by pt?
descending colonostomy
What are 3 bad parts of getting an ileostomy?
1. prone to dehydration
2. ADEK deficiency
3. greater chance of excoriation
With what type of ostomy are you prone to dehydration & ADEK deficiency?
ileostomy
What GI drug can cause Tardive Dyskinesia?
Reglan
What's a psych s/e of Reglan?
tardive dyskinesia
Tagament - uses? x3
duodenal ulcer,
ulcer prophylaxis,
GERD
Tagement - s/e? x5
dizzy,
HA,
agitation,
thrombocytopenia,
gynecomastia
Tagament - NI?
Take w/ food,
assess for gynecomastia, breast pain, impotence,
avoid alcohol,
take 1 hour before or 2 hours after antacids
What do the chemicals Secretin and cholecystokinin do to the esophagus?
v pressure in LES
If you suspect hiatal hernia, what do you want to be sure to r/o? x3
peptic ulcer, angina, gallbladder disease
What are 3 drugs that ^ LES pressure?
Urecholine, Propulsid, Reglan
What do the following drugs do that's in common?:
Urecholine, Propulsid, Reglan
^ LES pressure
What's are two elements to the proper diet for GERD?
high protein,
low fat
Why use Reglan for GERD?
^ LES pressure
^ or v LES pressure:
secretin?
decrease
^ or v LES pressure:
cholecystokinin
decrease
^ or v LES pressure:
theophylline
decrease
^ or v LES pressure:
valium
decrease
^ or v LES pressure:
morphine
decrease
^ or v LES pressure:
B-adrenergic blockers
decrease
^ or v LES pressure:
Calcium channel blockers
decrease
^ or v LES pressure:
Nitrates
decrease
^ or v LES pressure:
Urecholine
increase
^ or v LES pressure:
propulsid
increase
^ or v LES pressure:
reglan
increase
^ or v LES pressure:
fat
decrease
^ or v LES pressure:
chocolate
decrease
What are foods to avoid r/t GERD?

h
"CATNAP"

Chocolate, caffeine
Alcohol
Theobromine, tea
Nicotine
Anticholinergics
Progesterone, Peppermint
"CATNAP"
What are two drugs that don't effect LES directly used for GERD? (one general, one specific)
Antacids,
Tagament
When do you give antacids for GERD during the day? x3
1 hr after meals,
bedtime,
prn
What's the following describe?:
absence of peristalsis in the lower 2/3 of esophagus?
achalasia
What's a common GI disorder that people show up w/ at the ED thinking it's an MI?
achalasia
What are four clinical manifestations of ACHALASIA?

h
- dysphagia, gradual onset
- wt loss
- substernal CP
- Regurg of esophageal
- eating
- wt
- pain
- night
When is regurg worse r/t achalasia?
at night
What kind of diet for achalasia?
x2
semi-soft,
bland
What can pt w/ achalasia do at meals to help? x2
drink fluids,
use Valsalva's
What's the following describe?:
outpouching of esoph above the upper esoph sphincter?
Zenker's diverticulum
What are 2 risk factors of esoph diverticulum?
1. regurg'd material aspirated into lungs
2. enlarged diverticulum my obstruct esophageal
Assessment for esoph diverticulum?
- pain on swallow
- regurg
- gurgling sound over diverticulum
- cough
- foul breath
- wt loss, weakness, anemia
What esoph disorder might you have pain on swallow?
esophageal diverticulum,
Zenker's diverticulum
What GI disorder might you have if gurgling noise over esophagus?
esophageal diverticulum,
Zenker's diverticulum
How do you dx esophageal diverticulum, Zenker's diverticulum?
barium swallow (upper GI series)
What does the following describe?:
progressive dysphagia, regurg, foul breath & taste, coughing and pneumonitis form aspirated fluids
esoph cancer
What pathology predisposes to esophageal cancer?
achalasia
Achalasia predisposes to what disease?
esoph CA
What are 3 dx tests for esoph CA?
barium swallow,
biopsy w/ endoscopy,
CT scan
If po nutrition poss, what's good before surgery for esoph CA?
high protein,
high calorie
What 3 elements of nsg care pre op for esoph CA esoph?
1. improve nutritional status
2. oral hygiene
3. admin antibiotics
What's post op diet for esoph CA surgery?
x4
clear, soft, bland diet;
small feedings
What do you HAVE to do before po anything post surgery?
Auscultate bowel sounds and
Gag reflex
What are two things to assess for post esoph CA surgery?
1. signs of intolerance
2. leakage of feeding into mediastinum
What are 2 signs of intolerance post esoph CA surgery?
vomiting,
gastric distention
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?
What are 5 high risk dietary habits for gastric CA?
smoked,
highly salted (poss w/ nitrates),
spicy foods;
antiinflammatory agents,
alcohol
What pathology predisposes to gastric CA the most?
pernicious anemia
What does pernicious anemia predispose to?
gastric CA
Pernicious anemia - 7 sym?

h
weakness, sore tongue, paresthesia, DNV, cardiac failure
strength,
mouth,
CNS,
GI x3,
unique other sys affected
With what GI disorder in this unit might you get a sore tongue?
pernicious anemia
What's the one disorder from the first packet that has the sym of DIARRHEA?
pernicious anemia
What's the one disorder in this unit that you might see paresthesia?
pernicious anemia
With what GI disorder in this unit might you get CARDIAC FAILURE?
pernicious anemia
Gastric CA, what are clinical manifestations associated with specifically?
location of the mass
What set of sym is general for gastric CA?
obstruction sym
What are 2 sym r/t esophagogastric junction tumors?
progressive dysphagia,
wt. loss
What are 4 early signs of CA of pylorus?
mimic sym of peptic ulcer;
epigastic pain,
NV
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
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
What is one risk factor for colorectal CA?
polyps
What can polyps be a precursor for?
colorectal CA
What are 3 factors or conditions that can lead to colorectal CA (not polyps)?
ulcerative colitis > 10 yrs,
Crohn's disease,
dietary factors
What are three dietary factors that can lead to colorectal CA?
high saturated fat,
lots of meat,
low in fiber
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
What are 3 sym of rectal ca that pt could notice at home r/t elimination patterns (not habits)?
1. alternating diarrhea & constipation
2. incomplete emptying
3. constant fecal urgency
What are 3 warning signs for colorectal cancer?

h
rectal bleeding,
cramping abdominal pain,
change in bowel habits
x2 butt
x1 belly
If pt presents w/ the following, what could you suspect?:
rectal bleeding,
cramping abdominal pain,
change in bowel habits
colorectal ca
What could you suspect if pt presents w/ fecal urgency?
rectal ca
What are two GI disorders that might present alternating diarrhea & constipation?
colorectal ca,
celiac disease
If receiving radiation for colorectal ca, what do you want to avoid taking?
Pepto Bismol (conc radiation)
When is Pepto Bismol contraindicated r/t GI disorders?
if receiving radiation for colorectal ca
What foods do you encourage for client w/ diarrhea r/t pelvic radiation?
pasta, rice, cheese, dairy products
What do you want to document r/t changing bowel habits in colorectal ca?
volume and consistency of stools
What are two risk factors r/t pancreatic ca?
smoking,
high fat diets
To what disease do smoking and high fat diets predispose?
pancreatic ca
What are early sym of pancreatic ca?
mild and non-specific
What are 5 (now 7) sym of late pancreatic ca?
"JAWBONE"
Jaundice
Abdominal pain
Weight loss
Back pain
Obstruction of biliary
Not eating (anorexia
Extra tired
What's the diet for pt w/ pancreatic ca?
low-fat
If pt has back and abdominal pain and is jaundiced, what could you suspect?
pancreatic ca
What are 2 empirical s/s r/t hyperglycemia?
polydipsia,
polyuria
What with you have to admin if pt underwent pancreatic resection?
pancreatic enzymes
What is the name of obstructions caused by issues with muscles in the bowels, not a px blockage?
functional obstruction
What is the name of obstructions that are actual px blocks in the intestines?
mechanical obstruction
What is a functional obstruction?
neuromuscular or vascular disorder
What is a mechanical obstruction?
occlusion of bowel lumen
What are 10 sym of bowel obstructions?
"OVERINFLATED"
Obstipation
Vomiting
E
Rock hard abdomen
Inability to fart
Nausea
Fecal vomiting
Lacks peristalsis
Abdominal pain
Tinkling bowel sounds
E
Distention
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
What causes gangrene in the intestines?
mesenteric vascular occlusion
What's the basic definition for mesenteric vascular occlusion?
blood supply loss leads to inflamed or gangrenous intestine
What could an acute, sharp pain between xiphoid and umbilicus w/ absence of bowel sounds indicate?
sudden occlusion r/t mesenteric vascular occlusion
What are sym r/t partial blockage in mesenteric vascular occlusion?
crampy and colicky pain after eating
What are the 5 sym of sudden mesenteric vascular occlusion?
"SANDE"
Sharp pain between xiphoid & umbilicus,
Absent BS
NV
Distended abd
Elev WBC
What is a life-threatening nsg dx if pt has severe abdominal distention unrelated to GI sys?
ineffective breathing pattern
What is a systemic risk r/t mesenteric vascular occlusion?
septicemia
What is are 4 nsg dx r/t mesenteric vascular occlusion?
pain,
fluid volume deficit,
altered tissue perfusion,
ineffective breathing pattern
What are two conditions to assess r/t fluid volume deficit in mesenteric vascular occlusion?
hypovolemia,
electrolyte imbalance
What is the po alimentation status of pt with full mesenteric vascular occlusion?
NPO, not even ice chips
What are three serious conditions to assess for when tissue perfusion is altered r/t mesenteric vascular occlusion?
intestinal ischemia,
perforation,
septicemia
What GI disorder could you suspect if GI pt is going into hypovolemic shock?
mesenteric vascular occlusion r/t 3rd spacing
What are 6 s/s r/t septicemia in mesenteric vascular occlusion?
"THe FLAT"
Tachycardia, tachypnea
Hypotension,
Fever
Leukocytosis
Abdominal pain
Tender & distended abdomen
What must pt do after herniorrhaphy before they can go home?
void
How long must pt avoid heavy lifting, pulling or pushing r/t herniorrhaphy?
6 wks
TCDB, which one can't a post hernia surgery pt do?
cough
What are 3 disease that leave pt prone to lactase deficiency?
celiac, crohn's, ulcerative colitis
Post esoph surgery, if pt presents w/ pain, pyrosis, dyspnea, what could you suspect?
leakage of feeding into mediastinum
If pt presents s/s of leakage of feeding into mediastinum post esoph surgery, what do you want to be sure to rule out?
peritonitis
If pt presents w/ pyrosis, if not GERD, what coud it be?
axial (sliding) hernia
What are 4 s/s of axial (sliding) hernia?
pyrosis,
regurgitation,
dysphagia, or
asymptomatic
What are two s/s of paraesophageal hernia?
asymptomatic, or
pt experiences fullness after eating
What complications can occur r/t paraesophageal hernia? x3
hemorrhage,
obstruction,
strangulation
What's Rx for Zenker's Diverticulum?
surgery
What are 7 sym of celiac sprue?
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*
Pt must avoid all grains, except what 2 r/t celiac sprue?
corn and rice
What are 2 forms of ca that untreated celiac disease can be associated with?
lymphoma and carcinoma of the
small intestine
What should you teach pt to look for after barium tests?
white or pink stool
What's priority NI after barium tests?
avoid constipation
5-Flourouracil, use cautiously in: x4
renal & hepatic impairment,
infections,
edema,
ascites
5-Flourouracil, assess for s/s of:
toxicity
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
5-Flourouracil, CNS s/e: x1

H
acute cerebellar syndrome
(super dizzy)
Flourourourourourouracil... Woaw I'm getting dizzy.
Super dizzy (acute cerebellar syndrome) - assoc w/?
5-Flourouracil
If pt develops stomatitis and diarrhea 3 weeks after chemo, what drug would you suspect?
5-Flourouracil
5-Flourouracil, hematopoeitic s/e: x2
leukopenia, thrombocytopenia
5-Flourouracil, GI s/e: x1
GI bleeding
What are 2 drug interactions for 5-Flourouracil?
leucovorin calcium,
live virus vaccines
What is priority nsg ass r/t erlotinib (Tarceva)?

H
respiratory assessment
Think of the lung issues you'd have if you had loads of TAR in your lungs from smoking.
What drug might cause interstitial lung disease?
erlotinib (Tarceva)
For what ca is 5-Flourouracil used?
colorectal ca
What is the colorectal cancer drug we have to know?
5-Flourouracil
What are the two Pancreatic Cancer Meds?
Tarceva,
Gemzar
What drug could put pt into bronchospasm?
Gemzar
What system is at risk with Gemzar (besides immune and resp)?
renal
Gemzar - assoc w/ what unique sym?
hemolytic uremic syndrome
hemolytic uremic syndrome - assoc w/?
Gemzar
What is particular nsg imp r/t Gemzar?
monitor temp esp during 1st 12 hours of tx
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
What count to you want to know prior to admin of Taxotere?
What range is contraindicated?
neutrophil count
< 1,500 cells/mm3
What drug may cause cardiomyopathy or CHF, more common in children?
Adriamycin
What's the sys most threatened by s/e of Adriamycin? x1
Examples? x3
cardiovascular:
arrhythmias,
cardiomyopathy,
heart failure
r/t gastrectomy, from where and what drainage may you see indicating septicemia?
gastic fluid thru
sump or penrose drain
What are 5 ways to monitor hemodynamic status r/t gastrectomy?
Swan-Ganz or
CVP reading,
UO,
BP,
P
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
what are signs of postprandial dumping syndrome r/t gastrectomy?

h
sweating, DNV, weakness
picture being in the old west, hung on a "post" at high noon... you'd prob be sweaty and weak and have DNV
What are 4 dietary interventions rt postprandial dumping syndrome?
1. small feedings
2. low CHO
3. high fat
4. high protein
What are two drugs might you admin for postprandial dumping synd? (general category & specific)
Sandostatin,
anticholinergic drugs
For what is Sandostatin ordered?
What's it do?
postprandial dumping syndrome,
alters intestinal motility and v hormonal response to distention
For what are anticholinergics ordered r/t gastrectomy?
What do they do?
postprandial dumping syndrome,
reduce intestinal motility
If client has reactive hypo glycemia, what kind of food regimen might they be put on?
meals: high protein, low CHO
between meals: glucose foods
What is a resulting & expected pathology from total gastrectomy?
pernicious anemia
When do you want to avoid fluids during meals?
w/ diarrhea r/t gastrectomy
When oral feedings are initiated after gastrectomy, what do you monitor for r/t compromised nutrient absorption?

h
diarrhea, nausea, flatulence, cramping, anorexia
similar to IBS
If there is evidence of malabsorption after gastrectomy, what is your next move?
collaborate w/ DR, dietician, client
to dev plan for short bowel syndrome
What are 5 s/s of short bowel syndrome?
steatorrhea,
wt. loss,
malabsorption,
malnutrition,
F&E imbalance
What do you suspect if the following occurs post gastrectomy?
steatorrhea, wt loss, malabsorption, malnutrition, F&E imbalance
short bowel syndrome
When is TPN indicated?
when client cannot get adeq oral nutrition w/in 7 days
What 6 things does TPN contain?
water,
glucose,
amino acids,
vitamins,
electrolytes,
calories
Where are 3 places you can stick TPN w/ glucose?
subclavian vein,
internal jugular vein,
PICC
What's PICC stand for?
peripherally inserted central catheter
What are 2 things not put into line used for TPN?
lipids,
meds
What are 3 TPN catheter insertion complications?
pneumothorax,
hemothorax,
hydrothorax
What are 5 common s/s of TPN catheter insertion complications?
CP,
v breath sounds,
shallow rapid respirations,
dyspnea,
cyanosis
ouch
breathing related x3
color
If you note backache during TPN tx, what could you suspect?
infection
If you note flushed face during TPN tx, what could you suspect?
infection
What's a complication r/t TPN infusion in the first 48 hours?
refeeding syndrome
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
What are 4 conditions r/t refeeding syndrome?

h
hypophosphatemia,
hypomagnesemia,
hypocalcemia,
hyponatremia
refeed the hungry hungry hypos
How many calories are in TPN?
1 calorie/cc
What % of TPN can be glucose?
15-40%
What % of TPN can be amino acids?
4%
If during TPN, you note the following, what's it imply:
chest pain
cath insertion complications
If during TPN, you note the following, what's it imply:
v breath sounds
cath insertion complications
If during TPN, you note the following, what's it imply:
shallow rapid resp
cath insertion complications
If during TPN, you note the following, what's it imply:
dyspnea
cath insertion complications
If during TPN, you note the following, what's it imply:
cyanosis
cath insertion complications
If during TPN, you note the following, what's it imply:
chills
infection
If during TPN, you note the following, what's it imply:
fever
infection
If during TPN, you note the following, what's it imply:
malaise
infection
If during TPN, you note the following, what's it imply:
HA x2
infection or hyperglycemia
If during TPN, you note the following, what's it imply:
flushed face
infection
If during TPN, you note the following, what's it imply:
backache
infection
If during TPN, you note the following, what's it imply:
hypotension
infection
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
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"
If during TPN, you note the following, what's it imply:
confusion x5
refeeding syndrome, and all the electr's
hyponatremia,
hypocalcemia,
hypomagnesemia,
hypophosphatemia
If during TPN, you note the following, what's it imply:
weakness
refeeding syndrome,
hyperglycemia,
hypophosphatemia
If during TPN, you note the following, what's it imply:
cardiac arrest
refeeding syndrome
What are 4 categories of complications r/t TPN?
1. Cath insertion complications
2. Infection
3. Refeeding syndrome
4. Metabolic complications
How can you avoid refeeding syndrome? x3
start TPN slow,
1000 cal / 1st 24 hours,
monitor serum electrolytes
When would you remove catheter during TPN tx?
if s/s of infection
Protein r/t TPN - check what?
kidney function (BUN/creat)
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
During TPN, presents fatty liver syndrome, NI?
cyclic TPN as ordered
(cycle lipids then dextrose TPN)
What conditions put pt at risk for rise in serum triglyceride & cholesterol r/t TPN?
NI?
AIDS & cardiac conditions,
v fat emulsion
What are s/s hyponatremia r/t TPN tx?
"CLAC"
Confusion
Lethargy
Abdominal...
...Cramps
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
During TPN tx, what could you suspect if:
nausea
hyperglycemia
During TPN tx, what could you suspect if:
tachycardia x2
hypocalcemia,
hypomagnesemia
During TPN tx, what could you suspect if:
abdominal cramps
hyponatremia
During TPN tx, what could you suspect if:
tetany
hypocalcemia
During TPN tx, what could you suspect if:
muscle cramps
hypocalcemia
During TPN tx, what could you suspect if:
muscle spasms
hypomagnesemia
During TPN tx, what could you suspect if:
tremors
hypomagnesemia
During TPN tx, what could you suspect if:
paresthesia x2
hypocalcemia,
hypophosphatemia
TPN, what size filter if no fat?
what size if yes fat?
no fat: 0.22 micron
fat: 1.2 micron
What are 2 GI disorders that might cause steatorrhea?
celiac disease,
short bowel syndrome