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66 Cards in this Set
- Front
- Back
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Why is enteral feeding advocated over TPN for a multi trauma victim?
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because it maintains bowel function and prevents translocation of bacteria
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If a patient was admitted with an acute GI bleed what would be one of the first actions the nurse would want to take?
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start a large bore IV before they became hypovolemic
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Acute GI bleed causes a decrease in...
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blood volume which can decrease the venous return to the heart thus decreasing CO
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What are some causes of acute GI bleed...
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peptic ulcer disease(most common)
-hypersecretion of gastric acid with impaired GI mucus secretion -PUD can often be caused by helicobactor pylori (infection in the mucosa) gastroesophageal varices -if blood cannot flow easily to the liver because of obstruction; it is diverted to collateral channels -esophagus--esophageal varices -veins in the proximal stomach (gastric varices) -rectal vault (hemmorrhoids) |
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What is the portal vein? Hepatic artery?
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portal vein is how GI tract gets blood/nutrients to the liver (hepatic artery supplies oxygen)
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What does the liver do?
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every nutrient we consume passes through the liver
metabolizes carbs (synthesizes glucose), protein, lipids (produce cholesterol) bile formation (which clears bilirubin from the from the blood-which results from dead blood cells-increase in bilirubin means jaundice) (above pancreas and small intestine it is right upper abdomen) |
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How fast can PUD occur
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6-8 hrs especially with stress in the hospital
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Mallory Weiss syndrome
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nonperforating tear that occurs in the gastric mucosa near the gastroesophageal junction (esoph and stomach)
-result of ETOH abuse and inflammatory conditions -occurs most often due to the pressure changes in the stomach when vomiting |
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Hemorrhagic gastritis and it's cause
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"stress ulcers"
gastric lesions that do not penetrate the muscularis mucosa caused by NSAID use, ETOH abuse and severe stress (increased acid production) |
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What are some NSAIDS and what can they cause?
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ibuprofen (motrin, advil) aspirin (bayer) aleve
they can cause hemorrhagic gastritis |
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What are signs and symptoms of an acute GI bleed?
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hematemisis-throwing up blood
melena (tarry black sticky) /maroon colored stool nausea epigastric pain abdominal distention bowel sounds increased or decreased orthostatic hypotension, tachy, decreased pulses cold clammy skin |
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How do you diagnose acute GI bleed?
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labs: H+H, CBC, PTT h. pylori
endoscopic procedure: scope |
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What are important steps to manage GI bleed
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-insert two large bore IVs and IVFs
-administer blood products -insert NG (decompress abdomen) -position patient in left lateral decubitus position to decrease aspiration associated with hematemesis |
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What are surgical therapies for PUD/ gastritis
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biliroth I and II
removal of lower portion of stomach (pylorus) with end to end anastomosis of the remaining stomach with the duodenum I-anastomosis is directly to the duodenum II-gastric stump joins to the jejunum |
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endoscopic therapy for variceal UGI bleed
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sodium morrhuate is injected into the vessels which makes them shrink
rubberband ligation/hemoclips/ |
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What is a temporary fix of variceal UGI bleed
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sengstaken-blakemore tube (which emergently decreases blood flow through the varix to control bleeding)
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What pharm therapy could be done for variceal UGI bleed
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vasopression (vasoconstricts gastric inflow and portal pressure)
somatostatin (inhibits gastric blood flow) |
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What surgical option is available for varices?
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TIPS (transjugular inrahepatic portosystemic shunt)
artificial channel in the liver from the portal vein to the hepatic vein |
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Diverticulitus
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small pouches that develop in the large intestine secondary to aging
(occurs in 1/2 americans from60-80) fecal material gets trapped in pouches leading to inflammation (lack of fiber plays a role) |
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S&S of Diverticullitus
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localized pain in the left lower quadrant
fever chills nausea and vomiting cramping constipation |
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Diagnostics of diverticulitus
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CBC-check if WBC is high for a rupture
abdominal xray or CT |
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Management of diverticulitus
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rehydration with IVFs
NPO status NG placed for persistent vomiting medications -anticholingergics-reduce colonic spasms (cogentin, atrovent, atropine, robinul, spiriva, wellbutrin) -opiates-methadone, morphine, oxy -antibiotics |
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Crohns
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chronic inflammation of the digestive tract that can involve one or more areas of any portion of the GI tract from mouth to anus
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most common sites of inflammation in crohns
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ilium, colon, and perianal
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is crohns curable
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no
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causes of crohns
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-genetic
-environmental-smoking, (constricts blood flow)hormonal contraception, NSAID use |
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S&S of Crohns
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pain-at first right sided cramping that feels like appendicitis but later crampy abdomen pain associated with different foods
meals avoided to reduce pain-leads to weight loss/malnutrition N/V watery stool steatorrhea (fatty) fever( inflam process) |
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Diagnosing Crohns
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labs CBC-albumin and BMP
colonoscopy and biopsy |
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Treatment of Crohns
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antibiotics
anti inflammatory (sulfasalzine) corticosteroids (hydrocortizone, decadron, prednisone)-act on immune system preventing inflammation but can also decrease WBC immunosuppressive drugs bowel restrictions |
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What can occur with increased doses of steroids
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moonface/swollen
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ulcerative colitis
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type of IBD that affects large intestine
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cause of ulcerative colitis
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unknown
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S&S of ulcerative colitis
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sensation of rectal urgency
crampy abd. pain and tenderness bloody watery diarrhea (up to 30 stools/day) weight loss vomiting diarrhea |
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surgical treatment of ulcerative colitis
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coelctemy of lg intestine with ileostomy
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bowel infarction
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restricted blood flow to bowel
causes: abdominal distention, alpha stimulation sympathomimetic amines (epi and nor epi) hypovolemia, decreased CO |
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bowel infarction can lead to...
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bowel necrosis and then gangrene of the bowel
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bowel obstructions causes
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mechanical obstructions (ileum is most common site), adhesions from scar tissue, strangulated hernias (abd. muscle weakened or stressed-opening where bowel is caught and loses blood flow)
functional obstruction-paralytic ileus (no peristalsis) abd. surgeries |
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How would you position a pt with bowel obs/infarc
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HOB elevated to relieve pressure from distended abdomen
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goal of gastric bypass
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decrease caloric intake
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two catagories of bypass
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restrictive-less invasive banding the upper portion of the stomach creating a smaller stomach pouch
(1-3 oz) malabsorptive techniques permanent include actually bypassing segment of sm. intestine size of gastric pouch is reduced and anastomosed to a distal segment of the sm. bowel |
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after GI surgeries what precautions should be taken with med administration
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no sustained release meds or diabetes meds because they are not taking in enough food and fluids so there will be decreased insulin resistance
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What is hepatitis
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injury to the liver characterized by the presence of inflammatory cells in the tissues of the organ
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what causes hepatitis
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viral ABCDE
autoimmune drug related |
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hepatitis A
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fecal oral (most common) usually via contaminated drinking water
caused by hep A virus (HAV) |
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hep B
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DNA virus is present in all body secretions
exposure to blood/body fluids containing blood (needles, childbirth, sexual contact, blood transfusions) |
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hep C
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blood to blood
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hep D
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single stranded RNA virus
requires presence of hep B to establish infection parenterally |
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what form of hep requires another form to be transmitted
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hep D requires hep B
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hep E
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similar to A
fecal oral |
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autoimmune hep
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idiopathic genetic predisposition of acute liver infection
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drug related hep
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acetaminophen, allopurinol, amoxicillin, anti TB meds
form of drug allergy in which the immune response is directed at the liver cells causes necrosis |
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S&S of HEP
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usually asymptomatic
possibly flu like symp. |
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diagnosis of hep
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labs: liver panel, CBC, bilirubin levels
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Treatment of hep
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meds, transplant
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gamma globulin...hep?
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increases available antibodies
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most common cause of cirrhosis of the liver
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ETOH abuse
ETOH is directly toxic to liver cells, causing them to die liver cells are replaced by fibrous tissue causing liver to progressively fail |
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S&S of Hepatic failure
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jaundice
pruritis ascites (fluid collection in the peritoneum) hepatic encephalopathy electrolyte imbalances (hypo-) |
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hepatic encephalopathy
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worsening of brain function because the liver is unable to remove toxins from blood
ammonia is neurotoxic muscle tremors slurred speech and mental status changes |
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hepatic failure diagnostics
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labs
bilirubin PT/PTT ammonia liver panel ALT AST abd ultrasound (CT, MRI) liver angiography and biopsy |
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HOB for hepatic failure pt.
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45 degrees
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Pancreatitis
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inflammation of the pancreas resulting from premature activation of exocrine enzymes
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causes of pancreatitus
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Gallstones
Ethanol Trauma Steroids Mumps Autoimmune causes Scorpion venom Hyperlipidemias Ercp (dye) Drugs (tylenol, lasix, cocaine) |
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what diet form pancreatitis
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NPO rest (TPN usually without lipids due to the high triglycerides anyways)
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S&S of appendicitis
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RLQ pain
rebound tenderness anorexia N&V |
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Cholecystitis
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RUQ pain caused by gallstones (inflammation of gallbladder)
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Managing cholecystitis
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IVF, abx.
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