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166 Cards in this Set

  • Front
  • Back
What is the main function of the GI system?
-To supply nutrients to body cells
True or False:
Both psychologic and emotional factors, such as stress and anxiety influence GI functioning in may people.
-True
Stress may be manifested as anorexia, epigastric and abdominal pain, or diarrhea.
From the inside to the out; name the layers of the GI tract:
1.) Mucosa
2.) Submucosa
3.) Muscle
4.) Serosa
In what way does the parasympathetic nervous system control the GI tract?
-Mainly excitatory; peristalsis is increased when stimulated
In what way does the sympathetic nervous system control the GI tract?
-Mainly inhibitory; peristalsis is decreased when stimulated
This is the GI tracts own nervous system; it is composed of 2 nerve layers that lie between the mucosa and the circular and longitudinal muscle layers; contribute to the coordination and ability to control movement and secretion; also known as "gut brain":
-Enteric Nervous System
Where is the appetite center located?
-Hypothalamus
How is appetite directly or indirectly stimulated?
-Hypoglycemia, an empty stomach, a decrease in body temp, an input from higher brain centers, hormones: ghrelin (stimulation) and leptin (suppression)
The mechanical component of ingestion; a.k.a. swallowing:
-Deglutition
This serves many roles, including the lubrication of food and prevention of bacterial overgrowth in the oral cavity:
-Saliva
This is found at the distal end of the esophagus and remains contracted except during swallowing, belching, or vomiting; is an important barrier that normally prevents reflux of acidic gastric contents into the esophagus:
-Lower esophageal sphincter
What is the function of the stomach?
-Store food, mix the food with gastric secretions, and empty contents into the small intestine at a rate at which digestion can occur
What are the two primary functions of the small intestine?
1.) Digestion
2.) Absorption
These are minute, fingerlike projections in the mucous membrane of the small intestine; they contain goblet cells that secrete mucous and epithelial cells that produce the intestinal digestive enzymes; contain microvilli; greatly increases the surface area for absorption:
-Villi
The acidic environment of the stomach results in the conversion of pepsinogen to its active form ______.
-Pepsin (which begins the initial breakdown of proteins)
How long does the average meal remain in the stomach?
- 3-4 hours
The physical presence of this, along with its chemical nature in the small intestine, stimulates motility and secretion.
-Chyme
The hormone ______ stimulates the pancreas to secrete fluid with a high concentration of HCO3 which enters the duodenum and neutralizes acid in the chyme.
-Secretin
In response to the presence of chyme, the hormone _______ , produced by the duodenal mucosa, enters the bloodstream and stimulates contractions of the gallbladder and permits bile to flow from the common bile duct into the duodenum.
-Cholecystokinin (CCK)
Bile is necessary for the digestion of what?
-Fats
CCK also stimulates the pancreas to synthesize and secrete enzymes for enzymatic digestions of:
-Carbs, fats, and proteins
These liver cells carry out phagocytic activity (removal of bacteria and toxins from the blood):
-Kupff cells
What is the function of the gallbladder?
-to concentrate and store bile
This is a product of the hepatic cells and secreted into the biliary canaliculi of the lobules:
-Bile
A pigment derived from the breakdown of Hgb, is constantly produced and bound to albumin for its transport to the liver; excreted in bile:
-Bilirubin
Refers to difficulty when swallowing; leads to disability or decreased functional status, increased length of stay and cost of care, increased likelihood of discharge to institutional care, and increased mortality:
-Dysphagia
Complications of this nutrition alteration includes: aspirations pneumonia, dehydration, decreased nutritional status, and weight loss
-Dysphagia
Signs and symptoms of this nutrition alteration include: cough during eating, change in voice tone or quality after swallowing; abnormal movements of the mouth, tongue, and lips; slow, weak, imprecise, or uncoordinated speech, abnormal gag reflex, delayed swallowing, incomplete oral clearance or pocketing, regurgitation, pharyngeal pooling, delayed or absent trigger of swallowing, and inability to speak consistently:
-Dysphagia
Describe nursing actions for a patient with dysphagia:
-Assess for risk of dysphagia thru observation of client at a meal for change in voice quality, posture, and head control; percentage of meal consumed; eating time; drooling of liquids and solids; cough during/after a swallow; facial or tongue weakness; difficulty with secretions; pocketing; and presence of voluntary and dry cough
-Feed with head of bed elevated
-Follow dietary restrictions and feed thickened liquids
Herniation of a portion of the stomach into the esophagus through an opening, or hiatus, in the diaphragm:
-Hiatal Hernia (a.k.a. diaphragmatic hernia and esophageal hernia)
The junction of the stomach and esophagus is above the hiatus of the diaphragm, and a part of the stomach slides through the hiatal opening in the diaphragm. The stomach "slides" into the thoracic cavity when the patient is supine and usually goes back into the abdominal cavity when the patient is standing upright. This is the most common type hiatal hernia:
-Sliding Hernia
The esophagogastric junction remains in the normal position, but the fundus and the greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophageal:
-Paraesophageal or rolling hernia
Describe causes of hiatal hernia:
-Structural changes, such as weakening of the muscles in the diaphragm around the esophagogastric opening, are usually contributing factors
-Factors that increase intraabdominal pressure: obesity, pregnancy, ascites, tumors, tight girdles, intense physical exertion, and heavy lifting
-Predisposing Factors: age, trauma, poor nutrition, and a forced recumbent position
Describe signs and symptoms of hiatal hernia:
-Possible to be asymptomatic
-Mimics heartburn; especially after meals or in a supine position
-Bending over may cause severe pain but relieved when standing
-Dysphagia
-Mimics gallbladder dz, peptic ulcer dz, and angina
Describe treatment and nursing actions for a patient with hiatal hernia:
-Lifestyle modifications (eliminating constrictive clothing, avoid lifting or straining, elevating HOB), use of antacids and antisecretory agents, lose weight
-Surgical therapy
Any clinically significant symptomatic condition or histopathologic alteration secondary to reflux of gastric contents into the lower esophagus; most common upper GI problem see in adults; effects 14-20% of US population:
-Gastroesophageal reflux disease (GERD)
There is no one single cause; results when the defenses of the lower esophagus are overwhelmed by the reflux of acidic gastric contents into the esophagus; predisposing conditions include hiatal, incompetent LES, decreased esophageal clearance resulting from impaired esophageal motility, and decreased gastric emptying; result in esophageal irritation and inflammation (esophagitis); incompetent LES result from gastric contents moving from an area of higher pressure (stomach) to an area of lower pressure (esophagus) when the pt is in a supine position or has an increase in intraabdominal pressure:
-GERD
What are risk factors for GERD?
-Obesity
-Pregnancy
-Cigarette and cigar smoking
-Hiatal hernia
Describe symptoms of GERD:
-Symptoms vary
-Heartburn
-Dyspepsia
-Hypersalivation
-Noncardiac chest pain
-Wheezing, nocturnal coughing, dyspnea
-Hoarseness, sore throat, a globus sensation (lump in throat) and chocking
-Regurgitation
-Early satiety, postmeal bloating, N & V
What is does pyrosis mean?
-Heartburn; described as a burning, tight sensation that is felt intermittently beneath the lower sternum and spreads upward to the throat or jaw
What is dyspepsia?
-Pain or discomfort centered in the upper abdomen (mainly in or around the midline as opposed to the right or left hypochondrium)
Describe complications of GERD:
-Esophagitis
-Barrett's esophagus
-Cough, bronchospasm, laryngospasm, and cricopharyngeal spasm: due to irritation of the upper airway
-Dental erosion
This is considered a precancerous lesion that increases the pt's risk for esophageal cancer:
-Barrett's esophagus
Describe diagnostic measures for GERD:
-Barium swallow
-Endoscopy
-Biopsy and cytologic specimens
-Manometric studies
-Radionuclide tests
-High-dose proton pump inhibitors for 2 weeks
Describe nutritional therapy changes, lifestyle changes, and drug therapy that needs to occur for the treatment of GERD:
-Lifestyle Modifications: taught to avoid factors that aggravate symptoms, pay attention to drugs and diet that may affect the LES, acid secretion, or gastric emptying, smokers should stop
-Nutritional Therapy: avoid fatty foods, chocolate, coffee, peppermint, tea, milk products; avoid late evening meals and nocturnal snacking; Encourage to take small, frequent meals are advised, fluids should be taken between meals; weight reduction
-Drug Therapy: antacids, H2R blockers, PPIs
-Surgical Therapy: Nissen and Toupet fundoplications
-Endoscopic Therapy: ultilizes gastric tissue to increase the integrity of the LES; collagen contraction through electrical stimulation
Describe nursing actions for a patient with GERD:
-Encourage and teach a smoker to stop
-HOB elevated above 30 degrees
-Teaching the pt to avoid food and activities that cause reflux
-Observe side effects and effectiveness of drug therapy
-Postop care focuses on concerns related to prevention of respiratory complications, maintenance of fluid and electrolyte balance, and prevention of infection; verify peristalsis has returned; recording I & O
-Pt is instructed to remain on clear liquids for 24 hr and then a soft diet for the next 2 weeks; take liquid meds; should not take NSAIDs for 10 days
A complex of tortuous veins at the lower end of the esophagus, enlarged and swollen as a result of portal hypertension:
-Esophageal varices
Occur in 2/3 to 3/4 of pts with cirrhosis; collateral vessels contain little elastic tissue and are quite fragile, tolerate high pressure poorly, and the result is distended veins that bleed easily; most life-threatening complication of cirrhosis; rupture and bleed in response to ulceration and irritation from alcohol ingestion, swallowing of poorly masticated food, ingestion of course food, acid regurgitation from the stomach, and increased intraabdominal pressure caused by N & V, straining at stool, coughing, sneezing, or lifting heavy objects:
-Causes/Pathophysiology of Esophageal Varices
Describe the treatment and nursing actions for a patient with esophageal varices:
-Avoidance of bleeding and hemorrhage
-Pt should avoid ingesting alcohol, aspirin, and irritating foods
-URI should be treated promptly, and coughing should be controlled
-Management that involves a combination of drug therapy and endoscopic is more successful than either approach alone
-When it occurs: stabilize pt and manage airway, IV therapy is initiate and may include admin of blood products, drug therapy to stop bleeding (vasopressin)
An inflammation of the gastric mucosa. is one of the most common problems affecting the stomach; may be acute or chronic and may be diffuse or localized:
-Gastritis
Occurs as the result of a breakdown in the normal gastric mucosal barrier; when the barrier is broken, HCl acid and pepsin can diffuse back into the mucosa; results in tissue edema, disruption of capillary walls with loss of plasma into the gastric lumen, and possible hemorrhage:
-Etiology and Pathophysiology of Gastritis
What are the risk factors for development of gastritis?
-Drug-related gastritis
-H. pylori
-Autoimmune
Describe signs and symptoms of acute gastritis:
-Anorexia
-N & V
-Epigastric tenderness
-Saiety
-Hemorrhage is commonly associated with alcohol abuse
-Self-limiting, lasting from a few hours to a few days, with complete healing of the mucosa expected
Describe signs and symptoms of chronic gastritis:
-Anorexia
-N & V
-Epigastric tenderness
-Saiety
-Loss of intrinsic factor
A substance secreted by the gastric mucosa that is essential for the absorption of cobalamin (Vit B12) in the terminal ileum, ultimately results in cobalamin definiency:
-Intrinsic factor
Describe nursing actions for a patient with acute gastritis:
-care plan is supportive for N & V
-rest, NPO status, and IV fluids
-antiemetics
-In severe cases: NG tube is inserted to observe for bleeding, lavage of the precipitating agent from the stomach, and to keep the stomach empty and free of noxious stimuli
-If hemorrhage is likely, frequent checking of VS
-Admin drug therapy of antacids, H2R blockers, or PPIs to reduce gastric HCl acid secretions
-Teach patients about the therapeutic effects of drugs
Describe nursing actions for a patient with chronic gastritis:
-focus on evaluating and eliminating the specific cause
-antibiotics are given to rid H. pylori
-cobalamin is given for those with pernicious anemia
-teach patient to adapt to many lifestyle changes and adopt a strict adherence to a drug regimen: a nonirritating diet consisting of 6 small meals a day and the use of an antacid after meals
-Cessation of smoking
A condition characterized by erosion of the GI mucosa resulting from the digestive action of HCl acid and pepsin:
-Peptic ulcer disease (PUD)
This type of PUD is associated with superficial erosion and minimal inflammation; short duration and resolves quickly when cause is identified:
-Acute ulcer
This type of PUD is one of long duration, eroding through the muscular wall with the formation of fibrous tissue; present continuously for many months or intermittently throughout the person's lifetime; at least as common as acute erosion:
-Chronic ulcer
Develop only in the presence of an acid environment; normally, H20, electrolytes, and H20 soluble substances can easily pass through the mucosal barrier (prevents the back-diffusion of acid and pepsin from the gastric lumen through the mucosal layers to the underlying tissue); with certain conditions the mucosal barrier can be disrupted and back-diffusion of acid and pepsin can occur:
-Etiology and Pathophysiology of PUD
What results when back-diffusion of acid and pepsin occurs in PUD cases?
-Results in cellular destruction and inflammation which in return causes the release of histamine which results in vasodilation and increased capillary permeability; the released histamine stimulates further secretion of acid and pepsin
An increase in blood flow from the release of histamine compensates for the mucosal barrier disruption, How?
-As blood flow increases within the affected mucosa, H+ ions are rapidly removed from the area, buffers are delivered to help neutralize the H+ ions present, nutrients necessary for cell function arrive, and the rate of mucosal cell replication increases to heal the ulcer.
Most commonly found on the lesser curvature close to the antral junction; more prevalent in women and in older adults over 50 years of age; are more likely than duodenal ulcers to result in hemorrhage, perforation, and obstruction; the back diffusion is greater; H. pylori is present in 60-80% of cases; causes include: aspirin, NSAIDs, chronic alcohol abuse, chronic gastritis, and bile reflux gastritis from an incompetent pyloric sphincter, cigarette smoking:
-Gastric ulcers
Account for about 80% of all peptic ulcers; most likely to occur between 35 and 45 years; development is associated with a high HCl secretion particularly for those with COPD, cirrhosis of the liver, chronic pancreatitis, hyperparathyroidism, chronic kidney dz, and the Zollinger-Ellison syndrom; H. pylori is thought to play a key role (90-95% of cases); also has a familial tendency:
-Duodenal Ulcers
Describe the lesions for gastric and duodenal ulcers:
-Gastric: superficial; smooth margins; round, oval, or cone shaped
-Duo: penetrating
Describe the location for gastric and duodenal ulcers:
-Gastric: predominately in the antrum, also in body and fundus of stomach
-Duo: first 1-2 cm of duodenum
Is gastric secretion increased, decreased, or normal for gastric ulcers? Duodenal ulcers?
-Gastric: normal to decreased
-Duo: increased
Describe incidence rate and factors for gastric and duodenal ulcers:
-Gastric: greater in women; peak age 50-60 yr; more common in persons of lower socioeconomic status; increase with smoking, drug use (aspirin, NSAIDs), and alcohol use; increased with incompetent pyloric sphincter and bile reflux
-Duo: Greater in men, but increasing in women, especially postmenopausal; peak at 35-45 yr; associated with psychological stress; increased with smoking, drug and alcohol use; associated with other dz
Describe signs and symptoms for gastric and duodenal ulcers:
-Gastric: burning or gaseous pressure in LUQ and back; pain 1-2 hr post meal; if penetrating, aggravation of discomfort with food; occasional N & V, weight loss
-Duo: burning, cramping, pressurelike pain across midepigastrium and upper abdomen; back pain with posterior ulcers; pain 2-4 hr post meals and midmorning, midafternoon, and middle of night, periodic and episodic; pain relief with antacids and food; occasional N & V
Refers to acute ulcers that develop following a major physiologic insult such as trauma or surgery; receive prophylaxis with antisecretory agents, including H2R blockers and PPIs:
-Stress-related mucosal dz or physiologic stress ulcers
Name 3 major complications of chronic PUD:
1. Hemorrhage
2. Perforation
3. Gastric Outlet Obstruction
This PUD complication is most common; develops from erosion of the granulation tissue found at the base of the ulcer during healing or from erosion of the ulcer through major blood vessel; more often from duodenal ulcers than from gastric:
-Hemorrhage
This PUD complication is considered most lethal; commonly seen in lg penetrating of duodenal ulcers that have not healed and are located on the posterior mucosal wall; gastric ulcers found on the lesser curvature of the stomach are associated with higher mortality rates; occurs when the ulcers penetrates the serosal surface, with spillage of either gastric or duodenal contents into the peritoneal cavity:
-Perforation
Describe signs and symptoms of a patient experiencing a perforation:
-Sudden, severe upper abdominal pain that quickly spreads throughout the abdomen
-Abdominal muscles contract, appearing rigid and boardlike as they attempt to protect the abdomen from further injury
-Respirations become shallow and rapid
-Bowel sounds are usually absent
-N & V may occur
What contents could spill into the peritoneal cavity during a perforation?
-Air, saliva, food particles, HCl acid, pepsin, bacteria, bile, and pancreatic fluid and enzymes
This PUD complication is due to edema, inflammation, pylorospasm, as well as fibrous scar tissue formation, all of which contribute to the narrowing of the pylorus; ulcers located in the antrum and the pyloric areas of the stomach and the duodenum can predipose; in the early phase of this complication, gastric emptying is normal to near normal, however; over time, increased contractile force needed to empty the stomach results in hypertrophy of the stomach wall:
-Gastric Outlet Obstruction
Describe signs and symptoms for a patient with gastric outlet obstruction:
-Pt generally has a long hx of gastric pain
-Upper abdominal discomfort that become worse toward the end of the day as the stomach fills and dilates
-Relief is obtained by belching or projectile vomiting and offensive in odor
-Anoretic, weight loss, and complain of thirst and an unpleasant taste in mouth
-Swelling in the upper abdomen, loud peristalsis, and visible peristaltic waves
Describe nursing actions for a patient with PUD:
-Regimen consists of adequate rest, dietary modifications, drug therapy, elimination of smoking, and long-term follow up care
-Aim of treatment is to decrease gastric acidity, enhance mucosal defense mechanisms, and minimize the harmful effects on the mucosa
-Nurse must teach pt about the advantages outweighing any temporary discomfort imposed by NG tube
-Regular mouth care and cleansing of the nares
-Gastric analysis of the contents
-Nurse should be aware of any other current health problems
-Ensure environment is quiet and restful
Partial gastrectomy with removal of the distal 2/3 of the stomach and anastomosis of the gastric stump to the duodenum is called:
-gastroduodenostomy or Billroth I operation
Partial gastrectomy with removal of the distal 2/3 of the stomach and anastomosis of the gastric stump to the jejunum is called:
-gastrojejunostomy or Billroth II operation
Severing of the vagus nerve, either totally or selectively at some point in its innervation to the stomach:
-Vagotomy
Consists of surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach; commonly done after vagotomy or to enlarge an opening that has been constricted from scar tissue:
-Pyloroplasty
The direct result of surgical removal of a large portion of the stomach and the pyloric sphincter; associated with having a hyperosmolar composition; stomach no longer has control over the amount of gastric chyme entering the small intestine; consequently, a large bolus of hypertonic fluid enters the intestine and results in a fluid being drawn into the bowel lumen:
-Dumping syndrome
Describe signs and symptoms for a patient with dumping syndrome:
-Occurs at the end of a meal or within 15-30 minutes after eating; patient usually describes feelings of generalized weakness, sweating, palpitations, and dizziness, abdominal cramps, and urge to defecate
Stones in the gallbladder:
-Cholelithiasis
Inflammation of the gallbladder and usually associated with cholelithiasis:
-Cholecystitis
Actual cause is unknown; develops when the balance that keeps cholesterol, bile salts, and calcium in solution is altered so that precipitation of these substances occurs; conditions that upset this balance include infection and disturbances in the metabolism of cholesterol; with this condition bile secreted by both the liver and gallbladder is supersaturated with cholesterol which results in cholesterol precipitation; immobility, pregnancy, and inflammatory or obstructive lesions of the biliary system decreases bile flow and stasis of bile leads to progression of the supersaturation and changes in the chemical composition of the bile; stones may remain in the gallbladder or migrate to the cystic duct or to the common bile duct; they cause pain as they pass and may become lodged:
-Cholelithiasis
Describe signs and symptoms for a patient with cholelithiasis:
-Severe symptoms or none at all
-Gallbladder spasms occur in response to the stone and produces severe pain, which is termed biliary colic
-Pain can be excruciating and accompanied by tachycardia, diaphoresis, and prostration; it may last up to an hour, and when it subsides there is residual tenderness in the RUQ
-Pain frequently occur 3-6 hours after a heavy meal or when the pt lies down
Removal of gallbladder via laparoscopy using a dissecting laser:
-Laparscopic cholecystectomy
Describe treatment for a patient with cholelithiasis:
-Conservative Therapy: nonsurgical such as endoscopic sphincterotomy, mechanical lithotripsy, extracorporeal shock-wave lithotripsy
-Surgical Therapy: surgical interventions such as laparoscopic cholecystectomy
-Transhepatic Biliary Catheter
-Drug Therapy: Analagesics (Morphine), anticholinergics such as atropine and other antispasmodics may be used to relax smooth muscles and decrease ductal tone, fat-soluble vitamins for those with chronic gallbladder dz, questran (binds bile salts), drug used to dissolved the stones
-Low-fat diet
Describe nursing actions for a patient with cholelithiasis:
-Nursing actions include: relieving pain, relieving N & V, providing comfort and emotional support, maintaining fluid and electrolyte balance and nutrition, making accurate assessments for effectiveness of treatment, and observing for complications
-If pruritus occurs: baking soda baths; lotions; antihistamines; soft, old linen; and control of the temp
-Postop: monitoring for complications such as bleeding, making the patient comfortable, and preparing the pt for discharge, placing client in Sim's positions to relieve difficulty breathing, encourage deep breathing, along with movement and ambulation; allowed clear liquids and ambulating to the bathroom to void
-If T-tube: maintaining drainage and observe functioning
An acute inflammatory process of the pancreas; degree of inflammation varies from mild edema to severe hemorrhagic necrosis; most common in middle-aged men and women (affects equally); rate in African Americans is 3x higher than whites:
-Acute Pancreatitis
-Primary etiologic factors are biliary tract dz, alcoholism, gallbladder dz, trauma, viral infections, penetrating duodenal ulcer, cysts, abscesses, CF, Kaposi sarcoma, certain drugs, metabolic disorders, vascular dz, and sometimes idiopathic (unknown)
-Most common pathogenic mechanism is believed to be autodigestion of the pancreas (trypsin, elastase, phopholipase A):
-Etiology and Pathophysiology of Acute Pancreatitis
Describe signs and symptoms for a patient with acute pancreatitis:
-Abdominal pain; usually LUQ, but can be midepigastrium; commonly radiates to back
-Pain is sudden in onset and is described as severe, deep, piercing, and continuous or steady; it is aggravated by eating and frequently has its onset when the pt is recumbent and not relieved by vomiting
-Flushing, cyanosis, and dyspnea
-Flexion of the spine in an attempt to relieve the severe pain which is due to distention of the pancreas, peritoneal irritation, and obstruction of the biliary tract
-N & V, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice, bowel sounds may be decreased or absent, and crackles in lungs
This pancreatic complication is a cavity continuous with or surrounding the outside of the pancreas; filled with necrotic products and liquid secretions, such as plasma, pancreatic enzymes, and inflammatory exudates:
-Pseudocyst
This pancreatic complication is a large fluid-containing cavity within the pancreas; results from extensive necrosis in the pancreas:
-Pancreatic abscess
Describe treatment for a patient with acute pancreatitis:
-Treatment is focused on supportive care, including aggressive hydration, pain management, management of metabolic complications, and minimizing pancreatic stimulation
-If shock is present, blood volume replacements are used
-Fluid and electrolyte imbalances are corrected with LRS or other electrolyte solutions
-Typically placed on NPO and NG suction may be used
-Prophylactic use of antibiotics, peritoneal lavage or dialysis
-Surgical therapy: laparoscopic cholecystectomy
-Drug therapy
-Nutritional therapy: NPO, if severe enough, enteral feedings or parenteral nutrition may be initiated
Describe nursing actions for a patient with acute pancreatitis:
-Monitor VS, IV fluids, fluid and electrolyte balance closely monitored, assess respiratory function, observe for signs of hypocalcemia (tetany, numbness in lips, positive Trousseau or Chvostek signs)
-Provide relief of pain before it become severe
-Frequent oral and nasal care for NG pts
A continuous, prolonged, inflammatory, and fibrosing process of the pancreas; pancreas become progressively destroyed as it is replaced with fibrous tissue; strictures and calcifications may also occur:
-Chronic pancreatitis
This type of chronic pancreatitis is associated with biliary dz; inflammation of the sphincter of Oddi associated with gallstones:
-Chronic obstructive pancreatitis
This type of chronic pancreatitis is an inflammation and sclerosis, mainly in the head of the pancreas and around the pancreatic duct; most common form; alcohol-induced pancreatitis; the ducts are obstructed with protein precipitates which blocks the pancreatic duct and eventually clacify, followed by fibrosis and glandular atrophy; pseudocysts and abcesses commonly develop:
-Chronic calcifying pancreatitis
Describe signs and symptoms for a patient with chronic pancreatitis:
-Abdominal pain similar to acute pancreatitis
-May have episodes of acute pain, but is usually chronic and attacks may become more and more frequent until they are almost constant
-Pain is described as a heavy, gnawing feeling or sometimes as burning and cramplike
-Malabsorption, weight loss, constipation, mild jaundice with dark urine, steatorrhea, and DM
Describe nursing actions and treatment for a patient with chronic pancreatitis:
-Prevention of further attacks, relief of pain, and control of pancreatic exocrine and endocrine insufficiency
-Diet, pancreatic enzyme replacement, and control of DM
-Diet is bland, low in fat, and high in carbs; avoid fatty, rich, and stimulating foods and alcohol must be totally eliminated
-Antacids should be taken after meals
A dz in which the gastric mucosa is not secreting IF because of antibodies being directed against the gastric parietal cells and/or IF itself
-Pernicious anemia
A protein secreted by the parietal cells of the gastric mucosa; required for cobalamin (extrinsic factor) absorption:
-Intrinsic factor
Causes include: gastrectomy, gastritis, nutritional deficiency, chronic alcoholism, and hereditary enzymatic defects of cobalamin utilization; dz of insiduous onset that begins in middle age or later with 60 years being the most common age at diagnosis; results from the loss of IF-secreting gastric mucosal cells or impaired absorption of cobalamin in the distal ileum:
-Etiology of Pernicious Anemia
Describe signs and symptoms for a patient with pernicious anemia:
-Symptoms develop because of tissue hypoxia
-Sore tongue, anorexia, N & V, and abdominal pain, weakness, paresthesias of the feet and hands, reduced vibratory and position senses, ataxia, muscle weakness
Describe treatment and nursing actions for a patient with pernicious anemia:
-Increasing dietary cobalamin does not correct the anemia
-Parenteral or intranasal cobalamin admin
-Because there is a familial predisposition nurse should get a thorough history
-Nurse should ensure that injuries are not sustained because of the diminished sensations to heat and pain resulting from the neurologic impairment
-Ensuring good pt compliance; careful follow-up care; increase potential for cancer should have frequent and careful appropriate screenings
-Purpose of this diagnostic study: study is used to diagnose structural abnormalities of the esophagus, stomach, and duodenum
-Description of this diagnostic study: xray study with fluoroscopy with contrast medium
-Upper GI series/Barium swallow
Describe nursing responsibilities for a patient undergoing an upper GI series/barium swallow:
-Explain procedure to pt, the need to drink contrast medium, and the need to assume various positions on x-ray table; keep pt NPO 8-12 hours b4 procedure; tell pt to avoid smoking after midnight the night b4 the study; after x-ray, take measures to prevent contrast medium impaction; stool may be white up to 72 hours after
This diagnostic procedure is noninvasive and uses high-frequency sound waves (ultrasound waves), which are passed into body structures and recorded as they are reflected (bounded); a conductive gel (lubricant jelly) is applied to the skin and a transducer is placed on the area:
-Ultrasound
Describe nursing actions for a patient undergoing an ultrasound:
-Instruct pt to be NPO for 8-12 hours b4 ultrasound; air or gas can reduce quality of images; food intake can cause gallbladder contraction in suboptimal study
This diagnostic procedure is a noninvasive radiologic examination combines special x-ray machine that allows for exposures at different depths; study detects biliary tract, liver, and pancreatic disorders; use of contrast medium accentuates density differences:
-Computed tomography (CT)
Describe nursing actions for a patient undergoing a CT scan:
-Describe procedure to pt; determine sensitivity to iodine contrast
This diagnostic procedure is a noninvasive procedure using radiofrequency waves and magnetic field; procedure is used to detect hepatic metastases and sources of GI bleeding and to stage colorectal cancer:
-Magnetic resonance imaging (MRI)
Describe nursing actions for a patient undergoing a MRI scan:
-Explain procedure to pt; contraindicated in pt with metal implants (pacemaker) or who is pregnant
This diagnostic procedure is used to directly visualize mucosal lining of esophagus, stomach, and duodenum with flexible, fiberoptic endoscope; test may use video imaging to visualize stomach motility; inflammations, ulcerations, tumors, varices, or Mallory-Weiss tear may be detected; biopsies may be taken and varices can be treated with band ligation or sclerotherapy:
-Esophagogastroduodenoscopy (EGD)
Describe nursing actions for a patient undergoing an EGD:
-b4 the procedure, keep pt NPO for 8 hr; make sure consent is on chart; give preoperative med if ordered; explain to pt that local anesthetic may be sprayed on throat b4 insertion of scope and that pt will be sedated during the procedure
This diagnostic procedure uses a fiberoptic endoscope (using fluoroscopy) is inserted through the oral cavity into descending duodenum, then common bile and pancreatic ducts are cannulated; contrast medium is injected into ducts and allows for direct visualization of structures; technique can also be used to retrieve a gallstone from distal common bile duct, dilate strictures, obtain biopsy of tumor, and diagnose pseudocysts:
-Endoscopic Retrograde Cholangiopancreatography (ERCP)
Describe nursing actions for a patient undergoing an ERCP:
-B4 the procedure: explain procedure to pt, including pt role; keep pt NPO 8 hr b4 procedure; ensure that consent form is signed; admin sedation immediately b4 and during procedure; admin antibiotics if ordered
-After the procedure: check VS; check for signs of perforation or infection; be aware that pancreatitis is most common complication; check for return of gag reflex
This diagnostic procedure is a radionuclide study used to assess ability of stomach to empty solids or liquids; in solid-emptying study, cook egg white containing Tc-99m is eaten; in liquid-emptying study, orange juice with Tc-99m is drunk; sequential images from gamma camera are recorded q 2 min for up to 1 hr; study is used in pts with emptying disorders from peptic ulcer, ulcer sx, diabetes, or gastric malignancies:
-Gastric emptying studies
Describe nursing actions for a patient undergoing gastric emptying studies:
-Tell pt that substances contain only traces of radioactivity and pose little to no danger; schedule no more than one radionuclide test on the same day; explain to pt need to lie flat during scanning
This diagnostic procedure's purpose is to analyze gastric contents for acidity and volume; NG is inserted and gastric contents are aspirated; contents are analyzed mainly for HCl acid, but pH, pepsin, and electrolytes may be determined; histalog and pentagastrin may be used to stimulate HCl secretion; exfoliative cytology may be done to determine whether malignant cells are present:
-Gastric analysis
Describe nursing actions for a patient undergoing gastric analysis:
-Keep pt NPO for 8-12 hr; explain insertion of NG tube; withhold drugs affecting gastric secretions 24-48 hrs b4 test; ensure no smoking morning of test
This study measures secretion of amylase by pancreas and is important in diagnosing acute pancreatitis; level peaks in 24 hr and then drops to normal in 48-72 hr:
-Serum amylase
What is a normal range of serum amylase?
- 60-160 u/ml
What is a normal range of serum lipase?
- 0.2-1.5 u/ml
This study measures secretion of lipase by pancreas; level stays elevated longer than serum amylase:
-Serum lipase
What is a normal Hgb for men? Women?
-Men: 13.2-17.3 g/dl
-Women: 11.7-15.5 g/dl
What is a normal Hct for men? Women?
-Men: 43-49
-Female: 38-44
These drugs block the action of histamine on the H2-receptors and thus reduce HCl acid secretion; this decreases the conversion of pepsinogen to pepsin, and accelerates ulcer healing
-Route: may admin PO or IV; therapeutic effects last up to 12 hr; -Side Effects include: granulocytopenia, gynecomastia, diarrhea, fatigue, dizziness, rash, and mental confusion
-used in combination with antibiotics to treat ulcers related to H. pylori; --Interactions: cimetidine inhibits the ability of liver to metabolize certain drugs increasing the risk of toxicity (warfarin, antidepressants, metoprolol)
-Nursing Assessments: assess for confusion in the elderly and notify HCP is this occurs
-Pt Teaching: avoid taking with alcohol, aspirin, and NSAIDs
-Histamine (H2)-Receptor Blockers
Name certain H2-Receptor Blockers:
-cimetidine (Tagamet)
-ranitidine (Zantac)
-famotidine (Pepcid)
-nizatidine (Axid)
Name certain Proton Pump Inhibitors:
-omeprazole (Prilosec)
-lansoprazole (Prevacid)
-pantoprazole (Protonix)
-rabeprazole (Aciphex)
-esomeprazole (Nexium)
These drugs block the ATPase enzyme that is important for the secretion of HCl acid; more effective than H2R blockers in reducing gastric acid secretion and promoting ulcer healing; also used in combination with antibiotics to treat ulcers caused by H. pylori
-Nursing Assessments: admin b4 meals, preferably in the am
-Side Effects: abdominal pain, diarrhea, constipation, N & V, dizziness
-Route: PO
-Proton Pump Inhibitors (PPIs)
These drugs are used as adjunct therapy for PUD; they increase the gastric pH by neutralizing the HCl acid therefore, acid content of chyme reaching the duodenum is reduced; some (Al Hydroxide) can bind to bile salts, thus decreasing the detrimental effects of bile on the gastric mucosa
-Route: PO (liquid or tablet)
-Side Effects: constipation, diarrhea
-Nursing Assessments: effects last longer if taken after meals; assess for heartburn and indigestion as well as location, duration, character and precipitating factors of gastric pain; have the capacity to interact unfavorably with some drugs, therefore it is important to inform the HCP of any drugs that are being taken b4 therapy is begun:
-Antacids
These drugs are used to manage nausea and vomiting of many causes; some work by increasing gastric emptying, others work on the chemo trigger to inhibit, motion sickness
-Nursing Assessment: assess bowel sounds, N & V, and abdominal pain b4 admin; monitor I & O
-Side effects: blurred vision, dry eyes, hypotension, constipation, dry mouth
-Antiemetics
These drugs increase the digestion of fats, carbs, and proteins in the GI tract
-Side Effects: abdominal pain, diarrhea, nausea, stomach cramps
-Route: PO
-Nursing Assessments: assess pt's nutritional status, monitor stools for high-fat content; admin immediately b4 or with meal/snack
-Pancreatic enzymes
Broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, Popsicles:
-Clear liquid diet
-Includes clear liquids as well as, smooth-textured dairy products (ice cream) custards, refined cooked cereals, vegetable juice, pureed veggies, all fruit juices
-Full liquid diet
Includes clear, full liquids and pureed as well as ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked veggies, cooked or canned fruits, bananas, soups, peanut butter:
-Mechanical Soft
Indications for Enteral Nutrition include:
-Cancer: head/neck and upper GI
-Neurological and Muscular Disorders
-Gastrointestinal Disorders
-Inadequate Oral Intake: anorexia nervosa, difficulty chewing/swallowing, severe depression
Indications for Parenteral Nutrition include:
-Nonfunctional GI tract
-Extended Bowel Rest
-Preoperative TPN
Describe nursing management related to enteral feedings:
-Tube placement
-Feeding are typically placed at full strength at slow rates and increased every 8-12hr if no signs of intolerance are shown
-Assess for signs of aspiration
-Maintain HOB above 30 degrees
-Measure GRV every 4-6 hrs for clients receiving continuous feedings and immediately b4 the feeding for intermittent feedings
-measure for pH b4 each feeding or every 8 hrs for continuous feedings
-formula should be given at room temp
Describe nursing management related to parenteral feedings:
-Change tubing and solution every 24 hrs if PN with lipids; every 72 hrs for PN with amino acids and dextrose
-Monitor VS
-Follow proper aseptic techniques
-Initially VS every 4-8 hrs
-Daily weights
-Monitor lab results: glucose, electrolytes, BUN, CBC, and hepatic
-Monitor/change dressings
-Observe site for signs of inflammation and infection
-The nurse should periodically check the volume infused cuz pumps can fail
-The nurse must check the label and ingredients in the solution to see that they are what the physician ordered
-Examine for leaks, color changes, particulate matter, clarity, and fat emulsion cracking
-Oral care
Describe complications that can occur with enteral feedings:
-Pulmonary aspiration
-Diarrhea
-Constipation
-Tube occlusion
-Tube displacement
-Abdominal cramping, N & V
-Delayed gastric emptying
-Serum electrolyte imbalance
-Fluid overload
-Hyperosmolar dehydration
Describe complications that can occur with parenteral feedings:
-Electrolyte imbalance
-Hypercapnia (increased O2 consumption)
-Hyperglycemia
-Hypoglycemia
-Hyperglycemia hyperosmolar nonketotic dehydration/coma
-Mechanical problems: air embolus, hemorrhage, pneumothorax
-Infection
An abnormal increase in the proportion of fat cells; the most common nutritional problem, affecting almost 1/3 of the population; is the second leading cause of preventable deaths after smoking:
-Obesity
It occurs because energy intake exceeds energy output; cause involves significant genetic/biologic susceptibility factors that are highly influenced by environmental and psychosocial factors; caloric consumption (energy intake) must exceed the energy expended for the condition to continue; 50% of cases are estimated to be an inherited problem; regulation of eating behavior, energy metabolism, and body fat metabolism is controlled by signals from the periphery that act on the hypothalamus; most common form is considered to be polygenic arising from the interaction of multiple genetic and environmental factors; associated with increased circulating plasma levels of leptin, insulin, and ghrelin, and decreased levels of peptide YY; environmental causes include: repackaged and fast foods, soft drinks, portion size of meals has also increased, lack of physical exercise, socioeconomic status; emotional component of the tendency to overeat is powerful, birthday parties, and holidays:
-Etiology of Obesity
The majority of people have this classification of obesity which is excess calorie intake for the body's metabolic demands:
-Primary Obesity
The minority of people have this classification of obesity which can result from various congenital anomalies, chromosomal anomalies, metabolic problems, or CNS lesions and disorders:
-Secondary Obesity
What is the first step in the treatment of obesity?
-Determining whether any physical conditions are present
The degree to which a patient is classified as underweight, healthy (normal) weight, overweight, or obese is assessed by using this:
-Body Mass Index (BMI)
What is the BMI score for an individual who is considered to be underweight?
-Less than 18
What is the BMI score for an individual who is considered to be normal weight?
-Between 18 and 25
What is the BMI score for an individual who is considered to be overweight?
-Between 25 and 30
What is the BMI score for an individual who is considered to be obese?
-Greater than 30
What is the BMI score for an individual who is considered to be morbidly obese?
-Greater than 40
Approximately, what is the percentage of Americans with a BMI greater than 35?
-13%
True or False:
Obesity is the same as being overweight.
-False: Obesity carries many more risk factors and is a chronic condition with a strong familial element.
Individuals with fat located primarily in the abdominal area and are at a greater risk for obesity-related complications than those whose fat is primarily located in the upper legs are called this:
-Apple-shaped body or android shaped
The name for a person whose fat is primarily located in the upper legs:
-Pear-shaped body or gynoid obesity
Describe nutritional therapy for an overweight or obese person:
-A good weight loss plan should contain foods from the basic food groups
-A diet that includes adequate amounts of fruits and veggies, provides enough bulk to prevent constipation and meets daily vitamin A and vitamin C requirements
-Lean meat, fish, and eggs provide sufficient protein, as well as the B-complex vitamins
-Restricting dietary intake so that it is below energy requirements is an effective way to reduce body weight
-An obese pt must understand that following a well-balanced, low-calorie diet is an essential part of weight loss
-Avoid fad diets, provide and find motivation, setting a realistic and healthy goal that is mutually agreed upon
-Teach pt about plateau periods
-Avoid alcohol
Describe how exercise help a person lose weight:
-Should be done 30-60 minutes per day
-It produces more weight loss than does dieting alone and is especially important in maintaining weight loss in overweight and obese persons
-Goal of 10,000 steps/day
-Also provides reduction in tension and stress, better quality sleep and rest, increased stamina and energy, improved self-concept and self-confidence, better attitudes toward work and play, and increased optimism about the future can be achieved
These drugs reduces food intake through noradrenergic (drugs that mimic norepinephrine) or serotonergic mechanisms in the CNS; only recommended for short-term use:
-Appetite-Suppressing Drugs
These drugs were developed for weight loss and maintenance, works by blocking fat breakdown and absorption in the intestine; some fat-soluble vitamin levels may decrease and may need to be supplemented:
-Nutrient Absorption-Blocking Drugs