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119 Cards in this Set
- Front
- Back
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When fecal odor and bile are present in vomitus, where is the vomit most likely originating from?
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may be an indication of an obstruction below the level of the pylorus
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What type of vomitus is indicative of a gastric outlet obstruction?
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projectile vomit that may contain small food particles that were ingested many hours or days before and has a strong odor because the contents have been in the stomach for a long time
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What is coffee ground emesis and and why is it like that?
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this is emesis that contains blood that is dark brown in color and clumpy because it has mixed with the acid contents of the stomach
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What does bright red blood indicate in vomit?
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bright red blood is indicative of an active bleed in the GI
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name some drugs that can be used for nausea and vomiting?
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reglan, phenegran, scopolamine, thorazine, zofran
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Once the symptoms of N/v have subsided, what is the protocol for increasing intake of fluid and food?
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clear liquids are started first. Extremly hot and cold beverages should be avoided and warm or room temperature beverages should be used such as warm tea and carbonated beverages (without carbonation)
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When clear liquids are started after n/v subsides what type of food can be given to help alleviate the nausea?
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dry toast and crackers
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Why is gatorade and broth used with caution for n/v pts.
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because they are high in sodium
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What are some interventions that can be done to help a person experiencing N/V?
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Monitor I & O, VS, signs of dehydration, provide physical and emotional support, maintain a quiet and odor free environment
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What is GERD?
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GERD is when acidic gastric secretions reflux up into the lower esophagus and can result in esophegeal irritation and inflammation
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Symptoms of GERD include
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Heartburn (pyrosis), Dyspepsia (pain or discomfort centered in the upper abdomen), Regurgitation, sense of lump in the throat (globus sensation)
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A complication of GERD is Barret's esophagus ... what is this?
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it is considered to be a pre cancerous lesion that increases the persons risk of esophageal cancer
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What are some lifestyle complications that a person with GERD needs to do?
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stop smoking. avoid foods that irritate, lose weight, avoid caffeine intake, chocolate, and peppermint. avoid milk products at bedtime, eat smaller more frequent meals, drink fluid b/t meals rather than with them. avoid late night snacking
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Why is caffeine, chocolate, tea coffee and peppermint avoided in pts with GERD?
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because they predispose to reflux
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Why is milk products avoided in pts. with GERD?
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milk increases the gastric acid secretions
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What do antisecretory agents (h-2 receptor blockers) do for pts with GERD and what are some examples?
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they decrease the secretion of HCl acid by the stomach .... ex. tagament, zantac, pepcid
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What do antacids do for pts with GERD and what are some examples?
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they act by neutralizing the HCl acid but are short lived. ex. gaviscon, tums
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When are antacids taken?
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1 to 3 hours after meals and at bedtime
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What do PPI's do for pts with GERD and what are some examples?
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these act by inhibiting the proton pump mechanism responsible for H+ ions (promotes esophageal healing) .... ex. prilosec, nexium, prevacid
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What do Cholinergic do for pts with GERD and what are some examples?
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these are used to increase LES pressure, improve esophageal emptying, and increase gastric emptying ..... ex. urecholine
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What do Prokenetic (motility-enhancing) do for pts with GERD and what are some examples?
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they promote gastric emptying and reduce the risk of gastric acid reflux .... ex. reglan
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What surgical procedure can be done to relieve the symptoms of GERD and a hiatal hernia?
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Toupet fundoplication and the stretta procedure
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Post-op care for clients that had surgery for GERD or hernias?
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use drugs to prevent n/v and pain, monitor resp. status, strict I&O, monitor F&E, start on clear liquids only then progress to solids
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What is a sliding hiatal hernia?
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the stomach slides into the thoracic cavity when the patient is supine and usually goes back to normal when the patient sits up right
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What is a paraesophageal hiatal hernia?
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where the fundus and the greater curvature of the stomach roll up through the diaphragm, forming a pocket along side the esophagus
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Which is the most common type of hiatal hernia?
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sliding hernia
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What are some of the symptoms of hiatal hernias?
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Heartburn (especially after eating and lying supine), pain and severe burning when bending over and is relieved when sitting or standing up, dysphagia
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What disease processes do the symptoms of hiatal hernia mimic?
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gallbladder disease, PUD, and angina
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What are some of the complications associated with hiatal hernia?
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GERD, esophagitis, hemorrhage from erosion, stenosis, ulcerations, strangulation of the hernia
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What respiratory complications can come from a hiatal hernia?
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problems ranging from dyspnea to acute bronchhoconstriction
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What are lifestyle changes that can help with symptoms of an hiatal hernia?
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eliminate constrictive garments, avoid lifting and straining, stop smoking and drinking alcohol, elevate HOB, use PPI's and H-2 blockers, lose weight
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What two surgical procedures are done to help the symptoms of a hiatal hernia?
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Nissen and Toupet
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What is gastritis?
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an inflammation of the gastric mucosa
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What is drug-related gastritis?
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where drugs such as asprin and NSAIDS have direct irritating effects on the gastric mucosa
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What is autoimmune atrophic gastritis?
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this is a form of chronic gastritis that affects the fundus and the body of the stomach
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What are some of the viruses that can cause autoimmune atrophic gastritis?
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H. Pylori, CMV, and syphilis
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What are some symptoms of acute gastritis?
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anorexia, n/v, epigastric tenderness, and feeling of fullness, and sometimes hemorrhage (when associated with alcohol)
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What are the symptoms of chronic gastritis?
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similar to those of acute gastritis, although some have no symptoms related to a gastric lesion. pernicious anemia and neurologic complications are extreme but so occur
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what is the relationship between acute gastritis and cobalamin (vit b12) deficiency?
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When in acute gastritis the loss of intrinsic factor (essential for the absorption of b12) in the terminal ileum results in defiency
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What nursing interventions are required for acute gastritis?
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if vominting-rest, NPO, IV fluids possible, antiemetics; NG tube, VS for assesssment of hemorrhage, antacids for reduction of abdominal discomfort (raises pH above 6); clear liquids then to soft bland foods
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What other medications are used to promote healing of gastritis?
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H2R blockers & PPI's
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What is cobalamin?
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it is essential for the growth and maturation of RBC's
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What immediate physical assessments need to be made on a pt. with massive GI bleeding?
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BP's, rate and character of pulse, peripheral perfusion with cap refill, observation for the presence of or absence of neck vein distension, VS every 15 to 30 min, check for signs of shock, respiratory status, presence of bowel sounds, characteristics of abdomen
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what labs are commonly ordered in a pt. with a GI bleed?
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CBC, BUN, serum electrolytes, blood glucose, prothrombin time, liver enzymes, ABG's, type and cross
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Why are two IV lines established for a pt. with GI bleeding?
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one for fluid replacement and one for blood replacement
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How long does it take to be able to evaluate the effect of hemorrhage and a blood transfusion?
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4-6 hours after fluid replacement has taken place
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Why is a urinary catheter placed in a pt. with hemorrhage?
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so that urine volume can be accurately assessed hourly
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signs and symptoms of shock include?
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low BP, rapid and weak pulse, increased thirst, cold and clammy skin, and restlessness
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What acute interventions are implemented in a client with a GI bleed?
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obtain two IV lines, monitor I&O's hourly, auscultate breath sounds, watch for signs of fluid overload and shock
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What is PUD?
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a condition characterized by erosion of the GI mucosa resulting from the digestive action of HCL acid and pepsin
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What two areas of the GI tract are common sites for a peptic ulcer?
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gastric or duodenal
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What are the two categories of peptic ulcers?
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acute or chronic
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Describe the lesion of a gastric ulcer
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Superficial, smooth margins, round oval or coned shaped
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Describe the location of a gastric ulcer lesion
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predominantly antrum, also in the body and fundus of the stomach
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describe the gastric secretion of a gastric ulcer
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decreased or normal
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gastric ulcers have a greater incidence in who?
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women, peak age 50-60yrs, more common with lower socioeconomic status, increased with smoking and drug use and NSAIDS,
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Where is pain of a gastric ulcer?
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Burning or gaseous pressure in LUQ , back and upper abd,
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When does pain occur with gastric ulcers?
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pain is 1-2 hrs after meals
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Is nausea, vomiting and wt. loss associated with gastric ulcers?
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Yes
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Is the reoccurance rate high or low in pts with gastric ulcers?
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high
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What are some complications of pts with gastric ulcers?
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hemorrhage, perforation, gastric outlet obstruction, intractability
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describe the lesion of a duodenal ulcer
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penetrating
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describe the location of a duodenal ulcer
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in the first 1-2cm of duodenum
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describe the gastric secretion of a pt with a duodenal ulcer
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increased
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What type of person has a higher incidence of a duodenal ulcer?
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greater in men, and increasing in postmenopausal women, peak age 35-45yrs, associated with psychiological stress,increased with drug alcohol and cigarette use
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What conditions have a higher incidence for a duodenal ulcer?
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COPD, pancreatic disease, hyperparathyroidsm, Zollinger-Elison syndrome, chronic renal failure
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Describe the pain associated with a duodenal ulcer
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burning, cramping, pressurelike pain across midepigastric and upper abd, back pain is associated with posterior ulcers
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When does pain occur in pts with duodenal ulcers?
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2-4hrs after meals and in midmorning, midafternoon, and middle of the night, perodic and episodic
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Is nausea and vomiting associated with duodenal ulcers?
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occasionally
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duodenal ulcer pain can be relieved by...
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antacids
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Is the reoccurance rate of a duodenal ulcer high or low?
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high
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What are some complications of duodenal ulcers?
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Hemorrhage, obstruction, perforation
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What are physiologic ulcers?
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acute ulcers that develop following a major physiologic insult such as trauma or surgery
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What are the three most common complications of PUD?
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hemorrhage, obstruction, perforation
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What is the cause of hemorrhage in PUD?
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caused from erosion of the granulation tissue found at the base of the ulcer during healing or from erosion of the ulcer through a major blood vessel
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What assessments will the nurse implement in the case of a hemorrhage in a pt with PUD?
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change in VS, increase in the amount of reddness upon aspiration, decreased pain because blood neutralizes acid
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What are some nursing interventions for hemorrhage in a PUD pt.?
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NG tube, NG tube patency, similar intervention of GI bleeding
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What is the cause of perforation in a pt with PUD?
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this happens when the ulcer penetrates the serosal surface, with spillage of either gastric or duodenal contents into the peritoneal cavity
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What are some nursing assessments associated with perforation in a pt with PUD?
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sudden severe pain that is unrelated in intensity and location to the pain that brought the patient to the hospital, rigid boardlike abd, severe abdominal and shoulder pain, drawing up knees, shallow grunting respirations, absent or diminished bowel sounds
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What interventions would the nurse implement related to perforation in pts with PUD?
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VS every 15 to 30 minstop all oral and NG drugs and feedings, notify doctor, IV fluids should be maintained or increased, antibx therapy started
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Define diarrhea
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with unusually frequent or unusually liquid bowel movements, excessive watery evacuations of fecal material. The opposite of constipation.
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When is diarrhea considered to be chronic?
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When it lasts at least 4 weeks
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What is the treatment for different types of acute diarrhea?
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Treatment depends on cause
Foods and meds that cause diarrhea should be avoided Increasing fluids (IV and oral-Gatorade) to replace lost fluids and electrolytes |
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What meds are given for diarrhea?
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• Antidiarrheal agents are sometimes given to coat and protect mucous membranes, absorb irritating substances, inhibit GI motility, decrease intestinal secretions, and decrease central nervous system stimulation of the GI tract. Contraindicated in the Tx of infectious diarrhea, used cautiously in inflammatory bowel disease bc of the danger of toxic mega colon
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What is the med Demulcent for and what does it do?
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it is for the treatment of diarrhea and it soothes coats and protects mucous membranes
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Some examples of demulcent are?
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Bismuth, Donnagel, pectin, activated charcoal
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What are Anticholinergic for and what do they do?
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For the treatment of diarrhea and it inhibits GI motility
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What are some examples of Anticholinergics?
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Imodium, Donnagel, Lomotil
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What are Antisecretory for and what do they do?
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For the treatment of diarrhea an it decreases intestinal secretion
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What are some example of Antisecretory
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Sandrostatin
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Opioids are used for diarrhea, what do they do?
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decreases CNS stimulation of GO tract motility and secretion; directly inhibits GI motility
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What are some example of opioids used in the treatment of diarrhea?
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Paregoric, Donnagel-PG, Parepectolin, pectin
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What is irritable bowel syndrome (IBS)?
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IBS is a complex symptom of intermittent and recurrent abd pain and stool pattern irregularities.
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List the symptoms of IBS
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S/S: abd. pain, irregular stool patterns, diarrhea, constipation, abd. distention, excessive flatulence, bloating, continual urge to defecate and sensation of complete evacuation
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What is the treatment for IBS?
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based on S/S, need H&P
Diet-eliminate gas producing foods (broccoli, cabbage) R/O lactose intolerance (yogurt, milk) Increase fiber in diet when symptoms alleviate Antispasmodics and Synthetic opioid |
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How is IBS diagnosed?
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when the pt displays the characteristic S/S and other conditions are ruled out. Need a thorough H&P-emphasis should be on symptoms, past health hx, family hx, and drug and diet hx. Need to r/o colorectal cancer, PUD, IBD, and malabsorption disorders.
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What is ROME II criteria?
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Abd discomfort/pain for at least 12 weeks (not necessarily consecutive) within a 12 month period and having at least 2 of the following characteristics:
1. Relieved by defecation 2. Onset associated with a change in stool frequency 3. Onset associated with a change in stool appearance |
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What is appendicitis?
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Appendicitis is an inflammation of the appendix, a narrow blind tube that extends from the cecum
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What is the etiology and pathophysiology of appendicitis?
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Obstruction of the lumen by a fecalith (accumulated feces); resulting in distention, venous engorgement, and the accumulation of mucous and bacteria, which can lead to gangrene and perforation
Foreign bodies Tumor of the cecum or appendix Intramural thickening caused by excessive growth of lymphoid tissue |
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What are the signs and symptoms of appendicitis?
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Periumbilical pain followed by
Anorexia, N/v Pain is persistent and continuous, eventually localizing to RLQ, localized tenderness, rebound tenderness (push on left, hurts on right), and muscle guarding. Pt lies still with right leg flexed |
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What is peritonitis?
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Peritonitis results from a localized or generalized inflammatory process of the peritoneum
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What is primary peritonitis?
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occurs when blood-borne organisms enter the peritoneal cavity; ex) ascites that occurs with cirrhosis provides an excellent liquid environment for bacteria to flourish
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What is secondary peritonitis?
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is more common, occurs when abd organs perforate or rupture and release their contents (bile, enzymes, and bacteria) into the peritoneal cavity
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What are some causes of peritonitis?
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Ruptured appendix, perforated gastric or duodenal ulcer, severely inflamed gallbladder, and trauma from gun shot or knife wounds
Pts who use continuous ambulatory peritoneal dialysis are at high risk No matter the cause, the inflammatory response leads to massive fluid shifts, and adhesions as the body tries to wall off the infection. |
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What collaborative treatments are used for peritonitis?
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H&P, CBC, serum electrolytes, Xray, CT, ultrasound
(Preoperative or nonoperative) NPO, IV fluid replacement, antibiotics, NG suction, analgesics (morphine), oxygen PRN (Postoperative) NPO, NG tube to low-intermittent suction, Semi-fowler’s, IV fluids and electrolyte replacement, parenteral nutrition, antibiotics, blood transfusions if needed, sedatives and opioids |
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What are some S/S of peritonitis?
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o Abd pain, tenderness over involved area, rebound tenderness, muscular rigidity, and spasms, shallow respirations bc movement causes pain, abd distention, ascites, fever, tachycardia, tachypnea, N/V, altered bowel habits
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What are some complications of peritonitis?
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Hypovolemic shock, sepsis, intraabdominal abscess formation, paralytic ileus, and ARDS, death
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List two types of inflammatory bowel disease
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Crohn’s
Ulcerative colitis |
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Area of the intestine that is affected by crohns
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Occurs anywhere along the GI tract (mouth to anus); skips areas, most frequent site is the terminal ileum
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Area of the intestine that is affected by ulcertive cholitis
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Starts in rectum and spreads in a continuous pattern up the colon
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What are some s/s of crohns?
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-Diarrhea
-Colicky abd pain -Weight loss r/t malabsorption -Occ. Rectal bleeding -Occ. fever |
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What are some s/s of ulcerative cholitis?
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-Bloody diarrhea
-Abd. pain; varies from mild lower abd cramping associated with diarrhea to the severe, constant pain associated with acute perforations |
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What are some complications of crohns disease?
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Local:
-Hemorrhage -Strictures -Leaks, leading to peritonitis, leading to abscesses of fistulas to adjacent organs -rare colonic dilation Systemic: -increased risk of small bowel cancer -nutritional problems (fat malabsorption and anemia) -fever -anorexia -malaise |
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What are some complications of ulcerative cholitis?
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Local:
-Hemorrhage -Occ strictures -Colonic dilation (Toxic mega colon) -Perforation -rare fistulas -rare abscesses Systemic: -Increased risk of colon Cancer -fever -anorexia -malaise |
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What are the diagnostic studies used for ulcerative cholitis?
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H&P
-CBC -serum chemistries (Na, K, Cl, HCO3, Mg, albumin) -WBC -testing stool for occult blood or infection, pus, and mucous -capsule endoscopy -sigmoidoscopy with biopsy -colonoscopy with biopsy -double contrast barium enema |
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What are some diagnostic studies for crohns disease?
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H&P
-CBC -serum chemistries (Na, K, Cl, HCO3, Mg, albumin) -WBC -testing stool for occult blood or infection, pus, and mucous -capsule endoscopy -sigmoidoscopy with biopsy -colonoscopy with biopsy -double contrast barium enema |
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What are the treatment goals for crohns and ulcerative cholitis?
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**Goal is to help pts better regulate their immune systems**
-Rest the bowel -Control inflammation -Combat infection -Correct malnutrition -Alleviate stress -Provide symptomatic relief -Improve quality of life |
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What is the nutrition therapy for ulcerative cholitis?
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Diet: high calorie, high protein, low residue, lactose free
-avoid raw seeds, nuts, corn hulls -small frequent meals (6) -fluid intake of 1/2oz / lb of body weight -Sip liquids slowly -Eliminate one food at a time, evaluate if it alleviated symptoms -daily multi vitamin with minerals -Give antispasmodics/diarrheal meds 15-20 mins before meals to reduce cramping, bloating, gas, and diarrhea |
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What is the nutrition therapy for crohns?
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Titrate fiber (low if active), slowly introduce after symptoms subside
-Diet: high calorie, high protein, low residue, lactose free -avoid raw seeds, nuts, corn hulls -small frequent meals (6) -fluid intake of 1/2oz / lb of body weight -Sip liquids slowly -Eliminate one food at a time, evaluate if it alleviated symptoms -daily multi vitamin with minerals -Give antispasmodics/diarrheal meds 15-20 mins before meals to reduce cramping, bloating, gas, and diarrhea |
