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150 Cards in this Set

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What is the purpose of an Upper GI series or Barium Swallow?
It is an examination of the esophagus, stomach, and duodenum and other portions of the small bowel. It uses barium as a contrast medium.
What is the pre-procedure and nursing considerations for an upper GI series or Barium swallow?
Explain the procedure to patient, withold food and fluids, and administer fluids and enemas as presecribed.
What are the post-procedure nursing considerations for an upper GI series or Barium swallow?
Inform the patient that stools will be light colored for several days, administer fluids and enemas as presecribed.
What is the definition and purpose of a lower GI series?
Examination of large intestine, uses barium as contrast medioum instilled as an enema.
What is the pre-procedure nursing considerations of a lower GI series?
explain procedure to patient, withold food and fluids, administer laxatives and enemas as prescribed (bowel prep)
What is the post procedure nursing considerations for a lower GI series?
encourage fluids, unless restricted, administer laxatives and enemas as prescribed, monitor color, consistency and amount of stool.
What is an endoscopy?
direct visualization of the esophagus and stomach using an endoscope
What is the pre procedure nursing considerations for an endoscopy?
explain the procedure to patient, withold food and fluids for 8 hours before the test, check that informed consent has been signed, obtain baseline vitals, administer sedatives as prescribed
What are post procedure nursing considerations for an endoscopy?
withold food and fluids until the gag cough reflex has returned, monitor vitals signs, assess vasoveagal response, monitor SaO2, watch for signs of perforation: pain, increased temperature, bleeding, provide discharge care instructions to pt and person driving home
What is a fecal occult blood test?
lab test analyzing the stool for hidden blood using a reagent
what is the preprocedure for a fecal occult blood test?
explain procedure to pt, advise the patient to AVOID red meat, iron, and high fiber for 1-3 days prior to test!!
document use of aspirin, vitamin C, and anti-inflammatory drugs
What is a sigmoidoscopy?
direct visualization of the sigmoid colon, rectum, and anal canal using a lighted scope
What is the pre-procedure nursing considerations for a sigmoidoscopy?
explain procedure to pt, administer bowel prep as ordered, check that an informed consent has been signed, and document iron intake
What are post-procedure nursing considerations for sigmoidoscopy?
Check pt for bleeding, monitor vital signs
What is a colonoscopy?
direct visualization of the large intestine using a lighted scope, biopsies can be obtained
What are preprocedure nursing considerations for a colonoscopy?
explain procedure to pt, CLEAR LIQUID diet starting at NOON the DAY BEFORE the test, administer bowel prep, explain that the pt will probably feel cramping and the urge to poop, explain that air will be used to distend colon, check for informed consent
What is the postprocedure for a colonoscopy?
monitor for gross rectal bleeding, withhold food and fluid for 2 hours, monitor stool for blood if polups are removed, bed rest until fully alert, monitor LOC and vital signs, watch for signs of perforation: bleeding, pain, increased temperature, provide written post op instructions
What is an ultrasonography?
visualization of body organs using echoes from sound waves, this procedure is noninvasive
what is preprocedure nursing considerations for an ultrasonography?
explain procedure to pt, encourage a LOW residue, high simple fat diet for 1 day before the procedure, NPO after MN, note allergies to iodine, sea food, or radiopaque dyes, inform pt about possible throat irritation or facial flushing
What is the postprocedure nursing considerations for an ultrasonography?
moniter injection site for bleeding, monitor vital signs
What is computed tomography?
X-ray that shows cross sections of abdominal organs and structures, can be with or without contrast but with contrast is a much better image
What are preprocedure nursing considerations for an ultrasonography?
note allergies to iodine, shell fish, or xray dye, check current creatnine level and HCG, give sodium bicarbonate or mucomyst as ordered for renal protection
What is a MRI?
image of the area tested is created using magnetic fields and radio waves, sometimes use contrast
What is the preprocedure nursing consdierations for a MRI?
any objects that contain iron can be dangerous and cause injury, jewelry, pacemakers, dental implants, artifical valves, defibrillators, insulin pumps, tens units, aneuysm clips
remove all foil backed patches (transderm, catapres)
remove ALL jewelry and metal items
NPO 6-8 hours before the test
inquire about claustophobia
What is regurgitation?
vomit in mouth, partially digested comes up from stomach
What is projectile?
forecul expulsion of stomach contents, indiactes tumor or obstruction
What is vomiting?
stomach contents that come up into toilet or trashcan
What are clinical manifestations of oropharyngeal cancer?
Leukoplakia- "smokers patch"
-white patch on mucoas or tonque
- considered precancerous ledions, but not likely to develop into cancer
Erythroplakia:
-pre-cancer, more likely to develop into cancer
-red, velvety patches on mouth or tongue
Ulcerations
A sore that doesn't heal
Rough Area:
--basically you can feel with tongue.
What is treatment for oropharyngeal cancer?
Surgery
Radiation
Chemotherapy
Combination
What is stomach cancer?
Cancer of the stomach wall, no signal causitive agennts, has been associated with diets containing
*smoked foods
*salted fish or meats
*pickled vegetables
What are clinical manifestations of stomach cancer?
often spreads before symptoms occur
unexplained weight loss
lack of appetite
indigestion
abdominal pain
signs and symptoms of anemia such as
*pallor
*fatigue
*weak
*Shortness of breath
*dizziness
--Possible abdomen distention
What is GERD?
results when you eat. food passes from throat to stomach through esophagus, once the food is in the stomach, a ring of muscles prevents food from moving backward, if LES doesn't close well, then the stomach contents including the stomach acid can leak back into esophagus erroding the esophagus

*Most common upper GI problem in adults
What are risk factors for GERD?
diet, over weight, smoking, midnight eating, pregnancy
What are clinical manifestations of GERD?
heartburn is most common
hyper salivation
non cardiac chest pain
presistant reflux, occuring more then TWICE a week
resp symptoms such as coughing, wheezing, and SOB
Dispepsia- pain or discomfort centered in upper abdomen

**Elderly & unconscious patient at higher risk of aspiration
What are complications of GERD?
*Direct local effect of erroding esophagus
*Esophagitis- inflammation of esophagus which can cause scar formation, which may cause esophogeal stricture, narrowing of esophagus. It can feel like you're choking and can't get food down.
dysphagia (difficulty swallowing)
*barrets esophagus- reversible change in cell, could be precancerous
*repiratory complication from irritation of upper airway
What are diagnostics of GERD?
based on what dr gets from your history
endoscopy
what is treatment for GERD?
*lifestyle modifications-change diet
*stop smoking
*avoid late night snacks
*decrease weight
*
what is treatment for GERD @ night?
*elevate HOB, bricks under bed, pillow
What is the nursing mgmt of GERD?
*help patient figure out cause of GERD (food diary)
*stop smoking
*decrease stress
*increase HOB 30 degrees
*sit up 2-3 hours after meal
**CHRONIC AND RECURRING
What is a hiatal hernia?
herniation of a portion of the stomach into the esophagus through an opening in the diaphragm

*most common thing found on x-ray, upper GI exams
*occurs more often in woman and older adults
what is a sliding hiatal hernia?
sliding- *most common
when part of stomach and esophagus is above hiatis and part of the stomach slides through hiatis in diaphragm
--occurs when pt is supine (laying on back)
--usually goes back into abdomen cavity when patient stands up
what is a paraesophageal or rolling hiatal hernia?
where fundus and greater curvature of stomach roll up through diaphragm forming a pocket next to esophagus (along side esophagus)
**can be dangerous
****Acute paraesophageal hernia is a medical EMERGENCY.
what is the etiology of a hiatal hernia?
-weakening of muscles in diaphrgam
-facotrs that increase intraabdomen pressure are:
obesity
tumor
weight lifters
intense physical exertion
pregnancy
what are clinical manifestations of a hiatal hernia?
-heartburg especially after a meal
-burning pain, relieved by standing up
-large meal
-alcohol
-smoking
-dysphagia

**all can cause pain.
what are complications of a hiatal hernia?
-GERD
-esophagitis
-hemorrhage from erosion
-stenosis (narrowing)
-ulcerations of herniated part
-strangulated hernia-- *Medical emergency
-regurgitation w/ tracheal aspiration
what are diagnostics for hiatal hernias?
--upper GI
--endoscopy of lower esophagus
*damage, ulcerations
what is the treatment for hiatal hernias?
conservative
-life style modifications
-lose weight
-lighten up on weight lifting
-avoid straining (Bowel movement = stool softening)
-antacids
what is the surgical treatment for hiatal hernias?
-Herniotomy- excision of hernia
-Herniorraphy- closure of hiatal defect
-Gastropexy- attachment of stomach below diaphragn to prevent herniation
-Antireflux surgery- wrap stomach around esophagus and reinforces valve.
What is the nursing management of hiatal hernia?
-education
--decrease weight if obese
--decrease weight lifting
What is upper gastrointestinal bleeding?
bleeding from the upper gastrointestinal tract

**Obvious bleeding you can see!
What is hematemisis?
bloody vomit, looks like bright red or coffee grounds, more active, fresh

shown in upper gastrointestinal bleeding
what is melena?
black tarry stools
-digested blood from iron

shown in upper gastrointestinal bleeding
what is occult bleeding?
Can't see
--Guaiac test to detect blood
What is the etiology for upper gastrointestinal bleeding?
sudden onset most serious, vomiting blood.
dont underestimate occult bleeding because you cant see it so it may have been going on for a while which means anemia is a possibility.
severity depends on origin:
venous
capillary
arterial

*ARTERIAL: bright red vomit! no HCl contact, MOST SERIOUS.

if vomit is coffee ground consistency means its been in stomach for sometime.
What is considered a massive UGI bleed?
loss of >1500mL of blood.

Patient is at risk for hypovolemia!
what are increased bleeding risks for upper gastrointestinal bleeding?
NSAIDS
Steroids
Aspirin
Burn and Trauma patients
Tumors and stomach cancer
What is the emergency assessment and management for upper gastrointestinal bleeding?
ASSESS FOR HYPOVOLEMIA*
-most spontaneously stop
-Blood pressure
-Rate and character of pulse
-peripheral perfusion- capillary refill (make sure blood is getting to legs and arms)
Vital signs every 15-30 minutes
Watch for signs and symptoms of shock which include decreased BP, rapid weak pulse, restless, cold and clammy
find cause and treat
ABC's- assess resp status
do a good assessment of abdomen
Labs- test vomit and stool
*NO RED FOOD
-have blood ready to go, check religion
-IV- load with fluid and blood
---lactated ringers, helps revent schock, not massive blood use NS
What are diagnostics for upper gastrointestinal bleeding?
endoscopy if able.
what is the treatment for upper gastrointestinal bleeding?
-endoscopy hemostasis- coagulate bleeding vessel
-surgery- last resort and need to know where it is
-drugs that decrease HCl secretions to prevent irritation
-neautralize HCl that is present
-epinephrine- during endoscopy for bleeding
---- makes tissues edematous which puts pressure on bleeding, this temporarily stops bleeding
What is the nursing management of upper gastrointestinal bleeding?
-good assessment (subjective and objective)
-LOC
-v/s every 15-30 minutes
-neck veins
-capillary refill
-skin color
-abdomen assessment
-accurate I&O for hydration status
-CHF patient: watch for fluid overload
-no red food
-monitor lab values
What is esophogeal diverticula?
s/s non or sour taste in mouth, smelling foul odors

--saclike outpouching of the esophagus
*this causes food to get stuck
Zenkers diverticulum- above LES
traction diverticulum- middle of esophagus
efferfrenic diverticulum- below LES
s/s of effernic diverticulum: disphagia, regurgitation, aspiration, chronic cough, weight loss)
What are esophogeal strictures?
Narrowing of esophagus
Most commonly caused by GERD
Can result in dysphagia, regurgitation, weight loss
What is the tx for esophageal strictures?
dialating strictures endoscopically
what is esophageal varices?
dilated veins in the lower portion of the esophagus
*watch and prevent bleeding
What is foodborne illness?
Acute GI symptoms caused by intake of contaiminated food or liquids
what are symptoms of foodborne illness?
nausea, vomiting, diarrhea, abdominal pain, cramping
What is the treatment for foodborne illness?
more supportive care, fluid and electrolyte balance VERY IMPORTANT to start patient on fluids, educate patient on how to cook food, wash veggies, refrigerate food and leftovers
what should patients avoid while having foodborne illness?
** NO antidiarrheal agents
these can cause inflammation of intestine, increase risk for kidney failure
*wash hands after potty
raw meat
what are s/s of foodborne illness?
bloody diarrhea, abdominal cramping for 2-8 days
what is achalasia?
peristalsis of lower 2/3 of esophagus, food not getting to stomach which causes GERD like symptoms, regurgitation especially at night, dysphagia.

Drink with meals, soft food, increase HOB, increased risk for aspiration
What is gastritis?
inflammation of the gastric mucosa:
--one of the most common problems effecting the stomach
What is acute gastritis?
self-limiting, can last a few hours to few days, complete healing will occur
what is chronic gastritis?
can last from months to years
*parietal cells can be lost
-- secret gastric acid and entrinsic factor that helps absorb vitamin b12 which helps growth and maintenance of RBC's

causes pernicious anemia
What is the cause of gastritis?
breakdown in normal gastric lining layer
mucosal barrier broken down causing inflammation and edema
capillary walls leading to possible hemorrhage
what does the mucosal barrier?
protects from pepsin or HCl
what are drug related risk factors for gastritis?
NSAIDS- direct irritating on stomach and disrupt protective layer of stomach lining
-trauma
-burns
What are diet related risk factors for gastritis?
spicy food in large quantities
smoking
NG tube
alcohol binge
How does helicobacter pylori affect gastritis?
it can cause chronic gastritis
usually during childhood, low socioeconomic status, born before 1940 are all at greater risk
spread fecal-oral, no hand washing
what is autoimmune gastritis?
inherited*
immune system attack parietal cells
what are clinical manifestations of gastritis?
nausea and vomiting
anorexia
epigastric tenderness
feel "full", satiety
hemorrhage in alcoholics
what are diagnostics for gastritis?
history of drug and alcohol abuse (both illegal and scripts)
endoscopy
biopsy
test for H. Pylori
what is the treatment for acute gastritis?
-find cause and eiminate it
-fluid and electrolyte balance: fix it!
-NPO
-hydration status
-NG tube- look for blockage
-antacids, PDL's H2 receptor blockers
what is the treatment for chronic gastritis?
get rid of cause: H. Pylori- take antibiotics
pernicious anemia- oral, nasal, injection of b12 for life
-smaller meals, avoid foods that irritate
-antacid after meals
-NO SMOKING
what is the nursing management of acute gastritis?
supportive, treat N/V, educateion, find cause

*watch for dehydration, fluid and electrolyte imbalance, hemorrhage
what is the nursing mgmt of chronic gastritis?
find cause and help them get rid of it
b12 supplement
What is peptic ulcer disease? (PUD)
develop in presence of acidic environment
erosion of the GI mucosa due to the digestive action HCl acid and pepsin
stomach lining erroded or torn away from HCL or pepsin
What is acute PUD?
associated with superfical erosion with small amount of inflammation, usually short duration
What is chronic PUD?
long duration
erodes through muscular wall
can be present for many months or intermittent through out life
What is the connection between H. pylori and PUD?
alters gastric secretions
produces tissue damage
What is the connection between medication-induced injury?
-ulcergenic-NSAIDS- irritate stomach lining
- increase gastric acid secretion, break stomach barrier down

**Corticosteroids- affect mucosa cell renewal
what is the connection between lifestyle fators and PUD?
-alcohol intake stimulates increased gastric secretions
-coffee intake stimulates increased gastric secretions
-stress/depression decreases healing of ulcers
what is the connection between gastric ulcers and PUD?
In stomach, less common in the US, greater mortality rate, age >50 more likely to get gastric ulcers, usually result in obstruction
R/F- H. pylori, meds, smoking, bile reflux
what is the connection between duodenal ulcers and PUD?
more common in US,
can effect any age but usually 35-40 years old
R/F H. pylori is most common, smoking, alcohol,
what is the connection between stress-related mucosal disease and PUD?
give H2 receptor blockers (Zantac, Pepcid)
What are diagnostics for PUD?
endoscopy (most accurate)
after treatment you will do another endoscopy to see if treatment is working
What are clinicals manifestations of ulcers?
Gastric- dyspepsia (upset stomach) high in upper gastric
1-2 hours after meals, burning feeling
if eroded clear through mucosa, food will aggrivate even more

Duodenal ulcers- continuous and intermittent
2-5 hours after meal
burning, craming in mid-gastric pain that can radiate to back
food can help protect- acid eats food
antacids combined with H2 receptor blockers and food
what are complications of ulcers?
hemorrhage- most common, duodenal more likely to bleed
what is the nursing care of ulcers?
refert to upper GI bleeding
check vitals every 15-30 minutes
NG-watch color
what is perforation?
one of the most lethal of PUD

watch for third spacing which can lead to hypovalemia so CHECK VITALS

ulcer penetrates bowel, hole, poop, acid, food in cavitus

BIG- emergency, immediate surgery
Small- heals self usually
what are signs and symptoms of perforation?
distended rigid hard abdomen, severe abdominal pain radiates to black, shallow respirations, tachycardia, weak pulse, absent bowel sounds, nausea, vomiting
what is the nursing care of perforation?
assess v/s
watch for hypovolemia
NG tube- stop all drops and feedings
antibiotic therapy
prepare for surgery
what is gastric outlet obstruction?
obstruction of stomach by gastric ulcers causesd by scar tissure from ulcer
what are s/s of gastric outlet obstruction?
discomfort, pain (worsening at end of day)
relief- belching, self induced vomiting-- food has been left for long time.
what is the treatment of gastric outlet obstruction?
help decrease obstruction, inflammation
NG tube to give bowel rest
IV fluids- hydration
what is the nursing care for gastric outlet obstruction?
maintain patency of NG tube
position patient to move tube to prevent irritation
accurate I&O
what is the conservative treatment for PUD?
adequate rest
drug therapy
no smoking
dietary modifications if needed
long term follow up care
**decrease gastric acidity and protect lining
what is drug therapy for PUD?
-PPl's
H2 receptor blockers
for H. Pylor- antibiotics
antacids
cytoprotective (carafate) which provides lining over ulcer
What is the nutritional therapy for PUD?
avoid foods that cause discomfort
what is treatment for PUD?
partial gastrectomy, vagotomy, pyloroplasty
What is a partial gastrectomy? (gastroduodeumostomy)
removal of lower 2/3 of stomach, stomach stump connected to duodeum
what is a partial gastrectomy? (gastrojuejeumostomy)
remove lower part of stomach and connect to juejeum
what is a vagotomy?
severe vagus nerve
(brain stem to pelvic)
what is a pyloroplasty?
surgically enlarge pyloric sphincter to facilitate easy passage of stomach contents
what is the nursing care for surgery for PUD?
pre-op: educate, what to expect afterwards:

pain, PCA, incentive sperometer, deep breathe, coughing.


post-op: educate, pain, NG tube.

bright red blood within 24 hours is normal, yellow to green within 36-48 hours.
What is dumping syndrome?
meal dumps into the intestine following surgery for PUD
what are the s/s of dumping syndrome?
15-30 minutes after meal:
weakness
seating
palpitations
dizziness
hyperactive bowel sounds
abdominal cramping
urge to deficate
If the s/s of dumping syndrome last for an hour, what should the patient do?
eat small smeals
no fluids with meals
lie down for 30 minutes after meals
decrease carb content
symptoms resolve on own!
what is postprandial hypoglycemia?
following surgery for PUD
large amounts of carbs dumped into small intesting, blood vessels absorb that glucose and the body releases a ton of insulin
usually occurs couple hours after eating
what are s/s of postprandial hypoglycemia?
weakness
mental confusion
papitation
tachycardia
anxiety
what is bile reflux gastritis?
reflux of bile into stomach causing damage to stomach lining which leads to gastritis which leads to a reoccurance of ulcers
what are s/s of bile reflux gastritis?
epigastric distress, vomiting
What are gerontologic considerations for PUD?
increased risk
-incidence is increasing for people over 60
due to increase use of NSAIDS
pain may not be the first symptom
it may be gastric bleeding or decrease HCT
what is appendicitis?
small tubular appendage attached to the cecum, its the most common reason for emergency abdominal surgery in the US, most commonly between 10-30 years, morbidity and mortality is highest in patients over 70
what is perionitis?
abdominal pain, tenderness, distended abdomen, hypoactive bowel sounds
what is rebound tenderness?
push on stomach and it doesnt hurt, let go and it starts hurting
what is the worst case scenario of appendicites?
the appendix ruptures if diagnosis and treatment is delayed, leading to peritonitis. if this ruptures you will have a high fever and high WBC count
what are s/s of appendix?
increasing periumbilical pain evolves into RLQ pain, low grade fever, N/V/D, anorexia, coughing/sneezing will magnify the pain
What is Mcburney's point? (appendix)
halfway between the umbilicus and the anterior superior iliac spine-- pain will localize here (RLQ)
What is Rovsig's Sign?
LLG palpation causes RLQ pain
what is the diagnosis for appendix?
increased WBC
increased neutrophils
abdominal xrays, CT may reveal RLQ density or localized bowel distention
**CAT SCAN is GOLD standared to diagnosis!!
what do you do for an apendectomy post-op?
4-6 week post-op period, limit physical activity, no special diet
what do you do for an appendectomy pre-op?
antibiotics
NPO if going to surgery
Ice NOT heat if in a lot of pain prior to surgery
pain medication
what are nursing diagnosis for an appendectomy patient?
-pain
-risk of infection
- anxiety
What is Crohn's disease?
patches of inflammation in large intestine
a chronic, nonspecific inflammatory bowel disorder of unknown origin

Can affect ANY part of the GI tract from the mouth to the anus but most commonly seen in the terminal ileum and colon
What layers of the bowel wall does Crohns disease affect?
epithelium
lamina propria
muscularis mucosa
submucosa
muscularis propria
what layers of the bowel wall does ulcerative colitis affect?
mucosa and submucosa
what are skip lesions?
segments of normal bowel occuring between diseased portions
Narrowing of the ____ with stricture development occurs and may cause _____ or ______.
lumen
bowel obstruction
perforation
Microscopic leaks can allow ___ contents into ____ cavity.
bowel
peritoneal
what are the main manifestations of Crohns disease?
Watery diarrhea- not usually bloody
Colicky/Crampy abdominal pain
fever/fatigue
weight loss may occur if small intestine is involved
what are s/s of bile reflux gastritis?
epigastric distress, vomiting
What are gerontologic considerations for PUD?
increased risk
-incidence is increasing for people over 60
due to increase use of NSAIDS
pain may not be the first symptom
it may be gastric bleeding or decrease HCT
what is appendicitis?
small tubular appendage attached to the cecum, its the most common reason for emergency abdominal surgery in the US, most commonly between 10-30 years, morbidity and mortality is highest in patients over 70
what is perionitis?
abdominal pain, tenderness, distended abdomen, hypoactive bowel sounds
what is rebound tenderness?
push on stomach and it doesnt hurt, let go and it starts hurting
what is the worst case scenario of appendicites?
the appendix ruptures if diagnosis and treatment is delayed, leading to peritonitis. if this ruptures you will have a high fever and high WBC count
what are s/s of appendix?
increasing periumbilical pain evolves into RLQ pain, low grade fever, N/V/D, anorexia, coughing/sneezing will magnify the pain
What is Mcburney's point? (appendix)
halfway between the umbilicus and the anterior superior iliac spine-- pain will localize here (RLQ)
What is Rovsig's Sign?
LLG palpation causes RLQ pain
what is the diagnosis for appendix?
increased WBC
increased neutrophils
abdominal xrays, CT may reveal RLQ density or localized bowel distention
**CAT SCAN is GOLD standared to diagnosis!!