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292 Cards in this Set
- Front
- Back
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What is the out pouching of the intestinal mucosa?
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DiverticuLUM
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Where can a diverticulum occur?
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Can occur at any point in the GI tract but more commonly in the sigmoid colon.
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What is the cause of diverticulum?
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Congenital weakness
Increased pressure in the lumen. |
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What is it called if there is multiple divertidula?
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DiverticulOSIS (many)
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What is it called there is inflammation of diverticula?
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DiverticulITIS (inflammation)
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What is the most common colon disease in the western world due to high processed foods, and low fiber?
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Diverticulosis/Diverticulitis
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Is there s/s with diverticulosis/diverticulitis?
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No, not until complications develop.
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What are the complications of diverticulosis/diverticulitis?
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retained, undigested food in diverticular sac, resulting in a hard mass.
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What does diverticulosis/itis cause?
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abscess, fistulas, bowel obstruction, peritonitis, and hemorrhage.
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What are the s/s of diverticulosis/itis?
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constipation, diarrhea, flatulence, acute LLQ abdominal paid that may be relieved by having a BM or flatus.
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What are some other S/S? of diverticulosis/itis?
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my increase after meals and abdominal pressure (obesity, tight belts) and may see rectal bleeding or fever if infection present
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How is diverticulitis/osis diagnosed?
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H & P, colonoscopy and WBC if infection (increased bands and neutrophils
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What is the treatment for diverticulosis/itis?
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REST BOWEL--NPO-TNP, hydrophyllic colloid (bulk) laxatives to increasethe bulk and water content of stool
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What kind of medication is contraindicated for diverticulosis/itis?
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opiates
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What is the invasive procedure called when treating diverticulosis/itis?
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surgery-colon resection (colostomy) or temporary loop colostomy
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What are the nursing interventions for diverticulosis/itis?
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treat s/s, watch for complications, soft diet, (NPO if in hospital) fluids-8 a day, high fiber diet when stable
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What are some teaching that can be given to a person with diverticulosis/itis?
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avoid abd pressure (constipation, tight belts, clothing, lifting wrong, loose weight, have a BM daily, walk, fluid, tell DR if elimination patterns change, fever, pain
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What is the diet for a person who has diverticulosis?
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Long-term treatment for diverticulitis involves a high-fiber diet
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What is the inflammation of the vermiform appendix and classified as simple, gangreous, or perforated?
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Appendicitis
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Where is the appendix located on a person?
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attached to the cecum below the ileo-cecal valve
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What quad of the abdomen is usually diverticulosis/itis pain?
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Acute in the LLQ abd
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What part of the abd is the pain located with appendicitis?
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RLQ
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Does obstruction of the intestinal lumen (opening of the appendix) caus appendicitis
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YES, blocked ---fecal mass, tumors, viral infection leading to infection, thrombosis, necrosis, perforation
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How does the s/s of appendicitis begin?
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generalized flue feeeling or localized abd pain in RLQ followed by N/V/anorexia, tachycardia, decreased or no bowel tones
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What is McBurney's Point?
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The pain from appendicitis that is 1/2 way between the RT anterior iliac crest and the umbilicus
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What happens when appendix ruptures?
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SEVERE pain followed by a decrease in pain that is more generalized.
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What is the pain like for appendicitis?
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localized RLQ, with tenderness, guarding, sever abd spasms, and rebound tenderness
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What is the MOST common & most serious compliation of appendicitis?
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PERITONITIS-generalized abd pain, muscle ridgidity, rebound pain, rigid(board) abds, 3rd spacing, Increase HR, hypovolemia, s/s of infection
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What is a nursing intervention to avoid if the pt might have appendicitis?
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laxatives, enemas, heating pads may rupture the appendix
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What are the nursing interventions pre-surgery for appendicitis?
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NPO, I&O & IV fluid to prevent deydration
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Pain will be where if you have cholecystitis?
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In the RUQ
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What is cholecystitis?
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Inflammation of the gallbladder. can be acute or chronic.
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What is cholelithiasis?
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Stones in the gallbladder formed by cholesterol(80%) when bile becomes supersaturated with cholesterol)
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What is choledocholithiasis?
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stones in the common bile duct
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What is 4 times more common in women ages 40-50. (fair, fertile, overweight or forty)
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cholecystitis
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What are the risk factors of cholecystitis?
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obesity, diabetes, estrogen, pregnancy, genetics, rapid weight lose, habit of fasting, low calorie diet, cholesterol-lowering drugs, chronic liver disease, obstruction, or biliary infection
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What does bile do?
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helps digest fat and absorb certain vitamins and minerals. (imulsifies fat)
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Who are the at-risk group for cholecystitis?
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Native American men.
Pima Indian Women of Arizona Mexican American |
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What are the S/S of cholecystitis?
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indigestion abd pain in RUQ, rebound tenderness, N/V, bloating, burping, Murphy's sign
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What is Murphy's sign?
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Can't take a deep inspiration when assessors fingers are pressed below hepatic margin
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How is cholecystitis diagnosed?
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Ultrasound determines gallstones
ERCP-a scope down throat-can see and remove |
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What are the lab values that are used to diagnose cholecystitis?
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elevated WBC-indicates inflammation
Increased Amylase may be pancreatic involvement-stones in common bile duct ALP & Billirubin if obstruction common bile duct and liver involvement |
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What is a Gallbladder X-ray test?
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it radiopaque tablets taken before the x-ray
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If you have pain 2-4 hours after eating high fat food in the RUQ is it bilary obstruction or cholecystitis/cholelithiasis?
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It's cholecystitis/cholelithiasis.
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Do you have jaundice with bilary obstruction or cholecystitis?
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Bilary obstruction
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What does a lithotripsy do?
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It is a treatment for gall stones, kidney stones that sends shock waves thru the stones to break them up. Sedation is used.The shock waves are synchronized with the heartbeat. Narcotics are used pre/post for pain
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Why would a pt still have mild shoulder pain up to a week after a laparoscopic cholecystectomy?
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because the residual carbon dioxide that was used to inflate the abd cavity during OR.
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What is very important to have the pt use after a laparoscopic sholecystectomy?
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TED hose to prevent venous pooling
phemonic stockings or booties |
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After a laparoscopic cholecystectomy what drugs are given?
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antibiotics
antispasmodics & anticholinegics to reduce contraction of the gallbladder, pain meds |
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What diet should a pt eat after a cholecystectomy?
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Low fat healthy diet, if obese my have caloric restriction
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After a cholecystecomy most people can tolerate what kind of diet?
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a regular healthy diet with moderation in fat
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What is the most common complication following a cholecystecomy?
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PNEUMONIA--put in semi-fowlers position to facilitate breathing
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Should we assess for liver or pancreatic involvement with a cholecystecomy?
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YES
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In the common bile duct was explored, what may be in place?
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a T-Tube bay be in place to maintain patency
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How much bile drainage not unusual in the first 24 hours after a cholecystecomy?
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300-500ml
|
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How can you tell if bile is again entering the duodenum?
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stool is normal brown color
|
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What is pancreatitis?
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It is the inflammation of the pancreas (acute or chronic)
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Were is the pancreas?
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It lies behind the greater curvature of the stomach-its connected to the duodenum. (head)
|
|
What does the pancreas do?
|
Exocrine function-digestive enzymes
Endocrine function-Alpha cells secrete glucagon and beta cells secrete insulin |
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What is the pathophysiology of pancreatitis?
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Its AUTODIGESTION. Pancreatic enzymes bread dow tissue & cells causes vascular damage, edema, hemorrhage & necrosis.
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What organ in the body produces bile?
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the liver
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what is the major component of bile?
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bilirubin, produced from breakdown of RBC
|
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What is wrong when bile is entering the blood stream?
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blockage is occurring in the ducts preventing bile flow to the duodenum
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What does excessive bilirubin cause to the skin
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irritation effect on the skin (bile salt under the skin) causing PRURITUS (intense itching)
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What is the function of bile?
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digest fat by emulsifying it.
|
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If biliary obstruction occurs what happens?
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fat digestion is impaired and steatorrhea (increased fat in stools) occurs.
|
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What color is the stool when there is no bile?
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clay colored stool. lack of bile being absorbed in the duodenum
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Can fat-soluble vitamins be absorbed if bile is obstructed?
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no.
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What complication occurs when fat-soluble vitamins are not absorbed?
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Vit K aids in blood clotting so may increase bleeding tendencies
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What are the fat-soluble vitamins?
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A, D, E, & K
|
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What organ in the body produces bile?
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the liver
|
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what is the major component of bile?
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bilirubin, produced from breakdown of RBC
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What is wrong when bile is entering the blood stream?
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blockage is occurring in the ducts preventing bile flow to the duodenum
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What does excessive bilirubin cause to the skin
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irritation effect on the skin (bile salt under the skin) causing PRURITUS (intense itching)
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What is the function of bile?
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digest fat by emulsifying it.
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If biliary obstruction occurs what happens?
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fat digestion is impaired and steatorrhea (increased fat in stools) occurs.
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What color is the stool when there is no bile?
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clay colored stool. lack of bile being absorbed in the duodenum
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Can fat-soluble vitamins be absorbed if bile is obstructed?
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no.
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What complication occurs when fat-soluble vitamins are not absorbed?
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Vit K aids in blood clotting so may increase bleeding tendencies
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What are the fat-soluble vitamins?
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A, D, E, & K
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What does albumin contribute to?
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Albumin, a plasma protein, contributes to blood osmolality
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What happens when there is a decreased plasma albumin (hypoalbuminemia?
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leads to a reduced colloidal osmotic pressure causing decreased return of fluid from from interstitial to blood causing edema and ascites
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What happens when there is decreased fibrinogen and prothrombin
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they aid in blood coagulation. dereased factors that aid in blood coagulation results in increased bleeding
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What does the liver produce that aid in immunity?
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globulins. with decreased immunity, susceptibility to infections increase
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what does the liver do with toxic ammonia?
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converts to a less toxic substance called urea.
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What happens in hepatic encephalopathy?
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ammonia production increases because the liver can't convert to urea.
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What is ammonia toxic to?
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the nervous system
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What does the liver store?
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glucose as glycogen
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what does the liver do with the stored glucose and glycogen?
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covert it to glucose when glucose level decreased
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What is gluconeogensis?
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when the liver produces glucose from excessive proteins and fats
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What hormones does the liver inactivated?
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including aldosterone and estrogen.
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What happens when aldosterone is not inactivated by the liver?
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an increased level of aldosterone leads to NA retention which can cause hypervolemia and edema
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what happens when estrogen is not inactivated by the liver
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increased estrogen levels can cause gynecomastia (enlarged breasts in males)
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What other hormones are catabolized by the liver?
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growth hormone, glucocorticoids, thyroxin, glucagon and catecholamines
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What is referred to as the antechamber of the heart?
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the blood supply of the liver because it collects splenic & GI blood,
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How much blood can the liver accumulate
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up to 1000ml of blood- like a sponge
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What happens when right heart blood flow is immpeded>
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causing the liver to become engorged (hepatomegaly) enlarged liver
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What happens to drugs in the body if liver dysfunction
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a prolonged drug effect may occur because the liver inactivates drugs and toxic substances
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What is hepatitis?
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inflammation and necrosis of the liver caused by a virus
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What does inflammation do to liver?
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Inflammation kills healthy cells and replaces them with scar tissue called CIRRHOSIS
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WHAT IS THE CAUSE OF hepatitis A
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oral-fecal route. commonly caused by food contamination by food handlers, or shellfish
|
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Can Hep A survive in the freezer?
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YES, can survive for years in ice or frozen foods
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What is the incubation period for Hep A
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15-50 days-pt is asymtomatic but contagious. ususally for 2 weeks prior to s/s and 1-2 after s/s
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What is the recovery time for Hep A
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2-6 weeks. Determined by return to normal liver function and no s/s
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What is HAV associated with
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a lifelong immunity
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How do you prevent HAV?
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good hand washing, control & screening of foodhandlers.
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What are s/s of HAV?
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flu-like, depression, loss of appitite, n/v/d, fever, lethargy, jaundice, DARK ORANGE BROWN URINE
|
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What is passive temporary immunity for HAV?
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Immunoglobin (IG) should be given within 2 weeks of exposure and with Hep A vaccine
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Is there a vaccine for Hep A
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Yes, active immunity is hep A vaccination
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Is there a vaccine for Hep B
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Yes, HBV vaccine provides active immunity for 10-13 years.
|
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Is HBV contagious?
|
Yes HBV is more contagious than HIV. Can live on dried blood for 10 days
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What is the acute phase of HBV
|
pt becomes infected and lasts weeks to months
|
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What is the chronic phase of HBV
|
some pt's remain infected for the rest of their lives and become CHRONIC CARRIERS
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How can HBV be spread?
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articles containing blood (tattoos, piercings, toothbrushes, razors, diabetic glucose reading machines. body fluids-saliva, semen, blood
|
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Can moms transmit HBV to babies
|
yes mothers to infant transmission prior to/or at delivery, especially in developing countries
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What is the most common way HBV is spread
|
sexual contact and needle sharing
|
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How is HBV diagnosed?
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presence of antigen-antibody systems in the blood (HBsAg) incubation period 45-180 days. Infectious as long as HBV antigens are present
|
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What are the s/s of HBV?
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same as HAV.. flue like, n/v/d/ dark urine but some never have s/s Initially the liver becomes enlarged
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The incidence of HBV has remained steady in the US, Has it changed among health providers?
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The incidence of HBV among health providers remains consistent
|
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What is the goal of the CDC in regard to HBV
|
Universal vaccination to eliminate HBV in the US-screen all pregnant women, at risk individuals and vaccinate all infants
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What should you do if you have a change in bowel elimination patterns or characteristics, fever or abd pain? (diverticulosis)
|
Notify the physician
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What is very important to haver every day if you have diverticulosis?
|
importance of having a daily BM
|
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What should be avoided with diverticulosis?
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try to avoid an increase in intra-abdominal pressure (constipation, tight belts, restricted clothing & improper lifting techniques
|
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Is it ok to do low-impact weight lifting with diverticulosis?
|
yes
|
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What kind of diet would you have if admitted to the hospital with diverticulosis?
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a soft diet rich in fiber
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What kind of diet would you have if admitted to the hospital with diverticulitis?
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NPO for diverticulitis in the hopsital
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What inflammatory s/s would you have with diverticulitis
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may see rectal bleeding or fever if infection present
|
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With any bowel obstructive disease, what is the diet when in the hospital?
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NPO
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Often what is the first s/s if diverticulosis?
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constipation
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What relieves the pain of diverticulosis?
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a bowel movement
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What is the main test to see if you have diverticulosis?
|
colonoscopy
|
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When would you want to rest the bowels?
|
GI surgery, pancreatitis, diverticulitis, bowel obstruction
|
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What is the nursing intervention to make sure to monitor when a person is on TPN?
|
monitor glucose levels
|
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What labs do you want to make sure to look at if infection is possible?
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increase in bands and neutrophils
|
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with diverticulosis disorder what do you want to make sure to take care of.
|
prevent complications. can go into septic shock. and worry about fluid and electrolites
|
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What types of surgery can happen with diverticulosis/itis
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colostomy, temporary loop colostomy
|
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What food would a person at home with diverticulosis want to eat?
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high fiver diet.
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What should be encourage every day when teaching for diverticulosis?
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encourage activities that increase peristalsis like walking and lots of fluids
|
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What are some s/s might be seed with appendisitis?
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may see tempt of 99-101, increased WBC from 10,000 to 18,000 and shift left (incresed bands) (appy not ruptured
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If the appendix ruptures, then the infected content spills into the abdominal cavity causing?
|
peritonitis
|
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What is the most common and most serious complication of appendicitis?
|
peritonitis
|
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What is the s/s of peritonitis?
|
rigid abd, third spacing, tachycardia, hpovolemia, abd pain, left shoulder tip pain-can go into shock
|
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What is the treatment for peritonitis?
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must be rapid. include antibiotics, and may have drain in incision or open incision
|
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If the appendix does not rupture what is the # one complication?
|
pneumonia
|
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What bed position is appropriate nursing intervention for appendicitis?
|
simi-fowler's position to decrease pain & promote drainage which prevents fluid accumulation
|
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What should be avoided with appendicitis?
|
laxatives, enema, or heat may rupture the appendix
|
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What is very important after appendix surgery
|
ambulate and have a bowel movement
|
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What is inflammation of the gallbladder, acute or chronic?
|
Cholecystitis
|
|
What is stones in the gallbladder called?
|
cholelithiasis. formed by cholesterol (80%) when bile becomes supersaturated with cholesterol
|
|
what is it called when there is stones in the common bile duct?
|
choledocholithiasis
|
|
Cholecystitis is more common in who?
|
4 times more common in women (age 40-50) (fair, fertile, fat, over 40)
|
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What color is your skin if you do not have bile during digestion?
|
clay color
|
|
When is the pain most when someone had cholecystitis?
|
after a fatty meal 2-4 hours
|
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What are the risk factors for cholecystitis?
|
obesity, diabetes, estrogen, pregnancy, genetic, predisposition, rapid weight loss, habit if fasting, cholesterol-lowering drugs, liver disease, obstruction, infection
|
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Who is the biggest risk factor group for cholectystitis?
|
Native American men, Pima Indian women of Arizona
|
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Where is the pain most with a person with cholecystitis
|
RUQ - rebound tenderness,
|
|
what is murphy's sign?
|
cannot take a deep inspiration when assessor's fingers are pressed below hepatic margin
|
|
What is the gold standard to diagnosis gallstones
|
ultrasound determines gallstones
|
|
What is another diagnostic test for gallstones
|
ERCP- can see very tiny stones and remove them if necessary
|
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What lab values are might indicated cholecystitis?
|
WBC elevated-indicated inflammation
|
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Why might you see increased amylase increase with cholecystitis?
|
may indicate pancreatic involvement (stones in common bile duct)
|
|
Why might you see increased ALP & billirubin elevation with cholectystitis?
|
may be elevated if obstruction of the common bile duct and liver involvement
|
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What is it called when the bile salts are in the skin causing itching?
|
pruritus
|
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What is the difference between cholocystitis and bilary obstruction?
|
C-has pain 2-4 hrs after eating high fat meals RUQ
BO-pain, jaundice, feces clay color, pruritus, labs with amylase, alp, bilirubin increased |
|
What is a cholestecomy
|
Abdominal-removal of gallbladder
laparoscopic-removal thru endoscope. |
|
What is lithotripsy?
|
shock waves that break up stones (kidney or gallbladder)
The shock waves are synced with heartbeat |
|
Why do they give narcotics before and after lithotripsy?
|
help with pain, passage of stone fragments
|
|
What is an hiatal hernia (HH)
|
a portion of the stomach herniates thru the diaphragm and into the thorax
|
|
What is the characteristics of HH?
|
congenital weakness. But more commonly interabdominal pressure caused by obesity
aging, |
|
What is the most common type of HH
|
Sliding (direct) 90% of the time
|
|
What is the issue with HH?
|
things can get caught, stuck,
|
|
What is the most common co-morbid condition with GERDS
|
asthma
|
|
is reflux generally associated with HH?
|
yes
|
|
What is excess gastric fluids in the stomach where the lower esophageal sphincter is dysfunctioned
|
leads to GERDS
|
|
What is sometimes referred to as reflux esophagitis or lower esophageal sphincter dysfunction
|
GERDS
|
|
What does the acid do to the esophagus in GERDS
|
It causes heartburn, and red, scarring, narrowing
|
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What are some s/s for HH and GERDS
|
at first none until sphincter becomes incompetent
|
|
What are the s/s of HH and GERDS
|
dyspepsi (pain in upper abd)
pyrosis (heartburn) waterbrash (hypersalivation) gastric reflux (regurgitation) full feeling (distended abd) Dysphagia (painful swallowing |
|
Is chest pain involved with GERDS and HH
|
yes,
|
|
What is dispepsia?
|
pain in the upper abd, chest pain,
|
|
What is painful swallowing?
|
dysphagia
|
|
How is GERDS, HH Dx?
|
Barium swallow with fluoroscopy. can see the narrowing better than an EGD.
|
|
What are nursing interventions after an EGD?
|
assess for gage reflux to be intake
|
|
What are some treatments to GERDS, HH
|
loose weight, reduce stomach distention, smaller meals, no fluid with meals, reduce stomach acid , reduce pressure-lifting, obesity, tight clothes
|
|
what is the surgical precedure called for HH?
|
Nissen Fundoplication. prevents gastric reflux by reinforcement of spincter muscles
|
|
What is the nursing interventions following surgery of HH?
|
Pain management, diet, and prevention of pneumonia--cough and deep breath
|
|
What is some the diet after HH surgery?
|
first-NPO
next-clear liquid, liquid, next-low residue diet |
|
What do we want to prevent after HH surgery?
|
pneumonia
|
|
What are the meds associated with HH?
|
antacids--tums-short acting
H2receptor blockers- proton pump inhibitors-long lasting, prilosec, protonic-inhibits stomach acids |
|
What foods should avoid with GERDS, HH
|
caffeine, alcohol, tobacco, fatty foods, chocolate, citrus fruits, tomato products
|
|
What should you avoid during meals
|
avoid drinking fluids with meals to limit the volume in the stomach
|
|
What should you do before sleeping
|
do not eat for 3 hours prior to sleeping and maintain upright position for 2-3 hours after a meal and elevate head of bed while sleeping
|
|
What type of meals should be eaten with HH or GERDS?
|
small frequent meals. avoid stomach distention
|
|
What activities should be avoided with HH or GERDS?
|
avoid activities that increase abd pressure--heavy weight lifting, bending over , tight clothes
|
|
What is it called when there is inflammation of the lining of the stomach and small intestines
|
gastroenteritis
|
|
What causes gastroenteritis?
|
infection, diseases, and FOOD POISONING
|
|
What are the s/s of gastroenteritis?
|
N/V/D, borborygmi(hyperactive bowl sounds
|
|
If you see some one in the hospital with gastroenteritis what is the most common reason they are there
|
dehydration because of the N/V/D
|
|
What kind of diet is seen with gastroenteritis?
|
lots of liquids and bland foods, hight pro&carbs, low-fat and bulk foods
|
|
What is GASTRITIS?
|
inflammation of the stomach, acute or chronic
|
|
What is the cause of gastritis?
|
ASA, NSAIDS, steroids, and alcohol. most common cause of acute is alcohol
|
|
Stress ulcer is a form of ?
|
acute gastritis
|
|
Chronic gastritis is?
|
the gastric mucosa is thin
|
|
what does the H-pylori do?
|
its a gram-neg bacteria that cause gastritis--inflammation of stomach
|
|
what are some s/s of gastritis?
|
anorexia, N/V/D, belching, abd bullness, pain, intolerance of certain foods, dehydration, pernicious anemia
|
|
If you have H-pylori gastritis what is the Rx?
|
1-2 week of a triple therapy constisting of 2 anti-infective agents & a proton pump inhibitor
|
|
What should be monitored with gastritis?
|
anemia because intrinsic factor produced in the stomachs perietal cells that is essential for vit B12 absorption might be low
|
|
What are the only two places we will see a bland diet?
|
gastritis, gastroenteritis
|
|
What is the Dx for gastritis?
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EGD and H pylori--breath test or serum test, CBC, sed-rate to see if inflammation, WBC to see if infection
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What are the nursing interventions for gastritis?
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observe s/s dehydration, electrolyte imbalance, avoid the things that cause-alcohol, caffiene, smoking, ASA, bland diet
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In diagnosis if appendicitis, what WBC count would be consistent?
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mild to moderate elevation of 10,000 to 18 with left shift ; greater than 20 indicate peritonitis
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In preparing pt for appendix surgery what should the nurse anticipate?
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NPO status, deliver IV fluids, obtain surgical consent
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What are the 3 main characteristics of peptic ulcer disease?
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Inflammation-H Pylori
Increase gastric secretions-milk or food mucosal damage-drugs |
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Where are 80% of peptic ulcers located?
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in the duodenum-most common place
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Where is the 2nd most common location of peptic ulcers?
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stomach
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where is the least common location of peptic ulcers
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esophagus
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What is the difference between gastric and duodenal ulcers?
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Gastric-older male-blue collar
duodenal-younger male-white collar-more stress increases gastric secretions |
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Gastric ulcers are caused by a?
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breakdown in the body's protective mechanisms. OTC medications ANA, non-steroidal
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Duodenal ulcers are caused by?
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stress, hypersecretion of gastric acids
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What are other causes of peptic ulcer disease?
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drugs, stress, nicotine, calcium, high protein
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what are some s/s of peptic ulcer disease?
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dyspepsia, gnawing, boring or dull pain located in the mid-epigastrium or back
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What would the s/s be for peptic ulcer disease that has a perforated ulcer?
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board-like abdomen with no bowel tones--real hard abdomen
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Gastric ulcer pain will be how long after they eat?
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1-2 hours after a meal that will be relieved by antacids or vomiting-rare @ night
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Duodenal ulcer pain will be how long after they eat?
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2-4 hours after meals & at night. Pain follows ingestion of certain foods like coffee, ANA, alcohol
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Which peptic ulcer disease does vomiting occur more often?
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Vomiting is common with gastric ulcer disease and is uncommon with duodenal ulcer disease
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What does Melena mean?
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blood in feces
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When would you see melena?
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Melena is more common than hematemesis with duodenal ulcer.
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The Dx for peptic ulcer disease is how?
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1 H pylori
2 upper GI endoscopy (EGD) 3 upper GI xray-barium swallow 4 CBC Hgb/Hct & stool for blood |
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What is the Rx for peptic ulcer disease?
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treat H pylori
antacids, H2 receptor blockers proton pump inhibitors Carafate/Sucralfrate-mucosal barrier |
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What kind of surgery is used for peptic ulcer disease?
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billroth 1 and billroth 2
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What is billroth 1
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surgery that removes the lower portion of the stomach & attaches to the duodenum.
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What is billroth 2
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surgery that removes the antrum & distal portion of stomach and attachment of remaining to jejunum
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What is total gastrectomy surgery?
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esophagus is connected to jejunum (very rare) and will need monthly Vit B12 injections
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What is the most common complications of GI surgery?
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pneumonia is the most common
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What is dumping syndrome?
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a complication of GI surgery that the rapid passage of food is dumped straight into the small intestines (high in CHO), draws fluid from blood, increase blood sugar/insulin
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Dumping syndrome occurs when
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a lot, need extremely small portions, low in carbohydrates
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what happens 1-2 hours after a meal with dumping syndrome
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a 2nd period of discomfort & feeling shaky (hypoglycemia symptoms)may occur because overproduction of insulin
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What is paralytic ileus?
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a functional disorder -paralysis-the nerves 'going to sleep'. need to worry about bowel obstruction
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A functional paralysis caused by surgery, infection that will reveal no bowel sounds or gurgling is what?
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paralytic ileus
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What are some nursing care after GI surgery?
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DO not manipulate the NG tube after GI surgery to prevent pressure on the sutures
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When should you call the DR after GI surgery?
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if pt feels like vomiting or think NG is clogged. The NG should NEVER be manipulated and REQUIRES a dr order to irrigate
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is blood expected from the NG after GI surgery?
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yes 4-12 hours after the surgery-50-60cc
after 12-24 hours should not be seeing blood 100 cc is unexpected |
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The diet after GI surgery and after NG tube is pulled
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low-residue. low fat high protein and non-gas forming foods (fish, roast beef)
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What should we observe for in a pt after gastric surgery (labs)
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Pernicious anemia. the pariatal cells in the stomach might not be there anymore
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What is IBD
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Inflammatory Bowel Disease
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What is Inflammatory Bowel Disease?
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an inflammatory disease of the intestine that is chronic and relapsing.
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IBD is referred to as what?
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ulcerative colitis and
Crohn's disease |
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What are some complications of peptic ulcer disease?
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perforation, gi bleeding, pyloric obstruction, intractable disease
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Which peptic ulcer disease does the pain occur at night?
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duodenal ulcer often occurs at night
gastric ulcer does not occur at night |
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What education should be given to a pt about dumping syndrome?
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eliminate liquids with meals, avoid milk, sweets, sugars, small frequent meals are best
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What is ulcerative colitis?
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inflammatory reaction primarily involving the colon. begins in rectum and spreads upward. uniform and continuous-only affects the mucosa layer
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What is Crohns disease?
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chronic inflammation extending thru all layers of intestinal wall & is progressive-discontinuous-affects segments-terminal ileum and colon
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Where does ulcerative colitis start?
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beginning in the rectum and moves upward-inflammation in the mucosa layer
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How many bloody stools can you have a day with ulcerative colitis?
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10-20 bloody liquid stools a day
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Which IBD is when there is intermittent involvement thru out the entire GI tract that extends thru all layers of the bowels?
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Crohns disease
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Clients with IBS should avoid or limit what kind of food?
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gas forming foods
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What is the etiology of IBD?
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possible autoimmune, genetic environment, infectious, caucasian, jewish descent
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What are the differences between ulcerative colitis and Crohns
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UC-frequent liquid stool (10-20w/blood), only affects mucosa layer
CD-diarrhea often w/o blood, chronic inflammation thru all layers |
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What is the gold standard to diagnose IBD?
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colonoscopy
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What are the Dx for IBD
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colonoscopy, sigmoidoscopy, biopsy
CBC-anemia & infection guiac c-reactive protein & sed rate Culture & sensitivity test |
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What is the goal in the hospital to treat IBD?
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to rest bowel, get adequate nutrition, F&E balance, control inflammation, treat infection & pain
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What is the first line of treatment of IBD?
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Sulfonamide (5-aminosalicylic acid derivitive) that acts as a topical and anti-inflammatory effect on the colon
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When you see sulfonamide in the hospital, does it mean they have an infection?
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Not necessarily, it has an anti-inflammatory effect on the colon. 1 line treatment and then given as an antibiotic if has infection
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Why would bed rest be Rx for IBD?
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to decrease parastalasis, and rest bowel.
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What is the number 1 complication of crohns disease?
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bowel obstruction
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what is the #1 compliction of ulcerative colitis?
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bleeding-loss of blood.
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What kind of surgery may be curative for UC?
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GI surgery-removal of large intestine and create a stoma.
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Is colectomy and colostomy surgery a cure in chrohns disease?
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only palliative for crohns (70-80% of clients eventually need as it reoccurs in healthy intestines
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What nursing intervention must happen when there is NPO & TPN
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Monitor GLUCOSE
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What are the nursing interventions for IBD
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fatigue, weight loss, malnutrition, anemia, diarrhea (Hct, Hgb)
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What kind of diet is IBD
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low fat, high protein, and avoid foods that cause problems (spicy foods, beans, cabbage, nuts, caffeine, nicotine, alcohol) low residue diet
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can a pt get paritonitis with IBD?
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yes
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What is irritable bowel syndrome?
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a functional disorder of GI characterized by abd pain & constipation &/or diarrhea with no know cause
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what are the s/s of irritable bowel syndrome?
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abd pain relieved by MB
constipation/diarrhea |
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How is irritable bowel syndrome treated?
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treat the s/s, diet, antispasmodics like Lomotil and antiflatulents and stress management
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What should a nurse teach about irritable bowel syndrome?
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treat s/s, regular routine-meals, exercise regularly and daily BM
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What are all of the things the liver does?
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production & secretion of bile; protein metabolism; lipid & carbohydrate metabolism; hormone metabolism; removal, inactivation & detox of foreign substances; stores vitamins, iron, & other minerals
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What does excessive bilirubin causes?
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an irritating effect on the skin (bile salt under the skin causing PRURITUS
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If biliary obstruction occurs what happens to the fat?
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fat digestion is impaired & steatorrhea (fat in stools) occurs along with clay colored stool
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If there is increased bleeding, what could be the cause (liver)
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fat soluble vitamins (A D E K) especially K not being absorbed
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The liver metabolizes what proteins?
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plasma proteins (albumin), fibrinogen, prothrombin
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What happens if the liver can't metabolize albumin?
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albumin which contributes to blood osmolality (decreased leads to reduced colloidal osmotic pressure
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The produces _______? with decreased immunity, susceptibility to ________increases
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globulins
infections |
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To excrete nitrogen from the body, the liver does what?
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converts toxic ammonia to less toxic UREA.
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What is hepatic encephalopathy
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ammonia production increased because the liver cannot convert it to urea. Ammonia is toxic to the nervous system
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Hepatic encephalopathy can do what?
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increase cerebral edema-change in LOC
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What happens when the liver does not metabolize aldosterone & estrogen
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Increased aldosterone levels lead to NA retention-hypervolemia & edema
increased estrogen levels-gynecomastia in males |
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what happens when liver can's metabolize lipids and carb's
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pain when drinking alcohol and fatigue and lethergy
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what happens when the liver does not metabolize plasma proteins?
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decreased plasma albumin leased to a reduced colloidal osmotic pressure. causing 3rd spacing-edema & ascites
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What are the thing that make a person go to Dr with liver damage? hepatitis
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they have fatigue, tired, lethergy, hypoglycemia,
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The liver is also called what because of all of the blood?
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as antechamber of the heart because it collects splenic & GI blood-acts as a sponge & can accumulate up to 1000ml blood
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If you have right sided HF, where does it back up to?
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the liver, and prolonged will decrease liver function, increase liver size
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