Gi
What medications are used to treat PUD? "Please Make Tummy Better"
P = PPIs M = Metronidazole (Flagyl) T = Tetracycline B = Bismuth subsalicylate (Pepto bismol)
Signs of IBS include _____
Pain Bloating Abdominal distention Alteration in bowel patterns
Performed by inserting a needle through the abdominal wall into the peritoneal cavity
Paracentesis
Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus
Peptic ulcer
Complications of diverticular disease include _____
Perforation Peritonitis Abscess formation Bleeding
What are post-op complications of PUD surgery?
Pernicious anemia Dumping syndrome
Signs of appendicitis include _____
RLQ ABD pain (McBurney's point) Rigid abdomen, muscle guarding Leukocytosis (WBC > 20,000) Common in ages 20-30 y/o Low-grade fever! Diarrhea, constipation Anorexia
Causes of peritonitis include _____
Ruptured appendix Bladder perforation Perforated ulcer or bowel Pelvic inflammatory disease (PID) Traumatic rupture of liver or spleen
Signs of peritonitis include _____
Severe pain Board-like abdomen! Increased temperature! Decreased bowel sounds Leukocytosis N/V Shock: weak, pallor, daphoretic Paralytic ileus
Where does diverticular disease most often occur?
Sigmoid colon, but may occur anywhere
H. pylori damages _____
Stomach tissues and the lining of the duodenum
IBS is often caused by _____
Stress Foods Hormonal changes GI nervous system Changes in motility
Risk factors for gastric ulcers include _____
Stress Type O blood Excess HCL acid Familial tendency Men ages 25-50 y/o Rapid gastric emptying
Patients with malabsorption are at risk for _____
osteoporosis
"pockets" are used to describe _____
diverticular disease
Infection and inflammation of diverticula
diverticulitis
Patients with _____ should limit fiber
diverticulitis
Patients with _____ should increase fiber
diverticulosis
Multiple diverticula without inflammation
diverticulosis Someone with diverticulosis will always have diverticulosis
Sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer
diverticulum
Which type of gastritis is caused by NSAIDs, alcohol, and/or radiation treatment?
erosive
_____ is also known as "spastic colon"
irritable bowel syndrome (IBS)
The inability of the digestive system to absorb one or more of the major vitamins, minerals, or nutrients
malabsorption
Which type of gastritis is most often caused by infection (H. pylori)?
nonerosive
An assessment for gastritis should include _____
- A 72hr diet or diary - Abdominal assessment - S/Sx
Chronic gastritis is caused by _____
- Alcohol - Smoking - Medications - Smoking - H. pylori - Autoimmune diseases - Chronic reflux of pancreatic secretions or bile - Benign or malignant ulcers of the stomach
Nursing diagnoses and goals for gastritis
- Anxiety: reduce - Acute pain: relieve - Deficient knowledge: diet management - Imbalanced nutrition: avoid irritating foods; adequate nutrients - Risk for fluid volume imbalance
Nursing considerations for a paracentesis include _____
- Assess labs before and after - Pt should void before - Position upright or in high-fowler's - Take vitals before, during, and after - Drain fluid with needle and send to lab - Instruct pt to hold breath while inserting needle
How is acute gastritis managed?
- Avoid alcohol, fluids, and foods until sx subside - Avoid emetics and lavage - Supportive therapy
A scope allows for _____
- Biopsy - Cauterization - Removal of polyps, dilation, diagnosis
Manifestations of malabsorption include _____
- Diarrhea - Frequent, loose, bulky, foul smelling stools - Steatorrhea: light yellow or gray color, high-fat content - Weight loss - Vitamin, mineral deficiency - Anemia - ANorexia
Nursing interventions for patients with diverticular disease include _____
- Diet: soft, liquid - IV fluids, if oral is not adequate - Medications - Monitor stools for bleeding
Risk factors for PUD include _____
- Excessive secretion of stomach acid - Diet - Chronic NSAID use - Alcohol - Smoking - Familial tendency
Signs of diverticulosis include _____
- Frequently asymptomatic - Abdominal distention - Chronic constipation - Bowel irregularities - Anorexia - Bloating - Nausea
Causes of malabsorption include _____
- Gastric resection/bowel resection - Antibiotics - Parasitic infections - Overgrowth of bacteria in the small intestine - Radiation injury to mucosa of small intestine - Enteritis
Lab results that indicate diverticulitis include _____
- Hgb & Hct = low - ESR = high - WBC = high - Stool for occult blood = positive
Signs of diverticulitis include _____
- Mild-severe pain in LLQ - Fever and chills - Leukocytosis - N/V
Manifestations of chronic gastritis include _____
- N/V - Belching - Anorexia - Epigastric discomfort - Heartburn after eating - Sour taste in the mouth - Intolerance of some foods - Vitamin deficiency d/t malabsorption of B12
How is PUD managed?
- NPO - NG tube - Medications - Surgery (vagotomy, pyloroplasty)
Nursing considerations for upper endoscopy include _____
- NPO after midnight night before - Monitor for sx of perforation - NPO until gag reflex returns post procedure
Preop interventions for an appendectomy include _____
- NPO upon admission - IV fluids as prescribed - Semi-fowlers position - No laxatives or edemas
Nursing interventions for appendicitis include _____
- No heating pads, enemas, or laxatives - Ice bag to relieve pain - Maintain NPO until blood count received - No analgesics until cause of pain determined - Sudden absence of pain can indicate a rupture
Risk factors for diverticular disease include _____
- Older adults (50-60 y/o) - Hx of constipation - Diet low in veggie fiber and high in carbs
What should be done prior to a hydrogen breath test?
- Stop all acid suppressing drugs (PPIs) 2 weeks prior - Stop all antibiotics 4 weeks prior
How does a hydrogen breath test work?
- Swallow pill or liquid - If H. pylori is present, carbon's released when solution is broken down in the stomach - Pt exhales into a bag and carbon molecules are detected
How is normal bowel elimination promoted?
1.) Diet: bland, high in veggie fiber if no inflammation - Include: fruits, veggies, whole grain cereal, unprocessed bran - Avoid: food hard to digest (corn, nuts) 2.) Increase fluid intake of at least 2 L/day 3.) Bulk-forming agents as ordered - methylcellulose - psyllium 4.) Exercise program 5.) Monitor bowel sounds and abdominal distention
A nurse is completing discharge teaching with a patient who has IBS. Which of the following instructions should the nurse include in the teaching? A) Avoid foods that trigger exacerbation. B) Consume 15 to 20 g of fiber daily. C) Plan three moderate to large meals per day. D) Limit fluid intake to 1 L each day.
A
A patient with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the patient's continuing care in the home setting, what assessment question is most relevant? A. "Does anyone in your family have experience at giving injections?" B. "Are you going to be anywhere with strong sunlight in the next few months?" C. "Are you aware of your blood type?" D. "Do any of your family members have training in first aid?"
A
A nurse is teaching a patient who has a duodenal ulcer and a new prescription of esomeprazole. Which of the following information should the nurse include in the teaching? Select all that apply. A) Take the medication 1 hr before a meal. B) Limit NSAIDS when taking this medication C) Expect skin flushing when taking this medication. D) Increase fiber intake when taking this medication. E) Chew the medication thoroughly before swallowing.
A, B
Appendicitis results from _____
Obstruction Inflammation Infection of the appendix
A nurse is planning care for a patient who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? Select all that apply. A) Evaluate intake and output. B) Monitor laboratory reports of electrolytes. C) Provide three large meals a day. D) Administer ibuprofen for pain E) Observe stool characteristics
A, B, E
Signs of H. pylori include _____
ABD pain a few hrs after eating Swelling, bloating Peptic ulcers Weight loss Gastritis N/V
What is the most common sign of H. pylori?
Abdominal pain
No hydrochloric acid in gastric secretions
Achlorhydria
Acute and chronic gastritis may be associated with _____
Achlorhydria Hypochlorhydria Hyperchlorhydria
What are the different types of gastritis?
Acute Chronic Nonerosive Erosive
What foods/beverages should be avoided for patients with H. pylori?
Alcohol Coffee Caffeine Low-fat food Spicy food
Acute gastritis is caused by _____
Alcohol Bile reflex Medications Radiation therapy
What treatment strategies are used to treat H. pylori?
Antibiotics Diet H2 blockers: end in "tidine" PPIs: end in "prazole" Probiotics
What medications are used to treat diverticular disease?
Antibiotics: Ciprofloxacin, Flagyl, Vibramycin Antispasmotics: Bentyl
Surgical management of appendicitis includes _____
Appendectomy with a laparoscope or an open approach Open approach - Less common - Done if perforated Laparoscope - More common - Less risks
What is the gold standard treatment for H. pylori?
At least two PO antibiotics PO = go straight into GI tract
What tests are used to diagnose H. pylori?
Blood tests Hydrogen breath test Stool test
The nurse provides client education to a client about to undergo hydrogen breath testing. The nurse evaluates that the client understands the test when the client makes which statement? A. "First, I will drink a cherry flavored liquid." B. "The test will detect the presence of staph." C. "I should avoid antibiotics for 1 month before the test." D. "The test will detect the presence of oral cancer."
C
A nurse is completing an assessment of a patient who has a gastric ulcer. Which of the following findings should the nurse expect? Select all that apply. A) patient reports pain relieved by eating B) patient states that pain often occurs at night C) patient reports a sensation of bloating D) patient states that pain occurs 30 min to 1 hr after meal E) patient experiences pain upon palpation of the epigastric region
C, D, E
Patients with both acute and chronic gastritis should avoid _____
Caffeine Alcohol Cigarette smoking
A nurse is caring for a patient following a paracentesis. Which of the following findings indicate the bowel was perforated during the procedure? A) Patient report of upper chest pain B) Decreased urine output C) Pallor D) Temperature elevation
D
Manifestations of PUD include?
Dull, gnawing pain Burning in mid-epigastrium Heartburn Vomiting
Duodenal vs. gastric ulcers
Duodenal: - Pain relieved by eating - Pain 2-3hrs after eating - Most common - Melena occurs (black, tarry stool) Gastic: - Pain increased by eating - Pain 30min-1hr after eating - Not as common - Vomiting occurs
How is PUD diagnosed?
EGD (most common) Gastric analysis Upper GI series Stool for occult blood, CBC - Active bleed = low H & H
Appendicitis is caused by _____
Occlusion of the lumen of the appendix from infection, strictures, or fecal mass
Complications of an upper endoscopy include _____
Gastric bleed Obstruction Dehydration Pernicious anemia - Req monthly vitamin B12 injections
_____ is the inflammation of the stomach
Gastritis
_____ is a type of bacteria that infects the stomach
H. pylori
PUD is caused by _____
H. pylori (most common) NSAIDs Severe stress Hypersecretory states
H2 blockers vs. PPIs
H2 blockers: rapid onset, only last for 12hrs PPIs: delayed onset, last longer - Given daily - Best for chronic conditions
Manifestations of acute gastritis includes _____
HA N/V Fatigue Hiccups Abdominal discomfort
What is the most accurate test used to diagnose H. pylori?
Hydrogen breath test
Excess hydrochloric acid in gastric secretions
Hyperchlorhydria
Reduced hydrochloric acid in gastric secretions
Hypochlorhydria
H. pylori causes _____
Inflammation Peptic ulcers Gastritis
What does urease do?
Makes stomach acid less acidic (neutralizes it), weakening the stomach lining
Treatment for PUD includes _____
Medications Lifestyle changes Possible surgery
What antibiotic is most commonly used to treat H. pylori?
Metronidazole (Flagyl)
How is chronic gastritis managed?
Modify diet Promote rest Reduce stress Avoid alcohol and NSAIDs - Ibuprofen (tylenol)
How are bowels rested?
NPO and NG tube
What is the action of H2 blockers and PPIs?
Suppress acid production
How is appendicitis diagnosed?
Ultrasound of the abdomen Abdominal CT if symptoms present
How is gastritis diagnosed?
Upper GI x-ray Endoscopy and biopsy
A PUD emergency includes _____
Vasopressin = stabilizes BP IV fluids and blood replacement
What are some natural remedies for ulcer prevention and/or management?
Vitamins A, E, K Licorice = similar to PPIs Guided imagery Hypnotherapy Meditation, yoga Acupuncture
Risk factors for IBS include _____
Women Younger adults Heredity, family hx Psychological stress Depression Anxiety High-fat diet Irritating foods Alcohol Smoking
Diverticular disease increases with _____ and is associated with _____
age, a low-fiber diet
Inflammation of the appendix
appendicitis
What is the goal for the plan of care for patients with diverticular disease?
bowel rest during acute episodes
How is diverticular disease diagnosed?
colonoscopy
What is the hallmark sign of malabsorption?
diarrhea
Peritonitis is usually caused by _____
perforation
Inflammation of peritoneal cavity
peritonitis
Inflammation of peritoneal membrane covering abdominal organs
peritonitis
Widening of pylorus to improve gastric emptying
pyloroplasty
Stool sample looks for antigens associated with H. pylori
stool test
Small flexible scope inserted through the mouth into esophagus, stomach, and duodenum to visualize the upper digestive tract.
upper endoscopy
H. pylori creates an enzyme called _____
urease
Eliminates stimulation of gastric cells
vagotomy