MedSurg - GI

GI emergencies*** - all have surgery? when don't they? - Nursing Dx for GI bleed - when is emergency surgery done?

***- Not all gastrointestinal disorders are treated with surgery (e.g., an Ileus may be alleviated with an NGT) ***Nursing Dx for GI bleeding - Fluid Volume Deficit related to hemorrhage as evidenced by ... Put on gloves! Rx - ABCs, including starting a large bore IV to infuse normal saline (NS) Emergency surgery done when abdominal pain seems to be from: - intestinal obstruction - ruptured or perforated (punctured) organ (stomach, appendix, intestine) - hernia with too little blood flow - abdominal abscess

Peritonitis*** - what is it, what it is caused by, cardinal signs, if it ruptures what can happen

- A life-threatening, acute INFLAMMATION and INFECTION of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity - Caused by irritating substances such as feces, gastric acids, bacteria, or blood in the abdominal cavity - The cardinal signs of peritonitis are abdominal pain, tenderness, and distention***** - If appendix ruptures it can lead to peritonitis ***

Large Intestine - what does it do, last 5 inches, distal end

- Also known as the colon, the large intestine is responsible for absorbing water, electrolytes, and salts - The last 5 inches of the large intestine comprise the rectum - The distal end of the rectum forms the anal canal composed of muscles that control defecation - The opening to the anal canal is called the anus

Disorders of the GI Tract:Appendicitis - what is it, if it ruptures what can happen

- An inflammation of the vermiform appendix, a small, slender tube attached to the cecum - If the appendix ruptures, fecal content spills into the abdominal cavity causing peritonitis, which can be fatal

Small Intestine - how long, what does it do, the parts of SI

- Approximately 20 to 25 feet long and is responsible for absorbing nutrients from the chyme (semi-liquid mass of partially digested food) Small intestine* divided into: 1. Duodenum (first 10-12 inches) 2. Jejunum (the middle 8-10 feet) 3. Ileum (the distal 12 feet) * Note: Each part or section performs an important role in nutrient absorption

Colostomy Care***

- Bowel movement can be acidic to skin, put on skin barrier an then bags on top of that - Measurement will help fit the appliance, work with wound ostomy nurse for best therapies - dietary measures to control gas and odor (empty frequently to remove excess gas collection) - resumption of normal activities = Nursing Dx = alteration in body image

Inflammatory Bowel Disease - What does it consist of, Establish adequate Dx, Disease management, goals

- Crohn's disease and Ulcerative colitis (UC) Establish adequate diagnosis • which type of IBS • which part of bowel • level of active of inflammation • involvement of other organs • family history Disease management plan • relieve symptoms • treat inflammation • maintain remission and prevent flares • treat complications (psychological, psysiological) • replenish nutritional deficits • identify pre-cancer and detect cancer • minimize treatment toxicity • address psychosocial issues • improve daily functioning Goal • to have a higher quality of life • patients should take an active role of their disease

Crohn's Disease - what is it, risk factors, symptoms, treatment

- Crohn's disease is characterized by lesions that affect the entire thickness of the bowel and can occur anywhere throughout the colon and small intestine, most common is ileum (first portion of colon) - abnormal regulation of IS (bacteria in GI) Risk factors - Genetic - Environmental factors • Infections, smoking, • Antibiotics and NSAIDs - Dysregulated immune response in GI tract → inflammation Symptoms • Vary by location - everybody experiences disease differently • Most have abdominal pain and diarrhea • Abdominal tenderness, loss of appetite, weight loss, rectal bleeding, anal skin tags/ulcers • Children - Stunted growth, failure to thrive even if GI symptoms not present • Can affect other part of body - Joint pain, liver inflammation, osteoporosis, skin problems, eye problems, mouth ulcers, anemia Treatment - management of symptoms

Mouth/Esophagus

- Digestion begins in the mouth where the teeth mechanically break food down into smaller pieces by chewing and mixing it with saliva - The food is then swallowed and transported down into the esophagus through the rhythmic contraction of muscles known as peristalsis - Elderly population has decreased saliva production - at risk in the early process already Might have trouble with chewing - dentures

Stomach

- Further mechanical and chemical breakdown of the food occurs in the stomach, which secretes gastric juices that contain hydrochloric acid and pepsinogen, a non-active form of the enzyme pepsin

PUD - Complications, if untreated what happens

- Hemorrhage is the most serious complication; it tends to occur more often in patients with gastric ulcers and in older adults - Many patients have a second episode of bleeding if underlying infection with H. pylori remains untreated or if therapy does not include an H2 antagonist

Assessment for clients with GI complaints

- History - Nutritional history: Better to eat smaller meals throughout the day - Family history and genetic risk: screening would start earlier to prevent colon cancer - Current health problems - reflux, ulcer disease - Medications: NSAIDs can create peptic ulcers Can be on the lowest dose for their GERD, but you can increase the dose or frequency, alternative medications (herbal remedies) - can have interactions - Physical assessment - Psychosocial assessment

Upper Endoscopy (EGD) - what are you on - can't eat/drink for how long

- IV conscious sedation - Upper endoscopy - always on cardiac monitor because you're under sedation, pulse ox, prophylactic procedures, nasal cannula, spray back of throat with local anesthetic, bite block in mouth so you don't bite tongue or tube - can't eat/drink 6-12 hours before procedure if morning - if afternoon, only drink clear fluids 2-4 hours before

Accessory Organs

- Liver, gallbladder, pancreas The digestive system is also comprised of organs that aid in the digestion of food by delivering digestive juices to the duodenum to continue the process of digestion:

McBurney's Point *** (Appendicitis)

- McBurney's point is located midway between the anterior iliac crest and the umbilicus in the right lower quadrant - This is the classic area for localized tenderness during the later stages of appendicitis

Common causes of Upper GI bleeding

- Oesophagitis - usually with hiatus hernia - Liver disease or Portal vein thrombosis = Varices - NSAIDs or H. Pylori = Peptic ulcer - NSAIDs or alcohol = gastric erosions - Retching = Mallory-Weiss tear - Vascular malformations - Cancer of stomach or oesophagus - Aortic graft = aorto-duodenal fistula

Care of patient with problems of oral cavity

- Soft toothbrush or gauze for oral care - Encourage frequent rinsing of the mouth with warm saline, sodium bicarbonate (baking soda) solution, or a combination of these solutions - Avoid commercial mouthwashes, particularly those with high alcohol content, and lemon-glycerin swabs - Assist the patient in selecting soft, bland, and nonacidic foods

Ulcerative Colitis - what is it, risk factors, symptoms, goal

- UC is characterized by mucosal lesions occurring typically in the rectal area and progressing through the colon o Periods of time with active inflammation when patient is experiencing symptoms o Periods of no inflammation → remission o Most have long periods of remission and flares • Some patients have more severe flares than others Risk factors o Cause unknown o Genetic o Environmental factors • Infections, smoking, antibiotics or NSAIDs o Dysregulated immune response Symptoms o Inflammation of rectum • can't store contents • can't distinguish gas from liquid • Tenesmus - always feel like they have to go o Other symptoms • Frequent small stools • Fatique, low energy • Rarely, fever o Other parts of body • Joint pain, liver inflammation, osteoporosis, skin problems, mouth problems, anemia Goal o Manage disease, can lead normal lives

Common causes of lower GI bleeding

- Ulcerative colitis - Polyps - Colon cancer - Diverticulosis/diverticulitis - Rectal cancer - Hemorrhoids

Disorders of the GI Tract:Peptic Ulcer Disease - what is it, types of ulcers, what is it caused by

- a mucosal lesion of the stomach or duodenum - Peptic ulcer disease (PUD) results when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin Three types of ulcers may occur: - gastric ulcers, duodenal ulcers, and stress ulcers (less common) - Most gastric and duodenal ulcers are caused by H. pylori**** - Stress ulcers are acute gastric mucosal lesions occurring after an acute medical crisis or trauma; bleeding caused by gastric erosion is the main manifestation of acute stress ulcers*****

Intestinal Obstruction aka ? - non-mechanical, mechanical obstruction - how can obstructions be relieved - intussusception, volvulus, adhesions

- aka ileus - occurs when contents can't pass through intestine Non-mechanical - have surgery --> bowel still asleep --> can't move things through digestive system and they'll have N&V - put NG tube to relieve obstructions until bowel sounds come back Mechanical - tumor - fecal impaction - hernia - intussusception (telescoping of bowel where bowel slides into itself) - volvulus (twisting of the bowel on itself) - adhesions (scar tissue in the abdomen from prior surgeries or disease process)

Liver function tests - what does it measure*** - prone to bleeding --> what's increased/decreased

- blood tests to help diagnose and monitor liver disease/damage Measures**** - Alanine transaminase (ALT) - Aspartate transaminase (AST) - Albumin and total protein - Bilirubin - Prothrombin time (PT) and international normalized ratio (INR) - Complete blood count (CBC) - Alkaline phophatase (ALP) - Gamma-glutamyltransferease (GGT) - L-lactate dehydrogenase (LD) Prone to bleeding if: Increased - ALP, LDH, GGT, AST, ALT - serum and urinary bilirubin - prothrombin time and INR Decreased - serum albumin and proteins - platelet count

Colorectal Cancer - where is it, early forms (symptoms), risk factors, staging

- colon and rectum - begin as benign polyps > polyps grow, abnormal cells develop and invade surrounding tissue ***Early forms of colorectal cancer don't cause symptoms > screenings are important - most CRCs are adenocarcinomas ***Risk Factors/Etiology - > 50 years - genetic predisposition - Fam Hx - familial adenomatous polyposis Staging - usually found at 3 or 4, harder to recover and treat Stage 1 = tumor invades to muscle layer Stage 2 = other organs or perforates peritoneum Stage 3 = any level of tumor invasion, up to 4 regional lymph nodes Stage 4 = any level of tumor invasion, distant metastasis

Esophageal Varices - what is it, symptoms, treatment

- enlarged tortuous vein in esophagus -- assoc. with cirrhosis of liver - asymptomatic until it pops and bleeds - makes portal vein hypertensive Treatment - Sengstaken-Blakemore tube (emergency treatment) > balloon to esophageal area, inflate it to hold pressure on bleeding until you can surgically deal with it

Gastritis - what is it - gastroenteritis

- inflammation of gastric mucosa (stomach lining) - erosive or non-erosive - ***The onset of INFECTION with Helicobacter pylori can result in acute gastritis; H. pylori is a gram-negative bacterium that penetrates the mucosal gel layer of the gastric epithelium gastritis - only stomach (vomiting) vs. gastroenteritis - stomach and intestines (vomiting and diarrhea)

Peritonitis - manage care, what to look out for

- look for rigid abdomen, high fever, tachycardia, dry mucous membranes, low UO from third spacing, N&V, hiccups

Intestinal Obstruction - Nursing Care - if you have NG tube do you do

- monitor VS, especially BP for indications of fluid balance - assess abdomen 2x/day for bowel sounds, distentions, passage of flatus - monitor F&E - give analgesics for pain as prescribed - give a gut motility stimulate (Avimopan/Entereg) as prescribed for pt's with postoperative ileus - maintain parenteral nutrition if prescribed If have NG tube - monitor drainage, ensure tube patency, check tube placement with X-ray, irrigate tube as prescribed, maintain pt on NPO status, provide frequent mouth and nose care, maintain patient in semi-Fowler's positions - need to give more calories in the patient by total parental nutrition (TPN)

Gallbladder - functions, cholecystitis, cholelithiasis

- pear shaped sac attached to underside of liver Functions - stores and concentrates the bile until SI needs it Cholecystitis - inflammation of gallbladder, 90% gallstones present Cholelithiasis - presence of gallstones or calculi (concentration of mineral salts) in gallbladder

Disorders of GI Tract: Stomatitis - primary, secondary - what is priority of care for patients with oral cavity problems

- refers to a painful inflammation within the oral cavity and may present in many different ways Primary - most common type, includes aphthous (noninfectious) stomatitis, herpes simplex stomatitis, and traumatic ulcers Secondary - results from INFECTION by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised; it can also result from drugs, such as chemotherapy - commonly from Candida albicans - long term antibiotic therapy destroys normal flora and lets Candida to overgrow ***Be aware that airway management is the priority for care for patients with oral cavity problems Secondary - concerned with patients who are immunocompromised, infection develops candida If have tumor/obstructions in airway it will compromise airway circulation and breathing Radiation therapy > if head/neck area, it might cause sunburn-ish for patients, some need nasogastric tubes because of severe pain

Disorders of Accessory Organs - Cirrhosis - causes, complications*** - ascites, PSE, hepatorenal syndome, esophageal varices

- refers to chronic, degenerative changes in liver cells and thickening of surrounding tissue - from liver repairing itself after chronic inflammation Causes - alcohol, hepatitis B & C, non-alcoholic fatty liver disease Complications - neurological changes - jaundice - Ascites -- fluid won't drain on it's own, diuretics don't work, have to drain itself but it will come back. Pull too much = cardiac arrest (VS drop) - portal systemic encephalopathy (PSE) - neuropsychiatric syndrome assoc. w/ hepatocellular failure or portal-systemic venous shunting - Hepatorenal syndrome - dev. of renal failure with advanced chronic liver disease - Esophageal varices

Colostomies - what is it for, locations

- surgically created opening from the colon through abdominal wall to relieve a disease or functional problem in LI - temporary or permanent Different locations - Ascending colostomy = R. sided tumors - Transverse (double-barreled) = emergencies (obstruction or perforation), 2 stomas - 1 to drain feces and 1 for mucous - Descending = L. sided tumors - sigmoid = rectal tumors

Hemorrhoids - causes, interventions, teaching

- swollen vascular tissue in rectal area, common, not an issue unless pain or bleeding - internal or external Causes - increased abdominal pressure, worsens during pregnancy, constipation with straining, obesity, heart failure, prolonged sitting or standing, strenuous exercise and weight lifting Interventions - conservative, aimed to reduce symptoms, prevention of constipation (increase fiber, whole grains, raw veg and fruits, water) Teaching - don't strain, exercise regularly, maintain healthy weight

Gastritis Prevention

- well balanced diet, avoid excessive alcohol, NSAIDs (ibuprofen) and corticosteroids, aspirin - coffee/tea, no smoking, manage stress

Hernias - different types, factors, risk factors - reducible, irreducible, strangulated - what can cause hernias

- when wall of muscle weakens and intestine protrudes through muscle wall - umbilical hernia, incisional hernia, femoral hernia, direct inguinal hernia, indirect inguinal hernia - Reducible - contents from hernial sac can be placed back - Irreducible (incarcerated) - can't be placed back - Strangulated - when blood supply to herniated segment is cut off by hernial ring (band of muscle around hernia) = ischemia nad obstruction of the bowel loops > necrosis of bowel and perforation Signs of strangulation = abdominal distention, N&V, pain, fever, tachycardia ** Irreducible or strangulated = problem with blood supply and need surgery Important elements in development of hernia - congenital or acquired muscle weakness and increased intra-abdominal pressure *** Risk factors contributing to increased intra-abdominal pressure - obesity, pregnancy, heavy lifting

Acute Pancreatitis - Causes, S&S, Dx, Teaching

-An acute or chronic inflammation of the pancreas caused when pancreatic enzymes digest the lining of the pancreas Acute - sudden inflammation, intense pain Causes - heavy alcohol use, gallstones (most common) - abdominal trauma, meds, infections, tumors, genetics, high triglyceride, high calcium, idiopathic S&S - intense pain between umbilicus and chest, RUL, LUQ - N&V, fever, sudden attacks, pain Dx - pancreatic enzymes elevated (amylase, lipase), confirmed with CT scan, MRI, US Teaching - avoid alcohol/tobacco, fatty food, triglycerides, stay hydrated, healthy diet, fruits/vegetables

1. Why would patients complain of pain in the shoulder blades after an EGD? 2. What patient teaching should you provide, including foods to avoid for those diagnosed with GERD?

1. Air is blown into the tract to move debris - the air goes up and can be referred pain Sit patient up, they will pass gas, burp 2. No caffeine, high fiber, no citric, fatty, spicy, ground beef, coffee/tea/alcohol, milk, smoking , smaller meals (decrease amount of reflux from stomach to esophagus) o heartburn (and the more serious GERD) by lessening the effectiveness of the lower esophageal sphincter muscle to keep stomach contents in the stomach. Smoking also plays a large role, and carbonated beverages should be added to the list as they can put pressure on the stomach, forcing stomach acid back up into the esophagus.

Gallstones can form when...

1. Bile contains too much cholesterol - bile usually can dissolve cholesterol that's secreted by the liver, but if liver secretes too much = excess becomes crystals = stones 2. Bile contains too much bilirubin - end product of RBC - certain conditions (liver cirrhosis, biliary tract infections) liver can make too much bilirubin = gallstones 3. Gallbladder doesn't empty correctly - bile gets concentrated = gallstones

Dx Testing methods

1. Colonoscopy - a procedure in which the provider introduces a highly specialized engineered imaging scope into the lower GI tract (e.g., most of the small intestine and all of the large intestine) 2. Liver-spleen scan - a specialized radiology procedure used to examine the liver to identify certain conditions or to assess the function of the liver 3. Endoscopic Retrograde Cholangiopancreatography (ERCP) - a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope. 4. Liver biopsy - tissue samples are removed from the liver and checked under a microscope for signs of damage or disease

POST EGD ** 1. What are some post-procedure concerns when a patient has received Intravenous Conscious Sedation? 2. Why do we need to test for a gag reflex before allowing the patient to eat?

1. Have to have designated driver, can't eat right away, don't go back to work same day, respiratory rate If patient wakes up unconscious and groggy, try to get their attention first 2. To make sure their digestive system is awake after the anesthesia

Dx testing methods

1. Laboratory studies - CBC, H&H - if dropped = GI bleed - platelet count - helps clots to form. If it falls below normal, won't clot Cirrhosis or liver failure > have a lot of bleeding complications, have coagulation time issues and platelet count low 2. Ultrasound - rule out pregnancy 3. Barium X-Rays (Upper and Lower GI series) - Barium swallow - to look at contrast, upper GI - Barium enema - lower GI - don't give barium room temperature 4. Imaging Studies - e.g., CT scan (often referred to as a CAT scan) or MRI 5. Upper Endoscopy (EGD) - this technique allows providers to look into the upper GI tract to assess for problems afflicting the esophagus, stomach, and the first parts of the small intestines

Functions of liver

1. Produce and secrete bile, which emulsifies fat 2. Convert glucose into glycogen for storage 3. Convert glycogen to glucose when blood sugar level drops 4. Metabolize hormones 5. Break down nitrogenous wastes to urea 6. Incorporate amino acids into proteins 7. Filter blood and destroy bacteria 8. Produce prothrombin and fibrinogen, which are necessary for blood clotting 9. Manufacture cholesterol 10. Produce heparin 11. Store vitamin B12 and fat soluble vitamins A,D,E, and K 12. Detoxify poisonous substances

A client has been diagnosed with mild gastroesophageal reflux disease and asks the nurse about non-pharmacologic treatments to prevent symptoms. What does the nurse tell this client? A. "Avoid caffeine-containing foods and beverages." B. "Eat three meals each day and avoid snacking between meals." C. "Peppermint lozenges help to reduce stomach upset." D. "Sleep on your left side with a pillow between your knees."

A. "Avoid caffeine-containing foods and beverages."

A client is scheduled for a colonoscopy. What does the nurse tell the client to do before the procedure is performed? A. Begin a clear liquid diet 12 to 24 hours before the test." B. "Do not eat or drink anything for 12 hours before the test." C. "Give yourself tap water enemas until the fluid returns are clear." D. "You will have to drink a contrast liquid 2 hours before the test."

A. Begin a clear liquid diet 12 to 24 hours before the test." - also have a GI regimen to clear out the system before they come in

An older patient diagnosed with bacterial gastroenteritis reports abdominal cramping, diarrhea, nausea and vomiting, and fatigue for the past 24 hours. The nurse should monitor the patient for what priority assessment? A. Dehydration B. Hypokalemia C. Hypernatremia D. Perineal skin breakdown

A. Dehydration* B. Hypokalemia* C. Hypernatremia* D. Perineal skin breakdown* In older adults, dehydration occurs with viral and bacterial gastroenteritis and may require hospitalization. Electrolyte imbalances are also common, especially hypokalemia and hypernatremia. The aging skin is also at risk of compromise from frequent exposure to enzymes in the stool. Herbal medicines are now used by up to 50% of the Western population, in a substantial minority of instances for the treatment or prevention of digestive disorders. Although most indications for the use of such remedies are anecdotally or traditionally derived, controlled trials suggest some benefits for ginger in nausea and vomiting, liquorice extracts in peptic ulceration, Chinese herbal medicine in irritable bowel syndrome, opium derivatives in diarrhea and senna, ispaghula and sterculia in constipation. Herbal preparations contain many bioactive compounds with potentially deleterious as well as beneficial effects.

Which factors place a client at risk for gastrointestinal (GI) problems? (Select all that apply.) A. Eating a high-fiber diet B. Smoking C. Socioeconomic status D. Some herbal preparations E. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

A. Eating a high-fiber diet B. Smoking * C. Socioeconomic status* D. Some herbal preparations * E. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)* Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks; https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health NSAIDs- affects prostaglandins, need to drink with water, if not, it will sit on top of your gastritis and erode stomach > peptic ulcers

After abdominal surgery, what patient assessment finding alerts the nurse to the fact that peristaltic movement is returning? A. Passing flatus B. Reports of hunger C. Absence of nausea D. Presence of normal bowel sounds

A. Passing flatus Recent best evidence suggests that patient report of passing flatus is more reliable than return of bowel sounds in assessing peristaltic movement after abdominal surgery.

Digestive System

Also known as the gastrointestinal (GI) tract or the alimentary system, it is responsible for breaking down the complex food into simple nutrients the body can absorb and convert into energy This process is known as digestion

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? A. Abdominal pain relieved by bending the knees B. Chronic diarrhea, abdominal pain, and fever C. Epigastric cramping D. Hypotension with vomiting

B. Chronic diarrhea, abdominal pain, and fever

When administering a new medication to an older patient, the nurse understands that: A. The dose may need to be increased to greater-than-normal levels B. Close monitoring is needed because toxic levels may develop C. The dose may need to be decreased to lower-than-normal levels D. Nausea and vomiting may develop rapidly and are common side effects in older adults

B. Close monitoring is needed because toxic levels may develop The older patient should be monitored closely for adverse effects of all medications, even those administered in normal doses, because toxic levels can develop rapidly. Medications should never be increased to greater-than-normal levels because age-related changes in the liver and intestinal absorption may cause development of toxic drug levels. The patient also should not receive drug doses that are lower than normal. Nausea and vomiting in response to medication are not expected side effects of a patient's use of prescribed medication in appropriate dosages.

A nurse is teaching a client about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the client? A. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." B. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." C. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." D. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."

C. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet."

While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which of the following interventions? A. Administer a preparation to clean the GI tract, such as Golytely or Fleet Phospho-Soda B. Tell the client he/she must be on a clear liquid diet for 24 hours before the procedure C. Inform the client that he/she will receive a sedative before the procedure D. Tell the client that he/she may eat and drink immediately after the procedure

C. Inform the client that he/she will receive a sedative before the procedure The client shouldn't eat/drink for 6-12 hours before the procedure to ensure that the upper GI tract is clear for viewing; - if it's scheduled for the afternoon, some providers will allow the patient to drink clear liquid fluids up to 2-4 hours before the procedure. - sedative before the endoscope is inserted that will help him/her relax, but allow him/her to remain conscious. - A GI tract cleansing and a clear liquid diet are interventions for a client having a lower GI tract procedure, such as a colonoscopy. Food and fluids must be withheld until the gag reflex returns.

Which food does the nurse instruct a client undergoing chemotherapy for oral cancer with secondary stomatitis to avoid? A. Broiled fish B. Ice cream C. Salted pretzels D. Scrambled eggs

C. Salted pretzels

A 68-year-old patient presents to the ED the day after Thanksgiving, stating that he has "eaten and drunk quite a bit." He says that about 1 hour ago he experienced a sudden onset of pain in the left upper quadrant that radiates to his left flank. He rates the pain as an 8 on a 0-to-10 scale. The patient is admitted with acute pancreatitis. Which laboratory finding corroborates the diagnosis of acute pancreatitis? A. Serum lipase, 150 U/L (normal = 0-160 U/L) B. Serum amylase, 200 U/L (normal = 23 to 85 U/L) C. White blood cells (WBCs), 6000 mcL (normal = 4800-10,800 mcL) D. Serum glucose, 80 mg/dL (normal = 82-110 mg/dL)

C. White blood cells (WBCs), 6000 mcL (normal = 4800-10,800 mcL) Amylase, lipase, WBC, and glucose are often higher than normal in patients with acute pancreatitis.

Pancreas - exocrine and endocrine

Contains exocrine glands that produce enzymes for digestion > trypsin and chymotrypsin (proteins) > amylase (carbs) > lipase (fats) Endocrine - consists of islet cells that create/release hormones directly to bloodstream - Insulin (lowers blood sugar) - Glucagon (raise blood sugar)

Which patient statement requires a focused GI assessment? A. "Spicy foods upset my stomach." B. "I have had dentures for 3 years." C. "I experience occasional constipation." D. "I take ibuprofen 600 mg three times a day for arthritis pain."

D. "I take ibuprofen 600 mg three times a day for arthritis pain." Large amounts of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen can predispose the patient to peptic ulcer disease and GI bleeding.

Which patient is more likely to develop gallstones? A. 45-year-old Caucasian female with a family history of gallstones B. 55-year-old African-American male with a history of diabetes mellitus C. 62-year-old Hispanic/Latino female with a history of irritable bowel syndrome D. 60-year-old obese, American-Indian female with a history of diabetes mellitus

D. 60-year-old obese, American-Indian female with a history of diabetes mellitus Risk factors for developing gallstones include female gender, obesity, family history of gallstones, diabetes mellitus, American-Indian and Caucasian descent, rapid change in weight, and advanced age. More risk factors increase the likelihood of developing gallstones.

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? A. Clients with CD experience about 20 loose, bloody stools daily B. The peak incidence of UC is between 15 and 40 years of age C. Very few complications are associated with CD D. Clients with UC may experience hemorrhage

D. Clients with UC may experience hemorrhage

Diverticula, Diverticulosis, Diverticulitis - high or low fiber diet?

Diverticula - saclike protrusions of the intestinal wall Diverticulosis - condition of the colon in which multiple diverticula are present Diverticulitis - refers to the inflammation of one or more of the diverticula in sigmoid colon - happens when undigested food/bacteria trapped in diverticulum - Should be on high fiber diet - But during period of diverticulitis, they should be on low fiber diet

Risk factors for Cholecystitis****

Fat, female, fertile, forty 1. Gender and age - women and >60 yrs 2. Ethnic background - White, Mexican, American Indian 3. Overweight/obese - high cholesterol 4. Genetics - fam Hx of gallstones 5. Diabetes - blood has higher level of triglycerides 6. Medications with estrogen, hormone therapy drugs, BC - estrogen increases cholesterol levels, decreases motility of gallbladder 7. Cholesterol-lowering meds - sometimes blood cholesterol lowering drugs increase amount of cholesterol in bile 8. Dietary habits - diet rich in fat, low in fiber

Nursing Dx with Liver Failure****

Imbalanced nutrition - less than body req. - protein is a balancing act > decrease for PSE pt's but increased for pt's with cirrhosis - decreased Na (ascites) Impaired skin integrity - bile salts accumulate in the skin and cause pruritus Ineffective breathing pattern - ascites > increased pressure on diaphragm Risk for injury

Chronic pancreatitis - factors, S&S, Dx, teaching

Long term inflammation of pancreas → irreversible destruction of tissue - can't properly digest food and unable to get nutrients, can't maintain blood sugar - difficulty maintaining/gaining weight, persistent pain, weak bones, vision loss Factors - predominately triggered by lifestyle factors - heavy alcohol/tabacco use - medications, elevated triglycerides, auto-immune conditions genetic - cystic fibrosis, hereditary pancreatitis - idiopathic S&S - hallmark symptoms = abdominal pain - intermittent or chronic stabbing pain btwn belly button and chest, may radiate to back - triggered by eating, especially high fat foods - as disease progresses = pain more severe and constant - develop fatty stool, weight loss, pancreatic insufficiency, diabetes Dx - CT, MRI, endoscopic US to confirm - difficult to diagnose cases = pancreatic stimulation test (artificial stimulant with secretin) - no blood tests No cure - early Dx and treatment can help slow progression Teaching - no alcohol/smoking, fatty food, pain management, medication (pancreas enzyme replacement therapy), multivitamin and mineral supplements

Cholecystitis - Nursing Care - mildest and most common symptoms - acute biliary pain (how to treat) Treatment - infection of gallbladder, and acute/long term chronic cholecystitis

Mildest and most common symptom - intermittent pain called biliary colic (R or mid upper abdomen) Acute biliary pain - opioid analgesia (morphine or hydromorphine - dilaudid), opioids can cause sphincter of Oddi spasm Infection of gallbladder - emergency cholecystectomy Acute and long term chronic cholecystitis - Laparoscopic cholecystectomy

Neoplasms of GI system - Oral cavity and oropharyngeal cancers - risk factors and priorities***

Oral cancer - lips, tongue, oral cavity, pharynx Risk factors*** - Tobacco/alcohol use - Betel quid and gutka (Southeast Asia), chew leaves - HPV infection - Gender - more common in men - Age - > 55 - UV light - poor nutrition - low in fruits/vegetables - weakened immune system - AIDs - Graft v host disease (GVHD) - happens after stem cell transplant - Genetic syndromes - Lichen planus - middle aged, small white lines or spots Priorities*** - airway breathing and circulation

Changes in the Digestive System with Aging - oral changes - others

Oral changes - Sensory neurons - reduced sense of taste; results in reduced caloric intake - Slower healing of mucosa - Dysphagia (swallowing) occurs in 30-50% of the elderly - at risk for aspiration, swallowing studies Others - Decrease in saliva - Decreased hydrochloric acid production - Diminished sensation that can lead to constipation - may need enema or manual extraction - Fat is not digested as well in older adults - Decrease in peristalsis - if not moving around or ambulating, also natural with age - Pancreatic vessels become calcified - set up for pancreatic disorders If not hydrated > strain for bowel movement > hemorrhoids or can get impacted - May need enema, or manual extraction - LOC can be a factor if they forget or think they drink

Hiatal Hernia aka ? - Symptoms? Medication? Nursing Interventions? Surgery?

aka diaphragmatic hernia - protrusion of stomach through esophageal hiatus of the diaphragm into the chest - asymptomatic , similar symptoms to GERD (heartburn, regurgitation, dyspepsia) Medications - Antacids that neutralize stomach acid - Medications to reduce acid production; called H-2-receptor blockers - Medications that block acid production and heal the esophagus; proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal Interventions - small, frequent feedings, don't lie down for at least 1 hour after meals, elevate head of bed 4-8 inches when sleeping, don't eat before bed Surgery - fundoplication - tighten cardiac sphincter

Disorders of the GI Tract:Gastroesophageal Reflux Disease (GERD) - what is it, symptoms

• Chronic, more severe form of acid reflux • Can cause damage to lining of esophagus Symptoms • Chest pain, difficulty swallowing • Sore throat, hoarseness, dry cough • Feeling lump in throat that they can't get rid of o Esophageal sphincter supposed to close after you eat so food doesn't come back up