Module 6 - Alterations in Elimination: Gastrointestinal
A nurse is reinforcing teaching about ileostomy care with a client. The nurse should recognize which of the following statements by the client indicates a need for further teaching?
" I will be certain to take enteric coated meds"
non alchoholic liver disease
"Fatty Liver"
A nurse is reinforcing teaching a client who is scheduled for a barium swallow to evaluate dysphagia. Which of the following statements should indicate to the nurse that the client understands the instructions?
- "I will drink plenty of fluids after the test."
Type E hepatitis
-Fecal-oral transmission; primarily fecally* contaminated drinking water; also person-to-person; Similar to A ; transmitted through foods water contaminated w/ infected fecal matter; rare in U.S.
pyloric sphincter
Controls passage of food from stomach to small intestine
A nurse is contributing to the plan of care of a client who has a small bowel obstruction. Which of the following interventions should the nurse include?
Elevate the head of the bed.
specific cholangiographies
RCP, intraoperative, MRCP, PTC
A nurse is caring for a client who is 2 days postoperative for abdominal surgery. The client reports discomfort from abdominal distention and flatus. Which of the following suggestions should the nurse include?
ambulate several times a day
A nurse is caring for a client who is postoperative has an NG tube that has drained 2,500 mL in the past 6 hr. The nurse should monitor the client for which of the following electrolyte imbalances?
decreased potassium level
liver biopsy
ercutaneous; obtain liver tissue and examine it microscopically; helps detect malignant changes, infectious or inflammatory processes, liver damage, signs of rejection of liver transplant -Clients need to lie on right side for 2 hrs, but spend 8-12 hrs in bed; obtain vitals, monitor bleeding, swelling, or hematoma's; vascular organ; monitor breath sounds
jejunum and ileum
function mainly in absorption of nutrients and water
Nonradiographic Studies: MRI
magnetic energy; examine GI structures; can use oral contrast agencies
biliary cirrhosis
is scarring around bile ducts in the liver from chronic biliary obstruction, and infection, or autoimmune liver dx
Small bowel series (SBS)
a series of x-rays taken after the patient drinks a barium solution to visualize the duodenum, jejunum, & ileum; one w/ fluoroscopy of the small intestine to identify obstructions in the jejunum or the ilium, tumors, or inflammation
The large intestine
absorbs water and forms feces; contains symbiotic bacteria; is about 4 to 5 ft long; primary function is to receive waste from the small intestine, absorb water, some electrolytes, a bile acids --> consists of the cecum, and the colon w/ the ascending, transverse, descending, I sigmoid portions of the colon, the rectum is the anal canal
Peristalsis
is defined as the coordinated movement of those muscles to help propel food through the esophagus tothe stomach
Post Necrotic Cirrhosis (Liver)
is destruction of the liver cells, secondary to infection, dx, or exposure to hepatotoxins
duodenum
is the first portion and this is where bile pancreatic enzymes will enter the duodenum through the ducts to help break down fats, carbohydrates and proteins --> the chyme is then propelled through the small intestine by peristalsis
CT scan (computed tomography)
a series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the body; detect structural abnormalities of the GI tract in metastatic lesions, hollow GI organs; barium sulfate or IV calcium phosphate might be used; before test, try to clean out bowels
The appendix
is a blind to be at the tip of the cecum that has no known function in humans when the focal mass reaches the rectum, it's held there by contraction ofthe analsphincters until distens occurs, which stimulates the urge to defecate
A nurse is reinforcing teaching with a client who has cholelithiasis and is scheduled for an endoscopic retrograde cholangiopancreatography. Which of the following statements made by the client indicates an understanding of the teaching?
" Ill have an endoscope put down my throat so they can see my gallbladder."
Liver
Has 4 lobes, supported by mesenteries that connect the liver to the intestines, abd. wall, & diaphragm Metabolize glucose, proteins, fats, drugs, chemicals, bacteria, & foreign elements Converts glycogen to glucose and regulates blood glucose Stores vitamins, forms & excretes bile and bilirubin Synthesizes factors for blood coagulation
Type A Hepatitis
Transmitted through water, food, or medical equipment; can be contamined by infected fecal matter; rarely fatal
intussusception
Where bowel telescopes on itself, or fecal impaction
Crohn's disease
Patho & Etiology: regional enteritis; chronic digestive disorder w/ systemic manifestations May have arthritis, skin lesions, eye inflammation, liver & gallbladder disorders Can occur anywhere in GI tract, but primarily in the terminal portion of ilium -S/S: Have inflammation in submucosal layer; affected areas can cause hyperemia, edema, ulcerations, & fistula development May see genetic predisposition, smokers, caucasian w/ European or jewish history -S/S: Bilateral lower quadrant distention, tenderness, chronic diarrhea, fever, growth failure -Diagnostics: stool analysis, UBC count, ESR elevated, barium enema, endoscopic exam, biopsy, upper GIseries w/ small bowel follow through -Medical: supportive, appropriate changes to diet, TPN, IV therapy, whole blood, meds--> antidiarrheals & anti-peristaltics, Five ASA's, corticosteriods, immune modulators -Surgical: Reserved for complications like obstruction, perforation, fistulas, short bowel syndrome; intestinal transplant; ileostomy 75% will require surgery w/in 20 yrs of symptom onset 90% require surgery W/in 30 yrs -Nurses: Monitor for complications, and fluids nutrition replacement
Peritonitis
Patho &Etiology: inflammation of the peritoneum-lining of abdominal cavity can happen from perforated peptic ulcer, perforated bowel, ruptured appendix, inflammatory bowel dx, ruptured ectopic pregnancy, infectious from peritoneal dialysis, bacteria -S/S: lack of bowel motility following hyperactivity, paralytic ileus, rapid respirations, & can progress to hypovolemic shock -Diagnostics: WBC count, X-rays, CT scans, ultrasounds, culture sensitivity of peritoneal fluid -Med/surg: NG tube, IV fluids, electrolytes, antibiotics, anti-emetics, a surgery toclose perforation -Nurses: monitor their status, provide emotional support, a post-op care One of the classic signs of peritonitis is "board-like"abdomen when you palpate; rigid, hard
Colon & Rectal Cancer
Patho Etiology: Can develop anywhere in lower GI tract; colon cancer is 3rd most common cancer in U.S. can start from benign adenoma; may see adenocarcinoma, polyps are precursors, genetics, ulcerative colitis, lifestyle, & environment If have chronic bowel inflammation, or long term low fiber diet, or high fat diet can lead to colon cancer -S/S: change in bowel habits, frank blood or occult blood in stool, distended abd., abd. discomfort -Diagnostics: CBC, barium enema, colonoscopy, genetic testing, CEA test, & biopsies -Med/surg: examine any polyps, X-rays, scopes-endoscopy or colonoscopy w/ colorectal cancer --> surgery, radiation, therapy, chemotherapy, colectomy, segmental resection, or and perineal resection -Nurses: supportive care a post-op care
Diarrhea
Patho Etiology: Acute or chronic; frequent stool, more than 3/day; liquid or semi-liquid; -S/S :increased peristalsis, dehydration, electrolyte imbalances, vitamin deficiencies can be caused by infections, diet, intestinal dx., meds, formula used in tube feedings -S/S: frequent liquid or really soft stools, hyperactive bowel sounds, skin irritation, i impairment -Diagnostics: stool cultures, ova & parasite analysis, hemacult testing, proctosigmoidoscopy, colonscopy, endoscopy -Med/Surg: treatment dependent on duration; meds, probiotics, fluid eectrolyte replacement, dietary adjustments; total parenteral nutrition, anti-diarrheas
Esophageal Cancer
Patho Etiology: affects men more often; involves squamous cell carcinomas Correlated w/ alcohol abuse, is smoking. -S/S: Asymptomatic until cancer progresses interfere w/ swallowing -Diagnostics: barium swallows, biopsy, EGD, bronchoscopy, endoscopic ultrasound, mediastinoscopy -Med/Surg:surgery, chemotherapy, radiation, palliative measures if notcandidates for surgery -Nurses: consult w/ dietary, soft high calorie high protein semi-liquid food, liquid supplements, not drink from straws or narrow necked bottles, prevent post-op complications
constipation
Patho Etiology: stools that are dry, compact, difficult painful to pass Fewer than 3 week for several weeks; need to look at stool itself-dry?hard? Compact? soft? formed? some clients only have 1 BM /week and that's their normal -S/S: May see changes w/ peristalsis, anddistension, gastrocolic reflux, stool retention, insufficientdietary fiberswater, impaired GImobility, systemic disorders Chronic constipation causes include neurological issues, partial or complete blockage, musculardisorders, & hormonal conditions -S/S: infrequentBMs, distended abd., pain, liquid stool seeping around stool mass -Diagnostics: examination, X-rays, barium enema, anorectal motility studies -Med/surg: treat cause; administer enemas--> laxatives, stool softener's change diet --> legumes, fresh fruits & veggies, wheat bran seeds, nuts
Appendicitis
Patho Etiology:inflammation ofa narrow blind profusion that's located atthe tip of the recum Mostcommon in adolescents young adults Inflammation occurs when opening becomes narrow or obstructed;and see a bacterial infection -S/S: pain that begins around the umbilicus; then moves to the right lower quadrant, what we call mcburney's point; rebound tenderness; positive Rod sings sign--> pain felt in right lower quadrant when you palpate left lower quad; low grade fever, Increase WBC count, N/V, constipation, Rupture can occur w/in 24 hrs of pain onset if not treated; can cause peritonitis or an abscess -Diagnostics: Blood counts, abd. ultrasound, CT scan, -Med/surg: antibiotics, IV fluids, appendectomy Initially w/hold analgesics- don't want to mask pain if appendix ruptures -Nurses: quickly prepare for surgery; Post-op: avoid heavy lifting or straining for months following surgery; general activities can resume sooner If abdomen is palpated, the nurse should cease palpation ifpain is felt
lower esophageal sphincter (LES) (cardiac sphincter)
Ring of muscles between the esophagus and the stomach. Also called cardiac sphincter.; also known as the cardiac sphicter, helps prevent gas contents from entering the esophagus
The small intestine
The part of the digestive system in which most chemical digestion takes place.; is about 23 feet long a divided into 3 portions Primary function is to absorb nutrients from chyme
Cholangiography
a radiographic examination of the bile ducts with the use of a contrast medium; :determine patency of the ducts from the liver the gallbladder The gallbladder is not distinctly visible vomiting can interfere moral dye
ostomy appliances or pouches
applied to the opening to collect stool; collection device that's worn over a stoma, thatcollects species can be a disposable one or two piece device w/a pouch and a face plate or disc *Temporary would be preferred in the immediate post-op phase *Reusable equipment: involves O-ring on the face plate that allows a pouch to be replaced as needed; may also have a belt to help support weight of pouch; the adhesive will help seal better w/body warmth; make certain hole for stoma is not too large--> will help prevent skin irritation; If significant gas develops, the appliance may require burping;If skin impairment or repeated leakage occurs, may need to consult ostomy nurse
A charge nurse is reinforcing teaching with a newly licensed nurse about the common link between ulcerative colitis and Crohn disease. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
both illnesses and inflammatory in nature
A nurse is caring for a client who has a history of chronic ulcerative colitis and has a new diagnosis of anemia. The nurse should explain to the client that which of the following manifestations of colitis can result from anemia?
chronic blood loss
Cirrhosis
chronic degenerative disease of the liver that's caused by generalized cellular damage; have irreversibly damaged liver cells consequences of damage affects digestion i metabolism, fluid electrolyte imbalances, and impaired ability to metabolize hormones a detoxify chemicals Several types of cirrhosis:
Incubation phase for hepatitis
clients go through an incubation phase where they're asymptomatic; the virus is in the blood, bile, is stool clients are infectious
nausea and vomiting (N&V)
common symptoms in many GI disorders; -Patho Etiology: common causes is often occur together; nausea usually precede vomiting -S/S: increased salivation, cold clammy skin, tachycardia from vasoconstriction, loss of appetite, dehydration, bacterial or viral cause, or from bowel obstruction --> abdomen, distended, firm, tender, hypoactive or absent bowel sounds -Diagnostics: blood work, electrolytes -Med/Surg: IV fluids, electrolytes, meds to decrease nausea
Cirhorris Complications & Treatment,
complications of cirrhosis include portal HTN: blood backs up to portal system; may see congestion-causes pressures; GI bleed, ascites, encephalopathy -Treatment: Includes sodium restriction, drug therapy, surgical nonsurgical shunts Esophageal varices are a result of portal HIN, that causes blood vessels to dialate and bulge in the esophagus; easily traumatized, very fragile, and can cause esophageal bleeding, that can be life-threatening. Important clients avoid rough textured food, avoid straining, avoid chemical irritants that can erode or cause rupture of vessels --> can cause life threatening hemorrhage, scleropathy, variceband ligation, singh staken blakemore to be might be necessary; in addition to IV fluids, a blood products. -Ascites is another complication: which is a collection of fluid in the peritoneal cavity; we seethe hepatorenal syndrome, where serum protein has been collected in the peritoneal cavity clients may require an abdominal paracentesis, where we have a catheter that is inserted into and to drain off fluid; may need to alter diet; treator/drug therapy -Hepatic encephalopathy: CNS manifestation of liver failure; can lead to coma; death, and see increased ammonia level in blood studies; CNS affects include disorientation, confusion, personality changes, asterixis Treat by eliminating dietary protein, administering lactulose, remove residual protein, a deplete intestinal microorganisms
Ileostomy
creation of an artificial opening into the ileum; placed in the distal small intestine Temporary or permanent;depending on reason for it Standard or Brook ileostomy, conventional, which involves a total colectomy The fecal material is going to be liquid, mushy, or pasty May be a continent or abdominal pouch Involve creation of an internal reservoir that is removed (Stool contents) periodically w/ a catheter, or an ilioanal reservoir which helps maintain bowel continence may be performed for chronic ulcerative colitis is done in 2 stages Temporary ileostomy initially and then about 3 months later, the ileostomy would be reversed -Pre-op: encourage to consult w/ ostomy nurse; require cleansing of the bowel -Post-op: normal post-op care;NG tube, IV fluids, antibiotics; monitoring for complications; client education on ostomy placement
A nurse is contributing to the plan of care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse recommend for the incision in the plan of care?
decrease the clients fluid intake
A nurse is collecting data from a client who has a gastroesophageal reflux disease (GERD) and reports having heart burn every night. Which of the following actions should the nurse identify as a contributing factor to the clients heartburn?
drinking orange juice regularly
A nurse is reinforcing discharge teaching with a client who is postoperative for a traditional cholecystectomy and has a T-tube in place. Which of the following instructions should the nurse include in the teaching?
empty the drainage bag at the same time each day
A nurse is caring for a client who is postoperative following a laparoscopic cholecystectomy. Which of the following actions should the nurse take?
encourage ambulation on the day of surgery
Type D Hepatitis
exposure to infected blood and body fluids; Transmitted through skin, mucous membranes;see increased risk for chronic dx & possible liver failure
A nurse is contributing to the plan of care for a client who has a gastrostomy tube through which he is receiving continuous eternal feedings. Which of the following interventions should the nurse include in the plan?
flush the tube with 30 mL of water every 4 hr
Gastric secretions
gastric acid destroys pathogens; are going to help break thatfood down into chyme.
Ultrasonography (ultrasound)
high frequency sound wave that will detect the sizes location of organs ; outlines structures, abnormalities, chololathiasis, pyloric stenosis, and appendicitis changes
A nurse is preparing a client who has advanced cirrhosis for an abdominal paracentesis. Which of the actions should the nurse take?
instruct the client to empty his bladder
IBS with constipation specific drugs Medications
lubiprostone, linacotide o Adverse effects: Alosetron - ischemic colitis; lubiprostone - nausea, diarrhea, abdominal pain, flatulence o Contraindications: Lubiprostone - GI obstruction, children younger than 17
stool specimen
material evacuated from the bowels; feces
Fluoroscopic observation
may look at esophagus; Identify structural abnormalities of the esophagus w/swallowing dysfunction or oral aspiration
Alcoholic cirrhosis
most common; chronic alcohol intake; Poisoning or ingestion of hepatoxic drugs such as acetaminophen
Prostaglandin analogs medication
o Indication: Reduce gastric ulcers; heal duodenal ulcers o Contraindications: Drug allergy, pregnancy o Adverse effects: Headache, GI distress, vaginal bleeding, abdominal cramps, diarrhea o Drugs: misoprostol
Mucosal Protectant Medications
o Indications: Active stress ulcers, peptic ulcer disease, esophageal erosions o Action: Coats mucosa boosting mucosal defenses o Contraindications: Drug allergy o Adverse effects: Nausea, constipation, dry mouth o Nursing actions: Requires multiple daily dosing; administer 2 hours after other drugs and 1 hour before meals o Drugs: Sulcralfate
Antidiarrheals Medications
o Indications: Diarrhea o Contraindications: Drug allergy, intestinal obstruction, colitis o Adverse effects: Increased bleeding time, constipation, urinary retention, drowsiness, bradycardia, hypotension, N/V, respiratory depression o Interactions: Increases or decreases absorption of many drugs o Drugs: § Adsorbents - bismuth subsalicylate § Anticholinergics - belladonna alkaloid combinations § Opiates - diphenoxylate with atropine, loperamide § Probiotics - lactobacillus
Proton Pump Inhibitors (PPIs) medications
o Indications: Erosive esophagitis, symptomatic GERD, gastrointestinal ulcers o Contraindications: Drug allergy o Adverse effects: Increased risk of gastric infections; increased risk of osteoporosis if used long-term o Interactions: Diazepam, phenytoin, warfarin, ketoconazole, ampicillin, iron salts, digoxin, clopidogrel o Nursing actions: Capsules can be opened and contents dissolved for tube administration o Drugs: Omeprazole, lansoprazole, pantoprazole
Laxatives, stool softeners medications
o Indications: Facilitate bowel movements, remove toxic substances from the body, preparation for colonic diagnostic procedures or surgery; lactulose - reduce ammonia absorption o Contraindications: Drug allergy; caution with acute surgical abdomen, appendicitis symptoms, fecal impaction, intestinal obstruction, undiagnosed abdominal pain o Adverse effects: Impaction, gas formation, bloating, electrolyte imbalance, nutrient malabsorption o Interactions: Decreased absorption of many drugs; decreased CNS with hyperosmotic laxatives o Nursing actions: Encourage increased fluid intake, especially with bulk-forming laxatives to prevent obstruction o Drugs: § Bulk-forming laxatives - (Increase water absorption increasing total volume of intestinal contents) - methylcellulose, psyllium § Emollient laxatives - (Lubricate or soften stools) - docusate salts, mineral oil § Hyperosmotic laxatives - (Increase water content of the feces, resulting in distention, peristalsis, and evacuation) - glycerin, lactulose (Also functions as an ammonia detoxicant in hepatic encephalopathy), polyethylene glycol 3350 § Saline laxatives - (Increase osmotic pressure and draw water into colon - produces watery stool) - magnesium salts § Stimulant laxatives - (Induce intestinal peristalsis) - bisacodyl, senna (Can turn feces yellow to yellow-green, and cause urine to be red-pink color)
H2 receptor antagonists medications
o Indications: GERD, peptic ulcer disease, erosive esophagitis, upper GI bleed o Contraindications: Drug allergy; dosage adjustment if liver or kidney dysfunction o Adverse effects: Confusion, disorientation, impotence, gynecomastia, thrombocytopenia, hypotension, diarrhea, nausea o Interactions: Multiple drugs - check drug books prior to administration o Drugs: Cimetidine, ranitidine, famotidine o Nursing actions: Requires less frequent dosing than antacids
Prokinetic agents medications
o Indications: Prevent N/V, promote movement of substances through GI tract and increase GI motility o Contraindications: Seizure disorders, pheochroocytoma, breast cancer, GI obstruction, hypersensitivity to drug or procaine or procainamide o Adverse effects: Extrapyramidal effects, tardive dyskinesia o Drugs: Metoclopramide
A nurse is planning care for a client who is 1 day postoperative following a partial bowel resection. The client requires a complete dressing change, total parental nutrition administration, daily weight and is reporting pain at a level of 6 on a scale of 0 to 10 scale. Which of the following nursing actions should the nurse plan to complete first?
obtain the clients vitals
Ostomy
opening between an internal body structure and skin Ileostomy: placed in the distal small intestine colostomy: placed in colon stoma: the opening on the exterior and surface The need for an ostomy might be due to an inflammatory bowel disorder, rupture of an intestine, irreversible obstruction, compromised blood supply to the intestine, or a cancerous tumor A matured stoma is a process that provides healing and a smooth peristomal area Fecal matter from an ostomy may be liquid and contains digestive enzymes The appliance will consist of a pouch, may have some coria gun --> all protects skin and promote adhension to the skin
A nurse is collecting data from a client who has acts gastroenteritis . Which of the following data collection findings should the nurse identify as the priority?
potassium 2.5 mEq/L
X-ray observation:
pre-procedural requisites are low residue diet, laxative, seasmoking post-procedural requisites to drink fluids liberally, obtain stool specimens potentially laxatives
cholecystography
process of obtaining x-ray of the gallbladder; oral or gallbladder series to identify stones in the gallbladder, commone bile duct, stumors, and the abilityto store a dye like iodine-based radiopaque contrast medium
A nurse is assisting with the plan of care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan?
provide periods of rest
Upper esophageal sphincter (UES)
region of the upper part of the esophagus that opens to allow a mass of food to enter the esophagus; will prevent air from entering the esophagus & the stomach
Adhesions
scar tissues grown together that are normally separate
A nurse is collecting data from a client who has peptic ulcer disease. Which of the following findings is a manifestation of gastrointestinal perforation?
severe upper abdominal pain
fecal diversion
surgical creation of an opening of part of the colon or small intestine to the surface of the skin to allow for stool to exit the body
A nurse is reinforcing teaching with a client who reports right shoulder pain following a laparoscopic cholecystectomy. Which of the following statements should the nurse make?
the pain with dissipate if you ambulate frequently
Colosotomy
the surgical creation of an artificial excretory opening between the colon and the body surface; Placed in colon
Type B Hepatitis
transmitted by body fluid; Found in all body fluids of infected persons; transmitted by intimate contact w/ carries and contact w/ contaminated blood or medical equipment ;6% of infected past ages will develop chronic hepatitis Bw/increased risk of cirrhosis, liver failure, liver cancer
Endoscopy
visual exam of lumen of GI tract; using flexible fiber optic endoscope; evaluates appearances integrity of GI mucosa; detects lesions can do washings w/ endoscope I do biopsies
enteroclysis
washing or irrigation of the small intestine; include small bowel edema
Mouth
where mastication or chewing begins Food that contains starch undergoes partial digestion because of the salivary amylase moves on down to the esophagus located at the beginning of the pharynx goes down to the stomach opening. The muscle tissue surrounds the esophagus;
Pre-ictric or prodomal phase
where the client experiences N/V, anorexia, fever, right upper quadrant pain, rash, Uticaria
ileocecal value
will separate the ilium & the cecum and it controls the flow of intestinal contents, and helps prevent he reflux of feces into the small intestine
Hepatitis vaccinations - Hepatitis B
§ Noninfectious viral vaccine containing hepatitis B surface antigen § Indications: All children, healthcare workers, adults with diabetes mellitus § Contraindications: Hypersensitivity to yeast § Nursing actions: Series of 3 injections - 2nd 1 month later and 3rd 6 months later
A nurse is reinforcing teaching about dietary recommendations for a client who has a hiatal hernia. Which of the following client statements indicate understanding of the teaching?
-I will consume less caffeine and spicy foods -I will sleep with the head of my elevated -I will try not to gain weight
Pancreatic Cancer
-Patho Etiology: Can occur in glands, head, body, or tail see accumulation of malignant cells that block the pancreatic duct and cause symptoms that are similar to chronic pancreatitis There is rapid growth? usually poor prognosis Factors that correlate pancreatic cancer include diabetes, high-fat diet, chronic exposure to carcinogens, excessive body weight, or family history. Dx may be far advanced before any symptoms are noted -S/S: left upper abd. pain, jaundice, anorexia, weight loss, obstructive jaundice, pureitis, ascites, light colored stools, & dark urine -Diagnostic: abd. ultrasonography, CT scan, biopsy -Med/surg: ablative procedures, radical pancreatomectomy or whipple procedure --> removes head of pancreas & resects to the duodenum and stomach--> redirecting flow of secretions from the stomach, gallbladder, a pancreas; cholecystogenostomy--> rerouting of pancreatic & biliary drainage For inoperable tumors--> radiation or chemotherapy -Nurses: provide palliative care, post-op care, prevention of complications; monitor for bleeding & infection; teach on meds how to monitor glucose levels
Gallbladder disorders
-Patho Etiology: disorders include cholelithiasis (stones in the gallbladder), cholidogoliathus (stones located in the common bile duct), cholecystitis (inflammation or infection of the gallbladder that's caused by the formation of stones); acute or chronic -Risk factors: female, fat, fair, 40, fertile; also increases if diabetic S/S: biostasis; dietary factors involved, or infection; can impair passage of bile; gallbladder inflamed distended with bile -S/S :betching, N/V, discomfort that's result ofi nflammation; contractile spasms especially after high fat meals from reduced or absent bile; swelling or necrotic gallbladder; jaundice, light colored stools Diagnostics:cholecystography, CT scan, ultrasonography, radionuclide imaging, PTCA, ERCP, MRC -Med/surg:NG tube, antibiotics, parenteral fluids, low-fat diet; lithotripsy to help break up stones, sphincterotomy, laparoscopic or open cholecystectomy; T- tube to drain bile -Nurses: provide appropriate pre & post-op care; drain care; teach to avoid high fat foods; teach about any meds
Liver Tumors
-Patho Etiology:abnormal masses of cells, located in the liver; benign or malignant may be primary tumor meaning that's where it started; or a metastatic lesion that comes from the breast, lung, or GI tract Benign liver tumors can be found as a result of tuberculosis or fungal parasitic infections; can cause bile obstruction, jaundice, liver failure, portal HTN, and ascites -S/S:Jaundiced, right upper quadrant pain, live enlargement, ascities -Diagnostics: blood tests, liver scan, ultrasound, MRI or CT, liver biopsy -Med/surg: hepatic lobectomy, cryosurgery or cryoablation; In chemotherapy; directly infuse into hepatic artery or peritoneumy drug therapies; chemotherapy or radiation -Nurses: Ensure client safety comfort; support ventilatory system; teach med administration; provide support referrals to the client and family
A nurse is assisting in the plan of cate for a client who had surgery for a bowel obstruction. The client has a nasogastric tube in place. Which of the following actions should the nurse include in the clients plan of care?
-Perform leg excercises every 2 hr. -Encourage hourly use of an incentive spirometer while awake -Document the color, consistency and nasogastric drainage
Cirrhosis S/S, Diagnostics/ Med Surg & Nursing Care
-S/S: dependent on bilirubin is albumin levels, ascites, neurologic involvement nutritional status may be compensated and decompensated Chronic fatigue, anorexia, dyspepsia, nausea, clay colored stools, diarrhea, constipation, tea-colored urine or dark urine, weightloss, abd. discomfort, SOB, nosebleeds, signs of incomplete estrogen metabolism in men; liver/spleen enlarged, jaundice -Diagnostics: Liver biopsy, blood tests, CT scan, mRI, radioisotope liver scan; nodular configuration a distorted blood flow -Med/surg: No specific cure; goal is prevent further deterioration; provide vitamins nutritional supplements, no alcohol; W/ advanced liver dx, we may have torestrict protein intake, administer lactulose, deoxycolic acid potassium sparing diuretics, sodium intake need regulation, platelet transfusions liver transplantation -Nurses: Monitor vitals, weight, I&O's, abd. girth; give small meals, provide moisturization to the skin can develop itching leading toskin impairment;due to toxin buildup in the skin clients response to drug therapy needs monitoring, including change in mental status, and signs of GI bleed; provide teaching about disorder, guide to support groups, teach about treatment regimens, I home care
Emptying time of the stomach
2 to 3 hours , peristalsis is rapid; from the stomach will be determined by the amount the composition ofthe food that's ingested
Which observation of a client with an intestinal obstruction does the nurse report immediately? A. Urinary output of 1000 mL in an 8-hour period B. The client's request for something to drink C. Abdominal pain changing from colicky to constant discomfort D. The client is changing positions frequently
C. Abdominal pain changing from colicky to constant discomfort
The client has an abdominal hernia with a sac that can be returned into the abdominal cavity by gentle pressure. Which type of hernia does the nurse recognize? A. Incisional B. Irreducible C. Indirect inguinal D. Reducible
D. Reducible
colostomy
Opening into the large bowel; fecal matter will be semiliquid to formed; more formed the closer in the colon to the return that the ostomy is placed -Indications would be for cancerous lesions, ulcerative inflammatory processes, multiple polyposes, or injury to the bowel can be temporary, permanent; placed in ascending transverse, descending, or sigmoid colon May require regular irrigations to control the sigmoid descending colostomy; which could eliminate the need for a continuous appliance May be single barrel, double barrel, or a loop The single barrel has a single stoma; there is a segmental resection anabdominoperineal resection;this is for tumors in the lower third of the sigmoid The double barrel will have a stoma that's proximal distal; will duplicate medical record diagram; nursing care plan to assess the bowel function any irrigations required Temporary will treat the disorder, such as acute diverticilities a chronic constipation, inflammatory bowel dx; but interval before re-establishing will be 16 months or longer w/a Loop colostomy, we have a loop of bowel that's lifted & supported w/ a glass rod or plastic butterfly device The opening of the intestinal loops bowel lacks pain receptors; it protects the bed & client's clothing when the loop colostomy is opened Prepare client for the pungent odor of the fecal matter w/ temp ostomy pouch, it will receive the flow of liquid feces Nurses need to manage pre-op the same way an ileostomy Be certain you're aware of the anxiety levels, due to the cause for the the ileostomy or colostomy, especially if it's cancer; does create a significant body image deficit
GERD (gastroesophageal reflux disease)
Patho & Etiology: Gastroesophageal reflux dx; gastric contents regurgitate into the esophagus, includes food is gastric secretions (acidic) Usually caused by a lower esophageal sphincter insufficiency; Obesity, & pregnancy can increase incidence Increases risk of esophageal bleeding or Barrett's esophagus --> precursor to esophageal cancer Pain can be similar to myocardial infarction -S/S: epigastric pain, burning, regurgitation -Diagnostics: barium swallow, upper endoscopy, biopsy, capsule -swallow camera, bronchoscopy -Med/surg: treat conservatively initially, meds, surgical procedure--> Nissan fund application, or strata procedure, proton pump inhibitors, prostaglandin analogues, mucosal protectants, H2 receptor antagonists, antacids Encourage smaller meals, avoiding foods that increase gastric acidity (black a red pepper, coffee, alcohol), avoiding foods that allow for reflux (alcohol, chocolate, citrus fruits, high fat foods); loose weight; avoiding eating or drinking win couple of hours of going to bed
Pancreatitis
Patho & Etiology: Inflammation of the pancreas; acute or chronic Acute is mild; see inflammations edema of pancreas Chronic is severe; enzymatic digestion of the pancreas, necrotic tissue, and local systemic complications W/ pancreatitis, there's auto digestion from a reflux of bile and duodenal contents see swelling of pancreatic duct and destruction of the pancreas can be caused from structural abnormalities, abdominal trauma, infections, irritable bowel dx, and alcohol intake -S/S: severe mid-abd. to upper abd. pain radiating to the sides a back, that increases after eating; vomiting, frothy foul-smelling stools; signs of steadiria - increased fat in the stool, jaundice, hypoactive bowel sounds, hypotension -Diagnostics: ↑serum urine amylase, lipase, and liver enzyme levels; blood glucose levels and WBC counts; ↓ serum electrolyte levels; CT scan or endoscopic exam W/ chronic, causes can be from alcohol, hereditary predisposition, hyperparathyroid, autoimmune pancreatitis (for chronic) , trauma, anatomic abnormalities -S/S: experience severe persistent pain, digestive disturbances such as flatulence, vomiting, diarrhea, dark urine, secondary diabetes, light-colored stools, weight loss -Diagnostics: CT scans, MRI, ultrasound, endoscopic retrograde studies -Med/surg: abstinence from alcohol, fat-free diet, correction of associated biliary tract dx. Drugs include maperidine, narcotics, non-opioid methods, and pancreatic enzymes may see partial or total pancreatectomy Nurses: monitor for life-threatening symptoms, glucose levels, I&O's
Intestional obstruction
Patho & Etiology: blockage that interferes w/normal progression of intestional contents can be functional or mechanical; more common in small bowel or small intestine Can be fatal if not treatly rapidly w/mechanical, a dynamic complete or partial obstruction cause can be from a tumor, Adhesions - scar tissue in abd. or anywhere, hernias, volvulus-kinking of bowel, or intrssusception -where bowel telescopes on itself, or fecal impaction -S/S: distension of abd., emesis w/bile or fecal contents, cramps, is absent bowel sounds Perforation sympts: sudden sustained abd. pain, abd. distention, fever, "board-like" abdomen Diagnostics:X-rays, serum electrolytes, metabolic alkalosis may be present, WBC count, hematocrit level -Med/surg:IV fluids, electrolytes, antibiotics, decompress the intestine by inserting NG tube, surgery, ostomy placement depending on signif. of blockage -Nurses: observe vomitus, monitor client's status, reporturinary output below som/s/hourw/ intestional obstruction -indicate possible hypovolemic shock
Diverticulosis/diverticulitis
Patho & Etiology: little herniations or pouches in the mucosa of the GIt ract; usually in large intestine Diverticulosis is basically asymptomatic Diverticulitis is where we have an inflammation Can be caused from low fiber intake, congenital predisposition Have inflammation when diverticula become obstructed; can form abscesses or fistulas -Other factors: obesity, lack of exercise, smoking, some meds -S/S: alternating constipation or diarrhea, rectal bleeding causing stools to be maroon color or appear like a current jelly -Diagnostics: stool specimens, CT scans, barium enemas, colonoscopy -Med/surg: avoid food that contain seeds; high fiber diet, IV fluids, antibiotics, colectomy or colostomy if dx. process severe enough -Nurse: education on diet, avoid constipations laxatives; encourage fluid
Hernias
Protrusion of a loop of an organ or tissue through an abnormal opening
Type G hepatitis
Transmitted through blood transfusions
A nurse is reinforcing teaching about pain control with a client who has acute pain following a subtotal gastric resection. Which of the following client statements indicated understanding of pain control?
" I will call for a pain med before the previous dose wears off "
Stoma
opening on the exterior abdominal surface
barium enema
or lower GI series; to identify polyps, tumors, inflammation, strictures, abnormalities of the colon
kinking of the bowel
volvulus
A nurse is caring for a client who is scheduled for a colonoscopy. The client asks the nurse if there will be a lot of pain during the procedure. Which of the following responses should the nurse make?
"You may feel some cramping during the procedure."
A nurse is caring for a client who cirrhosis. When delivering the clients lunch tray which of the fooling food selection requires intervention by the nurse?
1 slice of ham on whole wheat bread
4 types of cirrhosis
1.) Alcoholic 2.) Post Necrotic 3.) Biliary 4.) Non- Alcoholic seato hepatitis: Fatty Liver
A nurse is reinforcing dietary instructions with a client who has episodes of billary colic from chronic cholecytitis. Which of the following diets should the nurse reinforce in the teaching plan?
A low fat diet
The nurse is caring for a client who has a bowel obstruction and a new prescription for the insertion of a nasogastric tube. Which of the following interventions should the nurse take when inserting the nasogastric tube?
Instruct the client to place his chin to his chest and swallow.
The nurse on a medical-surgical unit is caring for several clients with acute cholecystitis. Which task is best to delegate to the unlicensed assistive personnel (UAP)? A. Obtain the clients' vital signs B. Determine if any foods are not tolerated C. Assess what measures relieve the abdominal pain D. Ask the clients to describe their daily activity or exercise routine
A. Obtain the clients' vital signs
The student nurse is caring for a client with cirrhosis. Which action by the student nurse causes the supervising nurse to intervene? A. Uses a straight-edge razor to shave the client B. Monitors for orthostatic changes of blood pressure C. Avoids intramuscular injections D. Uses a toothette for oral care
A. Uses a straight-edge razor to shave the client
accessory structures of the stomach
Accessory structures include the peritoneum (encloses and organs) -> 3 digestive organs: ·Liver: glandular organ that forms bile, processes vitamins, proteins, fats, carbohydrates; stores glycogen, help w/ coagulation; metabolizes chemicals, bacteria, & foreign matter, informs antibodies and immunizing substances ·Gallbladder:stores bile that is released when food (esp. fats) is ingested ·Pancreas: an exocrine endocrine gland; produces enzymes to digest fats, proteins carbohydrates; also produces insulin glucagon
IBS with diarrhea specific drugs Medications
Alosetron, rifaximin, eluxadoline
Which physiologic factor contributes to gastroesophageal reflux disease (GERD)? A. Accelerated gastric emptying B. Irritation from reflux of stomach contents C. Competent lower esophageal sphincter D. Increased esophageal clearance
B. Irritation from reflux of stomach contents
The client with acute necrotizing pancreatitis experiences a temperature spike to 104oF. What does the nurse suspect? A. Pancreatic pseudocyst B. Pancreatic abscess C. Chronic pancreatitis D. Pancreatic cancer
B. Pancreatic abscess
Lab Tests
CBC, urinalysis, serum bilirubin, cholesterol, serum ammonia level, prothrombintime, protein electrophoresis, and enzymes Common tumor marker blood study if cancer suspected Gastric analysis or H pylori test ; hydrogen breath testing, stool analysis
Gastrostomy Tubes
Can administer feeding = enteral supplementation *Provides a route for nutrition, meds, decompress gastric system, lavage- NG to be in stomach to irrigate & move particles, or do diagnostics treatments Type of tube depends on *placement reason for placement Nasogastric tube goes intostomach, very upper part of small intestine Naso enteral to be goes further into small intestine can place tobe surgically --> Gastrostomy, called peg tubes, G-tubes, or J-genostomies *Long-term feeding: bolus feeding through to be, intermittently, cyclic, or continuous HOB should always be elevated to prevent aspiration If client has abdominal cramping, need to slow rate down monitor glucose levels- lots of carbohydrates in supplements; monitor blood glucose Add about 6hrs worth of formula w/ continuous infusion Feedings can quickly move through GI, resulting in diarrhea
Peptic Ulcer Disease (PUD)
Chronic irritation, burning pain, and erosion of the mucosa to form an ulcer; Patho Etiology: loss of tissue from contact w/hydrochloric acid a pepsin in lower esophagus, stomach, or jejunum May see infection w/helicobacter pylori, family history, other risk factors, chronic gastric inflammation Ulcers are likely to recur; affects more men -S/S :pain in abd. & back; can disturb sleeping, bleeding- hematoenesis, melanoma ; pain can increase w/empty stomach -Diagnostics: Upper GI, EGD, low hemoglobin or RBC count -Med/Surg: goals of treatment: eradicate any bacteria, reduce acid levels, pain management, drug therapy Gastrectomy - may experience dumping syndrome; causes weakness, sweating, cramping, & diarrhea due to rapid emptying of the stomach; can lead to HTV & hypoglycemia -Nurses: dietary modifications, monitoring for complications, monitoring stools bowel patterns
A client comes to the emergency department reporting rapid onset of epigastric pain with nausea and vomiting. The clients says the pain is worse than any heartburn he has had, and that he has not had an appetite for the past day. What does the nurse suspect this client has? A. Peritonitis B. H. pylori infection C. Duodenal ulcer D. Acute gastritis
D. Acute gastritis
Which laboratory finding does the nurse expect in the client with a diagnosis of appendicitis? A. Decreased hematocrit and hemoglobin B. Increased coagulation time C. Decreased potassium D. Increased white blood cell count
D. Increased white blood cell count
The nurse is assessing an older adult client with abdominal pain. Assessment findings include generalized abdominal pain with rigidity, nausea and vomiting, temperature 101.2o F, heart rate 122/minute, and chills. The client is also somewhat confused and does not know where he is. What does the nurse suspect with this client? A. Crohn's disease B. Ulcerative colitis C. Diverticulitis D. Peritonitis
D. Peritonitis
Clients with cirrhosis are susceptible to bleeding and easy bruising because there is a decrease in the production of bile in the liver, preventing the absorption of which vitamin? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K
D. Vitamin K
Post Icteric phase of hepatitis:
Enlarged liver, malaise, fatigue; liver test begin toreturn tonormal -Diagnostics: Serology analysis, liver biopsy--> watch for hemorrhage -Med/ surg: treat symptoms; provide bed rest, IV fluid, balanced diet, vitamins antiometics, and drug therapy may require liver transplants is immunosuppressives -Nurses: Teach transmission prevention; complication prevention; avoid/minimize alcohol, and liver toxic meds -Hep B vaccine: Non-infectious viral vaccine that contain hep b surface antigen
Icteric phase of hepatitis
Experience jaundice from obstruction, darker urine, light feces, liver tenderness, pruritus, & fatigue
A nurse is assisting with the plan of care for a client who had an upper endoscopy 1 hr ago. The nurse should place the priority on minoring which of the following?
Gag Reflex
A nurse is collecting data on a client who has acute pancreatitis. Which of the following factors should the nurser anticipate in the clients history?
Gallstones
Jaundice
Greenish, yellow discoloration of the tissue symptom of dx., often of liver *Results from abnormally high concentration of the pigment bilirubin in the blood *Visibly notable on the skin, oral mucosa, sclera Blanching is yellow, not white Three forms: 1.) Hemolytic jaundice: which is caused by excessive destruction of RBCs 2.) Hepatocellular Jaundice: caused by liver dx. 3.) Obstructive Jaundice: blockage of bile between liver intestinal tract
Nursing Assessment:
History ·objective - identify client's specific problems & its possible cause ·include the chief complaint ·focused assessmentof currentnutritional, metabolic, elimination patterns, a past hx. ·focus on and pain, issues w/ digestion, N/V, constipation diarrhea, incontinence, or other complaints ·determine use of tobacco or alcohol, any adverse reactions to food ----------------------- Physical Exam ·look generalappearance, client's skin-including abnormal colors, scars, a mucous membranes ·look @ mouth for sores, lesions, tooth condition, missing teeth, dentures or how dentures fit ·look @ abdomen;assessed in supine positionsknees slightly bent(helps relaxabd. muscles); observe shape, auscultate, palpate, a percuss ·measurements when distension is present;make place of measurement w/perm marker ·Anus; Inspected for hemorrhoids, skin tags, fissures, skin integrity, & stool characteristics
Radiographic studies
Identify location, structural appearance of organs in abd, chest, or GI system Radio-opaque contrastmedia or fluroscopy Barium Swallow or - Upper GI Series
Hepatitis
Liver inflammation after exposure to drugs or chemicals, alcohol abuse, or infection; acute or chronic; viral infection (A, B, C, D, E,G) -Hep B, C & D: are usually chronic & persistant -Type B & C: See hepatocellular carcinoma Other types of hepatitis can include autoimmune, toxic, & drug induced
ileostomy post op care
May require some rectal packing to absorb drainage and help promote healing; usually will be done for about 5-7 days Irrigations to promote healing; Nasogastric to be for GI decompression IV fluids to maintain fluid electrolyte & nutritional balance Antibiotic therapy along w/ analgesics Nurses monitor wound healing, & manage complications making sure there is no intestinal obstructions monitor stoma for bleeding or impaired blood supply, stenosis, prolapse, or excessive protrusion Monitor for prolapse or protrusion of the ileostomy Monitoring for edema, because this can cause obstruction or restrict stoma blood supply Monitoring for stomal necrosis; can prolapse if not managed promptly & skillfully
fluoroscopic fluoroscopically
Observe rectum sigmoid colon & descending colon
Gastritis
Patho & Etiology: inflammation of stomach lining caused from foods, meds, infections, or stress responses Helicobacter pylori can contribute to chronic gastritis;may see increased acid production -S/S: fullness, pressure, pain, N/V sympts. same whether bacterial or viral infection may have bleeding from meds or poisonings Diagnostics:CBC, gastroscopy, tests on feces -Med/surg: dependent on cause; diet restriction, IV fluids, meds, anti-emetics, antibiotics Nursing: Note color characteristics of vomit or stools; pills in vomit? Client education on diet & therapy
Chyme
Partially digested, semi liquid food mixed with digestive enzymes and acids in the stomach.
irritable bowel syndrome (IBS)
Patho & Etiology: "a-spastic" bowel; functional motility disorder; cluster of symptoms w/no known dx. process has fluctuating intestinal motility that intensifies w/ stress; occur more women's younger adults -S/S: chronic constipation, diarrhea, no blood, stable weight, andpain, bloating, flatus -Diagnostics:X-rays, endoscopic tests -Med/Surg: high fiber diet, meds, anticholinergics, antidiarrheals -Nurses: Encourage elimination of alcohol a smoking; stress management
radiography (x-ray)
Should be performed before other GI exams with dye tablets , should be no eating or drinking; may do a fatty test meal
ulcerative colitis (UC)
Patho etiology: chronic inflammation of colon, rectum see immune related disorders; genetic predisposition, infection, & allergies Common in young tomiddle age adult may see a toxic megacolon that can develop where the colon dilates becomes atonic (loses tone) can lead to emergent problems -S/S: abrupt onset, diarrhea, blood, pain, pus; mucus, dehydration, anorexia, sudden bowel urge (10-20 stools/day) Go through exacerbations is remissions -Diagnostics:barium enema, endoscopic exams, proctosigmoidoscopy, biopsies -Med/surg: goal: is to achieve remission; alter diet, TPN W/ lipids, surgical procedures, blood transfusions, drugs & fluid therapy -Nurses: monitor for stools; complications; teaching for meds; increase calories nutritional content
Radionuclide imaging
Radionuclides are injected into the blood stream and then monitored as they pass through the heart. This can be used to show heart function and blood supply.; : detectlesions of the liver or pancreas;assist in evaluating gastric emptying; to do procedure, injectN or orally ingested radionuclides
A nurse is collecting data from a client who has manifestations of appendicitis. Where should the nurse palpate to monitor for pain at McBurneys point?
Right Lower Quadrant ; McBurney's point is found between the navel and the anterior iliac crest.
Ileostomy Pre-Op:
Surgical management, interventions by physician, discuss appearance of stoma, it's function, & help mark site Interstomal therapists/ nurses may be consulted wound ostomy incontinences nurses may help collaborate with surgeon, & client's educational needs Identify risks from a total colectomy, such as bladder & sexual dysfunction w/ sexual dysfunctional, it may be necessary to collect & store sperm, and there might be a slightly diminished fertility in women cleansing of the bowel will be necessary along w/ dietary restrictions; may use laxatives or lavage agents, IV antibiotics, prophylaxis, or IV antibiotics Taper & discontinue any steriods to help avoid negative effects on tissue healing May do a preoperative stress dose of an IV steroid to help prevent adrenal crises Discontinue any immunosuppressant agents to prevent a negative effect on tissue healing Discontinue aspirin containing compounds to minimize risk of bleeding; in addition to obtaining any blood samples; type & cross match for the replacement of any potential blood loss
A nurse is reinforcing teaching with a client who is postoperative after having ileostomy established. Which of the following instructions should the nurse include in the teaching?
avoid meds In capsule or enteric form
Anorexia
loss of appetite; -Patho Etiology: Lack of appetite; prolonged can lead to malnutrition Appetite center is located in the hypothalamus & It stimulates or suppresses the appetite Glycogenolysis will convertglycogen to glucose during periods of reduced food intake Will get some nutrients but after stores depleted, then malnutrition can set in *In the older adult, anorexia can occur from ill-fitting dentures, fewer taste buds, a less active brds -S/S: absence of hunger, nausea, hyporitaminosis -Diagnostics: (BC, reduced hemoglobin, altered electrolytes protein levels -Med/Surg: treatment depends on cause; Short= term: no intervention; Persistent = high calorie diet supplements, enteral (through stomach) /parenteral feedings (through veins); psychological / psychiatric treatment; prokinetic agents to prevent N/V promote movement of substances through the GI or increase motility -Nurses: monitor consequences such as constipation or diarrhea; consult dietitian
Type C Hepatitis
mainly transmitted through the blood and often causes permanent liver damage; Transmitted by contact w/ contaminated bloods medical equipment or infected body fluid; some recover, some develop chronic infections, or liver cancer
Antacids Medications
o Indications: Peptic ulcer, gastritis, gastric hyperacidity, heartburn o Contraindications: Drug allergy, severe renal failure, electrolyte disturbance, GI obstruction o Adverse effects: Magnesium preparations - diarrhea; aluminum and calcium preparations - constipation; calcium preparations - kidney stones, rebound hyperacidity; overuse - alkalosis o Interactions: Numerous interactions - reduce ability of other drugs to be absorbed, inactivate other drugs, can increase absorption of base drugs