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