health and illness exam 3

Irritable Bowel Disease

(usually auto-immune related, usually familial) ulcerative colitis crohns

complications of cirrhosis

-esophageal varices: enlarged veins, ruptures are an emergency, can lead shock and hypovolemia -ascites: accumulation of serous fluid in peritoneal or abdominal cavity -hepatic encephalopathy: increase ammonia, causes confusion, lethargic, decrease Loc

nursing diagnosis colorectal cancer

. Diarrhea or constipation Anxiety Difficult coping

endoscopic therapy upper gi bleed

1st line management within 24 hr coagulate/thrombose bleeding, clips/bands compress vessel thermal ablation cauterize inject epinephrine

duodenal ulcers incidence

35-45yr old, H pylori, increase HCL secretion

mechanical intestinal obstruction

A physical obstruction Usually in the small bowel, such as surgical adhesions days or years following surgery

diagnostic studies acute pancreatitis

Abd ultrasound, x ray, ct, endoscopic, angiography, chest x ray

nursing diagnosis for peritonitis

Acute pain Fluid imbalance Impaired gas exchange Risk for Infection

ulcerative colitis

Always within the colon Usually starts in the rectum and works upward Fistulas and perforations are rare Can form pseudopolyps

Suggested food choices for a patient who has peptic ulcer disease includes:

Applesauce, cream of wheat, and apple juice

How should the nurse assess for asterixis in a patient with hepatic encephalopathy?

Ask the patient to extend their arms

Esophageal cancer risk factors

BE, smoking, alcohol, obesity, injury to esophageal mucosa, achalasia

abdominal trauma

Blunt (closed), compression or shear injuries Penetrating (open) Abdominal compartment syndrome

double barrel stoma

Bowel divided; two stomas created; both proximal and distal ends though abdominal wall

duodenal ulcers risk factors

COPD cirrhosis pancreatitis hyperparathyroidism zollinger ellison syndrome CRF

diverticula diagnosis

CT with oral contrast

acute pancreatitis patho

Caused by auto digestion of pancreas inflammation, injury to pancreatic cells, activation of pancreatic enzymes, inflammation delays release of pancreatic enzymes gives them time to attack pancreatic cells, activation of trypsinogen to trypsin within pancreas leads to bleeding

example disease of malabsorption

Celiac disease

What assessment is performed to assess for hypocalcemia?

Chvostek's sign

screenign for colorectal cancer

Colonoscopy (every 10 years) Flexible sigmoidoscopy (every 5 years) Double-contrast barium enema (every 5 years) CT (virtual colonoscopy) (every 5 years) Occult blood test (FIT test) (every year) Stool DNA test (every 3 years)

malabsorption syndrome causes

Decreased enzymes or surface area for absorption Effect of medications Fever

diagnostics of acute abdominal pain

Descriptors of pain Sequence of symptoms Positioning: Fetal (position of comfort) - likely peritoneal Supine (position of comfort) - likely visceral Restless when seated - likely an obstruction(1) Kidney stone(2) Bowel (large of small)(3) Gall stones

nursing diagnosis Diarrhea

Diarrhea f/e imbalance skin breakdown

nursing diagnosis ibd

Diarrhea Impaired nutrition Difficulty coping Chronic pain

hemorrhoids

Dilated veins, internal or external or both Treatment includes OTC creams, Sitz baths, stool softeners, surgical option`

end stoma

Distal bowel removed—permanent stoma Distal bowel oversewn—possible reanastomosis and stoma closed; Hartmann's pouch

post op complications gastric surgery

Dumping syndrome Postprandial hypoglycemia Bile reflux gastritis

Which instruction would the nurse provide when teaching the patient about how to avoid dumping syndrome?

Eat small meals with low carbohydrate and moderate fat content.

Which of the following is the appropriate diet for Crohn's disease?

Eat small, frequent meals; increase fiber

When caring for a client who is receiving enteral feedings, the nurse would take which measure to prevent aspiration?

Elevate the head of the bed between 30 and 45 degrees.

Why is it important for the nurse to monitor a patient with GERD for clinical manifestifestations of heart disease?

Esophageal pain may imitate the symptoms of a heart attack.

GERD complications

Esophagitis, Barrett's esophagitis, cough, bronchospasm, asthma, bronchitis, pneumonia, dental erosion

risk factors gallstones

Fair - more prevalent in Caucasians Fat - BMI >30 kg/m2 and hyperlipidemia Female Forty - age ≥40 years Fertile - one or more children

incontinence

Females will be affected by number and size of vaginal births Monitor for changes from previous bowel pattern

stomach cancer gastric surgery partial gastrectomy

Gastroduodenostomy (Billroth I) Gastrojejunostomy (Billroth II)

risk factors for PUD

H pylori, nsaids, alcohol, smoking, caffeine, stress

tube feeding administration aspiration risk prevention

HOB elevated, enteral tube in right position, check gastric residual volume

signs and symptoms of abdominal trauma

Hard, distended abdomen Decreased bowel sounds Abrasions/bruising Pain Evidence of bleeding (hematemesis, hematuria, hematochezia) signs/symptoms of shock Ecchymosis Umbilicus (Cullen's Sign) One or both flanks (Grey Turner's Sign Abdominal bruits (aorta damage) Bowel sounds in chest (ruptured aorta)

A common complication of peptic ulcer disease is:

Hemorrhage

lynch syndrome colorectal cancer

Hereditary nonpolyposis colorectal cancer DNA testing available Starts as a polyp

Hypertonic tube feedings may cause diarrhea. The nurse suspects that the diarrhea is related to which causative factor?

High osmolarity of the feedings

post op

ICU 1-2 days, dysrhythmias, monitor leaks fistula formation, pulmonary edema, respiratory distress, NG 5-7 days, bloody green yellow drainage, chest tube report more than 4-600 ml/8h, turn/repo, cough, deep breath, incentive spirometry, aspiration precautions, VTE or prophylaxis

parenteral nutrition

IV nutrition, administration of nutrients into bloodstream

malabsorption syndrome

Impaired absorption of nutrients from the GI tract

Hernias: incarcerated/ strangulated

Incarcerated - have contents within bowel segment and cannot be moved Strangulated - loss of blood supply to segment of bowel

Which assessment must be reported to the physician immediately for a patient with bowel obstruction?

Increased pain and rigid, board-like abdomen

gastroenteritis

Inflammation within the GI tract Usually self-limiting PO fluids with glucose and electrolytes (treatment similar to acute diarrhea)

short bowel syndrome

Intake of nutrition is not adequate to meet the body's needs Often post-surgical or other trauma related Treatment includes medications, dietitian, and possible transplant

Which is more likely to be identified in the client with ulcerative colitis than in the client with Crohn disease?

Involvement starting distally and spreads continuously up the colon

Lactase deficiency

Lack of enzyme Avoid lactose intake Lactase supplements

non mechanical intestinal obstruction

Lack of peristalsis, no bowel sounds Paralytic ileus or inflammatory response caused by peritonitis, pancreatitis, appendicitis, electrolyte imbalances, or thoracic or lumbar injuries Location determines imbalances (fluid, electrolytes, acid-base)

constipation causes

Low fiber Low activity Retaining stool Disease related (Parkinson's, multiple sclerosis) Medication related (anticholinergic burden such as opiates) Chronic laxative use

treat hepatic encephalopathy

Medications: lactulose trap ammonia in gut, rifaximin antibiotic, prevent constipation Dietary: lower protein intake

Starvation Pathophysiology 2nd phase

Mobilization of fat to supply energy

After a total gastrectomy, which treatment does the nurse include in the discharge teaching to prevent anemia?

Monthly injections of cobalamin

pud acute care

NG care and assessment oral care vs i+o monitor labs IV fluids rest assess for complications

post operative care stomach cancer, gastric surgery

NG tube care and assessment Assess for anastomotic leak Respiratory assessment and interventions to prevent respiratory complications Pain control Fluid and electrolyte balance Prevent infection Nutritional therapy

nutritional therapy acute pancreatitis

NPO initially, enteral vs parenteral nutrition, monitor triglycerides, small frequent feedings when able, high carb, no alcohol, supplemental fat soluble vitamins

types of access for enteral nutrition

Nasogastric, nasoduodenal, nasojejunal tubes Gastrostomy and jejunostomy tubes

goals of care colorectal cancer

Normal or new normal bowel pattern Appropriate quality of life Pain control Comfort, both physical and emotional (for cancer diagnosis and body changes) Ostomy Temporary or permanent Ileostomy (off small bowel) Ascending (right side) Ascending (left side) Sigmoid (left lower) Double barrel (transverse - two openings) Issues with sexual disfunction

fistulas

Open through from bowel to any other organ (including the skin

drug therapy upper gi bleed

PPI iv bolus antacids after acute phase

causes of upper gi bleed gastric and duodenal

PUD stress related mucosal disease stress ulcer

treatment goals acute pancreatitis

Prevent or treat shock: plasma or plasma volume expanders (dextran or albumin) Reduce pancreatic secretions Correct fluid and electrolyte imbalances (lactated ringer's solution, aggressive hydration, monitor electrolytes) Prevent or treat infections Remove the precipitating cause

Starvation Pathophysiology 3rd phase

Protein from internal organs and blood used- Protein synthesis decreases- Blood volume decreases- Sodium and potassium imbalance: sodium stays in cell-swelling, potassium out of cell

Pt. NG has a moderate amount of bloody drainage 2 hrs after a subtotal gastrectomy. Which action would the nurse take?

Record the observation and continue to monitor drainage from the tube.

goals of care of intestinal obstruction

Relieve obstruction and return to (new) normal bowel pattern Minimize discomfort Normal fluid, electrolyte, and acid-base balances

What is paracentesis?

Removal of fluid in the abdominal cavity

abdominal trauma affects

Respiratory function Cardiac output Venous return Arterial perfusion of organs

goals of treatment for ibd

Rest the bowel Control inflammation Control infection Correct malnutrition Symptom management Improve quality of life

polyps

Sessile - broad based Pedunculated - on a thin stalk Hyperplastic - noncancerous. Adenomatous - pre-cancerous, has a genetic link Diagnostics - colonoscopy, sigmoidoscopy, virtual colonoscopy (CT/MRI)

intestinal obstruction

Small or large bowel Partial or complete obstruction Simple or strangulated

risk factors for malnutrition

Socioeconomic factors- Food insecurity, Ethnicity/Race Age - older adults Underlying medical conditions/physical illnesses Hospitalization; prolonged illness GI disease

treat esophageal varices

Stabilize patient : prevent bleeding hemorrhage, manage airway start IV therapy and blood Endoscopic therapy: endoscopic variceal ligation sclerotherapy Medications: avoid aspirin, NSAIDS , nonselective B blocker decrease portal pressure - cause vasoconstriction, reduce portal blood flow, portal hypertension-octreotide, vasopressin Shunting procedure: TIPS trans jugular intrahepatic portosystemic Shunt

nursing interventions constipation

Stool softener vs. laxative (mush vs. push) Stool softener - emollient action on feces (adds water) Laxative - increases peristalsis

Which statement explains why total parenteral nutrition (TPN) is infused through a central line rather than peripheral?

The amount of blood in a major vein helps dilute the solution.

colorectal cancer

There is no single risk factor Usually no signs or symptoms until well advanced (iron deficient anemia from GI bleed)

locations of hernias

Umbilical Femoral Inguinal Ventral/incisional - in area weakened by previous injury or surgery

appendicitis

Usually 10 - 30 y/o Dull pain at McBurney's Point, nausea/vomiting CBC with differential UA - to rule out other causes CT is preferred over MRI or US If ruptured, surgical case with risk of peritonitis and/or abscess

VOMIT acute abdominal pain

Vestibular - anticholinergics (atropine, promethazine, scopolamine) Obstruction - stimulants/laxatives (senna) Motility - (metoclopramide) Infection/Inflammation - (prochlorperazine) Toxins - natural or chemotherapy agents (ondansetron, haloperidol)

assessment of acute abdominal pain

Vital signs (increased temp indicates inflammation with or without infection) Bowel soundsc. OPQRST pain assessment CBC UA (Culture and sensitivity if indicated Abdominal X-ray (KUB - kidneys, ureters, bladder) ECG Pregnancy test Ultrasound/CT

clinical manifestations of acute pancreatitis

abd pain LUQ or mid epigastric radiates to back, sudden onset, deep piercing continuous steady, eating worsens, n/v, dyspnea, fever diaphoresis, flushing, leukocytosis, hypotension, tachycardia, jaundice, crackles in lungs, decreased or absent bowel sounds, abdominal skin discoloration grey tuners spots-flank bruising , cullens sign-periumbilical bruising, shock

What is the most common presenting symptom of acute pancreatitis?

abdominal pain

diagnostics of intestinal obstruction

abdominal x-ray, CT, contrast enema, CBC and blood chemistry

which of the following is not a function of the liver

absorption of water

GERD pathophysiology

acid gastric contents cause irritation and inflammation

nursing diagnosis acute abdominal pain

acute pain fluid imbalance risk for infection

nursing diagnosis pud

acute pain, lack of knowledge, nausea

stomach cancer

adenocarcinoma of the stomach wall more men than women

interprofessional management pud

adequate rest, no smoking/alcohol, stress management, diet modifications, no nsaid/aspirin 4-6 weeks, endoscopic evaluation 3-6 months

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to...

administer iv fluids

Bile reflux gastritis

after reconstruction/removal/pylorus bile reflux causes damage to gastric mucosa, chronic gastritis, and PUD

catheter related complications parenteral nutrition

air embolus, sepsis, dislodgment, thrombosis of vein, phlebitis, hemorrhage, occlusion, pneumothorax, hemothorax

Which of the following is the major cause of acute pancreatitis?

alcoholism

acute pancreatitis etiology

alcoholism, biliary tract disease, trauma, infection, drugs, postop GI surgery, pancreatic cancer, gallbladder disease

risk factors for cirrhosis

alcoholism, exposure to toxins, hepatitis

metabolic complications parenteral nutrition

altered renal function, fatty acid deficiency, hyper/hypoglycemia, hyperlipidemia, liver dysfunction

pt teaching cirrhosis

ambulatory care, proper diet, rest, abstinence from alcohol, community support programs, when to seek medical attention

indications of enteral nutrition

anorexia, facial fractures, head/neck cancer, extensive burns, critical illness, chemo, radiation

Medications for GERD include:

antacids, H2 recptor blockers, and Proton pump inhibitors

drug therapy pud

antibiotics for H pylori, PPI: decrease gastric secretion eliminate H pylori H2 receptor blocker: cytoprotective drug therapy- sucralfate: protect esophagus stomach duodenum work best in low pH, 1-2h before or after antacid, bind with cimetidine, digoxin, warfarin, phenytoin, tetracycline antacids misoprostol

surgical therapy GERD

antireflux surgery nissen fundoplication

gastric ulcers location

antrum

A patient with gastroesophageal reflux(GERD) drinks juice with breakfast everyday. Which juice will the nurse recommend?

apple

Complications of portal hypertension include

ascites, esophageal varices, splenomegaly

general considerations enteral feeding

aseptic technique, label equipment, elevate HOB, trace all lines and tubes back to pt, right pt tube formula ALERT

Which action would the nurse take to evaluate whether the tube feeding is being absorbed?

aspirate for residual volume

PEG tube skin care

assess site around tube daily, monitor bumper tension, dressing until site healed after wash with soap and water, protective ointment skin barrier

side effects of hepatic encephalopathy

asterixis: flapping tremors most common in arms and hands apraxia: impairment in writing difficulty moving pen left to right fetor hepaticus: musty sweet odor of pt breath

With pancreatitis, the enzymes in the pancreas attack the pancreas itself. This process is known as...

autodigestion

celiac disease

autoimmune disease triggered by gluten associated with RA type 1 diabetes and thyroid disease

pt teaching GERD

avoid alcohol, caffeine, smoking, sit upright after meals, avoid tight clothing/bending at waist after eating, avoid eating 3-4h before bed, lose weight

nutritional therapy pud

avoid food that cause distress/irritation, caffeine alcohol

nutritional therapy GERD

avoid foods, decrease LES pressure and irritating foods-milk and eating before bed, small meals and fluid between meals

Which finding is an indication of ulcer perforation in a client with peptic ulcer disease (PUD)?

back and shoulder pain, hypotension, tachycardia, rigid abdomen

Ostomy care

balance diet with adequate fluids, avoid odor, gas, diarrhea producing foods resume ADLs 4-6 weeks

esophageal cancer chemo radiation

before surgery, as palliation

upper gi bleed melena

black tarry stool from upper gi source

When teaching a patient with peptic ulcer (PUD) during the acute phase, the nurse would stress which type of diet?

bland

upper gi bleed hematemesis

bloody vomitus- bright red, coffee ground contact with Hcl acid, digested blood

Starvation Pathophysiology 1st phase

body uses carbs (glycogen) for energy (glycolysis) gluconeogenesis: protein from skeletal muscle converted to glucose for energy

diverticula treatment

bowel rest, antibiotics (combination therapy of aerobic and anaerobic)

duodenal ulcers manifestations

burning cramplike pain in midepigastric or back 2-5 hr post meal bloating n/v

stomach cancer spread

by direct extension- liver and adjacent tissue

malnutrition

can be an excess or deficit of essential nutrients- imbalance under or overnutrition

Macronutrients

carbohydrates, proteins, and fats

Cholelithiasis etiology

cause of gallstones unknown, precipitation of cholesterol, bile salts and calcium, bile secreted by liver supersaturated with cholesterol, immobility, pregnancy, inflammatory or obstructive lesions in biliary system decreased bile flow, stones may stay in gallbladder or migrate to cystic or common bile duct, cause pain as pass

diagnostics peritonitis

cbc abdominal x ray us or ct for ascites/abscess

indications parenteral nutrition

chronic diarrhea/vomiting, GI obstruct, complicated surgery/trauma, GI abnormalities, anorexia, malabsorption, short bowel syndrome

causes of upper gi bleed esophageal

chronic esophagitis, mallory weiss tear, esophageal varices

Cirrhosis etiology

chronic hep C, alcohol use-excessive and prolonged, Nonalcoholic fatty liver disease, extreme dieting, Malabsorption, obesity, genetic predisposition

GERD

chronic syndrome of mucosal damage due to reflux of stomach acid into lower esophagus

stomach cancer chemo radiation

combination, may be given intraperitoneal for metastasis, radiation may be done with chemo or as palliative for obstruct or reduction of tumor mass

stomach and duodenum bleed risk

critically ill, coagulopathy, liver disease, organ failure, renal replacement therapy

May affect any part of the GI tract from mouth to anus

crohns disease

The nurse notes ecchymosis around the umbilicus when assessing a patient with abd. pain. This will be documented as:

cullens sign

interventions starvation

daily calorie count, increased protein, multiple small feedings, supplement, appetite stimulants, diet diary, dietitian consult

enteral feedings assessment

daily weight, bowel sounds pre feeding, I+O, glucose checks, label time and date, pump tubing change q24h

when total obstruction by gallstones

dark amber urine, clay color stools, pruritis, intolerance to fatty foods, bleeding tendencies, steatorrhea

drug therapy GERD

decreased volume and acidity of reflux, increase motility protect esophageal mucosa PPI and histamine receptor blockers

complications enteral feeding

diarrhea, vomiting, dehydration, constipation, skin irritation, pulling out tube

treatment cirrhosis

drug therapy: minimize or avoid aspirin, acetaminophen, NSAIDS, admin vit b avoid alcohol, sodium restriction 2g/day medications: diuretics, albumin, vasopressin receptor agonist

gastric outlet obstruction symptoms

edema, inflammation, pylorospasm, scar tissue cause obstruction in distal stomach and duodenum may be visible dilation, belching and projectile vomiting may relief

manifestations of starvation

edema, skin dry/wrinkled, muscle wasting, CNS, dry mouth, fatigue, increased infection risk, anemia

lab values parenteral nutrition

electrolytes, bun, creatinine, liver enzymes

health promotion acute pancreatitis

encourage early treatment, elimination of alcohol intake

A patient with GERD needs to make dietary and lifestyle changes. Which instructions would the nurse include?

encourage quit smoking, do not lay down for 2-3 hours post meal

The preferred diagnostic test for acute upper GI bleed is:

endoscopy

diagnostic studies for upper gi bleed

endoscopy, angiography, lab: cbc, hmg/hct, bun, gi tract bacteria/protein, serum electrolytes, PT, PTT, liver enzymes, abgs, vomitus and stool blood

diagnostic tests of PUD

endoscopy: include biopsy for H pylori Non-invasive test for H.pylori - urea breath test Laboratory tests- cbc, liver enzymes, serum amylase, stool examination

manifestations of gastric ulcers

epigastric discomfort 1-2h after meal, burning/gaseous pain, food may worsen, perforation is 1st symptom in some

peptic ulcer disease

erosion of GI mucosa from Hcl acid and pepsin

esophageal cancer surgery

esophagectomy, esophagogastrostomy, esophageneterostomy

Acute disease-related or injury-related malnutrition

ex major infections, burns, trauma, surgery

contributing factor of malnutrition-incomplete diet

ex: alcohol and drug use, chronic illness, poor dietary practices

indications for Gastrostomy and jejunostomy tubes

extended time, must have intact unobstructed GI tract

ng tube care and assessment

for decompression, reduce pressure to suture lines and decreases edema/inflammation, observe gastric aspirate: color, amount, odor bloody drainage expected 2-3 hr, report more than 75mL/h, monitor for clots/obstruction should change to yellow/green in 36-48hr

celiac disease Manifestations

foul smelling diarrhea, abdominal pain, flatulence, abdominal distention, malnutrition, weight decrease, muscle wasting, fatigue

surgical therapy acute pancreatitis

gallstones, not responding to conservative therapy, drainage of necrotic fluid collections

dumping syndrome

gastric chyme enters small intestine as large hypertonic bolus pulls fluid into bowel lumen causing decreased plasma volume, distention of bowel lumen and rapid transit within 15-30 min of eating

The patient reports N & V, bloating, and burning epigastric pain 1-2 hours after eating. This is likely related to:

gastric ulcer

pt education upper gi bleed

gi toxic drugs (nsaid, corticosteroid), avoid gastric irritants-smoking, alcohol, otc med, test for occult blood, varices

celiac disease treatment

gluten free diet

colon polyps

growths in the colon that may progress to colon cancer

upper gi bleed occult bleeding

guaiac test detect blood in gastric secretions, vomitus or stool

The most common cause of peptic ulcer is:

h pylori

risk for gastric ulcers

h pylori nsaid bile reflux

stomach cancer etiology

h pylori, autoimmune related inflammation, repeat exposure to irritants

nutrition

he science of optimal cellular metabolism and its impact on health and disease. the sum of processes by which one takes in and uses nutrients.

stomach cancer assessment

health hx, surgeries, GI, diagnostic find

nursing assessment starvation

health status, hx, change in wt, ADLs, lab results, physical

GERD manifestations

heartburn, dyspepsia, regurgitation, respiratory wheezing, cough, dyspnea, nighttime disturbances, hoarseness, sore throat, lump in throat, choking, increased salivation

complications of pud

hemorrhage, perforation, gastric outlet obstruction

complications of ibd

hemorrhage, strictures, C-diff, abscesses, colon dilation

Which lab abnormality is indicative of recent hepatocellular injury

high ALT

esophageal cancer nursing assessment

hx gerd, hiatal hernia, achalasia, BT, tobacco alcohol

Complications of total parenteral nutrition (TPN) via a central venous access device include:

hyperglycemia, infection

Which physical change would the nurse observe in a patient with malnutrition?

hypotension, dry dull hair, abdominal edema, delayed wound healing

Which med would the nurse question when reviewing the home medication list for a patient with peptic ulcer disease?

ibuprofen

nursing diagnosis upper gi bleed

impaired cardiac output, fluid imbalance, ineffective tissue perfusion, anxiety

nursing diagnosis starvation

impaired nutrition status, fluid imbalance, risk for impaired skin integrity

Which of the following is a primary etiology for Gastroesophageal Reflux Disease (GERD)?

incompetent LES

GERD etiology

incompetent LES, factors: food, drugs, obesity, smoking, hiatal hernia

lab values of starvation

increase potassium, decreased serum albumin, increased C reactive protein, decreased RBC, decreased hemoglobin, decreased lymphocyte count, increased liver enzymes

Labs in acute pancreatitis

increase serum amylase, serum lipase, liver enzymes, triglycerides, glucose level, bilirubin level, decreased serum calcium

Diverticulitis

infection of one of those pockets

diarrhea primary cause

infections Most are viral, symptom resolve within 24 hours Bacterial, (e. coli), usually has evidence of blood Giardia (parasitic)

acute abdominal pain organ damage related to

inflammation obstruction infection bleeding perforation

peritonitis

inflammation of abdominal wall usually secondary to appendicitis, perforation, gall bladder, or trauma Pain, tenderness, shallow breathing

cholecystitis

inflammation of gallbladder, usually associated with gallstones

Cholecystitis etiology

inflammation, gallbladder is edematous and hyperemic, may be distended with bile or pus, cystic duct may become occluded, scarring and fibrosis after attack

A patient takes Famitodine, a H2 receptor blocker, for peptic ulcer. What is the mechanism of action for this drug?

inhibit gastric acid secretion

nursing care notes ng

intermittent suction, first 12 hours darker blood

drug therapy acute pancreatitis

iv morphine, antispasmodics, carbonic anhydrase inhibitors, antacids, PPI, insulin, pancreatic enzyme products

High bilirubin levels lead to

jaundice

clinical manifestations of cirrhosis

jaundice, liver failure, ascites, peripheral edema, skin lesions, palmar erythema, spider angiomas, anemia, leukopenia, thrombocytopenia, coagulation disorders, decreased metabolism of hormones, peripheral neuropathy

surgical treatment gallstones

laparoscopic cholecystectomy treatment of choice, removal of gallbladder through 1-4 puncture holes, minimal post op pain, resume normal act within week

upper gi secretory diarrhea

large-volume, watery stools; low-grade or no fever

stomach cancer surgery

lesions in antrum or pylorus billroth I or II lesions in fundus total gastrectomy with esophagojejunostomy

assessment upper gi bleed

level of conciousness, vs, skin color, cap refill, abd distention, hx previous bleeds, blood transfusion reactions

gold standard for diagnosing cirrhosis?

liver biopsy

cirrhosis lab values and diagnostic studies

liver enzyme tests (alk phos, ast, alt, ggt), total protein and albumin levels, serum bilirubin, cholesterol levels, prothrombin time, platelets, liver biopsy

method of admin parenteral nutrition

long term support-central short term-peripheral

nutrition for gastric surgery

loss of intrinsic factor leads to pernicious anemia replace with cobalamin, multivitamin with folate, calcium, vitamin D and iron

pt teaching gallstones

low fat diet, wt reduction, fat soluble vitamin supplement, small frequent meals

What lifestyle change will decrease the severity of ascites?

low sodium diet

What is the goal of the medication lactulose, when given for hepatic encephalopathy?

lower ammonia levels

goals of fistula

maintain f/e balance, protect skin Control infection Manage output Nutritional support

nursing management pud assess

med/health/surgical hx, anxiety, epigastric tender, anemia, blood in stool, H pylori

A patient is admitted for gastric bleeding. Which area would the nurse assess most closely during the history?

medications taken routine or recent

Barrett's esophagus

metaplasia of esophageal cells; increase risk of cancer

acute care gi bleed

monitor airway circulation, iv access, ecg, vs, lab: cbc, clotting study, blood type NG, cath, i+o, abd sounds, npo

The rationale for daily weights for the patient with cirrhosis is...

monitor ascites

acute care acute pancreatitis

monitor vitals, hypotension, fever, tachypenia, monitor response to IV, resp status, f/e balance- chloride, sodium, potassium, hypocalcemia, hypomagnesemia. Pain assess, frequent position changes, oral/nasal care, admin of antacids, signs of infection, turn cough deep breath, serum glucose

incidence of gastric ulcers

more in females older than 50, high recurrence

emergency assessment and management of upper gi bleed

more than 1500mL blood loss, assess for shock: tachycardia, decreased pulse, hypotension, cool extremities, prolonged capillary refill, apprehension monitor hourly urine output, oxygen administration, iv fluids, blood transfusion

esophageal cancer

most are adenocarcinoma, incidence increases with age

cholelithiasis

most common disorder of biliary system, stones in gallbladder

cholecystectomy

most common surgical procedure in US removal of gallbladder

crohns disease

mouth to anus Affects all layers of intestinal wall and may lead to perforations and fistulas Can skip around and show up in different places cobblestone appearance deep ulcerations

celiac disease monitor

nutrition, anemia, bone density, dietary consult

A patient has severe pain and rigid abdomen 3 days after subtotal gastrectomy. Which action should the nurse take first?

obtain vitals

diverticulosis

out pockets from within the colon, usually descending and sigmoid

clinical manifestations of cholecystitis

pain more severe when stones moving or obstructing, steady excruciating, tachycardia diaphoresis prostration, residual tenderness in RUQ, 3-6 hr after high fat meal or when lie down

signs and symptoms of intestinal obstruction

pain, nausea/vomiting, distention, constipation, distention, change in bowel pattern/function, lack of flatus, tenderness, rigidity

secretory diarrhea

pathogens survive and enter cells of lining of canal

A patient with peptic ulcer has severe pain, rigid abdomen, and shallow respirations. These symptoms are indicative of:

perforation

esophageal cancer endoscopic therapy

photodynamic endoscopic mucosal resection, radio frequency ablation

esophageal varices are predominately casued by:

portal hypertension

Which assessment finding indicates that a patient is ready for postoperative oral feedings after a partial gastrectomy?

presence of flatulence

Starvation-related malnutrition

primary protein-calorie malnutrition (primary PCM) ex anorexia

esophageal cancer signs

progressive dysphagia, odynophagia, pain, choking, heart burn, hoarseness, cough, anorexia, weight loss, regurgitation

esophageal cancer manifestations

progressive dysphagia, pain with swallowing, weight decrease, regurgitation, hemorrhage, perforation, obstruction

Symptoms of malnutrition (muscle wasting, negative nitrogen balance, low serum albumin) are related to a deficiency of:

protein

What are two local complications of acute pancreatitis?

pseudocyst and abscess

complications of acute pancreatitis

pseudocyst-fluid pancreatic enzymes, debris and exudates surrounded by wall, pancreatic abscess- infected pseudocyst, results from extensive necrosis, hypovolemia, hemorrhage, hypovolemic or septic shock, pleural effusion, atelectasis, pneumonia, thrombi, pe, Diabetes, hypocalcemia

post op care cholecystectomy

pt comfort, referred pain to should from CO2, sim position, deep breath ambulation, clear liquids, d/c same day

pt teaching acute pancreatitis

pt, counseling, low fat high carb, signs of infection

which clinical manifestation indicates that a patient's right lower quadrant pain is likely due to appendicitis?

rebound tenderness

infection parenteral nutrition

red, tender, exudate, fever/chills, n/v, malaise get blood/catheter cultures, xray pulmonary status, daily dressing change

nursing management of cirrhosis health promotion

reduce or eliminate risk factors, treat alcoholism, maintain adequate nutrition, identify and treat acute hepatitis

goals of care for acute abdominal pain

relief of pain resolution of inflammation freedom from complications normal nutritional status

Interventions for a patient recovering from surgery for esophageal cancer include:

relieve pain and dysphagia, promote optimal nutrition, provide oral care

stomach cancer gastric surgery Total gastrectomy

remove stomach- anastomosis of esophagus to jejunum

esophageal cancer diagnosis

response to drugs, comfort, change in breathing/swallowing, digestion

acute care cirrhosis

rest, oral hygiene, between meal snacks, offer preferred foods, explain dietary restriction, assess for Jaundice, relieve pruritus-baking soda bath, lotion, soft linen, antihistamines, temp control, short nails, monitor color of urine and stool, I+O, daily wt, extremities measurement, abd girth measurement, relief of dyspnea, skin care, rom exercises, elevate lower extremities, monitor for hypokalemia, hypoatremia, observe for bleeding, prevent falls,

Chronic disease-related malnutrition

secondary protein-calorie malnutrition (secondary PCM) ex: organ failure, cancer, RA, obesity

nutritional therapy gallstones

small frequent meals with some fat, diet low in saturated fat, high in fiber and calcium, reduce calorie, avoid rapid wt loss

lower gi secretory diarrhea

small-volume, bloody diarrhea, fever

stomach cancer predisposing

smoked foods, salted fish and meat, pickled vegetables, H pylori, atopic gastritis, pernicious anemia, polyps, smoking, obesity

composition parenteral nutrition

solutions contain dextrose and protein in form of amino acids, prescribed electrolytes, vitamins, trace elements, iv fat emulsion

prevention of respiratory complications post surgery

splint incision with cough and deep breathing, analgesia, early ambulation, frequent repo, maintain comfort

perforation PUD symptoms

sudden severe abdominal pain, radiate to back/shoulders, no relief with food/antacids, abdominal rigidity, absent bowel sounds, n/v, shallow breath, pulse increased and weak

esophageal cancer pre op

support, care, teach, increase cal/protein, liquids, parenteral nutrition/fluids, record I + O, f/e balance, oral care, manage pain

Treatment of colorectal cancer

surgery, radiation, chemotherapy

treatments peritonitis

surgical antibiotics, NG suction, analgesics, IV fluids

ostomy

surgically create an opening

postprandial hypoglycemia signs

sweating, weakness, confusion, palpitations, tachycardia, anxiety

Anastamosis leak symptoms

tachycardia dyspnea fever abdominal pain anxiety restlessness

bile reflux gastritis relief

temp with vomiting, admin cholestyramine to bind bile salts

colostomy

the surgical creation of an artificial excretory opening between the colon and the body surface

stomach cancer gastric surgery vagotomy

total or selective, sever vagus nerve, decrease gastric secretion

cirrhosis patho

triggering event (Hep B or C virus, alcoholic liver disease, nonalcoholic steatohepatitis) -> inflammatory response -> formation of new blood vessels, new hepatocytes migrate to area- abnormal angiogenesis-> fibrosis develops-nodules replace normal liver tissue. Progression is slow 2-3 decades

enteral nutrition

tube feeding, administration of nutritionally balanced liquified food or formula through tube inserted into stomach, duodenum, jejunum

Inflammation is continuous; there are no patches of normal bowel

ulcerative colitis

The most common and often only symptom is blood in the stool

ulcerative colitis

stomach cancer clinical manifestations

unexplained weight loss, indigestion, abdominal pain, pale, weak, fatigue, dizzy, SOB, blood in stool, clavicular lymph node enlargement, ascites

Diagnostic Tests GERD

upper gi endoscopy, esophagram, motility studies, pH monitoring

loop stoma

usually temporary Loop of bowel to abdominal surface; anterior wall opened for fecal diversion; distal opening to drain mucus; plastic rod in place 7 to 10 days

postprandial hypoglycemia

variant of dumping syndrome, uncontrolled high carb bolus enters small intestine causing excess insulin leads to hyperglycemia 2h after eating

assessments parenteral nutrition

vitals q4-8h, daily wt, bg 4-6h, check volume on infusion pump periodically, dressing changes: site observation, re-feeding syndrome

Micronutrients

vitamins and minerals

dumping syndrome signs

weakness, palpitations, sweating, cramping, defacation urge lasts one hour reduced with rest after eating

IBS

with constipation or diarrhea rome iv criteria FODMAP diet

complications of gallstones

wt loss due to pain nausea inflammation , acute pain due to cholecystitis

Which method is best to use when confirming placement of a nasogastric feeding tube?

x ray