-
what substance is formed when milk is digested?
small intesting produces maltase, sucrase, & [milk enzyme] lactase (milk sugar).
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what portion of the GI tract absorbs food substances [nutrients]?
small intestine--most digestion of food, water, vitamins, & minerals.
-
what organs are found in the RUQ of the abd?
- liver.
- gallbladder (can't palpate it).
- tip of pancreas.
- part of small intestine.
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what organs are found in the LUQ of the abd?
- stomach.
- pancreas.
- small bowel?
-
what organs are found in the RLQ of the abd?
- appendix.
- large intestine.
- ascending colon.
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what organ is found in the LLQ of the abd?
descending colon.
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what is an EGD?
esophagogastroduodenoscopy--fiberoptic flexible scope that examines the lower esophagus, stomach & duodenum (pt. is under anesthesia).
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the EGD is used to look for what?
- infections.
- irritations.
- lesions.
- tumors.
- [peptic/duodenal] ulcers.
-
before any kind of GI series, the pt. should?
- be NPO after midnight.
- drink large amt. of barium to fill cavities (for contrast).
-
when doing a head-to-toe assessment, what do you do first?
- sequence of physical exam:
- 1. inspect (look)
- 2. auscultate (listen)
- 3. palpate (feel)
- 4. percuss.
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after an EGD, what should you be concerned about for pt.?
- ABCs.
- RR.
- return of gag reflex (2-4 hrs).
- pt. should remain NPO
-
what should you monitor after an EGD?
- pain/bleeding (due to perforation)
- monitor expulsion of barium post-procedure.
-
how do you prep the bowel [for a sigmoidoscopy--lower GI endscopy]?
enemas till clear--evening before &/ morning of procedure.
-
SITUATION: pt. comes in ER c/o having diarrhea for 2 days, has rebound tenderness in RLQ [Chron's disease/appendicitis] & blood was drawn. what would be elevated?
- WBC (8-10 is normal).
- altered electrolytes.
- low K (3.5-5 is normal).
- Na (135-145 is normal).
- Hct (30-45 is normal--usually 3x > Hgb).
-
when is the best time to collect stool specimen from pt. & how do you store it?
- morning.
- room temp. (not in fridge)
- if possible, take to lab ASAP
-
PRIORITY SETTING: who do you see 1st?
pt. recieving tube feeding (residual check needed)
pt. who had surgery 2 days ago (needs dressing changes)
pt. c/o pain given meds 2 hrs ago
new pt. c/o abd pain
- 1. new pt. c/o abd pain
- 2. pt. c/o pain given meds 2 hrs ago
- [depends] pt. recieving tube feeding
- [depends] pt. who had surgery 2 days ago
-
what tasks would you delegate to RN/LVN/CNA on med-surge floor?
giving meds
irrigation of NG tube
putting in foley
assisting pt. down hall/restroom
- [RN/LVN] giving meds
- [RN/LVN] irrigation of NG tube
- [RN/LVN] putting in foley
- [CNA] assisting pt. down hall/restroom
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SETTING: pt. had pneumonia, has been on antibiotics for past wk & is now c/o mouth pain w/ white fussy patches. what is the Dx?
candidiasis/thrush.
-
what is the Tx for candidiasis?
nyastatin--swish & swallow.
-
what is leukoplakia?
white plaque/patches in mouth.
-
if leukoplakia is seen on/under tongue & gums, what is it a sign of?
oral cancer.
-
what are risk factors for oral cancer?
- tobacco/alcohol use.
- chronic irritation from rough teeth.
- filings/dentures.
- infection w/ HPV.
-
what are common s/s of esophageal cancer?
- anorexia.
- vomiting.
- dehydration.
- regurgitation.
- dysphagia w/ weight loss.
- obstruction (feels like something is stuck).
- pain.
- hoarseness.
- cachexia.
-
what are s/s of GERD?
- burning & pressure behind sternum (substernal/retrosternal).
- pyrosis (heartburn).
-
what are some nursing considerations for GERD?
- provide frequent, small low-fat meals (no spicy foods), increase fluid intake.
- have pt. sit up during & after meals (HOB elevated).
- advise pt. to avoid alcohol, tobacco, caffiene, & tight clothing.
- provide meds as ordered.
-
what meds are given for GERD?
- antacids (ex: mylanta, maalox).
- h2 receptor blockers (ex: cimetidine [Tagamet], famotidine [Pepcid], rantidine [Zantac]).
- proton pump inhibitors (ex: omeprazole [Prilosec], lansoprazole [Prevacid], esomeprazole [Nexium]).
- motility agents (ex: metoclopramide [Reglan]).
-
all GI disorders have a prob. w/ what vitamin deficiency & why?
- b12.
- b/c its not being absorbed--hydrochloric acid produces intrinsic factors to produce vitamin b12.
-
how many steps does it take to produce b12?
3 steps.
-
w/o b12, what does it result to?
pernicious anemia.
-
what is the Tx for pernicious anemia?
- requires (monthly) b12 [cyanocobalamin] injections for life.
- can't be taken orally b/c it destroys.
-
what part of the GI system is considered antreium [produces hydrochloric acid--site for gastric/peptic ulcers]?
the stomach--lower part of stomach just before pyloric sphincter (going into ileum).
-
SITUATION: pt. has peptic ulcer & tried meds, but didn't work. what's the next step?
antrectomy procedure--removal of the antrium (gastric producing portion of lower stomach).
-
if an antrectomy procedure doesn't work, what else can be done?
vagotomy--removal of vagal innervation to the fundus (to decrease HCl acid).
-
if vagotomy procedure doesn't work, what else can be done?
[total] gastrectomy--removal of part/all of stomach.
-
SITUATION: pt. had partial gastrectomy, ate 1 hr after surgery, & is now cold, clammy, pale w/ low BP. what does pt. have?
dumping syndrome.
-
what are nursing considerations for dumping syndrome?
- provide 6 sm. meals (high-fat & protein, low-moderate carbs takes longer to produce chyme & less dumping) = less bulk & weight in stomach = less dumping.
- instruct pt. to eat slow in reclined position (& to lie down after meal).
- advise to avoid fluids [milk]/sweets/sugars during meals.
-
what can cause dumping syndrome?
any kind of surgery [bipass] on stomach.
-
UPPER GI BLEEDING: what is hematemesis?
vomiting of fresh/bright red blood.
-
UPPER GI BLEEDING: what color would vomit be if blood has stayed in stomach for a while?
black-coffee ground color.
-
UPPER GI BLEEDING: what happens if bleeding moved into intestine?
[melena] black/tarry stool.
-
what drugs are used for mild pain?
NSAIDS (notorious for [painless] GI bleeding & black tarry stools).
-
what are some nursing considerations for GI bleeding?
- provide meds [cox-2 inhibitor to protect mucous lining].
- assess/monitor bleeding.
- lab work [H&H--13-16 is normal, <7 = transfusion]
-
for what reasons would an NG tube be used?
- decompression--removes secretions for distention (before/after surgery).
- [gavage] feeding--liquid nutrition.
- compression--balloon inflated to prevent hemorrhage.
- [lavage] low-intermitten suction--irrigation for bleeding, poisoning/gastric dilation.
-
SITUATION: pt. had subtotal gastrectomy for stomach cancer & now has a prob. w/ dumping syndrome. what foods from the following are allowed?
peanut butter & bread.
coffee.
waffles & syrup.
cold cereal.
soup.
- peanut butter but w/ no bread.
- no coffee.
- no waffles & syrup.
- no cold cereal.
- no soup (liquid).
-
SITUATION: pt. has peptic [duodenal] ulcer. what kind of pain does pt. have & when does it occur?
- gnawing, sharp & burning epigastric pain (similar to hunger).
- increased pain when stomach is empty.
-
SITUATION: pt. has gastroenteritis [inflammation of intestines in stomach] & now has diarrhea. after prolonged vomiting & diarrhea [causes metabolic acidosis], what should you be concerned about & what should you assess?
- dehydration.
- postural VS (lying, sitting, & standing).
- elevated pulse, BUN level.
- pt. may have fever.
-
what kind of isolation would pt. be put in for vomiting/diarrhea?
contact isolation.
-
if pt. is on contact isolation, what precautions are needed?
PPE--gowns, gloves, masks, shoe covers.
-
SITUATION: pt. comes in w/ ulcerative colitis, anticipate pt. c/o what?
- weight loss (from diarrhea).
- foul smelling stools.
- recurrent bloody stools containing pus & mucus (15-20 per day).
- abd cramping.
- fecal urgency.
- abd distention.
- weakness.
-
w/ ulcerative colitis & Chron's disease, what should you pay close attention to?
electrolytes.
-
what kind of diet would pt. w/ Chron's disease have?
- high-calorie/protein.
- low-fat/fiber (low residue)--creamed potatoes, PB & crackers.
- no carbonated/caffeine drinks.
-
when assessing pt. w/ diarrhea, what do you chart?
- stool characteristics:
- amt.
- cosistency.
- quantity & how long they've had it.
- color.
- odor.
-
SITUATION: pt. comes in w/ appendicitis & is c/o RLQ pain. what is the name of point where pain occurs?
McBurny's point (tenderness).
-
what kind of diet would a pt. w/ diverticulosis/diverticulitis have?
- no little seeds--nuts, popcorn, rye/sesame seeds.
- clear liquid diet (until inflammation subsides).
- then high-fiber.
- low-fat.
-
what is the diff. between diverticulosis & diverticulitis?
- diverticulosis--exists when multiple diverticula are present w/o inflammation/symptoms (condition of having diverticuli--painless).
- diverticulitis--pain.
-
what is the rationale for giving neomycin & enemas?
to decrease bacterial count.
-
SITUATION: after surgery, pt.'s pulse went up from 80 to 90 15 min. later. what should you be concerned about?
- bleeding.
- hypovolemia.
- increased respiration.
- BP will eventually drop dramatically.
-
what assessments are found w/ abd bleeding?
- hard, distention.
- rebound tenderness.
-
what kind of BS is heard w/ abd bleeding?
paralytic ileus--hypoactive, diminished to none.
-
what are psychosocial factors for pt. who had a colostomy?
altered body image--assist to accept changes.
-
colostomy care:
- wash hands, apply gloves & arrange all needed equipment.
- empty pouch into toilet/bedpan & flush.
- locate stoma size pattern, trace hole on paper backing & cut out opening.
- remove paper backing from adhesive wafer & apply thin strip of stomadhesive past edge of cut adhesive wafer.
- remove old appliance & wipe stoma w/ tissue.
- dispose old appliance in plastic bag (save closure clip).
- inspect skin, cleanse area w/ warm water (don't use soap).
- dry skin carefully (apply new appliance holding it in place for 2 min).
- add few drops of deodorant to pouch & clamp closed.
- dispose of waste material & gloves (wash hands & document procedure).
-
what color should a new stoma be?
bright red (turns pink overtime).
-
what does a cyanotic stoma indicate?
constriction.
-
what does a black-colored stoma indicate?
disruption in blood supply.
-
how much fluid is used to irrigate stoma?
500 mL of fluid.
-
colostomy irrigation: instillation of fluid into lower colon via stoma to stimulate peristalsis & facilitate expulsion of feces.
- irrigate stoma @ same time ea. day to approx. usual bowel habits (provide uninterrupted care).
- insert well-lubricated cone into stoma approx. 7-8 cm (2 1/2-3 in.) in direction of remaining bowel.
- hold irrigating container 12-18 in. above colostomy (solution should be 105 deg. F).
- provide privacy while waiting for fecal return/permit pt. ambulation to stimulate peristalsis.
- cleanse peristomal area w/ water, apply barrier (apply appliance w/ opening 1/8 in. away from stoma).
-
what are common s/s of hiatal hernia?
- heartburn 1-4 hrs after eating (aggravated by reclining).
- regurgitation/vomiting.
- retrosternal/substernal chest pain [resembling angina] typically after meals/@ bedtime.
- feeling of postprandial fullness, breathlessness/suffocation.
- dysphagia.
-
what are risk factors for hiatal hernia?
- increasing age.
- obesity.
- pregnancy (occurs more often in women than men).
- congenital diaphragm.
- kyphoscoliosis.
- trauma.
- smoking.
-
inguinal hernias often occur where?
groin area--causing palpable bulge in inguinal area due to movement of intestine down inguinal ring (occurs more often in men due to lifting weights).
-
femoral hernia is more common in?
women.
-
where does [ventral]/incisional hernia occur?
occurs where old surgical scar was.
-
what is a ventral hernia?
condition where part of bowel/intestines portrude through weakened part of abd wall.
-
who gets umbilical hernias?
babies--often noted @ birth as portrusion @ umbilicus.
-
SITUATION: pt. who had abd surgery would have what [complaints] s/s?
paralytic ileus--burping, feeling of fullness/bloating, vomiting.
-
MATH: pt. had abd surgery & has an IV running for 150 mL per hr for 12 hrs & 2 IV piggyback (50 ea.). how many mL should you document in I&O chart?
1,900 mL.
-
what is an intussusception?
telescoping of 1 part of bowel into another (proximal to distal end).
-
what happens w/ a sm. bowel obstruction?
alkolosis.
-
what happens w/ a large bowel obstruction?
acidosis.
-
what are the Tx for intestinal obstruction?
- IV fluids & electrolytes (ultimate goal).
- NGT decompression.
- Tx of shock & peritonitis.
- surgical resection (if mechanical).
- nonopioid analgesics.
- TPN.
-
SITUATION: after surgery, pt. has an NG tube that needs suctioning. what will happen to pt.'s fluids?
decreases (metabolic alkolosis).
-
what are the early s/s of colorectal cancer?
- changes in bowel habits (bleeding).
- pain.
- anemia.
- anorexia.
- symptoms of local obstruction.
- symptoms of direct extension to adjacent organs (bladder, prostate, ureters, vagina, sacrum).
- fatigue.
-
SITUATION: pt. had a hemorroidectomy [injection sclerotherapy, rubber band ligation]. what are the common side effect post-surgically?
urinary retention.
-
what are some interventions that can be done to avoid/relieve constipation?
- excercise.
- increase fluid intake.
- administer stool softeners/enemas.
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