what substance is formed when milk is digested?
small intesting produces maltase, sucrase, & [milk enzyme] lactase (milk sugar).
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?
- gallbladder (can't palpate it).
- tip of pancreas.
- part of small intestine.
what organs are found in the LUQ of the abd?
- small bowel?
what organs are found in the RLQ of the abd?
- large intestine.
- ascending colon.
what organ is found in the LLQ of the abd?
what is an EGD?
esophagogastroduodenoscopy--fiberoptic flexible scope that examines the lower esophagus, stomach & duodenum (pt. is under anesthesia).
the EGD is used to look for what?
- [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.
after an EGD, what should you be concerned about for pt.?
- 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?
- 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?
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
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?
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?
what are risk factors for oral cancer?
- tobacco/alcohol use.
- chronic irritation from rough teeth.
- infection w/ HPV.
what are common s/s of esophageal cancer?
- dysphagia w/ weight loss.
- obstruction (feels like something is stuck).
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?
- b/c its not being absorbed--hydrochloric acid produces intrinsic factors to produce vitamin b12.
how many steps does it take to produce b12?
w/o b12, what does it result to?
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?
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.
waffles & syrup.
- 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?
- 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?
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.
w/ ulcerative colitis & Chron's disease, what should you pay close attention to?
what kind of diet would pt. w/ Chron's disease have?
- low-fat/fiber (low residue)--creamed potatoes, PB & crackers.
- no carbonated/caffeine drinks.
when assessing pt. w/ diarrhea, what do you chart?
- stool characteristics:
- quantity & how long they've had it.
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.
what is the diff. between diverticulosis & diverticulitis?
- diverticulosis--exists when multiple diverticula are present w/o inflammation/symptoms (condition of having diverticuli--painless).
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?
- 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.
- 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?
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).
- retrosternal/substernal chest pain [resembling angina] typically after meals/@ bedtime.
- feeling of postprandial fullness, breathlessness/suffocation.
what are risk factors for hiatal hernia?
- increasing age.
- pregnancy (occurs more often in women than men).
- congenital diaphragm.
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?
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?
what is an intussusception?
telescoping of 1 part of bowel into another (proximal to distal end).
what happens w/ a sm. bowel obstruction?
what happens w/ a large bowel obstruction?
what are the Tx for intestinal obstruction?
- IV fluids & electrolytes (ultimate goal).
- NGT decompression.
- Tx of shock & peritonitis.
- surgical resection (if mechanical).
- nonopioid analgesics.
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).
- symptoms of local obstruction.
- symptoms of direct extension to adjacent organs (bladder, prostate, ureters, vagina, sacrum).
SITUATION: pt. had a hemorroidectomy [injection sclerotherapy, rubber band ligation]. what are the common side effect post-surgically?
what are some interventions that can be done to avoid/relieve constipation?
- increase fluid intake.
- administer stool softeners/enemas.