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68C/LPN
Test 6 Gastrointestinal System Nursing and Medications
| Question | Answer |
|---|---|
| What is the bilary system? | A system that consists of the organs and ducts (bile ducts, gallbladder, and associated structures) that are involved in the production and transportation of bile |
| Cholelithiasis | Formation of stones in the gallbladder (gallstones). |
| Cholecystitis | inflammation of the gallbladder; |
| Cholecystokinin | A hormone secreted by the small intestine each time the person eats fatty food. |
| If a gallstone blocks the common bile duct it is called..... | Choledocholithiasis |
| Endoscopic retrograde cholangiopancreatography (ERCP) | is an endoscopic procedure used to identify the presence of stones, tumors, or narrowing in the biliary and pancreatic ducts |
| What procedure is done 80 to 85% of the time to treat cholecystitis? | Laparoscopic cholecystectomy. |
| what is CIRRHOSIS? | Degenerative disorder of the liver from generalized cellular damage |
| CIRRHOSIS, in the years it takes to advance; NAME THE STAGES OF PROGRESSIONS. | 1)Destruction 2)Inflammation 3)Fibrotic regeneration 4)Hepatic insufficiency |
| Clay colored stools/Deep orange color urine jaundice Spider telangiectases are a few manifestations of | CIRRHOSIS |
| peritoneovenous shunt (also called LeVeen Shunt) | is a shunt which drains peritoneal fluid from the peritoneum into veins, |
| Hepatic Encephalopathy | CNS manifestation of liver failure often leads to coma or death; |
| what are Dental Caries? | Dental decay |
| describe Candidiasis | also referred to as thrush or moniliasis |
| what is GERD(Gastroesophageal reflux)? | Gastroesophageal reflux disease is backward flow of stomach content |
| what is Achalasia? | inability of a muscle to relax, particulary in cardiac sphincter of stomach. commonly known as CARDIOSPASM |
| what is Gastritis? | Inflammation of the lining of the stomach. |
| A patient presents with a Gastritis, what should the LPN be aware of? | described as HEART BURN: LPN should be aware of possible electrolyte imbalances. |
| Diagnostic Test Gastritis | A complete blood count may reveal anemia Stool testing for occult blood |
| while monitoring I&O's of a patient with Gastritis the LPN is aware that when________ is observed in the stool, the Doctor should be notifed. | Bright red blood or dark brown particles may indicate bleeding in the stomach Maroon or tarry black stools indicate bleeding from the stomach |
| Peptic Ulcer Disease(PUD)is? | an ulceration of the mucous membranes of deeper structures of the GI tract |
| Most Common sites for Peptic Ulcer Disease is where? | in the stomach (called gastric ulcers) in the duodenum (called duodenal ulcers) |
| Normal acid production -Pain closely associated with food intake -Hemorrhage more frequent -Hematemesis more common than melena | Gastric Ulcers |
| -May be caused by hypersecretion of acid -Not related to food intake -May awake patient at night with pain - Bleeding more apt to be chronic in nature -Melena more common than hematemesis | Duodenal Ulcers |
| Diagnostic tests for Gastric and Duodenal Ulcers include__________. | CBC lab Upper GI series using a barium contrast Esophagogastroduodenoscopy Gastric washing or biopsy to differentiate between benign and malignant ulcers Breath test to detect H. pylori bacteria |
| Current treatment for peptic ulcer disease focuses on eradicating: | H. pylori Various combinations of antibiotics (e.g., amoxicillin, tetracycline, metronidazole, clarithromycin), bismuth, and antisecretory agents (e.g., H2 antagonists, proton pump inhibitors) |
| Gastric medication: Antacides | Neutralizing gastic acides; Nursing interventions include monitoring serum electrolytes with long term use. (Medications include; Maalox,Gaviscon, Rolaides,Tums,Mylanta and Riopan) |
| Prostaglandin E Analogue | inhibits gastric acid secretion and protect gastric mucosa |
| Proton pump inhibitor drugs | inhibit the secretion of gastrin in the stomach (e.g. Prilosec or Prevacid) |
| Dumping Syndrome | is a rapid gastric emptying causing distension of the duodenum or jejunum produced by a bolus of hypertonic food. |
| Gastric medication: Histamine(H2)receptor blocker | Decrease acide secretions by blocking histamine(H2) receptors (Med: Cimetidine,ranitidine,famotidine and niztidine) Do not give within 2 hrs of antacides. |
| Gastric medications: Proton Pump Inhibitors | Antisecretory agents that inhibit secretion of gastrin by the parietal cells of the stomach. (Meds include:Omeprazole,Lansoprazole,Pantoprazole,Rabeprazole and Esomeprazole) |
| Gastric medications: Mucosal Healing Agents | Heals ulcers without antisecretory properties. Sucralfate(Carafate)is a cytoprotective drug;accelerates ulcer healing. |
| Sucralfate (Carafate)is what kind of gastric medication? | Antacide( Power Point) Mucosal healing agent(foundations in nursing Book) |
| Drug therapy aimed at reducing gastric acid secretions might include which of the following? | Antacids H2 antagonists |
| Cimetidine (Tagamet) is an example of: | histamine (H2)-receptor antagonist. |
| Decreased symptoms of GERD, usually occurs in 5-8 days.Therapy is continued for________ after first episode. | 4-8 weeks |
| Antisecretory and Cytoprotective agents_______ gastric acid secretions and ______ gastric mucosa. | Inhibits/protects |
| Tetracycline (doxycycline) patient teachings include: | avoid taking dairy products Female patients should use a nonhormonal method of contraceptive |
| Antrectomy | Removal of the entire antrum, the gastric-producing portion of the lower stomach, to eliminate the main stimuli to acid production. |
| Gastroduodenostomy | direct anastomosis of the fundus of the stomach and the duodenum,used to removal ulcers or cancer located in the antrum of the stomach. |
| Escherichia coli is ______ in the bowl. | indigenous(Native) |
| Ascites | Ascites is the build up of fluid in the space between the lining of the abdomen and abdominal organs (the peritoneal cavity |
| what is the function of the Liver? | *Metabolizes fats *Manages blood coagulation and produces most of the clotting factors (in the presence of Vitamin K) *Manufactures cholesterol *Manufactures albumin (maintains normal blood volume) |
| What two functions does the pancreas perform? | endocrine and exocrine |
| Serum Bilirubin Test Nursing Interventions include; | Keep patient NPO until blood specimen is drawn Monitor venipuncture site for bleeding |
| Oral Cholecystography | Provides visualization of the gallbladder after ingestion of radiopaque contrast |
| Intravenous Cholangiography (IVC) | Radiographic dye, injected intravenously, is concentrated by the liver and secreted into the bile duct. bile ducts and gallbladder, able to detect abnormalities. |
| T-tube Cholangiography (Post-operative cholangiography) | Performed to identify retained stones in the postoperative cholecystectomy patient |
| Achlorhydria | An abnormal condition characterized by absence of hydrochloric acid in the gastric juice. |
| True or False The pancreas, Liver and Gallbladder are accessory organs. | True |
| Where are papillae found? | In the mouth. Are elevations on the tongue that contain taste buds |
| There are three salivary glad that secrete saliva to assist with food breakdown. What are they? | Parotid, submandibular, and sublingual glands. |
| Where is the stomach located? | Led upper quadrant under the diaphragm. |
| What is the chief enzyme of gastric juices that converts proteins into proteoses and peptones? | Pepsin |
| What is released to protect the lining of the stomach? | Mucin |
| Once food is broken up in the stomach, what is it called? | Chyme |
| Name the order of the small intestine | Duodenum, jejunum, and ileum |
| Where is the Liver located? | Right upper quadrent, extending into the left and right epigastrium. |
| Tumors of the large intestine grow into the _______, and are suspected of trauma by the fecal stream. | Lumen |
| Eventually, tumors in the lumen of the large intestine ulcerate and bleed, what kind of diagnostic test can be done to confirm? | Occult blood test of stool. Also called Guaiac, Hemoccult and Hematest. |
| What is a sigmoidoscopy? | Endoscopy of the lower GI tract allows visualization. |
| Therapeuticically, Barium Study may be used to reduce intussusception. What does that mean? | Infolding of one segment of the intestine into the Lumen of another segment. |
| The ___ ____ is a group of radio graphic studies proformed on the abdomen of a patient who may have a suspected bowl obstruction. | Obstruction series (Flate plate of the abdomen) |
| Define Pathognomonic | Signs or symptoms specific to a disease process. |
| Define Leukoplakia | A white, firmly attached patch on the mouth or tongue mucosa. |
| What is GERD? | A backward flow if stomach acid up into the esophagus. |
| What is the medical term for heart burn? | Pyrosis |
| Your patient has been diagnosis with BARRETTs ESOPHAGUS, and have asked you to preform family teaching to their spouse. What do you say? | The process of this diagnosis is a serious pathological change in the esophageal lining that has a higher possibility of changing into "precancerous cells" B/c of the higher risk, they will need to be monitored regularly. Every 1-3 yrs. |
| Define Anastomosis | Surgical joining of two ducts, blood vessels, or bowl segments to allow flow from one to another. |
| Where do peptic ulcers most commonly occur? | Stomach (most distal) and duodenum |
| What diagnostic test is done to detect both gastric and duodenal ulcers? | Fiberoptic Endoscopy also called a esophag/o/gastro/duoden/o/scopy. |
| The exit from the stomach is called the: | pyloric sphincter |
| The intrinsic factor is a gastric secretion necessary for the intestinal absorption of vitamin: | B12 |
| which organ manufactures protease (trypsin), lipase (steapsin), and amylase (amylopsin)? | pancreas |
| paralytic(adynamic)ileus is a functional intestinal obstruction that may result from: | Electrolyte imbalance, post abdominal surgery, or acute inflammatory reactions |
| how long can C.Diff survive on an object? | 70 days |
| Sigmoidoscope or Colonoscope examination and stool specimens are used to diagnose a type of innflamation or colitis called: | antibiotic-associated pseudomembranous colitis(AAPMC) |
| define Tenesmus: | ineffective and painful straining with defecation |
| An anticholinergic agent effect the bowls in what way? | The nerve fibers of the parasympathetic system are responsible for the involuntary movement of smooth muscles present in the gastrointestinal tract, this Drug Agent Blocks this involuntary action. |
| Ulcertive colitis is confined to _____ and ______ of the colon. | Mucosa and submucosa |
| Ulcerative colitis vs Crohn's: I can occur anywhere along the gastroIntestinal tract, my most common site is terminal ileum. who am I? | Crohn's disease |
| Antidiarrheals: Mechanism of Action; Adsorbents do what to the bowls? | -acts by coating walls of GI tract |
| Antidiarrheals: Mechanism of Action; Antichollinergics do what to the bowls? | -slows peristalsis |
| Antidiarrheals: Mechanism of Action; Opiates do what to the bowls? | -reduce bowel motility |
| Antidiarrheals: Mechanism of Action; Intestinal flora modifiers do what to the bowls? | -suppress growth of diarrhea causing bacteria |
| A patient states, he will be going on a cruise and has concerns about motion sickness. Which of the following medications is most effective in preventing motion sickness? | Anti-cholinergics |
| what is the differnce between Crohns and Ulcertive colitis? | Ulcerative Colitis deals with the Mucosa and submucosa,has a patchy white appearence Crohns disease is transdermal, has a cobblestoning appearence, right upper quad pain. |
| _____ is an opening between colon and abdominal wall | Colostomy |
| _______is through abdominal wall | Ileostomy |
| with an Ileostomy, Entire____ and_____ are removed | Colon and rectum |
| I am a Stoma located in right lower quadrant Stool and gas are both constantly released what am I? | Ileostomy |
| Ileostomy has an internal reservoir created by suturing loops of adjacent ileum together to form a pouch-like structure call a ______ | Kock Pouch |
| QUESTION: What kind of colostomy is considered a permanent colostomy? | ANSWER: A single-barrel colostomy. |
| Ileostomy: | - discharge is liquid to semi liquid and contains digestive enzymes. There is no bowel regulation. |
| Ascending Colostomy: | - fecal material is liquid to semi liquid requiring frequent emptying to keep the patient dry and to control odor |
| Descending Colostomy: | semi-formed to formed |
| Sigmoid Colostomy: | fecal material is formed. Stool that is semi-solid is more manageable than a liquid stool. A scheduled daily irrigation can establish regularity and help the patient achieve control. |
| QUESTION: Why is it important to assess the skin over the abdomen prior to surgery in which the patient will be given an ostomy? | ANSWER: Location of the stoma is dependent on the area of the intestine affected and the condition of the skin where the stoma needs to be placed. |
| QUESTION: True or False. A patient with an ostomy looses control of the content of the feces. | ANSWER: Although the location of the stoma along the intestines will determine the content of the feces, the patient can control the odor and the form by what they eat and how well they are able to regulate the elimination process. |
| QUESTION: What does a stoma with a dusky appearance, indicate? | ANSWER: The stoma is ischemic. |
| Even when the ostomy pouch is ahearing well, it is best to change it at least every ______ or according to pouch recommendations to allow skin observation of the stoma and the peristomal skin. | 5-7 days |
| a patient has been admitted with a diagnosis of peptic ulcers; what drugs are most commonly used in these patients to decrease secretions? | Tagament and Zantac |
| Why should morphine be avoided in a patient with pancreatitis? | Answer: Morphine may cause spasms of the Sphincter of Oddi. |
| Fistula | an abnormal opening on the cutaneous surface near the anus |
| Anal fissure | a linear ulceration or laceration of the skin of the anus |
| Hemorrhoids | varicosities of the lower rectum or anus resulting in congestion of the anal and rectal veins varicosities of the lower rectum or anus resulting in congestion of the anal and rectal veins |
| Fistulotomy | : opening of the fistula tract, incising the fistula with a partial anus division |
| Fistulectomy | removal of the fistula tract |
| Fistulas can be caused by: | Can form a local crypt abscess and is common in Crohn’s Disease |
| Fissures | Usually occur as a result of trauma caused by hard stool that overstretches the anal lining that is aggravated by defecation |
| Question:Why is it important to check vital signs frequently in the first 24 hours? | Answer: A decreased blood pressure can be an indicator of internal bleeding or hemorrhage. An increased temperature can be an indicator of infection. |
| What are double sheets of peritoneal membrane that hold some of the visceral organs in the proper position. | Mesenteries |
| The inner lining of the digestive tract consisting of a layer of loose connective tissue covered by an epithelium moistened by glandular secretions is the: | Mucosa |
| A painful condition caused by the blockage of the cystic or common bile duct by gallstones is: | Cholecystitis |
| Appendicitis | Is the inflammation of the vermiform appendix lower right quadrent Hypoactive bowl sounds |
| McBurney's point | point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus |
| Diverticulosis | the presence of pouch-like herniations through the muscular layer of the colon, particularly the sigmoid colon/left lower quad |
| Diverticulitis | is the inflammation or infection of one or more diverticula/Left lower quad |
| Diet high in_____, mainly fresh fruits and veggies, and decreased intake and red meat are recommended for preventing Divertcular disease. | High fiber |
| Hartmanns procedure/pouch | is the surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy |
| double-barrel transverse colostomy | surgeon completely divides the bowel, leaving two stomas on the abdominal wall—a proximal stoma that expels stool and a distal stoma that passes mucus. |
| Peritonitis is inflammation of the abdominal peritoneum True or False? | True |
| This condition occurs after fecal matter seeps from the rupture site, causing bacterial contamination of the peritoneal cavity. | Peritonitis |
| Question: A 91-year-old patient has end-stage Alzheimer’s disease and requires a daily laxative. The laxative of choice is a(an): | Bulk-forming laxatives are considered the safest laxative for routine use. Bulk-forming laxatives cause water to be retained within the stool, which increases bulk, and stimulates peristalsis. |
| Bulk-Forming Osmotic Cathartics Saline Laxatives Stimulants Stool Softeners Are all examples of what? | Laxitives |
| These layers of smooth muscle play an essential role in the mechanical processing and in the propulsion of materials along the digestive tract. This is the: | Muscularis externa |
| Attachment and opening of the colon to the abdominal wall, bypassing the distal portion of the large intestine, is called: | colostomy |
| an important aspect of nursing interventions in patients with hepatitis and cirrhosis of the liver is the relief of _______. | pruritus (is the sensation of itch due to nearly any liver disease) |
| vaccines are available to prevent hepatitis ___ and hepatitis ____. | Hep A and Hep B |
| _______ is the most commonly performed surgical procedure. | Cholecystectomy |
| Clinical manifestations of ____ _____ include sever abdominal pain raidating to back,pain is relieved by leaning forward taking pressure off stomach. | acute pancreatitis |
| Antiemetics Drugs | relieve nausea and vomiting |
| Anticholinergics med examples | Drug ex: Scopolamine; used for motion sickness and can cause sleepiness |
| Antihistamines (H1 receptor blockers) drug examples | Drugs: Dimenhydrinate (Dramamine) Dyphenhydramine (Benadryl) Meclizine (Antivert); most commonly used to treat dizziness, vertigo, nausea and vomiting associated with motion sickness |
| Antidopiminergics drug examples | Drugs: Prochlorperizine (Compazine) Promethazine (Phenergan) Droperidol (Inapsine) |
| Most commonly used tummor marker | CA 19-9 is elevated (in pancreatic cancer) |
| Prophylaxis for HEP B must in instituted_____ exposure. | before |
| Nursing diagnosis related to Liver Biopsy puncture. | pain, related to leakage of blood and bile into the peritoneal cavity |
| which clinical manifestations would the nurse expect to find with a common bile duct obstruction related to pancreas cancer? | Scleral icterus dark, tea colored urine jaundice |
| related to Hepatic encephalopathy, a nurse see the patient extended their arms and notes irregular flexion,extension and (flapping)of the wrist occures. what is the patient experiencing? | Asterixis(also called the flapping tremor, or liver flap) is a tremor of the hand when the wrist is extended. |
| Your patient has advanced cirrhosis of the liver with exacerbation of hepatic encephalopathy, what type of foods should you educated your patient on avoiding? | Meats |
| liver abscess are seen with vague s/s of: | fever accompanied by chills, abdominal pain/tenderness in RT UPPER QUAD. |
| Meclizine (Antivert); | most commonly used to treat dizziness, vertigo, nausea and vomiting associated with motion sickness |
| Prokinetics (prevents Increased movment of the intestine) | Metoclopromide (Reglan) |
| Anticholinergics uses: | Uses: motion sickness, secretion reduction before surgery, nausea and vomiting |
| Antihistamines uses: | Uses: motion sickness, nonproductive cough, sedation, rhinitis, allergy symptoms, nausea and vomiting |
| Antidopiminergics uses: | Uses: Psychotic disorders, (mania, schizophrenia, anxiety) intractable hiccups, nausea, and vomiting |
| Prokinetics uses: | Uses: Delayed gastric emptying, gastroesophageal reflux, nausea and vomiting |
| Tetrahydrocannabinoids (THC) uses: | Uses: Nausea and vomiting associated with cancer, chemotherapy, anorexia associated with weight loss in patients with AIDS and cancer |
| Question: A middle aged-woman is experiencing severe vertigo due to Meniere’s disease. The nurse expects this patient to receive which drug, which is considered the most appropriate drug treatment for vertigo? | Meclizine (Antivert) |
| Hep B,C,D, and G are spread mainly through the following: | blood transfusions, contaminated needles or instruments, direct contact with body fluid. |
| why is Meperidine no longer the opid drug of choice for acute pancreatitis? | its toxic metabolite, normeperidine, which can cause seizures. |
| normal PH in stomach | 0-4 |
| what drugs alter PH in stomach? | H2 antagonist such as Pepcid and Zantac(up to PH of 5) |
| most common type of Ulcers? | Duodenal ulcers |
| New type of diagnostic exam includes a patient swallowing a pill with a camera to visualize intestine. True or False? | True! |
| how can you find a GI bleed? | can be determined by characteristic of the emesis or stool material. |
| what bacteria has been found in 70% of all gastric ulcers and 95% of all duodenal ulcers? | H.pylori |
| true or false patients with IBS(irritable bowl syndrome)have a grater risk to developing cancer of the bowl. | True |
| Nursing diagnosis used when patient doesn't fast before a gastroscopy; | deficient knowledge of diagnostic exam and condition; inform patient of 6-8 hour fastening before test. |
| pulmonary complication related to abdominal incision include; | shallow respirations to reduce pain |
| which tests can distinguish between peptic ulcers and gastric malignancy? | endoscopy with biopsy |
| recently approved drug to treat Crohn's disease, infliximab(Remicade) is classified as which type of drug? | Monoclonal antibody |
| a patient with esophageal achalasia will complain of and is at risk for what? | Dysphagia, especially liquids; at risk for aspiration. |
| a males , post operative patient from a inguinal hernia is presenting with edema. what is the most important nursing intervention for this patient? | elevating the scrotum with a support or small pillow |
| the nurse know that the difference between Ulcerative Colitis and Crohn's disease is; | that Ulcerative colitis is curable with a colostomy, whereas Corhn's disease often recurs after surgery. |
| what drugs should be avoided with patients with E.Coli O157:H7 | Antimotility drugs |
| what should a patient be taught after a hemorrhiodectomy? | use of a prescribed analgesic after before a bowl movement. |
| a medication used to treat Helicobacter pylori (H.Pylori) infection is ________. | Metronidazole |
| Gastric Ulcers are believed to undergo a transient ischemia in association with hypotension, injury, burns or surgical complications. this results in the disorder of what? | stress ulcers |
| In Crohn's disease major complications thy develop due to granulomatous cobblestone lesions of the small intestine Include_______ ___ ________. | Malabsorption of nutrients |
| Sever infection related to undercooked beef from a specific pathogenic bacteria present in the same cattle is called: | E. Coli intestinal infection |
| The LPN in instructing the patient about postgastrectomy dumping syndrome. The nurse would know her needs further instruction when the patient state; | I will avoid fats and increase carbohydrates. |
| The primary medical management for a patient with duodenal ulcers is; | Antacids, Histamines (H2) receptor blockers, proton pump inhibitors, mucosal healing agents, antibiotic therapy. |
| Peptic ulcers result from; | Excess of gastric acid or decrease in natural ability of the GI mucosa to protect itself from acid and pepsin; invasion of H. Pylori in stomach or intestine; taking certain drugs ie; corticosteroids, anti inflammatory meds. |
| A patient returns returns from a common bile duct exploration, the nurse would expect the patient to return from surgery with: | A T-tube connected to a gravity drainage. |
| a patient diagnosed with cholecystitis associate with cholelithiasis are based on the knowledge that: |
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