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GI System
GI
| Question | Answer |
|---|---|
| Function of the GI system | responsible for the digestion and absorption of nutrients, which are essential for energy and growth. It plays a crucial role in the elimination of waste products from the body, ensuring homeostasis and preventing toxicity. |
| What is the GI system role in immune function | it contains a large number of immune cells that protect against pathogens. |
| The GI tract synthesis which vitamins | vitamin K and some B vitamins, through gut microbiota. |
| The gastroesophageal sphincter (cardiac sphincter) | controls the opening from the esophagus into the stomach; it prevents reflux from the stomach into the esophagus |
| The pyloric sphincter | release of food substances into the small intestine |
| The ileocecal valve | controls the progress of substances into the large intestine. |
| What function does the appendix have in the digestive process | no known function |
| Which systems control the GI system | nervous and endocrine systems These mechanisms help control the release of digestive hormones and enzymes as well as initiating peristalsis |
| what are some meds that can disrupt normal GI function. | NSAID, antibiotics |
| With aging, which sphincter becomes less efficient at opening and closing, and risk for aspiration increases. | esophageal |
| where is the liver located | in the upper right quadrant of the abdominal cavity under the diaphragm; it is protected by the rib cage. |
| This vein transports all venous blood and nutrients absorbed from the small intestine to the liver. | portal vein |
| where is the pancreas located | behind the stomach and consists of a “head” and a “tail” |
| The organs of the gastrointestinal (GI) system are | mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, and anus |
| The accessory organs of the GI tract | liver, gallbladder, and pancreas |
| The 4 layers of the digestive tract | mucosa, submucosa, muscular layer, and serosa |
| encloses the intestines, stomach, liver, and spleen, and partially encloses the uterus and uterine tubes. | The peritoneum |
| Helps the stomach break down food and particles for absorption | Mucus, hydrochloric acid (HCl), intrinsic factor, pepsinogen, and gastrin |
| reflex that initiates elimination | gastrocolic |
| Why are gallstones seen more in older adults | increase in biliary cholesterol related to diet and a tendency toward dehydration |
| contributes to blockages in the intestines | blockage of food, adhesions (scar tissue that bind together) tumor |
| Continued irritation and inflammation of the GI mucosa can lead to intestinal bleeding and to increased peristalsis, causing | inadequate absorption of nutrients. |
| Think Critically Why do you think health care providers frequently place hospitalized patients on GI prophylaxis medication? | to prevent stress-related mucosal damage that can lead to ulcers and bleeding, ppl under physiological stress, are at a higher risk for developing ulcers due to factors like immobility, serious illness, and the body’s stress response. |
| Foods That May Contribute to Colon Cancer | •Hot dogs • Bologna and other luncheon meats • Bacon • Ham • Smoked fish • Some imported cheeses |
| A diet lacking in fiber is one factor in the development | of diverticulosis |
| What contributes to hemorrhoid formation | Straining at stool increases intra-abdominal pressure, which causes the hemorrhoidal vessels to engorge |
| True or False Defecating at around the same time each day aids the defecation process and helps promote the continued ability to control defecation. | True |
| Developing healthy coping mechanisms and keeping stress within acceptable limits may prevent | ulcers and chronic irritability of the bowel. |
| Causes of gallbladder disorders | rapid weight loss, gastric bypass surgery, women, age. obesity, several children, diabetes, Crohn disorder |
| filters out many toxic substances and is constantly exposed to any infectious organisms circulating in the bloodstream | the liver |
| Hepatotoxic Drugs | • Acetaminophen (Tylenol) • Amiodarone • Atorvastatin • Carbamazepine • Erythromycin • Ibuprofen • Methyldopa • Phenytoin • Sulfonamides |
| Most parasites that damage the liver enter the body how | swimming in contaminated water, contaminated food |
| Pancreatitis is associated with | with alcoholism, obstructive cholelithiasis, peptic ulcer, hyperlipidemia, and trauma. |
| how would you access for the presence of edema and ascites (fluid in the abdominal cavity) | by observing for marked abdominal distention and taut, glistening skin. if presence of ascites measure abdominal girth. |
| The normal frequency for bowel sounds are | about 5 to 30 in 1 minute |
| If hyperactive, high-pitched sounds are heard in one quadrant and decreased sounds are heard in another quadrant, assess for nausea and vomiting because the patient may have an | intestinal obstruction |
| true or false Percussion detects excessive air in the intestinal tract, which occurs with irritation and inflammation. | true |
| Physical causes for a diminished interest in eating include | poorly fitting dentures, stomatitis, decaying teeth, halitosis, |
| If weight loss and loss of appetite occur in an older adult without evidence of any specific cause, what should we consider | possibility of depression |
| Ginger for Nausea has antiplatelet properties an should be used with caution in patients | taking anticoagulant or antiplatelet medications |
| formed by the action of digestive juices and bacteria on the ingested material, resulting in bloating | flatus |
| in addition to not passing stool regularly, s/s of constipation include | hypoactive bowel sounds, abdominal distention, a firm abdomen, and abdominal discomfort or pain. |
| a mild analgesic should be given how long before impaction removal | 30-60 min |
| The current recommendation for daily total water intake is | 3.7 liters for males and 2.7 liters for women |
| high fiber foods include | bean and lentils whole grains berries apples and pears leafy greens and broccoli nuts and seeds |
| treatment should begin If diarrhea persists for more than | 24-48 hrs severe diarrhea may require the use of total parenteral nutrition |
| Patients taking antibiotics can develop a bacterial infection that cause severe diarrhea | Clostridium difficile (C. diff.) |
| the building of body tissues from the nutrients | anabolism |
| provides enzymes for digestion and insulin | the pancreas |
| Continued irritation and inflammation of the GI mucosa can lead to | intestinal bleeding and increased peristalsis with inadequate absorption of nutrients. |
| Immunization for hepatitis A and B prevents | liver disease |
| Hepatitis B and C are risk factors for | liver cancer |
| stool whitish or clay color and dark urine the color of tea can indicate | the bile ducts may be blocked |
| What are some Eating disorders? | Anorexia nervosa ,Bulimia nervosa, Obesity |
| Define Obesity | defined by a body mass index (BMI) of 30 or above - is a known risk factor for cardiovascular disease and associated death |
| Name some factors of Obesity | a diet of foods high in calories and fat, lack of exercise, and overconsumption of food |
| What are some contributors of Obesity? | include readily available high-calorie prepackaged foods, the prevalence of high-fructose corn syrup in foods, consumption of sodas, and high-fat fast food and “supersized” portions available in restaurants |
| Some people overeating is a reaction to stress | TRUE |
| Complications of obesity include the following | Diabetes mellitus, Hypertension, Hyperlipidemia, Coronary artery disease, Obstructive sleep apnea, Cholelithiasis Cancer, Arthritis with back and/or knee problems, Increased susceptibility to infectious disease and decreased wound healing |
| What is the formula for BMI? | BMI= Weight (Kg)/ Height ( m2) |
| Bariatric surgery | is considered when BMI is greater than 40 or BMI is 35 or greater with one or more obesity-related complications |
| About a third who undergo bariatric surgery will develop | gallstones |
| What are the three common bariatric surgeries? | gastric restrictive, malabsorptive, and gastric restrictive combined with malabsorptive surgery. |
| What are the main treatments for Obesity? | Dietary control and exercise |
| What is laparoscopic sleeve gastrectomy (LSG) considered? | Restrictive surgical procedure |
| Why would older adults become obese? | Decreased mobility from arthritis or other joint disorders. Cooking and eating are less appealing if the person is living alone, and snacking on junk food may replace meals. Metabolic rate slows with age |
| What are some nursing diagnosis for someone that is obese? | Altered body image due to excess weight, Decreased self-esteem due to excess weight, Altered mobility due to excess weight. Potential for social isolation due to limited mobility. Weight above recommended BMI. |
| Stomatitis | is a generalized inflammation of the mucous membranes of the mouth |
| What are some symptoms of stomatitis? | pain and swelling of the oral mucosa, increased salivation or excessive dryness, severe halitosis, sometimes fever and canker sores |
| What can be used to treat canker sores? | Lysine |
| Dysphagia | means difficulty swallowing, have the patient take some “practice swallows” before beginning a meal or giving oral medications for the first time |
| Cancer of the Oral Cavity | the specific cause is unknown, oral or throat cancer is curable if discovered early. Oral cancers are primarily squamous cell carcinomas. Cell mutation occurs until an area of cells becomes neoplastic |
| What are risks that cause cancer of the Oral Cavity? | cigarette smoking, use of smokeless tobacco, pipe smoking, and heavy alcohol use |
| What are some symptoms of cancer of the Oral Cavity? | Sores or discolorations on the lips or in the mouth that do not heal within 2 weeks |
| Cancer of the Esophagus | Squamous cell carcinoma of the esophagus was the most common type of throat cancer |
| What are the major causes of cancer of the Esophagus? | cigarette smoking combined with heavy alcohol consumption |
| What is the cause of Barrett esophagus? | Gastroesophageal reflux disease (GERD |
| What causes Gastroesophageal reflux disease (GERD)? | caused by transient relaxation of the lower esophageal. Relaxation allows fluids or food to reflux into the esophagus from the stomach. |
| Symptoms of GERD | heartburn (dyspepsia), and reflux |
| Treatments for GERD | diet therapy (avoid highly seasoned and spicy food), lifestyle changes( weight loss) , drug therapy, and education |
| Hiatus (Hiatal) Hernia (Diaphragmatic Hernia) | the result of a defect in the wall of the diaphragm where the esophagus passes through; this creates protrusion of part of the stomach or the lower part of the esophagus up into the thoracic cavity. |
| What are treatments for Hiatus Hernia | weight reduction; avoidance of tight-fitting clothes around the abdomen; administration of antacids, histamine (H2)–receptor antagonists, or proton pump inhibitors (PPIs); and elevating the head of the bed 6 to 8 inches, avoid smoking |
| Gastroenteritis | inflammation of the stomach and small intestine, caused by food or water contaminated by virus, pathogenic bacteria, or parasites |
| Norovirus, Giardia, Shigella, and C. difficile are common cause for what | Gastroenteritis |
| Gastritis | it is an acute or chronic inflammation of the mucous membrane lining the stomach causing changes in the tissue. |
| Is gastritis a disease? | NO |
| what is the main cause of gastritis? | Helicobacter pylori bacteria, but other bacteria, viruses, or parasites |
| Drug-induced ulcers are most commonly caused by aspirin, NSAIDs, bisphosphonates, alcohol, and glucocorticoids | True |
| Stress does not cause progression of peptic ulcer | FALSE- Prolonged physiologic stress produces what is known as a physiologic stress ulcer |
| When does gastric ulcer the pain occur? | pain is most severe before meals and at bedtime |
| Three major complications of peptic ulcer | hemorrhage, perforation, and obstruction |
| Pyloroplasty with truncal or proximal gastric vagotomy | the pylorus, which has been narrowed by scarring, is widened, vagotomy is often done while a gastric resection is performed. |
| Subtotal gastrectomy | gastric resection) consists of removing a part of the stomach and then joining the remaining portion to the small intestine by anastomosis |
| Total gastrectomy | the surgical removal of all of the stomach. The esophagus is anastomosed to the small intestine |
| Gastric Cancer | Stomach cancer is usually discovered very late because patients often lack symptoms |
| Contributor of gastric cancer | Pernicious anemia and achlorhydria (absence of hydrochloric acid) are often present as an outcome of autoimmune disease Diet high in smoked, highly salted, or preserved foods |
| Stomach cancer has almost double the incidence in African Americans as in non-Hispanic whites | True |
| Native Americans and Hispanic Americans are also at an increased risk for stomach cancer. | True |
| Signs and Symptoms of Gastric cancer | indigestion, loss of appetite, nausea and vomiting, and weight loss, fatigue, weakness, dizziness, and sometimes shortness of breath, blood in the stool, Anemia |
| Proton Pump Inhibitor Drug | Because PPIs slow the liver's ability to metabolize and clear some drugs from the bloodstream, they should be used with caution in patients taking diazepam (Valium), phenytoin (Dilantin), and warfarin (Coumadin, watch for toxicity |
| Data Collection for Peptic Ulcer | Nausea or vomiting; presence of bright red or “coffee grounds” emesis, Dark, “tarry” stool or maroon-colored stool Laboratory Data Complete blood cell count (CBC) BUN H. pylori testing Coagulation pane |
| Alcohol use and tobacco smoking are both linked to gastric cancer | True |
| Prevention of Gastric Cancer | reduce diets high in smoked and salted foods or pickled vegetables, red meat ,bacon and many “lunch meats” are high in nitrites |
| Pernicious anemia | a rare autoimmune disease that prevents the body from absorbing enough vitamin B12, which results in a deficiency of red blood cells |
| Common Therapies for Disorders of the Gastrointestinal System | Gastrointestinal Decompression- abdominal distention with increased pressure within the abdominal cavity |
| Gastrointestinal Decompression | An NG tube to remove fluids and gas from the stomach may be inserted |
| Miller-Abbott tube | longer tube that can be directed past the stomach and into the small intestine. |
| Caring for a Patient With a Salem Sump Tube | keep the tube above the level of the stomach to prevent leaking of stomach contents from the pigtail |
| Enteral Nutrition (enteral feeding) are used when | If a patient has long-term difficulty taking in food orally, as when in a coma or with dysphagia from a stroke |
| Small-bore | flexible tubes are inserted with a stylet and are usually positioned with the tip in the duodenum (nasoduodenal) |
| Patients who require long-term nutritional support for problems such as inability to swallow may undergo percutaneous endoscopic gastrostomy (PEG) | True |
| What should a nurse be aware of in patients receiving Enteral feeding | Be certain that tube placement has been checked by x-ray and is correct |
| Total parenteral nutrition (TPN) | is indicated when the patient cannot ingest or digest foods normally or has a problem with malabsorption |
| Are enteral feedings and TPN feedings the same? | NO- Infusing an enteral feeding into an IV site can result in death and has happened |
| TPN solution must be sterile and administered at the ordered rate into a central blood vessel with high-volume blood flow | True |
| Cholelithiasis | gallstones in the gallbladder or in the biliary tract. seen in people with a sedentary lifestyle, a familial tendency, DM, obesity. |
| When stones lodge in the common bile duct, the patient has | choledocholithiasis. |
| hyperlipidemia can increase the risk for | gallstones |
| Cholecystitis | inflammation of the gallbladder and is associated with gallstones in 90% to 95% of occurrences. Other causes include obstructive tumors of the biliary tract and severely stressful situations such as cardiac surgery, severe burns, or multiple trauma. |
| Pathophysiology of Cholelithiasis (gallstones) | develops when the balance between cholesterol, bile salts, and calcium in the bile is altered to the point that these substances precipitate |
| As bile backs up into the liver and blood it can cause | jaundice |
| If cholecystitis is left untreated it can rupture and cause | peritonitis (Rupture spills gallbladder contents into the abdominal cavity) |
| Comparison of Gallbladder Disorders | see table 30.1 |
| Older Adult Care Points: Cholelithiasis | should be considered if there is abdominal pain, symptoms may be atypical with low grade fever instead of pain |
| Gallstones usually can be diagnosed with | ultrasonography or (CT) of the gallbladder and biliary tract. |
| treatment for gallstones | oral meds, ultrasonography or computed tomography (CT) of the gallbladder and biliary tract. |
| the gallbladder should be removed if symptoms are ongoing, or complications occur with a surgical procedure called | cholecystectomy |
| Constant irritation of the gallbladder from inflammation and infection produces purulent material, and a fistula may form. Necrosis, gangrene, and rupture of the gallbladder causing peritonitis may occur | True |
| Hepatitis viruses that may cause chronic inflammation and necrosis of liver tissue. | B,C,D |
| Drugs used to treat Liver disorders | see table 30.4 |
| Encephalopathy | malfunction or disease of the brain |
| Nursing diagnosis for liver disorders | • Altered nutrition due to anorexia, nausea, and vomiting. • Fatigue due to disease process and malaise. • Pain due to inflamed liver and pruritus. |
| Nursing diagnosis for liver disorders | • Altered body image due to yellow discoloration of skin. • Insufficient knowledge due to disease process and self-care needed. |
| Nursing interventions for liver disorders include | reviewing trends of serum liver enzyme levels and serum bilirubin values. Preventing the spread of infection |
| Cirrhosis | is a progressive, chronic disease of the liver. Normal hepatic structures are destroyed, replaced with fibrotic tissue. Fibrous bands of connective tissue develop in the organ and eventually constrict and partition the liver tissue into irregular nodules |
| Subjective symptoms of liver cirrhosis include | fatigue, weakness, headache, anorexia, indigestion, abdominal pain, nausea, and vomiting |
| Objective symptoms of liver cirrhosis include | excessive gas, skin rashes, and fever. Leg and foot edema and palmar erythema |
| Bleeding and bruising would be seen in a pt because of deficiencies in which vitamin | K |
| Spider angiomas | (abnormal collection of blood vessels under the skin) may appear on the face, neck, upper trunk, and arms. |
| Diagnosis of Cholelithiasis | Liver biopsy, liver function studies, CT and liver scan, magnetic resonance cholangiopancreatography |
| Can cause extensive inflammation of the liver which may form fibrous scar tissue | Hepatitis |
| Viral replication phase | no symptoms |
| Prodromal phase | nausea and fatigue |
| Icteric phase | jaundice |
| convalescent phase | jaundice begins to disappear, malaise and fatigue |
| Hepatitis diagnosis | serologic assays or enzyme immunoassays (EIAs), liver biopsy, elevations in liver function test (LFTs) |
| What is Hepatitis A and how is it treated | Fecal-to-oral route; poor sanitation, contaminated water and shellfish TX: rest, avoid substances that ca damage liver, well balanced diet, immune globulin |
| What is Hepatitis B and how is it treated | Sexual contact, blood and body fluid contact; perinatal TX: drug therapy is used to decrease the viral load, immune globulin |
| what is Hepatitis C and its treatment | Contact with blood and body fluids; sexual contact, contaminated surgical, tattooing, and piercing TX: Antiviral medications |
| Hepatitis B & C, alcoholic liver disease, and nonalcoholic fatty liver disease are the leading causes | Cirrhosis |
| liver transplantation nursing care | Care for drains, immunosuppressants, liver function monitoring |
| Cancer of the liver | metastatic is much more prevalent than primary |
| Two types of primary liver cancer | hepatoma (arise from hepatocytes) & cholangiocarcinoma (bile duct cancer) |
| signs and symptoms of liver cancer | Right upper quadrant pain, fatigue, anorexia, weight loss, weakness, fever plus signs of poor liver function |
| Treatment for liver cancer | surgical resection, liver transplantation, combined radiation and chemotherapy, tumor ablation, laser or radiofrequency ablation |
| Acute Pancreatitis | inflammation of the pancreas, acute or chronic pancreatitis, |
| signs and symptoms of acute pancreatitis | Epigastric or left upper quadrant pain, nausea, vomiting, sweating, jaundice, and weakness |
| Treatment for acute pancreatitis | pain evaluation and control, eliminate alcohol intake, small low-fat meals, adequate hydration, pancreatic enzymes |
| Cause is unknown, more common in men than in women, occurs more often in people older than 55 years | cancer of the pancreas |
| pathophysiology of pancreas cancer | cigarette smoking, adenocarcinoma, tumor of head and tail of the pancreas |
| epigastric pain, weight loss, anorexia, vomiting, jaundice, high incidence of clot formation are signs for | pancreas cancer |
| diagnosis for pancreas cancer | tumor markers CA 19-9 and CA 242, ultrasonography, imaging techniques, needle biopsy |
| Treatment for pancreas cancer | keep patient comfortable, treat and prevent malnutrition, surgical treatment, radiation and chemotherapy |
| Labs for cholelithiasis | liver function, CBC, amylase or lipase levels |
| which hepatitis virus is linked to eating raw food | A |
| which hepatitis virus is transmitted sexually | B,C |
| Ascites | Fluid leakage into the abdomen |
| Paracentesis | removal of ascites fluid |
| dilated, distorted, engorged veins in the esophagus | esophageal varices |
| Lactulose is given | to remove ammonia from the liver |
| more likely to occur in people with a sedentary lifestyle, a familial tendency, diabetes mellitus, and obesity. | Cholelithiasis |
| functional gastrointestinal disorder characterized by chronic abdominal pain, bloating, and altered bowel habits | IBS |
| What can cause IBS | Symptoms can be triggered by stress, certain foods, or hormonal changes |
| How does Diverticulitis Occurs | occurs when diverticula—small, bulging pouches that form in the walls of the colon—become inflamed or infected. |
| Symptoms of diverticulitis | Include left lower abdominal pain, fever, nausea, and changes in bowel habits. In severe cases, complications like perforation or abscess formation can occur. |
| What can cause diverticula to become inflamed or infected | Increased pressure within the colon, Infection, When stool or bacteria become trapped in these pouches |
| occurs when a portion of the intestine or other tissue becomes trapped in the hernial sac, cutting off its blood supply | A strangulated hernia |
| You are caring for a patient who has a history of a total gastrectomy, you are going to monitor for this syndrome? | Dumping Syndrome |
| a hernioplasty is a procedure that includes... | mesh a strong synthetic (mesh) is sewn over the defect to reinforce the area |
| You are doing discharge teaching, you are going to tell this person with this medical diagnosis to avoid high fiber foods and high fatty meats, and if possible avoid dairy as well... | Crohn's Disease |
| You are discharging a patient who had gastrectomy surgery and in your teaching to prevent dumping syndrome, you are going to teach them to avoid this... | concentrated sugar Sugar in any form is avoided, as are concentrated sweets such as fruit juice; should be diluted |
| An open are near the coccyx is draining, this is called a | Pilonidal Cyst |
| What is the purpose of a T-tube after a laparoscopic | drainage |
| You are caring for Mr. Smith and you realize his feeding tube is 6 cm further out than it was on the markings...the first thing you should do is .... | Stop the feeding *You should also notify the doctor, and get an x-ray* |
| In this disease the affected mucosa usually is located in the rectum or the upper part of the colon, it is red, bleeds easily and has pseudo polyps | Ulcerative Colitis |
| A high fiber diet with bulk laxatives would be recommended for this patient with this lower GI problem, at times they may be admitted to the hospital and treated if uncomplicated with clear liquids, antibiotics, and for pain demurral is normally used | Diverticulitis *Demurral is the key word that differentiates this from IBS* |
| The patient calls and you are the clinic nurse and says that he has not had a BM, since his barium swallow. His abd is distended and he has nausea and vomiting, and he is not passing gas. What do you suspect? | Bowel Obstruction- Recommend to be seen right away |
| What is the stool type that you would see in an ascending colon? | Liquid |
| What is a lab you would do for a patient who has ascites and edema and history of cirrhosis | Albumin |
| This is an emergent situation... it is caused when part of the intestine breaks through the muscular wall of the abdomen... | Incarcerated hernia |
| What type of ostomy teaching would you include with a patient with a new ileostomy about time released medication | Do not take extended release medication |
| You are discharging a patient who just had a cholecystectomy and you want them to avoid what type of food? | Fatty food |
| This patient just came into your clinic and he is telling you that he is having burning gnawing pain, that is diminished in the morning and severe after meals and at bedtime... what do you suspect? | peptic ulcer |
| You are in the ER and this patient comes complaining of weakness and feeling faint, nauseous, vomiting, restless and thirsty, what do you suspect? | GI Bleed |
| As a nurse what would you be monitoring for in the afternoon, when in the morning the NG tube was removed? | Abdominal Distention |
| The patients BMI is 23, and you are educating them on healthy diet... you would tell him that his weight is... | normal |
| This patient came in and is complaining of esophageal pain and chest pains that comes and goes ... it is worse after they eat and sometimes they experience abdominal bloating, what do you suspect? | GERD |
| This patient came in to the ED at about 2am and is having severe abd pain, nausea and anorexia. He admits that he has been binge drinking. As a nurse you suspect? | Gastroenteritis |
| Your patient with pancreatitis will have IV fluids and this as their prescribed diet? | NPO |
| The client refuses his lactulose and you are taking care of him. He tells you he has all this diarrhea, what do you tell him? | It helps eliminate the ammonia surge |
| The inslet cells are responsible for? | Regulating blood glucose in the pancreas |
| This sphincter can get blocked by gallstones and can cause pancreatitis... | Oddi Sphincter |
| Monitoring amylase is consistent in the diagnosis of... | Pancreatitis |
| When the sclera appears yellow, this is a sign of... | Jaundice |
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