Adult 1 GI site Group 1 Mr. Justice (Tamara, Anissa)
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| Esophageal varices are | Swollen, twisted veins
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| Peristalsis | Muscular wave-like movement that transports food through the digestive system
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| Amylase | Enzyme to digest starch
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| What are the 4 main functions of the GI system? | Ingestion & Propulsion of food, Digestion, Absorption, Elimination
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| Villi | Finger-like folds of the small intestines; they increase the surface for absorption
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| Which is the only organ in the body that has both endocrine and exocrine functions? | Pancreas
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| What is the exocrine function of the pancreas? | Contributes to the process of digestion – secretes pancreatic enzymes
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| What nerve is involved in “bearing down” to have a bowel movement? | Vagus Nerve
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| What are the functions of the liver? | Metabolic function (metabolisms), Bile synthesis, Storage of glucose in form of glycogen, Break down of old RBC’s, WBC’s, and bacteria
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| What is a paraesophageal (rolling) hernia? | The esophagogastric junction remains in the normal position, but the fundus and greater curvature of the stomach roll up through the diaphragm forming a pocket alongside the esophagus
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| Ulcer | Sore or lesion
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| Dyspepsia | Burning or indigestion
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| Hernia | Bulge or nodule in abdomen, usually appearing on straining
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| Hemorrhoids | Thromboses veins in rectum and anus
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| Fissure | Ulceration in the anal canal
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| What do you assess for pain r/t GERD? | When does it occur, Location, Duration, Intensity, Quality
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| Nursing considerations after small bowel series? | Encourage fluids to get rid of barium , Monitor BM – may be whitish d/t barium, Be observant for constipation, Stool softeners and laxatives as ordered
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| What are some non-invasive diagnostic tests? | Abdominal Ultrasound, CT scan, MRI-MRCP, Gastric emptying
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| EGD (Esophagogastroduodenoscopy) | Insertion of flexible tube into esophagus through the stomach and into the duodenum of the small intestines, Performed under MAC (monitored anesthesia care) – “Twilight sleep”, Pt. able to communicate if needed, Can be done outside of OR
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| Purpose of EGD | To assess for sites of bleeding, Identify ulcerations/lesions, Detect strictures, masses or tears, Repair of acute bleed, Biopsy
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| Invasive Diagnostics can also be used to: | Remove gall stones obstructing bile duct, (if distal), Dilate strictures, Biopsy tumors, Diagnose pseudocysts
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| Lab Work | Serum Bilirubin, Serum amylase & lipase, CBC (H & H), Platelets, WBC’s, BMP/CMP
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| Dumping Syndrome | Occurs when food is dumped out of stomach quickly such as after gastric stapling or resection of stomach
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| A 68 year old patient awakens at night with heartburn & belching. The nurse recognizes that these symptoms may occur when there is abnormal relaxation of the | lower esophageal sphincter
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| A patient returns to the nursing unit following an EGD. During postprocedure care, it is most important for the nurse to | keep the patient NPO until the gag reflex returns
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| While the nurse is obtaining a history from a patient, an OTC medication that the patient uses that the nurse recognizes as significant to liver disorders is | acetaminophen
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| A patient with difficulty swallowing is started on continuous tube feedings of a full-strength formula at 100ml/hr. The patient has 6 diarrhea stools for the first day. The action that is most appropriate for the nurse to take first is | slow the feeding flow rate
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| A patient with chronic GERD is experiencing increasing discomfort. During assessment of pt's current management of the problem, the nurse determines that further teaching is needed when the patient states | I try to keep my diet low in fat, and I eat small meals throughout the day anad at bedtime
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| When teaching a pt. with GERD about recommended dietary modifications, the nurse explains foods that decrease lower esophageal spincter pressure and should be avoided include | coffee, tea and chocolate
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| Upper GI assesses for | Structural abnormalities in the esophagus, stomach, & duodenum
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| Nrsg. Considerations for barium tests | encourage fluids, Monitor BM
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| Monitor BM after barium tests for | whitish color, constipation
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| Abd Ultrasound assesses for | cysts, abscesses, stones of gallbladder or kidney, masses or tumors
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| Types of Non- invasive Diagnositics | Abdominal US, CT scan, MRI/MRCP, and gastric emptying
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| NPO status with most GI tests | NPO after midnight prior to the test
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| EGD assess for | sites of bleeding, identifies ulcerations/lesions, detects strictures, masses or tears, repair of acute bleeding, biopsy
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| How is an EGD performed | Under MAC, "twilight sleep", pt. able to communicate if needed, can be done outside the OR
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| Where does the flexible tube go for an EGD | into the esophagus through the stomach and into the duodenum of the small intestine
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| Liver functions tests include | Urobilinogen, serum protein, ammonia levels, serum enzymes
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| If ammonia level is elevated, patient will show s/s of | confusion
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| What electrolyte is usually elevated in malnutrition? | potassium
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| Anemia is reflected in what lab values | RBC Hgb
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| What function must a person have for gastric & enteral feedings to be effective? | Bowel sounds; Normal GI tract functioning
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| What situations require use of enteral (duodenal or jejunal) feeding? | If NPO for longperiod; need to bypass stomach due to disease,surgery,trauma,or lack of emptying;any sit. where need more nutrition than able to retain orally(chem,rad,burns,dysphagia),at risk for aspiration,anorexia, orofacial fx ,head/neck surg
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| What should the nurse be assessing while first introducing fluid into the GI tract? | What face for signs of aspiration
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| Dumping Syndrome occurs... | when food is dumped out of the stomach quickly such as after gastric stapling or resection of the stomach
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| Avoid dumping syndrom with gastric feedings by: | start with more dilute feeding & increase concentration as tolerates; if symptoms occur, get orders for more dilute concentration; lie down after bolus feeding in case have BP drop, etc.,
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| How do you maintain patency of gastric feeding tube | irrigate with 30-50cmL (or ordered amt) before and after administering anything through tube; Usuall receive 250-500mL/shift of water
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| Feedings should hang no longer than? | 24 hours
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| Thrush | caused by candida albicans, white "milk curd" appearing lesions on mouth and tongue, can cause significant soreness leading to poor oral intake
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| Tx of thrush | Nystatin or Amphotericin B
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| Stomatitis | similar to thrush, prominent in CA patients, pallative care can be included with Nystatin if needed
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| What should you do with suction when performing abd assessments | turn it off - remember to turn it back on after
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| What is GERD | syndrome that results in backward flow of gastric contents into esophagus; over time can lead to erosive esophagitis if untreated
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| What relieves pyrosis (heartburn) | milk, antacids & water (milk feels better, but inc. HCl production makes it worse)
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| How do you diagnose GERD? | Hx, endoscopy (shows edema & erosion), Ambulatory pH monitoring
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| Complications of GERD | esophageal stricture from scar tissue, Barrett's esophagus, aspiration pneumonia
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| Treatment of GERD | Life style changes, Diet changes, avoid nicotine because it decreases bicarbonate prod., loose weight if obese, do not eat in pm, upright for 2 hours after eating, elevate HOB 6-8 inches
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| What foods should a GERD patient avoid that cause decrease LES pressure | chocolate, peppermint, caffeine, onions, fatty foods, alcohol
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| What foods should GERD patients avoid that cause inc. acid production | milk, caffeine
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| When should a patient with GERD take an antacid | 1-2 hours after meals and qhs
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| What do antacids do | neutralize acid
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| Types of antacids | Aluminum hydroxide, Mg hydroxide, Calcium carbonate, Sodium bicarbonate
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| S/S of hiatal hernia | Same as GERD, Belching, possible GI bleed,
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| Dx of Hiatal Hernia | barium swallow, endoscopy, CXR
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| Complication of Hiatal Hernias | esophagitis, aspiration, strangulation or incarceration
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| Tx of Hiatal Hernias | usually conservative (almost same as GERD), eating small meals, weight control, avoid tight constrictive clothing
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| Medications for Hiatal Hernias | Antacids for reflux
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| Surgery for Hiatal Hernias | Nissen Fundoplication; Angelchik prosthesis
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| Dysphagia results from | tumors (intrisic or extrinsic), strictures, diverticular herniations, Neuro disorders: stroke, head/spinal cord injury, Parkinsons, Achalasia
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| Tx of dysphagia | dependent on underlying cause
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| Gastritis | Inflammatory disorder of the stomach
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| Acute gastritis | med or chem related; self healing; minimal damage to mucosal lining
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| Chronic gastritis | usually in elderly; thins and degenerates stomach wall;
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| S/S of Gastritis | Vague; Fullness, N/V, anorexia, epigastric pain
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| Dx of gastritis | Gastroscopy, Bx, Gastric secretion evaluation
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| Tx of gastritis | small meals, soft/bland diet, avoid alcohol & aspirin, take B12 supplement
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| Peptic Ulcer Disease | erosion of the mucous membrane of the GI tract from digestive action of HCl & pepsin
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| Sites of peptic ulcers | esophagus, gastric, duodenal (most common)
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| S/S of peptic ulcers | gnawing epigastric pain with pain -food relief patterns, may radiate to back, relieved by antacids, worse when lean forward, worse when stomach empty
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| Dx of peptic ulcers | barium swallow, endoscopy, gastrin level studies, H.pylori detection
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| Complication of ulcers | hemmorhage, large vessel bleed, obstruction, perforation
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| S/S of a small vessel bleed from an ulcer | occult blood in stool, anemia, fatigue
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| S/S of a large vessel bleed from an ulcer | hematemesis, tarry stool, coffee-ground emesis - Emergency call PCP
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| S/S from an obstruction associated with ulcers | loud peristalsis with large visible waves, pain worse as eats more, vomit contains food long after eating, belching or vomiting dec. pain
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| Tx of an obstruction r/t ulcers | NG tube for decompression, f/e replacement, surgery to open pyloric sphincter
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| S/S of a perforation with ulcers | rigid abd., sever abd pain, pain radiating to R shoulder, absent bowel sounds, signs of shock
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| Tx of ulcers | relieve pain, heal ulcer, prevent complications, educate in lifestyle changes
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| Medications for ulcers | Antacids, Proton Pump Inhibitors, Histamine receptor blockers, Cytoprotective agents
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| What s/s occur with dumping syndrome | hypotension, sweating, weakness & palpitations occur
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| Measures to avoid dumping syndrome | avoid simple sugars & CHO, diet higher in protein & fats, avoid liquids with meals, small freq meals, lie down after meals for safety
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