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Nasuea, vomiting, rebound tenderness, and rigidity are the classic symptoms of what?
What is an important nursing intervention to remember with Peritonitis?
Document urine output every hour!
What kind of fluids are you giving with peritonitis?
- Colloids (holds fluid in vascular space)
- Large amts of protein= albumin!
- Isotonic fluids
What do you do when you run out of TPN?
Vitamin A, D, and K are ____ soluble
B12 and folic acid are _____ soluble
What foods are the worst culprit of GI pain?
What is the most common symptom of patients with GI dysfunction?
Dyspepsia (upper abdominal discomfort)- associated with eating- commonly called indigestion
What instructions need to be provided to the patient for an abdominal ultrasound?
Fast for 8 to 10 hours
When doing a barium study, which procedure is the patient going to be receiving enemas "till clear"?
Lower GI (colon)
What is administered to a patient who is allergic to iodine or shellfish and is receiving a Ct of the abdomen?
What renal protective measures are perfomed during a CT of the abdomen?
- IV sodium bicarbonate (1 hour prior, and 6 hours post).
- Oral Mucomyst (acetylcysteine) before or after procedure
What are the nursing interventions for an esophagogastrodueodensocopy?
- NPO 8 hours prior
- Atropine- reduce secretions
- Glucagon- relax smooth muscle
- Left lateral position- facilitate pulmonary secretions
What nursing interventions are needed for a patient undergoing a colonoscopy?
- CLEANSE the bowel
- Clear liquid diet (noon the day before the procedure)
- Go-Lytely (3-4 hours)
- Enema morning of (fleets or saline)
What complication occurs when feedings are stopped too abrupty?
Which type of ulcer is associated with an extensive burn injury?
Which type of ulcer is preceded by a head injury or seen in brain trauma patients?
Cushing's- (involves deep tissues)
Sudden sustained abdominal pain, abdominal distention, and fever are all symptoms of ________ in a patient with an intestinal obstruction.
What classification of drugs is Prevacid and Nexium?
PPI- proton pump inhhibitors
What classification of drugs is Pepcid?
Histamine 2- receptor antagonist
Halitosis and a sour taste in the mouth are major compaints of ________.
Esophageal diverticula (may retain decomposed food)
What is a difference between duodenal and gastric ulcers?
Vomiting is uncommon in patients with duodenla ulcers.
The presence of mucus and pus in the stool suggests which condition?
Inflammatory colitis (enteritis)
What does voluminous, greasy stools suggest?
What type of laxative is Dulcolax?
What type of laxative is Metamucil?
Bulk forming agent
Thickening and inflammation of the bowel is characteristic in what GI disorder?
Crohn's Disease (regional enteritis)
Inflammatory process affecting mucosa and sub-mucosa of colon and rectum
Which type of laxative draw's water into the intestines by osmosis?
Bulk forming agents (metamucil)
Inflammation of all layers of the intestinal mucosa
A patient diagnosed with ________ will show s & s including: hypotension, increased temp, tachycardia, and elevated ESR
Which part of the abdomen would pain be experienced in the patient with appendicitis?
Which disease would you see ulcers that have a cobblestone appearance?
Crohn's disease (regional enteritis)
What nursing consideration is associated with Flagyl?
Teaching patients that it leaves a mettalic taste in your mouth
A patient being treated for diverticulosis needs what dietary instruction?
Drink 8-10 large glasses of water everyday
Burning sensation in the esophagus and indicates GERD
________ hiatal hernis: fundus and greater curvature of stomach herniate alongisde the esophagus into thorax. Complicated.... Cardiovascular symptoms (chest pain, dyspnea, tachycardia, impaired gas exchange)
Rolling hiatal hernia
Which disease produces symptoms of pain after eating and at hours when supine?
Esophagitis (low fat diest, 6 small meals, high fowlers during mean and 1 hour post)
Esophageal motility- progressive worsening dysphagia- lower 2/3rds of organ. Radiating substernal pain resembling an MI.
What type of nutrition is preferred?
Enteral- (maintains gut, fewer complications)
What dietary teaching is needed for a patient with diverticulitis?
- Low fiber with acute
- Gradually introduce high fiber for asymptomatic pt.
- NO nuts, seeds, popcorn
What ulcers are more common? (usually occurs in ages 30-60)
Duodenal- 80% of peptic ulcers
How is an H.pylori ulcer treated?
- 10-14 days
- Antibiotics (flagyl, amoxicillin, biaxin)
- PPI (prevacid, prilosec)
- Bismuth salts
How is a non H.pylori ulccer treated (Ulcer caused by NSAIDS)?
- Histamine 2 receptor agonists (Zantac, pepcid, tagamet)
- PPI (prevacid, prilosec, Nexium)
- Carafate (protects lining)
________: is a condition in which there is increased production of the hormone gastrin. Usually, a small tumor (gastrinoma) in the pancreas or small intestine produces the high levels of gastrin in the blood.
How is a Zollinger-ellison syndrome ulcer treated?
- High doses of histamine 2 receptor agonist (zantac, pepcid, Nexium)
- Sandostatitin (suppreses gastrin levels)
Other than PUD, what other disease is related to H.pylori?
What does acholrhydia mean? What disease is it related to?
Production of gastric acid in stomach is absent. Related to gastritis!!
When should PPI's be taken?
1 hour prior to meals
If mucosal corrosion is severe in acute gastritis, why do you want to avoid emetics and gastric lavage?
Will cause Perforation
Which disease is characterized by inflammation of the stomach mucosa and is usually due to dietary indescretions (eating too much, or too rapidly, excessive seasoning, and infected foods), Aspirin and other NSAIDS often cause this too.
What long term education info needs to be explained to a person with chronic gastritis?
Longterm B12 injections
During the 3rd stage post gastric surgery, what kind of foods are allowed?
- Is begun at 2 weeks or at 8 weeks post surgery
- Soft foods high in protein (cottage cheese, eggs)- increasing consistency not amounts
What does stage 4 post gastric surgery entail?
Small portions unrestricted, meats cut up with liquids added
How long do the 4 stages last for a patient post op gastric surgery?
Inflammation of the mucous lining of any structures of the mouth.
Which type of stomatitis is more prevalent in young adults, esp. females?
Which type of stomatitis occurs in a compromised host (AIDS, malnourished)?
Which type of stomatitis shows signs of candidiasis (white patchy, milk like lesions on tongue, palate, and mucosa), is removable with tongue blade, and antimicrobial therapy is given 1 week after patches dissapear?
What is a UTI called which is located in the upper urinary tract?
Pylenophritis (inflammation of the kidney and renal pelvis)
How do we assess the abdomen?
- Inspection: skin changes, lesions, bruising, straie
- Auscultation: hpo, hyper, absent (3-5 mins), bruits
- Percussion: size & density of contents (organs, air, fluid, filled or solid masses)
- Palpation: light (tenderness, pain) deep (masses)
- 4 quadrants- 9 regions
- Non-invasive, but bones, gas and fluid prevent sound transmission
- Fast for 8 to 10 hours before (<gas)
- Gallbladder focus: fat free meal night before
- Schedule barium after ultrasound exams
When is a lower GI contraindicated?
Obstruction or perforation
Upper GI (to small bowel)
- Clear liquid diet
- NPO p 0000
- Bowel prep
- Not smoking, gum, or mints
- Oral meds (hold?)
- Excrete barium!!!
Lower GI (colon)
- Low residue diet 1-2 days prior
- Clear liquid & laxative diet day before
- NPO 0000
- Enemas "till clear"
- # BM > post procedure (more stools, white stools)
- Contraindicated: obstruction, perforation
CT of Abdomen
- With or w/o contrast?
- Patent IV site
- Allergies to Iodine, shellfish
- Serum creatine level (0.7-1.4 mg/dL)
- Prednisone IV (allergy to contrast)
- Renal protection
- - Iv sodium bicarbonate (1 hr prior, 6 hours post)
- -Oral Mucomyst (acetylcysteine)
What are the nursing interventions pre-procedure for a endoscopy (EGD)?
- NPO 8 hours prior
- Local anesthetic
- Moderate sedation (versed)
- Left lateral position
What are the nursing interventions post-procedure for a endoscopy (EGD)?
- Vital signs
- O2 stat
- Gag reflex
- Signs of perforation (Pain, bleeding, unusual difficulty swallowing, >temp)
What are the nursing interventions for a colonoscopy?
- CLEANSE the bowel
- Clear liquid (1200 day before)
- Go-lytely (3-4 hours)
- - Electrolytes,
- - Nausea, bloating, cramps
- - Elderly (fluid volume status)
- Enema morning of (fleets or saline)
What are the nursing interventions post procedure for a colonoscopy?
- LOC, vital signs, sat, abd distention, pain, vagal response
- Bowel perforation (rectal bleeding, pain, distention, fever, focal peritoneal signs)
- Written instructions to family if outpt.
What are the signs and symptoms associated with esophagitis?
- Pyrosis- radiating to back, neck, or jaw
- Pain after eating and at hours when supine
- Pain aggravated by activities increasing intra-abdominal pressure (strain,lift)
- Increased salivary secretion
- Belchin, flatulence
- Esophageal strictures
What test would you perform to diagnose esophagitis?
- Upper GI Barium swallow
- Endoscopy with biopsy
- Esophageal manometry
Esophageal motility- progressive woresning dysphagia- lower 2/3rds of organ
Radiating substernal pain resembling MI
Idiopathic, but familial tendency
What dietary teaching is needed for the patient with Achalasia?
6 small meals a day- low fat, high protein, avoid chocolate and citrus juices
What can happen secondary to esophageal cancer due to the progressive dysphagia?
What are two important nursing interventions for gastritis?
- Reduction of caffeinated beverages (caffiene increases pepsin secretion)
- Smoking cessation
Which ulcer is commonly seen in ventilator dependent and posttraumatic or surgical patients?
Curling's ulcer (stress ulcer)
______: erosion into peritoneal cavity
- sudden severe pain (rt shoulder)
- Rigid abdomen
Perforation (complication of PUD)
______: erosion into surrounding structures (pancreas, biliary tract, or omentum)
- Back and epigastric pain not relieved by medicines previously effective
An operation in which the pylorus is removed involving anastomosis of the distal stomach directly to the duodenum
an operation in which the lower part of the stomach (antrum) is removed and a loop of small bowel (jejunum) is brought up and joined to it for drainage (gastrojejunostomy)
was once popular as a way of treating and preventing PUD and subsequent ulcerative perforations (a way to reduce the acidity of the stomach by denervating peptic cells that produce acid- cut vagus nerve)