GI 1

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Author:
CierraW
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130117
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GI 1
Updated:
2012-01-23 23:49:56
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GI
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Description:
Anatomy thru Appendicitis
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  1. GI Anatomy
    • Mouth- oral cavity, soft/hard palet, teeth, tounge, salivary glands,cheeks
    • Esophagus- bolus (ball)
    • Stomach- chyme
    • Small Intestine
    • Large Intestine
  2. GI Anatomy Other Organs
    • Pancreas
    • Liver
    • Gallbladder
  3. Pancreas
    • Endocrine- production of glucagon and insulin to regulate the blood sugar lever
    • Exocrine- Amylase- converts carbs into glucagon, Lipase- aids in fat digestion, Protease- breaks down proteins
  4. Liver
    • most vascular organs
    • fliters 1500 ml of blood per min
    • functions- Produce and secretes bile
    • Converts glucose into glucogen for storage
    • Converts glucogen into glucose for use
    • Metabolize hormones
    • Break down nitro waste to urea
    • Incorporate amino acids into protein
    • Filter blood and destroy bacteria
    • Produce prothrombin and fibrinogen
    • Manufactures cholesterol
    • Produce heparin
    • Store Vitamin B12 and Vitamin A, D, E, K
    • Detoxify poisonous substances
  5. Gallbladder
    Stores and concentrates the bile until needed in the small intestine
  6. Changes with aging
    • Decreased peristalsis
    • Oral changes
    • Decreased enzyme secretion
    • Decreased Saliva

    May take longer to eat, can lose taste, high fiber, increase fluids, increase exercise, small frequent meals, chew food well (chew 25 times per bits)
  7. GI Data Collection
    • Past med history
    • Family history
    • Cultural differences
    • Meds
    • Nutrition
    • Psychosocial
    • Objective data
    • Diagnostic tests
  8. Diagnostic Labs
    • Bilirubin- old RBC
    • Albumin- 3.5-5mg- maintains blood volume and BP
    • Globulin- increase production of antibodies
    • Total Protein- albumin and globulin measured together
    • Alkaline Phosphatase- increase possible liver or bone cancer
    • Amylase- 56-190mg- enzyme from pancreas
    • PT- 9.5-11.8sec- increase bleeding time decrease clotting
  9. Diagnostics Stools
    • Guaiac- shows blood in stool
    • Ova and Parasites
    • Lipids- fat in the stool
  10. Diagnostic Tests
    • NCLEX pg 587
    • EGD
    • Upper GI- Barium swallow, after increase fluids, monitor stool
    • Lower GI- Barium enema
    • CT Scan
    • ERCP- endoscopy retograde cholangiopancreatography
    • Endoscopy
    • Colonoscopy
  11. Stomatitis
    • condition characterized by inflammation and ulceration of the mouth
    • can be caused by infection, damage to the mucous membranes by irritants or chemotherapy
  12. Stomatitis Data Collection
    Uclers in the mouth
  13. Stomatitis Interventions
    • Dilated and tortuous veins in submucosa of esophagus
    • Coughing and sneezing can cause them to pop
    • Often associated with cirrhosis of the liver
    • No signs till bleeding starts
  14. Esophageal Varices
    • Dilated and tortuous veins in submucosa of esophagus
    • Coughing and sneezing can cause them to pop
    • Often associated with cirrhosis of the liver
    • No signs till bleeding starts
  15. Esophageal Varices Data Collection
    Hematemesis (bloody vomit), tarry stool, ascites, dilated abdominal veins, hemorrhoids, bleeding and shock
  16. Esophageal Varices Interventions
    • Monitor vitals
    • Orthostatic hypertension
    • sclerotherapy (acid injected into veins)
    • Minnasota or sengstaken (blackamoor tube) balloon periodicly deflated to prevent necrosis
    • Shunt last option
    • NPO til further notice
    • Fiber in diet
    • LOC and daily weight, I&O
    • Elevate HOB for sleeping
    • Monitor for resp distress
    • No aspirin or NSAID's
    • Ligation (banding tie off vein to stop bleeding)
  17. Sandostatin octerotide
    • Antidiarrheas, Increase reabsorption of fluids and electrolyte, slows blood flow
    • SubQ, IM, IV
    • SE- dizziness, fatigue, pain at injection site, headache, hypotension, N, V, fat malabssorption
    • Interventions- monitor stool for bleeding, vitals, I&O, daily wt, clear med (throw out if discolor), teach injection technique, reconstitution, safety
  18. Carafate sucralfate
    • Mucosal protective med, protective barrier from acid and pepsin
    • PO
    • SE- constipation
    • Interventions- monitor stool for blood, give 60 mins before meal to coat stomach, 1 hr between med and antacids, give coumadin, dilantin and linoxin 2 hrs before or after
  19. Hemorrhoids
    Swollen vascular tissues in the rectal area
  20. Hemorrhoids Data Collection
    Pain, itching, irritation, swollen vascular tissues
  21. Hemorrhoids Interventions
    Sitz bath, creams and suppositories to decrease inflammatoin and swelling, 20-30g fiber, increase fluids, stool softeners, surgery if very big or bleeding, no ice packs or estringents
  22. Gastroesophageal Reflux Disease (GERD)
    • gastric secretions back up into cardiac sphincter d/t it not closing all the way
    • acid in esophagus irritates it
    • inability of lower esophageal sphincter to close
  23. GERD Data Collection
    heart burn, dysphagia, bleeding, indigestion
  24. GERD Intervention
    Avoid milk, liquirish, caffine, spicy foods, nicotine, calcium channel blockers, decrease fats, increase proteins, no laying for 2 hrs after eating, elevate HOB when sleeping, H2 blockers (Pepcid, Zantac, Tagament), PPI (Prilosec, Prevacid, Nexium), surgery to replace cardiac spincter, fundoplication (tighten spincter)
  25. Prilosec omeprazole
    • Proton Pump Inhibitor, stops gastric secretions
    • PO, IV
    • SE- dizziness, drowsiness, headache, diarrhea, flatulent, abd pain, N, V, constipation
    • Interventions- give before meal in am, 1 hr before eating, do not crush, safety, avoid alcohol, caffeine, spicy foods, no smoking, capsules can be sprinkled onto food
  26. Prevacid lansoprazole
    • Proton Pump Inhibitor, stops gastric secretions
    • PO, IV
    • SE- dizziness, drowsiness, headache, diarrhea, flatulent, abd pain, N, V, constipation
    • Interventions- give before meal in am, 1 hr before eating, do not crush,
    • safety, avoid alcohol, caffeine, spicy foods, no smoking, capsules can
    • be sprinkled on food
  27. Gastritis
    • Inflammation of stomach mucosa
    • causes- helicobactor pylori, over eating, smoking, aspirin, NSAID's, alcohol, spicy foods, food allergens, toxic chemicals
  28. Gastritis Data Collection
    heart burn, indigestion
  29. Gastritis Interventions
    • no using NSAID's, smoking, alcohol, foods that aggravate
    • antacids, H2 blockers, PPI, Bismuth
    • eliminate predisposing factors, changes to diet
    • usually managed with meds
    • talk to pt about B12 injections
  30. Pepto-Bismol bismuth subsalicylate
    • Anti-ulcer, promotes intestine to reabsorb fluid and electrolytes
    • PO
    • SE- constipation, black tarry stool, tinnitus (stop med call Dr), black harry tounge, bowel patterns
    • Interventions- monitor stool, dont give if pt has stomach ulcer, I&O, wt, pain, shake well, decreases absorption of meds, no H2 blockers within 1 hr, no aspirin
  31. Ulcers
    • ulceration of the mucosal wall of the stomach, pylorus, duodenum, or esophagus
    • erosion may extend through the muscle
    • Most common gastric and duodenal
  32. Gastric Ulcers
    • involve ulceration of the mucosal lining that extends to the submucosal layer of the stomach
    • Predisposing factors- stress, smoking, corticosteriods, NSAID's alcohol, history of gastritis, family history of gastric ulcers, or infection with H. Pylori
  33. Gastric Ulcer Complications
    hemorrhage, perforation, and pyloric obstruction
  34. Gastric Ulcers Data Collection
    Gastric- gnawing sharp pain in or left of the midepigastric region occurs 30 mins to 2 hrs after eating, hematemesis is more common than melena
  35. Gastric Ulcers Interventions
    vitals, small frequent bland meals, H2 blockers, antacids, anticholinergics, prostaglandins, mucosal barrier protectants 1 hr before meals, avoid alcohol, caffeine, chocolate, smoking, aspirin, NSAID's, adequate rest, neuro check
  36. Duodenal Ulcers
    • a break in the mucosa of the duodenum
    • risk factors- alcohol, smoking, stress, caffeine, aspirin, corticosteriods, NSAID's, infection with H.pylori
  37. Duodenal Ulcers Complications
    bleeding, perforation, gastric outlet obstruction, intractable disease
  38. Duodenal Ulcers Data Collection
    burnign pain in the midepigastric area 1.5 to 4 hrs after eating a meal and during the night, often awaken pt, melena more common then hematemesis, pain is often relieved by ingestion of food
  39. Duodenal Ulcers Interventions
    vitals, small frequent bland meals, adequate rest, no smoking, avoid aspirin, alcohol, caffeine, corticosteroids, NSAID's, antacids, H2 blockers, surgery only if unresponsive to meds or if hemorrhage, obstruction, or perforation occurs, neuro check
  40. Ulcers Onset of pain
    • Shock
    • Pale clammy skin
    • increased pulse rate
    • decreased BP
    • Pt will experence less pain after 24 hours of treatment
  41. Cytotec misoprostol
    • antiulcer/prostiglanden, decrease stomach secretions, increases mucosa protection
    • PO
    • SE- headache, abd pain, N, V, diarrhea
    • Interventions- monitor pain, give with meals, before bed, I&O, daily wt, report black tarry stool and abd pain,avoid alcohol, spicy foods,caffeine
  42. Gastric Surgeries
    • Gastrectomy
    • - billroth I- gastroduodenostomy
    • - billroth II- gastrojejunostomy
    • Total gastrectomy- remove stomach
    • Vagotomy- surgically split vagus nerve
    • intrinsic factor is either missing or very little (may need B12)
  43. Dumping Syndrome
    rapid emptying of stomach into small intestine
  44. Gastric Surgeries Data Collection
    can develop pernicious anemia, N, V, abd cramps, diarrhea, full feeling, weakness, tahcycardia, palpitation, avoid sugar and salt, lay down after eating, No fluids when eating, increase protein and fiber
  45. Appendicitis
    • inflammation of the appendix
    • can be inflamed, gangrenous, or rupture
    • if ruptured can cause peritonitis
    • Barium enema or ultrasound used to confirm
    • Causes blockage of appendix by feces, trauma, infection
  46. Appendicitis Data Collection
    pain starts at umbilicus and radiates to right lower quadrant, pain at mcburney's point, N, V, anorexia, increased WBC, fever, rebound tenderness, abdominal rigidity, gangrene
  47. Appendicitis Interventions
    monitor pain, no heat on abd, vitals, surgery to remove, NPO, check dressing for draingage, if rupture lay on right side at 20-30 degrees, ambulate asap after surgery, dr changes dressing first, doc pain, bowel sounds, firmness is a sign of rupture, pain stops if rupture occurs
  48. Appendicitis Complications
    perforations, abscess, peritonitis

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