all GI disorders have a prob. w/ what vitamin deficiency & why?
b/c its not being absorbed--hydrochloric acid produces intrinsic factors to produce vitamin b12.
how many steps does it take to produce b12?
w/o b12, what does it result to?
what is the Tx for pernicious anemia?
requires (monthly) b12 [cyanocobalamin] injections for life.
can't be taken orally b/c it destroys.
what part of the GI system is considered antreium [produces hydrochloric acid--site for gastric/peptic ulcers]?
the stomach--lower part of stomach just before pyloric sphincter (going into ileum).
SITUATION: pt. has peptic ulcer & tried meds, but didn't work. what's the next step?
antrectomy procedure--removal of the antrium (gastric producing portion of lower stomach).
if an antrectomy procedure doesn't work, what else can be done?
vagotomy--removal of vagal innervation to the fundus (to decrease HCl acid).
if vagotomy procedure doesn't work, what else can be done?
[total] gastrectomy--removal of part/all of stomach.
SITUATION: pt. had partial gastrectomy, ate 1 hr after surgery, & is now cold, clammy, pale w/ low BP. what does pt. have?
what are nursing considerations for dumping syndrome?
provide 6 sm. meals(high-fat & protein, low-moderate carbs takes longer to produce chyme & less dumping) = less bulk & weight in stomach = less dumping.
instruct pt. to eat slow in reclined position(& to lie down after meal).
advise to avoid fluids [milk]/sweets/sugars during meals.
what can cause dumping syndrome?
any kind of surgery [bipass] on stomach.
UPPER GI BLEEDING: what is hematemesis?
vomiting of fresh/bright red blood.
UPPER GI BLEEDING: what color would vomit be if blood has stayed in stomach for a while?
black-coffee ground color.
UPPER GI BLEEDING: what happens if bleeding moved into intestine?
[melena] black/tarry stool.
what drugs are used for mild pain?
NSAIDS(notorious for [painless] GI bleeding & black tarry stools).
what are some nursing considerations for GI bleeding?
provide meds [cox-2 inhibitor to protect mucous lining].
lab work [H&H--13-16 is normal, <7 = transfusion]
for what reasons would an NG tube be used?
decompression--removes secretions for distention (before/after surgery).
[gavage] feeding--liquid nutrition.
compression--balloon inflated to prevent hemorrhage.
[lavage] low-intermitten suction--irrigation for bleeding, poisoning/gastric dilation.
SITUATION: pt. had subtotal gastrectomy for stomach cancer & now has a prob. w/ dumping syndrome. what foods from the following are allowed?
peanut butter & bread.
waffles & syrup.
peanut butter but w/ no bread.
no waffles & syrup.
no cold cereal.
SITUATION: pt. has peptic [duodenal] ulcer. what kind of pain does pt. have & when does it occur?
gnawing, sharp & burning epigastric pain(similar to hunger).
increased pain when stomach is empty.
SITUATION: pt. has gastroenteritis [inflammation of intestines in stomach] & now has diarrhea. after prolonged vomiting & diarrhea [causes metabolic acidosis], what should you be concerned about & what should you assess?
postural VS(lying, sitting, & standing).
elevated pulse, BUN level.
pt. may have fever.
what kind of isolation would pt. be put in for vomiting/diarrhea?
if pt. is on contact isolation, what precautions are needed?
PPE--gowns, gloves, masks, shoe covers.
SITUATION: pt. comes in w/ ulcerative colitis, anticipate pt. c/o what?
weight loss(from diarrhea).
foul smelling stools.
recurrent bloody stools containing pus & mucus (15-20 per day).
w/ ulcerative colitis & Chron's disease, what should you pay close attention to?
what kind of diet would pt. w/ Chron's disease have?