H&I 3

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Author:
mowgli
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208057
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H&I 3
Updated:
2013-05-09 03:58:13
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GI d/o
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  1. Factors affecting GI
    • malnutrition
    • obstruction
    • pathological conditions
  2. What are some factors that cause discomfort in the GI?
    • inflammations,
    • decrease blood supply,
    • visceral type pain,
  3. Some factors that cause GI issues
    • infection
    • chemical trauma
    • defects
    • stress
    • Gi bleeding
  4. Actions to prevent GI issues
    • lower stress by
    •   exercise,
    •   relaxation techniques
    •   imagry
    •  
  5. What will people with increased gastric secretionis (esp hydrocloric acid) get?
    ...heartburn
  6. Will develop ulcers
  7. GI inflam proces cuases mitory
    scarring which causes obstruction if get enough scarring
  8. Why should you check the foods of people with Gi issues
    irritating foods should be avoided
  9. tests for GI p986
    • x-ray
    • upper lower gi tract study
    • lab  CBC, etc
    • breath test (for carbohydrates absorption.)
    • stool test
    • EGD
    • gastric analysis
    • abdominal ultrasound
    • Barrium
    • DNA
    • gastric analysis
    • •MRI’s.
  10. Lab studies for GI
  11. •CBC –
    look for infection, or bleeding
  12. What kind of obstructions can you have in GI tract?
    • mechanical
    • chemical
  13. CBC – look for infection, or bleeding
    • evaluate carbohydrate absorption
    • detects presence of helicobacter pylori-bacteria
  14. GI stool tests

    types of studies
    look for abn stools esp in  loose stools

    • Closridium difficile
    • fecal leukocytes
    • calcultation of stool
  15. What do you usually want in a ova or parasite stool test?
    • 3 specimen have to go to lab w/in 30min
    • can also examine stools for lipids
  16. should be avooided 72 hrs prior blood occult blood test
    • -hemorrhidal bleeding
    • -re meats
    • -aspirin
    • -NSAIDS
    • =turnips/horesradish
  17. What should you do do when taking stool sample
    • instruct pt to avoid red meat for 3 days before testing,
    •  
    • no more than 30minutes must pass n to labs,
  18. ABD ultrasound
    • .detect enlareged gallbladder/pancreas
    • .presence of gallstones
    • .elarged ovary
    • .appendicities
    • .Dx acute colonic diverticulits
  19. Endoscopic ultrasonography
    • specialized
    • aids in diagnosis of GI disorders

    • eval
    • barretts esophagus
    • portal hypertension
    • chronic pancreatitis
    • suspected pancreatic neoplasm
  20. What kind of obstructions can you have in GI tract?
    • mechanical
    • chemical
  21. GI abdominal ultra sound test
    endoscopic ultrasonography
  22. GI DNA test
    look for high risk
  23. What do Radiographic GI test look at
    • x-ray flate plane of abd
    • upper & lower barrium
  24. what do Radiographic tests look for
    • abn growth
    • polyps
    • obstructions
  25. What are some precaustions for radiograph tests?
    • NPO right before & 6-8 hr prior
    • clear liquids night prior
    • after test want to get rid of barrium
    •   -will crystalize
  26. why do you want to get rid of barrium after test

    How
    will turn into a rock

    • increase liquids to 12 8oz glasses of water for several days prior
    • lots of fluid after
  27. What will barrium do to stools
    turn them white
  28. How do you admin Barrium?
    • w/ lower-emema (get go lightly night before)
    • w/upper- drink

    w/ lower GI low residu diet up to 2 hrs
  29. What is TPN
    • treatment for GI problems
    • nutrients given IV

    hyperglycemia must be filtered & IV pump
  30. how soon does go lightly work
    w/ in 1 hr
  31. Where must TPN be formulated

    What does it have
    in pharmacy

    dextros/aminos/ fats/lipids/
  32. What is TPN used for
    who can give it
     
    undernurished

    only RN's can give
  33. important to know w/ TPN
    • no piggy backs
    • no interuption unless spec written order
    • w/TPN stat slowly- start rate slowly
    • when on TPN may be on insulin-has dextrose
    • slowly wean off to prevent hypoglycemia
    • can be given in central line
  34. Labs for TPN
    • albumin
    • CBC
    • platlets
    • TPP
  35. What does Anorexia mean
    lack of appetite
  36. should you worry about anorexia
    • no unless prolonged
    • affecting their system
  37. What are the differant types of anorexia
    • Eposotic-caused by certain thing
    • transient-come and go
    • Chronic-when you worry
  38. What is physical Anorexia affected by
    • GI/liver problems
    • inflammatory d/o
    • severe pulminary disease
    • uremia
    • CVA
    • poor oral hygine
    • distended
    • meds-ex amphetamines, antihist
  39. psyc factors of anorexia
    • fear
    • anxiety
    • depression
    • things that are offensive (ex oders, etc, conversations)
    • anything unpleasant
  40. What does prolonged anorexia lead to
    • malnutrion
    • electrolye imbalance
  41. What does med management of anorexia focus on
    • treating underlying cause
    • may need supplimental feeding or TPN
  42. What nurse care do you give anorexic
    • really good Hx
    •  -when started
    •  -cause
    •  -general appearance
    • check for wt loss
    • observe for s/s of malnutrition
  43. What is healthy general appearance
    • bright eyes
    • good muscle tone
    • shiney hair
    • non brittle hair/skin

    eating patterns, relationship to nutrition
  44. what type labs does malnutrition cause
    albumin  & lymphatics go down
  45. how many calories should adults eat
    no less than 15,000 cal /day
  46. What nursing intervention for anorexia
    • talk w/ DR/nutrionialist/famly/pt
    • try to find cause
    • get DR order & find out what they like & get out sides food
    • food should be attractive
    • encourage eating when feel hungary
    • food is important exp w/ underlying problems
  47. What causes anorexia nervosa

    how do they see themselves
    • often peer pressure
    • think they are fat when are slim
  48. when is anorexia nervosa a pathological problem
    only when starts to effect body

    have morbid obsessioin w/ weight and eating
  49. who has highes insidence of anorexia nervosa?
    females 12-18

    seen a lot in upper class
  50. what do people w/ anorexia nervosa do?
    • use differant way to stay thin
    • perge
    • over exercise
    • after a while stop eating
  51. What is Bulemia Nervosa
    • distorted image
    • increase use of laxitivs
    • binge
    • perge
  52. when do problems start w/ Bulemia nervosa
    when start purging/binging
  53. what problems assoc w/ Bulemia Nervosa?
    • losse electrolytes
    • prob w/ starvation
  54. What is Hiatal hernia  [1012-1013
    protrusion of portion of stomach through esophogial ring

    part of upper stomach move into lower portion of thorax
  55. how do you fix Hiatal hernia p
    nesal fundalplication
  56. What can Hiatal hernia cause
    • GERD
    • discomfort
    • regergitation
    • dysphagia
    • 50% + asymptomatic
  57. how is Hiatal Hernia Dx
    • x-ray
    • barium swallow
    • fluoroscopy
  58. What can cause hiatal hernia
    • obesity
    • pregnancy
    • cough
    • vomit
  59. 2 types hiatal hernias
    • sliding-most common 90%
    • rolling (paraesophageal)
  60. Sliding hiatal hernia
    • upper stomach and gastroesophageal junction displaced upward
    • --slide in and out of thorax

    most common
  61. Paraesophogeal hiatal Hernia
    all parts of stomach gets pushed through he diaphram beside the esophagus
  62. s/s of sliding hiatal hernia
    • 50% asymptomatic
    • heartburn
    • acid reflux
    • belching
    • difficulty swallowing
    • lowered motility
  63. s/s paraesopogeal hiatal hernia
    • no reflux
    • often no s/s

    many complain of fullness
  64. how do you Dx hiatal hernia
    • Hx of symptoms
    • once prob determained -treat symptoms
  65. How do you treat hiatal hernia
    • symptoms
    • elevate HOB @ least 6in to reduce
    • meds-H2 blockers-release hydorchloric acid
  66. Diet for hiatal hernia
    • bland
    • should eat @ least 1 hr before bed
  67. cause of GI bleeding
    can occur from any part of GI bleeding
  68. what are most common areas for GI bleed
    • upper-stomach
    • lower-jajunim/ colon/ rectum illium
  69. when dose chronic GI bleed
    over wk/mo
  70. What does blood color in stool tell
    how old/ from where

    • coffee ground color-old
    • bright red recent -outside hemroid
  71. what can GI bleeding be
    • acute or chronic-depending on underlying problem
    • reacurring or
    •  intermittent
    • persistant
  72. Pacreatitis
    most common cause of chronic
  73. s/s of gastritis
    • belching- can be long term few hrs to few days
    • heartburn after eating
    • sour taste in mout
  74. dx gastritis
    • upper gi xray series
    • endoscopy histologic exam of tissu
  75. Tx gastritis
    • refrain from alcohol & food till symptoms subside- usually few days
    • nonirritating diet
    • IV fluids

    antacids

    • NG intubation
    • analgesic
    • sedatives
    • fiberoptic endoscopy
  76. Leukoplaka
    • b/w gum & cheek white
    • irritated tongue
    • slow sore healing
    • pailess leasions w/ raised edges
  77. higher risk of esophogial CA
    • males
    • highest in af am
  78. esophogial CA s/s
    • susternal neck/back pain
    • late s/s -hiccup
  79. Gastric CA

    classic s/s
    next to bone causes lots of pain

    • high risk af am male over 70 yrs
    •   also seen in ppl under 40yrs
    • starts in mucosa


    pain above umbilicus-Dr have to r/o 1st
  80. iritable bowel disease
    Crohn's & ulcerative cholitis

    both get ulcer saffecting mucosal lining

    • unknown cause
    • attack usually under stress (phy/Psy)

    usually in young adults b/w 15-30 &.70yrs
  81. S/S of Crohn's & ulcerative colitis
    similar in both differance where occur

    • small intest-abd tenderness, pain, cramp
    • colon: -inflam , abd cramp, rectal bleeding, diarrhea w/ mucus
    • inflamed red eyes
    • will loss wt
    • fever
    • night sweat
    • arthritis
    • abn liver func
  82. Crohn's
    subacute & chronic infalmation of GI tract wall-extends through all layers

    • no cure get remmision
    • deeper lesions separated by good tissue
    • seen more often in smokers
    • linked to autoimmune response

    • can occur throughout GI tract
    • most common occurance in distal ileum & ascending colon
  83. Crohn's seen more in
    famales
  84. s/s of Crohn's
    • has periods of remission and exacerbation
    • begins w/ edema & thickening of mucosa
    • ulcers start to show
    • can form ulcer or lesion
    • get scarring from tissue break down

    • have areas of lesions separated by good tissue
    • hyperactive LUQ bowel sounds
  85. Crohn's s/s w/ area involvement
    • if stomach involve-n/v
    • small intestind- abd tender, pain , cramp
    • colon-inflamed / abd cramps, rectl
    •  bleeding, diarrhea, w/ mucus
  86. complications of Crohn
    • fissure
    • absess
    • fistula
    • be carrful what eat
    • high risk of colon CA
    • electrolte imbalances
    • cause scaration
    • protein in blood not absorped
  87. Dx Crohn's
    • enoscopy, colonoscopy, intestinal biopsy
    • barium enema=show ulcerations/fissure/fistula
    • CT-show bowel wall thickening & fistula formation
    • H&H -excess bleeding/anemia
  88. tx crohns
    • reliev symp-steroids
    • iron supp
    • surg if indicated-last resort

    steroids if severe
  89. Ulcerative Colitis
    • similar to Crohns
    • dev ulcers
    • high incidence in Euro Jews
    • affects superficial mucosa of colon
    • multiple ulcers
  90. s/s of colitis
    • shedding of colonic skin
    • bleeding from ulcerations
    • most will have bloody diarrhea

    complication- up colon CA
  91. ulc colitis lab
    serum albumin, skin lestion, liver involvement
  92. tx ulc colitis
    • surgery last resort
    • avoid iritating food
    • colonstomy will cure colitis not chrones-w/ crohns lesions alwayscome back
  93. ulcer colitis/chrons diet
    • low residue
    • low fat
    • high protein
  94. Appendicitis
    inflimation fo veriform appendis
  95. cause of appendicitis
    • pouch fills up
    • food ferments->bacteria ->bacteria can sread outside of appendix ->
    • opening becomes blocked
    • blood becomes blocked -can only stretch so much then rupture
    • can dev paritinitus
  96. s/s of appencicitis
    • LRQ pain
    • classic-reffered pain rebound pain
    • mimic flue like syp
  97.  Mick Burny's point
    • b/w naval & illiac crest
    • up temp
    • n/v legs flexed toward bed
    • can't straigten R leg b/c of pain
  98. Dx appendicitis
    WBC steadily go up >1500
  99. Tx Appendicitis
    appendectomy
  100. Peptic Ulcer
    • more common in duodemum
    • in pt 40-60yrs
    • loose/destroy mucus layers
  101. peptic ulcer causes
    • h Pylori-gram neg bact-mostly seen in elderly
    • transmitted
    • genetics
    • oral/fecalshock /burn/trauma
  102. s/s of peptic ulcer
    • worse w/ spicy foods
    • epigastric burning1-2hr after meal
    • n/v
    • anorexia
    • wt loss
    • some pt get cramping 2-4 hr after meal
    • pain usualy under xyphoid process
  103. Tx peptic ulcers
    • drugs for H-pylori
    • h2 blockers
    • antagonists
    • proton pump inhibitors
    • antibiotics

    • bland diet
    • freq small feedings , lower stress, no skip meals
  104. billroth I  surg
    subtotal gastroectome remove lower stomach attach to jejunum

    for tumor removal
  105. Billroth II
    • 50% stomac removed
    • lower stomace used spec for duadernal
  106. 50% stomach left
    for dumping syndrom, malabsorptionremove tumore
  107. Dumping syndrome
    • w/ gast surgery
    • stomach empty's too fast goes into dueodemum
    • lasts20-60 min
    • can occure after/during meal
  108. s/s of dumping syndrome
    • weak
    • ,faint,
    • tachycardic,
    • reactive hypoglycemia (3-4hr after meal)-tx w/orange juice / simple sugar
  109. Tx dumping syndrome
    • diet low carb
    • high proteing
    • mod fat
    • liquid 1hr prior/after meal
    • resting high fowlers 20min after meal
    • simple sugar than recheck
  110. Colectomy
    remove diseased coloncolectomy

    for temp - use accending & transvers

    colon ostomy becomes functional in  3-5 days
  111. colonostomy secretion
    • ascending-liquid
    • transvers liq-semi solid
    • descending-soft formed stools

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