Final GI 1

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kbryant86
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264086
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Final GI 1
Updated:
2014-02-26 13:30:31
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adults
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adults final 1
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  1. esophagus dx:
    2 types
    nsng care
    esophageal acidity= should be more basic than stomach

    esoph manometry= looks at motility

    • care:
    • npo
    • assess meds that may influence test such as PPI, H2, ant-acid, etc.
  2. Esoph and stomach dx:
    type
    nrusing care
    Barium swallow "upper GI series"= allows GI to be xray'd

    • care:
    • npo
    • drink chalky barium
    • no meds 8 hrs prior
    • post exam= constipation, inc fluids, white stools possible
  3. EGD
    esophagogastroduodenoscopy
  4. EGD nrsng considerations

    what is normal?
    • informed consesnt
    • npo
    • conscious sedation
    •  - safety issues
    •  - watch for return of swalling and gag reflex before eating

    nl= belching, bloating, flatulence
  5. what is abnl for an EGD
    • difficut swallowing 
    • epigastric, substernal, should pain
    • vomit blood or black tarry stools
    • fever
  6. types of stomach dx

    nursing care
    gastric analysis

    • care;
    • NG tube
    • NPO
    • assess meds
  7. what is normal for listening to the bowel
    sounds ever 5-15 seconds
  8. borboygmus
    high pitched, hyperactive bowel sounds

    indicates the onset of an obstruction and is associated with diarrhea
  9. stomatitis
    inflammation of the oral musoca
  10. causes of stomatits

    S & Sx
    • causes:
    • viral of fungal - thrush
    • mechanical trauma - cheek biting
    • irritants - smoking
    • impaired immunity
    • long term NPO

    • Sx= oral mucositis - ulcer like area
    •  =thursh
  11. Tx of stomatits
    • meticulous oral hygeine
    • comfort with saline or Na bicarb based mouth wash
    • meds;
    • oral anestheics
    • topical antifungals
    • antiviral angents
  12. GERD
    backward flow if gastri contents into the esophagus

    generally the lower esophogeal sphincter is the issue
  13. 4 contributing factors for GERD
    • transient relaxation og the LES
    • incompetent LES
    • Increased pressure in stomach
    • hiatal hernia
  14. complications of GERD
    • esophagitis
    • superficial ulcers
    • esophageal strictures
    • barrets esoph = pre-cancer state
    •   = cells morph in through to withstand stomach acid
  15. GERD S & Sx
    • heart burn
    • pain after eating
    • dysphagia
    • regurgitation
    • belching
    • chest pain = rule out things like MI, PE, and AAA
  16. GERD Dx
    • barium swallow "upper GI series"
    • EGD
    • esoph gastric acidity  -  24 hours ambulatory acid monitoring
    • esoph manometry
  17. GERD meds list 1-4
    • PPI (prazoles)
    • H2 receptor blockers (tidines)
    • antacids
    • metoclopramide (Reglan)
  18. PPI for GERD: nrsing considerations
    • monitor for liver fnct
    • encourage pt to stop smoking b/c it increases stomach acid
  19. H2 receptors blockers (tidines) nsing considerations
    • monitor platelet fnct
    • IV considerations include give slow to avoid HypoTN and dysrrhythmia
  20. antiacid nsing considerations and pt education
    • interfere w/ absorp of other drugs
    • monintor for possible e.lyte imbalance

    • pt edu= take the full course of therapy
    •  = take 1-3 hrs after meals and @ bedtime
    •  = 2 hrs before & 1 hr after other meds
    •  = report diarrhea or constipation
  21. Reglan

    nsing considerations and pt education
    increase motility @ the CNS level

    • monitor for extrapyramidal SE (involuntary twitching)
    • avoid in certain pts with diarrhea, GI bld, obstruction
    • Give PO 30min before meals and at bed time

    • edu= CNS depression
    •  = report involuntary mvt of eyes, face, limbs
  22. Pt education about GERD
    • avoid tomatoes, spicy food, ETOH, fatty acids
    • healthy weight
    • small, frequent meals
    • stop smoking and wearing tight clothes
  23. Surgical Tx of GERD 1-2
    • lap fundoplication
    • nissen (open) fundop
  24. 2 types of hiatal hernia
    sliding (most common) = hernia slides up into esoph

    paraesophageal = hernia is beside the esoph in the throat
  25. Hiatal causes are unknown, but the contributing factors are the same as GERD
    Hiatal causes are unknown, but the contributing factors are the same as GERD
  26. S & Sx of HH
    most are asymptomatic but if present, similar to GERD + the feeling of being "full"
  27. HH Dx and Tx
    • Dx= barium swallow
    •  = endoscopy

    • Tx= conservative therapy same as GERD but with caution for lifting and straining
    • Nissen fundoplication
  28. Gastritis

    types
    inflam of stomach lining

    • acute
    • erosive
  29. acute gastritis
    • benign, self limiting
    • disruption of mucosal barrier by local irritant
  30. chronic gastritis
    • stress induced
    • Ischemia of gastric mucosa from SNS vasoconstriction
    • progressive and irreversible changes in gastric mucosa
  31. S & Sx gastritis
    • anorexia
    • N/V
    • hematemisis
    • melena = black tarry stool
    • abd pain

    Erosive= initial symptom is painless gastric blding
  32. Type A vs B chronic gastritis
    • A= autoimmune
    • antibodies to parietal cells and intrinsic factor

    • B= MOST COMMON
    • H.pylori
    • inflamm of mucosa
    • outer layer of mucosa thins and atrophies
  33. S & Sx of gastritis
    • vague gastric distress
    • -discomfort/heaviness after eating
    • -not relieved w/ antacids

    • fatigue
    • -due to pernicous anemia
  34. Dx gatritis

    Tx
    • gastric analysis
    • H/H, RBC
    • serum B12
    • EGD

    • Tx= meds to prevent/Tx H.pylori
    •  = NPO for 6-12 hrs for ACUTE then advance as tolerated
  35. PUDS = peptic ulcer disease

    2 types
    • break in mucose lining of GI tract
    • chronic health issue

    • duodenal
    • gastric
  36. duodenal ulcers

    gastric ulcers
    • d= most common
    • =men > women

    g=smokers and chronic NSAID users
  37. PUD patho
    • disruption of mucosal barrier
    • inflamm process but gets out of control...
    • erosion and ulcer formation
  38. risk factors
    • h.pylori
    • nsaids, etoh, asa use
    • age
    • Hx of ulcers
    • smoke
  39. PUD Dx
    • barium swallow
    • EGD
  40. PUD S & Sx

    Tx
    • PAIN!
    • -gnawing, burning, aching
    • -epigastric
    • -occurs w/ empty stomach but subsides when eating

    • Tx= MEDS
    • -PPI
    • -H2 recep blocks
    • -mucosal protectants
    • -antacids
  41. PUD complications
    • hemorrhage
    • -stabalize circulation w/ fluid
    • -NG tube inserted
    • -EGD scope used to inject meds

    • gastric outlet obstruction
    • -stenosis of pyloric sphincter
    • -NG
    • -balloon dilation
  42. Perforation S & Sx
    • severe abd pain unrelenting even w/ meds
    • rigid abd
    • absent BS
    • fever
  43. PUD Tx
    • IV fluid
    • NG suction
    • semi-fowlers
    • IV antibiotics
    • surgery
  44. ULCER PERFORATIONS LEADS TO PERITONISITS
  45. Stomach CA patho
    • adenocarcinoma
    • begins localized then progresses to mucosa, then mets to liver, lungs, ovaries, and peritoneum
  46. S & Sx of CA
    • fullness
    • anorexia
    • indigestion
    • vomit
    • pain pc, no response w/ antacids
    • wt loss
    • abd mass
    • cachexia= apperas emaciated
    • heme in poo
  47. Dx of CA
    • CBC-anemia
    • UGI seris-visualie
    • upper endoscopy-visualize and bx
  48. Tx of CA
    • surgery prior to mets
    • radiation/chemo
    • palliative care
  49. complications of CA
    • dumping syndrome= food bolus pulls fluid into abd, inc. production of insulin, dec of bld glucose
    • anemia- iron or pernicious
    • folic acid deficiency
    • Ca and Vit D malabsorption

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