N120 Midterm Review + Week 4

GI

Term for overstretching or partial tearing of a tendon

strain

This IV fluid is used when the pt next bag of TPN or PPN isnt ready yet

10% Dextrose

The nurse knows this is the highest priority in pts with an exacerbation of UC or Chron’s disease

fluid and electrolyte balance

Before administering Furosemide, the nurse knows to check the pt’s — and —

BP and potassium levels

This condition may be treated with insulin, dextrose, albuterol, and Kayexalate

Hyperkalemia

This electrolyte imbalance potentially leads to cerebral edema and neurological changes

Hyponatremia

This term refers to fatty or oily stools, such as may be found in pts with Crohn’s disease

Steatorrhea

This GI anti-inflammatory medication may cause harmless yellow-orange discoloration of the skin and body fluids

Sulfasalazine

The nurse would anticipate the doctor ordering this test in a pt experiencing ascending muscle weakness/paralysis

Electrolytes/Potassium/BMP/CMP

The presence of — and — on a urinalysis is highly suggestive of a UTI

leukocyte esterase and nitrites 

This is rapid, deep breathing with a distinct odor, commonly associated with hyperglycemia in a T1DM

Kussmaul’s respirations 

In a pt with a gastric ulcer, the nurse would look for this sign to indicate the ulcer was bleeding 

Melena or hematemessis

The nurse would monitor for — and — as potential indicators the a pt with an infection is going into septick shock 

tachycardia and hypotension

This condition should be suspected if there is a sudden onset of dyspnea in a pt with a fracture

Fat embolism

A urea breath test is used to detect this bacteria in pt with a peptic ulcer

H pylori

The nurse would educate a pt to report red urine to their provider, unless they were taking this medication

Phenazopyridine/Pyridium

One of the actions of Aspirin, for which it is commonly prescribed in cardiovascular disease

decrease platelet aggregation

This body structure fails to prevent the reflux of acid from the stomach in pts with GERD

Lower esophageal sphincter

Term for maroon discoloration over intact skin from prolonged blood vessel compression

Deep tissue pressure injury

This type of nurse handles sterile equipment and helps with the sterile field in the OR

scrub nurse

Patients taking Nitrofurantoin should be warned about their urine turning this color

Dark brown

This anesthesia medication is contraindicated in pts with allergies to egg and soybeans

Propofol

An unconcious diabetic pt with an IV would be given this medication

50% dextrose 

This is the cutoff for diagnosing diabetes with a fasting plasma glucose test

126 mg/dL

The 6Ps are use when assessing for this condition

Compartment syndrome

Ulcerative collitis is isolated to

the large intestine

what happens in the small intestine

protein, carb, and fat breakdown

what happens in the large intestine 

fluid and electrolytes are absorbed, and feces are formed

assessment of the GI system

• weight gain/loss

• I&Os

• activity/ADLs

Enteral Nutrition

• G tubes

• PEG tubes 

• NG

enteral nutrition complications

• dislodgement

• infection

if feeding solution is refrigerated, allow to warm to room temp for how long

1 hour

this is usually ordered with the enteral feedings

sterile water

how to prevent aspiration during and after enteral feeding

HOB 30-45 while feeding and for 60 min afterwards

Nasogastric Tube 

A hollow tube inserted through the nose into the stomach, used for feeding or suctioning. 

short term

how to confirm pacement of NG tube

gastric aspirate (acidic)

x-ray, the best one 

if residual is >100 mL in the stomach

hold the feedings and notify provider

Parenteral Nutrition

• PPN (Peripheral or Partial)

• TPN (Total)

PPN

given through a peripheral IV

TPN

given through a central line

Parenteral Nutrition indications

• bowel rest

• have absorption issues

• severely malnourished 

what is the dextrose content cutoff for PPN

10% dextrose

higher than 10% dextrose content will be given through the —

central line

PPN and TPN feedings are only good for

24 hours

Gastroesophageal Reflux Disease

• reflux of acid and enzymes from the stomach up through the lower esophageal sphincter and into the esophagus, causes irritation and possibly damage over time

• increased by lying supine, straining, obesity, smokin, hiatal hernia

GERD S/S

heartburn, epigastric pain, dyspepsia, regurgitation, coughing, sore throat, dyspnea 

Barrett esophagus

precancerous lesions in the esophagus resulting from chronic gastroesophageal reflux disease (GERD).

Food that exacerbate GERD

• alcohol

• chocolate

• peppermint

• caffeine

• fatty foods

• spicy foods

• citrus

• anything eaten too close to lying down

  • eat 2-3 hours before bed

Meds that exacerbate GERD

anticholinergics (Atropine, Scopalamine)

NSAIDs

Beta blockers and calcium channel blockers (relax the lower esophageal sphincter) 

Opioids and benzodiazepines 

• use tylenol instead 

Laparoscropic Fundoplication

A minimally invasive surgical procedure that strengthens the lower esophageal sphincter to prevent acid reflux, often used to treat GERD.

Medications for GERD

• proton pump inhibitors

• histamine H2 receptor blocker

when is the best time to take an antacid

1-3 hours after eating and before bedtime to maximize effectiveness.

dont take antacids within 2-3 hours of other PO meds

true

Proton pump inhibitors

Omaprezole, Pantoprezole

• used to decrease stress-related ulcers and for conditions that benefit from decreased gastric acid secretion

Histamine H2 receptor blockers

Cimetidine, Famotidine 

• stops stomach acid production

• usually taken with meals and at bedtime 

Ulcerative Colitis 

• limited to the colon

• inflammation and ulceration of the mucosal layer

• continuous 

• minimal malabsorption 

• rectal bleeding, bloody diarrhea (Melena) 

• LLQ abdominal pain “less crampy”

Crohn’s Disease 

• entire GI tract (mouth - anus)

• inflammation of all layers of the bowel wall 

• patchy/cobblestone 

• Malabsorption = weight loss 

• Steatorrhea (fatty oily poop)

• RLQ abdominal cramping pain 

IBD diagnostic studies

• CBC 

• WBCs

• Fecal occult blood 

• transabdonimal ultrasound, CT, MRI

• double contrast barium enema

• Colonoscopy with tissue biopsy 

Double contrast barium enema

A diagnostic imaging procedure that involves filling the colon with barium and air to provide clear X-ray images, helping to identify abnormalities in the large intestine.

IBD goals of treatment

• correct F&E and nutrient imbalance

• bowel rest

• control inflammation 

• treat infection 

• alleviate stress

• manage s/s

• improve quality of life

• reportable s/s (bowel obstruction/vomiting)

dietary consult after the bowel rest

true (high protein, high cal, low fiber, and avoid alc and caffeine)

Sulfasalazine

• reduces inflammation of the intestinal mucosa

• S/S: nausea, fever, rash, yellow-orange discoloration of skin, urine, and contacts

Corticosteroids

• reduces inflammation

• never stop abruptly, must be tapered 

Immunosuppressants 

• Azathioprine, Cyclosporine, Methotrexate 

• SE: low WBCs (increases risk of infection)

• avoid large crowds 

Dipehnoxylate and atropine (Lomotil)

Loperamide (Immodium)

• used to reduce f&e loss due to diarrhea 

Metronidazole

antibacterial and anti-protozoa

Gastritis

inflammation of the inner tissue lining of the stomach that causes integrity of the gastric mucosal lining to be infected 

Gastritis Risk Factors

• older adults

• h pylori

• alcohol

• food poisoining 

• smoking

• long term use of NSAIDs

• stress 

• spicy fatty fried foods

Gastritis S/S

• heartburn

• dyspepsia (indigestion)

• belching

• abdominal pain and bloating

• anorexia

• N/V

Esophagogastroduodenoscopy (EGD)

used to diagnose gastritis under consious sedation

Gastritis treatment

• directed at the underlying cause

• antibiotics for infection

• decreased used of NSAIDs, alc, smoking

• diet change

• Antacids, PPI, H2 blockers

Peptic Ulcer Disease (PUD)

a wound in the lining of either the stomach or duodenum

PUD risk factors

• h pylori infections

• long term use of NSAIDs

• smoking, excessive alcohol use, family history, and stress

PUD s/s

• burning pain often after meals and at night

• N/V

• bloating

• weight loss

• blood in stool/vomit

H pylori diagnostic tests

• urea breath test

• fecal antigen testing

• rapis urease test