GI EXAM

_________ is a diagnostic test used to visualize the upper GI areas including esophagus, stomach, and small intestine.

Esophagogastroduodenoscopy (EGD)

What are the nursing interventions for before an EGD?

npo 6-8 hours

remove any nonpermanent objects in mouth

suppress gag reflex

What are the nursing interventions for after an EGD?

check gag reflex, vitals, resp status, education, clear liquid diet, IVF

______ is a potential complication of EGD and it is a medical emergency. It is characterized by severe excruciating retrosternal pain.

Esophageal perforation

What should be done if patient experiences esophageal perforation during an EGD?

get a CT and take them back to surgery

What is the #1 diagnostic test for accuracy in diagnosing GERD?

Esophageal pH monitoring

_______ is a diagnostic test where patient is made to swallow 3 small tubes that monitor the pressure readings of the lower esophageal sphincter, pH levels and peristaltic activity

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Esophageal manometry

_________ is a diagnostic test where patient ingests barium, then x-rays are completed to determine structural abnormailities

barium swallow

What is important to do to the barium container before a patient begins ingesting it for a barium swallow?

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mark the container to monitor how long it takes to drink it before procedure

___ is a condition in which gastric enzymes back flow into the esophagus and stomach

GERD

What are the signs and symptoms of GERD?

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dyspepsia

radiating pain

heart attack symptoms

pyrosis

pain with swallowing

dental caries

throat irritation

increased flatus and eructation

chest congestion

What type of recurrent infection is likely in patients with GERD?

respiratory, sinus

What are the risk factors for GERD?

obesity, age, sleep apnea, NG tube

What are some irritating foods that may contribute to GERD?

fatty

fried, or spicy foods

chocolate

citrus

tomatoes

caffeination

peppermint

carbonation

alcohol

What are some health promotion tips for patients with GERD?

maintain BMI 30 or less

avoid smoking alcohol/tobacco use

proper diet & no eating or drinking 2 hours before bed

avoid constricting clothes,

elevate HOB

Which medication for GERD reduces gastric acid?

Proton Pump Inhibitors (omeprazole)

Which medication for GERD reduces gastric acid and protects the mucosa?

antacids

Which medication for GERD suppresses gastric acid and lowers hydrogen ions?

Histamine Receptor Antagonists

Which medication for GERD controls nausea, vomiting by blocking dopamine and serotonin receptors increasing GI motility, and controls the tone of the lower esophageal sphincter

prokinetics

_____ is the utilization of radio frequency energy by an endoscope to decrease vagus nerve activity causing the LES muscle to contract and tighten.

Stretta Procedure

_________ is a surgical procedure in which the fundus of the stomach is wrapped around and behind the esophagus laproscopically to create a barrier.

Fundoplication

What are interventions apply for Fundoplication?

eat 4-6 small meals daily, raise HOB, NPO then clear liquid then soft GI for one week

_______ is a possible complication of Fundoplication that is a premalignant tissue or malignant tissue forming on the esophagus

Barrett's epithelium/ esophageal adenocarcinoma

Which type of hernia is characterized by part of the stomach and esophageal junction moving above the diaphragm which may result in GERD symptoms and heartburn?

sliding hernia

Which type of hernia is characterized by the fundus moving above the diaphragm but the esophageal junction remains below the diaphragm in which the patient may feel suffocation, SOB, fullness, and chest pain?

Paraesophageal hernia

What are diagnostic procedures for hernias?

barium swallow, EGD, CT scan of chest with contrast

Which medications can be given for hernia?

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antacids, PPIs

Which types of therapeutic procedures can be done for hernias?

Laparoscopic Nissen Fundoplication, Fundoplication

___ is a complication that results in twisting of the esophagus or stomach

volvulus

_____ is a complication of GI surgery that is characterized by blockage of food.

obstruction

____is a complication of GI surgery that is characterized by lack of blood flow to portions of the stomach

strangulation

________ is a complication of GI surgery from bleeding due to an obstruction

iron deficiency anemia

____ is erosion of the mucosa in the GI system including stomahc, esophagus, and or duodenum

peptic ulcer disease

What are some causes of Peptic Ulcer disease?

H. pylori

stress

NSAIDs

corticosteroids

family hx

tumors of the pancreas

type O blood

excessive alcohol consumption

chronic pulmonary or kidney disease

pernicious anemia

Zollinger-Ellison syndrome

What is Zollinger-Ellison syndrome?

rare condition characterized by gastrin-producing tumors in the duodenum and/or pancreas that lead to oversecretion of gastrin, which lead to gastric and duodenal ulcers

What are signs and symptoms of peptic ulcer disease?

dyspepsia, bloating, N/V, fullness, dull, gnawing pain, burning sensation, epigastric tenderness, hematemesis, melena, weight loss

If peptic ulcer progress they may lead to __________, which is a medical emergency in which patient will have rigid board-like abdomen, severe abdominal pain, sxs of hemorrhage.

perforation/ hemorrhage

What should the nurse do if a perforation after peptic ulcer disease occurs?

prepare for a blood transfusion- 18 gauge IV, possibly multiple IV sites, apply oxygen, get H/Hct

____ is a complication of peptic ulcer disease that is characterized by full, weak, diaphoresis, palpitations, dizziness, and diarrhea.

dumping syndrome

_______ is a complication of peptic ulcer disease that is characterized by fullness, distention, nausea, emesis with undigested food in it.

Pyloric obstruction

What are the symptoms of gastric ulcers

pain 30-60 minutes after meal

pain during DAY exacerbated by food consumption

malnourished

hematemesis

What are the symptoms of duodenal ulcers?

pain 1.5-3 hours after meals, pain during NIGHT, relieved by food consumption, well-nourished, melena (bloody stool)

When giving antibiotics for peptic ulcers, what risk if present that the nurse should be on the look out for?

c. diff

What is important to know about a Blliroth II procedure?

do not manipulate NG tube, call doctor if NG tube needs to be adjusted/ moved

What is a vagotomy?

surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion for peptic ulcer relief

What is nonerosive gastritis caused by?

infections such as H. pylori

What is erosive gastritis caused by?

NSAIDS, alcohol, radiation

Describe acute gastritis.

\n sudden onset, short time frame, caused by indigestion or an erosive substance

Describe chronic gastritis.

developed over time due to autoimmune disease, pernicious anemia, and H.pylori

What should nurses teach patient to administer if they have gastritis?

IM b12 injections

What are symptoms of gastritis

bloating

distention

hematemesis

melena

anorexia

gastric hemorrhage

pernicious anemia

spicy food intolerance

dyspepsia

abd discomfort

indigestion

HA

hiccups

burning

N/V

weight loss

poor appetite

Which labs would be ordered for Gastritis?

CBC, blood and stool antibody antigen test, C13 urea breath test

Which BMI is defined as being morbidly obese?

40 or greater

Which diseases does morbid obesity increase the risk for?

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\n diabetes, CAD, HTN

_____ is a weight loss medication utilized to block the fat consumed

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Orilstat (Xenixal or Alli)

______ is a serotonin 2C receptor antagonist, believed to decrease the consumption of food by causing a feeling of fullness, used for weight loss

Lorcaserin (Belvia)

________ aids in the release of catecholamine in the hypothalamus reducing appetite

Phentermine (topiramate)

What are pre-procedural nursing interventions for weight loss surgeries?

proper education of the procedure along with counseling and education r/t diet and exercise

What are post-procedural nursing interventions for weight loss surgeries?

monitor for s/sxs of infection and hemorrhage, strict I&Os, follow specific ordered diet, monitor BS, assess and tx pain, along with continued education on diet and exercise

What are the possible complications of weight loss surgeries due to the constrictive mechanisms of the stomach utilized for the surgical procedures?

Dehydration, malnutrition

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?

"I'll eat frequent, small, bland meals that are high in fiber."

A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect?

dumping syndrome

The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan?

frequently monitoring hemoglobin and hematocrit levels, observing stools and vomitus for color, consistency, and volume, checking the BP and pulse rate every 15-20 minute

Which of the following is an age-related change in the esophagus?

weakened gag reflex

A client was diagnosed with pernicious anemia. Which vitamin cannot be absorbed without an intrinsic factor?

vitamin b12

What is the recommended order for performing an abdominal examination?

inspect, auscultation, percussion, palpation

The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor?

hemorrhage, perforation, penetration, pyloric obstruction

A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary?

“I'm so relieved to start this medication. I really don't like having to exercise or change what I eat.”

The nurse determines a client scheduled to undergo an abdominal ultrasonography should receive which instruction?

restrict eating of solid food for 6-8 hours before the test

As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene?

Evaluate the client's understanding of the procedure.

A nurse is caring for a client who is suspected to have developed a peptic ulcer hemorrhage. Which action would the nurse perform **first**?

Place the client in a recumbent position with the legs elevated.

A client has been scheduled for a urea breath test in one month's time. What nursing diagnosis most likely prompted this diagnostic test?

risk for impaired skin integrity related to peptic ulcers

The nurse reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included?

do not eat and drink at the same time

drink plenty of water from 90minutes after each meal to 15 minutes before each meal

avoid fruit drinks and soda

A client is admitted with a new onset of pyloric obstruction. What client symptoms should the nurse anticipate?

anorexia, nausea and vomiting, epigastric fullness

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A patient comes to the clinic with the complaint, “I think I have an ulcer.” What is a characteristic associated with peptic ulcer pain that the nurse should inquire about?

burning sensation localized in the back or mid-epigastrium

feeling of emptiness that precedes meals from 1-3 hours

severe gnawing pain that increases in severity as the day progresse

While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which interventions?

tell the client he shouldn't eat or drink for 6-12 hours before the procedure, inform the client that he will receive a sedative before the procedure

The nurse is working in a diagnostic testing unit focusing on gastrointestinal studies. For which testing procedure is the nurse correct to assess the gag reflex before offering fluids?

esophagogastroduodenoscopy

A nurse is caring for a client with a BMI of 35 kg/m2 who is wanting to lose weight. What is the initial recommendation the nurse will expect from the client's health care provider?

lifestyle modifications

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected gastrointestinal problem. The client reports gnawing epigastric pain following meals and heartburn. What would the nurse suspect this client has?

peptic ulcer disease

A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?

perforation of the peptic ulcer

A client with acute gastritis asks the nurse what might have caused the problem. What is a possible cause of acute gastritis?

dietary indiscretion

excessive alcohol intake

radiation therapy

A client who has occasional gastric symptoms is receiving teaching on how to prevent gastroesophageal reflux disease (GERD). Which statement indicates the client understands the teaching?

“I will eliminate bothersome foods from my diet.”

The nurse is providing care for a client whose peptic ulcer disease will be treated with a Billroth I procedure (gastroduodenostomy). The nurse should address which of the following topics when providing health education?

the procedure carries a risk for dumping syndrome, the client's vagus nerve may be altered

A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend?

smoking cessation

substituting decaffeinated products for all forms of coffee

avoidance of alcohol

following a regular schedule for rest

relaxation and meals

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement?

"I have learned some relaxation strategies that decrease my stress."

The nurse is preparing a client for magnetic resonance imaging (MRI) of the abdomen. Which statement by the client would indicate the need to notify the physician?

“I really don’t like to be in small, enclosed spaces.”

Which of the following medications is classified as a proton pump inhibitor (PPI)?

omeprazole

An adult client with a history of dyspepsia has been diagnosed with chronic gastritis. The nurse's health education should include what guidelines?

avoid alcohol, avoid NSAIDs

The nurse is presenting health education to a 48-year-old man who was just diagnosed with type 2 diabetes. The client has a BMI of 35 and leads a sedentary lifestyle. The nurse gives the client information on the risk factors for his diagnosis and begins talking with him about changing behaviors around diet and exercise. The nurse knows that further client teaching is necessary when the client tells you what?

“There is nothing that can be done anyway, because chronic diseases like diabetes cannot be prevented.”

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A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response?

“The fat is passed in your stools"

Pre-procedure, the nurse must do what if a patient is undergoing an EGD procedure?

remove dentures, place in a cup with label, give to fam then document

What is the priority nursing intervention of an EGD post-procedure?

assess gag reflex & return to prevent aspiration pneumonia

what diagnostic testing might nurse expect to be ordered if a patient is experiencing excruciating, sternum throat pain?

barium swallow, CT scan, & x-ray to dx esophageal perspiration

An EGD is inserted through the mouth, into the esophagus, and stops at the __.

small intestine

A patient is scheduled for a CT scan. What is should the nurse take into consideration?

iodine allergies & kidneys (BUN/creatinine)

A barium swallow is used to determine structural abnormalities. The priority assessment for after a barium swallow is ___.

monitor bowel movements bc barium can be left in the GI & perspirate it

Anything that weakens or causes pressure on the sphinter increases ___, because it is what prevents backflow into the esophagus.

GERD (acid reflux)

A patient experiences chronic cough & chronic upper respiratory infections. What might this patient need to be further evaluated for?

GERDs disease

What medications does a patient experiencing GERDs need to avoid due to them being highly acidic?

aspirin

theophylline

NSAIDs

nitrates

Omeprazole is a medication, that if used long term, can cause ___. They must be taken on an empty stomach to prevent the acid secretion.

rebound hyperexcretion

calcium absorption

increase risk for infection due to lack of acid