Archer: GI system

pH of Stomach

1.5-3.5, rises when food enters

Where Are Nutrients Absorbed in the Body

Small Intestines

churn and turns food into chyme

receives digestive enzymes from pancrease and liver

which part of body absorps water and electrolytes

large intestine

and produce/absorbs vitamins

Liver Function

- Produce bile, albumin, and cholesterol

- Metabolizes drugs

- Produces clotting factors

- Converts glucose to glycogen

- Converts ammonia to urea

- Metabolizes bilirubin in the breakdown of RBCs

Complications of TPN

Infection risk(change bag and tubing every 24 hrs), fluid overload, hyper or hypoglycemia *check BG every 4-6 hours)

GIVE CENTRAL LINE hard on veins (check for air embolisim)

what to do if you run put pf TPN

run D10w at the same rate to prevent hypoglycemia

Antidiarrheals

Loperamide, Diphenoxylate, Bismuth Subsalicylate

Famotidine Nursing Considerations

- Can be given with meals

- Monitor CBC and kidney function

- Separate from other drugs when possible

Omeprazole Nursing Considerations

- Administer 30-60 mins before meal

- Report black, tarry stools

Sucralfate Nursing Consideration

- Take on empty stomach

- Don't give within 30 mins of antacids

- Can decrease the bioavailability of warfarin, digoxin, phenytoin, levothyroxine, and several classes of antibiotics

If Residual on NG Tube is greater than 500, What Happens

Call the doctor and hold feeding

high risk for aspiration

when tp empty ostomy

when it is 1/3-1/2 full

change pouch ever 3-5 days

Blakemore Tube

Used to stop bleeding on esophageal varices

For Blakemore Tube, what is important to keep at bedside

Must keep a pair of scissors at bedside to deflate the gastric balloon

Esophageal Varices

Dilated submucosal veins in the esophagus

Causes of Esophageal Varices

Liver disease and alcoholism

GERD Risk Factors

Conditions that increase abdominal pressure: vomiting, coughing, lifting, bending, or obesity

Treatment for GERD

Sit upright after eating, small frequent meals, H2 blockers, PPIs

Barrett's Esophagus

A condition that occurs when the cells in the epithelial tissue of the esophagus are damaged by chronic acid exposure

Gastritis is associated with

Helicobacter pylori, NSAIDs

increase stress and alc can also cause this

Gastric Ulcer Symptoms

Pain 1-2 hours after meal, abdominal pain aggravated by eating, vomiting, weight loss, hematemesis if hemorrhage occurs

Treatment for Gastric Ulcer

Treat H. pylori infection(aBX), reduce acid with PPIs and H2 blockers

Duodenal Ulcer Symptoms

-Pain 2-4 hrs after meals

-Eating makes it feel better

-Melena if hemorrhage occurs

Weight gain

EXACT CAUSES AND TX OF GASTRIC ULCERS

H2 RECEPTOR BLOCKERS

drugs and nursing consideration

-tidine

FOMATIDINE CIMETIDINE NIZATIDINE

block acid production

monitor CBC and kidney function, can be given with meals, only take small doses for short period of time cuz abrupt disocntinouation can cause rebound, can affect drug metabolisim (not used with phenytoin and warfrim)

proton pump inhibitors

"-prazole"

(Omeprazole, Lansoprazole, Rabeprazole sodium, Esomeprazole)

give 30-60 minutes before meal

REPORT BLACK TARRY STOOL(can cause GI bleed)

antacid

drug that neutralizes stomach acid

Sucrafate

gi protectant

give on empthy stomach (1 hr before or 2 hours after)

avoid giving with antacid

monitor blood sugar (contains sucrose)

give separate from warfarin dig and phenytoin and antibiotics to avoid reduced bioavalibility

contains aluminum (can impair kidney function)

Crohn's Disease Location

Inflammation and erosion of the ileum and anywhere throughout the GI tract

Skip lesions

Ulcerative Colitis Risk Factors

Jewish descent 20-40 years

Ulcerative Colitis Location

Only in colon, continuous

large instestine

chrons/ uc assessment

rebound tewnderness

cramping

diarreah after eating

vomiting

dehydration

recal bleed

bloody tool

fever

chrons/ uc tx

high fiber food

avoid hot and cold food

aoid smooking

antidiarreah

antibiotics

steroids

surgery (ileostomy. colonsotmy)

stool of someone has colonostomy or ileostomy

colonostomy - formed stool (UC)

ileostomy - small instetine is affected so watery stool (chrons)

Diverticula

Herniation of mucosa through layers of the colon wall

Diverticulosis

Asymptomatic diverticular disease

Diverticulitis

Inflammatory stage of diverticulosis

Causes of Diverticulosis

Decreased fiber

Abnormal neuromuscular function

Alterations in intestinal mobility

Older than 60

Assessment of Diverticulitis

Rebound tenderness, cramping, diarrhea, vomiting, dehydration, weight loss, rectal bleeding, bloody stools, anemia, fever

Treatment of Diverticulosis

Low fiber diet, avoid cold or hot foods, no smoking, antidiarrheals, antibiotics, steroids, in severe cases may end up surgically removing the affected portion of the intestines

Intestinal Obstruction

Any condition that prevents the flow of chyme through the intestinal lumen or failure of normal intestinal mobility in the absence of an obstructive lesion

Small Intestinal Obstruction Clinical Manifestation

Colicky pain caused by intestinal distension, followed by nausea and vomiting

Large Intestine Obstruction

Hypogastric pain and abdominal distension

Appendicitis Pain

Begins as dull, steady periumbilical pain over 4-6 hours; pain progresses and localizes to right lower quadrant; sudden relief of pain is bad

McBurney's Point

Pain in right lower quadrant with appendicitis

Pre-op Appendicitis

No heat - this can aggravate inflamed appendix and cause rupture; position right side, low fowlers for comfort

Post-op Appendicitis Treatment

IV fluids, IV antibiotics, pain management, NPO until return of bowel sounds, wound care

Number One Cause of Pancreatitis

Alcoholism

What Is Pancreatitis

Digestive enzymes of the pancreas autodigest

Assessment of Pancreatitis

Pain that increases with eating, abdominal distension, ascites, abdominal mass, rigid abdomen, fever, jaundice, hypotension

Cullen's Sign

Ecchymosis in umbilical area, seen with pancreatitis

Grey Turner's Sign

Bruising in flank area (lower back area) in pancreatitis

Pancreatitis Nursing Interventions

PANCREAS: Pain control (morphine or dilaudid), antispasmodic drugs to reduce gut motility, NPO/NGT suction, TPN, calcium replacement due to hypocalcemia, replace fluids and electrolytes (fluid shift), elevated enzymes (check amylase and lipase), antibiotics with fever, steroids-corticosteroids for acute attacks

Cholelithiasis Caused By

Hardened deposits of bile in the gallbladder; Causes: Hyperlipidemia, hyperbilirubinemia

Cholelithiasis Assessment Findings

Sudden, sharp RUQ pain; Pain continues to get worse, can radiate to back and between the shoulder blade or right shoulder, gets worse at night or after a fatty meal, nausea, vomiting

Treatment for Cholelithiasis

Cholecystectomy

Cholecystitis

Inflammation of the gallbladder

Clinical Manifestations of Cholecystitis

Fever, leukocytosis, rebound tenderness, and abdominal muscle guarding

Treatment of Cholecystitis

Pain control, replacement of fluids and electrolytes, fasting, antibiotic administration

Hepatitis Can Progress To

Cirrhosis or hepatic encephalopathy

can notice this by elevation in ammonia because the liver is not able to convert it to urea

rx for hepatic encephalopathy

high protein diet

hypovolemia hypokalemia

infection

gi bleed

drugs

constipation

Hep A Transmission

Fecal oral

Prevention of Hep A

Vaccine, sanitation + hygiene

Treatment of Hep A

Supportive

Hepatitises with Risk of Chronic Infection

B, C, D

Hepatitis B Transmission

Contact with infected body fluids such as blood, semen, vaginal fluids

Prevention of Hep B

Vaccine, blood screening, improved hygiene

Treatment of Hep B

Acute - Supportive, Chronic - Antiviral therapy with/without interferon

Hep C Transmission

Contact with infected body fluids (IV drug use, non-sterilized medical equipment)

Hep C Prevention

Blood screening, sterile needles for injection

Hep C Treatment

No specific treatment available, usually self-limiting

Hep D Transmission

Contact with infected body fluids

Hep E Transmission

Oral-fecal

Hep E Prevention

Hygiene and sanitation

Hep E Treatment

Supportive

Hepatic Encephalopathy

Protein in diet is broken into ammonia. When there is damage in the liver due to hepatitis, the ammonia builds up instead of being converted to urea. These increased ammonia levels can cause a hepatic coma.

Assessment Findings of Hepatic Encephalopathy

Change in LOC, asterix (tremor in hand), fetor, sleep, mood, and speech problems

tx hepatic encephalopathy

lactulose (allows ammonia to be excetred)

antibiotics (rifazmin or neomycin)

decrease fluid retensiosn (k sparing dirtic)

avoid cns depressants

Treatment for Hepatic Coma

Neomycin or rifaximin (reduces bacterial production of ammonia), lactulose, potassium-sparing diuretic

Drugs to Avoid with Hepatic Coma

Benzodiazepines and opioids

Cirrhosis

Chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening

Cirrhosis Assessment

Palpable firm liver, ascites, edema, abdominal pain, bloating, dyspepsia, poor appetite, spider angioma, jaundice, decreased albumin, increased liver enzymes

Liver Damage Leads to What Risk

Bleeding risk because the liver produces clotting factors

Treatment of Cirrhosis

Antacids, vitamins, diuretics, paracentesis, skin care, strict I and Os, daily weights, bleeding precautions

Diet for Cirrhosis

Low protein, low sodium

Drug Doses to Be Careful with for Liver Failure

Narcotics and acetaminophen

hepatic Steatosis

accumulation of fat in the liver cells

Ascites

accumulation of fluid in the peritoneal cavity

Hepatorenal Syndrome

progressive kidney failure in individuals with severe liver disease

Hepatopulmonary Syndrome

presence of pulmonary vascular dilatations in individuals with liver disease

Hepatocellular Carcinoma

primary malignancy of the liver