GI 27, 28, 29, 30 (test 7)

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Tylenol is toxic to what organ?

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Health

120 Terms

1

Tylenol is toxic to what organ?

Liver 4,000 mg in 24 hrs is max

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2

Name the three acsessory organs

Gallblader, liver, pancreas

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3

What cultural considerations for GI exsist?

  • Native americans have higher cholesterol in bile = increased gallstone risk

  • Mexican americans also have incrased gallstone risk

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4

What foods may increase the risk of colon cancer?

Foods in nitrates and nitrites

  • hot dogs

  • bacon

  • ham

  • charred grilled foods

  • bolonga

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5

How much water should one drink to lower constipation risk?

2500 mL/day

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6

Hydrocloric acid is reduced in older adults true or false

True, hydrocloric acid is a stomach acid that breaks down food and is lower in gertiatric patients.

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7

What are older adults more at risk for during bowel cleansing for tests?

Dehydration, electrolyte imbalance. fluid overload

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8

Health prevention for liver

  • Immunize against Hep A + B

  • No uprotected sex with known drug users to redue risk of Hep C

  • Less alchol

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9

Health prevention for Gallblader

  • Avoid rapid weight loss

  • low fat, low cholestol

  • high fiber and calcium

More pregnancies increases risk for gallbalder disease

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10

When is increasing fluids contraindiated?

  • Cardiac disease

  • Renal disease

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11

Gas can case right sided shoulder pain true or false?

true

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12

Interventions for gas pain

  • Trendelenburg position

  • Ambulation

  • Abd massage

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13

How to make laxatives more appealing?

Pour over ice or chill in fridge

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14

What allergies should you check for before a test with contrast dye?

Shellfish, iodine

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15

Normal BS

5-30 per minute

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16

Absent BS

No BS in all 4 quadrents for 5 minutes

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17

HyPOactive BS

None for 30 seconds or less

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18

What could absent or hypoactive BS in one quadrent and hyperactive in annother mean?

Intestinal obstruction

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19

What does a dull vs high pitched sound mean when purcussing?

Dull = mass such as organ Higher pitch = resonant = air/fluid

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20

Patients recieving TPN (total parenteral nutrition) should be aware of what?

Can cause hyperglycemia due to high glucose content

  • CBG testing q4h

  • Must be given through central line

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21

Why is low suction used on most tubes?

To avoid damage to mucosa

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22

How high should the HOB be during NG feedings?

30 degrees during and for one hour after

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23

Types of tubes used for feeding

NG,PEG

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24

Decompression tubes

  • Salem sump (into stomach) has pigtails

  • NG tube (into stomach)

  • Miller Abbott (into small intestine)

  • Cantor (into small intestine)

  • Harris (into small intestine)

  • Levin (into stomach)

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25

What should you do if salem sump pigtail is leaking/fluid inside?

Instill a few milli of air into tube to clear

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26

What does it mean to asess the patency of the tube?

Is it blocked or open

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27

NG tube hanging

Keep tubing leading into suction machine above the height of entry into drainage container

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28

Aspirating gastric juices

PH should be around 5 (proton pump inhibits can make higher)

  • looks like bile

  • Hold feeding if excessie residual is aspirated

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29

Pts draining large amounts of fluid from an NG tube are most at risk for what?

Metabolic alkalosis

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30

Consequnse of diarrhea?

Lowered nutitonal abosorption

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31

Foods for diarrhea

  • Banannas

  • white toast

  • applesause

  • rice

NO Coffee and tea

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32

Ngs management for dysphagia

  • thicken liquids

  • sit upright with head forward and chin tucked

  • keep suction equipment nearby always

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33

Risks for oral/throat cancer

  • smoking

  • alchol use

  • HPV infection

  • Oral lesions

Usually painless

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34

Bariatric sugery indicated when

BMI over 40

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35

Restritive bariatric surgery

Limits how much stomach can hold

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36

Malabsorption bariatric surgery

Decreases calorie and nurtient absoprtion

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37

Combintion bariatric surgery

Both restrictive and malabsorptive

  • gastric bypass RYGB

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38

Gallbladder side effect of bariatric surgery

Gallstones due to liver secreting extra cholestol into bile

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39

Obestiy VS morbid obestity

Obestiy = BMI greater than 30 Morbid Obesity = BMI greater than 40

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40

NG tube time frame/info

Less than 6 wks

  • x ray to check placement

  • test PH

  • Auctltating not relaibe

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41

PEG/PEJ tube time frame/info

  • long term

  • not used if needed shorter than 4 wks

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42

Feeding tube spoiling guidelines

-Opened feeding formula = disgaurd after 24 hrs -Feeding bags filled by nurses with commercial foruma digaurd after 4-8 hrs

  • Open systems change q24h

  • Closed systems changed q24-48 hrs (bags pre filled at factory with formula)

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43

Bolus feeding

Via gravity over 15 minutes, only for patients with intact gag reflex

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44

Intermittend feeding

Thorugh pump

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45

How many ML of water should be used to flush a tube after each med?

15 mL

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46

Keeping patency of feeding tube

Flush with 30mL of water q4h during continuous feedings

  • 30 mL of water after each residual check

  • 15 mL before and after each med

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47

Should you clamp the feeding and suction before giving meds via tube?

Yes, stop feeding and clamp suction for 30 minutes before restarting after meds

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48

What does the gallbladder do?

Stores bile produced in the liver and delivers it to the small intestine.

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49

What is ascites?

Fluid in the abdominal cavity

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50

What will bilirubin in the urine look like?

dark

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51

What does undigested fat look like in the stool?

Stool will float in the bowl, if there is bile stool may be white

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52

If damage to the liver is stopped before all tissue is affected, it can regenerate (true or false)

True

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53

What is dumping syndrome?

After bariatric surgery when large amounts of food and liquid pass into jejunum. Occurs 15-30 min after eating s/s:

  • weakness

  • dizziness

  • tachycardia

  • abd cramping **** may help to lie down for 30 minutes after eating****

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54

Bowel training

Patient should be in private environment 20-40 min after a meal, digital stimulation is performed.

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55

Barrett's esophagus

GERD is primary cause

  • precancerous lesions

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56

Hiatal Hernia

Lower esophagus/stomach slides up into diaphragm and thorax

  • result of a defect in diaphragm wall

  • more common in women

  • cannot be seen

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57

Treatment of hiatal hernia

  • No tight fitting clothes

  • elevating HOB 6-8 inches

  • not eating within 3 hours of bedtime

  • avoid fatty foods

  • reduce weight

  • no lifting heavy weight

  • Sit upright 2 hours after eating

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58

True or false: 90% of patients with GERD have a hiatal hernia

True

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59

What are patients on long term proton pump inhibitors at risk for?

Nutrient malabsorption of magnesium, calcium and b12

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60

Gastroenteritis

inflammation of stomach and small intestine

  • caused by intake of food/water contaminated with a virus (norovirus for example)

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61

Gastritis

Inflammation of MM on stomach lining (atrophic involves all layers)

  • usually caused by H-pyloi bacteria

H-pylori causes erosion of the gI mucosa, making it easily damaged by gastric juices.

  • massive hemorrhage can occur from ulcer

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62

Peptic ulcer (duodenal and gastric ulcers)

  • H-pylori, smoking, NSAIDS are major causes

  • H-pylori causes erosion of the gI mucosa, making it easily damaged by gastric juices.

  • Hot spicy foods and caffeine NOT PROVEN as a cause, but make s/s worse

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63

Acute stress ulcer

  • more likely to hemorrhage

  • most likely caused by unrelieved stimulation of the vagus nerve

  • r/t being severely ill, burn patients, trauma patients, ect.

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64

S/S of peptic ulcer

Pain relieved with meals and in morning (when secretion is low), and high before meals and at bedtime

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65

Gastric cancer

  • Usually discovered late because patients lack s/s

  • H-pylori, nitrites and nitrates in foods = risk factors

  • anemia like symptoms due to blood loss in GI tract, may see blood in stool

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66

IBS

Altered motility of the small and large intestine

  • no known cause

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67

S/S of IBS

  • Change in bowel elimination (constipation, diarrhea or both)

  • Abd pain and bloating relieved by defecation

  • Absence of detectable disease

  • Mucus in stool

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68

Where is diverticulitis pain located

Lower left abd

  • high fiber diet encouraged

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69

mechanical vs non-mechanical intestinal obstruction

Mechanical = tumors, twisting of bowel, strangulated hernias, adhesions Non-mechanical = absence of peristalsis

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70

Nursing care for intestinal obstruction

Fowler position to lower pressure

  • measure abd girth q 2-4 h

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71

Reducible hernia vs incarcerated hernia

Reducible = organ can be pushed back into place by pressing Incarcerated = organ is tightly wedged outside cavity, cannot be re-set

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72

Complications of incarcerated abd and inguinal hernias

Strangulation leading to necrosis

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73

Inguinal hernia

hernia in the groin area

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74

Non-incarcerated hernia nursing management

  • may disappear when lying down

  • avoid lifting

  • brace site when coughing, sneezing

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75

Treatment of hernias

Mesh places, or a truss to re-enforce the weakened cavity wall

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76

Inflammatory bowel disease covers which disorders?

Ulcerative colitis (UC) and crohn's disease

  • more common in Jewish population

  • attacks of diarrhea

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77

UC VS Crohn's

UC: inflammation of rectum/colon Crohn's: masses of inflamed tissue in small intestine with "cobblestone" appearance

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78

Is bloody stool more common with UC or crohn's?

UC

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79

Diet for IBD (UC and CD)

Low fiber!

  • high protein

  • low fat

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80

true or false: patients with UC are more likely to develop colon cancer?

true

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81

Where is appendicitis pain located?

Halfway between the umbilicus and the crest of the ilium at McBurney point (LRQ)

  • pain when extending leg, walking

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82

Hot or cold for appendicitis pain?

COLD. Never hot. Hot can cause rupture of the appendix.

  • Also laxatives can cause rupture

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83

Peritonitis

  • Inflammation of the peritoneum... usually occurs when one of the enclosed organs ruptures and contents spill out (ie appendix bursting)

  • peristalsis slows/stops CAN BE FATAL

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84

S/S of peritonitis

  • board like abd rigidity

  • rebound tenderness

  • fever, chills, ect. Keep pt semi fowler, turn and move gently

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85

Colon cancer

  • people most at risk = those with GI disorders such as UC

  • polyp like growths that cancer grows from

  • colonoscopy can help find polyps early and remove them b4 cancerous. Routinely starting at 45

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86

S/S of colon cancer

  • change in bowel habits

  • weight loss

  • bowel obstruction

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87

Acronym for colon names

Ascending, Transverse, Dissenting, Sigmoid (all frogs dislike salt)

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88

Normal color for stoma

Dark red/pink

  • purple or black could mean necrosis

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89

Indications for ileostomy

  • when disease causes the need to bypass the entire colon

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90

True or false: chewing gum can help reduce instances of postoperative ileus

true

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91

Cirrohosis

Chronic scarring of liver from disease such as

  • alcholism

  • Hep B and C

  • Blood vessels also begin to fail and leak into the abd

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92

True or false: if not too much tissue on the liver is damaged, it will regenerate?

True

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93

S/S of cirrosis of liver

  • Rash

  • Leg and food edema

  • Bleeding and bruising due to vit k defficiency

  • Palpable nobby liver under right rib cage

  • Abd distention/acities

  • Spider angiomas

  • Dark and foamy urine

  • Clay colored stool

  • Jaundice

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94

Esophageal varicies

Complication of liver cirrosis

  • caused because normal blood flow to the liver is diverted to veins of stomach/esophagus

  • vein walls rupture, massive bleeding occurs

  • Tx by vasopressin

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95

Encephalopothy

Complication of liver cirrosis

  • Build up of toxins/ammonia due to liver failure

  • S/S: confusion, coma, flapping tremors of hands

-Lactulose given to lower intestinal absorption of ammonia

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96

Fector hepaticus

Occurs as liver failure progresses

  • breath with a sweet, fecal odor

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97

Acute pancreatitis

Inflammation of the pancreas (acute)

  • frequently accompanies gallstones blocking pancreatic duct

  • most common cause = alcoholism

  • pseydocysts may occur (sac like structure around the pancreas, danger of hemorrhage if rupture occurs)

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98

S/S of pancreatitis

  • Left upper quad pain, eating makes pain worse

  • Lowered BS

  • gaurding and tenderness of abd

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99

Chronic pancreatitis

  • Most common in men who have been drinking for years

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100

S/S of chronic panreatitis

  • Abd pain

  • weight loss

  • mild jaundice

  • DM develops

  • dark urine

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