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

Tylenol is toxic to what organ?

Liver
4,000 mg in 24 hrs is max

Name the three acsessory organs

Gallblader, liver, pancreas

What cultural considerations for GI exsist?

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

• Mexican americans also have incrased gallstone risk

What foods may increase the risk of colon cancer?

Foods in nitrates and nitrites

• hot dogs

• bacon

• ham

• charred grilled foods

• bolonga

How much water should one drink to lower constipation risk?

2500 mL/day

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.

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

Dehydration, electrolyte imbalance. fluid overload

Health prevention for liver

• Immunize against Hep A + B

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

• Less alchol

Health prevention for Gallblader

• Avoid rapid weight loss

• low fat, low cholestol

• high fiber and calcium

More pregnancies increases risk for gallbalder disease

When is increasing fluids contraindiated?

• Cardiac disease

• Renal disease

Gas can case right sided shoulder pain true or false?

true

Interventions for gas pain

• Trendelenburg position

• Ambulation

• Abd massage

How to make laxatives more appealing?

Pour over ice or chill in fridge

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

Shellfish, iodine

Normal BS

5-30 per minute

Absent BS

No BS in all 4 quadrents for 5 minutes

HyPOactive BS

None for 30 seconds or less

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

Intestinal obstruction

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

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

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

Why is low suction used on most tubes?

To avoid damage to mucosa

How high should the HOB be during NG feedings?

30 degrees during and for one hour after

Types of tubes used for feeding

NG,PEG

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)

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

Instill a few milli of air into tube to clear

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

Is it blocked or open

NG tube hanging

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

Aspirating gastric juices

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

• looks like bile

• Hold feeding if excessie residual is aspirated

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

Metabolic alkalosis

Consequnse of diarrhea?

Lowered nutitonal abosorption

Foods for diarrhea

• Banannas

• white toast

• applesause

• rice

NO Coffee and tea

Ngs management for dysphagia

• thicken liquids

• sit upright with head forward and chin tucked

• keep suction equipment nearby always

Risks for oral/throat cancer

• smoking

• alchol use

• HPV infection

• Oral lesions

Usually painless

Bariatric sugery indicated when

BMI over 40

Restritive bariatric surgery

Limits how much stomach can hold

Malabsorption bariatric surgery

Decreases calorie and nurtient absoprtion

Combintion bariatric surgery

Both restrictive and malabsorptive
- gastric bypass
RYGB

Gallbladder side effect of bariatric surgery

Gallstones due to liver secreting extra cholestol into bile

Obestiy VS morbid obestity

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

NG tube time frame/info

Less than 6 wks

• x ray to check placement

• test PH

• Auctltating not relaibe

PEG/PEJ tube time frame/info

• long term

• not used if needed shorter than 4 wks

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)

Bolus feeding

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

Intermittend feeding

Thorugh pump

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

15 mL

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

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

What does the gallbladder do?

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

What is ascites?

Fluid in the abdominal cavity

What will bilirubin in the urine look like?

dark

What does undigested fat look like in the stool?

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

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

True

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****

Bowel training

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

Barrett's esophagus

GERD is primary cause
- precancerous lesions

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

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

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

True

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

Nutrient malabsorption of magnesium, calcium and b12

Gastroenteritis

inflammation of stomach and small intestine
- caused by intake of food/water contaminated with a virus (norovirus for example)

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

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

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.

S/S of peptic ulcer

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

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

IBS

Altered motility of the small and large intestine
- no known cause

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

Where is diverticulitis pain located

Lower left abd
- high fiber diet encouraged

mechanical vs non-mechanical intestinal obstruction

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

Nursing care for intestinal obstruction

Fowler position to lower pressure
- measure abd girth q 2-4 h

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

Complications of incarcerated abd and inguinal hernias

Strangulation leading to necrosis

Inguinal hernia

hernia in the groin area

Non-incarcerated hernia nursing management

• may disappear when lying down

• avoid lifting

• brace site when coughing, sneezing

Treatment of hernias

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

Inflammatory bowel disease covers which disorders?

Ulcerative colitis (UC) and crohn's disease

• more common in Jewish population

• attacks of diarrhea

UC VS Crohn's

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

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

UC

Diet for IBD (UC and CD)

Low fiber!

• high protein

• low fat

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

true

Where is appendicitis pain located?

Halfway between the umbilicus and the crest of the ilium at McBurney point (LRQ)
- pain when extending leg, walking

Hot or cold for appendicitis pain?

COLD. Never hot. Hot can cause rupture of the appendix.
- Also laxatives can cause rupture

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

S/S of peritonitis

• board like abd rigidity

• rebound tenderness

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

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

S/S of colon cancer

• change in bowel habits

• weight loss

• bowel obstruction

Acronym for colon names

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

Normal color for stoma

Dark red/pink
- purple or black could mean necrosis

Indications for ileostomy

- when disease causes the need to bypass the entire colon

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

true

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

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

True

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

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

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

Fector hepaticus

Occurs as liver failure progresses
- breath with a sweet, fecal odor

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)

S/S of pancreatitis

• Left upper quad pain, eating makes pain worse

• Lowered BS

• gaurding and tenderness of abd

Chronic pancreatitis

- Most common in men who have been drinking for years

S/S of chronic panreatitis

• Abd pain

• weight loss

• mild jaundice

• DM develops

• dark urine