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FLCC-NUR101
Gastrointestinal System Part 1
121
Nursing
Undergraduate 1
04/27/2012

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Term
The Digestive System
Definition
extends from the mouth to the anus, is responsible for receiving food, breaking it down into nutrients (a process called digestion), absorbing the nutrients into the bloodstream, and eliminating the indigestible parts of food from the body.
Term
The Esophagus
Definition
muscular channel lined with mucous membranes—connects the throat with the stomach
Term
The Stomach
Definition
a large, bean-shaped, hollow muscular organ consisting of three regions: the cardia, the body (fundus), and the antrum
Term
Mucus, Hydrochloric acid, and the precursor of Pepsin (pepsinogen)
Definition
The cells lining the stomach secrete three important substances
Term
Hydrochloric acid
Definition
The stomach's high acidity also serves as a barrier against infection by killing most bacteria
Term
Pepsin
Definition
the only enzyme that digests collagen, which is a protein and a major constituent of meat.
Term
Rugae
Definition
The folds of the duodenal lining are called?
Term
Villi and Microvilli
Definition
These increase the surface area of the duodenal lining, allowing for greater absorption of nutrients
Term
Duodenum, Jejunum and the Ileum
Definition
These parts of the small intestine are largely responsible for the absorption of fats and other nutrients
Term
Mucus
Definition
Released by the intestinal wall; lubricates the intestinal contents, and water, which helps dissolve the digested fragments
Term
Enzymes
Definition
Another substance released by the intestinal wall. Responsible for digesting proteins, sugars, and fats
Term
Small Intestine
Definition
absorbs most of the nutrients and all but about 1 liter of fluid before emptying into the large intestine.
Term
Pancreas
Definition
secretes digestive enzymes into the duodenum and hormones into the bloodstream
Term
Amylase, lipase, and trypsin
Definition
The digestive enzymes secreated by the pancreas but released by the cells of acini are called?
Term
Carbohydrates
Definition
Amylase digests __________?
Term
Fats
Definition
Lipase digests __________?
Term
Proteins
Definition
Trypsin digests __________?
Term
Sodium Bicarbonate
Definition
Protects the duodenum by neutralizing the acid that comes from the stomach
Term
Insulin & Glucose
Definition
Two antagonist hormones produced by the pancreas are?
Term
Insulin
Definition
Lowers the level of sugar (glucose) in the blood by moving sugar into cells
Term
Glucose
Definition
Raises the level of sugar in the blood
Term
Glucagon
Definition
When stimulated in respose to "hungry cells" the liver to release its storage to feed starving cells.
Term
Liver
Definition
Manufactures about half of the body's cholesterol; the rest comes from food. About 80% of the cholesterol made here is used to make bile
Term
Gallbladder
Definition
Bile is stored in this location
Term
Bile
Definition
It assists in the digestion and absorption of fats, and it is responsible for the elimination of certain waste products from the body—particularly hemoglobin from destroyed red blood cells and excess cholesterol
Term
Bacteria colonizes the colon (Protection)
Ferments indigestible carbohydrates
Produces gas
Inhibits growth of pathogens
Synthesis B Complex makes Vit K;clotting
Definition
Name (5) Roles played by Bacterial Flora
Term
O- Onset. When did your pain start?
P- Persistent. Constant or intermitent?
Q- Quality. sharp, dull, burns, achy
R- Regoin. Does it radiate or localized?
S- Severity. Pain scale 0/10
T- Time. How long have you had pain?
Definition
How would you Assess for pain? What should the Nurse do first? *HINT(O-PQRST)
Term
Inspection, Auscultation, Percussion, Palpation
Definition
What is the correct order to complete an abdominal assessment?
Term
Dyspepsia
Definition
upper abdominal discomfort; occurs in 25% of the adult population. Typically after ingesting fatty foods.
Term
Diarrhea, Constipation, Color & Caliber (Diameter)
Definition
What (4) areas do you assess for changes in bowel habits when interviewing a patient?
Term
Wash you hands. (Besides, the spreading the germs) If your hands are cold your patient may tense which alter your examination. Areas which are soft and tender may seem firm and solid.
Definition
What is the first thing you should do before starting an abdominal assessment? (you have already identified the patient)
Term
Inspection
Definition
An assessment technique used to determine expansion or distention of the abdominal wall that might accompany abnormal growth, enlargement of an organ or asymmetry.
Term

Auscultation

Definition

An assessment technique used to assess bowel sounds, character, location and frequency in peristalsis within the large intestine.

Term
Percussion
Definition
An assessment technique used to assess the size and density of abdominal organs by tapping your fingers over the organs. Determines if an organ is dense/hollow or full/empty.
Term
Palpation
Definition
An assessment technique used to feels for tenderness and any abnormal masses or enlarged organs by applying gentle pressure.
Term
Rebound Pain
Definition
Pain that is caused by gentle pressure on the abdomen and that is relieved when the pressure is released.
Term
Peritonitis
Definition
Inflammation and sometimes infection of the lining of the abdominal cavity
Term
Esophagogastroduodenoscopy (EGD)
Definition
allows direst visualization of the upper GI tract via fiber optic camera; takes pictures, biopsies & removes legions (polyps)
Term
NPO 8+ hrs or more
Pt receives local anesthetis & sedation
Pt is placed in left lateral position
Monitor VS
Assess gag reflex before anything po
Discharge Instructions w/Family member
Definition
Identify Nursing Interventions for a EGD procedure.
Term
Colonoscopy
Definition
allows direct visualization of the large intestine via fiber optic colonoscope; biopies, removes polys & cauterizes. Women >50 / Men >40 should receive one.
Term
The goal is to reach the ascending colon.
Definition
What is the goal during the colonoscopy procedure?
Term
Bowel Prep. (Patient Teaching: Encourage patients to drink the entire prep and DO NOT MIX with other beverages)
Definition
A successful colonoscopy depends on a successful__________?
Term
Clear liquid diet 24h prior to procedure
Bowel Prep (Go-Lytely Solution)
May experience n/v, bloating w/ prep
NPO 8h prior to procedure; NPO after 12a
Sedation during procedure
Prepare to have someone escort you home
Definition
Identify Nursing Interventions for a Colonoscopy procedure.
Term
Upper GI, Sm Bowel follow through (X-RAY)
Definition
A contrast medium (Barium)that collects in abnormal areas, showing ulcers, tumors, obstructions, erosions, and enlarged, dilated esophageal veins. Multiple films obtained after 24h.
Term
Clear liquid diet; NPO after 12a
No smoking or chewing gum
(stimulates gastric secretions)
Increase fluids post-procedure
Take MOM as directed (excretes Barium)
Definition
Identify Nursing Interventions for a Upper GI, Sm Bowel follow through procedure.
Term
Barium Enema
Definition
Used to detect polyps, tumors, and lesions. Colon prep is needed and patient may feel cramping during instillation. Most experience diarrhea after procedure.
Term
Barium
Definition
If a perforation is suspected this contrast is contraindicated.
Term
Abdominal Ultrasound
Definition
high frequency sound waves (echoes); create pictures. Used to dx: pancreatitis, appendicitis, cholecystitis & ectopic pregnancy.
Term
NPO 8-12h prior to procedure
*Gallbladder-fat free meals 24h prior
Exams requiring contrast; Schedule after
(contrast blocks soundwaves=bad pictures)
Definition
Identiify Nursing Interventions for Abdominal Ultrasounds.
Term
Computed Tomography (CT)
Definition
cross-sectional images of organs and other structures. patient is given a contrast medium. Shellfish allergy and poor renal function are contraindicated.
Term
Shellfish/Contrast allergies are interchangeable.

Contrast used for CT scans are metabolized by the kidneys.
Definition
Why are patients with shellfish allergies and/or poor renal function contraindicated for receiving a CT scan?
Term
Check your patients Creatinine levels. (normal range = (0.5-2.0mg/dL)
Definition
What is the best way to assess for healthy renal function?
Term
Magnetic Resonance Imaging (MRI)
Definition
magnetic and radio waves to produce images; may not be used for pstients with metal devices in the body.
Term
- NPO 6-8h prior to procedure
- Patient's who are claustrophobic are not good candidates for this procedure
- Warn paitents that the machine is very noisey (earplugs are available to minimize noise but will not eliminate)
- Procedure takes 60-90mins.
Definition
Identify Nursing Interventions used for patients receiving an MRI.
Term
Gastrointestinal-GI Intubation
Definition
Insertion of a tube into the stomach and beyond is called a _________?
Term
Esophageal Nasogastric-ENG Tube
Definition
A tube inserted into the mouth is called a __________?
Term
Nasogastric-NG Tube
Definition
A tube inserted into the nose is called a __________?
Term
PEG or G Tube
Definition
A tube inserted into the abdomen is called a _________?
Term
Levin Tube
Definition
A non-vented, non-suctioning, single lumen tube, 14"-18"french (up to 50" length);used for feeding ONLY. Meds will clog tubing.
Term
Gastric or Salem Sump Tube
Definition
NG or PEG, double lumen tube used for long term feedings & stomach decompression.
Term
Pig tail lumen
Definition
The smaller lumen on a Gastric (salem) Sump tube acts as a vent. Vent must be kept higher than the waiste. It's called a __________?
Term
Suctioning
Definition
The larger lumen on a Gastric (salem) Sump tube; used for __________?
Term
1 Place distal tip at the patients nose
2 Extend tube to the patients earlobe
3 Extend straight to xipoid process
Definition
How do you measure a patient for a GI Intubation? (3-Steps)
Term
High Fowlers position
Definition
What position should your patient be in when measuring them for a GI Intubation?
Term
Place patient in High Fowlers position
May use topical anesthetic (lidocaine gel)
Tip head forward
Advise patient to sip H20 (moist mucosal)
Instruct patient to breath
Insert behind nosopharynx into stomach
Confirm Placement (use pH tape)
Definition
Identify Nursing Interventions for a GI Intubation insertion.
Term
You should aspirate GI secretion then dip pH take to confirm secretions are within a pH 1.5-3.5.
Definition
How do you confirm placement of a GI , ENG or NG tube?
Term
Confirm Placement (Use permanent marker)
Secure tube with tape (immobilize tubing)
Monitor I/O
Irrigate with H2O or NaCl
Implement good Oral & Nasal hygiene
Assure sphincter is open (aspiration)
Definition
Identify Nursing Interventions for Care of a GI tube?
Term
Keep tubes patent (irrigate PRN)
Monitor I/O
Definition
What is the most important Nursing measure associated with caring for patients with any type of feeding, drainage or suctioning systems? (2)
Term
Nausea
Heartburn/Indigestion
Hiccups
Abdominal Distention
Pain
Vomiting (around the tube)
Definition
Identify patient s/sx of a clogged or poorly drained tube.
Term
Explain procedure to patient
Wear protective clothing (if pt n/v)
Check placement (pH tape)
Irrigate suction port (20-30ml NaCl)
Attempt to aspirate (document I/O)
Irrigate vent port; 20ml air-clear valve
Reconnect to suction
Recheck and confirm Patentcy of tubing
Definition
Identify Nursing Interventions for Suctioning & Irrigating an NG tube.
Term
HOB 30-45 degreees elevated
Definition
What postion should the patient be in when receiving a tube feed to prevent aspiration?
Term
1. Low cost
2. Well tolerated
3. Given at home & long term care
4. Maintains intestinal metabolism
5. Maintains insulin/glucagon rations
Definition
Identify (5) benefite of GI Intubations.
Term
Dobhoff Tube
Definition
A Dobhoff tube is a small, non-suctioning, flexible tube; used to administer nourishment and medicine. Correct placement in the small intestine is confirmed by an x-ray.
Term
1. Check Placement & residual
(>100ml HOLD-feeding)
2. HOB 45 degrees (prevent aspiration)
3. Equipment - change q24h
4. Solution - no longer than 4-6h
5. Assess Patient (feeding tolerable)
Definition
Identify Nursing Interventions for administering feedings via Dobhoff tube; may be continuous or cylclic (bolus)
Term
PEG or G-tube
Definition
Inserted directly through abdominal wall. Feedings may be continuous or cyclic. Inserted in surgery through abdominal wall; 1st day post-op pt received H20.
Term
Skin Care (prevents infection)
Definition
The most important intervention in caring for a person with a PEG or G-tube.
Term
1. Aspiration
2. Diarrhea
3. Hyperglycemia
4. Dumping Syndrome
Definition
Identify (4) Tube feeding complications.
Term
Dumping Syndrome
Definition
A condition caused by high osmolarity, s/sx are fullness, n/v, diarrhea (rapid gastric emptying), dehydration (fluid shift), tachycardia, hypotention.
Term
C-Diff
Definition
Patients dx:Dumping Syndrome are at higher risk of ___________?(infection)
Term
1. Slow Rate (ml/hr)- MD Order
2. Admin feedings room temperature
3. Admin continuous feedings(NOT bolus)
4. Use minimal H2O for flush
Definition
Identify Nursing Interventions to Prevent Dumping Syndrome.
Term
1. Improve Nutritional status
2. Establish Positive Nitrogen Balance
3. Maintain muscle mass
4. Weight maintenance
5. Enhance healing
Definition
Identify (5) patient goals for Parenteral Nutrition.
Term
1. When a patient has a negative nitrogen balance.
2. When 10-15% of admission wt is loss
3. Patients with long recovery periods
Definition
When are parenteral nutrition diets implemented?(3)
Term
2-3 liters/day
Definition
How much Formula (parenteral nutritional supplement) does a patient receive within a 24h period?
Term
1. Insufficient intake to meet metabolic needs
2. Inability to ingest food arally or via tube feeding
3. Unwillingness to ingest food
4. Pre & Post Operative Surgery
Definition
What s/sx would indicate needs for parenteral nutrition? (4)
Term
Central Venous Access Device-CVAD
Definition
Catheter inserted into a high flow, large blood vessel, usually subclavian vein (invasive procedure)
Term
1. Percutaneous
2. PICC
3. Tunneled catheter
4. Implanted port
Definition
Identify (4) Central Venous Access Devices.
Term
1. Insufficient intake to meet metabolic needs
2. Inability to ingest food orally or via tube feeding
3. Unwillingness to ingest food
4. Pre & Post Operative Surgery
Definition
What s/sx would indicate needs for parenteral nutrition? (4)
Term
1. Given through large vein (central)
2. MD order SPECIFIC solution; check bag
3. Given through fikter - 1.2 micron
4. Start slow 50ml/hr; advance per order
5. Dedicated port (feedings, NOT meds)
6. Infuse via pump (NEVER gravity)
Definition
Identify Nursing Interventions for administering parenteral nutrition via CVAD catheter.
Term
Pneumothorax
Definition
The most common complication after a CVAD insertion.
Term
Percutaneous Central Venous Tube
Definition
Commonly referred to as a "tripple lumen"
Term
PICC
Definition
Peripherally inserted; single or double lumen, central catheter inserted at the bedside by specially trained nurse or MD. Inserted into cephalic or basilic vein
Term
PICC
Definition
A central catheter for immediate time frame of use, inserted at the bedside into the cephalic or basilic vein; placement confirmed by x-ray. Less risk for pneumothorax.
Term
Tunneled Catheter
Definition
A cather hat is inserted for long-term usage may stay in place for years. Inserted surgically into subclavian vein and placed under the skin; reduced risk of infection.
Term
1. Neck
2. Shoulder
Definition
A Tunneled Catheter is tunneled up through the 1.______ then sutured at the 2.______
Term
Implanted Ports
Definition
Long-term ports used for Chemotherapy; placed in a subcutaneous pocket, minimal care provides freedom for the patient. The port does not exit the skin; accessed by a special non-coring needle.
Term
Huber Needle
Definition
A special needle used to access Implanted ports. This needle is non-coring (does not damage) to the port.
Term
1. Check Placement & residual
(>100ml HOLD-feeding)
2. HOB 45 degrees (prevent aspiration)
3. Equipment - change q24h
4. Solution - no longer than 4-6h
5. Assess Patient (feeding tolerable)
Definition
Identify Nursing Interventions for administering feedings via Dobhoff tube; may be continuous or cylclic (bolus)
Term
Pneumothorax
Definition
A complication of CVAD which always occurs at the time of the catheter insertion. s/sx: dyspnes, angina, absent lung sounds
Term
Pneumothorax
Definition
A complication of CVAD which always occurs at the time of the catheter insertion. s/sx: dyspnes, angina, absent lung sounds
Term
1. Administer Non-Rebreather Mask (15L)
2. Prepare Patient for chest tube insertion while someone else notifies the SWAT team. *(MD will be present)
3. Have x-ray ready to verify placement
4. Monitor VS (focus on Airway)
5. Offer reassurance
(*continue to pray...)
Definition
Identify Nursing Interventions associated with a pneumothorax complication.
Term
Air Embolism
Definition
Occurs when air is introduced into IV tubing; lodges into the heart and obstructs the pulmonic valve. s/sx: hypoxia, WHEEZING & "sucking" sound on inspiration; 50% die.
Term
1. Clamp the lumen that is leaking.
2. Administer O2 ;roll pt on left side
(while someone else notifies MD)
*(continue to pray...)
Definition
Identify Nursing Interventions when responding to an Air Embolism emergency.
Term
1. Prevention
2. Valsalva Maneuver
Definition
The best Nursing Intervention for Air Embolisms are 1.__________. When changing caps on IV tubing, risks of an air embolism can be reduced by teaching your patients the 2.________ __________.
Term
1. Infection
2. Sepsis
3. Tegaderm
Definition
Poor sterile technique during dressing changes cause 1._______ or 2._______. A 3.______ dressing should be place over the CVAD; insertion site t allow for visibility & assessment.
Term
1. Wash hands (aseptic technique)
2. Stop infusion, Notify MD & Pharmacy
3. Change bag & tubing q24h
4. Change DSD q72h
5. No piggy bags, blood draws or administrations via port.
Definition
Identify Nursing Interventions if an infection is suspected; when caring for a patient with a Implanted Port or CVAD.
Term
Hyperglycemia
Definition
A condition developed or glucose intolerance induced as a result of administering a concentrated, parenteral supplement.
Term
The Nurse should notify the Pharmacist regarding the new order. ONLY the pharmacist can add insulin to a bag of parenteral nutritional supplement.
Definition
As a result of Parenteral Nutritional induced hyperglcemia, the doctor orders insulin to add to the mixture. What Nursing Intervention is necessary for administering insulin via parenteral nutrition?
Term
Drug: omeprazole (PRILOSEC)
Definition
Class: (PPI) Proton Pump Inhibitors

Action: Inhibits bind to the gastric proton pump tx: prevent or decrease the release or amount of gastric acids from parietal cells.

Side Effects: headache, anxiety, dixzziness, abdominal pain, flatulence, dry mouth

NI:
DO NOT CRUSH TABLETS OR CAPSULES

PT:
AVERAGE HEALING TIME 4-8 WKS.

ADVISE PT'S TO USE ANTACIDS FOR ACUTE HEART BURN RELIEF.
Term
Drug: pantoprazole sodium (PROTONIX)
Definition
Class: (PPI) Proton Pump Inhibitors

Action: Inhibits daytime and nocturnal acid secretion. Long-term tx for healing & decrease amt of HCL acid in GI.

Side Effects: headache, anxiety, dixzziness, abdominal pain, flatulence, dry mouth

PT:
MAY TAKE 1-4 DAYS FOR A PATIENT TO EXPEREIENCE RELIEF OF SYMPTOMS.

ADVISE PT's TO USE ANTACIDS FOR ACUTE HEART BURN RELIEF.
Term
Drug: sucralfate (CARAFATE)
Definition
Class: (GI) Agents

Action: Does not secretion nor neutralize gastric acid. Binds to normal and ulcerated mucosa; forms protective barrier-"CHALK LIKE BARRIER"

Side Effects: headache, dixzziness, constipation, flatulence, dry mouth

NI:
SHAKE SUSPENSION BEFORE POURING
GIVE ON AN EMPTY STOMACH
-1h before or 2h after meals
SEPARATE DOSES OF ANTACIDS
-30 min from administration
*CAUTION WHEN USING W/ANTACIDS & H2 BLOCKERS
Term
Drug: aluminum hydroxide (AMPHOJEL)
Definition
Class: Antacid

Action: Alkaine substances that neutralize HCL acids, increases pH & strengthens stomach mucosal barrier

Side Effects: constipation

NI:
SHAKE WELL BEFORE DISPENSING

PT:
TeaTEACH PT S/S OF GI BLEEDING
NOTIFY MD IMMEDIATELY IF GI BLEED OCCUR
Term
Drug: aluminum hydroxide &
magnesium simethicone
(MYLANTA)
Definition
Class: Antacids, combos

Action: Alkaine substances that neutralize HCL acids & increases pH

Side Effects: diarrhea

NI: SHAKE WELL BEFORE DISPENSING
CONTRAINDICATED IN PT's w/RENAL DX
(pt's can't excrete magnesium)

PT:
TEACH PT S/S OF GI BLEEDING
NOTIFY MD IMMEDIATELY IF GI BLEED OCCUR
Term
Drug: Cimetidine (TAGAMET)
Definition
Class: H2 Receptor Anagonist

Action: blocks H2 receptors of gastric parietal cell inhibiting gastric secretions.

Side Effects;(occur rarely with prolonged usage >1m)headache, diarrhea, gynecomastia, antiandrogen (males), confusion (elderly)

NI:
DO NOT W/ANTACIDS (reduces absorption)

PT:
ACUTE ULCERS-MAY TAKE 8 WK FOR HEALING
Term
Drug: famotidine (PEPCID)
Definition
Class: H2 Receptor Anagonist

Action: blocks H2 receptors of gastric parietal cell inhibiting gastric secretions.

Side Effects;(occur rarely with prolonged usage >1m)headache, diarrhea, constipation, dizziness

NI:
DON'T GIVE w/ANTACIDS reduce absorption
MOST EFFECTIVE 30M PRIOR TO MEALS & HS
MAY ENHANCE EFFECTS OF WARFARIN



PT:
ACUTE ULCERS-MAY TAKE 8 WK FOR HEALING
Term
Drug: ranitidine (ZANTAC)
Definition
Class: H2 Receptor Anagonist

Action: blocks H2 receptors of gastric parietal cell inhibiting gastric secretions.

Side Effects;(occur rarely with prolonged usage >1m)headache, diarrhea, constipation, dizziness

NI:
DON'T GIVE w/ANTACIDS reduce absorption
MOST EFFECTIVE 30M PRIOR TO MEALS & HS
MAY ENHANCE EFFECTS OF WARFARIN=INCREASED INR=LOWER DOSE

PT:
ACUTE ULCERS-MAY TAKE 8 WK FOR HEALING
Term
Intrinsic Factor
Definition
Parietal cells in the stomach produce a substance that facilitates the absorption of vitamin B12.
Term
Pernicious Anemia
Definition
In absence or deficiency of intrinsic factor Vitamin B12 can not be absorbed causing this condition.
Term
Cullen's sign
Definition
Bruising around the umbilicus is a sign of intra-abdominal bleeding called?
Term
1. Monitor BG's cover w/sliding scale
2. Monitor I/O's
3.Assess s/s confusion,stupor,lethargy
4. Use pump & check infusion rate
Definition
Identify Nursing Interventions for administering parenteral nutrition with insulin.
Term
Signs & Symptoms include;
1. Cramping (abd pain)
2. Dyspepsia (gas & bloating)
3. Isolation (stay home near BR)
4. Frequent/Urgent diarrhea
5. Nausea & Vommiting
6. Anal discomfort (use baby wipes)
Definition
Patient Teaching: What should the Nurse incluse about the possible side effects of GoLYTELY bowl prep solution?
Term
s/s of GI Obstruction;
1. Bleeding
2. low BP
3. Hypoactive Bowel Sounds
4. Patient c/o abd pain
5. Inability to pass gas
Definition
If your patient has a GI Obstruction what s/s would you expect to see? (5)
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