Term
|
Definition
- heliobacter pylori infection
- NSAID use --> decrease protective prostaglandins --> increase gastric acid secretion
- Severe stress
- hypersecretory states
- alcohol, caffeine, smoking |
|
|
Term
| diagnostic procedures to confirm peptic ulcers |
|
Definition
Esophagogastroduodensocopy (EGD)
most definitive to confirm peptic ulcers |
|
|
Term
| Esophagogastroduodensocopy (EGD) |
|
Definition
NPO
remove dentures
informed consent form
post procedure: food/fluid following return of gag reflex |
|
|
Term
|
Definition
pain 30-60 minutes after meal
rarely occurs at night
pain goes up with food ingestion
> women and older adults |
|
|
Term
|
Definition
pain 90 mintes to 3 hours after meal
often occurs at night
pain relieved by food ingestion
80% of all PUD
H. pylori is found in 90-95% of pts with duodenal ulcer |
|
|
Term
peptic ulcer dx
complications to watch for |
|
Definition
Hemmorrhage (most common)
duodenal ulcer>gastric ulcer
perforation
GI outlet obstruction |
|
|
Term
peptic ulcer dx
complications to watch for
Perforation: |
|
Definition
sudden, severe epigastric pain spreading accors the abdomen and to the shoulder
- ulcer goes through stomach or duodenum --> stomach content enter periotneal cavity --> untreated --> bacterial peritonitis may occur (6-12 hours) --> rebound tenderness |
|
|
Term
peptic ulcer dx
complications to watch for
GI outlet obstruction |
|
Definition
c/o worsen pain at end of day d/t increase stomach content
belching or self-induced vomit (projectile vomit d/t obstruction) |
|
|
Term
| Nursing and collaborative management (conservative therapy) |
|
Definition
nutritional therapy
stress reduction and rest
therapy related to complications |
|
|
Term
Nursing and collaborative management (conservative therapy)
Nutritional therapy |
|
Definition
eat 6 small meals or 3 regular meals
avoid irritating food -- spicy foods
eat as normally as possible |
|
|
Term
Nursing and collaborative management (conservative therapy)
Therapy related to complications
ACute exacerbation/hemorrhage |
|
Definition
|
|
Term
Nursing and collaborative management (conservative therapy)
Therapy related to complication
PErforation |
|
Definition
Goal: stop spillage of gastric or duodenal content into peritoneal cavity
- NG tube, IV fluid replacement/PRBC, strict I/O, broad spectrum antibiotics, pain medicatio |
|
|
Term
|
Definition
operation removes part of the stomach
remaining segment attached to jejunum
end of teh duodenum is sewn up |
|
|
Term
Dumping syndrome
what is it? |
|
Definition
| rapid entry of ingested food into the jejunum without proper mixing and without the normal digestive process of the duodenum -- |
|
|
Term
Dumping syndrome
process... |
|
Definition
| the chyme are more hyperosmolar than the jejunal secreation --> cause fluid to be drawn from bloodstream into the jejunum because concentrated food and fluids move rapidly into the intestine --> decreasing blood volume --> hypotension --> diarrhea, feeling of fullness and discomfort |
|
|
Term
dumping syndrome
when does it occur |
|
Definition
5-30 minutes after meals
lasts 20-60 minutes |
|
|
Term
dumping syndrome
complaints |
|
Definition
| weakness, faintness, tachycardia, diaphoresis, pallor, fullness, discomfort, nausea and diarrhea |
|
|
Term
dumping syndrome
nursing interventions
most important |
|
Definition
| lying down after a meal slows movement of food within the intestines |
|
|
Term
| dumping syndrome medications |
|
Definition
antispasmodic medications: dicyclomine
octreotide (sandostatin) subq |
|
|
Term
dumping syndrome
other nursing interventions |
|
Definition
monitor nutrition and electrolyte balance I&O, wt
wach for postprandial hypoglycemia |
|
|
Term
dumping syndrome
nutritional education |
|
Definition
limit amount of fluids at one time
eliminate fluids with meals and 1 hr before/after meals
6 small meals are best
avoid milk, bread, sweets and sugars
have a high protein high fat and low to moderate carbohydrate diet |
|
|
Term
dumping syndrome
nutritional education
eliminate fluids with meals and 1 hr before/after meals |
|
Definition
| prevent distention/feeling of fullness |
|
|
Term
dumping syndrome
nutritional education
6 small meals are best |
|
Definition
| avoid overloading intestines at mealtime |
|
|
Term
dumping syndrome
nutritional education
avoid milk bread sweets and sugars |
|
Definition
| may cause dizziness, diarrhea, sense of fullness |
|
|
Term
dumping syndrome
nutritional education
have a high protein, high fat and low to moderate carbohydrate diet |
|
Definition
| promote rebuilding body tissues and meet energy needs |
|
|
Term
|
Definition
decreased taste and smell, sep sweet and sour
teeth enamel and dentin breakdown
periodontal disease
decreased motility of GI system
delayed gastric emptying
decreased acid production and intrinsic factor |
|
|
Term
constipation
complications |
|
Definition
fecal impaction/fecal incontinence
hemorrhoids
megacolon/megarectum
arterial HTN |
|
|
Term
constipation
collaborative care
medications |
|
Definition
Bulk formers: metamucil -- take with lots of fluid
stool softener: ducosate sodium (colace)
lubricants: mineral oil
hyperosmotic agents: colyte, golytely
saline laxative: milk of magnesia (MOM)
stimulat: dlucalox, castor oil |
|
|
Term
constipation
nursing interventions |
|
Definition
** adequate dietary fiber: apple sauce, prunes, prune jice, fruits and veggies
- fluid balance
- movement/ambulation/exercise
- bowel training program
- close commoed, use of bedpan, walking distance to restroom
- skin protection
- perianal pouching
- maintenance of skin integrity |
|
|
Term
Appendicitis:
diagnostic studie |
|
Definition
CBC, UA r/o GU concern
CT scan or US |
|
|
Term
appendicitis
nursing management |
|
Definition
keep npo until Dx is confirmed
before admit pain meds, confirm dx
no enema, no laxatives |
|
|
Term
inflammatory bowel disease (IBD)
ulcerative colitis |
|
Definition
edematous, inflamed mucosa with multiple abscesses begingin in the rectum and moving upward through the large intestine
can lead to cancer |
|
|
Term
inflammatory bowel disease (IBD)
ulcerative colitis
s/s |
|
Definition
| constipation alternating with bloody diarrhea, cramping and abdominal pain |
|
|
Term
inflammatory bowel disease (IBD)
chron's disease |
|
Definition
| intermittent involvement through the entire GI tract, most commonly in the small intestine and the terminal ileum. dz usually extends through all layers of the bowel over time |
|
|
Term
inflammatory bowel disease (IBD)
chron's disease
s/s |
|
Definition
| non-bloody diarrhea, weight loss and pain |
|
|
Term
inflammatory bowel disease (IBD)
treatment/intervention |
|
Definition
possible surgery: collectomy and colostomy
dz often recurs: Chron's dz
dz is curable with colectomy |
|
|
Term
|
Definition
low fiber (low residue)
high calories, high protein and low fat
mashed potatoes, canned fruits, boiled chicken |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Colonoscopy -- definitive diagnosis |
|
|
Term
|
Definition
clear liquids only for 24 hours prior
GoLYTELY or similar cathartic
NPO 8 hr prior due to conscious sedation
signed consent is necessary
vital signs and electrolyte monitored |
|
|
Term
| treatment for acute exacerbation of IBD |
|
Definition
NPO
IV fluids with TPN
**BOWEL REST |
|
|
Term
| post operative care: total colection |
|
Definition
** teach or emphasize that teh ostomy is permanent and teh ileum will be reconnected with the large bowel when it heals
** monitor ileostomy for high watery output-concern about the status of teh patient's fluid balance
ileostomy: stoma assessment and skin integrity-consider wound ostomy nurse
NG tube insertion and care
perineal skin care |
|
|
Term
intestinal obstruction
types of obstruction |
|
Definition
|
|
Term
intestinal obstruction
types of obstruction
mechanical |
|
Definition
occlusion of teh tract
**adhesions are most common cause
hernia, neoplasms-- other causes |
|
|
Term
intestinal obstruction
types of obstruction
nonmechanical |
|
Definition
paralytic ileus -- lack of peristalsis
may occur post any abdominal surgery |
|
|
Term
intestinal obstruction
etiology and pathophysiology |
|
Definition
laction of obstruction determines extent of acid-base, fluid and electrolyte imbalance
High: (close to pylorus) metabolic alkalosis (loss of HCL acid from vomiting, NG suction
Low: (small intestine) dehydration occurs rapidly, reverse perstalsis may cause vomiting of fecal material |
|
|
Term
colorectal cancer
clinical manifestations |
|
Definition
** alternating constipation and diarrhea
mostly asymptomatic
rectal bleeding - most common |
|
|
Term
colorectal cancer
diagnostic studies |
|
Definition
**colonoscopy -- gold standard
digital rectal exam |
|
|
Term
|
Definition
| stoma should be pink moist, health looking |
|
|
Term
stoma assessment
problems occur 3 ways |
|
Definition
|
|
Term
stoma assessment
problems
**color |
|
Definition
dusky red to blue or purple -- ischemia
brown to black -- necrosis
pale -- may inidcate anemia |
|
|
Term
stoma assessment
problems
**edema |
|
Definition
mild to mod - may be normal esp in immediate post op, may be trauma to stoma
mod to severe - obstruction of stoma, gastroenteritis, allergic reaction |
|
|
Term
stoma assessment
problems
**bleeding |
|
Definition
small: some oozing may be normal d/t high vascularity of stoma
mod to large: coagulation factor deficiency, stomal varices due to portal hypertension, low GI bleeding |
|
|
Term
|
Definition
outpouching of teh colon
occurs through circular smooth muscle of intestinal mucosa |
|
|
Term
|
Definition
** often asymptomatic
multiple noninflamed diverticula |
|
|
Term
|
Definition
|
|
Term
| complications of diverticulitis: |
|
Definition
** peritonitis
perforation
hemorrhage
bowel obstruction |
|
|
Term
| nursing management of diverticula |
|
Definition
high fiber diet, fiber supplements
stool softeners
anticholinergics ( decrease gI motility and spasms)
acute: antibiotics, NPO status, IV fluids, possible colon resection, NG suction |
|
|
Term
hemorrhoids
nursing management |
|
Definition
discharge teaching:
** sitz baths
preventative measures
pain control
prevent constipation |
|
|
Term
Enteral feedings:
reducing the risk of aspiration |
|
Definition
check ressidual: accumulation/back-ups
how much is too much (depends on the rate)
** return aspirate to the stomach and if high recheck the volume of aspirate in an hour
keep head of bed up as much as possible |
|
|
Term
Parenteral nutrition
complications |
|
Definition
** infection/sepsis (why PPNs have filters)
** hyperglycemia
** fluid overload
pneumothorax (from insertion of central line)
air embolism
clotted catheter line
catheter displacement
rebound hypoglycemia |
|
|
Term
Parenteral nutrition
nursing intervention |
|
Definition
** checking glucose levels
maintin optimal nutrition
prevent infection
maintain fluid and electrolytes balance
prevent metabolic imbalance
promte comfort
encourage activitiy |
|
|
Term
Liver
Viral hepatitis:stages |
|
Definition
early prodromal phase
preicteric phase
icteric phase
convalescent phase |
|
|
Term
Liver
Viral hepatitis:stages
common features of Early Prodromal phase |
|
Definition
flu like symptoms
occurs 2-3 weeks before jaundice |
|
|
Term
Liver
Viral hepatitis:stages
common features of Preicteric phase |
|
Definition
GI symptoms: N/V ab pain, anorexia
generalized malaise, myalgias, HA, fever
may last to several days to weeks; needs lots of rest |
|
|
Term
Liver
Viral hepatitis:stages
common features of Icteric phase |
|
Definition
** need adequate bedrest
s/s of jaundice, actual phase of illness
2-6 weeks |
|
|
Term
Liver
Viral hepatitis:stages
common features of convalescent phase |
|
Definition
| full recovery usually within 6 months |
|
|
Term
Diagnostic tests for liver disease
liver function tests |
|
Definition
** serum enzyme activity (AST & ALT) which are elevated
bilirubin metabolism
serum protein study
ammonia level
blood clotting functions
activated (APTT)
fat metabolism (cholesterol, phospholipids) |
|
|
Term
complications of hepatic dysfunction:
ascites: collaborative management |
|
Definition
| ** paracentesis: watch for hypovolemia |
|
|
Term
esophateal varices bleeding: collaborative management
goal for nursing |
|
Definition
| to maintain the pt's airway and prevent aspiration of blood |
|
|
Term
hepatic encephalopathy
pathophysiology |
|
Definition
| build up of toxins which the liver fails to remove ammonia and metabolic wastes from the blood causing altered mental status |
|
|
Term
hepatic encephalopathy
collaborative management |
|
Definition
** reduction of blood ammonia levels
** reduce protein intake
** eliminate intestinal bacteria by using nemycin |
|
|
Term
hepatic failure
collaborative management |
|
Definition
** activity and rest: assess for fatigue, needs rest
nurition: oral hygiene, avoid alcohol, increase calories -- low fat, low protein, low Na
LOC: no opioids or sedatives
skin integrity: pruritus... give questran or atarax |
|
|
Term
|
Definition
|
|
Term
|
Definition
cholesterol stones
pigment stones (billirubin) |
|
|
Term
|
Definition
| presence of one or more gallstones |
|
|
Term
cholelithiasis
pathophysiology and etiology |
|
Definition
| bile supersaturated with cholesterol --> bile stasis wihin the gallbladder --> decrease motility of gallbladder --> form crystal formation = microstones which aggregate more --> macrostones --> severe inflammation |
|
|
Term
|
Definition
2ndary to severe inflammation = **abdominal pain, nausea (usually after eating high fat foods)
obstruction of common bile duct --> bile reflux into liver --> jaundice, pain --> hepatic damage, pancreatitis, sepsis |
|
|
Term
management of cholelithiasis
laproscopic cholecystectomy
**procedure |
|
Definition
abdominal incision
lighted scope attached to video camera into one incision near belly button
inserting surgical instruments into other incisions
removes gallbladder
4 small incisions, which will be covered with dressing |
|
|
Term
Traditional cholecystectomy
Post-op care
Drainage catheters: penrose or Jackson-Pratt |
|
Definition
**FT-tube: expect large amount of bloody to greenish brown drainage teh first 24 hours: 400-600 ml:
over 1000 ml contact physician |
|
|
Term
pancreatitis
** Diagnostic studies |
|
Definition
- serum amylase level is elevated early and remains high for 24-72 hrs (normal: 56-190 IU/L
- acute pancreatitis: 400-800 IU/L
- urine amylase remains high up to 2 weeks
- lipase: 3-5 x's above normal
- serum liver enzymes and bilirubin levels high with associated biliary dysfunction
- elevated WBC count |
|
|
Term
pancreatitis
** Diagnostic studies
chronic pancreatitis |
|
Definition
| w/ pancreatic cell destruction. usually absence of high amylase level because less amylase is made within the pancreas |
|
|
Term
pancreatitis
nursing interventions
rest the pancreas |
|
Definition
** npo: no food until pain free
** NGT for gastric decompression
** TPN
once diet is resumed: bland, low fat
no stimulants, small frequent meals
no alcohol or smoking
limit stress |
|
|
Term
pancreatitis
nursing interventions
**pain management |
|
Definition
administer opioids prescribed (large doses of morphine IVP)
give antispasmodic:
- dicyclomine (Bentyl)
- propantheline bromide (Pro-banthine)
- (demerol given traditionally) |
|
|
