Flashcards
GI disorders
Cards in this deck (42)
- 1If I have inflammation of the gallbladder then I have what GI disease?Cholecystitis
- 2What are the risk factors for the cholecystitis patient?Female, Fat, Family history, forty, sedintary, & Native American
- 3What are the clinical manifestations of cholecystitis?1) Right upper quadrant pain & tenderness can radiate to right shoulder and scapula, indigestion.
2) Additional symptoms: N/V, restlessness, diaphoresis, inflammation hourly, fever and symptoms of obstruction (this is how we dx) - 4What are the clinical manifestation signs of cholecystitis obstruction which we also use as a form of diagnosis?BCJdaps
1) bleeding tendencies
2) clay colored stools
3) jaundice
4) dark amber urine-Dark urine due to dehydration is usually amber or honey-colored. Dark urine due to other causes can be tinged with brown or red. Some people have urine that appears almost syrup-like. This is the case when a person has liver or kidney disease.
5) pruritus
6) steatorrhea -the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine - 5How do we diagnose cholecystitis after we identify the signs of obstruction?1) High WBC
2) ERCP-is a procedure that enables your physician to examine the pancreatic and bile ducts. A bendable, lighted tube (endoscope) about the thickness of your index finger is placed through your mouth and into your stomach and first part of the small intestine (duodenum). - 6What treatment is available for cholecystitis?1) analgesic like NSAIDS & morphine-pain
2) Antispasmodics-Bentyl, dicyclomine, & atropine-relax smooth muscle
3) Fluid & electrolyte balance with vitamins ADEK and a bile salt binder Questran
4) Hydroxyzine (atarax)-decrease pruritus - 7What is the teaching available for cholecystitis?1). NSAID and morphine are for the pain and inflammation
2) antispasmodics-smooth muscle relaxer
3) Fluid & electrolyte balance-vitamin ADEK
4) Hydroxyzine ataraxic-decrease pruritus - 8What is the priority care for cholecystitis?1) pain control
2) low fat diet increase fiber and smaller more frequent meals - 9What GI disease is a complication of gangrenous, cholecystitis, pancreatitis, rupture of the gallbladder, biliary cirrhosis, and peritonitis and includes a obstruction of the cystic duct?Cholelithiasis-gallbladder stones
- 10What are the GI symptoms related to Cholelithiasis-gallbladder stones?1) you could be asymptomatic
2) or you have one or more stones will block the common bile duct causing biliary colic, tachy, & sweat
3) The pain will begin 4-6 hours after eating a high fat meal. - 11How do we diagnose cholelithiasis?1) NPO
2) US
3) bilirubin w/obstruction
4) WBC
5) LFP-liver fx panel
6) Serum amylase
7) prothrombin time - 12How do we treat cholelithiasis?1) sx tx-laparoscopic cholecystectomy (tx of choice)
2) Conservative therapy bile acids (cholesterol solvents); not permanent - 13What do we teach about cholelithiasis?Assess for bleeding
comfort position in left sims left or right prone lateral - 14What priority? care do we provide for cholelithiasis1) Pain control
2) Assess respiratory, pneumonia, wound care, & drains - 15What is a GI disease that is an inflammation of the pancreas and pancreas becomes obstructed (stones) spillage pancreatic enzymes release into the pancreatic tissue and then auto digestion takes place?Chronic Pancreatitis
- 16What are the complications of the GI disease pancreatitis?Pseudocyst (benign)
Abscess (requires surgical drainage that can rupture/peritonitis) - 17What are the symptoms and clinical manifestations of pancreatitis?1) Severe pain Left upper quadrant
2) Eating food aggravates the pain
3) cyanosis
4) dyspnea (can't breath)
5) flushing color
6) bowel sounds are decreased or absent
7) hypotension-low BP causing dizzy and faint
8) Tachycardia-rapid HR
9) jaundice
10) abnormal lung sounds
11) discolorations of abdominal wall (cohens sign) is a sign of shock
12) **Systemic Complications: pulmonary, septic shock, and electrolyte imbalance - 18how do you diagnose acute pancreatitis?1) BMP
2) CBC, Neutrophils are HIGH
3) LFT HIGH (albumin LOW)
4) Amylase and lipase high
5) CT of the pancreas
6) Xray of the abdomen
7) abdominal US - 19What is the treatment the GI disorder pancreatitis?1) IV morphine
2) Anstispasmodic Bentyl-is to help relax smooth muscle;
otherwise
3) sx therapy if related to gallstones - 20What teaching is associated with pancreatitis?1) prevent pain and shock
2 with muscle relaxer pentyl-vagal stimulation and gut motility pancreatic outflow, do not give the antispasmodic if pt. has a paralytic ileus - 21What is the priority care of a patient with pancreatitis?1) Pain control medications/positioning sitting up and leaning forward OR in a side-lying position with their knees flexed.
2) Suppress pancreatic enzymes by keeping pt. NPO, NG suction intermittently, and antacids.
3) Nutrition is important: enteral high carbs and low fats, avoid ETOH, check your glucose
4) Electrolyte balance - 22A continuous inflammatory and fibrosing process of the pancreas?Chronic pancreatitis
- 23What causes chronic pancreatitis?1) ETOH abuse
2) Gallstones
3) tumor
4) pseudocysts
5) trauma
6) systemic disease
7) acute pancreatitis
8) idiopathic - 24What are the symptoms of chronic pancreatitis?1) Abdominal pain (same as acute) + heavy gnawing feeling
2) burning
3) cramping
4) malabsorption
5) constipation
6) mild jaundice
7) dark urine
8) steatorrhea
9) DM
10) might have several attacks that become more frequent - 25How do you diagnose chronic pancreatitis?CLAWE
1) CT, MRI, MRCP-abd or endoscopic US
2) Lipase
3) Amylase
4) WBC mild leukocytosis
5) ERCP - 26How do you treat chronic pancreatitis?1) Sx when biliary disease is present or if obstruction or pseudocysts develop.
- 27What is a GI disorder that 95% of cases are deadly and cause is unknown and the big risk is smoking?Pancreatic cancer
- 28What are the symptoms/clinical manifestations of pancreatic cancer?1) abdominal pain
2) jaundice
3) wt loss - 29What is the diagnosis for pancreatic cancer?1) CT
2) ECRP - 30What is the treatment for pancreatic cancer?1) Whipple procedure, only if the cancer is at the head of the pancreas.
- 31It is not a condition but a disease that is characterized by fat that accumulates to the extent that health is impaired and it is usually to the consumption of more calories than are needed by the body for energy?Obesity
- 32What other things cause obesity?1) Congenital
2) metabolic problems
3) medications
4) steroids
5) CNS disorders - 33A cluster of conditions that increase the risk for heart disease, stroke, and DM?metabolic syndrome
- 34What are the signs and symptoms of clinical manifestations of obesity?Normal BMI is 18.5-24.9
1) overweight is 25-29.5
2) Obesity > 30 BMI
3) multiple health risks are associated with obesity - 35How did you diagnose obesity?there are 4 ways:
1) Body mass index
2) Weight circumference
3) Waist to hip ratio
4) Body shape apple/pear
**apple shape waist is larger than hips - 36What is the treatment for obesity?Diet
Exercise
& surgery - 37How do you diagnose a metabolic disorder?to diagnose an individual you must have three or more of these conditions:
1) visceral obesity in women >35, men >40
2) Low HDL <40
3) High triglycerides >150
4) HTN >130 systolic/ >85 Diastolic
5) Insulin resistance with a FastinBG>110 - 38What are you teaching a patient with metabolic syndrome?1) Low calories +fruit+veggies+fiber
2) Avoid concentrated sweets
3) Sm portions
4) Do not skip meals
5) Reduce fat intake
6) Exercise 30-60 min. 6-7 days a wk. - 39What priority care do you take with patients with metabolic syndrome1) patients must be ready for a change in their lifestyle+exercise+decrease calorie intake=wt. loss
- 40What 3 treatments do we provide the obese patient?1) restrictive surgery
Reduce the size of the stomach by banding, remove the part of the stomach, or insert a balloon into the stomach, less food is eaten DIGESTION IS NOT ALTERED, low risk for anemia
2) malabsorption surgery: small intestine is shortened, bypassed, less food is absorbed , better wt loss then restrictive--patient is at risk for anemia and vitamin deficiencies and dumping syndrome.
3) Sleeve gastrectomy-75% of the stomach is reduced and the functionality of the stomach is preserved. - 41What obesity teaching can we provide?Pre-op teaching:
1) TCDB exercises and splinting the incision
2) use an Incentive spirometer to prevent atelectasis and PNA
3) they need to walk around asap
4) Ted Hose and pneumatic compression device to prevent DVT
Post-op teaching complications:
1) re-sedation; altered mental status, check pulse ox and check for bradypnea--the body stores anesthetic in adipose tissue, as the adipose cells release anesthetics back into the bloodstream the pt may become sedated after surgery. If this happens happens be prepared to perform a head-tilt or jaw thrust maneuver and keep the patients' oral and nasal airway open
3) wound evisceration and dehiscence. protect the incision against undue strain when TCDB. Keep head elevated if evisceration and dehiscence happen just reinforce the dressing do not uncover dressing and notify HCP.
4) dumping syndrome; gastric content empty rapidly in the small intestine s/s: V/N, weakness, sweat, faint, diarrhea, prevent this by eating small meals, avoid high carb foods, sweets, and avoid drinking fluids w/ meals.
5) anastomosis leak: pain,fever,tachy - 42What is the priority nursing care for the obese patient?Preop preparation-
1) make sure all skin folds on the skin are clean
2) Planning for the care of the obese pt, large cuffs, gowns, proper size bedding and rails IV > 1in, Hoyer lift, change nursing techniques
Post op Care:
1) keep HOB elevated to reduce abdominal pressure and increase lung expansion
2) NG tube do not irrigate/ or reinsert assess for signs of infection
3) Diet-high protein, low fat, eat six small meals a day limit fluids 1000mL/ day and fluids should not be taken with meals.
4) Fe & Ca deficiency anemia common w/malabsorp sx pt should increase intake of protein, Fe, Ca, and B12, reconstruct sx, can be used for body contouring after wt. loss has been est.