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47 Cards in this Set
- Front
- Back
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Radiographic studies done w/ or w/o contrast that define anatomic or functional abnormalities |
-upper GI series -Barium enema |
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Indications for GI series |
Gastric ulcers peristaltic disorders tumors varicies intestinal enlargements or constrictions C/O abd pain, altered elimination habits, or GI bleeding |
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Nursing actions for GI series |
-pre procedure -post procedure |
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Endoscopy |
-allow direct visualization of body cavities, tissues, and organs for diagnostic and therapeutic purposes -indicated for: potential diagnoses, client presentation |
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list the different types of endoscopes and their uses |
-esophagogastroduodenoscopy (EGD) used for visualization of esophagus used to see if bowel function is normal -endoscopic retrograde cholangiopancrec (ERCP) looks at ducts and see if bile is flowing normally -Colonoscopy looks at lower procedures -sigmoidoscopy looks at lower procedures |
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actions of an endoscopic nurse during pre procedure |
-verify informed consent is obtained for proper procedure -assess vital signs and verify allergies -evaluate baseline lab values and report unexpected or abnormal results -assess history for risks of complications |
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nursing actions for post procedure |
-montior vital signs -assess for complications -if biopsy taken, may have food restrictions -EGD/ERCP (withgold fluids until gag reflex returns) -for a colonoscopy/ sigmoidoscopy (monitor for rectal bleeding, instruct that there may be increased flatulence due to air instillation during the procedure |
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hiatal hernia |
muscle weakness of the diaphragm at the esophageal hiatus |
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diagnostic testing for a hiatal hernia |
-X-rays -Barium swallow -Fluoroscopy |
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Medical management for hiatal hernia |
-medications (antacids, H2 blockers, PPI) -Funoplication |
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assessment for hiatal hernias |
-heartburn -regurgitation -pain -dysphagia -belching -worsening of symptoms after eating or when in recumbent position |
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things to monitor with hiatal hernia |
-nutritional status -aspiration -pain -complications: *strangulation (food trapped and blood flow gets cut off, and ischemia occurs) *incarceration (trapped in a wall, food gets stuck ) *Hemorrhage (Bleeding) |
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Diet modifications for hiatal hernias |
-avoid chocolate, fat, mints, spicy and acidic foods -4-6 small meals -avoid carbonated beverages and caffeine |
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lifestyle modifications for hiatal hernia |
-elevate HOB 6" -NO smoking or alcohol -No heavy lifting or straining (increase risk for strangulation, avoid eating before exercise) |
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GERD |
-characterized by gastric content and enzyme leakage into the esophagus -> irritate the esophageal tissue -> limits ability to clear contents from esophagus -untreated GERD -> inflammation -> breakdown -> long-term complications (adenocarcinoma or esophagus ) |
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medical management for GERD |
-diet -life style changes -medications -surgery |
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Risk factors for GERD |
-obesity -older age -sleep apnea -NG tube -diet -distended abdomen or delayed gastric emptying -increase abdominal pressure -medications -debitation or age-related conditions -hiatal hernia -lying flat -wearing tight belts |
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Clinical manifestations for GERD |
-dyspepsia -acid reflux -throat irritation -hypersalivation -eructation -flatulence -bitter taste in mouth -atypical chest pain -dysphagia -tooth erosion -hoarseness |
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diagnostic testing for GERD |
-EGD (see if there are esophageal changes) -24 hour ambulatory pH monitoring -Esophageal manometry -barium swallow |
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medical management for GERD |
-medications (antacids, H2 blockers, PPI, prokinetics) -Stretta Procedure -Fundoplication |
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Diet for GERD |
-avoid caffeine, beer, milk, mints, and carbonated beverages -low fat -4-6 small meals |
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Lifestyle changes for GERD |
-maintain normal weight -no smoking or alcohol -elevate HOB 6-8 inches |
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Education for GERD |
-avoid situations that causes esophageal irritation -avoid eating, drinking 2 hrs before bedtime -elevate upper body on pillows |
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Complications of GERD |
-Aspiration of Gastric Contents *reflux of gastric fluids into the esophagus can be aspirated into the trachea |
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Risks associated w/ aspiration from GERD |
-Asthma exacerbation -Frequent upper respiratory, sinus, or ear infections -aspiration pneumonia -barrett's epithelium (premalignant) and esophageal adenocarcinoma |
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Gastritis |
-Inflammation of the stomach -a common GI problem |
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Acute Gastritis |
rapid onset of symptoms usually caused by dietary indiscretion. other causes include medications, alcohol. bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause serious complications. Potential upper GI bleed=emergency
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Chronic gastritis |
prolonged inflammation due to benign or malignant ulcers of the stomach or by helicobacter pylori (H. pylori). May also be associated with some autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile. |
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Clinical manifestations of Gastritis |
Acute: abd discomfort, headache, lassitude, nausea, vomiting, hiccuping. (Keep them NPO) Chronic: epigastric discomfort, anorexia, heartburn after eating, belching, sour taste in the mouth, N/V, intolerance of some foods. May have vitamin deficiency due to malabsoroption may be associated w/ achlorydia, hypochloridia, or hyperchlorydia Diagnosis is usually by UGI X-ray or endoscopy and biopsy |
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primary treatment for gastritis |
identification and elimination of the causative factors |
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medications for gastritis |
- H2 blockers -Antacids -PPI -Triple therapy for H. pylori |
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surgical management for gastritis |
-gastrectomy -pyloroplasty -vagotomy |
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interventions for gastritis |
-monitor fluid intake and urine output -provide IVFs as prescribed -Monitor electrolytes -Assist in identifying triggering foods -provide small, frequent meals and encourage to eat slowly -advise to avoid alcohol, caffeine, and foods that cause gastric irritation -assist w/ identifying reduction of stress -monitor for signs of gastric bleeding -monitor for anemia |
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Peptic ulcer disease |
Erosion of the mucosal lining of the stomach or duodenum-> eroded to point epithelium is exposed to gastric acid and pepsin -> bleeding and perforation -> perforation that extended through all layers -> peritonitis includes gastric ulcers, duodenal ulcers, stress ulcers associated w/ infection of H. pylori |
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risk factors for PUD |
excessive secretion of stomach acid dietary factors chronic use of NSAIDs Alcohol Smoking familial tendency |
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manifestations of PUD |
dull gnawing pain burning in the mid epigastrium heartburn vomiting |
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laboratory test for PUD |
H. pylori H&H Stool hemooccult |
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diagnostic testing for PUD |
barium studies endoscopy w/ possible biopsy |
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medications for PUD |
-antibiotics -Histamine 2 receptor antagonists -PPIs -Antacids -Mucosal Protectant |
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collaborative care for PUD |
-bland nonirritating diet -monitor vital signs and for orthostatic changes -administer saline lavage via NGT if prescribed -decrease environmental stress -encourage smoking and avoid alcohol consumption |
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Complications and interventions of PUD |
-Hemorrhage/ perforation *emergency situation *fluid deficit management *NGT/Saline lavage *EGD w/ laser treatment -Pyloric obstruction -rigid board abd |
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surgical management for PUD |
gastroenterostomy vagotomy pyloroplasty |
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vagotomy |
vagus nerve is cut where it enters the stomach in order to decrease gastric acid |
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pylorplasty |
the outlet from the stomach to the duodenum is widened to increase gastric emptying |
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postoperative nursing care for bariatric surgeries |
-monitor for infections -monitor bowel sounds -provide pain medication as prescribed -may need stool softener -monitor fluid and electrolytes -monitor for diarrhea -slowly introduce foods -assess for abdominal distention and tenderness -monitor incision site for redness, discharge, and swelling -monitor for post-op complications |
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post-op complications for bariatric surgeries |
-Gastric bleeding -obstruction -dehydration -incisional or ventral hernias -pernicious anemia (chronic gastritis damages parietal cells-> decreases production of intrinsic factor that is needed to absorb vitamin B12) -Dumping syndrome |
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Dumping Syndrome |
-due to rapid passage of food into the jejunum and drawing of fluid into the jejunum to hypertonic intestinal contents -causes vasomotor and GI symptoms with reactive hypoglycemia -Steatorrhea (reduce fat intake and administer loperamide) -Avoid fluid w/ meals -Avoid high carbohydrate/sugar intake |
