Care of patients with Gastrointestinal disorders

Care of patients with Gastrointestinal disorders

The GI Tract

• composed of the mouth ,pharynx ,esophagus, stomach, small intestines, large intestines, and the Anus

• Peristalsis: Coordinated contraction of the smooth muscles of the Gi tract that pushes food and bile

The Mouth (pg.1392)

• The entrance of the Gi system

• Contains the tongue, Papillae (Taste buds),

• Contains the Salivary Glands: Parotid, submandibular, and sublingual(Excrete saliva)

• excretes 1,000-1,500ml/day to lubricate food and keep mouth moist

The Esophagus and Stomach

• The Esophagus moves food from the mouth to the stomach

• Food passes through the cardiac sphincter (LES)

• The stomach is located LUQ

• Food exist stomach through Pyloric sphincter

The Esophagus and Stomach

• The Esophagus moves food from the mouth to the stomach

• Food passes through the cardiac sphincter (LES)

• The stomach is located LUQ

• Food exist stomach through Pyloric sphincter

the small intestines (Ileostomy)

• begins in the pyloric sphincter, ends in the ileocecal valve-

• Composed of Duodenum, Jejunums, Ileum

• Intestinal juices turn proteins and fats carbs and proteins

• Bile breaks molecules into smaller droplets. Pancreatic juices(water, protein, inorganic salt, enzymes) break proteins to amino acid/starch to sugar.

• Villi(Movement) increase productivity of Small I, 600%

• Inside each Villi is a capillary bed+lymph capillaries(lacteals - metabolize fats)

Large Intestines (Colostomy)

• Begins ileocecal valve, ends in the rectum

• Cecum, appendix, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, anus rectum

• 4 functions: completion of absorption of water, manufactures vitamins(B7=+K), formation of feces, expulsion of feces

• appendix contains gut bacteria(nonpathogenic)+ immune cells and tissue

• Bacteria turns chyme to fecal matter+ synthesis of vitamin K and production of B complex.

• Water and and vitamin absorbed into blood stream(osmosis)

Multiple Select

Which of the following is not a functional part(organ) of the GI system?

• Pharynx

• esophagus

• stomach

• small intestine

• fecal matter

Multiple Choice

What are papillae?

• smooth muscle to move food through Gi system

• taste buds

• the esophagus

• the orinasal pharynx

Multiple Select

Which of the following are salivary glands?

• Parotid

• ileoparotid

• submandibular

• sublingual

Multiple Select

What does Intrinsic factor ?

• breaks down fats and carbs

• breaks down proteins

• absorbs vitamin D

• synthesis of vitamin B

Multiple Choice

chyme is

• solid

• semi-fluid

• liquid

• composed of vitamins k and B7

Multiple Choice

Define Les

• lesser celebratory status

• Lower cardiac sphincter

• laryngeal estranged silicates

• Lower esophageal sphincter

Multiple Select

What is the purpose of villi

• part of the GI blood barrier

• move food through GI tract

• Absorb emulsified waste

• assist enzymes to break down proteins

Multiple Select

What are the 4 functions of the large intestines?

• replace old villi with new villi

• absorb water

• manufacture vitamins

• form and eject feces

• house immune lymph cells

Liver

• located under the diaphragm of the RUQ and extends epigastric LUQ

  
  

• Largest organ in the body/divided into two lobes, which subdivide further.(2/3) and house blood vessels.

• 1500ml blood flows to liver per minute

• produces bile(brown-yellow/green-yellow)500-1000ml per day.

• Other functions: emulsify fats/carbs/ proteins, activate vitamin D, manufacture cholesterol, manufacture and maintain albumin, filters out old red blood cells, provides heat "at rest" breaks down nitrogenous waste(creatinine)

The Gallbladder and Pancrease

• areolar tissue connects it to the underside of the liver . The main purpose of the gallbladder is to store and eject bile into the duodenum.

• serves both endocrine and exocrine purpose

• secretes 1000-1500 ml pancreatic juice for digestion

• juice contains amylase, protease, lipase(digest fats, carbs, proteins)

• enzymes transported to duodenum through( major duodenal papilla

• pancrease contains alkaline substances, sodium bicarbonate to neutralize hca in gastric juices to the stomach

Multiple Select

What is the color range for bile?

• red-green

• yellow-brown

• green-brown

• orange-brown

Multiple Select

Which of the following is not a function of the liver?

• regulate coagulation

• manage toxins

• synthesize vitamin D

• metabolize fats, carbs, proteins

Multiple Select

What is the primary function of the Gall bladder?

• store bile and eject into the ilium

• store and eject bile into the duodenum

• store bile and eject into the jejunum

• filter "dirty" bile from the blood stream to cleanse it of irregularities

Multiple Choice

What connects the gallbladder to the underside of the liver

• collagenous tissue

• fibrous tissue

• areolar tissue

• ossilar tissue

The hypothalamus

• Houses the two appetite centers of the brain

• the first tells the body "I'm Hungry"

• The second tells the body "I'm Full"

• Graves vs Hashimoto's (Autoimmune)

The Upper Gastrointestinal Study(Upper GI Study, UGI)

• X-ray test of the lower esophagus, stomach, duodenum, using barium sulfate(flavored contrast)

• detects tumors, ulcerative lesions, abnormalities

• Nursing intervention: Client NPO+ no smoking after midnight before the test.

• Feces light (*72hrs)until barium excreted. failure to do so results in blockage as water hardens remaining contrast.

Esophagtroduodenoscopy (EGD, UGI, ENDOSCOPY, GASTROSCOPY)

• Look inwards using fiber optic scope

• EGD Visualizes esophagus, stomach, and duodenum

• looks for tumors, varices(abnormal veins), mucosal inflammation, hiatal hernias, ulcers, Helicobacter pylori, strictures, and obstructions

• sclerotherapy to ride veins of varices

• an endoscope can be attached to the end of a catheter to clear obstructions

• endoscopy views the esophagus, stomach and duodenum

EGD cont.

• Have the patient NPO and no smoking after midnight

• ensure informed consent is signed

• Iv for midazolam, Xylocaine for the throat

• monitor patients vital signs of oxygen saturation and perforation= signs of abdominal pain, tenderness, oral bleeding, melena(tarlike, fetid-smelling stool with blood) and hypovolemic shock

• Patient cannot eat till after they gag(depressor)

Barium swallow

• clear view than an UGI exam, esophagus movement does not show up on X-ray

• uses Barium/ promote water to expel

• allows for view of cerebrovascular accidents(stroke), hiatal hernias, esophagus cancers, GERD, and ulcers

• Allows easy recognition of swallowing difficulties

• Keep patient NPO after midnight, and all barium should be emptied

• Gastorgrapin the Barium of choice(dispersion)

Bernstein Test

• Acid perfusion test

• differentiates between esophageal reflux and angina pectoralis

• If patient suffers pain from Hydrochloric acid, they are positive for angina pectoralis

• keep the patient NPO 8hrs before procedure(antacids and analgesia)

• ask the patient if they feel pain when installing hydrochloric acid

Examination of stool for blood occult

• tumors often grow in the GI tract(lumen)

• If blood seen in stool, Guaiac test, Hemoccult, and Hema test are employed

• blood can also be a result of inflammation of the upper or lower GI tract

• for the test, keep the specimen free of tissue paper, no organ meat 24-48 hrs before the test

• use three separate tests

• Avoid anticoagulants

Sigmoidoscopy

• allows visualization of the inner lining of the lower GI tract

• if indicated this test is used like a biopsy

• Patient kept NPO after midnight. You need a informed consent for this

• preparation usually consists of laxatives and enemas or both

• assess patient for signs of perforation(abdominal pain, bleeding, tenderness, pain)

Barium enema study

• multiple x-rays of the colon to detect, polyps, tumors and diverticula

• can be used to treat intussusception in children using contrast

• night before cathartics(magnesium citrate) are administered

• encourage fluid and laxatives if constipation

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Colonoscopy

• can view from anus to cecum

• biopsy's can be obtained, malignancies viewed, actively bleeding vessels coagulated.

• Virtual colonoscopy used MRI or C scan to produce images of the colon, no sedatives required.

• does not allow for biopsies, removal of polyps, or coagulation of vessels.

• Nursing intervention: informed consent, clear liquid diet(1-3) days before procedure, NPO status 8 hrs before test

• after, monitor patient for signs of perforation: abdominal pain, distension, tenderness, rectal bleeding, or blood clots.

Stool culture

• feces examined for OVA, BACTERIA,OR PARASITES( Staphylococcus Aureus, Salmonella, Shigella, E. Coli, Clostridium difficile,(Escherichia coli - native).

• Three separate specimens needed

• If use of enema, use normal saline or tap water(soapsuds disuption).

• stool samples found with barium

• do not mix urine with feces, wear gloves

• Take the sample to lab within 30 min of collection

Multiple Select

how is barium expelled in a UGI

• filter needle

• hemovac

• emetic

• Water

Multiple Choice

What is the difference between a UGi and an EGD

• UGI is more precise

• EGD uses barium to spot irregularities

Multiple Choice

combination of midazolam and Xylocaine utilizes which methods of anesthesia?

• Malpractice

• negligence

• sedation anesthesia

• general anesthesia

• local anesthesia

Multiple Choice

When does a patient become positive in a Bernstein test?

• When they feel esophagus pain

• when they feel angina pectoralis

• When they feel nerve pain

• never

Multiple Choice

What is melena?

• eye color

• color of the GI tract

• bloody feces

Multiple Choice

What is used to replace barium in an Barium swallow for patients susceptible to Gi Bleeding

• H. Pylori

• melena

• Gastrografin

• medigrafin

Multiple Choice

Which of the following is not a sign of perforation?

• abdominal pain

• tenderness

• hemaccult

• distension

• bleeding

Multiple Choice

Of the following, which is non pathogenic?

• staphylococcus aureus

• Shigella

• Escherichia coli

• E. coli

Dental plaque and caries

• Cavities

• bacteria and/or Carbs in the mouth produce the acids. Dental decay cam be a result of the following....

• Dental plaque: made of mucin and colloidal material(found in saliva), inability of saliva to neutralize acid, length of time acids are in contact with the teeth, susceptibility to teeth decay

• Treatment: removal of plaque(brush twice a day, floss once)

• follow proper nutrition???

Candidiasis

• causes by C. albicans or Candida

• candida found in mucous membranes

• on the skin of people, called thrush, group most affected: infants

• tetracycline: Acne

• in adults, usually patients with leukemia, Diabetes mellitus, or alcoholism, or patients taking antibiotics

• looks pearly white, like"milk curd"

• treatment is Nystatin or Diflucan, one third strength hydrogen peroxide, amphotericin B, fluconazole(anti-fungal)

Carcinoma of the oral cavity

• occurs within the structures of the mouth(pharynx(throat), lips, oral cavity, and tongue.

• most are squamous epithelial cells which metastasize

• Salivary gland tumors: parotid gland/sub maxillary gland, highest instance of malignancies.

• Kaposi Sarcoma: purple and non ulcerated tumor of the skin of the mouth. treated with irradiation

• Risk Factors: History of heavy drinking, tobacco use, or exposure to HPV

• Clinical manifestations/assessment:

  Leukoplakia, aphasia, edema, numbness, toothache

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Carcinoma of the oral cavity: cont.

• Diagnostic procedures: Direct and indirect laryngoscopy(voice box) , more aggressive version= panendoscopy, MOST ACCURATE: Biopsy

• Medical management:- tongue), hemi glossectomy-part of the tongue, mandibulectomy-mandible, supraglottic laryngectomy- all of the larynx

• Radiation therapy: external radiation beam therapy, internal radiation( needles or seeds)+ possible chemo therapy

• Nursing intervention: Palliative,

• teach: less sun exposure, less alcohol, proper mouth care,

• Prognosis: depends upon size of tumor, metastisis, involvement of lymph nodes. prognosis depends on early detection

GERD

• Backwards flow of stomach acid

• symptoms: burning and pressure behind the chest,

• Gerd develops as LES weakens

• Symptoms: Pyrosis(heartburn)after eating, regurgitation warm fluid moving up the throat, Eructation(belching)and flatulence

• data: sour/bitter taste in mouth ,odynophagia (painful swallowing), nocturnal cough, wheezing

• Diagnostic procedure: Barium swallow, Bernstein test

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GERD CONT: Medical management

• Antacids or acid-blocking medications (I.e. aluminum hydroxide) –– DO NOT TAKE WITH OTHER MEDS

• ◦H2 Receptor antagonists/blockers (-dine)

• ◦PPIs (LOPE)

• ◦Antiulcer drug : (I.e. sucralfate/Carafate)

• ◦Antiemetic (metoclopramide/Reglan)

• Nursing intervention: 4-6 meals/day, low fat-moderate protein diet, less caffeine, limit alcohol, chew food slowly, do not eat 2-3 hrs before bed, reduce body weight

• reduce smoking, avoid tight clothing, avoid heavy lifting, bed should be raised 6-8 inches/never flat.

Multiple Choice

Which of the following is associated with Candidiasis?

• ludophilia

• Staphylococcus Aureus

• C. albicans

• Leukoplakia

• ecchymoses

Multiple Select

What drugs are used to treat candidiasis

• Nystatin

• Reynaud's phenomena

• acyclovir

• fluconazole

• amphotericin B

Multiple Select

tumors of this gland have the highest rate of malignancy in carcinoma of the oral cavity

• submandibular

• submaxillary

• oropharynx

• orolaryngeal

Multiple Choice

Kaposi syndrome

• purple, nonulcerated

• red and raised

Multiple Choice

What is leukoplakia

• excess carbs on the teeth(plaque)

• white tongue patch on the tongue

• turning white of the gums

Multiple Select

What are the main symptoms of GERD?

• Pyrosis

• odynophagia

• regurgitation

• eructation

• melena

Multiple Select

What diagnostic tests assess for GERD

• Bernstein test

• sigmoidoscopy

• Guaiac test

• barium swallow

Multiple Choice

In GERD, you would typically see aluminum hydroxide paired with what medicinally

• H2 drugs

• PPI's

• antiulcer drugs

• nothing

Multiple Choice

When this goes defunct, Gerd typically occurs

• Coagulation

• Les

• Dysphagia

• autonomia