GI

Question 1

what are the functions of the pancreas?

Answer 1

endocrine- insulin

exocrine-disgestive enzymes

Question 2

what is the causes for acute and chronic pancreatitis?

Answer 2

acute- 1. alcohol 2. gallbladder disease
chronic- alcohol
(alcohol destroys your gi tract!)

Question 3

s/s of pancreatitis?

Answer 3

pain- increased with eating
abdominal distention/ascites
abdominal mass- swollen pancreas
rigid broad-like abdomen (this is peritonitis)
bleeding around the umbilical area (cullen's sign)
fever (inflammation)
N/V
jaundice (liver is involved)
hypotension (ascites or bleeding)

Question 4

what lab value is most specific to pancreatitis?

Answer 4

amylase

Question 5

normal lab value for amylase and lipase?

Answer 5

amylase= 30-220

lipase=0-110

Question 6

Normal lab value for hemoglobin

Answer 6

male- 14-18

female 12-16

Question 7

diagnosis for pancreatitis

Answer 7

• serum lipase and amylase UP
• WBCs UP
• Blood sugar UP
• ALT, AST-liver enzymes UP
• PT,PTT LONGER
• serum bilirubin UP
• hemoglobin could go UP or DOWN (up for bleeding and down for ascites)

Question 8

patient with pancreatitis, keep the stomach ____.

Answer 8

empty and dry!!

Question 9

tx for pancreatitis

Answer 9

• NPO (decrease GI secretions)
• pain meds
• steroids
• anticholinergics (to dry up)
• GI protectants
• maintain f&e imbalance
• maintain nutritional status—ease into diet
• insulin (pancreas is sick, TPN (full of sugar), steroids(makes blood sugar go up))
• daily weight
• eliminate alcohol
• refer to AA f this is the cause

Question 10

anytime there is a liver problem, what chemical should you think of?!!

Answer 10

ammonia!

Question 11

**if you liver is sick, your #1 concern is

Answer 11

bleeding

Question 12

if you liver is sick, what should you do with the medication?

Answer 12

decrease the dose

Question 13

never give ____ to people with liver problems. antidote?

Answer 13

acetaminophen

antidote is acetylcysteine

Question 14

4 major functions of the liver

Answer 14

1. detoxify the body
2. helps the blood to clot
3. the liver helps to metabolize (break down) drugs
4. the liver synthesizes albumin

Question 15

Cirrhosis:
liver cells are destroyed and are replaced with connective/scar tissue—alters the ____ within the liver—the BP in the liver goes ____, this is called ____.

Answer 15

circulation
UP
potal hypertension

Question 16

s/s of cirrhosis

Answer 16

• firm, nodular liver
• abdominal pain -liver capsule has stretched
• chronic dyspepsia (gi upset)
• changes in bowel habits
• ascities
• splenomegaly (means immune has kicked in)
• decrease serum albumin
• increased ALT and AST
• anemia
• can progress to hepatic encephalopathy/ coma

Question 17

when the spleen is involve, this mean

Answer 17

immune system is involved!!

Question 18

what should you know with acetylcysteine

Answer 18

give with carb. drink
STINKS
come in a small vial

Question 19

what does albumin do?

Answer 19

hold on to fluid in the vascular space. if NO albumin, fluid goes to peritoneal cavity as ascites

Question 20

Liver biopsy:

• clotting studies pre-procedure: _____
• vital signs pre-procedure
• how do you position this client?
• exhale and hold ____. why?
• post-procedure: lie on ____ side. vital signs, worried about _____.

Answer 20

PT INR and aPTT
worried about hypotension
supine with right arm above bed
breath why? to get the diaphragm out of the way
lie on right side post op (to hold pressure!)
worry about hemorrage

Question 21

ammonia can lead to ___. it acts as a ___.

Answer 21

COMA hepatic encephalopathy.

SEDATIVE

Question 22

tx for cirrhosis

Answer 22

• antacids, vitamins, diuretics
• no alcohol
• i&o and daily weight
• rest (bc toxins are building in the body)
• prevent bleeding!
• measure abdominal girth (why? ascites)
• paracentesis
• monitor jaundice
• avoid narcotics
• diet

Question 23

what diet should cirrhosis patient ?

Answer 23

decrease protein

low NA diet

Question 24

Protein—-breaks down to ___—-the ___ converts ammonia to ___—-___excrete the urea

Answer 24

ammonia
liver
urea
kidneys

Question 25

asterixis

Answer 25

hand tremor liver flap (s/s of hepatic coma)

Question 26

what is fetor?

Answer 26

breath smells like ammonia

Question 27

tx hepatic coma

Answer 27

lactulose (decrease ammonia) cleansing enemas decrease protein monitor serum ammonia

Question 28

s/s hepatic coma

Answer 28

- minor mental changes/motor problems - difficult to awake - asterixis - handwriting changes - reflexes will decrease - eeg slow - fetor - anything that increase ammonia level will aggravate this problem - liver people tend to be GI bleeders!

Question 29

what is the liver drug to think of?

Answer 29

lactulose (decrease ammonia)

Question 30

high BP in the liver

Answer 30

portal HTN

Question 31

when you see an alcholic client that is GI bleeding it is usually esophageal varies. usually no problem until ____.

Answer 31

rupture

Question 32

tx for bleeding esophageal varies

Answer 32

``` replace blood VS CVP Oxygen (any time someone is anemic, o2 is needed) octreotide (lowers bp in the liver) ballon tamponade cleansing enemia to get rid of blood lactulose saline lavage to get blood out of the stomach ```

Question 33

what is balloon tamponade?

Answer 33

to hold pressure on bleeding varices it is an infrequently used emergency procedure that may be used to stabilize client with severe hemorrhage. it should not be used more then 12 hrs. many of the safety implications for the blakemore tube can be applied to other oropharynx or nasopharync tubes.

Question 34

peptic ulcers: common cause of ___. can be in the ____. mainly in females or males?

Answer 34

GI bleeding esophagus, stomach, or duodenum males but increasing in females (erosion is present)

Question 35

s/s of peptic ulcers

Answer 35

burning pain usually in the mid-epigastric area/back. heartburn (dyspepsia) erosion can lead to PAin!

Question 36

gastroscopy (EGD,endoscopy): Sedated NPO until what returns? watch for?

Answer 36

gag reflex returns watch for perforation by watching for pain, bleeding, or if they are having trouble swallowing.

Question 37

tx for peptic ulcers

Answer 37

--medications 1.antacids (liquid to coat stomach) 2. proton pump inhibitors (decrease acid secretion) "zole" at the end; omeprazole 3. h2 antagonist ---client teaching decrease stress, stop smoking, eat what you can tolerate, need to be followed for one year

Question 38

when should a client with a peptic ulcer take an antacid?

Answer 38

take when stomach is empty and at bedtime--- when the stomach is empty. acid can get on ulcer... take antacid to protect ulcer

Question 39

malnourished; pain is usually half hour to 1 hour after meals; food doesnt help, but vomitting does; vomit blood what is this?

Answer 39

gastric ulcer

Question 40

well-nourished; night time pain is common and 2-3hours after meals; food helps; blood is stools.

Answer 40

duodenal ulcer pain with stomach empty these are lower down than gastric

Question 41

what is hiatal hernia?

Answer 41

this is when the hole in the diaphragm is too large so the stomach moves up into the thoracic cavity - -main cause is large abdomen - -other cause include- congenital abnormalities, surgery, trauma

Question 42

s/s hiatal hernia?

Answer 42

heartburn fullness after eating regurgitation dysphagia

Question 43

tx hiatal hernia

Answer 43

``` small frequent meals sit up 1 hour after eating elevate HOB surgery teach lifestyle changes and healthy diet ```

Question 44

the stomach empties too quickly after eating and the client experiences many uncomfortable to severe side effects.... usually secondary to _____.

Answer 44

dumping syndrome gastric bypass gastrectomy gall bladder

Question 45

lay on ____ to keep food in the stomach. ____= leaves in ____= releases it

Answer 45

left side lying on left side right side lying

Question 46

tx for dumping syndome

Answer 46

- semi-recumbent with meals - lie down after meals - no fluid with meals - meals should be small frequent rather than large - avoid foods high in carbs and electrolyte( becuase they empty fast!)

Question 47

ulcerative colitis is ulcerative inflammatory bowel disease that is just in___.

Answer 47

large intestines

Question 48

post op for colonoscopy, you would watch for

Answer 48

perforation. we are going to assume the worst. the signs of perforation are pain or unusual discomfort

Question 49

difference between koch's ileostomy and a j pouch

Answer 49

koch's - has a nipple valve that opens and closes to empty intestines j pouch- removes the colon and attaches the ileum to the rectum ( no external bag)

Question 50

if the colostomy is in the ascending and transverse you will have _____. if it is in the descending or sigmoid you will have _____. which do you irrigate? why? best time to irrigate?

Answer 50

semi formed stools semi formed or formed (because the fluid is almost gone) descending and sigmoid regularity same time everyday, after a meal

Question 51

anytime you are giving an enema, if the client starts to cramp, ____ the fluids, lower the bag and/or check the ___ of the fluid. what side should the pt be on?

Answer 51

stop temperature turn the pt on the left side!!

Question 52

what position should pt be in with feeding tube?

Answer 52

elevate the hob and always want them on their side.

Question 53

appendicitis is related to a ____ fiber diet. major symptom? never give what to appendicitis client?

Answer 53

low initially pain localizes in the right lower quadrant (mcburney's point) abdominal pain 1st!! then n/v NEVER GET ENEMAS or LAXATIVES; worry about perforation

Question 54

when a pt with appendicitis waiting for surgery, what position should the client be in?

Answer 54

right side with hob elevated. so all the bowel content will settle in one area.

Question 55

hyperalinmentation is aka __.

Answer 55

(tpn) total parenteral nutrition

Question 56

should anything else go through the line for tpn?

Answer 56

no

Question 57

glucose in urine---- need ___ | ketone in urine---- need ____

Answer 57

insulin fat; you should change recipe

Question 58

what position sould the client be in for placement of a central line?

Answer 58

trendenlenburg left side