Guided Study Question GI GU Integument 2023.docx

NUR 729 Guided Reading Questions 2023 GI/GU/Integumentary 1. Describe the NPO guidelines for healthy patients undergoing elective procedures for: a. Clear liquids -- 2 hours b. Breast milk -- 4 hours c. Infant formula/non-human milk -- 6 hours d. Light meal (e.g. crack...

NUR 729 Guided Reading Questions 2023 GI/GU/Integumentary 1. Describe the NPO guidelines for healthy patients undergoing elective procedures for: a. Clear liquids -- 2 hours b. Breast milk -- 4 hours c. Infant formula/non-human milk -- 6 hours d. Light meal (e.g. crackers) - 6 hours e. Solid/fatty foods -- 8 hours 2. List six groups of patients who should undergo rapid sequence induction because of the risk of aspiration of gastric contents. Diabetic patients, bowel obstructions, pregnant women in labor, trauma patients, patients treated with opioids, patients who just ate a heavy meal 3. List 4 sources of information used to complete the preoperative evaluation Medical records, physical examination, patient history, and tests/labs 4. List 3 goals of preoperative evaluation Discovery of disease/disorders Verification/assessment of known diseases influencing anesthesia care Support the formulation of a specific plan of care 5. Identify the metabolic derangement associated with: f. Nausea and vomiting leads to metabolic alkalosis due to loss of gastric acid g. Diarrhea leads to metabolic acidosis due to loss of bicarbonate 6. Define: h. Dysphagia = difficulty swallowing i. Regurgitation = reflux of GI contents into the pharynx without nausea/vomiting j. Odynophagia = pain with swallowing k. Globus sensation = feeling of a lump in the throat 7. The two etiologies of dysphagia are **structural** and **functional/motility** 8. What is the best method for evaluation of the mechanical causes of dysphagia? Esophagogastroduodenoscopy \[EGD\] is the best method for evaluation of mechanical causes of dysphagia 9. Discuss the two categories of esophageal disorders and give examples of each. Motility-related - **Achalasia** = outflow obstruction caused by poor relaxation of the lower esophageal sphincter and hypomotile esophagus - **Distal esophageal spasm** = spastic distal portion of the esophagus Structure-related - Diverticula e.g. Zenker's diverticula - Hiatal hernia - Tumors 10. List three causes of Gastroesophageal Reflux Disease Transient relaxation of the lower esophageal sphincter (LES) Poor LES tone Anatomic distortion of the GE junction (e.g. hiatal hernia) 11. Identify the bacterium most often associated with peptic ulcer disease. H. pylori 12. Describe three complications of peptic ulcer disease. Bleeding -- common without treatment and can cause mortality Perforation -- increased mortality when accompanied by shock Obstruction -- edema and inflammation may lead to an outlet obstruction 13. Discuss the common location of carcinoid tumors and list three substances commonly secreted by carcinoid tumors. Occur most commonly in GI tract Secrete ACTH, 5-hydroxytryptophan (serotonin precursor), growth hormone releasing factor Secretory substances tend to vary depending on the location of the tumor 14. Discuss the frequency and symptoms of Carcinoid Syndrome Occurs in about 10% of patients due to secretion of large amounts of serotonin and vasoactive substances reaching the circulatory system Symptoms = flushing, N/V/D, excess serotonin with dehydration, electrolyte abnormalities, fibrosis (endocardial, retroperitoneal, pelvic), respiratory sx (cough, wheezing, dyspnea), cyanosis, pulmonic and tricuspid valve thickening and stenosis, hepatomegaly In carcinoid crisis = life threatening and characterized by flushing, diarrhea, abdominal pain, tachycardia, hypertension/hypotension 15. List the catecholamines and neuromuscular blocking drugs likely to provoke carcinoid vasoactive mediator release. Drugs provoking mediator release = Succs, mivacurium, atracurium, tubocurarine, epi, NE, dopamine, isoproterenol, thiopental 16. Describe the symptoms of pancreatitis Excruciating pain, N/V, ileus, dyspnea. Shock can occur secondary to hypovolemia, vasodilation, and release of pancreatic enzymes into the general circulation 17. Identify the two most common causes of pancreatitis Gallstones and alcohol abuse 18. List 6 complications of pancreatitis Shock, hypotension secondary to sequestration of fluid in peri-pancreatic space, ARDS, renal failure, GI hemorrhage, coagulopathy and DIC 19. Differentiate the likely sources of bleeding with melena and bright red bleeding. Melena suggests bleeding has occurred above the cecum (stomach, small intestine) Bright red bleeding and clots are from the rectum, distal colon, or sigmoid colon Upper GI bleeds commonly associated with gastric ulcers 20. In a patient experiencing a GI bleed, tachycardia is likely to occur when the estimated blood loss exceeds what percent of the patient's blood volume? Tachycardia and hypotension are common when EBL \> 25% of EBV 21. A hematocrit below what percentage is likely to be associated with orthostatic hypotension? Orthostatic hypotension typically occurs when the Hct \1.018 suggests urine concentrating ability is adequate 26. Define oliguria. Decrease in urine output to \0.3 mg/dL within 48 hours or 50% over a period of 7 days 28. List 6 risk factors for acute kidney injury. Pre-existing renal disease Cardiovascular disease including reliance on intraoperative inotropes Aortic cross clamping Respiratory disease Post-operative reliance on inotropes Post-operative diuretic use Sepsis Nephrotoxic drug administration 29. How is chronic kidney disease typically characterized? Characterized as a GFR \