Medsurg Lecture Notes PDF

Okay, here is the converted text from the images you sent, formatted in Markdown. I have done my best to preserve the original content, formatting and handwriting style feel. I have also attempted to interpret unclear sections. ## Page 1 **GLOSSARY** * **Absorption** - digestive process that oc...

Okay, here is the converted text from the images you sent, formatted in Markdown. I have done my best to preserve the original content, formatting and handwriting style feel. I have also attempted to interpret unclear sections. ## Page 1 **GLOSSARY** * **Absorption** - digestive process that occurs when small molecules, vitamins, & minerals pass through the walls of small & large intestine & into the bloodstream. * **Amylase** - enzyme aids digestion of starch * **Anus** - last section of GI track, rid of waste * **Chime** - mixture of food with saliva, salivary enzymes & gastric secretions * **Digestion** - digestive process occurs when digestive enzymes e secretions mixed with ingested food & when proteins, fats & sugars are broken down into smaller molecule * **Dyspepsia** - aka indigestion, upper abdominal discomfort * **Elimination** - digestive process when waste product evacuated from the body * **Ingestion** - phase of digestive process when food is taken into GI track via mouth & esophagus. * **Intrinsic factor** - gastric secretion that contains with vit 12 so that vitamin can be restored. * **Lipase** - enzyme aids digestion of fat * **Microbiome** - collective genome of all microbes in a microbiota * **Microbiota** - the complement of microbes in a given environment * **Trypsin** - enzyme aids in digestion of protein **ANATOMY & PHYSIOLOGIC OVERVIEW** * GI track pathway = 7 to 7.9km (23-24 ft) * Esophagus = 25 um (to inches) in * Diaphragmatic hiatus - opening at diaphragm * Stomach = 1500 ml capacity (approximately) A diagram of the stomach is included. The diagram labels the **Cardio**, **Fundus**, **Body**, and **Pylorus**. The **Cardio** term is connected to a "V". * Small intestine - largest segment 2/3 length, 70 m, absorption * duodenum - proximal * jejunum - middle * ideum - distal * Large intestine * ascending transverse descending ? * Anus, rectum & sigmoid colm * five large veins: superior intestine, inferior intestine, gastric, splenic, cystic veins vena protae enters the liver then terminate in inferior vena cava in inferior vena cava blood flow to the GI track is abret 20% of the total CO & significantly after eating. Major functions of the GI track that are included below: * breakdown of frod particles into mollecular form of digestion * Absorption into the bloodstream of small nutrient molecules produced by digestion * Elimination of undigested unabsorbed foodstaffs & other waste products. **Gastric Function** * 2-4 L\\d = pH, derives from HCI * function breakdown freed into more absorbable components. * aids in destruction of bacteria * Absence of intrinsic factor - pernicima anemia * Hormones, deuroregulators, and local regulation control that rate of gastric secretions **Small Intestine Function** * duodenal secretions are from the PANCREAS, LIVER & GALUBI-ADDER * pancreatic secretions have ALKALINE pH due to high concentration of bicarbonate * Bile secreted by the liver and stored in gallbladder: emulsifying ingested fats * sphincter of oddi -controls flow of bile * Intestinal secretions ( 1 L/d of pancreatic juice, 0.5L/d of bile, & 3L/d of glands of small intestines * 2 types of contractions * Segmentation contraction - produce mixing waves that move intestinal contents back and forth in a churning motion * Intestinal (contraction) peristalsis-propels contents of SIVECO ## Page 2 A diagram of the back and front of the stomach. The posterior diagram labels **pancreatitis** and **perforated durdenal ulcer**. Underneath, another section of the stomach is drawn and labelled as **“Assessment of the GI system #2”** Number 1 nursing consideration for pt. undergoing colonoscopy: 1. Patient's safety * because the pt. is risk for code because of muscle relaxants & sedative / sedation. **Oral cancer (early stage)** * painless sore * mass that does not heal **Absorption**- starts in the small intestine specifically in the jejunum: **MAJOR ENZYMES AND SECRETIONS** Chewing and Swallowing: saliva, salivary amylase Gastric Function: hydrochloric acid, pepsin, intrinsic factor Small Intestine: amylase, lipase, trypsin, bile Chyme, emussificatim, peristalsis, natural downward movement **Assessment of the GI System #1** **Health History!** * Information about abdominal pain, dyspepsia, gas, nausea and vomiting, diarrhea, constipation, fecal mamtinence, jaundice, and previous GI disease is obtained. **Pain:** * character, duration, pattern, frequency, location, distribution of referred abdominal pain, and time of the pain vary greatly depending on the underlying cause Anterior labels the following on a liver diagram: liver, heart, bilian colic, apprndicitis with pointers towards cholecystitis, pancreatitis and duodenal ulcer as well as Renal Colic, Small intestine pain, colon pain, and urethral Colic. **Assessment of the GI system # 2** **Dyspepsia** * Most common symptoms of pets with GI dysfunction * OTC! Antacids. * H2 Blocker * -proton pump Inhibitor’s * NEV * Berching Heartburn * Abd. pain & discomfort * Feeling full easily * easily bloated **Intestinal gas** * Brating, distension, or feeling "full of gas" with excessive flatulence as a symptom of food intolerance or gallbladder disease **Nausea & Vomitting** * Names a vague, uncomfortable sensation of sickness or "queasiness" that may or may not followed by vomitting. **Change in bowel habits and stool characteristics** *May Signal Colonic dysfunction or disease Constipation Diarrhea Past health, family and social history Oral care oral cavity lips gums VECO ## Page 3 * Les cortos disaccharriades (sucrose, matiiuse, galactose), mmosaccharides (glucose, fructose); Glucose-major carbs (food) * proteins - source of Energy after they're broken down is chyme stays sil 7-ihr * Vill- fingers like produces digestive enzymes & absorbs nutrients * Absorption- major function; begins in jejunum thru active transport & diffusion. * nutrients - absorbed in quodenum * jejunum fats, proteins, carbs, Na, Cl * ileum - Vit B12; bile * Colmic Functim * gut microbes (bacteria): major component of contents of 61 (large intestine) * 2 types of colonic secretions; electrolyte solutio & mucus **waste products of bigestim** * Fecal matter : 75% fluid; 25% Solid material * 61 has 150 ml of gases * Elimination of stool begins with distention of rectum. **Gut microbiome** * protect against pathogens, regulatory influences in innate and adaptive immune responses, and inflammation * colonization of 61 tract begins shortly after birth. **ASSESSMENT OF GASTROINTESTINAL SYSTEM** **Age Related changes in Gastrointestinal system.** **Structural changes** * ***Oral Cavity and pharynx*** * Injury / loss/decay of teeth. * Atrophy of taste buds * saliva production * reduced Ptyalin & amylase in saliv * **Implication** * Difficulty chewing & swallow Structural Changes * ***Esophagus*** * motility & emptying * weakened gag reflex * resting pressure of lower esophageal sphincter. * ***Implication*** * Reflux & heartburn Structural Changes * **Stomach** * Degeneration & atrophy of gastric mucosal surfaces with production of ta * secretions of gastric acids * gastric motility and emptying * ***Implication*** * Food intolerance, malabsorption, & vit. B12 absorption. **Structural Changes** * **Small Intestine** * atrophy of muscle and mucosal surfaces. * thinning of villi * **Implication** * motility & transit time complaints of indigestion and constipation **Structural changes** * **Large Intestine** * mucus secretion * elasticity of rectal wall * tone of internal anal sphincter * Slower and duller nerve impulses in rectal area * ***Implication*** * motility & transit time complaint of indigestion & constipation * absorption of nutrients (dextrose, fats, calcium & mor) * fecal incontinencu * **Common Symptoms** * pain * dyspepsia * intestinal gas leads to belching (expulsion of gas in stomach mouth) or flatulence (from rectum) * nausea and vomiting * "Queasiness" * characteristics of Mallory Weiss tear: emesis that's bright red * coffee grounds ## Page 4 * Anoscopy, protectoscopy, and sigmoidoscopy * Small bone enteroscopy **Manometry** * measures the pressure of the muscles 61 track **TYPES** * Esophageal- * swallowing disorder * Anurectal- * ability to control vowel movement * constipation or fecal incontinence **FTIR QUADRANTS** 1. RIGHT UPPER QUADRANT 2. RIGHT LOWER 3. LEFT UPPER 4. LEFT LOWER **NURSING INTERVENTION FOR GI DIAGNOSTIC TESTS** * Inform the primary provider of known medical conditions or abnormal laboratory vateres that may affect the procedure * Assess for adequate hyavatim before, during and immediately after the procedure, and provide education about maintenance of hyavatim- * Provide health informatim and procedural education to patients and significant offers * Provide instructions about post procedure care and activity restrictions * Help the patient cope with comfort and alleviate anxiety **NINE QUADRATES** 1. epigastric region 2. umbilical region 3. hypogastric or suprapubic region 4. right hypochondriac region 5. left hypochondriac region 6. right lumbar region. 7. left lumbar region. 8. right inguinal region 9. left inguinal region **Diagnostic Test** * Serum (aboratory studies * Stool test * Breath tests * Abdominal ultrasonography * Genetic testing * Imaging studies: CT BET MRI, Scintigraphy, virtual Colonos copy *what can diagnose?* * Heart burn * difficulty in swallowing * Abd pain * Bleeding * Unexplained weight iss *Upper GI tract study* * **Risk for** * Aspiration * Trauma * mfection * Bleeding **Adverse effect to sedatives.** * Lower GI tract study * motility studies. * Endoscopic procedures: * EED (Esoiphagogastroduodenoscopy)) * Colonoscopy * The role of the youth in general Health * Digestion begins in the mouth Changes in the oral cavity: influence the type and amount of food ingested * Degree to which food particles mix with salivary enzymes * Diseases of the mouth interferes with communication. Esophageal problems * Affect food and fluid intake. * Jeopardize general health, ## Page 5 1. Periodontal Disease * Periodontal disease: most common cause of tooth Joss un adults. * redness * Swelling * kreeding * Gingivitis inflammation of the gums. * periodontitis: Involves soft fissure and bone supporting the teeth. * Individual at risk: older adust, current smokers, low income, less educated. * Connected to systematic disease: CV, DM, rheumatoid **D. Dental Plaque and Carnes** * Dental plaque: causes dental decay; caries * Treatment for dental caries: treatment fillings, dental implants extraction * Preventim: * fluoride varnish\\gel and fluoride toothpaste * Routine dental care and applying dental sealants. * Community water fluoridation * Ketrain from smoking and alcohol use * Less sugar and starch in the diet, healthy snacks, and brushing after meals. * Manage systematic disease - control your DM * **Periapical Abscess** * Abscessed tooth * Presence of pus in the apical dental periosteum and fissure summunding the apex * Clinical manifestations: pain, cellulitis, facial edema, fever, malaise Medical and nursing management *needle aspiratim drill opening to relieve pressure, pain, and promote drainage, extraction *assesses for bleeding; instruct to use warm Saline eanalgesic. antibiotic and take **IV.Disorders of the Jaw** *temporomandiular dissorders. affects muscles of jaw function -Myofascial pain Causes: overuse, stress tension, misalignment -Internal devrangement of joint - click popping Sound- *pain of jaw Degenerative joint disease pain, stifness * Mandibular structural abnormalities * Fractures (of bone) congenital developmental *Treatment Surgery* 1. **Disorders of the Salivary glands**(neck, ears) * Parotitis: inflammation of parotid gland * causes- viral infecting (mumps) * Sigladenitis: inflammation of the salivary glands * Sinalolthiasis: salivary stones : (Blockage)- *s/s* * Redness infection: * Swelling * Inflammation Nursing Ngt: Antibiotic therapy Hydration warm Compress Massage if dila madala 4Oral Cancer risk factor* 2. Tobacco use, including smokeless, tobacco 3. Alcohol (IMB) bacterial infection * Infection with human papilloma virus prevention * History of head and neck cancer * Increased incidence in men twice as often as women * May occur in any area, but lips, lateral tougue, and floor of the mouth are most frequently affected ***Prevention*** *lifestyle changes do not smoke, do not drink HPV vaccine *sun protection, sunscreen, lip balm Wip SPF healthy diet* *4 Early stages or/s of oral cancer* *Cardinal few or no symptoms in early stage* * Painless sore or Mass that does not heal; indurated uler with Raised edges ***later manifestations Include*** Complains of tenderness, Difficulty chewing swallowing on Speaking Coughing blood tinged sputum Enlanged cervical lymph nodes Assessments, Medical management of the If with cancer of the oral Cavity Assessment *Health history Include symptoms related to problems oral hyiene and dental care use of tobacco Alcohol and rating Nutrition **Inspect and palpate the Structure of the mouth and Neck** ## Page 6 * w/ * 5 without * eth **Health HS**: et gid movina with new and prevent infection * s/s of é problem (duoendingum pt.) * ***Oral hygiene Tehnique*** *use of Alcohol tabacco* * Nutritional status Medical Mangement surgical resectim Radiation therapy Chemotherapy Nursing Management of the patient & Disorders of & oran Cavity #1 Promoring mrith cave *Dental care before Surgery or Radiation therapy* *preventive oral care* Frequent gentle brushing and Hissing or if patient cannot tolerate Brushing use of mrithwasher and arther methods of Cleaning and Rinsing If the pt cannot tolerare: use; *cutton swab -wrap fingers -baluze, dip in ther mrithwash - in Cinular motim clean the Teeth mrath *pt. education related to oral hygiene maintain oral bygiene Encourage fluide Intake Reduce pry mouth ise of Synthetic saliva Such as oral Balance ar saliva *production Stimulant Such as alagen ensure Adequate food and Pruid intake 100 assesses nupitimal Requirements in & 244 diet 140 wumifimig maintaning weight dietary patterns - Assess patient preferences and take into account Social & cultural factors when encnuraging and Recommending dietary Intake "dietary corisult" Support as pasitive Self-Image * Encourage Patient to Verbalize *Listen and offer acceptance and Support (we empathy Refenal to Support Group Pyychatric Liaison, in or Spiritial Advisor. Restimate's to Prevent Solutima* Miminize pain" Avoid Hot, spicy, in word trade oral cave viscous lidocaine or aother pain medicatiw -diet Restriction Na pat Salf Diet *Detecting Farly Suen/Symptoms af Infant* * *Diet Restriction* *Medication Migt.* what is Xerostomia? Causes* **Dry Mouth* * Psychopharmacologic Drigs Taking multiple medications ( 5* * @using Drug Recreatiomally @) * to WhO have Rheumatoid Diaeaws (6.1-) Eating Disorders (too) ⑦HV injan * it Who cannot close è minitch *breaths Through the morith Instead of enase II.Disorders of the Esephagus abnarmal contractions* Motility disourders* *(Achalasia forophagsal spasm* *Hiatal hernias: difficuly wi Swing (5)* *LEF(lowes esapageal sphnicter) *Unable to Relax lass of peristalsis *Toad Build up esapogeal clattim Mimetics cardio-pain *part of stomach pushes to diaphragm of chest canify* *GERd (Gastroesophageal Reflux) Regurgitatim. Heart bum *Diverticula Zenker's Diverticulum (mast common typer) * *Pruct Formation foard topping diff in Swallowing * **bad breath (halicosis)* **Gastro esophegal Reflux* ## Page 7 1. Ng Considersations for pt & chronic iinest: PROMOTE INDEPENDENCE perforation causes tranmo Surgical Enor profuse vomiting - Foreign Bodies Chumical Burns sive Agents ACID on ALKALINE GERD Gastro Esophageal Reflux Disease Se regurgitatim of And * Heart bum **Burret Esophagus* result Inmanaged GERn head to Esoophagueal adene Carcinoma *benign cumors*** Carcinoma **Squamous Cell Carcinoma-nod life threatening*** -AdenoCarcinoma unless it Metal fasize *Lakisk Factors:* Smoke Alcohal severe cerda Se dysphagia* 9 -Acute Pain in Swallowing **Odynophagia most common*** other 5/Se* Regrgitatim Heart burn chest.parn Unexplained will Loss Cough & horseness of voice." Sliting Esaphageal Hernia and paraesophages Hernia 1. Gerp * **(Gastro Esaphageal Reflux Disease)** **Common disorder marked by back fino of gastric or duodenal entents into the esophagus that causes troublesome Symptoms andlar mucosal injury to the esophagusressive reflux may becur because of an incompetent loweresophageal sphincter, pyloric stenosis, niatal hernia, trà motility disorder** _Incidence Increases with age Irritable bowel syndrome ird obstructive airway disorders ( Asthma copD. 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