AH-2 Study Guide Exam 1 PDF

**Chapter 38: Assessment of Digestive and Gastrointestinal Function** - **Organs of the Digestive System** - **Esophagus** - **Stomach** - **Small intestine** - **Large intestine** - **Function of Digestive System** - **Breakdown of food particles into the mo...

**Chapter 38: Assessment of Digestive and Gastrointestinal Function** - **Organs of the Digestive System** - **Esophagus** - **Stomach** - **Small intestine** - **Large intestine** - **Function of Digestive System** - **Breakdown of food particles into the molecular form for digestion** - **Absorption into the bloodstream of small nutrient molecules produced by digestion** - **Elimination of indigestion unabsorpted foodstuffs and other waste products** - **Major Enzymes and Secretions** - **Chewing and Swallowing** - **The process of digestion begins with chewing** - **Food is broken into small particles that can be swallowed and mixed with digestive enzymes** - **Amylase is an enzyme that begins the digestion of starches** - **Water and mucus helps lubricate so swallowing can occur** - **Gastric Function** - **The stomach, which stores and mixes food with secretions, secretes a highly acidic fluid in response to the Prescence or anticipation ingestion of food** - **Pepsin, an important enzyme for protein digestion, is the product of the conversion of pepsinogen form the chief cells** - **Small Intestine** - **The digestive process continues in the duodenum** - **Duodenal secretions come from the digestive organs- the pancreas, liver and gallbladder and the glands in the wall of the intestine itself** - **The secretions contain amylase, lipase, and bile** - **Chyme, emulsification, perstalis** - **Assessment of the GI system** - **Obtain focused health history and physical examination** - **Health History** - **Information about abdominal pain, dyspepsia, gas, nausea and vomiting, diarrhea, constipation, fecal incontinence, jaundice, and previous GI disease obtained** - **Changes in Bowel Habits and stool characteristics** - **Can be sign of disease or colonic dysfunction** - **Diarrhea or constipation** - **Characteristics of stool can vary-normally light to dark brown** - **Light gray or clay color stool indicated absence of conjugated bilirubin** - **Past Health, Family and Social History** - **Ask Patient about toothbrushing, flossing routine, frequent dental visits, lesions or irritants in mouth, discomfort by certain foods, daily food intake, alcohol or tobacco use, if they wear dentures** - **Labs** - **Discuss changes in appetite or unexplained weight loss** - **Physical Assessment** - **Oral Cavity** - **Lips** - **Gums** - **Tongue** - **Abdominal Assessment** - **Inspection** - **Auscultation** - **Percussion** - **Palpation** - **Rectal inspection** - **Division of Abdomen** A diagram of the human body Description automatically generated  - **Diagnostic Tests of the GI System** - **Serum laboratory studies** - **Stool tests** - **Breath tests** - **Abdominal ultrasonography** - **Genetic testing** - **Imaging studies, CT, PET,MRI, scintigraphy, virtual colonoscopy** - **Upper GI tract study** - **Lower GI tract study** - **GI motility studies** - **Endoscopic procedures** - **EGD** - **Colonoscopy** - **Anoscopy, proctoscopy, sigmoidoscopy** - **Small-bowel enteroscopy** - **Endoscopy through an ostomy** - **Manometry and electrophysiologic studies** - **Nurse interventions for GI Diagnostic tests** - **Upper Gastrointestinal Tract Study** - **Instruction regarding dietary changes prior to the study may include low residue or clear liquid diet and nothing by mouth** - **No smoking or gum** - **Preparation agent** - **Oral meds withheld** - **Lower Gastrointestinal Tract Study** - **Emptying and cleansing the lower bowel** - **Low residue diet, clear liquid diet, laxative evening before** - **Post procedure- increase fluids** - **Endoscopic Procedures** - **NPO 8 hours before procedure** - **After procedure, assess consciousness, pain level, monitor VS, oxygen saturation, temp and assess for gag reflex to return before giving fluids** **Chapter 39: Management of Patients with Oral and Esophageal Disorders** **1. The Role of the Mouth in General Health** **- Digestion begins in the mouth.** **- Oral diseases affect food intake, communication, and overall health.** **- Esophageal disorders jeopardize general health due to difficulty in food and fluid** **intake.** **2. Periodontal Disease** **- Most common cause of tooth loss in adults.** **- Risk factors: older adults, smokers, low-income, and less educated individuals.** **- Systemic connections: cardiovascular disease, diabetes mellitus, rheumatoid arthritis.** **3. Dental Plaque and Caries** **- Dental plaque leads to tooth decay (caries).** **- Treatment: fillings, dental implants, extractions.** **- Prevention: Maintain proper oral hygiene.** **4. Disorders of the Jaw** **- Includes temporomandibular disorders, fractures, and mandibular structural** **abnormalities.** **5. Disorders of the Salivary Glands** **- Conditions like parotitis, sialadenitis, and neoplasms affect salivary glands.** **6. Oral Cancer** **- More common in men than women.** **- Risk factors: tobacco and alcohol use.** **- Locations: lips, lateral tongue, and floor of the mouth.** **- Management: Early diagnosis, surgical intervention, radiation, or chemotherapy based** **on staging.** **7. Disorders of the Esophagus** **- Common disorders: Achalasia, esophageal spasm, hiatal hernia, diverticula, GERD** **(Gastroesophageal Reflux Disease), and carcinoma.** **- GERD management: Low-fat diet, avoid caffeine, and elevate the head during sleep.** **8. Gastroesophageal Reflux Disease (GERD)** **- Backflow of gastric contents into the esophagus.** **- Symptoms: Dysphagia, odynophagia, regurgitation.** **- Management: Avoid risk factors (spicy foods, alcohol), low-fat diet, medications (as** **per Table 39-4).** **9. Nutrition via Enteral Feeding** **- For patients unable to eat but have a functioning GI tract.** **- Nursing responsibilities: Monitor tube placement, hydration, prevent complications like** **dehydration or infections.** **10. Nursing Management of Oral and Esophageal Disorders** **- Mouth care: Frequent brushing, flossing, use of mouthwash, encouraging fluid intake.** **- Nutritional assessment: Monitor food preferences, provide dietary consultations.** **- Pain management: Minimize discomfort and prevent infection.** **- Education: Encourage patient education on oral hygiene and post-treatment care.** **11. Radical Neck Dissection Surgery** **- Removal of cervical lymph nodes, muscle, vein, and nerve tissue to treat cancers.** **- Postoperative nursing care: Respiratory management, pain control, wound care, and** **maintenance of nutrition.** **12. Nursing Interventions for Tube Feeding** **- Position: Maintain the head elevated at least 30 degrees to prevent aspiration.** **- Tube care: Ensure proper insertion, check placement, and manage complications such** **as obstruction or infection.** **\-\--** **Key Nursing Considerations:** **- Mouth care is crucial in preventing infection and promoting healing.** **- Patient education and support are essential to coping with changes in body image and** **function (e.g., after a neck dissection or use of feeding tubes).** **- Management of pain and prevention of complications (such as aspiration in enteral** **feeding) are top priorities.** **Chapter 40: Management of Patients with Gastric and Duodenal Disorders** - **Gastritis- disruption of the mucosal barrier that normally protects the stomach tissue from digestive juices** - **Definitive diagnosis by endoscopy and histologic examination of biopsy specimen** - **Acute gastritis** - **May be classified as erosive or nonerosive, based on pathologic manifestations present in the gastric musosa** - **Usually the erosive is caused by local irritants such as aspirins and other NSAIDS, corticosteroids, alcohol consumption, and gastric radiation therapy** - **Nonerosive is caused by an infection with a spiral-shaped gram-negative bacterium, H. pylori** - **More severe form of acute gastritis is caused by the ingestion of strong acid or alkali** - **Type: stress-related gastritis or ulcer** - **Medical Management** - **Refrain from alcohol and food until symptoms subside, supportive therapy, IV fluids, NG tubes, antacids, histamine-2 receptor antagonists, proton pump inhibitors** - **Chronic gastritis** - **Often classified according to the underlying causation mechanism, which most often included an infection with H Pylori** - **Implicated in the development of peptic ulcers** - **Can be caused by chemical gastric injury as the result of long-term therapy or reflex of duodenal contents into the stomach** - **Medical Management** - **Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDS** - **Pharma logic therapy including a variety of medication** - **Nurse Management of Gastritis** - **Reduce Anxiety- nurse should use a calm approach** - **Promote optimal nutrition- reduce alcohol consumption, coffee** - **Promote fluid balance- drink fluids** - **Measure to relieve pain- usually antibiotics and PPI's** - **Peptic Ulcer Disease (gastritis can form into this)** - **Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus** - **More likely in the duodenum** - **Associated with infection of H. pylori** - **Risk factors:** - **Alcohol** - **NSAIDS** - **History of peptic ulcer disease** - **Older individuals** - **Manifestations** - **Dull, gnawing pain or burning sensation in mid-epigastrium or back** - **Gastric ulcers- usually pain occurs after eating** - **Duodenal ulcers are more likely express relief of pain after eating** - **Treatment** - **Medications** - **antibiotics, PPI's and sometimes bismuth salts** - **Lifestyle changes** - **avoid oversecretion of acid and hypermotility, avoid extreme temperature foods and beverages, no alcohol or coffee, caffeinated beverages, neutralize acid by eating three regular meals a day, avoid foods that cause pain** - **Occasionally surgery** - **Assessment of Patients with Gastritis or Peptic Ulcer Disease** - **History including presenting signs and symptoms** - **Dietary history** - **72- hour diet, dairy may be helpful** - **Abdominal assessment, vital signs** - **Medication- include use of NSAIDS** - **Signs and symptoms of anemia or bleeding** - **Major Goals/ Nurse Interventions** - **Relief of pain** - **Reduce Anxiety** - **Maintenance of nutritional requirements** - **Absence of complications** - **Gastric Cancer** - **Risk Factors** - **Diet** - **Smoker** - **Family history** - **Gastric Surgery** - **Prognosis** - **Generally poor** - **5 year survival rate** - **Diagnosis is usually late so most of the cancer is spread to other parts of the body** - **Manifestations** - **Early-stage** - **Pain that is relieved by antacids resembling those of benign ulcers and seldom definitive** - **Advanced disease symptoms** - **Dyspepsia** - **Early satiety** - **Weight loss** - **Abdominal pain just above the umbilicus** - **Loss or decrease in appetite** - **Bloating after meals** - **Nausea or vomiting** - **Fatigue** - **Treatment** - **Surgical removal** - **Pallative care** - **Chemo** - **Assessment of the Patient with Gastric Cancer** - **Dietary History and nutritional status** - **Risk Factors and smoking and alcohol history** - **Social support, individual or family coping** - **Resources** - **Physical assessment, including assessment of the abdomen** - **Nurse Interventions** - **Reduce anxiety** - **Promote optimal nutrition** - **Relieving pain** - **Provide psychosocial support** - **Promoting self-care activities** - **Educate on treatments and what to expect** - **Tumor of the Small Intestine** - **64% malignment** - **Higher rates of cancer among older adults (age 60), African Americans and men** - **May be asymptomatic or present with pain, occult bleeding, weight loss, nausea, vomiting, and intestinal obstruction** - **Assessment/ Diagnose** - **CBC may reveal low hematocrit and hemoglobin** - **Upper X ray series** - **Abdominal CT** - **Treatment** - **Benign-Endoscopically by excision/resection or electrocautery** - **Malignant- chemotherapy and radiation, abdominal surgery** **Chapter 41** **Management of patients with intestinal and rectal disorders** **Constipation:** - **Manifestations of Constipation: Fewer than 3 bowel movements a week, abdominal distention, pain & bloating, sensation of incomplete bowel movement, straining, and elimination of small volume, lumpy, hard, and dry stools.** - **Assessment & Diagnostic Findings of Constipation:** - **Chronic constipation is usually idiopathic, further testing for severe, intractable constipation, history/ medical examination, Barium enema, sigmoidoscopy, & stool testing, Defecography & colonic transit studies, and MRI** - **Complications of Constipation:** - **Increased arterial pressure, striking effect on arterial blood pressure, Straining- During active straining the flow of venous blood in the chest is temporarily impeded because of large intrathoracic pressure. This pressure tends to collapse the large veins in the chest. The atria and ventricles receive less blood. Cardiac output decreases and a drop in arterial pressure causes orthostatic dizziness or syncope.** **Other issues include Incontinence, hemorrhoids, fissures, rectal prolapse, megacolon, fecal impaction, ulcer perforate on the colon wall and leading to peritonitis.** **Diarrhea: An increased frequency of bowel movements (more than 3 per day) with altered stool.** - **Patho: Acute and persistent are classified either noninflammatory or inflammatory pg.1290** - **Clinical manifestations: Increase frequency, abdominal cramps, distention, borborygmus, anorexia, Fluid and electrolyte imbalances and thirst/ dehydration. Painful spasmodic contractions of the anus.** - **Assessments & Diagnostic Findings: CBC, serum chemistries, urinalysis, and stool examination. Endoscopy or Barium enema may assist in identifying the cause.** - **Complications: \#1 Dehydration w electrolyte loss** - **Patient learning needs for diarrhea: Recognition of need for medical treatment, rest, diet and fluid intake, avoid irritating foods such as caffeine, carbonated drinks, very hot and very cold foods, perineal skin care, medications, may avoid milk, fat, whole grains, fresh fruit, and vegetables, & lactose intolerance.** - **Fecal Incontinence causes: Factors that influence this disorder include the ability of the rectum to sense and accommodate to stool, the amount and consistency of stool, the integrity of the anal sphincters and musculature, and rectal motility.** - **Manifestations of Fecal Incontinence: Patients may have minor soiling, occasional urgency and loss of control, or complete incontinence. Patients may also experience poor control of flatus, diarrhea, or constipation.** - **Assessment of Diagnostic Findings of Fecal Incontinence: History to determine etiology, rectal examination, endoscopic examinations, radiography studies, barium enema, CT, and Anorectal manometry.** **Irritable Bowel Syndrome:** - **Clinical Manifestations: Alterations in bowel patterns, pain, bloating, and abdominal distention.** - **Assessment and Diagnostic Findings: Stool studies, contrast radiography studies, proctoscopy, barium enema, colonoscopy, manometry, and electromyography.** - **Patient Learning Needs: Medication management, complimentary medicine, dietary changes, food diary, adequate fluid intake, avoid alcohol and smoking, and relaxation techniques.** **Malabsorption:** - **The inability of the digestive system to absorb one or more of the major vitamins, minerals, or nutrients.** - **Conditions** **Assessment and Diagnostic Findings: Fat analysis, lactose tolerance tests, D-xylose absorption tests, schilling tests, hydrogen breath test, endoscopy with biopsy, ultrasound, CT, radiography, CBC, pancreatic function tests.** **Celiac Disease:** - **Manifestations: Diarrhea, steatorrhea, abdominal pain, abdominal distention, flatulence, and weight loss. (More common in children than adults) Adults can present with non- GI signs and symptoms of celiac disease which include fatigue, general malaise, depression, hypothyroidism, migraine headaches, osteopenia, anemia, seizures, paresthesia's in the hands and feet, and a red, shiny tongue.** - **Management: Refrain the exposure to gluten in foods and other product like alcohol.** **Appendicitis:** - **Manifestations: Vague periumbilical pain, visceral pain that is dull and poorly with anorexia progresses to right lower quadrant pain, and a low grade fever, and rebound tenderness** - **Management: Immediate surgery** **Diverticular Disease:** - **Diverticulum: Sac- like herniation of the lining of the bowel that extends through a defect in the muscle layer. May occur anywhere in the intestine but most common in the sigmoid colon.** - **Nursing management: Fluid intake 2L/day, foods that are soft and increased in fiber, exercise program, and encourage taking laxatives.** **Intestinal Obstruction** - **Nursing Management: Maintaining the function of the nasogastric tube, Assessing and measuring the nasogastric output, Assessing for fluid and electrolyte imbalance, Monitoring nutritional status, Assessing for manifestations consistent with resolution (Return of normal bowel sounds, decreased abdominal distention, subjective improvement in abdominal pain and tenderness, passage of flatus or stool.)** **Inflammatory Bowel Disease:** - **Assessment of the patient: Health history to identify output, duration and characteristics of pain, diarrhea, urgency, tenesmus, nausea, anorexia, weight loss, bleeding, and family history.** - **Discuss dietary patterns, alcohol, caffeine, and nicotine use.** - **Assess bowel elimination patterns and stool** - **Abdominal assessment** - **Collaborative Problems and Potential Complications: Electrolyte imbalance, cardiac dysrhythmias, GI bleeding with fluid loss, and perforation of the bowel.** - **Nursing Interventions: Maintaining normal elimination patterns; Identify relationships between diarrhea and food, activities, or emotional stressors; Provide ready access to bathroom or commode; Encourage bed rest to reduce peristalsis; Administer medications as prescribed; Record frequency, consistency, character, and amounts of stools.** - **Patient Education: Understanding of disease process; Nutrition and diet, Medications, and Ileostomy care.** - **Collaborative Problems and Potential Complications: Pneumothorax, air embolism, clotted or displaced catheter, Sepsis, Hyperglycemia, Rebound hypoglycemia, Fluid overload \*Table 41-7\* Pg.1317** - **Planning and Goals: Attaining an optimal level of nutrition, Absence of infection, Adequate fluid volume, optimal level of activity, knowledge of self-care, and absence of complications.** - **Nursing Interventions: Maintaining optimal nutrition, preventing infection, and maintaining fluid balance** **Colorectal Cancer:** - **Assessment: Health History, Fatigue and weakness, abdominal or rectal pain, nutritional status and dietary habits, elimination patterns, abdominal assessment, characteristics of stool.** - **Collaborative Problems and Potential Complications: Intraperitoneal infection, complete large bowel obstruction, GI bleeding, Bowel perforation, Peritonitis, abscess, and sepsis** - **Planning and Goals for patient with cancer or colon: Attainment of optimal level of nutrition, maintenance of fluid and electrolyte balance, reduction of anxiety, knowledge of diagnosis and treatment, self-care ability, optimal tissue healing, protection of peristomal skin, expressing feelings and concerns, and avoidance of complications.** **Anorectal Conditions:** - **Assessment of the Patient with Anorectal Condition: Health History, Pruritus, pain, or burning; elimination patterns; diet; exercise and activity; occupation; inspection of the area.** - **Planning and Goals: Adequate elimination patterns, reduction of anxiety, pain relief, promotion of urinary elimination, management of the therapeutic regimen, and absence of complications.** - **Nursing Interventions: Encourage Intake of at least 2L of water a day; High fiber foods; bulk laxatives; stool softeners; and topical medication; promote urinary elimination; hygiene and sitz baths; monitor for complications; and educate on self-care.** **Ch 42: Causes of Obesity** - **Complex, multifactorial** - **Behavioral** - **Environmental** - **Physiologic** - **Genetic** **Associated Diseases and Disorders** - **Obesity is associated with 6‐ to 20‐year decrease in life expectancy** - **Refer to Figure 42-2 and Chart 42-1** - **Risk for cancer increases with increased BMI** - **Likelihood of type 2 diabetes by 10-fold** - **Asthma or hypertension by fourfold** - **Twice as likely to have Alzheimer's** **Assessment** - **Height and weight to determine BMI** - **Overweight = BMI 25 to 29.9** - **Obese = BMI exceeding 30** - **Severe/extreme obese = BMI exceeding 40** - **Waist circumference \>35 in women and \>40 in men = greater risk for obesity** - **Hip‐to‐waist ratio** - **Lab studies: cholesterol, triglycerides, fasting blood glucose, HA1c, liver function tests** **Obesity Management Interventions** - **Lifestyle modifications** - **Pharmacologic** - **Nonsurgical** - **Surgery** **Lifestyle Modification** - **Aimed at weight loss and maintenance** - **Setting weight-loss goals** - **Improving diet habits** - **Increasing physical activity** - **Addressing barriers to change** - **Self-monitoring and strategizing ongoing lifestyle changes aimed at a healthy weight** - **Health sleep habits** **Medications for Obesity** - **Antiobesity medication meant to supplement not supplant diet modification and exercise** - **Indications: BMI \>30, BMI \>27 with related concomitant morbidity** - **Action: Inhibit gastrointestinal absorption of fats, Altering central brain receptors to enhance satiety or reduce cravings** **Nonsurgical Interventions** - **Minimally invasive interventions** - **Vagal blocking** - **Intragastric balloon therapy** - **Bariatric embolization** **Nursing Management** - **Approach patients with obesity with the same respectful, courteous, and empathetic behavior as extended to patients without obesity** - **Understand the effects of obesity** **Effects of Obesity** - **Mechanics of ventilation and circulation** - **Central and peripheral circulatory compromise** - **Pharmacokinetics and pharmacodynamics** - **Skin integrity and body mechanics** **Bariatric Surgery** - **Results in weight loss of 10% to 35% body weight within 2 to 3 years** - **Improvement in comorbid conditions** - **Selection by multidisciplinary team** - **Selection criteria has changed to include BMI of 30 for patients with comorbid conditions** **Bariatric Procedures** - **Roux-en-Y gastric bypass (RYGB)** - **Gastric banding** - **Sleeve gastrectomy** - **Biliopancreatic diversion with duodenal switch** - **Performed by laparoscopy or by an open surgical technique** Roux-en-Y Gastric Bypass This Picture Describes about the Roux-en-Y Gastric Bypass **Gastric Banding**  **Sleeve Gastrectomy** This Picture Describes about the Sleeve Gastrectomy **Biliopancreatic Diversion with Duodenal Switch**  **Preoperative Considerations** - **Preoperative care: education and counseling** - **Risks and benefits of surgery** - **Complications** - **Postsurgical outcomes** - **Dietary changes** - **Lifelong follow-up** - **Lab testing** **Postoperative Considerations** - **Postoperative care:** - **Assess to ensure goals for recovery are met** - **Assess for absence of complications** - **Manage pain** - **Nutritional status** - **Fluid volume balance** - **Decrease anxiety** - **Body image changes** **Collaborative Problems and Potential Complications** - **Hemorrhage** - **Venous thromboembolism** - **Bile reflux** - **Dumping syndrome** - **Dysphagia** - **Bowel or gastric outlet obstruction** **Planning and Goals for the Patient Undergoing Bariatric Surgery** - **Relief of pain** - **Maintenance of homeostatic fluid balance** - **Prevention of infection** - **Adherence to diet** - **Knowledge about vitamin supplements** - **Need for lifelong follow-up** - **Achievement of positive body image** - **Maintain normal bowel habits**