Final Review - 77 Questions GI PDF

FINAL REVIEW-77 QUESTION GI GERD-s/s and patient teaching With gerd you have dyspepsia( burning/heartburn), worsen pain while lying down, and weight loss, regurgitation, dysphagia, bleeding, and loss of tooth enamel. You should not have a bedtime snack with gerd and give small frequent meals. You...

FINAL REVIEW-77 QUESTION GI GERD-s/s and patient teaching With gerd you have dyspepsia( burning/heartburn), worsen pain while lying down, and weight loss, regurgitation, dysphagia, bleeding, and loss of tooth enamel. You should not have a bedtime snack with gerd and give small frequent meals. You give antacids, H2 blockers (tidine), and PPI (Prazole). Drink fluids between meals instead of with meals. Avoid caffeine, milk products, and spicy foods. Avoid alcohol, chocolate, caffeine, citrus, milk, peppermint, tomato products, spearmint. HOB up for at least 3 hrs after eating and Sleep with HOB up 4 to 6 inches. Cholecystectomy- post op, nursing care, T-tube and patient teaching It's the removal of the gallbladder using a laparoscopy and then a t- tube is placed in the common bile duct. The drainage should be a yellowish brown color. Keep the tube under the surgical site and turn off suction to assess bowel sound. You want to avoid atelectasis so tell pt to deep breath and cough only when medicated, and spilt pillow is provided. Encourage early ambulation. Pain is a concern so Demerol may be given. They are at high risk for impaired gas exchange and fluid deficit. Cirrhosis - s/s and patient education RUQ pain and Can cause fatigue so you should limit activity and give rest periods. Ascites can happen from low albumin so decrease a patient's fluid intake. The pt should stop drinking and use Lasix to decrease abdominal swelling. Do paracentesis for ascites and instruction to sit, empty bladder,and local anesthetic is used so you may experience some pain. With Encephalopathy the PT may experience Asterixis which is flapping of hands when arms are extended, and confusion due to increased ammonia levels!!!, check LOC before and continue to check until LOC is normal. Liver Biopsy During you are in a left side lying position. Post op they are in a right lying position. For Esophageal varices give Vasoconstrictors/ Propranolol to decrease varices and Give vitamin K for clotting. NO NGT, STRAINING, IF VOMITING BLOOD Protect airway, VS, and Side lying position. GI perforation assessment Hard rigid board-like abdomen are indicative of perforation. Abdominal pain that radiates to the shoulder, restlessness, apprehension (feeling uneasy). Appendicitis -assess, s/s and treatment— Is located in the RLQ. they may have positive McBurney’s point (Pain RLQ when touched) Or Rovsig’s point (Sometimes pain in RLQ when LLQ palpated), Rebound Tenderness, radiating pain. If Rigid abdomen that is the indicative of a perforation and they may have peritonitis. DO NOT apply heat because it increases risk of perforation!!!!! If ruptured IV and antibiotic Therapy for 8 hours then OR. Gallstones- s/s, patient teaching pre and post op, diet uses laparoscopy and then a t- tube is placed in the common bile duct. The drainage should be a yellowish brown color. Keep the tube under the surgical site and turn off suction to assess bowel sound. You want to avoid atelectasis so tell pt to deep breath and cough only when a medicated and spilt pillow is provided. Encourage early ambulation. Pain is a concern so Demerol may be given. They are at high risk for impaired gas exchange and fluid deficit. Have a low fat diet. Ileal Conduit/colostomy- drainage, patient teaching ileostomy/ileal conduit is when Colon removed the end of a small bowel brought thru abdomen. Stoma should be pink, post op check every 8 HOURS, you will have a watery stool so you can use Applesauce and peanut butter thickens stool, Can shower with appliance on. Colostomy the Large intestines and bring them outside the abdomen. Healthy stoma should be pink and moist. post op check stoma every 8 HOURS for discoloration and abnormalities. Ascending has liquidy stool so a bag is needed ALL the Time. Transverse is a semi formed stool. Descending is semi formed to form stool. Loop stoma there is a bridge under it, and a double barrel stoma is temporary and has 2 stomas, top one the feces come out the 2nd mucus does. Eat small frequent meals and Good to eat: Yogurt, oatmeal, mashed potatoes, bananas, peanut butter, toast, pasta. Avoid eating: ETOH, apple juice, baked beans, coffee, tea, fatty foods, seeds, broccoli, corn, intracoate ik d/SR meds. Shrinking stoma is normal. Gastroenteritis Is the Inflammation of the GI tract. In Chronic type A it is autoimmune and is pernicious anemia. Body doesn't make enough intrinsic factor causing malabsorption of B-12 and require lifelong B-12 injections, at risk for bleeding. CHronic Type B results in PUD from H pylori. S/S of heartburn, belching, sour taste, nausea/vomiting. TX. You give PPI + 2 antibiotics. PUD-s/s, treatment-meds Peptic Gastric ulcer you have gut pain 1-2 hours after meals, may radiate to the shoulder area, may have Wt loss. With Peptic Duodenal Ulcer you don't have gut pain until food is digested so 2 to 4 hours after meal which is more common, may cause wt gain. Peptic Ulcer causes H pylori many times which is dx. With an urea breath test , when positive urea turns to CO2. c/o severe abdominal pain, usually stays with a bland diet and eats small frequent meals to decrease pain. Complication is Perforation, hard rigid abdomen. Treat with (PPI plus 2 antibiotics) Review Gl med classification and patient teaching- best time to take med You give antacids with acute pain, should be taken 1hr before or after meals and not taken with other meds, they are bad for HF pts. Antacid neutralizes stomach acid. You can also give H2 blockers (tidine), you take 30 min before meals and they decrease acid production and can cause confusion. no overeating, smoking, or NSAIDS with H2 blockers, fatigue is normal. Check baseline orientation prior to drug administration. Drug interacts, DON'T GIVE WITH theophylline, phenytoin, warfarin, and beta blockers. You can also give a PPI (Prazole) which is used for the long term and the best med for PUD and GERD. It works by preventing final transportation of Hydrogen ions. Your at risk for bacterial infections such as C DIFF with PPIs. should be taken with calcium because it can cause bone breakdown. You should give meds in AM and the capsule will be swallowed whole. You can sprinkle in apple sauces but use immediately. SL dose can be given through NGT. monitor CBC and liver enymes. You can give Cytoprotective drugs which are used as a bandaid (pepto-bismol, sucralfate). Has S/E of constipation and abdominal discomfort. Teach pt to take as directed for a full period of time and on empty stomach. Best taken LATE AT NIGHT. Ostomy assessments Vital signs, Stoma should be Pink to beefy red, moist. If Bluish it means Inadequate blood supply. If Black goes through Necrosis. The Skin around my stomach is monitored for irritation. Stoma shrinks over weeks which is normal. Dumping syndrome Dumping syndrome is rapid entry of food into jejunum. It occurs 5 to 30 minutes after eating. It decreases blood volume causing dizziness, increases HR, sweating, nausea, abdominal cramps, diarrhea. Avoid fluids 1 hour before and 2 hours after eating. Fundoplication MD wraps the upper part of the stomach completely around the esophagus to form a collar-like structure which puts pressure on LES. The Goal is to prevent acid back-upep and air hiatal hernia. 6-10 day HOB elevated and Assessed for dysphagia. REPRO BSE