Gastrointestinal 1 Student-1 PDF

Gastrointestinal I Honan Chapter 20 & 21 Learning Objectives: 1. Describe the anatomy and physiology of the gastrointestinal (GI) tract. 2. Identify the metabolic functions of the liver. 3. Discuss important physical assessment findings of the GI tract. 4. Identify the assessm...

Gastrointestinal I Honan Chapter 20 & 21 Learning Objectives: 1. Describe the anatomy and physiology of the gastrointestinal (GI) tract. 2. Identify the metabolic functions of the liver. 3. Discuss important physical assessment findings of the GI tract. 4. Identify the assessment parameters used to determine the status of the upper and lower GI tract. 5. Describe nursing management of patients with conditions of the oral cavity. 6. Use the nursing process as a framework for care of patients undergoing neck dissection. 7. Describe the various conditions of the esophagus and their clinical manifestations and management. 8. Describe the purposes and types of gastrointestinal intubation. 9. Discuss nursing management of the patient who has a nasogastric or nasoenteric tube. 10.Identify the purposes and uses of parenteral nutrition.  Gastrointestinal I Honan Chapter 20 Learning Objectives: 1. Describe the anatomy and physiology of the gastrointestinal (GI) tract. 2. Identify the metabolic functions of the liver. 3. Discuss important physical assessment findings of the GI tract. 4. Identify the assessment parameters used to determine the status of the upper and lower GI tract.  ANATOMY Anatomy of the GI tract 23-26 ft long Mouth Esophagus Through the diaphragmatic hiatus Stomach Small Intestine Duodenum, jejunum, ileum Large Intestine Ascending colon, transverse colon, descending, colon, sigmoid, rectum, anus  DIGESTIVE, GI & METABOLIC Function of the Digestive System Digestion, absorption and elimination Chewing/Swallowing Requires saliva, intact CNS and sphincter function Gastric Function Gastric acid, pepsin, intrinsic factor. Chyme is propelled to the small intestine by peristalsis of the stomach  SMALL INTESTINE Small Intestine Function Receive secretions from the pancreas, liver and gallbladder Pancreas- trypsin, amylase and lipase (via the ampule of Vater) Liver/Gallbladder – Bile through the Sphincter of Oddi Contractions Segmental Intestinal peristalsis Absorption of Nutrients  COLON Colon Function Ileocecal valve receives residual waste material Use of intestinal flora (normal bacteria) completes breakdown Slow transport allows for reabsorption of water and electrolytes  LIVER Liver Function A chemical factory that manufactures, stores, alters and excretes a large number of substances involved in metabolism. Functions: Glucose Metabolism Conversion of ammonia to urea Protein and fat metabolism Vitamin and iron storage Drug metabolism Bile formation Bilirubin excretion GALLBLADDER & PANCREAS  ASSESSMENT Common complaints Pain Dyspepsia Gas Nausea/vomiting Change in bowel habits Jaundice Ascites  ASSESSMENT Inspection Auscultation Percussion Palpation Murphy’s sign McBurney's point Blumberg's sign GI Assessment  DIAGNOSTICS Stool tests Breath tests Ultrasound Upper GI/Lower GI (Barium) CT/MRI/PET  DIAGNOSTICS Endoscopic retrograde cholangiopancreatography (ERCP), Esophagogastroduodenoscopy (EGD) Varices Colonoscopy LFTs Liver biopsy Paracentesis  Gastrointestinal I Honan Chapter 21 Learning Objectives: 1. Describe nursing management of patients with conditions of the oral cavity. 2. Use the nursing process as a framework for care of patients undergoing neck dissection. 3. Describe the various conditions of the esophagus and their clinical manifestations and management. 4. Describe the purposes and types of gastrointestinal intubation. 5. Discuss nursing management of the patient who has a nasogastric or nasoenteric tube. 6. Identify the purposes and uses of parenteral nutrition.  TMJ DISORDER Clinical manifestations Medical management Nursing management  DISORDERS OF SALIVARY GLANDS Sialadenitis Parotitis  ORAL/OROPHARYNGEAL CANCER Patho Risk factors Clinical manifestations Management Neck Dissection Types: Radical, Modified, Selective Complications: Hemorrhage, chyle fistula, nerve injury  ACHALASIA Patho Clinical manifestations Management  HIATAL HERNIA Patho Clinical manifestations Management  DIVERTICULUM Patho Clinical manifestations Management  ESOPHAGUS Perforation Foreign bodies Chemical burn  ESOPHAGUS Gastroesophageal Reflux Disease (GERD) Barrett’s Esophagus  ESOPHAGEAL CANCER Patho Clinical manifestations Management  GASTROINTESTINAL INTUBATION Clinical indications Types of tubes Nursing management Insertion Confirmation of placement Patientcy Medication administration Unclogging tubes Removing the tube Complications of tube feeding  ADMINISTERING TUBE FEEDINGS Purpose Delivered to: Stomach Distal duodenum or proximal jejunum Priorities for Care Reducing the risk for aspiration Residual Assessment Preventing Dumping Syndrome Formulas and frequency of administration Complications of Tube Feedings  GASTROSTOMY Clinical Indications Types Complications  PARENTERAL NUTRITION Clinical Indications Administration Discontinuing  NCLEX REVIEW QUESTIONS Which of the following symptoms would be suspicious of appendicitis? Select all that apply. A. Right lower quadrant pain B. Periumbilical pain C. Anorexia D. Nausea E. Hypothermia F. Projectile vomiting  NCLEX REVIEW QUESTIONS Which of the following physiologic processes is Not performed in the small intestine? A. Breakdown of fats into absorbable particles B. Breakdown of carbohydrates into simple sugars C. Reabsorption of water D. Peristalsis  NCLEX REVIEW QUESTIONS The exocrine functions of the pancreas are differentiated from the endocrine functions by the fact that the exocrine functions involve: A. Secretion of enzymes B. Insulin synthesis C. Initiation of peristalsis D. Bile synthesis  NCLEX REVIEW QUESTIONS An elderly patient is suspected of having a chronic GI bleed. The initial test that would address this possibility is: A. A PET Scan B. Stool Testing C. An upper GI series D. A Lower GI series  NCLEX REVIEW QUESTIONS Serum bilirubin levels would be among the most relevant laboratory findings for a patient who has jaundice A. True B. False  NCLEX REVIEW QUESTIONS The nurse recognizes that most nutrients and electrolytes are absorbed by which of the following? A. Esophagus B. Stomach C. Colon D. Small Intestine  NCLEX REVIEW QUESTIONS A patient with cancer of the tongue has a radical neck dissection. What nursing assessment would be the highest priority for this patient? A. Assessment of acute pain and anxiety B. Assessment of tissue integrity and color of the operative site C. Assessment of respiratory status and airway clearance D. Assessment of self esteem and body image  NCLEX REVIEW QUESTIONS Constipation is one of the most common complications of tube feedings and appropriate nursing interventions to prevent this is necessary. A. True B. False  NCLEX REVIEW QUESTIONS Which of the following methods is the most accurate indication of correct GI tube placement? A. Installation of air with simultaneous abdominal auscultation B. Abdominal x-ray C. Aspiration of gastric contents D. Gentle traction on the tube  NCLEX REVIEW QUESTIONS The nurse is administering liquids to a patient who has recently been changed from NPO to a clear liquid diet. The patient coughs and occasionally gags with sips of water. Which healthcare team member will the nurse consult? A. Physical Therapist B. Respiratory Therapist C. Dietician D. Speech pathologist  NCLEX REVIEW QUESTIONS A nurse is caring for a patient who is on strict bowel rest and will need IV nutrition. The nurse knows the following devices are appropriate for TPN. Select all that apply A. PICC line B. Triple lumen catheter C. Large bore IV line D. Implantable venous access device (port a cath)  NCLEX REVIEW QUESTIONS Which assessment finding does the nurse expect as a normal consequence of aging? A. Increased salivation and drooling B. Hyperactive bowel sounds and loose stools C. Increased gastric production and heartburn D. Decreased sensation to defecate and constipation  NCLEX REVIEW QUESTIONS Which of the following foods could give a false-positive result on the fecal occult blood test (FOBT)? Select all that apply. A. Red meats B. Pasta C. Turnips D. Fish E. Whole-grain bread  NCLEX REVIEW QUESTIONS Which question will best assist the nurse in the assessment of a patient with acute diarrhea? Select all that apply. A. “Have you had a colonoscopy in the last 3 months?” B. “Have you traveled outside the country recently?” C. “Do you have any trouble swallowing?” D. “Do you have hypertension?” E. “Have you recently been treated with antibiotics?” F. “Do you have hyperthyroidism?”  NCLEX REVIEW QUESTIONS When performing an abdominal assessment on a patient with suspected cholecystitis, how does the nurse palpate the patient’s abdomen and what findings may be expected? Select all that apply. A. Palpate the right lower quadrant only B. Palpate the upper quadrants only C. Defer palpation and use percussion only D. Palpate the right upper quadrant last E. Positive rebound tenderness at McBurney’s point F. Positive Murphy’s sign  NCLEX REVIEW QUESTIONS A patient has an NG tube inserted and placement is confirmed by x-ray. Select from the list below, appropriate options to verify the NG tube placement is maintained. Select all that apply. A. Air insufflation into NG tube and listening for air bubble B. Reassessing the marking at the nares or mouth and length of the external portion of the tube in centimeters C. Testing the NG tube drainage pH D. Using capnographic devices to determine placement E. Visually assessing the aspirate  NCLEX REVIEW QUESTIONS A nurse is caring for a patient on strict bowel rest and will need IV nutrition. The nurse knows the following devices are appropriate for TPN. Select all that apply. A. PICC line B. Triple-lumen catheter C. Large-bore IV line D. Implantable venous assess device (Port-A-Cath) E. Arterial line  NCLEX REVIEW QUESTIONS A nurse receives report on a patient experiencing dumping syndrome. What symptoms would the patient be displaying 30 minutes after eating? Select all that apply. A. Difficulty swallowing B. Heartburn C. Constipation D. Cramping in the abdomen E. Diarrhea  NCLEX REVIEW QUESTIONS The nurse recognizes which of the following is a cause of xerostomia? Select all that apply. A. HIV infection B. Oral hypoglycemic medications C. Tracheostomy tube D. Inability to close the mouth E. Kidney failure