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Final Exam Study Guide-65 questions GI Assessment: Inspect, auscultate, percuss, then palpate. Hyperactive Bowel Sounds: early indications of obstruction [diarrhea or inflammatory bowel disorder]. H ... ypoactive Bowel Sounds: later indications of obstruction. If bowel sound are absent, could mean a paralytic ileus. Remember: Hypoactive bowel sounds may indicate an adverse drug reaction. Bruit can indicate arterial obstruction. An abnormal finding is the Cullen’s sign [bluish discoloration around the umbilicus], it is an indication of hemorrhage. Ask patient of dietary practices and preventative health. Liver: look at carbohydrate metabolism, they store and release glycogen, helps absorb dietary fat, stores vitamin A/B12/D, excretes excess calcium. Major functions of liver include (1) absorption and metabolism of nutrients; (2) degradation of toxins, hormones, and medications; and (3) synthesis of proteins (clotting factors, albumin, several clotting factors, fibrinogen, and prothrombin). Liver aids in the digestion of fat by producing bile acids and lecithin. Remember: A normal liver span is 6 to 12 cm. Hepatomegaly is term used to describe an enlarged liver. Hooking technique is used to assess the edge of liver. Standing to left of the patient and placing fingers under the 12th rib [5-7 intercostal space], when the patient inhales, liver’s edge may come below the rib and be palpated by pads of provider’s fingers. Intestines: Small intestine is divided into three components: duodenum, jejunum, and ileum. Protein, carbohydrate, and fat digestion and absorption occur. Cholecystokinin is released from jejunum and duodenum when gastric acid, long fatty chains, and certain amino acids are present. Release of cholecystokinin stimulates release of pancreatic enzymes that contract gallbladder and relax hepatopancreatic sphincter for release of bile into duodenum. Secretin is released from small intestine in response to the presence of the acidic chyme in small intestine. Release of secretin stimulates liver and pancreas to release sodium bicarbonate, which neutralizes acidic chyme and protects intestinal lining. Diagnostic Studies/Endoscopy: Anticoagulants and aspirin (acetylsalicylic acid, or ASA) are usually held temporarily after a lower endoscopy because of the risk of bleeding. Look at stool and describe. Blood in emesis (vomit) is hematemesis. Bright red blood in stool is hematochezia. Blood in sputum is hemoptysis. Black, tarry stool is melena. Age-related changes: As smooth muscle tone decreases in GI system, contractions responsible for propelling food along weaken and movement of food through digestive system is slower. This usually presents as constipation. Diverticulitis: A diverticulum is a small, pouchlike protrusion or herniation. Often occurring in GI tract, particularly the colon. Thought to be related to the lack of fiber in the diet, obesity, and lack of physical activity. Diverticuli forms when you have a decreased bulk of stool and narrow lumen in sigmoid colon. To prevent, patient needs high-fiber diet and at least 2L of fluid each day. It calls for use of antibiotics since you have an infection present Risk factors (increasing age, obesity, smoking, low-fiber diet, heredity, and some medications [NSAIDs, acetaminophen, oral corticosteroids, and opiates]) IV started nothing by NPO. 1 Stomatitis: painful inflammation in mouth. Risk Factors (viral, bacterial, fungal infections, irritants [mouthwash, alcohol], radiation therapy [7-14 days after starting treatment], chemotherapy [peaks 6-12 days after last dose], allergic [metal, meds, dental material, cosmetics, gum, foods], Vitamin deficiency [Vit B, folate, zinc, iron], systemic disease [chronic kidney disease, inflammatory bowel disease]) Pathophysiology and Clinical Manifestations (painful inflammation and ulceration of lining of mouth. Primary occurs most often, painful small oral ulcers, herpes, and traumatic ulcers. Secondary occurs as result of viral, bacterial, or fungal infections with suppressed immune systems. Candidiasis [yeast infection] is another common cause of stomatitis; common factors [radiation therapy, chemotherapy, long-term use of antibiotics, steroids, certain antidepressant meds, diabetes, malnutrition, dementia, denture colonization, poor oral hygiene, Xerostomia {dry mouth}, decreased immune function, anxiety and stress]. Higher in females than males. Risk of developing stomatitis up to 90%. Healing: mouth care, hydration, using artificial saliva, avoiding food that is hot or has rough edges. Factors that affect rate of stomatitis age, nutrition, type of cancer, chemoradiation, oral hygiene.) Oral Stomatitis Grading Scale , Complications (increased risk for pain, dysphagia [difficult swallowing], odynophagia [painful swallowing], unable to eat require parenteral or enteral feedings, open lesions, edema oral and systemic infections) Nursing Manage : Assessment (dry red swollen and cracked oral mucosa, mouth ulcers, recurrent aphthous ulcers [canker sores], open bleeding mouth sores, pain, presence in inflammation or irritations in other mucosal areas [vagina, rectum, esophagus]), Diagnosis (acute pain, risk for infection, imbalanced nutrition less than body requirements, impaired oral mucous membranes, knowledge deficit, impaired swallowing), Interventions (assess vital signs, oral mucosa, nutritional intake, weight, I&O, implement aspiration precautions, administer prescribed meds [antimicrobials {relief of infection related symptoms}, antiviral {impaired immune function}, antifungal, viscous lidocaine {relief of local discomfort}], administer water-soluble lubricants for lips and mouth, teach mouth care after each meal using soft-bristled toothbrush, discourage use of alcohol-containing mouthwash and lemon-glycerin swabs, dentures and other oral appliances should be removed if severe stomatitis/oral pain is present, encourage regular dental checkups, encourage saline mouth rinses every 4 hrs, dietary choices high in protein or vit C for healing) Remember: Alcoholbased mouth rinses are likely to cause pain and inflammation for a patient diagnosed with stomatitis; therefore, this is discouraged by the nurse. Frequent, gentle mouth care cleanses the mouth of pathogens and prevents further infection. Frequent mouth rinsing with warm saline or sodium bicarbonate (baking soda) solution promotes comfort and gentle cleansing and rinses pathogens from the oral cavity 2 Hiatal Hernia: Risk Factors: lack of dietary fiber, obesity, pregnancy, smoking. Clinical Manifestations (Hernia type 1: heartburn, regurgitation, chest pain, dysphagia, belching. Hernia type 2: feeling full after eating, feeling breathless after eating, feeling suffocation, chest pain feels like angina, increased symptoms when lying flat), , Complications (Type 1 hernia is GERD most common, symptoms: coughing, obesity, ascites, positional changes bending/lying supine. Type 2 hernia are supradiaphragmatic volvulus and obstruction; very rare; symptoms: iron-deficiency anemia, gastric ulcer, erosion.), Nursing Manage (Assessment [heartburn, regurgitation, dysphagia, eructation {belching}, breathlessness, feeling suffocation, chest pain, GERD, iron deficiency anemia], Diagnosis [impaired swallowing, anxiety, pain, knowledge deficit], Interventions [assessing breathlessness, feelings of suffocation, chest pain, palpitations, dysphagia, clinical manifestations of GERD, heartburn, nausea, vomiting, eructation, iron deficiency anemia, take action meds management {antacids neutralize stomach acid, histamine receptor agonists acid production is decreased, proton pump inhibitors acid production blocked, prokinetic meds gastric emptying}, position patient supine on right side, elevate HOB at least 30 degrees after meals, teach patient to limit following foods {spicy/fatty foods, caffeine, chocolate, carbonated beverages, acidic food, peppermint, alcohol, certain meds such as calcium channel blockers; anticholinergic meds; and smooth muscle relaxers}, encourage patient to eat meals 2 hrs before lying supine, educate patient not to wear tight clothing, educate patient and family about maintain a normal weight, proper positioning after eating, conduct postoperative education for patient after LNF). SAFETY ALERT: GI and cardiac symptoms are similar, it is important to assess patient, notify healthcare provider, and perform an electrocardiogram if patient complains of chest pain or shortness of breath. 3 Gastroesophageal Reflux Disease: An incompetent lower esophageal sphincter remains open, allowing gastric acid to reflux into esophagus. Risk Factors: lifestyle, pregnancy, obesity, hiatal hernia, ascites, tight belts or girdles, presence of a NG tube, LES hypotension, loss of esophageal motility, increased compliance of hiatal canal, increased states of gastric secretion, eating large meals, delayed emptying of gastric contents. Meds (Antacids [increase gastric pH], Histamine receptor antagonists [decrease gastric acid production; short acting], prokinetic meds [increase gastric emptying], proton pump inhibitors [decrease gastric acid production; long acting]), Nursing Manage (Assessment [heartburn, severe atypical chest pain, odynophagia, hemorrhage, dental caries, aspiration pneumonia, chronic cough, morning hoarseness, adult-onset asthma, laryngitis, pharyngitis, bronchitis, regurgitation], Diagnosis [acute/chronic pain, risk for aspiration, impaired swallowing, imbalanced nutrition], Interventions [assess respiratory symptoms, regurgitation, severe atypical chest pain, hemorrhage, CBC, dyspepsia {indigestion}, dysphagia/odynophagia, signs of Barrett’s esophagus {damaged esophagus from acid reflux}, dental caries, water brash {excessive saliva} eructation/flatulence/bloating, nausea, globus {lump on throat}, pH of gastric aspirate, give meds, position patient on right side with HOB elevated 6-12 inch, provide 4-6 meals per day, teach patient to limit following foods {spicy/fatty foods, caffeine, chocolate, carbonated beverages, acidic foods, peppermint, alcohol, certain meds {calcium channel blockers, anticholinergic meds, smooth muscle relaxers}, avoid smoking/avoiding, avoid NSAIDs/aspirin, encourage patient to eat meals 2 hrs before lying supine, educate patient to wear tight clothes, educate patient and family about body weight]) Remember: Respiratory symptoms occur with aspiration of acid reflux into tracheobronchial tree, larynx, pharynx, nose, and mouth (especially when supine). Aspiration is a medical emergency necessitating immediate action. Appropriate patient outcomes are freedom from pain and knowledge of lifestyle changes to manage GERD. Weight loss, small, frequent meals, and avoiding lying down within 3 hours of eating indicate correct management. Remember: Acute pain management is priority of nursing care. [Show More]

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