NURS 372 Med Surg 2 Exam With
Complete Solutions
important health history of GI issues - ANSWER demographic data
family history
history of GI symptoms, disorders
** previous abdominal surgery (scar tissue forms when tissue is exposed to air
smoking habits
etoh, drugs
travel
stress
nursing assessment of GI system - ANSWER pain
dysphagia ( difficulty swallowing)
dyspepsia (indigestion, belching)
n&v
intestinal gas
change in bowel habits
stool characteristics
physical assessment of GI system - ANSWER mouth
- breath
- tongue
- buccal mucosa
- teeth & gums
- lips
- swallowing ability
abdomen
- inspection
- auscultation
- palpation
- percussion
rectum/perianal area
**pain may be referred to a different area
gerontologic considerations - ANSWER dentition
anorexia
,dysphagia
dyspepsia
decreased gastric motility (muscles in neck weaken)
decreased HCL production
constipation
altered drug metabolism
diagnostic evaluation of GI issues - ANSWER CBC
metabolic panel
PT, PTT
cancer screening
- CEA (carcinoembryonic antigen)
- CA19-9 (most common in pancreatic cancer, can be seen with other cancers.
Not eveyr patient with pancreatic cancer has high level)
enzymes
- AST
- ALT
- amylase
- lipase
- trypsin
bilirubin (high may be related to blocked gallbladder ducts)
ammonia
- chemical made by bacteria in intestines/cells while you process protein. if liver
not functioning, ammonia will be elevated
stool
- FOBT (fecal occult blood testing)
- O & P (ova and parasite)
- c diff
- steatorrhea (fat in stool)
- fecal antigen
upper GI series - barium swallow - ANSWER pre procedure
- NPO 8 hours prios
- clear liquid diet the day before
- avoid GI stimulants (opioids, anticholinergics, tobacco, gum, mints)
intra procedure
- if cannot swallow do NG tube
- ingest prep liquid
- x rays taken
- white liquid lights up with x ray
post procedure
- fluids
- laxatives
- monitor BMs
,- assess abdominal pain and cramping
*** will harden if it sits for too long
lower GI series - barium enema - ANSWER pre procedure
- low residue diet 1-2 days prior
- clear liquid diet the day before
- NPO 8 hrs prior to procedure
- cleanse lower GI tract - laxatives, GoLytely, magnesium citrate, enemas
intraprocedure
- barium enema (500 - 1500 ml)
- double contrast study - air injected
- abdominal cramping may occur
post op
- fluids
- laxatives
- monitor BMs
- assess abdominal pain and cramping
GI imaging - ANSWER esophagastroduodenoscopy (EGD)
endoscopic retrograde cholangiopancreatography (ERCP)
- in addition to typical endoscopy
- looks at pancreatic and bile ducts
flexible sigmoidoscopy
colonoscopy
EGD - ANSWER pre procedure
- NPO for 8 hours
- local anesthetic
- moderate sedation (not usually on general care unit. versed, propofol):
antidote for versed - flumazanil
- atropine or scopolamine to dry up secretions
intra procedure
- patient in left lateral sims
- endoscope inserted orally
post procedure
- frequent VS (look for trends relating to hemorrhage)
- siderails up
- NPO until gag reflex returns
- lozenges for throat discomfort
ERCP - ANSWER * can cause inflammation, abdominal pain
, pre procedure
- same as EGD
intra procedure
- scope advanced further into duodenu, and biliary tract
- contrast dye inserted
- postion changes
post procedure
- VS until stable
- NPO until gag reflex returns
- assess for colocky abdominal pain, intractable n&V
flexible sigmoidoscopy - ANSWER - lower portion of colon viewed (rectum and
sigmoid), to evaluate chronic diarrhea, fecal incontinence, ischemic colitis, and
to observe for ulceration, fissures, abcesses, tumors, polyps, internal
hemorrhoids
- no special diet
- oral prep: go lytely, suppositories, enemas
- no sedation
- position in left lateral sims
- takes approx 30 mins
- potential for slight bleeding if biopsy performed
colonoscopy - ANSWER - direct visualization of colon to cecum, passing through
rectum, sigmoid colon, descending colon, transverse colon, ascending colon
- liquid diet 24 hrs, NPO 8 hrs prior
- oral prep: go lytely, suppositories, enemas, electrolytes
- moderate sedation
- left lateral sims
- takes approx 1 hr
- potential for slight bleeding if biopsy performed
disorders of lips, mouth, gums - ANSWER stomatitis - inflammation of mucus
membranes of mouth
herpes simplex 1
apthous stomatitis - painful ulcers
candidasis/thrush - yeast
kaposi's sarcoma - type of cancer that forms in mouth, throat
oral cancers - ANSWER ** usually painless
- occurs in any part of lips, mouth, tongue, throat
- usually curable if discovered early
- associated with tobacco, etoh, HPV
- squamous cell carcinoma most common
Complete Solutions
important health history of GI issues - ANSWER demographic data
family history
history of GI symptoms, disorders
** previous abdominal surgery (scar tissue forms when tissue is exposed to air
smoking habits
etoh, drugs
travel
stress
nursing assessment of GI system - ANSWER pain
dysphagia ( difficulty swallowing)
dyspepsia (indigestion, belching)
n&v
intestinal gas
change in bowel habits
stool characteristics
physical assessment of GI system - ANSWER mouth
- breath
- tongue
- buccal mucosa
- teeth & gums
- lips
- swallowing ability
abdomen
- inspection
- auscultation
- palpation
- percussion
rectum/perianal area
**pain may be referred to a different area
gerontologic considerations - ANSWER dentition
anorexia
,dysphagia
dyspepsia
decreased gastric motility (muscles in neck weaken)
decreased HCL production
constipation
altered drug metabolism
diagnostic evaluation of GI issues - ANSWER CBC
metabolic panel
PT, PTT
cancer screening
- CEA (carcinoembryonic antigen)
- CA19-9 (most common in pancreatic cancer, can be seen with other cancers.
Not eveyr patient with pancreatic cancer has high level)
enzymes
- AST
- ALT
- amylase
- lipase
- trypsin
bilirubin (high may be related to blocked gallbladder ducts)
ammonia
- chemical made by bacteria in intestines/cells while you process protein. if liver
not functioning, ammonia will be elevated
stool
- FOBT (fecal occult blood testing)
- O & P (ova and parasite)
- c diff
- steatorrhea (fat in stool)
- fecal antigen
upper GI series - barium swallow - ANSWER pre procedure
- NPO 8 hours prios
- clear liquid diet the day before
- avoid GI stimulants (opioids, anticholinergics, tobacco, gum, mints)
intra procedure
- if cannot swallow do NG tube
- ingest prep liquid
- x rays taken
- white liquid lights up with x ray
post procedure
- fluids
- laxatives
- monitor BMs
,- assess abdominal pain and cramping
*** will harden if it sits for too long
lower GI series - barium enema - ANSWER pre procedure
- low residue diet 1-2 days prior
- clear liquid diet the day before
- NPO 8 hrs prior to procedure
- cleanse lower GI tract - laxatives, GoLytely, magnesium citrate, enemas
intraprocedure
- barium enema (500 - 1500 ml)
- double contrast study - air injected
- abdominal cramping may occur
post op
- fluids
- laxatives
- monitor BMs
- assess abdominal pain and cramping
GI imaging - ANSWER esophagastroduodenoscopy (EGD)
endoscopic retrograde cholangiopancreatography (ERCP)
- in addition to typical endoscopy
- looks at pancreatic and bile ducts
flexible sigmoidoscopy
colonoscopy
EGD - ANSWER pre procedure
- NPO for 8 hours
- local anesthetic
- moderate sedation (not usually on general care unit. versed, propofol):
antidote for versed - flumazanil
- atropine or scopolamine to dry up secretions
intra procedure
- patient in left lateral sims
- endoscope inserted orally
post procedure
- frequent VS (look for trends relating to hemorrhage)
- siderails up
- NPO until gag reflex returns
- lozenges for throat discomfort
ERCP - ANSWER * can cause inflammation, abdominal pain
, pre procedure
- same as EGD
intra procedure
- scope advanced further into duodenu, and biliary tract
- contrast dye inserted
- postion changes
post procedure
- VS until stable
- NPO until gag reflex returns
- assess for colocky abdominal pain, intractable n&V
flexible sigmoidoscopy - ANSWER - lower portion of colon viewed (rectum and
sigmoid), to evaluate chronic diarrhea, fecal incontinence, ischemic colitis, and
to observe for ulceration, fissures, abcesses, tumors, polyps, internal
hemorrhoids
- no special diet
- oral prep: go lytely, suppositories, enemas
- no sedation
- position in left lateral sims
- takes approx 30 mins
- potential for slight bleeding if biopsy performed
colonoscopy - ANSWER - direct visualization of colon to cecum, passing through
rectum, sigmoid colon, descending colon, transverse colon, ascending colon
- liquid diet 24 hrs, NPO 8 hrs prior
- oral prep: go lytely, suppositories, enemas, electrolytes
- moderate sedation
- left lateral sims
- takes approx 1 hr
- potential for slight bleeding if biopsy performed
disorders of lips, mouth, gums - ANSWER stomatitis - inflammation of mucus
membranes of mouth
herpes simplex 1
apthous stomatitis - painful ulcers
candidasis/thrush - yeast
kaposi's sarcoma - type of cancer that forms in mouth, throat
oral cancers - ANSWER ** usually painless
- occurs in any part of lips, mouth, tongue, throat
- usually curable if discovered early
- associated with tobacco, etoh, HPV
- squamous cell carcinoma most common
