NR324 Midterm Exam 3

What function do the GI tract preform - -ingestion, digestion, and elimination Pain focused GI assessment - -when the pain occurs - before meals, after meals, in the middle of the night, and any food associations. Specifically ask about heartburn and problems with a sore mouth, tongue, or throat. Teeth/Gums: focused GI assessment - -problems with bleeding gums, dental caries, abscesses, and use of dentures and partial plates. Obtain date of last dental exam and results if possible. Throat: focused GI assessment - -hoarseness or voice changes that might indicate the presence of a tumor, any difficulty swallowing, and the presence or absence of tonsils. Appetite: focused GI assessment - -Appetite: Assess any changes in appetite, food in tolerances, and the presence of nausea and/or vomiting. Lower GI: focused GI assessment - -Lower GI: Assess for problems with eructation, flatulence, hemorrhoids, hernia. When assessing the abdomen, should the nurse palpate or auscultate first - -always inspect, auscultate and then pappate skin: focused GI assessment - -for color, lesions, scars, petechiae, etc. Abdominal contour and perianal area for intact skin, hemorrhoids. When palpating the abdominal - -you should use light touch and advance to deep palpation What are some age related changes in the GI tract - -Saliva secretion decreases , inhibiting the digestion of complex carbs - gum and tooth loss making nutrition difficult- Peristalsis in the esophagus is no longer triggered with each swallow and there is delayed entry of food into the stomach causing a premature feeling of fullness- heart burn and reflux- Constipation is common due to decreased intake and decreased intestinal motility. What is a Barium enema - -- examination of large intestine; give laxatives before and monitor stool after procedure What is a Esophagogastroduodenoscopy (EGD) - -- visualize esophagus, stomach, duodenum; keep NPO after procedure until gag reflex returns What is an Colonoscopy - -- examination of colon, biopsies and polyps removed; bowel prep before and observe for perforation What is an Nasogastric (NG) Tube - -- nutrition, medication and decompression; proper technique during use, verify placement What is a Gastrostomy Tube - -- nutrition, medication; proper technique for use, verify placement, monitor for infection, HOB elevated What is Nausea - -a feeling of discomfort in the epigastrium with a conscious desire to vomit. How do you Management nausea and vomiting - -: medications, assess vomitus, progressive nutrition, non-pharmacological measures, weight, I&O Which laboratory findings should the nurse expect in the patient with persistent vomiting? - -Increased pH, decreased K, increased Hct. A patient who has been vomiting for several days from an unknown cause is admitted to the hospital. What should the nurse anticipate will be included initially in the collaborative care? - -- the patient with severe or persistent vomiting requires IV replacement of fluids and electolytes until able to tolerate oral intake to prevent serious dehydration and electrolyte imbalances. Oral fluids are not given until vomiting has been relieved and parenteral antiemetics are often not used initially until a cause of the vomiting can be established. NG intubation may be indicated in some cases, but fluid and electrolyte replacement is the first priority A patient treated for vomiting is to begin oral intake when the symptoms have subsided. To promote rehydration, the nurse plans to administer which fluid first? - -water is the fluid of choice for rehydration by mouth. Very hot or cold liquids are not usually well tolerated and although broth and Gatorade have been used for patients with severe vomiting, these substances are high in sodium and should be administered with caution. Risk Factors for Oral Cancer - -tobacco, alcohol, sun, HPV Assessment for Oral Cancer - -ulcer, soreness, dysphagia, difficulty speaking Management:for Oral Cancer - -surgery, radiation, chemotherapy, palliative treatment, pain control, nutrition, prevent aspiration, communication techniques What are the two types of oral cancer - -: oral cavity cancer (starts in mouth) and oropharyngeal cancer (starts in pharynx). What is the Assessment: for Gastroesophageal Reflux Disease (GERD) - -no single cause defenses of the lower esophagus are overwhelmed by reflux of gastric contents into esophagus causes heartburn, dyspepsia, regurgitation, coughing may also cause wheezing coughing, and dyspnea What is GERD related to - -certain foods, obesity, cigarette smoking, incompetent lower esophageal sphinchter. What aree the Complications - -- asthma from irritants of gastric secretions, pneumonia from aspiration What are the tests that can be done for GERD - -- Endoscopy to assess the LES competence and degree of inflammation. Biopsies to rule out cancer. Motility or manometric studies to assess pressure of esophagus and LES motility What is the Management for GERD - -- Lifestyle (no smoking, alcohol, stress reduction). Nutrition (low fat, small frequent, no carbonated drinks - especially after eating, don't lie down 2-3 hours after eating, don't wear constrictive clothes), sleep with HOB elevated. Medications (proton pump inhibitors - prilosec; histamine receptor blockers - Pepcid; antacids - Tums) What are some different surgery for GRED - -- fundus of stomach is wrapped around the lower portion of the esophagus to reinforce and repair the defective barrier. Endoscopic therapy - endoscopic mucosal resection, photodynamic therapy, cryotherapy, radiofrequency ablation What is a Hiatal Hernia - -A herniation of the stomach into the esophagus through an opening in the diaphragm. Could be due to weakening of the muscles in the diaphragm around the esophagogastric opening with aging or any factor that increases intra abdominal pressure (pregnancy) What is the most common types of a Hiatal Hernia - -Sliding - The junction of the stomach and the esophagus is above the diaphragm, and a part of the stomach slides through the hiatal opening in the diaphragm. This occurs when the patient is supine, and the hernia usually goes back into the abdominal cavity when the patient is standing upright. This is the most common type of hiatal hernia. What is another type of Hital hernia - -Rolling (may be emergent) - The esophagogastric junction remains in the normal position, but the fundus and the greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus. Acute paraesophageal hernia is a medical emergency. What are the Complications for hiatal hernia - -, esophagitis, hemorrhage, stenosis, ulcerations, regurgitation with aspiration. What kind of test can you do for hiatal hernia - -- esophagram (barium swallow) to