NURS 372 MED SURG 2 EXAM STUDY GUIDE
Important health history of GI issues - Answers -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 - Answers -pain
Dysphagia ( difficulty swallowing)
Dyspepsia (indigestion, belching)
N&v
Intestinal gas
Change in bowel habits
Stool characteristics
Physical assessment of GI system - Answers -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 - Answers -dentition
Anorexia
Dysphagia
Dyspepsia
Decreased gastric motility (muscles in neck weaken)
Decreased HCL production
Constipation
Altered drug metabolism
,Diagnostic evaluation of GI issues - Answers -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 - Answers -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 - Answers -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 - Answers -esophagastroduodenoscopy (EGD)
Endoscopic retrograde cholangiopancreatography (ERCP)
- in addition to typical endoscopy
- looks at pancreatic and bile ducts
Flexible sigmoidoscopy
Colonoscopy
EGD - Answers -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 - Answers -* 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 - Answers -- 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 - Answers -- 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 - Answers -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 - Answers -** 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
TNM classification of tumors - Answers -T - size/degree of penetration of tumor
N- presence, size, number, location of involved lymph nodes
M- presence of metastasis
Nursing assessment of oral cancers - Answers -- assess for risk factors
Important health history of GI issues - Answers -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 - Answers -pain
Dysphagia ( difficulty swallowing)
Dyspepsia (indigestion, belching)
N&v
Intestinal gas
Change in bowel habits
Stool characteristics
Physical assessment of GI system - Answers -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 - Answers -dentition
Anorexia
Dysphagia
Dyspepsia
Decreased gastric motility (muscles in neck weaken)
Decreased HCL production
Constipation
Altered drug metabolism
,Diagnostic evaluation of GI issues - Answers -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 - Answers -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 - Answers -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 - Answers -esophagastroduodenoscopy (EGD)
Endoscopic retrograde cholangiopancreatography (ERCP)
- in addition to typical endoscopy
- looks at pancreatic and bile ducts
Flexible sigmoidoscopy
Colonoscopy
EGD - Answers -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 - Answers -* 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 - Answers -- 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 - Answers -- 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 - Answers -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 - Answers -** 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
TNM classification of tumors - Answers -T - size/degree of penetration of tumor
N- presence, size, number, location of involved lymph nodes
M- presence of metastasis
Nursing assessment of oral cancers - Answers -- assess for risk factors
