NR324 Adult Health Exam 3 Running Review

Week 5 Ch. 38: Assessment of GI System • Labs o N/A • Terms and Concepts o Absorption-transferring food products into circulation o Bilirubin-pigment derived from the breakdown of hemoglobin o Borborygmi-loud stomach growling or loud gurgles o Cheilosis-softening, fissuring, and cracking of lips at angles of mouth o Deglutition-swallowing o Digestion-breaking down food o Endoscopy  Upper: inflamations, tumors, disease of esophagus, stomach, duadonem. 10 to 20 mins. H.pylori, can take sample. • Monitor for effects and throat sore, bleeding. • Assess for bleeding, hemotosis, decrease blood pressure and increased heart rate.  Lower: lower gi, up sigmoid colon o Hematemesis: throwing up blood o Kupffer cells: macrophages located in liver cells o Melena: black tarry stool  Occult bleeding: poop with feces but cannot tell o Pyorrhea: inflammation of the gums can destroy jaw bone o Pyrosis: heart burn o Steatorrhea: excess fat in stool o Tenesmus: constant urge to move bowels o Valsalva maneuver: stim vagel nerve in svt, beardown, slow heart rate.  PSN o Ingestion: ingest of food starts with appetite influences how much you eat. Ghrelin is the hungry hormone released by the stomach’s mucosa. o Digestion and Absorption: stomach and small intestine  Physiology of Digestion • Stomach: store, mix with secretions empties into duodenum • Small Intestine o Pancreas: secrete enzymes o Biliary Tract: o Liver- (portal vein into liver) filerts and into blood stream, liver bile- emulsifies fat. Acetomenifen hurts liver. Add Tylenol!  Elimination • Large Intestine: stool formation and fiber, last undigested food. o Hydrate to preven constipation. o 5-6 feet long o Chapter 41: Upper GI Problems Low chloride and ph messes up diagestion. • Terms and Concepts o Achalasia: no paralstalsis in the lower esoph o Barrett's esophagus: Damage to the lower portion of the tube that connects the mouth and stomach (esophagus). Mucosal lining starts to change. Can head in to cancer. o o Dysphagia: trouble swallowing o esophageal cancer: increasing rates, most are adenocarcinomas, others are squamous cell tumors o esophageal diverticula:sac like outpouchings of one or more layers of the esophagus o esophagitis: hollow tube to swallow food  we swallow a 1L a day  why would a patient drool? Assess that. Swallow test. o Gastritis: inflammation of the gastric mucosa o gastroesophageal reflux disease (GERD): acid of the stomach irritates the linning of esophagus cause its not supposed to be there o hiatal hernia: protrusion of stomach through diaphragm o Mallory-Weiss tear: tears in the lining of the esophagus from excessive emisis o Nausea: stimulated by 5-ht (serotonin) and dopamine o peptic ulcer disease (PUD): can be associated with i, sore in lining of stomach or first part of intestestin called duodonem. o stomach (gastric) cancer: carcinoid tumer, loss of appitite, feeling full. Unhealed ulcers can be a risk. o stress-related mucosal disease (SRMD): deep mucosal range not typically seen in chronic illed pts. o Vomiting: emisis o Drug alerts  Promethazine: Phenergan: causes tissue necrosis!! Deep vein, big catheter, slow, iv patent, ask if you can dilute-50ml of NA.  Metoclopramide (Reglan): promotes gastric emptying, keeps things moving. Long term use tardive diskonesia. • Disease States: CALL POISEN CONTROL when injestion of something. o Nausea and vomiting: subjective,  Patho: CRTZ in brain chemo receptor trigger zone,  Assessment  Diagnostics  Interventions: NG tube, iv, iv fluids, deep breathing, make NPO, consider EKG for adult and female over 45, preg test, labs, accucheck, • Pharm: blocks serotonin in cns., prokinetics (regalin), zofran o Oral Cancer  Patho: smoking, chewing tobacco, poor oral hygiene, smoking,  Assessment: oral health, decay,  Diagnostics: dentist  Interventions: sx  Pharm: o Gastroesophageal Reflux Disease (GERD)  Patho: burning chest pain, from weakend sphincter, mucus lining. Bleeding, eats away at lining.  Assessment: chest pain, same nerve to heart so that’s why it feels like a heart attack. Dry caugh.  Diagnostics: endoscopy upper gi, stop smoking.  Interventions: bland foods, no tomatoes, no alcohol • Pharm: Proton pump inhibitor-decreases production of acid, decreases acid stimulation, h2blocker: omeprazole. Antacid: nutrolizes it. Too much alkalosis. o Hiatal hernia  Patho: pain n/v, potrussion in weak area of diaphragm, up comes stomach,  Assessment: ridget, abd.  Diagnostics: endoscopy  Interventions: weight management and elevation of bed, antiacids bc gerd is commonly seen. • Pharm: proton pump inhib and antibiotic o Gastritis  Patho: eroding lining of stomach lining.  Assessment: risk for fluid col def  Diagnostics:  Interventions: NPO, iv fluids, NG tube,  Pharm: antibiotic proton pump inhib and antibiotic, isotonic solution (nc) o Peptic Ulcer Disease (PUD)  Patho: ulcer in peptial mucosa. Look at peptic ulcer PUD memory book page. Stress. Hpylori, alcohol, smoking  Assessment: upper and lower endoscopy  Diagnostics  Interventions • Pharm: cytotec-misoprostol (liquid badage)=instant labor do not give to preggers. o Gastric Ulcers: reg nsaid, smoking,  Patho: chime cannot move out of stomach due to obstruction.  Assessment: does the pt take nsaids? Risk!  Diagnostics: edoscopy, edg  Interventions: medication • Pharm: proton pump inhibitors, -pazoles, probiotic o Gastric Outlet Obstruction: scar tissue, pyloric obstruction, consequence of a disease process.  Patho: no specific cause, from multiple disease process, impede gastric emptying.  Assessment: bloating, burping, vomiting,  Diagnostics: CT, endoscopy (swallow a pill)  Interventions: keep npo, balance i/o, maybe walk to encourage peristalsis stimulation, watch breathing patters. • Pharm o Dumping Syndrome: post pramial. Also called rapid gastric emptying; occurs when food (especially sugar) move from stomach to small bowel too quickly  Patho-typically