GI structure and function
Where does mechanical and chemical digestion begin?
In the mouth!
What is the order of abdominal assessment?
Inspection, Auscultation, Percussion, Palpation
Which body shape in obesity has a better prognosis, but is harder to treat?
Apple greater risk for complications, pear better prognosis, hard to treat
When do most people acquire Herpes Simplex (HSV1) Cold Sores
Childhood
Which of the following does NOT predispose someone to GERD?
Pregnancy
Diabetes
H.pylori
Obesity
Diabetes
Gastric infection w Helicobacter pylori, Hiatal hernia, Incompetent lower esophageal sphincter (LES), Certain foods (caffeine, chocolate), drugs (anticholinergics), Obesity, pregnancy, Cigarette, cigar smoking, ↓ esophageal clearance, ↓ gastric emptying
Your patient is a 38 year old male who is coming in with the complain of heart burn. He tells you that the pain happens 2-3 hours after eating and it radiates to his shoulder blade. He tells you that after he has a snack he feels better. He also hasn't been able to sleep well because the pain keeps waking him up. What condition do you suspect?
Duodenal ulcer
Methods to check placement of nasogastric tube? How do we check? Best way to check?
Aspiration of stomach contents
pH check- pH <5, which is indicative of stomach contents
Most accurate: x-ray visualization! Gold Standard**
How long is the small intestine?
26 feet
What organ concentrates and stores bile?
Gallbladder
Your patient is due for a colonoscopy and has been told to prepare with a clear liquid diet. Which of the following would be acceptable foods?
Broth
Red Jello
Celery
Cucumber
Yellow gatorade
Ginger ale
Broth
Yellow gatorade
Ginger ale
Which example below is incorrect?
Body mass index (BMI) Weight (kg)/Height (m2)
Underweight = BMI 17 kg/m2
Normal = BMI 20 kg/m2
Overweight = BMI 25 kg/m2
Obese = BMI 27 kg/m2
Severely obese = BMI 45 kg/m2
Obese = BMI 27 kg/m2
Body mass index (BMI) Weight (kg)/Height (m2)
Underweight = BMI <18.5 kg/m2
Obese = BMI 27 kg/m2
Normal = BMI 18.5-24.9 kg/m2
Overweight = BMI 25-29.9 kg/m2
Obese = BMI >30 kg/m2
Severely obese = BMI > 40 kg/m2
True or false
Aphthous Stomatitis is contagious
False
Aphthous Stomatitis is not contagious, it just canker sores
Define- Narrowing of esophagus due to repeated inflammatory injury, healing & re-healing.Creates rings of scar tissue that cause narrowing of the esophagus
Esophageal Strictures
Give an example of an erosive cause of gastritis
caused by local irritants: NSAIDS, ASA, alcohol
2 main purposed of a Nasogastric tube
Removal of material from stomach (air, secretions, blood, toxins)
Instillation of materials into the stomach (feeding, fluids, meds, contrast media)
Your patient has indegestion, dyspepsia, hiccups, and hematemesis. The patient has a history of excessive alcohol consumption and overuse of NSAIDS. The patient is suspected to have acute gastritis. What test would be used to confirm this condition?
ERCP
EGD biopsy
Colonoscopy
Barium swallow
EGD biopsy
What is bilirubin metabolized from?
Break down of hemoglobin
Unconjugated bilirubin is bound to albumin for transport to liver
Conjugated bilirubin is soluble & excreted in bile
What medications should be avoided before a Urea Breath test? Select all that apply
Calcium carbonate
Cephalosporin
Maalox
pantoprazole
subsalicylate
Avoid antibiotics and bismuth subsalicylate, PPI,
Which hormone stimulates appetite in fasting states, ↓ if food in stomach
Ghrelin
Leptin- Suppresses appetite, ↑ physical activity, ↑ fat metabolism
Ghrelin- Stimulates appetite in fasting states, ↓ if food in stoma
You are a nurse at a clinic for homeless women. A patient comes in with complaints of soreness in her mouth. She says her mouth feels cottony and she sometimes has a hard time eating because of the pain. Upon inspection you notice that she has cottage cheese like lesions in her mouth. What is she suffering from?
Oral Candidiasis (Oral Thrush) Overgrowth of fungus Candida albicans
Treatment: Antifungal med - Nystatin
What is the replacement of normal squamous epithelium w columnar epithelium, Precancerous?
Esophagitis – Inflammation; may lead to Barrett’s
Barrett’s esophagus- Replacement of normal squamous epithelium w columnar epithelium, Precancerous
Diagnosed in 5-15% of patients w chronic reflux
S&S: None to perforation
Must be monitored every 1 - 3 years by endoscopy
Respiratory- due to irritation of upper airway by secretions
Dental erosion
You walk in after being given report to meet your patient who is here for gastric ulcers. She is pale, dizzy, and vomiting blood. Her BP is 60/p and her pulse is 110. What is wrong and how did that happen?
Hemorrhage (Most common)
Dizziness, N/V, syncope
On a Salem Sump what is the purpose of the blue pigtail
Salem Sump
Most common, Double lumen
Air vent (blue pigtail) keep patent to allow interaction w atmospheric air; purpose to prevent adherence to gastric wall
You notice a new nurse take the tpn for her patient out of the med room and enters her patient's room by herself. She sets up the tpn and attached it to an iv in the right ac. Before she starts the infusion she calls the doctor to say the glucose concentration is too high at 30%. Identify what the nurse is doing wrong.
2 nurses needed to verify
Centeral parenteral nutrition
20-50% glucose for tpn
What is quality of stool is the common bile duct responsible for?
Common Bile Duct (CBD)
Delivers bile to the duodenum at the ampulla of Vater
Gives stool brown color
What is some patient teaching before/ during a percutaneous liver biopsy? Select all the apply.
NPO after midnight
Eat normally
Take Aspirin for pain
Check clotting times
Right hand above head, supine
Left hand above head, supine
NPO after midnight
Check clotting times
Right hand above head, supine
Name the bariatric SURGERY that is reversible/ modifiable. This is the most common restrictive weight loss surgery.
Restrictive Surgery Adjustable gastric banding (AGB)
Your patient comes into the clinic stating she has a hard time swallowing solid foods and always has a feeling of food stuck in her throat. She thinks she may have caught something from her grandkids because she has had a cough for a few weeks and her voice sounds hoarse. What might you suspect
Early esophageal cancer.
What is the treatment for Achlasia that is derived from an anaerobic bacterium?
C. botulinum= BOTOX
Your patient is experiencing Nausea and constipation. She complains. that after dinner is when her stomach hurts most. You notice her abdomen is distended and she has no bowel sounds. What is going on?
Gastric outlet obstruction
Which of the following shows a nursing student understands how to provide feedings via nasogastric tube? Select all the apply:
I need to wear sterile gloves during the feeding
I should always check placement before a feeding
This procedure is used for patients without a functioning GI tract
This procedure is used for patients with a functioning GI tract
This is used for short term nutritional supplementation
This is used for long term nutritional supplementation
I should always check placement before a feeding
This procedure is used for patients with a functioning GI tract
This is used for short term nutritional supplementation
Which intervention would NOT help your patient with GERD. Select all that apply.
Eat small frequent meals
Peppermint tea
Elevate HOB
Lying flat after eating
Antiacids
Peppermint tea
Lying flat after eating
The pancreas creates exocrine and endocrine hormones. Name 3 of the 4 hormones.
Exocrine-GI-enzymes: amylase, lipase
Endocrine-insulin & amylin
Your patient is getting a ERCP or Endoscopic retrograde cholangiopancreatography. What structures are being investigated during this procedure? Select all that apply
liver
small intestine
GB
large intestine
bile ducts
mouth
esophagus
pancreas
liver, GB, bile ducts, pancreas.
Your patient recently had bariatric surgery. He just finished dinner 30 minutes ago. You come in and notice that he is guarding his abdomen and his HR is 115. Your patient complains of nausea and excuses himself to the restroom. Afterword having a bowel his symptoms have resolved. What just occurred? What should you monitor for in the next few hours?
Dumping syndrome, Hypoglycemia
Rapid transit of food from stomach to small intestine, Release of metabolic peptides
Your patient comes into the office for his first physical in a few years. He made this appointment because he has had a hard time swallowing and thinks he may have strep. You notice a unilateral lump in his neck. He also has ear pain, painful swallowing and has lost weight over the last few months without dieting or exercise. What might you suspect? How can you be sure?
Laryngeal cancer, biopsy
change in speech; hoarseness, lump in neck, swelling of nearby tissues, enlarged lymph nodes, trouble breathing, difficulty speaking, neck or throat pain, ear pain, painful swallowing, weight loss
late stage: pain, limited movement of tongue, dysphagia
Your patient has come in because she has had some gas issues. She is embarrassed that she can't go out to dinner with her boyfriend because she belches, makes gurgling noises, and regurgitates after eating. She's always had morning breath, but her breath recently has been noticeably bothering others when she's taking to them. She's been waking up with a bad cough. What would you suspect?
Esophageal Diverticula
Your patient just had a Billroth II- Gastrojejunostomy. When you go in to check on your patient you begin chatting. Your patient then yells out. He tells you he is in pain from his abdoment to his shoulder and back. He passes out. His continuous Hear monitor is reading 140 and his abdomen is rigid? What is going on? What are you going to do?
Call DR prep for OR
List 5 nursing considerations for a tube feeding/ med administration
NSG Care: TF & Med Admin
HOB ↑30-45°; Turn TF off if rolling, repositioning or if pt’s head is down
GRV checks not indicated. Only if problem or continuous feed.
If agency policy to GRV check; guidelines support holding TF x 2hr if GRV >500mL
Assess patient for nausea, vomiting, diarrhea
If NGT to suction, give med then clamp tube for 30 mins
Don’t mix meds w formula; Whenever possible obtain liquid form of meds
Don’t give oily meds via NGT (they cling to inside tube)
Don’t crush sustained released or enteric coated meds (or intended effect lost)
Capsules containing beads can be opened & given via NGT
Meds should be well diluted in 15-30 cc warm water (better dilution)
Give liquids at room temperature (cold causes cramping)
Give meds before bolus feed to ensure patient tolerance
If med to be given on empty stomach, stop feed 15-30 mins, give med then leave feed off 1 hr after
Which of the following foods increase your risk for gastric cancer? Select all that apply
Smoked salmon
Peppermint tea
Tomato soup
Pickles
Corn beef
Grapefruit juice
Smoked salmon
Pickles
Corn beef
Diet high in nitrates (smoked fish, salted fish & meat, pickled veges), low in fruits & veges