GI
What is a priority vital sign for post-op patients with GI surgeries
RR 14
Temp 99.8
BP 86/50
HR 102
Blood pressure showing poor perfusion
What bacteria is implicated in PUD?
h pylori
- Hypersecretion of protein without an increase in ductal bicarbonate secretion
- Inflammation
True or False: The degree to which liver enzymes are elevated is directly correlated to disease severity/prognosis
false
Hemorrhage
What is the most common cause of constipation? How do we treat this?
Lack of dietary fiber - increasing dietary fiber to 25-35g/day and fluid intake >2L/day
Difference between gastric and duodenal ulcer?
Gastric
⎻ Less common
⎻ Associated with mucosal damage
⎻ RF: H. pylori, medications (NSAIDs) and smoking
⎻ Symptoms: pain worse with eating
Duodenal
⎻ 80% of all peptic ulcers
⎻ Associated with high acid production
⎻ RF: Smoking, alcohol, H. pylori
⎻ Symptoms: pain relieved with eating
Symptoms of both:
⎻ Asymptomatic or
⎻ Hallmark: Burning, gnawing, cramp-like mid-epigastric pain or
dyspepsia
What other disease is chronic obstructive pancreatitis associated with
biliary disease
What liver enzymes must be ordered by specialists
GGT and AST
What is the most common stone found in cholelithiasis?
What is the difference between dyspepsia and heartburn?
Dyspepsia: epigastric discomfort, postprandial fullness, early satiety, anorexia, belching, bloating
Heartburn: extreme pain, difficult to distinguish from angina pectoris, retrosternal pain
What meds for quadruple therapy for h pylori
Bismuth quadruple therapy
consists of bismuth,
metronidazole, tetracycline, and
a PPI
What triad of vascular emergencies can cause severe pain?
Mesenteric ischemia, AAA, MI
How much blood must be in stool to be able to see melena
100-200ml
Pain relief with eating is seen in which type of ulcer?
Duodenal ulcers
What drugs can cause GERD?
Anticholinergic
BB
CCB
Diazepam
Estrogen and progesterone
Nicotine
Theophylline
What are the most common causes of pancreatitis?
Gallbladder disease, alcohol use disorder,
hypertriglyceridemia
You have 4 clients with orders for Enteral feeding. Which one would you question as Dr Snow outlined in class
1. Unresponsive ICU client
2. Anorexia Nervosa client
3. Small Bowel Obstruction client
4. CVA client with dysphagia
SBO.
No feedings!
No laxatives!
What can cause odorless vomiting?
Achalasia
What is a red flag symptom in GERD?
Painful swallowing or hoarseness
True or false: Stool can be positive for occult blood in GERD
true
A pseudocyst is a
a) A cavity that is filled with necrotic products, plasma, pancreatic
enzymes, and inflammatory exudates that may lead to peritonitis
b) A cavity that is filled with necrotic products, red blood cells, pancreatic enzymes and inflammatory exudates that cannot lead to peritonitis
c) A cavity that is filled with necrotic products, red blood cells, pancreatic enzymes and inflammatory exudates that may lead to peritonitis
d) A cavity that is filled with necrotic products, plasma, pancreatic enzymes and inflammatory exudates that cannot lead to peritonitis
A
What electrolyte disturbance is constipating?
Hypercalcemia
What are functional causes of dysphagia
Functional: neurologic (CVA, PD, MS, ALS, achalasia); neurological (globus hystericus refers to
manifestation of acute anxiety/panic attacks; depression
What lab values do we monitor in those on long term ppi therapy
Magnesium deficiency or b12 deficiency
Match the blood cells with the likely corresponding manifestation
A. Low erythrocyte count
B. Low leukocyte count
C. Low thrombocyte count
with
1. oozing at IV site, epistaxis
2. pallor and fatigue
3. increased temperature, cough
A-2 , B-3 C-1
Clients with GERD should avoid eating
a. 6 hours before bed
b. 3 hours before bed
c. 1 hour before bed
d. 1 hour after bed
What is 3 hours before bed?
Your Client has an exacerbation of Crohn's Disease.
What lab would you likely see
a. hyperkalemia
b. hypokalemia
c. hypoglycemia
d. hyperglyemia
What is hypokalemia?
50/50 question
Which IBD dz is more likely to develop Colon Cancer?
Which IBD dz is more likely to develop Malnutrition?
Crohns- Malnutrition
UC - Colon Cancer
Severe abdominal pain and rigid stomach after an EGD procedure could indicate:
a. return of peristalsis
b. passing of a gallstone
c. spasm of the LES
d. perforation of GI tract
What is perforation of GI tract?
Your Client has a GI bleed and needs a transfusion.
You review in your mind the ABO typing . Your patient is A - .
Which ABO donors are compatible
What is:
O can only receive blood from: O
A can receive blood from: A and O
B can receive blood from: B and O
AB can receive blood from: AB, A, B and O
Rh blood system
Rh+ can receive blood from: Rh+ and Rh-
Rh- can receive blood from: Rh-
Double Jeopardy!!!! 2 Billion points
_____1_____is caused by patient antibodies directed against antigens present on transfused lymphocytes. Cues include fever, chills, flushing, headache, tachycardia, anxiety.
___2____ is the most serious reaction which occurs due to incompatible blood. It is characterized by hematuria, low back pain, and s/s of shock.
_____3____is the most common and cues include hives, itching, flushing, SOB, anxiety.
____4____ can occur and is evidenced by elevated BP, tachycardia, crackles in the lungs, JVD, and dyspnea.
1-Febrile
2- Hemolytic reaction
3- Allergic reaction
4- Fluid overload
An exacerbation of this includes significant diarrhea, rectal bleeding, and inflammation in the colon.
What is this and what nursing interventions are to be expected?
What is UC and Monitoring hemoglobin and hematocrit, frequent vital signs, administering a corticosteroid, and providing isotonic fluids are appropriate
Exacerbation of UC requires which important initial inpatient diet?
Clear liquids with high protein
NPO
High fiber, High fat High protein
Full liquids , low protein, high residue
What is NPO!
Double Jeopardy !!! 2 Billion Points!
True or False for GERD patients
1._ The client should eat four to six small meals per day.
2. _ The client should sleep supine or left side lying
3. _ The client should avoid large wedge-style pillows
4_ The clients should be encouraged to increase their intake of milk
5_ The client should wait at least 1 hr after eating before going to bed.
1. True, avoid big meals
2. False, HOB should be elevated
3. False, encourage wedge style pillow
4. False, avoid milk products
5. False, wait at least 3 hours after eating