Term
| Nursing priorities in dysphagia |
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Definition
First priority; airway and breathing
Second priority: nutrition |
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Term
| Causes of inability to protect airway (leading to aspiration pneumonia) |
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Definition
- Local: poor chewing, oropharyngeal surgery, local cancer/treatment
- Systemic: stroke, Parkinson's, Alzheimer's/dementia, chronic illness |
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Term
| Acute but temporary causes of dysphagia |
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Definition
- Decrease in LOC
- Tube feedings or NG tubes
- Invasive airways
- Any procedure involving numbing the pharynx |
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Term
| Why does increased age bring increased risk for aspiration pneumonia? |
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Definition
- Slowed swallowing rate and digestion
- Poor dentition
- Chronic GI conditions
- More meds
- Might not show signs of aspiration until pneumonia develops so watch for respiratory trends |
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Term
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Definition
- Empiric (from symptoms, PMH, HPI, exam)
- FEES: flexible endoscopic evaluation of swallowing (by speech pathologist)
- Barium or video swallow (by radiology)
- Endoscopy |
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Term
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Definition
- Alternative texture diet
- Speech therapy
- Tube feeding to maintain nutrition
- Surgery or endoscopy to treat cause |
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Term
| Interventions to prevent aspiration |
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Definition
- Hold PO in pts with altered LOC
- Have complete suction set up at bedside
- Oral care before meals and at bedtime (to stimulate mouth)
- Position at 90 angle with PO intake
- Supervised slow feeding/handfeeding |
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Term
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Definition
Wasting syndrome
An objective sign |
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Term
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Definition
| Decline in muscle related to aging |
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Term
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Definition
- Transient impairment of GI motility after surgery
- Bowel distension, absence of BS, lack of flatus and stools
- Order of recovery: small intestine, stomach, colon |
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Term
| What is the priority in a GI bleed? What are the symptoms? |
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Definition
Shock
- increased HR (over 100)
- decreased BP (SBP under 90)
- decreased peripheral perfusion (cool extremities, thready pulse)
- Syncope
- Orthostatic BP
- Reduced LOC
- Vomiting bright red blood
- decreased Hct |
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Term
| Upper GI (esophagus, stomach, duodenum) causes |
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Definition
- Peptic ulcer disease (PUD)
- NSAIDs
- Anticoagulants
- Erosive esophagitis or gastritis
- Acute stress gastritis
- Gastric cancer
- Esophageal varices: can rupture
- Mucosal tears r/t forceful vomiting or injury |
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Term
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Definition
- Hematemesis
- Melena (black tarry stools)
- Syncope
- Dyspepsia
- Abdominal pain
- Weight loss |
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Term
| Treatment of upper GI bleed |
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Definition
- Stabilize hemodynamically
- NGT: relieve pressure in stomach, prevent vomiting, assess condition and response to treatment
- Treat cause
- Protect the airway |
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Term
| Ways to diagnose GI bleeds |
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Definition
- Labs: CBC, troponin (underlying cardiac issue?), coags, type and crossmatch (for blood transfucions)
- NGT lavage
- Endoscopy
- CXR, CT
- Tagged RBC bleeding scan, angiogram |
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Term
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Definition
- SE meds
- Diet lacking in fiber
- Lack of activity
- Laxative dependence
- Dehydration
- Rule out colon cancer |
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Term
| Constipation complications |
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Definition
- Hemorrhoids
- Fecal impaction/bowel obstruction (usually in descending colon)
- Increased risk of cancer |
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Term
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Definition
Dyspepsia
Regurgitation
Coughing, hoarseness or wheezing at night
Hypersalivation
Dysphagia
Odydophagia
Epigastric pain
Belching
Flatulence
Nausea
Pyrosis
Globus
Pharyngitis |
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Term
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Definition
- Eat 406 meals a day
- Decrease fatty foods, acid foods, coffee, and tea
- No evening snacks
- Eat slowly, chew lots
- Elevate HOB 6-12 inches
- Wt loss if overwt
- Avoid constrictive clothing
- Follow chewable antacids w/ 8oz h2o |
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Term
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Definition
- Rapid onset
- N/V
- Hematemesis
- Gastric hemorrhage
- Dyspepsia
- Anorexia |
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Term
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Definition
- Vague report of epigastric pain relieved w/ food
- Anorexia
- N/V
- Intolerance fatty/spicy foods
- Pernicious anemia |
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Term
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Definition
- Vasomotor symptoms occurring 30 min after eating bc of rapid emptying of food into SI
- Seen with gastric bypass
- Symptoms: vertigo, tachycardia, syncope, sweating, pallor, palpitations |
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Term
| Treatment of dumping syndrome |
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Definition
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Term
| Small bowel obstruction causes |
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Definition
- Site of most bowel obstructions
- Causes: adhesions, cancer |
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Term
| Small bowel obstruction S/S |
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Definition
Colicky severe abd pain, N/V
Absence of stools or flatus
Late sign: fecal vomiting |
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Term
| Diagnosis and management of small bowel obstruction |
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Definition
- Diagnosis: X-ray and CT show abnormal amt of air and fluid in intestine
- Management: decompression with NG tube and bowel rest.
If worsens and bowel at risk for ischemia then bowel resection |
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Term
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Definition
| Bands of scar tissue that bind 2 parts of tissues or organs together |
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Term
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Definition
Complete twisting of a loop of intestine around its mesenteric attachment
Causes strangulation |
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Term
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Definition
Slower onset of symptoms
- Constipation
- Abdominal distention
- Fecal vomiting
Diagnostics
- Abdominal X-rat
- CT reveal a distended colon |
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Term
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Definition
Protrusion fo part of organ through wall of cavity that contains it
In abdomen: loop of bowel slipping between weak areas in abdominal fascia/muscles |
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Term
| Classification of hernias |
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Definition
Reducible: you can push the bulge back in
Irreducible: the intestine is flat and you can't push it back in
Strangled: tightly trapped, blood supply cut off = medical emergency |
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Term
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Definition
| Gram+ bacteria produces toxins causing severe diarrhea and inflammator changes in colon when competing bacteria in gut has been wiped out |
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Term
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Definition
Significant diarrhea
Recent antibiotic exposure
Abdominal pain
Fever
Foul stool odor |
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Term
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Definition
Diagnosed by lab from stool specimen
Gone when stools are formed again |
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Term
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Definition
IV or oral Flagyl, if it doesn't work...
Oral vancomycin (not IV bc it has to work in gut)
- Spores can stay tucked in colon unaffected by meds, 24% reocurrence rate w/n 2 months |
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Term
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Definition
Inflammation of the appendix, can burst
- RLQ abdominal pain
- Rebound pain (on LLQ)
- Low grade fever
- N/V
- Leukocytosis |
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Term
| Appendicitis complications |
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Definition
- Performation (generally 24hr w/n onset of pain)
- Peritonitis
- Abscess formation |
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Term
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Definition
Immediate surgery, IV fluids and antibiotics
Nursing management:
- Relieve pain
- Promote wound healing
- Teaching re: wound care, nutrition, activity guidelines |
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Term
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Definition
| Presence of multiple diverticulum (sac-like herniation of lining of colon-95% in sigmoid colon) without inflammation or symptoms |
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Term
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Definition
| Inflammation of a diverticulum resulting from retained food and bacteria that can lead to obstruction, perforation, peritonitis and septicemia |
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Term
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Definition
- Pain in LLQ
- N/V
- Fever
- Chills
- Leukocytosis |
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Term
| Diagnosis of diverticulitis |
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Definition
- Diverticulosis diagnosed by colonoscopy
- Diverticulitis diagnosed by CT
= Lab: leukocytosis, elevated ESR (shows you have inflammation in body but doesn't say where) |
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Term
| Diverticulitis medical treatment |
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Definition
- Rest, analgesics, anti-spasmotics
- Clear liquid diet initially, then increase to high-fiber, low-fat diet as tolerated
- Antibiotics 7-10 days
- Acute cases: NPO, IV fluids, NGT to suction for bowel rest, antibiotics 7-10 days
- If complications (perforation, peritonitis, hemorrhage, obstruction) immediate surgery to remove diseased section of colon |
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Term
| Nursing assessment for diverticulitis |
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Definition
- Onset and duration of pain
- Dietary habits (fiber)
- History of conspitation/straining/abdominal distention
- Auscultate for bowel sounds
- Palpate for LLQ pain
- Inspect stool for pus/mucus/blood
- Vital signs |
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Term
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Definition
Inflammation of peritoneum usually from bacterial infection
- Abdominal pain increased w/ movement
- Abdominal rigidity
- Anorexia
- Low grade fever
- Tachycardia
- Leykocytosis
- Abdominal ultrasound may reveal abscesses and fluid collections |
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Term
| Peritonitis complications |
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Definition
Paralytic ileus
Bowel obstruction from adhesions
Sepsis
Septic shock
Respiratory distress |
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Term
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Definition
- Fluid and electrolyte replacement
- Analgesics
- Anti-emetics
- Antibiotics
- Oxygen therapy if respiratory distress
- Surgical management: resection (remove disease colon), repair (perforation), drainage (abscess) |
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Term
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Definition
Crohn's disease
Ulcerative colitis |
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Term
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Definition
A chornic autoimmune disease that most commonly occurs in ileum but can occur anywhere in GI tract
- Inflammation of GI tract wall extends through all layers
- Begins with edema and thickening of mucus
- Ulcers not continuous, makes cobblestone pattern
- As disease advances bowel wall becomes thick and fibrotic and intestinal lumen narrows |
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Term
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Definition
- Cramping abdominal pain
- Diarrhea unrelieved by defecation (caused by disrupted digestion and absorption), bloody stools
- Steatorrhea (fat in stools)
- Fever
- Weight loss |
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Term
| Diagnosis of Crohn's disease |
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Definition
- Stool positive for occult blood and steatorrhea
- Barium study showing classic string sign indicating constriction of intestine
- Labs: low H&H, high WBC, high ESR, low Albumin |
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Term
| Complications of Crohn's disease |
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Definition
- Intestinal obstruction or stricture formation
- Fluid and electrolyte imbalances
- Malnutrition
- Fistula and abscess formation |
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Term
| What is ulcerative colitis |
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Definition
- Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
- Characterized by multiple continuous ulcerations, inflammations, and shedding of the colon's epithelium
- Bleeding from ulcers
- Begins at rectum and spreads up through entire colon |
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Term
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Definition
- Diarrhea (10-20/day)
- Stool contains mucus and pus
- LLQ abdominal pain
- Tenesmus (constantly feeling like you need to poop)
- Rectal bleeding |
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Term
| Diagnosis of ulcerative colitis |
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Definition
- Stool (positive for occult blood)
- Barium enema, colonoscopy, CT scan
- Labs: low H&H, high WBC, high ESR, low Albumin and protein |
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Term
| Complications of ulcerative colitis |
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Definition
- Toxic megacolon
- Perforation
- Bleeding |
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Term
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Definition
Medical management (80% effective)
- Nutrition (increase fluid, high protein, high calorie diet)
- Meds: anti-inflammatory (steroids), immunosuppressants, anti-diarrheals
Surgery if med treatment is ineffective
- UC: total colectomy w/ ileosomy or ileal conduit |
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Term
| What is irritable bowel syndrome? |
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Definition
Normal bowel structure
- Functional disorder of intestinal motility resulting in spastic contractions, distention, and mucous accumulation in the intestines
- Most common intestinal problem
- Diagnosis made after tests rule out other disorders |
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Term
|
Definition
- constipation/diarrhea/both
- pain (precipitated by eating, relieved by defecation)
- Bloating
- Abdominal distention |
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Term
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Definition
- Relieve abdominal pain
- Control diarrhea/constipation
- Relieve stress |
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