Documente Academic
Documente Profesional
Documente Cultură
SYSTEM
Anatomy & Physiology
A. Upper gastrointestinal tract
a. ascending
b. transverse
c. descending
d. sigmoid
e. rectum - last seven - eight inches of
intestines
Accessory digestive organs
1. Liver - largest gland of the body
a. lobes dived into lobules by blood
vessels and fibrous material
b. ducts - hepatic duct from liver; cystic
duct from gallbladder; common bile
duct formed by joining of hepatic duct
and cystic duct and drains into
duodenum
c. functions: Metabolism of fat,
carbohydrates and protein
i. converts glucose to glycogen for
storage
ii. converts glycogen to glucose and
releases into blood
iii. forms glucose from fats or proteins
iv. breaks down fatty acids into ketones
v. stores fat
vi. synthesizes triglycerides, phospholipids,
cholesterol, and choline (B complex factor)
vii. synthesizes various proteins
viii. converts amino acid to ammonia
ix. converts ammonia to urea
d.other functions
i. secretes bile, which is important in the
emulsifying of fats
ii. detoxifies substances such as drugs,
hormones
iii. metabolizes vitamins
iv. Pancreas
1.fish-shaped organ extending from
duodenal curve to the spleen
2.both an endocrine and exocrine gland
• Management
a. radiation
b. chemotherapy
c. treatment of choice is surgery - bowel resection,
colostomy
i. right hemicolectomy - involves ascending colon
ii. left hemicolectomy - involves descending colon
iii.abdominal-perineal resection: removal of
sigmoid colon and rectum with formation of a
colostomy
Nursing interventions
a.manage pain
b.monitor for complications
i. wound infection
ii. atelectasis
iii. thrombophlebitis
c.maintain fluid and electrolyte balance
d.care of ostomy
APPENDICITIS
Clinical manifestations
1. Acute abdominal pain, usually in the right
lower quadrant, rebound tebderness, or
both.
2. Nausea and vomiting
3. Low grade fever
4. Leukocytosis
APPENDICITIS
Nursing management
1. Provide general preoperative and
postoperative care
2. Provide discharge teaching.
Disorders of the Liver
A. Hepatitis
1.Definition/etiology - acute inflammatory
disease of the liver caused by viral,
bacterial, or toxic ingestion
2.Pathophysiology
a.inflammation of liver, enlargement of
Kupffer cells, bile stasis
b.regeneration of cells with no residual
damage
c.types
i. hepatitis A
• transmitted from infected food, water, milk,
shellfish
• fecal-oral route of infection common in
poor sanitation/overcrowding
• higher incidence in fall and winter
• new vaccine available
ii. hepatitis B
• blood-borne and sexually transmitted
• may become a carrier
iii.hepatitis C
• transmitted parenterally (post-transfusion
hepatitis) and possibly fecal-oral route
• may become a carrier
iv. hepatitis D
• blood borne
• coexists with hepatitis B
v. hepatitis E
• water borne
• contaminated food or water; rare in the
United States
Hepatitis B
1.Risk factors/infection route
a.homosexuality
b.iv drug use
c.health professionals
d.hemodialysis
e.transmission routes
i. sexual
ii. fecal-oral route: incubation 12 to 14 weeks
or longer
iii. contaminated body fluids
f. pathophysiology
i. hepatitis B has three distinct antigens
• HBsAg - surface antigen
• HBcAg - core antigen
• HBeAg - e antigen
ii. damage to the hepatocytes causes
inflammation and necrosis
iii. liver function decreased in proportion to
damage
iv. healing takes three - four months
• Findings
a.jaundice if liver fails to conjugate bilirubin
or excrete it
b.clay-colored stools from lack of urobilin
c.urine is dark from urobilin excreted in urine
rather than stool
d.urine foams when shaken
e.pruritus from bile salts excreted through
skin
f. right upper quadrant pain from edema and
inflammation of liver
g.anorexia, nausea, vomiting, malaise,
weight loss
h.prolonged bleeding from impaired
absorption of vitamin K
i. anemia from decreased RBC lifespan
Diagnostics - serologic markers of HBV
a.HBsAg - hepatitis B surface antigen
b.anti-Hbc - antibodies to B core antigens
c.elevated alanine aminotransferase (ALT
previously SGPT)
d.elevated bilirubin
e.elevated aspartate aminotransferase
(AST; previously SGOT)
f. elevated alkaline phosphatase
g.prolonged prothrombin time
Management - nonspecific and supportive
HEPATITIS
4.Diagnostics: endoscopy
Management
a. Sclerotherapy - injection of a sclerosing
agent into varices
b. balloon tamponade
i. Sengstaken-Blakemore tube is inserted
into the stomach
ii. gastric balloon is inflated and presses on
lower esophagus while allowing suctioning
iii. esophageal balloon places pressure on
varices
iv. pressure is released as ordered to
prevent necrosis
Sengstaken-Blakemore tube
v. traction for increased pressure added by
attaching tube to football helmet
vi. assess for bleeding and signs of shock
vii. assess for respiratory distress -
aspiration or displacement of tube, suction
PRN
viii. keep head of bed elevated
c. medications
i. vasopressin
• constricts veins and decreases portal
blood flow
• given IV or into superior mesenteric artery
• side effects include hypothermia,
myocardial ischemia, acute renal failure
ii. nitroglycerin will decrease myocardial
effects
iii. beta-adrenergic neuron-blocking agents
may decrease risk of recurrent bleeding by
decreasing pressure in portal system
iv. cathartics to remove blood from GI tract
and decrease absorption of ammonia
d.surgical intervention
i. shunt to decrease blood flow to liver and
therefore pressure splenorenal shunt
• mesocaval shunt
• portacaval shunt
ii. TIPS (transjugular intrahepatic
portosytsemic shunt) - shunt placed
between hepatic and portal vein
Nursing interventions
a.prevent bleeding
b.avoid intake of alcohol, irritating or rough
food
c.avoid increased pressure in abdomen
d.if bleeding occurs - administer
transfusions, fresh frozen plasma, vitamin
K
e.monitor for infection
Ascites
1.Definition/etiology - accumulation of fluid in
the peritoneum
2.Pathophysiology
a.portal hypertension causes increased
plasma and lymphatic hydrostatic pressure
in portal system
b.hypoalbuminemia causes decreased
colloid osmotic pressure
Ascites
PARACENTESIS
4.Management
a.neomycin sulfate (Mycifradin) - inhibits
action of intestinal bacteria
b.lactulose (Cephulac) - absorbs ammonia
and produces evacuation of the bowel
c.low protein diet
5.Nursing interventions
a.tremor, confusion can lead to injury:
maintain safety
b.ascites and low intake decrease fluid
volume
c.diarrhea from medications
Disorders of Pancreas and Gallbladder
A. Acute pancreatitis
1.Definition/etiology - inflammation of the
pancreas
a.alcohol ingestion
b.gall stones
c.drug ingestion
d.viral infections
e.trauma
2.Pathophysiology
a.autodigestion from premature activation of
pancreatic enzymes
b.proteases and lipases, normally active in
small intestine, are activated in the
pancreas
c.phospholipase A digests adipose and
parenchymal tissues
d.elastase digests elastic fibers of blood
vessels, producing bleeding
e.amylase digests carbohydrates
f. inflammation response occurs from
enzyme release
3.Findings
a.left upper quadrant abdominal pain
b.pain worsens after eating and when lying
flat
c.nausea and vomiting
d.fever, agitation, confusion
e.hypovolemia and shock
f. hemorrhage into retroperitoneal space
may produce ecchymosis in flank or
around umbilicus
g.tachypnea, pulmonary infiltrates,
atelectasis from circulating enzymes
h.Diagnostics
A. elevated enzymes: serum amylase,
serum lipase, and urinary amylase
B. elevated WBCs, decreased hemoglobin
and hematocrit
C. elevated LDH and AST (SGOT)
D. hyperglycemia
E. hypocalcemia
F. chest x- ray, CT scan, ultrasound, ERCP
Complications
a.respiratory problems - atelectasis,
pneumonia from the immobility imposed
by pain
b.tetany from decreased calcium levels
c.abscess or pseudocyst
Management
a.treat cause
b.pain relief - meperidine (Demerol)
c.fluid maintenance to prevent shock
d.insulin for hyperglycemia
e.calcium replacement
f. decrease stimulation of pancreas
i. NPO-TPN (nothing by mouth; total
parenteral nutrition)
ii. NG tube
iii. anticholinergics
iv. h2-receptor antagonists
Nursing interventions
a.manage pain
b.monitor alteration in breathing patterns
c.monitor nutritional status
d.oral care when NPO
e.if eating is allowed, diet high in proteins
and carbohydrates and low in fat
f. monitor fluid and electrolyte balances
Cholecystitis
1.Definition/etiology - inflammation of the
gallbladder
a.usually due to gallstones (Cholelithiasis)
b.types
i. cholesterol - most common
ii. pigment - unconjugated bilirubin
c.bile is blocked, and infects tissue
d.more common in women, especially those
over 40 and those who use birth control
pills
2.Pathophysiology
a.common bile duct is obstructed by a
gallstone
b.bile cannot be excreted, some is
reabsorbed
c.remaining bile distends and inflames gall
bladder
d.may scar gallbladder, resulting in less
storing of the bile from the liver
e.can perforate gall bladder
i. Findings
1.colicky pain in right upper quadrant with
possible radiation to right shoulder and
back
2.indigestion after eating fatty foods
3.nausea and vomiting
4.jaundice (if the liver is involved or inflamed
or the common duct obstructed)
5.low grade fever
ii. Diagnostics
1.endoscopic retrograde cholangiography
(ERCP)
2.endoscopic retrograde catheterization of
the gallbladder (ERCG)
3.ultrasound
Management
a.rest
b.low-fat diet
c.removal of stone in common duct by
endoscopy
d.to dissolve cholesterol stones
i. chenodeoxycholic acid (Chenodiol) - side
effects are diarrhea and hepatotoxicity
ii. ursodeoxycholic acid (UDCA)
e.control pain - meperidine (Demerol) is
drug of choice
f. replace vitamin K if bleeding time is
prolonged
g.extracorporeal shock wave lithotripsy -
may have hematuria after procedure, but
not longer than 24 hours
h.choledocholithotomy - to remove or break
up stones
i. laparoscopic laser cholecystectomy
j. cholecystectomy
Nursing interventions
a.monitor vital signs
b.monitor pain and medicate as needed
c.teach client - dietary restriction of fatty
foods
Situation- Mr. Maribojo was brought to the
emergency room complaining of pain
located in the upper abdomen. Diagnosis
is peptic ulcer.
1. Prescribed diet for him is:
A. Full C. Soft
B. Low Purine D. Bland
2. The purpose of dietary treatment of Mr.
Maribojo is to:
A. Neutralize the free HCl in the
stomach
B. Delay gastric emptying
C. Prevent constipation
D. Delay surgery
3. Antacids are administered to Mr.
Maribojo to:
A. Tranquilize the intestine
B. Decrease gastric motility
C. Lower acidity of gastric secretions
D. Aid in digestion
4. A patient is admitted to the hospital with
an exacerbation of his chronic gastritis.
When assessing his nutritional status, the
nurse should expect a deficiency in:
A. Vitamin A C. Vitamin B6
B. Vitamin B12 D. Vitamin C
Situation- Ms. Kim Anderson is scheduled
for stat total gastrectomy.
5. What is the involvement of this
surgery?
A. Removal of stomach only
B. Removal of the stomach, with
anastomosis of the esophagus to the
jejunum
C. Removal of the ovary and fallopian
tube
D. Removal of the stomach, with
anastomosis of the duodenum to the
jejunum
6. Which of the following is a postprandial
problem that may occur post gastric
reaction?
A. Headache C. Dumping syndrome
B. Nausea D. Vomiting
7. She is experiencing dumping
syndrome, what is the dietary
management needed?
A. Full diet
B. Bland diet and high protein
C. High protein, high carbohydrate, low
fat
D. High protein, low carbohydrate, high
fat and dry diet
Situation- Jenny Lyn, 50 years of age, was
accompanied by her husband in the hospital.
She is complaining of severe sharp right
abdominal pain and frequently precipitated
after ingestion of fatty foods.
8. The ingestion of fatty food usually
precipitated Jenny Lyn’s episode of upper
abdominal pain because:
A. Fat in the stomach increases the rate of
peristaltic movements
B. Fat in the duodenal contents initiates the
reaction that cause gallbladder
reaction
C. Fatty foods are likely to generate gas
D. Fatty food contain higher amounts of
cholesterol than do proteins
9. Reasons why Jenny Lyn’s stool is clay-
colored:
A. Increase in the red blood cell
breakdown
B. Obstruction of bile flow to the bowel
C. Absence of normal bacterial flora of
the bowel
D. Interference with the absorption of
fats
10. Results of x-ray revealed presence of
stone in the gallbladder known as:
A. Cholelithiasis C. Cholecystitis
B. Choledocholithiasis D. Uterolithiasis
Situation- Ms. Sandara Park, a cook has
cholecystitis and cholelithiasis. She is
experiencing severe biliary colic.
11. The drug of choice during her attack is:
A. Ponstan C. Morphine Sulfate
B. Demerol D. Aspirin
12. Which of these drugs when given to
Ms. Park would produce spasm of
sphincter of Oddi and thereby increase
biliary pressure?
A. Ponstan C. Demerol
B. Benadryl D. Morphine
13. Usually you expect that the approach
used for her surgery is through a:
A. Right Iliac incision
B. Left subcostal incision
C. Right subcostal incision
D. Left Iliac incision
14. When teaching Mary Ann how to
control her symptoms of GERD, the nurse
provides her with many health promotion
modifications. Which modification is
correct when trying to control GERD?
A. Only eat two to three meals per day.
B. Sleep flat in a left lying position.
C. Drink tea instead of coffee.
D. Avoid working in a bent-over position.
15. Which signs and symptoms would the
nurse expect to find when assessing a
client with esophagitis?
A. Mid-epigastric pain and tenderness
B. Abdominal distention and fever
C. Abdominal cramping and vomiting
D. Heartburn and dysphagia
16. When assessing a client admitted with a
bleeding gastric ulcer, the nurse would
expect to assess which type of stool?
A. Coffee-ground colored
B. Clay colored
C. Black, tarry
D. Bright red
17. When developing a teaching plan for a
client with GERD, the nurse should
include which discharge instruction?
A. “Elevate the foot of the bed by 6” to 8”.”
B. “Lie down immediately after a meal.”
C. “Take antidiarrheal medication after
each loose stool.”
D. “Avoid caffeine, tobacco, and pepper
mint.”
18. A 17-year-old patient with a temperature
of 100.7 oF comes into the emergency
department complaining of severe
abdominal pain in the RLQ and has had
nausea and vomiting in the last 6 hours.
Which condition would the nurse suspect?
A. Diverticulits
B. Appendicitis
C. Gastroenteritis
D. Irritable bowel syndrome (IRS)
19. Which would be an appropriate outcome
for the client experiencing constipation?
A. The client eats a high-fiber diet
B. The client avoids physical execise
C. The client drinks one to two glasses of
water daily
D. The client maintains a sedentary
lifestyle
20. A Billroth I procedure is a surgical
approach to ulcer management whereby:
A. A partial gastrectomy is done with
anastomosis of the stomach segment to
the duodenum.
B. A sectioned portion of the stomach is
joined to the jejunum.
C. The antral portion of the stomach is
removed and a vagotomy is performed.
D. The vagus nerve is cut and gastric
drainage is establishe.
END