GI NCLEX

Pancreas

Liver

albumin – albumin keeps water in the blood vessels (maintains BP)

Gallbladder

- Stores bile (greenish, yellowish, brown liquid)

- Helps absorb fats
- Secreted by liver but stored in gallbladder
- Releases bile to small intestine

Large Intestine

- Absorb water and electrolytes

- Produces and absorbs vitamins
- Forms and propels poo
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Total Parenteral Nutrition (TPN) also called hyperlimentation -> CENTRAL LINE PREFERRED

- Nutrition delivered intravenously

- Contains ADE (Amino acids, Dextrose, Electrolytes)
- Indications:
o When Enteral Nutrition is contraindicated (G-Feed, NG Tube)
o High risk of choking
o GI Obstruction
- Complications of TPN:
o Infection
 Bag + tube is change q24h
 Refrigerated until ready to hang
 Wash hands, use gloves, scrub the hub!
o Fluid overload
 Take daily weights
 Check electrolytes
o Hypo/hyperglycemia (if u stop it abruptly without weaning you can get hypoglycemia!)
 Do not turn on or off suddenly
 If you run out of TPN give Dextrose 10% at the same rate the TPN was running
 Titrate up when turning on
 Titrate down when turning off
 Check BS q4-6h
o Embolism

Nasogastric Tube (NG TUBE) (Nose-> Ear -> Xyphoid process)

- Uses
o Med admin
o Removal of stomach content after an overdose
o Decompression
o Feeds

Verify placement

- CXR
- Aspirate gastric contents also residiual check if less than 500 ml; more = hold)
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Anti-Emetic (n/v)
Ex. Ondansetron
- Blocks vagal nerve and CNS serotonin
- So admin slowly or else it can cause QT prolongation and VT
Anti-ulcer agents
H2 Blockers
- Famotidine
- Indicated for: GERD, ulcers, Zollinger-Ellison Syndrome, GI Distress
- Monitor
o CBC and kidney function
o Can be given with meals
o Peak is 2-3 hours
Proton Pump Inhibtor (PPI -azole) -> increases stomach pH
- Omeprazole
o Indications: GERD and ulcers
o Report black tary stools and admin 30 mins – 1 hour before meals
Gi Protectant
- Sucralfate
o Lines and coats the ulcers to help heal (like a band-aid)
o Take on empty dry stomach 1 hour before or 2 hours after meals
o Don’t give within 30 mins of antacids
o Take care giving antacids that contain aluminum to kidney failure pts
o Monitor BS with diabetes
o Can decrease effectiveness of warfarin, digoxin, and phenytoin,
levothyroxine, and several class of antibiotics
o SEPEERATE THESE DRUGS FROM SUCRALFATE FOR AT LKEAST 2
HOURS
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GI Disorders

Esophageal Varices

- Varices = Dilated veins

- These can burst or bleed and are life threatening
- Causes:
o Liver disease
o Alcoholism
- Treatment
o Blakemore tube
o Surgery

GERD

- Acid and refluxes from stomach into esophagus causing esophagitis

- Things that increase risk for Gerd
o Vomiting
o Cough
o Lifting
o Bending
o Obesity
- Treatment
o Sit upright after meals
o Small frequent meals
o H2 Blockers
o PPIs
- Complications
o Barrett’s esophagus (pre-cancer d/t acid burning over time)

Gastritis

- Inflammation of gastric tissue

- Acute Gastritis
o Associated with H. Pylori, NSAID drugs, chemicals
- s/s: abdo discomfort, epigastric tenderness, and bleeding
- Treatment

o Stop NSAIDs o Antibiotics for the H. pylori

o H2 blockers and or PPIs o Healing occurs spontaneously
with few days

Gastric Ulcer

- Cause: overuse of NSAIDs and H. Pylori

- S/s: PAIN 1-2 hours AFTER meal, weight loss, vomiting (maybe even blood), worse when pt eats
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Duodenal ulcer – same causes but pain 2-4 hours after meal, weight gain, melena (black tarry stools) if
bleed, food helps pain

Crohn’s Disease Ulcerative Colitis

- Inflammation and erosion of the ileum and anywhere - Inflammation of large intestine
through the small and large intestine - Common in 20-40 y/o jews
- Possible causes:
- From mouth to anus anywhere o Infection
Not sure the cause o Autoimmune
o Dietary
o Genetic
Ileostomy NO SKIPPED LESIONS AND ARE LIMITED TO THE LARGE
INTESTINE
Diverticular Disease

Diverticula = hernia in muscle layer of colon

Diverticulosis = asymptomatic

Diverticulitis = symptomatic (inflammatory stage)

Causes:

- Decreased fiber
- Abnormal neuromuscular function
- Alterations in intestinal motility
- Over 60

Assessments for these abdo issues

- Rebound tenderness (when you release after pressing they have pain)
- Cramping
- Diarrhea
- Vomiting
- Dehydration
- Weight loss
- Rectal bleeding
- Bloody stools
- Anemia
- Fever

Treatment

- Low fiber diet

- Avoid cold or hot foods
- No smoking
- Antidiarrheals
- Antibiotics
GI NCLEX

- Steroids
- If severe then ileostomy (liquidy in bag) and colostomy (

Intestinal Obstruction

- Any prevention of chyme flow through intestine

- Small intestine obstruction: colicky pain caused by intestinal distention followed by n/v
- Large intestine obstruction: hypogastric pain and abdominal distention

Appendicitis

- Inflammation of appendix
- Most common in 10 y/o
- Dull, steady belly button pain
- Over 4-6 hours pain localizes RLQ
- SUDDEN RELIEF OF PAIN RANDOMLY MEANS THE
APPENDIX RUPTURED (WHICH CAN LEAD TO
PERITONITIS) -> notify HCP
- McBurney’s sign = pain when you press down on
RLQ

Treatment – appendectomy

Pre-op

- No heat (don’t add flame to inflammation)

- Position right side, low fowler

Post-op

- IV fluids and a/b

- Pain management
- NPO until; bowel sounds return
- Wound care

Pancreatitis (inflammation of pancreas usually caused by alcoholism) – starts releasing enzymes inside
itself

- Assessment
o Pain – increases with eating
o Abdo distention
o Ascites
o Abdo mass
o Rigid abdo
o Cullen’s Sign – C shape bruising above belly button
o Gray Turner Sign – Bruising along flank
o Fever and serum lipase increase
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o N/V
o Jaundice
o Hypotension

Cholelithiasis (GALLSTONES)

- When hard bile gets in gall bladder

- Causes
o Hyperlipidemia (too much cholesterol)
o Hyperbilirubinemia (too much bilirubin)

Assessment:

- Sudden RUQ abdo pain

- Pain gets worse and radiates between shoulder blades or right shoulder
- Gets worse at night or after fatty meal
- n/v

treatment

- cholecystectomy

Cholecystitis

- inflammation of gallbladder
- causes: cholelithiasis, infection, block bile duct

Assessment

- fever
- rebound tenderness
- abdo muscle guarding
- leukocytosis

Treatment

- pain control
- fluid and electrolyte
- fasting
- a/b admin
- cholecystectomy if perforated gallbladder
GI NCLEX

Liver – Hepatitis

- inflammation of the liver

- can progress to cirrhosis ( caused by infection or alcoholism)
- types A B C D E – caused by different viral infections
- can cause hepatic coma (hepatic envcephalopathy)

Hepatic Coma (Hepatic Encephalopathy)

- protein in diet is broken into ammonia

and liver converts it to urea
- when inflamed the ammonia builds up
and doesn’t convert
- increased ammonia levels cause
hepatic coma

Treatment

- lactulose to decrease ammonia

- A/B and decrease protein in diet
- Monitor serum ammonia
GI NCLEX

- Decrease fluid retention (k sparring)

- AVOID CNS Depressants
o Avoid benzos and opioids as they worsen the encephalopathy

Cirrhosis
GI NCLEX