NCLEX RN GUIDE                                                                                   the best of NCLEX

Gastrointestinal 6

  1. Diagnostics
    1. elevated enzymes: serum amylase, serum lipase, and urinary amylase
    2. elevated WBCs, decreased hemoglobin and hematocrit
    3. elevated LDH and AST (SGOT)
    4. hyperglycemia
    5. hypocalcemia
    6. chest x- ray, CT scan, ultrasound, ERCP
  1. Complications
    1. respiratory problems - atelectasis, pneumonia from the immobility imposed by pain
    2. tetanyfrom decreased calcium levels
    3. abscessor pseudocyst
  2. Management
    1. treat cause
    2. pain relief - meperidine (Demerol)
    3. fluid maintenance to prevent shock
    4. insulin for hyperglycemia
    5. calcium replacement
    6. decrease stimulation of pancreas
      1. NPO-TPN (nothing by mouth; total parenteral nutrition)
      2. NG tube
      3. anticholinergics
      4. h2-receptor antagonists
  3. Nursing interventions
    1. manage pain
    2. monitor alteration in breathing patterns
    3. monitor nutritional status
    4. oral care when NPO
    5. if eating is allowed, diet high in proteins and carbohydrates and low in fat
    6. monitor fluid and electrolyte balances
    7. Cholecystitis
  1. Definition/etiology - inflammation of the gallbladder
    1. usually due to gallstones (Cholelithiasis)
    2. types
      1. cholesterol - most common
      2. pigment - unconjugated bilirubin
    3. bile is blocked, and infects tissue
    4. more common in women, especially those over 40 and those who use birth control pills
  2. Pathophysiology
    1. common bile duct is obstructed by a gallstone
    2. bile cannot be excreted, some is reabsorbed
    3. remaining bile distends and inflames gall bladder
    4. may scar gallbladder, resulting in less storing of the bile from the liver
    5. can perforate gall bladder
  1. 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
  2. Diagnostics
    1. endoscopic retrograde cholangiography (ERCP)
    2. endoscopic retrograde catheterization of the gallbladder (ERCG)
    3. ultrasound
  1. Management
    1. rest
    2. low-fat diet
    3. removal of stone in common duct by endoscopy
    4. to dissolve cholesterol stones
      1. chenodeoxycholic acid (Chenodiol) - side effects are diarrhea and hepatotoxicity
      2. ursodeoxycholic acid (UDCA)
    5. control pain - meperidine (Demerol) is drug of choice
    6. replace vitamin K if bleeding time is prolonged
    7. extracorporeal shock wave lithotripsy - may have hematuriaafter procedure, but not longer than 24 hours
    8. choledocholithotomy- to remove or break up stones
    9. laparoscopic laser cholecystectomy
    10. cholecystectomy
  2. Nursing interventions
    1. monitor vital signs
    2. monitor pain and medicate as needed
    3. teach client - dietary restriction of fatty foods

  • Most obstructions occur in the small bowel.
  • Most large bowel obstructions are caused by cancer.
  • Onset of cirrhosis is insidious with symptoms such as anorexia, weight loss, malaise, altered bowel habits, nausea and vomiting.
  • Management of cirrhosis is directed towards avoiding complications. This is achieved by maintaining fluid, electrolyte and nutritional balance.
  • A client with esophageal varices must be monitored for bleeding (e.g., melena stools, hematemesis, and tachycardia.)
  • The rupture of esophageal varices is life threatening and associated with a high mortality rate.
  • Pancreatitis is often associated with excessive alcohol ingestion.
  • Pancreatic cancer is an insidious disease that often goes undetected until its later stages.
  • Diverticula are most common in the sigmoid colon.
  • Clients with diverticulosis are often asymptomatic.
  • A deficiency in dietary fiber is associated with diverticulitis.
  • Colostomies: an ascending colostomy drains liquid feces, is difficult to train and requires daily irrigation; a descending colostomy drains solid feces and can be controlled.
  • Frequent liquid stools can be indicative of a fecal impaction or intestinal obstruction.
  • Bowel sounds tend to be hyperactive in the early phases of an intestinal obstruction.