NURS 6550N MIDTERM EXAM STUDY GUIDE | WALDEN UNIVERSITY

NURS 6550N MIDTERM EXAM STUDY GUIDE
Gastrointestinal System
 Evaluation, differential diagnosis, treatment options, and complications

o Dyspepsia: acute, chronic, or recurrent pain in the upper abdomen
 Etiology:
1. Food or drug intolerance, functional with no obvious
cause, luminal GI tract dysfunction, H-pylori infection,
pancreatic disease, biliary tract disease or other
conditions such as DM, thyroid disease, CKD, pregnancy
or gastrointestinal ischemia.
 Symptoms:
1. Epigastric pain or burning, postprandial fullness,
bloating, nausea or vomiting
2. If there is weight loss, persistent vomiting, severe pain or
hematemesis then endoscopy warranted.
 Labs:
1. >50 years – CBC, BMP, LFT, calcium and thyroid
function tests
2. <50 years with uncomplicated dyspepsia use noninvasive
strategies 1st; H-pylori fecal test
 Upper Endoscopy:
1. Use for pts over the age of 50 who have new dyspepsia
associated with weight loss, dysphagia, recurrent
vomiting, bleeding or anemia.
 Other tests:
1. Patient with persistent symptoms or progressive weight
loss, check for celiac disease, stool for parasites, or
abdominal imaging such as CT or ultrasound
 Treatment:
1. Empiric
 Proton pump inhibitor x 4 weeks, may have to use
long term if symptomatic after stopping
 If H-pylori positive, then antibiotic therapy
warranted
2. Functional dyspepsia
 Life style changes (limiting alcohol and caffeine
intake), small low-fat meals

,  Pharmacologic
 Oral PPI (omeprazole 20 mg or pantoprazole
40mg) for 4-8 weeks
 Low dose antidepressants (desipramine or
nortriptyline) have been effective in some
patients
 Alternative therapies: hypnotherapy,
psychotherapy, peppermint, caraway
o Nausea / vomiting
 Variety of causes
 Acute without pain
1. Food poisoning, infectious gastroenteritis, drugs or
illness
 Acute with pain:
1. Peritoneal irritation, acute gastric or intestinal
obstruction, or pancreaticobiloiary disease
 Persistent Vomiting:
1. Pregnancy, gastric outlet obstruction, gastroparesis,
intestinal dysmotility, psychogenic disorders, and central
nervous system or systemic disorders
2. Vomiting undigested food hours later is indicative of
gastroparesis or a gastric outlet obstruction
3. All patients with acute or chronic symptoms need to be
asked about neurological symptoms
 Examinations:
1. Serum electrolytes for vomiting: hypokalemia, azotemia,
or metabolic alkalosis
2. Abdominal CT for pain
3. Gastroparesis: confirmed by either nuclear scintigraphic
studies or C-octanoic acid breath tests
4. LFT’s for pancreaticobiliary disease
5. CT or MRI for central nervous system cause
 Treatment:
1. General:
 most cause self-limiting, clear liquids, small
quanitities or dry foods (crackers), ginger.
 If severe, may require hospitalization with IV 0.45
with 20mEq potassium. NG tube for obstruction
2. Antiemetic Medications

,  Serotonin 5-HT receptor agonists: ondansetron,
granisteron, dolasetron
 Corticosteriods: dexamethasone
 Neurokinin receptor antagonists: Aprepitant and
rolapitant are used with corticosteroids and
serotonin antagonists for prevebtion of acute or
delayed nausea and vomiting
 Dopamine Antagonists: promethazine,
prochlorperazine. Can have sedative effects
 Antihistamines and anticholinergics: meclizine,
dimenhydrinate or transdermal scopolamine. Used
in vertigo, motion sickness and migraines. May
induce drowsiness
 Cannabionoids: Dronabinol contains THC used as
an appetite stimulant.
o Constipation: Most common in elderly and in women
 Etiology:
1. Primary – structural abnormalities, systemic disease.
Normal colonic transit site is 35 hours
2. Secondary – medications (anticholinergics or opioids),
colonic lesions, endocrine disorders, electrolyte
abnormalities (hypercalcemia or hypokalemia)
 Signs/Symptoms
1. Digital rectal exam: for anatomic abnormalities
2. Laboratory studies: CBC, BMP, calcium, glucose,
thyroid
 Special examinations:
1. Those not responding to routine medical management
may need to have a anorectal manometry. This will show
if the patient is having pelvic floor dyssynergia.
 Treatment:
1. Dietary and Lifestyle: fluids, fiber, exercise, changing
toileting habits such as timing, or positioning
2. Laxatives:
 Osmotic Laxatives: Magnesium hydroxide,
lactulose, polyethylene glycol. Safe for acute and
chronic cases. Increase water into the colon.
Generally, work within 24 hours
 Stimulant laxatives: Prescribed as a “rescue” agent
or used 3-4 times per week. Bowel movement

, within 6-12 hours for PO or 15-60 mins rectal.
Bisacodyl, senna, cascara
 Chloride secretory agents: Lubiprostone or
linaclotide which increase intestinal fluid and
accelerate colonic transit.
 Opioid receptor antagonists: Methylnaltrexone
(subcutaneous injection), used for those on chronic
opioids that can inhibit peristalsis
3. Refer: Refer patients with alarm symptom’s and over the
age of 50 for a colonoscopy.
o Diarrhea
 Acute
1. Noninflammatory: watery, non-bloody, usually mild and
self-limiting, caused by a virus or noninvasive bacteria
(enterotoxigenic E coli, staph aureus, bacillus cereis,
giardia, viruses)
2. Inflammatory: fever, blood in stool, usually caused by an
invasive (shigellosis, salmonellosis, campylobacter) or
toxin producing bacterium (C-diff, e-coli) Associated
with left lower quadrant cramps, urgency and tenesmus.
 Evaluation:
1. Prompt medical evaluation is required for
 Signs of inflammatory diarrhea with fever
 Passage of 6 or more unformed stools in 24hrs
 Profuse watery diarrhea and dehydration
 Frail elders
 Immunocompromised patients
 Exposure to antibiotics
 Hospital acquired diarrhea
 Systemic illness
2. Physical Exam
 Level of hydration, mental status, abdominal
tenderness
3. Hospitalization required for severe dehydration, organ
failure, marked abdominal pain or altered mental status
4. Treatment:
 Diet
 Aqequate oral fluids containing
carbohydrates and electrolytes