NCLEX Review: Gastrointestinal and Accessory Organs of Digestion Module
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This week, we will be covering the Gastrointestinal and Accessory Organs of Digestion Module from our Online NCLEX Review. The topics covered in the Gastrointestinal NCLEX Review are Gastrointestinal Pharmacology, Upper GI Series Diagnostic Test, Diverticulitis, and Gastroesophageal Reflux Disease.
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The main pharmacology classifications that the nursing student needs to know for the Gastrointestinal NCLEX Review are:
- Antacids neutralize acid and have a protective action on the stomach.
- H-2 blockers reduce acid in the stomach by blocking the acid producing cells.
- Proton pump inhibitors prevent the acid producing pump from working in the stomach. Results in a cessation of all acid production.
- Antiemetics block the chemicals and the pathways to the brain which cause nausea. Safety a priority consideration with administration.
- Antiflatulents are used as a defoaming agent to help with gas symptoms.
- Anticholinergics are used for irritable bowel symptoms.
- Antidiarrheal: Adsorbents coat the intestinal wall and bind with causative bacteria and toxins to eliminate them from the gastrointestinal tract through the stool.
- Laxatives: Numerous mechanisms of action including adding bulk to the stool, increasing liquid in the stool, providing lubrication or stimulation of the nerves resulting in increased peristalsis.
Upper GI Series Diagnostic Test
The Upper GI Series diagnostic test is an examination of the upper gastrointestinal tract. Series of x-ray images to follow the contrast through the esophagus, stomach and duodenum. May be done with Barium or Gastrografin.
It may be used for diagnosis of Gastroesophageal reflux disease (GERD) and hiatal hernia:
This disorder is the regurgitation of acid into the esophagus. May be due to weakening of the lower esophageal sphincter and/or because the upper part of the stomach has herniated through the diaphragm.
Some facts about the test:
- Takes 5-6 hours to complete.
- Clear liquid diet after supper the evening before the exam
- NPO after midnight.
- Enemas and laxatives are not given in preparation for the procedure.
- Laxative or enema post-procedure if barium is used.
- Barium takes 14 days to clear the colon.
- Gastrografin may cause diarrhea.
Diverticulitis is the inflammation of the pouches leading to pain and potentially perforation of the bowel.
- Nausea, vomiting
- Low grade fever
- Palpable mass
- Constipation alternating with frequent stools.
- Most cases are asymptomatic or present with mild complaints.
- Rectal bleeding may be present on diagnosis or develop later.
- Pain is constant or cramping and ranges from mild to severe.
- If perforation, pain is generalized.
- Flat plate of the abdomen
- Barium enema
- Stool for occult blood
Drug therapy includes antibiotics, opioids, stool softeners and bulk forming laxatives
Gastroesophageal Reflux Disease
We talked earlier about the Upper GI Series Test and how it is used to test for Gastroesophageal Reflux Disease.
Management of Gastroesophageal Reflux Disease
- Avoid tight, restrictive clothing
- No bending over after meals
- Avoid straining for bowel movements
- Upright position for 30-60 minutes after eating
- Put the bed on 4-6 inch blocks to decrease tracheal aspiration
Dietary Do’s and Dont’s
- Small frequent meals
- High protein
- Low fat
- Moderate to high carbohydrate
- Increase fluids with meals
- No large meals
- No eating within 3 hours of HS
- No caffeine
- No fruit juices except apple
- No tomatoes
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