GIT

EJ Flaminiano, RN, MAN

3 Functions:
Breakdown food

Definition of Terms:
GERD - Backflow: umatras ang pagkain
Hiatal Hernia - Protrusion
Gastritis - Inflammation
PUD - Varices: sugat

GI Process
Starts with mouth
Masticate: muscles in the jaw to chew food
Amylase - digests starch - part of chemical digestion

Cardiac Spincter: LES

While swallowing dapat ba open
ang LES? yes
If bumaba ang food, dapat
closed ang LES para hindi
tumaas ang food

Chemical Mechanical Pyloric Sphincter: once pumasok ang food sa

HCl Chewing stomach, it should stay for 2-4 hours. After non, dapat
Pepsin Tongue movement mag open na ang PS
Bile Churning: pagsakal ng Jejunum - Where majority of absorption of nutrients
stomach takes place.
Pag madami laman, GERD - BACKFLOW
increased tension ● Regurgitation - vomiting
Amylase: digests starch Peristalsis ■ LES is not closing properly
Lipase: digests fat Segmentation: pagpiga ng ● Difficulty swallowing - dysphagia
intestines sa stool para ● Indigestion - dyspepsia
lumabas ■ Dahil hindi nababa ang pagkain
Chemical - more on ENZYMES ● Heartburn - pyrosis
Mechanical - more on MOVEMENT ■ Because LES is close to the heart.
HCl - product of stomach Nararamdaman ng puso ang sensation sa LES
Pepsin and HCl - for the breakdown of protein (closest anatomical
A&L - pancreatic juices ■ HCl causes injury pag nataas
Esophagus Stomach ● Hypersalivation - dahil iniisip ng GI na nag didigest
“Bridge”; malambot and Pouch: elastic pa din ng food
madali mag bleed
Communicates Fundus, cardia, Diagnosis: Upper Endoscopy
food from mouth body, pylorus ✔ Tube will be inserted to visualize the esophagus
to stomach ✔ “Esophagogastroduodenoscopy”
Soft tissues Chief cells: perpsinogen ✔ LA/Sedation + Atropine
■ Local anes: to kill the gag reflex
10 inches Parietal cells: HCL
■ Atrop Sulfate; to prevent saliva from entering
the lungs. Decreases GI activity
Pepsinogen + HCl = pepsin
■ Dec GI act
■ Dec salivation
■ Atroine DECREASES ALL GI ACTIVITY
✔ NPO for 6-8 hrs: for clearer observation
✔ Monitor for airway patency: there could be
aspiration
✔ NPO 1-2hrs after the procedure: you killed na gag
reflex= no swallowing. WOF gag reflex before
giving food
✔ Analgesics and Lozenges: to treat the throat kasi
nagpasok ng long tube

Interventions:
✔ Small frequent feeding - Para less pressure sa • Laxatives as prescribed after the procedure: to make
stomach. To prevent food reflux sure na maalis ang barium sa stomach. BS may cause
✔ Elevate head of bed - To decrease chances of food obstruction sa stomach
reflux • Monitor for “chalky white” substance in feces: sign of
✔ Avoid gas forming food passage ng barium
✔ Avoid eating 2hrs before HS
■ HS: hours of sleep GASTRITIS - INFLAMMATION
■ If asleep, may decreased GI activity Acute: mild
■ Phlegm: drink lots of fluids to liquefy secretions - Alcoholism
✔ Avoid restrictive clothing - dahil naiipit ang - Microorganisms
abdomen - NSAID’s, ASA: gastric irritants
■ Increased intra abdominal pressure will push - Highly seasoned food:
the food forward
✔ Admin: Chronic
■ Antacids - Alcoholism
■ H2-receptor antagonist - H. Pylori: also cause of ulcers. H.P is the only
■ PPI microorganism than can withstand the pH of the
■ Prokinetics: promotes downward movement stomach. Bago mamatay, agawa ng injury sa lining ng
of food; muteleum? stomach. HCl would then exacerbate the “scratches” or
✔ Avoid administering Pirenzepine: anti cholinergic injury caused by HCl.
drug: decreases gastric activity like atropine sulfate - Ulcers
✔ Bakit binigay kanina? Dahil diagnostic procedure - Autoimmune - immune system is attacking
and to prevent aspiration microorganisms
✔ Problem: backflow, what you need is downflow!
Movement = Prokinetics Indigestion: dyspepsia
✔ Surgery: Fundoplication; natulong si fundus na Elevate head of the bed after eating
isara si LES to prevent backflow of food Atropine sulfate: after dx, NO DO NOT GIVE

GERD VS Gastritis Acute Chronic

If you take PPI for 1 month and hindi naalis ang Early onset Late onset
manifestations, possible na Gastritis na Frequent hiccupping Frequent belching
Anorexia, N&V Anorexia, N&V
HIATAL HERNIA Abdominal discomfort Pyrosis: pain
-Decreased capacity ng stomach dahil nasasakal ng Headache Vit B12 deficiency
Hiatus Stomach has parietal
Diaphragm: major muscle for respiration Cells: produces HCl and
Opening sa Diaph: Hiatus intrinsic factors
Manifestations - Same as GERD Intrinsic factor: absorption
Interventions - Same as GERD of Vit B12
Dec vit b12: pernicious
GERD: Hiatal Anemia
After kumain then humiga Comfort - discomfort - pain
kaya nag backflow ang
food Interventions
Upward movement of Upward movement of ● AVOID: gas forming foods
Food Stomach ■ Highly seasoned food
- due to reversed - due to increased intra ■ Spicy food: irritating to the gastric mucosa
peristalsis abdominal pressure ■ Alcohol
Reverse peristalsis Increased IAP ■ Smoking
Incompetent LES Abdominal tumor: inc ■ Caffeine
abdominal pressure * Layer ay thickens while the surface thins out
Pyloric stenosis Pregnancy: inc abdominal For example pag ang dark green balloon hinipan,
Diba sapat after 2-4 hrs pressure nag eexpand at magiging light green
bubukas si PS? In this
case, hindi ● WOF - Hemorrhagic gastritis:
Decreased GM Heavy lifting ■ Hypotension, tachycardia,
■ tachypnea, hematemesis,
Diagnosis: Upper GI Study ■ Melena
• “Barium Swallow” ■ *Hypo tachy tachy, isuka mo, itae mo
• Examination of upper GI tract – barium sulfate
BS - if binigay sa may HH, magiging irregular ang istura ● Administer medications as ordered:
ng stomach, ipapakita na sinasakal ng hiatus ang ■ H2-receptor Antagonists
stomach ■ Antacids like Pepto-bismol: “Pink Bismuth”
•NPO – midnight before procedure ■ Antibiotics: dahil baka microorganism ang
reason
Dx: Endoscopy, Barium Vagus nerve -
swallow, Fecalysis PPI - greatly reduce HCl from stomach
•Avoid dark colored food: beef, soy sauce containing H2 receptor Antagonist: decreases HCL.
food items, chocolate (false positive melena)
Dark green leafy veggies: okay TYPES RISK FACTORS
•Avoid ASA: blood thinner and may promote bleeding Esophageal F - Family history
• Send specimen to laboratory stat Gastric A - Alcohol and smoking
• Test for fecal: Duodenal N - NSAIDs and ASA
pathogens I - Infection (H. pylori)
parasites S - Stress
nitrogen
Fat: not normal sa stool
Manifestations:
1. A female client with dysphagia is being prepared
✔ Burning stomach pain
for discharge. Which outcome indicates that the
✔ Intolerance to fatty food
client is ready for discharge?
✔ Feeling of fullness
A. The client does not experience rectal bleeding
✔ Fever
a) Rectal to, ang problem ay dysphagia kaya
Gastric Duodenal
mali!
B. The client is free from esophagitis and Less common: HCl lang More common
achalasia ang aggressor Aggressors:
C. The client reports duodenal inflammation HCl
D. The client has normal gastric structures Bile
a) Walang kinalaman ang gastric structures sa Pancreatic Juices
swallowing! Immediate pain :30-60mins Late pain:2-4hrs
Answer: looking for NORMAL display! Achalasia: GERD Relieved by sleep Relieved by
eating
2. The nurse is monitoring a female client receiving Hematemesis: mas Hematemesis
treatment for diarrhea. Which drugs can common dahil high
produce additive constipation when given with structure
an opium preparation? Melena Melena: mas common
A. Antiarrhythmic drugs dahil low structure
B. Anticholinergic drugs
C. Anticoagulant drugs
D. Anti-hypertensive drugs Interventions:
Answer: B will affect GI activities ✔ AVOID:
■ Alcohol and smoking
■ NSAID’s
PUD ■ Aspirin
■ Chocolates: fatty food
■ Caffeine
Gas forming food items increases tension of the
stomach
✔ Small frequent feeding
✔ Reduce stress; we can never eliminate, just reduce
✔ Promote rest
✔ Administer medications as ordered
■ H2-receptor antagonists
■ Prostaglandins
■ Mucosal barrier protectants (Carafate)
■ Antacids
Layers of the Stomach ■ Anticholinergics: bawal sa GERD at H. Hernia!
Mucosa: inner layer of the stomach. When attacked= Pero pwede kay ulcers dahil we need to lessen
bleeding HCl production
Submucosa: highly vascular; madami blood vessel. ✔ Monitor VS
When attacked = heavy bleeding ✔ Monitor HemHem: Hematocrit and Hemoglobin
Muscularis ■ Bleeding will only increase the pain
Adventitia ✔ NPO
✔ IVF
Parietal cells - produces HCl ✔ Blood transfusion
Enterochromaffin Cells: produces Histamine-2: stimulant ✔ NGT - Lavage: papasukin ng water to evacuate
to produce HCl blood
G cells - produces gastrin: inspires production of HCl ✔ Vasopressin: vasoconstriction
D cells - somatostatin (balance production of HCl)
Prostaglandins: lines stomach mucosa to protect it from Surgery
HCl insult. Parang raincoat ● Vagotomy - Separation of vagus nerve
NSAID’s - prostaglandin inhibitor ■ Vagus nerve stimulates production of GCL
● Total Gastrectomy - Removal of stomach
● Billroth I - Gastroduodenostomy
● Billroth II - Gastrojejunostomy
● Pyloroplasty - Widening of Pyloric Sphinc para mas
madali bumaba ang kinain
Post-op:
•NPO 1-3 days depending on peristalsis
• Advance from NPO to sips of water
• Monitor for electrolyte imbalances
• Administer IVF and electrolytes as ordered
• Administer TPN as ordered
No vagus, increased alkali
A 53 y.o. patient has undergone a partial
gastrectomy for adenocarcinoma of the stomach.
An NG tube is in place and is connected to low
continuous suction. During the immediate
postoperative period, you expect the gastric
secretions to be which color?
a) Brown
b) Clear
c) Red: expected dahil kaka opera pa lang
d) Yellow

DUMPING’S SYNDROME You’re performing an abdominal assessment on

(Increased gastric motility) Brent who is 52 y.o. In which order do you
• Increased peristalsis proceed?
• Hyperactive bowel sounds A. Auscultation, percussion, palpation, observation
• Diarrhea B. Observation, auscultation, percussion,
• Abdominal cramping palpation
• Palpitations C. Percussion, palpation, auscultation, observation
• Diaphoresis D. Palpation, percussion, observation, auscultation

(Delay gastric emptying) Inflammatory Bowel Disease

• Low residue diet Appendicitis
• Fluids PC Diverticular Disease
• Lie flat on bed PC
• Antispasmodics to delay
gastric emptying

VITAMIN B12 DEFICIENCY

•Due to lack of Intrinsic Factor from the parietal cells
• Lack of intrinsic factor also leads to pernicious anemia
•Weight loss
• Severe pallor
• Red beefy tongue
• Paresthesias of hands and feet
• Fatigue
•Increase Vitamin B12 in the diet (Citrus fruit, organ
meat, GLV)
• Vitamin B12 injectables: inject sa blood stream kasi
hindi na proprocess
Notes:
Sample Medications:
Main role of large intestine: absorb WATER. FLUID
•Antacids
ABSORPTION
- Pepto Bismol
Jejunum: majority absorption of NUTRIENTS
- Na Bicarbonate
- Milk of magnesia
INFLAMMATORY BOWEL DISEASE
• PPI (prazole): greatly reduces HCl (omeprazole,
● Chronic Inflammation of the colon
pantopazole?
● Ulcerations may occur: dahil may friction ang
•H2-receptor antagonsist (tidine): ranitidine, Cimetidine
frequent na pag pass ng stool
•NSAIDs - INIIWASAN
● Risk factors:
D - diclofenac
■ Smoking
A - aspirin
■ Microorganisms
N - naproxen
■ Stress
C - celecoxib
■ Cytokines
E - etoricoxib
If autoimmune, choose cortico!!
Manifestations:
● Abdominal cramping
Your patient has a retractable gastric peptic
● Abdominal pain
ulcer and has had a gastric vagotomy. Which
● Vomiting: dahil may pressure sa colon
factor increases as a result of vagotomy?
■ Nagninipis ang lumen dahil namamaga
A. Peristalsis
● Diarrhea
B. Gastric acid
● Weight loss: dahil hindi na aabsorb ang water
C. Gastric motility
● Bleeding: ulcerations may occur
D. Gastric pH
● Fever: stool contains microbes
*Dahil vagus nerve stimulates production of HCl
 Koch’s Ileostomy: new colon

APPENDICITIS
•Inflammation of the appendix
• Rupture may occur: may cause infection to the cavity
(peritonitis)
• Pain(Right Lower Quadrant)
• Pain intensifies in Mcburney’s point: midpoint ng ileac
crest and umbilical area
• Rebound tenderness: nasakit pag inalis ang pressure
• Rovsing’s sign: pain felt in the RLQ when LLQ is
palpated due to the nerves connected to the appendix
• Psoa’s sign - pain felt when R knee is flexed
•Obturator’s sign - pain felt during internal rotation of
Ulcerative Colitis Crohn’s knee, external rotaion of foot
From rectum, c Nag start sa Cecum, • Vomiting
patchy ang pagkalat • Fever
Transmural: all 4 layers ay •NPO status
tatamaan •IVF as ordered
Submusoca • Semi-Fowler’s: position of comfort
Muscularis •Avoid heat application: dilates - papasok ang dugo -
Serosa increased pressure sa appendix = increased chances of
Mas malala, higher risk for rupture
cancer •Avoid laxatives: liliko ang cenum
•Avoid enemas: increases segmentation, gagalaw si
Diagnostic: (SCOPY) cecum
● Anoscopy - Rigid scope to visualize the anal area •Apply ice
● Proctoscopy - Flexible scope to visualize the rectum •WOF: Rupture: Stool sa abdominal cavity
● Sigmoidoscopy - Flexible scope to visualize the • Surgery: Appendectomy
sigmoid area
● Colonoscopy - Flexible scope to visualize the entire GERD, Hiatal avoid gas forming food
colon UC and Crohn’s: Acute phases: pain tenderness sa
● Biopsies and polypectomies may be performed abdomen: NPO
■ Polyps are risk fcators for cancer Pancreatitis and Appendicitis: NPO AGAD
● Enemas are given until returns are clear
● Left side lying: mas madali insert pag LSL DIVERTICULAR DISEASE:
(anatomical structuring)
● For colonoscopy, put client on NPO midnight
before procedure - yes to dinner, no midnight snack

Interventions:
● Acute phase: Maintain NPO(admin IVF &
electrolytes)
● After acute phase, progress diet from liquid to low
residue (low fiber, turbulent flow of feces may cause
frictions)
● Increase protein in the diet
● Avoid gas forming food: nagpapanipis ng lumen ● Outpouching of the colon due to increased pressure
● Avoid smoking in the colon
● Administer medications: ● Can occur in any part of the colon
■ Immunosupressants - cytokines are attacking ● Common in the sigmoid area- has bowl effect; dito
thecells kaya we need immunosup nag stay ang feces. Would lead to fecal impaction
■ Corticosteroids (long term): to lessen and increase pressure
inflammation ■ Pag increased ang pressure sa lumen, nagawa
ng out pouching
Surgery: ● Diverticulum (1 outpouch)
● Total proctocolectomy (permanent ileostomy) ● Diverticula (plural)
● Koch’s ileostomy ● Diverticulosis (presence of diverticula without sx)
● Diverticular disease (presence of diverticula with or
without sx)

Telescoping: to create stoma

 A. “I know just how you feel”
B. “You seem upset”: ACKWOLEDGEMENT OF PT’S
FEELINGS
C. “Oh don’t worry about it, everything will just be fine”
D. “Why do you think you have cancer?”

Anthony, a 60 y.o. patient, has just undergone a

bowel resection with a colostomy. During the first
24 hours, which of the following observations
about the stoma should you report to the doctor?
A. Pink color
B. Light edema
C. Small amount of oozing
D. Trickles of bright red blood
Manifestations:
● Asymptomatic at first Findings during an endoscopic exam include a
● Painful diverticular disease cobblestone appearance of the colon in your
■ Pain at the lower ileac fossa patient. The findings are characteristic of which
■ Co-exist with IBD disorder?
● Bleeding diverticular disease - Dark red blood in A. Ulcer
feces B. Crohn’s: patchy
● Diverticulitis: may infection na C. Chronic gastritis
■ Nakapal ang layer, nagninipis ang surface D. Ulcerative colitis
■ Acute ileac pain
■ Tachycarida Liver cirrhosis
■ Fever Cholecystitis
Pancreatitis

Hepatobiliary Tree:
• Liver
- Largest gland
- Stores and filters blood
- Kopffer’s cells: specific cells that filters blood
- first pass of meds: drugs are detoxified by the liver
- Produces albumin: to prevent edema. Blood is inside
blood vessels because of albumin. Mantains coloid
oncotic pressure
Sodium and Albumin holds on to water. If wala sila,
magkakarin ng fluid shifting
•Gallbladder - Stores bile
Interventions: Bile emulsifies fats - makes fats usable
● NPO or clear liquids as ordered (pag nasa acute Liver produces, gallbladder stores
phas: w pain or bleeeding) • Pancreas
● As diet resumes, avoid fiber rich food - Endocrine gland: ductless
● Introduce fiber once inflammation is resolved - Exocrine gland: with ducts
● Increase OFI - oral fluid
● Avoid gas forming foods NOTES:
● Avoid lifting, straining, coughing, bending: increase
inraabdominal pressure= increased chances of
rupture of diverticulum

Administer Medications as ordered:

•Antibiotics
•Analgesics: for pain
•Anticholinergics: dec gi activity

Surgery:
• Colon resection
•Anastomosis
• Colostomy

Arthur has a family history of colon cancer and Lipase and Amylase: inactive sa loob ng pancreas
is scheduled to have a sigmoidoscopy. He is Islets of Langerhans
crying as he tells you, “I know that I have colon Alpha cells - glucagon
cancer, too.” Which response is most pag mababa ang glucose, nag iincrease si glucagon
therapeutic? Beta Cells - insulin
Delta cells - somatostatin: balance between production ● Hepatobiliary problem
of glucagon and insulin ■ Jaundice
Presence of fats in the duodenum will stimulate ■ Clay colored stools
cholecystikinin: contract gallbladder and pinapasama ■ Dark & foamy urine
ang bile papunta sa duodenum para ma metabolize ang ■ Pruritus
fat ● Splenomegally
Dead RBC - sa spleen pupunta or magiging bilirubin sa ● Esophageal Varices: soft tissues. Increased
liver pressure would lead to bleeding
Fats should be emulsifies ■ Painless hematemesis
Fat Soluble ■ Melena
A - vision/blurring ■ Signs of shock
D - calcium/osteoporosis ● Hemorrhoids
E - skin/skin impairments ■ Hematochesia
K - clotting/bleeding ■ Rectal pain
Bilirubin - gives stool yellow pigment ■ Rectal itching

Hepatobiliary Problem: ● Ascites: Tympany (gitna ng resonance at dullness)

● Clay colored stools (grey) ● Resonance: hangin - Lungs
● Jaundice ● Dullness: solid - femur
● Dark tea Colored urine ■ Abdominal Distension
● Pruritus ● Hepatorenal syndrome: urinary retention. Hindi mabato
sa liver ang dugo
If bilirubin is not ecxreated with stool, mag circulate siya
■ Edema
sa blood and will cause jaundice
■ Swelling of the hands
ERCP: Endoscopic Retrogade ■ Swelling of the ankles and feet
Cholangiopancreatography ● Spider Angiomas
• Examination of hepatobiliary system ● Amonia: Destructive for the brain. Should be excreted
•NPO 8hrs prior to procedure through the liver
• Sedation ● Hepatic encephalopathy
•After procedure, WOF return of gag ■ Loss of memory
•WOF perforation ■ Confusion
■ Asterexis: tremors
LIVER CIRRHOSIS
•Degeneration of hepatocytes
•Hepatotoxicity: post necrotic
• Viral exposure: post necrotic
•Obstruction of ducts: biliary cirrhosis
• Congestive heart failure: cardiac cirrhosis (decreased
circulation saliver?)
•Alcohol induced: Laenec’s
“Cirrhosis cause scarring that increases pressure in the
liver”

Manifestations:
✔ Anorexia
✔ Generalized edema
✔ Malnutrition
✔ Steatorrhea:Fat sa stool
✔ Abdominal pain
✔ Bleeding tendencies
✔ Increased susceptibility to infection
Interventions:
● Semi-fowler’s position
● High protein if no encephalopathy, ascites or edema
(LOW PROTEIN DAPAT)
■ Protein increases ammonia
■ Prevents PCM and tissue wasting
● Low sodium and fluid intake as ordered
● Administer diuretics for ascites and edema
● WOF signs of bleeding

● WOF hepatic encephalopathy

● Administer neomycin or metronidazole (prevent protein
synthesis in bacteria
● Administer Lactulose to decrease pH and ammonia in 2. Pancreatitis
GIT (acidic environment kill bacteria)
● Avoid opioids, sedatives and barbiturates (hepatotoxic) Post-op:
Prepare client for paracentesis (for ascites) ● Administer anti-emetics as ordered
● WOF esophageal varices: Sengstaken Blakemore Tube ● Administer analgesics as ordered
● WOF hemorrhoids - sitz bath ● Splint abdomen when coughing/sneezing
● Monitor drainage from T-tube - Semi-Fowler’s
CHOLECYSTITIS ■ Drainage bag is lower: gravity
● Inflammation of the gallbladder ■ Monitor drainage - check for pus and blood. Should
● Acute cholecystitis - Formation of gallstones be greensih
● Chronic cholecystitis - Fibrosis in gallbladder walls ■ WOF bleeding
● Acalculous cholecystitis - Absence of gallstones; caused ■ WOF purulent drainage
by viral infection ■ Clamp & unclamp as ordered - clump when fat is
introduced in the diet
Terms: ■ 500 to 1000cc - normal
● Inflammation - Cholecystitis ■ Less than 500cc - pwede na tanggalin
● Formation of stones - Cholelithiasis
● Removal of gallbladder - Cholecystectomy PANCREATITIS
● Removal of gallstones - Choledocholithotomy ● Inflammation of the pancreas
● Scar tissue replaces normal tissues
Diagnostic: Cholecystography ● Causes:
● Used only for detection of Cholelithiasis ■ Stones
● Assess for allergies ■ Trauma
● Eat fatty foods the night before procedure: to cleanse; ■ Bacterial infection
para maubos ang bile ■ Viral infection
● NPO midnight before procedure ■ Alcohol abuse
● Inform client that dysuria is normal after procedure: exit
point of dye (through urine) Manifestations:
● Pain: mid epigastric region to LUQ to back
Manifestations: ● Pain aggravated by fatty meal
● Indigestion ● Abdominal guarding
● Frequent belching ● Weight loss
● Flatulence ● (+) Cullen’s & Turner’s
● Nausea & vomiting ● Cullen’s - umbilical
● Pain ● Tuner’s - flank
■ Galbladder: Right Upper Quadrant Pain radiating to ● Significant increase:
R shoulder or R scapula ■ Amylase in blood
● Tachycardia ■ Lipase in blood
● Mass palpated in the RUQ
● Murphy’s sign: There is pain on RUQ when the client is Interventions:
instructed to inhale
✔ NPO
● Elevated temperature
● Hepatobiliary problem ✔ IVF as ordered
■ - Jaundice
■ - Dark foamy urine ✔ Administer analgesics as ordered
■ - Clay colored stools
✔ Administer anticholinergics as ordered
■ - Pruritus
✔ Avoid alcohol
Interventions:
● N & V - NPO (if no N & V – low fat & avoid gas forming) ✔ Note that chronic pancreatitis may have
● Administer anti-emetics as ordered
✔ signs and symptoms of DM
● Administer anticholinergics as ordered
● Administer analgesics as ordered
● Surgery: You’re assessing the stoma of a patient with a
■ Cholecystectomy healthy, well-healed colostomy. You expect the
Drainage Bag -dito napupunta ang bile pag inalis na stoma to appear:
ang gallbladder A. Pale and moist
■ Choledocholithotomy B. Red and moist
Ulcer: NPO pag may bleeding lang C. Dark or purple
Diverticu Acute NPO D. Dry and black

2 conditions ns NPO LAGI You’re caring for a patient with a sigmoid

1. Appendicitis colostomy. The stool from this colostomy is:
A. Formed 18. A Empty bladder to prevent accidental puncture
B. Semisolid
C. Semiliquid 19. B
D. Watery
20. A
The student nurse is teaching the family of a
patient with liver cirrhosis who has confusion and 21. A Lactulose binati kanina
loss of memory. You instruct them to limit which
foods in the patient’s diet? 22. C - Gerd ang kabaliktaran ng management ay Dumpingd
A. Meats and beans
B. Butter and gravy 23. C
C. Potatoes and pastas
D. Cakes and pastries 24. 1010 to 1030 ang normal. Dahil dehydrated, mabigat
dapat ang urine
NOTE!
25. A. For gastric decompression
✔ Normal pH of stomach – 1.5 – 3.5

✔ Normal pH of intestines – 5.5 – 7.0

✔ Normal SGOT – 5 – 40 units/L

✔ Normal SGPT – 7 – 56 units/L

✔ Normal serum amylase – 30 – 110 units/L

✔ Normal serum Lipase – 0 – 160 units/L

RATIO OF TEST 1- 25

Give Morphine instead na Demerol kasi nuerotoxic ang

Demerol?

Upper GI Bleeding: Endoscopy

Bakit hindi hgb and hct: malalaman na may bleeding pero

hindi diagnostic

6. B

7. B - choose lipase, higher chuchu

8. A - jaundice

9. D REMEBER FANIS

10. D

11. B - best answer: cover ng basa para hindi dumikit sa sugat

12. A - Hypoalbuminemia - Hypotension ang effect. Fluid

component of blood will go out = mas kaunti ang laman =
hypo

13. D Yoghurt - nagpapabawas ng amoy ng utot

14. B Six small meals - frequent

15. Dumping dizziness and sweating

16. A. Omit fluids

17. B. Paracentesis - ang goal ay to decrease abdominal

distention and decrease intra thoraric pressure