NCLEX-RN cheat sheet · Gastrointestinal
GI bleeding and liver disease
Reflux, ulcers, bleeding and dumping; hepatitis, cirrhosis and its complications
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Upper GI problems range from nagging heartburn to a bleed that can send a client into shock. The liver filters toxins, makes clotting factors and proteins, and stores energy.
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At a glance
Reflux and hiatal hernia
- The valve at the bottom of the esophagus relaxes and acid flows up. A hiatal hernia (stomach bulging up through the diaphragm) is a leading cause.
- Heartburn after meals or lying down; regurgitation, trouble swallowing. Some have chest pain, a chronic cough or hoarseness.
- Chest pain can mimic a heart attack, especially in women: assess it fully.
- Teach: nothing for 3 hours before bed, head of the bed raised, upright after meals, small frequent meals.
- Proton pump inhibitors (pantoprazole) are standard; famotidine is another option. Long-term, they can lower magnesium and B12.
- Trouble swallowing, anemia, vomiting blood or weight loss: a scope exam.
Peptic ulcers
- Most come from H. pylori or anti-inflammatory drugs like aspirin and ibuprofen; blood thinners add risk.
- Gastric ulcer: pain soon after eating. Duodenal: 2 to 3 hours after, and it can wake the client at night.
- Tests: a scope (the gold standard); a breath, stool or blood test for H. pylori.
- Acid reducers heal it; for H. pylori, a proton pump inhibitor is paired with antibiotics. Anti-inflammatories are stopped or reduced; avoid smoking, alcohol and caffeine, even decaf coffee.
- Sucralfate: empty stomach, an hour before or two hours after meals.
- Dangers: bleeding and perforation. A sudden change in pain can mean perforation.
GI bleeding
- Upper: ulcers, gastritis, inflamed esophagus, varices, tears from severe vomiting. Lower: diverticular disease, hemorrhoids, polyps, cancer, colitis.
- Bright red or coffee-ground vomit; black, tarry stools or red blood in the stool.
- Severe bleeding causes shock: confusion, a fast pulse, pale, cold skin, sweating. Slow, hidden bleeding causes anemia.
- Act fast: get help, monitor vital signs, follow the hemoglobin; expect a scope to stop the bleeding.
- Known varices: check with the provider before an NG tube goes in. Transfusions need consent, unless it's an emergency.
Reflux or dumping: opposite habits
| Reflux | Dumping | |
|---|---|---|
| After meals | Stay upright | Lie down 30 minutes |
| Meals | Small, frequent | About six small |
| Fluids | Usual | At least 30 minutes after meals |
| Food | Avoid triggers | Protein, fiber, fat; avoid sugar, milk |
Dumping syndrome: Food moving too fast into the small intestine, after stomach surgery. Early (within 30 minutes): cramping, diarrhea, sweating. Late (1 to 3 hours): low blood glucose.
Hepatitis
| Virus | Spread | Course |
|---|---|---|
| A | Fecal-oral | Usually acute. Vaccine |
| B | Blood, body fluids, sex, birth | Can become chronic. Vaccine (newborns, health care workers) |
| C | Blood, like shared needles | Can become chronic. Antivirals cure most in 8 to 12 weeks |
| D, E | D needs B; E: contaminated water | E usually clears |
Chronic: Lasting over 6 months. Chronic B and C can lead to cirrhosis and liver cancer.
Hepatitis: signs and care
- Early: poor appetite, nausea, vomiting, fatigue. Later: jaundice, right upper belly pain, dark urine, light stools.
- Clotting tests rise, so bleeding risk rises: electric razor, soft toothbrush; check gums, urine, stool and IV sites.
- Drugs that harm the liver, like acetaminophen, are avoided. Hepatitis A and most acute B get supportive care. Hepatitis C gets curative antivirals, and chronic B gets antivirals when needed.
- Itching: cool showers or baking soda baths, short nails, no alkaline soaps.
Cirrhosis
- Scarring from long-term liver damage (alcohol, fatty liver disease, chronic hepatitis B or C) raises portal vein pressure, pushing blood into fragile veins that can burst. Treating the cause can let it regress, but cancer risk remains.
- Signs: fatigue, itching, poor appetite; later easy bruising, swelling, jaundice, confusion; spider angiomas, red palms. Labs: high liver enzymes and clotting times, low albumin, low platelets.
- No alcohol. Check with the provider before any medicine. Avoid anti-inflammatory drugs; acetaminophen only in reduced doses.
- Avoid long fasts: small meals every 3 to 4 hours and a bedtime snack, enough calories and protein; no raw shellfish or unpasteurized milk.
- Vaccinate against hepatitis A and B, flu and pneumonia; screen for liver cancer about every six months.
Complications of cirrhosis
| What happens | What the nurse does | |
|---|---|---|
| Encephalopathy | Ammonia and other toxins reach the brain. Early: sleep changes, forgetfulness, worse handwriting; musty or sweet breath. Later: asterixis (flapping tremor), disorientation, slurred speech, coma | Treat triggers: GI bleeding, infection, kidney failure, sodium or potassium changes. Lactulose lowers gut ammonia (can cause diarrhea); rifaximin or neomycin. Avoid sedatives |
| Varices | Swollen veins from portal hypertension, silent until they bleed. Bleeding: vomited blood, black or bloody stools, paleness, a fast pulse, low pressure | Acute bleeding: resuscitation, IV octreotide or vasopressin, banding, preventive antibiotics; protect the airway. Prevention: nonselective beta blockers, like propranolol |
| Ascites | Fluid in the belly: bloating, pain, breathlessness | Abdominal girth and daily weight. Sodium about 2 g a day, individualized; diuretics as ordered. Paracentesis drains and tests the fluid |
| Infection, kidneys | Spontaneous bacterial peritonitis: ascites infection without a surgically treatable source. Hepatorenal syndrome: kidney failure | Watch for infection: SBP is life-threatening. Paracentesis tests the fluid for infection |
Priority and safety calls
- ★ Coffee-ground vomit with a fast pulse and low pressure is a bleed with early shock: report it now.
- ★ Cirrhosis with known varices, vomiting bright red blood: call for help now, protect the airway and watch for shock. Don't push an NG tube blindly.
- ★ Newly confused and drowsy, with asterixis, and a sedative ordered: hold the sedative, report the change, expect lactulose. Cutting all protein isn't the answer.
- Sudden severe pain in a client with an ulcer: possible perforation. Assess and report at once.
- New chest pain in a client with reflux: assess it fully, as possible cardiac pain.
- After a GI bleed, review every medicine: anti-inflammatories and blood thinners raise the risk.
- Traps: ibuprofen for ulcer pain; anti-inflammatories for cirrhosis pain; sweet drinks with meals after gastric surgery; sitting a dumping client upright.
How the NCLEX tests it
- Reflux: upright after meals, nothing 3 hours before bed, and acid reducers.
- Ulcers: H. pylori or NSAIDs; gastric pain soon after eating, duodenal later.
- Bleeding: coffee-ground vomit or black stools; watch for shock and act fast.
- Dumping: small meals, liquids between meals, lie down after, and less sugar.
- Hepatitis A is fecal-oral; B and C are bloodborne and can turn chronic.
- Encephalopathy: asterixis and confusion; lactulose, and no sedatives.
- Varices: bleeding is an emergency. Ascites: girth, weight, and low sodium.
Practice it next
This sheet comes from Upper GI disorders and GI bleeding and Liver disorders in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- A ___ ulcer hurts 2 to 3 hours after eating and can wake the client.
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duodenal - Sucralfate is given on an ___ stomach.
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empty - Early dumping comes within ___ minutes of a meal.
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30 - Hepatitis A spreads by the ___ route.
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fecal-oral - Lactulose lowers the ___ made in the gut.
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ammonia - A flapping tremor of the hands is called ___.
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asterixis - For ascites, measure abdominal ___ and weigh daily.
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girth
Sources
- Open RN, Nursing: Health Alterations, 11.9 Gastroesophageal Reflux Disease
- Open RN, Nursing: Health Alterations, 11.10 Peptic Ulcer Disease
- NIDDK, Symptoms and Causes of GI Bleeding
- NIDDK, Symptoms and Causes of Dumping Syndrome
- Open RN, Nursing: Health Alterations, 11.15 Hepatitis
- NIDDK, Treatment for Cirrhosis
- MedlinePlus, Loss of brain function: liver disease (hepatic encephalopathy)
- MedlinePlus, Bleeding esophageal varices
- MedlinePlus, Ascites
More gastrointestinal cheat sheets
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.