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Adult Hlth 2- Test 1
GI Part 1
| Question | Answer |
|---|---|
| What are the most common causes of GERD? | Inappropriate relaxation of the lower esophageal sphincter; Irritation from the refluxed material; Delayed gastric emptying; and Abnormal esophageal clearance |
| What diet is best for a client with GERD? | Smaller meals; Avoid carbonation; Restrict spicy or acidic foods; Avoid:Fatty foods, caffeinated beverages, such as coffee, tea and cola; Chocolate; Citrus friuts; Tomatoes & tomato products; Nicotine in cigarette smoke; Cl+ channel blockers; Nitrates; |
| Peppermint, spearmint; alcohol; anticholinergic drugs; High levels of estrogen & progesterone; Nasogastric tube placement are all things to avoid in ____? | GERD |
| What lifestyle changes will help decrease the symptoms of GERD? | Stop eating 3 hrs prior to laying down/sleeping; Remain upright 1-2 hrs after meals; Elevate HOB; Eat slowly & chew fully; Sleep in Left lateral (side)position; Dont' wear tight clothing; don't stay in stooped position & minimize lifitng heavy objects |
| By maintaing a healthy wt a pt with gerd can ___ the symptoms of GERD? | decrease |
| What drugs can be used to treat GERD conservatively? | Antacids; Histamine blockers; Proton pump inhibitors |
| What are some examples of Antacids? | chew thoroughly and follow with a glass of water--Mylanta, Gaviscon |
| Name som Histamine blockers that are used to treat GERD:___? | Pepcid, Zantac, Tagamet |
| Name some proton pump inhibitors used to treat GERD:? | Prilosec, Prevacid, Aciphex, Protonix, Nexium |
| When giving drugs for GERD watch for potential interactions with other drugs like ____? | Coumadin, Inderal, Procardia, Dilantin, and Theophylline |
| T/F Rebound reflux in GERD is uncommon after stopping the drugs? | False Rebound reflux is NOT uncommon after stopping the drugs |
| ____- is the most common hernia; the esophagogastric junction and a portion of the fundus of the stomach slides upward through the esophageal hiatus into the thorax. | Sliding Hiatal Hernias |
| Heartburn; Regurgitation; Chest pain; Dysphagia; and Belching are all manifestations of ______ hernias? | Sliding Hiatal Hernias |
| ____ Hernias--the esophagogastric junction remains in place but the fundus and sometimes part of the stomach's greater curvature roll through the esophageal hiatus & into the thorax beside the esophagus. | Paraesophageal Hernias |
| Feeling of fullness after eating; Breathlessness after eating; Feeling of suffocation; Chest pain that mimics angina; and worsening of manifestations in a recumbent position are all manifestations of ___ Hernias? | Paraesophageal Hernias |
| Non-surgical management would include what nursing instructions? | Similar reflux medicines as in GERD; Similar diet modifications as in GERD; Similar lifestyle modifications as in GERD |
| Following a fundoplication (Nissen), what are teh priority interventions to avoid post-op complications (e.g. respiratory, NG management, nutrition)? | NG tube until peristalsis returns; Painful breathing due to incision location (educate deep breathing and pain control teaching) Cl will be on a clear diet at 1st then advanced as tolerated. Stay on SOFT diet about 1 week. Stay on anti-reflux meds 1month |
| What are some examples of a soft diet? | mashed potatoes, puddings, custard, and milkshakes; avoid carbonated beverages, tough foods, and raw vegetables taht are difficult to swallow |
| Following a fundoplication (Nissen) surgery when can a pt drive? Should they walk? Can they lift heavy items? | Do not drive for a week after surgery; do not drive if taking opioid pain meds; walk every day, but do not do any heavy lifting |
| When should gauze dressings following a Nissen surgery be removed and how? | Remove gauze dressings 2 days after surgery and shower; do not remove steri-strips until 10 days after surgery; Wash inciisions with soap and water, rinse well, and pat dry; report any redness or drainage from the incisions to your surgeron |
| Following a Nissen surgery what should a pt report and when should they schedule a follow up appointment? | Report fever above 101F, N/V, or uncontrollable bloating or pain; Schedule an appointment for follow-up with your surgeon in 3-4 weeks |
| What is the most common cause of gastritis? | H. pylori |
| What are the typical drugs prescribed to treat gastritis? | Similar antacids, H2 antagonists, and PPIs in GERD; Antibiotics; Mucosal barrier fortifiers --sucralfate; Prostaglandin analogues -- Cytotec; Limit use of NSAIDs & other stomach irritating meds |
| What diet is most appropriate for a client with gastritis? | Instruct cl w/ gastric disease to limit intake of any foods and spices that cause distress. Tea, coffee, cola, chocolate, mustard, paprika, cloves, pepper, and hot spices may increase discomfort. alcohol and tobacco should also be avoided. |
| After the cl has an acute episode of ___, help him/her identify foods that cause discomfort. New foods should be introduced 1 at a time. Avoidance of substances that cuases symptoms is important. Most cl seem to progress better on what diet? | acute gastritis episode; Most cl seem to progress better with a soft, bland diet and smaller, more frequent meals |
| What is the most common cause of Peptic Ulcer Disease? | H. pylori |
| o Normal gastric secretion + delayed gastric emptying + increased diffusion of gastric acid back into the stomach tissues is one of the most common causes of ___? | PUD |
| o Normal diffusion of gastric acid into stomach tissues + increased secretion of gastric acid + increased stomach emptying is one of the most common cause of ___? | PUD |
| What are the most common complications of gastric ulcers? | Hemorrhage; Perforation; Pyloric obstruction; and Intractable disease |
| How often does Hemorrhage occur in gastric ulcers and what does it look like? | 15-20% of pts; coffee ground emesis & black stools |
| ___- is a complication of gastric ulcer and there is extreme pain due to stomach acid leaking into the surrounding abdomen. | Perforation |
| ____- is a complicaiton of gastric ulcers; vomiting can lead to metabolic alkalosis; monitor electrolytes | Pyloric Obstruction |
| ____-is a complication of gastric ulcers and there is recurrent pain & discomfort despite treatment | intractable disease |
| What interventions are appropriate to prevent gastric ulcer complications? | Follow diet, lifestyle, and medication regimen; Treat early |
| In Gastric Ulcers what is the general nourishment, stomach acid prodcution, and occurrence? | May be malnourished; Normal secretion or hyposecretion; mucosa exposed to acid-pepsin secretion |
| Pain with Gastric ulcer occurs when? | occurs 30-60 min after meal; at night: rarely; Pain is accentuated by ingestion of food |
| In a gastric ulcer is melena more common then Hematemesis? | NO hematemesis is more common than melena |
| In a gastric ulcer there is less than ___% chance for malignant change? | 10% |
| After a gastric ulcer heals there is a potential for it to recur where? | in the same location |
| What is the surrounding mucosa of a gastric ulcer like? | atrophic gastritis |
| With a duodenal ulcer what is the blood group it most often occurs with? | type O |
| Waht is the general nurishement of duodenal ulcer? | well nourished |
| With duodenal ulcer what is the stomach acid production, occurrence, and clinical course> | Hypersecretion, mucosa exposed to acid-pepsin secretion; Healing and recurrence (clinical) |
| When does pain occur with duodenal ulcers? | occurs 1.5-3 hrs after meal; at night: often awakens cl between 1-2am |
| What relieves duodenal ulcers? | ingestion of food |
| In a duodenal ulcer is melena more common than hematemesis? | Yes |
| T/F there is a rare malignant change associated with duodenal ulcers? | True |
| what is the recurrence rate of duodenal ulcers? | 60% recur w/in 1yr, 90% recur w/in 2 yrs |
| What is the surrounding mucosa like of a duodenal ulcer? | No gastritis |
| N, V, Diarrhea, Dehydration, abs distention, HA, Malaise, hyperactive Bowel sounds, Diffuse tenderness (not rebound), WBS&/or RBCs in stool, & Abs cramps are all manifestions of ___? | Gastroenteritis |
| What diet therapy is indicated for gastroenteritis? | Avoid food/fluids until N/V subside; small volumes of clear liquids (replace e-, so not plain H20); saltine crackers; toast w/ jelly, bland foods, avoid caffenine, advance to regular diet as tolerated |
| What are the effects of aging on the stomach? | 1. decreased HCl 2 NI: frequent feedings, bland, iron, vitamins |
| What is the effects of aging on the large intestines? | decreased sensation to defecate; NI: fiber and activity |
| What are the effects of aging on the Liver? | 1. decreased enzyme activity--> 2. NI: depressed drug metabolism |
| What is the effects of aging on th ebiliary tract? | 1. incidence of cholesterol stones increases 2. NI: dietary limitations |
| What is the effects of aging on the pancreas? | 1. decreased fat absorption & digestion 2. obesity, fat content increases 3. atherosclerosis common in pancreatic vessels 4. NI: diet |
| CBC-anemia; PT/PTT-clotting factos; Electrolytes and Albumin are laboratory assessments for ____? | GI problems |
| Upper GI and small bowel series; Barium enema; and gallbladder series are all radiographic exams for? | GI |
| What are two key features of Hiatal Hernia? | Sliding and para esophageal....It slides in and out of the para esophageal |
| A Fundo Plictation keeps the hiatal hernia from ___? | sliding up |
| H. Pylori; NSAIDs, alcohol; cytotoxic agents; caffeine; corticosteroids; stress-induced (80-100% of ICU cl) are all causes of ____ gastritis | acute |
| H pylori and antibodies to parietal cells are all causes of ____ gastritis? | chronic |
| How is gastritis Dx? | EGD w/ biopsy for H. pylori |
| Drugs; Diet-avoid spicy food; and stress reduction are all nonsurgical managements of ___? | gastristis |
| What are the locations of PUD? | esophagus (rare); stomach (gastric); jejunum (after gasteroenterostomy) and duodenum |
| What are the three types of PUD? | gastric, duodenal, stress (erosive gastritis) |
| Where are gastric ulcers located? | lesser curvature of the stomach |
| What is the pathophysiology of gastric ulcers? | H. pylori bacteria (70%) 2. injurious substances 3. reflux of bile acid 4. decreased blood flow |
| T/F gastric ulcers heal less quickly than duodenal? | true |
| Describe the pain of a gastric ulcer. | pain is nawing pain, unusually hungry |
| what is the most common type of ulcers? | Duodenal ulcers |
| What is the pathophysiology of duodenal ulcers? | H. Pylori bactera; excess acid secretion; activity of vagus nerve results in increased release of gastrin & hydrochloric acid; pH levels are low for long period of time; Rapid emptying of food from stomach; alchol and cigarette smoking-irritants |
| ___ ulcers are acute gastric erosion and has major assaults of severe trauma or major illness; severe burns; Head injury/intracranial disease; drug ingestion; SHOCK; SEPSIS. | Stress ulcers |
| What is the clinical manifestions of duodenal ulcers? | "burning" or "cramps" in midepigastric region, beneath xiphoid process |
| What is the clinical manifestions of gastric ulcers? | "burning" or "gaseous" high in epigastric region |
| Complications of ulcers are? | Hemorrhage; perforation; gastric outlet obstruction; and intractable disease |
| With acute exacerbation of ulcers what will the pt be on in hospital? | NPO, NG, Bed rest (IV (lactated Ringer's &/or albumin); Blood transfusion |
| Surgical management of ulcers? | Vagotomy; Pyloroplasty; subtotal (Billroth I); and Total (billroth II) gastrectomy |
| How do you care for a pt post-op of PUD? | Mgmt of NG, Monitor for complications, dumping syndrome; Nutritional management, Health teaching-risk for recurrence of PUD |
Created by:
cgwayland
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