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Dx/MGMT GI Disorders

ANCC Board review

QuestionAnswer
This organism is present in >90% of duodenal ulcers and >75% gastric ulcers H. pylori
True or false Peptic ulcer disease (PUD) is more common in women? False: 3:1 in men vs women
True or false smoking >1/2 ppd smokers are more likely to have occurrences of PUD True
What medications are contributory to PUD? NSAIDS, ASA, and glucocorticoids
These Ulcers are common among those who are ages 30-55 Duodenal
These Ulcers are common among those who are ages 55-65 Gastric
___________ ulcers have relief with eating Duodenal
___________ ulcers worsen with eating Gastic
Melena is Dark tarry stool
hematemesis vomiting bright red blood
Those with PUD may nate the following on labs anemia
First Line therapy for PUD is H2 Blockers (tidine drugs)
2nd line therapy for PUD is H2 blockers BID
3rd line therapy for PUD PPI therapy (prazoles)
When giving Mucosal protective agents the NP educates the patient to give them ________ at least 2 hours apart from other medications
Bismuth subsalicylate (Pepto-Bismal) has direct antibacterial action against ________ H. pylori
Misoprostol (cytotec) is used for the following ____________ and may cause______ prophylaxis against NSAID ulcers/ stimulation of uterine contraction and induction of abortion
H. pylori eradication therapy must be _______ combination therapy: 2 antibiotics + PPI or bismuth
MOC is _______ H. Pylori eradication Metronidazole 500mg BID w/meals Omeprazole 20mg BID b4 meals Clarithromycin 500mg bid with meals x7 days
AOC is ________ H. Pylori eradication Amoxicillian 1gm daily Omeprazole 20mg BID Clarithromycin 500mg bid x7 days
MOA is __________ H. Pylori eradication Metronidazole (flagyl) 500mg BID w/meals Omeprazole 20mg BID Amoxicillin 1g bid with meals
When using a Bismuth regimen for H pylori eradication the dosing is _______ QID
BMT Bismuth subsalicylate 2tabs QID Metronidazole 250mg QID Tetracycline 500mg QID
BMTO Bismuth subsalicylate 2tabs QID Metronidazole 250mg QID Tetracycline 500mg QID Plus Omeprazole 20mgBID
In hospital MGMT of PUD IV access CBC, PT/PTT, BMP O2 Endoscopy, GI sonography FC NPO GI consult/surgical eval
A quiet, rigid abdomen with rebound tenderness is representative of a ______ Perferation
Causes of Gerd? Incompetent lower esophageal sphincter (LES) and Delayed gastric emptying
S/S of Gerd Retrosternal "burning" bitter taste in mouth Excessive salivation Frequently occurs at night and/or in recumbent position May have symptom relief from antacids, H2O or food
Diagnostics for GERD EGD can be considered to R/O Barrett's esophagus or PUD
Non pharmacologic mgmt for GERD Stop smoking weight los if obese avoid ETOH, caffeine, spices Elevate HOB
Pharmacologic MGMT of Gerd Antacids PRN H2 blockers in high does nightly or divided BID dosing PPI if H2 are ineffective GI/surgical consult PRN
Hep A transmission contaminated Food/H2O body secretion exhange
HEP B transmission Blood borne DNA virus transmitted via blood and blood products sexual activity and mother fetus
HEP C transmission Blood Borne RNA virus source of infection often uncertain Traditionally associated with blood transfusions 50% of cases from IV drug use
Pre-icteric S/s of Hep infection fatigue malaise anorexia NV HA aversion to smoking/ETOH
Icteric (Acute) S/s Hep infection Weight loss Jaundice purritus RUQ pain clay colored stools (unable to conjugate billy rubin) low grade fever may be present Hepatoslenomegaly may be present
The ALT and AST would be (elevated/decreased) in Hepatitis elevated
You would expect the pt with a HEP infection to have _____ to __________ WBC Low to normal
Serology for an Active Hep A infection would be Anti-HAV, IgM (immediate)
The following serology indicates what: Anti-HAV, IgG Recovery from a HEP A infection. The IgG is an antibody to HEP that implies previous exposure and confers immunity
you run serology on a pt and get the following results: HBsAg, HBeAG, Anti-Hbc, IgM. You know this to represent __________ Active HBV infection HBeAG indicates circulating HBV and viral replication IgM defines an acute infection
You run serology on a pt and get the following results: HBsAg, Anti-Hbc, Anti-HBe, IgM, IgG Chronic HBV infiection Anti-Hbe signifies diminished viral replication Chonic state is indicated by the presence of Anti-Hbe, IgM, IgG
A recovered HBV serology would be ANti-HBc, Anti-HBsAg All markers are gone
The serologies for Acute and chronic hepatitis infections are Identical Anti-HCV, HCV RNA
What test is used to differentiate between active and chronic HCV polymerase chain reaction (PCR)
MGMT of HEP infections AVOID ETOH and drugs detoxified by the liver Increase fluids 3 to 4L daily no/low protein diet
Your pt has a prolonged PT >15 seconds with know HCV infection. The acute care np would prescribe ___________ to reduce PT time Vitamin K
Lactulose is used on the treatment of Hepatic encephalopathy (increased ammonia levels)
Your pt have a low grade fever and LLQ tenderness to palpitation. Labs show WBC of 12000 and ESR of 40. you suspect Diverticulitis
why is plain abdominal film ordered when a pt has diverticulitis look for evidence of free air
S/S Cholecystitis often precipitated by large or fatty meal sudden onset of severe epigastrium/right hypochondriac pain Vomiting may provide relief
Deep pain on inspiration while fingers are placed under the right rib cage Murphy's sign
RUQ pain to palpation is a sign of Cholecystitis
Other signs of Cholecystitis Muscle guarding/rebound pain Fever
Created by: EL92578
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