Adult Health II Exam 3 (GI, Headaches, Seizures, Strokes) Flashcards
what are GI system serum blood tests and indications>
CBC, electrolytes, prothrombin, liver function tests
What are the different imaging studies for upper GI disorders?
Barium studies = x rays after ingesting radiographic opaque fluid
–Do not do if perforation is suspected!
Endoscopy = bx and gastric analysis
What is an esophagogastroduodenoscopy? How long NPO for?
EGS = procedure to visualize upper GI for ulcers, inflammation, GERD, cancer, dysphagia
NPO until gag reflex returns
What are 4 age changes in the GI system?
Constipation, hemorrhoids, pyrosis, tooth loss
What do the mucous glands do?
Mucous glands located in the mucosa and prevent autodigestion by secreting an alkaline protective covering.
What does HCL do?
Hydrochloric acid kills microorganisms, breaks down food into digestible particles, and supports an environment for gastric enzyme activation.
What does pepsin do?
Pepsin is a chief coenzyme in gastric juices, and converts proteins to proteases and peptones.
What treatment is indicated for pernicious anemia?
- -chronic gastritis—B12 injections for pernicious anemia
- -Intrinsic factor comes from parietal cells and is necessary for absorption of vitamin B12. Loss of parietal cells from chronic gastritis leads to pernicious anemia in patients.
what does gastrin do?
Gastrin controls gastric acidity.
What are the risks, prevention, assessments, diagnosis, s/sx and management of oral cancer?
Risks: smoking, ETOH
Dental visits should be 2x/year
Manifestations = leukoplakia (white patch), erythroplakia (red patch)
Dx = tissue exam/excisional bx
Treatment = radiation, chemo, glossectomy, radical neck dissection
What are the risks, prevention, assessments, diagnosis, s/sx and management of Esophageal cancer?
- -Can lead to barrett’s esophagus
- -Caused by alcohol, smoking, bad dental care
- -Manifestations = progressive dysphagia, odynophagia, hoarseness
- -Diagnosis = barium swallow; esophageal biopsy
- -Treatment = esophagectomy; esophagogastrostomy
What are the risks, prevention, assessments, diagnosis, s/sx and management of stomach cancer?
–risks = male, genetics, workers, japanese, h pylori, pickled nitrate foods, smoked foods
–s/sx = asymptomatic until late, dyspepsia, belching, feeling full all the time, atrophic glottis (pernicious anemia vitamin b12 deficiency beefy red tongue), bloody vomit, anemia, enlarged lymph nodes, ascites
–Diagnosis = endoscopic biopsy, barium x rays, CBC, CEA (carcinoembryonic antigen)
treatment =
–Medical = chemo, radiation (palliative), no treatment
–Surgical = partial/complete gastrectomy, can develop dumping syndrome
Complication w/partial: dumping syndrome (DS)
—Early: 30 min after eating, dizzy, tachycardia, sweating
—Late: 1.5-3 hr post eating, release of insulin → hypoglycemia
–To help with DS = lay down after eating, avoid liquids with foods, high protein, high fat, low carb diet, eat additional vit b12, Fe, K
What are the 2 types of hiatal hernias? Which is most common?
Type 1 = Sliding hiatal hernia
Type 2 = Paraesophageal (rolling) hiatal hernia
what is hiatal hernia conservative management?
AVOID obesity, pregnancy, coughing, lifting heavy, tight clothes
for hiatal hernias, what is Nissen fundoplication? Nursing considerations?
Surgery = nissen fundoplication ABCs Pain NGT output, small meals Walk around good Soft diet x1 week, anti reflux meds x1 month No driving 1 week
What are LES relaxers, aggravators, manifestations and dx? What is the gold standard for the GERD diagnosis?
- -GERD = Reflux from stomach → esophagus from failing esoph cardiac sphincter (LES), failing = achalasia
1. LES relaxers = NSAIDs, caffeine, alcohol, fatty foods, peppermint, progesterone, beta blockers, calcium channel blockers
2. LES aggravators = tight clothes, bending over, vomiting
What are GERD lifestyle mod and nutrition?
Avoid spicy foods, fatty fried foods, losing weight
What are meds for GERD?
Antacids, Histamine Blockers, Prokinetics, Proton Pump inhibitors
In PUD, what is a gastric ulcer vs a duodenal ulcer location, cause, s/sx, management and considerations?
–Gastric ulcers – from normal secretion, delayed emptying
Increased pain after eating
–Duodenal ulcers – from speeding up secretion and emptying
Decreased pain after eating
Increase in HCL secretion, h pylori found 80%, perforations likely
What are meds for PUD?
Antacids, H2 blockers, Mucosal barrier fortifiers, PPI, Prostaglandin analogs
What is surgery for PUD? Complications?
bilateral vagotomy, pyloroplasty, distal gastrectomy
–Complications = bleeding, leaking, diarrhea, gallstones, dumping syndrome, perforation
what are s/sx of perforation?
s/sx = rigid abdomen, pain, upper abd pain, fever, vomiting
What is H pylori and how treated? What complications can occur from this?
Gastric mucosal barrier is the protector, h pylori breaks down
- -Breakdown and hypersecretion of acid→ ulcer
- -Can lead to scarring (barrett’s esophagus) and CANCER
What are calculus causes and acalculous causes of cholecystitis?
–Calculus = From cholesterol stones (most common), pigmented stones (various materials), mixed stones (cholesterol/pigmented), stay in BG, migrate to cystic duct or CBD
–Acalculus = from biliary stasis, e oli, prolonged fasting, multiple trauma, Sickle cell disease, DM, long term TPN
What are diagnostics/labs for cholecystitis?
- -+ murphys
- -U/S 90% effective for dx, No barium prior to US
- -HIDA (hepatobiliary iminodiacetic acid scan), NPO prior
- -Labs = CRP (inflammation), bilirubin (jaundice), liver enzymes–AST, ALT; WBC
What are acute and chronic s/sx, nursing interventions, pt ed for cholecystitis?
–Acute = sx control, pain, NPO/NG/IVFs
focus on pain relief, analgesics, anticholinergics, opioids, antispasmodics, NSAIDs, antibiotics
–Chronic = cholestyramine (bile salt binder) for pruritus, oral agents used to dissolve stones
Ursodiol, chenodiol
--Nutrition Fat soluble vitamins ADEK Diet low in saturated fats Weight loss needed 6 small meals, keep gallbladder working Avoid fat, dairy, gassy foods
What are nursing care after laparoscopic cholecystectomy?
- -Cholecystectomy: removal of GB
- –Laparoscopic and MIS (NOTES)
1. Lap chole = less pain and complications, short stay, early week, ABCs and infection, steri strips will fall off in 10 day, ice/opioids for incision pain and ambulation for CO2 retention
2. MIS or NOTES = surgical approach through natural orifice–Mouth, vagina, rectum, can d/c want to give antiemetic (zofran) to prevent V/aspiration; Can go home same day, no surgical incision since through hole
nursing care after open cholecystectomy?
ABCs, ROI, drains (JP, T tube), report drainage more than 1000mL, nutrition (NG tube then ADAT), post cholecystectomy syndrome
what is leptin?
appetite suppressor, made in adipose cells, want MORE of this
Tells the brain “you’ve had enough.”
In obesity, body becomes less resistant to leptin, so you eat more
Losing weight helps the body to respond more to leptin
What is ghrelin?
appetite stimulator/hunger hormone, Made in the stomach, You want LESS of this
Tells the brain “I need/want more food.”
Cardio a few times a week helps reduce ghrelin
Fatigue and stress increase ghrelin release
what are 3 main types of headaches??
*Primary
–Tension = muscular
Constant pressure pain, sensitivity to light
–Cluster = neurologic
Unilateral pain around the eye. (ipsilateral = same side)
associated with trigeminal neuralgia
–Migraine = vascular
Mood changes, fluid retention, excessive yawning, aura, 4 phases
*Secondary = other causes, infection, TMJ, sinus infection, neck pain etc
what are headache triggers?
MSG, sweeteners, wine, flashing lights, lack of sleep, poorly fitting dentures
What are the diff stages of migraine?
Premonitory
Aura
Headache (4-72 hr)
Postromal (exhausted)
What are preventative med treatments for headaches?
NSAIDs w/ B blocker (propranolol), Ca channel blockers (norvasc) antiepileptics (topiramate), botox
What are abortive med treatments for headaches? Severe?
–NSAIDs, caffeine, muscle relaxants
–Severe =
triptan meds to increase serotonin and cause vasoconstriction
ergot alkaloids to decrease pain messaging (most effective)
What are common manifestations of brain tumors?
Manifestations = headaches, seizures, numbness, ICP (vomiting, change LOC, gait change, mood change, hemiparesis, memory, speech)
What are brain tumor classifications? What type are most aggressive?
Graded I-IV (I = noninvasive slow growing); primary or secondary (met)
Gliomas–most aggressive and lethal, age 20-50
Meningiomas–F more than M, age 40-70
Oligodendrogliomas–cerebrum, slow growing
Acoustic neuromas (CN VIII) “Shwannomas”–slow growing, cranial nerve compression
Pituitary tumor–typically benign
What manifestations indicate increasing ICP? Normal = 5-15mmHg
Altered LOC, headache, vomiting, seizures
Vital signs changing = ominous sign
Cushing’s triad
- -Bradycardia
- -Irregular respirations
- -Widened pulse pressure (systolic rises)
What is the significance of Glasgow Coma Scores in relation to neuro status? What’s a “good” score? “bad” score?
score 3-15, lower is worse. Based on eye opening response, verbal, motor
what is complication post craniotomy? What meds given?
hemorrhage
DVT prevention meds (eliquis, lovenox)
Diuretics, steroids to reduce pressure
what are presentation findings of spinal cord tumors? What is immediate treatment?
medical emergency if sudden loss of neuro function = Numbness, tingling, loss of motion
Radiation tx to immediately shrink tumor
What are the diff types of seizures?
Focal onset = one hemisphere
- -Focal aware–aware
- -Focal impaired awareness–automatisms
- -Focal-bilateral tonic clonic–muscle jerk, relaxation
Generalized onset = both hemispheres
- -Tonic-clonic–stiffening/contraction, rhythmic jerking
- -Myoclonic–quick, involuntary muscle jerk
- -Atonic–without tone, can fall down suddenly
What are the diff stages of seizures?
Prodromal/preictal–hours/days before
Aura–right before seizure
Ictus–seizing
postictal–LOC changes, confusion
What is seizure management during? Meds?
- -safety during
- -imaging, labs, EEG after
- -status epilepticus meds – give Lorazepam IV (Ativan), Midazolam IV (Versed); If no IV: rectal diazepam (valium)–takes longer to be absorbed
What meds given after seizure?
Phenytoin (Dilantin)
Levetiracetam (Keppra)
What diet should seizure ppl follow?
keto–no carb reduce seizure
What are surgical seizure management options?
–Vagal nerve stimulation (VNS)= Stimulating device implanted in L chest wall, electrode attached to L vagal nerve; Observe for hoarseness, cough, dyspnea, dysphagia
–Deep brain stimulation works in what manner to control seizures? Deep brain stimulation–electrodes placed in brain, for uncontrolled seizure activity–interrupts signaling
–Partial corpus callosotomy works in what manner to control seizures? Partial corpus callosotomy (peds)–sever R&L brain connection, for uncontrolled, tonic/clonic, atonic seizures2
What are the anti-epileptic drugs MOAs? Phenytoin Benzos Valproic Acid Levetiracetam Gabapentin Carbamazepine Topiramate Lamotrigine
Phenytoin (Dilantin)
- -MOA = stabilize Na channel/pump blocks seizure activity spread
- -SE = excessive hair growth, gingival hyperplasia, birth defects, anemia
- -Considerations = Interferes with vitamin D (osteoporosis) and vitamin K (clotting)
- -Slow IV push–drops BP, precipitates in dextrose so do not use, use normal saline
Benzodiazepines (diazepam, lorazepam, clonazepam)
- -MOA = Enhances GABA, sedates neurons
- -SE = respiratory depression, birth defects
- -Considerations = Give for status epilepticus–long term seizure
Valproic acid (depakote)
- -MOA = Increases GABA, inhibits Na channels
- -SE = GI upset, hepatotox, weight gain, stronger link to NTD
- -Considerations = Give for petit mal seizures, teratogenic maybe
Levetiracetam (Keppra)
- -MOA = Calcium agonist, modifies GABA release
- -SE = SI, sedation, resp depr
- -Considerations = OK for preg
Gabapentin (Neurontin)
- -MOA = MOA unknown, membrane stabilizer
- -SE = somnolence, mood swings
- -Considerations = Use for partial seizures in ppl > 12 and neuropathic pain, watch Kidneys –I&O, don’t use if renal failure
Carbamazepine (Tegretol)
- -MOA = Inhibits Na channels
- -SE = rash, drowsiness, bone marrow suppression (check CBC)
- -Considerations = CBC, Interact w oral contraception and coumadin
Topiramate (Topamax)
- -MOA = Blocks Na channels, enhances GABA
- -SE = impair heat regulation, glaucoma, resp depr
- -Considerations = Can cause glaucoma, caution in children, cleft palate in preg, kidney stones
Lamotrigine
- -MOA = inhibits sodium channels, stabilizing presynaptic neuronal membranes
- -SE = rash
- -Considerations = All seizure types
What are causes/risks for strokes?
HTN Smoking Hypercholesterolemia illicit drug use, ETOH Bad diet sleep apnea heart disease 55+ gender, race TIA hx or genetics
What are acute vs chronic issues from strokes?
acute = aspiration, cytotoxic edema, hemorrhagic transformation
chronic = physical impairment, visual, speech, motor, depression
what are causes of hemorrhagic strokes (bag of worms)?
–Intracerebral hemorrhage, nontraumatic subarachnoid hemorrhage, intraventricular hemorrhage
–s/sx = prodromal pain behind eye, classic sx severe occipital headache, n/v
Complications of hemorrhagic strokes?
Complications: ischemia, hyponatremia (SIADH, CSWS), vasospasms, hypervolemia, HTN (permissive HTN keep less than 220/120), hemodilution
treatments for hemorrhagic strokes?
Ca channel blockers (prevent vasospasm), VS, NO anticoagulants, cerebral perfusion, coil, clipping
What are 4 kinds of TIAs?
large vessel
small vessel (lacunar)
Embolic
Cryptogenic
what does body do in response to TIA?
collateral circ
What labs and test for stroke?
CT, ABGs,
What is stroke BE FAST?
assess for stroke = BE FAST
Balance--ataxia Eyes--vision changes, loss, dbl vision Facial Drooping--smile, tongue deviation Arm Weakness Speech Difficulty--slurred/strange Time to call 911
what meds for prevention of stroke?
A- antihypertensives
L- antihyperlipidemics
P- platelet inhibitors
A- anticoagulants
What is L side vs R side of brain responsible for? Stroke affects opposite side.
L brain = speech, language, linear analytical sequential thinking
R brain = spatial and perceptual, emotions, holism, passion, abstract, imagination
What are gas and airway considerations for stroke?
Aspiration precautions: raise patient up 90, tuck chin when swallowing, suction available
Position: Neutral head, avoid rotation, ↑ HOB >30
Test gag/swallow, NG tube placement contraindicated if no gag
What is stroke sx of expressive aphasia, receptive aphasia?
Expressive aphasia = (Broca’s or motor) aphasia/dysphasia = Understands; minimal speech but ↑ effort…frustration!
Receptive aphasia = (Wernicke’s or sensory) aphasia/dysphasia = Doesn’t understand, easy speech but gibberish (neologisms)
what is homonymous hemianopsia from stroke?
from stroke blindness in half of both eyes corresponding with the stroke side
what is agnosia from stroke?
Agnosia–limb neglect, forgetting about body part, could injure
what are manifestations of lower back pain?
Lumbar pain
radiculopathy
what dx tests used for lower back pain?
X rays MRI CT Myelogram EMG straight leg test (lifting foot to 90 degrees)
What conservative tx for lower back pain?
decrease activity, heat, ice, williams exercises (semi fowler w pillow under knees), complimentary/alt (acupuncture, tai chi)
What med tx for lower back pain?
NSAIDs–monitor liver (jaundice, hepatotox!), daily limit 4g, retain fluid/salt fyi, GI bleeding
Epidural block–corticosteroids and anesthesia, takes 5-7 days to fully work
Muscle relaxants–flexeril, drowsiness
TCAs–amitriptyline for chronic pain
Antiepileptic meds–gabapentin, neurontin
what surgical treatments for lower back pain? post op considerations?
- -Transcutaneous electrical nerve stim (TENS) unit
- -laminectomy/discectomy
- -Post op care = wound care (CSF leak, test for glucose), pain control, neutral alignment, no heavy lifting 5 lb limit
what are manifestations of herniated nucleus pulposus?
weakening/tear of annulus fibrosus, radiculopathy, lumbar pain, shoulder pain and arm weakness
medications and surgery options for herniated nucleus pulposus?
Medications = NSAIDs, muscle relaxants, sedatives, gabapentin, lyrica (long term pain)
Surgery = Lumbar fusion = gold standard if meds etc don’t work
what is radiculopathy for herniated nucleus pulposus?
acute nerve compression–> Leads to motor impairment, sensory impairment, numbness, tingling, RISK FOR INJURY
