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AHI > Care of Patient with Stomach Disorders > Flashcards

Care of Patient with Stomach Disorders Flashcards

1
Q

Inflammation of gastric mucosa or submucosa after exposure to local irritants or other causes
Complete regeneration and healing occur within a few days
If the stomach muscle is not involved, complete recovery usually occurs with no residual gastric inflammation
If the stomach muscle is affected, hemorrhage could occur
Etiology/risk factors:

A

Gastritis acute

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2
Q

Helicobacter pylori (gram-negative bacterium) - HUGE RISK FACTOR
Long-term NSAID use
Diet: alcohol; coffee; caffeine
Corticosteroids
Radiation therapy
Accidental or intentional ingestion of corrosive substances

A

Etiology/risk factors: - Gastritis acute

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3
Q

Chronic inflammation of the mucosal lining of the stomach
Walls and lining of the stomach thin and atrophy
Intrinsic factor (critical for absorption of vitamin B12) is lost
Vitamin B12 stores are depleted, pernicious anemia results - decrease RBC because not absorb B12
Amount and concentration of acid in stomach secretions gradually decrease
Associated with increased risk for gastric cancer
Types

A

Gastritis chronic

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4
Q

Type A - autoimmune cause
Type B – H. pylori infection most common cause; Also associated with alcohol ingestion, radiation therapy, and smoking
Atrophic – caused by exposure to toxic substances in the workplace, H. pylori infection, or autoimmune factors

A

Types - Gastritis chronic

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5
Q

Eat a well-balanced diet
Avoid drinking excessive amounts of alcohol
Avoid taking large doses of aspirin, NSAIDs (e.g., ibuprofen), and corticosteroids
Avoid excessive intake of coffee/caffeine
Avoid contaminated water or food
Manage stress levels
Stop smoking
Avoid exposure to toxic substances in the workplace
Treat symptoms of esophageal reflux

A

Gastritis prevention

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6
Q

Limit foods with high acid contact or heavily seasoned with spices

A

Eat a well-balanced diet

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7
Q

Rapid onset of epigastric pain or discomfort
Nausea/vomiting
Hematemesis (vomiting blood)
Gastric hemorrhage – life-threatening emergency
Dyspepsia (indigestion)
Anorexia - not want to eat

A

Gastritis CM: Acute

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8
Q

Vague report of epigastric pain that is relieved by food
Anorexia
Nausea or vomiting
Intolerance of fatty and spicy foods and anything not bland
Pernicious anemia - not absorbing B12

A

Gastritis CM: Chronic

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9
Q

Biopsy via EGD is the gold standard for diagnosing gastritis
Tissue samples can confirm or rule out gastric cancer and detect H. pylori

A

Gastritis diagnostic testing: Esophagogastroduodenoscopy (EGD)

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10
Q

Treated symptomatically and supportively because the healing process is spontaneous
Drug therapy
Blood transfusion if bleeding
Fluid replacement for dehydration
Surgery with major bleeding

A

Gastritis interventions: Acute:

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11
Q

Varies with cause
Drug therapy
Elimination of causative agent: Ex. H pylori treated with antimicrobials
Treatment of any underlying disease
Avoidance of toxic substances

A

Gastritis interventions: Chronic:

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12
Q

H2-receptor antagonists (famotidine - Pepcid, nizatidine - Axid)
Mucosal barrier (Sucralfate - Carafate, Sulcrate): coat lining of stomach
Antacids (Maalox, Mylanta)
Proton pump inhibitors (omeprazole - Prilosec, pantoprazole - Protonix)
Vitamin B12

A

Gastritis interventions: Drug therapy - chronic and acute

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13
Q

Blocks gastric secretions

A

H2-receptor antagonists (famotidine - Pepcid, nizatidine - Axid)

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14
Q

Buffering agent

A

Antacids (Maalox, Mylanta)

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15
Q

Suppress gastric acid secretion

A

Proton pump inhibitors (omeprazole - Prilosec, pantoprazole - Protonix)

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16
Q

prevention or treatment of pernicious anemia (with chronic gastritis)

A

Vitamin B12

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17
Q

Open Mucosal lesion of the stomach or duodenum
Occurs when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin
3 types of ulcers - depends on location
Most gastric and duodenal ulcers are caused by H. pylori infection

A

Peptic ulcer disease

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18
Q

Gastric
Duodenal
Stress

A

3 types of ulcers - depends on location - Peptic ulcer disease

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19
Q

Develop in the antrum of the stomach near acid-secreting mucosa

A

Gastric ulcer

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20
Q

Develop in the upper portion of the duodenum

A

Duodenal ulcer

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21
Q

Occur after an acute medical crisis or trauma

A

Stress ulcer

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22
Q

Can be undiagnosed in older adults because of vague symptoms associated with physiologic changes of aging and comorbidities that mask dyspepsia

A

Most gastric and duodenal ulcers are caused by H. pylori infection - Peptic ulcer disease

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23
Q

Hemorrhage
Perforation
Pyloric obstruction
Intractable disease

A

Peptic ulcer disease comps

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24
Q

Emergency and life threatening
Occurs more often in patients with gastric ulcers and in older adults

A

Hemorrhage - Peptic ulcer disease comps

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25
Q

Surgical emergency and can be life threatening
Symptoms include sharp, sudden pain beginning in the mid-epigastric region and spreads over the entire abdomen
Septic quickly; abdomen rigid quickly
Abdomen is tender, rigid, and boardlike

A

Perforation - Peptic ulcer disease comps

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26
Q

Symptoms include abdominal bloating and N/V

A

Pyloric obstruction - Peptic ulcer disease comps

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27
Q

Characterized by a lack of response to conservative management and with symptoms that interfere with ADLs

A

Intractable disease - Peptic ulcer disease comps

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28
Q

Primarily associate with H. pylori and NSAIDS
Certain substances may contribute by altering gastric secretion

A

Peptic ulcer disease etiology

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29
Q

Corticosteroids (prednisone)
Theophylline (Theo-Dur)
Caffeine
Radiation therapy

A

Certain substances may contribute by altering gastric secretion - Peptic ulcer disease etiology

30
Q

History
Physical assessment/clinical manifestations:
Laboratory assessment:
Diagnostic testing:

A

Peptic ulcer disease assessment

31
Q

Dyspepsia (indigestion)
Epigastric tenderness - pain
N/V

A

Physical assessment/clinical manifestations: - Peptic ulcer disease assessment

32
Q

Most common symptom
Described as sharp, burning, or gnawing pain

A

Dyspepsia (indigestion)

33
Q

Serologic testing for H. pylori antibodies
Decreased hemoglobin and hematocrit, if bleeding
Stool may be positive for occult blood, if bleeding

A

Laboratory assessment: - Peptic ulcer disease assessment

34
Q

Esophogastroduodenoscopy (EGD)
Nuclear medicine scan to test for bleeding

A

Diagnostic testing: - Peptic ulcer disease assessment

35
Q

no special preparation
patient injected with a radioactive contrast medium and the GI system is scanned for the presence of bleeding after a waiting period; see if bleeding through GI tract

A

Nuclear medicine scan to test for bleeding

36
Q

Acute or chronic pain
Upper GI bleeding

A

Peptic ulcer planning - Priority problems:

37
Q

Bland diet may assist in relieving symptoms
Teach the patient to exclude foods that cause discomfort
Avoid bedtime snacks, alcohol, tobacco, caffeine-containing beverages, and both caffeinated and decaffeinated coffees and foods highly acidic

A

Peptic ulcer disease interventions - Diet

38
Q

Hypnosis
Imagery
Yoga
Mediation techniques

A

Peptic ulcer disease interventions - Complementary and alternative therapies - stress sig risk factor for peptic ulcer disease so these can help

39
Q

Antacids
H2 antagonists
Mucosal barrier fortifier
Proton pump inhibitors (PPI)
Prostaglandin analogs
Purpose of Medications:

A

Peptic ulcer disease meds

40
Q

increases pH of gastric contents by deactivating pepsin
Buffer

A

Antacids - Peptic ulcer disease meds

41
Q

decreases gastric acid secretions by blocking histamine receptors in parietal cells

A

H2 antagonists - Peptic ulcer disease meds

42
Q

binds with bile acids and pepsin to protect stomach mucosa
stimulates mucosal protection
may cause the stools to be discolored black
Coat lining

A

Mucosal barrier fortifier - Peptic ulcer disease meds

43
Q

suppresses H, K-ATPase enzyme system of gastric acid secretion

A

Proton pump inhibitors (PPI) - Peptic ulcer disease meds

44
Q

stimulates mucosal protection and decreases gastric acid secretions, helps resist mucosal injury in patients taking NSAIDs and/or high-dose corticosteroids
Build up mucosal lining

A

Prostaglandin analogs - Peptic ulcer disease meds

45
Q

Eliminate H. pylori infection
Heal ulcerations
Prevent recurrence
Provide pain relief

A

Purpose of Medications: - Peptic ulcer disease meds

46
Q

PPI triple therapy
PPI quadruple therapy

A

Eliminate H. pylori infection

47
Q

PPI: decrease gastric acid secretions
Two antibiotics such as metronidazole (Flagyl) and tetracycline or clarithromycin (Biaxin) and amoxicillin (Amoxil) for 10-14 days

A

PPI triple therapy

48
Q

PPI: decrease gastric acid secretions
Any two antibiotics as above
Bismuth (Pepto-Bismol)

A

PPI quadruple therapy

49
Q

Teach the patient who has peptic ulcer disease to seek immediate medical attention if experiencing any of these symptoms:
Sharp, sudden, persistent, and severe epigastric or abdominal pain
Bloody or black stools
Bloody vomit or vomit that looks like coffee grounds

A

Upper GI bleeding

50
Q

Maintain airway, breathing, circulation
Provide oxygen and other ventilatory support as needed
Start two large bore IV lines
Monitor VS and oxygen
Labs to monitor:
Monitor fluid replacement
NG tube placement and gastric lavage; might suction
Prepare for endoscopic therapy or interventional radiologic procedures
EGD to cauterize certain areas

A

Upper GI bleeding treatment: If actively bleeding/life-threatening emergency:

51
Q

Replace fluids, blood and fresh frozen plasma (help blood clot)

A

Start two large bore IV lines

52
Q

Hemoglobin/hematocrit and coagulation studies

A

Labs to monitor:

53
Q

I/O
BIG

A

Monitor fluid replacement

54
Q

Perforation
Obstruction

A

Upper GI bleeding complications

55
Q

Replace fluids, blood, electrolytes
Most have NG tubes
Administer antibiotics
Keep patient NPO
NGT and suction
Monitor I/O and VS
Monitor for septic shock (fever, pain, tachycardia, lethargy, anxiety)
Surgery

A

Upper GI bleeding complications: Perforation

56
Q

Replace fluids and electrolytes
NGT and suction to decompress dilated stomach
Surgery may be required

A

Upper GI bleeding complications: Obstruction

57
Q

Teach risk factors for recurrence
Recognize new complications and what to do if they occur and s/s of GI bleeding
Help them plan ways to make needed lifestyle changes
Avoid OTC products containing aspirin or other NSAID - irritate stomach lining; acidic foods, alcohol, smoking, coffee, stress
Identify situations that cause stress and develop a plan for coping with stressors

A

Upper GI bleeding teaching

58
Q

Severe Abdominal pain; N/V; black, tarry stools; weakness; dizziness

A

Recognize new complications and what to do if they occur and s/s of GI bleeding

59
Q

Usually adenocarcinomas
Usually begins in the glands of the stomach mucosa
Symptoms
Etiology and genetic risk:
Diagnostic testing:

A

Gastric cancer

60
Q

Early stages: heartburn and abdominal discomfort
Late stages: progressive weight loss and N/V

A

Symptoms - Gastric cancer

61
Q

H. pylori largest risk factor
Medical history risk factors: pernicious anemia, gastric polyps, chronic atrophic gastritis, and achlorhydria (absence of secretion of hydrochloric acid); chronic peptic ulcer disease
Diet risks: eating pickled food, nitrates from processed foods, added salt and low intake of fruits and vegetables
Increased risk: gastric surgery, Barrett’s esophagus from prolonged or severe GERD

A

Etiology and genetic risk: - Gastric cancer

62
Q

EGD for definitive diagnosis
Biopsies
CT, PET, and MRI are used in determining the extent of the disease and planning therapy

A

Diagnostic testing: - Gastric cancer

63
Q

Drug therapy, radiation and/or chemotherapy

A

Gastric cancer interventions - Nonsurgical:

64
Q

Resection of tumor
Total gastrectomy - attach esophagus to dejunum because no longer have stomach - issues with diet
Subtotal (partial) gastrectomy - issues with diet

A

Gastric cancer interventions - Surgical:

65
Q

Surgical dressing changes
Review manifestations of incisional infection
Side effects of radiation therapy/chemotherapy (N/V, fatigue)
Instruct patient to eat small, frequent meals
Issues if stomach removed
Avoid drinking liquids with meals
Avoid foods that cause discomfort
Eliminate caffeine and alcohol consumption
Stop smoking
B12 injections
Lie flat after eating for a short time

A

Gastric cancer interventions - Patient/family teaching:

66
Q

Prob if part/all stomach removed
Refers to a group of vasomotor symptoms that occur after eating
Rapid emptying of food contents into the small intestine
Early manifestations (occurs within 30 minutes of eating):
Late dumping (occurs 90 minutes to 3 hours after eating):
Managed by nutrition changes:

A

Dumping syndrome

67
Q

Can occur after gastric surgery
Causes abdominal distension

A

Rapid emptying of food contents into the small intestine - Dumping syndrome

68
Q

Vertigo, tachycardia, syncope, sweating, pallor, palpitations, desire to lie down

A

Early manifestations (occurs within 30 minutes of eating): - Dumping syndrome

69
Q

Caused by a release of an excessive amount of insulin and BG dropping quickly
Dizziness, light-headedness, palpitations, diaphoresis, confusion

A

Late dumping (occurs 90 minutes to 3 hours after eating): - Dumping syndrome

70
Q

Decrease the amount of food taken at one time
Eliminate liquids ingested with meals - not eat and drink at same time
Eat high protein, high fat, and low to moderate carbohydrate - best meal
In severe cases some medications are used that slows stomach and intestinal motility

A

Managed by nutrition changes: - Dumping syndrome

AHI (77 decks)

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