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NU 360 > Ch. 47 & 48 > Flashcards

Ch. 47 & 48 Flashcards

1
Q

peptic ulcer disease is

A

a mucosal lesion of the stomach or duodenum
- gastric mucosal defenses are impaired and no longer able to protect the epithelium from the effects of acid and pepsin
- deep, sharply demarcated lesions that penetrate through the mucosa and submucosa into the muscularis propria (muscle layer)

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2
Q

types of PUD

A
  • gastric
  • duodenal
  • stress
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3
Q

ulcer development by (hint: substances)

A
  • acid
  • pepsin
  • H. pylori
  • NSAIDs
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4
Q

stress ulcers are

A
  • Acute gastric mucosa lesions occurring after an acute medical crisis or trauma
  • Associated with head injury, major surgery, burns, respiratory failure, shock, and sepsis
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5
Q

stress ulcers are associated with

A

head injury, major surgery, burns, respiratory failure, shock, and sepsis

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6
Q

stress ulcers can be prevented with

A

medication prophylaxis

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7
Q

general s/sx for all types of peptic ulcers

A
  • epigastric tenderness usually located at the midline between the umbilicus and the xiphoid process
  • dyspepsia (indigestion)
    -typically described as sharp, burning, or gnawing pain
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8
Q

gastric ulcer: secretion of gastric acids

A
  • normal or hyposecretion
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9
Q

gastric ulcer: pain

A

occurs 30-60 min after food
- accentuated/made worse by food

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10
Q

gastric ulcer: hemorrhage

A

hemorrhage = hematemesis or melena

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11
Q

duodenal ulcer: secretion of gastric acids

A
  • hypersecretion
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12
Q

duodenal ulcer: pain

A

occurs 1.5-3 hrs after food and occurs during the night
- relieved by food

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13
Q

duodenal ulcer: hemorrhage

A

hemorrhage = melena

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14
Q

common risk factors of peptic ulcer disease

A
  • stress
  • H. pylori
  • alcohol
  • smoking
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15
Q

s/sx of gastric ulcer

A
  • weight loss
  • HCL - normal or hyposecretion
  • pain 1/2-1 hr after meals
  • vomiting
  • eating may increase pain
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16
Q

s/sx of stress ulcer

A
  • physiological stress shock
  • cushing’s ulcer - brain injury
  • cushing’s ulcer - extensive burns
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17
Q

s/sx of duodenal ulcer

A
  • most common
  • well nourished
  • pain 2-3 hrs after meals
  • food may decrease pain
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18
Q

general treatment for PUD (drugs)

A
  • proton pump inhibitors
  • H2receptor antagonists
  • antacids
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19
Q

proton pump inhibitors

A

Antisecretory agents
- Omeprazole (Prilosec)
- Lansoprazole (Prevacid)
- Pantoprazole (Protonix)
- Esomeprazole (Nexium)

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20
Q

H2receptor antagonists

A

Block the action of the H2-receptors of the parietal cells, thus inhibiting gastric acid secretion
- Ranitidine (Zantac)
- Famotidine (Pepcid)
- Nizatidine (Axid)

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21
Q

drugs that block histamine-stimulated gastric secretion

A

H2receptor antagonists

22
Q

s/e of H2receptor antagonists

A
  • HA
  • diarrhea
  • depression
  • GI disturbances
  • rash
23
Q

antacids are used to

A

buffer gastric acid and prevent the formation of pepsin
- they are effective in accelerating the healing of DUODENAL ulcers

24
Q

antacids: most widely used preparations

A

mixtures of aluminum hydroxide and magnesium hydroxide
(mylanta, maalox)

24
Q

s/e of antacids (hint: electrolytes affected)

A
  • aluminum/calcium
  • magnesium
  • sodium
24
Q

nursing implication with antacids

A
  • timing of giving antacid in relation to other meds and food
  • meds: 1 hr before or 4 hr after (?)
  • food: with food or right after (?)
25
Q

treatment for H. Pylori specific PUD

A
  • Clarithromycin (Biaxin)
  • Amoxicillin
  • Tetracycline
  • Metronidazole (Flagyl)
  • H2-receptor blockers/antagonists
  • Proton pump inhibitors
26
Q

complications of ulcers

A
  • GI bleeding
  • infection
  • obstruction
    -pyloric obstruction: stasis and gastric dilation
27
Q

diet therapy for ulcers

A
  • diet therapy may be directed toward neutralizing acid and reducing hyper motility.
  • a bland, nonirritating diet – especially during acute phase
  • timing of diet is important
28
Q

interventions to reduce GI bleeding

A
  • endoscopy with interventions
  • acid-suppressive agents are used to stabilize the clot by raising the pH level of gastric contents
  • med: Octreotide (Sandostatin)
  • NGT
    -saline lavage
    -to suction
    -active bleeding is life-threatening (hypovolemic shock)
29
Q

surgical management of ulcers

A
  • a simple gastroenterostomy permits neutralization of gastric acid
  • vagotomy eliminates the acid-secreting stimulus to gastric cells and decreases the response of parietal cells
  • pyloroplasty facilitates emptying of stomach contents
30
Q

what needs to be done in pre-op for surgical management of ulcers?

A

insert NGT

31
Q

post-op care of ulcers

A
  • monitor NGT
  • monitor for complications:
    -dumping syndrome
    -reflux gastropathy
    -delayed gastric emptying
32
Q

post-op complications: dumping syndrome

A
  • constellation of vasomotor symptoms after eating
  • food is dumped straight to the duodenum instead of passing through the stomach first
  • 15 min after eating
  • tachycardia
  • abd cramping
  • epigastric fullness
  • weakness
  • dizziness
  • diaphoresis (sweating)
  • self-limiting
33
Q

post-op complications: reflux gastropathy

A
  • gate is broken as result of surgery
  • food comes back up esophagus ( reflux )
34
Q

post-op complications: delayed gastric emptying

A
  • usually resolved w/in 1 week
  • think slow from anesthesia and from messing with the GI tract
35
Q

what not to do with dumping syndrome:

A
  • no fluids with meals ( drink between meals )
  • no salt
  • no high carbs, bread, potatoes
36
Q

intestinal obstruction: mechanical (hint: location & example)

A
  • outside GI ie adhesions
  • bowel wall ie Crohn’s
  • lumen ie tumors
  • hernia
  • appendicitis complications
37
Q

intestinal obstruction: non-mechanical

A
  • paralytic ileus
  • handling of intestines during surgery
38
Q

intestinal obstructions: etiology (causes)

A
  • fecal impactions
  • strictures- blockages
  • intussusception- seen more with children
  • volvulus- folding over of intestines
  • fibrosis- hardened intestines are narrow
39
Q

pathophysiology after initial obstruction (what happens to the body)

A
  • decrease absorption of fluids and electrolytes into vascular space
  • decrease circulatory volume
  • hypovolemic shock
40
Q

s/sx of mechanical obstruction

A
  • mid-abdominal pain or cramping
  • vomiting (small intestines)
  • obstipation (no stool)
  • diarrhea (leaking around obstruction)
  • alteration in bowel pattern and stool: obstipation and diarrhea
  • abdominal distention
  • bowel sounds (borboygmi): decreased to none
  • abdominal tenderness
41
Q

s/sx of non-mechanical obstruction

A
  • constant diffuse discomfort
  • abdominal distention
  • bowel sounds decreased to none
  • vomiting
  • obstipation: no stool output
42
Q

key sx of SBO (small bowel obstructions)

A
  • abdominal discomfort/pain
  • Upper epigastric/ABD distention
  • nausea, early profuse vomiting
  • obstipation
  • severe fluid and electrolyte imbalance
  • metabolic ALKALOSIS
43
Q

key sx of LBO (lower bowel obstruction)

A
  • Lower ABD cramping
  • Lower ABD distention
  • MINIMAL vomiting
  • obstipation or ribbon like
    stools
  • may have metabolic ACIDOSIS
44
Q

non-surgical management of a bowel obstruction

A
  • NPO
  • NGT
  • fluid and electrolyte replacement: IVFs
  • pain management
  • drug therapy
45
Q

surgical management of bowel obstruction

A
  • operative procedure: exploratory laparotomy to determine procedure
  • STRANGULATED obstruction must go to surgery!
46
Q

post-op care for pt recovering from bowel obstruction surgery

A
  • NGT
  • can have colostomy
47
Q

colostomy care

A
  • normal appearance of the stoma: red, beefy
  • s/sx of complications: dusky/purple stoma, stooling leaking
  • measurement of the stoma
  • choice, use, care, and application of appropriate appliance to cover stoma
48
Q

s/sx of colostomy complications

A
  • leaking stool
  • purple or dusky stoma

NU 360 (12 decks)

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