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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
s/e of antacids (hint: electrolytes affected)
- aluminum/calcium - magnesium - sodium
24
nursing implication with antacids
- 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
treatment for H. Pylori specific PUD
- Clarithromycin (Biaxin) - Amoxicillin - Tetracycline - Metronidazole (Flagyl) - H2-receptor blockers/antagonists - Proton pump inhibitors
26
complications of ulcers
- GI bleeding - infection - obstruction -pyloric obstruction: stasis and gastric dilation
27
diet therapy for ulcers
- 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
interventions to reduce GI bleeding
- 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
surgical management of ulcers
- 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
what needs to be done in pre-op for surgical management of ulcers?
insert NGT
31
post-op care of ulcers
- monitor NGT - monitor for complications: -dumping syndrome -reflux gastropathy -delayed gastric emptying
32
post-op complications: dumping syndrome
- 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
post-op complications: reflux gastropathy
- gate is broken as result of surgery - food comes back up esophagus ( reflux )
34
post-op complications: delayed gastric emptying
- usually resolved w/in 1 week - think slow from anesthesia and from messing with the GI tract
35
what not to do with dumping syndrome:
- no fluids with meals ( drink between meals ) - no salt - no high carbs, bread, potatoes
36
intestinal obstruction: mechanical (hint: location & example)
- outside GI ie adhesions - bowel wall ie Crohn's - lumen ie tumors - hernia - appendicitis complications
37
intestinal obstruction: non-mechanical
- paralytic ileus - handling of intestines during surgery
38
intestinal obstructions: etiology (causes)
- fecal impactions - strictures- blockages - intussusception- seen more with children - volvulus- folding over of intestines - fibrosis- hardened intestines are narrow
39
pathophysiology after initial obstruction (what happens to the body)
- decrease absorption of fluids and electrolytes into vascular space - decrease circulatory volume - hypovolemic shock
40
s/sx of mechanical obstruction
- 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
s/sx of non-mechanical obstruction
- constant diffuse discomfort - abdominal distention - bowel sounds decreased to none - vomiting - obstipation: no stool output
42
key sx of SBO (small bowel obstructions)
- abdominal discomfort/pain - Upper epigastric/ABD distention - nausea, early profuse vomiting - obstipation - severe fluid and electrolyte imbalance - metabolic ALKALOSIS
43
key sx of LBO (lower bowel obstruction)
- Lower ABD cramping - Lower ABD distention - MINIMAL vomiting - obstipation or ribbon like stools - may have metabolic ACIDOSIS
44
non-surgical management of a bowel obstruction
- NPO - NGT - fluid and electrolyte replacement: IVFs - pain management - drug therapy
45
surgical management of bowel obstruction
- operative procedure: exploratory laparotomy to determine procedure - STRANGULATED obstruction must go to surgery!
46
post-op care for pt recovering from bowel obstruction surgery
- NGT - can have colostomy
47
colostomy care
- 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
s/sx of colostomy complications
- leaking stool - purple or dusky stoma

NU 360 (12 decks)

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