Chapter 15 Gastrointestinal Diseases Flashcards
In this disease the teeth become loose and fall out because the support structures and the gums become diseased and unable to hold the teeth in place.
Periodontal disease
In this disease the bones become fragile, as do the teeth, since those are the two major storage areas for calcium.
Osteoporosis
Inflammation of the gums is called?
Gingivitis
Gingivitis may cause pain and bleeding and may lead to what? The progressive loss of bone around the teeth.
Periodontitis
What medication can cause an overgrowth of the gingivae causing gingivitis?
Dilantin or phenytoin
Nursing interventions to prevent and treat gingivitis and periodontitis include promoting what?
Good oral hygiene, regular dentist visits, and maintaining normal nutrition.
Prevention is the most important intervention.
What is one of the most common causes of dysphagia in older adults?
It is usually the result of chronic acid reflux leading to Esophageal stricture. However it can also be a symptom of other more severe problems such as cancer, stroke. Also Parkinson’s disease.
This is the movement of stomach contents, Usually hydrochloric acid, back into the esophagus.
Gastroesophageal reflux disease
Risk factors for esophageal reflux disease include?
Obesity, and use of estrogen, nitroglycerin, and tobacco. Other causes include hiatal hernia, infections, and illnesses such as lupus.
Symptoms of reflux disease include?
Acid taste in the back of the throat, heartburn, and in severe cases, chest pain. People often cannot tell the symptoms between cardiac and reflux disease and sometimes a trip to the emergency room for evaluation is necessary
Chronic reflux causes?
Esophageal strictures. When strictures are present dysphagia begins to occur.
Common interventions for GERD Include?
Avoiding large and high fat meals,
avoid lying down for three hours after eating,
and sleeping in bed with the head elevated approximately 8 inches.
Common medications to treat GERD include?
Histamine blockers such as Zantac and Pepcid, or PPI’s such as omeprazole or protonix.
Esophagitis is an inflammation of the esophagus caused by?
The most common cause includes gastroesophageal reflux and prolonged vomiting
This Occurs when a part of the stomach protrudes through the Esophageal gastric junction. Part or all of the stomach and, in some cases the intestines may herniate up into the Esophagus.
Hiatal hernia
Common signs and symptoms of hiatal hernia include?
Dyspepsia, heartburn, indigestion, and dysphagia, in severe cases, severe retrosternal chest pain and gastric ulcer can occur.
Risk factors for hiatal hernia include?
Genetics and age-related changes in the esophageal wall.
Diagnostics used to detect hiatal hernias include?
Chest x-ray, barium contrast studies, endoscopy, and 24 hour Esophageal pH monitoring.
By age 60 what percentage of adults have hiatal hernias?
60%
This condition is an inflammation of the gastric mucosa and comes in two forms acute and chronic.
Gastritis
This type of gastritis is temporary inflammation, hemorrhage, or erosion of the gastric lining and can because by alcoholism aspirin use smoking, NSAIDs, and severe stress
Acute gastritis
This type of gastritis recurs over weeks or months and is caused by vitamin deficiency, chronic alcohol use, gastric mucosal atrophy, Chronic use of acid suppressive medications, and hiatal hernias.
Chronic gastritis
Chronic gastritis leads to what?
It leads to decreased gastric secretions which can eventually lead to deficiency of all B vitamins, peptic ulcer disease, or gastric cancer.
An imbalance between the effects of gastric acid and pepsin on the gastric and duodenal mucosa can cause an ulceration known as?
Peptic ulcer disease
Common Causes of peptic ulcer disease include?
Helicobacter pylori infection
Overproduction of HCl in the stomach
Decreased resistance of gastric mucosa that can occur with the use of NSAIDs and in chronic gastritis
Common treatment for H. Pylori is?
PPI’s, clarithromycin plus amoxicillin.
In gastric ulcers the amount of HCl is usually what?
Normal or reduced. The problem is with the increased diffusion of this acid back into the tissues, common symptoms of gastric ulcers include epigastric pain, some relief of pain with eating, nausea, vomiting, and weight loss.
In duodenal ulcers the level of gastric acid is?
Increased, as is the rate of gastric acid release from the stomach into the duodenum. If acid is not buffered in the stomach before it is passed to the duodenum, the unbuffered acid will irritate the duodenum.
Symptoms of duodenal Ulcers include?
Epigastric pain, pain that is relieved with foods and antacids, pain that is worse when the stomach is empty, and weight gain.
Nursing interventions for older adults with PUD, peptic ulcer disease include lifestyle modification such as?
Smoking cessation, avoiding alcohol, avoiding aspirin, avoiding NSAIDs, reducing stress.
Dietary changes that a patient may make to avoid PUD include?
Foods that irritate the stomach such as caffeine and alcohol and avoiding foods that cause symptoms to get worse.
To reduce the likelihood of diverticulitis disease, a patient should eat a diet that is high in what?
Fiber, Most experts believe that a diet that is low in fiber is the main contributor to the increase of intraluminal pressure. When there is little stool volume, the intestinal muscles have to exert more force to propel the fecal matter through the colon, the end result is increased pressure.
What percentage of older adults over age 85 have diverticular disease?
Two thirds.
This is an inflammation or infection in and around a Diverticular sac, That is usually the result of trapped undigested food, stool, or bacteria in the sac.
Diverticulitis
Common symptoms of diverticulitis include?
Change in bowel habits, lower left abdominal pain, constipation, and increased flatus, nausea, and vomiting. However, many older adults with diverticulitis may be afebrile and had minimal abdominal symptoms.
A common laboratory findings in older patients with diverticulitis is?
Leukocytosis
Treatment for diverticulitis includes?
Bowel rest, analgesics, antibiotics, and in severe cases, surgical resection.
Nursing management for older adults with diverticular disease includes?
Prevention and elimination of constipation. A high fiber diet. Patients should be instructed on foods to avoid such as nuts, popcorn, corn, celery and other fresh uncooked vegetables. Adequate fluid intake is also important.
This inflammation of the stomach or small intestine may be caused by bacteria, viruses, medications, ingestion of irritating foods or some type of allergic response.
Enteritis or gastroenteritis.
This enteritis is causing parasite is found in a improperly cooked pork and game animals.
Trichinosis
If your patient developed enteritis after traveling in a tropical part of the world were sanitation is poor, what parasite might you suspect?
Amoebae
Occurs when a bacterium or virus invades the G.I. tract and produces a toxin that causes inflammation.
Acute enteritis
Acute enteritis usually has increased fluid in the intestinal lumen along with increased intestinal motility resulting in what?
Massive loss of fluid and electrolytes. Other symptoms include abdominal cramping, diarrhea, and vomiting.
Nursing assessment with suspected enteritis includes?
Recent foods eaten, symptoms, recent travel, recent use of antibiotics, and any new routine medications.
The most important nursing intervention in patients with enteritis is?
Assessment and monitoring hydration status
Common causes of constipation are?
Low fiber diet, medications, diabetes, thyroid disease, decreased bowel motility, mechanical obstruction, depression, functional issues, or overuse of laxatives
Common medications that can cause constipation include?
Antacids, iron preparations, anticholinergics, calcium channel blockers, opiates, antidepressants, antipsychotics, barium sulfate, and anxiolytics.
This type of medication used to treat constipation is known as a bulking agent and includes?
Bran, psyllium.
Name an example of a surfactant used to treat constipation.
Colace or Ducosate
This treatment for constipation is known as an emollient.
Mineral oil
A saline cathartic used to treat constipation.
Milk of magnesia, magnesium citrate, sodium or potassium phosphate.
Name a few stimulants used to treat constipation?
Cascara, castor oil, or bisacodyl
Osmotic agents used to treat constipation include?
Lactulose, sorbitol, MiraLAX.
Nurses should determine the cause of diarrhea by assessing what?
Onset, precipitating events, timing, other symptoms, recent dietary or medicine changes, recent antibiotic use, nocturnal diarrhea.
Acute diarrhea is classified as what in Duration?
Less than two weeks
Chronic diarrhea is classified as what duration?
Greater than four weeks.
High morbidity and mortality rates in frail older adults in long-term care can because by what organism?
E. coli