Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS3313 Adult Health > Chapter 40 Gastric & Duodenal Disorders > Flashcards

Chapter 40 Gastric & Duodenal Disorders Flashcards

1
Q

Gastritis

A

Inflammation of the gastric & stomach mucosa
- Can be acute (lasting several hours- few days) or chronic (repeated exposure to irritating agents or recurring gastritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Prevalence of Gastritis

A

Common GI problem accounts for 2 Million visits to outpatient clinics annually in the United States

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 2 types of acute gastritis?

A

Erosive & Non-erosive Gastritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Erosive Gastritis

A

Caused by long-term use of nonsteroidal anti-inflammatory drugs
(NSAIDS, ex: ibuprofen, alcohol abuse, and recent exposure to radiation therapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Non-Erosive Gastritis

A

Often caused by spiral-shaped, gram (-) Heliobacter pylori (H.pylori)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Prevalence of H. pylori Infections

A

~50% of individuals globally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stress-Related Gastritis

A

May develop in acute illnesses when the patient has had major traumatic injuries, burns, severe infection, lack of perfusion to stomach lining, or major surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Severe Acute Gastritis

A

Caused by ingestion of strong acids or alkali-> mucosa may either become gangrenous or perforation
- Scarring causes pyloric stenosis or obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathophysiology of Gastritis

A

Gastritis is a disruption of the mucosal barrier that protects the stomach tissue from digestive juices.

In gastritis, the gastric mucous membrane becomes edematous and hyperemic (congested with fluid and blood) and undergoes superficial erosion.

Superficial ulcerations may occur as a result of erosive disease and leads to ->hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical Manifestations of Acute Gastritis

A

Anorexia
Epigastric pain (rapid onset)

Hematemesis: Vomiting blood

Hiccups

Melena or hematochezia

Nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical Manifestations of Chronic Gastritis

A

Belching

Early satiety

Intolerance of spicy/fatty foods

Nausea and vomiting

Pyrosis (heartburn)

Sour taste in the mouth, halitosis

Vague epigastric discomfort relieved by eating and inability to absorb vitamin B12

Possible signs of shock

Anemia

Fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dyspepsia

A

Indigestion

Upper abdominal discomfort associated w/eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hematochezia

A

Bloody stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pyrosis

A

Heartburn

Burning sensation in the stomach & esophagus that moves up to the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is a patient dx w/ gastritis?

A

The definitive dx is determine by an endoscopy and histologic exam of a tissue specimen obtained by biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medical Management of Gastritis

A

NGT, IV Fluids, Fiberoptic endoscopy, antacids, H2 blockers (ex. famotidine, ranitidine), proton pump inhibitors (ex. omeprazole, lansoprazole)

In extreme cases surgery is required to remove gangrenous or perforated tissue
Ex: Gastric resection or a Gastrojejunostomy (anastomosis of jejunum to stomach to detour around
the pylorus), this is necessary to treat pyloric obstruction

Chronic gastritis is managed by modifying the pt’s diet, promoting rest, reducing stress, recommending avoidance of alcohol and NSAIDS, and initiating medications that may include antacids, H2 blockers, or proton pump inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Nursing Management of Gastritis: Managing Anxiety

A

The nurse offers supportive therapy
& uses a calm approach to assess
the pt and answer all questions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nursing Management of Gastritis: Promoting Optimal Nutrition

A

Pt should refrain from alcohol and food until symptoms subside

A nonirritating diet is introduced when pt is able to take nourishment by mouth
- IV Fluids are needed if symptoms persist
- Fluid I & O w/electrolytes are closely monitored

As food is introduced, nurse evaluates & reports any symptoms that suggest a repeat episode of gastritis

NO caffeinated beverages & NO smoking!! Caffeine is a stimulant that increases gastric activity & pepsin secretions. Nicotine will increase gastric acid secretions & interfere w/ GI mucosal barrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Nursing Management of Gastritis: Promoting Fluid balance

A

Daily I’s & O’s to detect early signs of dehydration
- Minimal fluid intake 1.5L/day
- Urine output: < 1mL/kg/hr

If NPO:
- IV fluids 3L/day usually are prescribed
- Record of 1 L of 5% dextrose in water= 170 cal of carbs need to be maintained

Electrolyte values (Na+, K+, & Cl -) are assessed every 24 hrs to detect any imbalances

Be alert of any signs of hemorrhagic gastritis
- Hematemesis
- Tachycardia
- Hypotension

All stools should be examined for the presence of frank or occult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nursing Management of Gastritis: Relieving Pain

A

Instruct patients to avoid foods & beverages that may irritate the gastric mucosa as well as correct use of meds to relieve chronic gastritis

Nurse must regularly assess the patient’s level of pain & extent of comfort achieved through use of meds & avoidance of irritating substances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Gastric Outlet Obstruction

A

Any condition that medically impedes normal gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pyloric Obstruction

A

Obstruction of the channel of the pylorus & duodenum through which the stomach empties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Peptic Ulcer

A

An excavation (hollowed-out area) that forms in the
mucosal wall of the stomach, in the pylorus, duodenum, or esophagus
- Can be referred to as gastric, duodenal, esophageal, or pyloric ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pylorus

A

Opening between the stomach & duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Duodenum

A

1st part of small intestine between stomach & jejunum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Causes of Peptic Ulcer Disease

A

Erosion of a circumscribed area of mucous membrane is the cause

Most peptic ulcers results from H. pylori bacteria

27
Q

Where are peptic ulcers more likely to occur?

A

They are more likely to occur in the duodenum
-Gastric ulcers occur in the lesser curvature of the stomach, near the pylorus
-> Esophageal ulcers occur as a result of backflow of HCl from the stomach to the into the esophagus (GERD

28
Q

Risk Factors for Peptic Ulcer Disease

A

NSAIDS and ASA is a major risk factor for peptic ulcers

Increased secretion of HCL in the stomach & stress

Smoking and alcohol may be risk factors, but evidence is
inconclusive
-There is no evidence that milk, caffeinated drinks, and spicy foods are associated with peptic ulcers

Familial tendency may also be a significant risk factor

29
Q

Pathophysiology of Peptic Ulcer Disease

A

The erosion of tissue is caused by the ↑’ed
activity of acid-pepsin or by the ↓’ed resistance of the mucosa

A damaged mucosa cannot secrete enough mucus to act as a barrier against HCL

Damage to the gastroduodenal mucosa results in ↓ resistance to bacteria → H. pylori infection occurring

30
Q

Clinical Manifestations of Peptic Ulcer Disease

A

May last for a few days, weeks, or months
- May disappear only to reappear w/out an identifiable cause

Dull, gnawing pain or burning in the midepigastrium or the back

Symptoms shared by both: pyrosis (heartburn), vomiting, constipation or diarrhea, and bleeding
- May be accompanied w/ burping when, patient’s stomach is empty
- Vomiting is rare but could be a sign of an ulcer complication
-> Gastric outlet obstruction (caused by either muscular spasm or the pylorus or mechanical obstruction from scarring)
-> May also be due to acute swelling of the inflamed mucous membranes adjacent to the liver

Emesis may contain undigested food eaten may hours earlier

31
Q

Clinical Manifestations of Gastric Ulcers

A

Pain occurs 30-60 min. after eating
30-40% of pts awake with pain during the night

32
Q

Clinical Manifestations of Duodenal Ulcers

A

Pain occurs 2-3 hrs after meals
50-80% of pts awake with pain during the night
- More likely to express pain relief after eating or taking an antacid than those with gastric ulcers

33
Q

Clinical Manifestations of Bleeding Ulcers

A

May present w/ symptoms of GI bleed
- Hematemesis
- Passage of melena

~20% of pts w/ bleeding ulcers do not experience abdominal pain at time of dx

34
Q

Signs & Symptoms of Ulcer Perforation

A

May be sudden in onset

Severe, sharp upper abdominal pain (may be referred to the shoulder)

Extreme abdominal tenderness

N/V may also occur

WATCH OUT FOR SIGNS OF SHOCK!!
- Hypotension
- Tachycardia

35
Q

Nursing Therapy for Peptic Ulcer Disease

A

Relieve Pain
- Eat meals @ regularly paced intervals

36
Q

Nursing Management of Complications Associtaed

A

Hemorrhage
* Bleeding is manifested by hematemesis or melena
* The vomited blood can be bright red or dark coffee ground
* When hemorrhage is large (2000-3000 mL) most of the blood is vomited and immediate correction of blood loss is needed to prevent hemorrhagic shock
from happening

The nurse assess for dizziness and nausea, evaluate for tachycardia, hypotension, tachypnea, monitor H/H, and assess stool occult blood

Patients with symptoms of GI bleed should have an endoscopy within 24 hours to confirm diagnosis

Endoscopic interventions include injecting the bleeding site with epinephrine, cauterizing the site, or clipping the ulcer to stop the bleeding

Treatment Measures
- Insert at least an 18 G IV
- Fluid replacement therapy
- Packed RBCs, frozen plasma cells
- NG tube insertion to decompress the stomach

37
Q

Dyspepsia

A

Indigestion

Upper abdominal discomfort associated w/eating

38
Q

Pyrosis

A

Heartburn

Burning sensation in the stomach & esophagus that moves up to the mouth

39
Q

Purpose of Pharmacological Therapy in Peptic Ulcer Disease & Gastritis

A

Used to eradicate H. pylori & manage gastric acidity

Recommended therapy is for 10-14 days

40
Q

4 Antibiotics Used to Treat Peptic Ulcer Disease & Gastritis

A

Amoxicillin, clarithomycin, metronidazole, & tetracycline

41
Q

Major Action & Key Nursing Considerations of Amoxicillin in Peptic Ulcer Disease & Gastritis

A

Bacterial antibiotic that aids in eradicating H.pylori bacteria in the gastric mucosa

Key Nursing Considerations:
- May cause abdominal pain & diarrhea
- Should NOT be used in patients w/ allergies to penicillin

42
Q

Major Action & Key Nursing Considerations of Clarithomycin in Peptic Ulcer Disease & Gastritis

A

Exerts bactericidal effects to eradicate H. pylori bacteria in the gastric mucosa

Key Nursing Considerations:
- May cause GI upset, headache, altered state
- Many drug-drug interactions
Ex) Colchicine, lovastatin, warfarin
- Interacts w/ grapefruit juice

43
Q

Major Action & Key Nursing Considerations of Metronidazole in Peptic Ulcer Disease & Gastritis

A

Synthetic antibacterial & antiprotozoal agent that assists w/ eradicating H. pylori in the gastric mucosa when given w/ other antibiotics & proton pump inhibitors

Key Nursing Considerations:
- Should be given w/ meals to prevent GI upset
- May cause anorexia & metallic taste
- Patient should AVOID alcohol
- Increases blood-thinning effects of warfarin

44
Q

Major Action & Key Nursing Considerations of Tetracycline in Peptic Ulcer Disease & Gastritis

A

Exerts bacteriostatic effects to eradicate H. pylori bacteria in the gastric mucosa

Key Nursing Considerations:
- May cause photosensitivity reaction
-> Advise patients to use sunscreen
- May cause GI upset
- Must be used in CAUTION w/ renal or hepatic impairment
- Milk or dairy products may decrease the effectiveness

45
Q

Anti-Diarrheal Agent Used in Peptic Ulcer Disease & Gastritis Treatment

A

Bismuth subsalicylate

46
Q

Major Action & Key Nursing Considerations of Bismuth subsalicylate in Peptic Ulcer Disease & Gastritis

A

Suppresses H. pylori bacteria in the gastric mucosa & assists w/ healing of mucosal ulcers

Key Nursing Considerations:
- Given concurrently w/ antibiotics to treat H.pylori infection
- Should be taken on empty stomach
- May darken BMs

47
Q

Proton Pump Inhibitors of Gastric Acid

A

Esomeprazole

Lansoprazole

Omeprazole (May cause diarrhea, N/V, constipation, abdominal pain, headache, or dizziness)

Pantoprazole (May cause diarrhea & hyperglycemia, headache, abdominal pain, & abnormal LFTs)

Rabeprazole (May cause abdominal pain, nausea, diarrhea, & headache)
- May be taken w/out regard to meals
-> In duodenal ulcers, give after meals
-> In H. pylori treatment, give w/ food
- Drug-drug interactions w/ digoxin, iron, & warfarin

48
Q

Major Action & Key Nursing Considerations of Proton Pump Inhibitors in Peptic Ulcer Disease & Gastritis

A

Decreases gastric acid secretion by slowing the H+, K+-ATPase pump on the surface of the parietal cells of the stomach

Key Nursing Considerations:
- Used mainly for the treatment of duodenal ulcer disease & H. pylori infection
- A delayed-release capsule that is to be swallowed whole & taken before meals

49
Q

Major Action & Key Nursing Considerations of Misoprostal in Peptic Ulcer Disease & Gastritis

A

Protects the gastric mucosa from agents that cause ulcers & increases mucus production & bicarb levels

Key Nursing Considerations:
- Used to prevent ulceration in pts using NSAIDs
- Used mainly for the treatment of duodenal ulcers
- Administer w/ food
- May cause diarrhea & cramping (includes uterine cramping)
- DO NOT USE IN PREGNANT WOMEN!!!!! (Category X)

50
Q

Major Action & Key Nursing Considerations of Sucralfate in Peptic Ulcer Disease & Gastritis

A

Creates a viscous substance in the presence of gastric acid that forms a protective barrier, binding to the surface of the ulcer, & prevents digestion by pepsin

Key Nursing Considerations:
- Should be taken w/out food but, taken w/ H2O 1hr before meals
- Other meds should be taken 2 hrs before/after this med
- Many drug-drug interactions (digoxin, phenytoin, warfarin)
- May cause constipation or nausea

51
Q

Triple Therapy

A

2 antibiotics and 1 proton pump inhibitor
* Antibiotics: Metronidazole, Amoxicillin, Clarithromycin

  • Proton Pump Inhibitor: Omeprazole, Lansoprazole, Rabeprazole
52
Q

Quadruple Therapy

A

2 antibiotics, 1 proton pump inhibitor, and 1 bismuth salt
* Antibiotics: Metronidazole and Tetracycline

  • Proton Pump Inhibitor: Omeprazole, Lansoprazole, Rabeprazole
  • Bismuth Salt: Pepto Bismol
53
Q

Key Difference between the Triple & Quadruple Therapy (Peptic Ulcer Disease)

A

Tetracycline
- Do NOT add to triple therapy

54
Q

What effect does smoking have on patients w/ peptic ulcer disease?

A

Decreases the secretion of bicarbonate from the pancreas, into the duodenum -> Increased acidity of the duodenum

Continued smoking is associated w/ delayed healing of peptic ulcers

55
Q

Goal of Dietary Modification in Management of Peptic Ulcer Disease

A

Avoid oversecretion of acid & hypermotility of in the GI tract

56
Q

Nursing Management of Peptic Ulcer Disease: Dietary Modification

A

Avoid consuming food/beverages w/extreme temperatures

Minimize alcohol, & caffeinated beverages ( includes de-caff coffee)

Eat 3 regular meals a day to neutralize acid
- Small, frequent feedings are NOT necessary as long as an antacid or an H2 blocker is taken

Diet compatibility becomes an individual matter: Pt eats foods that are tolerated & avoids those that produce pain

Maintain optimal nutrition: Assess for malnutrition & weight loss

57
Q

Nursing Management of Peptic Ulcer Disease: Pain Relief

A

Eat meals at regularly paced intervals in a relaxed
setting

Utilize medications prescribed to treat the ulcer

Teach relaxation techniques to help manage stress/pain

58
Q

Nursing Management of Peptic Ulcer Disease: Reduce Anxiety

A

Explain diagnostic tests & meds

Help the pt identify stressors and explain coping techniques

Encourage the family to participate in care and provide support

59
Q

Nursing Management of Peptic Ulcer Disease: Manage Potential Complications (Bleeding)

A

Bleeding is manifested by hematemesis or melena
* The vomited blood can be bright red or dark coffee ground

When hemorrhage is large (2000-3000 mL) most of the blood is vomited and immediate correction of blood loss is needed to prevent hemorrhagic shock
from happening

The nurse assess for dizziness and nausea, evaluate for tachycardia, hypotension, tachypnea, monitor H/H, and assess stool occult blood

Patients with symptoms of GI bleed should have an endoscopy within 12 hrs to confirm diagnosis
* Endoscopic interventions include injecting the bleeding site with epinephrine, cauterizing the site, or clipping the ulcer to stop the bleeding

60
Q

Perforation

A

Erosion of the ulcer through the gastric serosa into the peritoneal cavity w/out warning

THIS IS AN EMERGENCY and requires immediate surgery

Chemical peritonitis develops w/in a few hours after perforation & is treated w/ immediate closure &
abdominal lavage stomach contents

61
Q

Clinical Manifestations of Peptic Ulcer Perforation

A

Sudden, severe upper abdominal pain
- Pain may be referred to the shoulders

Vomiting

Fainting

Extremely tender/rigid (board-like) abdomen

Hypotension and tachycardia, indicating shock

62
Q

Penetration

A

Erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary
tract, or gastrohepaticomentum
- Requires surgical intervention

63
Q

Clinical Manifestations of Peptic Ulcer Disease Penetration

A

Back & epigastric pain not relieved by medications
that were effective in the past

NURS3313 Adult Health (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions