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Lewis’s Medical Surgical Nursing > Chapter 46 Problems of Ingestion, Digestion, Absoption, and Elimination Part 2 > Flashcards

Chapter 46 Problems of Ingestion, Digestion, Absoption, and Elimination Part 2 Flashcards

1
Q

What is a key component of diagnostic assessment for Peptic Ulcer Disease?

A

History and physical assessment

This includes taking a detailed medical history and conducting a physical examination.

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2
Q

Which procedure involves taking a biopsy for diagnosis of Peptic Ulcer Disease?

A

Upper Gl endoscopy

This procedure allows direct visualization of the stomach and duodenum.

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3
Q

What are the tests for H. pylori infection?

A

Breath, urine, blood, tissue testing

These tests help identify the presence of Helicobacter pylori, a common cause of ulcers.

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4
Q

Which blood tests are included in the diagnostic assessment of Peptic Ulcer Disease?

A

Complete blood cell count, liver enzymes, serum amylase

These tests help assess overall health and detect possible complications.

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5
Q

What is one of the management strategies for Peptic Ulcer Disease?

A

Adequate rest

Rest helps in the healing process of ulcers.

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6
Q

Fill in the blank: Smoking and alcohol cessation are part of _______ therapy for Peptic Ulcer Disease.

A

Conservative

Lifestyle changes are crucial in managing ulcers.

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7
Q

What type of drug therapy is used for H. pylori eradication?

A

Antibiotics

Antibiotics are prescribed to eliminate H. pylori infection.

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8
Q

Name two types of drugs used in the management of Peptic Ulcer Disease.

A

PPIs, H2-receptor blockers

These drugs reduce stomach acid production.

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9
Q

What does NPO stand for in the context of acute exacerbation management?

A

Nothing by mouth

This is a common practice during severe ulcer flare-ups.

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10
Q

What is a management step for acute exacerbation without complications?

A

NG suction

Nasogastric suction helps relieve pressure in the stomach.

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11
Q

In cases of acute exacerbation with complications, what is one potential treatment?

A

IV PPI

Intravenous proton pump inhibitors are used to manage severe symptoms.

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12
Q

What surgical procedure might be performed for gastric outlet obstruction?

A

Pyloroplasty and vagotomy

These procedures help facilitate gastric drainage.

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13
Q

True or False: Blood transfusions may be necessary in the management of acute exacerbation with complications.

A

True

Transfusions can be critical in cases of significant bleeding.

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14
Q

What is stomach lavage and when might it be used?

A

Washing out the stomach

It may be used in cases of severe bleeding or obstruction.

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15
Q

Fill in the blank: Surgical therapy may involve _______ or reduction of the ulcer.

A

Ulcer removal

This is considered when ulcers are severe or recurrent.

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16
Q

What is the role of cytoprotective drugs in Peptic Ulcer Disease management?

A

Protect the stomach lining

They help prevent further damage to the gastric mucosa.

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17
Q

What type of therapy includes stress management for Peptic Ulcer Disease?

A

Conservative Therapy

Stress management is essential as stress can exacerbate symptoms.

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18
Q

What is the effect of anticholinergic properties in drug therapy for PUD?

A

Reduced acid secretion

Anticholinergic drugs are sometimes used for PUD treatment.

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19
Q

What should patients with PUD avoid in their diet?

A

Foods that may cause gastric irritation include:
* Pepper
* Carbonated beverages
* Broth (meat extract)
* Hot, spicy foods
* Caffeine-containing beverages
* Alcohol

Alcohol can delay healing.

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20
Q

What is the most common complication of PUD?

A

GI bleeding

Duodenal ulcers cause more bleeding episodes than gastric ulcers.

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21
Q

What is the most lethal complication of PUD?

A

Perforation

The risk is highest with large penetrating duodenal ulcers.

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22
Q

What are the contents that may spill into the peritoneal cavity during perforation?

A

Contents may include:
* Air
* Saliva
* Food particles
* HCl acid
* Pepsin
* Bacteria
* Bile
* Pancreatic fluid and enzymes

The manifestations of perforation are sudden and dramatic in onset.

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23
Q

What are the initial symptoms of perforation?

A

Symptoms include:
* Sudden, severe upper abdominal pain
* Pain radiating to the back and shoulders
* Rigid and board-like abdomen
* Absence of bowel sounds
* Nausea and vomiting
* Increased and weak pulse

Food or antacids do not relieve the pain.

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24
Q

What is the immediate focus of managing a patient with perforation?

A

Stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume

An NG tube can provide continuous aspiration and gastric decompression.

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25
Q

What type of solutions are used to replace circulating blood volume in perforation management?

A

Lactated Ringer’s and albumin solutions

These substitute for the fluids lost from the vascular and interstitial space as peritonitis develops.

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26
Q

What may occur within 6 to 12 hours if a perforation is untreated?

A

Bacterial peritonitis

The intensity of peritonitis is proportional to the amount and duration of the spillage through the perforation.

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27
Q

True or False: Small perforations may spontaneously seal themselves.

A

True

Symptoms cease when spontaneous sealing occurs due to fibrin.

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28
Q

What is the drug class used for acid suppression in H. pylori infection?

A

PPI

PPI stands for Proton Pump Inhibitors.

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29
Q

Name two standard antibiotics used to treat H. pylori infection.

A
  • Amoxicillin
  • Clarithromycin

These antibiotics are commonly prescribed to combat H. pylori.

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30
Q

What is the dosage of PPI in triple therapy for H. pylori infection?

A

20-40 mg, 2 times daily

This dosage is standard for PPI in this treatment regimen.

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31
Q

What is the dosage of Amoxicillin in triple therapy for H. pylori infection?

A

1 g, 2 times daily

Amoxicillin is used at this specific dosage in triple therapy.

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32
Q

What is the dosage of Clarithromycin in triple therapy for H. pylori infection?

A

500 mg, 2 times daily

Clarithromycin is administered at this dosage in the regimen.

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33
Q

What is the dosage of Metronidazole in Bismuth Quadruple Therapy for H. pylori infection?

A

500 mg, 4 times daily

Metronidazole is utilized at this frequency in the Bismuth Quadruple Therapy.

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34
Q

What are the components of Bismuth Quadruple Therapy for H. pylori infection?

A
  • PPI
  • Bismuth compound
  • Metronidazole
  • Tetracycline

This therapy includes these four components for effective treatment.

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35
Q

What is the dosage of Bismuth compound in Bismuth Quadruple Therapy?

A

2 tablets, 2 times daily

This is the specified dosage for the Bismuth compound.

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36
Q

What is the dosage of Tetracycline in Non-Bismuth Quadruple Therapy?

A

500 mg, 3 times daily

This dosage is specific to Tetracycline in this treatment regimen.

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37
Q

Fill in the blank: The drug class used for acid suppression in H. pylori infection is _______.

A

PPI

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38
Q

True or False: Clarithromycin is used in both triple therapy and Bismuth Quadruple therapy for H. pylori infection.

A

True

Clarithromycin is a common antibiotic in both regimens.

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39
Q

What can lead to fibrinous fusion of the duodenum or gastric curvature?

A

Perforation of the stomach

This can also lead to strictures that obstruct intestinal contents and stool passage.

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40
Q

What is the recommended procedure for larger perforations?

A

Immediate surgical closure

The choice between open or laparoscopic repair depends on the ulcer’s location and HCP preference.

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41
Q

What is the least risky surgical procedure for perforation repair?

A

Simple oversewing of the perforation and reinforcement with a graft of omentum

Excess gastric contents are suctioned from the peritoneal cavity during the procedure.

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42
Q

What causes gastric outlet obstruction in PUD?

A

Edema, inflammation, pylorospasm, or fibrous scar tissue formation

Both acute and chronic PUD can lead to this obstruction.

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43
Q

What symptoms are associated with gastric outlet obstruction?

A

Discomfort or pain, belching, projectile vomiting, and constipation

Vomitus may contain food particles ingested hours or days before.

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44
Q

What is the aim of therapy for gastric outlet obstruction?

A

Decompress the stomach, correct fluid and electrolyte imbalances, and improve general health

An NG tube can be used for continuous decompression.

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45
Q

What treatments are used for active ulcers causing obstruction?

A

PPI or H2 receptor blocker

Balloon dilation may be used to open a pyloric obstruction.

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46
Q

What subjective and objective data should be obtained from a patient with PUD?

A

Pain and impaired GI function

Detailed information can be found in Table 46.15.

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47
Q

What are the overall goals for a patient with PUD?

A

Adhere to therapeutic regimen, achieve pain relief, be free from complications, have complete healing, and make lifestyle changes

These goals aim to prevent recurrence of PUD.

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48
Q

What role do healthcare providers play in preventing PUD?

A

Identify those at risk and encourage early detection and treatment

Patients on ulcerogenic drugs should take them with food.

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49
Q

What are common symptoms during an acute exacerbation of PUD?

A

Increased pain, nausea, vomiting, and potential bleeding

Many patients may cope with symptoms at home before seeking care.

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50
Q

What does the patient management during an acute phase of PUD typically include?

A

Being NPO, NG tube with intermittent suction, and IV fluid replacement

Regular mouth care and cleaning of nares are also recommended.

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51
Q

What analysis may be performed on gastric contents?

A

pH testing and analysis for blood, bile, or other substances

These tests help assess the condition of the stomach during treatment.

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52
Q

Fill in the blank: The surgical procedure that involves suctioning excess gastric contents is called _______.

A

simple oversewing of the perforation

This procedure is part of managing perforations in PUD.

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53
Q

What are important health conditions associated with Peptic Ulcer Disease?

A

Chronic kidney disease, pancreatic disease, OP, serious illness or trauma, hyperparathyroidism, cirrhosis, Zollinger-Ellison syndrome (ZES)

ZES is a condition characterized by gastrin-secreting tumors leading to excessive gastric acid production.

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54
Q

Which medications are commonly associated with Peptic Ulcer Disease?

A

Aspirin, corticosteroids, NSAIDs

These medications can irritate the gastric lining and contribute to ulcer formation.

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55
Q

What types of surgeries or treatments may be linked to Peptic Ulcer Disease?

A

Complicated or prolonged surgery

Surgical stress can increase the risk of developing ulcers, especially in vulnerable patients.

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56
Q

What lifestyle factors may affect health perception in patients with Peptic Ulcer Disease?

A

Chronic alcohol use, smoking, caffeine use, family history of PUD

These factors can exacerbate symptoms and contribute to the development of ulcers.

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57
Q

List some nutritional and metabolic symptoms of Peptic Ulcer Disease.

A

Weight loss, anorexia, nausea and vomiting, hematemesis, dyspepsia, heartburn, belching

These symptoms can significantly impact a patient’s quality of life.

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58
Q

What elimination symptom is indicative of Peptic Ulcer Disease?

A

Black, tarry stools

This symptom suggests the presence of digested blood, often from an upper gastrointestinal source.

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59
Q

What are the characteristics of duodenal ulcers?

A

Burning, midepigastric or back pain occurring 2-5 hours after meals, relieved by food; nighttime pain common

The pattern of pain is a key diagnostic feature of duodenal ulcers.

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60
Q

What are the characteristics of gastric ulcers?

A

High epigastric pain occurring 1-2 hours after meals; food may precipitate or worsen pain

This contrasts with duodenal ulcers where food typically alleviates pain.

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61
Q

What psychological symptoms may be observed in patients with Peptic Ulcer Disease?

A

Anxiety, irritability

Psychological stress can exacerbate gastrointestinal symptoms.

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62
Q

What objective data might indicate Peptic Ulcer Disease?

A

Epigastric tenderness

Tenderness in the epigastric region is a common physical examination finding.

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63
Q

What possible diagnostic findings are associated with Peptic Ulcer Disease?

A

Anemia, guaiac-positive stools, positive tests for H. pylori, abnormal upper GI endoscopic and barium studies

These diagnostic tests help confirm the presence of ulcers and underlying causes.

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64
Q

What factors determine the type and amount of IV fluids given to a patient?

A

The volume of fluid lost, the patient’s signs and symptoms, and laboratory test results (hemoglobin, hematocrit, electrolytes)

Laboratory test results are crucial in assessing the patient’s condition and guiding treatment.

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65
Q

How frequently should vital signs be taken to detect and treat shock?

A

Initially and then at least hourly

Regular monitoring is essential to identify changes in the patient’s condition.

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66
Q

What is helpful for ulcer healing?

A

Physical and emotional rest

A restful environment contributes to the healing process.

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67
Q

What might be administered to help a patient who is anxious and apprehensive?

A

A mild sedative

Care must be taken as sedatives can mask signs of shock.

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68
Q

True or False: Changes in vital signs and an increase in the amount and redness of aspirate often signal massive upper GI bleeding.

A

True

Monitoring these changes is crucial for timely intervention.

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69
Q

What should be maintained to prevent obstruction from blood clots in cases of upper GI bleeding?

A

The patency of the NG tube

A blocked tube can lead to abdominal distention.

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70
Q

What immediate action should be taken if a patient with an ulcer develops manifestations of a perforation?

A

Notify the HCP immediately

Timely communication is critical in managing potential complications.

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71
Q

What should be temporarily stopped if perforation is suspected?

A

All oral or NG drugs and feedings

Oral intake can exacerbate discomfort and complications.

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72
Q

What type of therapy will patients with confirmed perforation start on?

A

Antibiotic therapy

This is essential to prevent infection following perforation.

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73
Q

What condition can occur at any time in patients with ulcers, especially near the pylorus?

A

Gastric outlet obstruction

Symptoms typically develop gradually.

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74
Q

What can help relieve symptoms of gastric outlet obstruction?

A

Constant NG aspiration of stomach contents

This allows for edema and inflammation to subside.

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75
Q

How should the NG tube be irrigated to assist proper functioning?

A

With a normal saline solution per agency policy

Regular irrigation is important for maintaining tube patency.

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76
Q

What should be done to check for ongoing obstruction with an NG tube?

A

Clamp the NG tube intermittently and measure the gastric residual volume

This helps assess the patient’s comfort and the effectiveness of the NG tube.

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77
Q

Fill in the blank: Patients with PUD should be educated about drugs, lifestyle changes, and _______.

A

Regular follow-up care

Ongoing management is crucial for preventing complications.

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78
Q

What should patients be informed about regarding prescribed drugs for PUD?

A

Their actions, side effects, and dangers if omitted

Understanding medication is vital for adherence and safety.

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79
Q

What negative effects should patients be informed about concerning alcohol and cigarettes?

A

Their impact on PUD and ulcer healing

Education on these effects is crucial for lifestyle modifications.

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80
Q

True or False: PUD is a chronic, recurring disorder.

A

True

Patients need to be aware of the potential for complications and the need for long-term care.

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81
Q

What is the goal regarding smoking and alcohol use for patients with PUD?

A

Total cessation

While reduction may be a first step, complete cessation is ideal for healing.

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82
Q

What should patients do if they experience a return of symptoms?

A

Seek immediate intervention

Early intervention can prevent complications.

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83
Q

What should patients with Peptic Ulcer Disease avoid to prevent epigastric distress?

A

Foods that cause epigastric distress, such as acidic foods

Acidic foods can exacerbate symptoms of Peptic Ulcer Disease.

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84
Q

How does smoking affect Peptic Ulcer Disease?

A

Smoking promotes ulcer development and delays ulcer healing

Quitting smoking can significantly improve healing and prevention of ulcers.

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85
Q

What is advised regarding alcohol use for patients with Peptic Ulcer Disease?

A

Reduce or stop alcohol use

Alcohol can irritate the stomach lining and worsen ulcer symptoms.

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86
Q

Why should over-the-counter drugs be avoided unless approved by a healthcare provider?

A

Many preparations contain ingredients like aspirin, which should not be taken without approval

Aspirin can increase the risk of bleeding and irritation in the stomach.

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87
Q

What is important to check with a healthcare provider regarding NSAIDs?

A

Check with the HCP about the use of NSAIDs

NSAIDs can exacerbate ulcer symptoms and cause gastrointestinal bleeding.

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88
Q

Why should patients not interchange brands of PPI, antacids, or H2 receptor blockers?

A

This can lead to harmful side effects

Consistency in medication brands is important for effective treatment and safety.

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89
Q

What should patients do to prevent a relapse of Peptic Ulcer Disease?

A

Follow prescribed drug therapy, including antisecretory and antibiotic drugs

Adhering to medication regimens is crucial for healing and preventing recurrence.

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90
Q

What symptoms should be reported to a healthcare provider?

A
  • Increased nausea or vomiting
  • Increased epigastric pain
  • Bloody emesis or tarry stools

These symptoms may indicate complications or worsening of the ulcer condition.

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91
Q

How can stress be related to Peptic Ulcer Disease?

A

Stress can be related to PUD; learn and use stress management strategies

Managing stress is an important aspect of overall health and can help alleviate ulcer symptoms.

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92
Q

What should patients share with their healthcare provider regarding their condition?

A

Share concerns about lifestyle changes and living with a chronic illness

Open communication about lifestyle and emotional health can aid in effective management of Peptic Ulcer Disease.

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93
Q

What is the expected outcome for a patient with Peptic Ulcer Disease (PUD) regarding pain management?

A

Have pain controlled without the use of analgesics

This outcome emphasizes effective pain management strategies that do not rely on medication.

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94
Q

What lifestyle commitment is expected from a patient managing Peptic Ulcer Disease?

A

Commit to self-care and management of the disease

Self-care includes dietary changes and adherence to treatment plans.

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95
Q

What are the morbidity and mortality rates in older adults with Peptic Ulcer Disease attributed to?

A

Concurrent health problems and a decreased ability to withstand hypovolemia

This highlights the need for careful monitoring in older patients.

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96
Q

In older patients, what might be the first sign of a peptic ulcer?

A

Frank gastric bleeding or a decrease in hematocrit

Pain may not be the initial symptom in this demographic.

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97
Q

What type of cancer is stomach cancer primarily classified as?

A

Adenocarcinoma of the stomach wall

This is the most common form of stomach cancer.

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98
Q

What is the average age at diagnosis for stomach cancer?

A

68.5 years

Stomach cancer predominantly affects older adults.

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99
Q

What percentage of stomach cancer patients have disease confined to the stomach at diagnosis?

A

10% to 20%

This statistic indicates the advanced stage at which many patients are diagnosed.

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100
Q

What is the overall 5-year survival rate for all people with stomach cancer?

A

About 32%

This reflects the seriousness of the disease and its late diagnosis.

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101
Q

What are some lifestyle factors that influence the risk of stomach cancer?

A

Smoking, obesity, and diets high in smoked foods, salted fish and meat, and pickled vegetables

Healthy dietary choices can help reduce risk.

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102
Q

What role does H. pylori play in stomach cancer?

A

It may induce nonspecific mucosal injury leading to cancer

H. pylori infection is a significant risk factor for stomach cancer.

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103
Q

What are common clinical manifestations of stomach cancer?

A

Unexplained weight loss, indigestion, abdominal discomfort, anemia, and early satiety

Symptoms often appear late in the disease progression.

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104
Q

What is the best diagnostic tool for stomach cancer?

A

Upper GI endoscopy

This procedure allows for direct visualization and biopsy of stomach lesions.

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105
Q

What is the primary treatment for stomach cancer?

A

Surgical removal of the tumor

The goal is to excise the tumor along with a margin of healthy tissue.

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106
Q

What determines the type of surgery performed for stomach cancer?

A

The lesion location and the HCP’s preference

Examples include open versus laparoscopic surgery.

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107
Q

What procedures are typically done for lesions in the antrum or pyloric region?

A

Billroth I or II procedures

These procedures involve subtotal gastric resection.

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108
Q

What surgical procedure is performed when the lesion is in the fundus?

A

Total gastrectomy with esophagojejunostomy

This procedure is indicated for fundic lesions.

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109
Q

What is done if there is metastasis to adjacent organs?

A

The surgical procedure is extended as needed

This may include resection of affected organs.

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110
Q

What is the focus of preoperative management in stomach cancer?

A

Correcting nutrition deficits and treating anemia

Packed RBCs transfusions may be used to address anemia.

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111
Q

What may be necessary if gastric outlet obstruction occurs before surgery?

A

Gastric decompression

This is done to relieve symptoms before surgical intervention.

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112
Q

Name some chemotherapy drugs used to treat stomach cancer.

A
  • Fluorouracil
  • Capecitabine
  • Carboplatin
  • Cisplatin
  • Docetaxel
  • Epirubicin
  • Irinotecan
  • Oxaliplatin
  • Paclitaxel

Combination therapies often yield better outcomes.

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113
Q

What are examples of combination therapies for stomach cancer?

A
  • ECF (epirubicin, cisplatin, fluorouracil)
  • Docetaxel with irinotecan
  • Oxaliplatin with fluorouracil or capecitabine

These combinations are used to improve treatment efficacy.

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114
Q

What role does combined radiation therapy and chemotherapy play in stomach cancer treatment?

A

Reduces recurrence or provides temporary relief of obstruction

It may also reduce tumor mass.

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115
Q

What are the targeted therapies for stomach cancer mentioned?

A
  • Trastuzumab (Herceptin)
  • Ramucirumab (Cyramza)

These therapies target specific proteins involved in cancer cell growth.

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116
Q

What percentage of stomach cancer patients have excessive HER-2 protein?

A

About 20%

Trastuzumab specifically targets this protein.

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117
Q

What is the function of ramucirumab in stomach cancer treatment?

A

Binds to the receptor for VEGF and prevents its binding

This action inhibits cancer growth and spread.

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118
Q

What is assessed during the nursing management of a patient with stomach cancer?

A

Nutrition assessment, psychosocial history, and physical assessment

Understanding coping mechanisms is also crucial.

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119
Q

What common symptoms may a patient with stomach cancer experience?

A
  • Unexplained weight loss
  • Anorexia
  • Dyspepsia
  • Intestinal gas discomfort or pain

These symptoms often indicate advanced disease.

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120
Q

What is cachexia in the context of stomach cancer?

A

A syndrome characterized by severe weight loss and muscle wasting

It can occur if oral intake has been significantly reduced.

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121
Q

True or False: A malnourished patient responds well to chemotherapy or radiation therapy.

A

False

Malnourishment increases surgical risks and decreases treatment efficacy.

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122
Q

What are the key components of the diagnostic assessment for stomach cancer?

A
  • History and physical assessment
  • Endoscopy and biopsy
  • CT, MRI, PET scans
  • Upper GI barium study
  • Exfoliative cytologic study
  • Endoscopic ultrasonography
  • CBC
  • Liver enzymes
  • Urinalysis
  • Stool examination
  • Serum amylase
  • Tumor markers
  • a-Fetoprotein
  • Carbohydrate antigen (CA)-19-9, CA-125, CA 72-4
  • Carcinoembryonic antigen (CEA)

Each component plays a crucial role in diagnosing stomach cancer.

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123
Q

What are the types of surgical therapy for stomach cancer?

A
  • Subtotal gastrectomy (Billroth I or II procedure)
  • Total gastrectomy with esophagojejunostomy

Surgical options depend on the extent of the cancer and patient health.

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124
Q

What therapeutic options are included in the interprofessional care management of stomach cancer?

A
  • Surgical therapy
  • Chemotherapy
  • Radiation therapy
  • Targeted therapy

These therapies may be used alone or in combination based on individual patient needs.

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125
Q

True or False: Endoscopy and biopsy are part of the diagnostic assessment for stomach cancer.

A

True

Endoscopy allows for direct visualization and tissue sampling.

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126
Q

Fill in the blank: The tumor marker _______ is used in the diagnostic assessment for stomach cancer.

A

Carcinoembryonic antigen (CEA)

CEA is often elevated in various cancers, including stomach cancer.

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127
Q

What imaging studies are used in the diagnostic assessment of stomach cancer?

A
  • CT scans
  • MRI scans
  • PET scans
  • Upper GI barium study

These imaging studies help in assessing the extent of the disease.

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128
Q

What is the anatomic structure of the stomach?

A

Normal anatomic structure of the stomach includes the esophagus, pylorus, and jejunum.

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129
Q

What is total gastrectomy?

A

Total gastrectomy is the removal of the stomach.

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130
Q

What is esophagojejunostomy?

A

Esophagojejunostomy is the anastomosis of the esophagus with the jejunum.

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131
Q

What are the clinical problems associated with stomach cancer?

A
  • Nutritionally compromised
  • Pain
  • Impaired GI function
  • Difficulty coping
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132
Q

What are the overall goals for a patient with stomach cancer?

A
  • Minimal discomfort
  • Optimal nutrition status
  • Maintain spiritual and psychological well-being
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133
Q

What is the role of health promotion in early detection of stomach cancer?

A

Identifying patients at risk due to H. pylori infection, pernicious anemia, and achlorhydria.

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134
Q

What symptoms should be monitored for stomach cancer?

A

Symptoms often occur late and can mimic other conditions, such as PUD.

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135
Q

True or False: Patients with a positive family history of stomach cancer should undergo diagnostic evaluation if they present with anemia.

A

True

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136
Q

What emotional reactions may patients and families experience upon cancer diagnosis?

A
  • Shock
  • Disbelief
  • Depression
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137
Q

What dietary adjustments may be necessary for patients with stomach cancer?

A

Patients may tolerate several small meals a day better than three regular meals.

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138
Q

What nutritional support may be provided if a patient cannot ingest oral feedings?

A

Enteral nutrition (EN) or parenteral nutrition (PN) may be prescribed.

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139
Q

What therapies are used as an adjuvant to surgery for stomach cancer?

A
  • Radiation therapy
  • Chemotherapy
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140
Q

What should be taught to patients undergoing chemotherapy and radiation therapy?

A
  • Skin care
  • Nutrition and fluid intake
  • Use of antiemetic drugs
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141
Q

What is the role of home health care after discharge for cancer patients?

A

To help with recovery and provide support to the patient and caregiver.

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142
Q

What are the expected outcomes for a patient with stomach cancer?

A
  • Minimal discomfort, pain, or nausea
  • Optimal nutrition status
  • Degree of psychological well-being appropriate to disease stage
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143
Q

What are gastrointestinal stromal tumors (GISTs)?

A

GISTs are a rare cancer originating in cells in the wall of the GI tract.

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144
Q

What are interstitial cells of Cajal?

A

Cells that help control the movement of food and liquid through the stomach and intestines.

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145
Q

Where are most GISTs located?

A

About 60% in the stomach, 30% in the small intestine, and the rest in the esophagus, colon, or peritoneum.

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146
Q

What age group is most affected by GISTs?

A

People between the ages of 50 and 70.

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147
Q

What likely plays a role in the cause of GISTs?

A

Genetic mutations.

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148
Q

Which genetic mutations are associated with some GISTs?

A
  • KIT
  • PDGFRa
  • Neurofibromatosis type 1
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149
Q

What are early manifestations of GISTs?

A
  • Early satiety
  • Fatigue
  • Bloating
  • Nausea or vomiting
  • Change in bowel habits
150
Q

Why is early detection of GISTs difficult?

A

Early manifestations are often subtle and similar to many other GI problems.

151
Q

What later manifestations may occur with GISTs?

A
  • GI bleeding
  • Obstruction caused by larger tumors
152
Q

How are GISTs often discovered?

A

During imaging for other problems.

153
Q

What is the basis for the diagnosis of GISTs?

A

Histologic examination of biopsied tissue.

154
Q

What imaging techniques are used to determine the extent of GIST disease?

A
  • Endoscopic ultrasound
  • CT
  • MRI
155
Q

What offers the only permanent cure for GISTs?

156
Q

Are GISTs responsive to conventional chemotherapy?

A

No, they are unresponsive.

157
Q

What types of drugs are effective against some GISTs?

A

Tyrosine kinase inhibitor drugs, such as imatinib mesylate, sunitinib, and regorafenib.

158
Q

What occurs when gastric chyme enters the small intestine after surgery?

A

A large bolus of hypertonic fluid enters the intestine, drawing fluid into the bowel lumen.

159
Q

What symptoms may occur after gastric surgery within 15 to 30 minutes after eating?

A
  • Generalized weakness
  • Sweating
  • Palpitations
  • Dizziness
160
Q

What condition is characterized by symptoms due to a sudden decrease in plasma volume?

A

Dumping syndrome.

161
Q

What is postprandial hypoglycemia a variant of?

A

Dumping syndrome.

162
Q

What causes postprandial hypoglycemia?

A

Uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine.

163
Q

What are the symptoms of postprandial hypoglycemia?

A
  • Sweating
  • Weakness
  • Mental confusion
  • Palpitations
  • Tachycardia
  • Anxiety
164
Q

What surgeries are performed to treat stomach conditions?

A
  • Partial gastrectomy
  • Gastrectomy
  • Vagotomy
  • Pyloroplasty
165
Q

What can result from gastric surgery involving the pylorus?

A

Reflux of bile into the stomach.

166
Q

What is the main symptom of bile reflux gastritis?

A

Continuous epigastric distress that increases after meals.

167
Q

What is cholestyramine used for in gastric surgery patients?

A

To bind with bile salts that are the source of gastric irritation.

168
Q

What does vagotomy do?

A

Decreases gastric acid secretion.

169
Q

What does pyloroplasty promote?

A

The easy passage of contents from the stomach.

170
Q

What are common long-term postoperative complications from gastric surgery?

A
  • Dumping syndrome
  • Postprandial hypoglycemia
  • Bile reflux gastritis
171
Q

What does postoperative care focus on after gastric surgery?

A
  • Maintaining fluid and electrolyte balance
  • Preventing respiratory complications
  • Maintaining comfort
  • Preventing infection
172
Q

What are common complications after surgery?

A

Complications include:
* atelectasis
* pneumonia
* anastomotic leak
* deep vein thrombosis
* pulmonary embolus
* bleeding

Morbidly obese patients have a higher risk for complications.

173
Q

What is the purpose of an NG tube after surgery?

A

The NG tube is used for decompression to decrease pressure on suture lines and allow edema and inflammation to resolve.

174
Q

What should be observed in the gastric aspirate?

A

Observe for color, amount, and odor.

175
Q

What is expected from the NG tube drainage in the first 2 to 3 hours post-surgery?

A

Small volumes of bloody drainage.

176
Q

When should bright red bleeding be reported to the HCP?

A

If it does not decrease after 2 to 3 hours or becomes excessive (more than 75 mL/hr).

177
Q

What color should the NG aspirate change to within 24 hours after surgery?

A

The aspirate should gradually darken and normally change to yellow-green within 36 to 48 hours.

178
Q

Why does the NG tube not drain a large quantity of secretions after total gastrectomy?

A

Removing the stomach eliminates the reservoir capacity.

179
Q

What should be done if the NG tube stops draining or appears obstructed?

A

Notify the HCP immediately.

180
Q

What can happen if accumulated gastric secretions are not drained?

A

It can lead to:
* rupture of the sutures
* leakage of gastric contents
* bleeding
* abscess formation.

181
Q

Who should replace or reposition the NG tube?

A

The HCP should perform this task.

182
Q

What therapy should be maintained while the NG tube is connected to suction?

A

IV therapy.

183
Q

What is the purpose of beginning clear liquids before removing the NG tube?

A

To determine the patient’s tolerance level.

184
Q

What should be monitored for after surgery to detect an anastomotic leak?

A

Signs include tachycardia, dyspnea, fever, abdominal pain, anxiety, and restlessness.

185
Q

True or False: Most procedures are done laparoscopically, which reduces respiratory complications.

186
Q

What should be performed to assess for respiratory complications in open surgical approaches?

A

A respiratory assessment.

187
Q

What signs should be noted to identify pneumothorax?

A

Signs include dyspnea, chest pain, and cyanosis.

188
Q

What technique can help protect the abdominal suture line during deep breathing and coughing?

A

Splinting with a pillow.

189
Q

What should be monitored in abdominal wounds?

A

Monitor the amount and type of drainage, condition of the incision, and signs of infection.

190
Q

What is essential to control in the postoperative period?

A

Nausea and vomiting.

191
Q

What long-term complications may patients experience after surgery?

A

Complications may include:
* malnutrition
* metabolic bone disease
* anemia
* weight loss.

192
Q

What is the role of nutrition interventions post-surgery?

A

To minimize complications and maximize nutrient intake.

193
Q

What is a potential issue for patients who were malnourished preoperatively?

A

A small bowel feeding tube may be placed during surgery.

194
Q

Fill in the blank: Pernicious anemia is a long-term complication of _______.

A

[total gastrectomy].

195
Q

What is the purpose of following dietary restrictions after a gastrectomy?

A

To slow the rapid passage of food into the intestine and control symptoms of dumping syndrome

Symptoms of dumping syndrome include dizziness, sense of fullness, diarrhea, and tachycardia.

196
Q

How many small feedings should meals be divided into after a gastrectomy?

A

6 small feedings

This approach helps avoid overloading the stomach and intestine.

197
Q

When should fluids be consumed in relation to meals?

A

At least 30-45 minutes before or after meals

This practice helps prevent distention or a feeling of fullness.

198
Q

What types of foods should be avoided to prevent symptoms of dumping syndrome?

A

Concentrated sweets such as:
* honey
* sugar
* jelly
* jam
* candies
* pastries
* sweetened fruit

These foods can cause dizziness, diarrhea, and a sense of fullness.

199
Q

What is the recommendation for protein consumption after a gastrectomy?

A

Protein consumption is unlimited

This helps promote the rebuilding of body tissues.

200
Q

What should be done with milk and milk products after surgery?

A

Introduce them slowly several weeks after surgery

Milk contains lactose, which may be hard to digest.

201
Q

What types of beverages and foods should be avoided to prevent gastric distention?

A

Carbonated beverages and gas-forming foods

These can contribute to discomfort and gastric distention.

202
Q

What types of foods are allowed a few weeks after surgery?

A

Low-roughage and raw foods as tolerated

These can be gradually reintroduced based on tolerance.

203
Q

What should be increased in the diet to meet energy needs after a gastrectomy?

A

Complex carbohydrates and fats

Examples include bread, vegetables, rice, and potatoes.

204
Q

What is intrinsic factor and why is it important?

A

Intrinsic factor is made by the parietal cells and is essential for the absorption of cobalamin in the terminal ileum.

Cobalamin is crucial for red blood cell (RBC) growth and maturation.

205
Q

What dietary supplements should patients take for life after partial gastrectomy?

A

Patients should take multivitamins with:
* folate
* calcium
* vitamin D
* iron

These supplements help compensate for nutritional deficiencies.

206
Q

What dietary changes should be made after partial gastrectomy?

A

Patients must reduce meal size and consume:
* soft, bland foods
* low fiber
* high complex carbohydrates
* protein

They should avoid simple sugars, lactose, and fried foods.

207
Q

What should patients avoid doing while eating after surgery?

A

Patients should avoid drinking fluids with meals and eating large portions.

This helps prevent discomfort and digestive issues.

208
Q

How can patients avoid hypoglycemic episodes after surgery?

A

Patients should:
* limit sugar intake with each meal
* eat small, frequent meals
* include moderate amounts of protein and fat

Immediate intake of sugared fluids or candy can relieve hypoglycemic symptoms.

209
Q

What type of care might patients need after a total gastrectomy?

A

Patients may need skilled care for symptom management and pain relief.

This includes teaching wound care and collaborating with dietitians for nutritional guidance.

210
Q

What is gastritis?

A

Gastritis is an inflammation of the gastric mucosa, which can be acute or chronic, and diffuse or localized.

It is a common problem affecting the stomach.

211
Q

What causes gastritis?

A

Gastritis occurs due to a breakdown in the normal gastric mucosal barrier, allowing HCl acid and pepsin to diffuse back into the mucosa.

This results in tissue edema and possible bleeding.

212
Q

What are some risk factors for drug-related gastritis?

A

Risk factors include:
* Being female
* Being over age 60
* History of ulcer disease
* Taking anticoagulants, LDA, or corticosteroids
* Having chronic disorders like CVD

NSAIDs and corticosteroids inhibit prostaglandin synthesis, increasing mucosal injury risk.

213
Q

How can diet contribute to gastritis?

A

Diet indiscretions, such as binge drinking alcohol or consuming large quantities of spicy foods, can cause acute gastritis.

Prolonged alcohol use can lead to chronic gastritis.

214
Q

What role does Helicobacter pylori play in gastritis?

A

H. pylori infection causes acute gastritis in most infected persons and may lead to chronic gastritis and stomach cancer.

Prolonged inflammation from H. pylori can cause functional changes in the stomach.

215
Q

What are other potential causes of chronic gastritis?

A

Other causes include:
* Bacterial, viral, and fungal infections
* Reflux of bile salts from the duodenum
* Prolonged vomiting
* Intense emotional responses
* CNS lesions

These factors can cause inflammation of the mucosal lining.

216
Q

What is autoimmune gastritis?

A

Autoimmune metaplastic atrophic gastritis is an inherited condition where the immune response targets parietal cells.

It often affects women of northern European descent and is associated with other autoimmune disorders.

217
Q

What is the consequence of losing parietal cells in autoimmune gastritis?

A

Loss of parietal cells leads to low chloride levels and inadequate production of intrinsic factor.

This can result in cobalamin malabsorption.

218
Q

What are some environmental factors that can cause gastritis?

A

• Radiation
• Smoking

Environmental factors play a significant role in the development of gastritis.

219
Q

Name a drug that is known to cause gastritis.

A

Aspirin

Aspirin is a common nonsteroidal anti-inflammatory drug (NSAID) that can irritate the gastric lining.

220
Q

What dietary factors can contribute to gastritis?

A

• Alcohol
• Large amounts of spicy, irritating foods

Certain foods and beverages can exacerbate gastric irritation.

221
Q

List two diseases or disorders that can lead to gastritis.

A

• Crohn disease
• Renal failure

Various medical conditions can influence the development of gastritis.

222
Q

Which microorganism is most commonly associated with gastritis?

A

H. pylori

Helicobacter pylori is a bacterium that is a common cause of chronic gastritis.

223
Q

What is a non-microbial factor that may cause gastritis?

A

Endoscopy procedures

Certain medical procedures can lead to irritation of the gastric mucosa.

224
Q

Fill in the blank: _______ can cause gastritis due to its irritating properties.

A

Alcohol

Alcohol consumption can lead to inflammation of the gastric lining.

225
Q

True or False: Stress is a known factor that can contribute to gastritis.

A

True

Psychological and physical stress can exacerbate gastric inflammation.

226
Q

What are some common drugs that can lead to gastritis?

A

• Nonsteroidal antiinflammatory drugs (NSAIDs)
• Corticosteroids
• Digitalis

Many medications can irritate the stomach lining and lead to gastritis.

227
Q

Which of the following is NOT a cause of gastritis: Sepsis, Heart Disease, Shock?

A

Heart Disease

Sepsis and shock are conditions that can lead to gastritis due to physiological stress on the body.

228
Q

Name one microorganism other than H. pylori that can cause gastritis.

A

Cytomegalovirus

Various viral and bacterial infections can contribute to gastritis.

229
Q

What is intrinsic factor essential for?

A

Cobalamin (vitamin B12) absorption

Lack of intrinsic factor can lead to pernicious anemia.

230
Q

What are the clinical manifestations of acute gastritis?

A
  • Anorexia
  • Nausea and vomiting
  • Epigastric tenderness
  • Feeling of fullness
  • GI bleeding

GI bleeding is often associated with alcohol use and can be the only symptom.

231
Q

How long does acute gastritis typically last?

A

A few hours to a few days

Acute gastritis is self-limiting.

232
Q

What may be a symptom of chronic gastritis?

A

Asymptomatic in some patients

When parietal cells are lost due to atrophy, intrinsic factor is also lost.

233
Q

What diagnostic studies are used for acute gastritis?

A
  • Patient’s symptoms
  • Presence of risk factors
  • Endoscopic examination with biopsy
  • Tests for H. pylori infection
  • CBC for anemia

A tissue biopsy can rule out gastric cancer.

234
Q

What is the main treatment approach for acute gastritis?

A

Eliminating the cause and supportive care

If vomiting is present, rest, NPO status, and IV fluids may be prescribed.

235
Q

What should be monitored in cases of severe acute gastritis?

A

Vital signs and vomitus for blood

Management strategies for upper GI bleeding apply to severe gastritis.

236
Q

What types of medications are used for drug therapy in acute gastritis?

A
  • H2 receptor blockers (e.g., cimetidine)
  • PPIs (e.g., omeprazole)

These reduce gastric HCl acid secretion.

237
Q

What is the treatment focus for chronic gastritis?

A

Evaluating and eliminating the specific cause

This can include cessation of alcohol or drug use.

238
Q

What dietary changes might help patients with chronic gastritis?

A

Nonirritating diet with 6 small feedings a day

Smoking is contraindicated in all forms of gastritis.

239
Q

What is the incidence of acute upper GI bleeding in the U.S.?

A

103 cases per 100,000 adults per year

The mortality rate in hospital admitted patients is 14%.

240
Q

What type of bleeding is characterized by bright red blood?

A

Arterial source bleeding

This indicates that the blood has not been in contact with gastric HCl acid.

241
Q

What are common causes of upper GI bleeding?

A
  • Peptic ulcers
  • H. pylori infection
  • NSAID use

About 25% of people on chronic NSAIDs may develop ulcers.

242
Q

What does melena indicate in relation to upper GI bleeding?

A

Slow bleeding from an upper GI source

The longer blood passes through the intestines, the darker the stool color.

243
Q

What percentage of patients with disease will experience bleeding?

A

2% to 4%

This statistic highlights the prevalence of bleeding among patients with various diseases.

244
Q

What is Stress-related mucosal disease (SRMD)?

A

Mucosal damage in the GI tract associated with serious illness

Damage can range from small lesions to major bleeding, often occurring in critically ill patients.

245
Q

Who is at highest risk for SRMD?

A

Patients with coagulopathy, liver disease, organ failure, and those receiving renal replacement therapy

These conditions increase vulnerability to mucosal damage.

246
Q

What are common causes of esophageal bleeding?

A

Chronic esophagitis, Mallory-Weiss tear, esophageal varices

Chronic esophagitis can be caused by GERD, smoking, alcohol use, and irritant drugs.

247
Q

What is the primary diagnostic tool for UGI bleeding?

A

Endoscopy

Endoscopy helps identify sources like esophageal varices, PUD, and gastritis.

248
Q

When is angiography used in the context of UGI bleeding?

A

When endoscopy cannot be performed or bleeding persists after endoscopic therapy

Angiography involves inserting a catheter to locate the site of bleeding.

249
Q

What laboratory studies are included in the assessment of UGI bleeding?

A

CBC, BUN, serum electrolytes, prothrombin time, partial thromboplastin time, liver enzymes, ABGs, type and crossmatch

These tests help evaluate the patient’s condition and need for transfusion.

250
Q

What does an increased BUN level indicate?

A

Increased protein breakdown by bacteria or renal hypoperfusion/renal disease

Elevated BUN levels can reflect several underlying conditions.

251
Q

What is classified as a massive UGI hemorrhage?

A

Loss of more than 1500 mL of blood or 25% of intravascular blood volume

Massive hemorrhage requires immediate identification of the cause and treatment.

252
Q

What are signs and symptoms of shock to assess in an emergency?

A

Tachycardia, weak pulse, hypotension, cool extremities, prolonged capillary refill, apprehension

Identifying these signs is crucial for early intervention.

253
Q

How is urine output monitored in patients with UGI bleeding?

A

Through an indwelling urinary catheter for hourly output assessment

Urine output is a key indicator of vital organ perfusion.

254
Q

What fluids are typically used for volume replacement in massive hemorrhage?

A

Whole blood, packed RBCs, fresh frozen plasma

These fluids help restore blood volume in critical situations.

255
Q

What is the first-line management for UGI bleeding?

A

Endoscopy within the first 24 hours

Timely endoscopy is essential for diagnosis and treatment.

256
Q

What are the techniques used for endoscopic hemostasis?

A

Mechanical therapy, thermal ablation, injection

Techniques include clips, bands, cauterization, and epinephrine injection.

257
Q

What is the goal of endoscopic hemostasis?

A

To coagulate or thrombose the bleeding vessel

Effective hemostasis is critical to manage UGI bleeding.

258
Q

What is a common cause of upper GI bleeding related to drug use?

A

Drug-induced

Common drugs include NSAIDs and salicylates.

259
Q

Name two conditions that can cause upper GI bleeding in the esophagus.

A
  • Esophageal varices
  • Esophagitis

Esophageal varices are often associated with liver disease.

260
Q

What is a Mallory-Weiss tear?

A

A tear in the esophagus caused by severe vomiting or retching

This condition can lead to upper GI bleeding.

261
Q

List three medications that can cause upper GI bleeding.

A
  • Corticosteroids
  • NSAIDs
  • Salicylates

These medications can irritate the gastrointestinal tract.

262
Q

What is erosive gastritis?

A

Inflammation and erosion of the stomach lining

It can lead to upper GI bleeding.

263
Q

What does PUD stand for?

A

Peptic Ulcer Disease

PUD can result in upper GI bleeding.

264
Q

True or False: Stress-related mucosal disease can cause upper GI bleeding.

A

True

It is often seen in critically ill patients.

265
Q

Name a systemic disease that can lead to upper GI bleeding.

A
  • Blood dyscrasias (e.g., leukemia, aplastic anemia)
  • Renal failure
  • Stomach cancer

These conditions can affect the blood and gastrointestinal health.

266
Q

Fill in the blank: Upper GI bleeding can occur due to _______ in the stomach.

A

[Stomach cancer]

Stomach cancer can lead to significant bleeding.

267
Q

What are polyps in the context of upper GI bleeding?

A

Abnormal growths on the stomach lining or gastrointestinal tract

Polyps can sometimes bleed and cause upper GI bleeding.

268
Q

What are some strategies for managing variceal bleeding?

A

Variceal ligation, injection sclerotherapy, balloon tamponade

These strategies are detailed in Chapter 48.

269
Q

When is surgical intervention needed for UGI bleeding?

A

When bleeding continues despite therapy and there is an identified site of bleeding

Surgery may be necessary if the patient continues to bleed after rapid transfusion of up to 2000 ml of whole blood or is still in shock after 24 hours.

270
Q

How do mortality rates relate to age in patients with UGI bleeding?

A

Mortality rates increase greatly in older patients.

271
Q

What is the purpose of drug therapy during the acute phase of UGI bleeding?

A

To decrease bleeding, decrease HCl acid secretion, and neutralize HCl acid.

272
Q

What type of therapy is often started before endoscopy in acute UGI bleeding?

A

Empiric PPI therapy with high-dose IV bolus and subsequent infusion.

273
Q

Why is it important to reduce acid secretion during UGI bleeding?

A

Because the acidic environment can alter platelet function and interfere with clot stabilization.

274
Q

What may be done if the pH of stomach contents is less than 5?

A

Intermittent suction may be used or the frequency or dosage of the antacid or antisecretory agent increased.

275
Q

What essential assessment should be performed for a patient with UGI bleeding?

A

Immediate assessment of consciousness, vital signs, skin color, and capillary refill.

276
Q

What are signs and symptoms of shock from blood loss?

A

Low BP, rapid weak pulse, increased thirst, cold clammy skin, restlessness.

277
Q

How often should vital signs be monitored in a patient with UGI bleeding?

A

Every 15 to 30 minutes.

278
Q

What are some clinical problems associated with UGI bleeding?

A
  • Fluid imbalance
  • Inadequate tissue perfusion
  • Impaired GI function
279
Q

What are the overall goals for a patient with UGI bleeding?

A
  1. No further GI bleeding
  2. Cause of bleeding identified and treated
  3. Return to normal hemodynamic stability.
280
Q

Fill in the blank: A thorough assessment is essential when caring for a patient with _______.

A

UGI bleeding

281
Q

What subjective and objective data should be gathered from a patient with UGI bleeding?

A

History of bleeding episodes, blood transfusion history, transfusion reactions, other illnesses, medications, religious preferences regarding blood products.

282
Q

What health history information is important before a bleeding episode?

A

Precipitating events before bleeding episode, prior bleeding episodes and treatment, PUD, esophageal varices, esophagitis, acute and chronic gastritis, stress-related mucosal disease

PUD refers to peptic ulcer disease, which is a significant risk factor for upper gastrointestinal bleeding.

283
Q

Which medications are associated with upper gastrointestinal bleeding?

A

Aspirin, NSAIDs, corticosteroids, anticoagulants

These medications can increase the risk of bleeding due to their effects on the gastric mucosa or coagulation.

284
Q

What functional health patterns may indicate upper gastrointestinal bleeding?

A

Family history of bleeding, smoking, alcohol use, nausea, vomiting, weight loss, thirst, diarrhea, black tarry stools, decreased urine output, sweating, weakness, dizziness, fainting, epigastric pain, abdominal cramps, acute or chronic stress

These patterns reflect both physical symptoms and lifestyle factors that could contribute to the risk of bleeding.

285
Q

What are some general objective data findings in a patient with upper gastrointestinal bleeding?

A

Fever

Fever may indicate an underlying infection or inflammatory process.

286
Q

What cardiovascular signs may indicate upper gastrointestinal bleeding?

A

Tachycardia, weak pulse, orthostatic hypotension, slow capillary refill

These signs can reflect hypovolemia due to blood loss.

287
Q

What gastrointestinal signs are indicative of upper gastrointestinal bleeding?

A

Red or coffee-grounds vomitus, tense rigid abdomen, ascites, hypoactive or hyperactive bowel sounds, black tarry stools

The appearance of vomitus and stools can help differentiate between upper and lower GI bleeding.

288
Q

What neurologic signs may be observed in a patient with upper gastrointestinal bleeding?

A

Agitation, restlessness, decreasing level of consciousness

These symptoms may result from decreased perfusion or significant blood loss.

289
Q

What respiratory signs may indicate complications from upper gastrointestinal bleeding?

A

Rapid, shallow respirations

This may occur due to hypoxia or anxiety related to the bleeding.

290
Q

What skin findings may be present in a patient with upper gastrointestinal bleeding?

A

Clammy, cool, pale skin; pale mucous membranes, nail beds, and conjunctivae; spider angiomas; jaundice; peripheral edema

These findings can indicate shock, liver disease, or significant blood loss.

291
Q

What urinary signs may suggest upper gastrointestinal bleeding?

A

Decreased urine output, concentrated urine

These signs may reflect renal perfusion issues due to hypovolemia.

292
Q

What possible diagnostic findings are associated with upper gastrointestinal bleeding?

A

Hematocrit and hemoglobin levels, hematuria, guaiac-positive stools, endoscopy results, levels of clotting factors, liver enzymes abnormal

These tests help assess the severity of bleeding and identify possible sources.

293
Q

What patients are at high risk for GI bleeding?

A

Patients with a history of chronic gastritis, cirrhosis, or PUD.

PUD stands for Peptic Ulcer Disease.

294
Q

What should patients taking anticoagulants be aware of?

A

They are at risk for GI bleeding, especially those over 60 years old with a history of PUD.

295
Q

What types of medications can cause GI toxicity?

A
  • Corticosteroids
  • NSAIDs

NSAIDs are non-steroidal anti-inflammatory drugs.

296
Q

How can patients reduce irritation from GI toxic drugs?

A

By taking these drugs with meals or snacks.

297
Q

What substances should at-risk patients avoid?

A
  • Alcohol
  • Smoking
  • OTC drugs with aspirin

OTC stands for over-the-counter.

298
Q

What is a key teaching point regarding occult blood testing?

A

Patients should report positive results promptly to the HCP.

299
Q

Why is it important to treat upper respiratory tract infections promptly in at-risk patients?

A

Severe coughing or sneezing can increase pressure on fragile varices and may result in massive hemorrhage.

300
Q

What patient conditions increase the risk for GI bleeding?

A
  • Blood dyscrasias (e.g., aplastic anemia)
  • Liver problems
  • Chemotherapy drugs

These conditions decrease clotting factors and platelets.

301
Q

What is the initial management step in acute GI bleeding?

A

Place IV lines, preferably 2, with a 16- or 18-gauge needle.

302
Q

Why is monitoring intake and output essential in acute care?

A

To assess the patient’s hydration status.

303
Q

What vital signs should be closely monitored in patients with CVD?

A

Heart rate and rhythm due to the risk of dysrhythmias.

304
Q

What should be observed in older adults or patients with CVD during IV fluid administration?

A

Signs of fluid overload and pulmonary edema.

305
Q

What is the purpose of gastric lavage in acute GI bleeding?

A

To clear the stomach of blood, although its effectiveness is questionable.

306
Q

What symptoms indicate the onset of delirium tremens during alcohol withdrawal?

A
  • Agitation
  • Uncontrolled shaking
  • Sweating
  • Hallucinations
307
Q

When beginning oral intake after GI bleeding, what should be monitored?

A

Symptoms of nausea, vomiting, and recurrence of bleeding.

308
Q

What should patients and caregivers be taught to avoid future bleeding episodes?

A

Adhere to drug therapy and avoid drugs that can cause bleeding.

309
Q

Fill in the blank: Patients should not take any drugs, especially _______.

311
Q

What should be assessed first if the patient is unresponsive?

A

Circulation, airway, and breathing

This is critical in emergency management to ensure patient safety.

312
Q

List the initial findings associated with acute gastrointestinal bleeding.

A
  • Abdominal pain
  • Abdominal rigidity
  • Hematemesis
  • Melena
  • Nausea

These findings are important for diagnosis and management.

313
Q

What is the first intervention for a responsive patient with abdominal issues?

A

Monitor airway, breathing, and circulation

Continuous monitoring is essential for patient stability.

314
Q

What is a key sign of hypovolemic shock?

A

Cool, clammy skin

This indicates decreased perfusion and requires immediate action.

315
Q

What is the appropriate urine output threshold indicating potential shock?

A

<0.5 mL/kg/hr

This is a critical measurement in assessing kidney perfusion.

316
Q

Fill in the blank: Establish ______ access with a large-bore catheter.

A

IV

IV access is crucial for fluid replacement therapy.

317
Q

What type of oxygen delivery method should be used for patients in hypovolemic shock?

A

Nasal cannula or nonrebreather mask

Adequate oxygenation is vital in managing shock.

318
Q

What should be monitored ongoing in a patient with acute gastrointestinal bleeding?

A
  • Vital signs
  • Level of consciousness
  • O2 saturation
  • ECG
  • Bowel sounds
  • Intake/output

These parameters help assess the patient’s condition continuously.

319
Q

What is the purpose of giving IV PPI therapy?

A

To decrease acid secretion

This helps manage gastrointestinal bleeding and protect the mucosa.

320
Q

What should be done if shock is present in a patient with gastrointestinal bleeding?

A

Insert a second large-bore catheter

This allows for more effective fluid resuscitation.

321
Q

True or False: Patients should be kept NPO during ongoing monitoring.

A

True

This prevents complications such as aspiration.

322
Q

What emotional support should be provided to patients and caregivers?

A

Reassurance and emotional support

This is essential for patient and caregiver well-being during a crisis.

324
Q

What toxin causes botulism?

A

Toxin from Clostridium botulinum

Ingested toxin is absorbed from the gut and blocks acetylcholine at the neuromuscular junction.

325
Q

What is the most common source of Clostridial bacterial food poisoning?

A

Improperly canned or preserved food, home-preserved vegetables

Also includes preserved fruits and fish, canned commercial products.

326
Q

What is the onset time for symptoms of botulism?

A

12-36 hours

Symptoms include nausea, vomiting, abdominal pain, and neurological issues.

327
Q

What are the manifestations of E. coli 0157:H7 infection?

A

Bloody stools, hemolytic uremic syndrome, abdominal cramping, profuse diarrhea

Onset varies by strain, ranging from 8 hours to 1 week.

328
Q

What are common sources of Staphylococcal food poisoning?

A

Meat, bakery products, cream fillings, salad dressings, milk

Contaminated by the skin and respiratory tract of food handlers.

329
Q

What is the treatment for botulism?

A

Maintain ventilation, polyvalent antitoxin, guanidine hydrochloric acid

Guanidine hydrochloric acid enhances acetylcholine release.

330
Q

What preventative measure can be taken against botulism?

A

Correct processing of canned foods, boiling of suspected canned foods for 15 minutes before serving

This helps eliminate the risk of toxin ingestion.

331
Q

What is a common symptom of Salmonella infection?

A

Nausea and vomiting, diarrhea, abdominal cramps, fever, and chills

Onset can range from 30 minutes to 7 hours.

332
Q

What is the treatment for Salmonella infection?

A

Symptomatic, fluid and electrolyte replacement

Focuses on alleviating symptoms and preventing dehydration.

333
Q

Fill in the blank: Symptoms of Clostridial food poisoning typically onset within _______.

A

8-24 hours

334
Q

What is the primary prevention method for Staphylococcal food poisoning?

A

Immediate food refrigeration, monitoring food handling

Helps prevent bacterial growth and toxin production.

335
Q

What is the onset time for symptoms of E. coli 0157:H7?

A

8 hours to 1 week

This variability depends on the specific strain of E. coli.

336
Q

What are the gastrointestinal manifestations of botulism?

A

Nausea, vomiting, abdominal pain, constipation, distention

These symptoms indicate a serious condition requiring immediate attention.

338
Q

What is a nonspecific term that describes acute GI symptoms caused by contaminated food or liquids?

A

Foodborne illness (food poisoning)

Foodborne illness includes symptoms such as nausea, vomiting, diarrhea, and abdominal pain.

339
Q

How many Americans get a foodborne illness each year?

A

1 in 6 Americans, or 48 million people

This statistic highlights the prevalence of foodborne illnesses in the United States.

340
Q

What are the hospitalization and death statistics associated with foodborne illness?

A

128,000 hospitalized and around 3000 die

These figures indicate the serious health risks posed by foodborne illnesses.

341
Q

What accounts for most foodborne illnesses?

A

Bacteria

Bacteria are the primary cause of foodborne illnesses, often originating from raw foods.

342
Q

What is the most common source of bacterial food contamination?

A

Raw foods that become contaminated during growing, harvesting, processing, storing, shipping, or final preparation

Contamination can occur at any stage of food handling.

343
Q

At what temperature range do bacteria multiply quickly?

A

Between 40°F and 140°F

This temperature range is known as the ‘danger zone’ for food safety.

344
Q

What should be emphasized for hospitalized patients suffering from foodborne illness?

A

Correcting fluid and electrolyte imbalances from diarrhea and vomiting

Fluid and electrolyte management is crucial in the treatment of foodborne illnesses.

345
Q

Fill in the blank: Each year, _______ Americans get a foodborne illness.

A

48 million

This statistic underscores the widespread impact of foodborne illnesses.

346
Q

What interventions should focus on preventing infection related to foodborne illness?

A

Teaching correct food preparation and cleanliness, adequate cooking, and refrigeration

These practices help reduce the risk of foodborne illnesses.

347
Q

What are the expected outcomes for a patient with UGI bleeding?

A
  • Be free from UGI bleeding
  • Maintain normal fluid volume
  • Understand potential risk factors and make lifestyle modifications

These outcomes guide the evaluation of care for patients with UGI bleeding.

348
Q

What support should be given to patients regarding smoking and alcohol?

A

Support the patient in smoking and alcohol cessation

Cessation of smoking and alcohol can reduce the risk of complications related to UGI bleeding.

349
Q

True or False: Long-term follow-up care may be needed for patients with UGI bleeding due to possible recurrence.

A

True

Monitoring for recurrence is an important aspect of patient care.

350
Q

What should patients and caregivers be taught regarding acute bleeding?

A

What to do if acute bleeding occurs in the future

Education on emergency responses can be critical for patient safety.

352
Q

What is the primary characteristic of Escherichia coli 0157:H7?

A

It makes a powerful toxin that can cause severe illness with hemorrhagic colitis and kidney failure

353
Q

In which populations can E. coli 0157:H7 infection be life-threatening?

A

In the very young and older adults

354
Q

What types of food are primarily associated with E. coli 0157:H7?

A

Undercooked meats, especially poultry and hamburger

355
Q

Name two other sources of E. coli 0157:H7 infection.

A
  • Contaminated leafy vegetables
  • Unpasteurized or contaminated fruit juices
356
Q

How is E. coli 0157:H7 transmitted between individuals?

A

Person-to-person contact in families, long-term care, and childcare centers

357
Q

How long after swallowing E. coli 0157:H7 do symptoms typically start?

A

1 to 10 days

358
Q

What are the common manifestations of E. coli 0157:H7 infection?

A
  • Diarrhea (often bloody)
  • Vomiting
  • Abdominal cramping pain
359
Q

What is the variability of diarrhea associated with E. coli 0157:H7?

A

It can range from mild to bloody and may progress from watery to bloody

360
Q

What are some systemic complications of E. coli 0157:H7 infection?

A
  • Hemolytic uremic syndrome (HUS)
  • Thrombocytopenic purpura
361
Q

How is infection with E. coli 0157:H7 diagnosed?

A

By detecting the bacteria in the stool

362
Q

What should all people with sudden diarrhea containing blood undergo?

A

A stool culture for E. coli 0157:H7

363
Q

What is the primary treatment for E. coli 0157:H7 infection?

A

Hydration to maintain blood volume

364
Q

Why should patients avoid antidiarrheal agents when treating E. coli 0157:H7?

A

They slow GI motility and can prolong infection

365
Q

What therapies may be necessary in severe cases of E. coli 0157:H7 infection?

A
  • Dialysis
  • Plasmapheresis
366
Q

Why are antibiotics seldom given to patients with E. coli 0157:H7 infection?

A

They increase the risk of complications and do not appear to treat the infection

367
Q

What is hemolytic uremic syndrome (HUS)?

A

A life-threatening condition where RBCs are destroyed and kidneys fail

368
Q

What is the mortality rate associated with hemolytic uremic syndrome (HUS)?

369
Q

What long-term complications can arise from E. coli 0157:H7 infection?

A
  • Abnormal kidney function
  • Hypertension
  • Seizures
  • Blindness
  • Paralysis
370
Q

Fill in the blank: A small number of patients, especially young children and older adults, develop ______.

A

hemolytic uremic syndrome (HUS)

Lewis’s Medical Surgical Nursing (8 decks)

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