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Med Surg 3 > Chapter 54 > Flashcards

Chapter 54 Flashcards

1
Q

GERD

A

A result of persisepnt backward flow of stomach contents into the esophagus.

Chronic condition of exposing the esophagus irritating effects of gastric or duodenum contents resulting in inflammation.

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2
Q

Most common cause of GERD

A

Excessive relaxation of the LES causing reflex of gastric contents into the esophagus

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3
Q

Who is at risk of developing GERD

A

Overweight/obese

Hital Hernia

H pylori

Increased intra abdominal pressure

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4
Q

How can patient with GERD develop cancer.

A

By the body replace columnar cells with damaged squamous cell known as Barrett’s Epithelium

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5
Q

Esophageal Stricture

A

Narrowing of the esophagus opening due to scarring.

Can lead to difficulty swallowing

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6
Q

What is normal PH of the stomach

A

1.5-2.0

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7
Q

What Factors contribute dcreased LES pressure

A

Caffeinated beverages
chocolate
citrus fruits tomatoes and tomato products
smoking, use of other tobacco products or alcohol
calcium channel blocker’s nitrates cholinergic drugs
peppermint spearmint
high levels of estrogen and progesterone
nasogastric tube

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8
Q

What are the two main symptoms of Gerd?

A

Dyspepsia (indigestion)

And

Regurgitation

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9
Q

What would be the diagnosis of a patient presenting with asthma morning hoarseness pneumonia reflux heartburn and atypical chest pain?

A

Severe reflux that reaches the pharynx or the mouth or pulmonary aspirations

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10
Q

What are some additional signs and symptoms of Gerd?

A

Water brash (hyper salvation)

Dysphagia ( difficultly swallowing)

Odynophagia painful swallowing)

pyrosis (heartburn)

Globus (filling up something in the back of the throat)
Nausea
pharyngitis
Coughing  
Hoarness
belching
Epigastric pain
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11
Q

Factors that increase intraabdominal gastric pressure

A

Pregnancy
wearing tight belt
Girdle
Ascites

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12
Q

Signs of indigestion signs and symptoms

A 
Abdominal discomfort 
feeling uncomfortable full 
Nausea burping
 Worsens bends  over strains or lies down 
severe may radiate to the neck or jaw 
referred to the back
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13
Q

Patient reports to ED severe GERD and discomfort. He last ate two hours ago. He felt worse when lying down The pain went to his neck and jaw felt nausea and feeling uncomfortable.

What is the nursing teaching for prompt relief?

A

Drink fluids

take antacids

maintain an upright 1-2 hours after eating

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14
Q

What are some complications older adults may experience because of Gerd due to physiological changes?

A 
Atypical chest pain 
ear nose and throat infections 
pulmonary problems; aspiration pneumonia 
sleep apnea 
 Asthma
Barretts esophagus 
 esophageal erosion
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15
Q

Diagnostic Test for Gerd?

A

Barium swallow
EGD
PH monitor examination (most accurate)

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16
Q

48 hour Bravo Esophageal pH test

A

A small capsule is temporarily attached to esophagus
Patients asked diary of activities and update
the PH is continuously monitored and recorded
a wireless monitoring device may be used f

17
Q

Priority collaborative problems with the current patients

A

Potential for compromised nutrition

acute pain

18
Q

Patient teaching nutritional therapy for GERD

A

Limit; peppermint chocolate fatty food and fried foods
Caffeine/carbonated beverages
restrict spicy and acidic foods;orange juice and tomatoes
use my fitness pal
Limit foods that increase the gastric acid or cause pain
do not snack in the evening
do not eat 2-3 hours before bed
eat slowly and chew food thoroughly to prevent Belching

19
Q

Patient teaching of lifestyle changes with the GERD

A

Elevate the head of the bed 6 to 12 inches;use blocks or wedge pillow
sleep on the right side to promote gas exchange
swallow frequently to clear esophagus
weight reduction
avoid constructive clothing lifting heavy objects or straining and working in a bent over a stooped position to
Chew chewable antacids completely and followed with a glass of water

20
Q

What drugs lower LES and cause reflux?

A 
Oral contraceptives 
anticholinergic agents 
sedatives
NSAID such as ibuprofen 
nitrates 
calcium channel blocker’s
21
Q

Long-term use Protein pump inhibitor’s may cause what?

A

Community acquired pneumonia

G.I. infection such as CDiff

22
Q

What 2 protein pump inhibitor’s can be administered by IV form for short term treatment or prevention of stress ulcers?

A

Pantoprazole (protonix)

Esomepraxole (nexium)

23
Q

What is the main treatment for severe Gerd?

A

Protein pump Inhibitors

End in prazole

24
Q

Action of PPIs?

A

Long acting inhibitors of gastric acid secretion by affecting the protein pump of parietal cells

Reduce gastric acid secretion the long acting except omeprazole

25
Q

Histamine receptor antagonists action?

A

long acting and decrease acid and promote healing of the inflamed esophageal tissue so comfort is improved.

Reduce gastric secretions

26
Q

Antacids use?

A

Occasional use of heartburn discomfort not for long term use

27
Q

Antiacid action?

A

Elevating the pH level of gastric contents there by deactivate and pepsin.

Neutralize HCI
Reduce pepsin

28
Q

Why shouldn’t antacids be used long-term

A

Their length of action is short

nighttime effectiveness is the minimum

increase LES pressure

29
Q

Joint commission core measures to decrease LES pression

A

Teach patient that smoking and alcohol us should be avoided. Explore smoking cessation and make appropriate referrals activation about his or her use of alcohol beverages and if your puppy left the patient help find alcohol

30
Q

5 Sliding hiatal hernia key feature

A 
Heartburn 
 chest pain 
dysphagia ( difficultly swallowing)
Regurgitation
belching
31
Q

Five key features of paraesophegal hernia

A

Fill of fullness after eating

breathlessness after eating

feeling of suffocation

chest pain that mimic angina

worsening of manifestations in a lying or recumbent position

regurgitation is usually not present

32
Q

Risk associated with having a paraesophageal hernia

A

Twisting of the G.I. structure (Volvulus)

obstruction (blockage) is high

strangulation (stricter) is high

development of iron deficiency anemia is common due to slow bleeding

Large bleeding or hemorrhage is rare

33
Q

Four positioning teaching for hitial hernia?

A

Sleep at night with the head of the bed elevated 6 inches

remain upright for several hours after eating

avoid training or excessive vigorous exercise

refrain from wearing clothing that is tight or constructive around the abdominal

34
Q

What is the most important role of gthe nurse for caring for a patient with a hernia?

A

“Health teaching” encourage the patient to ….

avoid eating in the late evening

avoid foods associated with

teach the patient and family follow a restricted diet and exercise

reduce weight is beneficial because obesity increases enter abdominal pressure and worsens both the hernia and the symptoms of reflux

35
Q

Preoperative care for surgical management of hernia

A

If not urgent instruct patient to lose weight

smoking or significantly reduce smoking

reinforce the surgeons instructions and prepare the patient for what to expect after surgery

36
Q

Operative procedure for a hernia

A

Fundoplication= Re-enforcement of the LES surgeon wraps a portion of the stomach or fund around the distal

LNF=Minimum invasive with less complications some patients are not a candidate

Paraesophageal repair = One large incision or several 1/2 incision made in ab. Hernia is reinforced with mesh.

37
Q

Operative procedure for Trans thoracic space hernia repair?

A

nasogastric tube inserted and will remain several days

oral intake will be started gradually with clear liquids after peristalsis

Teach deep breathing and use of incentive spirometer

informed that breathing will be painful

teach patient about postoperative pain and meds

38
Q

Post operative risk for LNF procedure or paraesophageal for your repair via laparoscopically

A

The nursing care priority is to observe for complications of bleeding and provide health teaching patient at high risk of bleeding and infection

Med Surg 3 (6 decks)

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