Chapter 58 Flashcards
The inflammation of gastric mucosa or stomach lining. Can be scattered or localized; erosive or non erosive
Gastritis
GI disorders such as gastritis, peptic ulcer disease, and gastric cancer can all result in altered _______ and _______.
Digestion, nutrition
Pathologic changes of gastritis include ________ congestion, ______, acute __________ cell infiltration, and ____________ changes in the superficial epithelium of the stomach lining
vascular, edema, inflammatory, degenerative
Inflammation of the gastric mucosa or submucosa that occurs after exposure to local irritants or other causes.
Acute gastritis
If the stomach muscle is affected during acute gastritis, _______ may occur .
Hemorrhage
Appears as a patchy, diffuse inflammation of the mucosal lining of the stomach. Leads to thinning of the the stomach walls and lining and muscle atrophy.
Chronic gastritis
When body stores of vitamin B12 are depleted ___________ results
Pernicious anemia
The _____________________ is critical for absorption of vitamin B12
Intrinsic Factor
Three types of chronic gastritis
A, B, atrophic
Chronic gastritis is associated with an increased risk for _________
Gastric cancer
_________ chronic gastritis is associated with autoimmune cause.
Type A
________ gastritis is associated with genetic links and pernicious anemia.
Type A
The most common form of chronic gastritis is ________.
Type B
________ gastritis is associated with H. Pylori infection.
Type B
_____ gastritis is seen most often in older adults.
Atrophic
_______ gastritis is associated with toxic exposure in the workplace such as benzene, lead, or nickel as well as H. pylori and autoimmune factors.
Atrophic
Chronic gastritis is caused by local irritation including irritation from.... 1- alcohol 2- Smoking 3- Chrohn's disease 4- Saliva 5- Pyloric sphincter surgery 6- Milk ingestion 7-Uremia 8- Radiation
All but 4, 6
__________, _________, and ________ can help prevent gastritis.
Balanced diet
Regular exercise
Stress- reduction
Which of these foods should be limited to avoid gastritis?
- Fish
- Chocolate
- Mustard
- Ice cream
- Alcohol
- Spices
All but 1, 4
Excessive use of ______ should be avoided when trying to prevent gastritis.
NSAIDs
Which of these are signs and symptoms of Acute gastritis?
- Pernicious anemia
- Epigastric discomfort relieved by food
- Nausea
- Anorexia
- Cramping
- Hematemesis
3, 4, 5, 6
Which of these are symptoms of Acute gastritis?
- Rapid onset of gastric pain
- Gastric hemorrhage
- Diarrhea
- Intolerance of fatty/spicy foods
- Dyspepsia
- Abdominal tenderness and bloating
- Melena
1, 2, 5, 6, 7
Aspiring/NSAID related gastritis may result in _______.
Dyspepsia
Gastritis or food poisoning caused by endotoxins has an abrupt onset usually occurring within __ hours of indigestion of contaminated foods and may present with _________, which is life-threatening.
5, gastric hemorrhage
Which of these are symptoms of chronic gastritis?
- Pernicious anemia
- Vomiting
- Anorexia
- Rapid onset epigastric pain
- Upper abdominal discomfort
- Intolerance of fatty and spicy foods
1, 2, 3, 5, 6
Which of these are symptoms of chronic gastritis?
- Hematemesis
- Epigastric pain relieved by food
- Nausea
- Gastric hemorrhage
- Dyspepsia
- Bloating
2, 3
______ is the gold standard for diagnosis gastritis.
EGD (via an endoscope with biopsy)
A ____________ of the biopsy of specimens from the EGD of gastritis is performed to rule out gastric cancer.
Cytologic examination
Tissue samples can be taken from a patient with gastritis to detect H. pylori using ___________. This test is most reliable if patients stop taking _________ for at least a week before .
Rapid urease testing, antacids
Flare ups of acute or chronic gastritis can result in _____________________.
Fluid and electrolyte imbalances
The healing process for acute gastritis is ________ and usually occurs within _________.
Spontaneous, few days
Interventions for acute gastritis include:
- ________ for patients with fluid imbalances
- ____________ if bleeding is severe
- Surgery (partial gastrectomy, pyloroplasty, vagotomy) for patients with ________ or ________.
- fluid replacement
- blood transfusions
- major bleeding, ulceration
IN the acute phase of gastritis, the health care provider prescribes drugs that ______ and _______ acid secretions in order to ____________.
block, buffer, relieve pain
_______________ are used to block gastric secretions in patients with gastritis.
H2-receptor antagonists
_____________ are used as buffering agents in patients with gastritis
Antacids
Famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac) are examples of….
H2-receptor antagonists
Maalox and Mylanta are examples of ….
Antacids
aluminum hydroxide combined with: magnesium hydroxide (Maalox) and simethicone and magnesium hydroxide (Mylanta
__________ are antisecretory agents
PPIs (Proton Pump Inhibitors)
Omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid), rabeprazole (Aciphex), and esomeprazole (Nexium) are all…..
PPIs
_______, _______, and ______ are used to treat gastritis .
H2-receptor antagonists, Antacids, PPIs
_______ is used to suppress gastric acid secretion in patients with gastritis
PPIs
True of False: The patient taking PPIs for gastritis should also take OTC Pepcid AC
False- Do not take any additional OTC drugs.
_________ increase pH of gastric contents by deactivating pepsin.
Antacids
___________ decreases gastric acid secretions by blocking histamine receptors in the parietal cells
H2- antagonists
Antacids should be given…
1hr and 3hrs after meals and at bedtime
You should not give other drugs within ______ hours of antacids
1-2
When giving Maalox or Mylanta, you should assess the patients for history of _______ disease and ______ failure and observe for side effect of ______. Liquid preparations are preferred.
Renal, Heart, diarrhea
When giving Amphojel, you may give to patients with _____ failure. Observe for side effect of ______ and alternate with magnesium antacid if this occurs. Liquid preparation is preferred
Renal, constipation
H2 antagonists should be given….
At bedtime (single dose preferred)
IV _______ and _______ may be given to prevent surgical stress ulcers.
H2-receptor antagonists: rantidine, famotidine
Sucralfate (carafate) is a…. .
Mucosal barrier Fortifier
___________ binds with bile acids and pepsin to protect the stomach mucosa.
Mucosal Barrier Fortifiers (Carafate)
Sucralfate (carafate) should be given….
1hr before and 2hrs after meals and at bedtime
*Do not give within 30 minutes of other drugs and antacids
________ suppresses H1K-ATPase enzyme system of gastric secretion
PPIs
DO not give ______ or ______ IV with other drugs. (give with filter and a separate line)
(pantoprazole) Protonix, esomeprazole (Nexium)
PPIs should be given…..
At bedtime: omeprazole (Prilosec), lansoprazole (Prevacid)
After morning meal: rabeprazole (Aciphex)
1 hour before meals: esomeprazole (Nexium)
True or False: PPIs may be crushed to be put into tube feedings.
False. DO NOT CRUSH
_______ gastritis may require vitamin B12 for prevention or treatment of ____________.
Chronic, pernicious anemia
Drugs associated with gastric episodes and irritation are _________, _______, and ________.
Corticosteroids, erythromycin, NSAIDs
True or False: bell peppers and onions are foods that may irritate the gastric mucosa for patients with gastritis.
True
True or False: Patients with gastritis should eat a bland diet and smaller, more frequent meals
True
True or False: Reducing stress through various techniques is helpful in reducing anxiety, but has nothing to do with gastritis
False (they help gastritis)
A mucosal lesion of the stomach or duodenum
Peptic Ulcer
Results when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin.
Peptic ulcer disease
Three types of ulcers:
Gastric, Duodenal, Stress
Most gastric or duodenal ulcers are caused by _________
H. Pylori infection
Gastric ulcers may result from a dysfunction of the ______
pyloric sphincter
___________ is delayed in patients with gastric ulceration
Gastric emptying
True or False: Increased blood flow to gastric mucosa allows ulceration to occur.
False- Decreased blood flow.
Gastric ulcers are deep and penetrating and usually occur….
On the lesser curvature of the stomach near the pylorus
Duodenal ulcers are deep, sharply demarcated lesions that penetrate through the mucosa and submucosa int other muscle layer (Muscularis propria.) Most duodenal ulcers occur…
In the upper portion of the duodenum.
The main feature of a duodenal ulcer is…
High gastric acid secretion
In patient with duodenal ulcers, pH levels are _____ in the duodenum for long periods.
low
_____________ meals, ________, and ______ excitation stimulate acid secretion
High-protein, calcium, vagus nerve
Along with hypersecretion, ____________ of food from the stomach results in a large acid bolus to the duodenum.
rapid emptying
Acute gastric mucosal lesions occur after an acute medical crisis or trauma (such as head injury or sepsis)
Stress ulcers
_____ for major surgery may lead to stress ulcers.
NPO
Patients susceptible to stress ulcers are those who are critically ill including those who have _________ (Curling’s ulcer), _______ (ischemic ulcer), or _____________ (Cushing’s ulcer)
extensive burns, sepsis, increased intracranial pressure
___________ (caused by gastric erosion) is the main manifestation of acute stress ulcers
Bleeding
ischemia— erosions—- ulceration—- may progress to massive hemorrhage
The most common complications of PUD are ______, ______, ______, and _______.
Hemorrhage (MOST SERIOUS)
Perforation
Pyloric obstruction
Intractable disease
Which of these are symptoms of an upper GI bleed?
- Vomiting
- Hematemesis
- Dizziness
- Distention
- Increased appetite
- Syncope
- Bradycardia
- Hypotension
2, 3, 6, 8
Which of these are symptoms of an active upper GI bleed?
- tarry stools/frank blood in stools
- Melena
- Vertigo
- Hypertension
- Confusion
- Tachycardia
- Increased respirations
- Decreased hemoglobin and hematocrit
1, 2, 3, 5, 6, 8
________ is a sign of gastric ulcers while ______ is a sign of duodenal ulcers.
Hematemesis (bloody/coffee-ground vomit), melena (bloody/tarry stools)
Occurs when the ulcer becomes so deep that the entire thickness of the stomach or duodenum is worn away.
Perforation
A major concern of perforation in ulcers is… .
leakage of stomach/duodenal contents into the peritoneal cavity
Signs of perforation of ulcers: (4)
- Sudden, sharp pain (begins in mid-epigastric region spreads over entire abdomen)
- Apprehension
- Tender, rigid, boardlike (peritonitis) abdomen.
- Patient in knee-chest (fetal) position
Perforation of ulcers can cause the patient to become severely ill within ______, and ________ and ________ follow, resulting in diminished peristalsis and ___________.
hours, bacterial septicemia, hypovolemic shock, paralytic ileus
** SURGICAL EMERGENCY, LIFE-THREATENING
_________ occurs in small percentage of patients with ulcers and is caused by scarring, edema, inflammation or a combination of these at the pylorus. It is manifested by _________, __________, and _________. This can result in ________ and _______.
Pyloric obstruction, abdominal bloating, nausea, vomiting, metabolic alkalosis, Hypokalmeia
Peptic ulcer development is associated with ______ and _______.
H. pylori, NSAIDs
NSAID ulcers are difficult to treat because…
they have a high rate of recurrence
________, ______, and _________ stimulate hydrochloric acid production and contribute to ulceration.
Corticosteroids, caffeine, theophylline (Theo-Dur)
True of False: Family history is related to higher risk of PUD.
True
The two main treatments for PUD include…
PPIs, H. pylori treatments
True or False: alcohol intake and tobacco use do not affect the risk of PUD.
False
True or false: acidic foods and caffeine make symptoms of PUD worse.
True
Drugs that affect PUD include:
- NSAIDs
- Antacids
- Corticosteroids
- Chemotherapy/radiation
- PPIs
1, 3, 4
The patient has sudden constant pain that radiates to the back or upper quadrant. What might the nurse suspect?
Ulcer perforation
True or false: Many patients with gastric or duodenal ulcers report no symptoms
True
________ is the most commonly reported symptom associated with PUD.
Dyspepsia (described as sharp, burning or gnawing)
_____ ulcer pain occurs in the upper epigastrium with localization to the left of the midline and is aggravated by food .
Gastric
_____ pain is usually located to the right of the epigastrium and usually occurs 90min- 3hrs after eating and often awakens patients at night.
Duodenal
A person with a ______ ulcer is usually malnourished while a person with a _______ ulcer is well nourished.
Gastric, duodenal
Orthostatic pressure is taken if the nurse suspects __________, and is present if there are changes of more than ______mm Hg systolic and _____mm Hg diastolic.
Fluid deficit, 20, 10
___________ testing for _____ anti-H. pylori antibody is the most common noninvasive message to test for/confirm H.pylori infection. The _____ test may be done to determine effectiveness of treatment, a ________ result suggest successful treatment.
Serologic, IgG, ELISA, negative
The major diagnostic test for PUD is _______ which is the most accurate means of establishing a diagnosis
EGD (esophagogastroduodenoscopy)
Allows the provider to have direct visualization of the ulcer crater and to take specimens for H. pylori testing and for biopsy and cytologic studies to rule out gastric cancer.
EGD (esophagogastroduodenoscopy)
The GI system is scanned for the presence of bleeding after the patient is injected with a contrast medium (Tc99m). May be used to diagnose GI bleeds or to measure effectiveness of interventions. No special prep needed.
nuclear medicine GI bleeding study.
The priority problems for the patient with PUD are… (2)
- Acute/chronic pain related to gastric and/or duodenal ulceration
- Potential for upper GI bleed
The primary focuses of drug therapy in PUD are…. (4)
- Provide pain relief
- Treat H. pylori infection
- Heal ulcers
- Prevent recurrance
Drug combination used to treat H. pylori infection are….
PPIs plus 2 antibiotics for 7-14 days
*May also use a PPI, Levaquin, and amoxicillin or clarithromycin for 7 days.
Clarithromycin (Biaxin), amoxicillin (Amoxil), Tetracycline, or metronidazole (Flagyl) are…..
Antimicrobials used to treat H. pylori
Misoprostol (Cytotec) is a _______, and decreases gastric secretions while enhancing resistance to mucosal injury when the patient is taking __________. The patient should take ______________, and avoid __________________.
Prostaglandin Analog, NSAIDs, with food, magnesium-containing antacids
Which population is at largest risk with H. pylori?
Older adults
The main prescribed drugs used to treat PUD are…
PPIs and H2 agonists.
______ are the drug class of choice when treating patients with acid-related disorders.
PPIs
__________ and ________ may be dissolved in a sodium bicarbonate solution to be given through any feeding tube. They can also be opened and the _________ capsules can be put into apple juice or orange juice and be given through a large-bore feeding tube.
Omeprazole, and lansoprazole, enteric-coated
_________ and _________ should and not be crushed or dissolved.
rabeprazole (Aciphex)
pantoprazole (Protonix)
PPIs (should or should not) be taken for a long period of time. They may cause __________ in older women, and effect the use of Plavix, a _______ drug. Teach patients to tell the health care provider if they are taking ________.
Osteoporotic-related fractures/spinal fractures
Antiplatelet
clopidogrel
__________ are drugs that block histamine-stimulated gastric secretions and may be used for indigestion and gastritis. They are usually given…
H2-receptor antagonists, single dose at bedtime
______ buffer gastric acid and prevent formation of pepsin and may help ______ ulcers heal but are not usually used alone.
Antacids, duodenal
*Liquid suspension is most effective
BE CAUTIOUS FOR PATIENTS WITH RENAL IMPAIRMENT
_____ are a potent antacid but trigger gastrin release known as a…
TUMS, rebound acid secretion
This antacid has a low sodium content for patients with heart failure
magaldrate (Riopan)
_____________ is a mucosal barrier fortifier and may be used with ________ or _________ to treat peptic ulcers. It should be given……. The main side effect is ________.
sucralfate (Carafate), antacids
H2-receptor antagonists
Empty stomach 1hr before meals and at bedtime
Constipation
_______ diet is used for patients with PUD, and the food itself acts to neutralize gastric acid for 30-60minutes. A rebound may follow.
Bland
True or False: Herbs such as slippery elm, marshmallow root, licorice, and quercetin should not be used by patients with gastritis and PUD
False.
True or False: Patients with gastritis and PUD should take zinc, vitamin C, essential fatty acids, acidophilus, vitamins E and A, and glutamine to promote healing.
True
What is the main goal of a patient with an upper GI bleed?
have vital signs within normal limits
If the patient has extensive blood loss and vomiting from a PUD, what is the priority intervention?
Fluid replacement for dehydration and electrolyte imbalances.
An active bleed is a life-threatening emergency. The priority interventions are…. (3)
- Provide oxygen or other ventilatory support if needed
- Start two large bore IV lines for replacing fluid and blood
- Monitor vital signs, hematocrit, and oxygen saturation, and I&O
* *Goals are to prevent hypovolemic shock, look for signs!
If the patient has chills, palpitations, diaphoresis, and a weak, thready pulse, what is the nurses main concern.
Hypovolemic shock
*EMERGENCY
If a patient comes to the ER and was actively bleeding at home, what is the priority intervention concerning the NG tube?
Lavage
After the upper GI bleed has stopped, what are the three main drugs used?
PPIs, H2-receptor antagonists, and antacids
Gastric lavage for active bleeding requires a _______ tube with instillation of fluid 200-300mL
Large-bore
The patient should be in what position for lavage?
Left side lying
______ can assist in achieving homeostasis during an acute hemorrhage by isolating the bleeding artery to embolize/clot it.
EGD (esophagogastroduodenoscopy)
Before the patient has a EGD, the nurse should…. (3)
- Insert 2 large-bore catheters (for moderate sedation and possible blood transfusion)
- Keep the patient NPO for 4-6hrs before the procedure to prevent risk for aspiration
- Ensure the patient has signed informed consent with the physician
Priority interventions after an EGD include…
- Monitor vital signs, heart rhythm and O2 sat. frequently until they return to baseline
- Assess the patient’s ability to swallow saliva
- Keep the patient NPO until the gag reflex is intact!!!
For patients with persistent, massive upper GI bleeding, _________________ may be performed where a liquid substance is used to clot the bleeding artery.
catheter-directed embolization
___________ agents are used to stabilize the clot after bleeding stops. They work by raising the pH level of gastric contents. __________ , _________, and ________ are used.
Acid-suppressive, PPIs, H2-receptor antagonists, antacids
Perforation is managed by immediately….
- Replacing fluid, blood, and electrolytes
- Keeping the patient NPO
- Maintaining NG suction to drain secretions and prevent further peritoneal spillage
- Monitor for septic shock and monitor I&O and vitals HOURLY at least.
If the patient has had perforation and shows signs of pain, tachycardia, lethargy, anxiety, and fever, the nurse should suspect….
Septic shock
________ is caused by edema, spasm, or scar tissue and results in difficulty emptying the stomach. Symptoms include…
Pyloric obstruction
- feelings of fullness, distention, nausea, and vomiting undigested food
Treatment for pyloric obstruction includes…..
- Decompressing the stomach with NG suction
- Correct metabolic alkalosis and dehydration
- Gastric retention should not be more than 50mL in 30 min (100mL/hr)
MIS (minimally invasive surgery) is used to treat chronic gastric ulcer or treat hemorrhage for perforation. The procedures done include…. (3)
- Subtotal gastrectomy (remove part of the stomach)
- Pyloroplasty (open the pylorus)
- Vagotomy (vagus nerve cutting to control acid secretion)
The primary focus of home care for the patient with PUD is ________.
teaching (risk factors, complication recognition, signs and symptoms)
A rare disease that is manifested by upper GI tract ulceration, increased gastric acid secretion, and one or more duodenal or pancreatic tumors (Gastrinomas)
Zolling-Ellison syndrome
True or False: Metastasis does not occur with Zollinger-Ellison syndrome
False- Mainly on the liver and regional lymph nodes
Caused by gastrin-secreting tumors that stimulate the acid-secreting cells of the stomach to maximal activity. These large quantities of acid cause GI ulceration.
Zollinger-Ellison syndrome
Symptoms of ZES are similar to PUD but….
tend to progress and respond poorly to therapy.
Diarrhea or Steatorrhea may also be present.
Gastrinoma are tumors present in ZES but are also present in…
MEN-1 (Multiple endocrine neoplasia type 1 syndrome)
**Gastrinomas contain ACTH (adrenocorticotropic hormone)
True or False: ZES has genetic links
True
Diagnosis for ZES is made by __________ that reveal increased serum gastrin levels.
Radioimmunoassay studies
Drugs used to control symptoms of ZES are….
PPIs (drug of choice)
High doses of H2- receptor antagonists
Chemotherapy (5-flurouracil, doxorubicin, streptozocin) used before surgery to reduce tumor size
True of False: There is no cure for ZES
False- surgical resection can cure ZES
Most stomach cancers are…
Adenocarcinomas
True or False: Stomach cancers usually have no symptoms during early stages
True
True or False: Atrophic gastritis and intestinal metaplasia (abnormal tissue development) are precancerous conditions
True
H. pylori spread can cause _____________
MALT lymphoma (mucosa-associated lymphoid tissue)
__________ is the largest risk factor for gastric cancer.
Infection with H. pylori (it carries the cytotoxin associated antigen A, CagA, gene)
True or False: patient with pernicious anemia, gastric polyps, chronic atrophic gastritis, and achlorhydria (absence of hydrochloric acid secretion) are far more likely to get gastric cancer.
True (2-3x more likely)
True or False: Diet does not affect a person’s chance of getting gastric cancer
False
- Eating pickled or processed foods increases chance
- Diets high in salts increase the chance
- Low intake of fruits and vegetables increase the risk
Which of these are risk factors for gastric cancer?
- Previous gastric surgery
- GERD
- Weight loss
- Barrett’s esophagus
- Diets high in diary products
1, 2, 4
Which of these ethnic groups are most likely to get gastric cancer?
- Asians
- Caucasians
- Blacks
- American Indians
- Hispanics
- Alaska natives
1, 3, 4, 6
*Men have a slightly higher risk
The most common symptoms of early gastric cancer are…
Indigestion/heartburn and Abdominal discomfort
*May also have epigastric or back pain
Which of these are signs and symptoms of ADVANCED gastric cancer?
- Vomiting and nausea
- Weight gain
- Palpable epigastric mass
- Iron deficiency anemia
- Indigestion
- Obstructive symptoms
1, 3, 4, 6
Hard enlarged lymph nodes in the ____________________ suggest metastasis from gastric cancer while masses on the _____ suggest metastasis in the perigastric lymph nodes or liver.
Left supraclavicular chain, left axilla, umbilicus
Right
Which of these are symptoms of ADVANCED gastric cancer?
- Enlarged lymph nodes
- Weight loss
- Fatigue
- Epigastric, back, or retrosternal pain
- Blumer’s shelf, Virchow’s nodes, or Krukenberg’s tumor
- Feeling of fullness
1, 2, 3, 5
Which of these are symptoms of EARLY gastric cancer?
- Nausea and vomiting
- Feelings of fullness
- Indigestion
- Abdominal discomfort
- Epigastric, back, or retrosternal pain
- Weakness and fatigue
2, 3, 4,5
The level of _____ is elevated in advanced cancer in the stomach.
CEA (carcinoembryonic antigen)
_______ is used as a definitive diagnosis for gastric cancer.
EGD (esophagogastroduodenoscopy)
True of False: CT, PET, and MRI scans are all used to diagnose gastric cancer
False- All used to determine extend of the disease, while EGD is used to diagnose
___________ and ___________ usually prolong survival in patients with advanced gastric cancer.
Chemotherapy and radiation
Side effects of radiation include: 1. Impaired skin integrity 2. Weight gain 3. Confusion 4 .Diarrhea, nausea, vomiting 5. Fatigue 6. Anorexia 7. Agitation 8. Dehydration
1, 4, 5, 6
_____________ is the preferred method for treating gastric cancer
Surgical resection (by removing the tumor)
True or False: A patient whose gastric cancer has metastasized into the supraclavicular lymph nodes may have a curative resection
False- Metastasis into the supraclavicular lymph nodes, inguinal lymph nodes, liver, umbilicus, or perirectal wall indicates loss of curative resection.
Preoperative Care for a gastric cancer resection includes….
- Placement of an NG tube to empty stomach (that will remain in place a few days post-op)
- Nutrition therapy for malnutrition/weight loss (TPN supplements, enteral)
Total gastrectomy is performed when…..
Gastric bleeding or obstruction is present
Postoperative care for the patient with gastric cancer includes…. (4)
- Prevention of atelectasis, paralytic ileus, and wound infection.
- Auscultate for adventitious lung sounds and bowel sounds
- Take vitals signs to detect infection or bleeding
- Keep the head of the bed elevated to prevent aspiration!
The patient has a feeling of fullness, hiccups, tachycardia, and hypotension post operatively. What does the nurse suspect and prepare to do?
- Acute gastric dilation from a clogged NG tube.
- Irrigation or replacement of NG tube per surgeon’s request
Refers to a group of vasomotor symptoms that occur after eating.
Dumping syndrome
Which of these are early symptoms of Dumping syndrome and which are late symptoms:
- Vertigo
- Abdominal distention
- Dizziness
- Palpitations
- Confusion
- Diaphoresis
- Vertigo- early
- Abdominal distention- early
- Dizziness- late
- Palpitations- early, late
- Confusion- late
- Diaphoresis- late, early (sweating)
Which of these are early symptoms and which are late symptoms of dumping syndrome?
- Tachycardia
- Syncope
- Pallor
- Light-headedness
- Desire to lie down
- Bleeding
- Tachycardia- early
- Syncope- early
- Pallor- early
- Light-headedness- late
- Desire to lie down- early
- Neither
Early dumping syndrome occurs _________ and is a result of…
Within 30 minutes of eating, rapid emptying
Late dumping syndrome occurs___________ and is caused by….
90min- 3hours after eating, release of excessive amounts of insulin/ rapid entry of high-carbohydrate food into the jejunum
Patients with dumping syndrome should consume which type of diet?
High-protein, high-fat, low/moderate-carbohydrate diet
Early satiety, abdominal discomfort, and vomiting are symptoms of….
Alkaline reflux gastropathy
Edema at the anastomosis after a gastric surgery may cause….
Delayed gastric emptying (usually resolves in one week)
Delayed gastric emptying caused by edema at the anastomosis can be resolved by…
- NG suctioning
- Maintaining fluid and electrolyte balance (could be caused by hypo-kalemia, proteinemia, or natremia)
- Proper nutrition
The patient reports painful contractions and bloating 40 minutes after eating. The patient has nausea and vomiting. The nurse should consider….
Afferent loop syndrome (occurs 20-60min after meals) and is corrected by surgery.
When the stomach is removed or partial removed, what deficiencies may occur? (4)
B12, folic acid, iron, calcium/vitamin D (due to reduction of intrinsic factor and inadequate absorption)
The patients tongue is shiny, smooth, and beefy. The nurse suspects…
Atrophic Glossitis (from pernicious anemia/vitamin B12 deficiency)
True or False: Gastric cancer is life-threatening and often times the patient will require hospice care.
True
Which of these interventions help prevent dumping syndrome?
- Eat small, frequent meals
- Drink liquids with meals
- Eliminate caffeine and alcohol consumption
- Stop smoking
- Remain seated upward after meals
- Receive vitamin B12 injections
1, 3, 4, 6
2: DO NOT drink liquids with meals- in between meals only
5. Lie flat after eating for a short period of time
Which foods are appropriate for a patient with dumping syndrome?
- Fruit juice
- Beef
- Spicy foods
- Doughnuts
- Milk products
- Butter
- Sugar substitutes
- Broccoli
2, 6, 7
Which foods are NOT appropriate for patients with dumping syndrome?
- Diet drinks
- Mayonnaise
- Whole-grain bread
- Soup with meals
- Onions
- Salad dressing
2, 3, 4, 5
Which of these foods is NOT appropriate for the patient with dumping syndrome?
- Honey
- Milk products
- Meat substitutes
- Pork
- Potatoes
- Sugar-free jello
1, 2, 3,6
Pepto bismal with antibiotics is used to treat….
H. pylori
A hemoglobin level below ___ will usually require a blood transfusion
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