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Nursing Semester 3 > Cyndi - Week 1 - Exam 1 > Flashcards

Cyndi - Week 1 - Exam 1 Flashcards

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1
Q

what is achalasia?

A

lower esophageal sphincter can’t relax and aperistalsis of the lower espohagus

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2
Q

what are the causes/risk factors of achalasia? (4)

A

– Nerve degeneration of inhibitory neurons
– Esophageal dilation due to accumulation of
food and fluid
– Hypertrophy (bigger esophagus)
– Unknown cause

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3
Q

is achalasia common?

A

no, not common

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4
Q

what are the clinical manifestations of achalasia? (7)

A
  • substernal chest pain (need to rule out MI w/ 12 lead EKG)
  • dysphagia
  • coughing (trying to move the food or get it out - could go into lungs → aspiration)
  • regurgitation of food (esp. when lying down)
  • weight loss
  • weakness
  • poor skin turgor
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5
Q

what are the 6 possible complications of achalasia?

A
  • Megaesophagus
  • GERD
  • Chest pain
  • Nocturnal regurgitation (laying down after eating, wake up and vomit)
  • Aspiration (new crackles, get chest xray)
  • Halitosis (bad breath)
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6
Q

what are the 3 diagnostic tests used for achalasia?

A
  • upper GI barium xray
  • espohageal manometry
  • esphoagogastroduodenoscopy (EGD)
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7
Q

what is important pre-assessment for a patient who is to undergo a EGD?

A
  • NPO for 8 hours
  • signed consent
  • sedation education (possible risks - perforation)
  • NPO after procedure
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8
Q

what are 4 things to include in achalasia patient education?

A
  • dietary adjustments (small meals, small sips b/t meals)
  • meds (relax muscle → anticholinergics)
  • elevate HOB after eating/at night
  • procedural teaching
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9
Q

what side is the patient positioned during a EGD and why?

A

on the left side; considered the “recovery side”; least likely to vomit.

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10
Q

what 3 types of pharm treatments are used in achalasia?

A
  • anticholinergics
  • smooth muscle relaxants before meals
  • botulism injection to lower esophageal sphincter (short term fix)
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11
Q

what 3 invasive treatments are used in achalasia?

A
  • dilation of LES
  • surgery (Heller myotomy)
  • POEM (peroral endoscopic mytomy)
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12
Q

what is gastritis?

A

inflammation of mucosa d/t breakdown in protective barriers

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13
Q

what are the risk factors for gastritis?

A
  • meds (aspirin, NSAIDs)
  • alcohol use
  • H. pylori
  • radiation exposure
  • physiological stress conditions (↑ acid)
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14
Q

what are the clinical manifestations of gastritis?

A
  • heartburn
  • epigastric pain
  • nausea
  • anorexia
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15
Q

what are the diagnostic tests of gastritis?

A

EGD, H. pylori test, biopsy, CBC (intrinsic factor), guaic stool

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16
Q

what is the treatment for gastritis?

A
  • Eliminate cause, if known (H. pylori)
  • NG tube for bowel rest
  • PPIs
  • H2 blockers
  • antacids
  • antibiotics for H. pylori infection
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17
Q

what are the possible complications for gastritis?

A
  • ulcer
  • hemorrhage
  • ↑ risk of stomach cancer
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18
Q

what is GERD?

A

gastroesophageal reflux disease - reflux of gastric contents into the esophagus d./t LES incompetence; may include a gastroparesis component also.

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19
Q

what are the risk factors for GERD?

A
  • foods (spicy, acidic, coffee, tea, too much food)
  • medications
  • obesity
  • smoking
  • hiatal hernia
  • abd pressure
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20
Q

what are the s/sx of GERD?

A
  • heartburn
  • dyspepsia (indigestion)
  • regurgitation
  • pain (dyspepsia)
  • may have respiratory symptoms (coughing, aspiration, wheezing)
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21
Q

what are the diagnostic tests used for GERD?

A
  • endoscopy
  • biopsy
  • pH monitoring (tests how much acid is produced)
  • manometry
  • upper GI barium study
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22
Q

what are the possible complications from GERD?

A
  • esophagitis
  • barret’s esophagitis (cells change with inflammation)
  • respiratory compromise
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23
Q

what are the treatment options for GERD?

A
  • medications (PPI, H2 blockers, others)
  • lifestyle changes (weight loss, diet)
  • surgery
  • magnet (lynx system)
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24
Q

what is a hiatal hernia?

A

herniation of stomach above diaphragm

- weakened diaphragm around esophagus

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25
Q

what are the risk factors of hiatal hernias?

A

age, gender, abd pressure, meds

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26
Q

what are the two different types of hiatal hernias

A

sliding and rolling

27
Q

what are the characteristics of a sliding hiatal hernia?

A
  • most common
  • stomach slides above diaphragm and back down
  • epigastric pain and vomiting
  • not emergent
28
Q

what are the characteristics of rolling hiatal hernias?

A

– Fundus of stomach rolls through diaphragm and stays
– Forms a pocket next to esophagus – risk for strangulation → necrosis → infection → EMERGENT
- projectile vomiting

29
Q

what are the diagnostic tests for hiatal hernias?

A
  • upper GI barium study

- EGD

30
Q

what are the clinical manifestations of hiatal hernias?

A
  • CHEST PAIN/PRESSURE
  • heartburn
  • dyspepsia
  • regurgitation
  • pain
31
Q

what are the complications of hiatal hernias?

A
  • GERD
  • strangulation
  • esophagitis
  • hemorrhage
  • ulcer
  • regurgitation with aspiration
32
Q

what is the conservative treatment for hiatal hernia?

A
  • similar to GERD (prevent problems with gastric reflux)

PPIs, H2 receptor blockers, lifestyle changes

33
Q

what are the surgery options for hiatal hernia?

A

Nissen or Toupet fundoplication

34
Q

how does a peptic ulcer occur?

A

balance of stomach protective and aggressive mechanisms lost

35
Q

an increase in which aggressive factors could contribute to an ulcer formation?

A
  • ↑ acid secretion
  • ↑ pepsin secretion
  • ↑ H. pylori infection
36
Q

a decrease in which protective factors could contribute to an ulcer formation?

A
  • ↓ mucus
  • ↓ bicarbonate secretion
  • ↓ gastric mucosa blood flow
37
Q

what is a peptic ulcer?

A

excavation formed in wall of stomach or duodenum

38
Q

what are characteristics of peptic ulcers?

A
  • Extends into the mucularis layer (blood/nerves)
  • Acute
  • Chronic
  • Scarring caused by repeated episodes (doesn’t stretch/absorb)
  • Stomach vs duodenal location (more common in duodenum)
39
Q

what are the diagnostic tests used for peptic ulcers?

A
  • Upper GI endoscopy with biopsy
  • Barium tests
  • Labs (CBC [HnH])
  • H. Pylori tests
40
Q

what are the risk factors for peptic ulcers?

A
  • Similar to GERD, gastritis, H. pylori, stress, alcohol, smoking, medication
  • Duodenal 80% of ulcers, near pyloric sphincter
  • Genetic predisposition (often lifestyle)
  • NSAIDS and H. pylori together = high risk
41
Q

what are the s/sx of peptic ulcers?

A 
• Pain –burning, gnawing 
• Pain
– Stomach
• Shortly after meals 
– Duodenal
• 2‐3 hours after eating 
• Nocturnal pain more likely
• Dyspepsia
• Hematemesis (bloody vomit)
• Melena (bloody stools)
42
Q

what is the POC for a patient with a peptic ulcer?

A 
• NPO
• IVF
• NG tube for bowel rest
• Medications 
• Pt education
– ID cause and eliminate
– Avoid foods that irritate (spicy/acidic)
– Smoking, alcohol, stress, etc.
• Possible blood transfusion
43
Q

what are complications of peptic ulcers?

A

hemorrhage, perforation, gastric outlet obstruction

44
Q

what medications are given for ulcers?

A

ones that decrease acidity, enhance mucosa (antacids, PPIs, sucralfate, H2 blockers, prokinetic agents, ATB)

45
Q

what do antacids do?

A

neutralizes stomach acid

46
Q

what does sucralfate do?

A

viscous substance augments stomach’s protective lining

47
Q

what do H2 receptor blockers do? (ranitidine)

A

blocks histamine receptors on the cells of the stomach lining, decreasing stomach acid production

48
Q

what do PPIs do? (pantoprazole)

A

decreases stomach acid production by inhibiting active enzymes (a building block for H+ ions) in some parietal cells

49
Q

what do prokinetic agents do? (metoclopramide)

A

increases gastric emptying

50
Q

what are antibiotics used for regarding H. pylori?

A

eradicates the bacteria

51
Q

what surgical treatments are there for ulcers?

A 
• Partial gastrectomy
–Billroth I (gastroduodenostomy)
–Billroth II (gastrojejunostomy)
• Vagotomy
• Pyloroplasty
52
Q

what is an upper GI bleed?

A

the presence of bleeding in the esophagus, stomach, duodenum urgent focus on finding the source!

53
Q

what are characteristics of a GI bleed?

A

site and type of blood vessel

54
Q

what are the causes of an upper GI bleed?

A

gastritis, ulcer, cancer, meds, other

55
Q

UGI bleeds can be chronic or acute. Whats the difference?

A

• Chronic ‐ insidious; difficult to detect
– May occur intermittently
• Acute ‐ sudden or massive onset

56
Q

T/F: Any disorder that involves bleeding can develop into hypovolemic shock, and requires primary hemodynamic stabilization

A

TRUTH

57
Q

what are the diagnostic tests used for UGI bleeds?

A
  • Labs – frequent H & H (Q 4‐6 hours) – monitor trends
  • Upper endoscopy ( may need to be emergent)
  • Guaiac stool for presence of occult blood
  • Frequent VS to monitor trends
58
Q

what are the s/sx of UGI bleeds?

A

• Fatigue, low energy, especially with chronic bleed
• Pain
• Dyspepsia
• Hematemesis – coffee ground, or red?
• Melena
• If sudden or massive, may have anxiety, restlessness, change in LOC,
tachycardia, dyspnea, tachypnea, cool, clammy skin, nausea
(signs of shock)

59
Q

what assessments should occur for a pt with UGI bleed?

A

Monitor for s/s hypovolemia/shock or perforation!
• FrequentVS, H&H, LOC, and oxygenation status
• Multiple large bore IVs (18 gauge or central line)
• NG tube
• Fluid replacement
• Blood transfusion if needed

60
Q

what txs are used for UGI bleed?

A

Medications:
• PPI or H2 blocker IVP or infusion
• Octreotide (Sandostatin) IV infusion
• Chronic will need PPI, Sucralfate, iron supplement
Endoscopy
– Thermal probe, Laser , Scleral therapy
Surgery to repair the site of bleeding if unable to control

61
Q

what are the NIs for gastric surgery?

A
  • Monitor for bleeding
  • Watch for s/s of decreased peristalsis
  • Post‐prandial hypoglycemia
62
Q

what patient teaching is needed for gastric surgery?

A
  • Pernicious anemia long term complication
  • Dumping syndrome
  • S/s, dietary changes, meds to delay gastric emptying
63
Q

what are the complications of gastric surgery?

A

• 20% Dumping syndrome; pernicious or iron deficient anemia, postprandial hypoglycemia, bile reflux

Nursing Semester 3 (29 decks)

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