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Medical Surgical Nursing > Disturbance in Digestion > Flashcards

Disturbance in Digestion Flashcards

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1
Q

Gastritis

A

inflammation of the gastric/stomach mucosa

  • older adults
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2
Q

Gastritis

Acute Gastritis

A
  • several hours - few days
  • → gangrenous/perforate mucosa → scarring → obstruction/pyloric stenosis
  • more severe form form is caused by ingestion of strong acid/alkali
  • → severe illness
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3
Q

Acute Gastritis (Gastritis)

Erosive

A

caused by:
* local irritants (aspirin, NSAIDs)
* gastric radiation therapy

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4
Q

Acute Gastritis (Gastritis)

Nonerosive

A

caused by H. pylori infection

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5
Q

Gastritis

Chronic Gastritis

A
  • repeated exposure
  • most often from H. pylori infection
  • in devt. of PU, gastric cancer, gastric mucosa-associated lymphoid tissue lymphoma
  • caused by gastropathy
  • w/ Hashimoto thyroiditis, Addison d., Grave’s d.
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6
Q

Gastritis

Pathophysiology

A

mucosal barrier → disrupted/damaged → irritants (gastric juices) → inflammation

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7
Q

Gastritis

Clinical Manifestations

Acute Gastritis

A
  • Epigastric pain/discomfort
  • Dyspepsia
  • Anorexia
  • Hiccups
  • Nausea
  • Vomitting
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8
Q

Gastritis

Clinical Manifestations

Erosive Gastritis

A
  • hematemesis
  • melena
  • hematochezia
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9
Q

Gastritis

Clincal Manifestation

Chronic Gastritis

A
  • fatigue
  • pyrosis/heartburn
  • anorexia
  • nausea
  • vomitting
  • mild epigastric discomfort
  • intolerance to spicy/fatty foods
  • slight pain relieved by eating
  • not absorb Vit. B12 → pernicious anemia
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10
Q

Gastritis

Systemic Manifestations

A
  • signs of shock
  • fatigue
  • anemia
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11
Q

Gastritis

Assessment & Diagnostic Findings

A
  • endoscopy
  • hisotlogic examination
  • CBC
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12
Q

Gastritis

Medical Management

A
  • recovery = 1 day
  • appetite diminished to 2/3 days
  • non-irritating diet
  • NGT
  • antacids
  • H2 receptor antagonists
  • PPIs
  • fiberoptic endoscopy
  • emergency surgery
  • gastrojejunostomy (for gastric outlet obstruction/pyloric obstruction)
  • diet modification
  • rest
  • reduce stress
  • X alcohol, gastric irritant meds
  • PPIs, antibiotics, bismuth salts
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13
Q

Gastritis

Nursing Management

A
  • reduce anxiety, stress
  • X induce vomitting
  • NPO
  • ice chips → clear liquids
  • X caffeine (CNS stimulant → ↑ gastric activity & pepsin secretion
  • X nicotine (< pacreatic bicarbonate → neutralizes gastric acid)
  • Fluid intake = 1.5 L/day
  • UO = 0.5 mL/kg/h
  • IVF = 3 L/day
  • Fluid intake + caloric value = 1L = 170 calories of CHO
  • NaClK q 24 hours
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14
Q

Peptic Ulcers

A

ulcers/breaks on the mucosal lining

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15
Q

PUD

Gastric Ulcer

A
  • > 50 yo
  • both sexes
  • 15% - 20%
  • stomach antrum
  • 30 mins - 1 hr pc
  • churning
  • vomitting = weight loss
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16
Q

PUD

Duodenal Ulcer

A
  • 30-60 yo
  • male
  • 80%
  • pylorus
  • 2-3 hrs pc
  • gnawing
  • eating = weight gain
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17
Q

PUD

Risk Factors

A
  • H. pylori
  • Smoking
  • Pancreatic tumor (Zollinger-Ellison syndrome)
  • Type O
  • Family hx
  • Drugs (steroids, aspirin, NSAIDs)
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18
Q

PUD

Nursing Assessment

A
  • characteristic: burning, aching, gnawing pain
  • location: epigastrium
  • test for H. pylori
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19
Q

PUD

Nursing Interventions

A
  • Perforation
  • Pain
  • Pyloric Obstruction (vomitting, fullness)
  • Peritonitis (board-like abdomen/rigid abdomen)
  • Hemorrhage
20
Q

PUD

Therapeutic Management

A
  • aggravants: soda, coffee, tea, chocolate, spicy, ↑ Na and spices
  • X smoking
21
Q

PUD

Drugs

A
  • Antacid (neutralizes acid; ac/pc)
  • H2 receptor antagonist (-tidine; block histamine-stimulated gastric secretion)
  • Proton pump inhibitor (-ozole; suppress HCl production; ac)
  • Prostaglandin analogue (misoprostol/cytotec; ac)
  • Mucosal barrier fortifier (sucralfate; ac)
22
Q

PUD

Diet

A

↑ CHO
↓ CHON

23
Q

PUD

Treatment

A
  • Vagotomy (cut CN 10 = X nerve stimulation in stomach)
  • Billroth I
  • Billroth II
24
Q

PUD (Treatment)

Billroth I

A

creation of anastomosis bet. duodenum and gastric remnants

gastroduodenostomy

feeling of fullness and dumping syndrome

25
Q

PUD (Treatment)

Billroth II

A

sewing a loop of jejunum to the gastric remnant

gastrojejunostomy

dumping syndrome, anemia, wieght loss

26
Q

Gastric Cancer

A
  • 69 yo adults
  • men
  • hispanic american, african american, asian
  • sporadic
  • prognosis = poor (5 years)
  • adenocarcinoma
  • 40% lower, 40% middle, 15% upper, 10% more than 1 part
  • common site of mestasis = liver, peritoneum, lungs, brain
27
Q

Gastric Cancer

Risk Factor

A
  • diet = ↑ smoked, salted, pickled
  • diet = ↓ fruits, vegetables
  • h. pylori infection (major)
  • chronic inflammation
  • pernicious anemia
  • smoking
  • obesity
  • achlorhydria
  • gastric ulcer
  • previous gastrectomy
  • genetics (type A, first degree relative)
28
Q

Gastric Cancer

Clinical Manifestations

Early Stage

A
  • pain relived by antacids
29
Q

Gastric Cancer

Clinical Manifestations

Advanced Disease

A
  • Dyspepsia
  • Early satiety
  • Weight loss
  • Abdominal pain (above umbilicus)
  • decrease in appetite
  • bloating pc
  • nausea and vomitting
  • fatigue
30
Q

Gastric Cancer

Assessment

A
  • palapble as mass
  • ascites
  • hepatomegaly
  • palpabe nodules around umbilicus (Sister Mary Joseph’s Nodules)
31
Q

Gastric Cancer

Diagnostic Findings

A
  • Esophagogastroduodenoscopy
  • Barium X-ray of UGIT
  • CT scan
  • Endoscopic UTZ
32
Q

Gastric Cancer

Medical Management

A
  • Chemotherapy
  • Targeted therapy
  • Radiation therapy
33
Q

Gastric Cancer

Surgical Management

A
  • total gastrectomy (stomach + duodenum ++ LE + mesentery + lymph nodes)
  • esophagojejunostomy (jejunum + esophagus)
  • radical partial (subtotal) gastrectomy (middle and distal)
  • Billroth I or II
  • proximal partial (subtotal) gastrectomy (proximal)
34
Q

Gastric Cancer

Complications of Gastric Surgery

A
  • Hemorrhage
  • Dumping Syndrome
  • Bile reflux
  • Gastric Outlet Obstruction
35
Q

Gastric Cancer (Complications from Gastric Surgery)

Dumping Syndrome

A
  • rapid passage of food → not enough time for digestion and absorption → intestinal dilation, ↑ inestinal transit, hyperglycemia, rapid onset of GI & vasomotor symptoms
  • 25% - 50%

hyperglycemia = ↑ insulin = hypoglycemia 2-3 hours pc

36
Q

Dumping Syndrome (Complications from Gastric Cancer Surgery)

Early Symptoms

A
  • early satiety
  • cramping abdominal pain
  • nausea
  • vomitting
  • diarrhea

occur within 10-30 minutes pc

resolved within 1 hour or with bowel evacuation

37
Q

Dumping Syndrome (Complications from Gastric Cancer Surgery)

Vasomotor Symptoms

A
  • headache
  • flushing/feelings of warmth
  • diaphoresis
  • dizziness
  • palpations
  • drwosiness
  • syncope
38
Q

Gastric Cancer (Complications from Gastric Surgery)

Bile reflux

A
  • manipulation or removal of the pylorus
  • = irritation and damage to the gastric mucosa → gastritis, esophagitis, PU
  • burning epigastric pain
39
Q

Bile Reflux (Complications from Gastric Cancer Surgery)

Pharmacologic Management

A
  • Sucralfate/cholestyramine
  • Cholestyramine = prevent reabsorption; eliminatin of bile acids in stools
40
Q

Gastric Cancer (Complications from Gastric Surgery)

Gastric Outlet Obstruction

A

from stenosis or stricture

fullness, vomitting

41
Q

Gastric Cancer

Chemotherapy

chemotherapeutic agents

A
  • fluorouracil
  • carboplatin
  • capecitabine
  • cisplatin
  • docetaxel
  • epirubicin
  • irinotecanoxaliplatin
  • paclitaxel
42
Q

Gastric Cancer (chemotherapy)

Trastuzumab

A

with fluorouracil or capecitabine and cisplatin = improvement in surival with advanced GC who are HER-2 positive

43
Q

Gastric Cancer

Radiation Therapy

A
  • before: decrease the size
  • after: destroy remaining cancer cells
  • 3-dimensional conformal radiation therapy
44
Q

Gastric Cancer

Nursing Assessment

A

nutritional intake and status

45
Q

Gastric Cancer

Nursing Intervention

A
  • Reducing Anxiety
  • Promoting Optimal Nutrition
  • Relieving Pain
  • Providing Psychosocial Support
46
Q

Gastric Cancer (Nursing Intervention)

Promoting Optimal Nutrition

A
  • small frequent feedings of non-irritating food
  • ↑ calories, Vit A and C
  • ↓ CHO
  • fluid between meals
  • Vit B12 injection
47
Q

Gastric Cancer (Nursing Intervention)

Relieiving Pain

A
  • opioid/PCA
  • position changes
  • imagery
  • distraction
  • rest and relaxation
  • backrubs
  • massage

Medical Surgical Nursing (2 decks)

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