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Nursing 130 Perioperative > Exam 2 Chapter 23 > Flashcards

Exam 2 Chapter 23 Flashcards

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1
Q

inflammation of gastric/stomach mucosa

A

Gastritis

Acute or chronic

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2
Q

cause of acute gastritis

A 
contaminated food
irritating foods (spicy)
overuse of ASA, NSAIDS
 alcohol
bile reflux
radiation therapy
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3
Q

what are some SxS of acute gastritis

A 
abd discomfort
anorexia 
nausea
vomiting
headache 
hiccuping
lassitude (fatigue)
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4
Q

Gastritis may be the first sign of systemic infection.

True or False

A

True

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5
Q

Chronic gastritis may be associated with which autoimmune disease?

A

Pernicious anemia

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6
Q

which medications can cause chronic gastritis

A

NSADs

Bisphosphonate (Fosamax, Actonel, Boniav)

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7
Q

causes of chronic gastritis

A 
medications (NSAIDs, bisphosphonate)
ulcers
H.pylori 
dietary factors 
alcohol 
smoking
reflux of pancreatic secretions and bile into the stomach
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8
Q

SxS of chronic gastritis

A 
anorexia 
nausea 
vomiting 
belching
heartburn after eating
sour test in mouth
Vitamin B12 deficiency
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9
Q

PUD

A 
peptic ulcer disease 
An excavation (hollowed out area) that forms in the mucosal wall of the stomach, pylorus, duodenum (first part of the small intestine)
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10
Q

An excavation (hollowed area) that forms in the mucosal wall of the stomach, pylorus, and duodenum?

A

Peptic ulcer disease (PUD)

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11
Q

Chronic gastric ulcers tend to occur where?

A

lesser curvature of the stomach, near the pylorus.

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12
Q

Amoxicillin (Amoxil)

A

bactericidal antibiotic that assists with eradicating H.pylori in the gastric mucosa.

May cause diarrhea
should not be used in patients allergic to penicillin

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13
Q

Clarithromycin (Biaxin)

A

Exerts bactericidal effects to eradicate H.pylori in gastric mucosa.

may cause GI upset, headache, altered taste.
many drug-drug interactions (eg. cisapride, colchicine, lovastatin, warfarin)

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14
Q

Metronidazole (Flagyl)

A

synthetic antibacterial and antiprotozoal that assists with eradicating H.pylori when administered with other antibiotics and PPIs.
should be given with meals to decease GI upsets.
may cause anorexia and metallic taste.
increases blood thinning effects of warfarin.
pts should avoid alcohol

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15
Q

Tetracycline

A

exerts bacteriostatic effects to eradicate H.pylori.
may cause photosensitivity; warn patient to use sunscreen.
may cause GI upset.
caution in pts with renal or hepatic impairment.
milk or dairy produces may reduce effectiveness.

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16
Q 
Anti diarrhea
	Bismuth subsalicylate (pepto-Bismol)
A

suppresses H.pylori in the gastric mucosa and assists with healing of mucosal ulcers.
Given concurrently with antibiotics.
SHOULD BE TAKING ON EMPTY STOMACH

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17
Q

Histmaine-2(H2) Receptor Antagonists

A 
Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)
Roxatidine (Roxane)
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18
Q

Histmaine-2 (H2) antagonist

A

decrease amount of HCI produced by stomach by blocking action of histamine on histamine receptors or parietal cells in the stomach.

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19
Q

Cimetidine (Tagamet)

A

H2 Antagonists
least expensive
may cause confusion, agitation or coma in the elderly or those with renal or hepatic insufficiency.
long-term use may cause diarrhea, dizziness, gynecomastia.
Many drug-drug interactions (benxodiazepines, metoprolol, phenytoin, warfarin, amitriptyline, amiodarone)

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20
Q

Famotidine (Pepcid)

A

H2 receptor antagonist.
Best choice for critically ill patients because it is known to have the least risk of drug-drug interactions; does not alter liver metabolism.
Prolonged half-life in patients with renal insufficiency.
short-term relief for GERD.

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21
Q

which H2 receptor antagonist is the best choice for critically ill patients?

A

Famotidine (Pepcid)
it know to have the least drug-drug interactions.
does not alter liver metabolism

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22
Q

Nizatidine (Axid)

A

H2 receptor antagonist.
use for treatment of ulcers and GERD.
Prolonged half-life in patients with renal insufficiency.
May cause headache, dizziness, diarrhea, nausea/vomiting, GI upset, urticaria (hives).

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23
Q

Ranitidine (Zantac)

A

H2 receptor antagonists
prolonged half-life in patients with renal and hepatic insufficiency.
fewer side effects than cimetidine.
May cause headache, dizziness, CONSTIPATION, nausea/vomiting, or abdominal discomfort.

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24
Q

Roxatidine (Roxane)

A

H2 receptor antagonist.
prolonged half-life in patients with renal and hepatic insufficiency.
single bedtime dose in combination with PPI to reduce nocturnal acid reflux.
may cause headache, dizziness, CONSTIPATION, nausea/vomiting, or abd discomfort

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25
Q

Proton Pump Inhibitors of Gastric Acid (PPIs)

A 
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (AcipHex)
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26
Q

What is the major action of PPIs

A

decreases gastric acid secretion by slowing the hydrogen-potassium adenosine triphosphatase (H, K ATPase) pump on the surface of the parietal cells of the stomach.

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27
Q

Esomeprazole (Nexium)

A

Used maily for Tx of duodenal ulcer disease and H.pylori infection.
A delayed release capsule that is to be swallowed whole and taken before meals.

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28
Q

which of the PPIs has drug-drug interactions with digoxin, iron, and warfarin?

A

Rabeprazole (AcipHex)
delayed-release tablet to be swallowed whole.
may cause abdominal pain, diarrhea, headache, nausea.

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29
Q

This type of PPI when given may cause hyperglycemia and abnormal liver function tests?

A 
Pantoprazole (Protonix)
delayed-release capsule 
should be swallowed whole 
taken before meals.
may also cause headache, diarrhea, abd pain
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30
Q

Omeprazole (Prilosec)

A 
PPI
delayed-release capsule.
should be swallowed whole.
taken before meals.
May cause diarrhea, nausea/vomiting CONSTIPATION, abd pain, headache or dizziness.
31
Q

Misoprostol (Cytotec)

A

synthetic prostaglandin.
protects the gastric mucosa from agents that cause ulcers.
increase mucous production and bicarbonate levels.
used to prevent ulceration in patients using NSAIDs.
Given with food.
May cause diarrhea and cramping (including uterine cramping).

32
Q

Sucralfate (Carafate)

A

creates a viscous substance in the presence of gastric acid that forms a protective barrier, binding to the surface of the ulcer, and prevents digestion by pepsin.
used mainly for the Tx of duodenal ulcers.
SHOULD NOT BE TAKEN WITH FOOD BUT WITH WATER.
Other medications should be taken 2 hours before or after.
may cause constipation or nausea.

33
Q

Duodenal Ulcer

A 
30 to 60 years 
mostly in men
80% are duodenal
hypersecretion of stomach acid (HCl)
may have weight gain
pain occurs 2 to 3 hours after a meal
often awakened 1 or 2 a.m
ingestion of food relieves pain
vomiting uncommon
hemorrhage less likely if present= melena 
more likely to perforate
Risk factors: H.pylori, alcohol, smoking, cirrhosis, stress.
34
Q

Gastric ulcer

A

usually > 50 years
15% are gastric
normal to hyposecretion of stomach acid (HCl)
weight loss may occur
pain occurs half to 1 hour after a meal.
rarely occurs at night
may be relieved by vomiting
ingestion of food does not help, sometimes increases pain.
vomiting is common
hemorrhage more likely to occur (hematemesis).
malignancy occasionally
risk factors: H.pylori, gastritis, alcohol, smoking, NSAIDS, stress.

35
Q

How does aspirin and NSAIDS destroyer the mucosal barrier to cause PUD?

A

by inhibiting the syntheses of prostaglandins causing abnormal permeability.

36
Q

Helicobacter pylori destroyers mucosal barrier by?

A

producing enzyme urease which mediates inflammation making mucosa more vulnerable.

37
Q

Corticosteroids destroyers the mucosal barrier by…

A

decreasing rate of mucosal cell renewal.

decreasing protective effects.

38
Q

how does Lipid-soluble cytotoxic drug destroy the mucosal barrier causing PUD?

A

passing through and destroying it.

39
Q

vagal nerve stimulation association with PUD

A

emotions (stress)

increase HCl acid production

40
Q

why is endoscopy the preferred diagnostic procedure in PUD?

A

because it allows direct visualization of inflammatory changes, ulcers and lesions.

41
Q

Gastric ulcer pain

A

high in epigastrium
1 to 2 hours after meals
gastric acid pain
burning or gaseous

42
Q

Duodenal ulcer pain

A

midepigastric region beneath xiphoid process
back pain-if located posterior aspect.
2 to 4 hours after meals.

43
Q

what are the three major complications associated with PUD

A

hemorrhage
perforation
gastric outlet obstruction

All considered emergency situations.

44
Q

why should the nurse advice a patient with PUD to stop smoking?

A

smoking decrease the secretion of bicarbonate from the pancreas into the duodenum, resulting in increase acidity of the duodenum.

45
Q

which types of patient with PUD are surgical management usually recommended for?

A

intractable ulcers (those that fail to heal after 12-16 weeks of medical treatment).
life-threatening hemorrhage.
perforation or obstruction
ZES not responding to medications.

46
Q

which drug regimen are used to treat NSAID induce ulcers and other ulcers not associated with H.pylori?

A

Histamine-2 (H2) receptor antagoists

PPIs

47
Q

SxS of hemorrhage

A 
cool skin
confusion
increase heart rate
labored breathing 
blood in the stool
48
Q

SxS of penetration or perforation

A

sudden, dramatic onset
severe abdominal pain spreads throughout abdomen
rigid( boardlike) tender abdomen muscles
nausea and vomiting
elevated temperature
hypotension and tachycardia (indicating shock)
increased heart rate
No bowel sounds
pain may be referred to shoulders, especially the right because of irritation of the phrenic nerve in the diaphragm.

49
Q

SxS of pyloric obstruction

A

nausea and vomiting
distended abdomen
abdominal pain

50
Q

gastric outlet obstruction is due to?

A

edema
inflammation
pylorospasm
fibrous scar tissue formation

All contributing to narrowing of pylorus

51
Q

clinical manifestations of gastric outlet obstruction

A

pain worsen toward end of day as stomach fills and dilates.
relief obtained by belching or vomiting
projectile vomiting is common (due to pressure).

52
Q

The erosion of ulcer through the gastric serous into the peritoneal cavity without warning?

A

PERFORATION

it is an abdominal catastrophe and requires immediate surgery.

53
Q

Erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary tract, or gastropepatic omentum?

A

PENETRATION.
symptoms include: back and epigastric pain not relieved by medications that were working in the past.

requires surgical interventions

54
Q

occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissues that forms when an ulcer alternately heals and breaks down…?

A 
Pyloric obstruction also called gastric outlet obstruction (GOO).
SxS: N/V
constipation
epigastric fullness
anorexia 
later weight loss.
55
Q

what is the first consideration in treating a patient with pyloric obstruction or GOO?

A

inserting and NG tube to decompress the stomach.
Confirmation is done by assessing the amount of fluid aspirated from the NG tube.
A residual of more than 400 mL strongly suggests obstruction.

56
Q

which nursing interventions may improve GOO and avert the need for surgical intervention?

A

decompression of the stomach via NG tube.
management of extracellular fluid volume and electrolyte balances.
monitor vitas, watch for signs of bleeding indicated by decrease BP, increase HR, RR.
Monitor H&H
pt teaching to avoid alcohol, coffee (decaff too), meat extrats, diets rich in milk and cream.

57
Q

Interventions for PUD

A

monitor vitals; watch for bleeding signs.
Assess for dehydration.
NPO
monitor H&H
NG tube if patient has obstruction
give drug therapy.
teach patient to avoid alcohol, smoking, coffee (including decaffeinated), diets rich in milk and cream.
3 regular meals a day to neutralize acid.

58
Q

Drug therapy for PUD

A

H2 blockers
PPIs
Antibiotics
Antacids
Anticholinergics (blocks cholinergic vagal stimulation, rarely used)
cytoprotective therapy( with cytotc and sucralfate)

59
Q

what is Tx for PUD aimed at?

A

allowing stomach to rest (NG Tube).
allowing natural repair of mucosal lining.
if unsuccessful surgery will be performed.

60
Q

what are the two drugs for cytoproctective therapy

A 
misoprostol (cytotec)
	secretes bicarbonate and cytoprotective mucus.
	Give with meals
	can cause diarrhea and abd pain
	DO NOT USE IF PREGNANT!!
Sucralfate (carafate) 
	creates a protective barrier
	TAKE ON AN EMPTY STOMACH!!
	may cause constipation
	interacts with several medications, separate administration by 2 hour.
61
Q

Removal of stomach with attachment of esophagus to jejunum or duodenum?

A

Total Gastrectomy

surgical therapy for PUD

62
Q

Partial gastrectomy with removal of distal 2/3 stomach and anastomois of gastric stump to duodenum

A

Billrotth I (gastroduodenostomy)

Pt may have problems with feeling of fullness, dumping syndrome, and diarrhea.

63
Q

Transecting nerves that stimulate acid secretion and opening the pylorus to enhance gastric emptying

A

PYLOROPLASTY

64
Q

ANTRECTOMY

A

removal of the pyloric (antrum) portion of the stomach with anastomosis to either the duodenum (gastroduodenostomy or Billroth I) or jejunum (gastrojejunostomy or Billroth II)

65
Q

Vagotomy

A

severing of vagus nerve.

eliminates vagal stimulation therefore decreasing gastric acid

66
Q

partial gastrectomy with removal of distal 2/3 stomach and anastomosis of gastric stump to jejunum..?

A

Billroth II (gastrojejunostomy).

Pt may have problems with..
dumping syndrome
anemia
 malabsorption
weight loss
67
Q

what is the most common postoperative complications associated with PUD?

A

dumping syndrome

68
Q

Patient teaching to prevent dumping syndrome in patient who have undergone surgery for PUD

A

Avoid sugar, salt and milk.
eat high-protein, high fat, low-carb diet
eat six small meals
avoid fluids with meals, drink fluids 1 hour before or after
lie down after meals 20 to 30 minutes

69
Q

Double-drug therapy for H. Pylori infection

A

Bismuth salts and one antibiotic (clarithromycin)

70
Q

Triple-drug treatment for H.Pylori

A 
PPI or Bismuth salts (pepto-bismol)
two antibiotics (amoxicillin and clarithromycin)
71
Q

Quadruple drug therapy for H.Pylori treatment

A

Bismuth salts
PPI
two antibiotics (tetracycline, metronidazole (Flagyl)

72
Q

surgical therapy for PUD which involves the enlargement of pyloric sphincter to enhance grastric emptying

A

Pyloroplasty

73
Q

postop care for patient with PUD who had surgical therepy

A

Monitor NG output
Color: bright red at first with darkening within 1st 24 hours
color change yellow -green within 36 to 48 hours
check amount
odor

Nursing 130 Perioperative (12 decks)

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