Fall Mid Term Flashcards
Major cause of cancer in the GI tract?
Tobacco use and smoking
GI Tract
mouth —> esophagus —> duodenum, jejunum, and illeum —> cecum —> ascending, transverse, descending and sigmoid colon
Purpose of small intestine
Absorbs nutrients from the chyme
Main purpose of colon
Waste; absorbs water, some electolytes, vit K, and bile acids
3 main sphincters to know
Lower esophageal
Pyloric
Ileocecal
What to tell you patient with GERD
Small meals
Sit up after eating
Lower protein since it takes longer to digest
Medications: PPI,
Drink milk - it can help, but it has protein in it and can cause problems
What causes peptic ulcers?
H. Pylori
Stress
Smoking
Difference between pepcid and omeprozole and antacids
Pepcid is an H2 blocker (blocks histamine; histamine stimulates acid production) Give it before eating, give in the morning
Omeprozole is a PPI (decreases the amount of acid produced): Give before eating
Antacids (neutralize acid): give after eating
Keraphate
Medication that coats entire stomach. Give digoxin half hour before keraphate or two hours after
How do you get H. pylori
Costco. Hahah. No but really, fecal-oral and respirations. GOOD HANDWASHING!!
Hiatal Hernia
Results from a defect in the diaphragm at the point where the esophagus passes through it (Sliding Hiatal Hernia: part of the stomach goes up through the established hole in the diaphragm. Paraesophageal Hiatal Hernia: hernia in diaphragm over from the esophageal opening and some stomach gets trapped); common in women; Cause: congenital muscle weakness or weakness resulting from trauma; Causes: multiparaty, obesity, age-related loss of muscle tone, smoking
Peptic Ulcer
Circumscribed loss of tissue in an area of the GI tract that is in contact with hydrochloric acid and pepsin; most occur in duodenum (can also occur anywhere from the esophagus to the duodenum (including the jejunum if gastric bypass surgery)); can turm malignant; Cause: H. pylori, chronic NSAID use, smoking, physiologic stress; S/S: pain dec when full/inc when empty, burning localized pain, bleeding, unexplained wt loss
GERD
gastric contents flow upward into the esophagus. Some reflux is common; considered a disease process only when it is excessive or causes undesirable symptoms such as pain or resp distress
Gastritis
inflammation of the stomach lining; can be acute or chronic; Causes: dietary secretions, reflux of duodenal contents, aspirin/NSAID/steroid use, alcohol, caffiene, smoking, ingestion of poisons or corrosives, food allergies, infection (esp H. pylori), stress, autoimmune
Bleeding ulcer-what meds NOT to take?
NSAIDs, warfarin, plavix, aspirin
Bleeding ulcer-what TO take?
PPI’s, H2 blockers, antibiotics, antacids, carafate (forms seal over ulcer, protecting from irritation)
Tx for hemmorhage from ulcer
Complete rest for the GI tract, blood transfusions, gastric lavage with saline solution, IV fluids.
Serotonin antagonists and Dopamine antagonists
Serotonin antagonist: -setron (ie Ondansetron)
Dopamine antagonist
Why doesn’t Eileen like dopamine antagonists?
(makes them weird and loopy) Messes with them, extra pyramidal effects.
Metabolic problem if they vomit a lot?
Alkalosis (they may have started with acidosis but all the vomiting has pushed them to alkalosis)
Chemo: to prevent them from vomiting
Give zofran 1 hour before chemo
Vomiting Patients
Precautions. Assess them. Condition you want to worry about before giving them pills? ARE THEY PREGNANT
Know the difference between diverticulosis and diverticulitis
Diverticula-the sacs
Diverticulosis-disease where you have diverticula in the intestine
Diverticulitis-Inflammation of the diverticula
Cirrhosis, know the basics and how you get it
Alcohol consumption
Hepatitis
Drug use
Ascites - how do you take care of them
Weigh them
Measure the belly
Protein isn’t metabolized properly
If the ammonia level is down, give them protein to eat
If the ammonia level is up, decrease their protein intake
Low albumin levels
Signs and symptoms of low albumin levels: Edema in their belly, especially ascite
Give them chicken. All the protein they need is right there. Rice and beans would require a large consumption
Ammonia in your body
too much.. You start getting wacky it’s called Hepatic Encephalopathy
Given them lactulose for treatment
What does lactulose do? It binds the ammonia and the person poops it out
Know how to take care of someone with a total hip replacement
No rotation
No sitting straight up
Pillow between the knees
Lay them on the unaffected side
Amputations. Why do people get them
Trauma
Diabetes
Cancer
Long-standing infections of bone and tissue that prohibit restoration of Fx
Thermal injuries
Deformity of limb
Life-threatening disorders (ie arterial thrombosis or gas bacillus infections)
Phantom pain
The brain perceives that the limb is still there and causing pain because the nerves still work that go to the stump. If severe: nerve endings may be removed at end of the stump.
Post knee amputation care
Reduce pain and anxiety; support patient as they begin to grieve the loss of the limb and adapt to potential changes; admin narcotics; assist in ADLs; promote adequate sleep; discuss coping techniques; be understanding
Common bile duct is connected to the pancreas, gallbladder and the liver. What can cause an obstruction?
A stone
Gallbladder attack
Foods to eat during an attack? Low fat diet; RUQ pain
What is the daily requirement for calcium with supplements and/or food?
1000 mg
Rheumatoid Arthritis
Autoimmune, systemic inflammatory disorder of connective tissue/joints characterizes by chronicity, remissions, and exacerbations; great potential for disability; other body systems may be affected (ie eyes, skin, heart, lungs, kidney, blood vessels); can cause malaise and fever; majority affected are women; onset typically middle-age (can occur at any age); rxn from RA occurs primarily in the synovial tissue; Tx: NSAIDs, steroids, immunosuppressents
Osteoarthritis
aka Degenerative Joint Disease (DJD); most common form of arthritis; “wear and tear” disease and typically affects wt-bearing joints (ie knees, hips, spine, hands); no remissions or systemic symptoms; primary: no known etiology; secondary: known underlying cause such as injury, obesity, inactivity, congenital disorder; starts with cartilage breakdown, leading to bone spurs (growth of bone in places where the cartilage has broken down); pain and limited joint mobility; deformity of the joint; possible slight dislocation of the join; self-Tx for pain: NSAIDs and PPIs. Prob: PPIs can reduce bone density
Gout
hyperuricemia (accumulation of uric acid in the blood) caused by alterations in uric acid production, excretion, or both. Primary: severe dieting or starvation, excessive ingestion of purines, heredity; Secondary: abnormal purine metabolism, inc rate of protein synthesis with overproduction or underexcretion of uric acid, inc cellular turnover (as in leukemia, mult myeloma, and other cancers, some anemias, psoriasis), dec excretion of uric acid r/t diuretics, salicylates or excessive R-OH intake esp beer; S/S acute paint and tenderness in one joint, skin redness, swelling of joint, common in Hallux, attack may last 1-2 weeks
Osteoporosis
A loss of bone density, occurs principally in older adults: more women than men; bone loss exceeds bone creation-overtime leads to total bone density reduction, porous/brittle/fragile bones; causes: dec PTH/estrogen/Calcitonin (promotes bone formation) levels, family Hx, tobacco use, chromic low calcium intake, excessive caffeine intake, prolonged use of corticsteroids, hyperthyroidism, hyperparathyroidism, Cushing’s syndrome, malabsorption syndromes, breast cancer, renal/liver failure, vit D deficiency, some meds (inc heparin and SSRIs)
Hepatitis
A/E from food or water
B/C/D from blood/body fluids
Asses patient for appendicitis
Blood tests - CBC, CMP or BMP, amylase, lipase
NPO prior to surgery
No enemas
RLQ pain
Osteomyelitis
Infection of the bone, resulting in limited blood supply to the bone, inflammation of and pressure on the tissue, bone necrosis, and formation of new bone around devitalized bone tissue; diff to treat; most common: S. aureus infection; acute: injury that leads to infection; vasc insufficiency in diabetes; pin sites of skeletal traction; long-term dialysis/chemo/corticosteroid Tx/immunosuppressant meds inc risk; weakened bone prone to pathologic fracture; septicemia risk
