gastric and duodenal disorders

Question 1

BMI <18.5 means…

Answer 1

underweight

Question 2

BMI >30 means…

Answer 2

obese

Question 3

how do you calculate BMI

Answer 3

height in inches vs body weight in pounds

Question 4

what are some causes of hiatal hernia

Answer 4

• weakened muscle
• age related changes
• injury
• persistent pressure

Question 5

whats happening with hiatal hernia

Answer 5

stomach through diaphragm

Question 6

how will a client present with hiatal hernia

Answer 6

• small = asymptomatic
• acid reflux
• possible bulge in abd
• difficulty swallowing
• CP or abd pain
• SOB
• vomiting blood (coffee ground lookin) and black tarry stools

Question 7

what are some labs and diagnostics for hiatal hernia

Answer 7

• xray
• EGD

Question 8

what meds can help with hiatal hernia

Answer 8

• antacids
• H2 blockers
• PPI

Question 9

what are some complications of hiatal hernia

Answer 9

• very large = surgery
• strangulation/ischemia

Question 10

whats a surgical intervention for hiatal hernia

Answer 10

nissen fundoplication

Question 11

describe nursing focus and education for hiatal hernia

Answer 11

• smaller frequent meals
• avoid triggers
• stay upright after eating
• eat 2-3hrs bfore bed
• maintain healthy weight
• stop smoking
• elevate HOB
• med compliance
• discuss complications

Question 12

what are some causes of gastritis

Answer 12

• H. pylori (contaminated foods)
• NSAIDs
• older age
• excessive alc
• stress
• autoimmune (crohns)

Question 13

whats happening with gastritis

Answer 13

• injury to gastric mucosa
• HCL damage/inflammation

Question 14

how will the client present with gastritis

Answer 14

• asymptomatic
• gnawing/pyrosis
• N/V, anorexia
• fullness in abd even after small meals
• if severe: hematochezia, hematemeiss, melena

Question 15

what are some labs and diagnostics for gastritis

Answer 15

• EGD (with biopsy if H. pylori suspected)
• H&H and CBC

Question 16

what meds can help with gastritis

Answer 16

• antibiotics (clarithromycin, amoxicillin, metronidazole) for H. pylori
• PPI (omeprazole): daily, slows HCL production
• H2 (ranitidine): PRN, slows HCL production
• antacids (TUMS)

Question 17

describe surgical interventions for gastritis

Answer 17

if severe = surgery

Question 18

what are some complications of gastritis

Answer 18

• ulcers
• bleeding
• pernicious anemia
• stomach CA (rare)

Question 19

describe nursing focus and education for gastritis

Answer 19

• often self resolving
• eat smaller, more frquent meals
• avoid irritating foods
• avoid alc
• avoid NSAIDs (tylenol for pain relief)
• H. pylori
• assess for bleeding

Question 20

what are some causes of PUD

Answer 20

• H. pylori (most common)
• long term NSAID/ASA
• other meds like SSRIs

Question 21

whats happening with PUD

Answer 21

• increased acid and decreased mucus
• stomach lining eroding
• open sores (ulcers)

Question 22

how will the client present with PUD

Answer 22

• asymptomatic
• gnawing/burning epigastric pain
• bloating/belching
• fatty food intolerance (duodenal ulcer)
• pyrosis
• nausea
• gastric vs duodenal
• seldom: vomiting and hematemesis

Question 23

what are some labs and diagnostics for PUD

Answer 23

• stool testing (occult)
• CBC/BMP
• EGD w/ biopsy
• fluoroscopy

Question 24

what meds can help with PUD

Answer 24

H. pylori:
- triple antibiotic
- PPI/H2/antacids

not H. pylori:
-PPI/H2/antacids

alternative medicine

Question 25

what are some complications of PUD

Answer 25

• internal bleeding
• infection
• obstruction
• refractory ulcers

Question 26

describe nursing focus and education for PUD

Answer 26

• have meds ready for attack: ranitidine not omeprazole for attacks
• avoid NSAIDs: talk to doc about PPI/H2 if you have to
• avoid triggers
• choose healthy diet
• consider probiotic foods
• milk doesnt do shit for ya
• adequate sleep = stronger immune system = less stress

Question 27

what are some possible triggers for PUD

Answer 27

• smoke (interferes with stomach lining)
• alcohol (limit or avoid)
• spicy foods
• stress (healthy coping)

Question 28

describe obesity

Answer 28

• metabolic disease characterized by fat that accumulates so that health is impaired
• BMI >30 = obese
• associated with significant morbity and mortality
• low self esteem, impaired body image, depression, diminshed quality of life
• environmental, genetic, metabolic, cultural, socioeconomic factors

Question 29

describe lifestyle modification for obesity

Answer 29

• weight loss diet and behavioral modification and exercise
• dieticians with meal planning
• acupuncture and hypnosis?

Question 30

name some anti-obesity meds

Answer 30

• orlistat
• lorcaserin
• sibutramine HCL PULLED

meds have many unwanted adverse effects
meds rarely result in weight loss >10% of total body weight

Question 31

why would gastric bypass (aka roux-en-y) be used

Answer 31

• when diet and exercise dont work
• when serious health probs occur
• conditions: BMI >40 or BMI 35-39.9 w/ serious weight related health issues

Question 32

whats happening with gastric bypass (aka roux-en-y)

Answer 32

• small puch from stomach
• connected to small intestine
• bypass stimach and duodenum
• walnut size stomach (one ounce)

Question 33

what are some risks of gastric bypass (aka roux-en-y)

Answer 33

• same as general surgeries
• dumping syndrome
• bowel obstruction
• hypoglycmia
• malnutrition
• stomach perforation
• ulcers
• gallstones

Question 34

describe education for gastric bypass (aka roux-en-y)

Answer 34

• counseling before and after
• presurgery weight loss goals
• physical activity programs
• tobacco stop
• inpatient 3-5days
• progressive diet
• vitamin/mineral supplementation
• 3-6mo of malaise
• psychosocial aspects