gastric and duodenal disorders Flashcards
BMI <18.5 means…
underweight
BMI >30 means…
obese
how do you calculate BMI
height in inches vs body weight in pounds
what are some causes of hiatal hernia
- weakened muscle
- age related changes
- injury
- persistent pressure
whats happening with hiatal hernia
stomach through diaphragm
how will a client present with hiatal hernia
- small = asymptomatic
- acid reflux
- possible bulge in abd
- difficulty swallowing
- CP or abd pain
- SOB
- vomiting blood (coffee ground lookin) and black tarry stools
what are some labs and diagnostics for hiatal hernia
- xray
- EGD
what meds can help with hiatal hernia
- antacids
- H2 blockers
- PPI
what are some complications of hiatal hernia
- very large = surgery
- strangulation/ischemia
whats a surgical intervention for hiatal hernia
nissen fundoplication
describe nursing focus and education for hiatal hernia
- 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
what are some causes of gastritis
- H. pylori (contaminated foods)
- NSAIDs
- older age
- excessive alc
- stress
- autoimmune (crohns)
whats happening with gastritis
- injury to gastric mucosa
- HCL damage/inflammation
how will the client present with gastritis
- asymptomatic
- gnawing/pyrosis
- N/V, anorexia
- fullness in abd even after small meals
- if severe: hematochezia, hematemeiss, melena
what are some labs and diagnostics for gastritis
- EGD (with biopsy if H. pylori suspected)
- H&H and CBC
what meds can help with gastritis
- antibiotics (clarithromycin, amoxicillin, metronidazole) for H. pylori
- PPI (omeprazole): daily, slows HCL production
- H2 (ranitidine): PRN, slows HCL production
- antacids (TUMS)
describe surgical interventions for gastritis
if severe = surgery
what are some complications of gastritis
- ulcers
- bleeding
- pernicious anemia
- stomach CA (rare)
describe nursing focus and education for gastritis
- often self resolving
- eat smaller, more frquent meals
- avoid irritating foods
- avoid alc
- avoid NSAIDs (tylenol for pain relief)
- H. pylori
- assess for bleeding
what are some causes of PUD
- H. pylori (most common)
- long term NSAID/ASA
- other meds like SSRIs
whats happening with PUD
- increased acid and decreased mucus
- stomach lining eroding
- open sores (ulcers)
how will the client present with PUD
- asymptomatic
- gnawing/burning epigastric pain
- bloating/belching
- fatty food intolerance (duodenal ulcer)
- pyrosis
- nausea
- gastric vs duodenal
- seldom: vomiting and hematemesis
what are some labs and diagnostics for PUD
- stool testing (occult)
- CBC/BMP
- EGD w/ biopsy
- fluoroscopy
what meds can help with PUD
H. pylori:
- triple antibiotic
- PPI/H2/antacids
not H. pylori:
-PPI/H2/antacids
alternative medicine
what are some complications of PUD
- internal bleeding
- infection
- obstruction
- refractory ulcers
describe nursing focus and education for PUD
- 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
what are some possible triggers for PUD
- smoke (interferes with stomach lining)
- alcohol (limit or avoid)
- spicy foods
- stress (healthy coping)
describe obesity
- 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
describe lifestyle modification for obesity
- weight loss diet and behavioral modification and exercise
- dieticians with meal planning
- acupuncture and hypnosis?
name some anti-obesity meds
- orlistat
- lorcaserin
- sibutramine HCL PULLED
meds have many unwanted adverse effects
meds rarely result in weight loss >10% of total body weight
why would gastric bypass (aka roux-en-y) be used
- 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
whats happening with gastric bypass (aka roux-en-y)
- small puch from stomach
- connected to small intestine
- bypass stimach and duodenum
- walnut size stomach (one ounce)
what are some risks of gastric bypass (aka roux-en-y)
- same as general surgeries
- dumping syndrome
- bowel obstruction
- hypoglycmia
- malnutrition
- stomach perforation
- ulcers
- gallstones
describe education for gastric bypass (aka roux-en-y)
- 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
