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NURS2522 > GERD/HH/CELIAC/BPH > Flashcards

GERD/HH/CELIAC/BPH Flashcards

1
Q

What is nausea?

A

Feeling of discomfort in the epigastrium w/ the conscious desire to vomit

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2
Q

what is vomiting?

A

the forceful ejection of partially digested food and secretions from the upper GI tract

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3
Q

How are nausea and vomiting related?

A

N+V is a complex act requiring the coordination of several structures

nausea slows emptying
- vomiting centers activated leading to closing of pylorus, relaxation of stomach and LES, contraction of abdominal muscles to increase pressure

Nausea occurs before vomiting

  • right before vomiting, the symNS is stimulated = nausea
  • during vomiting, parasymNS is activated (everything relaxes)
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4
Q

Pathophysiology of vomiting

A

1) person becomes aware of the need to vomit
2) ANS activated
3) symNS —> tachycardia, tachypnea, diaphoresis
4) parasymNS –> relaxed LES, increased gastric motility and salivation

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5
Q

Manifestations of N+V

A

N - subjective complaint
- often accompanied by anorexia (due to decreased appetite)

V - rapid loss of fluids

  • dehydration
  • alkalosis - due to loss of HCl from stomach
  • metabolic acidosis can occur if vomiting continues
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6
Q

What is bile-colored vomit indicative of?

A

lower intestinal obstruction

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7
Q

what is coffee brown vomit indicative of?

A

GI bleeding

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8
Q

What is bright red vomit indicative of?

A

Active bleeding

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9
Q

Antiemetics

  • use?
  • action?
A

Act on the chemoreceptor trigger zone (CTZ) of CNS to block the chemicals that trigger nausea

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10
Q

Nondrug therapy for N+V

A 
acupuncture
acupressure
botanicals
ginger
peppermint oil 
breathing exercises
massage
biofeedback
music therapy
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11
Q

What is GERD?

A

Gastro-esophageal reflux disease
a SYNDROME not a disease

reflux of stomach acid to the esophagus

can lead to esophagitis
- inflammation and irritation of esophagus

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12
Q

what is the cause of GERD?

A 
NO SINGLE CAUSE 
potential causes:
- hiatal hernia 
- incompetent LES
- decreased esophageal clearance due to impaired esophageal motility 
- decreased gastric emptying
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13
Q

Manifestations of GERD

A

Varies across individuals

  • heartburn
  • respiratory symptoms (wheezing, coughing, dyspnea) due to aspirations
  • hoarseness, sore throat, globus sensation (feeling of food being stuck in esophagus)
  • regurgitation
  • early satiety
  • bloating
  • n+v
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14
Q

How is GERD diagnosed?

A
  • physical exam
  • health Hx
  • barium swallow - series of X-rays after pt swallows barium (see how it moves down the esophagus)
  • motility studies
  • pH monitoring
  • upper GI endoscopy w/ biopsy and cytological analysis (analysis of cells)
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15
Q

Potential complications of GERD

A
  • esophagitis
  • hiatal hernia
  • esophageal stricture (occurs from repeated inflammation and scarring
  • Barrett’s esophagus (precancerous lesion that increases risk for esophageal cancer)
  • pneumonia (d/t aspirations)
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16
Q

Treatment for GERD

A

Lifestyle modifications

  • losing weight to decrease intra-abdominal pressure
  • changing diet to avoid triggers (fats, sugar, caffeine, dairy products)
  • eating smaller and more frequent meals

Drug therapy
Surgical therapy

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17
Q

What types of Meds are used to treat GERD

A 
ANTACIDS
- ex. tums neutralize acid 
ANTI-SECRETORY
- prevent the production of HCl
- H2-receptor blockers
- PPI
CHOLINERGIC
- increases LES pressure so that it stays closed
PROKINETICS
- encourages passage through the GI tract 
CYTOPROTECTIVE
- alginic acid-antacid
- acid-protective
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18
Q

Nursing Interventions for GERD

A

HEALTH PROMOTION

  • teach clients to avoid triggers that cause the reflux
  • smoking cessation
  • avoiding late-night eating
  • avoid lying down 2-3 hrs after eating

ACTIONS

  • elevate HOB to 30 degrees
  • evaluate effectiveness + adverse effects of medication taken for heartburn
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19
Q

What is Hiatal Hernia?

A

Herniation of a portion of the stomach into the esophagus through an opening (hiatus) in the diaphragm.

D/t weakening of the muscles in the diaphragm around the esophagogastric opening; or congenital

20
Q

Risk factors for hiatal hernia

A

increased intra-abdominal pressure d/t:

  • obesity
  • pregnancy
  • ascites, tumors,
  • intense physical exertion
  • heavy lifting on a continual basis

increased age
trauma
poor nutrition
forced recumbent position

21
Q

Manifestations of hiatal hernia

A
  • Similar to GERD
  • dysphagia
  • mimics gallbladder disease, peptic ulcer disease, and angina
  • reflux + discomfort associated w/ position
  • nocturnal symptoms of heartburn
22
Q

Complications of hiatal hernia

A 
hemorrhage
stenosis - scar tissue
ulcerations
strangulation of hernia 
regurgitation + aspiration
23
Q

How to diagnose HH

A

Same as GERD

  • barium swallow test
  • endoscopy
24
Q

How is HH treated?

A

SURGERY
- closing off the hernia and tightening the esophagus

LIFESTYLE CHANGES
- reduce intra-abdominal pressure (wear loose clothing, avoid heavy lifting)
- nutrition (quit alcohol + smoking)
lose weight

NURSING

  • keep HOB 10-15 degrees
  • MEDS - antacids, PPIs
25
Q

What are the age-related considerations for GERD and HH?

A

both associated w/ weakening of the diaphragm, obesity, kyphosis, or anything that increases intra-abdominal pressure

First indications:
- esophageal bleeding secondary to esophagitis or respiratory complications

26
Q

What is IBS

A

Irritable Bowel Syndrome is a chronic functional disorder due to a sensitive and excitable gut wall.
- Canada has one of the highest rates of IBS in the world (5 million)

3 possible components are involved:

  • GI motility
  • visceral hypersensitivity
  • NT imbalance
27
Q

GI focused assessment

A

BLOCK
B - bowel sounds (full min each quadrant)
L - look for fluid imbalance
O - observe quantity and consistency of stool
C - check vital signs and labs
K - keep strict monitoring of I/O and daily weights

28
Q

Causes of IBS

A
  • severe infection + inflammation in the intestines (enteritis)
  • changes in microflora
  • antibiotic use/medications
  • neurological hypersensitivity within the GI tract
  • surgery
  • stress/hormonal imbalances
  • dietary issues (food allergies)
  • chronic alcohol abuse
29
Q

manifestations of IBS

A
  • abdominal pain, cramping, bloating
  • excess gas
  • diarrhea or constipation
  • mucus in stool
  • heartburn
  • nausea
30
Q

Diagnosis of IBS

A
  • assess symptoms
  • past Hx
  • psychological health Hx
  • family Hx
  • drug Hx
  • dietary Hx

+ diagnostic test to rule out more serious or life-threatening disorders

31
Q

What is the diagnostic criteria for IBS?

A

ROME III CRITERIA

  • Abdominal pain for at least 3 days per month for at least 3 months w/ onset at least 6 months prior and must have at least 2/3 of the criteria below:
    1) relieved w/ defection
    2) onset associated w/ a change in stool frequency
    3) onset associated w/ a change in stool appearance
32
Q

Nursing and collaborative care for IBS

A

encourage pt to verbalize and develop coping for stress and anxiety
- the role of acupuncture, massage, meditation

diet - referral to a dietician 
- limit caffeine, alcohol, fatty foods 
- at least 20g/day of dietary fiber 
- eliminate gas-producing foods
use lactose-free products 
avoid trigger food

Metamucil, antidepressants, herbal, flax, probiotics

33
Q

How is serotonin involved in IBS?

A

Gut-brain axis

- 80% of serotonin is produced in the gut
- And microbial flora in the gut influences the production of serotonin
34
Q

PTs w/ IBS need NO ‘STRESS’

A

S - stools vary from loose, to diarrhea, and constipation.
T - teach to avoid foods that are irritating. (gas-forming, caffeine, alcohol)
R - record food intake and bowel patterns to refine diet and prevent exacerbations
E - encourage a high-fiber diet
S - stress reduction + exercise
S - symptoms to report are rectal bleeding and weight loss

35
Q

What is Celiac Disease

A
  • autoimmune disease
  • 1 in 133 in Canada
  • most common in European Ancestry
  • damage to microvilli in small intestines cased by inflammation due to ingestion of gluten
  • prolamines (peptides) released d/t partially digested gluten
  • absorption causes an inflammatory response
36
Q

Components of celiac disease

A 
- genetic predisposition 
immune mediated disorder
- gluten intolerance
- inflammation of small intestine
- reduced absorption of Ca2+, iron, vit A, D, E, K, folate
37
Q

Manifestations of celiac disease

A 
lethargy + fatigue
dermatitis, herpetiformis rash 
osteoporosis
diarrhea, steatorrhea 
weight loss
abdominal pain
38
Q

Diagnosis of celiac disease

A

1) IgA-EMA or IgA-TTG
2) endoscopy and biopsy
3) symptoms disappear with gluten-free diet

39
Q

Treatment for celiac disease

A

Avoid gluten

corticosteroids for those who don’t respond to a GF diet

40
Q

Nursing interventions for celiac disease

A

Educate

  • disease
  • identification of food and other items that contain gluten
  • emphasis on avoiding gluten

dietician referral

41
Q

Nursing care for GI - FAINT

A 
F - fluids
A - acid base imbalance
I - infection 
N - nutrition 
T - the pain/tissue and skin integrity
42
Q

What is BPH

A

BENIGN PROSTATIC HYPERTROPHY

  • non-inflammatory enlargement of the prostate gland
  • 50% of men in their lifetime will develop BPH
  • major urological problems (enlarged prostate compresses urethra = difficulty urinating)
43
Q

Manifestations of BPH

A 
Nocturia - the first symptom
obstructive symptoms
- decreased in the caliber and force of the urinary stream
- difficulty initiating voiding 
- intermittency 
- dribbling at the end of urination

irritative symptoms

  • urinary frequency
  • urgency
  • dysuria
  • bladder pain
  • nocturia
  • incontinence
44
Q

How to diagnose

A
  • Hx and physical examination
  • Digital rectal examination (DRE)
  • urinalysis w/ culture
  • serum creatinine
  • prostate-specific antigen (PSA)
  • postvoid residual
  • uroflowmetry
  • transrectal ultrasonography (TRUS)
  • cystourethroscopy
45
Q

Meds for BPH

A
  • 5 alpha-reductase inhibitors
  • alpha-adrenergic receptor blockers
  • erectogenic drugs
46
Q

Treatments for BPH

A

medication

minimally invasive treatments

  • intraprostatic urethral stents
  • laser prostatectomy
  • transurethral electrovaporization of the prostate (TUVP)
  • transurethral microwave thermotherapy (TUMT)
  • transurethral needle ablation (TUNA)

invasive treatments

  • open prostatectomy
  • transurethral incision of the prostate (TUIP)
  • transurethral resection of the prostate (TURP) ** common**

NURS2522 (5 decks)

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