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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
What are the age-related considerations for GERD and HH?
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
What is IBS
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
GI focused assessment
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
Causes of IBS
- 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
manifestations of IBS
- abdominal pain, cramping, bloating - excess gas - diarrhea or constipation - mucus in stool - heartburn - nausea
30
Diagnosis of IBS
- 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
What is the diagnostic criteria for IBS?
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
Nursing and collaborative care for IBS
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
How is serotonin involved in IBS?
Gut-brain axis - 80% of serotonin is produced in the gut - And microbial flora in the gut influences the production of serotonin
34
PTs w/ IBS need NO 'STRESS'
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
What is Celiac Disease
- 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
Components of celiac disease
``` - genetic predisposition immune mediated disorder - gluten intolerance - inflammation of small intestine - reduced absorption of Ca2+, iron, vit A, D, E, K, folate ```
37
Manifestations of celiac disease
``` lethargy + fatigue dermatitis, herpetiformis rash osteoporosis diarrhea, steatorrhea weight loss abdominal pain ```
38
Diagnosis of celiac disease
1) IgA-EMA or IgA-TTG 2) endoscopy and biopsy 3) symptoms disappear with gluten-free diet
39
Treatment for celiac disease
Avoid gluten | corticosteroids for those who don't respond to a GF diet
40
Nursing interventions for celiac disease
Educate - disease - identification of food and other items that contain gluten - emphasis on avoiding gluten dietician referral
41
Nursing care for GI - FAINT
``` F - fluids A - acid base imbalance I - infection N - nutrition T - the pain/tissue and skin integrity ```
42
What is BPH
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
Manifestations of BPH
``` 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
How to diagnose
- 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
Meds for BPH
- 5 alpha-reductase inhibitors - alpha-adrenergic receptor blockers - erectogenic drugs
46
Treatments for BPH
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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