Medsurg 3 part 2 Flashcards
an erosion of the mucosal lining of the stomach or duodenum
peptic ulcer
PUD: The mucous membranes can become eroded to the point that the epithelium is exposed to gastric acid and pepsin, which can precipitate
bleeding and perforation
PUD: Perforation that extends through all the layers of the stomach or duodenum can cause
peritonitis
PUD prevention: use ___ management techniques
stress
2 drugs that can cause PUD
NSAIDS and steroids
which blood type is a risk factor for PUD
type O
when does a Gastric ulcer occur
30 to 60 minutes after meal
when does a duodenal ulcer occur
1.5 to 3 hours after meal
ulcer that often occurs at night
duodenal
ulcer where pain is exacerbated by ingestion of food
gastric ulcer
duodenal ulcer pain is relieved by
ingestion of food or antacid
Pain findings in someone with PUD
pain on palpation
back pain
PUD: Pain that radiates to the back may indicate
perforation is imminent
Where might you find blood with PUD pt
Bloody emesis (hematemesis) or stools (melena).
PUD pt’s weight might
decrease
PUD: Gastric samples are collected via an ___ to test for H. pylori.
endoscopy
C 13 urea breath testing is used for
detecting H pylori in PUD
IgG serologic testing documents the presence of
H pylori in PUD
provides a definitive diagnosis of peptic ulcers and may be repeated to evaluate the
effectiveness of treatment
EGD
PUD: Monitor for __ __ and tachycardia as these findings are suggestive of gastrointestinal bleeding.
orthostatic hypotension
PUD: Administer ___ lavage via nasogastric tube, if prescribed.
saline
PUD: A combination of two to three different ___ may be used to eliminate H pylori
antibiotics
Medication used to prevent stress ulcers in clients who are NPO after major surgery, have large areas of burns, are septic, or have increased intracranial pressure.
histamine blocker
Histamine blocker tx for PUD: Instruct clients to notify the provider of
obvious or occult GI bleeding
PPIs: Reduce gastric acid secretion by
irreversibly inhibiting the enzyme that produces gastric acid.
Mucosal protectant: when should they take the meds?
1 hr before meals and bedtime
Mucosal protectant: monitor for
constipation
PUD: areas of bleeding may be treated with ___ or ___ ___
epinephrine or laser coagulation.
Vagotomy
a PUD procedure where certain nerves are cut (the nerves that cause acid secretion)
Surgical procedure for PUD: after the procedure, Notify the provider before
repositioning or irrigating the nasogastric tube (disruption of sutures)
PUD surgery, POST op: Consume small, frequent meals while avoiding large quantities of ___ as directed.
carbohydrates
rebound tenderness in someone with PUD can indicate
perforation (which is an emergency)
if someone with PUD has a perforation and you palpated the abd it would feel
rigid and stiff
PUD perforation: maintain BP by
increasing fluids
PUD perforation: insert
NG tube
PUD perforation: provide
saline lavages
Complication of PUD: ___ anemia occurs due to a deficiency of the intrinsic factor normally secreted by the gastric mucosa.
Pernicious anemia
Pernicious anemia: Monthly lifelong vitamin __ injections will be necessary.
B12
a group of manifestations that occur following eating. A shift of fluid to the abdomen is triggered by rapid gastric emptying or high-carbohydrate ingestion.
dumping syndrome
Dumping syndrome: In response to the sudden influx of a hypertonic fluid, the small intestine pulls fluid from the
extracellular space to convert the hypertonic fluid to an isotonic fluid
Dumping syndrome: instruct the client to __ __ when vasomotor manifestations occur
lie down
Dumping syndrome: Client teaching: Eliminate liquids with meals for
1 hr prior to, and following a meal.
Dumping syndrome: Client teaching: diet should be low in
sugar, diary, fiber, and carbs
Dumping syndrome: Client teaching: diet should be high in
protein and fat
an inflammation in the lining of the stomach
Gastritis
___ enzymes produce mucosal prostaglandins that form a protective layer over the lining of the stomach.
Cox 1
Chronic gastritis has a slow onset and, if profuse, may damage parietal cells resulting in ___ anemia.
pernicious
autoimmune diseases that increase risk for gastritis
SLE and RA
___ therapy can increase risk for gastritis
radiation therapy
A risk factor for Gastritis is excessive ___
stress
Pt with gastritis might have weight
loss
what’s the main bacteria you want to check for in gastritis
H pylori
what do you tell the pt about anesthesia/pain having to do with an upper endoscopy
a local anesthetic will be sprayed onto the back of the throat, but throat may be sore following the procedure
With what drug should you monitor for Monitor for neutropenia and hypotension
histamine blockers
Do not give antacid to clients with
kidney problems
Monitor aluminum antacids for
constipation
Monitor magnesium antacids for
diarrhea
2 Medications that should be taken on an empty stomach
antacid and PPI
Medication that needs an IV filter
PPI
Medication: Advise to allow 30 min before eating and not to crush or chew pills
PPI
PPI: It can take up to
4 days to see the effects
Gastric bleeding intervention: Insert a nasogastric (NG) tube for ___ ___
gastric lavage
Gastric bleeding intervention: Insert a nasogastric (NG) tube for gastric lavage (irrigate with __ __ or ___ to stop active gastric bleed)
normal saline or water
Gastric bleeding intervention: After you insert the NG, but BEFORE you use it you must
do an x ray to confirm the proper placement
distended or edematous intestinal veins resulting from increased intra-abdominal pressure (straining, obesity)
Hemorrhoids
Hemorrhoids result from
increased intra-abdominal pressure (straining, obesity, pregnancy)
A hernia that cannot be ________________ is considered irreducible and should be treated surgically.
moved back into place with gentle palpation
Physical finding of hernia
Protrusion or “lump” at involved site
Hernia for a nonsurgical pt: Instruct client to wear
truss pad with hernia belt during waking hours and to inspect skin daily
Hernia for surgical pt: Instruct client to avoid increased intra-abdominal pressure for
2 to 3 weeks postoperatively
IBS: Avoid foods that contain
dairy, eggs, and wheat products
IBS: eat lots of
fiber
Although IBS is difficulty to dx with a specific test, one test used is the
Hydrogen Breath Test
2 IBS-specific medications
Alosetron and Lubiprostone
Intestinal obstruction can result from ___ or ___ causes
mechanical or nonmechanical
Intestinal obstruction: Mechanical obstructions have ___, ___ pain that is milder.
colicky, intermittent
Intestinal obstruction: Nonmechanical obstructions tend to have vague, diffuse, constant pain and significant
abdominal distention
Intestinal obstruction: bowel sounds are
hyperactive above the block, hypoactive below
Intestinal obstruction: nonmechanical obstruction is aka
paralytic ileus
an electrolyte imbalance that can lead to nonmechanical obstruction (aka paralytic ileus)
hypokalemia
Small or Large intestine block? Severe fluid and electrolyte imbalance
small
Small or Large intestine block? Minor fluid and electrolyte imbalance
large
Small or Large intestine block? Metabolic alkalosis
small
Small or Large intestine block? Metabolic acidosis
large
Small or Large intestine block? Visible peristaltic waves
small
Small or Large intestine block? Significant abdominal
distention
large
Small or Large intestine block? Abdominal pain, discomfort
small
Small or Large intestine block? Intermittent abdominal cramping
large
Small or Large intestine block? Profuse, sudden projectile vomiting with fecal odor; vomiting relieves pain
small
Small or Large intestine block? Infrequent vomiting
large
Small or Large intestine block? Diarrhea or “ribbon-like” stools around an impaction
large
In bowel obstruction, ___ hemoglobin, BUN, creatinine, and hematocit may indicate dehydration.
Increased
In bowel obstruction, ____ serum amylase and WBC count may be due to strangulating obstructions
Increased
Intestinal block dx test that evaluates the presence of free air and gas patterns.
x ray
Intestinal block dx test that determines the cause of obstruction.
endoscopy
Intestinal block dx test that determines the cause and exact location of the obstruction.
CT scan
Intestinal block: if surgery is needed for a mechanical block, withhold food until
peristalsis returns
Intestinal block: with suspected bowel strangulation, the best meds are
broad spectrum antibiotics
Intestinal block: Monitor for ___ instability
hemodynamic
Intestinal block: after surgery, advance diet as tolerated when prescribed, beginning with clear liquids – clamp tube after
eating for 1 to 2 hr
Small intestinal obstruction causes vomiting, leading to metabolic
alkalosis
a lower level obstruction causes metabolic acidosis because
alkaline fluids aren’t being reabsorbed
Edema and inflammation of the rectum and sigmoid colon
Ulcerative colitis
