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
Ulcerative colitis
Edema and inflammation of the rectum and sigmoid colon
Crohn’s disease
Inflammation and ulceration of the gastrointestinal tract, often at the distal ileum.
Inflammation and ulceration of the gastrointestinal tract, often at the distal ileum.
Crohn’s disease
Ulcerative colitis may cause
obstruction
Ulcerative colitis: intestinal mucosal cell changes may cause ___ ___
colon cancer
Ulcerative colitis: intestinal mucosal cell changes may cause insufficient production of intrinsic factor, resulting in
insufficient absorption of vitamin B12 (pernicious anemia).
Crohn’s disease: supplemental ___ may be needed
B12
Diverticula may perforate and cause
peritonitis
A diet low in ___ may predispose a client to ulcerative colitis and the development
of diverticula.
fiber
Ulcerative colitis: pain
Abdominal pain/cramping: often left-lower quadrant pain
Ulcerative colitis or Crohn’s disease: Steatorrhea
Crohn’s disease
Ulcerative colitis or Crohn’s disease: Rectal bleeding
Ulcerative colitis
Crohn’s disease: pain
RLQ
Small intestine ulcerations and narrowing may be consistent with
Crohn’s disease
Ulcerative colitis and Crohn’s disease: seek emergency care if you have ___, severe abdominal pain, ___
fever, vomiting
Ulcerative colitis and Crohn’s disease: Educate the client to eat foods that are
high in protein and calories, and low in fiber
Ulcerative colitis and Crohn’s disease: take a multivitamin that contains
iron
Diverticulitis: give client ___ for pain
opiates
Diverticulitis: Educate the client to consume a ___ __ diet until manifestations subside
clear liquid
Diverticulitis: Instruct the client to add fiber to the diet once solid foods are tolerated without other manifestations. The client should slowly advance to a
high-fiber diet as tolerated
Diverticulitis: Teach client to avoid seeds or indigestable material, which can block diverticulum (3 examples)
nuts, popcorn, seeds
Diverticulitis: limit fat to ___ of daily calorie intake
30%
Ulcerative colitis and Crohn’s disease: 5 ASA is prescribed to
decrease inflammation
Ulcerative colitis and Crohn’s disease: steroids are prescribed to
decrease inflammation
Surgical Procedure for Ulcerative Colitis
Colectomy with or without ileostomy
Surgical Procedures for Crohn’s Disease
Stricturoplasty
or
Surgical repair of fistulas
Surgical Procedures for Diverticulitis (dependent on problem type)
Colon resection
Double-barrel colostomy, but may be temporary
Treatment of complications (peritonitis, abscess, obstruction, fistula, bleeding)
An ileostomy may drain as much as __ mL/day.
1,000
Complications of ulcerative colitis, Crohn’s disease, and diverticulitis: ___ may occur due to perforation of the bowel
Peritonitis
hallmark sign of peritonitis
rigid, board like abd
a life threatening inflammation involving the abd cavity
peritonitis
peritonitis positioning
Fowler or semi-Fowler’s position. (This promotes comfort and allows for the
client to breathe easier.)
Peritonitis: No __ __ for at least 6 weeks.
heavy lifting
Abscess and fistula formation: diet should be
high in protein and calories (at least 3,000 calories/day), and low in fiber.
an inflammation of the gallbladder wall
Cholecystitis
cholelithiasis
gallstones
Cholecystitis can obstruct the pancreatic duct, causing
pancreatitis
Cholecystitis: health promotion: consume a diet that is
low-fat diet rich in HDL sources (seafood, nuts, olive oil)
Cholecystitis: Sharp pain in the right upper quadrant, often radiating to the
right shoulder
Cholecystitis: Pain with deep inspiration during
right subcostal palpation (Murphy’s sign)
Cholecystitis: Intense pain after
ingestion of high-fat food
Cholecystitis findings: s____
steatorrhea
Cholecystitis findings: ___ ___ stools
clay-colored stools
Cholecystitis findings: J____
jaundice
Cholecystitis findings: ___ urine
dark
Cholecystitis findings: p____
pruritus
Older adult clients who have diabetes mellitus may have atypical presentation of cholecystitis (absence of ___ or ___)
pain or fever
Cholecystitis findings: Amylase and lipase are
increased
Cholecystitis findings: increased (AST), (LDH), and (ALP) may indicate the
common bile duct is obstructed.
Cholecystitis Dx: _____ visualizes gall stones and a dilated common bile duct.
Ultrasound
Cholecystitis Dx: An abdominal ___ or ___ scan can visualize calcified gallstones and an enlarged gall bladder
x-ray or CT
Cholecystitis Dx: ___ scan (HIDA) assesses the patency of the biliary duct system after an IV injection of contrast
hepatobiliary
Cholecystitis Dx: allows for direct visualization using an endoscope that is inserted through the esophagus and into the common bile duct via the duodenum
(ERCP)
Cholecystitis Dx: involves the direct injection of contrast into the biliary tract through the use of a flexible needle. The gallbladder and ducts can be visualized.
PTC
___ acid gradually dissolves cholesterol-based gall stones, with few adverse effects.
Bile acid (it’s a medication)
Shock waves are used to break up gall stones
(ESWL)
Extracorporeal shock wave lithotripsy (ESWL) – Shock waves are used to break up stones. This may be used more on nonsurgical candidates of normal weight who
have small, cholesterol-based stones
open surgical approach to gallbladder removal: A ___ may be placed in the common bile duct
T-tube
open surgical approach to gallbladder removal: the T-tube drainage is
initially bloody, then green-brown bile
open surgical approach to gallbladder removal: the amount of T-tube drainage
more than 400 mL of drainage in 24 hr initially, with gradual decrease in amount
surgical approach to gallbladder removal: the stools will be ____ ___ until biliary flow is reestablished
clay-colored
Laparoscopic removal of gallbladder: in order to treat free air pain
ambulate pt
A rupture of the gallbladder wall can cause a local abscess or peritonitis (which is manifested by ___, ___ abdomen)
rigid, board-like
This can occur if adequate amounts of bile are not drained from the surgical site after gallbladder removal
Bile peritonitis
Manifestations of gallbladder disease can continue after surgical removal. This is called
Postcholecystectomy syndrome
an inflammation of liver cells
Hepatitis
Cirrhosis
permanent scarring of the liver that is usually caused by chronic inflammation
Use PPE for Hep A pts that are
incontinent
Use PPE for Hep B and C pts who are
bleeding
Hep A and E transmission
fecal-oral
Hep B and C transmission
blood
Hep that can be passed from mother to offspring
B
Hep that’s a coinfection with Hep B
D
Hep findings: skin color
jaundice
Hep findings: stool
clay color
Hep findings: urine
dark
Hep: Dx test used to identify the intensity of the infection, and the degree of liver damage
liver biopsy
Hep: the most definitive diagnostic approach
liver biopsy
Before liver biopsy, pt must be NPO for
2 hours
Liver biopsy: Assist the client into the supine position with the
upper right quadrant of the
abdomen exposed
Liver biopsy: instruct the client to breath by
Instruct client to exhale breath and hold for at least 10 seconds
Liver biopsy: After needle is removed
Pt can resume breathing after the needle is removed
Apply pressure to the insertion site
Liver biopsy: after the procedure, position the pt
right side-lying position and maintain for several hours.
Hepatitis A vaccination is recommended for ___ protection
postexposure
Acute Hep B: Tx
No medications, supportive care.
Chronic Hep B: Tx
Antiviral medications
Hepatitis C: Combination therapy with peginterferon and ___ is the preferred treatment.
ribavirin
Hepatitis D: Tx
same as Hep B
Hepatitis E: Tx
same as Hep B
Chronic Hepatitis results from which Heps?
BCD
Extremely progressive form of viral hepatitis.
Fulminating hepatitis
cirrhosis caused by viral hepatitis or certain medications or toxins.
Postnecrotic
cirrhosis caused by chronic alcoholism
Laennec’s
biliary cirrhosis is caused by chronic biliary obstruction or ___ disease
autoimmune
Cardiac cirrhosis results from severe right heart failure inducing necrosis and fibrosis due to
lack of blood flow
Cirrhosis: Personality and mentation changes such as
emotional lability, euphoria, sometimes depression
Cirrhosis Objective findings: Altered
sleep/wake pattern
Cirrhosis Objective findings: Ascites, specifically
fluid buildup in abdomen and legs
Cirrhosis Objective findings: 2 skin findings besides jaundice
petechiae
Ecchymoses
Cirrhosis Objective findings: Hands
red warm
Cirrhosis Objective findings: red lesions, vascular in nature called
spider angiomas
Cirrhosis Objective findings: Dependent ___ ___
peripheral edema
Cirrhosis Objective findings: tremor characterized by rapid, nonrhythmic extension and flexion of the wrists and fingers
Asterixis
Cirrhosis Objective findings: odor
fruit/musty breath
Cirrhosis: ALT and AST are elevated initially due to hepatic inflammation, and return to normal when liver cells are no longer able to
create an inflammatory response
Cirrhosis: ___ increases in cirrhosis due to intrahepatic biliary obstruction.
ALP (Alkaline phosphatase)
Cirrhosis: Bilirubin level
elevated
Cirrhosis: serum albumin level
decreased
Cirrhosis: serum protein level
decreased
Cirrhosis: H and H level
decreased
Cirrhosis: all blood components
decreased
Cirrhosis: PT/INR is
prolonged due to decreased synthesis of prothrombin
Cirrhosis: Ammonia and creatinine levels
increase
Cirrhosis: Dx test: used to detect ascites, hepatomegaly, splenomegaly, biliary stones, or biliary obstruction.
Ultrasound
Cirrhosis: Dx test: Used to visualize possible hepatomegaly, ascites, and splenomegaly.
Abdominal x-rays and CT scan
Cirrhosis: Dx test: Used to visualize mass lesions and determine whether the liver is malignant or benign.
MRI
Cirrhosis: Dx test: most definitive
biopsy
Cirrhosis: Dx test: A liver biopsy identifies the ___ of the cirrhosis.
extent
Cirrhosis: Dx test: This is performed under moderate (conscious) sedation to detect the presence of esophageal
varices, ulcerations in the stomach, or duodenal ulcers and bleeding.
EGD
Cirrhosis: Dx test: Used to view the biliary tract to assist in removing stones, to collect specimens for biopsy, and for placement of a stent.
ERCP
EGD is performed under ___ sedation
moderate (conscious)
Cirrhosis: to decrease the itching, encourage
washing with cold water and applying lotion
Cirrhosis: Because the metabolism of most medications is dependent upon a functioning liver, general medications are administered ___
sparingly
Type of drug used for clients who have varices to prevent bleeding.
beta blockers
Cirrhosis: Drug used to promote excretion of ammonia from the body through the stool.
Lactulose
Paracentesis: Position the client
supine with head of bed elevated.
Cirrhosis: Performed in interventional radiology for clients who require further intervention with ascites or hemorrhage
Transjugular intrahepatic portosystemic shunt (TIPS)
This is a last resort for Cirrhosis clients who have portal hypertension and esophageal varices
Surgical bypass shunting procedures
Cirrhosis: Surgical bypass shunting procedures: The ascites is shunted from the abdominal cavity to the
superior vena cava
Clients who have severe cardiac and respiratory disease, metastatic malignant liver cancer, and a continued history of alcohol/substance abuse are not candidates for
liver transplantation
liver transplantation, acute graft rejection: t____
tachycardia
liver transplantation, acute graft rejection: f___
fever
liver transplantation, acute graft rejection: pain in the
RUQ (where the liver is….)
liver transplantation, acute graft rejection: increased ___ or ___ levels
ALT or AST
Cirrhosis pt: quitting drinking helps to
regenerate the liver
Cirrhosis diet: high __ and moderate ___
high calorie and moderate fat
Cirrhosis diet: low __ and ___
sodium and protein
Cirrhosis diet: Supplemental vitamin-enriched liquids like ___ or ___
ensure or boost
Cirrhosis complication: Portal systemic _____ (PSE)
Portal systemic encephalopathy (PSE)
What is this condition: Clients who have a poorly functioning liver are unable to convert ammonia and other waste products to a less toxic form. These products are carried to the brain and cause neurological symptoms
Portal systemic encephalopathy (PSE)
Portal systemic encephalopathy (PSE) medication
Lactulose (reduces ammonia level)
The main concern with varices is
bleeding (they are fragile)
Acute graft rejection post liver transplantation usually occurs around
4 to 10 days after surgery
Serum creatinine – produced due to ___ and ___ breakdown.
protein and muscle
Kidney disease is the only condition that increases serum ____ level
creatinine
Kidney function loss of at least __ will cause an elevation of serum creatinine values.
50%
Serum creatinine values are ____ in older adults unless kidney disease is present.
normal
Blood urea nitrogen (BUN) – results from breakdown of ____ in the liver
protein
Elevated BUN is highly suggestive of
kidney disease
Urinalysis: Collection of an ___ specimen provides a more concentrated sample.
early-morning
Kidney Dx tests: Allows for visualization of structures and to detection of renal calculi, strictures, calcium deposits, or obstructions.
X ray
Kidney Dx tests: Provides three-dimensional imaging of renal/urinary system to assess for kidney size and obstruction, cysts, or masses.
CT
Kidney Dx tests: IV contrast dye (iodine-based) may be used to enhance images.
CT
Kidney Dx tests: Useful in staging cancer
MRI
Kidney Dx tests: Used to assess size of kidney, image the ureters, bladder, masses, cysts, calculi, and obstructions of the lower urinary tract
Ultrasound
