Medsurg 3 part 4 Flashcards
Upper gi series with barium- contraindicated in-
complete bowel obstruction and perforation
Upper gi series with barium- complications-
aspiration, constipation
Lower gi series with barium: diet
clear liq diet day before test
NPO starting at midnight
After endoscopy, you must be NPO until
gag reflex returns
Cat scan with or without contrast is contraindicated with
seafood allergy
pregnancy
Cat scan-with contrast: afterwards encourage the pt to
drink fluids to flush out the contrast
Consequences of malnutrition in the elderly: Pulmonary:
less able to clear secretions
how often do you flush a non-tunneled central line catheter
weekly
how often do you flush a PICC
daily
how often do you flush a port central line catheter
monthly
Clean central lines openings with alcohol w povidine iodine ___ or ___
tincture or chlorohexidine
____ ointments should not be applied to central line openings
Antibiotic
Between small bore and large bore feeding tubes, which has the greater risk for complication during insertion
small bore (could be misplaced easier)
After NG, check for
Observe for coughing, choking,or cyanosis
Have client speak
a narrowing or tightening of the esophagus that causes swallowing difficulties
Esophageal stricture
___ ___ tube is used to control ruptured esophageal varices
sengstaken-blakemore
if sudden respiratory distress from sengstaken-blakemore tube
cut the balloons with scissors
on the salem sump, never
tie off the vent (It prevents the tube from sticking to the gastric mucosa)
Columnar epithelium replaces squamous epithelium lining distal esophagus
Barrett’s esophagus
Barrett’s esophagus diagnosed with
Endoscopic biopsy to look for dysplasia
rare disorder that puts you at risk for esophagus cancer
achalasia
lye ingestion puts you at risk for
esophagus cancer
GERD involves a weakness in the
LES
Besides a weakened LES, GERD can be caused by ___ ___ or ____
Hiatal hernia
Scleroderma
word for Food, acid, bile, pancreatic juice from the stomach going to the esophagus
reflux
4 Protective factors against reflux:
Competent LES
Saliva
Mucosal blood flow
Mucus
A manifestation of GERD is heartburn in the ___ position
supine
painful swallowing
Odynophagia
besides antacids, another household cure for too much acid is
chewing gum
The 2 main drugs of acid suppression
Histamine blocker
PPI
GERD tx: Do not lie down within
3 hours after eating
GERD tx: Reduce intake and avoid after
6pm
GERD tx: do not use ___ toothpaste
mint
PUD pain is described as a___
Aching
PUD pain is described as b___
Burning
PUD pain is described as c___
Cramplike
PUD pain is described as g___
Gnawing
Benign Gastric Ulcer: Even if there is no sign of bleeding, and no evidence to suggest malignancy, it’s essential to do ___ __ or ___
brush cytology or biopsy
Medical management PUD: reduce ___ secretions
reduce gastric secretions (using histamine blockers and PPIs)
Medical management PUD: the best method is
eliminate the H pylori
Just because someone tests positive for h pylori,
doesn’t mean they def have ulcer
Medical management PUD: classes of drugs used to reduce gastric secretion
histamine blockers and PPIs
Strengthen mucosal barrier-mucosal barrier fortifies-____-in presence of mild acid forms viscid and sticky gel and adheres to ulcer surface
carafate
Billiroth 1 is aka
gastroduodenostomy (stomach to duodenum)
Billiroth 2 is aka
gastrojejunostomy (stomach to jejunum)
In a total gastrectomy, the esophagus goes right to the jejunum. You have decreased absorption of (3 things)
intrinsic
vit D
calcium
With billroth ii (gastrojejunostomy) you have decreased ___ and ____ secretion because the usual stimulus of food passing through the duodenum is missing
pancreatic and bile
Management of dumping syndrome: decreasing amount of and maintaining a high-protein, high fat, low-cho, dry diet. Gastric emptying can be delayed by eating in a recumbent or semi-recumbent position,l lying down after meals, increasing the fat content and avoiding fluids 1 hour before , with or 2 hours after meals
food eaten at one time
Management of dumping syndrome: maintaining a high-___, high ___, low-___, dry diet.
high-protein, high fat, low-cho, dry
Management of dumping syndrome: Gastric emptying can be delayed by eating in a ____ position
recumbent
Management of dumping syndrome: Gastric emptying can be delayed by __ __ after meals
lying down
____ disease is most common in individuals living in developed countries whose diets consist primarily of refined foods
Diverticular
what disease is this: you can lose massive amounts of fluid from diarrhea
ulcerative colitis
occurs is discontinuously/deep layer in any seg of gi tract
crohn’s disease
major problem with crohn’s disease
malabsorption (malnutrition)
2 broad ideas of managing UC and crohn’s disease: decrease ___ and rest ___
decrease diarrhea
rest bowel
Ulcerative colitis affects which layer of the colon?
mucosal
Ulcerative colitis hallmark
bloody diarrhea
Ulcerative colitis: Abdominal pain and diarrhea worse after ___ and in the ____
meals and in the morning
manifestation of Crohn’s vary according to
where the lesions are
Anti-saccharomyces cerevisiae antibody is a laboratory finding of
Crohn’s
Ostomy: Skin barriers, such as wafers are cut to fit __ inch around the fistula
1/8 inch
asterixix aka ___ ___
Flapping tremor
asterixix is a manifestation of
hepatic encephalopathy
Hepatitis A: route
Oral/fecal/parenteral, sexual
Hepatitis A: onset
acute with fever
Hepatitis A: prophylaxis
Hygeine, vaccine
Hepatitis A: Antigen/body
Anti HAV
Hepatitis A: Incubation
30 days
Sengstaken-Blakemore tube in place for the ___ treatment of hemorrhage from esophageal varices
emergency
Cholecystitis: ___ and ___ ___ may be elevated
bili and alkaline phosphatase
Turners and Cullen’s are associated with
pancreatitis
abdominal distention with periumbilical ecchymosis
(Cullen’s sign)
ecchymosis of the flank
( Turner’s sign)
Suggested by persistent pain or continued high amylase levels (may be present for 4-6 wks afterward)
Pseudocyst (complication of pancreatitis)
which system should you especially watch for pancreatitis complications
respiratory
