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N233 > Module 2 Part 2: Peptic Ulcer Disease > Flashcards

Module 2 Part 2: Peptic Ulcer Disease Flashcards

1
Q

what are the 3 types of ulcers?

A
  • gastric
  • duodenal
  • esophageal
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2
Q

what forms in the mucosal wall of the stomach or in the duodenum?

A

an excavation

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3
Q

what does the name of the ulcer depend on?

A

it’s location

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4
Q

what are potential risk factors/ causes?

A
  • infection from H. pylori
  • excessive secretions of HCl
  • familial tendancy
  • people with O blood type
  • chronic use of NSAIDs
  • ETOH
  • excessive smoking
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5
Q

what is H. pylori?

A

a gram negative bacteria

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6
Q

how can H. pylori be acquired?

A

through the ingestion of food and water

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7
Q

do most infected people with H. pylori develop ulcers?

A

no

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8
Q

when is testing for H. pylori recommended?

A

only when there is PUD

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9
Q

what are the clinical manifestations of PUD?

A
  • many people have no symptoms
  • may differ depending on the location
  • pain
  • pyrosis (heart burn)
  • eructation (burping)
  • vomiting (rare), constipation or diarrhea
  • bleeding in stools(occult or melena)
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10
Q

what are the assessments for PUD?

A
  • pain, epigastric tenderness or abdominal distension
  • endoscopy
  • inflm changes, ulcers, lesions
  • stools until they are negative for occult blood
  • serologic testing
  • stool antigen test
  • urea breath test
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11
Q

what are three types of management for PUD?

A
  • medication
  • lifestyle changes
  • possible surgery
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12
Q

what are some potential complications of PUD?

A
  • perforation
  • hemorrhage
  • penetration
  • pyloric obstruction
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13
Q

what are some nursing diagnoses for PUD?

A
  • acute pain
  • anxiety r/t an acute illness
  • imbalanced nutrition r/t changes in diet
  • deficient knowledge about prevention of symptoms and management of conditions
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14
Q

what are the medications used for PUD?

A
  • proton pump inhibitors
  • histamine 2 receptor blockers
  • antacids
  • antibiotics
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15
Q

what is the mechanism of proton pump inhibitors?

A

irreversible inhibition of the proton pump (generates gastric) in parietal cells. PPIs effects both both basal and stimulated acid release

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16
Q

what is the use of proton pump inhibitors?

A

gastric and duodenal ulcers, GERD, Zollinger-Ellison syndrome

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17
Q

what are the side effects proton pump inhibitors?

A
  • minimal in short term use
  • can infrequently includes headaches
  • diarrhea
  • N/V
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18
Q

what can proton pump inhibitors increase the risk of?

A
  • pneumonia
  • acid rebound
  • c-diff infection
  • hypomagnesemia
  • gastric cancer
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19
Q

what are examples of proton pump inhibitors?

A
  • omeprazole
  • esomeprazole
  • rabeprazole
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20
Q

what are nursing considerations for proton pump inhibitors?

A
  • even if medication is discontinued effects can last for weeks
  • watch for signs of c-diff infection
  • assess for epigastric/abdominal pain, signs of bleeding
  • administer 60 mins before meals
  • take the lowest dose for shortest time to minimize side effects
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21
Q

what is the mechanism of H2 antagonists?

A

block H2 receptors on gastric parietal cells

  • suppress secretion of gastric acid
  • decreases volume of gastric fluid and increases pH
22
Q

what are the uses for H2 antagonists?

A
  • preop preparation
  • GERD
  • gastric and duodenal ulcers
23
Q

what are the side effects of H2 antagonists?

A
  • serious side effects not common but could include:
  • headache
  • diarrhea
  • N/V
  • increase in gastric pH increases susceptibility to infection
24
Q

what are examples of H2 antagonists?

A
  • ranitidine
  • famotidine
  • cimetidine
25
Q

what are the nursing considerations for H2 antagonists?

A

rantidine recently recalled

- usually replaced with pantoprazole (PPI), in peds using famotidine

26
Q

what are antacids used for?

A

alkaline substances used to neutralize stomach acid, may also enhancing mucosal protection

27
Q

what are two benefits of antacids?

A
  • relatively safe

- inexpensive

28
Q

what might antacids contain/?

A
  • aluminum
  • magnesium
  • sodium bicarbonate
  • alginate
  • calcium
29
Q

what formula of antacids are contraindicated in renal failure?

A

those with aluminum

30
Q

what are some examples of antacids?

A
  • calcium carbonate (tums)
  • magnesium hydroxide (milk of magnesia)
  • aluminum hydroxide (almagel)
31
Q

why would antibiotics be indicated for PUD?

A
  • when H. pylori is the cause of PUD
32
Q

what are the common antibiotics that are used for PUD?

A

clarithromyocin and amoxicillan (or metronidazole for penecilin allergies)

33
Q

how long would someone be on antibiotics for with PUD?

A

10-14 days “triple therapy”

34
Q

what three drugs do you combined together?

A

antibiotics, PPI, and bismuth salts

35
Q

what meds do you use to treat NSAID induced ulcers?

A
  • H2RA

- PPI

36
Q

how long do you have to maintain the dosage for H2RA?

A

1 year

37
Q

how are stress ulcers treated?

A

stress ulcers may be treated prophylactically with IV H2RA

38
Q

what are non-pharmacological management for PUD?

A
  • stress reduction and rest
  • smoking cessation
  • dietary modification
  • Sx management
39
Q

what dietary modifications need to be made?

A
  • avoid over-secretion of acid and hyperosmolarity in the GI tract
  • avoid consumption of meat extracts, alcohol coffee, and other beverages
  • avoid diet rich in milk and cream
  • eat three regular meals a day
  • small and frequent feedings are not necessary
40
Q

when is surgery recommended?

A

when pt have intractable ulcers and they fail to heal after 12-16 weeks
- when there is a life threatening haemorrhage, perforation, or obstruction

41
Q

what are some assessments for PUD?

A
  • describe pain and strategies used to relieve it
  • how often emesis takes place
  • usual food intake for 72 hours period and to describe food habits
  • pts level of anxiety
  • current stressors
  • stool for occult blood
  • physical exam
42
Q

what vitals are most important for PUD?

A

hypotension, tachycardia

43
Q

what are the nursing interventions for PUD?

A
  • relieve pain
  • reduce anxiety
  • malnutrition
  • maintaining optimal nutritional status (assess for malnutrition and weight loss)
44
Q

what are signs of haemorrhage in pts with PUD?

A
  • vomited blood can be bright red: hemorrhage is large
  • haemorrhage is small: passed in stools
  • assess for faintness, dizziness, and nausea
  • monitor vitals
  • tachycardia, hypotensions, and tachypnea
  • hematocrit and hemoglobin tested
45
Q

what are interventions for hemorrhage?

A
  • inserting peripheral IV line
  • NG tube to distinguish fresh blood
  • NG lavage of saline solution
  • indwelling catheter and monitor urinary output
  • recumbent position
  • hemorrhagic shock
  • selective embolization (unable to undergo Sx)
46
Q

what happens with perforation and penetration with PUD?

A
  • erosion of the ulcer through the gastric serosa
  • requires immediate sx
  • back and epigastric pain
  • severe upper abdominal pain
  • vomiting
  • tender rigid
  • hypotension and tachycardia
47
Q

what is a pyloric obstruction?

A

area distal to the pyloric sphincter becomes scarred and stenosed from spasm edema or scar tissue

48
Q

what are S&S of pyloric obstructions?

A

nausea, vomiting, constipation, epigastric fullness, anorexia, later weight loss

49
Q

what are interventions for pyloric obstruction?

A
  • insert an NG tube

- management of extracellular fluid volume electrolyte balance

50
Q

how can people with PUD care for themselves at home?

A
  • avoid certain meds and foods that exacerbate symptoms
  • avoid acid producing potential substances
  • meals at regular times and relaxed setting and to avoid over eating
51
Q

what are the expected patient outcomes from PUD?

A
  • freedom of pain
  • feeling less anxiety
  • complies with regimen
  • maintains weight
  • no complx

N233 (6 decks)

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