NUR 228 Exam 2 Flashcards
1
Q
Name 2 esophageal disorders?
A
GERD, Hiatal hernia
2
Q
3 Inflammatory disorders of the stomach?
A
gastritis, PUD, acute gastroenteritis
3
Q
What means difficulty difficulty swallowing?
A
Dysphagia
4
Q
Examples of mechanical obstruction of swallowing?
A
stenosis, diverticula, tumor
5
Q
What can dysphagia lead to?
A
Aspiration
6
Q
What is it called when the LES can’t open properly?
A
Achalasia
7
Q
What does GERD stand for?
A
Gastroesophageal Reflux Disease
8
Q
GERD is ? from the ? to the ? ……
A
Backflow, stomach, esophagus
9
Q
GERD occurs via the lower __ ____?
A
esophageal sphincter
10
Q
what is the PH of the material with GERD ?
A
Highly acidic
11
Q
List some irritants of GERD?
A
Caffeine, fatty foods, alcohol, cigarette smoking, sleep, and spicy foods.
12
Q
List the clinical manifestations of GERD?
A
Heartburn (pyrosis), dyspepsia, regurgitation, chest pain, dysphagia.
13
Q
What are other causes of esophagitis?
A
Infection, chemical ingestion, drugs, emesis.
14
Q
Worst sleeping position for GERD?
A
flat on the back
15
Q
What is a defect in the diaphragm that allows part of the stomach to pass into the thorax?
A
Hiatal hernia
16
Q
What are the 2 main types of hiatal hernias?
A
Sliding hernia, Paraesophageal hernia
17
Q
Name risk factors of hiatal hernia?
A
Age, anything that loosens the muscular band around the gastroesophageal junction
18
Q
Clinical manifestations of hiatal hernia?
A
Asymptomatic OR same as GERD
19
Q
What is the temporary inflammation of the stomach lining?
A
acute gastritis
20
Q
What can cause acute gastritis?
A
alcohol, NSAIDS, infection
21
Q
What is a progressive disorder with chronic inflammation in the stomach?
A
Chronic gastritis
22
Q
Two main etiologies of chronic gastritis?
A
autoimmune, H. pylori
23
Q
What does H. pylori stand for?
A
Heliobacter pylori
24
Q
What environment does H. pylori prefer?
A
Acidic
25
What does H. pylori cause?
destructive pattern of persistent inflammation
26
How is H. pylori transmitted?
Oral
27
Symptoms of gastritis?
anorexia, N/V, postprandial discomfort, hematemesis, anemia
28
What is acute gastroenteritis?
inflammation of stomach & small intestine
29
What are the clinical manifestations of acute gastroenteritis?
diarrhea, abdominal pain, N/V, fever/malaise.
30
Complication of acute gastroenteritis?
Fluid volume deficit
31
Peptic ulcer disease is any kind of ulcer in the ?
Upper GI tract (esophagus, stomach, duodenum)
32
Peptic ulcer disease develops when GI tract is exposed to acid & ____?
Pepsin
33
Defensive factors in Upper GI?
mucus, bicarbonate, blood flow, prostaglandins.
34
Aggressive factors of Upper GI Health?
H. pylori, NSAIDs, Acid, Pepsin, Smoking
35
What are some common causes of Peptic ulcer disease?
H. pylori, NSAIDs, Alcohol, Excess acid secretion, stress, smoking, and family history.
36
How does H pylori cause PUD?
They can imbed themselves into the stomach lining and grow there.
37
What 2 enzymes do NSAIDs inhibit?
COX-1 and COX-2
38
where are COX-1 enzymes found?
In all tissues
39
Where are COX-2 enzymes found?
at site of injury
40
What do COX-2 enzymes do?
Mediates inflammation and pain
41
What is the job of COX-1 enzymes?
to protect gastric mucosa by secreting prostaglandin E
42
What is the pathogenesis of PUD?
1.) Mucosa is damaged
2.) histamine is secreted which results in :
- Increase in acid and pepsin secretion
- Vasodilation
3.) Ulcer formed
43
PUD clinical manifestations:
N/V, anorexia, weight loss, bleeding, pain
44
Characteristics of gastric ulcer?
Burning, cramping, gas like
45
Characteristics of duodenal ulcer?
Burning, cramping, gas like
46
Location of both gastric and duodenal ulcer?
epigastrium, back
47
When does gastric ulcer pain develop>
1-2 hours after eating
48
When does Duodenal ulcer pain occur?
2-4 hours after eating
49
PUD "HOP" complications ?
H: Hemorrhage
O: Obstruction
P: Perforation and Peritonitis
50
MOA of large doses of Antacids?
Neutralizes acid- 50%
51
MOA of small dose antacids?
increased secretion of mucous, PGE, HC03
52
Indication of antacids?
PUD healing, GERD symptoms, Stress ulcers
53
Side effect of aluminum based antacids?
constipation
54
Side effect of calcium based antacids?
Constipation
55
Side effect of magnesium based antacids?
Diarrhea
56
Adverse effects of Antacids?
Diarrhea or constipation, Acid rebound
57
Interactions of antacids?
Chelation(cause other meds to not be absorbed), altered gastric absorption
58
Sucralafate is composed of?
Sucrose and aluminum hydroxide
59
MOA fo sucralafte?
alters when exposed to gastric acid. Sticky, thick gel--> protective barrier
60
Indication of sucralafate ?
Duodenal uclers, gastric ulcers
61
Should sucralfate be take with antacids?
NO
62
Sucralafate route?
PO- tablet or suspension
63
Interaction of sucralfate?
decreased drug absorption, take 2 hours apart
64
How to treat H. pylori?
several antibiotics + gastric acid inhibitor
- metrinidazole, tetracycline, bismuth
65
Why combination therapy to treat H. pylori?
minimize resistance
66
What is the prototype of Histamine Type 2 receptor antagonists (H2RA)?
Cimetidine and famotodine
67
MOA of histamine type 2 receptor antagonists?
Block H2 receptor, reduces gastric acid secretion
68
Indications og H2RA
GERD, PUD
69
Adverse effects of H2RA?
CNS in elderly, slight pneumonia risk in elderly
70
Interactions of H2RA?
inhibits CYP 450 enzymes
71
Proton pump inhibitors prototype?
Omeprazole, pantoprazole
72
MOA of PPIs?
Binds to proton pump, irreversibly inhibits secretion of HCL?
73
Indication of PPIs?
Short term treatment of PUD and GERD
74
Adverse effects of PPIs?
Long term: pneumonia, hip fx, stomach CA
75
Nursing implications of PPIs?
short term use only
other PPIs given IV
Monitor VB12
76
What does the intrinsic factor do?
Binds to B12 in stomach and travels to terminal ileum where b12 is then absorbed
77
Metoclopramide class?
pro kinetic, antiemetic
78
MOA of metoclopramide?
Increases Upper GI motility, suppresses emesis
79
Indications fo metoclopramide?
GERD, chemo induced N/v
80
AE of metocloprmaide ?
Sedation, restlessness, extrapyramidal reactions
81
NC for metoclopramide?
Short term therapy, check pt drug regimen
82
What is the extrapyramidal system?
network of neurons in the brain that coordinate movement
83
Symptoms of extrapyramidal reactions?
Akinesia, akasthesia
84
Total body water %?
60% of body weight
85
Functions of body fluid?
lubricant, metabolism, transport of O2, nutrients, chemical, regulate body temp
86
What perfect of total body water is extracellular fluid?
33%
87
What percent of total body water is blood plasma?
8%
88
What is osmolality?
solute concentration in the the blood
89
What is water movement across a semi-permeable membrane from low to high concentration?
osmosis
90
What is the movement of particles down a concentration gradient?
diffusion
91
what is movement of particles against a concentration gradient and requires energy?
active transport
92
Water Pushing pressure?
Hydrostatic
93
water pulling pressure?
Osmotic
94
What particle has a large impact on pressure?
protein
95
Colloidal osmotic pressure has to do with what molecule?
protein
96
What protein is the main colloid?
Albumon
97
Artery pressure is ?
High
98
Venous pressure is ?
low
99
What secretes aldosterone?
adrenal cortex
100
Renal tubes reabsorb ___ & ____ and excrete ____?
Na, Water, K
101
Where is Antidiuretic hormone synthesized?
hypothalamus
102
Where is ADH stored and released from?
posterior pituitary
103
Where is atrial natriuretic peptide released from?
Right atrium when heart is stretched
104
What is increased production of urine by the kidneys?
Diuresis
105
Where is the most sodium and water reabsorption
Loop Of Henle
106
Diuretic types with class?
Furosemide: Loop
Hydrochlorothiazide: Thiazide
Spironolactone: Potassium sparing
Mannitol: Osmotic
107
What is related to the osmotic pressure of a solution and how much it influences the movement of water?
Tonicity
108
Tonicity equation?
2(Na+) + Gluc/18
109
When concentration of stuff is equal to intravascular plasma?
Isotonic
110
When concentration of stuff is less than plasma?
hypotonic
111
When concentration of stuff is more than plasma?
Hypertonic
112
Hypertonic causes the cell to?
shrink
113
Hypotonic causes the cell to?
Enlarge
114
Imbalance of volume is?
too much or too little
115
Imbalance of concentration is?
too many or too few
116
What is equal decreased water & Na+?
isotonic hypovalemia
117
What can cause isotonic hypovalemia?
emesis , diarrhea, burns, hemorrhage, excessive perspiration.
118
Clinical manifestations of hypovalemia?
Increased HR, weight loss, oliguria, decreased skin tumor, Dry mucous membranes, hard stools, absence of sweat, dizziness.
119
Causes of hypervalemia?
excessive infusion of fluids, CHF, Cirrhosis
120
Clinical manifestations of hypervalemia?
Weight gain, edema, bounding pulses, DJV, crackles, orthopnea.
