Nurse 313R Med Surge

Question 1

Haital Hernia

Answer 1

• protrusion of a portion of the stomach into the esophagus through an opening, or hiatus in the diapgragm

Question 2

2 Types of Hiatal Hernia

Answer 2

• Sliding

* Paraesophageal or rolling

Question 3

Clinical Manifestations

Answer 3

• heartburns
• dysphagia
• severe burning pain when bending over (sit upright)

Question 4

Drugs for use with Hiatal Hernias

Answer 4

 H2 receptor blockers(dine)-Tagamet, Zantac, Pepcid
 PPI’s (zole)-Prevacid, Protonix, Nexium
 Cholinergics-used to increase LES pressure and increase gastric emptying-bethanechol
 Prokinetic-motility enhancing-Reglan-promotes gastric emptying

Question 5

Collaborative Care / Nursing Therapeutics

Answer 5

• reduce intraabdominal pressure
• use of antacid and antisecretory agent
• wt. loss management

Question 6

Non-Conservative Therapies

Answer 6

 Surgery
 Reduction of the herniated stomach into abdomen
 Herniotomy-excision of the hernia sac
 Herniorraphy-closure of the hiatal defect
 Gastropexy-attachment of the stomach subdiaphragmatically to prevent reherniation

Question 7

Conservative

Answer 7

• Reduce intra-abdominal pressure
• Eat small meals, wear loose clothing, avoid heaving lifting, stop alcohol and tobacco use, keep hob up to sleep (weight loss management)

Question 8

Diagnostic Studies

Answer 8

 Barium swallow-shows protrusion of gastric mucosa through esophageal hiatus
 Endoscopic visualization of lower esophagus will show mucosal abnormalities or any inflammation
 Upper GI endoscopy
 Motility studies

Question 9

Complications

Answer 9

 GERD, esophagitis, hemorrhage from erosion, stenosis of esophagus, ulcers in herniated part of stomach, strangulation of the hernia, regurgitation with tracheal aspiration

Question 10

Gastritis

Answer 10

 Inflammation of the gastric mucosa- a result of the breakdown of the normal gastric mucosa barrier that protects stomach from the corrosive action of HCL acid and pepsin. HCL and pepsin diffuse back into the mucosa causing edema, capillary walls lose plasma into gastric lumen, and possible hemorrhage. (mucus membrane starts to be thin)
 Acute or chronic
 Diffuse or localized

Question 11

Chronic gastritis causes

Answer 11

	Focus is on evaluating and then eliminating the specific cause
	Drugs 
	Alcohol
	H. Pylori
	Pernicious anemia

Question 12

Acute Gastritis interventions

Answer 12

 Eliminating the cause is all that is needed to treat acute gastritis (stopping to much alcohol)
 If vomiting occurs, rest, NPO status, and IVF may be prescribed.
 In severe cases an NGT will be used to monitor for bleeding, for lavage of the precipitating agent from the stomach, and to keep the stomach empty
Procedure: lavage (drain out)(ng drains to keep stomach empty)

Question 13

Risk Factors

Answer 13

 Drug related gastritis
NSAIDs-risk factors for NSAID related gastritis is being female, over age 60, history of ulcer disease, concomitant use of anticoagulants, use of other NSAIDs, use of corticosteroids, having a chronic debilitating disorder
 Diet –alcohol, spicy foods
 H.Pylori infection
 Autoimmune metaplastic atrophic gastritis an immune response against parietal cells

Question 14

Clinical Manifestations

Answer 14

Symptoms for acute gastritis
	Anorexia
	Nausea and vomiting
	Epigastric tenderness
	Feeling of fullness
Symptoms for chronic gastritis
Above plus loss of parietal cells=loss of intrinsic factor=loss of absorption

Question 15

Diagnostic Studies

Answer 15

 Diagnosis based on patient’s history of drug and alcohol use
 Endoscopic exams with biopsy needed for definitive diagnosis
 For H. pylori there are breath, serum, stool and urine tests
 Stool for occult blood
 Serum for anemia or lack of intrinsic factor
 Serum for antibodies to parietal cells, and IF

Question 16

Peptic Ulcer Disease

Answer 16

• condition characterized by erosion of the GI mucosa resulting from digestive action of HCl acid and pepsin.

Question 17

Type of Peptic Ulcer Disease

Answer 17

• Acute ulcer

* Chronic ulcer

Question 18

Type of Ulcerations

Answer 18

• Gastric Ulceration

• Duodenal Ulcers
• Physiologic Stress Ulcer

Question 19

Clinical Manifestation

• may have no pain
• burning or cramp like
• back pain

Answer 19

Complications

• hemorrhage
• perforation
• gastric outlet obstruction

Question 20

Collaborative Care / Nursing Therapeutics

Answer 20

	adequate rest
	bland diet
	cessation of smoking
	aspirin and NSAIDS
	Drugs
                 - H2R Blockers
                 - Proton pump inhibitors
                 - ABT
                 - Antacid
                 - Anticholinergic drugs
                 - cytoprotective drug
	Nutritional Therapy

Question 21

Ulcerative Colitis

Answer 21

• characterized by inflammation and ulceration of the colon and rectum
• colon may become hyperemic and edematous may develop abscess then ulceration

Question 22

Clinical Manifestation

Collaborative Care / Nursing Therapeutics

Goals:

• Drug therapy
• Surgical Intervention
• Nuritional Therapy

Answer 22

Clinical Manifestation

• bloody diarrhea
• abdominal pain
• 4-5 stools BM/ day
• Fever, malaise, anorexia
• Wt. loss
• Anemia, tachycardia
• Dehydration
• Goals:
• rest the bowel, control inflammation, combat infections, alleviate stress, symptomatic relief

•

Question 23

Collaborative Care / Nursing Therapeutics

Goals:

• Drug therapy
• Surgical Intervention
• Nuritional Therapy

Answer 23

Collaborative Care / Nursing Therapeutics

- rest the bowel, control inflammation, combat infections, alleviate stress, symptomatic relief

Question 24

Goals:

• Drug therapy
• Surgical Intervention
• Nuritional Therapy

Answer 24

Drug therapy

   * antimicrobial
   * corticosteroid * sedative
   * antidiarrheal •	Nuritional Therapy

Question 25

Nuritional Therapy

Surgical Intervention

Answer 25

• proctocolectomy with ileostomy

- ileostomy vs. colostomy