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NUR 155 med surg > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Populations at risk for PUD

A
  • Age 65 and older

- Men and women

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2
Q

Population at risk for GERD

A
  • Obesity

- cigarette smoking

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3
Q

Population at risk for gallbladder disease

A

4 F’s

Female
Fat
Forty
Fertile

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4
Q

AST/ ALT

A

0-35

Liver dysfunction

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5
Q

Amylase and Lipase

A

Amylase: < 120

Lipase: < 160

Pancreatitis

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6
Q

Ammonia

A

10-80

Increase = liver dysfunction

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7
Q

Bilirubin

A

< 1

Liver dysfunction, bile duct obstruction

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8
Q

Albumin

A

3.5-5

Decease= liver dysfunction/ Malnutrition

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9
Q

Peptic ulcer disease (PUD)

A

Erosion of mucous membranes forms and excavation in the stomach, pyloric, duodenum or esophagus

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10
Q

PUD is caused by

A
  • H. Pylori infection (most common)
  • NSAIDS
  • stress
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11
Q

PUD risk factors

A
  • excessive secretion of stomach acid
  • smoking and alcohol
  • fam history
  • chronic NSAID usage
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12
Q

PUD clinical manifestations

A

Dull, gnawing pain or burning sensation on the back or mid epigastric area

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13
Q

PUD gastric ulcer signs

A
  • pain occurs immediately or 30 mins-1hr after eating
  • weight loss
  • pain worse during day
  • eating increase pain
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14
Q

PUD duodenal ulcer signs

A
  • pain occurs 2-3 hr after meals
  • awake w/ pain at night
  • food temporarily relieve pain
  • most common form
  • well nourished
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15
Q

Stress ulcers

A
  • ulcer occurs after a physiological stressful event
    • burns, shock, severe sepsis
  • once Patel t is better, the ulcers reversed
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16
Q

PUD assessment / diagnostic test

A
  • CBC: (anemia) for bleeding peptic ulcer
  • LFTs ( liver function test)
    • ALT/ AST, amylase/lipase
    • to rule out other possible diseases
  • CT: rule out other disease
  • Upper endoscopy w/ biopsy (diagnostic)
  • start w/ lest invasive first ( lab, CT, EDG)
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17
Q

PUD medications

A
  • Antibiotics: H. Pylori
  • PPI: inhibit acid production in stomach
  • H2 Blocker: block histamine which trigger acid production in stomach
  • Bismuth Salts: coats the ulcer and protects it from stomach acid
  • Cytoprotective agents: inhibit gastric secretion and promote healing of ulcers
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18
Q

Antibiotics

  • for PUD
A

Will eradicate H. Pylori

  • Clarithromycin + Amoxicillin or Metronidazole
  • use more than one
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19
Q

Cytoprotective agent

  • for PUD
A

Mucosal healing

  • misoprostol
  • sucralfate
  • 1hr before meals
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20
Q

Antacids

  • for PUD
A

Used to neitralize stomach acid

  • calcium carbonate
  • don’t give with other meds ( 1hr before or after)
  • don’t give with meals (2hr after)
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21
Q

Diet for PUD

A
  • 3 regular meals a day
  • limit coffee, caffeine, and alcohol
  • avoid extremes in food (hot/cold)
  • keep dairy of food eaten ( to determine triggers)
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22
Q

PUD health promotion

A
  • avoid NSAIDS
  • take antacids 1-3 hr after meals
  • report any bleeding or tarry stool
  • smoking cessation
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23
Q

PUD complication Internal bleeding (Hypovolemic shock) signs and symptoms

A

Symptoms:

  • Hematemesis ( vomit blood)
  • melena ( black tarry stool)

Early signs:
- ⬆️ HR, RR , BP may still be norm

Late signs:
- ⬇️ BP, rapid RR (over 30) ⬆️ HR over 120

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24
Q

PUD complication perforation signs

A
  • Emergency

Sudden onset of symptoms:

  • detect changes in fitness or distention of abd ( rigid, board like)
  • sharp upper abd pain, may refer to shoulder
  • VS change just like in hypovolemic shock
  • can turn into peritonitis
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25
Q

GERD

A
  • mucosal damage by reflux of stomach acid into lower esophagus
  • is the most common upper GI problem
26
Q

GERD most common cause

A
  • incompetent loser esophageal sphincter (LES)
  • this normally acts as reflux barrier but when not working properly contents move in esophagus when patient is supine or had increase intraabdominal pressure
27
Q

Factors affecting LES pressure

A
  • alcohol
  • chocolate
  • drugs
  • fatty foods
  • nicotine
  • peppermint/ spearmint
  • pregnancy
  • tea/ coffee (caffeine)
28
Q

Complications of GERD

A

1) Esophagitis

2) Barrett’s Esophagus (BE)
- changes in epithelial cells in esophagus
- is a precancerous lesion that increases patients risk for esophageal cancer

3) Respiratory
- cough
- bronchospasm/ laryngospam
* all due to gastric secretions irritating upper airway

29
Q

GERD Diagnostic Studies

A
  • typically diagnosed based on symptoms in patients response to drug therapy
  • endoscopy can be used to determine LES competence and degree of inflammation in the patient’s unresponsive to drug therapy or complications of Gerd are expected
30
Q

Lifestyle modification for GERD

A
  • HOB elevated 2-3 after meals
  • no supine after meals
  • smoking cessation
31
Q

Drug therapy for GERD

A

Most common-

  • PPI
  • H2 blockers

Adjunctive therapy -
- antacids: quick, short lived relief

  • prokinetic agent (metoclopramide)
    • accelerates gastric emptying
32
Q

GERD nutrition

A
  • no specific diet, avoid foods that decrease LES pressure

- avoid late evening meals/nighttime snacking

33
Q

GERD surgical therapy

A
  • reserves for patients with complications
  • Nissan and Toupet Fundoplications: are common laparoscopic antireflux surgery
    • usually outpatient
  • goal is to reduce reflects by enhancing the integrity of the LES
  • LINX reflux management system: option for patients who have symptoms despite med management
    • ring of small flexible magnet enclosed in titanium beads and connect by titanium wires
    • ring strength the LES- help keep closed
34
Q

Upper GI Bleed cause

A

Gastritis and hemorrhage form PUD most common cause

35
Q

Upper GI bleed signs and symptoms

A
  • melena
  • bright red or dark coffee ground vomit
  • N/ V
  • dizziness or fainting
  • Vital changes: ⬆️ HR ⬇️ BP
36
Q

Upper GI bleed diagnosis and treatment

A

1) Hemoglobin and Hematocrit - evaluate extent of blood loss
2) upper endoscopy within 24 hr to confirm diagnosis and locate source
3) administer IV PPI for acid suppression

37
Q

Upper GI bleed nursing interventions

A
  • NGT to distinguish fresh blood for “coffee ground”- aid in removal of clots and prevent N/ V through suction of gastric contents
  • Hemoccult stool
  • Hourly I/O
38
Q

Gallbladder disease - cholecystitis signs

A
  • fever and leukocytosis
  • jaundice
  • N/V
  • Anorexia
  • Fat intolerance ( fatty stool “steatorrhea”)
  • feeling of fullness
  • abdominal distention

Pain:
RUQ or right shoulder- may radiate to back, increase with deep breathe (MURPHY SIGN)

39
Q

Gallbladder disease Cholelithiasis signs

A

Pain : RUQ or epigastric region and may radiate to shoulder

- NV

40
Q

Cholelithiasis effect on pancreas

A

If stone blocks common bile duct ( biliary obstruction) it may block the pancreatic duct

Patient would experience pancreatitis

41
Q

Cholelithiasis- common bile duct obstruction

A

May cause build up of bilirubin in the blood due to liver not being able to ride the bile

This can lead to additional symptoms of jaundice

See a increase in LFT, Bilirubin and alkaline phosphatase labs

If stone block cystic duct- gallbladder become distended, inflamed and infected

42
Q

Diagnostic test for gallbladder disease

A

1) abdominal ultrasound (DX of choice)
2) abd x-ray / abd CT scan
3) endoscopic retrograde cholangiopancreatography ( ERCP) vidize biliary structures and pancreas via endoscopy

43
Q

Treatment for gallbladder disease

A
  • most patients are asymptonatic and don’t need surgery
    1) ERCP - can be use to remove stone
    2) cholecystectomy (used most often)

3) Extracorporel shock wave lithotripsy ( ESWL)
- non surgical - good option for Patients who can’t undergo surgery

44
Q

Post op care cholecystectomy

Pain, R, skin, Nutrition

A

1) pain
- analgesia
- ambulation
- abd binder or splinting w/ pillow

2) Resp status
- turn, cough, deep breath
- IS
- early ambulation
- VTE prophylaxis

3) Skin - drains ( t-tube, JP drain)

4) Nutrition
- once resume norm diet- low fat, high carb/ protein immediately post op
- once home- healthy diet, avoid fats
- 4-6 wk post op- resume norm diet

45
Q

Complication from cholecystectomy

A

Bleeding / Hemorrhage

  • monitor VS
  • inspect surgical site For drainage or bleeding
- GI assessment for 
   • tenderness and rigidity of abd
   • N/V
   • abd distention 
   • temp elevation
46
Q

Education post cholecystectomy

A

1) activity
- light exercise immediately
- avoid lifting object > 5 lb for 1-2 wk
- if lap: shower after 1-2 d (open procedure longer)

2) wound care
- check daily for infection
- dermaband (lap) don’t scrub, lightly wash w/ soap and water ( dermaband will crust over and fall off we wounds are healing) don’t pull off!!!

3) pains
- medication
- lap procedure will feel CO2 pain in chest shoulder and upper back- get up walking

47
Q

Obesity risk

A
  • greater risk mortality (6-20 y decrease)
  • as BMI ⬆️ risk for cancer ⬆️
  • ⬆️ type 2 diabetes
  • ⬆️ HTN and asthma
  • twice as likely to be diagnosed with Alzheimer’s
48
Q

Lifestyle modification for obesity

A

Multicomponent behavior interventions:

  • weight loss goals
  • increase physical activity
    • 150 min of moderate- intense exercise per wk or 75 mins of vigorous- intense
  • addressing barriers to change ( issues with not losing weight)
  • improve diet
    • calories deficit if 500-1000 per day
    • DASH or Mediterranean diet
49
Q

Pharmacotherapy for obesity

A
  • Antiobesity med: meant to be supplement with changes in diet and exercise, not replace !
  • these meds should only be use for up to 12 wk
  • can cause severe N/V
50
Q

Complications of obesity

A
  • obstructive sleep apnea
  • heart failure
  • hypertension
  • DTV and PE risk
  • difficult finding venous access due to adipose tissue
  • medication change
  • pressure ulcer and skin breakdown
51
Q

Bariatric surgery factors

A
  • restrict ability to eat
  • perform only after non surgical attempts fail

1) selection factors
- body weight ( try to lose some)
- patient history
- support network
- ability to perform ADL

2) exclusion factors
- current drug or alcohol abuse
- Cushing (bc it causes obesity)
- severe psychiatric illness

52
Q

Post Bariatric surgery dietary restrictions

A
  • SLOW progression from clear liquid-> full liquid -> soft-> regular
  • typically go home on clear liquid
53
Q

Bariatric surgery pain relief

A
  • PCA : morphine, hydromorophone
54
Q

Bariatric surgery anastomotic leak signs

A

Fever

Abd pain

Tachycardia

Leukocytosis - can lead to sepsis

55
Q

Bariatric surgery bowls habit

A
  • diarrhea is more common post surgery
  • constipation may result from general anesthesia and post op opioids
    • may be placed on docusate
- once BS and oral intake resume-> 6 small feeding of a total of 600-800 cal a day
  • eat slow! Stop when full!
   • may be B12 or iron supplements 
  • don’t drink liq w/ meals 
   • avoid milk and sugars
56
Q

Bariatric surgery potential complications

A
  • hemorrhage
  • dumping syndrome
  • dysphagia : most sever 4-6 wk post op (can’t swallow)
  • bowel or gastric outlet obstruction: NO NGT!!! May disrupt the surgical suture line and cause anatomotic leak or hemorrhage
57
Q

Dumping syndrome signs

A

15 -2 hr after eating

  • tachycardia
  • dizziness
  • sweating
  • N/V
  • bloating or abd cramping
  • diarrhea
58
Q

Dumping syndrome effect of blood glucose

A

Blood glucose rises rapidly, followed by increased insulin secretion -> results and reactive hypoglycemia

Polar 
palpitations
 headaches 
feeling of warmth 
dizziness or drowsiness
59
Q

EDG

A
  • Allows direct visualization of a Esophagus gastric and duodenum mucus through an endoscope

Preoperative:

  • NPO for eight hours prior to exam
  • verify consent
  • explain use of local anesthesia - spray down throat

Post Op:

  • NPO until gag reflex returns
  • warm saline gargles -> relief of sore throat - -check temperature every 15 to 30 minutes (spike in temp is sign of proliferation)
60
Q

Colonoscopy

A

Moderate sedation

  • entire colon
  • position change freq during
  • allow for biopsy and removal of polyps

Pre-op:

  • bowel prep- evening before
  • drink cleansing south on evening before
  • 4-6 he beige drink second
  • stool will be clear to clear yellow

Post-op:

  • abd cramp expected bc of air
  • passing gas= good
  • monitor for rectal bleeding and perforation (abd distention)

NUR 155 med surg (15 decks)

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