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med surg 2 > PUD and GERD > Flashcards

PUD and GERD Flashcards

1
Q

FUNCTIONS OF THE DIGESTIVE SYSTEM

A
  • ingestion
  • mechanical processing
  • digestion
  • secretion
  • absorption
  • excretion
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2
Q

THE STOMACH

A
  • holding tank for food
  • food is exposed to stomach acids and digestive
  • saturates food with gastric juices
  • excretes hydrochloric acid
  • PH 2.0
  • absorbs H2O, alcohol, sugars, salt, electrolytes, and some drugs
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3
Q

ALTERATION IN GATSRIC DIGESTION

A
  • gastroesophageal reflux disease (GERD)
  • hiatal hernia
  • peptic ulcer disease(PUD)
  • gastric cancer
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4
Q

GERD

A
  • caused by gastric acid flowing upward into the esophagus
  • incompetent lower esophageal sphincter
  • acid becomes an irritant destroying esophageal lining
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5
Q

DEGREE OR REACTION

A

HEARTBURN

  • most common symptom
  • burning chest pain behind breast bone
  • moves upward toward throat
  • worse after eating, lying down or bending down
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6
Q

GERD- LIFESTYLE VARIBLES

A
  • relaxed lower esophageal sphinter
  • being overweight
  • over eating
  • caffine/alcohol
  • smoking
  • stress
  • ulcer disease
  • gastritis
  • NSAID’s (aspirin and ibuprofen)
  • certain foods (citrus,peppermint, chocolate, fatty/spicy food)
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7
Q

GERD DIAGNOSIS

A

-UPPER GI SERIES (barium swallow) ingestion of barium followed by x-rays

ESOPHAGOGASTRODUODENOSCOPY(EGD)

  • endoscope used
  • direct visualization
  • can perform biopsy
  • oral anesthetic
  • observe for return of “gag reflux”

ESOPHAGEAL MANOMETRY

  • determines the strength of the muscles in the esophagus
  • small nasal tube

PH MONITORING

  • small nasal tube
  • rest above LES
  • lasts 12-24 hours

BERSTEIN TEST
-mild acid placed in the esophagus

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8
Q

GERD TREATMENT DETERMINED BY

A
  • age, overall health and medical history
  • extent of condition
  • tolerance to specific meds, procedures and therapies
  • expectation for the course of the condidtion
  • patient opinion or preference
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9
Q

GERD TREATMENT

A
  • diet and lifestyle changes
  • quit smoking
  • medications
  • observe food intake and food types
  • eat smaller portions
  • avoid overeating
  • watch alcohol consumption
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10
Q

GERD TREATMENT PART 2

A
  • don’t lie down right after eating
  • decrease fluid intake
  • lie on left side, elevate HOB 30 degrees
  • lose excess weight
  • surgical correction (nissen fundoplication)
  • non surgical correction(stretta procedure)
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11
Q

STRETTA PROCEDURE

A
  • done on the LES
  • use of radiofrequency
  • tiny cuts leading to scar tissue
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12
Q

GERD MEDICATIONS : ANTACIDS

A

-neutralize stomach acid
-OTC
-tablet or liquid form
fast pain relief

sodium bicarbonate
calcium bicarbonate
aluminum bydroxide
magnesium hydroxide

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13
Q

GERD MEDICATIONS:

H2 RECEPTOR BLOCKERS

A
  • OTC or by prescription
  • blocks histamine
  • reduces acid and pain

zantac (ramotadine)
Pepcid (famontdine)
tagment (cimedine)
axid ( nizatidine)

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14
Q

GERD MEDICATIONS: PROTON PUMP INHIBITORS

A
  • blocks the enzyme in the stomach that produces acid
  • promotes healing of the stomach and esophagus
prevacid (lansoprazole)
aciphex ( rabeprazole)
Prilosec (omeprazole)
protonix (pantoprazole)
nexium ( esomeprazole)
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15
Q

GERD MEDICATIONS: PROKINETIC AGENTS

A
  • assists the stomach to empty more rapidly
  • may help tighten the LES
  • prescription

reglan (metoclopramide)

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16
Q

GERD MEDICATIONS: ANTISPASMOTICS

A
  • relaxes smooth muscles of intestine
  • works to decrease digestion
  • prescription

bentyl, dibent (dicyclomine)
levsin , cystospaz(hyoscyamine)

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17
Q

GERD MEDS: CYTOPROTECTIVE AGENTS

A
  • protects lining of stomach and intestine
  • doesn’t decrease amount of acid
  • used to prevent ulcer formation

pepto bismol ( bismuth ssubsalicylate)

Carafate(sucrafate)

cytotec(misoprostol)

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18
Q

GERD COMPLICATIONS

A
  • esophagitis
  • esophageal stricture
  • barrett’s esophagus (considered precancerous)
  • hiatal hernia
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19
Q

NURSING DIAGNOSES

A
  • altered nutrition
  • pain(acute vs chronic)
  • altered sleep pattern
  • knowledge deficit
  • risk for fluid volume imbalance
  • risk for impaired swallowing
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20
Q

GERD NURSING MANAGEMENT

A 
-patient and family teaching 
foods
smoking cessation
stress avoidance 
medications and side effects
importance of following medical regime
s&s to report to physician 
possible pre and post operative care
21
Q

HIATAL HERNIA CLASSIFICATIONS

A

sliding- stomach moves back and forth through hiatus of the diaphragm

paraesophageal or rooling:- greater curvature of the stomach move above diaphragm forming a pocket

22
Q

PRIMARY PREVENTION OF HIATAL HERNIA

A
  • unknown
  • weakening of diaphragm muscles
  • increased intra-abdominal pressure
  • increased age
  • trauma
  • poor nutrition
  • obesity
  • forced recumbent positioning
23
Q

HIATAL HERNIA DEGREE OD REACTION

A
  • may be asymptomatic
  • heartburn
  • nocturnal heartburn
  • dysphagia
  • mimics gallbladder disease
24
Q

PRECIPTATING FACTORS OF HIATAL HERNIA

A
  • large meals
  • alcohol
  • smoking
25
Q

COMPLICATIONS OF HIATAL HERNIA

A 
GERD 
hemmorrage
 esophageal stenosis
ulceration
strangulation
regurgitation with aspiration
26
Q

HIATAL DIAGNOSIS TEST

A

-EGD and barium swallow

27
Q

SECONDARY PREVENTION SECONADARY PREVENTION

A

CONSERVATIVE THERAPY

  • lifestyle modifications
  • medications

SURGICAL THERAPY
-nissen fundoplication

28
Q

NURSING DIAGNOSES (NIESSEN FUNDOPLICATION)

A
  • knowledge deficit
  • chronic pain
  • altered nutrition
  • risk for aspiration
  • altered skin integrity
  • risk for impaired swallowing
29
Q

PEPTIC ULCER DISEASE

A
  • erosion of the GI mucosa from the action of HCL and pepsin
  • includes gastric and duodenal ulcers
30
Q

PUD risk causes

A
  • lifestyle
  • NSAIDs
  • physical stress
  • corticosteroids
  • stress
  • alcohol
  • caffine
  • smoking
  • vagal nerve stimulation
  • overactive acid and pepsin secretion
31
Q

PHASES OF PUD

A
  1. erosion
  2. acute ulcer
  3. perforated ulcer
32
Q

PUD ETIOLOGY

A

-HELICOBACTER PYLORI( H.PYLORI)

  • 80-90% of all ulcers
  • bacterium infection
  • weakens the stomach’s protective mucus
33
Q

PUD DEGREE OF REACTION

A

MAY BE ASYMPTOMATIC UNTIL SERIOUS COMPLICATIONS OCCUR

  • heartburn
  • gnawing/burning pain
  • acid,bitter, slimy taste in mouth
  • belching/indigestion
  • nausea/vomiting
  • weight loss and poor appetite
  • feeling tire and weak
34
Q

PUD COMPLICATIONS : HEMORRAGE

A
  • most common
  • black,tarry stools(melena)
  • occult blood
  • emesis( coffee ground or fresh)
35
Q

PUD COMPLICATIONS: GASTRIC OUTLET OBSTRUCTION

A

-narrowing of pylorus
scar tissue
pylorspasm
edema/inflammation

  • vomiting projectile
  • contains food particles
  • offensive odor
36
Q

PUD COMPLICATIONS : PERFORATION

A
  • most lethal complication
  • requires surgery
  • causes peritonitis
  • S&S onset sudden and dramatic
  • sudden,severe upper abdominal pain
  • abdomen muscle contract- rigid and board like
  • respirations shallow and rapid
  • absent bowel sounds
37
Q

PUD DIAGNOSTIC PROCEDURES

A

-ENDOSCOPY : direct visualization

  • H.PYLOR TESTING
    sputum, urine, blood, tissue, breath
    *urea breath shows active infection

-OCCULT BLOOD

38
Q

PUD TREATMENTS

A
  • LIFESTYLE MODIFICATIONS
  • bland diet and 6 small meals a day
  • protein neutralizes but stimulates gastric secretions
  • adequate physical /emotional rest
  • strict adherence to prescribes meds
  • antibiotic therapy for H.Pylori( may use two or more antibiotics)
  • stop ASA and NSAIDs
39
Q

PUD DRUG THERAPY

A

CARAFATE (SUCRAFATE)

  • slurry
  • give on empty stomach 1hour before meals and bedtime
  • PEPTO BISMOL
  • promotes healing
  • partially effective against H.Pylori
  • may blacken stools
  • CYTOTEC (MISOPROSTOL)
  • for pts taking ASA or NSAIDS
  • prevents gastric ulcers induced by the above
40
Q

PUD SURGERY

A 
20% of ulcer patients 
indications:
-obstruction
-perforation
- hemorrhage
-ulcers unresponsive to treatment 
-multiple ulcer sites
-possible malignancy
41
Q

PUD VAGOTOMY

A
  • selective
  • reduces acid
  • decreases gastric motility
  • often combined with billroth I and II
  • truncal (total)
42
Q

PUD PYLORPLASTY

A
  • surgical enlargement
  • aids gastric emptying
  • can do balloon angioplasty
43
Q

PUD SURGERY

A
  • billroth I
  • billroth II
  • Gastrojejunostomy
  • for gastric outlet obstruction
  • food bypasses the obstruction
44
Q

POST OP COMPLICATIONS

A

DUMPING SYNDROME
-results of large portion of stomach and pyloric pginter removal

POSTPRANDIAL HYPOGLYCEMIA

  • form of dumping syndrome
  • large bolus of carbs dumps into small intestine

BILE REFLUX GASTRITIS
-related to surgery on pyloric sphincter

45
Q

PREOPERATIVE TEACHING

A 
NPO status
the procedure itself
IV therapy 
NG tube
Pain relief 
answering all patient questions
C and DB, IS use, incisional splinting
46
Q

POSTOPERATIVE PATIENT CARE

A
  • promote comfort
  • promote effective airway management and gas exchange
  • monitor I and O
  • NG drainage: amount ,color, odor
  • bright red in beginning, then coffee ground
  • becomes yellow green after 36-48hrs
47
Q

POSTOPERATIVE PATIENT CARE

A
  • abdominal dressing: drainage, bleeding, odor
  • always at risk for ulcer redevelopment
  • adequate rest, nutrtion with avoidance of stressors
  • emphasize avoidance of med not prescribed by MD, alcohol and smoking
48
Q

NURSING DIAGNOSIS

A
  • fluid volume deficit
  • acute pain
  • impaired skin integrity
  • knowledge deficit
  • fear/anxiety
  • risk for ineffective breathing pattern
  • risk for infection
  • risk for electrolyte imbalance

med surg 2 (17 decks)

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