Test 3 Flashcards
What are some of the pharmacological causes of GERD?
Calcium Channel blockers
Nitrates
Anti-cholinergic drugs
NSAIDS
What are some specific time related SSAs for GERD?
Horseness in the AM
Coughing and wheezing in PM
What is Odynophagia?
Painful swalowing and is a symptom of GERD
If pharmacologic treatment is not successful for GERD, what are the other 2 options?
Ambulatory pH Monitoring Examination
Esophagogastroduodenoscopy
What are the two types of Ambulatory pH Monitoring Examinations?
Placing a small catheter through the nose into the distal esophagus for 24 hours
Temporarily attaching a small capsule to the wall of the esophagus during an upper endoscopy (Patient is asked to keep a journal of the food they eat for 24 to 48 hours)
Which antacids are magnesium based?
Maalox and Mylanta
What is Gaviscon?
An aluminum containing antacid that is given to pts with CKD
What are the different side effects from aluminum and magnesium antacids?
Aluminum = constipation; Mag = diarrhea
How do H2 blockers like Famotidine work?
Generally decreases acid by blocking the parietal cells in the stomach
What is a Stretta Procedure?
Nonsurgical procedure that uses radiofrequency energy through an endoscope to help tighten the LES (lower esophageal sphincter).
What are the post procedure nursing interventions after a stretta procedure?
Clear Liquids for 24 hrs
After first day advance to soft diet
Avoid NSAIDs for 10 days
Use liquid medications when possible
No NG tube for 1 month
What is a Laparoscopic Nissan Fundoplication?
A procedure commonly used in hiatal hernia repair that wraps the stomach qqaround esophagus to reinforce the function of the Lower Esophageal Sphincter.
What are some of the factors that contribute to peptic ulcer disease (PUD)?
Corticosteriods (prednisone)
Caffeine
Spicy foods
NSAIDs
What SSAs would be observed for a gastric ulcer?
Pain occurs 30-60 minutes after a meal and rarely is worse at night
Pain is worse with ingestion of foods
Pain located to the left of the midline or upper epigastrium
What SSAs woudl be observed with a duodenal ulcer?
Pain occurs 1 ½ - 3 hrs after a meal
Pain often awakens the patient between 1 & 2 am
Pain relieved by ingestion of food
Melena (blood in stool) more common than hematemesis (bloody vomit)
Pain located to the right or below epigastrium (Duodenal)
What are signs and symptoms of both gastric and duodenal ulcers?
Dyspepsia
Sharp burning or gnawing pain
Bloating
Nausea
Uncomfortable feeling of fullness or hunger
Weight Loss due to changes in nutrition and intake
Anemia
What are the education points for Sucralfate (Carafate), Bismuth Subsalicylate (Kaopectate)?
Give 1 hr before and 2 hrs after meal & HS
Do not administer within 30 mins of antacids or other medications
Bismuth: avoid ASA (asprin)
What are the two common pairs of antibiotics given during triple therapy for H. Pylori infections?
Metronidazole + Tetracycline, Clarithromycin + Amoxicillin
What is a Gastrectomy?
A surgical treatment for PUD that involves all of part of the stomach removed. More common with gastric cancer than with PUD though
What is a Gastroduodenostomy?
Also known as a biliroth I, lower portion of stomach removed, remaining portion attached to duodenum
What is a Gastrojejunostomy?
Also known as a biliroth II, lower portion of stomach removed, remaining portion attached to jejunum
What is a Vagotomy?
branches of vagus nerve (fibers) that supply stomach are cut to interrupt acid production
What is a Pyloroplasty?
opening between the stomach and small intestine is enlarged to increase the rate of gastric emptying
What are some of the signs of a GI hemorrage?
Increased HR, RR
BP drop
Boardlike abdomen
Rebound tenderness
Fetal position
What are the early symptoms of dumping syndrome?
Vertigo
Diaphoresis Tachycardia Palpitations Nausea Vomiting Pallor
What are the late symptoms of dumping syndrome?
These are driven by hypoglycemia
Cramping
Dizziness
Diaphoresis
Confusion
What is the cause of pernicous anemia?
Lack of intrinsic factor causes a decrease in B12 absorption
What are the SSAs for pernicous anemia>
Parathesias
Pallor
Glossitis
Fatigue
Decrease H&H
Loss of appetite
Patchy tongue lesions
What are the characteristics of ulcerative colitis?
10-20 bloody stools per day
Location: begins in the rectum and proceeds in a continuous manner towards the cecum
Complications: Hemorrage and nutritional deficiences
Less frequent need for surgery
What are the characteristics of Crohn’s disease?
5-6 loose stools per day (not bloody with steatorrhea)
Location: Most often occurs in the terminal ileum with patchy involvement through all layer of the bowel
Complications: Fistula, nutritional deficencies, anemia common
Frequent need for surgery
Unintentional Weight loss
What type of diet is recommended for IBS?
low fiber during acute
high fiber when stable
Low residue diet (no nuts, seeds, or indigestible particles)
What is a dangerous complication of IBS?
Toxic mega colon (enlarged dilation of colon that can lead to gangrene and peridontis)
What are the different types of fistulas?
Enterocutaneous:
Enteroenteric:
Enterovesicular:
Enterovaginal:
Enterocutaneous opening between gut and skin
Enteroenteric opening between gut and gut
Enterovesicular gut and bladder
Enterovaginal gut and vagina
What nursing procedure should you never perform on a patient who has had a history of esophageal or gastric surgery?
An NG tube
What viruses are most commonly the causes of hepatitis?
Hepatitis A, B, C
What medications can commonly cause hepatitis?
Acetaminophen, NSAIDs
What secondary infections can present themselves with hepatitis if the person has a compromised immune system>
Epstein Barr (mono)
Varicella Zoster
Herpes Simplex
Cytomegalovirus
What causes pruritus during hepatitis?
Bile salt accumulation
An increased AST, ALT, ALP indicates?
A decrease in the function of the liver
What do we expect to see with albumin with liver impairment?
We expect albumin to go down
What is fulmanating hepatitis?
Hepatitis that cannot be resolved->severe liver failure
What are the different types of cirrhosis?
Post - necrotic:
Laennec’s:
Biliary:
Post - necrotic: result of hepatitis Laennec’s – chronic alcoholism
Biliary – chronic biliary obstruction or autoimmune disease
What lab values increase in liver cirrhosis?
We see an increase in AST, ALT,LDH, Alkaline phosphatase, Bilirubin, Ammonia, Creatinine
What labs do we see a decrease in liver cirrhosis>
Serum albumin
RBC, WBC
An increase in creatinine when the liver is cirrhosed can indicate?
A predictor of mortality because this indicates the renal system is also starting to fail
What is Hepatic encephalopathy?
deteriorating mental status due to a buildup of ammonia
What are the nursing interventions for Hepatic encephalopathy?
Implement safety and fall precautions
Administer lactulose to excrete ammonia in stool
What medication should you administer to lower the risk of esophageal varicies rupture?
Beta Blockers
What is Endoscopic Variceal Ligation?
Small ”O” bands placed @ base of varices occludes the vessel
What is Endoscopic Sclerotherapy?
Varices injected with sclerosing agent
What is a Balloon Tamponade in regards to esophageoal varicies?
the balloon puts pressure on the varices until long term permanent intervention can be completed
What is a Transjugular Intrahepatic Portal-Systemic Shunt?
A nonsurgical procedure performed in IR where a sheath introduced in jugular and advanced to portal vein where stent is placed
Stent is expanded using balloon inflation
Stent forms a shunt between portal vein and hepatic vein that bypasses the liver to reduce pressure in hepatic vasculature
What are the pros and cons of a transjugular intrahepatic portal-systemic shunt?
The pros are that it is used when other interventions aren’t successful
The cons are that it bypasses the liver’s filtration and metabolizing processes
When is a Sengstaken-Blakemore Tube used?
Only in the ICU setting when esophageal varicies rupture, because you can easily loose the airway
What is Hepatopulmonary syndrome?
When the liver fails, you begin to see the respiratory system fail too
What is Nephritic syndrome?
chronic, progressive destruction of glomeruli
What is Nephrotic syndrome?
Massive damage to glomeruli that is immunologic in nature
What will you see in the urine during nephritic syndrome?
A little protein and a LOT of red blood cells
What will you see in the urine during nephrotic syndrome?
Lots of protein, little rbcs
What are SSAs are you going to see with nephritic syndrome?
Oligura
Proteinura
Hematuria
HTN
Fatigue
Edema
Crackles in lungs
increased BUN and Creatinine
What are SSAs are you going to see with nephrotic syndrome?
significant loss of protein (proteinuria)
generalized edema (anasarca), hypotension (losing volume)
RAAS activation leading to fluid retention and worsening edema, HTN
hyperlipidemia
hypoalbuminemia
What is chronic kidney disease?
Involves progressive, irreversible loss of kidney function defined by pathological abnormalities (over 50% of nephrons are damaged before symptoms appear), biomarkers of damage in laboratory values and an under 60 mL/min GFR for more than 3 months
What are the greatest risk factors for chronic kidney disease?
Diabetes and HTN
What are the early stage symptoms of CKD?
Azotemia, mild acidosis, anemia, F&E imbalances, HTN, polyuria
What are the late stage symptoms of CKD?
Uremia
encephalopathy
neuropathy
osteodystrophy
oliguria/anuria
skin disorders
CV disorders
GI disorders
Metabolic derangements
What is diverticulitis?
The impaction and infection of pouches in the intestine
What is diverticulosis?
presence of pouch like herniations protruding through the intestinal wall
Where are divertiuli most likely to form?
In the sigmoid colon
What diet does someone with diverticultis need to eat?
Low fiber during acute phase
high fiber once pain resides
low residue diet
What kind of fruits and vegtables should be avoided?
strawberries,cucumbers, tomatoes, figs, popcorn
Should a client with diverticultis use laxatives?
No, because it can increase peristalsis and increase outpouching of the lumen
An Irreducible hernia is one that?
Cannot be moved back by gentle palpation
What is bowel intusseption?
A telescoping of bowel
What is a bowel volvus?
180 twist of bowel
What is a truss?
A pad that can be worn after the provider has reduced the hernia
What type of obstruction would symptoms of abdominal discomfort with epigastric abd distention, nausea & profuse projectile vomiting, obstipation and metabolic alkalosis indicate?
A small bowel obstruction
Pain in the chest or abd that radiates to the back or right shoulder, abdominal distention, vomiting, board like abdomen, rebound tenderness, hemodynamci instability all are indicators of a?
Bowel perforation
What are the different types of urinary incontienence?
Stress: precipitated by increased abd pressure
Urge: Strong urge to void followed by leakage
Overflow: Overditended bladder, incomplete emptying
Functional: Barriers to get to bathroom
What are the surgical interventions for BPH?
Transurethral needle ablation
Prostatic stent
Transurethral microwave therapy
Prostate artery embolization
Transurethral resection of prostate
What electrolytes do we limit in CKD?
Na, Phos, Mag
What is the first step if someone comes in with CKD?
Place them on a cardiac monitor
In CKD, what is platlet malfunction caused by?
Uremia
What are the nutritional recommendations for CKD?
Carbs for energy
Limited sodium/potassium/phosphate
Restrict protein
Cold/frozen food for stomatitis
*Educate on metallic taste in mouth from uremia
What is odium Polystyrene Sulfonate (Kayexalate) used to treat?
Hyperkalemia
Pt will poop ALOT
How long does Epoetin alpha (Epogen) take to work, and what is it used for?
3 weeks
Used to treat anemia by raising H &H
What is
continuous Renal Replacement Therapy (CRRT)?
A type of dialysis used in critically ill patients in the ICU–more gentle processes for those who can’t handle sudden shifts
What are the indicators for hemodialysis?
BUN > 75-120 mg/dL (Uremia)
Uncontrolled hypertension
Metabolic acidosi
GFR < 15mL/min
Serum potassium > 6mEq/L
Fluid volume overloa
Thrombosis
False Aneurysm Formation, Infection
What are the components of hemodialysis?
Dialyzer (machine)
Dialysate (fluid; NEVER GOES INTO PATIENT)
Vascular Access– emergent or long-term (Fistula)
What are the risks of peritoneal dialysis?
Infection (peritonitis)
Weight gain (because fluid has a lot of glucose that can be absorbed by the body causing hyperglycemia)
Weakening of the abdominal muscles
