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NURSING 2 > UGI > Flashcards

UGI Flashcards

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1
Q

Oral and oropharyngeal cancer: cause

A

Alcohol and tobacco
Sun and Wind exposure
Generally squamous cell

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2
Q

Oral and oropharyngeal cancer: s/s

A

typically no symptoms until late - then a painless sore or mass that will not heal

As cancer progresses, patient may have difficulty swallowing or talking

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3
Q

Oral and oropharyngeal cancer: assessment

A

airway

secretions

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4
Q

Oral and oropharyngeal cancer: neck dissection

A

May have a trach
Xerostomia
Stomatitis
Bleeding

Concerned about airway - if tracheal compression occurs client will need trach

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5
Q

Perforations of esophagus: cause

A

stab, bullet, trauma, chemical injury

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6
Q

Perforation of the esophagus: assess / things you might see

A 
Excruciating pain
Dysphagia
Leukocytosis
Severe hypotension 
Crepitus
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7
Q

Perforation of esophagus: intervention

A 
IV fluids (to increase BP)
Broad spectrum antibiotics
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8
Q

Perforation of esophagus: nutrition

A

Enteral jejunal or parenteral
NPO for 7 days
Nasal jejunal tube is placed by provider because we do not want to rupture anything further

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9
Q

Foreign bodies

A
  • Issue as the foreign body can cause damage to the GI tract

- Surgery to retrieve the ingested, may cause perforation

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10
Q

Chemical burns - things to remember

A

Do not induce vomiting
Medical team only to insert NG tube
NPO
May cause perforation

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11
Q

What are s/s of heartburn, gastritis and ger(d)

A

Heaviness, belching, vomiting, flatulence, boating, and pain

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12
Q

Gastritis: patho

A

inflammation of the stomach mucosa

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13
Q

Gastritis can lead to what

A

hemorrhage, pyloric stenosis from scarring, or perforation

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14
Q

Gastritis: acute causes

A

contaminated foods, OD, medications

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15
Q

Gatritis: chronic causes

A

smoking, H. pylori (can lead to gastritis and cancer), medications, alcohol

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16
Q

How is H. Pylori often treated

A

2 weeks of PPI and Flagil

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17
Q

Gastritis: assessment

A

N/V, feeling full, anorexia, epigastric tenderness, gastric hemorrhage, belching, anemia from lack of B12

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18
Q

Gastritis: testing

A

H. Pylori (stool)

RBC (scope)

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19
Q

Gastritis: interventions

A

NPO - may need NG
IV fluids for dehydration
Clear liquids

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20
Q

Gastritis: potential and actual complications

A

Peptic ulcer
Pernicious anemia
H. Pylori gastritis - cancer

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21
Q

Gastritis: medications

A

PPI

Histamine blockers

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22
Q

Gastritis: education

A
  1. Diet - foods to avoid (fatty, peppermint, chocolate, coffee, alcohol)
  2. stop smoking
  3. small meals
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23
Q

GER(D): patho

A

Back flow of gastric contents into esophagus

- pepsin and HCL irritate and lead to inflammation

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24
Q

GER(D): factors that can predispose

A

Incompetent sphincter
Delayed emptying
Hiatal hernia (part of stomach pouches up and food and chemicals settle there)
Obesity

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25
Q

GER(D): assessments / signs and symptoms

A 
Heartburn - pain in upper abdomen
Fullness throat
Coughing/wheezing
Dry throat 
Diet (ETOH, smoking)
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26
Q

GER(D) testing

A

Scope
Biopsy r/t barretts v cancer
Nuclear scan
Manometry

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27
Q

GER(D): interventions

A

Elevate head at night

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28
Q

GER(D): potential and actually complications

A 
Esophagitis 
Barrett’s esophagus 
Respiratory involvement 
laryngospasms 
bronchospasms 
asthma- 
pneumonia
29
Q

GER(D): meds

A

PPI
Histamine Blockers
Urecholine- decrease pressure on sphincter – improve emptying
Antacids

30
Q

GER(D): education

A

Don’t eat 2 hours before bed
Small frequent meals
Diet changes how to take antacids
Avoid caffeine, fatty foods, peppermint, ETOH

31
Q

Peptic ulcer disease

A

Ulceration in gastric mucosa

    • gastric (stomach), duodenal or esophageal
    • acute vs. chronic
32
Q

Peptic ulcer disease: factors

A 
H pylori requires antibiotic therapy
NSAID and corticosteroids 
smoking & alcohol 
Stress
Diet
33
Q

What can happen to the stomach is peptic ulcer disease gets really bad

A

can scar and stenos

34
Q

Peptic ulcer disease: assessment

A

Pain - meal related
If get relief from eating – duodenal
If get pain with eating – gastric

Vomiting- color consistency
- coffee ground emesis (blood partially digested)

BP & HR to evaluate for hypotension and perforation

Obstruction

35
Q

Peptic ulcer disease: tests

A 
Hpylori 
Stool occult blood (want to know if there is bleeding) 
Scope (go in and look)
Barium- if unable to scope 
CBC
36
Q

Peptic ulcer disease: interventions for acute

A 
NPO
NG (decompression) 
IV fluids
I&O
Analgesics
monitor electrolytes 
Clear liquid and advance 
Surgery
37
Q

Peptic ulcer disease: medications

A 
PPI
Histamine Blockers 
Antacids – renal considerations 
Sucralfate – coats stomach 
Amoxicillin, clarithromycin, tetracycline-metronidiazole if H pylori along w PPI
Bismuth (pepto bismol) coats stomach
38
Q

Peptic ulcer disease: education

A

Med adherence
follow up scope
Diet- spicy, peppers, caffeine, carbonated, NSAIDS aspirin should be avoided

Signs of bleeding

39
Q

Gastric surgery: what

A

Remove part of stomach and attach it directly to duodenum or jejunum

40
Q

What are things to consider post gastric surgery?

A

Lie down after meals

Low fowler position during meals

Avoid carbs

Vitamin B12 and iron supplements because don’t have ability to absorb as much

Will have NG tube when they come back from surgery

41
Q

Varices

A

Dilated tortuous veins that are generally found in lower esophagus

Bleeding associated with high mortality

42
Q

Varices: dx

A

EGD- esophagastroduodensocopy

43
Q

types of varices

A

Esophageal

Gastric

44
Q

what causes varices?

A

Cirrhosis –> portal HTN –> varices

45
Q

Varices: acute management of bleeding

A

Hemodynamic resusitation
Octreotide
Banding, sclerotherapy
Prophylactic abx

46
Q

Varices: chronic management of bleeding

A

BB

Endoscopic variceal ligation

47
Q

What must the nurse consider when a client has bleeding or a hemorrhage?

A

fluid volume depletion

48
Q

Vasoconstrictor with endoscopic therapy

A
  • octreotide or somatostatin
  • vasopressin slows hemorrhage and may be used in conjuction with nitro to prevent side fx from vasoconstriction (cardiac iscemia)
49
Q

Balloon tamponade

A 
Temporary to treat active bleed
-- Sengstaken-Blakemore tube
ICU
Monitor for respiratory complications
Patient must not dislodge
Can cause esophageal rupture, aspiration and rebleeding
Temporary bridge to other treatments
50
Q

GI bleed: upper

A

Coffee ground emesis
not as emergent as lower GI bleed
Frank blood

51
Q

Frank blood

A

bright red blood, patient is vomiting - you have active bleed

52
Q

Lower GI s/s

A

Dark, tarry, high up
Melena - burgundy - midway through
Frank blood - usually much lower

53
Q

GI bleed: assessment

A

BP
HR
Vomiting or stool
perfusion - brain and extremities

54
Q

GI bleed: priority labs/diagnostics

A

CBC
—> H&H (h&h going to be effected by hydration)

Scope – may need cauterization
Radionuclide
Surgery

55
Q

GI bleed - priority interventions

A

Address bleeding-
Fluid replacement
Blood products
Vasopressors

56
Q

GI bleed: complications

A

Hypovolemic shock

Exsanguination

57
Q

GI bleed: medications

A

Esophageal varices- Octreotide
Norepinephrine (levophed)
And previously listed based on cause

58
Q

GI bleed: teaching acute phase

A

What is happening
treatment purpose
support

59
Q

GI bleed: Discharge

A

Will reflect underlying cause and teachings for maintenance and follow up care

60
Q

Bowel perforation: s/s

A 
Sudden severe abdominal pain
N/V
fever
chills
swelling and bloating of abdomen
61
Q

Bowel perforation: intervention

A 
Surgery
Fluids 
NG
ABX
Drain
May have ostomy depending on what is perforated
62
Q

Peritonitis: patho

A

inflammation of peritoneum

Life threatening emergency requires prompt surgical intervention

63
Q

Peritonitis: cause

A

bacterial infection from GI tract

64
Q

Peritonitis: s/s

A

Rigid, distended abdomen
Rebound tenderness
Guarding by the patient

tachycardia 
HTN
dehydration
pain
decrease bowel sounds
"board-like" abdomen 
increase WBC
65
Q

Peritonitis: risk factors

A

Abdominal surgery
Ectopic pregnancy
Perforation (trauma, ulcer, appendix rupture, diverticulum)

66
Q

peritonitis: management

A 
Fluid/electrolyte replacement
NG
Respiratory support
Abx therapy
Monitor bladder pressure to ID compartment syndrome
67
Q

Peritonitis: complications

A

septic shock
PEs
Bowel adhesions

68
Q

Morbid obesity

A

More than two times ideal body weight
Significant health risks associated with weight
Medications have cardiac risk

Weight loss goals
Positive reinforcement
Address comorbidities

69
Q

Complications of bariatric surgery

A 
Malabsorption, dumping syndrome 
Dietary modifications small meals-
Eat slowly 
Supplemental vitamin B12, calcium & iron
Dehydration 
Do not eat and drink at the same time
May be on FL 1000 mL/day

NURSING 2 (12 decks)

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