upper GI

Question 1

GERD
a) patho
b) risk factor

Answer 1

a) Incompetent Lower esophageal sphincter
Increased abdominal pressure
b) obesity,pregnent
hiatal hernia
stress
Alcohol,chocolate,fatty food,tabacco,caffeine

Question 2

Manifestations

Answer 2

Heartburn(pyrosis)
Chest pain
Dyspepsia(indigestion)
Regurgitation
Respiratory (coughing, whezzing, dyspnea)
pain worse when bending,straining, laying down should be up right

Question 3

Complications
cause aspiraton?

Answer 3

Asthma exacerbations
sinus, ear infections
aspiration pnemonia

Question 4

Diagnositic

Answer 4

endoscopy
barium swallon
manometry

Question 5

GERD
care

Answer 5

Diet and life style change!!!
Weight reduction
Elevating HOB
Smoking cessation
Avoid acidic food
-coffee
-alcohol
-soda
-wine
Avoid Fat food
Small frequent meal
Walk daily

Question 6

GERD
medications
Proton Pump Inhibiter

Answer 6

PPI(prazole)
-most effective
-decrease stomach acid production
-long term or high doses may incrase risk of fracture and kidney disease, vit B and magnesium deficiency
-increase risk of c-diff in hospitalized pt
monitor for fever, diarrhea

Question 7

GERD
Histamine2 receptor blockers

Answer 7

H2 receptor blockers (tidine)
-reducing secrition of acid
-take with meals at bedtime

Question 8

Endoscopy
a) what is it?
b) before
c) after

Answer 8

a) ulcers or tumors can be directly seen
b) NPO for 8hr
local anesthesia throat spray(sedation)
Need ride home
c) NPO untill gas reflex returned

Question 9

Hiatal Hernia
a) sliding
b) rolling/paraoesphageal

Answer 9

a) most common
the upper portion of the stomach “slides” up
d/t increased abdominal pressure
b) more serious type
life threated
stomach can slowely die

Question 10

Manifestations

Answer 10

Sliding
heartburn
refulex
chest pain
dysphagia
rolling
fullness after eating
breathnessless
worse when reclining

Question 11

Hiatal Hernia
Risk factor

Answer 11

Aging structural changes
Increased abdominal pressure
Obesity
Kyphosis

Question 12

Pepticulcer
a) patho
b) risk lifestyle

Answer 12

a) Erosion of GI mucosa from HCL and pepsin
腐食、溶ける
b) Alcohol
Coffee
Smoking
Stress

Question 13

H.Pylori major risk factor?

Answer 13

Infection likely occur in childhood with transmission from family member from family member to child.

Question 14

Pepticulcer
Clinical Manifestations
Gastric

Answer 14

High epigastric burning 1-2 hrs after meals
Burning or gaseous pressure in epigastrium(right over the stomach)
Greater in older women age 50-60
Eat more feel worse

Question 15

Pepticulcer
Clinical Manifestations
Duodenal

Answer 15

Most common
Mid-epigastric burning 2-5 hrs after meals,midmorning, midafternoon, middle of night
relieved by food and antacids
Greater risk in younger men (25-45)
Eat more,feel better

Question 16

Acute exacerbations

Answer 16

Hospitalization needed
NGT
NPO
IV hydration
Avoid alcohol & tobacco
Avoid irritating foods
Reduce stress-quiet and restful enviroment
Assess for perforation, hemorrhage, obstruction

Question 17

Acute and Chronic
gastritis
a) patho
b) risk factor

Answer 17

a) inflamation caused by brakdown in normal gastric mucosal barrier
b) diet(spicy food,alcohol)
drug(NSAIDs)
microorganisum(H.pulori,staphy)
stress,pain, anxiety

Question 18

Manifestations

Answer 18

Anorexia
N/V
Epigastric tenderness and pain
Felling full
melena(bleedng stool)

Question 19

Acute
management

Answer 19

Assess for dehydration
(diarrhea,vomiting)
NGT(sever cases)
H2 blocker
PPI

Question 20

Clonic
managemant

Answer 20

Eliminate underkying cause
Lifestyle changes
-Non-irritating, frequent small meal
-Smoking cessation

Question 21

A pt tells the nurse that her mother had been nausated all dat and has vomited twice. Before the nurese hangs up and calls the HCP, she should tell the M.J to?
a) administer antiemetic drugs and assess her mther’s skin turgor
b) offer her mother large quantities of Gatorade to decrease the risk for sodium depletion
c) give her mother sips ater and elevate the head of her bed to prevent aspiration
d) giver her mother a high proteing liquid supplement to deink to mainntatin her nutirional need

Answer 21

c

Question 22

The nurse teaching young aduls about behaviors that put them at risk for oral cancer includes
a) discouraging use of chewing gum
b) avoiding use of perfumed lip gross
c) avoiding use of smokeless tabacco
d) doscouranging drinking of carnonate drinks

Answer 22

c

Question 23

Which instructions would the nurse include in a teaching plan for a pt with mild GERD?
a) the best time to take an as-needed antacid is 1-3 hrs after a meal
b) A glass of warm milk at bedtime will decrease your discomfort at night
c) Do not chew gum, the excess saliva will cause you to secrete more acid
d) limit your intake of foods high in protein because they take longer to digest

Answer 23

a

Question 24

The nurse is teaching the pt and family that PUC are
a) caused by stressful lifestyle and other acid-producing factors, such as H, pylori
b) inherited within families and reinforced by bacterial spread of staphylococcus in childhood
c) promoted by factors that cause oversecretion of acid, such as excess dietary fats, smoking and alcohol use
d) promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H, pylori

Answer 24

d

Question 25

An optimal teaching plan for an outpatient with stomach cancer receiving radiation theray should include information about?
a) cancer support group, alopecia and stomatitis
b) nutrition supplement ostomy care, and support groups
c) prosthetic devices, wound and skin care, and grief care provide
d) wound skin care,nutrition, drugs, and community resources

Answer 25

d

Question 26

The teaching plan for the pt being discharged after an acute episode of upper GI bleeding includers information about the importance of SATA?
a) limiting alcohol intake to 1 serving per day
b) Onlu taking aspirin with milk or brad product
c) avoiding taking aspirin and drugs containing aspirin
d) only talking drugs prescribed by the health care provide
e) taking drugs 1 hr before mealtime to prevent further bleeding

Answer 26

c,d