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NURSADN6 Med Surg > Week 1 GI > Flashcards

Week 1 GI Flashcards

1
Q

GERD
PUD
IBD are all what?

A

GI Disorders and Intestinal Obstructions

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2
Q

IBD is umbrella term for what 3 diseases?

A

Crohn
UC
Diverticulitis

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3
Q

Incompetent LES
Pyloric Stenosis
Hiatal Hernia
Motility Disorder
Barrett’s Esophagus

A

GERD

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4
Q

In GERD what generally happens to the LES?

A

It is relaxed and then causes HCI to reflux back into the esophagus

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5
Q

Hiatal Hernia

A

Occurs when the upper part of the stomach pushes up into the chest through small opening in the diaphragm the muscle separates the abdomen from the chest.

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6
Q

What happens in Barrett’s Esophagus?

A

Condition that occurs when the lining of the esophagus is damaged by stomach acid and heals abnormally.

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7
Q

Name the clinical manifestations of GERD

A

Pyrosis
Dyspepsia
Regurgitation
Dysphagia
Odynophagia
Hypersalivation
Esophagitis

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8
Q

Body Protective Mechanisms

A

Gravity- Upright body. Assist with the flow back to stomach.
Swallowing-Carries refluxed liquid back to stomach.
Salivary Glands produce saliva that contains bicarbonate.

At night ….
- Gravity has no effect and swallowing stops and secretion of saliva is reduced.

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9
Q

Name some increased risks of GERD

A

Pregnancy- elevated hormone levels
Growing Fetus
Weaken Esophageal Muscles
Mixed Connective Tissue Diseases - Sclerodermas

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10
Q

Diagnostic for GERD include

A

Endoscopy
Barium Swallow
Ambulatory 12-36 hr esophageal pH monitoring

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11
Q

Management of GERD self care include

A

Avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation

Elevate HOB
Dietary modification
Weight Loss

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12
Q

Medication management of GERD

A

Antacids
HS blockers
PPIs
TLERs, Baclofen
Reflux Inhibitors, Bethanecol Chloride
Surface Agents, Sucralfate

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13
Q

Management Self Care for GERD include

A

Low fat diet
Avoid caffeine
Avoid tobacco
Avoid beer
Avoid milk
Avoid peppermint/ spearmint
Elevate upper body

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14
Q

Complications of GERD include

A

Throat and laryngeal inflammation
Cough and asthma
Inflammation and infection of lungs
Collection of fluid sinuses and middle ear
Esophagitis
Strictures
Barrett’s Esophagus

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14
Q

Management of Self GERD

A

Avoid carbonated beverages

Avoid eating 2 hrs before bedtime

Avoid tight fitting clothing

Normal body wt

HOB elevated 6-8 in

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15
Q

Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus

A

Peptic Ulcer

Associated with H. Pylori

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16
Q

Risk factors of GERD include

A

Excessive secretion of stomach acid
Dietary factors
Chronic use of NSAIDs
Alcohol
Smoking
Familial Tendency

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17
Q

Manifestation of this disease include

Dull gnawing pain or burning in the mid epigastrium, heart burn and vomiting may occur

A

Peptic Ulcer

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18
Q

Treatment of this disease includes

Treatment MEDS
Lifestyle changes
Occasionally surgery

A

Peptic Ulcer

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19
Q

Peptic Ulcers are likely to occur where >

A

Duodenum

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20
Q

Peptic ulcers are solidarity or nonsolidarity

A

Solidarity

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21
Q

Chronic gastric ulcers occur where?

A

Lesser curvature

Near the pylorus

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22
Q

These ulcers occur d/t retrograde flow of HCI

A

Esophageal Ulcers

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23
Q

70-90% of peptic ulcers are associated with

A

H. Pylori

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24
Q

What ages are affected with peptic ulcer?

A

Between 40-60 yr

Can occur in infants/ children

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25
Q

Is peptic ulcer common in childbearing age?

A

No

Uncommon

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26
Q

Post menopausal women increase the incidence of what?

A

Peptic Ulcer

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27
Q

Etiologies of Peptic Ulcer include

A

-H. Pylori- Ingested through food and water
- Blood Type o plus
- Familial Tendency
- COPD, Cirrhosis, CKD and autoimmune disorders
- NSAID- Impair protective gastric mucosa
- ZES- Zollinger Ellison Syndrome

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28
Q

H. Pylori Characteristics

A

-Gram - rod
- Selective to the stomach
- Inhabits the antrum
- Causes low level inflammation in the lining
- Strongly linked to PUD’s and stomach cancer
- 80% asymptomatic
- Affects > 50% world population
- Prevalence in developing countries
- Transmission: Oral ( Food, water, close contact to emesis)

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29
Q

Pathophysiology of PUD

A
  • Duodenal Ulcers - Increased amounts of the acid
  • Increases production of gastric acid HCI or pepsin
    -Decrease resistance of mucosa
  • Damaged mucosa decreases mucous production and protection lining
  • Erosion of gastric lining - exposure nerve endings
  • In gastric ulcers- normal or decreased acid amount
  • Decreases acidity results in decrease resistance to bacteria causes increased bacterial Infections - H. Pylori
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30
Q

Manifestations of Peptic Ulcer

A

-Symptoms intermittent over days, weeks, and months
- Appearing-Disappearing- reappearing

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31
Q

Chief Complain of PUD is

A

Dull gnawing burning pain in the mid epigastric region or back

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32
Q

Pain immediately after eating is with

A

Gastric Ulcer

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33
Q

Pain after 2-3 hours of eating is what type of ulcer is

A

Duodenal Ulcer

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34
Q

Heartburn is also known as

A

Pyrosis can be shown in PUD with sour eructation or burping

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35
Q

Manifestation of PUD is

A

vomiting “ relief” after bout of severe pain and bloating

  • Diarrhea/ Constipation
  • GIB- Bleeding in 15% - Melena - Tarry stools
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36
Q

Assessment and Diagnostic Findings for PUD

A
  • Physical Examination
  • Endoscopy- PREFEERED DIAGNOSTIC
  • Histologic Examination- H. Pylori
  • Serologic Examination- H. Pylori
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37
Q

Treatments both pharmacological and Surgical is aimed at what for PUD?

A

Controlling the activity of “ certain portions of the stomach”

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38
Q

The pylorus secretes what?

A
  • Pepsinogen II
  • Gastrin- 34
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39
Q
A
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40
Q

The antrum secretes what?

A
  • Gastrin 17
  • Gastrin 34
    Pepsinogen II
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41
Q

Pharmacological Treatments for PUD

A

Medications

  • ABX+PPIs+ Bismuth Salts= 10-14 days - suppress or eradicate H. Pylori

H2 Receptors Antagonists- Tx NSAID induced Ulcers
- PO or IV
- Ex: Cimetidine, famotidine, ranitidine, nizatidine

PPIs
- PO or IV
ex- Esomeprazole, omeprazole, pantoprazole, rabeprazole

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42
Q

Ulcer Healing use what meds?

A

H2 Receptor Antagonist
PPIs

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43
Q

H. Pylori Infection

A

Quadruple therapy with Bismuth Salts

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44
Q

Prophylactic Therapy for NSAID ulcers

A

Peptic Ulcer Healing doses
Misoprostol

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45
Q

Dietary Modifications for PUD include

A

-Avoid extremes in temp. or food and beverages
- Avoid alcohol, coffee, and other caffeinated beverages
- Eat 3 regular meals/ day- Neutralize acid
- Individualized- pts should avoid any foods that cause pain

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46
Q

Name the surgical procedures for Peptic Ulcer Surgery

A
  1. Pyloroplasty- Pylorus- note longitudinal incision then have a vertical suture
  2. Vagotomy- Vagal nerve
  3. Bili Roth II-gastrojejunostomy
  4. Antrectomy Bill Roth I- Gastroduodenostomy
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47
Q

Surgical procedure #1 for PUD is

A

Vagotomy
- Severing the vagus nerve, decreases cholinergic to parietal cells
- Can be done w/ drainage-pyeloplasty to aid w/ emptying

Side effects include: c/o absence of satiety, diarrhea, and gastritis
—– Dumping Syndrome

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48
Q

Surgical Procedure #2 for PUD is

A

Pyloroplasty
- Note longitudinal incision w/ vertical suture

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49
Q

What is a pyloroplasty?

A

Longitudinal incision made into the pylorus
- Transversely sutured closed to enlarge the outlet and relax the muscle

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50
Q

Side effects c/o absence of satiety. recurrence of ulcer 10-15%

No dumping

A

Surgical Procedure - Pyloroplasty

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51
Q

Surgical Procedure #3 for PUD is

A

Antrectomy- Biliroth I

  • Removal lower part of the antrum
  • Controls the release of gastrin
  • Dumping Syndrome
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52
Q

Surgical Procedure #4 for PUD is

A

Billroth II
- Removal of the lower portion with anastomosis to jejunum
- Dumping Syndrome
- Anemia
- Malabsorption
- Weight loss
- recurrence rate of ulcer is 10-15%

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52
Q

_________ is a vasomotor response to the food ingested

A

Dumping Syndrome

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53
Q

Patho of Dumping Syndrome

A

Rapid emptying of gastric contents into small intestines resulting from the sudden mix of hypertonic fluid- small intestine pulls fluid from EC space to convert to hypertonic state to isotonic fluid consistency
- Fluid shift results in decrease circulating volume

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53
Q

Symptoms in Early Dumping Syndrome

A

Early
- 30 min after meals - vertigo, syncope, pallor, diaphoresis, increased HR, palpitations)

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54
Q

Late Symptoms of Dumping Syndrome

A
  • 90 min after meals
  • Excessive insulin nrelease
  • abd distention
  • Cramping
  • borboryrmi, nausea, dizziness, diaphoresis, confusion
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55
Q

Lying down after meals - delays gastric emptying
- Eliminate liquids with meals one hour before or after
- Consume high PRO, high fat, low to mod CHO diet
- Avoid milk, sweets, or sugars - fruit juices
- Small frequent meals

A

Dumping Syndrome

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56
Q

Assessment care of PUD patient

A
  • Assess pain/ anxiety
  • Dietary intake and 72 hr diet diary
  • Lifestyle and habits such as cigarette and alcohol use
  • Medications include use of NSAIDs
  • S/S of anemia or bleeding
  • Abdominal Assessment
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57
Q

Nursing Process Diagnosis of Peptic Ulcer

A

Imbalanced Nutrition
Acute Pain
Anxiety
Deficient Knowledge

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58
Q

Nursing Process of Peptic Ulcer planning

A

Major goals include relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications

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59
Q

Relieve pain in PUDs include

A

Treat with prescriptions medications
Avoid aspirin, NSAIDs, alcohol

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60
Q

Anxiety of PUD

A
  • Assess anxiety
  • Calm manner
  • Explain all procedures and treatments
    Help- Help identify stressors
  • Explain- Explain the various coping and relaxation methods such as biofeedback, hypnosis, and behavior modification
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61
Q

Patient Education for PUD includes

A

-Medication Education
- Dietary Restrictions
- Lifestyle Changes

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62
Q

Collaborative Problems and Potential Complications

A
  • Hemorrhage- Most common 15%
  • Perforation
  • Penetration
  • Pyloric Obstruction- Gastric Outlet Obstruction
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63
Q

Hemorrhage is common complication in what?

A

PUD

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64
Q

Hemorrhage complication in PUD monitor for ?

A

S/S of anemia or bleeding
- CBC
- > 60 y/o- hematemesis may be fatal
- Occurs in 10-20%
-Manifested
— Hematemesis- Large volumes 2-3 L loss or coffee ground emesis
- Melana- Small volumes loss, blood in stools or tarry stools

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65
Q

Management of Potential Complications

Hemorrhage

A
  • Assess for evidence of bleeding, hematemesis or melena, and symptoms of shock/ impending shock and anemia

Tx: Includes IV fluids, NG, and Saline or water lavage, oxygen, tx of potential shock including monitoring of VS and UO; may require endoscopic coagulation or surgical intervention

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66
Q

Management of Potential Complications Pyloric Obstruction

A

Symptoms include
- Nausea/ Vomiting, constipation, epigastric fullness, anorexia, and later weight loss

Insert Ng tube to decompress the stomach, provide IV fluids and electrolytes. Balloon dilation or surgery may be required

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67
Q

Management of Potential Complications

A

Management of perforation or penetration

Signs include
- Severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board like abdomen, and symptoms of shock or impending shock

patient requires immediate surgery

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68
Q

Diverticulum

A

Sac like herniation of the lining of the bowel that extends through a defect in the muscle layer

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69
Q

Diverticular Disease may occur anywhere i the intestine but most common where

A

Sigmoid Colon

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70
Q

Multiple diverticula without inflammation

A

Diverticulosis

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71
Q

Infection and inflammation of the diverticula

A

Diverticulitis

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72
Q

Increases with age and is associated with low fiber diet

A

Diverticular Disease

Diagnosis usually done with colonoscopy

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73
Q

Pathophysiology of this disease is where diverticula form when mucosa/ submucosal layers of colon herniate through muscular wall

A

Diverticulosis

  • High intraluminal pressure
  • Low volume in the colon
  • Decreased muscle strength

Bowel contents accumulate
- Inflammation
- Infection
- Abcess/ Perforation

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74
Q
A
75
Q

Manifestations of Diverticulosis

A
  • Chronic constipation over years
  • Bowel irregularity intervals N/D, anorexia
  • Bloating or abd distention

Narrowing from fibrotic strictures leading to;
—— Cramps
———— Narrow stools
———– Increased constipation
———- Intestinal obstruction

76
Q

Stool goes how?

A

Type 1-7
1 being marble like
7 liquid type

77
Q

Complications of

A

abd pain, rigid board like abdomen, loss of bs, s/s of shock
- Abcess formation
- Fistulas
- Bleeding

78
Q

Medical management for Diverticulitis includes

A

Diet
- Clear liquid until inflammation subsides
- High Fiber

Bulk Forming Laxative

Medication
- Antibiotics
- Antispasmotics
- Pain Meds

79
Q

Nursing Process of Diverticulitis Assessment Includes

A
  • Chronic constipation preceding development of diverticulosis, frequently asymptomatic but may include bowel irregularities, nausea, anorexia, bloating, and abd. distention
  • With diverticulitis symptoms include mild or severe pain in LLQ : nausea, vomiting, fever, chills, and leukocytosis
  • Ask regarding the onset and duration of pain and past present elimination patterns
  • Nutrition and dietary patterns including fiber intake
  • Inspect stool and monitor complications for symptoms potential comlications
80
Q

Collaborative Problems and Potential Complications

A
  • Perforation
  • Peritonitis
  • Bleeding
  • Abscess Formation
81
Q

Nursing Process The care of the patient with Diverticulitis Diagnosis

A

Constipation

Acute Pain

82
Q

Nursing Process Planning for pt with Diverticulitis

A

Major goals may include attainment and maintenance of normal elimination patterns, pain relief, and absence of complications

83
Q

Maintaining Normal Elimination Pattern

A
  • Encourage fluid intake of at least 2 L/ D
  • Soft foods with increased fiber, such as cooked vegetables
  • Individualized exercise program
  • Bulk laxatives- pysillium and stool softeners
84
Q

Crohn’s is a disease that is

A

Regional Enteritis

85
Q

Right upper quadrant pain

A
  • Gastrodudenal Crohn’s Disease
86
Q

Left Upper Quadrant Pain and Left Lower Quadrant Pain includes

A

Ulcerative Colitis

87
Q

Crohn’s Disease first diagnosed when?

A

Adolescence or young adulthood

  • Incidences increase over past 30 years
88
Q

Crohn’s Disease affects who more?

A

Smokers than non smokers
Affects men and women equally
- Familial
- Jewish Heritage Risks
- African Americans are at the least risk

89
Q

This is an acute/ subacute inflammation of the GI tract and affects any area from the mouth to the anus

A

Crohn’s Disease

90
Q

Does Crohn’s extend through all layers?

A

True

91
Q

Where is Crohn’s commonly found in?

A

Ileum

92
Q

Crohns does have periods of what?

A

Remission and exacerbation

93
Q

How does Crohn’s begins?

A

Begins with edema and thickening of the mucosa- unfamed mucosa develops ulcers

94
Q

How are the lesions described in Crohn’s?

A

Not in continuous contact- (separated by normal mucosa)

Ulcer cluster- Cobblestone like

95
Q

The inflammation in Crohn’s extends into the peritoneum forming what?

A

Fistulas and fissures and abscess

  • Granulomas in 50% of patients
96
Q

In advanced Crohn’s what happens?

A

Thicken Bowel wall and fibrotic intestinal lumen

97
Q

In Crohn’s what happens to the diseased bowel loops and they adhere to?

A

Other portions of the bowel

98
Q

Crohn’s is ________________ but worsening diagnosis increases what?

A

Insidious

Increases extraintestinal symptoms

99
Q

This disease is unrelieved diarrhea by defecation

A

Crohn’s

100
Q

Crohn’s disease the abdominal will be?

A

Tenderness and spasm

101
Q

Where is the cramp usually in Crohn’s disease?

A

RLQ- Crampy abd. pain p.c. d/t food/ peristalsis

  • Weight loss- Limit food intake d/t pain leads to anorexia
  • Malnutrition and chronic diarrhea and more deficits

-2nd is anemia

102
Q

How are the ulcers in Crohn’s?

A

Weepy discharge, weepy into colon

103
Q

Is the person thin in Crohn’s?

A

Yes, emaciated r/t malabsorption

104
Q

What are the stools like in crohn’s?

A

Steatorrhea- Fatty Stools

105
Q

Crohn’s disease will show what?

A

Fever and Leukocytosis
- Intra abd and anal abscesses

106
Q

Name the diagnostic findings for Crohn’s Disease

A
  • CT Scan
    —Wall thickening, mesenteric edema, obstructions, abscesses and fistulas

-MRI
– Identify pelvic and perianal abscesses and fistulas

Labs
–CBC, H&H may be decreased
Elevated WBC and ESR elevated
-Albumin and Protein decreased

107
Q

Intestinal obstruction
Perianal Disease
Fluid and electrolyte imbalances
Malnutrition from malabsorption
- Fistula– abscess formation (enterocutaneous fistula)

A

Crohn’s Disease Complication

108
Q

This is a recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum

A

UC

109
Q

Highest prevalence in Caucasians and people of Jewish Descent

A

UC

110
Q

UC is more common in men than women

A

False

111
Q

UC has many complication r/t disease and has a high mortality rate

A

True

112
Q

What age group does Crohn’s affect?

A

15-40

5% develop colon cancer

113
Q

Where does UC affect more?

A

The superficial mucosa of colon

114
Q

Where does UC begin?

A

Rectum and spreads proximally to entire colon

  • Multiple contagious ulcerations and diffuse inflammations
115
Q

This disease involves desquamation or shedding of colonic epithelium

  • Bleeding from ulcerations
A

UC

116
Q

The mucosa her becomes edematous and inflamed and the lesions are contagious

A

UC

117
Q

This disease has the bowel narrowing, thickening, and shortening

A

UC

—Muscular hypertrophy

118
Q

What lining does UC affect?

A

Only the inner lining

NOT transmural

119
Q

This disease has passage of mucous, pus, or blood.

A

UC

120
Q

LLQ pain
Tenesmus
Rectal bleeding (mild or severe)

A

UC

121
Q

This disease has
-pallor, Anemia, and fatigue, hypocalcemia
-Anorexia, wt loss, vomiting, dehydration
- Fever
- Cramping( feeling of urgency to defecate)
6 or more liquid stools/ day
Extraintestinal manifestations

A

UC

122
Q

This disease during the assessment is showing
VS: ^HR, Decrease BP, ^RR, ^T

Skin: Pallor Abdominal: BS plus, stool plus occult, distention and tenderness

Hematology: H/H decreased, Increased WBC, Decreased Albumin levels and electrolyte abnormalities

A

UC Assessment and diagnostic findings

123
Q

This is a definitive test, reveals friable, inflamed mucosa with exudate and ulcerations; Biopsies taken

A

Colonoscopy

124
Q

CT, MRI, and US do what in UC

A

Identify abscesses and perirectal involvement

125
Q

In UC we do a stool exam for parasites ?

A

R/O dysentery from organisms

126
Q

What are 3 major complications of UC?

A

Megacolon
Perforation
Bleeding

127
Q

What is Toxic Megacolon?

A

Inflammatory process- absence of contractility- colonic distention

-s/s- fever, abd. pain, distention, vomiting, fatigue

128
Q

Tx if no response for UC is?

A

Surgery for total colectomy and ileostomy

Interventions: 24-72 with NGT, IV fluids, steroids, abx, then surgery

129
Q

Management of IBD is aimed at what?

A

-Remission
-Prevention of flareups
- improving QOL

130
Q

Nutritional and fluid therapy of IBD includes

A

Low fiber, high protein, high caloric diet with vitamins and iron
- Severe dehydration- IV therapy and TPN

131
Q

Pharmacological Therapy for IBD

A

Aminoacylates- Azulfidine
Corticosteroids- For pt refractory to remission with other meds
-Immunomodulators- alter immune response
- Anti Tumor Necrosis Factor meds- monoclonial Abs inhibit inflammatory effects of cytokine TNF in gut
- ABX (2ndary infections)

132
Q

For managements of IBD sx are intractable and QOL is affected. t/f

A

True

133
Q

33% for UC
60-70% for Crohn’s

A

True

134
Q

Strictureplasty is used for

A

Management for IBD

-Laparoscopic

135
Q

Management of IBD includes small bowel resection up to 80% tolerated

A

True

136
Q

Proctocolectomy with ileostomy

A

True for management for IBD

  • Intestinal Transplant
137
Q

IBD Assessment includes?

A

Health Hx
- ID onset, duration, and characteristics of pain
- Diarrhea- urgency, tenesmus
- Nausea, anorexia, wt loss
- Bleeding
- Family Hx

138
Q

Nursing Process The care of the patient with IBD - Diagnoses

A
  • Diarrhea
  • Acute Pain
  • Deficient fluid
  • Imbalanced Nutrition
  • Activity intolerance
  • Anxiety
  • Ineffective coping
  • Risk for impaired skin integrity
  • Risk for ineffective therapeutic regimen management
139
Q

Nursing Process Planning of Care with IBD

A

Major goals include
- attainment of normal bowel elimination patterns
- relief of abdominal pain and cramping, prevention of fluid deficit
- maintenance of optimal nutrition and weight
- Avoidance of fatigue
- Reduction of anxiety
- Promotion of effective coping
- Absence of skin breakdown
-Increased knowledge of disease process and therapeutic regimen
-Avoidance of complications

140
Q

How can we maintain normal elimination pattern interventions?

A
  • Identify relationship between diarrhea and food, activities, or emotional stressors
  • Provide ready access to bathroom or commode
  • Encourage bed rest to reduce peristalsis
  • Administer medications as prescribed
  • record frequency, consistency, character, and amount of stools
141
Q

Other Interventions of IBD include

A

Reduce anxiety- Therapeutic manner, listen and let patients express feelings

  • Assessment and tx of pain or discomfort, anticholinergic meds before meals, analgesics, positioning diversional activities, and prevent fatgue

-Optimal Nutrition-Elemental feedings that are in protein and low residue or PN may be needed

  • Fluid deficit, I&O, daily weight, assessment of symptoms of dehydration or fluid loss, encourage oral intake, measures to decrease diarrhea
142
Q

Patient education for IBD include

A

-Understanding of disease process
- Nutrition and diet
- Medications
- Ileostomy care if applicable

143
Q

Evaluation of IBD Nursing Process

A

Patient reports
- Decrease in stool
-Complies with dietary restrictions
- Drink 1-2 L of fluids per day
- Normal T, skin turgor, moist mucosa
- Tolerates small, frequent feedings w/o diarrhea
- Avoids fatigue
- Adequate coping noted( verbalizes feelings, decreased stress)
- Maintains skin integrity- at stomal and anal areas
- Understands disease process and avoid complications

144
Q

This disease happens in adolescence and young adulthood
-Affects all layers of intestine
- Affects mouth to anus- common in ilium
- Develops ulcer cluster/ cobblestone
- Insidious but worsens
-Diarrhea, cramps. steatorrhea, malnutrition
- No cure

A

Crohn’s

145
Q

Ages 15-40
- Only affects mucosal/ submucosal layers
- Begins in rectum/ spreads proximally
- Multiple ulcerations/ diffuse inflammations
- Exacerbations/ remissions
- 10-20 liquid stools/ day (with blood and mucus), cramping and urgency to defecate
- Can surgically treat with the 4 procedures

A

UC

146
Q

_____ is body mass indices above 30 ng/ m squared

A

Obesity

147
Q

Obesity related mortality rates are _____ greater for every gain of 5kg/ m sqaured of body mass beyond BMI of 25 kg/ m squared

A

30%

148
Q

Obesity puts one at the risk for

A

Disease disorders
Low self esteem ‘impaired body image
Depression
Diminished quality of life

149
Q

Obesity prevalence is higher in who?

A

Women
African American
Hispanic

150
Q

Less educated and who earn less reflects ?

A

Disparities in the disease burden of obesity

151
Q

Obesity management includes

A

Lifestyle modifications
- Diet exercise
Pharmacotherapy
Bariatric Surgery

152
Q

Pharmacotherapy includes

A

Olistat (Xenical)
Lorcaserin ( Belviq)
Sibutramine HCL (Meridia)
Rimonabant ( Acomplia)

153
Q

Morbid obesity persons more than two times IBW, BMW exceeds 30 kg/ m squared, or more than 100 pounds greater than IBW, high risk complications for health

A

Bariatric Surgery

154
Q

_____________ surgery is only performed only after nonsurgical methods have failed

A

Surgery

155
Q

What are the selection factors for bariatric surgery?

A

Body weight
pt hx
Failure to lose weight using other means
Absence of endocrine disorders
Psychological Stability

156
Q

Name the different Bariatric Procedures

A

Roux en gastric bypass
Gastric Banding
Sleeve Gastrectomy
Biliopancreatic division with duodenal switch
Performed by laparoscopy or by an open surgical technique

157
Q

Roux en Y Gastric Bypass

A

Weight loss surgery that restricts food intake and prevents absorption of nutrients

  • Creates small pouch in the stomach and connecting the newly created pouch directly to the small intestine
158
Q

Gastric Banding

A

Type of weight loss surgery

  • Involves placing an adjustable silicone band around the upper part of the stomach to help people with obesity to eat less.
159
Q

Surgical procedure to help people lose weight

  • 50%-85% of the stomach is removed leaving smaller tube shaped stomach that resembles a banana
A

Sleeve Gastrectomy

160
Q

Biliopancreatic Diversion with Duodenal Switch

A

Complex weight loss surgery that combines a sleeve gastrectomy with an intestinal bypass to reduce how much food the body absorbs and how much it can eat

161
Q

Pre operative care and evaluation and counseling
- Postoperative care is similar to gastric resection, ut patient is at greater risk for complications related to obesity
- Post op diet- small feedings totaling 600-800 calories/ day
- Patient require psychosocial interventions to modify their eating behaviors
- Follow up care
- Education regarding long term effects

A

Nursing care for patient undergoing bariatric surgery

162
Q

-Hemorrhage
- Dumping Syndrome
- Bowel or gastric outlet obstruction
- Bile reflux
- Dysphagia
- Venous thromboembolism

A

Collaborative Problems and Potential Complications

163
Q

Gallbladder stores what

A

Bile

164
Q

Pancreas is responsible

A

Insulin
Glucagon
Somatostatin

165
Q

Cholelithiasis Pigment stones is how many %

A

10-25% cases in US

166
Q

Cholesterol Stones is how many %?

A

75%

167
Q

What are risk factors for cholelithiasis?

A

-Obesity
- Women- esp mult pregnancies, Native -American or US SW Hispanic ethnicity
- Frequent changes in weight/ rapid weight loss
- Treatment with high- dose estrogen
- Low - dose estrogen therapy
- Ileal resection or disease
- Cystic Fibrosis
- Diabetes

168
Q

Name the clinical manifestations of cholelithiasis

A
  • None or minimal symptoms - acute or chronic
  • Pain (Frequently after rich meal)
  • Biliary Colic
  • Jaundice (With Obstruction of Bile Duct)
  • Grayish or putty colored
169
Q

Medical Management of Cholelithiasis

A
  • Dietary Management
  • Medications– Ursodeoxycholic acid and Chenodeoxycholic acid (takes 6-12 mo)
  • ERCP
  • Dissolving- Infusion of MTBE into GB
  • Laparoscopic Cholecystectomy

Non Surgical removal
- By instrumentation
- Intracorpeal or extracorpeal lithotripsy

170
Q

ERCP

A

Procedure that uses an endoscope and X rays to examine the liver, gallbladder, bile ducts and pancreas

Used for diagnosis and to treat problems as well.

171
Q

Name nonsurgical ways to remove gallstones

A

A. T- tube tract to remove stone
B. Removal of stone with basket to catheter threaded through T tube tract
C. ERCP endoscope inserted to Duodenum
D. Papillotome inserted into common bile duct
E. Enlarging opening of sphincter of Odi
F. Retrieval and removal of stone with basket inserted through endoscope

172
Q

Laparoscopic Cholecystectomy

A

Minimal invasive procedure to remove the diseased gallbladder

173
Q

Nursing Process Care of the Patients with Cholelithiasis Assessment includes?

A

-Patient Hx
- Knowledge and education needs
- Resp. status and risk factors for resp. complications post operative
- Nutritonal status
- Monitor for potential bleeding
GI Symptoms

174
Q

What are the GI symptoms after laparoscopic ?

A

Loss of appetite
Vomiting
Pain
Distention
Fever
Potential infection or disruption of GI tract

175
Q

Nursing Process The care of the patient with Cholelithiasis Diagnosis includes

A

Acute Pain
Impaired Gas exchange
Impaired skin integrity
Imbalanced nutrition
Deficient Knowledge

176
Q

Collaborative Problems and Potential Complications

A
  • Bleeding
  • GI Symptoms
  • Complications r/t to surgery in general
    —-atelectasis, thrombophlebitis
177
Q

Planning of care for a patient with cholelithiasis

A

Goals may include relief of pain, adequate ventilation, intact skin, improved biliary drainage

Then Optimal nutrition

Then Absence of complications

  • Understands self- care routines
178
Q

Nursing Process for patient with cholelithiasis interventions include

A

–Relieving pain- eds, splinting, and positioning
– Improving resp. status- deep breathing, IS
— Care of biliary drainage system
—Maintain skin integrity
—Improve nutritional status
—Self care education- Refer to chart 44-2`

179
Q

Pancreas Exocrine function includes

A

-Secretes digestive enzymes
- Released into pancreatic duct

180
Q

Pancreas Endocrine Function includes

A

-Islets of Langerhans
- Alpha
-Beta

181
Q

Pancreatic duct enzymes becomes obstructed and enzymes back up
- Causing autodigestion and inflammation in the pancreas

A

Acute Pancreatitis

182
Q

Progressive inflammatory disorder with destruction of the pancreas
- Cells are replaced by fibrous tissue
- Pressure within the pancreas increases, obstructing the pancreatic and common bile ducts

A

Chronic Pancreatitis

183
Q

Severe abd. pain/ back tenderness
- May be accompanied by distention, abd mass, decreased peristalsis, vomiting

A

Acute Pancreatitis

184
Q
  • Recurring attacks of severe upper abd./ Back pain
  • Become more frequent and severe
A

Chronic Pancreatitis

185
Q

What is a major symptom of chronic pancreatitis?

A
  • Recurrent attacks of severe abdominal and back pain accompanied by vomiting
  • Fever, jaundice, confusion, and agitation
  • Ecchymosis in the flank or umbilical area
  • ABD. guarding

**Recuurent attacks

186
Q

Medical Management

A

Acute

Chronic

187
Q
A

NURSADN6 Med Surg (9 decks)

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