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H & Illness 4: A & C illness > week 5: concept of elimination > Flashcards

week 5: concept of elimination Flashcards

1
Q

what is peptic ulcer disease?

A

A condition characterized by erosion of the gastric or duodenal mucosa.
The mucosal barrier is broken and HCL enters the tissues causing injury to the tissues

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2
Q

why does PUD happen?

A

can be precipitated by drugs, stress and H pylori

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3
Q

whats the difference between gastric and duodenal ulcer?

A

gastric: Peak at age 50-70 years
* Pain can be aggravated by food
* May be malnourished
* N or decreased gastric secretion
* Pain 30-60 min after a meal
* Heals with tx -if it recurs it is in the same location

Duodenal
* Peak at age 20-50 years.
* Pain relief with antacid and food. * Usually well nourished.
* Increased Gastric secretions
* Pain 1 1⁄2-3 hrs after meal
* Often has remissions and
exacerbations

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4
Q

what kind of ulcer does this look like?
* Peak at age 20-50 years.
* Pain relief with antacid and food. * Usually well nourished.
* Increased Gastric secretions
* Pain 1 1⁄2-3 hrs after meal
* Often has remissions and
exacerbations

A

duodenal

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5
Q

what kind of ulcer does this resemble?
* Peak at age 50-70 years
* Pain can be aggravated by food
* May be malnourished
* N or decreased gastric secretion
* Pain 30-60 min after a meal
* Heals with tx -if it recurs it is in the same location

A

gastric

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6
Q

what is apart of recognize cues - assessment/diagnostic test

A

Pt Hx
* Review Rx nd OTC drugs, alcohol and tobacco use, diet, stress, other factors that cause GI upset, dyspepsia (gnawing pain)

Lab Assessments
* H pylori testing (blood, breath or stool)
* HGB and HCT low if bleeding ulcer

Esophagogastroduodenoscopy
* Gold Standard for dx
* Can visualize ulcers, take bx
* Test for H. pylori

Nuclear Medicine Scan
* Can test for bleeding

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7
Q

what are the four complications for PUD?

A

hemorrhage/ upper gi bleed, perforation, gastric outlet obstruction (* Narrowing of pylorus from scarring, edema inflammation of pyloric sphincter)

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8
Q

what are the recognize cues(ASSESSMENT) and take action for upper GI bleed?

A

upper gi bleed: * When an ulcer erodes causing a bleed that can lead to hemorrhage
Recognize Cues: Assessment
* Hematemesis/ coffee ground emesis
* Tarry black stool (bleed from higher up/longer duration) * Abdominal pain
* Can proceed to shock
Take Action: Stabilize Patient
* Treat like for hypovolemic shock
* Calm approach, frequent VS, O2,
* IV fluids +++ (monitor for fld overload)
* I&O, monitor urine output
* Monitor stools/emesis
* Monitor lab work

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9
Q

take action: stop the bleed! what are you doing?

A

Endoscopic therapy (primary treatment procedure)
* Epinephrine sclerosing needles (epinephrine or glue)
* Endoclips (clamp off bleed)
* Electrocoagulation probes ( heat coagulates bleed)
Surgery
* If bleeding continues despite endoscopic therapy
may have to repair by open surgery
Drug Therapy
* Octreotide (Sandostatin)
* Vasopressin
* Antacids- aluminum hydroxide (Amphogel) * PPIs-omeprazole (Losec)
* H2 Receptor Blockers- famotidine (Pepsid)

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10
Q

true or false: gastric outlet obstruction-narrowing of the pyloris from inflammation and scar tissue buildup overtime
Recognize Cues
* Pain that progresses and becomes
* Swelling of upper abdomen
* Projectile vomiting
* undigested particles from hours or days ago
Take Action
* Decompress with NG tube
* IV fluid and electrolyte replacement
* Surgery to open obstruction and remove scar tissue

A

true

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11
Q

put take action Pharma- what are you giving?

A

H2 receptor blockers:
* famotidine (Pepsid)
PPI:
* omeprazole (Losec),
* pantoprazole (Pantoloc)
Antibiotics for H Pylori
* Tetracycline,Amoxicillin
* metronidazole (Flagyl) Cytoprotective
* sulcrafate bismol subsalicylate (Pepto-Bismal)
Antacids
* Magnesium Hydroxide (Milk of Magnesia)
* calcium carbonate (Tums)

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12
Q

true or false: teaching for PUD-conservative therapy
* Dietary Modifications
* Avoid spicy foods, acidic foods, caffeine, alcohol
* Stop Smoking
* Avoid OTC Meds
* Take all meds as prescribed
* dont Report bloody emesis, tarry stools, increased epigastric pain
* Encourage patient to share concerns about following lifestyle changes

A

all true but REPORT always report

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13
Q

surgery is uncommon only if pharmacological management isn’t working- which are?

A

billroth I: gastroduodenostomy
* Billroth II: Gastrojejunostomy
* Vagotomy
* Pyloroplasty

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14
Q

what is billroth I and II?

A

Partial gastrectomy with removal of distal
2/3 stomach and anastomosis of gastric stump to duodenum. Antrum and pylorus removed.

billroth II: Partial gastrectomy with removal of distal 2/3
stomach and anastomosis of gastric stump to Jejunum. Antrum and pylorus removed.

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15
Q

severe of vagus nerve - eliminates the stimulus to secrete HCL is vagotomy

A

true

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16
Q

what is pyloroplasty ?

A

Surgical enlargement of the pyloric sphincter

17
Q

what is apart of take action post op care for surgery PUD - just read

  • Will have NG to decompress stomach
  • Monitor bowel sounds
  • Monitor N/G content (color and amounts)
  • Ensure patency of NG tube
  • Remove NG tube when peristalsis returns
  • IV fluids with K+ and vitamin replacement
  • Introduce foods when ordered
  • Care of abdominal incision
  • Encourage DB&C with splinting
  • Encourage ambulation to increase peristalsis
A
18
Q

why is pernicious anemia long term comp?

A

remove so much of tissue removed - intrinsic factor is produced, need intrinsic factor ro syn vit b12 and we need this for the syn of hgb

19
Q

what is dumping syndrome?

A
  • Happens after removal of large portion of stomach and pyloric sphincter
  • Result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into small intestine.
    Take Action: Prevent dumping syndrome
  • Small dry feedings daily
  • Avoid fluids with meals
  • Low carbs mod protein &fat * Restrict sugar
20
Q

what is the post op complications for bilroth 1 and 2?

A

Postprandial hypoglycemia
* Variant of dumping syndrome
* Hyperglycemia releases insulin resulting in secondary hypoglycemia

and bile reflux gastritis:
When the surgery involves the pylorus
* Results in back up of bile into stomach

21
Q

how to treat postprandial hypoglycemia?

A

Take Action: Treat and prevent
* Immediate ingestion of sugar when hypoglycemic
* Prevent rebound hypoglycemia by limiting the amount of sugar consumed with each meal and by eating small frequent meals

22
Q

how to treat bile reflux gastritis?

A

Take Action: Treat and Prevent
* Cholestyramine either before or with meals.
* Can administer antacid

23
Q

what is gastric cancer?

A

Adenocarcinoma of the stomach wall (tumor can start small and grow big)

24
Q
  • No specific causative agent
  • May be genetic component
  • May be caused by long term exposure to irritants (spicy/ salty food, NSAID use, alcohol,H. pylori)

what is this describing?

A

gastric cancer

25
Q

what are the recognize cues for gastric cancer?

A
  • Anemia
  • Vague epigastric fullness
  • feelings of early satiety after meal
  • weight loss, dysphagia, dyspepsia
    the tumour can take up space
26
Q

what are the diagnostics for gastric cancer?

A

Esophagastroduduodenoscopy with bx
* During an endoscopic ultrasound can be performed to evaluate
depth of tumor and presence of lymph nodes
* Other tests are CT, PET and MRI to look for metastasis

27
Q

true or false for gastric ca:
* Staging is determined based on diagnostic tests.
* Type of surgery and chemo/ radiation in combination with surgery depends on extent of CA
* If in early stages laparoscopic surgery may be all that is needed however in late stages a total gastrectomy may be required.

A

true

28
Q

what are the two take action for gastric cancer?

A

Total Gastrectomy with Esophagojejunostomy (removal of stomach with resection of esophagus to jejunum) and Partial Gastrectomy: Billroth I or II procedure

29
Q

Total Gastrectomy with Esophagojejunostomy (removal of stomach with resection of esophagus to jejunum)
* will have N/G (drainage minimal)
* will have chest tubes because enter through chest wall. * Clear fluids initiated after several days to solid foods
* At risk for poor nutritional status, wt loss, vitamin
deficiency, pernicious anemia, dumping syndrome, postprandial hypoglycemia
* Radiation/ chemotherapy to adjunct or if surgery is not an option

A

truuu

H & Illness 4: A & C illness (21 decks)

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