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NURS 3512 - Class 1-6 > Week 5 - Peptic Ulcer Disease > Flashcards

Week 5 - Peptic Ulcer Disease Flashcards

1
Q

what is peptic ulcer disease

A
  • condition characterized by erosion of the gastric or duodenal mucosa resulting from the digestive action of HCl and pepsi
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2
Q

what are 2 types of ulcer

A
  • gastric

- duodenal

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3
Q

what can cause PUD (3)

A

circumstances that cause the mucosal barrier to be impaired

  • drugs
  • stress
  • bacteria
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4
Q

what kind of bacteria commonly causes PUD

A
  • H. pylori
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5
Q

what types of drugs can cause PUD (3)

A
  • NSAIDs
  • asa
  • corticosteroids
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6
Q

are gastric or duodenal ulcers more common

A
  • duodenal
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7
Q

describe the difference in gastric secretion in a gastric vs duodenal ulcer

A
  • gastric = normal to decreased

- duodenal = increased

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8
Q

what sex is a gastric ulcer more common in? duodenal?

A
  • gastric = women

- duodenal [ men

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9
Q

what is the peak age of a gastric ulcer vs duodenal

A
  • gastric = 50-60 years

- duodenal = 35-45 years

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10
Q

describe pain in a gastric ulcer

A
  • burning or gaseous pressure in high left epigastrium, back, upper abdomen
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11
Q

describe pain in a duodenal ulcer

A
  • burning, cramping, pressure-like pain across midepigastrium and upper abdomen
  • pain is periodic and episodic
  • pain in midmorning, midafternoon, and middle of night
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12
Q

describe how pain changes after meals in a gastric vs duodenal ulcer

A
  • gastric = pain 1-2 hour after meal

- duodenal = pain 2-4 hours after meal

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13
Q

describe the impact of food on a gastric vs duodenal ulcer

A
  • gastric = pain aggravted by food

- duodenal = relieved by food (and antacid)

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14
Q

what are 3 complications of PUD

A
  • hemorrhage
  • perforation
  • gastric outlet obstruction
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15
Q

what is the most common complication of PUD

A
  • hemorrhage
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16
Q

how does PUD cause hemorrhage

A
  • develops from erosion of the granulation tissue, or erosion thru a major blood vessel
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17
Q

what type of ulcer accounts for a greater percentage of uper GI bleeds

A
  • duodenal
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18
Q

what will you see during hemorrhage of PUD (3)

A

same as GI bleed

  • melena, hematemesis, coffee group emesis
  • signs of hypovolemic shock
  • abdominal pain
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19
Q

what are some interventions for hemorrhage of PUD (6)

A

same as GI bleed

  • monitor VS
  • endoscopic therapy
  • monitor fluid and electrolytes
  • monitor I&O
  • monitor for shock
  • monitor lab studies
  • etc.
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20
Q

what is the most lethal complication of PUD

A
  • perforayion
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21
Q

when does perforation of PUD occur

A
  • when ulcer penetrates the serosal surface
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22
Q

what does perforation of PUD cause

A
  • spillage of gastric or duodenal contents into the peritoneal cavity
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23
Q

what are manifestations of perforation of PUD (7)

A
  • sudden, severe upper abdominal pain that quickly spreads throughout whole abdomin
  • shoulder pain (if irritates phrenic nerve)
  • rigid, boardlike abdomen
  • shallow, rapid resp
  • absent BS
  • NV sometimes
  • distension
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24
Q

what is the goal of interventions for perforation of PUD(3)

A
  • monitor for hypovolemic shock
  • treat
  • stop the spillage of gastric or duodenal contents into peritoneal cavity
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25
Q

how can PUD perforation be treated/interventions for it (5)

A
  • maintain NG for gastric decompression (get rid of whats spilling)
  • antibiotics
  • replace circulating blood volume (lose fluids from the vascular and interstitsal space)
  • surgery if perforation fails to seal sponatenously
  • VS
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26
Q

if the mucosa is perforated, what should the nurse not do?

A
  • have the pt swallow anything or put anything down the NG tubes –> would just contribute to peritonitis and irritation
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27
Q

what is gastric outlet obstruction

A
  • narrowing of the pylorus from inflammation and scar tissue
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28
Q

what are signs of gastric outlet obstruction (4)

A
  • ulcer-like pain that progresses and becomes worse towards end of day as stomach fills and dilates
  • swelling of upper abdomen
  • projectile vomitting
  • loud peristalsis
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29
Q

describe the vomit during gastric outlet obstruction (2)

A
  • contains undigested food particles

- poor odour

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30
Q

what can the projectile vomitting in gastric outlet obstruction lead (3)

A
  • weight loss
  • complains of thirst
  • complains of unpleasant taste in mouth
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31
Q

what are interventions of gastric outlet obstruction (3)

A
  • decompress with NG tube
  • IV fluid and electrolyte replacement
  • surgery to open obstruction and remove scar tissue
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32
Q

what can be used to diagnose PUD (4)

A
  • similar to those for upper GI bleed*
  • endoscopy
  • tests to confirm H. pylori
  • barium contrast studies
  • lab analysis
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33
Q

what tests can be done to test for H. pylori (3)

A
  • breath test
  • blood test
  • biopsy during endoscopy
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34
Q

what is the con to barium contrast studies

A
  • not accurate in identifying shallow, superficial ulcers
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35
Q

what are barium studies specifically useful for

A
  • diagnosing gastric outlet obstruction
36
Q

what are the different types of treatment for PUD

A
  • conservative therapy

- drug therapy

37
Q

list whats included in conservative therapy for PUD (6)

A
  • rest (physical and emotional)
  • quiet, calm enviro
  • eliminate or reduce stress (to decrease HCl)
  • absence from smoking
  • bland diet
  • meds
38
Q

what are 6 types of meds used for treatment of PUD

A
  • H2R blockers
  • PPIs
  • antibiotics for H pylori
  • antacids
  • anticholinergics
  • cytoprotective drugs
39
Q

describe pt teaching r/t meds for PUD (3)

A
  • strict adherence imp (d/t frequent recurrence of ulcers)
  • maintain lifestyle changes along w meds
  • no other drugs, unless prescribed by HCP, should be taken
40
Q

what do H2R blockers do

A
  • block action if histamine on H2R = decreased HCl secretion
41
Q

what is an example of H2R receptor blocker (2)

A
  • famotidine (pepsid)

- rantidine (zantac)

42
Q

what are 2 examples of PPIs

A
  • omeprazole (losec)

- pantoprazole (pantoloc)

43
Q

are PPIs or H2R blockers more effective in reducing gastric acid secretion and promoting ulcer healing?

A
  • PPIs
44
Q

why are ab used for PUD treatment

A
  • to eradicate H. pylori
45
Q

what are 2 types of ab used for h. pylori

A
  • amoxicillin

- metronidazole (flagyl)

46
Q

what do antacids do (2)

A
  • neutralize the acid = increased pH

- prevents further breakdown

47
Q

what are some examples of antacids (3)

A
  • sodium bicarb
  • magnesium hydroxide (milk of mg)
  • calcium carbonate (tums)
48
Q

how do anticholinergic meds help treat PUD

A
  • decrease cholinergic (vagal) stimulation of HCl secretion
49
Q

what is a type of cytoprotective drug

A
  • sulcrafate bismol subsalicyclate (pepto bismol)
50
Q

what do cytoprotective drugs do

A
  • protects mucosal lining
51
Q

what nutritional therapy is done for a pt with PUD (4)

A

dietary mod:

  • bland duet w 6 small meals/day if symptomatic
  • avoid alcohol and caffeine
  • avoid irritating foods: spicy foods, acidic foods
  • combo of protein, carbs, and fats
52
Q

describe acute interventions for acute exac of an ulcer (6)

A
  • NPO status for few days
  • IV fluid and electrolyte replacement
  • connected to intermittent suction
  • cleaning and lubrication of nares
  • vitals to detect and treat shock if needed
  • physical and emotional rest
53
Q

describe discharge teaching for a pt with PUD (8)

A
  • explain dietary mods (avoid irritating food, small, frequent meals, avoid alcohol)
  • explain smoking avoidance
  • avoid OTC meds, unless approved by HCP
  • take all meds as precribed
  • signs to report
  • explain need to reduce stress
  • need for long term follow ups
  • encourgae pt to share concerns about lifestyle changes and living w chronic illness
54
Q

why should pts with PUD avoid OTC med

A
  • many contain ingredients, like asa
55
Q

what symptoms should a pt with PUD report (4)

A
  • bloody emesis
  • tarry stools
  • increased epigastric pain
  • increased NV
56
Q

what are some surgical procedures used for treatment of PUD (4)

A
  • gastroduodenostomy (billroth 1)
  • gastrojejunostomy (billroth2)
  • vagotomy
  • pyloroplasty
57
Q

what is a gastroduodenostomy (billroth 1)

A
  • partial gastrectomy
  • with removal of the distal 2/3 of the stomach
    & anastomosis of the gastric stump to the duodenom
58
Q

what is a gastrojejunostomy (billroth 2)

A
  • partial gastrectomy

- removal of distal 2/3 of stomach and anastomosis of gastric stump to jejunum

59
Q

what procedure is preferred for duodenal ulcers and why

A
  • bill roth 2 –> bc duodenom is bypassed
60
Q

what is a vagotomy

A
  • severing of the vagus nerve

= eliminates stimulus to secrete HCl

61
Q

what is a pyloroplasty

A
  • surgical enlargement of the pyloric sphincter
62
Q

what does a pyloroplasty result in

A
  • facilitates easy passage of contents from the stomach
63
Q

list 3 post-op complications for surgery for PUD

A
  • dumping syndrome
  • postprandial hypoglycemia
  • bile reflux gastritis
64
Q

what causes dumping syndrome

A
  • result of removal of large portion of the stomach and the pyrloric sphincter (billroth 1&2)
65
Q

describe what dumping syndrome is

A
  • normally, gastric chyme enters the small intestine in small amounts and shifts in fluid from the extracellular space are minimal
  • but after surgery, the stomach has no control over the amt of gastric chyme entering the large intestine
    = large bolus of hypertonic fluid enters intestine & fluid drawn into bowel
    = decrease in plasma volume
    = distension of bowel lumen = urge to defecate
66
Q

what are symptoms of dumping syndrome (8)

A
  • epigastric fullness
  • weakness
  • sweating
  • palpitations
  • tachycardia
  • dizziness
  • abdominal cramping
  • borborygmi
  • urge to defecate

signs of hypovolemia

67
Q

what are interventions / treatment for dumping syndrome (6)

A
  • small, dry feedings daily
  • avoid fluids w meals (already have too much)
  • low carb (bc already concentrated)
  • moderate protein & fat
  • restrict sugar
  • rest after meals
68
Q

describe the onset of symptoms of dumping syndrome

A
  • 15-30 min after eating

- usually last no longer than 1 hr after mea

69
Q

what can you teach a pt regarding dumping syndrome

A
  • body eventually adjusts and the symptoms go away
70
Q

what is postprandial hypoglycemia

A
  • variant of dumping syndrome

- where hyperglycemia releases insulin, resulting in secondary hypoglycemia

71
Q

what causes postprandial hypoglycemia after PUD surgery

A
  • result of the uncontrolled gastric emptying of a bolus high in carb = hypergylcemia
72
Q

when do symptoms of postprandial hypoglycemia occur

A
  • ~2 hr after eating
73
Q

what are symptoms of post prandial hypoglycemia (6)

A

symptoms of hypoglycemia

  • sweating
  • weakness
  • mental confusion
  • palpitations
  • tachy
  • anxiety
74
Q

what are interventions for post prandial hypoglycemia after PUD surgery (3)

A
  • immediate ingestion of sugar when hypoglycemia
  • prevent rebound hyperglycemia by limiting amt of sugar consumed with each meal
  • eat small, frequent meals
75
Q

what causes bile reflux gastritis

A
  • occurs with gastric surgery involving the pylorus

= back up of bile into stomach

76
Q

what are symptoms of bile reflux gastritis (2)

A
  • epigastric distress that increases after meals

- vomitting

77
Q

what are interventions of bile reflux gastritis (2)

A
  • cholestyramine before or w meals

- can administer antacid

78
Q

describe postop care for PUD (13)

A
  • will have NG tube to decompress stomach & decrease P on suture line
  • observe gastric aspirate
  • ensure patency of NG tube (irrigations)
  • monitor BS and for abdominal discomfort (may indicate intestinal obstruction)
  • remove NG tube when peristalsis returns
  • I&O
  • VS q4h
  • frequent position change
  • pain meds
  • encourage DB&C with splinting
  • care of abdominal incision
  • encourage ambulation to increase peristalsis
  • IV fluids with K+ and vitamin replacement
79
Q

what should monitor regarding gastric aspirate postop

A
  • color and amt
  • bright red at first
  • gradual darkening withing first 24 hr
  • changes to yellow/green in 36-48 hho
80
Q

how can the pt splint during DB&C exercises? why should they splint?

A
  • protects abdominal suture line from rupturing,

- splint area w pillow

81
Q

why si DB&C imp post op

A
  • prevents pulmonary complication
82
Q

what should monitor regarding the abdominal incision (2)

A
  • signs of infection (odor, drainage)

- signs of bleeding

83
Q

before the NG tube is removed, what must be done

A
  • pt must be started on oral feedings of clear liquid to determine tolerance
  • aspirate stomach 1-2 h after to assess amt remaining, color, consistency
84
Q

what is a long-term complication of PUD surgery? why?

A
  • pernicuous anemia

- d/t loss of IF

85
Q

what are interventions for pernicuous anemia

A
  • injections of cobalamin (vit. B12)

NURS 3512 - Class 1-6 (47 decks)

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