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Health and Illness 4 : Part2 > week 6 > Flashcards

week 6 Flashcards

1
Q

what are the upper GI disorders

A

gerd
hiatal hernia
esophageal tumour

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2
Q

gi accessory organs disorders

A

cholecystitis
pancreatitis
liver cirrhosis
hepatitis

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3
Q

what is gerd ?

A

backward flow of gastric contents into esophagus

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4
Q

what can gerd result from ?

A

increased abdominal pressure ( obesity , pregnancy, ascites )

LES problems ( food durgs smoking ng tubes )

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5
Q

what are the complications of gerd

A

barret’s epithelium , resp complications, esophagitis, dental decay, hemorrhage

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6
Q

what are the symptoms of gerd ?

A

dyspepsia, regurttion, dysphagia, odophagia, coughing, chest pain, pyrosis, belching

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7
Q

true or false. tissue injury, ingestion, swallowing, and stomach issues are common in gerd

A

true

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8
Q

hiatal hernia : assess for cues
what are the two kinds

A

sliding hernia and rolling hernia

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9
Q

what is sliding hernia

A

most common type : occurs the junction between the stomach and esophagus, slides up to thoracic cavity

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10
Q

what is this describing : usually lying down or supine and returns to normal, positioning when standing up

A

sliding hiatal hernia

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11
Q

what is rolling hernia

A

esophagus and stomach are in the correct position, but the position of the top of the stomach herniates into the diaphragm, forming a pocket beside the esophagus

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12
Q

symptoms for hiatal hernia would be the same ?

A

yes

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13
Q

sliding hiatal hernia and rolling hiatal hernia would be affect the functioning of ______ which lead to stomach acid leaking up into the esophagus and causing gerd, is that true ?

A

yes this is true, LES

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14
Q

gerd and hiatal hernia take action : Non-surgical interventions to minimize pain and allow healing
Optimize nutrition & Lifestyle modification

A
  • Eat several small meals a day & stop eating 3 hrs before bed
  • CPAP for sleep apnea
  • Avoid smoking and drinking alcohol ( peppermint, chocolate, fatty foods, caffeine, carbonated drinks, spicy/acidic food)
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15
Q

Control symptoms: gerd and hiatal hernia

A

*Drugs(Antacids,PPIs,H2ReceptorBlockers)

  • Avoid drugs that lower LES pressure (oral contraceptives, anticholinergic drugs, sedatives, NSAIDs, nitrates, CCB)
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16
Q

true or false: New research links long term PPl use to CAP, c diff, increased bone fractures, kidney injury, vit deficiencies

A

true

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17
Q

true or false.multiple pillows, work with gravity acid travelling up

A

true

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18
Q

GERD & Hiatal Hernia: Take Action
Surgical Interventions
*Performed when medication and lifestyle modification does not control symptoms

what is prep ip

A

weight loss, quit smoking ( contributes to gerd )

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19
Q

intra op for gerd

A

open or laparoscopic surgery

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20
Q

post op for surgical intervention for gerd and hiatal hernia

A

Monitor for bleeding and infection

  • Prevent respiratory complications (↑HOB, early ambulation, DB&C-support
    incision, pain control)
  • Prevent DVTs (compression stockings/SCDs)
  • NG in situ initially (drainage goes from dark brown →yellowish green)
  • Gradual diet progression (watch for dysphagia, aerophagia, inability to belch)
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21
Q

esophageal tumours: assess for cues : define what it is

A

most tumours are malignant developing from epithelium

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22
Q

what are the risk factors of esophageal tumours

A

alcohol
malnutrition
obesity
smoking
untreated gerd

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23
Q

assessment : recognizing cues for esophageal tumours

A

asymptomatic/silent at first
dysphagia
weight loss, odynophagia, hoarseness

nausea and vomiting

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24
Q

esophageal tumors : take action
non surgical intereventions

A

nutritional and swallowing therpahy
chemo,radiation, or combo of both
esophageal dilation

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25
Q

what undergoes nutritional and swallowing therapy

A

sit upright, soft foods, if not tolerated tube feeds, daily wts

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26
Q

surgical intervention for esophageal tumor is what ?

A

esophagectomy

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27
Q

esophagectomy
prep and intra op

A

pre op : nutrional support, smoking cessation, excellent oral care and resp rehab

intra : open or laparoscopic

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28
Q

what is the post op care for esophagectomy
resp care is the highest priority ( db and c , turning/pain/incisional support )

A

semi folowers or high fowlers
monitor chest tube ( allow drainage from incision site )
ng care: ensure patency ( watch drainage ) placement
nutriton initially hrough jejenostomy

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29
Q
  • DO NOT reposition or irrigate NG unless prescribed in post op for esopahgeal tumors
A

true

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30
Q

what is the serious complication for esophageal tumor

A

anatomotic leak - mediastinitis, infection/shock

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31
Q

what is cholecystitis

A

inflammation of the gallbladder
acute or chronic

32
Q

what is this describing : often related to gall stones ( obstructed )
inflammation cause bile cystitis

A

cholecystitis

33
Q

what is this describing : decreased in blood flow to the gallbladder or conditions that cause bile stasis or lack of
movement or forward flow to bile. this includes conditions like sepsis
burns, tpn, or even

A

cholecystitis

34
Q

Cholecystitis: Take Action
Non-Surgical Interventions

Goal: avoid pain d/t cholecystitis:

A
  • Withhold fatty food → low fat, high fibre
  • Treat nausea & vomiting (antiemetic)
  • IV fluid if dehydrated
  • Treat acute pain (Hydromorphone or Morphine)
  • Treat mild to moderate pain (Ketoroloac- NSAID, watch for bleeding)
35
Q

Non-Surgical stone management:

A
  • Extra-corporeal shock wave lithotripsy (ESWL)
  • Percutaneous Transhepatic Biliary Catheter (drain)
    umanitoba.ca/nursing
    https://w
36
Q

Cholecystitis: Take Action
Surgical Interventions: Cholecystectomy (removal of gallbladder)

Laparoscopic Cholecystectomy

A
  • Most common method (gold standard)
  • Minimally invasive
  • Rarely complications
37
Q

Post-op Nursing:
* Pain management
* DB&C
* Prevent DVT (early ambulation)
* Monitor/Treat N&V (Ondansetron)
* IV fluids until eating and drinking
* Discharge same day

true or false for laprascopic

A

true

38
Q

Open Approach Cholecystectomy
* Used in severe biliary obstruction when ducts need exploration
Post-Op Nursing:
* Jackson Pratt drain
* Antibiotics given to prevent infection * Pain management
* DB&C
* Prevent DVT (early ambulation)
* Monitor/Treat N&V (Ondansetron) * Assess surgical site
* Discharge 1-2 days after surgery

true or false

A

true

39
Q

what is pancreatitis

A

inflammation of the pancreas ( can be life threatening )
can range from mild ( edema ) to severe ( necrotizing )

40
Q

what is the cause of pancreatitis ?

A

gallbladder stones and alcohol use

41
Q

symptoms
acute and chronic

A

acute : severe abd pain, wt loss, jaundice, tender, rigid abdomen, decreased/absent bowel sounds, grey/blue flanks

42
Q

what can occur after surgery ?

A

stomach, duodenum, biliary tract

43
Q

what are the less common acute symptom of pancreatitis

A

abdominal trauma and infections

44
Q

what is chronic pancreatitis ?

A

episodes of abd pain, ascites, LUQ mass, steatorrhea, wt loss, jaundice, dark urine, DM

45
Q

what are the complications of pancreatitis?

A

jaundice, intermittent hyperglycemic, multisystem organ failure, coagulation defects, shock, paralytic ileus

46
Q

why is paralytic ileus happening due to complication?

A

ongoing inflammation, blockage, and organ failure

47
Q

pancreatitis: take action
non surgical management
what is goal ?

A

manage pain, decrease inflammation, treat complications

48
Q

pancreatitis : take action
acute pancreatitis what are the interventions ?

A

drugs, nutritional intervention, fetal position ( knees drawn up ), observe for signs of hypocalcemia, monitor resp status

49
Q

what undergoes drugs :
nutritional interventions :

A

drugs : opioids ( might be PCA )
ranitidine and PPI ( decrease gastric secretions )
antibiotics ( acute necrotizing )

50
Q

what undergoes nutrional interventions for pancreatitis ?

A

npo ( hold po/fluid make it iv fluid ) allowing rinsing out
oral care is important
ng tube to low suction ( severely ill )
jejunal tube feed ( after 1 to 2 days NPO )
gradually resume food

51
Q

what is chronic pancreatitis intervention
undergoes drugs

A

opioids – non opoid analgesics
pancreatic enzymes
ranitidine and PPI ( decrease gastric secretions )

52
Q

what undergoes nutritional interventions for chronic pancreatitis

A

TPN
4000-6000 calories/day
Avoid high fat food
alcohol cessation recommended

53
Q

liver cirrhosis : assess for cues
what is it ?

A

extensive, irreversible scarring of liver

54
Q

what are the causes of liver cirrhosis ?

A

viral hepatitis, nafld, toxic/drug induced, autoimmune , excessive, chronic biliary chronic

55
Q

what are the early signs of liver cirrhosis

A

fatigue, weight change, n and v , pain

56
Q

what are the late stage of liver cirrhosis

A

jaundice, dry/itchy skin, rashes, purpuric lesions, vascular lesions, ascites/edema, blood in stool/emesis, fector hepaticus, neuro changes, asterixis

57
Q

what are the complications of liver cirrhosis

A

portal htn, varices, ascites/edema, hepatic encephalopathy, coagulation dysfunction and anemia

58
Q

one of our goals is less fluid as evidenced by decreased in ascites, and edema and adequate circulatory volume

what undergoes this ?

A

manage fluid volume :
low na diet
vitamin supplements - folate, thiamine from iv to po
diuretic ( weight daily, abd circumference, assess peripheral edema )

59
Q

true or false. peritonitis should be monitored when it comes to liver cirrhosis ( fever, loss of appetite, abd pain, change in mental status )

A

true

60
Q

what should be utilized if ascites if affecting the breathing ?

A

paracentesis

61
Q

what is TIPS ? or transhepatic portal systemic shunt procedure ?

A

connects a branch of portal vein to a branch of the hepatic vein

62
Q

it is known that free of bleeding episdoes but if bleeding occurs we have to sto it quickly : how should we manage the bleeding ?

A

screening for esophageal varices
beta blockers ( reduce hr and hepatic venous pressure )
treat infections ( major indicators of bleed )
vasoactive drugs for active bleed ( octreotide and vasopressin )

63
Q

endsocopy is needed to manage the bleeding
such as

A

ligatation
sclerotherpahy ( injected into veins )
balloon tamponade, stents

64
Q

true or false. TIPS could also be used in manage of bleeding

A

true

65
Q

our goal is to kep liver cirrhosis patients free form acute or chronic confusion, if confusion develops early interevention to maintain safety
what undergoes this

A

neuro assesment
monitor ammonia levels
— moderate protein ( esp if levels are elevated )
drugs used apringly ( barbituates, opoids, sedatives )
lactulose
- lax effect
-goal is 2-3 stools a day- decreased confusion
-risk for hypokalemia and dehydration

monitor for asterixis and fetor hepaticus

66
Q

our goal is to also have less discomfort from itchy skin

how should we manage pruritis

A

avoid warm temp
moisturize skin
avid irritants
cool compresses
corticosteroid creams- sertraline

67
Q

what is viral hepatitis :
what are the types of viral hepatitis

A

widespread inflammation of the liver
types : hep a , hep b , hep c

68
Q

what are the symptoms of viral hepatitis

A

right upper quadrant pain, fatigue, myalgia, athralgia, malaise, fever, jaundice, dark yellow urine, light clay coloured stool, anorexia, n and v , dry itchy skin

69
Q

what is the complications of viral hepatitis

A

depression, polyarthrithis, myalgia, renal insufficiency, cognitive impairment, heart disease

70
Q

why is upper right quadrant pain happening due to viral hepatitis?

A

secondary liver enlargement and light clay coloured stool (happening in the liver - causing blockage )

71
Q

true or false. related to antigen lodge in various parts othe body including the
joints muscles kidneys and even blood vessels, brain and heart

A

true

72
Q

viral hepatitis : take action
goal : prevent weight loss from complications of hepatitis

is to promote nutrition

A

nutrional assesment ( dietician )
diet in high in carbs and calories ( mod in fat and protein )
small fequent meals ( food pt likes )

73
Q

true or false. we should offer viral hepatitis high calories snacks between meals

A

true

74
Q

recall that non pharmacological approaches should control nausea, what are some examples ?

A

acupuncture, scenery, relaxes

75
Q

supplemental vitamins could be prescribe to viral hepatitis?

A

true

76
Q

viral hepatitis : take action
goal is to reduce fatigue due to infection and decreased metabolic energy production

A

alternate periods of rest and activity
drugs used sparingly ( antiemetic for nausea )
hep b and c drug management ( antiviral drugs ) — antiviral drugs ( can make ppl more susceptible to infection )

77
Q

true or false. antiviral can suppress immune system ( avoid large crowds or sick people ) high risk for another infection due to suppress immune system

A

true

Health and Illness 4 : Part2 (9 decks)

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