Week Five Modules (AFTER MID 1) Flashcards
what are the two offending agents in GERD?
gastric acid and bile salts
what are some defects and abnormalities that can cause GERD?
relaxation of the lower esophageal sphincter; irritation from refluxed material; delayed gastric emptying; impaired clearance from the esophagus
what are some “classic symptoms” you’ll find on a patient who is suffering from GERD?
heartburn, regurgitation, and hypersalivation
what are some complications that can occur due to GERD?
stricture/difficulty swallowing and esophagitis which is painful swallowing
what are some nursing problems that a nurse will define when providing care for a patient who has GERD?
acute/chronic pain, risk for aspiration, and impaired swallowing
what are some lifestyle modifications that can be made to help reduce/treat GERD?
weight reduction; elevate the HOB/ lay on the left side; and smoking cessation
what are some diet tips to avoid for a patient who has GERD?
avoid eating large meals, avoid lying down after meals, and avoid late night snacking
what are some PHARMACOLOGIC interventions for a patient with GERD?
antacids, H2 receptor blockers, and proton pump inhibitors like pantoprazole
peptic ulcer disease occurs when an excoriated segment of the _______, typically in the stomach penetrates through the _______
GI mucosa; muscularis mucosae
what are the offending agents in peptic ulcer disease?
helicobacter pylori, NSAIDS (such as ibuprofen and naproxen), and other things such as steroids and caffeine
what are two abnormalities can cause peptic ulcer disease?
break in the mucosal lining of the stomach or duodenum which increases the susceptibility to damage by stomach acids and bile
peptic ulcer disease also includes what other ulcers?
gastric ulcer, duodenal ulcers, and stress ulcers
what are some risk factors for stress related mucosal disease?
what causes stress related mucosal disease?
major surgery, burns, and trauma
b/c of the erosion of superficial blood vessels
mucosal injury tends to occur in __ - __% of patients in the ICU
80 - 85%
PAIN IN A GASTRIC ULCER:
where is the pain located in a gastric ulcer?
how long does it take for gastric ulcer pain to occur after eating?
can eating food help relieve the gastric ulcer pain?
high in the epigastrium; 1-2 hours; no, it is not relieved by eating
PAIN IN A DUODENAL ULCER:
where is the pain located in a duodenal ulcer?
how long does it take for duodenal ulcer pain to occur after eating?
can eating food help relieve duodenal ulcer pain?
midepigastric area; 2-4 hours; yes, it is relieved by food
what are some signs and symptoms of stress related mucosal disease?
bloating, lack of appetite, nausea/vomiting, and early sense of fullness when eating
what are some complications that can occur due to stress related mucosal disease?
hemorrhage, aka GI bleeding, perforation (ulcer is going directly through the lining of the gut), and pyloric obstruction
SPECIAL COMPLICATIONS OF GI BLEEDS:
_____ and _____
what is hematemesis?
what is hematochezia?
hematemesis and hematochezia
bright red or coffee ground emesis which happens with an upper GIB bleed
the passage of bright red blood through the anus which is usually associated with a lower GIB bleed
what are some nursing problems we’ll see with stress related mucosal disease?
pain, imbalanced nutrition, nausea/vomiting, and potential hemorrhage
what are some pharmacological nursing therapy goals when it comes to treating stomach ulcers?
pain relief; eradicating h. pylori, heal the ulcers, and prevent recurrence
what are some ways to treat h. pylori?
you can treat h. pylori through triple therapy or quadruple therapy
what is included in triple therapy?
prilosec, clarithromycin, and amoxicillin
what is included in quadruple therapy?
pepto bismol, flagyl, omeprazole, and an antibiotic like tetracycline
what would be some dietary modifications to make in order to help reduce pain and treat stress related mucosal disease?
eating smaller meals, eating food that does not cause distressing symptoms, eliminating alcohol and caffeine, and eating lots of food with high fibers (such as fruits and veggies)
will a person who has stress related mucosal disease have absent or present bowel sounds?
absent bowel sounds
what can occur with gastric outlet obstruction?
gastric contents are retained, patient will experience generalized abdominal pain, dehydration, and anorexia/weight loss
what can help relieve gastric outlet obstruction?
belching or vomiting
what are some treatment options for gastric outlet obstruction?
gastric decompression (NGT), correction of electrolyte imbalances (look at the labs), and surgery if the obstruction is severe
what are some signs and symptoms of a GI bleed?
coffee-ground emesis, tarry stools, vital sign changes (low BP), orthostatic hypotension, and decreased hemoglobin and hematocrit
how do we manage gi bleeds/hemorrhage?
suppression of gastric acid (through the use of NGT), saline lavage, or endoscopic therapy which occurs under conscious sedation
what happens in endoscopic therapy?
the patient is injected with epinephrine then cauterization is used which uses heat to destroy any bacteria/tumors
what are some surgical management/treatment options that are used to treat GI bleeds/hemorrhage
pyloroplasty and vagotomy
what is pyloroplasty?
what is vagotomy?
the pyloric stricture is enlarged
this is selective severing of vagal innervation to the fundus in order to decrease acid production
what is a major complication that can occur with surgery while trying to treat GI bleeds?
dumping syndrome which is where water is drawn into the intestine causing large boluses of hypertonic fluid to enter the intestine
what are some signs and symptoms of dumping syndrome?
generalized weakness, sweating, palpitations, dizziness, and hyperactive bowel sounds
what is another complication that can occur with surgery?
postprandial hypoglycemia
what is postprandial hypoglycemia?
what are some signs and symptoms?
occurs when gastric contents high in CHO are dumped into the intestine causing secondary hypoglycemia to occur typically 4 hours after eating
cool, clammy sweat, weakness, palpitations, and tachycardia
what are some treatment options to help with the complications of surgery?
encourage patient to eat smaller meals, have moderate protein and fat intake with LOW CHO, reduce intake of fluids, and ingest sugary fluids or candy to treat the hypoglycemia
what does the “exocrine” pancreas do?
creates digestive enzymes such as trypsin, chymotrypsin, amylase, and lipase
what does the “endocrine” pancreas do?
creates hormones like insulin and glucagon
what is acute pancreatitis?
it is an inflammatory disorder of the pancreas caused by premature activation of pancreatic enzymes and intrapancreatic/extrapancreatic inflammation
what is the etiology of acute pancreatitis?
gallstone disease and obstruction of the pancreatic duct
what is some additional information you want to have before the acute pancreatitis patient arrives on your floor?
effect of pain medication, effect of anti-nausea medication, urine output, and lung sounds
with acute pancreatitis, what are we looking out for?
calcium levels and signs of hypocalcemia
what are some morning labs that will be included with the patient’s orders?
amylase, lipase, comprehensive metabolic panel, CBC, and c-reactive protein levels
what kind of pain medications will be ordered for the acute pancreatitis patient who is on a PCA pump?
dilaudid per protocol
when assessing your acute pancreatitis patient, what are some signs and symptoms you might see?
severe abdominal pain (localized in the epigastrium or LUQ), nausea/vomiting, absent or hypoactive bowel sounds, and abdominal distention
what can you expect the patient’s vital signs to look like if they’re suffering from acute pancreatitis?
decreased O2 sat, decreased BP, increased pulse, increased temp, and increased RR
patients with acute pancreatitis will also experience _____ lung sounds and _____
diminished; crackles
patients with acute pancreatitis will also experience other side effects like ____, _____, and _____
pallor; diaphoresis; and anxiety
what are two “special side effects” of acute pancreatitis?
cullen’s sign and turner’s sign
what are goals of treatment for acute pancreatitis?
relief of pain; reduction of pancreatic enzymes; correction of fluid/electrolyte imbalances; and prevention/treatment of infection
what are some potential nursing problems of patients who have acute pancreatitis?
acute pain; fluid volume deficit; imbalanced nutrition; electrolyte imbalances; nausea; risk for impaired gas exchange; and risk for disturbed sleep patterns
what nursing problems are the PRIORITY for acute pancreatitis?
acute pain and imbalanced nutrition
how can we help reduce the patient’s acute pain?
make the patient NPO; NG tube to LIS (if possible), analgesics, and positioning
how can we help improve the patient’s imbalanced nutrition?
anti-emetics and total or parenteral feedings
is nutritional support recommended for patients with mild/moderate acute pancreatitis?
no, not at all
what is the difference between enteral versus parenteral nutrition?
enteral nutrition is less expensive, has fewer complications, and encourages normal gut function
parenteral nutrition increases risk for infection, indirectly stimulates the release of pancreatic enzymes, and causes translocation of bacteria from the gut
what are two types of nutritional support?
enteral and parenteral nutrition
enteral feedings are usually given through what two places?
the dobhoff tube or the peg tube
how are patients with acute pancreatitis given their medications?
usually, given through feeding tubes
how can reduce the risk for disturbed sleep pattern?
through the use of pain control and sleep medication
when the acute pancreatitis patient is suffering from fluid volume deficit what are some nursing interventions you could do?
give iv fluids; strict I & O, maybe a foley?
because the patient is suffering from acute pancreatitis what is an electrolyte imbalance you want to look out for?
calcium level imbalances –> look for trousseau’s sign or chvostek’s sign
if your patient is suffering from impaired gas exchange what are some nursing interventions you could perform?
monitor O2 saturation, give O2 as needed, and encourage the use of incentive spirometer
what are other complications of acute pancreatitis?
pseudocysts and abscess
what is a pseudocyst?
what is a abscess?
fluid, pancreatic enzymes, tissue debris, and exudate surrounded by a wall
collection of pus
what teaching would you provide the acute pancreatitis patient upon discharge
avoid alcohol and smoking, report s/s of infection, and dietary teaching (low fat, encourage the patient to eat lots of carbs)
what is chronic pancreatitis?
a progressive, destructive disease with remissions and exacerbations
______ and diminished function can also cause chronic pancreatitis
pancreatic insufficiency
what are some signs and symptoms of chronic pancreatitis?
continuous dull abdominal pain with acute exacerbations, abdominal tenderness, shortness of breath, orthopnea and diminished lung sounds, and ascites
chronic pancreatitis can also cause what 3 p’s to happen ?
polyuria, polyphagia, and polydipsia
chronic pancreatitis can also cause ____ urine
and is also known to cause things like ____ and ____ muscle mass
dark; weight loss; decreased
what are some laboratory findings that will point to chronic pancreatitis?
elevated bilirubin, elevated glucose, and normal or moderately elevated amylase & lipase
what are some interventions for chronic pancreatitis?
pain management, enzyme replacement (such as viokase and donazyme), the administration of insulin, H2 blockers, and fat soluble vitamins
with enzyme replacement, how is effectiveness of treatment evaluated?
evaluated by decreasing number and fatty content of stools
what are some examples of fat soluble vitamins used for treatment of chronic pancreatitis?
vitamins a, d, e, and k
what type of diet is recommended as a treatment plan for patients who have chronic pancreatitis?
high caloric intake, food high in CHO and protein, but LOW in fat
also remember, you want to avoid caffeine and alcohol
what is the purpose of the liver?
liver is responsible for the production and secretion of bile, storage of vitamins and minerals, metabolism, and protection like engulfing harmful bacteria and anemic RBCs
what is cirrhosis?
necrosis of cells, regeneration of cells, or scarring
what is the etiology of cirrhosis?
chronic alcoholism, hepatitis, toxins like drugs and industrial chemicals, right sided heart failure, and chronic biliary obstruction
when a patient has liver fibrosis is recovery possible?
with cirrhosis is the damage reversible?
yes, but scar tissue will remain
no, it is irreversible
what happens with early cirrhosis?
what happens with advanced cirrhosis?
abnormal liver nodules and scarring
abnormal liver nodules and extensive scarring
what kinds of NEUROLOGICAL FINDINGS might you discover upon your assessment of a cirrhosis patient?
peripheral neuropathy, changes in mental status like disorientation and mental confusion, stupor, muscle twitching, and asterixis which is a flapping tremor
what are some DERMATOLOGIC findings of a patient who has cirrhosis?
jaundice, itching, spider angiomas, ecchymosis, palmar erythema, anemia, and caput medusae
what are some GI findings of a patient who has cirrhosis?
hemorrhoids, esophageal varices, ascites, and fluid waves present with palpitation
what is an expected RENAL finding of cirrhosis?
bilirubinuria
what is a CARDIOVASCULAR finding of cirrhosis?
peripheral edema
what is a REPRODUCTIVE finding of cirrhosis?
gynecomastia
when my patient has been diagnosed with cirrhosis what are some laboratory values I need to pay attention to?
bilirubin in urine or blood, liver enzymes like ALT and AST, protein, ammonia, prothrombin time, CBC, and electrolytes
if my patient has been diagnosed with cirrhosis, what diagnostic tests might be ordered for the patient?
liver ultrasound, CT scan, liver biopsy, and paracentesis
what are my priority nursing diagnosis for a patient who has been diagnosed with cirrhosis?
excess fluid volume and imbalanced nutrition
what are some “collaborative problems” for my nursing diagnosis of my patient who has cirrhosis?
potential for hemorrhage or potential for hepatic encephalopathy
what are some appropriate interventions for imbalanced nutrition?
sodium restriction of 500-2000 mg a day, vitamin supplements, individualized protein intake, fluid restriction if Na is low, drug therapy like diuretics and beta blockers, daily weights, I & O, and skin care
what are some appropriate interventions for potential hemorrhage?
monitor laboratory values like PT/INR, monitor VS, monitor stool and emesis for blood, and look out for esophageal varices/hemorrhoids
what are some appropriate interventions for the patient that is EXPERIENCING hemorrhage?
ice lavage, medications like vasopressin/NTG, blood transfusion, and esophagogastric balloon tamponade
what are the leading factors of hepatic encephalopathy?
GI bleeding, constipation, infection, metabolic alkalosis, and uremia/renal failure
when it comes to hepatic encephalopathy what is the treatment goal?
decrease ammonia production and increase elimination
with a patient who has hepatic encephalopathy what would their diet regime look like?
multiple small feedings, continue restrictions as stated by cirrhosis diagnosis, vitamin replacement, and probiotics
