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NURS 4390 Adult Health Theory > Week Five Modules (AFTER MID 1) > Flashcards

Week Five Modules (AFTER MID 1) Flashcards

1
Q

what are the two offending agents in GERD?

A

gastric acid and bile salts

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2
Q

what are some defects and abnormalities that can cause GERD?

A

relaxation of the lower esophageal sphincter; irritation from refluxed material; delayed gastric emptying; impaired clearance from the esophagus

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3
Q

what are some “classic symptoms” you’ll find on a patient who is suffering from GERD?

A

heartburn, regurgitation, and hypersalivation

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4
Q

what are some complications that can occur due to GERD?

A

stricture/difficulty swallowing and esophagitis which is painful swallowing

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5
Q

what are some nursing problems that a nurse will define when providing care for a patient who has GERD?

A

acute/chronic pain, risk for aspiration, and impaired swallowing

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6
Q

what are some lifestyle modifications that can be made to help reduce/treat GERD?

A

weight reduction; elevate the HOB/ lay on the left side; and smoking cessation

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7
Q

what are some diet tips to avoid for a patient who has GERD?

A

avoid eating large meals, avoid lying down after meals, and avoid late night snacking

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8
Q

what are some PHARMACOLOGIC interventions for a patient with GERD?

A

antacids, H2 receptor blockers, and proton pump inhibitors like pantoprazole

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9
Q

peptic ulcer disease occurs when an excoriated segment of the _______, typically in the stomach penetrates through the _______

A

GI mucosa; muscularis mucosae

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10
Q

what are the offending agents in peptic ulcer disease?

A

helicobacter pylori, NSAIDS (such as ibuprofen and naproxen), and other things such as steroids and caffeine

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11
Q

what are two abnormalities can cause peptic ulcer disease?

A

break in the mucosal lining of the stomach or duodenum which increases the susceptibility to damage by stomach acids and bile

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12
Q

peptic ulcer disease also includes what other ulcers?

A

gastric ulcer, duodenal ulcers, and stress ulcers

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13
Q

what are some risk factors for stress related mucosal disease?

what causes stress related mucosal disease?

A

major surgery, burns, and trauma

b/c of the erosion of superficial blood vessels

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14
Q

mucosal injury tends to occur in __ - __% of patients in the ICU

A

80 - 85%

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15
Q

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?

A

high in the epigastrium; 1-2 hours; no, it is not relieved by eating

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16
Q

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?

A

midepigastric area; 2-4 hours; yes, it is relieved by food

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17
Q

what are some signs and symptoms of stress related mucosal disease?

A

bloating, lack of appetite, nausea/vomiting, and early sense of fullness when eating

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18
Q

what are some complications that can occur due to stress related mucosal disease?

A

hemorrhage, aka GI bleeding, perforation (ulcer is going directly through the lining of the gut), and pyloric obstruction

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19
Q

SPECIAL COMPLICATIONS OF GI BLEEDS:

_____ and _____

what is hematemesis?

what is hematochezia?

A

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

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20
Q

what are some nursing problems we’ll see with stress related mucosal disease?

A

pain, imbalanced nutrition, nausea/vomiting, and potential hemorrhage

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21
Q

what are some pharmacological nursing therapy goals when it comes to treating stomach ulcers?

A

pain relief; eradicating h. pylori, heal the ulcers, and prevent recurrence

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22
Q

what are some ways to treat h. pylori?

A

you can treat h. pylori through triple therapy or quadruple therapy

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23
Q

what is included in triple therapy?

A

prilosec, clarithromycin, and amoxicillin

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24
Q

what is included in quadruple therapy?

A

pepto bismol, flagyl, omeprazole, and an antibiotic like tetracycline

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25
Q

what would be some dietary modifications to make in order to help reduce pain and treat stress related mucosal disease?

A

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)

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26
Q

will a person who has stress related mucosal disease have absent or present bowel sounds?

A

absent bowel sounds

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27
Q

what can occur with gastric outlet obstruction?

A

gastric contents are retained, patient will experience generalized abdominal pain, dehydration, and anorexia/weight loss

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28
Q

what can help relieve gastric outlet obstruction?

A

belching or vomiting

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29
Q

what are some treatment options for gastric outlet obstruction?

A

gastric decompression (NGT), correction of electrolyte imbalances (look at the labs), and surgery if the obstruction is severe

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30
Q

what are some signs and symptoms of a GI bleed?

A

coffee-ground emesis, tarry stools, vital sign changes (low BP), orthostatic hypotension, and decreased hemoglobin and hematocrit

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31
Q

how do we manage gi bleeds/hemorrhage?

A

suppression of gastric acid (through the use of NGT), saline lavage, or endoscopic therapy which occurs under conscious sedation

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32
Q

what happens in endoscopic therapy?

A

the patient is injected with epinephrine then cauterization is used which uses heat to destroy any bacteria/tumors

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33
Q

what are some surgical management/treatment options that are used to treat GI bleeds/hemorrhage

A

pyloroplasty and vagotomy

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34
Q

what is pyloroplasty?

what is vagotomy?

A

the pyloric stricture is enlarged

this is selective severing of vagal innervation to the fundus in order to decrease acid production

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35
Q

what is a major complication that can occur with surgery while trying to treat GI bleeds?

A

dumping syndrome which is where water is drawn into the intestine causing large boluses of hypertonic fluid to enter the intestine

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36
Q

what are some signs and symptoms of dumping syndrome?

A

generalized weakness, sweating, palpitations, dizziness, and hyperactive bowel sounds

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37
Q

what is another complication that can occur with surgery?

A

postprandial hypoglycemia

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38
Q

what is postprandial hypoglycemia?

what are some signs and symptoms?

A

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

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39
Q

what are some treatment options to help with the complications of surgery?

A

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

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40
Q

what does the “exocrine” pancreas do?

A

creates digestive enzymes such as trypsin, chymotrypsin, amylase, and lipase

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41
Q

what does the “endocrine” pancreas do?

A

creates hormones like insulin and glucagon

42
Q

what is acute pancreatitis?

A

it is an inflammatory disorder of the pancreas caused by premature activation of pancreatic enzymes and intrapancreatic/extrapancreatic inflammation

43
Q

what is the etiology of acute pancreatitis?

A

gallstone disease and obstruction of the pancreatic duct

44
Q

what is some additional information you want to have before the acute pancreatitis patient arrives on your floor?

A

effect of pain medication, effect of anti-nausea medication, urine output, and lung sounds

45
Q

with acute pancreatitis, what are we looking out for?

A

calcium levels and signs of hypocalcemia

46
Q

what are some morning labs that will be included with the patient’s orders?

A

amylase, lipase, comprehensive metabolic panel, CBC, and c-reactive protein levels

47
Q

what kind of pain medications will be ordered for the acute pancreatitis patient who is on a PCA pump?

A

dilaudid per protocol

48
Q

when assessing your acute pancreatitis patient, what are some signs and symptoms you might see?

A

severe abdominal pain (localized in the epigastrium or LUQ), nausea/vomiting, absent or hypoactive bowel sounds, and abdominal distention

49
Q

what can you expect the patient’s vital signs to look like if they’re suffering from acute pancreatitis?

A

decreased O2 sat, decreased BP, increased pulse, increased temp, and increased RR

50
Q

patients with acute pancreatitis will also experience _____ lung sounds and _____

A

diminished; crackles

51
Q

patients with acute pancreatitis will also experience other side effects like ____, _____, and _____

A

pallor; diaphoresis; and anxiety

52
Q

what are two “special side effects” of acute pancreatitis?

A

cullen’s sign and turner’s sign

53
Q

what are goals of treatment for acute pancreatitis?

A

relief of pain; reduction of pancreatic enzymes; correction of fluid/electrolyte imbalances; and prevention/treatment of infection

54
Q

what are some potential nursing problems of patients who have acute pancreatitis?

A

acute pain; fluid volume deficit; imbalanced nutrition; electrolyte imbalances; nausea; risk for impaired gas exchange; and risk for disturbed sleep patterns

55
Q

what nursing problems are the PRIORITY for acute pancreatitis?

A

acute pain and imbalanced nutrition

56
Q

how can we help reduce the patient’s acute pain?

A

make the patient NPO; NG tube to LIS (if possible), analgesics, and positioning

57
Q

how can we help improve the patient’s imbalanced nutrition?

A

anti-emetics and total or parenteral feedings

58
Q

is nutritional support recommended for patients with mild/moderate acute pancreatitis?

A

no, not at all

59
Q

what is the difference between enteral versus parenteral nutrition?

A

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

60
Q

what are two types of nutritional support?

A

enteral and parenteral nutrition

61
Q

enteral feedings are usually given through what two places?

A

the dobhoff tube or the peg tube

62
Q

how are patients with acute pancreatitis given their medications?

A

usually, given through feeding tubes

63
Q

how can reduce the risk for disturbed sleep pattern?

A

through the use of pain control and sleep medication

64
Q

when the acute pancreatitis patient is suffering from fluid volume deficit what are some nursing interventions you could do?

A

give iv fluids; strict I & O, maybe a foley?

65
Q

because the patient is suffering from acute pancreatitis what is an electrolyte imbalance you want to look out for?

A

calcium level imbalances –> look for trousseau’s sign or chvostek’s sign

66
Q

if your patient is suffering from impaired gas exchange what are some nursing interventions you could perform?

A

monitor O2 saturation, give O2 as needed, and encourage the use of incentive spirometer

67
Q

what are other complications of acute pancreatitis?

A

pseudocysts and abscess

68
Q

what is a pseudocyst?

what is a abscess?

A

fluid, pancreatic enzymes, tissue debris, and exudate surrounded by a wall

collection of pus

69
Q

what teaching would you provide the acute pancreatitis patient upon discharge

A

avoid alcohol and smoking, report s/s of infection, and dietary teaching (low fat, encourage the patient to eat lots of carbs)

70
Q

what is chronic pancreatitis?

A

a progressive, destructive disease with remissions and exacerbations

71
Q

______ and diminished function can also cause chronic pancreatitis

A

pancreatic insufficiency

72
Q

what are some signs and symptoms of chronic pancreatitis?

A

continuous dull abdominal pain with acute exacerbations, abdominal tenderness, shortness of breath, orthopnea and diminished lung sounds, and ascites

73
Q

chronic pancreatitis can also cause what 3 p’s to happen ?

A

polyuria, polyphagia, and polydipsia

74
Q

chronic pancreatitis can also cause ____ urine

and is also known to cause things like ____ and ____ muscle mass

A

dark; weight loss; decreased

75
Q

what are some laboratory findings that will point to chronic pancreatitis?

A

elevated bilirubin, elevated glucose, and normal or moderately elevated amylase & lipase

76
Q

what are some interventions for chronic pancreatitis?

A

pain management, enzyme replacement (such as viokase and donazyme), the administration of insulin, H2 blockers, and fat soluble vitamins

77
Q

with enzyme replacement, how is effectiveness of treatment evaluated?

A

evaluated by decreasing number and fatty content of stools

78
Q

what are some examples of fat soluble vitamins used for treatment of chronic pancreatitis?

A

vitamins a, d, e, and k

79
Q

what type of diet is recommended as a treatment plan for patients who have chronic pancreatitis?

A

high caloric intake, food high in CHO and protein, but LOW in fat

also remember, you want to avoid caffeine and alcohol

80
Q

what is the purpose of the liver?

A

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

81
Q

what is cirrhosis?

A

necrosis of cells, regeneration of cells, or scarring

82
Q

what is the etiology of cirrhosis?

A

chronic alcoholism, hepatitis, toxins like drugs and industrial chemicals, right sided heart failure, and chronic biliary obstruction

83
Q

when a patient has liver fibrosis is recovery possible?

with cirrhosis is the damage reversible?

A

yes, but scar tissue will remain

no, it is irreversible

84
Q

what happens with early cirrhosis?

what happens with advanced cirrhosis?

A

abnormal liver nodules and scarring

abnormal liver nodules and extensive scarring

85
Q

what kinds of NEUROLOGICAL FINDINGS might you discover upon your assessment of a cirrhosis patient?

A

peripheral neuropathy, changes in mental status like disorientation and mental confusion, stupor, muscle twitching, and asterixis which is a flapping tremor

86
Q

what are some DERMATOLOGIC findings of a patient who has cirrhosis?

A

jaundice, itching, spider angiomas, ecchymosis, palmar erythema, anemia, and caput medusae

87
Q

what are some GI findings of a patient who has cirrhosis?

A

hemorrhoids, esophageal varices, ascites, and fluid waves present with palpitation

88
Q

what is an expected RENAL finding of cirrhosis?

A

bilirubinuria

89
Q

what is a CARDIOVASCULAR finding of cirrhosis?

A

peripheral edema

90
Q

what is a REPRODUCTIVE finding of cirrhosis?

A

gynecomastia

91
Q

when my patient has been diagnosed with cirrhosis what are some laboratory values I need to pay attention to?

A

bilirubin in urine or blood, liver enzymes like ALT and AST, protein, ammonia, prothrombin time, CBC, and electrolytes

92
Q

if my patient has been diagnosed with cirrhosis, what diagnostic tests might be ordered for the patient?

A

liver ultrasound, CT scan, liver biopsy, and paracentesis

93
Q

what are my priority nursing diagnosis for a patient who has been diagnosed with cirrhosis?

A

excess fluid volume and imbalanced nutrition

94
Q

what are some “collaborative problems” for my nursing diagnosis of my patient who has cirrhosis?

A

potential for hemorrhage or potential for hepatic encephalopathy

95
Q

what are some appropriate interventions for imbalanced nutrition?

A

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

96
Q

what are some appropriate interventions for potential hemorrhage?

A

monitor laboratory values like PT/INR, monitor VS, monitor stool and emesis for blood, and look out for esophageal varices/hemorrhoids

97
Q

what are some appropriate interventions for the patient that is EXPERIENCING hemorrhage?

A

ice lavage, medications like vasopressin/NTG, blood transfusion, and esophagogastric balloon tamponade

98
Q

what are the leading factors of hepatic encephalopathy?

A

GI bleeding, constipation, infection, metabolic alkalosis, and uremia/renal failure

99
Q

when it comes to hepatic encephalopathy what is the treatment goal?

A

decrease ammonia production and increase elimination

100
Q

with a patient who has hepatic encephalopathy what would their diet regime look like?

A

multiple small feedings, continue restrictions as stated by cirrhosis diagnosis, vitamin replacement, and probiotics

NURS 4390 Adult Health Theory (9 decks)

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