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NURS 347 EXAM 5 UROLOGY > Disorders Of Stomach And Upper Small Intestine > Flashcards

Disorders Of Stomach And Upper Small Intestine Flashcards

1
Q

What is peptic ulcer disease?

A

Condition characterized by erosion of gi mucuous from the digestive action of HCI acid and Pepsin

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2
Q

What are the 2 types of peptic ulcers?

A

Acute vs chronic

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3
Q

What is acute peptic ulcer (3)

A

Superficial Erosion
Minimal inflammation

Short duration
- resolved quickly when cause is identified and removed

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4
Q

What is chronic peptic ulcer disease? (2)

A

Muscular wall erosion with formation of fibrous tissues

More common than acute erosions

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5
Q

Chronic can be in two locations, which are?

A

Gastric and duodenal

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6
Q

Chronic gastric ulcer is ?(5)
What are risk factors (4)

A

Superficial
Pain 1-2 hours post meals with foods
Peak age 50-60 ( women )
Increased obstruction
Increased mortality

Risk factors are
- h.pyloric, medications, smoking, bile reflux

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7
Q

Chronic duodenal ulcers is?(6)
What are risk factors (4)

A

80% of all ulcers
Deep
Pain 2-4 hours post meals
Pain decrease with food
Peak 35-50 men
Associated with stress and chronic disease

Risk factors
- h. Pylori, ETOH( alcohol), smoking, increase HCL acid

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8
Q

H. Pylori is a major risk factor why?
% gastric
% duodenal
How is it transmitted?
Mainly found in who?
Life span?
What does it produce?

A

80%
90%
Oral or oral / fecal to oral
African Americans & Hispanic
Long
Urease

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9
Q

What are the 3 overall risk factors for peptic ulcers?

A

H. pylori
Medications
Life styles

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10
Q

Medications induced injury such as? (3)

A

NSAIDS
Corticosteroids/anticoagulants

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11
Q

Life styles factors for peptic ulcers are? (5)

A

Alcohol
Smoking
Caffeine
Psychological distress
Stress related muscoal disease in upper gi bleed

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12
Q

What are diagnostic studies for peptic ulcers?(5)
(3)(3)(3)(3)(1)

A

Endoscopy
- direct visualization
- obtain specimens for h.pylori ( urease )
- monitor toward healing

Noninvasive h. Pylori : serology, stool, breathe test

Barium contrast, high fasting serum gastric levels, secretin stimulation

Labs : CBC, liver enzymes, serum amylase

Stool- blood

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13
Q

Treatment goals of peptic ulcers are?

A

Decreased gastric acidity and en goes muscoal defense mechanism

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14
Q

What is conservative care for peptic ulcer? (6)

A

Adequate rest
No smoking/alcohol
Stress management
Dietary modifications
Pain mangement ( NO NSAIDS/ASPIRN!! ( unless with PPI, H2 recotor, misoprostol )
Endoscopy evaluation follow up 3-6 months

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15
Q

Drug therapy for peptic ulcers (5)

A

PPI
Antibiotic therapy
( peptiod bismuth )Bismuth alone or combined with tetracycline & Metronizadole
Cytoprotective drug therapy

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16
Q

Antibiotic therapy for the?
Do for how long ( days?)
If allergic use what?

A

H. Pylori 14 days of PCN ( if allergic, use metronidazole )

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17
Q

Cytoprotective drug therapy
What is the drug?
Helps how?
Works best in?
Bonds with?

A

Sucralfate
Protects esophagus, stomach and duodenum

Low ph; 1-3 hours before and after antacid

Cimetidine, digoxin, warfarin, phenytoin and tetracycline

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18
Q

What are the 3 complications of drug therapy?
Is it emergent? Yes or no

A

Hemorrhage
Perforation
Gastric outline obstruction
Emergent !!

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19
Q

Out of the 3, what is most common?
What is the most lethal?

A

Hemorrhage
Perforation

20
Q

Why is perforation so lethal from the drug therapy complication?
Causing?
Intensity will amount to?

A

GI contents will spill into the peripheral cavity
Causing
Suddenly severe abdominal pain; going to the back and shoulders with no relief of food or antacids

Bowl sounds become absent ; nausea and vomiting
Respiratory shallow
Pulse increase & weak

Intensity will amount to duration of spillage

21
Q

Perforation; the belly will be rigidly like and that is?
Rigid, board like abdomen
We need surgery!!

A

Peritinistisis

22
Q

If perforation isn’t untreated you will get what within 6-12 hours?

A

Bacterial peritonitis

23
Q

Your immediate focus with perforation in peptic ulcer is to?

A

Stop the spillage and restore blood volume

24
Q

What will we do for perforation? (5)

A

NGT for aspiration and gastric suppression
IV fluids and blood
Central line

Small - self sealing
Large - surgery & closure

25
Q

Gastric outlet obstruction, what is going to happen for peptic ulcer patients?

A

Stomach fills and dilated causing discomfort and pain ; worse at end of day and may be visibility dilated

Belching and vomiting ( protective ) may provide some relief ; constiplayion & anorexia

26
Q

Gastric outlet obstruction manifestations ? (4)

A

Edema
Inflammation
Pylorospams
Scar tissue obstruction in distal stomach & duodenum

27
Q

Treatment of gastric outlet obstruction? (4)

A

Decompress with NGI
PPI or H2
Pain management
Fluid and electrolytes replacement
Surgery & ballon dilation

28
Q

Nursing management for peptic ulcers are? (2)

A

Ulcerogenic drugs
Teach to report gastric distress symptoms to HCP

29
Q

Acute care for peptic ulcers are? (7)

A

NPO
NGT
IV FLUIDS
monitor for shock
Gastric content analysis : check ph, blood or bile
Monitor labs
Manage pain & anxiety ; restful environment

30
Q

Gerontologic considerations PUD (4)

A

increase morbidity & mortality
Frequent use of NSAIDS ( arthritis)
First symptom may be GI bleed or decrease HCT
Treatment plan is similar with emphasis in teaching and preventing

31
Q

Upper GI blessing
Hemaremesis
What is it?

A

Bloody vomits
Coffee ground contact with HCI acid ; digested blood

32
Q

Upper gi bleed Melena means?

A

Black
Tarry stools

33
Q

What is occult?

A

A guaiac test that detects blood in gastric secretions, vomitus and stool

34
Q

What causes blood stools? (4)

A

Black licorice
Bleeding ulcers
Pepto bismol
Mallory weiss tear

35
Q

What else causes upper gi bleeding ? (4)

A

Stomach & Duondeal
- PUD ( most common ?
- stress related mucosal disease
- physiologic stress ulcers

36
Q

For upper GI bleed, you have an increase risk of? (5)

A

Being critically Ill
Coagulopathy
Liver disease
Organ failure
Renal replacement therapy

37
Q

GI bleeding for esophageal origin? (3)

A

Chronic esophagitis
Mallory weiss tear
Esophageal varices

38
Q

Diagnostic studies for UPPER GI bleeding? (4)

A

Endoscopy
Angiopgraohy
Labs ( CBC, BUN )
vomitus and stool - gross or occult blood

39
Q

Emergency assessment for massive gi bleed is? (3)

A

Greater than 1500ml blood loss 25% intravascular volume
(80-85% spontaneously )

Shock
( tachy, weak pulse, hypotension, cool extremities, prolonged capillary refill, apprehension )

Monitor urine hourly

40
Q

Emergency assessment and management (5)

A

Hemodynamic monitoring
Oxygen administration
Monitor for perforation & Peritonitis
Administer IV fluids
Blood/blood product transfusion

41
Q

What is the first like emergency management?
In order to determine ?

A

Endoscopic therapy
24 hours to determine treatment and surgery

42
Q

Goal for endoscopic therapy is to? (5)

A

Coagulate or thrombose bleed
- clips or bands ( compres vessel )
- thermal ablation ( cauterized )
- injection ( ephinoehrine or alcohol )
- sclerotherapy

43
Q

Surgical therapy requires more than how much Ml or blood ?

A

2000

44
Q

Drug therapy for emergency? (3)

A

Antacids
Ppi
Iv Bolus then infusion

45
Q

Nursing assessment for gi bleeding ? (4)

A

Manage physical needs
Assess LOC & VS
Determine histiry
Labs

46
Q

Health promotion of gI bleeding? (6)

A

Identify risk
Avoid GI toxic drugs (NSAIDS)
Avoid gastric irritants ( smoking, alcohol, OTC )
Test for occult blood
Varies : avoid pressure ( severe coughing and sneezing )
Blood dyscrasias - teach about disease drugs and risk of gi bleeding

47
Q

Acute care
You also want to put them on clear liquids, and lavage of 50-100 ml ?
True or false

A

True

NURS 347 EXAM 5 UROLOGY (16 decks)

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