Esophageal Disorders

Question 0

_______ used to be the ONLY H2 receptor antagonist medication given to patient’s until _______ medication came out.
These medications can be given PO, IV, and IM.
We don’t really see these medications being used that much anymore because of the introduction of the _________.

Answer 0

Tagamet
Zantac/Pepcid
Proton Pump Inhibitor

Question 1

This type of hernia is attached to the esophagus but it can also slide. This is diagnosed with a barium swallow or endoscopy. Treat the patient even if they don’t have any symptoms.
What type of hernia is this?

Answer 1

Mixed Hernia

Question 2

What are the 2 most commonly used Gastrointestinal Stimulants used to treat GERD?

Answer 2

Metoclopramide / Reglan

Dexpanthenol / Ilopan

Question 3

This medication is contraindicated in patient’s that have a perforation because the patient’s GI contents will leak into the abdomen and the nurse wouldn’t want to speed up that process or GI bleeding because it can cause a hypertensive crisis in patient’s that have pheochromocytoma.
What medication has this nursing intervention?

Answer 3

Metoclopramide / Reglan

Question 4

This medication is given to prevent stress ulcers as a prophylaxis. They do stress ulcer and DVT prophylactics on 90% of the patient’s in the hospital.
What therapeutic classification of medication is this?

Answer 4

Proton Pump Inhibitor

Study Tip: When doing your care plans and taking care of your patient’s and you can’t find anywhere that they have GERD and they chart states that they do not have GERD then it is being used as a prophylactic and you can find that in the physician’s notes.

Question 5

What are the two major Esophageal Disorders?

Answer 5

Hiatal Hernia

Gastroesophageal Reflux Disease (GERD)

Question 6

A piece of the fundus is wrapped around the distal esophagus and that helps to strengthen and anchor the lower esophageal sphincter below the diaphragm. What is the name of this surgical intervention?

Answer 6

Nissen Fundoplication

Study Tip: The fundus is the upper part of the stomach.

Question 7

When the stomach is digesting or there is something going on that has increased the intra-abdominal pressure which could include ________, _______, _______, and _______. All of these things will increase the pressure on that sphincter and if that sphincter isn’t strong enough, it will open up and the stomach contents will reflux back up into the esophagus and it is will lead to pain and narrowing of the esophagus.
What is the name of this gastrointestinal disorder?

Answer 7

Coughing
Sneezing
Wearing tight clothes
Heavy lifting
Gastroesophageal Reflux Disease (GERD)

Question 8

No treatment is necessary in a _______ hernia although if it occurs with ________ hernia which can cause the stomach to become strangulated. Surgery is usually recommended if that occurs and that can be done laparoscopically.

Answer 8

Mixed

Paraesophageal

Question 9

This patient will have an incompetent _______ that which will allow contents from the stomach to reflux back up into the esophagus, it occurs most often in adults, and the problem is that the esophageal cells are very delicate and they are not designed to withstand that highly acidic content like the stomach cells are made to withstand so this can cause scar tissue to develop that is able to resist that highly acidic content but it can also be a precursor to a malignancy or cancerous growth. This is why early treatment of this disorder is very important.
What is the name of this gastrointestinal disorder?

Answer 9

Lower Esophageal Sphincter

Gastroesophageal Reflux Disease (GERD)

Question 11

This medication is contraindicated in patient’s that have a sensitivity or have a mechanical obstruction of their GI tract.
If the patient has a bowel obstruction or something blocking it like they are constipated or they have a stricture, or adhesions, then you do NOT want to stimulate the upper GI tract, you don’t want to get that peristalsis active when it is just going to hit an obstruction which can cause an even bigger problem.
What medication has this nursing intervention?

Answer 11

Metoclopramide / Reglan

Question 12

These medications stimulate motility in the upper GI tract, they help to increase the rate of gastric emptying without stimulating gastric, biliary, or pancreatic secretions. What is the therapeutic classification of medication?

Answer 12

Gastrointestinal Stimulants

Question 12

What is the most commonly used GI stimulant medication given to treat GERD?

Answer 12

Metoclopramide / Reglan

Question 14

Most of the time we do NOT know the cause of this type of hernia. This usually happens in patient’s over the age of 50. This is commonly seen in overweigh people and especially women and people that smoke.
What type of hernia is this?

Answer 14

Paraesophageal Hernia

Question 15

This medication has been around for a long time and it is used for patient’s GERD with an ileus (blockage) and the patient has NO peristalsis.

Answer 15

Dexpanthenol / Ilopan

Study Tip: This medication can help stimulate peristalsis in these patients.

Question 17

This medication is not safe to administer to pregnant women because we don’t have data to support the safety of it’s use in pregnant women.
What medication has this nursing intervention?

Answer 17

Metoclopramide / Reglan

Study Tip: Anytime safety and pregnancy has NOT been established by the FDA then it is considered contraindicated.

Question 18

Proton Pump Inhibitors have very little side effects which is the major benefit of giving it to your patient. There is a major adverse effect they are finding that in women who are on high doses or prolonged treatment that they are more susceptible to ______ and that is a pretty significant adverse effect.

Answer 18

Hip Fractures

Question 19

Now everyone in the hospital is on a ______ when in the past everyone used to be on H2 antagonists.

Answer 19

Proton Pump Inhibitor

Study Tip: This medication is used to prevent stress ulcers BECAUSE NOT EVERY PATIENT HAS GERD. This is IMPORTANT!

Question 20

This medication can cause Parkinsonian like symptoms so people given this medication will look like they have Parkinson’s Disease.
What medication has this nursing intervention?

Answer 20

Metoclopramide / Reglan

Study Tip: The pill rolling and resting tremor symptoms will go away when the patient discontinues this medication.

Question 21

If you notice the name of a medication ends in -prazole this is a MAJOR indicator that your patient is on what therapeutic classification of medication? What is the only exception to this rule?

Answer 21

Proton Pump Inhibitors
The anti-psychotic drug Aripriprazole

Study Tip: DO NOT CONFUSE THIS WITH A PROTON PUMP INHIBITOR.

Question 22

Anticholinergics
Narcotic analgesics
These can decrease the effect of this medication.
What medication has this nursing intervention?

Answer 22

Metoclopramide / Reglan

Question 23

Alcohol
Sedatives
Cyclosporine
Tranquilizers
These can increase the effect of this medication.
What medication has this nursing intervention?

Answer 23

Metoclopramide / Reglan

Question 23

Suppress secretions of gastric acids to treat GERD. These medications can alleviate symptoms of heartburn and they assist in the prevention of peptic ulcer disease.
What therapeutic classification of medication is this?

Answer 23

Histamine H2-Receptor Antagonists

IMPORTANT: These medications can also be used to prevent stress ulcers.

Question 23

What are the 5 most commonly used Histamine H2-Receptor Antagonists used to treat GERD?

Answer 23

Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)
Ranitidine (bismuth citrate)

Question 24

This disorder is characterized by the cardinal symptom that a portion of the stomach and the esophagus just slide up into the chest through that opening called the hiatus.
What type of hernia is this?

Answer 24

Sliding Hiatal Hernia

Study Tip: The hiatus is the opening in the diaphragm that the esophagus goes through to connect to the stomach.

Question 25

This is the least commonly seen hernia but it the biggest cause for concern. The esophagus and the stomach stay in their normal position but then a part of the stomach squeezes right through so there is not that sliding it’s the stomach coming up through the hiatus and you can have this without any symptoms but the DANGER here is that part of the stomach can strangulate and have it’s blood supply cut off which is very dangerous.
What type of hernia is this?

Answer 25

Paraesophageal Hernia

Question 26

This medication is usually given right before meals like 30 mins before meals and right before bedtime around 4x a day.
What medication has this nursing intervention?

Answer 26

Metoclopramide / Reglan

Question 27

What are the 5 most common therapeutic classifications of medications given to treat GERD?

Answer 27

GI Stimulants 
Antacids 
H2 receptor antagonists
Proton pump inhibitors
Anti-ulcers agents 

Study Tip:
GI Stimulants > Cisapride & metoclopramide
Antacids > to be given after GI Stimulants
Anti-ulcers agents > Sulcrafate

Question 27

What are the 5 most commonly used Proton Pump Inhibitor used to treat GERD?

Answer 27

Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)

Study Tip: LOPER

Question 29

_________ is a surgery that is performed if surgery is indicated for a patient with a hernia or GERD.

Answer 29

Nissen Fundoplication

Question 31

What are 3 surgical interventions used to treat a Hiatal Hernia?

Answer 31

Hill’s repair
Belsey’s repair
Fundoplication

Question 32

When you have a patient who is on long term _________ they should have bone density measurements taken regularly. This effect on the bone’s density occurs because this medication interferes with the absorption of _________ in the stomach because it alters the acidity.

Answer 32

Proton Pump Inhibitors

Calcium

Question 33

The esophagus ends in a sphincter called the lower esophageal sphincter (LES) and this sphincter needs to be strong enough to stay closed when there is high pressure activity going on in the stomach. What is the name of this gastrointestinal disorder?

Answer 33

Gastroesophageal Reflux Disease (GERD)

Question 33

Restlessness
Drowsiness
Extrapyramidal reaction (unintentional movements)
Dizziness
Insomnia
Headache
What medication has these side effects?

Answer 33

Metoclopramide / Reglan