Chapter 46

Question 1

What are the common upper gastrointestinal (GI) problems reviewed in this chapter?

Answer 1

• Nausea and vomiting
• Oral and gastric cancers
• Gastroesophageal reflux
• Ulcerative disease
• Inflammatory and infectious bowel disorders
• GI bleeding
• Structural problems

These problems can lead to various complications in patients undergoing upper GI surgery.

Question 2

What nutritional issues may patients with impaired GI function face?

Answer 2

Malnutrition from decreased intake

Impaired GI function can lead to insufficient nutrient absorption and overall nutritional deficits.

Question 3

What risks are associated with patients who have impaired GI function?

Answer 3

• Altered fluid balance
• Altered electrolyte balance
• Altered acid-base balance

These imbalances can complicate the clinical management of patients with GI issues.

Question 4

How can problems with eating, drinking, or talking affect patients?

Answer 4

They may impair the ability to communicate

Communication difficulties can arise from both physical and psychological factors related to GI problems.

Question 5

What is the relationship between pain and aspiration risk?

Answer 5

Pain increases the risk for aspiration

Pain can lead to changes in swallowing patterns, increasing the likelihood of aspiration.

Question 6

What are the most common manifestations of GI disease?

Answer 6

Nausea and vomiting

These symptoms can occur in various GI disorders and significantly impact patient quality of life.

Question 7

What effect does swallowing difficulty have on patients?

Answer 7

Increases the risk for aspiration

Difficulty swallowing can lead to food entering the airway, which poses serious health risks.

Question 8

What is the primary function of the vomiting center?

Answer 8

Coordinates the multiple signals that trigger the vomiting reflex.

Question 9

What does the chemoreceptor trigger zone (CTZ) respond to?

Answer 9

Chemical stimuli from drugs, toxins, and labyrinthine stimulation.

Question 10

What are the clinical manifestations associated with nausea?

Answer 10

Subjective experience that usually accompanies anorexia.

Question 11

What can prolonged vomiting lead to?

Answer 11

Dehydration, severe electrolyte imbalances, fluid volume loss, and circulatory failure.

Question 12

What metabolic condition can result from loss of gastric hydrochloric acid due to vomiting?

Answer 12

Metabolic alkalosis.

Question 13

What is the goal of interprofessional care in managing nausea and vomiting?

Answer 13

Determine and treat the underlying cause, correct complications, and provide symptomatic relief.

Question 14

What type of drugs are used to treat nausea and vomiting?

Answer 14

Antiemetic drugs that act in the CNS via the CTZ.

Question 15

What are the risks of using promethazine via parenteral routes?

Answer 15

Severe tissue injury.

Question 16

What are 5-HT3 receptor antagonists effective for?

Answer 16

Reducing chemotherapy-induced vomiting (CINV), postoperative nausea and vomiting (PONV), and nausea related to migraine and anxiety.

Question 17

What is the risk associated with chronic use of metoclopramide?

Answer 17

Tardive dyskinesia.

Question 18

What is tardive dyskinesia characterized by?

Answer 18

Involuntary and repetitive movements of the body.

Question 19

What is a potential outcome of severe vomiting related to weight?

Answer 19

Weight loss due to fluid loss.

Question 20

What can metabolic acidosis occur with in the context of vomiting?

Answer 20

Vomiting of small intestine contents.

Question 21

What is the role of dexamethasone in antiemetic therapy?

Answer 21

Given with other antiemetics to manage acute and delayed CINV.

Question 22

What is the function of the autonomic nervous system during vomiting?

Answer 22

Results in both parasympathetic and sympathetic stimulation.

Question 23

What does sympathetic activation during vomiting cause?

Answer 23

Tachycardia, tachypnea, and diaphoresis.

Question 24

What happens to the lower esophageal sphincter (LES) during parasympathetic stimulation?

Answer 24

It relaxes.

Question 25

What is the mechanism of action of scopolamine?

Answer 25

Block cholinergic pathways to vomiting center ## Footnote Used as an anticholinergic drug for nausea and vomiting.

Question 26

Name two antihistamines used for nausea and vomiting.

Answer 26

* dimenhydrinate (Dramamine) * diphenhydramine * hydraxyzine * meclizine (Antivert) ## Footnote Antihistamines block histamine receptors that trigger nausea and vomiting.

Question 27

What are common side effects of cannabinoids like dronabinol?

Answer 27

Dry mouth, somnolence ## Footnote Cannabinoids inhibit the vomiting control mechanism in the medulla oblongata.

Question 28

What is the primary action of corticosteroids in managing nausea?

Answer 28

Not well understood how it prevents nausea and vomiting ## Footnote Dexamethasone is a commonly used corticosteroid.

Question 29

What do dopamine D2/D3 receptor antagonists do?

Answer 29

Block dopaminergic receptors in the CTZ ## Footnote Amisulpride (Barhemsys) is an example of this class of drugs.

Question 30

What is the action of 5-HT3 (serotonin) antagonists?

Answer 30

Block action of serotonin ## Footnote Examples include granisetron, ondansetron (Zofran), and palonosetron (Aloxi).

Question 31

What are the side effects of phenothiazines?

Answer 31

Hyperglycemia, insomnia, euphoria, chills, hypokalemia, hypotension, abdominal distention ## Footnote These drugs act on the CNS level of the CTZ.

Question 32

What is the role of prokinetic agents like metoclopramide?

Answer 32

Inhibit action of dopamine, enhance gastric motility and emptying ## Footnote CNS side effects can include anxiety and hallucinations.

Question 33

What do substance P/neurokinin-1 receptor antagonists block?

Answer 33

Interaction of substance P at NK-1 receptor ## Footnote Examples include aprepitant (Emend), netupitant, and rolapitant (Varubi).

Question 34

What does the presence of bile in emesis suggest?

Answer 34

Obstruction below the ampulla of Vater ## Footnote This is significant in assessing the cause of vomiting.

Question 35

What does bright red blood in vomitus indicate?

Answer 35

Active bleeding ## Footnote Possible causes include Mallory-Weiss tear or esophageal varices.

Question 36

What does 'coffee-grounds' appearance of vomitus indicate?

Answer 36

Gastric bleeding ## Footnote Blood changes to dark brown due to interaction with HCl acid.

Question 37

What is the difference between vomiting and regurgitation?

Answer 37

Vomiting is forceful expulsion of stomach contents; regurgitation is effortless ## Footnote Retching or vomiting rarely occurs before regurgitation.

Question 38

What is projectile vomiting?

Answer 38

Forceful expulsion of stomach contents without nausea ## Footnote Often occurs with brain and spinal cord tumors.

Question 39

What are important health information factors to assess in patients with nausea and vomiting?

Answer 39

• Recent illness • Travel history • Medication use (including alcohol and antibiotics) • Surgical history • Pregnancy • Cancer • Cardiovascular disease (CVD) • Renal disease • Eating disorders

Question 40

What are common symptoms associated with nausea and vomiting?

Answer 40

• Anorexia • Weight loss • Weakness • Fatigue • Dry mouth

Question 41

What objective data should be collected in patients experiencing nausea and vomiting?

Answer 41

• Lethargy • Sunken eyeballs • Frequency and character of vomitus • Content of vomitus (undigested food, bile, feces) • Color of vomitus (red, coffee-grounds, green, yellow) • Pallor • Dry mucous membranes • Poor skin turgor

Question 42

What is the initial management for patients with persistent vomiting?

Answer 42

• NPO status • IV fluids • Possible nasogastric (NG) tube for decompression

Question 43

What are the risks associated with prolonged vomiting?

Answer 43

• Dehydration • Acid-base imbalance • Electrolyte imbalances

Question 44

How should a patient be positioned to prevent aspiration during vomiting?

Answer 44

• Semi-Fowler's position • Side-lying position

Question 45

What is the initial fluid of choice for oral rehydration after vomiting?

Answer 45

Water

Question 46

What dietary recommendations should be given to a patient recovering from severe vomiting?

Answer 46

• Clear liquids initially • Bland foods (e.g., baked potato, rice, cooked chicken, cereal) • High carbohydrates and low fat diet

Question 47

What clinical problems can arise from nausea and vomiting?

Answer 47

• Fluid imbalance • Electrolyte imbalance • Nutritional compromise • Impaired gastrointestinal function

Question 48

What are the overall goals for a patient with nausea and vomiting?

Answer 48

1. Minimal or no nausea and vomiting 2. Normal electrolyte levels and hydration status 3. Return to normal fluid and nutrient intake

Question 49

What teaching should be provided to patients and caregivers regarding nausea management?

Answer 49

• How to manage nausea • Ways to prevent nausea and vomiting • Maintaining fluid and nutrition intake • Keeping the environment quiet and well-ventilated • Avoiding sudden position changes and unnecessary activity

Question 50

When should a dietitian be consulted for a patient with nausea and vomiting?

Answer 50

When determining nutritious foods that the patient can tolerate

Question 51

What is aphthous stomatitis commonly known as?

Answer 51

Canker sore ## Footnote It is a recurrent and chronic form of infection related to various causes.

Question 52

What are the causes of gingivitis?

Answer 52

Neglected oral hygiene, malocclusion, missing or irregular teeth, faulty dentistry ## Footnote Gingivitis presents with inflamed gingivae and interdental papillae.

Question 53

What is the treatment for aphthous stomatitis?

Answer 53

Tetracycline oral suspension, tetracycline (topical or systemic) ## Footnote Prevention includes health teaching and dental care.

Question 54

What virus is responsible for herpes simplex infections?

Answer 54

Herpes simplex virus (type 1 or 2) ## Footnote Risk factors include upper respiratory tract infections and excessive exposure to sunlight.

Question 55

What are the manifestations of oral candidiasis?

Answer 55

Pearly, bluish white 'milk-curd' membranous lesions, sore mouth, yeasty halitosis ## Footnote It is caused by Candida albicans.

Question 56

What is parotitis and its common causes?

Answer 56

Inflammation of the parotid gland caused by Staphylococcus or Streptococcus species ## Footnote Associated with debilitation and dehydration.

Question 57

What are the symptoms of stomatitis?

Answer 57

Halitosis, sore mouth, trauma from pathogens or irritants ## Footnote Can be a side effect of chemotherapy and radiation.

Question 58

What are the risk factors for Vincent's infection?

Answer 58

Stress, excessive fatigue, poor oral hygiene, nutrition deficiencies (B and C vitamins) ## Footnote It presents with ulcers that bleed and a fetid mouth odor.

Question 59

What is the primary concern for older adults experiencing nausea and vomiting?

Answer 59

Fluid loss and rehydration therapy ## Footnote They have a higher risk for life-threatening fluid and electrolyte imbalances.

Question 60

What is the recommended action if an older adult suspects a medication is causing nausea?

Answer 60

Notify the healthcare provider (HCP) immediately ## Footnote Stopping medication without consultation may have adverse effects.

Question 61

What are expected outcomes for older adults with nausea and vomiting?

Answer 61

* Be comfortable, with minimal or no nausea and vomiting * Have normal electrolyte levels * Able to maintain adequate intake of fluids and nutrients ## Footnote Careful assessment and monitoring are crucial.

Question 62

What methods may help reduce postoperative nausea and vomiting (PONV) in some patients?

Answer 62

Acupressure, acupuncture, herbs (ginger, peppermint oil), changes in body position, exercise ## Footnote These methods can be beneficial for certain individuals.

Question 63

What are the CNS side effects of antiemetic drugs in older adults?

Answer 63

Confusion and increased fall risk ## Footnote Doses should be reduced and efficacy closely evaluated.

Question 64

What are the common risk factors associated with oral cancer?

Answer 64

About 75% to 90% report a history of either tobacco or frequent alcohol use, prolonged exposure to sunlight, irritation from pipe smoking, and HPV infection ## Footnote HPV contributes to 25% of oral cancer cases, especially with multiple oral sex partners.

Question 65

What is leukoplakia and its significance in oral cancer?

Answer 65

Leukoplakia, called 'smoker's patch', is a white patch on the mouth mucosa or tongue that is a pre-cancerous lesion, with 15% transforming into cancer ## Footnote It results from chronic irritation, especially from smoking.

Question 66

What is erythroplasia and its risk in developing cancer?

Answer 66

Erythroplasia (erythroplakia) is a red velvety patch on the mouth or tongue, with more than 50% of cases progressing to squamous cell cancer.

Question 67

What are common clinical manifestations of oral cancer?

Answer 67

Chronic sore throat, sore mouth, voice changes, leukoplakia, erythroplasia, asymptomatic neck mass, and oral lesions ## Footnote Lip cancer typically appears as an indurated, painless ulcer.

Question 68

What are the diagnostic studies used for oral cancer detection?

Answer 68

Oral exfoliative cytologic study and the toluidine blue test ## Footnote The toluidine blue test is a screening test for oral cancer.

Question 69

What is the average age for oral cancer diagnosis?

Answer 69

Oral cancer is not common after age 35, with the average age at diagnosis being around 62.

Question 70

What is the relationship between oral cancer and HPV?

Answer 70

HPV contributes to 25% of oral cancer cases and is associated with multiple sexual partners.

Question 71

What are the treatment options for oral cancer?

Answer 71

Surgery, radiation ## Footnote Specific surgical procedures include mandibulectomy, radical neck dissection, and glossectomy.

Question 72

Which demographic has the highest incidence of oral cancer?

Answer 72

Incidence and mortality rates are highest in Black men.

Question 73

What is the prognosis for lip cancer compared to other types of oral cancer?

Answer 73

Lip cancer has the most favorable prognosis due to earlier diagnosis from visibility.

Question 74

What later symptoms may indicate advanced oral cancer?

Answer 74

Increased saliva, slurred speech, dysphagia, toothache, earache.

Question 75

What are the four processes of ingestion related to oral cancer?

Answer 75

Ingestion, Digestion, Absorption, Elimination

Question 76

What is the purpose of chemotherapy in cancer treatment?

Answer 76

Chemotherapy is applied to treat cancer.

Question 77

What does a negative cytologic smear indicate regarding cancer diagnosis?

Answer 77

A negative cytologic smear or negative toluidine blue test does not necessarily rule out cancer.

Question 78

What imaging techniques are used for staging cancer after diagnosis?

Answer 78

CT scan, MRI, and positron emission tomography (PET)

Question 79

What are the main management strategies for oral cancer?

Answer 79

Surgery, radiation, chemotherapy, or a combination of these

Question 80

What is the most effective treatment for early-stage oral cancer?

Answer 80

Surgery

Question 81

What factors determine the surgical procedure for oral cancer?

Answer 81

Location and extent of the tumor

Question 82

What types of surgeries may be performed for oral cancer?

Answer 82

Partial mandibulectomy, hemiglossectomy, glossectomy, resections of the buccal mucosa and floor of the mouth, radical neck dissection

Question 83

What does radical neck dissection involve?

Answer 83

Wide excision of the primary lesion with removal of regional lymph nodes, deep cervical lymph nodes, and lymphatic channels

Question 84

What structures may be removed during a radical neck dissection?

Answer 84

Sternocleidomastoid muscle, internal jugular vein, mandible, submaxillary gland, thyroid and parathyroid glands, spinal accessory nerve

Question 85

What is the typical postoperative care for patients after radical neck surgery?

Answer 85

Tracheostomy, drainage tubes for fluid and blood removal

Question 86

What nutritional therapy is recommended for patients before surgery?

Answer 86

Placement of a percutaneous endoscopic gastrostomy (PEG) tube for enteral nutrition (EN)

Question 87

What is the initial nutritional support provided after radical neck surgery?

Answer 87

Parenteral nutrition for the first 24 to 48 hours

Question 88

What are the options for enteral nutrition after the initial postoperative period?

Answer 88

NG tube, gastrostomy tube, jejunostomy tube

Question 89

What should be assessed for feeding tolerance in patients?

Answer 89

Adjust the amount, time, and formula if nausea, vomiting, diarrhea, or distention occur

Question 90

What is the role of radiation therapy in the treatment of oral cancer?

Answer 90

Used alone to treat small cancers or when lesions cannot be removed

Question 91

Why is radiation therapy typically avoided before surgery?

Answer 91

Radiated tissue becomes fibrotic and heals slower, making it hard to remove

Question 92

What diagnostic assessments are used for oral cancer?

Answer 92

History and physical assessment, biopsy, oral exfoliative cytology, toluidine blue test, CT, MRI, PET scans

Question 93

What are common clinical problems faced by patients with oral cancer?

Answer 93

Nutritionally compromised, pain, difficulty coping

Question 94

What are the overall goals for a patient with oral cavity cancer?

Answer 94

Patent airway, able to communicate, adequate intake to maintain nutrition, relief of pain and discomfort

Question 95

What key role do healthcare providers play in the management of oral cancer?

Answer 95

Early detection and treatment, identifying patients at risk

Question 96

What are the subjective data important for nursing assessment of oral cancer?

Answer 96

• Recurrent oral herpetic lesions • HPV infection or vaccination • Exposure to sunlight • Immunosuppressants • Removal of prior tumors or lesions • Alcohol and tobacco use • Poor oral hygiene • Difficulty speaking, dysphagia

Question 97

What are some objective data findings for oral cancer?

Answer 97

• Slurred speech • Foul breath odor • Painless ulcer on lip • Painless neck mass

Question 98

What are the expected outcomes for a patient with oral cancer?

Answer 98

• Have no respiratory complications • Be able to communicate

Question 99

What is Gastroesophageal reflux disease (GERD)?

Answer 99

A symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus

Question 100

What is the most common upper GI problem?

Answer 100

Gastroesophageal reflux disease (GERD)

Question 101

What are the primary factors causing GERD?

Answer 101

• Incompetent lower esophageal sphincter (LES) • Increased intraabdominal pressure • Certain foods and drugs • Obesity • Smoking

Question 102

What does the reflux of acidic gastric contents into the esophagus cause?

Answer 102

Esophageal irritation and inflammation (esophagitis)

Question 103

What are some risk factors for GERD?

Answer 103

• Obesity • Hiatal hernia • Cigarette and cigar smoking

Question 104

What can cause medication-induced esophagitis?

Answer 104

Certain drugs, such as nonsteroidal antiinflammatory drugs (NSAIDs) and potassium

Question 105

How can good oral hygiene impact health?

Answer 105

• Improves quality of life • Lowers risk for teeth loss • Reduces pain and disability • Aids in early detection of oral and craniofacial cancers • Decreases cost of care needed from dental professionals • Decreases risk for periodontal disease, gingivitis, and dental caries

Question 106

What should patients be taught regarding early detection of oral cancer?

Answer 106

To report unexplained pain or soreness of the mouth, unusual bleeding, dysphagia, sore throat, voice changes, or swelling or lump in the neck

Question 107

What factors decrease lower esophageal sphincter pressure?

Answer 107

* Alcohol * Chocolate (theobromine) * Opiates * Anticholinergics * B-Adrenergic blockers * Calcium channel blockers * Diazepam (Valium) * Morphine sulfate * Nitrates * Progesterone * Theophylline * Fatty foods * Nicotine * Peppermint, spearmint * Tea, coffee (caffeine)

Question 108

What factors increase lower esophageal sphincter pressure?

Answer 108

* Bethanechol (Urecholine) * Metoclopramide (Reglan)

Question 109

What is the most common symptom of GERD?

Answer 109

Heartburn (pyrosis)

Question 110

Describe heartburn.

Answer 110

A burning, tight sensation felt beneath the lower sternum and spreading upward to the throat or jaw.

Question 111

What should be evaluated in cases of heartburn?

Answer 111

Heartburn that occurs more than twice a week, is severe, is associated with dysphagia, or occurs at night.

Question 112

What is GERD-related chest pain commonly mistaken for?

Answer 112

Angina

Question 113

How does GERD-related chest pain differ from angina?

Answer 113

Antacids relieve GERD-related chest pain.

Question 114

What is dyspepsia?

Answer 114

Pain or discomfort centered in the upper abdomen.

Question 115

What is regurgitation?

Answer 115

Hot, bitter, or sour liquid coming into the throat or mouth.

Question 116

What respiratory symptoms may a person with GERD report?

Answer 116

* Wheezing * Coughing * Dyspnea

Question 117

What are some otolaryngologic symptoms of GERD?

Answer 117

* Hoarseness * Sore throat * Globus sensation * Hypersalivation * Choking

Question 118

What is Barrett's esophagus?

Answer 118

A precancerous lesion characterized by metaplasia in the distal esophagus.

Question 119

What are some risk factors for Barrett's esophagus?

Answer 119

* Being male * Chronic GERD * Age over 50 * Central obesity * Ethnicity (white)

Question 120

What complications can arise from GERD?

Answer 120

* Esophagitis * Ulcers * Strictures * Dysphagia * Respiratory complications (cough, bronchospasm, laryngospasm) * Dental erosion

Question 121

What diagnostic studies are used for GERD?

Answer 121

* Endoscopy * Biopsy and cytologic specimens * Manometric studies * Ambulatory esophageal pH monitoring * Radionuclide tests

Question 122

What is esophagitis?

Answer 122

Inflammation of the esophagus.

Question 123

What lifestyle modifications can help manage GERD?

Answer 123

Lifestyle modifications, drug therapy, and nutrition therapy.

Question 124

What is GERD?

Answer 124

Gastroesophageal reflux disease, a chronic digestive condition

Question 125

What is a hiatal hernia?

Answer 125

A condition where part of the stomach pushes through the diaphragm into the chest

Question 126

What is the purpose of a barium swallow?

Answer 126

To assess swallowing and identify abnormalities in the esophagus

Question 127

What is Nissen fundoplication?

Answer 127

A surgical procedure to treat GERD by wrapping the top of the stomach around the lower esophagus

Question 128

What lifestyle modification should be made to manage GERD?

Answer 128

Follow a low-fat diet

Question 129

What should patients do after eating to help manage GERD?

Answer 129

Avoid lying down for 2-3 hours

Question 130

What position should the head of the bed be for GERD management?

Answer 130

Elevated 30 degrees

Question 131

What types of medications are commonly used to treat GERD?

Answer 131

* Proton pump inhibitors (PPIs) * H2 receptor blockers * Antacids * Prokinetics

Question 132

What dietary items should be avoided by GERD patients?

Answer 132

* Acidic beverages (colas, red wine, orange juice) * Alcohol * Fatty foods * Chocolate * Peppermint

Question 133

What is the goal of drug therapy for GERD?

Answer 133

To decrease reflux volume and acidity, improve LES function, and protect esophageal mucosa

Question 134

How do proton pump inhibitors (PPIs) work?

Answer 134

They suppress gastric acid production

Question 135

What are potential side effects of long-term PPI use?

Answer 135

* Decreased bone density * Kidney disease * Vitamin B12 deficiency * Magnesium deficiency

Question 136

What is the onset of action for H2 receptor blockers?

Answer 136

1 hour

Question 137

What are common antacids used for heartburn relief?

Answer 137

* Magnesium hydroxide * Aluminum hydroxide

Question 138

When are antacids most effective?

Answer 138

1 to 3 hours after meals and at bedtime

Question 139

What is the effect duration of antacids taken on an empty stomach?

Answer 139

20 to 30 minutes

Question 140

What is a key recommendation for patients who smoke?

Answer 140

Encourage quitting smoking

Question 141

What is the effect of stopping smoking on LES pressure?

Answer 141

Causes an immediate, marked decrease

Question 142

What is the primary purpose of adjunctive treatments in GERD?

Answer 142

To provide quick relief of heartburn symptoms

Question 143

What is the mechanism of action for Proton Pump Inhibitors (PPIs)?

Answer 143

Inhibit the proton pump (H+-K+-ATPase) responsible for the secretion of H+ ## Footnote Examples of PPIs include dexlansoprazole, esomeprazole, lansoprazole, omeprazole, and pantoprazole.

Question 144

List the common side effects of Proton Pump Inhibitors (PPIs).

Answer 144

* Headache * Abdominal pain * Nausea * Diarrhea * Vomiting * Flatulence ## Footnote These side effects can vary in intensity among individuals.

Question 145

What is the mechanism of action of Histamine (H2) Receptor Blockers?

Answer 145

Block the action of histamine on the H2 receptors to decrease HCl acid secretion ## Footnote Examples include cimetidine, famotidine, and nizatidine.

Question 146

List the common side effects of Histamine (H2) Receptor Blockers.

Answer 146

* Headache * Abdominal pain * Constipation * Diarrhea ## Footnote These side effects can vary in severity.

Question 147

What is the primary function of antacids?

Answer 147

Neutralize HCl acid ## Footnote Antacids are often taken 1-3 hours after meals and at bedtime.

Question 148

What are some examples of single substance antacids?

Answer 148

* Aluminum hydroxide (Amphojel) * Calcium carbonate (Tums) * Sodium bicarbonate (Alka-Seltzer) ## Footnote These substances vary in their side effects and should be chosen based on patient needs.

Question 149

What are the side effects associated with aluminum hydroxide?

Answer 149

* Constipation * Phosphorus depletion with chronic use ## Footnote Caution is advised in patients with chronic use.

Question 150

What side effects can calcium carbonate cause?

Answer 150

* Constipation or diarrhea * Hypercalcemia * Milk-alkali syndrome * Renal calculi ## Footnote These side effects may require monitoring.

Question 151

What are some potential side effects of magnesium preparations?

Answer 151

* Diarrhea * Hypermagnesemia ## Footnote Use magnesium preparations with caution in patients with renal issues.

Question 152

What is the mechanism of action of cytoprotective agents like sucralfate?

Answer 152

Form a protective layer and serve as a barrier against acid, bile salts, and enzymes in the stomach ## Footnote Sucralfate can lead to constipation.

Question 153

What is the primary action of prokinetic agents like metoclopramide?

Answer 153

Increase gastric motility and emptying ## Footnote Metoclopramide can have CNS side effects ranging from anxiety to hallucinations.

Question 154

What is the function of prostaglandin (synthetic) agents like misoprostol?

Answer 154

Increase production of gastric mucus and mucosal secretion of bicarbonate ## Footnote Misoprostol also has antisecretory effects.

Question 155

What are the risks associated with the use of antacids in patients with renal failure?

Answer 155

Risk for magnesium toxicity ## Footnote Patients with renal issues should avoid magnesium preparations.

Question 156

How can antacids interact with other medications?

Answer 156

Enhance the effects of some drugs and decrease absorption rates of others ## Footnote Timing adjustments may be necessary when administering other medications.

Question 157

What is a common agent used to promote gastric emptying?

Answer 157

Cisapride

Question 158

What is the purpose of laparoscopic antireflux surgeries?

Answer 158

To reinforce the lower esophageal sphincter and reduce reflux symptoms

Question 159

List some complications of laparoscopic antireflux surgery.

Answer 159

* Gastric or esophageal injury * Splenic injury * Pneumothorax * Perforation * Bleeding * Infection * Pneumonia

Question 160

What is the LINX Reflux Management System?

Answer 160

A ring of small, flexible magnets that strengthens the weak lower esophageal sphincter

Question 161

What are the potential problems associated with the LINX system?

Answer 161

* Nausea * Swallowing problems * Pain when swallowing food

Question 162

Can patients with a LINX system undergo MRI scans?

Answer 162

No, it could cause serious harm

Question 163

What is a hiatal hernia?

Answer 163

Herniation of part of the stomach into the esophagus through an opening in the diaphragm

Question 164

What are the two types of hiatal hernias?

Answer 164

* Sliding hiatal hernia * Paraesophageal (rolling) hernia

Question 165

What occurs during a sliding hiatal hernia?

Answer 165

The junction of the stomach and esophagus slides above the diaphragm when the patient is supine

Question 166

What characterizes a paraesophageal hernia?

Answer 166

The fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus

Question 167

What factors contribute to the development of a hiatal hernia?

Answer 167

* Weakening of diaphragm muscles * Obesity * Pregnancy * Ascites * Tumors * Intense physical exertion * Heavy lifting

Question 168

What are some clinical manifestations of hiatal hernia?

Answer 168

Similar to those of GERD, and some individuals may be asymptomatic

Question 169

What complications can arise from a hiatal hernia?

Answer 169

* GERD * Esophagitis * Bleeding from erosion * Stenosis * Ulcerations * Strangulation * Regurgitation with tracheal aspiration

Question 170

What diagnostic study may show protrusion of gastric mucosa through the esophageal hiatus?

Answer 170

Esophagram (barium swallow)

Question 171

What are alternatives to surgery for treating hiatal hernia?

Answer 171

* Endoscopic mucosal resection (EMR) * Radiofrequency ablation

Question 172

What is the surgical procedure for hiatal hernia that involves wrapping the fundus of the stomach around the distal esophagus?

Answer 172

Nissen fundoplication ## Footnote The fundus is then sutured to itself.

Question 173

What are the conservative therapies for managing hiatal hernia?

Answer 173

Similar to those described for GERD: reducing intraabdominal pressure by eliminating constricting garments and avoiding lifting and straining.

Question 174

What surgical treatments are included for hiatal hernia?

Answer 174

* Reducing the herniated stomach into the abdomen * Herniotomy (excision of the hernia sac) * Herniorrhaphy (closure of the hiatal defect) * Fundoplication * Gastropexy (attachment of the stomach below the diaphragm to prevent re-herniation)

Question 175

What are the goals of surgery for hiatal hernia?

Answer 175

* Reduce the hernia * Provide an acceptable LES pressure * Prevent movement of the gastroesophageal junction

Question 176

What techniques are commonly used for laparoscopic surgery to repair hiatal hernia?

Answer 176

Nissen or Toupet techniques.

Question 177

What factors increase the incidence of hiatal hernia and GERD in older adults?

Answer 177

* Weakening of the diaphragm * Obesity * Kyphosis * Other factors that increase intraabdominal pressure

Question 178

What medications may decrease LES pressure in older adults, increasing their risk for hiatal hernia and GERD?

Answer 178

* Nitrates * Calcium channel blockers * Antidepressants

Question 179

What is the overall 5-year survival rate for esophageal cancer in the United States?

Answer 179

20%.

Question 180

What are the most common types of esophageal cancer?

Answer 180

* Adenocarcinomas * Squamous cell tumors

Question 181

What are key risk factors for developing esophageal cancer?

Answer 181

* Barrett's esophagus (BE) * Smoking * Excess alcohol use * Obesity

Question 182

What condition associated with delayed emptying of the lower esophagus is linked to squamous cell cancer?

Answer 182

Achalasia.

Question 183

Where do most esophageal tumors occur?

Answer 183

In the middle and lower portions of the esophagus.

Question 184

What is the most common symptom of esophageal cancer?

Answer 184

Progressive dysphagia.

Question 185

How does dysphagia progress in patients with esophageal cancer?

Answer 185

* First with meat * Then with soft foods * Eventually with liquids

Question 186

What is a common site of metastasis for esophageal cancer?

Answer 186

* Liver * Lung

Question 187

What is esophagectomy?

Answer 187

Removal of part or all of the esophagus ## Footnote Esophagectomy may involve the use of a Dacron graft to replace the resected part.

Question 188

What are the types of surgical procedures for esophageal cancer?

Answer 188

* Esophagectomy * Esophagoenterostomy * Esophagogastrostomy ## Footnote These procedures involve removing or resecting parts of the esophagus and connecting it to other parts of the digestive tract.

Question 189

What is endoscopic mucosal resection (EMR)?

Answer 189

A procedure that involves removing cancer tissue using an endoscope ## Footnote EMR is an option for small, very early-stage cancers.

Question 190

What is photodynamic therapy?

Answer 190

A treatment that uses a photosensitizer, porfimer sodium, activated by light to destroy cancer cells ## Footnote Patients must avoid direct sunlight for up to 6 weeks after treatment.

Question 191

What is radiofrequency ablation?

Answer 191

A technique that uses electric currents to kill cancer cells ## Footnote This method is often used when other treatments are not effective.

Question 192

What are the benefits of minimally invasive esophagectomy?

Answer 192

Decreased ICU and hospital stays with fewer pulmonary complications ## Footnote This approach often uses laparoscopic techniques.

Question 193

List some diagnostic assessments for esophageal cancer.

Answer 193

* History and physical assessment * Endoscopy of esophagus with biopsy * Esophagram (barium swallow) * Bronchoscopy * CT, MRI, PET scans ## Footnote These assessments help determine the type and stage of cancer.

Question 194

What is the role of chemotherapy in treating esophageal cancer?

Answer 194

Chemotherapy can be used with or without radiation therapy to treat esophageal cancer ## Footnote Regimens may include various combinations of chemotherapy drugs.

Question 195

Fill in the blank: The surgical approach may be open or _______.

Answer 195

laparoscopic ## Footnote Laparoscopic surgery involves smaller incisions and is often associated with quicker recovery times.

Question 196

True or False: Stents can help relieve obstruction in the esophagus.

Answer 196

True ## Footnote Stents allow food and liquid to pass through stenotic areas.

Question 197

What is the purpose of dilation in esophageal cancer treatment?

Answer 197

To increase the lumen of the esophagus and relieve dysphagia ## Footnote Dilation can help improve nutrition by allowing better passage of food.

Question 198

What are some chemotherapy regimens used for esophageal cancer?

Answer 198

* Carboplatin and paclitaxel * Cisplatin and irinotecan * Oxaliplatin with fluorouracil or capecitabine ## Footnote DCF (docetaxel, cisplatin, fluorouracil) is an option for metastatic disease.

Question 199

What is targeted therapy in the context of esophageal cancer?

Answer 199

Therapy that targets cancers with excessive HER-2 protein to inhibit cancer cell growth ## Footnote Trastuzumab is a common targeted therapy used.

Question 200

What is the function of Herceptin?

Answer 200

Targets the HER-2 protein and kills cancer cells.

Question 201

What type of drug is Ramucirumab (Cyramza)?

Answer 201

An angiogenesis inhibitor.

Question 202

How does Ramucirumab work?

Answer 202

Binds to the receptor for vascular endothelial growth factor (VEGF) and prevents VEGF from signaling to make more blood vessels.

Question 203

What types of cancers does Ramucirumab treat?

Answer 203

Advanced cancers that start at the gastroesophageal junction.

Question 204

What is a common postoperative care intervention following esophageal surgery?

Answer 204

The patient receives IV fluids.

Question 205

What may be placed depending on the type of esophageal surgery?

Answer 205

A feeding tube.

Question 206

What is essential for postoperative care after esophageal surgery?

Answer 206

Meticulous oral care.

Question 207

What should be given when starting oral fluids post-surgery?

Answer 207

Water (30 to 60 ml) hourly.

Question 208

How long should the patient remain in an upright position after eating?

Answer 208

At least 2 hours.

Question 209

What symptoms may indicate leakage of feeding into the mediastinum?

Answer 209

Pain, fever.

Question 210

What is a common complication to assess for in postoperative patients?

Answer 210

Dysphagia and odynophagia.

Question 211

What should be assessed in the patient with esophageal cancer?

Answer 211

History of GERD, hiatal hernia, achalasia, BE, and tobacco and alcohol use.

Question 212

What is the typical duration for an NG tube post-esophageal surgery?

Answer 212

5 to 7 days.

Question 213

What color does the NG tube drainage change to after 8 to 12 hours?

Answer 213

Greenish yellow.

Question 214

What is an important nursing action regarding the NG tube?

Answer 214

Do not irrigate, reposition, or reinsert without consulting the HCP.

Question 215

What should be monitored in chest tube drainage?

Answer 215

Amount and type of drainage.

Question 216

What are the overall goals for a patient with esophageal cancer?

Answer 216

* Relief of symptoms * Optimal nutrition intake * Quality of life appropriate to stage of disease and prognosis.

Question 217

What should be implemented to prevent respiratory complications?

Answer 217

Have the patient turn, cough, and deep breathe, and use an incentive spirometer every 2 hours.

Question 218

What is a key health promotion strategy for patients with GERD?

Answer 218

Regular follow-up evaluation.

Question 219

What dietary habits should be encouraged for patients post-esophageal surgery?

Answer 219

Intake of fresh fruits and vegetables.

Question 220

What may be necessary for long-term nutritional support after surgery?

Answer 220

A permanent feeding gastrostomy.

Question 221

What is the expected outcome for a patient with esophageal cancer regarding airway management?

Answer 221

Maintain a patent airway

Question 222

What is the expected outcome for a patient with esophageal cancer regarding pain management?

Answer 222

Have relief of pain

Question 223

What is the expected outcome for a patient with esophageal cancer regarding swallowing ability?

Answer 223

Be able to swallow comparably and consume adequate intake

Question 224

What is the expected outcome for a patient with esophageal cancer regarding quality of life?

Answer 224

Have a quality of life appropriate to stage of disease and prognosis

Question 225

What is Zenker's diverticulum?

Answer 225

A pharyngoesophageal diverticulum located just above the upper esophageal sphincter

Question 226

What are the three main areas where esophageal diverticula occur?

Answer 226

* Above the upper esophageal sphincter (Zenker's) * Near the esophageal midpoint (traction) * Above the LES (epiphrenic)

Question 227

What is Eosinophilic Esophagitis?

Answer 227

A condition characterized by infiltration of eosinophils in the esophagus, often associated with allergic diseases

Question 228

What are common environmental allergens that may be involved in Eosinophilic Esophagitis?

Answer 228

* Pollens * Molds * Cat allergens * Dog allergens * Dust mite allergens

Question 229

What are the typical symptoms of Eosinophilic Esophagitis?

Answer 229

* Severe heartburn * Vomiting * Dysphagia * Food impaction

Question 230

What is the primary treatment approach for Eosinophilic Esophagitis?

Answer 230

Avoiding foods that trigger allergic reactions

Question 231

What is the most common cause of esophageal strictures?

Answer 231

Chronic GERD

Question 232

What are potential causes of esophageal strictures?

Answer 232

* Ingesting strong acids or alkalis * External beam radiation * Surgical anastomosis * Trauma (e.g., throat lacerations, gunshot wounds)

Question 233

What are common symptoms of esophageal strictures?

Answer 233

* Dysphagia * Regurgitation * Weight loss

Question 234

What are the methods to dilate strictures in the esophagus?

Answer 234

* Mechanical bougies * Balloons * Endoscopy or fluoroscopy

Question 235

What is Achalasia?

Answer 235

A chronic disorder characterized by the absence of peristalsis in the lower two thirds of the esophagus

Question 236

What are the typical symptoms of Achalasia?

Answer 236

* Dysphagia * Regurgitation * Chronic cough * Aspiration * Weight loss

Question 237

What occurs in the lower esophagus during Achalasia?

Answer 237

Food and fluid accumulate, leading to dilation of the esophagus above the affected segment

Question 238

How is the diagnosis of Achalasia typically established?

Answer 238

Through endoscopy or barium studies

Question 239

What is a serious surgical complication associated with esophageal diverticula treatment?

Answer 239

Esophageal perforation

Question 240

What medications are commonly used to treat Eosinophilic Esophagitis when avoiding allergens does not relieve symptoms?

Answer 240

* PPIs * Corticosteroids

Question 241

How can corticosteroids be administered for esophageal conditions?

Answer 241

* Orally (e.g., prednisone) * Topically (e.g., inhaled fluticasone)

Question 242

What is a common side effect of using inhaled corticosteroids for esophageal conditions?

Answer 242

Esophageal candidiasis (yeast infection of the throat)

Question 243

What sensation may patients report during or right after a meal?

Answer 243

Globus sensation and/or substernal chest pain

Question 244

What percentage of patients experience nighttime regurgitation?

Answer 244

About a third

Question 245

What is halitosis?

Answer 245

Foul-smelling breath

Question 246

What symptoms may indicate gastroesophageal reflux disease (GERD)?

Answer 246

Regurgitation of sour-tasting food and liquids, especially when lying down

Question 247

What common symptom is associated with this condition?

Answer 247

Weight loss

Question 248

What diagnostic methods are used for this condition?

Answer 248

Esophagram (barium swallow), manometric evaluation, and/or endoscopic evaluation

Question 249

What are the treatment goals for patients with this condition?

Answer 249

Relieve dysphagia and regurgitation, improve esophageal emptying, and prevent megaesophagus

Question 250

What is endoscopic pneumatic dilation?

Answer 250

A procedure that dilates the LES muscle using balloons of progressively larger diameter

Question 251

What happens if endoscopic pneumatic dilation is ineffective?

Answer 251

A Heller myotomy may be performed laparoscopically

Question 252

What does a Heller myotomy involve?

Answer 252

Cutting through the muscles of the LES to allow food to pass

Question 253

What common complication may arise after treatment?

Answer 253

GERD with esophagitis and stricture

Question 254

What is the role of nitrates in treatment?

Answer 254

They are used for symptom management, taken sublingually before meals

Question 255

What are the side effects of using nitrates?

Answer 255

Drug tolerance and short duration of action

Question 256

What dietary recommendations are given for symptomatic treatment?

Answer 256

Eating a soft diet, eating slowly, drinking fluids with meals, and keeping the head elevated

Question 257

What are esophageal varices?

Answer 257

Dilated, tortuous veins occurring in the lower part of the esophagus

Question 258

What causes esophageal varices?

Answer 258

Portal hypertension

Question 259

What environment is necessary for the development of peptic ulcers?

Answer 259

An acid environment is necessary for the development of peptic ulcers.

Question 260

Is an excess of HCl acid necessary for ulcer development?

Answer 260

No, an excess of HCl acid is not necessary for ulcer development.

Question 261

What changes pepsinogen to pepsin?

Answer 261

HCl acid and a pH of 2 to 3 change pepsinogen to pepsin.

Question 262

What happens to pepsin activity at a pH of 3.5 or more?

Answer 262

Pepsin has little or no proteolytic activity.

Question 263

What results from the back diffusion of HCl acid into the gastric mucosa?

Answer 263

Cellular destruction and inflammation result from the back diffusion of HCl acid.

Question 264

What is released from the damaged mucosa during ulcer development?

Answer 264

Histamine is released from the damaged mucosa.

Question 265

What are the effects of histamine release in the context of ulcers?

Answer 265

Vasodilation, increased capillary permeability, and further secretion of acid and pepsin occur.

Question 266

What is the major risk factor for peptic ulcer disease (PUD)?

Answer 266

Infection with Helicobacter pylori is the major risk factor for PUD.

Question 267

What percentage of gastric ulcers are related to H. pylori infection?

Answer 267

80% of gastric ulcers are related to H. pylori infection.

Question 268

What is the infection rate of H. pylori in the United States for persons younger than 30 years?

Answer 268

20% of persons younger than 30 years are affected by H. pylori.

Question 269

What is the infection rate of H. pylori in the United States for persons older than 60 years?

Answer 269

50% of persons older than 60 years are affected by H. pylori.

Question 270

How is H. pylori likely transmitted to children?

Answer 270

H. pylori is likely transmitted during childhood from family members through fecal-oral or oral-oral routes.

Question 271

What distinguishes chronic ulcers from acute ulcers?

Answer 271

Chronic ulcers are more common and can erode through the muscular wall.

Question 272

What are the common sites for gastric and duodenal ulcers?

Answer 272

Common sites include the stomach and small intestine.

Question 273

What strains of H. pylori are more likely to cause PUD?

Answer 273

CagA-positive strains of H. pylori are more likely to cause PUD.

Question 274

What are the characteristics of duodenal ulcers?

Answer 274

Superficial, smooth margins; penetrating with deformity of duodenal bulb from healing of recurrent ulcers ## Footnote Duodenal ulcers are typically found in the first 1-2 cm of the duodenum.

Question 275

Where are gastric ulcers primarily located?

Answer 275

Predominantly in the antrum; also in the body and fundus of the stomach ## Footnote Gastric ulcers can occur in any part of the stomach but are most commonly found in the antrum.

Question 276

What is the typical gastric secretion level in duodenal ulcers?

Answer 276

Normal to decreased ## Footnote This contrasts with gastric ulcers, which may have different secretion levels.

Question 277

What is the peak age for duodenal ulcers?

Answer 277

50-60 years ## Footnote The incidence of duodenal ulcers is higher in men but increasing in women, especially postmenopausal.

Question 278

What is the incidence of H. pylori infection in duodenal ulcers?

Answer 278

80% ## Footnote H. pylori infection is a significant risk factor for duodenal ulcers.

Question 279

What are common clinical manifestations of duodenal ulcers?

Answer 279

Burning or gaseous pressure in midepigastrium and upper abdomen; back pain with posterior ulcers ## Footnote Pain typically occurs 1-2 hours after meals.

Question 280

What is the recurrence rate of gastric ulcers compared to duodenal ulcers?

Answer 280

Higher for gastric ulcers ## Footnote Recurrence rates can vary significantly between the two types of ulcers.

Question 281

What is the role of NSAIDs in peptic ulcer disease (PUD)?

Answer 281

Responsible for most non-H. pylori peptic ulcers; they inhibit prostaglandin synthesis and increase gastric acid secretion ## Footnote NSAID use in the presence of H. pylori further increases the risk for PUD.

Question 282

What lifestyle factors can contribute to the development of ulcers?

Answer 282

High alcohol intake, smoking, stress, and depression ## Footnote These factors can stimulate acid secretion and delay healing of ulcers.

Question 283

What is the effect of corticosteroids on the gastric mucosa?

Answer 283

Affects mucosal cell renewal and decreases its protective effects ## Footnote Patients taking corticosteroids with NSAIDs have a higher risk for PUD.

Question 284

What is a significant consequence of H. pylori infection?

Answer 284

Increased gastric secretion and tissue damage, leading to PUD ## Footnote H. pylori produces urease, which metabolizes urea into ammonium chloride and other damaging chemicals.

Question 285

What are the characteristics of gastric ulcers?

Answer 285

Round, oval, or cone shaped lesions; can occur in any part of the stomach, most often in the antrum ## Footnote Gastric ulcers are less common than duodenal ulcers.

Question 286

What is the peak incidence age for gastric ulcers?

Answer 286

35-45 years ## Footnote Gastric ulcers are more prevalent in women and those over 50 years of age.

Question 287

What is the incidence of H. pylori infection in gastric ulcers?

Answer 287

90% ## Footnote This high incidence indicates a strong link between H. pylori and gastric ulcers.

Question 288

What symptoms are associated with gastric ulcers?

Answer 288

Burning, cramping, pressure-like pain across the epigastrium; pain can occur 2-5 hours after meals ## Footnote Pain may also occur midmorning, midafternoon, and during the night.

Question 289

What happens to gastric mucosal blood flow in the presence of ulcers?

Answer 289

Inadequate blood flow leads to tissue anoxia and acidosis ## Footnote This can result in severe injury to the gastric mucosa.

Question 290

What are the main risk factors for duodenal ulcers?

Answer 290

High gastric acidity and pulmonary disease ## Footnote Other risk factors may include chronic use of NSAIDs and smoking.

Question 291

Where is the discomfort generally located in gastric ulcers?

Answer 291

High in the epigastric region

Question 292

How soon after meals do gastric ulcer symptoms typically occur?

Answer 292

1 to 2 hours

Question 293

What is the description of pain in gastric ulcers?

Answer 293

Burning or gaseous

Question 294

What symptoms occur in duodenal ulcers when gastric acid comes in contact with the ulcers?

Answer 294

Burning or cramplike pain

Question 295

When do symptoms of duodenal ulcers typically occur after meals?

Answer 295

2 to 5 hours

Question 296

What region is the pain most often located in duodenal ulcers?

Answer 296

Midepigastric region beneath the xiphoid process

Question 297

What additional symptoms can duodenal ulcers cause?

Answer 297

Bloating, nausea, vomiting, early feelings of fullness

Question 298

What are silent peptic ulcers more likely to occur in?

Answer 298

Older adults and those taking NSAIDs

Question 299

What is the most accurate procedure to determine the presence and location of an ulcer?

Answer 299

Endoscopy

Question 300

What does endoscopy allow for in relation to ulcers?

Answer 300

Direct viewing of the gastric and duodenal mucosa

Question 301

What is the gold standard for diagnosing H. pylori infection?

Answer 301

Biopsy of the antral mucosa with testing for urease

Question 302

What noninvasive tests are available to confirm H. pylori infection?

Answer 302

Serology, stool, and breath testing

Question 303

Which test is more accurate for identifying active H. pylori infection?

Answer 303

Urea breath test

Question 304

What laboratory tests may be done to assess complications from ulcers?

Answer 304

CBC, liver enzyme studies, serum amylase, and stool examination

Question 305

What is the aim of treatment for duodenal ulcers?

Answer 305

Decrease gastric acidity and enhance mucosal defense mechanisms

Question 306

What is the typical duration for ulcer healing?

Answer 306

3 to 9 weeks

Question 307

How long after diagnosis and treatment is the usual follow-up endoscopic evaluation?

Answer 307

3 to 6 months

Question 308

What should be stopped for 4 to 6 weeks in ulcer treatment?

Answer 308

Aspirin and nonselective NSAIDs

Question 309

What may be prescribed when aspirin must be continued during ulcer treatment?

Answer 309

PPI, H2 receptor blocker, or misoprostol

Question 310

What are the diagnostic assessments for Peptic Ulcer Disease?

Answer 310

* History and physical assessment * Upper GI endoscopy with biopsy * Endoscopic ultrasound * H. pylori testing of breath, urine, blood, tissue * Complete blood cell count * Liver enzymes * Serum amylase * Stool testing for blood ## Footnote These assessments help in confirming the diagnosis and understanding the severity of the condition.

Question 311

What are the components of conservative therapy for Peptic Ulcer Disease?

Answer 311

* Adequate rest * Smoking and alcohol cessation * Stress management ## Footnote Conservative therapy aims to promote healing and prevent complications.

Question 312

What types of drug therapy are used for H. pylori infection?

Answer 312

* Antibiotics * Proton pump inhibitors (PPIs) * H2 receptor blockers * Cytoprotective drugs * Antacids ## Footnote These medications work synergistically to eradicate H. pylori and promote ulcer healing.

Question 313

What is the management approach during an acute exacerbation without complications?

Answer 313

* NPO (nothing by mouth) * NG suction * Adequate rest * IV fluid replacement ## Footnote These measures help stabilize the patient's condition and prevent further complications.

Question 314

What additional management is required during an acute exacerbation with complications?

Answer 314

* NPO * NG suction * IV proton pump inhibitors (PPIs) * Bed rest * IV fluid replacement * Blood transfusions * Stomach lavage (possible) ## Footnote Complications may include bleeding, perforation, or obstruction, necessitating more intensive management.

Question 315

What surgical therapies may be indicated for Peptic Ulcer Disease?

Answer 315

* Pyloroplasty and vagotomy for gastric outlet obstruction * Simple closure with omentum graft for perforation * Ulcer removal or reduction * Billroth I and II procedures * Vagotomy and pyloroplasty ## Footnote Surgical interventions are considered when medical management fails or complications arise.

Question 316

What role do proton pump inhibitors (PPIs) play in the treatment of ulcers?

Answer 316

PPIs are more effective than H2 receptor blockers in reducing gastric acid secretion and promoting ulcer healing. ## Footnote They are often used in combination with antibiotics to treat ulcers caused by H. pylori.

Question 317

What is the function of sucralfate in ulcer treatment?

Answer 317

Sucralfate provides mucosal protection for the esophagus, stomach, and duodenum but does not have acid-neutralizing capabilities. ## Footnote It is most effective at a low pH and should be administered at least 60 minutes before or after an antacid.

Question 318

What are the potential side effects of misoprostol?

Answer 318

* Diarrhea * Abdominal pain * Teratogenic effects ## Footnote Misoprostol is used to prevent gastric ulcers caused by NSAIDs but must be used cautiously in women of childbearing age.

Question 319

What are adjunct drugs used in the management of Peptic Ulcer Disease?

Answer 319

* H2 receptor blockers * Antacids ## Footnote These adjunct therapies promote ulcer healing by increasing gastric pH and reducing acid content.

Question 320

Which antibiotics may be included in a regimen for H. pylori treatment?

Answer 320

* Amoxicillin * Rifabutin * Metronidazole ## Footnote These antibiotics can be part of a combination therapy to effectively eradicate H. pylori.

Question 321

What is the impact of smoking on ulcer treatment?

Answer 321

Smoking irritates the mucosa and delays mucosal healing. ## Footnote Patients are advised to stop smoking to enhance treatment outcomes.

Question 322

What is the first-line drug therapy for H. pylori infection?

Answer 322

PPI, Amoxicillin, Clarithromycin ## Footnote PPI: Proton Pump Inhibitor

Question 323

What are the components of Triple Therapy for H. pylori infection?

Answer 323

PPI, Amoxicillin, Clarithromycin ## Footnote Typically involves 20-40 mg of PPI, 1 g of Amoxicillin, and 500 mg of Clarithromycin.

Question 324

What is included in Bismuth Quadruple Therapy?

Answer 324

PPI, Bismuth compound, Metronidazole, Tetracycline ## Footnote Dosages include 20-40 mg PPI, 2 tablets of Bismuth, 500 mg of Metronidazole, and 500 mg of Tetracycline.

Question 325

What are the major complications of chronic Peptic Ulcer Disease (PUD)?

Answer 325

GI bleeding, Perforation, Gastric outlet obstruction ## Footnote These complications can be emergency situations requiring surgical intervention.

Question 326

What is the most common complication of PUD?

Answer 326

GI bleeding ## Footnote Duodenal ulcers cause more bleeding episodes than gastric ulcers.

Question 327

What is the most lethal complication of PUD?

Answer 327

Perforation ## Footnote The risk of perforation is highest with large penetrating duodenal ulcers.

Question 328

What happens during perforation of an ulcer?

Answer 328

Ulcer penetrates the serosal surface, spilling contents into the peritoneal cavity ## Footnote Contents may include air, saliva, food particles, HCl, pepsin, bacteria, bile, and pancreatic fluid.

Question 329

What are the initial symptoms of perforation?

Answer 329

Sudden severe upper abdominal pain, rigid abdomen, absent bowel sounds ## Footnote Pain may radiate to the back and shoulders, and food or antacids do not relieve it.

Question 330

What is the immediate focus of managing a patient with a perforation?

Answer 330

Stop spillage of gastric or duodenal contents and restore blood volume ## Footnote An NG tube can provide continuous aspiration and gastric decompression.

Question 331

What fluids are used to replace circulating blood volume in perforation management?

Answer 331

Lactated Ringer's and albumin solutions ## Footnote These substitute for fluids lost as peritonitis develops.

Question 332

What is the role of broad-spectrum antibiotics in perforation management?

Answer 332

To treat bacterial peritonitis ## Footnote Initiated immediately after perforation is diagnosed.

Question 333

What may happen with small perforations without treatment?

Answer 333

They may spontaneously seal themselves ## Footnote Symptoms cease due to fibrin formation.

Question 334

What is the recommended therapy for patients with a history of heart disease during perforation management?

Answer 334

ECG monitoring or pulmonary artery catheter for left ventricular function assessment ## Footnote Important for monitoring cardiovascular status.

Question 335

What is Peptic Ulcer Disease (PUD)?

Answer 335

A condition characterized by open sores on the lining of the stomach or the first part of the small intestine.

Question 336

What are the common medications associated with PUD?

Answer 336

* Aspirin * Corticosteroids * NSAIDs

Question 337

What immediate action is required for larger perforations in PUD?

Answer 337

Immediate surgical closure.

Question 338

What is the purpose of suctioning gastric contents during surgery for PUD?

Answer 338

To remove excess gastric contents from the peritoneal cavity.

Question 339

Identify some subjective data to assess in a patient with PUD.

Answer 339

* Chronic pain * Anorexia * Nausea * Vomiting

Question 340

What are some signs of gastric outlet obstruction caused by PUD?

Answer 340

* Discomfort or pain worse toward the end of the day * Belching * Projectile vomiting

Question 341

What symptoms might indicate a patient is experiencing gastric outlet obstruction?

Answer 341

* Constipation from dehydration * Visible swelling in the upper abdomen * Anemia

Question 342

What is the aim of therapy for gastric outlet obstruction?

Answer 342

* Decompress the stomach * Correct fluid and electrolyte imbalances * Improve general health

Question 343

What diagnostic findings can suggest PUD?

Answer 343

* H. pylori presence * Abnormal upper GI endoscopic studies * Barium studies

Question 344

What nursing management strategies are essential for patients with PUD?

Answer 344

* Identify at-risk patients * Early detection and treatment * Encourage taking ulcerogenic drugs with food

Question 345

What are the overall goals for a patient with PUD during treatment?

Answer 345

* Adhere to therapeutic regimen * Achieve pain relief * Be free from complications * Complete healing of the ulcer * Make lifestyle changes to prevent recurrence

Question 346

What might analysis of gastric contents include?

Answer 346

* pH testing * Analysis for blood * Analysis for bile or other substances

Question 347

What should patients be taught regarding symptoms related to gastric irritation?

Answer 347

To report symptoms, including epigastric pain, to their healthcare provider.

Question 348

What is the initial treatment for a patient with acute upper gastrointestinal problems?

Answer 348

IV fluids with electrolyte replacement to keep the patient hydrated ## Footnote This treatment is essential until edema and inflammation resolve.

Question 349

What should patients with Peptic Ulcer Disease (PUD) be taught to prevent recurrence?

Answer 349

Teaching should cover aspects of the disease process, drugs, lifestyle changes, and dietary modifications ## Footnote Important lifestyle changes include reducing alcohol use and quitting smoking.

Question 350

What medications should patients with PUD avoid unless approved by their healthcare provider?

Answer 350

Over-the-counter drugs such as NSAIDs and aspirin ## Footnote These medications can exacerbate ulcer symptoms.

Question 351

What is a common complication of PUD that requires immediate intervention?

Answer 351

Gastric outlet obstruction ## Footnote This is most likely to occur when the ulcer is close to the pylorus.

Question 352

What are the key lifestyle changes recommended for patients with PUD?

Answer 352

* Avoid acidic foods * Avoid cigarettes * Reduce or stop alcohol use ## Footnote Smoking delays ulcer healing and promotes ulcer development.

Question 353

What should be monitored to check for ongoing obstruction in a patient with PUD?

Answer 353

Gastric residual volume measured by clamping the NG tube intermittently ## Footnote Clamping the tube helps assess the patient's comfort level and the amount of aspirate obtained.

Question 354

What should patients do if they experience increased nausea or vomiting while managing PUD?

Answer 354

Report any increased nausea or vomiting to the healthcare provider ## Footnote This could indicate complications that need immediate attention.

Question 355

What should be emphasized to patients regarding prescribed drug therapy for PUD?

Answer 355

Follow prescribed drug therapy to prevent a relapse, including antisecretory and antibiotic drugs ## Footnote Adherence to medication is crucial for managing PUD effectively.

Question 356

What is the recommended action if symptoms of obstruction return after resuming oral feedings?

Answer 356

Promptly inform the healthcare provider ## Footnote Quick communication is essential for timely intervention.

Question 357

What is a common method for assessing gastric residual volume in patients with PUD?

Answer 357

Clamp the NG tube overnight and measure the residual volume in the morning ## Footnote A residual volume below 200 mL indicates that the patient can begin oral intake of clear liquids.

Question 358

What should patients with PUD learn about stress management?

Answer 358

Learn and use stress management strategies ## Footnote Stress can be related to the exacerbation of PUD symptoms.

Question 359

What is the main type of cancer associated with the stomach?

Answer 359

Adenocarcinoma ## Footnote Stomach cancer is primarily classified as adenocarcinoma.

Question 360

What are the demographics with the highest rates of stomach cancer?

Answer 360

Asian Americans, Pacific Islanders, Blacks, and Hispanics ## Footnote These groups have the highest incidence rates of stomach cancer.

Question 361

What is the average age at diagnosis for stomach cancer?

Answer 361

68.5 years ## Footnote This statistic reflects the typical age at which patients are diagnosed with stomach cancer.

Question 362

What percentage of stomach cancer patients have disease confined to the stomach at diagnosis?

Answer 362

10% to 20% ## Footnote This indicates that a majority of patients present with more advanced disease.

Question 363

What is the overall 5-year survival rate for stomach cancer?

Answer 363

About 32% ## Footnote This survival rate reflects the prognosis for all diagnosed individuals.

Question 364

What are common clinical manifestations of stomach cancer?

Answer 364

* Unexplained weight loss * Indigestion * Abdominal discomfort or pain * Anemia * Early satiety * Fatigue ## Footnote These symptoms may indicate the presence of stomach cancer.

Question 365

What is the best diagnostic tool for stomach cancer?

Answer 365

Upper GI endoscopy ## Footnote This procedure allows for direct visualization and biopsy of the gastric mucosa.

Question 366

What does endoscopic ultrasound help with in the context of stomach cancer?

Answer 366

Staging the disease ## Footnote This imaging technique is useful for assessing the extent of cancer spread.

Question 367

What is the primary treatment option for stomach cancer?

Answer 367

Surgical removal of the tumor ## Footnote Surgery aims to excise the tumor along with a margin of healthy tissue.

Question 368

What are some risk factors for stomach cancer?

Answer 368

* Atrophic gastritis * Pernicious anemia * Adenomatous polyps * Hyperplastic polyps * Smoking ## Footnote These factors can increase the likelihood of developing stomach cancer.

Question 369

What is a poor prognostic sign in stomach cancer patients?

Answer 369

Presence of ascites ## Footnote Ascites indicates advanced disease and is associated with a worse prognosis.

Question 370

What is the relationship between first-degree relatives of stomach cancer patients and their risk?

Answer 370

Increased risk of stomach cancer ## Footnote Family history can be a significant risk factor for developing stomach cancer.

Question 371

What is the significance of tumor markers in stomach cancer diagnosis?

Answer 371

They can help diagnose cancer ## Footnote Tumor markers are substances that can indicate the presence of cancer in the body.

Question 372

What is the role of blood studies in diagnosing stomach cancer?

Answer 372

* Detect anemia * Determine severity ## Footnote Blood tests can reveal complications related to stomach cancer.

Question 373

What common symptom might not be the first to present in older adults with PUD?

Answer 373

Pain ## Footnote Older patients may experience different symptoms, such as gastric bleeding, as initial indicators.

Question 374

What lifestyle factors can influence the development of stomach cancer?

Answer 374

* Tobacco use * Obesity * Diet high in smoked foods ## Footnote These lifestyle choices can contribute to the risk of stomach cancer.

Question 375

What is subtotal gastrectomy?

Answer 375

A surgical procedure where a portion of the stomach is removed, either as Billroth I or Billroth II procedure.

Question 376

What are the primary types of surgical therapy for stomach cancer?

Answer 376

* Subtotal gastrectomy (Billroth I or II) * Total gastrectomy with esophagojejunostomy

Question 377

What are the common biomarkers used in the diagnosis of duodenal cancer?

Answer 377

* Carbohydrate antigen (CA) 19-9 * CA-125 * CA 72-4 * Carcinoembryonic antigen (CEA)

Question 378

What is vagotomy?

Answer 378

A surgical procedure that involves cutting the vagus nerve to reduce acid secretion in the stomach.

Question 379

What is the purpose of preoperative management in stomach cancer?

Answer 379

To correct nutritional status and treat anemia, often through packed RBCs transfusions.

Question 380

What may be necessary if gastric outlet obstruction occurs?

Answer 380

Gastric decompression may be needed before surgery.

Question 381

What are the main chemotherapy agents used in stomach cancer treatment?

Answer 381

* Docetaxel * Epirubicin * Irinotecan * Oxaliplatin * Paclitaxel

Question 382

What is the significance of a nutrition assessment in stomach cancer patients?

Answer 382

To evaluate appetite changes, weight loss, and overall nutrition status, as malnourished patients respond poorly to treatment.

Question 383

What are the two targeted therapies mentioned for stomach cancer?

Answer 383

* Trastuzumab (Herceptin) * Ramucirumab (Cyramza)

Question 384

How does Trastuzumab work in treating stomach cancer?

Answer 384

It targets the HER-2 protein on cancer cells and kills them.

Question 385

What role does ramucirumab play in cancer treatment?

Answer 385

It binds to the VEGF receptor, preventing VEGF from binding and thus inhibiting cancer growth.

Question 386

What symptoms might a patient with stomach cancer experience?

Answer 386

* Vague abdominal symptoms * Dyspepsia * Intestinal gas discomfort or pain

Question 387

What is cachexia in the context of stomach cancer?

Answer 387

A condition characterized by severe weight loss and muscle wasting due to prolonged oral intake reduction.

Question 388

What is the potential benefit of combining radiation therapy with chemotherapy?

Answer 388

It can reduce recurrence or provide palliative measures to decrease tumor mass and relieve obstruction.

Question 389

What is the primary focus of acute care for patients with stomach cancer?

Answer 389

Assessing the patient's expectations about surgery and their response to previous surgical procedures.

Question 390

List some clinical problems for patients with stomach cancer.

Answer 390

* Nutritionally compromised * Pain * Impaired GI function * Difficulty coping

Question 391

What are the overall goals for a patient with stomach cancer?

Answer 391

* Have minimal discomfort * Achieve optimal nutrition status * Maintain a degree of spiritual and psychologic well-being appropriate to the disease stage

Question 392

What is the role of health promotion in early detection of stomach cancer?

Answer 392

Identifying patients at risk due to problems like H. pylori infection, pernicious anemia, and achlorhydria.

Question 393

What symptoms should patients with a positive family history of stomach cancer monitor?

Answer 393

* Anemia * PUD * Vague epigastric distress

Question 394

What is an important consideration for patients treated for PUD?

Answer 394

Recognizing the possibility of stomach cancer if relief was not achieved.

Question 395

What are the expected outcomes for a patient with stomach cancer?

Answer 395

* Have minimal discomfort, pain, or nausea * Achieve optimal nutrition status * Maintain a degree of psychologic well-being appropriate to the disease stage

Question 396

What are gastrointestinal stromal tumors (GISTs)?

Answer 396

A rare cancer that originates in cells in the wall of the GI tract.

Question 397

What should be provided to patients undergoing chemotherapy or radiation treatment?

Answer 397

A referral to home health care for support during recovery.

Question 398

Why is regular follow-up important for cancer patients?

Answer 398

Recurrence of cancer is common, requiring regular examinations and imaging assessments.

Question 399

What is dumping syndrome?

Answer 399

A condition that occurs after surgical removal of a large part of the stomach and pyloric sphincter, leading to rapid gastric emptying.

Question 400

What are the common symptoms of dumping syndrome?

Answer 400

* Generalized weakness * Sweating * Palpitations * Dizziness * Abdominal cramps * Borborygmi * Urge to defecate

Question 401

How quickly do symptoms of dumping syndrome typically begin after eating?

Answer 401

Within 15 to 30 minutes.

Question 402

What is postprandial hypoglycemia?

Answer 402

A variant of dumping syndrome caused by uncontrolled gastric emptying of high-carbohydrate fluids into the small intestine, leading to excess insulin release.

Question 403

What symptoms are associated with postprandial hypoglycemia?

Answer 403

* Sweating * Weakness * Mental confusion * Palpitations * Tachycardia * Anxiety

Question 404

How long after eating do symptoms of postprandial hypoglycemia typically occur?

Answer 404

Generally 2 hours after eating.

Question 405

What types of surgeries are performed to treat upper gastrointestinal problems?

Answer 405

* Partial gastrectomy * Gastrectomy * Vagotomy * Pyloroplasty

Question 406

What is bile reflux gastritis?

Answer 406

A condition that results from bile entering the stomach, causing damage to the gastric mucosa and leading to chronic gastritis and PUD.

Question 407

What are the main symptoms of bile reflux gastritis?

Answer 407

Continuous epigastric distress that increases after meals.

Question 408

What treatment can be used to manage bile reflux gastritis?

Answer 408

Cholestyramine, which binds with bile salts to reduce gastric irritation.

Question 409

What is vagotomy?

Answer 409

The surgical procedure involving the severing of the vagus nerve to decrease gastric acid secretion.

Question 410

What is pyloroplasty?

Answer 410

The surgical enlargement of the pyloric sphincter to facilitate the passage of contents from the stomach.

Question 411

What are the common long-term postoperative complications from gastric surgery?

Answer 411

* Dumping syndrome * Postprandial hypoglycemia * Bile reflux gastritis

Question 412

What is the focus of postoperative care after gastric surgery?

Answer 412

* Maintaining fluid and electrolyte balance * Preventing respiratory complications * Maintaining comfort * Preventing infection

Question 413

What is a total gastrectomy?

Answer 413

A surgical procedure involving the resection of the lower esophagus and the entire stomach, with anastomosis to the jejunum.

Question 414

What is the role of a short rest period after meals in managing dumping syndrome?

Answer 414

It reduces the chance of experiencing dumping syndrome symptoms.

Question 415

What monitoring is necessary for postoperative care following gastric surgery?

Answer 415

Monitoring for acute postoperative bleeding, fluid balance, and respiratory complications.

Question 416

What are some complications that morbidly obese patients face after surgery?

Answer 416

Complications include atelectasis, pneumonia, anastomotic leak, deep vein thrombosis, pulmonary embolus, and bleeding.

Question 417

What is the purpose of using an NG tube after surgery?

Answer 417

The NG tube is used for decompression to decrease pressure on suture lines and allow edema and inflammation to resolve.

Question 418

What should be observed in the gastric aspirate after surgery?

Answer 418

Observe the gastric aspirate for color, amount, and odor.

Question 419

What is the expected change in NG aspirate color within the first 24 hours after surgery?

Answer 419

The NG aspirate should gradually darken and change to yellow-green within 36 to 48 hours.

Question 420

What should be reported immediately regarding NG tube drainage?

Answer 420

Report bright red bleeding that does not decrease after 2 to 3 hours or excessive bleeding (more than 75 ml/hr).

Question 421

What are the potential complications if the NG tube is not functioning properly?

Answer 421

Complications include rupture of sutures, leakage of gastric contents, bleeding, and abscess formation.

Question 422

What should be done if the NG tube becomes clogged?

Answer 422

Notify the HCP immediately and gentle irrigations with normal saline solution may be ordered.

Question 423

What should be maintained while the NG tube is connected to suction?

Answer 423

Maintain IV therapy.

Question 424

What indicates a possible anastomotic leak?

Answer 424

Signs include tachycardia, dyspnea, fever, abdominal pain, anxiety, and restlessness.

Question 425

What is the purpose of splinting during deep breathing and coughing?

Answer 425

Splinting protects the abdominal suture line from rupturing.

Question 426

What dietary changes are recommended for patients after a gastrectomy?

Answer 426

Dietary changes include dividing meals into 6 small feedings, avoiding fluids with meals, and limiting concentrated sweets.

Question 427

What are the purposes of dietary restrictions after gastrectomy?

Answer 427

Purposes include slowing the rapid passage of food and controlling symptoms of dumping syndrome.

Question 428

What types of foods should be increased in the diet post-gastrectomy?

Answer 428

Increase protein consumption, particularly meat and eggs.

Question 429

How should milk and dairy products be introduced after surgery?

Answer 429

Introduce milk and milk products slowly several weeks after surgery.

Question 430

What types of foods should be avoided to prevent gastric distention?

Answer 430

Avoid carbonated beverages and gas-forming foods.

Question 431

What types of carbohydrates should be increased in the post-gastrectomy diet?

Answer 431

Increase complex carbohydrates such as bread, vegetables, rice, and potatoes.

Question 432

What is a long-term complication of total gastrectomy?

Answer 432

Pernicious anemia.

Question 433

What is intrinsic factor essential for?

Answer 433

The absorption of vitamin B12 ## Footnote Intrinsic factor is produced by the stomach and is crucial for the absorption of vitamin B12 in the intestines.

Question 434

What are some drug-related causes of gastritis?

Answer 434

* Aspirin * Bisphosphonates * Corticosteroids * Digitalis * Iron supplements * Nonsteroidal anti-inflammatory drugs (NSAIDs) ## Footnote These drugs can irritate the gastric mucosa and lead to gastritis.

Question 435

What dietary indiscretions can lead to acute gastritis?

Answer 435

* Alcohol binge drinking * Large quantities of spicy, irritating foods ## Footnote These factors can cause damage ranging from superficial injury to significant mucosal destruction.

Question 436

What is the primary infectious agent associated with acute gastritis?

Answer 436

Helicobacter pylori ## Footnote H. pylori infection is common and can lead to both acute and chronic gastritis.

Question 437

What are some other risk factors for gastritis?

Answer 437

* Prolonged vomiting * Reflux of bile salts * Intense emotional responses * CNS lesions ## Footnote These factors can contribute to the inflammation of the gastric mucosa.

Question 438

What is autoimmune gastritis?

Answer 438

An inherited condition where there is an immune response against parietal cells ## Footnote It often affects women of northern European descent and is associated with other autoimmune disorders.

Question 439

What are the consequences of a broken gastric mucosal barrier?

Answer 439

* Tissue edema * Disruption of capillary walls * Loss of plasma into the gastric lumen * Possible bleeding ## Footnote These consequences arise when HCl acid and pepsin diffuse back into the gastric mucosa.

Question 440

What are common symptoms of gastritis?

Answer 440

* Nausea * Vomiting * Abdominal pain * Loss of appetite ## Footnote Symptoms may vary based on the severity and type of gastritis.

Question 441

What is the impact of NSAIDs on the gastric mucosa?

Answer 441

They inhibit the synthesis of prostaglandins that protect the gastric mucosa ## Footnote This inhibition makes the mucosa more susceptible to injury and can lead to gastritis.

Question 442

What is chronic gastritis?

Answer 442

A long-term inflammation of the gastric mucosa that may result from repeated acute gastritis episodes ## Footnote Chronic gastritis can lead to functional changes in the stomach and increase the risk of stomach cancer.

Question 443

What is an important dietary recommendation for patients to avoid hypoglycemic episodes?

Answer 443

Limit the amount of sugar with each meal and eat small, frequent meals ## Footnote This helps manage blood sugar levels effectively.

Question 444

What is the role of intrinsic factor in the body?

Answer 444

Intrinsic factor is essential for cobalamin (vitamin B12) absorption. ## Footnote A deficiency in intrinsic factor can lead to pernicious anemia.

Question 445

What are common symptoms of acute gastritis?

Answer 445

* Anorexia * Nausea and vomiting * Epigastric tenderness * Feeling of fullness * GI bleeding ## Footnote GI bleeding is often associated with alcohol use and may be the only symptom in some cases.

Question 446

How long does acute gastritis typically last?

Answer 446

Acute gastritis is self-limiting, lasting from a few hours to a few days. ## Footnote The mucosa should heal completely within this time.

Question 447

What are the manifestations of chronic gastritis?

Answer 447

Similar to acute gastritis; some patients may be asymptomatic. ## Footnote Loss of parietal cells due to atrophy can result in a lack of intrinsic factor.

Question 448

What diagnostic studies are used for acute gastritis?

Answer 448

* Patient symptoms and risk factors * Endoscopic examination with biopsy (occasionally) * Breath, urine, serum, stool, and gastric tissue biopsy tests for H. pylori * CBC to check for anemia * Stools tested for occult blood * Serum tests for intrinsic factor and antibodies to parietal cells * Tissue biopsy to rule out gastric cancer ## Footnote H. pylori is a common cause of gastritis.

Question 449

What is the primary treatment approach for acute gastritis?

Answer 449

Eliminating the cause and supportive care. ## Footnote Treatment may include rest, NPO status, IV fluids, and antiemetics.

Question 450

What are the indications for using an NG tube in severe acute gastritis?

Answer 450

* Monitor for bleeding * Lavage the precipitating agent from the stomach * Keep the stomach empty and free of noxious stimuli ## Footnote Clear liquids should be resumed once symptoms subside.

Question 451

What medications are commonly used to treat acute gastritis?

Answer 451

* H2 receptor blockers (e.g., cimetidine) * Proton pump inhibitors (PPIs) (e.g., omeprazole) ## Footnote These medications help reduce gastric acid secretion.

Question 452

What lifestyle changes may be necessary for patients with chronic gastritis?

Answer 452

* Abstaining from alcohol * Smoking cessation * Following a diet of small, frequent meals ## Footnote A team approach involving healthcare providers can support these lifestyle changes.

Question 453

What is the incidence of acute upper GI bleeding in the U.S.?

Answer 453

103 cases per 100,000 adults per year. ## Footnote The mortality rate in hospitalized patients is 14%.

Question 454

What factors can influence the severity of upper GI bleeding?

Answer 454

The severity depends on whether the origin is venous, capillary, or arterial. ## Footnote Arterial bleeding is profuse and bright red, while venous bleeding may present differently.

Question 455

What is the most common cause of upper GI bleeding?

Answer 455

Peptic ulcers due to H. pylori infection and NSAID use. ## Footnote About 25% of people on chronic NSAIDs develop ulcers.

Question 456

What is melena and what does it indicate?

Answer 456

Melena refers to black, tarry stools, indicating slow bleeding from an upper GI source. ## Footnote The darker the stool, the longer the blood has been in the intestines, undergoing breakdown.

Question 457

What are the causes of upper GI bleeding from the esophagus?

Answer 457

* Esophageal varices * Esophagitis * Mallory-Weiss tear

Question 458

What might an increased BUN level indicate in patients with significant upper GI bleeding?

Answer 458

* GI tract bacteria breakdown proteins * Renal hypoperfusion * Renal disease

Question 459

What constitutes a massive upper GI hemorrhage?

Answer 459

Loss of more than 1500 mL of blood or 25% of intravascular blood volume

Question 460

What is the risk percentage of spontaneous cessation of bleeding in patients with massive hemorrhage?

Answer 460

80% to 85%

Question 461

What is stress-related mucosal disease (SRMD)?

Answer 461

Damage in the GI tract associated with serious illness, ranging from small ulcers to major bleeding

Question 462

What are common causes of chronic esophagitis?

Answer 462

* GERD * Smoking * Alcohol use * Irritating drugs

Question 463

What is the primary diagnostic tool for identifying the source of upper GI bleeding?

Answer 463

Endoscopy

Question 464

When is angiography used in the context of upper GI bleeding?

Answer 464

When endoscopy cannot be done or when bleeding persists after endoscopic therapy

Question 465

What laboratory studies are important in assessing upper GI bleeding?

Answer 465

* CBC * Blood urea nitrogen (BUN) * Serum electrolytes * Prothrombin time * Partial thromboplastin time * Liver enzymes * Arterial blood gases (ABGs) * Type and crossmatch for possible blood transfusions

Question 466

Why are hemoglobin and hematocrit values not immediately helpful in estimating blood loss?

Answer 466

They may not reflect the loss until 4 to 6 hours after fluid replacement

Question 467

What are the signs and symptoms of shock to identify during emergency assessment?

Answer 467

* Tachycardia * Weak pulse * Hypotension * Cool extremities * Prolonged capillary refill * Apprehension

Question 468

What is one of the best measures of vital organ perfusion?

Answer 468

Urine output

Question 469

What type of solution is generally started for fluid replacement in upper GI bleeding?

Answer 469

Isotonic crystalloid solution (e.g., lactated Ringer's solution)

Question 470

What are the three techniques used in endoscopic hemostasis?

Answer 470

* Mechanical therapy with clips or bands * Thermal ablation * Injection (e.g., epinephrine)

Question 471

What is the goal of endoscopic hemostasis?

Answer 471

To coagulate or thrombose the bleeding vessel

Question 472

What devices are commonly used in thermal ablation during endoscopic therapy?

Answer 472

* Neodymium: yttrium-aluminum-garnet (YAG) laser * Monopolar or bipolar electrocoagulation * Heater probes * Argon plasma coagulation (APC)

Question 473

What are the strategies for managing variceal bleeding?

Answer 473

Variceal ligation, injection sclerotherapy, balloon tamponade ## Footnote See Chapter 48 for detailed information.

Question 474

When is surgical intervention needed for UGI bleeding?

Answer 474

When bleeding continues despite therapy and there is an identified site of bleeding.

Question 475

What indicates the choice of surgery in UGI bleeding?

Answer 475

The site of the bleeding.

Question 476

What is a critical factor in the mortality rates of patients with UGI bleeding?

Answer 476

Increased mortality rates in older patients.

Question 477

What is the purpose of drug therapy during the acute phase of UGI bleeding?

Answer 477

To decrease bleeding, decrease HCl acid secretion, and neutralize HCl acid.

Question 478

What type of therapy is often initiated before endoscopy for UGI bleeding?

Answer 478

Empiric PPI therapy with high-dose IV bolus and subsequent infusion.

Question 479

Why is it important to reduce acid secretion during UGI bleeding?

Answer 479

Because the acidic environment can alter platelet function and interfere with clot stabilization.

Question 480

What may be given after the acute phase of UGI bleeding?

Answer 480

Antacids, either orally or through the NG tube.

Question 481

What should be done if the pH level of stomach contents is less than 5?

Answer 481

Intermittent suction may be used or the frequency or dosage of the antacid or antisecretory agent increased.

Question 482

What is the first step in nursing management for a patient with UGI bleeding?

Answer 482

Perform a thorough assessment.

Question 483

What vital signs should be monitored in a patient with UGI bleeding?

Answer 483

BP and pulse.

Question 484

What are signs and symptoms of shock due to blood loss?

Answer 484

Low BP, rapid weak pulse, increased thirst, cold clammy skin, restlessness.

Question 485

How often should vital signs be monitored in patients with UGI bleeding?

Answer 485

Every 15 to 30 minutes.

Question 486

What important health information should be assessed in a patient with UGI bleeding?

Answer 486

History of chronic gastritis, medications like aspirin, NSAIDs, corticosteroids, anticoagulants.

Question 487

What are some functional health patterns to assess in a patient with UGI bleeding?

Answer 487

Alcohol use, nausea, vomiting, weight loss, weakness, dizziness.

Question 488

What is a possible diagnostic finding in a patient with UGI bleeding?

Answer 488

Hematocrit and hemoglobin levels, hematuria, guaiac-positive stools.

Question 489

What are the clinical problems associated with UGI bleeding?

Answer 489

Fluid imbalance, inadequate tissue perfusion, impaired GI function.

Question 490

What are the overall goals for a patient with UGI bleeding?

Answer 490

No further GI bleeding, cause identified and treated, return to normal hemodynamic state.

Question 491

What is the primary risk associated with patients taking chemotherapy drugs?

Answer 491

Increased risk for GI bleeding due to decreased production of clotting factors and platelets. ## Footnote Patients with blood disorders or liver disease are also at risk.

Question 492

What are the initial assessment findings for acute GI bleeding?

Answer 492

* Abdominal pain * Hematemesis * Melena * Nausea * Abdominal rigidity * Cool, clammy skin * Altered level of consciousness * Slow capillary refill * Decreased urine output (<0.5 mL/kg/hr) ## Footnote These findings are critical for determining the severity of the condition.

Question 493

What are the priority nursing interventions for a patient with acute GI bleeding?

Answer 493

* Assess circulation, airway, and breathing if unresponsive * Monitor airway, breathing, and circulation if responsive * Establish IV access with a large bore catheter * Start fluid replacement therapy * Initiate ECG monitoring * Obtain blood for CBC and clotting studies * Insert an NG tube as needed * Provide oxygen via nasal cannula or nonrebreather mask ## Footnote These interventions are essential for stabilizing the patient.

Question 494

Why is monitoring vital signs critical in patients with CVD?

Answer 494

Dysrhythmias may occur, necessitating close observation. ## Footnote Patients with cardiovascular disease are particularly vulnerable to changes in their vital signs.

Question 495

What should be done when an NG tube is present in a patient with GI bleeding?

Answer 495

* Keep the tube in proper position * Check the aspirate for blood * Use caution if resistance is felt during aspiration ## Footnote Resistance may indicate the tip of the NG tube is against the gastric mucosal lining.

Question 496

What is the purpose of gastric lavage in the context of UGI bleeding?

Answer 496

To remove blood and other contents from the stomach. ## Footnote The effectiveness of gastric lavage for UGI bleeding is questionable.

Question 497

What symptoms indicate the onset of delirium tremens in patients with alcohol withdrawal?

Answer 497

* Agitation * Uncontrolled shaking * Sweating * Hallucinations ## Footnote These symptoms require close monitoring in patients with a history of chronic alcohol use.

Question 498

What is the recommended approach when beginning oral intake after UGI bleeding?

Answer 498

* Start with clear fluids hourly * Gradually introduce foods if no signs of problems arise * Observe for symptoms of nausea and vomiting * Monitor for recurrence of bleeding ## Footnote This gradual approach helps ensure patient safety and tolerance.

Question 499

What are the signs of fluid overload to monitor in older adults or patients receiving large amounts of IV fluids?

Answer 499

* Signs of pulmonary edema * Auscultate breath sounds * Observe respiratory effort * Elevate the head of the bed to prevent aspiration ## Footnote Fluid overload can lead to serious complications in these patients.

Question 500

What should patients and caregivers be taught to avoid future bleeding episodes?

Answer 500

* Adherence to drug therapy * Avoidance of drugs that increase bleeding risk, especially aspirin ## Footnote Education on medication management is crucial for preventing recurrence.

Question 501

What is the importance of maintaining an accurate intake and output record in acute care?

Answer 501

To monitor the patient's fluid balance and guide further interventions. ## Footnote Accurate documentation is essential for effective patient management.

Question 502

What toxin causes botulism?

Answer 502

Toxin from Clostridium botulinum

Question 503

What is the primary source of bacterial food poisoning?

Answer 503

Improperly canned or preserved food

Question 504

What are the common symptoms of Clostridial food poisoning?

Answer 504

Nausea, vomiting, abdominal pain, constipation, distention

Question 505

What are the symptoms of Escherichia coli food poisoning?

Answer 505

Bloody stools, hemolytic uremic syndrome, abdominal cramping, profuse diarrhea

Question 506

What is the onset time for Salmonella food poisoning?

Answer 506

8 hours to several days

Question 507

What are the symptoms associated with Staphylococcal food poisoning?

Answer 507

Vomiting, nausea, abdominal cramping, diarrhea

Question 508

What is the treatment for botulism?

Answer 508

Maintain ventilation, polym antitoxin, guanidine

Question 509

How can bacterial food poisoning be prevented?

Answer 509

Correct food preparation and handling

Question 510

What percentage of Americans experience foodborne illness annually?

Answer 510

1 in 6 Americans, or 48 million people

Question 511

What is the most common cause of foodborne illnesses?

Answer 511

Bacteria

Question 512

At what temperature range do bacteria multiply quickly in food?

Answer 512

Between 40°F and 140°F

Question 513

What is a key instruction for cooking ground beef safely?

Answer 513

Cook until a thermometer reads at least 160°F

Question 514

What should you do if served undercooked ground beef in a restaurant?

Answer 514

Send it back for further cooking

Question 515

What should be done to avoid spreading harmful bacteria while cooking?

Answer 515

Keep raw meat separate from ready-to-eat foods and wash hands and utensils

Question 516

What type of milk should be consumed to prevent foodborne illness?

Answer 516

Pasteurized milk

Question 517

How should fruits and vegetables be prepared to ensure safety?

Answer 517

Wash thoroughly, especially those not being cooked

Question 518

What food product should immunocompromised individuals avoid?

Answer 518

Alfalfa sprouts until safety is confirmed

Question 519

What are the expected outcomes for a patient with UGI bleeding?

Answer 519

Be free from UGI bleeding, maintain normal fluid volume, understand risk factors

Question 520

What is the primary characteristic of most strains of Escherichia coli?

Answer 520

Most strains are harmless and live in the intestines of healthy humans and animals.

Question 521

What severe illnesses can E. coli 0157:H7 cause?

Answer 521

Hemorrhagic colitis and kidney failure.

Question 522

Who is at higher risk for severe illness from E. coli 0157:H7?

Answer 522

Very young children and older adults.

Question 523

What are common sources of E. coli 0157:H7 infection?

Answer 523

* Undercooked meats * Contaminated leafy vegetables * Contaminated fruits and nuts * Raw milk * Unpasteurized or contaminated fruit juices * Sewage-contaminated water

Question 524

How is E. coli 0157:H7 primarily transmitted?

Answer 524

Person-to-person contact in families, long-term care, and childcare centers.

Question 525

What is the incubation period for E. coli 0157:H7 infection?

Answer 525

1 to 10 days after swallowing the organism.

Question 526

What are the main symptoms of E. coli 0157:H7 infection?

Answer 526

* Diarrhea (often bloody) * Vomiting * Abdominal cramping pain

Question 527

What is a significant systemic complication of E. coli 0157:H7 infection?

Answer 527

Hemolytic uremic syndrome (HUS).

Question 528

How is E. coli 0157:H7 infection diagnosed?

Answer 528

By detecting the bacteria in the stool.

Question 529

What should all patients with sudden diarrhea containing blood undergo?

Answer 529

A stool culture for E. coli 0157:H7.

Question 530

What is the primary treatment for E. coli 0157:H7 infection?

Answer 530

Hydration to maintain blood volume.

Question 531

Why should patients avoid antidiarrheal agents during E. coli 0157:H7 infection?

Answer 531

They slow GI motility and can prolong the infection.

Question 532

What are potential treatments for severe cases of E. coli 0157:H7 infection?

Answer 532

* Dialysis * Plasmapheresis

Question 533

Why are antibiotics seldom given for E. coli 0157:H7 infection?

Answer 533

They increase the risk of complications and do not appear to treat the infection.

Question 534

What is hemolytic uremic syndrome (HUS)?

Answer 534

A condition where RBCs are destroyed and kidneys fail, often life-threatening.

Question 535

What is the mortality rate associated with hemolytic uremic syndrome (HUS)?

Answer 535

Around 5%.

Question 536

What long-term complications can arise from E. coli 0157:H7 infection?

Answer 536

* Abnormal kidney function * Hypertension * Seizures * Blindness * Paralysis

Question 537

What percentage of patients may have abnormal kidney function for years after E. coli 0157:H7 infection?

Answer 537

About one-third.