Chapter 46 Problems of Ingestion, Digestion, Absoption, and Elimination Part 2 Flashcards
(370 cards)
1
Q
What is a key component of diagnostic assessment for Peptic Ulcer Disease?
A
History and physical assessment
This includes taking a detailed medical history and conducting a physical examination.
2
Q
Which procedure involves taking a biopsy for diagnosis of Peptic Ulcer Disease?
A
Upper Gl endoscopy
This procedure allows direct visualization of the stomach and duodenum.
3
Q
What are the tests for H. pylori infection?
A
Breath, urine, blood, tissue testing
These tests help identify the presence of Helicobacter pylori, a common cause of ulcers.
4
Q
Which blood tests are included in the diagnostic assessment of Peptic Ulcer Disease?
A
Complete blood cell count, liver enzymes, serum amylase
These tests help assess overall health and detect possible complications.
5
Q
What is one of the management strategies for Peptic Ulcer Disease?
A
Adequate rest
Rest helps in the healing process of ulcers.
6
Q
Fill in the blank: Smoking and alcohol cessation are part of _______ therapy for Peptic Ulcer Disease.
A
Conservative
Lifestyle changes are crucial in managing ulcers.
7
Q
What type of drug therapy is used for H. pylori eradication?
A
Antibiotics
Antibiotics are prescribed to eliminate H. pylori infection.
8
Q
Name two types of drugs used in the management of Peptic Ulcer Disease.
A
PPIs, H2-receptor blockers
These drugs reduce stomach acid production.
9
Q
What does NPO stand for in the context of acute exacerbation management?
A
Nothing by mouth
This is a common practice during severe ulcer flare-ups.
10
Q
What is a management step for acute exacerbation without complications?
A
NG suction
Nasogastric suction helps relieve pressure in the stomach.
11
Q
In cases of acute exacerbation with complications, what is one potential treatment?
A
IV PPI
Intravenous proton pump inhibitors are used to manage severe symptoms.
12
Q
What surgical procedure might be performed for gastric outlet obstruction?
A
Pyloroplasty and vagotomy
These procedures help facilitate gastric drainage.
13
Q
True or False: Blood transfusions may be necessary in the management of acute exacerbation with complications.
A
True
Transfusions can be critical in cases of significant bleeding.
14
Q
What is stomach lavage and when might it be used?
A
Washing out the stomach
It may be used in cases of severe bleeding or obstruction.
15
Q
Fill in the blank: Surgical therapy may involve _______ or reduction of the ulcer.
A
Ulcer removal
This is considered when ulcers are severe or recurrent.
16
Q
What is the role of cytoprotective drugs in Peptic Ulcer Disease management?
A
Protect the stomach lining
They help prevent further damage to the gastric mucosa.
17
Q
What type of therapy includes stress management for Peptic Ulcer Disease?
A
Conservative Therapy
Stress management is essential as stress can exacerbate symptoms.
18
Q
What is the effect of anticholinergic properties in drug therapy for PUD?
A
Reduced acid secretion
Anticholinergic drugs are sometimes used for PUD treatment.
19
Q
What should patients with PUD avoid in their diet?
A
Foods that may cause gastric irritation include:
* Pepper
* Carbonated beverages
* Broth (meat extract)
* Hot, spicy foods
* Caffeine-containing beverages
* Alcohol
Alcohol can delay healing.
20
Q
What is the most common complication of PUD?
A
GI bleeding
Duodenal ulcers cause more bleeding episodes than gastric ulcers.
21
Q
What is the most lethal complication of PUD?
A
Perforation
The risk is highest with large penetrating duodenal ulcers.
22
Q
What are the contents that may spill into the peritoneal cavity during perforation?
A
Contents may include:
* Air
* Saliva
* Food particles
* HCl acid
* Pepsin
* Bacteria
* Bile
* Pancreatic fluid and enzymes
The manifestations of perforation are sudden and dramatic in onset.
23
Q
What are the initial symptoms of perforation?
A
Symptoms include:
* Sudden, severe upper abdominal pain
* Pain radiating to the back and shoulders
* Rigid and board-like abdomen
* Absence of bowel sounds
* Nausea and vomiting
* Increased and weak pulse
Food or antacids do not relieve the pain.
24
Q
What is the immediate focus of managing a patient with perforation?
A
Stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume
An NG tube can provide continuous aspiration and gastric decompression.
25
What type of solutions are used to replace circulating blood volume in perforation management?
Lactated Ringer's and albumin solutions
## Footnote
These substitute for the fluids lost from the vascular and interstitial space as peritonitis develops.
26
What may occur within 6 to 12 hours if a perforation is untreated?
Bacterial peritonitis
## Footnote
The intensity of peritonitis is proportional to the amount and duration of the spillage through the perforation.
27
True or False: Small perforations may spontaneously seal themselves.
True
## Footnote
Symptoms cease when spontaneous sealing occurs due to fibrin.
28
What is the drug class used for acid suppression in H. pylori infection?
PPI
## Footnote
PPI stands for Proton Pump Inhibitors.
29
Name two standard antibiotics used to treat H. pylori infection.
* Amoxicillin
* Clarithromycin
## Footnote
These antibiotics are commonly prescribed to combat H. pylori.
30
What is the dosage of PPI in triple therapy for H. pylori infection?
20-40 mg, 2 times daily
## Footnote
This dosage is standard for PPI in this treatment regimen.
31
What is the dosage of Amoxicillin in triple therapy for H. pylori infection?
1 g, 2 times daily
## Footnote
Amoxicillin is used at this specific dosage in triple therapy.
32
What is the dosage of Clarithromycin in triple therapy for H. pylori infection?
500 mg, 2 times daily
## Footnote
Clarithromycin is administered at this dosage in the regimen.
33
What is the dosage of Metronidazole in Bismuth Quadruple Therapy for H. pylori infection?
500 mg, 4 times daily
## Footnote
Metronidazole is utilized at this frequency in the Bismuth Quadruple Therapy.
34
What are the components of Bismuth Quadruple Therapy for H. pylori infection?
* PPI
* Bismuth compound
* Metronidazole
* Tetracycline
## Footnote
This therapy includes these four components for effective treatment.
35
What is the dosage of Bismuth compound in Bismuth Quadruple Therapy?
2 tablets, 2 times daily
## Footnote
This is the specified dosage for the Bismuth compound.
36
What is the dosage of Tetracycline in Non-Bismuth Quadruple Therapy?
500 mg, 3 times daily
## Footnote
This dosage is specific to Tetracycline in this treatment regimen.
37
Fill in the blank: The drug class used for acid suppression in H. pylori infection is _______.
PPI
38
True or False: Clarithromycin is used in both triple therapy and Bismuth Quadruple therapy for H. pylori infection.
True
## Footnote
Clarithromycin is a common antibiotic in both regimens.
39
What can lead to fibrinous fusion of the duodenum or gastric curvature?
Perforation of the stomach
## Footnote
This can also lead to strictures that obstruct intestinal contents and stool passage.
40
What is the recommended procedure for larger perforations?
Immediate surgical closure
## Footnote
The choice between open or laparoscopic repair depends on the ulcer's location and HCP preference.
41
What is the least risky surgical procedure for perforation repair?
Simple oversewing of the perforation and reinforcement with a graft of omentum
## Footnote
Excess gastric contents are suctioned from the peritoneal cavity during the procedure.
42
What causes gastric outlet obstruction in PUD?
Edema, inflammation, pylorospasm, or fibrous scar tissue formation
## Footnote
Both acute and chronic PUD can lead to this obstruction.
43
What symptoms are associated with gastric outlet obstruction?
Discomfort or pain, belching, projectile vomiting, and constipation
## Footnote
Vomitus may contain food particles ingested hours or days before.
44
What is the aim of therapy for gastric outlet obstruction?
Decompress the stomach, correct fluid and electrolyte imbalances, and improve general health
## Footnote
An NG tube can be used for continuous decompression.
45
What treatments are used for active ulcers causing obstruction?
PPI or H2 receptor blocker
## Footnote
Balloon dilation may be used to open a pyloric obstruction.
46
What subjective and objective data should be obtained from a patient with PUD?
Pain and impaired GI function
## Footnote
Detailed information can be found in Table 46.15.
47
What are the overall goals for a patient with PUD?
Adhere to therapeutic regimen, achieve pain relief, be free from complications, have complete healing, and make lifestyle changes
## Footnote
These goals aim to prevent recurrence of PUD.
48
What role do healthcare providers play in preventing PUD?
Identify those at risk and encourage early detection and treatment
## Footnote
Patients on ulcerogenic drugs should take them with food.
49
What are common symptoms during an acute exacerbation of PUD?
Increased pain, nausea, vomiting, and potential bleeding
## Footnote
Many patients may cope with symptoms at home before seeking care.
50
What does the patient management during an acute phase of PUD typically include?
Being NPO, NG tube with intermittent suction, and IV fluid replacement
## Footnote
Regular mouth care and cleaning of nares are also recommended.
51
What analysis may be performed on gastric contents?
pH testing and analysis for blood, bile, or other substances
## Footnote
These tests help assess the condition of the stomach during treatment.
52
Fill in the blank: The surgical procedure that involves suctioning excess gastric contents is called _______.
simple oversewing of the perforation
## Footnote
This procedure is part of managing perforations in PUD.
53
What are important health conditions associated with Peptic Ulcer Disease?
Chronic kidney disease, pancreatic disease, OP, serious illness or trauma, hyperparathyroidism, cirrhosis, Zollinger-Ellison syndrome (ZES)
## Footnote
ZES is a condition characterized by gastrin-secreting tumors leading to excessive gastric acid production.
54
Which medications are commonly associated with Peptic Ulcer Disease?
Aspirin, corticosteroids, NSAIDs
## Footnote
These medications can irritate the gastric lining and contribute to ulcer formation.
55
What types of surgeries or treatments may be linked to Peptic Ulcer Disease?
Complicated or prolonged surgery
## Footnote
Surgical stress can increase the risk of developing ulcers, especially in vulnerable patients.
56
What lifestyle factors may affect health perception in patients with Peptic Ulcer Disease?
Chronic alcohol use, smoking, caffeine use, family history of PUD
## Footnote
These factors can exacerbate symptoms and contribute to the development of ulcers.
57
List some nutritional and metabolic symptoms of Peptic Ulcer Disease.
Weight loss, anorexia, nausea and vomiting, hematemesis, dyspepsia, heartburn, belching
## Footnote
These symptoms can significantly impact a patient's quality of life.
58
What elimination symptom is indicative of Peptic Ulcer Disease?
Black, tarry stools
## Footnote
This symptom suggests the presence of digested blood, often from an upper gastrointestinal source.
59
What are the characteristics of duodenal ulcers?
Burning, midepigastric or back pain occurring 2-5 hours after meals, relieved by food; nighttime pain common
## Footnote
The pattern of pain is a key diagnostic feature of duodenal ulcers.
60
What are the characteristics of gastric ulcers?
High epigastric pain occurring 1-2 hours after meals; food may precipitate or worsen pain
## Footnote
This contrasts with duodenal ulcers where food typically alleviates pain.
61
What psychological symptoms may be observed in patients with Peptic Ulcer Disease?
Anxiety, irritability
## Footnote
Psychological stress can exacerbate gastrointestinal symptoms.
62
What objective data might indicate Peptic Ulcer Disease?
Epigastric tenderness
## Footnote
Tenderness in the epigastric region is a common physical examination finding.
63
What possible diagnostic findings are associated with Peptic Ulcer Disease?
Anemia, guaiac-positive stools, positive tests for H. pylori, abnormal upper GI endoscopic and barium studies
## Footnote
These diagnostic tests help confirm the presence of ulcers and underlying causes.
64
What factors determine the type and amount of IV fluids given to a patient?
The volume of fluid lost, the patient's signs and symptoms, and laboratory test results (hemoglobin, hematocrit, electrolytes)
## Footnote
Laboratory test results are crucial in assessing the patient's condition and guiding treatment.
65
How frequently should vital signs be taken to detect and treat shock?
Initially and then at least hourly
## Footnote
Regular monitoring is essential to identify changes in the patient's condition.
66
What is helpful for ulcer healing?
Physical and emotional rest
## Footnote
A restful environment contributes to the healing process.
67
What might be administered to help a patient who is anxious and apprehensive?
A mild sedative
## Footnote
Care must be taken as sedatives can mask signs of shock.
68
True or False: Changes in vital signs and an increase in the amount and redness of aspirate often signal massive upper GI bleeding.
True
## Footnote
Monitoring these changes is crucial for timely intervention.
69
What should be maintained to prevent obstruction from blood clots in cases of upper GI bleeding?
The patency of the NG tube
## Footnote
A blocked tube can lead to abdominal distention.
70
What immediate action should be taken if a patient with an ulcer develops manifestations of a perforation?
Notify the HCP immediately
## Footnote
Timely communication is critical in managing potential complications.
71
What should be temporarily stopped if perforation is suspected?
All oral or NG drugs and feedings
## Footnote
Oral intake can exacerbate discomfort and complications.
72
What type of therapy will patients with confirmed perforation start on?
Antibiotic therapy
## Footnote
This is essential to prevent infection following perforation.
73
What condition can occur at any time in patients with ulcers, especially near the pylorus?
Gastric outlet obstruction
## Footnote
Symptoms typically develop gradually.
74
What can help relieve symptoms of gastric outlet obstruction?
Constant NG aspiration of stomach contents
## Footnote
This allows for edema and inflammation to subside.
75
How should the NG tube be irrigated to assist proper functioning?
With a normal saline solution per agency policy
## Footnote
Regular irrigation is important for maintaining tube patency.
76
What should be done to check for ongoing obstruction with an NG tube?
Clamp the NG tube intermittently and measure the gastric residual volume
## Footnote
This helps assess the patient's comfort and the effectiveness of the NG tube.
77
Fill in the blank: Patients with PUD should be educated about drugs, lifestyle changes, and _______.
Regular follow-up care
## Footnote
Ongoing management is crucial for preventing complications.
78
What should patients be informed about regarding prescribed drugs for PUD?
Their actions, side effects, and dangers if omitted
## Footnote
Understanding medication is vital for adherence and safety.
79
What negative effects should patients be informed about concerning alcohol and cigarettes?
Their impact on PUD and ulcer healing
## Footnote
Education on these effects is crucial for lifestyle modifications.
80
True or False: PUD is a chronic, recurring disorder.
True
## Footnote
Patients need to be aware of the potential for complications and the need for long-term care.
81
What is the goal regarding smoking and alcohol use for patients with PUD?
Total cessation
## Footnote
While reduction may be a first step, complete cessation is ideal for healing.
82
What should patients do if they experience a return of symptoms?
Seek immediate intervention
## Footnote
Early intervention can prevent complications.
83
What should patients with Peptic Ulcer Disease avoid to prevent epigastric distress?
Foods that cause epigastric distress, such as acidic foods
## Footnote
Acidic foods can exacerbate symptoms of Peptic Ulcer Disease.
84
How does smoking affect Peptic Ulcer Disease?
Smoking promotes ulcer development and delays ulcer healing
## Footnote
Quitting smoking can significantly improve healing and prevention of ulcers.
85
What is advised regarding alcohol use for patients with Peptic Ulcer Disease?
Reduce or stop alcohol use
## Footnote
Alcohol can irritate the stomach lining and worsen ulcer symptoms.
86
Why should over-the-counter drugs be avoided unless approved by a healthcare provider?
Many preparations contain ingredients like aspirin, which should not be taken without approval
## Footnote
Aspirin can increase the risk of bleeding and irritation in the stomach.
87
What is important to check with a healthcare provider regarding NSAIDs?
Check with the HCP about the use of NSAIDs
## Footnote
NSAIDs can exacerbate ulcer symptoms and cause gastrointestinal bleeding.
88
Why should patients not interchange brands of PPI, antacids, or H2 receptor blockers?
This can lead to harmful side effects
## Footnote
Consistency in medication brands is important for effective treatment and safety.
89
What should patients do to prevent a relapse of Peptic Ulcer Disease?
Follow prescribed drug therapy, including antisecretory and antibiotic drugs
## Footnote
Adhering to medication regimens is crucial for healing and preventing recurrence.
90
What symptoms should be reported to a healthcare provider?
* Increased nausea or vomiting
* Increased epigastric pain
* Bloody emesis or tarry stools
## Footnote
These symptoms may indicate complications or worsening of the ulcer condition.
91
How can stress be related to Peptic Ulcer Disease?
Stress can be related to PUD; learn and use stress management strategies
## Footnote
Managing stress is an important aspect of overall health and can help alleviate ulcer symptoms.
92
What should patients share with their healthcare provider regarding their condition?
Share concerns about lifestyle changes and living with a chronic illness
## Footnote
Open communication about lifestyle and emotional health can aid in effective management of Peptic Ulcer Disease.
93
What is the expected outcome for a patient with Peptic Ulcer Disease (PUD) regarding pain management?
Have pain controlled without the use of analgesics
## Footnote
This outcome emphasizes effective pain management strategies that do not rely on medication.
94
What lifestyle commitment is expected from a patient managing Peptic Ulcer Disease?
Commit to self-care and management of the disease
## Footnote
Self-care includes dietary changes and adherence to treatment plans.
95
What are the morbidity and mortality rates in older adults with Peptic Ulcer Disease attributed to?
Concurrent health problems and a decreased ability to withstand hypovolemia
## Footnote
This highlights the need for careful monitoring in older patients.
96
In older patients, what might be the first sign of a peptic ulcer?
Frank gastric bleeding or a decrease in hematocrit
## Footnote
Pain may not be the initial symptom in this demographic.
97
What type of cancer is stomach cancer primarily classified as?
Adenocarcinoma of the stomach wall
## Footnote
This is the most common form of stomach cancer.
98
What is the average age at diagnosis for stomach cancer?
68.5 years
## Footnote
Stomach cancer predominantly affects older adults.
99
What percentage of stomach cancer patients have disease confined to the stomach at diagnosis?
10% to 20%
## Footnote
This statistic indicates the advanced stage at which many patients are diagnosed.
100
What is the overall 5-year survival rate for all people with stomach cancer?
About 32%
## Footnote
This reflects the seriousness of the disease and its late diagnosis.
101
What are some lifestyle factors that influence the risk of stomach cancer?
Smoking, obesity, and diets high in smoked foods, salted fish and meat, and pickled vegetables
## Footnote
Healthy dietary choices can help reduce risk.
102
What role does H. pylori play in stomach cancer?
It may induce nonspecific mucosal injury leading to cancer
## Footnote
H. pylori infection is a significant risk factor for stomach cancer.
103
What are common clinical manifestations of stomach cancer?
Unexplained weight loss, indigestion, abdominal discomfort, anemia, and early satiety
## Footnote
Symptoms often appear late in the disease progression.
104
What is the best diagnostic tool for stomach cancer?
Upper GI endoscopy
## Footnote
This procedure allows for direct visualization and biopsy of stomach lesions.
105
What is the primary treatment for stomach cancer?
Surgical removal of the tumor
## Footnote
The goal is to excise the tumor along with a margin of healthy tissue.
106
What determines the type of surgery performed for stomach cancer?
The lesion location and the HCP's preference
## Footnote
Examples include open versus laparoscopic surgery.
107
What procedures are typically done for lesions in the antrum or pyloric region?
Billroth I or II procedures
## Footnote
These procedures involve subtotal gastric resection.
108
What surgical procedure is performed when the lesion is in the fundus?
Total gastrectomy with esophagojejunostomy
## Footnote
This procedure is indicated for fundic lesions.
109
What is done if there is metastasis to adjacent organs?
The surgical procedure is extended as needed
## Footnote
This may include resection of affected organs.
110
What is the focus of preoperative management in stomach cancer?
Correcting nutrition deficits and treating anemia
## Footnote
Packed RBCs transfusions may be used to address anemia.
111
What may be necessary if gastric outlet obstruction occurs before surgery?
Gastric decompression
## Footnote
This is done to relieve symptoms before surgical intervention.
112
Name some chemotherapy drugs used to treat stomach cancer.
* Fluorouracil
* Capecitabine
* Carboplatin
* Cisplatin
* Docetaxel
* Epirubicin
* Irinotecan
* Oxaliplatin
* Paclitaxel
## Footnote
Combination therapies often yield better outcomes.
113
What are examples of combination therapies for stomach cancer?
* ECF (epirubicin, cisplatin, fluorouracil)
* Docetaxel with irinotecan
* Oxaliplatin with fluorouracil or capecitabine
## Footnote
These combinations are used to improve treatment efficacy.
114
What role does combined radiation therapy and chemotherapy play in stomach cancer treatment?
Reduces recurrence or provides temporary relief of obstruction
## Footnote
It may also reduce tumor mass.
115
What are the targeted therapies for stomach cancer mentioned?
* Trastuzumab (Herceptin)
* Ramucirumab (Cyramza)
## Footnote
These therapies target specific proteins involved in cancer cell growth.
116
What percentage of stomach cancer patients have excessive HER-2 protein?
About 20%
## Footnote
Trastuzumab specifically targets this protein.
117
What is the function of ramucirumab in stomach cancer treatment?
Binds to the receptor for VEGF and prevents its binding
## Footnote
This action inhibits cancer growth and spread.
118
What is assessed during the nursing management of a patient with stomach cancer?
Nutrition assessment, psychosocial history, and physical assessment
## Footnote
Understanding coping mechanisms is also crucial.
119
What common symptoms may a patient with stomach cancer experience?
* Unexplained weight loss
* Anorexia
* Dyspepsia
* Intestinal gas discomfort or pain
## Footnote
These symptoms often indicate advanced disease.
120
What is cachexia in the context of stomach cancer?
A syndrome characterized by severe weight loss and muscle wasting
## Footnote
It can occur if oral intake has been significantly reduced.
121
True or False: A malnourished patient responds well to chemotherapy or radiation therapy.
False
## Footnote
Malnourishment increases surgical risks and decreases treatment efficacy.
122
What are the key components of the diagnostic assessment for stomach cancer?
* History and physical assessment
* Endoscopy and biopsy
* CT, MRI, PET scans
* Upper GI barium study
* Exfoliative cytologic study
* Endoscopic ultrasonography
* CBC
* Liver enzymes
* Urinalysis
* Stool examination
* Serum amylase
* Tumor markers
* a-Fetoprotein
* Carbohydrate antigen (CA)-19-9, CA-125, CA 72-4
* Carcinoembryonic antigen (CEA)
## Footnote
Each component plays a crucial role in diagnosing stomach cancer.
123
What are the types of surgical therapy for stomach cancer?
* Subtotal gastrectomy (Billroth I or II procedure)
* Total gastrectomy with esophagojejunostomy
## Footnote
Surgical options depend on the extent of the cancer and patient health.
124
What therapeutic options are included in the interprofessional care management of stomach cancer?
* Surgical therapy
* Chemotherapy
* Radiation therapy
* Targeted therapy
## Footnote
These therapies may be used alone or in combination based on individual patient needs.
125
True or False: Endoscopy and biopsy are part of the diagnostic assessment for stomach cancer.
True
## Footnote
Endoscopy allows for direct visualization and tissue sampling.
126
Fill in the blank: The tumor marker _______ is used in the diagnostic assessment for stomach cancer.
Carcinoembryonic antigen (CEA)
## Footnote
CEA is often elevated in various cancers, including stomach cancer.
127
What imaging studies are used in the diagnostic assessment of stomach cancer?
* CT scans
* MRI scans
* PET scans
* Upper GI barium study
## Footnote
These imaging studies help in assessing the extent of the disease.
128
What is the anatomic structure of the stomach?
Normal anatomic structure of the stomach includes the esophagus, pylorus, and jejunum.
129
What is total gastrectomy?
Total gastrectomy is the removal of the stomach.
130
What is esophagojejunostomy?
Esophagojejunostomy is the anastomosis of the esophagus with the jejunum.
131
What are the clinical problems associated with stomach cancer?
* Nutritionally compromised
* Pain
* Impaired GI function
* Difficulty coping
132
What are the overall goals for a patient with stomach cancer?
* Minimal discomfort
* Optimal nutrition status
* Maintain spiritual and psychological well-being
133
What is the role of health promotion in early detection of stomach cancer?
Identifying patients at risk due to H. pylori infection, pernicious anemia, and achlorhydria.
134
What symptoms should be monitored for stomach cancer?
Symptoms often occur late and can mimic other conditions, such as PUD.
135
True or False: Patients with a positive family history of stomach cancer should undergo diagnostic evaluation if they present with anemia.
True
136
What emotional reactions may patients and families experience upon cancer diagnosis?
* Shock
* Disbelief
* Depression
137
What dietary adjustments may be necessary for patients with stomach cancer?
Patients may tolerate several small meals a day better than three regular meals.
138
What nutritional support may be provided if a patient cannot ingest oral feedings?
Enteral nutrition (EN) or parenteral nutrition (PN) may be prescribed.
139
What therapies are used as an adjuvant to surgery for stomach cancer?
* Radiation therapy
* Chemotherapy
140
What should be taught to patients undergoing chemotherapy and radiation therapy?
* Skin care
* Nutrition and fluid intake
* Use of antiemetic drugs
141
What is the role of home health care after discharge for cancer patients?
To help with recovery and provide support to the patient and caregiver.
142
What are the expected outcomes for a patient with stomach cancer?
* Minimal discomfort, pain, or nausea
* Optimal nutrition status
* Degree of psychological well-being appropriate to disease stage
143
What are gastrointestinal stromal tumors (GISTs)?
GISTs are a rare cancer originating in cells in the wall of the GI tract.
144
What are interstitial cells of Cajal?
Cells that help control the movement of food and liquid through the stomach and intestines.
145
Where are most GISTs located?
About 60% in the stomach, 30% in the small intestine, and the rest in the esophagus, colon, or peritoneum.
146
What age group is most affected by GISTs?
People between the ages of 50 and 70.
147
What likely plays a role in the cause of GISTs?
Genetic mutations.
148
Which genetic mutations are associated with some GISTs?
* KIT
* PDGFRa
* Neurofibromatosis type 1
149
What are early manifestations of GISTs?
* Early satiety
* Fatigue
* Bloating
* Nausea or vomiting
* Change in bowel habits
150
Why is early detection of GISTs difficult?
Early manifestations are often subtle and similar to many other GI problems.
151
What later manifestations may occur with GISTs?
* GI bleeding
* Obstruction caused by larger tumors
152
How are GISTs often discovered?
During imaging for other problems.
153
What is the basis for the diagnosis of GISTs?
Histologic examination of biopsied tissue.
154
What imaging techniques are used to determine the extent of GIST disease?
* Endoscopic ultrasound
* CT
* MRI
155
What offers the only permanent cure for GISTs?
Surgery.
156
Are GISTs responsive to conventional chemotherapy?
No, they are unresponsive.
157
What types of drugs are effective against some GISTs?
Tyrosine kinase inhibitor drugs, such as imatinib mesylate, sunitinib, and regorafenib.
158
What occurs when gastric chyme enters the small intestine after surgery?
A large bolus of hypertonic fluid enters the intestine, drawing fluid into the bowel lumen.
159
What symptoms may occur after gastric surgery within 15 to 30 minutes after eating?
* Generalized weakness
* Sweating
* Palpitations
* Dizziness
160
What condition is characterized by symptoms due to a sudden decrease in plasma volume?
Dumping syndrome.
161
What is postprandial hypoglycemia a variant of?
Dumping syndrome.
162
What causes postprandial hypoglycemia?
Uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine.
163
What are the symptoms of postprandial hypoglycemia?
* Sweating
* Weakness
* Mental confusion
* Palpitations
* Tachycardia
* Anxiety
164
What surgeries are performed to treat stomach conditions?
* Partial gastrectomy
* Gastrectomy
* Vagotomy
* Pyloroplasty
165
What can result from gastric surgery involving the pylorus?
Reflux of bile into the stomach.
166
What is the main symptom of bile reflux gastritis?
Continuous epigastric distress that increases after meals.
167
What is cholestyramine used for in gastric surgery patients?
To bind with bile salts that are the source of gastric irritation.
168
What does vagotomy do?
Decreases gastric acid secretion.
169
What does pyloroplasty promote?
The easy passage of contents from the stomach.
170
What are common long-term postoperative complications from gastric surgery?
* Dumping syndrome
* Postprandial hypoglycemia
* Bile reflux gastritis
171
What does postoperative care focus on after gastric surgery?
* Maintaining fluid and electrolyte balance
* Preventing respiratory complications
* Maintaining comfort
* Preventing infection
172
What are common complications after surgery?
Complications include:
* atelectasis
* pneumonia
* anastomotic leak
* deep vein thrombosis
* pulmonary embolus
* bleeding
## Footnote
Morbidly obese patients have a higher risk for complications.
173
What is the purpose of an NG tube after surgery?
The NG tube is used for decompression to decrease pressure on suture lines and allow edema and inflammation to resolve.
174
What should be observed in the gastric aspirate?
Observe for color, amount, and odor.
175
What is expected from the NG tube drainage in the first 2 to 3 hours post-surgery?
Small volumes of bloody drainage.
176
When should bright red bleeding be reported to the HCP?
If it does not decrease after 2 to 3 hours or becomes excessive (more than 75 mL/hr).
177
What color should the NG aspirate change to within 24 hours after surgery?
The aspirate should gradually darken and normally change to yellow-green within 36 to 48 hours.
178
Why does the NG tube not drain a large quantity of secretions after total gastrectomy?
Removing the stomach eliminates the reservoir capacity.
179
What should be done if the NG tube stops draining or appears obstructed?
Notify the HCP immediately.
180
What can happen if accumulated gastric secretions are not drained?
It can lead to:
* rupture of the sutures
* leakage of gastric contents
* bleeding
* abscess formation.
181
Who should replace or reposition the NG tube?
The HCP should perform this task.
182
What therapy should be maintained while the NG tube is connected to suction?
IV therapy.
183
What is the purpose of beginning clear liquids before removing the NG tube?
To determine the patient's tolerance level.
184
What should be monitored for after surgery to detect an anastomotic leak?
Signs include tachycardia, dyspnea, fever, abdominal pain, anxiety, and restlessness.
185
True or False: Most procedures are done laparoscopically, which reduces respiratory complications.
True.
186
What should be performed to assess for respiratory complications in open surgical approaches?
A respiratory assessment.
187
What signs should be noted to identify pneumothorax?
Signs include dyspnea, chest pain, and cyanosis.
188
What technique can help protect the abdominal suture line during deep breathing and coughing?
Splinting with a pillow.
189
What should be monitored in abdominal wounds?
Monitor the amount and type of drainage, condition of the incision, and signs of infection.
190
What is essential to control in the postoperative period?
Nausea and vomiting.
191
What long-term complications may patients experience after surgery?
Complications may include:
* malnutrition
* metabolic bone disease
* anemia
* weight loss.
192
What is the role of nutrition interventions post-surgery?
To minimize complications and maximize nutrient intake.
193
What is a potential issue for patients who were malnourished preoperatively?
A small bowel feeding tube may be placed during surgery.
194
Fill in the blank: Pernicious anemia is a long-term complication of _______.
[total gastrectomy].
195
What is the purpose of following dietary restrictions after a gastrectomy?
To slow the rapid passage of food into the intestine and control symptoms of dumping syndrome
## Footnote
Symptoms of dumping syndrome include dizziness, sense of fullness, diarrhea, and tachycardia.
196
How many small feedings should meals be divided into after a gastrectomy?
6 small feedings
## Footnote
This approach helps avoid overloading the stomach and intestine.
197
When should fluids be consumed in relation to meals?
At least 30-45 minutes before or after meals
## Footnote
This practice helps prevent distention or a feeling of fullness.
198
What types of foods should be avoided to prevent symptoms of dumping syndrome?
Concentrated sweets such as:
* honey
* sugar
* jelly
* jam
* candies
* pastries
* sweetened fruit
## Footnote
These foods can cause dizziness, diarrhea, and a sense of fullness.
199
What is the recommendation for protein consumption after a gastrectomy?
Protein consumption is unlimited
## Footnote
This helps promote the rebuilding of body tissues.
200
What should be done with milk and milk products after surgery?
Introduce them slowly several weeks after surgery
## Footnote
Milk contains lactose, which may be hard to digest.
201
What types of beverages and foods should be avoided to prevent gastric distention?
Carbonated beverages and gas-forming foods
## Footnote
These can contribute to discomfort and gastric distention.
202
What types of foods are allowed a few weeks after surgery?
Low-roughage and raw foods as tolerated
## Footnote
These can be gradually reintroduced based on tolerance.
203
What should be increased in the diet to meet energy needs after a gastrectomy?
Complex carbohydrates and fats
## Footnote
Examples include bread, vegetables, rice, and potatoes.
204
What is intrinsic factor and why is it important?
Intrinsic factor is made by the parietal cells and is essential for the absorption of cobalamin in the terminal ileum.
## Footnote
Cobalamin is crucial for red blood cell (RBC) growth and maturation.
205
What dietary supplements should patients take for life after partial gastrectomy?
Patients should take multivitamins with:
* folate
* calcium
* vitamin D
* iron
## Footnote
These supplements help compensate for nutritional deficiencies.
206
What dietary changes should be made after partial gastrectomy?
Patients must reduce meal size and consume:
* soft, bland foods
* low fiber
* high complex carbohydrates
* protein
## Footnote
They should avoid simple sugars, lactose, and fried foods.
207
What should patients avoid doing while eating after surgery?
Patients should avoid drinking fluids with meals and eating large portions.
## Footnote
This helps prevent discomfort and digestive issues.
208
How can patients avoid hypoglycemic episodes after surgery?
Patients should:
* limit sugar intake with each meal
* eat small, frequent meals
* include moderate amounts of protein and fat
## Footnote
Immediate intake of sugared fluids or candy can relieve hypoglycemic symptoms.
209
What type of care might patients need after a total gastrectomy?
Patients may need skilled care for symptom management and pain relief.
## Footnote
This includes teaching wound care and collaborating with dietitians for nutritional guidance.
210
What is gastritis?
Gastritis is an inflammation of the gastric mucosa, which can be acute or chronic, and diffuse or localized.
## Footnote
It is a common problem affecting the stomach.
211
What causes gastritis?
Gastritis occurs due to a breakdown in the normal gastric mucosal barrier, allowing HCl acid and pepsin to diffuse back into the mucosa.
## Footnote
This results in tissue edema and possible bleeding.
212
What are some risk factors for drug-related gastritis?
Risk factors include:
* Being female
* Being over age 60
* History of ulcer disease
* Taking anticoagulants, LDA, or corticosteroids
* Having chronic disorders like CVD
## Footnote
NSAIDs and corticosteroids inhibit prostaglandin synthesis, increasing mucosal injury risk.
213
How can diet contribute to gastritis?
Diet indiscretions, such as binge drinking alcohol or consuming large quantities of spicy foods, can cause acute gastritis.
## Footnote
Prolonged alcohol use can lead to chronic gastritis.
214
What role does Helicobacter pylori play in gastritis?
H. pylori infection causes acute gastritis in most infected persons and may lead to chronic gastritis and stomach cancer.
## Footnote
Prolonged inflammation from H. pylori can cause functional changes in the stomach.
215
What are other potential causes of chronic gastritis?
Other causes include:
* Bacterial, viral, and fungal infections
* Reflux of bile salts from the duodenum
* Prolonged vomiting
* Intense emotional responses
* CNS lesions
## Footnote
These factors can cause inflammation of the mucosal lining.
216
What is autoimmune gastritis?
Autoimmune metaplastic atrophic gastritis is an inherited condition where the immune response targets parietal cells.
## Footnote
It often affects women of northern European descent and is associated with other autoimmune disorders.
217
What is the consequence of losing parietal cells in autoimmune gastritis?
Loss of parietal cells leads to low chloride levels and inadequate production of intrinsic factor.
## Footnote
This can result in cobalamin malabsorption.
218
What are some environmental factors that can cause gastritis?
• Radiation
• Smoking
## Footnote
Environmental factors play a significant role in the development of gastritis.
219
Name a drug that is known to cause gastritis.
Aspirin
## Footnote
Aspirin is a common nonsteroidal anti-inflammatory drug (NSAID) that can irritate the gastric lining.
220
What dietary factors can contribute to gastritis?
• Alcohol
• Large amounts of spicy, irritating foods
## Footnote
Certain foods and beverages can exacerbate gastric irritation.
221
List two diseases or disorders that can lead to gastritis.
• Crohn disease
• Renal failure
## Footnote
Various medical conditions can influence the development of gastritis.
222
Which microorganism is most commonly associated with gastritis?
H. pylori
## Footnote
Helicobacter pylori is a bacterium that is a common cause of chronic gastritis.
223
What is a non-microbial factor that may cause gastritis?
Endoscopy procedures
## Footnote
Certain medical procedures can lead to irritation of the gastric mucosa.
224
Fill in the blank: _______ can cause gastritis due to its irritating properties.
Alcohol
## Footnote
Alcohol consumption can lead to inflammation of the gastric lining.
225
True or False: Stress is a known factor that can contribute to gastritis.
True
## Footnote
Psychological and physical stress can exacerbate gastric inflammation.
226
What are some common drugs that can lead to gastritis?
• Nonsteroidal antiinflammatory drugs (NSAIDs)
• Corticosteroids
• Digitalis
## Footnote
Many medications can irritate the stomach lining and lead to gastritis.
227
Which of the following is NOT a cause of gastritis: Sepsis, Heart Disease, Shock?
Heart Disease
## Footnote
Sepsis and shock are conditions that can lead to gastritis due to physiological stress on the body.
228
Name one microorganism other than H. pylori that can cause gastritis.
Cytomegalovirus
## Footnote
Various viral and bacterial infections can contribute to gastritis.
229
What is intrinsic factor essential for?
Cobalamin (vitamin B12) absorption
## Footnote
Lack of intrinsic factor can lead to pernicious anemia.
230
What are the clinical manifestations of acute gastritis?
* Anorexia
* Nausea and vomiting
* Epigastric tenderness
* Feeling of fullness
* GI bleeding
## Footnote
GI bleeding is often associated with alcohol use and can be the only symptom.
231
How long does acute gastritis typically last?
A few hours to a few days
## Footnote
Acute gastritis is self-limiting.
232
What may be a symptom of chronic gastritis?
Asymptomatic in some patients
## Footnote
When parietal cells are lost due to atrophy, intrinsic factor is also lost.
233
What diagnostic studies are used for acute gastritis?
* Patient's symptoms
* Presence of risk factors
* Endoscopic examination with biopsy
* Tests for H. pylori infection
* CBC for anemia
## Footnote
A tissue biopsy can rule out gastric cancer.
234
What is the main treatment approach for acute gastritis?
Eliminating the cause and supportive care
## Footnote
If vomiting is present, rest, NPO status, and IV fluids may be prescribed.
235
What should be monitored in cases of severe acute gastritis?
Vital signs and vomitus for blood
## Footnote
Management strategies for upper GI bleeding apply to severe gastritis.
236
What types of medications are used for drug therapy in acute gastritis?
* H2 receptor blockers (e.g., cimetidine)
* PPIs (e.g., omeprazole)
## Footnote
These reduce gastric HCl acid secretion.
237
What is the treatment focus for chronic gastritis?
Evaluating and eliminating the specific cause
## Footnote
This can include cessation of alcohol or drug use.
238
What dietary changes might help patients with chronic gastritis?
Nonirritating diet with 6 small feedings a day
## Footnote
Smoking is contraindicated in all forms of gastritis.
239
What is the incidence of acute upper GI bleeding in the U.S.?
103 cases per 100,000 adults per year
## Footnote
The mortality rate in hospital admitted patients is 14%.
240
What type of bleeding is characterized by bright red blood?
Arterial source bleeding
## Footnote
This indicates that the blood has not been in contact with gastric HCl acid.
241
What are common causes of upper GI bleeding?
* Peptic ulcers
* H. pylori infection
* NSAID use
## Footnote
About 25% of people on chronic NSAIDs may develop ulcers.
242
What does melena indicate in relation to upper GI bleeding?
Slow bleeding from an upper GI source
## Footnote
The longer blood passes through the intestines, the darker the stool color.
243
What percentage of patients with disease will experience bleeding?
2% to 4%
## Footnote
This statistic highlights the prevalence of bleeding among patients with various diseases.
244
What is Stress-related mucosal disease (SRMD)?
Mucosal damage in the GI tract associated with serious illness
## Footnote
Damage can range from small lesions to major bleeding, often occurring in critically ill patients.
245
Who is at highest risk for SRMD?
Patients with coagulopathy, liver disease, organ failure, and those receiving renal replacement therapy
## Footnote
These conditions increase vulnerability to mucosal damage.
246
What are common causes of esophageal bleeding?
Chronic esophagitis, Mallory-Weiss tear, esophageal varices
## Footnote
Chronic esophagitis can be caused by GERD, smoking, alcohol use, and irritant drugs.
247
What is the primary diagnostic tool for UGI bleeding?
Endoscopy
## Footnote
Endoscopy helps identify sources like esophageal varices, PUD, and gastritis.
248
When is angiography used in the context of UGI bleeding?
When endoscopy cannot be performed or bleeding persists after endoscopic therapy
## Footnote
Angiography involves inserting a catheter to locate the site of bleeding.
249
What laboratory studies are included in the assessment of UGI bleeding?
CBC, BUN, serum electrolytes, prothrombin time, partial thromboplastin time, liver enzymes, ABGs, type and crossmatch
## Footnote
These tests help evaluate the patient's condition and need for transfusion.
250
What does an increased BUN level indicate?
Increased protein breakdown by bacteria or renal hypoperfusion/renal disease
## Footnote
Elevated BUN levels can reflect several underlying conditions.
251
What is classified as a massive UGI hemorrhage?
Loss of more than 1500 mL of blood or 25% of intravascular blood volume
## Footnote
Massive hemorrhage requires immediate identification of the cause and treatment.
252
What are signs and symptoms of shock to assess in an emergency?
Tachycardia, weak pulse, hypotension, cool extremities, prolonged capillary refill, apprehension
## Footnote
Identifying these signs is crucial for early intervention.
253
How is urine output monitored in patients with UGI bleeding?
Through an indwelling urinary catheter for hourly output assessment
## Footnote
Urine output is a key indicator of vital organ perfusion.
254
What fluids are typically used for volume replacement in massive hemorrhage?
Whole blood, packed RBCs, fresh frozen plasma
## Footnote
These fluids help restore blood volume in critical situations.
255
What is the first-line management for UGI bleeding?
Endoscopy within the first 24 hours
## Footnote
Timely endoscopy is essential for diagnosis and treatment.
256
What are the techniques used for endoscopic hemostasis?
Mechanical therapy, thermal ablation, injection
## Footnote
Techniques include clips, bands, cauterization, and epinephrine injection.
257
What is the goal of endoscopic hemostasis?
To coagulate or thrombose the bleeding vessel
## Footnote
Effective hemostasis is critical to manage UGI bleeding.
258
What is a common cause of upper GI bleeding related to drug use?
Drug-induced
## Footnote
Common drugs include NSAIDs and salicylates.
259
Name two conditions that can cause upper GI bleeding in the esophagus.
* Esophageal varices
* Esophagitis
## Footnote
Esophageal varices are often associated with liver disease.
260
What is a Mallory-Weiss tear?
A tear in the esophagus caused by severe vomiting or retching
## Footnote
This condition can lead to upper GI bleeding.
261
List three medications that can cause upper GI bleeding.
* Corticosteroids
* NSAIDs
* Salicylates
## Footnote
These medications can irritate the gastrointestinal tract.
262
What is erosive gastritis?
Inflammation and erosion of the stomach lining
## Footnote
It can lead to upper GI bleeding.
263
What does PUD stand for?
Peptic Ulcer Disease
## Footnote
PUD can result in upper GI bleeding.
264
True or False: Stress-related mucosal disease can cause upper GI bleeding.
True
## Footnote
It is often seen in critically ill patients.
265
Name a systemic disease that can lead to upper GI bleeding.
* Blood dyscrasias (e.g., leukemia, aplastic anemia)
* Renal failure
* Stomach cancer
## Footnote
These conditions can affect the blood and gastrointestinal health.
266
Fill in the blank: Upper GI bleeding can occur due to _______ in the stomach.
[Stomach cancer]
## Footnote
Stomach cancer can lead to significant bleeding.
267
What are polyps in the context of upper GI bleeding?
Abnormal growths on the stomach lining or gastrointestinal tract
## Footnote
Polyps can sometimes bleed and cause upper GI bleeding.
268
What are some strategies for managing variceal bleeding?
Variceal ligation, injection sclerotherapy, balloon tamponade
## Footnote
These strategies are detailed in Chapter 48.
269
When is surgical intervention needed for UGI bleeding?
When bleeding continues despite therapy and there is an identified site of bleeding
## Footnote
Surgery may be necessary if the patient continues to bleed after rapid transfusion of up to 2000 ml of whole blood or is still in shock after 24 hours.
270
How do mortality rates relate to age in patients with UGI bleeding?
Mortality rates increase greatly in older patients.
271
What is the purpose of drug therapy during the acute phase of UGI bleeding?
To decrease bleeding, decrease HCl acid secretion, and neutralize HCl acid.
272
What type of therapy is often started before endoscopy in acute UGI bleeding?
Empiric PPI therapy with high-dose IV bolus and subsequent infusion.
273
Why is it important to reduce acid secretion during UGI bleeding?
Because the acidic environment can alter platelet function and interfere with clot stabilization.
274
What may be done if the pH of stomach contents is less than 5?
Intermittent suction may be used or the frequency or dosage of the antacid or antisecretory agent increased.
275
What essential assessment should be performed for a patient with UGI bleeding?
Immediate assessment of consciousness, vital signs, skin color, and capillary refill.
276
What are signs and symptoms of shock from blood loss?
Low BP, rapid weak pulse, increased thirst, cold clammy skin, restlessness.
277
How often should vital signs be monitored in a patient with UGI bleeding?
Every 15 to 30 minutes.
278
What are some clinical problems associated with UGI bleeding?
* Fluid imbalance
* Inadequate tissue perfusion
* Impaired GI function
279
What are the overall goals for a patient with UGI bleeding?
1. No further GI bleeding
2. Cause of bleeding identified and treated
3. Return to normal hemodynamic stability.
280
Fill in the blank: A thorough assessment is essential when caring for a patient with _______.
UGI bleeding
281
What subjective and objective data should be gathered from a patient with UGI bleeding?
History of bleeding episodes, blood transfusion history, transfusion reactions, other illnesses, medications, religious preferences regarding blood products.
282
What health history information is important before a bleeding episode?
Precipitating events before bleeding episode, prior bleeding episodes and treatment, PUD, esophageal varices, esophagitis, acute and chronic gastritis, stress-related mucosal disease
## Footnote
PUD refers to peptic ulcer disease, which is a significant risk factor for upper gastrointestinal bleeding.
283
Which medications are associated with upper gastrointestinal bleeding?
Aspirin, NSAIDs, corticosteroids, anticoagulants
## Footnote
These medications can increase the risk of bleeding due to their effects on the gastric mucosa or coagulation.
284
What functional health patterns may indicate upper gastrointestinal bleeding?
Family history of bleeding, smoking, alcohol use, nausea, vomiting, weight loss, thirst, diarrhea, black tarry stools, decreased urine output, sweating, weakness, dizziness, fainting, epigastric pain, abdominal cramps, acute or chronic stress
## Footnote
These patterns reflect both physical symptoms and lifestyle factors that could contribute to the risk of bleeding.
285
What are some general objective data findings in a patient with upper gastrointestinal bleeding?
Fever
## Footnote
Fever may indicate an underlying infection or inflammatory process.
286
What cardiovascular signs may indicate upper gastrointestinal bleeding?
Tachycardia, weak pulse, orthostatic hypotension, slow capillary refill
## Footnote
These signs can reflect hypovolemia due to blood loss.
287
What gastrointestinal signs are indicative of upper gastrointestinal bleeding?
Red or coffee-grounds vomitus, tense rigid abdomen, ascites, hypoactive or hyperactive bowel sounds, black tarry stools
## Footnote
The appearance of vomitus and stools can help differentiate between upper and lower GI bleeding.
288
What neurologic signs may be observed in a patient with upper gastrointestinal bleeding?
Agitation, restlessness, decreasing level of consciousness
## Footnote
These symptoms may result from decreased perfusion or significant blood loss.
289
What respiratory signs may indicate complications from upper gastrointestinal bleeding?
Rapid, shallow respirations
## Footnote
This may occur due to hypoxia or anxiety related to the bleeding.
290
What skin findings may be present in a patient with upper gastrointestinal bleeding?
Clammy, cool, pale skin; pale mucous membranes, nail beds, and conjunctivae; spider angiomas; jaundice; peripheral edema
## Footnote
These findings can indicate shock, liver disease, or significant blood loss.
291
What urinary signs may suggest upper gastrointestinal bleeding?
Decreased urine output, concentrated urine
## Footnote
These signs may reflect renal perfusion issues due to hypovolemia.
292
What possible diagnostic findings are associated with upper gastrointestinal bleeding?
Hematocrit and hemoglobin levels, hematuria, guaiac-positive stools, endoscopy results, levels of clotting factors, liver enzymes abnormal
## Footnote
These tests help assess the severity of bleeding and identify possible sources.
293
What patients are at high risk for GI bleeding?
Patients with a history of chronic gastritis, cirrhosis, or PUD.
## Footnote
PUD stands for Peptic Ulcer Disease.
294
What should patients taking anticoagulants be aware of?
They are at risk for GI bleeding, especially those over 60 years old with a history of PUD.
295
What types of medications can cause GI toxicity?
* Corticosteroids
* NSAIDs
## Footnote
NSAIDs are non-steroidal anti-inflammatory drugs.
296
How can patients reduce irritation from GI toxic drugs?
By taking these drugs with meals or snacks.
297
What substances should at-risk patients avoid?
* Alcohol
* Smoking
* OTC drugs with aspirin
## Footnote
OTC stands for over-the-counter.
298
What is a key teaching point regarding occult blood testing?
Patients should report positive results promptly to the HCP.
299
Why is it important to treat upper respiratory tract infections promptly in at-risk patients?
Severe coughing or sneezing can increase pressure on fragile varices and may result in massive hemorrhage.
300
What patient conditions increase the risk for GI bleeding?
* Blood dyscrasias (e.g., aplastic anemia)
* Liver problems
* Chemotherapy drugs
## Footnote
These conditions decrease clotting factors and platelets.
301
What is the initial management step in acute GI bleeding?
Place IV lines, preferably 2, with a 16- or 18-gauge needle.
302
Why is monitoring intake and output essential in acute care?
To assess the patient's hydration status.
303
What vital signs should be closely monitored in patients with CVD?
Heart rate and rhythm due to the risk of dysrhythmias.
304
What should be observed in older adults or patients with CVD during IV fluid administration?
Signs of fluid overload and pulmonary edema.
305
What is the purpose of gastric lavage in acute GI bleeding?
To clear the stomach of blood, although its effectiveness is questionable.
306
What symptoms indicate the onset of delirium tremens during alcohol withdrawal?
* Agitation
* Uncontrolled shaking
* Sweating
* Hallucinations
307
When beginning oral intake after GI bleeding, what should be monitored?
Symptoms of nausea, vomiting, and recurrence of bleeding.
308
What should patients and caregivers be taught to avoid future bleeding episodes?
Adhere to drug therapy and avoid drugs that can cause bleeding.
309
Fill in the blank: Patients should not take any drugs, especially _______.
aspirin.
310
311
What should be assessed first if the patient is unresponsive?
Circulation, airway, and breathing
## Footnote
This is critical in emergency management to ensure patient safety.
312
List the initial findings associated with acute gastrointestinal bleeding.
* Abdominal pain
* Abdominal rigidity
* Hematemesis
* Melena
* Nausea
## Footnote
These findings are important for diagnosis and management.
313
What is the first intervention for a responsive patient with abdominal issues?
Monitor airway, breathing, and circulation
## Footnote
Continuous monitoring is essential for patient stability.
314
What is a key sign of hypovolemic shock?
Cool, clammy skin
## Footnote
This indicates decreased perfusion and requires immediate action.
315
What is the appropriate urine output threshold indicating potential shock?
<0.5 mL/kg/hr
## Footnote
This is a critical measurement in assessing kidney perfusion.
316
Fill in the blank: Establish ______ access with a large-bore catheter.
IV
## Footnote
IV access is crucial for fluid replacement therapy.
317
What type of oxygen delivery method should be used for patients in hypovolemic shock?
Nasal cannula or nonrebreather mask
## Footnote
Adequate oxygenation is vital in managing shock.
318
What should be monitored ongoing in a patient with acute gastrointestinal bleeding?
* Vital signs
* Level of consciousness
* O2 saturation
* ECG
* Bowel sounds
* Intake/output
## Footnote
These parameters help assess the patient's condition continuously.
319
What is the purpose of giving IV PPI therapy?
To decrease acid secretion
## Footnote
This helps manage gastrointestinal bleeding and protect the mucosa.
320
What should be done if shock is present in a patient with gastrointestinal bleeding?
Insert a second large-bore catheter
## Footnote
This allows for more effective fluid resuscitation.
321
True or False: Patients should be kept NPO during ongoing monitoring.
True
## Footnote
This prevents complications such as aspiration.
322
What emotional support should be provided to patients and caregivers?
Reassurance and emotional support
## Footnote
This is essential for patient and caregiver well-being during a crisis.
323
324
What toxin causes botulism?
Toxin from Clostridium botulinum
## Footnote
Ingested toxin is absorbed from the gut and blocks acetylcholine at the neuromuscular junction.
325
What is the most common source of Clostridial bacterial food poisoning?
Improperly canned or preserved food, home-preserved vegetables
## Footnote
Also includes preserved fruits and fish, canned commercial products.
326
What is the onset time for symptoms of botulism?
12-36 hours
## Footnote
Symptoms include nausea, vomiting, abdominal pain, and neurological issues.
327
What are the manifestations of E. coli 0157:H7 infection?
Bloody stools, hemolytic uremic syndrome, abdominal cramping, profuse diarrhea
## Footnote
Onset varies by strain, ranging from 8 hours to 1 week.
328
What are common sources of Staphylococcal food poisoning?
Meat, bakery products, cream fillings, salad dressings, milk
## Footnote
Contaminated by the skin and respiratory tract of food handlers.
329
What is the treatment for botulism?
Maintain ventilation, polyvalent antitoxin, guanidine hydrochloric acid
## Footnote
Guanidine hydrochloric acid enhances acetylcholine release.
330
What preventative measure can be taken against botulism?
Correct processing of canned foods, boiling of suspected canned foods for 15 minutes before serving
## Footnote
This helps eliminate the risk of toxin ingestion.
331
What is a common symptom of Salmonella infection?
Nausea and vomiting, diarrhea, abdominal cramps, fever, and chills
## Footnote
Onset can range from 30 minutes to 7 hours.
332
What is the treatment for Salmonella infection?
Symptomatic, fluid and electrolyte replacement
## Footnote
Focuses on alleviating symptoms and preventing dehydration.
333
Fill in the blank: Symptoms of Clostridial food poisoning typically onset within _______.
8-24 hours
334
What is the primary prevention method for Staphylococcal food poisoning?
Immediate food refrigeration, monitoring food handling
## Footnote
Helps prevent bacterial growth and toxin production.
335
What is the onset time for symptoms of E. coli 0157:H7?
8 hours to 1 week
## Footnote
This variability depends on the specific strain of E. coli.
336
What are the gastrointestinal manifestations of botulism?
Nausea, vomiting, abdominal pain, constipation, distention
## Footnote
These symptoms indicate a serious condition requiring immediate attention.
337
338
What is a nonspecific term that describes acute GI symptoms caused by contaminated food or liquids?
Foodborne illness (food poisoning)
## Footnote
Foodborne illness includes symptoms such as nausea, vomiting, diarrhea, and abdominal pain.
339
How many Americans get a foodborne illness each year?
1 in 6 Americans, or 48 million people
## Footnote
This statistic highlights the prevalence of foodborne illnesses in the United States.
340
What are the hospitalization and death statistics associated with foodborne illness?
128,000 hospitalized and around 3000 die
## Footnote
These figures indicate the serious health risks posed by foodborne illnesses.
341
What accounts for most foodborne illnesses?
Bacteria
## Footnote
Bacteria are the primary cause of foodborne illnesses, often originating from raw foods.
342
What is the most common source of bacterial food contamination?
Raw foods that become contaminated during growing, harvesting, processing, storing, shipping, or final preparation
## Footnote
Contamination can occur at any stage of food handling.
343
At what temperature range do bacteria multiply quickly?
Between 40°F and 140°F
## Footnote
This temperature range is known as the 'danger zone' for food safety.
344
What should be emphasized for hospitalized patients suffering from foodborne illness?
Correcting fluid and electrolyte imbalances from diarrhea and vomiting
## Footnote
Fluid and electrolyte management is crucial in the treatment of foodborne illnesses.
345
Fill in the blank: Each year, _______ Americans get a foodborne illness.
48 million
## Footnote
This statistic underscores the widespread impact of foodborne illnesses.
346
What interventions should focus on preventing infection related to foodborne illness?
Teaching correct food preparation and cleanliness, adequate cooking, and refrigeration
## Footnote
These practices help reduce the risk of foodborne illnesses.
347
What are the expected outcomes for a patient with UGI bleeding?
* Be free from UGI bleeding
* Maintain normal fluid volume
* Understand potential risk factors and make lifestyle modifications
## Footnote
These outcomes guide the evaluation of care for patients with UGI bleeding.
348
What support should be given to patients regarding smoking and alcohol?
Support the patient in smoking and alcohol cessation
## Footnote
Cessation of smoking and alcohol can reduce the risk of complications related to UGI bleeding.
349
True or False: Long-term follow-up care may be needed for patients with UGI bleeding due to possible recurrence.
True
## Footnote
Monitoring for recurrence is an important aspect of patient care.
350
What should patients and caregivers be taught regarding acute bleeding?
What to do if acute bleeding occurs in the future
## Footnote
Education on emergency responses can be critical for patient safety.
351
352
What is the primary characteristic of Escherichia coli 0157:H7?
It makes a powerful toxin that can cause severe illness with hemorrhagic colitis and kidney failure
353
In which populations can E. coli 0157:H7 infection be life-threatening?
In the very young and older adults
354
What types of food are primarily associated with E. coli 0157:H7?
Undercooked meats, especially poultry and hamburger
355
Name two other sources of E. coli 0157:H7 infection.
* Contaminated leafy vegetables
* Unpasteurized or contaminated fruit juices
356
How is E. coli 0157:H7 transmitted between individuals?
Person-to-person contact in families, long-term care, and childcare centers
357
How long after swallowing E. coli 0157:H7 do symptoms typically start?
1 to 10 days
358
What are the common manifestations of E. coli 0157:H7 infection?
* Diarrhea (often bloody)
* Vomiting
* Abdominal cramping pain
359
What is the variability of diarrhea associated with E. coli 0157:H7?
It can range from mild to bloody and may progress from watery to bloody
360
What are some systemic complications of E. coli 0157:H7 infection?
* Hemolytic uremic syndrome (HUS)
* Thrombocytopenic purpura
361
How is infection with E. coli 0157:H7 diagnosed?
By detecting the bacteria in the stool
362
What should all people with sudden diarrhea containing blood undergo?
A stool culture for E. coli 0157:H7
363
What is the primary treatment for E. coli 0157:H7 infection?
Hydration to maintain blood volume
364
Why should patients avoid antidiarrheal agents when treating E. coli 0157:H7?
They slow GI motility and can prolong infection
365
What therapies may be necessary in severe cases of E. coli 0157:H7 infection?
* Dialysis
* Plasmapheresis
366
Why are antibiotics seldom given to patients with E. coli 0157:H7 infection?
They increase the risk of complications and do not appear to treat the infection
367
What is hemolytic uremic syndrome (HUS)?
A life-threatening condition where RBCs are destroyed and kidneys fail
368
What is the mortality rate associated with hemolytic uremic syndrome (HUS)?
Around 5%
369
What long-term complications can arise from E. coli 0157:H7 infection?
* Abnormal kidney function
* Hypertension
* Seizures
* Blindness
* Paralysis
370
Fill in the blank: A small number of patients, especially young children and older adults, develop ______.
hemolytic uremic syndrome (HUS)
