Dementia/GI Flashcards
(72 cards)
1
Q
Dementia
A
An umbrella term for loss of memory and other thinking abilities severe enough to interfere with daily life
- Gradual
- Structural changes in the brain
2
Q
Types of dementia
A
- Alzheimers
- Vascular
- Lewy body
- Frontotemporal
- Other (Huntington’s, Parkinson’s)
- Mixed (One or more causes)
3
Q
Early signs of dementia
A
Memory loss
Speech or writing changes
Visual image changes
Altered judgement
Problem solivng changes
Personality or mood changes
Social changes
Misplacing Items
4
Q
What is Alzheimers Dementia
A
Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain
5
Q
What is Frontotemporal Dementia
A
Abnormal amounts or forms of tau and TDP-43 proteins accumulate inside neurons in the frontal and temporal lobe
6
Q
What is Lewy body dementia
A
Abnormal deposits of the alpha-synuclean protein, called “Lewy bodies” affect the brains chemical messengers
7
Q
Vascular dementia
A
Conditions, such as blood clots, disrupt blood flow in the brain
8
Q
Medications for Alzheimers
A
Cholinesterase Inhibitors (donepizil)
NMDA antagonist (memantine)
Avoid
- Sleep aids, anxiolytics, antipsychotics, anticonvulsants
- BEERS criteria (List of potentially inappropriate meds)
9
Q
Caring for patients with dementia
A
- Consistency is key
- Promote independence but safety is priority
- Work with patient not against patient
- Do not attempt to reorient
10
Q
Do’s of dementia communication
A
- Keep communication short, simple and clear
- Call your loved one by name, tell them who you are
- Speak slowly
- Use repetition as much as necessary
- Use techniques to attract and maintain your loved ones attention
11
Q
Don’ts of dementia communication
A
- Don’t say things such as “do you remember, try to remember, how could you forget.”
- Ask questions that challenge short term memory
- Talk in paragraphs, complex sentences, or slang
- Use baby talk, sarcasm, or irony
12
Q
Caring for the caregiver of dementia
A
- Immense physical and emotional strain
- If patient is admitted to the hospital, encourage the caregiver to take a break
- Connect with resources
13
Q
Delirium
A
Sudden decline in mental function in relation to an underlying condition.
- S/S fluctuate
- Lasts Hours to weeks
- Reversible when addressed
13
Q
Management of Delirium
A
- Treat underlying cause
- Anxiety reduction (Noise reduction, dim lighting, reorientation)
- Behavioral management (Safety)
- Antipsyhcotics/Anxiolytics
14
Q
Delirium risk factors
A
Limited or not modifiable
- Patient characteristic (age, gender, etc)
- Chronic pathology (predisposing illnesses)
More modifiable
- Environment
- Acute illness
15
Q
Upper GI complications
A
GERD
Hiatal Hernia
Anatomical esophageal disorders
Gastritis
PUD
16
Q
GERD Etiology
A
- HCl acid and pepsin secretion in refluxate -> irritation and inflammation (Esophagitis)
- Intestinal proteolytic enzymems and bile salts add to irritation
17
Q
S/S of GERD
A
Heart burn
Dyspepsia
Regurgitation
Chest Pain**
Hoarsness, sore throat
18
Q
Complications of GERD
A
- Esophagitis
- Repeat exposure (Scarring, stricture, dysphagia)
- Barrets esophagus (Precancerous condition)
- Dental Erosion
- Respiratory complications
19
Q
GERD diagnosis
A
Barrium swallow
Endoscopy
20
Q
GERD Treatment
A
Lifestyle and diet modifications
PPI= Omeprazole
Cytoprotective = Sulcrafate
Prokinetic: Promote gastric emptying = Metoclopramide
Antacids
Surgery: Nissan Fundoplication
21
Q
Nissan surgery
A
Reinforcement of the LES by wrapping a portion of the fundus of the stomach around the distal esophagus
Complications
- Temporary dysphagia
- Gas bloat syndrome - Distention
- Atelectasis and pneumonia
22
Q
GERD lifestyle modifications
A
Nutritional therapy
- Small frequent meals
- Avoid late evening meals
- Drink fluid between meals
- Chewing gum and oral lozenges
Others
- Remain upright after meals
- Maintain a healthy weight
- Avoid tight fitting clothing
- Elevate HOB 6-8 inches after meals at night
23
Q
Hiatal Hernia, S/S
A
Outpouching of stomach into esophagus or through an opening in the diaphragm
S/S
- Asymptomatic
- Reflux, dysphagia
24
Hiatal Hernia complications and treatment
Complications
- Stenosis
- Ulcerations
- Strangulation of hernia
Treatment
- Lifestyle modifications
- Surgery
25
Gastritis
Inflammation of the gastric mucosa
- Very common
Causes:
- Acute: [NABS] NSAIDs, Acid/Alkali ingestions, Bacterial [Salmonella]
- Chronic: autoimmune, H. pylori
25
Gastritis Complicatations and Treatment
Complications
- Pernicious anemia due to inability to absorb cobalamin r/t loss of intrinsic factor
- Erosive ulcers due to extensive gastric mucosal wall damage
Treatment
- Hydration, antiemetics, elimiating cause
- NPO diet, advance as tolerated
- H2 Antagonist (-tidine), PPI (-prazole), antacids, prostaglandins
26
PUD: peptic ulcer disease
- Erosion of GI mucosa resulting from digestive HCl acid and pepsin
Causes:
H. pylori
NSAIDs
Stress
27
How do we identify ulcers
Based on location
Gastric ulcers
- Pain 30-60 minutes after meal, malnourished, hematemesis
Duodenal
- Pain 1.5-3 hours after meal, awakening at night with pain, well nourished, melena
28
28
H. pylori (PUD)
- Most likely transmission during childhood -> Fecal oral
- Bacteria produces urease -> Activates immune response -> release of inflammatory cytokines -> Increase gastric secretion -> tissue damage and PUD
29
Complications and treatment of PUD
Complications
- Pernicious anemia
- Hemorrhage
- Perforation
- Gastric outlet obstruction
Treatment of PUD
- Discontinue NSAIDs
- Medications to reduce acid
- Antibiotics if H. pylori
- Surgery if severe: gastrectomy
30
EGD
Allows for visualization of the esophagus, stomach and duodenum using a flexible endoscope
- Can be both diagnostic and interventional
- Generally an outpatient procedure
Pre-procedure
- NPO 6-8 hrs, no red dyes
Anesthesia for moderate or conscious sedation
Post preceudre
- Monitor VS, Airways
- Sore throat, hoarseness expexted
31
Barrium swallow
Used to diagnose hiatal hernia, strictures, or structural abnormalities
- Outpatient
Patient swallows barium and a series of Xrays are taken to watch dye move through the digestive tract
Post procedure
- Stool softeners and laxatives to eliminate barrium
- Failure to eliminate barrium increases risk of fecal imaction
32
Inflammatory Bowel Syndrome
Alternates between constipation and diarrhea
Causes
- Unknown, Possibly genetic, environments, hormonal, stress related
33
IBS treatment
Avoid triggers
Medications
- Diarrhea predominant IBS: Loperamide, Psyllium, Alostetron
- Constipation predominant IBS: Lubiprostone, Linaclotide
Support groups
34
Chrohns Disease
Inflammation ant segment of GI tract from mouth to anus
- All layers of the bowl can become involved
35
S/S of Chrohns Disease
Sporadic Lesions (Skip lesions, Cobblestoning)
Can cause malabsorption, malnutrition
S/S
- Diarrhea, Cramping, Weight loss
36
Treatment of Chrohns
Medications
- Anti-inflammatories, Corticosteroids, Immunosuppressants
Most patients will require surgery
- Colectomy
- Repairing fistulas
- Strictures
37
Ulcerative Colitis
Inflammation and the ulceration of colon and rectum
- Affects the mucosa and submucosal layers -> They become hyperemic and the colon becomes edematous and reddened
38
S/S and Treatment of Ulcerative Colitis
Can lead to bowel obstruction
Mucosal changes can lead to colon cancer, pernicious anemia
- Bloody Diarrhea and Pain
Treatment
- Medications
Anti-inflammatories, Corticosteroids, Immunosuppressants
39
Celiac Disease
Autoimmune disease characterized by damage to small intestinal mucosa from ingensting wheat, barely, rye
Manifestations
- Foul smelling diarrhea
- Steatorrhea
- Flatulence, abdominal distension, malnutrition
- Dermatitis herpetiformis = Intensely pruritic vesicular rash
40
Treatment and complications of Celiac disease
Treatment
- Gluten free diet
Complications
- Chronic Inflammation can lead to increased risk of cancer
41
Appendicitis
Inflammation of the appendix
- Most common reason for emergency abdominal surgery
Manifestations
- Initially - dull periumbillical pain, N/V, anorexia
- Pain shifts to RLQ, Mcburney point
- Low grade fever
- As it worsens -> Rebound tenderness, muscle gaurding, rigidity
42
Complications and treatment of appendicitis
Complications
- Ruptured appendix, peritonitis, death
Treatment
- Emergency appendectomy
43
Peritonitis
A life threatening inflammation of the peritoneum and lining of the abdominal cavity often due to bowel perforation
44
What can cause peritonits
Peritoneal dialysis
Perforated diverticula
Ruptured appendix
Surgery
45
Bowel Perforation
Occurs when a hole forms all the way through the stomach, large bowel, or small intestine.
Clinical presentation
Initial phase (0-2 hrs after perforation)
- Sudden severe upper abdominal pain, quickly spreads throughout the abdomen
- Pain radiates to back, rigid board like abdomial muscles
46
Causes of Bowel perforation
- Trauma
- Diverticulitis, UC, Crohns Disease, PUD
47
Peritonitis S/S
Rigid, board like abdomen, abdominal distension
- N/V
- Rebound tenderness
- Fever
- Tachycardia
48
Immediate actions of Peritonitis
- Call physician, take vitals, ensure O2
- Semi fowlers -> improve lung expansion
- Maintain NPO
- Administer antibiotics, fluids, electrolytes
- Prepare patient for surgery if indicated
49
Signs of internal bleeding
Cullens Sign: Bruising around the belly button
Grey Turners Signs: Bruising in flank area (between rib and hip)
50
Intestinal Obstruction
Can result from mechanical or non-mechanical causes
Mechanical: Adhesions, tumors, hernias, fecal impactions, strictures, volvulus (twisting)
Non mechanical: Diminished peristalsis (paralytic illeus)
- Post operative complication
- Neurogenic Disorder
51
Intestinal Obstruction manifestations
Depends on the location of the obstruction
Small Bowel
- Severe fluid and electrolyte imbalance (metabolic alkalosis)
- Epigastric, upper abdominal pain
- Projectile vomiting with fecal smelling emesis
Large intestine
- Minor fluid and electrolyte imbalances
- Lower abdomial pain
- Less vomiting
- Diarrhea pr ribbon like stools (indicating stool is moving around obstruction)
52
Intestinal obstruction Diagnosis and Treatment
Diagnosis
- Abdominal X-ray
Treatment
- Bowel rest: NPO, NG placement to LIS
- Fluid and electrolyte replacement
- Surgery may be necessary (exploratory laparoscopy)
- Encourage ambulation
53
NG management
Suction is usually set to LIS (Low intermittent suction)
Assess placement and patency
- Litmus paper
- Auscultation
- Xray (gold standard)
Monitor output of NG
- Generally green/yellow/brown
Clamp NG 30-45 minutes after PO meds
- Trial clamping before removal
54
Toxic Megacolon
Due to inactivity of the colon
- Massive dilation of the colon occurs
- Patient at risk for bowel perforation
55
Toxic Megacolon nursing actions
NG suction
IV abx, fluids, electrolytes
Prepair for surgery
- Patient may need a bowel resection with possible colostomy or ileostomy placement
56
Familial Adenomatous Polyposis
Genetic disorder characterized by hundreds or thousands of polyps in the colon -> Eventually become cancerous
- Autosomal dominant inheritance pattern
- Cancer is inevitable (most patients will require removal of colon and rectum by age 25)
- Patients are also at risk for developing other cancers as well
57
Colon cancer & Diagnostics
Second leadong cause of cancer-related deaths
- Third most common in men and women
Diagnostics
- Colonoscopy starting at age 45, and every 10 years
58
Colon cancer manifestations and treatment
Early disease: Non specific findings
Later disease: Abdominal tenderness, palpable masses, hepatomegaly, ascites, GI bleeds
Tx
Chemotherapy, Radiation, and surgery
- Surgery may require ostomy placement
59
Colonoscopy
Outpatient procedure
Should be done by age 45
Pre-procedure
- Bowel prep including laxatives the night before
- NPO after prep is complete
Post Procedure
- Monitor for rectal bleeding
- Resume normal diet, encourage fluids
60
Diarrheal Illnesses
C. Dif
- Noscocmail infection
- Requires contact isolations, bleach wipes to clean
- Often a result of antibiotic therapy
Lactobacillus is often ordered to prevent C.Dif
Any patient admitted with diarrhea or develops diarrhea in the hospital -> Tested for C.dif before antidiarrheal meds can be ordered
61
Bowel surgery complications
Bowel perforation
Sepsis
Altered bowel motility
Scar Tissue -> Adhesions -> Obstructions
62
Gastric Bypass
Indicated for BMI > 40
Works by two principles: Malabsorption and Restriction
- Adjustable band gastroplasty: Restrictive
- Vertical banded gastroplasty: Restrictive
- Roux-en-Y gastric bypass: Malabsorptive and restrictive (More sustained weight loss, problems with malabsorption long term)
63
Gastric Bypass complications
Dehydration after surgery
Malabsorption (Eat small, nutrient dense foods, Dumping syndrome)
64
Gastric Bypass post procedure care
- Patients immediately at risk for complications r/t obesity
- Monitor for dehydration
- Abdominal binders may be used to decrease chance of dehiscence
- Monitor for anastomotic leak (JP amylase compared to serum amylase, S/S: Back, shoulder, abdominal pain, restlessness, tachycardia)
- Encourage ambulation
65
Dumping Syndrome
Rapid movement of food through digestive tract
- Usually triggered by high carb or high sugar foods
Early manifestations
- Occurs within 30 mins of eating
66
S/S of Dumping Syndrome
Nausea
Sweating
Dizziness
Tachycardia
Palpitation
Diarrhea -> Malnutrition
Late manifestations
- Hypoglycemia -> body response to produce insulin, but no absorption of food
S/S r/t hypoglycemia
67
Dumping syndrome treatment
Encourage patient to stay in a low fowlers position 30 mins after eating -> Delay gastric emptying
- Avoid triggers
- Consume small frequent meals
- Monitor for fluid and electrolye imbalance
68
Ostomy Placement
Ileostomy: Ostomy created into the ileum to drain stool
- Stool will be liquid (Large intestine is bypassed)
Colostomy: Ostomy created in the large intestine
- Stool will be more formed
- Indications: Cancer, Diverticulitis, Ischemic injury
Some ostomy's can be reversed
69
Ostomy care
Assess stoma
- Should be pink/red and moist
- Black or grey stoma needs to be assessed by a surgeon
- Stoma should be painless
Assess peristomal skin
Patient education
- Diet modifications
- Ostomy care (Emtpy when 1/4 - 1/2 full, may need to burp bag if air, use appropriate products)
Support groups
