everything Flashcards
(245 cards)
1
Q
condition where gastric content and enzymes backflow into the esophagus
A
GERD
2
Q
primary treatment of GERD
A
diet and lifestyle changes
3
Q
medication treatment of GERD
A
antacids
H2 receptor antagonists
proton pump inhibitors
4
Q
untreated GERD leads to
A
inflammation
breakdown
long term complications (barretts esophagus)
adenocarcinoma of esophagus
5
Q
condition where lining of esophagus gets damaged by acid reflux
A
barretts esophagus
6
Q
GERD prevention includes
A
BMI below 30
smoking cessation
limit alcohol/tobacco use
low fat diet
no eating 2 hrs before bed
no tight fitting clothes
elevate head of bed 6-8 inches
7
Q
risk factors of GERD
A
obesity
old age
sleep apnea
nasogastric tube
8
Q
what type of foods relax LES and cause GERD
A
fatty fried foods
chocolate
caffenated beverages
peppermint
spicy foods
tomatoes
citrus fruits
alcohol
9
Q
burning sensation in the esophagus is called
A
pyrosis
10
Q
pain when swallowing is called
A
odynophagia
11
Q
what color will esophageal lining be in GERD pt
A
red
12
Q
allows visualization of esophogus and can reveal barretts epithelium or esophagitis
A
EGD
13
Q
diagnostic procedure done under moderate sedation to observe for tissue damage
A
EGD
14
Q
what should you verify has returned before giving a pt oral fluids or food after a EGD
A
gag reflex
15
Q
manifestations of esophageal perforation
A
fever
pain
dyspnea
bleeding
16
Q
most accurate method of diagnosing GERD
A
esophageal pH monitoring
17
Q
diagnostic procedure where small catheter is placed through nose into esophagus to get pH readings for 24-48 hrs
A
esophageal pH monitoring
18
Q
nursing action for esophageal pH monitoring
A
have pt log food/beverages consumed, manifestations and activity during 24 hr test period
19
Q
records lower esophageal sphinter pressure & peristaltic activity of esophagus
A
esophageal manometry
20
Q
identifies hiatal hernia, strictures or structural abnormalities that contribute to GERD
A
barium swallow
21
Q
not eliminating barium places pt at risk for what?
A
fecal impaction
22
Q
proton pump inhibitors
A
pantaprazole
omeprazole
esomeprazole
rabeprazole
lansoprazole
23
Q
what do proton pump inhibitors do?
A
stop stomach cells from pumping acid into the stomach
24
Q
what to watch for in diabetic pts taking PPIs
A
electrolyte imbalances
hypoglycemia
25
signs of C.diff diarrhea secondary to PPI use
abdominal cramping
fever
diarrhea
26
long term PPI use can increase the risk for what especially in older pts
fractures
27
types of antacids
aluminum hydroxide
magnesium hydroxide
calcium carbonate
sodium bicarbonate
28
what do antacids do?
neutralize acid in stomach to make it less abrasive
29
what med cant be taken w antacids
levothyroxine
30
what function should you check for pts taking magnesium hydroxide (antacid)
kidney function
31
when is acid secretion highest
1-3 hrs after eating
bedtime
32
when should acacia be taken
when acid secretion is high
33
how long should you wait to take other meds before/after antacids
1 hr
34
h2 receptor antagonists
ranitidine
famotidine
cimetidine
nizatidine
35
what do h2 receptor antagonists do
reduce stomach acid secretion
36
difference between antacids & h2 receptor
h2 takes longer to kick in but lasts longer
37
use h2 receptor antagonists carefully in pts with
kidney disease
38
pt education for h2 receptor antagonists
take w meals and at bedtime
take 1 hr apart from antacids
39
med that increases motility of esophagus and stomach
metoclopramide
40
what should you monitor in pt taking metoclopramide
extrapyramidal adverse effects (involuntary movement)
41
procedure that uses radio frequency energy from an endoscope to decrease vagus nerve activity
stretta
42
post op stretta pt education
clear liquids for first 24 hrs
no NSAIDS for 10 days after
report CP, abd pain, bleeding, difficulty swallowing, dyspnea, nausea/vomiting
43
what is used to treat bleeding esophageal varices
vassopressin
44
what does peppermint do to indigestion
increases indigestion (bad for hiatal hernias)
45
most common area for peptic ulcer
duodenum
46
what infection causes peptic ulcers
H. pylori
47
how do you get H pylori
food, water, or exposure to body fluids
48
curlings ulcer is found in patients
with burns
49
cushings ulcers are found in patients with
head/brain trauma
50
what is used prophylactically to prevent stress ulcers
PPIs
51
gastric ulcer pain usually occurs
30-60 mins after a meal
52
gastric ulcer pain is exacerbated by
ingestion of food
53
does gastric ulcer pain usually occur at night
no
54
what kind of ulcer pain is found in malnourished patients
gastric ulcer
55
what ulcer pain has hematemesis as a symptom
gastric ulcer
56
patient with what kind of ulcer would be throwing up blood
gastric ulcer
57
what ulcer pain has melena as a symptom
duodenal (peptic) ulcer pain
58
patient with dark stool would have what kind of ulcer
peptic (duodenal) ulcer
59
when would pt with duodenal (peptic) ulcer feel pain
1.5-3hrs after a meal
60
which ulcer will wake patient up at night
peptic (duodenal) ulcer
61
which ulcer would occur in a well nourished patient
peptic (duodenal) ulcer
62
which ulcer is relieved by food or an antacid
peptic (duodenal) ulcer
63
physical signs of peptic ulcer
epigastric pain or tenderness
vomiting blood
poo-ing blood
losing weight
64
how is H pylori tested for
endoscopy
urea breath test
stool sample test
hemoglobin and hematocrit
stool sample
65
how does a urea breath test find H.pylori
pt drinks carbon rich urea solution
blows into collection container
66
positive urea breath test
carbon dioxide will be released if h pylori is present
67
foods to avoid w/ ulcer
coffee
tea
carbonated beverages
68
meds for ulcers
antibiotics
H2 receptor antagonists
PPIs
antacids
mucosal protectants
69
what to do before EGD procedure
start 2 large bore IV catheters
70
what to do after EGD procedure
monitor vitals
NPO until gag reflex returns
71
surgerys if ulcers dont heal
gastrectomy
vagotomy
pyloroplasty
72
procedure that part or whole stomach is removed
gastrectomy
73
procedure that vagus nerve is cut to decrease gastric acid production
vagotomy
74
how is vagotomy done to prevent post op complications
laparoscopically
75
procedure where opening between stomach opening and small intestine is enlarged to increase gastric emptying rate
pyloroplasty
76
what happens to pts HR w peptic ulcer
tachycardia
77
abdominal signs of peptic ulcer
rigid abdomen
rebound tenderness
78
what happens to peptic ulcer pt BP
hypotension because of GI bleed
79
what is dumping syndrome
high sugar food moves from stomach to small intestine too quick
80
gastritis caused by h pylori infection
nonerosive
81
gastritis caused by NSAIDS, alcohol use, recent radiation
erosive gastritis
82
gastritis w sudden/short onset and results in gastric bleeding if severe
acute gastritis
83
chronic gastritis can be caused by
autoimmune disease
bacterial infection
84
lab tests for gastritis
CBC (anemia)
blood/stool antibody test (h. pylori)
urea breath test (h pylori measurement)
85
pernicious anemia is treated with
monthly vitamin b12 injections
86
what does famotidine do
antacid (stops acid production)
87
ulcerative colitis is characterized by
frequent stools
cramping/abdominal pain
exacerbations/remissions
88
edema & inflammation in the rectum and rectosigmoid colon is called
ulcerative colitis
89
Inflammation and ulceration of GI tract at distal ileum is called
crohns disease
90
cultures w high risk get ulcerative colitis
caucasian
jewish
91
culture w high risk for crohns disease
jewish
92
crohns disease requires what monthly
vitamin b12 injections
93
part of abdomen that ulcerative colitis is felt
LLQ
94
part of abdomen crohns disease is felt
RLQ
95
hematocrit & hemoglobin lvls with ulcerative colitis
decreased
96
ESR lvls with ulcerative colitis
increased
97
WBC with ulcerative colitis
increased
98
CRP w/ ulcerative colitis
increased
99
albumin w/ ulcerative colitis
decreased
100
electrolytes w/ ulcerative colitis
decreased
101
hematocrit & hemoglobin in crohn's disease
decreased
102
ESR in crohns disease
increased
103
WBC in crohns disease
increased
104
CRP in crohns disease
increased
105
albumin in crohns disease
decreased
106
folic acid and b12 in crohns disease
decreased
107
urynalisis in crohns disease will show
WBC
108
electrolytes in crohns disease will be
decreased
109
diagnostic procedures for ulcerative colitis
colonoscopy
sigmoidoscopy
barium enema
CT scan/MRI
stool exam
110
crohns disease diagnostic procedure
endoscopy
proctosigmoidoscopy
colonoscopy
abd US
barium enema
111
life threatening inflammation of peritoneum and abdominal cavity lining
peritonitis
112
cause of peritonitis
bacteria in peritoneal cavity
113
nursing actions for peritonitis
place pt in fowlers (drain fluid)
monitor for hypovolemia
adminitser hypertonic IVF & antibiotics
114
crohns disease diet
high protein diet
115
ulcerative colitis diet
low fiber diet
116
inflammation of gallbladder wall
cholecystitis
117
cholelithiasis is
gallstones
118
where is bile stored
the gallbladder
119
cholecystitis risk factors
females
oral contraceptives
obesity
older pts
type 2 DM (high triglycerides)
crohns disease
rapid weight loss
native/mexican american
120
cholecystitis would be felt where
RUQ radiating to right shoulder
121
physical assessment test for cholecystits
murphys sign
122
positive murphys sign
pain w/ deep inspiration during palpation of R subcostal
123
food that causes pain in pt w cholecystitis
high fat food caused by biliary colic
124
physical findings in cholecystitis pts
jaundice
icterus
clay colored stool
steatorrhea
dark urine
125
cholecystitis WBC labs will be
increased (inflammation)
126
cholecystitis blood bilirubin will be
increased
127
cholecystitis amylase and lipase will be
increased
128
AST, LDH & ALP can indicate what in cholecystitis
common bile duct is obstructed
129
cholecystitis diagnosis exams
US
abd CT
hepatobiliary scan (HIDA)
endoscopic retrograde cholangiopancreatography
magnetic resonance cholangiopancreatography
130
bile duct obstruction can cause
ischemia
gangrene
rupture of gallbladder wall
131
a ruptured gallbladder can cause
bile peritonitis
132
when can a pt eat a normal diet of choice after a cholecystectomy
upon discharge
133
what pain would a pt s/p laparascopic cholecystectomy experience
shoulder pain (from free air introduced into the abdomen during surgery)
134
what does chenodiol do?
dissolves gallstones over 2 years
135
what does the pancreas secrete
insulin
glucagon
136
autodigestion of pancreas by enzymes that activate early before reaching stomach
pancreatitits
137
pancreatitis is felt where in the abdomen
LUQ, midepigastric and radiates to the back
138
pancreatitis pain is worse when
lying down
139
pancreatitis pain is relieved by what position
fetal position
sitting upright
bending forward
140
what does insulin do to glucose
decreases it
141
what does glucagon do to glucose
increases it
142
lipase breaks down
lipids
143
amylase breaks down
carbohydrates
144
what worsend cholecystitis pain
movement and eating
145
referred pain is
pain felt in different area than problem area
146
nerves that elevate the diapraghm
frenic nerves
147
pancreatitis risk factors
gallbladder stones
alcoholism
diet (high fat meal)
148
pancreatitis meds
antibiotics
h2 receptor antagonists
PPIs
pancreatic enzymes
149
hypercalcemia will cause pt to be
fatigued
bradycardia
hyperactive muscles
150
what will pancreatitis do to blood glucose
increase
151
pancrelipase should be given with what
every meal or snack
152
what should pt do after taking pacrelipase
drink full glass of water
153
what can you sprinkle pancrelipase on
non protein food
154
severe, boring epigastric pain that radiates to back, left flank, or left shoulder is a sign of
pancreatitis
155
gray-blue discoloration in periumbillical area is a manifestation of
pancreatitis
156
inflammation of liver cells
hepatitis
157
permanent scarring of liver that is caused by chronic inflammation
cirrhosis
158
most common type of hepatitis
viral hepatitis
159
can hepatitis be asymptomatic
yes
160
hepatitis A is transmitted through
food/water contaminated w feces
161
hepatitis B is transmitted through
blood
162
you get hepatitis B from
unprotected sex w infected person
contact w infected blood
substance use disorder
163
hepatitis C is transmitted through
blood
164
hepatitis D is transmitted through
co-infection with hepatitis B
165
hepatitis E is transmitted through
contaminated food/water
166
physical manifestations of hepatitis
fever
vomiting
dark color urine
clay colored stool
jaundice
167
HBV lab tests
ALT (elevated)
AST (elevated)
ALP (elevated)
total bilirubin (elevated)
HBV antibodies (will be present)
168
normal ALT level
4-36 units/L
169
normal AST
0-35 units/L
170
normal ALP
30-120 units/L
171
total bilirubin
0.3-1.0 mg/dL
172
HCV labs
AST
ALP
ALT
total bilirubin
HCV antibodies
EIA
HCV PCR
173
HDV labs
intrahepatic delta antigen identification
HDV antibodies
174
hepatitis diagnostic procedures
liver biopsy
175
what to do during liver biopsy
put pt in supine position w RUQ exposed
exhale and hold for 10 secs while needle inserted
175
what to do during liver biopsy
put pt in supine position w RUQ exposed
exhale and hold for 10 secs while needle inserted
176
post op liver biopsy
put pt in right side lying position
assess for pneumothorax
177
medication for chronic HCV
antiviral medication
178
HCV treatment
combination of peginterferon alfa-2a & ribavirin (antivirals)
179
are there meds for HBV & HEV?
no only supportive care
180
chronic hepatitis results from
HBV
HCV
HDV
181
chronic hepatitis increases risk for
liver cancer
182
post necrotic cirrhosis is caused by
viral hepatitis
183
laennecs cirrhosis is caused by
chronic alcohol use
184
biliary cirrhosis is caused by
chronic biliary obstruction or autoimmune disease
185
s/s of cirrhosis
cognitive changes
GI bleeding
splenomegaly
ascites
jaundice
petechiae
red palms
spider angionomas
186
cirrhosis labs
ALT (elevate)
AST (elevated)
ALP (elevated)
blood bilirubin (elevated)
blood protein (decreased)
blood albumin (decreased)
PT/INR (prolonged)
ammonia (increase)
creatine levels (increase)
187
cirrhosis diagnostic procedures
US
CT
MRI
liver biopsy
EGD
ESRC
188
monitor what for cirrhosis
resp status
skin integrity
fluid balance
vital signs
neurologic status
GI status
pain status
189
meds for cirrhosis
diuretics
beta blocking agent
lactulose
nonabsorbable antibiotic
190
procedures for cirrhosis
paracentesis
endoscopic sclerotherapy
transjugular intrahepatic portosystemic shunt
surgical bypass shunting procedures
liver transplant
191
pre op for paracentesis procedure
assis pt to bathroom to void
192
during paracentesis procedure
put pt supine with elevated bed head
apply dressing over puncture
193
post op paracentesis procedure
measure fluids and document amount/color
send to lab
asses puncture site for drainage
weigh pt
194
diet for pt with cirrhosis
high calorie mod fat
low sodium (ascites)
lowprotein (encephalopathy)
small frequent well balanced meals
195
cirrhosis complications
hepatic encephalopathy
esophageal varices
acute graft rejection post liver transplantation
196
medication for hepatic encepholopathy
lactulose (reduces ammonia)
197
signs hepatic encepholopathy is worsening
asterixis (hand flapping)
fetor hepaticus (bad breath)
198
HBV diet
high calorie high carbs
199
inappropriate amounts of T3 and T4 indicate
hypo or hyperthyroidism
200
what gland secretes TSH
anterior pituitary gland
201
T3 normal range
70-205 in adults
40-180 in old ppl
202
T4 normal range
4-12 mcg/dl up to 60 yrs old
5-11 mcg/dL over 60 y/o
203
increased TSH indicates
hypothyroidism
204
decreased TSH indicates
hyperthyroidism
205
TSH normal range
0.3-0.5 mU/L
206
hbA1c measures blood glucose for the past
120 days
207
lab values of pt with SIADH
low sodium
increased urine osmolarity
high urine sodium
increased urine specific gravity
208
excess growth hormone in adults w increased body part size but not height
acromegaly
209
untreated acromegaly can cause
HTN
DM
cardiac issues
210
acromegaly risk factors
age
benign tumors
211
s/s of acromegaly
headaches
visual disturbance
joint pain
hyperglycemia
barrel chest
212
types of diabetes insipidus
primary neurogenic
secondary neurogenic
nephrogenic
213
defects in pituitary gland cause lack of ADH
primary neurogenic
214
lack of ADH caused by infetions or tumors near pituitary gland
secondary neurogenic
215
renal tubules that dont react to ADH
nephrogenic
216
diabetes insipipidus urine labs will all be
decreased
217
diabetes insipidus blood labs will be
increased
218
meds for diabetes insipidus
desmopressin
chkorpramide
thiazide
219
hyperthyroidism risk factors
graves disease
thyroiditis
toxic adenoma
toxic goiter
220
synthroid hormone replacement
levothyroxine
221
levothyroxine increases the effects of what drugs
warfarin
222
levothyroxine is increased how often
every 2-3 weeks
223
levothyroxine should be taken on
an empty stomach before breakfast
224
how long is levothyroxine treatment
lifelong
225
abnormal menstrual periods (mennorrhia)
dry skin
hoarseness are manifestations of
hypothyroidism
226
methimazole treats
graves disease
227
disease caused by long term gluccocorticoid use
cushings syndrome
228
result of tumor in pituiatary gland resulting in release of ACTH hormone
cushing disease
229
cushings disease risk factor
females 20-40
230
cushings disease labs
cortisol levels (elevated)
urine (elevated free cortisol)
ACTH levels (elevated)
salivary cortisol (elevated)
blood potassium and calcium lvls (decreased)
blood glucose level (increased)
blood sodium level (increased)
lymphocytes (decreased)
231
pt with cushings disease increased risk for
infection
gastric ulcer
bone fractures
232
pt s/p transsphenoidal hyposectomy nasal drainage should be testes for
glucose
233
primary addisons disease causes
autoimmune dysfunction
TB
histopasmosis
adrenalectomy
cancer w metastasis
abd radiation therapy
234
secondary addissons disease causes
steroid withdrawal
hypophysectomy
pituitary neoplasm
high dose radiation of pituitary gland
235
s/s of addissons disease
weight loss
salt craving
hyperpigmentation
weakness/fatigue
nausea/vomiting
abdominal pain
constipation/diarrhea
236
addisons disease labs
blood electrolytes (increased)
BUN/Creatine (increased)
blood glucose (decreased)
blood/salivary cortisol (decreased)
237
unable to produce insulin
type 1 DM
238
diabetes screening `
BP greater than 140/90
HgA1c over 5.7%
HDL less than 35
triglycerides greater than 250 mg/dL
239
rapid acting insulin is given
before meals
240
rapid acting insulin onset
10-30 mins
241
give rapid acting insulin with
intermediate or long acting insulin
242
regular insulin (short acting) should be given
30-60 mins before meals
243
NPH insulin (intermediate acting insulin) should be given
given between meals
244
long acting insulin should be given
anytime but at the same time daily
