exam 2 chapter 22 Flashcards

1
Q

The ability of the esophagus to transport food and fluids is facilitated by which two sphincters?

A
  1. upper esopharyngeal (hypopharyngeal)
  2. lower esopharyngeal (gastroesophageal or cardiac)
    prevents reflux (backward flow) of gastric contents
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2
Q

difficult swallowing

A

dysphagia

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3
Q

odynophagia

A

acute pain on swallowing

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4
Q

Achalasia

A

absent or ineffective peristalsis of the distal esophagus, accompanied by failure of the sphincter to relax in response to swallowing.

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5
Q

what is the common symptom of achalasia

A

difficult swallowing fluids and solids.

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6
Q

Pyrosis

A

chest pain and heartburn.

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7
Q

How is achalasia treated

A

by pneumatic dilation

RN should instruct patient to eat slowly and drink fluids with meals.

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8
Q

what is a potential complication when pneumatic dilation is performed to treat achalasia?

A

perforation

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9
Q

what are some reasons GI intubation

A
decompress stomach fluid or air
lavage the stomach and remove toxins
administer medicaitons and nutrition
treat an obstruction
bypass sections of the GI tract to allow them to rest.
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10
Q

what should the suction be when a levine tube is used?

A

intermittent low wall suction (30 to 40 mm Hg)

To prevent gastric erosion or tearing of the stomach lining.

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11
Q

what are NG tubes such as the Levin used for?

A

decompression of distended stomach due to air or fluid.

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12
Q

tube feeding is also known as

A

enteral nutrition

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13
Q

administration of nutritionally balanced liquefied food or formule through tube inserted into stomach, deodenum or jejunum

A

tube feeding or enteral nutrition

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14
Q

contraindications for gastric feedings

A

patients at risk of aspiration

patients undergoing gastric surgery

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15
Q

A patient having a pancreatic surgery may have what type of tube?

A

jejunal tube to rest the pancreas by bypassing the hepatopancreatic ampulla, thereby avoiding the release of digestive enzymes into the duodenum.

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16
Q

when should feeding be started after inserting tube feeding

A

bowel sounds
x-ray
tube lenght from insertion site to distal end should be measured and recorded.
Tube should be marked at skin insertion site.
insertion lenght should be checked regularly.

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17
Q

tube feeding administration

A

HOB >30
HOB remains elevated for 30 to 60 minutes for intermittent delivery.
HOB remains semi Fowlers (45) with continuous feeding.
after feeding the HOB remains high fowlers (90) for 30-60 min.

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18
Q

Bolus feeding

A

resembles normal feedings pattern
300-400 formula over 30 -60 min
given every 3-6 hrs.

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19
Q

continous feeding

A

for 24 hours period pt remains in semi fowlers position

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20
Q

type of feeing, given over a 8-16 hr period, usually given at night to allow freedom during the day.

A

cyclic feeding

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21
Q

reasons for cyclic feeding

A

pt weaned from tube feeding to oral diet

supplements for pt who cannot eat enough.

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22
Q

position of the tube

A

placement checked before each feeds and medication.
every 8 hours with continuous feeds.
must be checked before administration of any contents.

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23
Q

Tube patency

A

continuous feedings adminstered on feeding pump with occlusion alarm.
some machines have a water bag that infuses Qhour.
bolus/cyclic irrigated with water before/after each feeding and meication administration.

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24
Q

what do you do with residual and why?

A

put back

to prevent F&E imbalance

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25
Q

Before feeings

A

aspirate gastric contents and measure amount of residual

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26
Q

general nursing consideration for tube feeding

A
daily weights
assess for bowel sounds before feedings
accurate I&O
initial glucose checks Q6
label with date and time started
feedings have life of 8-24 hours
pump tubing changed Q24
formula room/body temperature.
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27
Q

Tube feeding complications

A
vomiting
diarrhea
constipation
dehydration
aspiration
clogged tube
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28
Q

if there is asiration compications

A

check tube placement
check residual
elevate HOB

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29
Q

when tube is clogged

A

use liquid medications if possible
flush with 30-50 ml of H2O
flush with H2O Q4h for continuous feeding

Do not crush externed relase!!

30
Q

two potential problems for tube

A

skin irritation

pulling out of tube

31
Q

gerontologic considerations

A
more vulnerable to complications
F&E imbalances
glucose intolerance 
decrease ability to handle large volumes
increased risk of aspiration
32
Q

what is the primary factor in GERD

A

incompetent LES

33
Q

what is the results of incompetent LES

A

results in decrease pressure in distal portion of esophagus.

34
Q

what happens when there is a decrease pressue in the distal portion of the esophagus

A

gastric contents move from stomach to esophagus.

it can be due to certain foods (caffeine, chocolate) and drugs (anticholinergics.

35
Q

meal size and number for a patient with GERD

A

6-8 small males a day

36
Q

symptoms of GERD

A

heartburn(pyrosis)

37
Q

most common clinical manifestation of GERD

A

buring
tight sensation felt beneath the lower sternum and spreads upward to throat or jaw
felt intermittenly
relieved by milk, alkaline substances, or water

38
Q

what are some complications with GERD

A
  1. Barrett’s esophagus; replacement of normal squamous epithelium with columner epithelium.
    s&s none, to bleeding, to perforation
    monitor every2 to 3 years by endoscopy.
  2. Respiratory
    due to irritation of upper airway by secretions
  3. Dental erosion
39
Q

Drug there for GERD

A
  1. step up
    start with antacids and OTC H2R blockers and progress to prescription H2R blockers and finally PPIs
  2. Step down
    start with PPIs and titrate down to prescription H2R blockers and finally OTC H2R blockers and antacids
40
Q

Histamine (H2) receptor blockers for GERD

A
remember (tidines)
Famotidine (Pepcid)
Ranitidine (Zantac)
Cimetidine (Tagamet)
Nizatidine (Axid)

Suppress secretion of gastric acid (HCl)

41
Q

when is the best time for the patient to take H2 for GERD

A

HS (hours of sleep)

to decrease vagally induced histamine release in the stomach

42
Q

caution with cimetidine

A

increases bioavailability of many drugs ( beta blockers, morphine, theophyllin, warfarin, dilantin.
passes the blood brain barrier (causes CNS effects)
reacts with antacids

43
Q

Proton pump inhibitors (PPI) for GERD

A
REMEMBER (THE PRAZOLES)
omeprazole (Prilosec)
Esomeprazole (Nexium)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Lansoprazole (Prevacid)
44
Q

PPIs

A

suppress gastric acid secretion
promotes esophageal healing
may be beneficial in decreasing esophageal strictures
Tx of active ulcer
take 30 minutes before 1st meals of the day
Side Effects: headache, diarrhea, abd pain, nausea

45
Q

Drug therapy for GERD; Antacids

A

quick but short lived relief
Neutralize HCl acid
take 1 to 3 hours after meal before bedtime
Allow 1-2 hour between administration of other medications

Aluminum hydroxide preparations (Maalox, alu-cap)
slow-acting
contain lots of NA (caution: renal, CHF, hypertentsion)
may cause constipation

46
Q
Antacids
Calcium carbonate (Mylanta, Tums)
A

Rapid acting
may cause constipation
SE: belching and flatulence (the release of carbon dioxide in the stomach)

47
Q

Magnesium hydroxide (Milk of magnesia)

A

rapid acting
may cause diarrhea
caution in renal (toxicity)
often given in combo with aluminum prep

48
Q

what is vitamin B12 important for

A
health of peripheral and central nervous system
brain health
nerve health
RBC production 
happines
49
Q

True or false

evidence that C.difficile is higher risk if patient is on PPIs

A

True

acid zaps food born pathogens

50
Q

what happens when acid production is blocked

A

decreases intrinsic factor

51
Q

Treatment of B12 deficiency

A

diet ( citrus fruits, dried beans, green leafy veggies, liver, buts, organ meats.
B12 injection weekly at first and monthly for lifelong.

52
Q

which surgical intervention may be necessary if medical management of GERD is unsuccessful

A

Nissen fundoplication : wrapping of a portion the gastric fundus around the sphincter area of the esophagus.

53
Q

herniation of portion of the stomach into esophagus through an opening or hiatus in diaphragm

A

Hiatal Hernia

AKA: diaphragmatic and esophageal hernia

54
Q

most common type of hiatal hernia

stomach slides into thoracic cavity when supine, goes back into abdominal cavity when standing upright

A

Sliding or type 1 hiatal hernia

55
Q

Paraesophageal Hiatal hernia

A

Esophageal junction remains in place, but fundus and greater curvature of stomach roll up through diaphragm.
no reflux
pt usually feels a sense of fullness after eating or chest pain

56
Q

causes of hiatal hernia

A
structural changes: weakening of muscles in diaphragm.
Increased intraabdominal pressure
	obesity
	pregnancy
	heavy lifting
	tumors
	ascites
57
Q

what are some risk factors for esophageal cancer

A
smoking
excessive alcohol intake
Barrett's esophagus 
GERD
diets low in fruits and veggies
central obesity
58
Q

what is noted in the latter stages of esophagus cancer

A

obstruction of the esophagus

possible perforation into the mediastinum and erosion into the great vessels.

59
Q

what will be the Dx for an EGD that reveals an esophageal lining that is red rather than pink?

A

Barrett’s Esophagus

60
Q

saclike outpouching of one or more layers of esophagus

A

Esophageal diverticula

61
Q

what is the most common type of esophageal diverticula found most frequently in men than in women?

A

Zenker’s diverticulum

62
Q

clinical manifestations by patients with phargngoesophageal pulsion diverticulum

A
difficulty swallowing
fullness in the neck
belching
regurgitation of undigested food
gurgling noise after eating
halitosis and sour test in the mouth
63
Q

True or false? Esophagoscopy contraindicated in patient with esophageal diverticula.

A

True
because of the danger of perforation of the diverticulum
Blind insertion of NG tube should be avoided.

64
Q

after a removal of esophageal diverticula (diverticulectomy) what should the nurse monitor for

A

observed for evidence of leakage from the esophagus
developing fistual.
withhold food and fluids until radiographic studies indicate there is no leakage at the surgical site.
diet begins with liquids and progressed as tolerated.

65
Q

post op care for esophagectomy

A
Place patient in a low fowlers position and later in fowlers.
monitor for regurgitation and dyspnea.
monitor for aspiration and pneumonia 
Use of IS, sitting in a chair
nebulizer treatment 
monitor temp
drainage from cervical neck wound (saliva) evidence of leak
DO NOT MANIPULATE NG TUBE!!
66
Q

what is an excellent marker for malnutrition

A
prealbumin
it has a shorter half life (2 days)
does not influence fluid balance 
normal level 19 to 38 mg/dL
should be checked before tube placement
67
Q

what should be done before placement of NG when patient has head trauma

A

Evaluated for basilar skull fracture

68
Q

a pulse pressure of less than 30 mm Hg is indicative of what

A

fluid volume deficit (FVD)

69
Q

True or False? Hemoccult test for stool can be used for evaluation of gastric drainage

A

false

70
Q

what is the optimal position of central venous access devices (CVADs)

A

midproximal third of the superior vena cave at the junction of the right atrium.