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Nursing 130 Perioperative > exam 2 chapter 22 > Flashcards

exam 2 chapter 22 Flashcards

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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
Before feeings
aspirate gastric contents and measure amount of residual
26
general nursing consideration for tube feeding
``` 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. ```
27
Tube feeding complications
``` vomiting diarrhea constipation dehydration aspiration clogged tube ```
28
if there is asiration compications
check tube placement check residual elevate HOB
29
when tube is clogged
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
two potential problems for tube
skin irritation | pulling out of tube
31
gerontologic considerations
``` more vulnerable to complications F&E imbalances glucose intolerance decrease ability to handle large volumes increased risk of aspiration ```
32
what is the primary factor in GERD
incompetent LES
33
what is the results of incompetent LES
results in decrease pressure in distal portion of esophagus.
34
what happens when there is a decrease pressue in the distal portion of the esophagus
gastric contents move from stomach to esophagus. | it can be due to certain foods (caffeine, chocolate) and drugs (anticholinergics.
35
meal size and number for a patient with GERD
6-8 small males a day
36
symptoms of GERD
heartburn(pyrosis)
37
most common clinical manifestation of GERD
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
what are some complications with GERD
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
Drug there for GERD
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
Histamine (H2) receptor blockers for GERD
``` remember (tidines) Famotidine (Pepcid) Ranitidine (Zantac) Cimetidine (Tagamet) Nizatidine (Axid) ``` Suppress secretion of gastric acid (HCl)
41
when is the best time for the patient to take H2 for GERD
HS (hours of sleep) | to decrease vagally induced histamine release in the stomach
42
caution with cimetidine
increases bioavailability of many drugs ( beta blockers, morphine, theophyllin, warfarin, dilantin. passes the blood brain barrier (causes CNS effects) reacts with antacids
43
Proton pump inhibitors (PPI) for GERD
``` REMEMBER (THE PRAZOLES) omeprazole (Prilosec) Esomeprazole (Nexium) Rabeprazole (Aciphex) Pantoprazole (Protonix) Lansoprazole (Prevacid) ```
44
PPIs
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
Drug therapy for GERD; Antacids
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
``` Antacids Calcium carbonate (Mylanta, Tums) ```
Rapid acting may cause constipation SE: belching and flatulence (the release of carbon dioxide in the stomach)
47
Magnesium hydroxide (Milk of magnesia)
rapid acting may cause diarrhea caution in renal (toxicity) often given in combo with aluminum prep
48
what is vitamin B12 important for
``` health of peripheral and central nervous system brain health nerve health RBC production happines ```
49
True or false | evidence that C.difficile is higher risk if patient is on PPIs
True | acid zaps food born pathogens
50
what happens when acid production is blocked
decreases intrinsic factor
51
Treatment of B12 deficiency
diet ( citrus fruits, dried beans, green leafy veggies, liver, buts, organ meats. B12 injection weekly at first and monthly for lifelong.
52
which surgical intervention may be necessary if medical management of GERD is unsuccessful
Nissen fundoplication : wrapping of a portion the gastric fundus around the sphincter area of the esophagus.
53
herniation of portion of the stomach into esophagus through an opening or hiatus in diaphragm
Hiatal Hernia | AKA: diaphragmatic and esophageal hernia
54
most common type of hiatal hernia | stomach slides into thoracic cavity when supine, goes back into abdominal cavity when standing upright
Sliding or type 1 hiatal hernia
55
Paraesophageal Hiatal hernia
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
causes of hiatal hernia
``` structural changes: weakening of muscles in diaphragm. Increased intraabdominal pressure obesity pregnancy heavy lifting tumors ascites ```
57
what are some risk factors for esophageal cancer
``` smoking excessive alcohol intake Barrett's esophagus GERD diets low in fruits and veggies central obesity ```
58
what is noted in the latter stages of esophagus cancer
obstruction of the esophagus | possible perforation into the mediastinum and erosion into the great vessels.
59
what will be the Dx for an EGD that reveals an esophageal lining that is red rather than pink?
Barrett's Esophagus
60
saclike outpouching of one or more layers of esophagus
Esophageal diverticula
61
what is the most common type of esophageal diverticula found most frequently in men than in women?
Zenker's diverticulum
62
clinical manifestations by patients with phargngoesophageal pulsion diverticulum
``` difficulty swallowing fullness in the neck belching regurgitation of undigested food gurgling noise after eating halitosis and sour test in the mouth ```
63
True or false? Esophagoscopy contraindicated in patient with esophageal diverticula.
True because of the danger of perforation of the diverticulum Blind insertion of NG tube should be avoided.
64
after a removal of esophageal diverticula (diverticulectomy) what should the nurse monitor for
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
post op care for esophagectomy
``` 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
what is an excellent marker for malnutrition
``` 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
what should be done before placement of NG when patient has head trauma
Evaluated for basilar skull fracture
68
a pulse pressure of less than 30 mm Hg is indicative of what
fluid volume deficit (FVD)
69
True or False? Hemoccult test for stool can be used for evaluation of gastric drainage
false
70
what is the optimal position of central venous access devices (CVADs)
midproximal third of the superior vena cave at the junction of the right atrium.

Nursing 130 Perioperative (12 decks)

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