lewis ch 41 upper GI problems

Question 1

3 precipitating causes of vomiting

Answer 1

• pathogenic (obstruction, viral)
• latrogenic (chemo, radiation, meds)
• pregnancy (morning sickness)

Question 2

what does bright red emesis mean

Answer 2

active bleeding

Question 3

what does coffee-ground emesis mean

Answer 3

old blood/lower GI bleed

Question 4

what does fecal odor in vomit mean

Answer 4

backflow of intestinal content into stomach - typically lower GI obstruction

Question 5

what imbalance could vomiting lead to

Answer 5

metabolic alkalosis

Question 6

until a diagnosis is confirmed, what can you do for a vomiting patient

Answer 6

NPO status
IV fluids
possible NG suction

Question 7

what increases patient risk for aspiration with vomiting

Answer 7

decreased LOC

flat HOB

Question 8

health history factors for gastritis

Answer 8

gastric irritants
smoking
stress
H. Pylori
alcohol abuse

Question 9

2 characteristics of gastritis

Answer 9

• epigastric tenderness

- GI discomfort (N/V, bloating, anorexia)

Question 10

risk factors for GERD (7)

Answer 10

• obesity
• alcohol
• smoking
• meds
• caffeine
• spicy/fatty foods
• lying down after eating

Question 11

characteristics of GERD (5)

Answer 11

• regurgitation
• pain radiates to back and neck
• heart burn
• dyspepsia
• burping, bloating and pain after meals

Question 12

diet alterations for treating GERD

Answer 12

less of:

• fatty foods
• wine, alcohol
• spicy foods
• chocolate
• caffeine

Question 13

nursing treatment for GERD (4)

Answer 13

• elevate HOB 30
• don’t lie down for 2-3 hours after eating
• don’t eat right before bed
• avoid factors that cause reflex (smoking, alcohol, caffeine, acidic foods)

Question 14

what time of day should a patient take a PPI med for GERD

Answer 14

before first meal of day

Question 15

antacids that contain _______ can cause constipation

Answer 15

aluminum

Question 16

antacids that contain _________ can cause diarrhea

Answer 16

magnesium

Question 17

3 signs pneumothorax (lung collapse)

Answer 17

• dyspnea
• chest pain
• cyanosis

Question 18

what surgery can be done for GERD

Answer 18

laparoscopic fundoplication (lap nissen)

Question 19

common risk factors peptic ulcer disease (4)

Answer 19

• stress
• H. pylori
• alcohol
• smoking

Question 20

S+S gastric ulcers (5)

Answer 20

• weight loss
• HCL normal or hyposecretion
• pain 1/2-1 hour after meals
• vomiting
• eating may increase pain

Question 21

S+S duodenal ulcers (2)

Answer 21

• pain 2-3 hours after meals

- food may decrease pain

Question 22

nursing care for peptic ulcer disease (4)

Answer 22

• hourly VS
• NG tube
• IV fluid replacement
• regular mouth care

Question 23

S+S hemorrhage with peptic ulcer (3)

Answer 23

• increase in amount and redness of aspirate
• increased amount of blood in gastric contents
• decreased pain

Question 24

S+S perforation with peptic ulcer (4)

Answer 24

• sudden severe generalized abdominal pain and severe shoulder pain
• rigid boardlike abdomen
• shallow respirations
• bowel sounds diminished or absent

Question 25

nursing care for perforation from peptic ulcer (6)

Answer 25

• VS q15-30minutes
• stop all drugs and feedings
• IV fluids increased
• pain meds
• antibiotics
• possible surgery

Question 26

nursing care for gastric outlet obstruction (4)

Answer 26

• constant NG aspiration
• regularly irrigate NG tube
• clamp NG tube intermittently and check for residual volume
• accurate I/O

Question 27

lifestyle changes for peptic ulcer disease (3)

Answer 27

• appropriate dietary changes
• no smoking
• no/less alcohol