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NUR 111 UNIT 4 > Study Guid COPY > Flashcards

Study Guid COPY Flashcards

1
Q

where is the pancreas located?

A

only a small portion of the pancreas i s located in the right upper quadrent. the larger portion is located in the left upper quadrent

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2
Q

where is the pancrease in regards to the stomach?

A

it is positioned inferior to the stomach

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3
Q

what is positioned inferiror to the stomach?

A

the pancreas

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4
Q

what are the parts of the small intestine?

A

duodenum
jejunum
illium

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5
Q

what happend in the small intestine?

A

absorptio of
protien
carbohydrarted
fat digestion

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6
Q

what is villi?

A

finger like projections that increse absorption of nutrient

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7
Q

where are pancreatic enzimes and bile released?

A

in the duodenum

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8
Q

where does digestion occur?

A

in the jejunum

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9
Q

what has a rich blood supply and a muscular intestinal wall?

A

jejunum

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10
Q

what is the shortest segment of the small intestin?

A

duodenum

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11
Q

what is the first segment of the small intestin?

A

duodenum

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12
Q

where does digestion and absorption occure?

A

jejunum

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13
Q

what is the thickest portion f the small intestine?

A

jejunum

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14
Q

what has a rich blood supply and muscular intestinal wall?

A

jejunum

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15
Q

what is the lower portion of the small intestine?

A

illium

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16
Q

what connects to the large intestine at the ileocecal level?

A

illium

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17
Q

what inhibits the gastric motility and enzyme secreation?

A

the secreation of secretin and cholecystokinin

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18
Q

what pancreatic enzymes are stored in the duodenum and relased as chyme arrives?

A

cholecystokinin

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19
Q

what is released form the jejunum and duodenum when gastric, log fatty shains, and amino acids are present?

A

cholecystokinin

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20
Q

what stimulated the release of pancreatic enzymes that contract the gallbladder and relax the hepatopancreatic sphincter (sphincter of Oddi) for release of bile into the duodenum?

A

cholecystokinin

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21
Q

what is released from the small intestin in response to the presence of the acidic chyme in the small intestine?

A

secretin

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22
Q

what neutralizes the acidic chyme and protects the intestinal

A

sodium bicarbonate

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23
Q

what stimulates the liver and pancreas to release sodium bicarbonate

A

secretin

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24
Q

what is hematochezia?

A

the presence of blood in the stool can be described as bright blood in the stool

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25
Q

what is melena?

A

black, tarry, stool

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26
Q

what is the sequence of an abdominal assesment?

A

inspection
auscultation
precussion
palpation

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27
Q

what kind of bowels are caused by

opiods
anticholinergic medications
constipation
ileus (absence of normal gastrointestinal motility)

A

hypoactive bowel sounds

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28
Q

what kind of bowels are caused by cholinergic medications or infectious and inflammatory bowel disorders?

A

hyperactive bowel sounds

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29
Q

what do hypoactive sounds indicate?

A

obstruction

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30
Q

what do hyperactive bowel sounds indicate

A

obstruction
diarrhea
inflammatory bowel disorder

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31
Q

what do absent bowel sounds indicate

A

paralytic ileus casued by mechanical or neurological dysfunction

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32
Q

what do bruits indicate?

A

arterial obstruction

whooshing sound of a bruit may indicate partial obstruct of the vessel

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33
Q

is a bruit in the abdomen a normal varient?

A

no

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34
Q

what questions do you ask to asses the GI system

A 
do you smoke?
do you use prescription or OTC medications?
do you use herbals?
do you drink alcohol?
recent antibiotic use?
any recent international travel
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35
Q

what questions can you ask to asses the health HX of the GI system?

dietary practices

A

who prepaires your food at home?
do you fast for cultural or religious reasons?
do you have dietary restriction or cultural practices?
how often do you eat?
what do you consider to be healthy and unhealthy food?
do you use food to treat ilnesses?
any food intolerences?
any food allergies?

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36
Q

what questions can you ask to asses the health HX of the GI system?

preventitive health

A

what are your excersise habits?
have you had hepatitis vaccines?
have you had a colonoscopy or sigmoidoscopy? if so what were the results?

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37
Q

what is “cullen’s sign”?

A

blue or purple coloring around the periumbilical area

associated with intra-abdominal bleeding

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38
Q

what sound do you hear when you precuss over the liver or stomach?

A

flat dull sound

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39
Q

what can dulness also indicate?

A

precense of displaced fluid

constipation

ascites

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40
Q

what is dullness similer to in sound?

A

tapping on a ballon filled with water

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41
Q

what is the normal span of the liver?

A

6-12 cm

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42
Q

what is hepatomegaly?

A

term used to describe an enlarged liver

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43
Q

what is teqnique is used to asses the edge of the liver?

A

palpation, hooking technique

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44
Q

how do you perform a palpation, hooking technique?

A
  1. stand to the left of the patient and place fingers under the 12th rib
  2. when the patient inhales, the lives edge may come below the rib and be palpated by the providers fingers
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45
Q

what are the age related changes in bile synthesis??

A
  1. decreased bile synthesis
  2. widend common bile duct
  3. increased cholecystokinin secreation
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46
Q

what is the subjective data and objective data for age related changesin bile synthesis?

A

subjective data: ask about right upper quadrent pain, early satiety, decreased appetite

objective data: 1.inspection of the skin
2. palpation of the abdomen

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47
Q

what is the normal level of serum albumin?

A

3.4-5.1

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48
Q

what is a level of less than 3.5 g/dk of serum albumin indicate?

A

altered nutritional status

associated with increased morbidity and mortality in older adults

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49
Q

what is the normal level of prealbumin?

A

12-42 mg/dl

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50
Q

what do decresed levels of prealbumin indicate?

A

increased morbidity and mortality in older adults

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51
Q

what is considered a more accurate indicator of plasma protiens?

serum albumin or prealbumin

A

prealbumin

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52
Q

after an endoscopy what does the nurse monitor for before providing oral care?

and why?

A

the return of swallow

to decrease the risk of aspiration

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53
Q

after a lower endoscopy what is held teporarity due to the risk of bleeding?

A

anticoagulants and aspirin

ascetylsalic acid, or ASA

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54
Q

what is an Esophagogastroduodenoscopy

A

visualization of the esophaphagus, stomach, and duodenum

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55
Q

what is the rational of an Esophagogastroduodenoscopy

A

suspected upper gastrointestinal bleeding,

dysphagia

epigastric pain

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56
Q

what are the special considerations of Esophagogastroduodenoscopy

A

monitor return of gag reflex

vital signs

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57
Q

what is the NPO status of Esophagogastroduodenoscopy

A

8-10 hr prior to study

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58
Q

what are the significance of findings of Esophagogastroduodenoscopy

A

peptic ulcers

H pylori infection

gastritis

hiatal hernia

esophageal

  • varices
  • strictures
  • cysts
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59
Q

describe

stomatitis

grade 1

functional symptoatic

clinical examination

A

able to eat a normal diet

redness of mucosa

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60
Q

describe

stomatitis

grade 2

functional symptoatic

clinical examination

A

symptomatic but can eat a modified diet

patchy oral ulcerations

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61
Q

describe

stomatitis

grade 3

functional symptoatic

clinical examination

A

symptomatic and unable to eat or drink by mouth

confluent oral ulcerations that bleed with minor trauma

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62
Q

describe

stomatitis

grade 4

functional symptoatic

clinical examination

A

symptoms are life threatening

tissue necrosis with significant bleeding; lifethreatening consequenses

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63
Q

describe

stomatitis

grade 5

functional symptoatic

clinical examination

A

death

death

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64
Q

when should mouth care be performed?

A

after each meal and as needed

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65
Q

what kind of a tooth brush do you use for proper mouth care?

A

soft-bristled

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66
Q

when doing mouth care what kind of rinse do you use?

A

warm saline

or

sodium bicarbonate (baking soda)

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67
Q

what kind of mouth wash should you not use to perform mouth care?

A

alchohol-containing mouth wash

lemon-glycerine swabs

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68
Q

what kind of mouth care can irritate a sore or implame oral tissue?

A

lemon- glycerin swabs

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69
Q

what kind of motuh care can irritate the oral mucosa?

A

alcohol containing mouth wash

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70
Q

what disease is caused by acid reflux for the stomach or duodenum into the esophagus?

A

GERD

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71
Q

what kind of disease has a backward flow of gastroduodenal contents (refluxate) into the esophagus and/or adjacent organs, producing a variety of clinical manifestations that may or maynot cause tissue damage

A

GERD

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72
Q

what disease has factors that are associated with a decrease in LES presure that influence transient or chronic gastroesophageal reflux

A

GERD

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73
Q

what are these examples of?

  • Hiatal hernia
  • LES hypotension
  • Loss of esophageal motility
  • Increased compliance of the hiatal canal
  • Increased states of gastric secretion
  • Eating large meals
  • Delayed emptying of gastric contents
  • Obesity
  • Pregnancy
  • Ascites
  • Tight belts or girdles
  • Presence of a nasogastric tube
A

GERD

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74
Q

what disease has this pathophysiology/ clinical manifestation?

retrograde flow of GI contents into the esophagus, resulting in inflammation

A

GERD

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75
Q

wich disease has this manifestation?

hyperemia (increased blood flow)

erosion (ulceration)

possible minor bleeding to the esophagus?

A

GERD

these are episods of acid reflux

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76
Q

what may be present during reflux?

A

pepsin and bile

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77
Q

what is the post-op care for laparoscopic nissen fundolipication?

A
  1. follow a soft diet for 1 week, untill swallowing improves.

avoid foods that arenot easy to swallow

take small bites and eat slowly

avoid activities that cause air to be swalloed. carbonated beverages, menoade, gum, stwas

driving is allowed 1 week and after narcotic pain medications have been discontinued

no heavy lifting

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78
Q

what kind of ristriction are these?

  • After surgery, the doctor usually changes the original surgical dressing after 2 days. Steri-Strips are left intact and usually fall off in about 10 days. Keep them clean and dry and do not peel them off.
  • Wash incisions with soap and water and pat them dry with a clean towel.
  • Observe incisions for redness or drainage, and report any of these symptoms to the healthcare provider.
  • Notify the healthcare provider for a fever greater than 101°F, or 38.3°C. Patients older than 65 years: report temperature above 100°F, or 37°C. Report nausea, vomiting, and severe bloating or unusual pain.
  • Bring a list of questions to the first postoperative appointment, usually within 4 weeks after surgery.

Walking is encouraged.

Notify the healthcare provider for chest pain or difficulty breathing that gets worse with time.

• Continue antireflux medication regimen unless notified otherwise by a healthcare provider.

A

Postoperative Patient Education After Laparoscopic Nissen Fundoplication

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79
Q

what procedurehas these emergency care

Feeling very full, with inability to vomit or burp

  • Thick drainage that has a foul odor coming from incisions
  • Difficulty swallowing
  • Abdomen that feels hard and painful
  • Gauze that becomes soaked with blood
  • Stools that are black, bloody, or tarry
  • Vomiting up blood or “coffee grounds” emesis
  • Difficulty breathing and feeling light-headed
  • Coughing up blood, new chest pain when breathing in
  • An arm or leg that is painful, swollen, warm, and red
A

Emergency care after Laparoscopic Nissen Fundoplication

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80
Q

what disease has this assessment of respiratory symptoms

aspiration pneumonia,
chronic cough,

morning hoarseness,

night-time wheezing,

adult-onset asthma,

laryngitis,

pharyngitis,

bronchitis with long-term regurgitation

A

GERD

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81
Q

what is a is a causative factor in the development of adult-onset asthma.

A

GERD

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82
Q

when do GERD respiratory symptoms occur?

A

occur with aspiration of acid reflux into the tracheobronchial tree, larynx, pharynx, nose, and mouth (especially when supine).

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83
Q

what medications should be limited when a patient has GERD?

A

spicy/fatty foods

caffeine

chocolate

carbonated beverages

acidic foods

pepermint

alchohol

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84
Q

what kind of medications should be limited with a patient that has GERD?

A

calcium channel blockers

anticholinergic medications

smoothmuscle relaxers

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85
Q

what should be avoided because decreeses the presure in the LES

A

smoking

alcohol

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86
Q

in a patient with GERD what should be avoided because it can irritate the lining of the esophagus

A

NSAID

Aspirin

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87
Q

when should a patient with GERD have there last meal?

A

2 hrs before lying suspine

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88
Q

with a patient with GERD what should you educate them on?

A

wear nonrestrictive clothing

maintain body weight

89
Q

what bacteria causes gastritis?

A

Hpylori

90
Q

what disease is caused by

Crohns’s disease

teberculosis

bile reflux

alchocol

NSAID

A

gastritis

91
Q

what disease can lead to malapsoption of vit. b12. wich then leads to pernicious anemia?

A

gastritis

92
Q

what test are used to dianose gastritis?

A

biopsy

upper GI x-ray series or endoscopy

stool testing

urea breath testing

histological examination of a tissue specimen

93
Q

what diagnostic tests can rule out disorders that can siggest gastritis such as polyps and gastric neoplams

A

biopsy
upper GI x-ray series or endoscopy

histological examination of a tissue speciemn

stool testing

94
Q

what are other names for stool testing?

A

guaiac
hematest
hemoccult

95
Q

what diagnostic test can detect active infection w/ hpylori. a patient drinks a solution that contains a special carbon atom

A

urea breath testing for gastritis

96
Q

what disease has these manifestations?

epigastric pain

nausea and vomiting

weight loss

Pain with spicy food

decreased appetite

changes in color of the stool

dehydration

upper GI bleeding.

Significant fluid or blood loss

Hypovolemic Shock

Pallor

Tachycardia

hypotension

A

acute gastritis

97
Q

what kind of disease presents no symptoms?

A

atrophic gastritis

98
Q

in what order should you rentroduce liquids after treatment?

A

1st- broth,tea,gelatin,carbonated beverages

2nd- ingestion of heavier liquids cream soups, pudding, milk

3rd, gradual reintroduction of solid food

99
Q

what medications are associated with gastritis?

A
  1. proton pump inhibitor
  2. H2 receptor antagonis
  3. esome/lanso/panto-prazole
  4. antacids
  5. sucralfate (carafate)
  6. B12
  7. H pylory
100
Q

what medications relive pain and discomfort

bloock and buffer gastric secreations for pain relief

A

PPIs & H2 receptor antagonist

101
Q

what medication block enzyme in the gastric parietal cell?

A

PPI

102
Q

what medication maintain the intragastric PH greater than 4?

A

Esome/lanso/panto-prazole

103
Q

what medication decrese gastric acidiy by neutralizing the acid?

A

antacids

aluminum or magnesium compounds

maalox, mylanta

104
Q

what has no effect on gastric PH but provides a physical barrier to prevent mucosal damage by gastric acid?

A

sucralfate (carafate)

105
Q

what treatment is used for the eradication of H pylori

A

combination of PPI with to antibiotics for 7-14 days

106
Q

what reduces the risk of antibiotic resistant H pylori strains?

A

using a combinations of antimicrobial agents

107
Q

what therapies are recomended as the first-line treatmetn of H pylori?

A

PPI

108
Q

what therapies are recomended as the second-line treatmetn of H pylori?

A

quadrupal therapy

109
Q

what medications are in triple therapy?

A

PPI

clarithromycin

amoxicillin/metronidazole

110
Q

what medications are in quadruple therapy?

A

bismuth

metronidazole

tetracycline

PPi

111
Q

what are nursing diagnosis associated with gastritis?

A

Acute pain related to irritated stomach mucosa

  • Anxiety related to treatment
  • Deficient knowledge about dietary management and the disease process
  • Risk for deficient fluid volume related to insufficient fluid intake and excessive fluid loss subsequent to vomiting
112
Q

what is hematemesis?

A

vomiting of blood

gastritis

113
Q

what may lead to vometing of blood? (hematemesis)

A

hemorragic gastritis

gastritis

114
Q

when should you report hematemesis and why?

A

immidiatly

to prevent shock

gastritis

115
Q

what does hematemesis look like?

A

bright red

dark coffe ground appearance

gastritis

116
Q

what kind of bacteria causes gastroenteritis?

A

salmonella

campylobactor

shigella

117
Q

what two bacterias come from ingesting raw or undercooked poultry?

A

salmonella and campylobacter

118
Q

what kind of bacteria comes from ingesting raw or undercooked chicken and unpasturired milk?

transmited by dogs or cats with diarreha?

A

campylobacter

119
Q

what kind of backteria comes form undercooked eggs

reptiles birds or amphibians?

A

salmonella

120
Q

what kind of bacteria is transmitted person to person by fecal-oral rout or food born?

A

shigella

121
Q

what can be a cause of gastereonteritis?

A

virus, bacteria, parasite

-noravirus/ rotavirus

acid suppresing medications
- PPI (it reduces the acidis environment that provides an initial defense against gastrointestinal infections)

122
Q

what kind of food should be avoided in someone who has gastroenteritis?

A

caffeine and milk products

123
Q

how should foods be reintroduced with someone who has gastroenteritis

A

gradually reintroduce foods starting with bland easy to digest foods

124
Q

what kind of liquids are initially prescribed as tolerated for a patient recovering with gastroenteritis?

A

clear liquids are prescribed as tolerated

125
Q

name the clear liquids that are prescribed to a patient who has gastroenteritis

A

oral glucose- electrolyte solutions

broth or bullon

take frequent small sips

126
Q

what are the risk factors for Peptic ulcers?

A

H pylori

NSAID

Asprin

smoking

alchohol

sarcoidosis

crohns disease

rare infectious disease

other mediations

neoplasia

acid hypersecretory disorders

myeloproliferative disorder

systemic mastocytosis

ill patients (burns, head injury, physical trauma, organ failure)

127
Q

what disease has this manifestation?

burning epigastric pian aggravated by fasting?

pain improved with food or antacids

A

duodenal ulcer

128
Q

what kind of disease has this manifestation?

pain awakens patient from sleep because of nocturnal gastric acid secretion

A

duodenal ulcer

129
Q

what kind of disease is triggered or worsend by eating?

A

gastric ulcer

130
Q

what kind of disease occurs after meals with little or no reliefs from antacids

A

gastric ulcer

131
Q

what kind of pain radiates below the costal margins into the back or right shoulder?

A

peptic ulcer desiease pain

duodenal/gastric ulcer

132
Q

what kind of pain is located midline in the epigastrium near the xiphoid

A

Peptic Ulcer disease pain

133
Q

what is a charecteristic of ulcer pain

PUD?

A

exacerbations occurs daily for a period of several weeks and then remits intill the next recurrence

134
Q

what is the perfered diagnostic test for PUD?

A

Upper GI endoscopy

135
Q

what are some other diagnostic test for PUD?

A

barrium upper GI x-rays

endoscopy

esophagogastroduodenoscopy

noninvasive testin
-serum antibody testing

  • urease breath testing
  • stool antigen testing

cbc

fecal occult blood test

136
Q

what medications are given to a patient who has PUD

A
  1. antacids
  2. H2-receptors
  3. PPI
  4. Prostaglandin E analog
  5. sucrafate (carafate)
137
Q

what medication neutralizes gastric acids

contains

aluminum hydroxide

sodium bicarbonate

calcium carbonate

magnesium hydroxide

simethicone

A

antacids

138
Q

what medication

decreases acid production?

A

H2-receptor anatgonist

139
Q

name some H2 receptor antagonist

A

ranitidine
nizatidine
cimetidine
formotidine

140
Q

what should patients who must continue NSAID therapy use?

A

PPI

141
Q

what medication blocks the final stage of hydrogen ion secretion by bloking the action of gastric parietal cell proton pump?

A

PPI

142
Q

name some PPIs

A

omeprazole
lansoprazol
pantoprazole

143
Q

what medication prevents mucosal damage in chronic users of NSAIDs

A

prostaglandin E analog

144
Q

name a prostaglandin E analog

A

Misoprostol

145
Q

what medication enhances mucosal defenses?

A

sucralfate (carafate)

146
Q

what medication binds to necrotic ulcer tissue and serves as a barrier to acid, pepsin, bile, and can directly absorb bile salts

A

sucralfae (carafate)

147
Q

what kind of diet should a patient with PUD follow?

A

no spices, alchohol, caffeine, smoking

6small meals a day or small hr meals

intake of adequate fluids

if bleeding=NPO

148
Q

what complication of PUD has these charecteristics?

sudden, severe, without warning

symptoms of pain may not be present (common with NSAID use)

A

gastrointestinal bleeding

149
Q

what complication of PUD has these characteristics?

circulatory shock may develop depending on amount of blood loss

acute hemorrage, sudden weakness, dizziness, cold, moist skin,

passage of loose tarry stools and coffe-ground emesis

A

gastrointestinal bleed

150
Q

what complication of PUD has these characteristics?

ulcers on the anterior wall of stomach or duodenum

perforation is a seriuous medical condition requiring immidiate attention

A

perforation

151
Q

what complication of PUD has these characteristics?

release of gastrointestinal contents into peritoneum

abdominal distention and third spacing

A

perforation

152
Q

what complication of PUD has these characteristics?

peritonitis causes sudden intense epigastric pain

abdomen is tender to palpation, abdominal muscles are rigid, HYPOACTIVE OR ABSENT BOWEL SOUNDS

A

perferation

153
Q

what complication of PUD has these characteristics?
caused by edema, spasm, contraction of scar tissue

interference w/ free passage of gastric contents

A

obstruction

154
Q

what complication of PUD has these characteristics?

symptoms of early satiety, epigastric fullness and heaviness post meals, gastric reflux, weight loss, abdominal pain

vomiting of undigested food

A

obstruction

155
Q

what is hematemesis?

A

vometing of blood

156
Q

in a patient with gastrointestinal bleeding what is the hallmark of upper gastrointestinal bleeding?

A

hematemesis- vometing of blood

157
Q

in a patient with gastrointestinal bleeding what is bright red blood in the emesis indicative of?

A

active bleeding

158
Q

in a patient with gastrointestinal bleeding what does coffe-ground emesis indicate?

A

older blood that has had time to be reduces by acid in the stomach

159
Q

in a patient with gastrointestinal bleeding

what is due to the degradation of blood in the small intestine and colon?

A

melena (black tarry stool with a foul odor)

160
Q

what are the risk factors involved in Hiatal Hernia?

A

obesity
pregnancy
smoking
barrets esophagitis

50 or older- increses with age as supportive structures weaken over time

161
Q

what is the most specific diagnostic test of Hiatal hernia?

A

barium swallow w/ fluoroscopy

162
Q

name some diagnostic test for Hiatal Hernia

A

barrium swallow with fluroscopy

upper abdominal x-ray

endoscopy

esophagogastroduodenoscopy EDG

163
Q

what are the clinical manefestations of hernias?

A

bulging or swelling at the site of the hernia

ache that radiates in the are of the hernia

feelings of fullness or presure in the area of the hernia

164
Q

what disease has this clinical manifestation?

bulge or visible swelling
* associated when coughing or bering down

A

hernia

165
Q

what disease has this clinical manifestation?

Strangulation clinical manifestations include abdominal distention, nausea, vomiting, pain, fever, and tachycardia.

*This is a medical emergency, and the patient must be prepared for surgery immediately to prevent the development of gangrene.

A

hernia

166
Q

a patient with a stangulated hernia may present with what?

A

clinical manifestations of an intestinal obstruction

167
Q

why must a patient with a strangulated hernia prepair for imidate surgery?

A

to prevent gangrene

168
Q

what are the signs and symptomps for a patient with a strangulated hernia?

A

abdominal distention

nausea
vomiting

pain
fever

tachycardia

169
Q

what pain management techniques should you give to a patient with a hernia?

A

tell them to avoid driving ot operating machinery while taking medication

170
Q

what medication provides temporary relief from burning, itching, and pain? for a patient with hemorrhoids?

A

local anesthetics

benzocaine

dibucaine

lidocaine

171
Q

what kind of medication forms a physical barrier on the skin to prevent irritation of the perianal regoin to a patient who has hemorrhoids?

A

protectants/ emollients

cocoa butter

lanolinen

white petroleum

zinc oxide

mineral oil

cod liver oil

shark liver oil

172
Q

what medication promotes skin dryness, wich helps relieve itching, irritation and inflamation to a patioen who has hemorrhoids?

A

astringents

witch hazel

zinc oxide

calmaine

173
Q

wich medication reduces inflammation in a patient who has hemorrhoids?

A

corticosteroids

hydrocortisone

174
Q

what can lead to constipation and should be avoided because it will futher increase pain and bleeding at surgical site for a patient who has a hiatal hernia?

A

avoiding having a bowel mobement due to painful defecation

175
Q

when is a mild laxitive ordered for a patient who has a hernia?

A

after 3 days

176
Q

what do bulk laxitives require the use of for a patient who has a hernia?

A

the use of increased fluids

177
Q

what mesures to prevent constipation are taken in a patient who has a hernia?

A

good sources of fiber such as;

whole grain

raw vegetables

fruit

178
Q

what helps relive constipation in a patient who has a hernia?

A

increasing fluids & fiber

OTC stool softners (docusate sodium

179
Q

what increses the chances of constipation in a patient with hemrroids?

A

narcotic anagesics

180
Q

what medications are sed to treat IBS?

A

antidiarreheals
- loperamide (imodium)

tricyclic antidepressants (TCAs)

  • ami-triptyline
  • nor-triptyline

im-ipramine
des-ipramine

181
Q

name some tricyclic antidepressants (TCAs)

A

ami-TRIPTYLINE- elavil
nor-TRIPTYLINE- pamelor

im-IPRAMINE- tofranil

des-IPRAMINE- norpramin

182
Q

what medication block norepinephrine reiptake and are belived to slow transit time and improve pain tolerance?

A

Tricyclic antidepressants (TCAs)

Amitriptyline (Elavil); imipramine (Tofranil); nortriptyline (Pamelor); desipramine (Norpramin)

183
Q

what medication slow bowel transit, enhance water absoption and stenghten anal sphincter tone, resulting in fewer stools but does not relive pain?

A

antidiarreahls

loperamide

imodium

184
Q

are herbal medicines classifies as diatary medicins in the united states?

A

no

185
Q

what are some reputible online resources for herbal remidies?

A
  • Natural Medicines Comprehensive Database
  • Natural Medicines Research Collaboration
  • ConsumerLab
  • Medline Plus Drugs and Supplement Directory
  • National Institutes of Health National Center for Complementary and Alternative Medicine Herb Fact Sheets
  • NIH Office of Dietary Supplements
186
Q

what kind of ilness is a irritable bowl

A

its a psychological ilness

187
Q

what is necessary for a patient with irritable bowl to have?

A

a therapeutic, trusting relashion ship

establish a trusting relationship

188
Q

what kind of teaching should you give to a patient with IBS

A

no smoking

smoking cessation techniques

189
Q

what increases GI motility, wich can increase pain/ diarrhea

A

smoking

190
Q

what disease has 5-6 soft, loose, nonbloody stools a day?

A

crohns disease

191
Q

what kind of disease has these charecteristics of stool?

loose, semiformed

A

crohns disease

192
Q

what kind of disease has these charecteristics of stool?

frequent, watery, with blood and mucus

A

ulcerative colitis

193
Q

what kind of disease has 10-20 liquid, bloody stools a day?

A

ulcerative colitis

194
Q

what disease has elevated ESR is seen with inflamation?

Erythrocyte Sedimentation Rate Test (ESR Test)

A

crohns disease iflamitory bowel

195
Q

what levels are used to determine nutritional status?

A

Albumin levels are frequently used to determine nutritional status,

196
Q

what is the primary goal of treatment in IBD?

A

rest the bowel and control the inflamation

197
Q

in what disease are monthly B12 injections may be necessary because of the inability of the ileum to absorb this nutrient.

A

crohn’s disease

198
Q

how do you give vit to a patient who has cronh’s IBD?

A

liquid vitamin

199
Q

what medication are given to a patient who has IBD?

A

biological therapies

antidiarrheals

200
Q

what medications provide symptom relief and bowel rest?

these medications must be used with caution becuse they can cause colon dilation

A

antidiareahls

201
Q

name some antidiarrheals

A

loperamide- imodium

atropine sulfate- lomotil

dipnoxylate hydrochloride

202
Q

name some biologic therapies

A

centoLIZUMAB- cimzia

nataLIZUMAB-humira

adalimUMAB-tysabri

203
Q

what kind of medication

alter a persons immune response
an inflammatory protien called TNF

traditionally used as second line agents but are now prescribed as an earlier treatment

A

biologic therapies

204
Q

what medications have many toxic side effects like blood dyscrasias, infection, pancreatitis
digestive intolerence

A

biologic therapies

205
Q

what are the 4 surgical options for ulcerative colitis?

A
  1. proctocolectomy with permanent illiostomy
  2. proctoclectomy with continent ileostomy (Kock pouch)
  3. abdominal colectomy with ileoanal anastamosis
  4. colectomy, mucosal protectomy and ileal pouch-anal canal anastomosis (IPPA)
206
Q

what surgical option is it when the colon and rectum are removed, and the anus is closed

the ileostomy is peminent

A

proctocolectomy with permanent ileostomy

207
Q

what surgical option is it when the colon is removed

the distal portion of the ileum is used to crete a pouch, wich serves for stool

the patient must then insert a catheter into the pouch several times a day to eleminate the stool

A

proctocolectomy with continent ileostomy (Kock pouch)

208
Q

what surgical option is it when the colon is removed and the ileum is sutured to the anal canal

leakage of stool is a problem for these patients

A

abdominal colectomy with ileoanal anastomosis

209
Q

what surgical option is it when a 2 step procedure is performed?

1st procedure- colon and rectal mucosa are removed

ileoanal reservoir is created by using a portion of the ileum

a temporary ileostomy is created

2nd surgery is performes 2-3 months after the pouch heals

the ileostomy is reversed

normal continence of bowel is restored

A

j pouch

Colectomy, mucosal proctectomy, and ileal pouch-anal canal anastomosis (IPAA)

210
Q

what are some complications of IBD

A
  • Enterocutaneous fistula (between skin and intestine)
  • Enteroenteral fistula (between intestine and intestine)
  • Enterovesicular fistula (between bowel and bladder)
  • Enterovaginal fistula (between bowel and vagina)

Perineal abscesses

fistulas

strictures

joint swelling & pain

ankylosing spondylitid, osteoporosis, kidney stones, eye inflamation, mouth sores, skin lsesions

fever
anorexia
malaise

anal fissures

intestinal obstruction

inflammation

edema

fibrosis

scarring

malnutriton

anemia from hemorrhage

Surgical complications may include anal canal strictures, pelvic sepsis, pouch failure, fecal incontinence, pouch dysplasia/cancer, sexual dysfunction, and female infertility.

211
Q

what skin care actions should you take when treating a patient with IBD?

A

use witch hazle compress to reduce anal irritation

do not use soap

212
Q

what kind of skinc care should you have with a patient who hs IBD?

A

meticulous skin care at all times

213
Q

what kind of disease has these manifestations?

diarrhea (often foul smelling, light in color and frothy), steatorrhea, flatulence, weight loss, and other signs of malabsorption.

fatigue and weakness

longstanding impaired absorption

severe abdominal pain

increased bleeding

manifestations are similar to irritable bowel syndrome (IBS) and lactose intolerance,

Atypical symptoms

anemia, dental enamel defects, osteoporosis, arthritis, neurological symptoms, infertility, and increased transaminases.

A

celiac disease

214
Q

what food choises should a patient with diverculitis have?

A

Fiber intake

Do not eat

Seeds, corn, nuts

None

Except for clear liquid diet for 2-3 days is common when there is an active outburst

215
Q

what disease has these clinical manifestations?

Abdominal pain over the sigmoid colon

Fever or leukocytosis

Palpable mass is felt over the involved area

Flatulane

Anorexia

Bloting

Distention

Diarreah

Constipation

Stools will have mucus or blood

Bleeding

Change in mental status

Confusion, falling, anorexia

Sepsis

Peritonitis

Rebound tenderness

A

deverculitis

216
Q

what disease has this kind of treatment?

Broad spectrum antibiotics for 7-10 days

consume a clear liquid diet untill symptoms subside

antibiotics used to treat diverticulitis include:

Ciprofloxacin and metronidazole, trimethoprim-sulfamethoxazole and metronidazole, amoxicillin-clavulanate, Augmentin or Moxifloxacin.

IV fluids

NPO

Nasogastric tube

Pain medications

DO NOT GIVE LAXITIVES OR ENEMAS

A

devirculitis

217
Q

what disease has these diatery recomendations?

fiber from raw fruits and vegetables

DO NOT increase your fiber during acute phases

A

diverculitis

218
Q

what disease has this etiology?

Without adequate fiber intake, more water is absorbed from the stool. This slows transit time and makes it more difficult for the stool to pass through the colon. This then causes increased intraluminal pressure from constipation and straining,

A

diverculitis

219
Q

how do you give vit to a patient who has cronh’s IBD?

A

liquid vitamin

NUR 111 UNIT 4 (9 decks)

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