Test #1 Flashcards
(106 cards)
1
Q
what is achalasia
A
When the LES cannot relax causing food / fluid to build up
2
Q
what are complications of achalasia
A
- distention of the esophagus leading to risk for aspiration
- GERD
- halitosis (foul breath)
- malnutrition leading to weight loss, weakness and poor skin turgor
3
Q
s/s of achalasia
A
- dysphagia= most common
- substernal chest pain- usually after eating
- regurgitation/ nocturnal regurgitation
- halitosis (foul breath)
- inability to burp
- gerd
4
Q
why would you expect someone with achalasia to have weight loss
A
because they are not adequately digesting food because it cannot enter the stomach therefore the pt is losing nutrition and hydration
5
Q
what causes achalasia
A
nerve degeneration esophageal dilation d/t food backed up hypertrophy of the sphincter can be viral or genetic. unknown
6
Q
what kind of tests can we do if we suspect achalasia
A
- Upper GI barium- to see how the fluid moves through the GI track
- esophageal manometry
- EGD
7
Q
what does an esophageal manometry look for
A
it checks the pressure on the esophageal sphincter
8
Q
what does a pt need to do prior to having an EGD
A
NPO for 8 hrs prior
have the procedure explained by the MD
consent signed
9
Q
what kind of sedation is given when an EGD is performed
A
usually a benzodiazepine such as Versed (antianxiety agent/sedative hypnotic)
10
Q
what kind of medications are given for achalasia
A
smooth muscle relaxants such as anticholinergics, nitrates(smooth muscle relaxants), calcium channel blockers
or botulism injections to the LES
11
Q
what are the invasive procedures for achalasia treatment
A
Dilation of the cardiac sphincter (can end up causing problems with reflux)
Heller Myotomy- surgical incision and release the muscle around the LES (can end up causing problems with reflux)
POEM- the heller myotomy except it is done laparoscopically
12
Q
what is gastritis
A
chronic or acute inflammation of the stomach d/t breakdown of the protective barrier
13
Q
what happens to the stomach lining with gastritis
A
the breakdown in the protective layer of the stomach.
-when the barrier is broken, HCL and pepsin secrete into the tissue and cause edema, disruption of capillary walls and can cause hemorrhage.
14
Q
what are some causes of gastritis
A
NSAIDS, aspirin and corticosteroids (inhibit the synthesis of prostaglandins)
alcohol use- increases HCL production
H pylori
radiation exposure
stress
15
Q
what contributes to the protective layer of the stomach
A
-prostaglandins
16
Q
manifestations of Gastritis
A
Heartburn
epigastric pain
anorexia
nausea
17
Q
what is a complication of chronic gastritis
A
Pernicious anemia because the parietal cells are lost d/t atrophy and thus less IF is being secreted = less b12 absorption
18
Q
What types of test would you do for a pt with gastritis
A
EGD/bx
H Pylori
cbc w/ IF
guaic stool
19
Q
how do we treat gastritis
A
eliminate cause if known (i.e.: meds)
- NG tube for bowel rest
- PPIs (omeprazole)
- H2 blockers(ranitidine)
- antacids
- Abx (for H pylori infection)
20
Q
complications of acute/chronic gastritis
A
ulcer formation
hemorrhage d/t ulceration
increased risk for stomach cancer d/t cells changing
21
Q
What is Gerd
A
reflux of the gastric contents into the esophagus d/t incompetent LES
22
Q
what puts pts at greater risk for GERD
A
- Incompetant LES
- food- caffeine, chocolate, peppermint
- Medications- anticholinergics(cause relaxation of the sphincter)
- smoking
- hiatal hernia
- obesity/increased abd pressure
23
Q
s/s of GERD
A
- heartburn
- dyspepsia
- regurgitation- hot bitter sour liquid into throat or mouth
- respiratory sis (coughing, wheezing, dyspepsia, aspiration)
- chest pain burning squeezing or radiating to the back
24
Q
what type of diagnostic tests would you suggest for a pt with GERD
A
-Endoscopy w/ bx (good is assessing the LES competence and the degree of inflammation
(bx to determine carcinoma from barrette and degree of dysplasia)
- pH monitoring- to determine the pH in the lower esophagus
- manometry- measure the LES pressure and motility
- Upper GI barium to see how the GI system is working
25
what are complications of GERD
- Esophagitis
- Barretts esophagitis
- respiratory compromise (aspiration, bronchospasm, cough,)
26
what is barretts esophagus
breakdown of tissue outside the esophageal sphincter. the cells begin to change and become precancerous
27
what are some medications that can be used to treat GERD
- PPIs
- H2 blockers
- prokinetic agents
- sulcrafate
- cholinergic
- antacids
- aluminum and magnesium
- Prostaglandins (cytotec)
28
what are the PPIs that can aid with GERD
```
dexilant
nexus
prevacid
omeprazole
pantoprozole
```
29
how do PPIs work
Inhibit the H+K+-atpase pump (responsible for gastric acid secretion)
thus decreasing HCL secretion
30
what are side effects of PPIs
```
HA
Abd pain
N&V
diarrhea
flatus
```
31
how do H2 blockers work
blocks the H2 receptors that way histamine cannot bind and thus decreasing the HCL secretion
32
what are the H2 blocker meds
Tagamet
Pepcid
nizatidine
ranitidine
33
Side effects of H2 blockers
HA
abd pain
diarrhea
constipation
34
what type of lifestyle changes should a pt make with GERD
- smaller more frequent meals throughout the day
- do not lay down for 2-3 hours after eating
- avoid triggering factos
- lose weight
- loose clothing around mid section
35
what types of surgery can be performed for GERD
LINX reflux management
| (magnet around the LES that will act as the sphincter
36
What are the two types of hiatal hernias
sliding (most common- stomach slides up above diaphragm and back down)
-rolling (funds rolls through diaphragm and stays- causes risk for strangulation)
37
what diagnostic tests can you perform for hiatal hernia
- upper GI barium swallow
| - EGD
38
what are s/s of a hiatal hernia
- Heartburn
- dyspepsia
- regurgitation
- pain
39
what contributes to the cause of a hiatal hernia
- weakening of the muscles of the diaphragm
- aging
- increasing abdominal pressure
- obesity
- pregnancy
- ascites
- heavy lifting
40
what are complications of a hiatal hernia
```
GERD
esophagitis
hemorrhage (from erosion- from gerd)
stenosis
ulceration of of herniated portion
regurgitation
strangulation
```
41
how do you treat hiatal hernias as a nurse
- decrease intra abdominal pressure
- avoid drugs and diets that effect the LES
- avoid late means/ before bed meals
- sleep at a 45 degree angle
- medications to relieve sxs such as PPIs or H2 blockers
- avoid carbonated beverages
**prevent problems with gastric reflux**
42
what are surgical options for hiatal hernias
Lap nissen- take the fundus of the stomach and wrap it around the LES - enhancing the function
Toupet fundoplication= only goes 270 degrees around the LES
43
what is peptic ulcer disease
erosion of the GI mucosa resulting from HCL and pepsin
a loss in balance of the stomach protective and agressive mechanisms
it can occur in any portion of the GI tract.
44
what determines the classification of PUD
the degree and duration of mucosal involvement
45
what tests are done for PUD
Endoscopy (most accurate)
biopsy to test for H pylori
labs- H&H
barium tests- to diagnose gastric outlet obstruction or for ulcer detection
46
risk factors for peptic ulcer disease
```
H pylori
stress
alcohol
smoking
medications- NSAIDS aspirin, corticosteroid, anticoags
coffee (caffeine and decaffeinated)
genetics
```
47
what are signs and symptoms of PUD
burning, gnawing pain
- in the stomach- shortly after meals
- in the duodenum - 2-3 hrs PC
dyspepsia
hematemesis
melena
coffee ground emesis
48
what should you do for a patient with PUD
- make them NPO for bowel rest
- IVF usually with 2 large bore IVs
- NG tube for bowel rest
- medications
- if pt still is not recouping, possible blood transfusion
help pt ID the cause and eliminate it. teach them to avoid foods that irritate it and cessation of smoking drinking and avoid stress
49
what are the complications that can arise from PUD
- Hemorrhage
- peforation
- gastric outlet obstruction- ( in chronic pud pts, scarring and tissue remodeling can lead to this)
50
what are signs of perforation
```
*signs are usually sudden*
sever upper abd pain spreading to the back
rigid/board like abdomen
shallow/rapid breathing
tachycardia
weak pulse
melena
N&V
hemataemesis
```
51
what are some medications used for PUD
- Antacids- neutralize the stomach acid
- sucralfate-coats lining of stomach
- H2 blockers- blocks histamine receptors = decreased acid production (ranitidine)
- PPIs- inhibits active enzymes in parietal cells = decreased acid production (omeprazole)
- Metoclopramide (pro kinetic agent)- increases gastric emptying
- antibiotics - for H Pylori infection
52
what is a gastric outlet obstruction
an obstruction at the distal end of the stomach resulting in edema, inflammation, scar tissue formation
53
what surgeries can be done for PUD
- Partial gastrectomy
- vagotomy (clips vagus nerve and limits stimulation)
- pyloroplasty (dilates the pyloric sphincter)
54
what are the 2 partial gastrectomy surgeries
- Billroth I (gastroduodenostomy)- remove part of the stomach and connect it with the duodenum
- BIllroth II- (gastrojejunostomy)- remove part of the stomach and connect it with the jejunum
55
what is the primary goal of treatment for a pt with an upper GI bleed
**find the source of the bleeding**
56
what are causes of upper GI bleeds
gastritis
ulcer
cancer
medications
57
what diagnostic tests should you run for a pt with suspected or known UGI bleed
- frequent H&H q4-6 hrs
- upper GI- may be emergent- to find source of bleed
- guiac stool
- frequent vitals
- labs-cbc, bun, electrolytes, pt ptt. liver enzymes ABG
58
what are clinical manifestations of a pt with a UGI bleed
- fatigue
- pain
- dyspepsia
- hemataemesis
- melena
```
-if sudden or massive bleed, pt may experience
anxiety
restlessness
change in LOC
tacky
dyspneic
tachypnea
cool clammy skin
nausea
(signs of shock!)
```
59
why is a BUN helpful in a GI bleed
because during significant hemorrhage, blood proteins are broken down by GI tract bacteria resulting in an elevated BUN
also
elevated BUN levels may indicate renal hypo perfusion or renal disease
60
what treatment will a pt with an UGI bleed get
- frequent vital signs
- frequent H&H
- neuro checks for altered LOC
- oxygenation
- multiple large bore IVs- for fluid and blood
- NG tube for bowel rest
- fluid replacement and blood if needed
PPI or H2 blocker via IVP/infusion
sandostatin - IV infusion-- will decrease blood flow to the gi tract and decrease acid secretion
(chronic bleed will need psi sucralfate and iron supp)
61
what does your pt need to be educated about after gastric surgery
-they may need to be on B12 for the rest of their life d/t there is not enough IF to absorb the b12
(they are at risk for pernicious anemia)
-they may experience dumping syndrome which causes pain, discomfort nausea and epigastric fullness, dizziness
62
what type of diet should someone have after gastric surgery
-low carb
high protein
high fat
63
what is rebound pain
the pt does not feel pain on palpation but feels pain after you lift your hands after palpation
64
what can cause appendicitis
obstruction, stricture
| -- the fecal matter gets trapped and becomes a harbor for bacterial growth
65
what are manifestations of appendicitis
```
rebound RLQ pain
guarding/knees drawn up
anorexia, vomiting
fever
constipation/bloating/diarrhea
```
66
what diagnostic tests can be done for appendicitis
observe pain pattern
abdominal assessment (mcburneys point)
labs- cbc may be elevated, ua to r/o GU problems that can mimic appendicitis, CT or US to confirm, hcg for females to r/o pregnancy
67
what are complications of appendicitis
- ileus
- perforation- can lead to peritonitis (fatal)
- shock
68
what are nursing interventions for a pt that comes in with appendicitis
- NPO- prep for sx
- treat for pain- only with diagnosis
- IV fluids and Abx to prep for sx
- monitor for worsening
- surgical consult
69
what happens when a laxative is given to a pt with appendicitis
-it increases peristalsis therefore it can cause the inflamed appendix to rupture
70
what does post op care of a lap appy consist of
- abx for 48hrs
- ambulation
- anti emetics
- monitor for flatus
- advance diet as tolerated
- monitor for s/s of peritonitis
71
signs and symptoms of peritonitis
- Severe bd pain-tenderness over involved area
- abdominal distention or rigidity
- N&V
- tympanic abd-(air inside)
- rebound tenderness
- hypotension
- fever/chills
- weak rapid pulse
- tachypnea d/t distention
- weakness
72
what diagnostic tests are done for pertonitis
- labs- abc to determine abc count and hemoconcentration
- abd xray- determine bowel loops for paralytic ileus or free air if perforation has occured
- US/CT to detect abscess or ascites
73
what are complications of peritonitis
- if care is delayed it can lead to
- septic shock
- hypovolemic shock
- paralytic ileus
- acute respiratory distress syndrome
74
what is the treatment for a pt with peritonitis
- NPO and NG tube to decrease gastric distention and to decrease further leakage of bowel contents
- IVF to replace lost fluids and to have access for ABX
- analgesics for comfort
- I&O to determine replacement therapy
- anti emetics to control nausea
- Monitor patient closely
75
what surgery is performed for a pt with pertonitis
-Laparotomy
| find the cause and repair the damage, drain purulent fluid and flush with abx solution
76
what is crohns disease
a chronic incurable inflammatory bowel disease
- mostly occurs in the ileum
- consists of inflamed lesions with spaces of healthy tissue
-an inapropriate sustained response to their own GI response
77
what can develop with crohns disease
deep fissures that can lead to fistulas and abscesses
as well as
altered nutrition r/t unable to absorb a lot of the nutrients d/t those lesions
78
what are risk factors for developing crohns
-diet (refined sugars, saturated fats, meats), hygiene, stress, smoking and NSAIDS
(increase susceptibility by influencing the environment of the bacteria and immune system),
genetic factors (heredity, gender, age, family)
altered immune system
79
signs and symptoms of crohns disase
- episodes of diarrhea and and pain
- steatorrhea (oily with odor)
- anorexia, N&V
- malabsorption leading to weight loss, anemia, fatigue
- rectal bleeding
(anemia d/t decrease in production of RBC d/t not enough nutrients to make RBC)
80
what is ulcerative colitis
an auto immune inflammatory disease of the colon consisting of inflammation and ulcerations in the mucosal layer (it does NOT extend through all bowel wall layers)
81
what are s/s of UC
- 4-20 stools/day
- watery diarrhea w/ poss blood and pus
- abd cramping
- weight loss- d/t chronic water loss
- involuntary leakage of stool
82
what diagnostic tests are used for IBD
- colonoscopy for differentiation
- biopsy
- CT/MRI/ transabd US/ sm bowel follow through, BE
- labs-cbc, cmp, albumin (r/t poor nutrition), ESR, CRP,
- stool culture to look for blood/pus
capsule endoscopy - For Crohns Only
83
what type of nutritional tx will a pt require with IBD
- may need enteral, parenteral or vitamins for Crohns
- manage weight loss and dehydration for Colits
- may need dietary consult to have diet with adequate nutrition and not cause exacerbation
84
what types of meds are used for Tx of crohns and UC
- Sulfasalazine- anti inflammatory
- immune suppressors- given to retain remission
- Corticosteroids- used to achieve remission
- abx
- anti diarrheals
- pain meds
- anti emetics
immune suppressors have delayed action so they are not good for acute flare ups. Steroids should be used in an acute situation
85
what are nursing interventions for Crohns and Colitis
- bowel rest- poss NPO
- control inflammation & infection and nutrition
- Monitor I&O
- teach pt to avoid triggers and minimize stress
- provide symptom releif
86
what foods do you want to avoid with UC
```
cabbage
sprouts
capsicum
radish
raw salads
okra
brocoli
raw onions
```
87
what are complications of IBD
Toxic megacolon- colonic dilation- at risk for perforation
| Bowel obstructions
88
difference between Diverticulosis and diverticulitis
- osis= pockets/outpouches in colon
- itis= inflammation of one or more of those outpouchings
usually occurs in the area where blood vessels penetrate the colon wall
89
what are causes of diverticulosis/itis
weakening of the bowel wall and increased intraluminal pressure
which can be associated with age, prior sx, decreased fiber intake (causing hardening of stool making it harder to move increasing pressure weakening walls)
90
what are complications of diverticulitis
Perforation
peritonitis
abscess
scarring
91
what are signs and symptoms of diverticulitis
```
mostly asymptomatic
but can show as LLQ and pain
change in bowel habits
diarrhea/constipation
bloating
flatulence
```
92
what diagnostic tests can be used for suspected diverticulitis
- colonoscopy
- XR
- CT
- MRI
- Labs-cbc for infection, crp
- stool
93
what is the treatment for diverticulitis
- bowel rest-NPO w/ IV hydration
- education for pt on dietary modifications
- --high fiber, no seeds, find the aggravating factor
- medications (abx, stool softness, anticholinergics, laxatives)
- NG w/ low intermittent suction
- surgery- colon resection or poss temp colostomy
94
what can be the cause of a bowel obstruction
- Mechanical
- -adhesion/stricture
- -intussusception (bowel slips into itself)
- -volvulus- (twisting of the bowel)
- -cancer
- -hernia
- Non Mechanical
- -Paralytic ileus
95
what are complications of a bowel obstructoin
- ileus
- perforation
- necrotic bowel
96
what diagnostic studies can be done to diagnose bowel obstruction
- CT scan
- abd xr
- poss endoscopy, sigmoidoscopy, colonoscopy
- labs (elevated CBC can indicate strangulation, elevated hct may refelct hemoconcentration, decreased H&H = bleeding or strangulation, electrolytes bun and creat to assess dehydration, abg to monitor metabolic alkalosis)
97
clinical manifestations of a pt with a bowel obstruction
- severe abdominal pain
- N&V
- sweating
- anxiety
- restlessness
- abd distention
- constipation
- lack of flatus
- hyperactive/hypoactive bowel sounds
98
what is the treatment for bowel obstruction
```
NPO status and NG tube for decompression
IV fluids- NS or LR (isotonic), + electrolyte replacement
anti emetics
pain control
abx- prophylactically
-TPN if pt NPO for extended time
**monitor for worsening condition**
Consult with surgeon (sx will be required for mechanical obstruction)
```
**NO laxatives in bowel obstruction**
99
how is colon cancer preventable
colon cancer begins as a polyp of the tissues in the colon and rectum. These are seen via colonoscopy. Identified early enough it can be prevented
100
what are risk factors for colon cancer
- Genetic
| - ethnicity (african americans, men, red meat, processed meat, low fiber, obesity, alcohol, smoking, IBD, age)
101
what are clinical manifestations of colon cancer
```
-vague in the beginning and do not show symptoms until the disease is advanced.
when they do appear they include
-rectal bleeding,
-anemia
-abdominal pain
-weight loss
```
102
what are ways to decrease the risk of developing colon cacner
high fiber diet, no processed meat, no smoking/drinking
increase fruit and veggies
-long term use of NSAIDS can decrease risk
103
what are the warning signs of colon cancer
- change in bowel elimination
- blood in the stool
- rectal/abdominal pain
- change in character of stool
- sensation of incomplete emptying
104
what are the diagnostic tests for colon cancer
- colonoscopy (q10yrs)
- sigmoidoscopy (q5yrs)
- BE (q5yrs)
- CT, MRI, US- to detect metastasis)
- labs (fecal occult blood test, CEA, serum iron, LFTs/coag studies, cbc to check for anemia)
105
what is treatment for colon cancer
- bowel prep for surgery - colectomy, colostomy, colon resection
- chemo
- radiation
106
what type of post op care would a bowel surgery pt need
- dressing changes (sterile)
- NG tube and Strict NPO
- -diet to be progressed after flatus
- AMBULATE!!!!!!!!!!!!!!!!!!!!!!!!!
- maintain fluid volume status
- Strict I&O
- drain care if there is one
