Test #3 Chapter 55 - 58: Stomach Flashcards Preview

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Flashcards in Test #3 Chapter 55 - 58: Stomach Deck (55):
1

Where is the stomach located?

LUQ

2

What does the stomach secrete?

Hydrochloric Acid that we use to digest food. The liver and the gallbladder also aid in this.

3

What are Stomach Muscle Cells responsible for-

are responsible for gastric motility. (keeps things moving)

4

The stomach as a lot of Nerves….

Richly innervated with intrinsic and extrinsic type nerves. They do things like stretch when their is flood within the stomach. can speed or slow down the movement of your food. The stomach produces more acid when you eat. Those types of things.

5

Parietal Cells

The parietal line the wall of the stomach. They excrete your hydrochloric acid. The hydrochloric acid is good because it kills bacteria, breaks down your food so it is necessary to have it. You also have to protect your stomach from the HCL because if you didn’t, it is so corrosive it would just eat right through it.

6

Intrinsic Factor

The Intrinsic Factor is a protein that allows the body to absorb vitamin b-12.

7

Chyme

Chyme is a liquid that is in the stomach. It is just broken down food. This is the term that we use for that. It goes into the duodenum after it leaves the stomach.

8

Secretion-

is a hormone that once the acid production is where it needs to be, it will decrease it, or slow it down by triggering the bicarbonate. It also decreases your gastric motility. It does this so that the intestines are not damaged by the high levels of acid that your stomach needs to have.

9

Prostaglandins-

provide a protective mucosal barrier, which prevents the stomach from auto digestion.

10

RUQ-

Right lobe of the liver, gallbladder, pylorus, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the transverse and ascending colon.

11


RLQ-

Cecum and appendix, Portion of the ascending colon

12

LUQ-

Left lobe of the liver, spleen, stomach, body and tail of the pancreas, splenic flexure of the colon, portions of the transverse and descending colon.

13

LLQ-

Sigmoid colon, portion of the descending colon.

14

What is the Correct Order of Sequence for assessing the abdomen.

Inspect, Auscultate, Percuss and palpate.

15

When you are Assessing Bowel Sounds, where should you start.

RLQ because that is where the ileocecal valve is there. If you cannot hear it there, you are probably not going to hear it somewhere else.

16

Which statements about intrinsic factor are correct?

A. It is produced by the parietal cells.
B. It is essential to fat emulsification.
C. It aids in the absorption of Vitamin B12.
D. It forms and secretes bile.
E. Its absence causes pernicious anemia.

A. It is produced by the parietal cells.
C. It aids in the absorption of Vitamin B12.
E. Its absence causes pernicious anemia.

17

What is Gastritis?

Inflammation of gastric mucosa (stomach lining)


It can be Scattered or Localized and Erosive or Non-Erosive. and it is classified as either Acute or Chronic Gastritis

18

Gastritis ~ Pathophysiology

Break in protective barrier, mucosal injury occurs resulting in worsening by histamine release and vagus nerve stimulation. Hydrochloric acid can diffuse back into the mucosa and injure small vessels. This diffusion causes edema, hemorrhage and erosion of the stomach lining.

19

Acute Gastritis Etiology

Helicobactor Pylori- Gram negative bacteria that is spiral shaped and it digs its way into the stomach. The end result is that it increases the acid in the stomach.

****Long Term NSAID’s are the biggest contributors. They inhibit the prostaglandins, which allows the stomach to loose its protective barrier.

Alcohol, Caffeine, Corticosteroids- increases acid production.

Emotional Stress and Acute Anxiety- increases acids.

Radiation Therapy, Accidental or Intentional Ingestion fo Corrosive Substances

20

What is Acute Gastritis-

typically heals within several months as long as muscle is not involved and is not really deep.

21

What is Chronic Gastritis

is persistent inflammation and is very deep. The mucosal damaging of the glands can cause cellular changes. This puts the patient at risk for cancer.

22

What are the 3 different types of Chronic Gastritis (Etiology)?

Type A: Non-Erosive-Genetic Component. Your body produces antibodies that damage the parietal cells. This can cause pernicious anemia.

Type B: Most Common r/t H. Pylori Infection

Atrophic: Most often older adults

23

Which are pathologic changes associated with acute gastritis? (select all that apply)

A. Vascular congestion

B. Severe mucosal damage and ruptured vessels

C. Edema

D. Acute inflammatory cell infiltration

E. Increased cell production in the superficial epithelium of the stomach lining

A. Vascular congestion

C. Edema

D. Acute inflammatory cell infiltration

24

A patient with chronic gastritis is being admitted. Which S&S does the nurse identify as being associated with this patient’s condition?

A. Pernicious anemia
B. Gastric hemorrhage
C. Hematemesis
D. Dyspepsia

A. Pernicious anemia

25

Assessing for Gastritis

***What are the main S&S?

Know the difference between acute and chronic signs and symptoms.

Acute is more hemorrhaging, vomiting blood, indigestion.

chronic has fewer signs and symptoms. more vague.

26

If gastritis suspected, blood test available. What are they?

(IgG/IgM anti-H. Pylori antibody

27

****EGD (Esophagogastroduodenoscopy)- after the procedure- you monitor?

you monitor their vital signs until they return to baseline. (so need to get a baseline before they go). What happens during the procedure is that they numb their throat to keep them from gagging.

Since it has been numbed, swallowing is an issue. This means no eating or drinking until their gag reflex is present. This can take a few hours. They need to remain NPO in the mean time.

Assess their ability to swallow, if they do ok you can start them off with drinking before you progress to a full meal.

28

***What are the Gastritis Nursing Interventions?

Remove the Cause, such as NSAID’s, Alcohol. Whatever the etiology is.

If Severe Blood Loss (Meaning H&H is low, BP is low) they will get a Blood Transfusion

If Severe Fluid Loss (B/P is decreased but H&H is ok) will will give them a Fluid Replacement.

Surgery with major bleeding and ulceration.

Medications- focus on handout. Malox, Mylanta. Increases PH of the stomach. Nursing interventions for these medications include take 1-3 hours after meals. Assess the renal function because it is metabolized by the kidneys. No other meds within 1-2 hours of taking antacids.

Sodium bicarb (Baking soda)- treats heartburn. causes fluid retention and edema, so not good for CHF patients.

Pepsid / zantac- Pepsid is stronger, give at bedtime. can be given IV to prevent stress ulcers.

Teach patients to continue taking them even if heartburn stops

Proton pump inhibitors- prilosec, nexium, - keeps acid from being release from parietal cells. rules are no crushing. and give an hour before meals. at risk for pernicious anemia.

cytotec- not good for pregnant. no magnesium antacids. helps to protect if on NSAIDS

29

What are the Medications to Avoid when you have gastritis

Teach Patients to avoid drugs and other irritants that are associated with gastritis episodes

Corticosteroids because causes increased acid.

Erythromycin because causes increased acid.

NSAIDs (naproxen, ibuprofen)
NSAIDs in other OTC medications.

Other Items to Avoid

Teach Patients to avoid these irritants that are associated with gastritis episodes

Caffeine

Alcohol

Tobacco

High Acid Content- tomatoes, oranges, juice, no spicy like peppers or onions.

Heavy Seasoning, Spicy

30

****What would you teach as Health Promotions
For Gastritis?

Balanced Diet, Regular Exercise (helps movement of your gut) , Stress reduction techniques
Avoid Alcohol and Tobacco
Avoid excessive use of ASA and other NSAIDs

31

What is Peptic Ulcer Disease?

Peptic Ulcer-Mucosal lesion of the stomach or duodenum.

Peptic Ulcer Disease (PUD)- (might start out as gastritis) Results when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin

32

What is the Etiology & Pathophysiology of Peptic Ulcer Disease?

Etiology: H. Pylori and NSAIDs (Main Causes)

Patho: When body responses to bacteria the cytokines, neutrophils and other substances are activated and cause epithelial cell necrosis and disrupts the mucosal protection.

33

What are the 3 Types of peptic Ulcers:

Gastric, Duodenal, Stress

34

What are the risk factors for Peptic Ulcers?

same as gastritis.

35

What are the S&S of peptic ulcers.

Pain, indigestion.

36

What are Gastric Ulcers?

Ulcer pain often occurs in upper epigastrium (Lower part of the stomach) with localization to left of the midline and is aggravated by food.

Usually develop in antrum of stomach, complain that it hurts after they eat.

Usually r/t H. Pylori & NSAIDs

37

Duodenal Ulcers

Pain is usually located to the right of the epigastric. Pain 90 minutes to 3 hours after eating and often waked patient at night.

Usually develops in the upper portion of the duodenum where pH levels are low. So if you have rapid emptying of the stomach, it does not give the stomach enough time to buffer it so it tends to develop an ulcer there.

38

Differences B/T Gastric and Duodenal Ulcers

Gastric ulcer hurt right after eat, duodenal hurt 90 min after and can wake you up at night.

39

The nursing student caring for a patient with a duodenal ulcer is about to administer a proton pump inhibitor (PPI). Which statement about this medication is true?

A. These drugs should not be used for a prolonged period of time bc they may contribute to osteoporotic-related-fractures.

B. PPIs may not be given via feeding tube.

C. These drugs help prevent stress-induced ulcers.

D. PPIs work by coating the stomach with a protective barrier.

A. These drugs should not be used for a prolonged period of time bc they may contribute to osteoporotic-related-fractures.

40

Stress Ulcers

Occurs after acute medical crisis or trauma (ex head injury and sepsis) the patient can develop stress ulcers. They are not sure why.

Less Common, etiology unclear

41

*** Hemorrhage-

is the most serious. Typically patient who have gastric ulcers. and if you are older with a gastric ulcer it puts you at greater risk.

Perforation

Pyloric Obstructions

42

***Hemorrhage Complication

Most serious and tends to occur more often in patients with gastric ulcers and in older adults.

S&S: Vomiting bright red or coffee-ground blood (has time to sit before they throw it up). Hematemesis (Bright red) (usually indicates upper GI bleed) and Melena (more common with duodenal ulcers)

43

****GI Bleed
Nursing Interventions

Actively bleeding is an emergency. Priority ABC. set them up in the bed. suction ready.

Large-bore IV access for replacing fluids and blood (16-18G)

Monitor Vital Signs, Hct/Hgb, Oxygen Saturation

Insert NG tube, patient NPO to decompress the stomach.

Lab values- focus on H&H. Continous vitals as well

Gastric Lavage- Flush with room-temperature tap water in volumes of 200-300ml into the NG tube and then pull it back out to clear out the stomach. Patient MUST BE ON THEIR left side. THis limits the flow of the water flowing through the GI tract. Then chart what you put in on the I&O sheet.

44


NG Tube

HOB Elevated 30% or >

45

Perforation Complication

Perforation,
Surgical Emergency!! goes to surgery 100% of the time

Occurs when the ulcer becomes so deep that the entire thickness of the stomach/duodenum is worn away. The content leak into the peritoneal cavity.

Assessment: Sudden sharp pain in mid-epigastric region and spreads over entire abdomen. Abdomen is tender, rigid, board-like with rebound tenderness (peritonitis) must know how to assess for perforation.

46

Perforation
Nursing Interventions

NPO
Fluids Replacements
Antibiotics
NG Tube
I&O
Vital Signs
Monitor for Shock- tachy, bp low, fever, lethargic
Surgery

47

Pyloric Obstruction
Complication

Etiology: Obstruction occurs at the pylorus and is r/t Scarring, Edema and Inflammation. Manifested by vomiting caused by stasis and gastric dilation

S&S: Vomiting, Abdominal Bloating, Nausea. They will throw up undigested food.

48

Pyloric Obstruction Nursing Interventions

Restore Fluid Balance and electrolytes. Vomiting a lot leads to hypokalemia, because of acid loss. Kidneys hold on to acid and let go of potassium

NG to decompress the dilating stomach- do not want anything going through to rest the bowel.

Surgery,

49

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?

a) An intestinal obstruction has developed.
b) Additional ulcers have developed.
c) The esophagus has become inflamed.
d) The ulcer has perforated.

d) The ulcer has perforated.

50

Gastric Cancer

Usually begins in the glands of the stomach mucosa (from chronic gastritis that changes the cells)

No symptoms in early stages (this is why hard to cure)

Disease is advanced when detected

***Risk Factors, - chronic gastritis
Chronic Gastritis

****Correlated with H. Pylori, history of untreated GERD, eating pickled foods, nitrates from processed foods (hotdogs and bacon) and salt added to food. (what is used to preserve these foods are what puts you at risk)

51

Treatments for gastric cancer

once diagnosed longevity id decreased

Non-Surgical: Radiation and Chemotherapy
Surgical: Resection by removing the tumor

Surgical: Palliative- removing part of the stomach.

52

****Postoperative Care for gastric cancer surgery

Prevent atelectasis, paralytic ileus, wound infection, monitor for complications

Dumping Syndrome, the result of rapid emptying of food into the intestines. Earyl dumping syndrom happens within 30 min of eating have syncope, get tachy, have to sit down.

Late dumping is 90 min-3 hours after eating. causes hyperglycemia. (dizziness). teach small meals, decrease liquid intake when they eat.

53

To reduce the risk of dumping syndrome, the nurse should teach the client to do which of the following?

a) Sit upright for 30 minutes after meals.
b) Drink liquids with meals, avoiding caffeine.
c) Avoid mild and other dairy products.
d) Decrease the carbohydrate content of meals.

d) Decrease the carbohydrate content of meals.

54

The nurse has been assigned to provide care for 4 clients at the beginning of the day shift. In what order should the nurse assess these clients?

a) A client awaiting surgery for a hiatal hernia repair at 11am.

b) A client with suspected gastric cancer who is on NPO status for tests.

c) A client with peptic ulcer disease experiencing a sudden onset of acute stomach pain.

d) A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.

c) A client with peptic ulcer disease experiencing a sudden onset of acute stomach pain.

55

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?

a) “I should take the antacid before I take my other medications.”

b) “I need to decrease my intake of fluids so that I do not dilute the effects of my antacids.”

c) “My antacid will be most effective if I take it whenever I experience stomach pains.”

d) “It is best for me to take my antacid 1-3 hours after meals.”

d) “It is best for me to take my antacid 1-3 hours after meals.”