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NURSING 2 > UGI > Flashcards

UGI Flashcards

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1
Q

Oral and oropharyngeal cancer: cause

A

Alcohol and tobacco
Sun and Wind exposure
Generally squamous cell

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2
Q

Oral and oropharyngeal cancer: s/s

A

typically no symptoms until late - then a painless sore or mass that will not heal

As cancer progresses, patient may have difficulty swallowing or talking

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3
Q

Oral and oropharyngeal cancer: assessment

A

airway

secretions

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4
Q

Oral and oropharyngeal cancer: neck dissection

A

May have a trach
Xerostomia
Stomatitis
Bleeding

Concerned about airway - if tracheal compression occurs client will need trach

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5
Q

Perforations of esophagus: cause

A

stab, bullet, trauma, chemical injury

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6
Q

Perforation of the esophagus: assess / things you might see

A 
Excruciating pain
Dysphagia
Leukocytosis
Severe hypotension 
Crepitus
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7
Q

Perforation of esophagus: intervention

A 
IV fluids (to increase BP)
Broad spectrum antibiotics
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8
Q

Perforation of esophagus: nutrition

A

Enteral jejunal or parenteral
NPO for 7 days
Nasal jejunal tube is placed by provider because we do not want to rupture anything further

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9
Q

Foreign bodies

A
  • Issue as the foreign body can cause damage to the GI tract

- Surgery to retrieve the ingested, may cause perforation

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10
Q

Chemical burns - things to remember

A

Do not induce vomiting
Medical team only to insert NG tube
NPO
May cause perforation

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11
Q

What are s/s of heartburn, gastritis and ger(d)

A

Heaviness, belching, vomiting, flatulence, boating, and pain

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12
Q

Gastritis: patho

A

inflammation of the stomach mucosa

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13
Q

Gastritis can lead to what

A

hemorrhage, pyloric stenosis from scarring, or perforation

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14
Q

Gastritis: acute causes

A

contaminated foods, OD, medications

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15
Q

Gatritis: chronic causes

A

smoking, H. pylori (can lead to gastritis and cancer), medications, alcohol

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16
Q

How is H. Pylori often treated

A

2 weeks of PPI and Flagil

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17
Q

Gastritis: assessment

A

N/V, feeling full, anorexia, epigastric tenderness, gastric hemorrhage, belching, anemia from lack of B12

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18
Q

Gastritis: testing

A

H. Pylori (stool)

RBC (scope)

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19
Q

Gastritis: interventions

A

NPO - may need NG
IV fluids for dehydration
Clear liquids

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20
Q

Gastritis: potential and actual complications

A

Peptic ulcer
Pernicious anemia
H. Pylori gastritis - cancer

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21
Q

Gastritis: medications

A

PPI

Histamine blockers

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22
Q

Gastritis: education

A
  1. Diet - foods to avoid (fatty, peppermint, chocolate, coffee, alcohol)
  2. stop smoking
  3. small meals
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23
Q

GER(D): patho

A

Back flow of gastric contents into esophagus

- pepsin and HCL irritate and lead to inflammation

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24
Q

GER(D): factors that can predispose

A

Incompetent sphincter
Delayed emptying
Hiatal hernia (part of stomach pouches up and food and chemicals settle there)
Obesity

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25
GER(D): assessments / signs and symptoms
``` Heartburn - pain in upper abdomen Fullness throat Coughing/wheezing Dry throat Diet (ETOH, smoking) ```
26
GER(D) testing
Scope Biopsy r/t barretts v cancer Nuclear scan Manometry
27
GER(D): interventions
Elevate head at night
28
GER(D): potential and actually complications
``` Esophagitis Barrett’s esophagus Respiratory involvement laryngospasms bronchospasms asthma- pneumonia ```
29
GER(D): meds
PPI Histamine Blockers Urecholine- decrease pressure on sphincter – improve emptying Antacids
30
GER(D): education
Don’t eat 2 hours before bed Small frequent meals Diet changes how to take antacids Avoid caffeine, fatty foods, peppermint, ETOH
31
Peptic ulcer disease
Ulceration in gastric mucosa - - gastric (stomach), duodenal or esophageal - - acute vs. chronic
32
Peptic ulcer disease: factors
``` H pylori requires antibiotic therapy NSAID and corticosteroids smoking & alcohol Stress Diet ```
33
What can happen to the stomach is peptic ulcer disease gets really bad
can scar and stenos
34
Peptic ulcer disease: assessment
Pain - meal related If get relief from eating – duodenal If get pain with eating – gastric Vomiting- color consistency - coffee ground emesis (blood partially digested) BP & HR to evaluate for hypotension and perforation Obstruction
35
Peptic ulcer disease: tests
``` Hpylori Stool occult blood (want to know if there is bleeding) Scope (go in and look) Barium- if unable to scope CBC ```
36
Peptic ulcer disease: interventions for acute
``` NPO NG (decompression) IV fluids I&O Analgesics monitor electrolytes Clear liquid and advance Surgery ```
37
Peptic ulcer disease: medications
``` PPI Histamine Blockers Antacids – renal considerations Sucralfate – coats stomach Amoxicillin, clarithromycin, tetracycline-metronidiazole if H pylori along w PPI Bismuth (pepto bismol) coats stomach ```
38
Peptic ulcer disease: education
Med adherence follow up scope Diet- spicy, peppers, caffeine, carbonated, NSAIDS aspirin should be avoided Signs of bleeding
39
Gastric surgery: what
Remove part of stomach and attach it directly to duodenum or jejunum
40
What are things to consider post gastric surgery?
Lie down after meals Low fowler position during meals Avoid carbs Vitamin B12 and iron supplements because don’t have ability to absorb as much Will have NG tube when they come back from surgery
41
Varices
Dilated tortuous veins that are generally found in lower esophagus Bleeding associated with high mortality
42
Varices: dx
EGD- esophagastroduodensocopy
43
types of varices
Esophageal | Gastric
44
what causes varices?
Cirrhosis --> portal HTN --> varices
45
Varices: acute management of bleeding
Hemodynamic resusitation Octreotide Banding, sclerotherapy Prophylactic abx
46
Varices: chronic management of bleeding
BB | Endoscopic variceal ligation
47
What must the nurse consider when a client has bleeding or a hemorrhage?
fluid volume depletion
48
Vasoconstrictor with endoscopic therapy
- octreotide or somatostatin - vasopressin slows hemorrhage and may be used in conjuction with nitro to prevent side fx from vasoconstriction (cardiac iscemia)
49
Balloon tamponade
``` Temporary to treat active bleed -- Sengstaken-Blakemore tube ICU Monitor for respiratory complications Patient must not dislodge Can cause esophageal rupture, aspiration and rebleeding Temporary bridge to other treatments ```
50
GI bleed: upper
Coffee ground emesis not as emergent as lower GI bleed Frank blood
51
Frank blood
bright red blood, patient is vomiting - you have active bleed
52
Lower GI s/s
Dark, tarry, high up Melena - burgundy - midway through Frank blood - usually much lower
53
GI bleed: assessment
BP HR Vomiting or stool perfusion - brain and extremities
54
GI bleed: priority labs/diagnostics
CBC ---> H&H (h&h going to be effected by hydration) Scope – may need cauterization Radionuclide Surgery
55
GI bleed - priority interventions
Address bleeding- Fluid replacement Blood products Vasopressors
56
GI bleed: complications
Hypovolemic shock | Exsanguination
57
GI bleed: medications
Esophageal varices- Octreotide Norepinephrine (levophed) And previously listed based on cause
58
GI bleed: teaching acute phase
What is happening treatment purpose support
59
GI bleed: Discharge
Will reflect underlying cause and teachings for maintenance and follow up care
60
Bowel perforation: s/s
``` Sudden severe abdominal pain N/V fever chills swelling and bloating of abdomen ```
61
Bowel perforation: intervention
``` Surgery Fluids NG ABX Drain May have ostomy depending on what is perforated ```
62
Peritonitis: patho
inflammation of peritoneum | Life threatening emergency requires prompt surgical intervention
63
Peritonitis: cause
bacterial infection from GI tract
64
Peritonitis: s/s
Rigid, distended abdomen Rebound tenderness Guarding by the patient ``` tachycardia HTN dehydration pain decrease bowel sounds "board-like" abdomen increase WBC ```
65
Peritonitis: risk factors
Abdominal surgery Ectopic pregnancy Perforation (trauma, ulcer, appendix rupture, diverticulum)
66
peritonitis: management
``` Fluid/electrolyte replacement NG Respiratory support Abx therapy Monitor bladder pressure to ID compartment syndrome ```
67
Peritonitis: complications
septic shock PEs Bowel adhesions
68
Morbid obesity
More than two times ideal body weight Significant health risks associated with weight Medications have cardiac risk Weight loss goals Positive reinforcement Address comorbidities
69
Complications of bariatric surgery
``` Malabsorption, dumping syndrome Dietary modifications small meals- Eat slowly Supplemental vitamin B12, calcium & iron Dehydration Do not eat and drink at the same time May be on FL 1000 mL/day ```

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