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NURB 3141 > Upper GI > Flashcards

Upper GI Flashcards

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1
Q

dental caries

A

cavities caused by a breakdown of tooth enamel

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2
Q

contributing factors of dental caries

A
  • lack of fluoride in water
  • lack of dentist visits
  • dry mouth
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3
Q

manifestations of dental caries

A
  • tooth erosion
  • tooth pain
  • halitosis
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4
Q

collaborative care for dental caries

A
  • visit dentist
  • well balanced diet
  • good hygiene
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5
Q

risk factors for oral cancer

A
  • tobacco
  • HPV
  • men
  • excessive ETOH
  • hx of cancer in the head or neck
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6
Q

manifestations of early stages of oral cancer

A

little to none

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7
Q

manifestations of late stages of oral cancer

A
  • painless lesions/sores that bleed but never heal
  • red or white patches in the mouth or throat
  • painless indurated ulcer
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8
Q

sx seen in oral cancer as it progresses

A
  • tenderness
  • difficulty swallowing, chewing, and speaking
  • blood-tinged sputum
  • enlarged lymph nodes
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9
Q

medical management of oral cancer

A
  • surgical dissection
  • radiation
  • neck dissection (only if it metastasis to the neck)
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10
Q

preoperative nursing implications for oral cancer

A
  • monitor nutrition status & how to handle post-op

- arrange post-op communication- writing or electronic device if larynx is affected

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11
Q

postoperative implications for oral cancer

A
  • monitor airway

- suction available on side of bed at all times

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12
Q

how to minimize pain and discomfort in oral cancer

A
  • soft liquids and foods
  • soft toothbrush
  • pain medications
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13
Q

how to prevent infection in oral cancer

A
  • monitor labs
  • monitor temperature
  • proper dressing changes
  • aseptic technique
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14
Q

types of esophageal disorders

A
  • achalasia
  • hiatal hernia
  • diverticulum
  • perforation
  • GERD
  • Barret Esophagus
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15
Q

main symptoms fo esophageal disorders

A
  • dysphagia

- odynophagia

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16
Q

achalasia

A

-absent or ineffective peristalsis of distal esophagus with failure of esophageal sphincter to relax with swallowing

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17
Q

manifestations of achalasia

A
  • dysphagia
  • food regurgitation
  • chest discomfort or epigastric pain and pyrosis
  • aspiration
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18
Q

treatment of achalasia

A
  • sit up while eating to help empty esophagus
  • eat slow and drink fluids while eating
  • take nitrates to help with chest pain
  • pneumatic dilation- stretches the esophagus
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19
Q

hiatal hernia

A

when the upper part of your stomach bulges through the diaphragm where the esophagus passes through

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20
Q

contributing factors to a hiatal hernia

A
  • obesity
  • high fat diet
  • high caffeine ingestion
  • tobacco
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21
Q

manifestations of hiatal hernia

A
  • heartburn
  • regurgitation
  • belching
  • SOB, worsens after eating
  • chest pain, worsens after eating
  • chronic cough
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22
Q

diagnostics for hiatal hernia

A
  • barium swallow

- EGD

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23
Q

interventions for a hiatal hernia

A
  • small frequent meals
  • sit up 1-2 hours after eating
  • avoid eating 3 hours before bed time
  • be careful with straining and exercise
  • encourage loose fitting clothing around waist for relief
  • increase fluid while eating to help empty the stomach
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24
Q

diverticulum

A

-out-pouching of mucosa protruding through a weakened area of the esophagus

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25
diverticulum manifestations
- dysphagia - fullness in neck - belching - halitosis (sour taste) - regurgitation of indigested foot - stomach gurgling after meals
26
diagnostics of diverticulum
-barium swallow for location
27
diverticulum treatment
- surgery to remove diverticulum - NPO until proof of no leakage at surgical site; may or may not need NG tube - diverticulotomy- decrease risk of a fistula, no NG, quicker discharge
28
causes of perforation
- severe straining | - secondary to surgery
29
manifestations of perforation
- severe retrostemal pain follow by dysphagia | - infection, fever, leukocytosis, severe hypotension
30
diagnostics for perforation
- barium swallow - esophagram - ct
31
treatment for perforation
- npo - iv fluids - ABG - close monitoring in ICU - prep for surgical repair or esophagostomy
32
postop treatment for perforation
- NPO 7 days - ENIPN - abx - repeat esophagram for verifying no leaks or ileus
33
GERD
-back flow of gastric or duodenal contents into the esophagus
34
causes of GERD
- possible esophageal injury - incompetent LES - pyloric stenosis - hiatal hernia - mobility problems
35
contributing problems of GERD
- age - obesity - smoking - high EOTH - high caffeine - big meals - obstructive airway disorders (sleep apnea, asthma, COPD)
36
effects of GERD
- dental erosion - pharynx and esophagus ulcerations - esophageal strictures - adenocarcinoma - pulmonary complications
37
complications of GERD
- esophagitis - barrel's esophagus - respiratory: couch, bronchospasm, laryngospasm, potential for asthma - bronchitis - pneumonia
38
manifestations of GERD
- pyrosis - hypersalivation - respiratory problems: wheezing, coughing, dyspnea, nocturnal discomfort - dyspepsia - regurgitation: hot, bitter, sour taste - GERD related chestpain
39
nursing interventions for GERD
- lifestyle modifications: find triggers, follow up when dr. when notice s/s of barrots esophagus - diet: 4-6 small frequent high protein, low fat meals to prevent distention, fluids between meals, eat 3 hours before bedtime - avoid chocolate, caffeine, ETOH, fried food, high fat food, peppermint/spearmint, milk, smoking - position: HOB up to promote stomach emptying, lay on right side, sit up for three hours after eating, loose clothing around waist - endoscopic procedures
40
-drug therapy for GERD
- PPIs - Histamine 2 receptors blockers - antacids - anti ulcer, protectants - cholinergic - prokinetic drugs
41
surgical therapy for GERD
-nissen fundoplication
42
barret esophagus
alteration in esophageal lining caused by reflux
43
manifestations of barret esophagus
-GERD sx-frequent hearburn
44
dx of barret esophagus
- EGD with reddened esophageal lining | - biopsies with evidence of dysplasia
45
management of barret esophagus
- depends on stage of disease | - close monitoring- biopsy, PPIs
46
gastritis
group of conditions with one thing in common: inflammation of the lining of the stomach
47
risk factors of gastritis
- drugs: anything that directly irritates gastric mucosa- NSAIDS, aspirin, corticosteroids - diet: no ETOH or spicy food - microorganisms: h. pylori - environmental factors: radiation, smoking - pathophysiologic conditions: sever illness such as renal failure, sepsis, burns
48
manifestations of gastritis
- acute: epigastric pain, dyspepsia, self limiting; can cause anorexia, full felling, nausea (based on hx of ETOH or drug use) - chronic: lining of stomach atrophies, loss of parietal cells function, vitamin B12 deficiency; same as acute with fatigue
49
diagnostics of gastritis
- endoscopy with biopsy and histologic exam - cbc - diagnostics to detect H. pylori
50
acute gastritis collaborative care
- supportive care: NPO, IV fluids, rest, antiemetics, no ETOH or NSAIDS - supportive therapy: NG tube (observe for bleeding) - promote fluid balance and monitor electrolytes - optimal nutrition: liquids, advance as tolerated; no caffeine - so smoking- offer cessation measures - if hemmorhage is likely: frequent VS and fluids
51
drug therapy for acute gastritis
- antacids, H2R blockers, PPIs - focused on reducing irritation to mucosa and provide symptomatic relief - Abx for H.pylori - Cobalamin supplements fo pernicious anemia
52
Peptic Ulcer Disease
erosion of the mucosal lining of the stomach, esophagus, or duodenum; can be eroded to the point that the epithelium is exposed to gastric acid and pepsin, which can precipitate bleeding and perforation
53
risk factors of PUD
- h. pylori - med-induced injury: NSAIDs, aspirin, corticosteroids, anticoagulants, SRIs - Excessive ETOH & caffeine - smoking - uncontrolled stress - type O blood - CKD - liver failure - COPD
54
manifestations of PUD
- dyspepsia - dull, gnawing pain - localized tenderness - constipation/diarrhea - bleeding (upper or lower) - perforation
55
diagnostics of PUD
- endoscopy with biopsy - chest, abdominal x-ray - stool specimen - H&H anemia test - H. pylori test
56
interventions of PUD
- decrease stress - monitor diet - smoking/alcohol cessation - surgery: pyloroplasty, antrectomy, vagotomy
57
drug therapy for PUD
- H2R blockers - PPIs - Antibiotics - Antacids - Anticholinergics - cytoprotective therapy- short term
58
complications of PUD
- hemorrhage: frank blood in upper GI | - perforation: most lethal, more prevelant in duodenal
59
s/s of hypovolemic shock in PUD
- pale - clammy - disoriented - decrease bp - tachycardia - tachypnea
60
perforation in PUD
- elderly had more comorbid - can cause perforation due to spillage - can cause bacterial peritonitis (small- seal themselves, large- immediate surgery closure)
61
manifestations of perforation in PUD
- sudden, dramatic, severe generalized abdomen and shoulder pain - rigid board like abdomen - knees drawn up - tachycardia, weak pulse - shallow, grunting, rapid respirations - absent bowel sounds - N/V
62
treatment for PUD
- Notify HCP - Frequent VS..every15-30 min - STOP all NG, oral feedings/drugs - Continue IV fluids…continue/increase rate to replace depleted plasma volume - NG tube…continuous suction - Restore volume…LR, albumin, PRBCs - Foley – hourly I&O - Broad-spectrum antibiotics - Pain medication - Surgery (open or laparoscopic)
63
emergency assessment and management of PUD
- ABCs - Physical Exam - recognize early signs of shock - monitor respiratory status - abdominal exam - monitor urine - decrease anxiety, keep cal and assured - fluid/blood replacement - supplemental O2 - indwelling urinary catheter, assess volume - CVP line- monitor fluid volume status - empiric PPI therapy - UO- best measure of organ perfusion
64
postoperative complications of PUD
dumping syndrome
65
dumping syndrome
- direct result of surgical removal of a large portion of stomach and pyloric sphincter - decrease in the ability of stomach to control amount of gastric chyme entering small intestine - large bolus of hypertonic fluid in intestine and increase fluid in bowel lumen - occurs at end of meal or 15-30 minutes after eating
66
manifestations of dumping syndrome
- weakness - diaphoresis - palpitations - dizziness - abdominal cramps - borborygmi - urge to defecate - lasts no longer than an hour

NURB 3141 (5 decks)

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