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Health and Illness 4 : Part2 > WEEK 5 > Flashcards

WEEK 5 Flashcards

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1
Q

peptic ulcer disease : what is it ?

A

a condition characterized by erosion of the gastric or duodenal mucosa

the mucosal barrier is broken and HCL enters the tissues causing injury to the tissues

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2
Q

why does PUD happen ?
can be precipitated by what ?

A

drugs
stress
bacteria ( H. pylori )

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3
Q

just read : gastric ulcer vs duodenal

Gastric
* Peak at age 50-70 years
* Pain can be aggravated by food
* May be malnourished
* N or decreased gastric secretion
* Pain 30-60 min after a meal
* Heals with tx -if it recurs it is in the same location

Duodenal
* Peak at age 20-50 years.
* Pain relief with antacid and food. * Usually well nourished.
* Increased Gastric secretions
* Pain 1 1⁄2-3 hrs after meal
* Often has remissions and
exacerbations

A

yes

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4
Q

recognize cues : assessment diagnostic tests
explain it

A

pt hx
lab assesments
esophagogastroduodenoscopy
nuclear medicine scan

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5
Q

what are the complications of PUD
explain it

A

hemorrhage/upper gi bleed
perforation
gastric outlet obstruction

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6
Q

GI bleed

can be apply to a patient that comes in for a GI bleed that perhaps is not as a result of an ulcer as well. so you can apply what you learn here to any patient that comes in with a GI bleed

A

yes

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7
Q

what are the recognize cues: assessment

if the blood has not hit the stomach acid yet, then it is bright red
and vomiting lots of bright red blood

what undergoes it

A
  • Hematemesis/ coffee ground emesis
  • Tarry black stool (bleed from higher up/longer duration) - higher up intestinal bleed
  • Abdominal pain
  • Can proceed to shock
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8
Q

take action : stabilize patient ( upper GI bleed )

A
  • Treat like for hypovolemic shock
  • Calm approach, frequent VS, O2,
  • IV fluids +++ (monitor for fld overload)
  • I&O, monitor urine output
  • Monitor stools/emesis
  • Monitor lab work
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9
Q

upper GI bleed : take action : stop the bleed

explain each and everything

A

endoscopic therapy ( primary treatment procedure )

surgery

drug therapy

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10
Q

antacids, PPIs, h2 receptor blockers

A

helpful decreases the irritants and help that bleed stop

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11
Q

what is octreotide ( sandostatin )

A

used to decrease blood flow to the abdominal organs it causes phases
constriction of vessels and its given IV over five to six days after the initial bleed
and helps with that bleed helps that bleed to stop

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12
Q

true or false. vasopressin , causes vasoontriction but vasopressin we have to watch carefully because it can also contrict all other vessels
so it needs to be given with caution and that pt needs to be monitored

A

true

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13
Q

perforation is the spillage of gastric contents into peritoneal cavity

A

this is where stomach mucosa erose away until theres a whole in the stomach
it spill into the peritoneal cavity

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14
Q

recognize cues : what undergoes perforation

A

Sudden severe abdominal pain
* rigid board like abdomen
* pain
* increasing distention

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15
Q

what undergoes take action for perforation

A
  • Monitor for hypovolemic and /or septic shock and treat
  • Maintain NG for gastric decompression
  • Antibiotic therapy
  • Prepare for surgery
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16
Q

what is the contraindication if mucosa is perorated , what should the nurse not do ?

A

is put anything down that ng tube
because whatever goes down that stomach is just going to spill out into the peritoneal cavity

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17
Q

just read : complication of pud : gastric outlet obstruction

Gastric Outlet Obstruction
* Narrowing of pylorus from…
Recognize Cues
* Pain that progresses and becomes
* Swelling of upper abdomen
* Projectile vomiting
* undigested particles from hours or days ago
Take Action
* Decompress with NG tube
* IV fluid and electrolyte replacement
* Surgery to open obstruction and remove scar tissue

A

trueeee

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18
Q

PUD pharmacological therapy

HAPCA

A

h2 receptors
antacids
PPIs
cytoprotective
antibiotics for H pylori

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19
Q

just read for the discharge planning for PUD :
Discharge Teaching of PUD: Conservative Therapy
* Dietary Modifications
* Avoid spicy foods, acidic foods, caffeine, alcohol
* Stop Smoking
* Avoid OTC Meds
* Take all meds as prescribed
* Report bloody emesis, tarry stools, increased epigastric pain
* Encourage patient to share concerns about following lifestyle changes

A
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20
Q

explain what pud surgical procedures are
billroth I
billroth II
vagotomy
pyloroplasty

A
  • Billroth I: Gastroduodenostomy
  • Partial gastrectomy with removal of distal
    2/3 stomach and anastomosis of gastric stump to duodenum. Antrum and pylorus removed.
  • Billroth II: Gastrojejunostomy
  • Partial gastrectomy with removal of distal 2/3
    stomach and anastomosis of gastric stump to Jejunum. Antrum and pylorus removed.
  • Vagotomy
  • Severing of the vagus nerve
  • Eliminates the stimulus to secrete HCL
  • Pyloroplasty
  • Surgical enlargement of the pyloric sphincte
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21
Q

Take Action:Post-op care after surgery for PUD
just read :
* Will have NG to decompress stomach
* Monitor bowel sounds
* Monitor N/G content (color and amounts)
* Ensure patency of NG tube
* Remove NG tube when peristalsis returns
* IV fluids with K+ and vitamin replacement
* Introduce foods when ordered
* Care of abdominal incision
* Encourage DB&C with splinting
* Encourage ambulation to increase peristalsis

A
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22
Q

explain ensure patency of ng tube

A

may need saline irregations every 4 hours
if the tube plugs and the stomach becomes distended this could cause rupture of the suture lines and leakage of the gastric contents of peritoneal cavity

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23
Q

why is there pernicious anemia ?

A

when we remove so much of the stomach and the bowel were losing a lot of parietal cells
where the intrinsic factor is produced , we need that intrinsic factor b12 and b12 is needed to synthesize hemoglobin needed to synthesize hemoglobin so this patients ends up with pernicious anemia

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24
Q

true or false. putting up pillow against their stomach while they’re doing their deep breathing and coughing really helps them when it comes down for surgery pud

A

true

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25
post op complications for billroth I and billroth II
dumping syndrome post prandial hypoglycemia bile reflux gastritis
26
what is the variant of dumping syndrome ?
postprandial hypoglycemia
27
what is this describing ; Hyperglycemia releases insulin resulting in secondary hypoglycemia.
post prandial hypoglycemia
28
gastric cancer : recognize cues
* Anemia * Vague epigastric fullness * feelings of early satiety after meal * weight loss, dysphagia, dyspepsia
29
true or false. * During an endoscopic ultrasound can be performed to evaluate depth of tumor and presence of lymph nodes
true
30
true or false. If in early stages laparoscopic surgery may be all that is needed however in late stages a total gastrectomy may be required.
true
31
Total Gastrectomy with Esophagojejunostomy (removal of stomach with resection of esophagus to jejunum)
* will have N/G (drainage minimal) * will have chest tubes because enter through chest wall. * Clear fluids initiated after several days to solid foods * Radiation/ chemotherapy to adjunct or if surgery is not an option
32
* At risk for poor nutritional status, wt loss, vitamin deficiency, pernicious anemia, dumping syndrome, postprandial hypoglycemia : is this true or false when it comes down to surgical management of gastric cancer
true
33
what are the two autoimmune disorders of GI tract
ulcerative collitis crohn's
34
recognize cues : ulcerative collitis
* Peaks between the ages of 15 & 25 * Bloody diarrhea * Abdominal pain * Located distally in the rectum and spreads proximally in a continuous fashion of the colon * Cured with Surgery
35
recognize cues : crohn's disease
* Peaks between the ages of 15 & 30 * Non-bloody diarrhea * Abdominal pain * Can occur any where in the colon from mouth to anus (most often in the ilium)
36
true or false. ulcerative collitis, gone for good in the bowel when it comes to surgery
true
37
crohn's disease, reoccurrence after surgery
more lessions may form multiple surgeries ( less and less bowel to work with )
38
Recognize Cues: Intra-intestinal complications of IBD ulcerative collitis
hemorrhage perforation colonic dilation colorectal cancer
39
this is an extensive dilation and paralysis of the colon
toxic megacolon
40
true or false. If they have UC for greater than 10 years, the pt is at risk
true
41
often associated with the deep longitudinal ulcers that penetrate in this inflamed mucosa and it looks like kind a cobble stone appearance
this is crohn's disease
42
what undergoes intra intestinal complications of IBD: recognize cues
* * Stricture, obstruction Perforation, intra-abdominal abscess Malabsorption , **Fistulas (Cardinal feature)** * May communicate with loops of bowel, vagina, urinary tract causing feces in urine and UT
43
what are the extra intestinal complications of ulcerative colitis and crohn's
anthroplasty arthritis ocular manifestations ostepenia./osteoporosis skin manifestations thromboembolic events
44
take action for acute phase : uc and crohns ****Frequency, amount and color of stools most important to monitor because the severity of diarrhea determines how much fluid replacement is necessary **** what should be utilized ?
nutrition and fluid an electrolyte balance daily wts meticulous perianal care
45
what should u monitor during acute phase of uc and crohn's for taking action
dehydration fatigue skin breakdown ineffective coping strategies intra/extra intestinal complications blood in stools
46
take action for maintenance phase ( uc and crohn's) chronic/long term disease ... remissions and exacerbations what are the maintenance drugs C I I V A
* ***5-ASA-Sulphasalazine–longterm(worksbestinlargeintestinetodecreaseinflammation) * Corticosteroid Drugs -prednisone * Immunosuppressant's–cyclosporine(Neoral) * Immunomodulators-infliximab(Remicade) * Vitamins- oral iron (ferrous gluconate), IV iron (iron dextran) * Antidiarrheal-diphenoxylate (Lomotil)
47
diet : maintenance phase ( uc and crohns )
* Avoid triggers -Need a food diary * Often avoid dairy –(but ok in moderation) *Eat high Calorie, high protein low fat * Nutritional supplements * Low residue diet
48
Take Action: UC surgery Total proctocolectomy (with permanent ileostomy)
is a one stage operation involving the removal of the colon, rectum, anus with the closure of the anus. * The end of the terminal ileum is brought out through the abdominal wall and forms a stoma, or stoma. * The stoma is usually placed in the right lower quadrant of the rectus muscle. * Colostomy bag at all times
49
Take Action: UC surgery Total proctocolectomy - ileoanal reservoir (pelvic pouch) and anal anastomosis
Can be staged depending on pre-op health of patient. * First colectomy with temporary ileostomy (while pt restores health and improves status) * Next takedown of ileostomy, ileoanal reservoir created from small bowel and attached to anus. * Results in 6-8 pasty stools/day and good daytime continence
50
what is the post ip care after proctolectomy with permanent ileostomy or ileonanal resorvoir
* Stoma care * Dressings/packings * Expected tubes/ drains * N/G * Stool amount/type/frequency * Anal sphincter control (if have a reservoir) * Kegel exercises * Nutrition/Diet
51
bowel obstruction , can be partial or complete obstruction of the intestine
yes
51
where can bowel obstruction occur ?
* Small bowel * Large bowel
52
how does bowel obstruction happen
hernia adhesions paralytic ileus cancer anything that blocks
53
true or false. purturdes through the muscle blocking stool that moving forward can cause obstruction
true
54
recognize cues : assessments what is the difference between LBO and SBO start with SBO
rapid onset frequently vomiting colicky intermittent abd pai bm for short pain mild/moderate distention
55
recognize cues : assesments what is the difference between lbo and sbo what is the LBO
gradual onset vomiting in late stages low grade cramping constipation significant abd distention
56
this is higher up so whatever stool is below that is still may pass through so they may actually have bowel movements for short time where is this occuring
SBO
57
bowel obstruction " recognize cues : diagnostics
abd xray, ct ( show gas and fluid in intestines )
58
interventions: take action for bowel obstruction
decompression of ng abd assesments pain assesments n/g care nutrition/fluid/lytes replacement prepare for surgery if not resolved monitor for perforation
59
what is colorectal cancer
malignant disease of colon rectum or both symptoms not often seen until late stages
60
what are u assessing for when it comes to colorectal cancer
change in elimination habits change in consistency, shape gas pains/rectal pain not usual blood in stools
61
diagnostic tests for colorectal cancer
fobt, family history, colonscopy, dre, cea, ct, u/s1
62
what are the risk factors for colorectal cancer
alcohol use for to six drinks a day if the pts greater than 50, if they have history of irritable bowel disease genetic cause and what they eat
63
what are the clini mani for colorectal cancer
bleeding diarrhea, or ribbon like stool if the tumour is blocking
64
current recommendations for screening in canada?
if low risk fobt or fit every 2 years after turning 50 if results positive then go for colonscopy if high risk start earlier than 5o and start with colonoscopy
65
Recognize Cues: Diagnostics Colonoscopy
* used to diagnose * take biopsy * remove polyps
66
pretty sedated to a time and they wont be going to play any sports, thats for sure for colonscopy
true
67
Take Action: Surgical Management for colon cancer if they do have colon cancer surgery is the only treatment for it what is it
Remove section of bowel with the tumor and reanastomosis (reconnect) ends
68
what is right hemicolectomy
is performed when the cancer is located in the cecum, ascending colon, hepatic flexure and transverse colon
69
what is left hemicolectomy
involves resection of left transvere colon, splenic flexor and descending colon, sigmoid colon and upper portion of the rectum remove section of bowel with the tumor and reanastomosis ends
69
take action : abdominal peritoneal ( AP ) resection
performed when the cancer is located within 5 cm of the anus distal sigmoid colon, rectum and anus removed proximal sigmoid brought through abdominal wall permament colostomy
70
take action : abdominal peritoneal ( AP ) resection two wounds and a colostomy after AP resection
abd incision perineal incision is sewn closed with drain in place or packed and left open
71
where the colostomy located in two wounds and a colostomy after AP resection
colostomy stoma in LLQ
72
take action : abd peritoneal resection Potential Complications
delay wound healing and infections urinary incontinence and sexual dysfunction
73
take action : post op care specific to ap resection
careful wound assessment and care and positioning
74
careful wound assessment and care post op care specific to ap resection abdominal and perineal incisions and colostomy
keep perineum clean and dry ( irrigate with NS ) dressing changes drain care
75
positioning for post op care specific to AP resection
side to side positioning pressure cushion if sitting no pressure on perineum
76
the pt will probably go home with how to keep that area clean and the dressing care the dressing changes or care of the wound
true
77
ostomy is a surgical opening of the intestine to permit diversion of fecal material what are the types of ileostomy colostomy
--- ileum brought in the abdomen
78
depending on the location : the higher up where the ostomy is, that means there is less absorption of fluid taking place for ex: ileostomy ( removed most of the colon ) that stool in the ostomy bag will be very liquidy colostomy - that stool is normal looking, pt can sometimes time it dont have to wear big bag just read
79
Recognize Cues -Stoma Assessment assess stoma q8h. expect to see :
mild to moderate edema small amount bleeding, oozing when touched amount of drainage in the first 24-48 hrs negligible
80
true or false. With stoma assessment, will begin to pass flatus as peristalsis increases ( 4h hrs )
true, yes this will increase ( expect it )
81
Discharge Teaching: Colostomy & Ileostomy care teach the following
* inspect stoma and skin for breakdown * empty pouch when 1/3 full or inflated with gas * Deodorants as needed * Avoid food that cause odor gas, diarrhea or obstruction * Initially low residue diet then increase gradually
82
what are the examples of food to avoid because it causes gas , diarrhea, obstruction
onions, garlic, eggs, and all odor producing gas forming popcorn, nuts, raisins , potential obstructors in the ostomy
83
discharge teaching : colostomy and ileostomy care
Increase fluid intake and observe for S&S of dehydration * Assess stool consistency (liquid for ileostomy, formed for sigmoidoscopy) * Support groups for emotional adjustment * Follow up care Report S&S of ------- Fever, diarrhea, constipation, other stoma problems
84
Rules that apply to all GI surgery post-op
pain control, nausea, constipation
85
what undergoes pain control
pca or regular analgesia for 72 hrs splint incision with db & c position for comfort/ambulate to relieve gas pains
86
what undergoes nausea
antiemetics ng to low suction assesses bowel sounds/and distention eliminate unpleasant sights smells and stimuli
87
what undergoes constipation
assess for distention and bowel sounds q shift ambulation as tolerated stool softeners or antidiarrheals increase fluid intake
88
true or false dehydration is rlly a risk factor for these ppl so watch out for that when it comes down to gi surgery post op
true
89
recognize cues : assessment : diverticular disease what is diverticulosis
presence of multiple non inflamed diverticula ( outpounchings ). pt is asymptomatic except may have crampy pain, constipation, or diarrhea
90
what is diverticulitis
inflammation of the diverticula due retention of stool in the outpounchings forms a fecalith ( hard mass )
91
true or false. inflammation spreads to surrounding tissues. what can diverticulitis cause?
edema, abscesses, perforations, peritonitis
92
what will we see in diverticulitis ?
abd pain over invovled area
93
where would the tender be in diverticulitis and what are the s and s
tender lower left quadrant mass s and s infection ( fever, chills, nausea, anorexia, elevated wbcs)
94
what are the diagnostics of diverticular disease
ultrasound or ct scan
95
interventions :take action diverticular disease complications
abscess bleeding bowel obstruction perforation with peritonitis fistula formation ureteral obstruction
96
treatment for take action : diverticular disease
monitor for infection rest the bowel - npo with iv fluid low fiber diets for mild flare ups iv fluids and A/B for severe symptoms surgery
97
recognize cues : assessment hernia what is it ?
protusion of viscus ( usually intestines or tissue )
98
what is this describing : Protrusion of a viscus (usually intestines or tissue) through an abdominal opening or weakened area in the wall of the cavity in which it is normally contained
hernia
99
what are the different types of hernia
inguinal, femoral, umbilical, incisional
100
what will you see in hernia
pain to area of hernia if can be placed back into abd cavity, it is reducible
101
what will happen if strangulated can have s and s of bowel obstruction :
hernia, and this is a surgical emergency
102
interventions : take actions hernia what are they ?
watchful waiting herniorrhaphy hernioplasty post op care
103
what is watchful waiting for hernia ?
may wear truss ( live with a hernia, lay down and reduce it back it ) hold everything in place.
104
herniorrphaphy what is it ?
surgical repair of hernia
105
hernioplasty
surgical reinforcement of the weakened area with a fascia or mesh
106
what is the post op care for herniorrphy, hernioplasty observe for bladder distension
* Accurate input and output * Scrotal support may help relieve discomfort. * Coughing is not encouraged, but deep breathing and turning should be done. * Splint incision. * Position appropriately (decrease pressure in suture line).
107
Ano-rectal conditions : Hemorrhoids what is it ?
varicosities in the lower rectum or the anus caused by congestion in the veins
108
what are the cause of ano-rectal conditions : hemorrhoids
pregnancy prolonged constipation portal hypertension prolong standing and sitting heavy lifting straining to defecate
109
prolonger constipation and straining to defecate causes what ?
straining a lot of pressure
110
what are the collaborative care : ano-rectal conditions : hemorrhoids
band ligation ( put a rubber band and lower instrument deploys on the hemorrhoids and falls off ) cryotherapy, laser treatment ( freezing of the hemorrhoids and falls off ) high fibre diet ( to prevent constipation ) increased fluid intake surgical excision hemorrhoidectomy ( surgical incision of the hemorrhoids )
111
Discharge Teaching after Hemorrhoidectomy
* Narcotics for Sphincter Spasm * Sitz Bath 1-2 days post surgery * Dressing change/packing
112
recall that we already know to teach the pt about hemorrhoidectomy : * Narcotics for Sphincter Spasm * Sitz Bath 1-2 days post surgery * Dressing change/packing
* Stool Softeners -docusate sodium (Colace) * Analgesics before bowel movement
113
true or false. they will have dressing with hemorrhoidectomy and keep it clean
true
114
what is sitz bath ?
warm water and swirls ( and cleans the area )

Health and Illness 4 : Part2 (9 decks)

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