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139 Cards in this Set
- Front
- Back
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The ____ is a mucous lined, muscular tube that carries food from mouth to stomach.
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esophagus
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Disorders that are Upper GI related include:
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Gastroesophageal reflux
hiatal hernia cancer |
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____ is the backward flow of gastric contents into the esophagus due to an incompetent lower esophageal sphincter.
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GERD
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GERD can cause inflammatory or mechanical problems called ____.
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strictures
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Gastroesophageal reflux becomes GERD when there is ______.
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tissue damage
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3 causes of GERD include:
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-transient lower esophageal sphincter relaxation
-Incompetent lower esophageal sphincter -Increased intragastric pressure |
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Manifestations of GERD are
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-heartburn
-regurgitation -dysphagia -chest pain -belching -pain after eating -hoarseness and sore throat -loss of tooth enamel |
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Diagnostic tests for GERD include:
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Barium (Ba) swallow
EGD pH monitoring |
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A _____ outlines structure and function of the upper GI.
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Barium swallow
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Nursing care for a pt having an EGD includes:
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-getting informed consent
-NPO 8-10 hours prior and until gag reflex returns -20-30 minutes to perform |
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____ determines the degree of acid reflux for a patient with GERD.
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pH monitoring
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Complications related to GERD include permanent tissue damage leading to:
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-strictures
-ulcers -erosions -also respiratory and laryngeal symptoms |
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Tx for GERD includes
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-lose weight; avoid tight clothing
-decrease or stop smoking -increase HOB and/or sit up after meals for at least 2 hours -modify diet- spicy, acidic, fatty, caffeine, and alcohol |
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Surgical Tx for GERD is
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Nissen Fundiplication
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A Nissen fundiplication is the
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tightening of the esophageal opening.
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Medications used to treat GERD include:
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antacids (Maalox, Mylanta, Ca Carbonate)
H2 antagonists (Tagamet, Pepsid, Zantac) PPIs (Prilosec, Prevacid, Protonix) stimulants (Reglan) |
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____ should be taken 30 minutes prior to a meal and should not be taken with coumadin.
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Antacids
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If taking antacids and coumadin, the antacid comes ___ hours before the coumadin or ___ hours after.
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2 hours
1 hour |
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______ treat GERD by decreasing the amount of gastric acid. They actually heal the ulcer but decrease the amount of Ca absorbed and therefore are not a long term treatment.
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PPIs
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____ block histamine 2 receptor sites in the gut.
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H2 antagonists
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_____ is an antacid that can cause diarrhea.
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Milk of Magnesia
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____ is an antacid that can cause constipation.
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Amphojel
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____ is used for nighttime GERD.
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Reglan
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____ help reduce the amount of HCl being released.
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H2 antagonists
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Smoking contributes to GERD because it decreases the amount of ____ produced in the stomach.
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bicarbonate
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Nursing diagnoses for GERD are
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-Pain (Acute or Chronic)
-Lifestyle changes -Imbalanced nutrition: Less then body requirements -Knowledge deficit -Medication Management |
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A ____ occurs when the stomach protrudes through a weakened and/or enlarged opening in the diaphragm.
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hiatal hernia
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2 types of hiatal hernia are
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sliding and paraesophageal
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Manifestations of a hiatal hernia include:
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reflux
chest pain belching regurgitation dysphagia feeling of fullness |
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A ____ distinguishes between GERD and a hiatal hernia.
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chest x-ray
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The tests for diagnosing a hiatal hernia are
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Ba swallow and EGD
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Medications for treating a hiatal hernia include:
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PPIs, antacids, H2 antagonists
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____ is the surgical procedure for a hiatal hernia.
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Nissen fundiplication
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If a hiatal hernia is paraesophageal ____ can be used in the surgery.
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mesh
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Tagamet, Pepsid, and Zantac are types of _____.
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H2 antagonists
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Cytotec is a type of _____.
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prostaglandin agent
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Prilosec, Prevacid, and Protonix are types of ______.
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PPIs
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Aluminum Hydroxide, Milk of Magnesia, and Calcium Carbonate are types of _____.
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antacids
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Antibiotics for H. pylori infection are:
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flagyl, biaxin, and amoxil.
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Carafate is a type of ______.
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mucosal protectant
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Tx for hiatal hernia include:
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-lifestyle changes
-medications -surgery |
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The biggest risk factor for esophageal cancer is ____.
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smoking
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In addition to smoking, other risk factors for esophageal cancer are:
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alcohol, Barrett's esophagus, radiation therapy damage, chronic reflux, achalasia, and ingested carcinogens
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_____ is a precancerous condition that can develop in people with chronic GERD or esophagitis.
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Barrett's esophagus
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____ is a condition when the lower muscular ring of the esophagus fails to relax during swallowing of food. The pt experiences gradually increasing dysphagia with swallowing solids and liquids.
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Achalasia
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Symptoms of esophageal cancer are
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-diff. and pain with swallowing
-pressure or burning in chest -indigestion or heartburn -vomiting -frequent choking on food -unexplained wt loss -coughing or hoarseness -pain behind breastbone or in throat |
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Diagnosis of esophageal cancer is done with the following
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-biopsy during EGD
-barium swallow -upper endoscopy |
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Diagnosis of an esophageal metastasis includes:
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-bronchoscopy
-CT/CAT scan -MRI -PET scan -CBC and LFTs |
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A ____ is using a light in the lungs to look for cancer.
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bronchoscopy
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A ____ checks for cancer in other organs.
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CT scan
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Tx for esophageal cancer includes
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surgery
chemotherapy radiation |
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Esophageal resection can lead to
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dumping syndrome
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Chemotherapy is done for ____.
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metastasis
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Radiation is used to...
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shrink tumor size therefore limiting invasiveness of surgery.
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After an esophageal resection the patient will have a ____ for 6-8 weeks.
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jejunostomy tube
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The most common problem from gastrectomy procedures is ______.
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dumping syndrome
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Manifestations of dumping syndrome occur within 5-30 minutes of eating. They include:
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NVD
epigastric pain with cramping borborygmi tachycardia orthostatic hypotension dizziness flushing diaphoresis |
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2-3 hours after eating dumping syndrome causes _____.
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hypoglycemia
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_____ is inflammation of the stomach.
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Gastritis
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Acute gastritis is caused by a local irritant such as
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smoking, alcohol, caffeine, ASA, and bacteria
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Chronic gastritis is progressive and irreversible atrophy of the _____.
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mucosa
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____ are a major factor with gastritis.
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NSAIDS
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NSAIDS cause problems with the mucosal lining of the stomach because they inhibit _____.
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prostaglandins
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Type A Chronic gastritis is ____.
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autoimmune
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Type B chronic gastritis is seen with
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chronic smoking, alcohol and NSAID use.
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The major cause of gastritis, chronic gastritis and PUD is ______.
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Helicobacter Pylori
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In addition to H. pylori, other causes of chronic Type B gastritis include:
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-vague gastric distress
-heaviness after meals -ulcer-like symptoms unrelieved by antacids -fatigue -B-12 anemia |
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Chronic Type B gastritis causes B12 anemia because there is ____ and therefore there isn't enough intrinsic factor.
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atrophy of stomach lining
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Nursing care for Acute gastritis includes:
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assess oral intake, monitor electrolytes, add fluid and foods back slowly, and administer antiemetics
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Nursing care for Chronic gastritis includes:
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administer PPIs, dietary consult, 6-8 small high protein meals, treat with antibiotics
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____ is a break in the mucous lining of the GI tract whereby gastric juices come in contact with it.
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Peptic Ulcer disease
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____ ulcers are often seen in people ages 20-55.
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Duodenal
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____ ulcers are seen in ages 50-70.
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Gastric
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Peptic Ulcer disease is common in
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smokers, ASA/NSAID users, H. pylori
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NSAIDS cause PUD because they
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cause decreased mucous and inhibit prostaglandins.
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Smoking causes PUD because they decrease _____.
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bicarbonate
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____ is the causative factor for most ulcers.
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H. pylori
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Overproducing the amount of gastric acid could cause PUD. This is known as
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hypersecretory state or Zollinger- Ellison
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People with ___ ulcers feel better when they eat.
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duodenal
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People with ___ ulcers often have more pain when eating because gastric acid is being secreted.
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gastric
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Manifestations of PUD include:
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-PAIN (gnawing, burning, aching, or hungerlike)
-heartburn or vomiting (coffee ground emesis) |
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Additional Manifestations of PUD in the older adult are
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vague discomfort, chest pain, dysphagia, nausea, wt. loss
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3 of the main complications with PUD are
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-hemorrhage (melenal stools)
-obstruction (vomiting) -perforation |
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The most lethal complication of PUD is
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perforation because it causes peritonitis.
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____ is inflammation or infection of peritoneal lining.
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Peritonitis
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Manifestations of Peritonitis include:
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-severe, upper abdominal pain radiating through abdomen
-rigid, board-like abdomen with absent bowel sounds |
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Peritonitis may cause shock. Signs of shock include:
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diaphoresis
tachycardia increased respiration decreased BP |
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Management of PUD includes:
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-relief of symptoms
-healing of existing ulcers with PPIs -preventing or reducing recurrence of ulcers |
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Strategies for PUD management include:
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behavior modification
medication therapy surgical interventions |
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Lab/diagnostic tests for PUD include:
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CBC- assess for anemia
Stool- for occult blood serologic test for H. pylori upper GI EGD |
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The diagnostic test of choice when looking for PUD is
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EGD
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If a hemocult blood test turns ____ it is positive.
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blue
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PUD pharmacology includes:
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antacids
H-2 antagonists Proton Pump Inhibitors Antibiotics for H. pylori Cytotec |
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Antacids that are used for PUD Tx are
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Maalox, Aluminum hydroxide, MOM, Calcium Carbonate
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H-2 antagonists that are used for PUD Tx are
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Tagamet, Pepsid, Zantac
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PPIs that are used for PUD Tx are
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Prevacid, Protonix, Nexium, Zegrid
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Antibiotics that are used to treat H. pylori are
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Flagyl, biaxin, amoxicillin, and tetracycline with a PPI
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Nsg consideration for Flagyl is tell the patient not to
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drink.
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____ is a synthetic prostaglandin that is for people who may abuse NSAIDS. It helps rebuild mucosal lining.
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Cytotec
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The #1 cause for PUD is
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H. pylori
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Nursing care for patients with PUD includes:
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Pain
Imbalanced Nutrition Knowlegde deficit Deficient Fld Volume r/t hemorrhage Medication management |
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The most common type of stomach cancer is ____ which forms in the cells that line the stomach.
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adenocarcinoma
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Risk factors for stomach cancer include:
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-age
-gender (men more) -family history -race (AA, hispanic, asian and japanese) -diet (smoked foods) -H. pylori -previous gastric resection -occupational exposure to dust or fumes -tobacco and alcohol -gastric polyps -chronic gastritis -hobbies |
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Symptoms of stomach cancer include
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-indigestion and heartburn
-pain or discomfort in ABD -NV -diarrhea or constipation -bloating after meals -loss of appetite -weakness and fatigue -vomiting blood or blood in stool -unexplained weight loss |
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Diagnostic tests for stomach cancer are
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-EGD (go down and look around)
-CBC (look for bleeding) -CT/MRI (look for spread) -LFT (look for spread to liver) |
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Treatments for stomach cancer include:
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-surgery (partial or total gastrectomy)
-jejunostomy tube feedings or TPN for nutrition -pain management |
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All gstric cancer surgeries result in
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-dumping syndrome
-lifestyle changes -diet changes -hypoglycemia |
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A ____ is when the total stomach is removed.
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total gastrectomy
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A ____ removes the distal 2/3s of the stomach.
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partial gastrectomy
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A ____ is also called a ____ and it removes the lower 1/3 of the stomach but still attaches to the duodenum.
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Billroth I
gastrodudenostomy |
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A ____ is also called a ____. It is the removal of about 2/3 of the stomach and therefore the stomach must now attach to the jejunum.
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Billroth II
gastrojejunostomy |
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A total gastrectomy is also called a _____.
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Roux-en-Y
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When a person has gastric resection or bypass of the pylorus, there will be rapid movement of ___ chyme into the SI causing fluid to be drawn into the bowel by osmosis. This is called ____.
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hypertonic
Dumping syndrome |
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When dumping syndrome occurs the person will have ____ blood volume and intestinal _____ and increased _____.
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decreased
dilation peristalsis |
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Manifestations of dumping syndrome include:
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tachycardia
orthostatic hypotension dizziness flushing diaphoresis NVD epigastric pain abdominal pain borborygmus |
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Nursing care for a person with dumpring syndrome includes
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-Imbalanced nutrition: Less than body requirements
-Anemia (iron and B-12) -Pain -End of life care and issues -Body image disturbance |
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Manifestations of gastric ulcers are
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-weight loss
-burning in left epigastric area -food frequently aggravates pain -no pain at HS |
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____ ulcers are asymptomatic.
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Stress or drug induced
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Manifestations of Duodenal ulcers are
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-epigastric pain at HS
-burning, cramping, mid epigastric pain -pain 2-4 hours after meal -eating decreases pain -weight GAIN -Nausea and vomiting |
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History of ulcers, use of antacids, and sudden onset of ABD pain suggests ____.
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perforated peptic ulcer
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Peptic ulcers can occur
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anywhere in the digestive tract
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Manifestations of a perforated peptic ulcer are:
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-rigid ABD w/ rebound tenderness
-absent bowel sounds -pallor, diaphoresis -referred pain to right shoulder -tachycardia, hypotension, widening pulse pressure -air under diaphragm -vomiting -low urine output -acute pain of peritonitis |
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If there are signs of hemorrhagic shock, infuse ____ until blood is available and administer oxygen via nasal cannula to keep PaO2 between _____.
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Ringer's lactate
80-100 |
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S/Sx of peritonitis are:
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-fever
-NV, anorexia -ABD rigidity and distention -rebound tenderness -increased WBC -increased P and BP -dehydration -decreased bowel sounds -presence of a cause |
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Tx for peritonitis includes:
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1st- ID the cause,
Then... antibiotics, IV fluids, decrease ABD distention |
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The IV solution used to treat peritonitis is
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NS with K
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Normal WBC counts are
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4-10,000
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For clients with peritonitis, a ____ is used to decrease abdominal distention.
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NGT (salem/sump/levine)
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After placement of a salem/sump tube, the nurse should ____ to confirm placement.
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aspirate for contents
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Diagnosis of peritonitis is done with
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CBC and ABD x-ray
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Capillaries burst if an NGT is set at ____mmHg.
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35
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Low constant suction for a NGT is ____.
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40-60mmHg
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Intermittent suction for a NGT is _____.
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80-100mmHg
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Nursing care for a patient with peritonitis is
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-restore fluid and electrolyte balance and GI distention
-decrease infection process -prevent complications (immobility, pulmonary, infection) |
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A person with peritonitis often can't breathe well d/t ABD distention and this causes ____ and ____.
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atelectasis and pneumonia
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Risk factors for developing peritonitis are
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-ABD surgery
-Ectopic pregnancy -Perforation d/t (trauma, ulcer, appendix rupture, diverticulum) -jejunostomy and PEG tubes leaking |
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Dumping syndrome occurs ____ after eating.
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15 minutes
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Manifestations of dumping syndrome include:
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-weakness
-dizziness -diaphoresis -epigastric fullness -tachycardia -ABD cramping -self-limiting |
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If a person has dumping syndrome they should avoid
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High CARBS (bread, potatoes)
FLUIDS with meals SALT |
