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107 Cards in this Set

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what is the most common kind of ulcer, 80% of ulcers
duodenol ulcer
close to pylorus, funnel shaped lesions extends into muscularis layer
what is the most common kind of ulcer, 80% of ulcers
duodenol ulcer
close to pylorus, funnel shaped lesions extends into muscularis layer
What is PUD
break in mucosal wall of the stomach, pylorus or duodenum
gastric ulcer- 15%
duodenal ulcer- 80%
what is the pylorus
opening between the stomach and the duodenum
duodenol ulcers occur here
duodenol ulcer
funnel shaped lesion extending into muscularis layer
-pyloric region
-30 to 45 yrs old
-blood type O
-increased acid secretion
Duodenal Ulcer: Associated Diseases
Alcoholic, cirrhosis, COPD, renal failure, chronic pancreatitis
heliobactor: present in 100%
Gastric Ulcer: Associated Diseases
Increase with stress ulcers, after major trauma or emotional stress
heliobactor: present in 60-80%
Duodenal Ulcer: Family History?
YES, family Hx
30-45 yrs:peak age
Gastric Ulcer:Family History?
NO, no family Hx
50-60yrs:peak age
Duodenal Ulcer:peak age
30-45 yrs:peak age
YES, family Hx
Gastric Ulcer:location, acid
antral region & lesser curvature
acid secretion: normal to less
Duodenal Ulcer:location, acid
pyloric region
acid secretion: increased
Duodenal ulcer: pain occurs when?
pain occurs when? 2-3 hours after meal, ingestion of food relieves pain, Awakens @ night
hemorrhage - / melena
Gastric Ulcer: pain occurs when?
pain occurs when?- 30min-1 hour after meal; no pain @ night; relief by vomiting; hemorrhage +/ hematemisis
PUD tests
s&s, endoscopy, upper gi series, EGD, test for heliobactor pylori
treatment for PUD (nonsurgical)
medical: same as GERD
Pharm: *treat for H. Pylori *PPInhibitor- Prevacid, Prilosec, Aciphex
*Antiobotic 10-14 days- Flagly, Amoxil, Biaxin
Diet for PUD
same as GERD
Duodenal Ulcer Incidence- male to female
2-3:1
Gastric Ulcer Incidence- male to female
1:1
PUD surgical treatment
Vagotomy (w or w/o pyloroplasty)
Antrectomy
Subtotal Gastrectomy
Biliroth removal
Vagotomy
PUD t/x surgery: severing vagus nerve (-) gastric acid/ parietal cells less responsive to gastrin;
problems: fullness, dumping syndrome, diarrhea, gastritis
Antrectomy
removal of part of stomach that contains gastrin secreting cells and small part of duodenum and pylorus; problems: fullness, dumping syn. diarrhea
pyloroplasty
assists with gastric emptying. adjunct to Vagotomy.
Biliroth I
removal of distal half of the stomach w/anastomosis to the duodenum
Biliroth II
removal of distal portion of the stomach w/anastomosis to the proximal jejunum
PUD surgery post op N.I
post-op: observe site- excess drainage, hemorrhage, gastric distension, NV, pulm prob, F/E, monitor bowel sounds
PUD surgery pre op N.I
pre-op teaching ex. reason for NG tube, IV line, DB, splinting, coughing
PUD surgery DIscharge teaching
diet, meds, activity, stress mgmnt, F/U appts
Gastric Cancer Causes
*dietary exposure (nitrate preserved foods (smoked/pickled), salt, fat)
*environmental- metal/ chemical industry
*other exposure- peptic ulcer, polyps, pern anemia, H pylori infection
*genetic- Fam Hx, Type A blood
2 types of Gastric cancer
* Diffuse
*Intestinal
Diffuse Gastric Cancer
more common in women; poorly differentiated tumor cells; "leather bottle" appearance
typical p/t w/ Gastric Cancer
non-white (N.A, HA, AA are twice as likely), male, btwn 40-70 yrs
Gastric Cancer Assessment
-Loss of weight
-Dyspepsia (indigestion)
-Can't eat full meal
-Change in Eating habits
-decrease app/ nausea
-chronic bleeding-->guiac stool
-Hx of H. pylori
-Hx of smoking/ ETOH abuse
Labs for Gastric Cancer
-presence of lactic acid
-increased LDH in Gastric juice
Dx for Gastric Cancer
-biopsy: esophagogastroduodenoscopy
-CT exam for staging
-Uper GI Series and endoscopy
Dumping Syndrome: what is it?
rapid emptying of the stomach contents into the small intestines causing sweating, weakness, diarrhea
Describe how Osmolality >300 can cause Dumping Syndrome
large amounts of fluid/water-->to stomach & sm. Intestines from organs & vasc. compartmnts: fullness, nausea, diarrhea/ dehydration, Hypotension, tachycardia
deficiency in Vitamin B12, caused by DUmping Syndrome or dietary presents with these symptoms
numbness, tingling in hands or feet
Gastric Cancer: Medical Intervention
-TPN->> Central line
-small frequent meals
-pain control
Gastric Cancer: Surgical Intervention
-Gastric resection
-Partial Gastrectomy Billroth I
-Billroth II (gastrojejunostomy)
-Total gastrectomy
Total Gastrectomy causes what?
removal of the stomach = pernicious anema
Gastric Cancer: Complications of surgery
*Iron loss, increase/decrease vit B12
*Vita, Mineral deficiencies
*s&s
*postop hemmorrhage (monitor S&s for blood loss)
*dumping S (after eating foods high in CHO/electrolyes
S&S of Gastric Surgery (dumping syndrome)
dizziness, weakness, diaphoresis, cramps, vasomotor symptoms (pallor, palpitations, HA, feeling warm, nauseated
Gastric Cancer P/O complications:
hemorrhage, intestinal obstruction, anastomatic leaks, infection, peritonitis
Benign tumors of mouth
Lipomas, Neurofibromas
premalignant tumors of mouth
leukoplakia, erythroplakia
leukoplakia
precancerous, yellow-white or grey lesion <25 malignant
erythroplakia
red velvety appearing patch; indicates early squamous cell carcinoma; 50-60 yrs of age
Malignant tumors:Medical management
*Radiation T/x
*Interstitial Radiation T/x
*Chemotherapy (if advanced)
Radiation T/x
external beam therapy or interstitial thereapy passes through the skin or mucous membrane to tumor
Interstitial radiation T/x
involves implanting radioactive seeds used for small lesions that haven't infiltrated surrounding tissue
chemotherapy
if cancer is advanced
Cancer of Esophagus: S&S
-Dysphagia
-Odynophagia
-increases salivation
-mucous in throat
-regurgitation
-can't swallow liquids/food
Odynophagia
pain on swallowing
Cancer of Esophagus:Test Ordered
Upper Gi endoscopy, Barium Swallow, CT scans, cytology exams & biopsy
Cancer of Esophagus:T/x
*Radiation T/x
*Chemotherapy
*Total Resection of esophagus
*esophagectomy
Malignant Tumor in Mouth: Nursing Intervention
*meticulous oral care with 1/2 h202 ( hydrogen peroxide)
*semifowlers- lymph drainage
*patent airway- pulse ox/suction
*monitor beeding- 1<jp
Cancer of Esophagus: Diet
no caffeine, no carbonation, avoid eating 2-3 hours before bedtime
electrolytes depleted r/t Dumping Syndrome
K+ (potassium) Na (sodium)
what IV is given for dumping syndrome ( k + or Na depletion)
3% NS
electrolytes depleted r/t Dumping Syndrome
K+ (potassium) Na (sodium)
what IV is given for dumping syndrome ( k + or Na depletion)
3% NS hypertonic
What labs findings show Gastric Cancer
LACTIC ACID & increased LDH in gastric juice
What is Pernicious Anemia
Decrease in red blood cells because body can't absorb B12 (absorbed in Ileum), or lack of B12.
Why is Pernicious Anemia a complication of a partial or total Gastrectomy?
Pernicious Anemia is caused by lack of Vitamin B12. Intrinsic factor, produced by parietal cells of gastric mucosa, is necessary for B12 absorption.
What is hemopoietic factor?
combination of b12 and intrinsic factor
Medical Interventions for Gastric Cancer
small freq meals w/supplements
TPN- CENTRAL LINE
pain control; Surgery; radiation or chemo
Empyema
gall bladder with pus
acute cholecystitis
90% associated with gall stones
cholelithiasis
presence of gallstones
pain in what quadrant is commonly r/t cholecystitis
RUQ
what factors are associated with cholecystitis and cholelithiasis?
5 F's Fat, Fertile, Female, Forty, Fair
Diabetes, Obesity, Chrohn's, cirrhosis
Pima women- 75% over 25
whites 2x than blacks (U.S)
Alkaline phosphate (ALP)
42-136 u/L
enzyme produced in liver and bone
-if elevated: OBD; or other bone/liver disease
Cholesterol (lipoprotein)
normal level: below 200 mg/dl
synthesized in liver to form bile salts
if greater: artherosclerosis; DM; biliary cirrhosis
Ammonia
15-45 mcg/dl
-byproduct of protein (by liver)->> urea excreted by kidneys
-if high, hepatic failure, coma
Treatment for high Ammonia (NH4)
low protein diet, neomycin, Lactulose, Magnesium Sulphate
ALT Alanine Aminotransferase
10-35 u/L
if high: acute viral hep, hepatocellular destruction, ETOH
AST Apartate Aminotransferase
8-38 u/L
-exercise
-liver damage
common complications of partial or total gastric resection
1. dumping syndrome
2.hemorrhage
3. pneumonia
4. pernicious anemia
gastric bypass nursing plan
foods rich in calcium
high protein diet (exits stomach slowly)
vitamin B12 shots
increase fluids (bc of DS)
High Protein Diets are prescribed with these diseases/procedures
Pancreatitis
Gastrectomies
Chron's
Low Protein Diet prescribed if:
Liver Failure
Contraindicated in Cholecystitis but prescribed for Pancreatitis
Morphine
+HIDA
screening for Cholelithiasis (along with Ultrasound)
5f's
Cholecystitis
Cholelithiasis
Pima N.A women 75% over age 25
Cholelithiasis
cardinal symptom-pain after eating fat
cholecystitis
+ Murphy's sign
Cholecystitis
Labs to check Cholecystitis
Alkaline Phosphate; Serum direct bilirubin
where does pain begin in pancreatitis
mid-epigastrium, radiates to back
Labs for Pancreatitis
Serum Lipase (15-280 iu/L)
mild azotemia (BUN)
diseases of spleen
mono, malraia, ITP idiopathis thrombocytopenia purpura, splenomegaly
Hemolytic Uremic Syndrome
10% of e. coli infected develop it
TPN glucose and Amino Acid percentage
glucose-50 % in 500ccs
amino acids - 8.5 % in 500 ccs
Each liter of TPN provides how many calories?
1000 cal= 6 g of nitrogen
Intralipids
white solution and fat emulsion, isotonic
how often do you accucheck if TPN
AT LEAST Every 12 hours, every 6 hours more common
How often do you change tubing for TPN
every 24 hours
How often do you change dressing site for TPN
every 3 to 5 days
Labs for Gastric Cancer
high lactic acid and LDH in gastric juice
what med for Cancer of Esophagus
Calcium Channel Blockers- reduce spasms
symptoms of hiatal hernia
heartburn 30-60 min after meals
gerd
acid regurg(water brash)
salty spit,
eructation (belching)
Pain in Left Lower Quadrant
Ulcerative Colitis
Diverticulitis
Toxic Megacolon
Ulcerative colitis- extreme dilation of colon
spans entire length of colon
involves only mucosa and sub mucosa
sigmoid and descending colon
Ulcerative colitis areas
may skip segments of alimentary tract, common location:terminal ileum. involves entire thickness
Chron's disease
liver labs
1. ALT > 10-35 u/L
2. AST > 8-38 u/L (exercise increases levels)
3. Ammonia > 15-45 mcg/dL