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32 Cards in this Set
- Front
- Back
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What is obesity?
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BMI 25+ is considered overweight
BMI 30+ is considered obese BMI 40+ is considered morbid obesity |
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Complications of obesity
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Atherosclerosis
Heart disease Diabetes Mellitus (DM2 or NIDDM) HTN Sleep apnea Osteoarthritis (OA) Decreased mobility Low self esteem Depression |
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Treatment of obesity
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Exercise and calorie restriction
Surgery, to decrease stomach volume or decrease calorie/nutrient absorption |
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Gastric Bypass
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A small stomach pouch is made, which causes a quick feeling of fullness after eating
Digestive enzymes from the larger part of the stomach continue to be produced, and flow into the jejunum. Post-op care: clear liquid diet. Advance to full liquids, pureed diet, and regular diet (about 6 weeks after surgery) |
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Complications of (any kind of) Gastric surgery
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Hemorrhage
Abd distension Pernicious anemia Steatorrhea Pyloric obstruction Dumping syndrome |
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What is GERD?
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Gastric secretions reflux (flow back) into the esophagus.
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What causes GERD?
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Lower esophageal sphincter does not close completely.
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S/sx of GERD:
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Heartburn
Regurgitation Dysphagia Bleeding Risk for aspiration |
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Patient teaching: GERD
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Eat small, frequent meals
Avoid lying down for 2 hours after eating Avoid smoking and drinking alcohol Identify and avoid foods that cause discomfort (acidic or spicy foods, carbonated beverages, caffeine, etc) Take medications as ordered by the MD. |
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Complications: GERD
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Barrett’s esophagus: a precancerous condition.
If left untreated, can develop into adenocarcinoma of the esophagus (cancer), which has a poor prognosis. |
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What is PUD:
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Peptic Ulcer Disease
Gastric ulcers caused by infection with H. pylori S/sx: epigastric pain (burning), anorexia, cramping abd pain, N/V, bleeding, occult blood in the stool Tx: antibiotics, PPI, H2 blockers. Modify diet (see GERD diet). |
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Antiulcer agents
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Antacids
Tums (Ca CO3) Milk of Magnesia (MOM) H2 receptor blockers (H2 antagonists) Ranitidine (Zantac) Proton Pump Inhibitors (PPI) Lansoprazole (Prevacid) Omeprazole (Prilosec) |
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Upper GI Bleed Causes:
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Ulcer perforation
Tumors Gastric surgery Other S/sx: Melena, occult blood in stool, or hematemesis (coffee ground emesis) If mild: weakness, diaphoresis If severe, may result in hypovolemic shock |
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Hypovolemic shock
S/sx: |
Hypotension
Tachycardia Weak, thready pulse Palpitations Chills Diaphoresis Low RBC, Hb, HCT |
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Tx of GIB
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Prevent or treat hypovolemic shock
IVF Blood transfusion O2 Prevent further bleeding Insert NGT to assess rate of bleeding, decompress stomach, lavage prn NPO EGD to remove, cauterize, or ligate bleeding areas Start on iv proton pump inhibitors |
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What is nausea?
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A stomach distress with distaste for food and an urge to vomit.”
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Pathophysiology of nausea:
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Stimulation of the vomiting center by
Visceral stimuli (gut) Chemoreceptor stimuli (brain) Vestibular stimuli (ear) |
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Causes of N/V
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First trimester of pregnancy
Medication (side effects of) Migraine HA Motion sickness Food poisoning Gastroenteritis CA treatments Other |
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Treating N/V
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Treat the cause! I.e. if a medication blocks histamine, use it to treat nausea caused by histamine release.
If a patient is vomiting, should you give them po nausea meds? Side effects include CNS depression. Use cautiously in combination with other CNS depressants. |
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Ondansetron (Zofran)
What kind of nausea does this treat: Visceral,Chemical, Vestibular? |
Serotonin (5HT3) Antagonist
Side effects HA Constipation/diarrhea |
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Promethazine (Phenergan)
Dopamine antagonist, antihistamine What kind of nausea does this treat? |
Side effects:
CNS depression, AEB confusion, disorientation, and sedation. Can cause severe hypotension, when used with other meds that lower BP Neuroleptic malignant syndrome |
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Metoclopramide (Reglan)
Dopamine antagonist |
Side effects:
Drowsiness Restlessness Extrapyramidal symptoms (EPS) caused by an imbalance between dopamine and acetylcholine Examples: inability to sit still, absence of physical and mental movements (akinesia), inability to execute voluntary movements (dyskinesia), impaired muscle tone (dystonia) |
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Scopalamine
Muscarinic inhibitor, anticholinergic What kind of nausea does this treat? |
Comes in a transdermal form, as well as IV and IM.
Side effects: drowsiness Anticholinergic Side effects include: Tachycardia Urinary hesitancy Dry mouth Blurred vision |
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What is obesity?
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BMI 25+ = overweight
BMI 30+ = obese BMI 40+ = morbid obesity |
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Discuss obesity prevalence
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Prevalence of obesity in adults in America (2002):
Overweight or obese: 65% Obese: 30% Extremely obese: 5% |
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Discuss obesity complications
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Atherosclerosis
Heart disease Diabetes Mellitus (DM2 or NIDDM) HTN Sleep apnea Osteoarthritis (OA) Decreased mobility Low self esteem Depression |
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Discuss obesity treatment
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Exercise and calorie restriction
Surgery, to decrease stomach volume or decrease calorie/nutrient absorption |
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List complications of gastric surgery
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Hemorrhage
Abd distension Pernicious anemia Steatorrhea Pyloric obstruction Dumping syndrome |
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Differentiate between GERD and PUD
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GERD: Gastric secretions reflux (flow back) into the esophagus. Lower esophageal sphincter does not close completely
PUD: Peptic Ulcer Disease Gastric ulcers caused by infection with H. pylori |
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Antiulcer agents
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Antacids
Tums (Ca CO3) Milk of Magnesia (MOM) H2 receptor blockers (H2 antagonists) Ranitidine (Zantac) Proton Pump Inhibitors (PPI) Lansoprazole (Prevacid) Omeprazole (Prilosec) |
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Upper GI Bleed (GIB)
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Causes:
Ulcer perforation Tumors Gastric surgery Other S/sx: Melena, occult blood in stool, or hematemesis (coffee ground emesis) If mild: weakness, diaphoresis If severe, may result in hypovolemic shock |
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Medications used to treat N/V:
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Ondansetron (Zofran)
Serotonin (5HT3) Antagonist Side effects: HA, Constipation/diarrhea Promethazine (Phenergan) Dopamine antagonist, antihistamine Side effects: CNS depression, AEB confusion, disorientation, and sedation. Can cause severe hypotension, when used with other meds that lower BP Neuroleptic malignant syndrome |
