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152 Cards in this Set
- Front
- Back
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Carcinoembryonic Antigen (CEA)
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peripheral blood study for GI and breast CA tumor markers, determines tumore burden, monitors progress and treatment , chronic smokers also have
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CA-19
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follows course of cancer
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Antacid def. and uses
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neutralizes gastric acidity and decreases rate of emptying, heartburn, PUD, gerd, gastritis
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Antacid nursing
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multiple DI's, no meds within 1 hr. of drug
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Antacid ex:
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calcium carbonate (Tums), aluminum hydroxide (maalox)
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H2 Antagonists
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inhibits H2 receptor sites in parietal cells in stomach to decrease gastric acid secretion to allow healing
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H2 Uses and S/E
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Ulcers, GERD, heartburn SE headache, naseau, rash, diarrhea
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H2 nursing
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many drug interactions, give 1/2 hr. before meals
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H2 ex:
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"tidine" cimetidine, ranitidine
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Proton Pump Inhibitors def.
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block ATPase enzyme (final step in acid production)
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Proton Pump Inhibitors use
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GERD, Ulcers
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Proton Pump Inhibitors S/E
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headache, nauseau, abd. pain, blood, dizziness
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Proton Pump Inhibitors nursing and ex:
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many drug interactions, "prazole" pantoprazole, omeprazole
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Mucosal Barrier Fortifier def. and uses
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coats duodenal ulcer site, ulcers, mucositis
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Mucosal Barrier Fortifier S/E and ex:
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nauseau, GI disturbances sucralfate
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Mucosal Barrier nursing
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multiple drug interactions, give on empty stomach, binds with some drugs
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Prokinetics/Gi stimulants def.
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stimulates motility of upper Gi increase gastric emptying
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prokintics uses
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GERD, N, V, delayed gastric emptying
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prokinetics S/E amd ex:
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anxiety, fatigue, extrapyramidal reactions, metoclopramide
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prokinetics nursing
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do not give if obstructed, perforated or GI bleeding, have IM benadryl available for extrapyramidal reaction
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Prostaglandin analogs def.
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protective by increasing mucus production and bicarbonate and decrease gastric acid secretions
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Prostaglandin use and S/E
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ulcers, prevention of NSAID ulcers, S/E abdominal cramping, miscarriage
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Prostaglandin Nursing and ex:
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DO NOT GIVE IF PREGNANT, misoprostol
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Anti-diarrheal/Bismuth Salts
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coats mucosa and soothes bowel lining, removes irritant by absorbing from intestine
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Anti-diarrheal/Bismuth Salts use and S/E
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indigestion, gas pain, cramps S/E black stool and tongue
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Anti-diarrheal/Bismuth Salts nursing
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allergy to aspirin, DI's w/ warfin and oral antibiotic meds, radioopaque affects GI tests
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Hiatal Hernia
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protrusion of stomach through esophagael hiatus of diaphram
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Hiatal Hernia S/S
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heartburn, regurgitation, dysphagia, pain, belching
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Hiatal hernia meds
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antacids, ant-secretory agents, H2 blockers
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Hiatal hernia nursing
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HOB 4-8 in elevated, no reclining after eating, GERD diet
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Hiatal hernia post-op complication
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difficulty belching/vomiing, dysphagia, recurrence, bleeding and infection
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GERD def. and S/S
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backflow of gastric contents in esophogus S/S dyspepsia, reguritation, dysphagia, hypersalivation,
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GERD tests
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endoscopy w/ biopsy, barium, reflux scan, motility study
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GERD surgeries
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laparoscopic Nissen fundoplication,endoscopy w/ Stretta device, endoscopy w/ Enteryx, Bard EndoCinch Suturing system
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GERD nursing
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NPO 2-3 hrs before bed, HOB elevated 6-8 in., avoid large meals
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GERD diet
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low fat, smaller, more frequent meals, no spicy, no carbonation
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Barrett's Esophagus
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cell changes in esophagus, pre-cancer, risk factor- long standing GERD
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Esophageal Cancer
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squamous cell CA, Adenocarcinoma-Barrett's esophagus, poor prognosis
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Esophageal Ca Meds
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chemotherapy, radiation, photodynamic therapy, surgery-esohageal dilation or esophagectomy
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Esophagectomy
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total resection of esophagus
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esophagogastrostomy
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removal of lower esophagus
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esophagoenterostomy
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part of jejunum replaces part of esophagus
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Staphylococcal
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meat, milk, and milk prod. within 30 min-7 hr
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Clostridial perfinens
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improperly cooked meat or poultry, caned veg 8-24hr.
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Salmonella
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improperly cooked poultry, eggs, within 8hr-7 days
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Botulism
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improperly canned or preserved veg 12-36 hr.
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Escherichia coli
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contaminated meat, milk prod 8 hr- 1wk
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gastritis complications
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dehydration, f&E imbalance, bleeding, anemia
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Peptic Ulcer Disease PUD
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erosion of gastric mucosa membrane with various depths resulting from the digestive action of HCI acid and pepsin
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PUD casue
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most by H. Pylori
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PUD Esophageal cause
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GERD
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PUD Gastric
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mucus production decreased and normal or low level acid secretion
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PUD Duodenal
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stomach secretes too much acid
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Zollinger-Ellison syndrome
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gastrin secreting pancreatic tumor and lots o duodenal ulcers
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Helicobacter pylori
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bacterium burrows into mucosal lining,
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H. Pylori med. mgmt.
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antibiotics, proton pump inhibitors/H2 blockers, mucosal barrier fortifier, 2wk triple therapy ideal to eradicate
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PUD Complications-Hemorrage
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minimal to massive- coddee ground emesis, black tarry stool
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PUD complication Perforation
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severe sharp pain, rigid abd., tachycardia, dec. bowel sounds
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PUD complication Obstruction
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bloating, nauseau, prjectile vomiting containing old food particles
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Gastric Vagotomy
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resection of vagus nerve to decrease acidic secretions
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Gastric pyloroplasty
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enlargement of pylorus used with pyloric stenosis(narrowing of pyloric sprhincter which prevents food from entering small intestine)
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Gastric antrectomy
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removal of antrum
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Gastric Billroth 1
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gastroduodenostomy, removal of antrum and connect to duodenum
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Gastric Billroth 2
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removal of antrum and duodenum and connect to jejunum, astrojenostomy
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Total Gastrectomy
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connect esophagus to jejunum
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Dumping Syndrome
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food enters jejunum to rapidly, after meal problems
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Gastric Surgeries-Nurse Mngt
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assess vomit, NGT drainage-type and amt., check abd. Dsg., emergency measures for severe GI bleed
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Gastric cancer type
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most adenocarcinomas
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Castric Ca cause
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H. pylori, crappy diet, previous subtotal gastrectomy,
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Gastric Ca tests
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upper GI series with double contrast or barium, EGD, ultrasound, CEA, CA 19-9, CA 50
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calculate BMI
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(weight lbs/height in in. squared)*703
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Morbid Obesity
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2x ideal, BMI >40 or >100 over ideal
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cholelithiasis
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gallstones
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Gallstone causes:
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decrease in bile acid synthesis and increase cholesterol synthesis in liver extra chol forms stones
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cholecystitis
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inflammation of gallbladder
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cholecystitis cause
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calculous (stones obstruct bile outflow while it remains in GB), acalculous ( alteration in f&E in GB after surgery or trauma)
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GB prob S/S
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epigastric distress, midsternal pain in RUQ which radiates to back or R shoulder, N, V, jaundice, fever
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Cystitis
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infection of bladder
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Pylonephritis
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infection of renal pelvis,
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Most comon UTI pathogen
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E. Coli
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Acute Pylonephritis
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infection of functional tissue of kidney
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BUN and Creatinine
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shows glomular filtration rate increase can indicate decrease kidney function (upper uti)
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Unrinalysis W/ UTI
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presence of nitrates, WBC's, and leukocyte esterase
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Posiive bacteria culture
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greater than 100,000
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IVP
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intravaneous pyloregram, series of xrays taken after dye injected
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Cystoscopy
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for recurrent UTI, id's abnormalities that cause UTI
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How often should bladder be emptied?
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2-3 hrs.
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Adequate fluid intake?
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2-3L/day (15 ml/lb/day)
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Lithiasis
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stone formation
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urolithiasis
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stone in urinary tract
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neprolithiasis
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stone in kidney
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why get stones
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chemicals and other elements of urine become concentrated and form crystals
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normal urine pH?
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4.6-8.0 avg. 6-7
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Calcium Oxalate
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ph>6, most common, decrease dietary oxelates and increase acidic foods, smal get trapped in ureters
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Calcium Phosphate
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cause mixed stones, alkaline urine, hyperparathyroidism, increase diet acidic foods
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Uric Acid
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men especially jewish men, gout, acidic pH, make more alkaline avoid purine rich foods
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Cystine
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genetic defect in renal absorbtion of cystine, acidic urine, hydrate, maintian alkaline urine ( k citrate), lmit animal protein,
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Struvite
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associated with UTI, alkaline urine, infectious stone, acidyfing foods and antibiotics
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KUB
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xray of kidneys ureters and bladder, may detect stones greater than 2 mm
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Gastric Bypass
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R&M, small compartment(new stomach upper), free end of small intestine connected to pouch
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Biliopancreatic diversion with duodenal switch
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M&R, remove part of stomach, sew to bottom of small intestine
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vertical banded gastroplasty
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window cut in stomach, staples to espohagus, band around outside of window, slower emptying
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Circumgastric banding
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wrap band around upper stomch
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Gastric sleeve
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R, cut stomach superior to inferior, no rerouting
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lipectomy
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fat surgically cut out
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paniculectomy
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tummy tuck
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endolumenal surgery
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M sleeve lines intestine, prevents absorbtion, throuh mouth, no incision
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Diet after bariatric
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3 meals large in protein and fiber, 2 protein snacks, meal size <1 cup, h20 90 min after meal to 15 min before,
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cholelithiasis
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presence of gallstones
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cholecystitis
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gallladder inflammation
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cholelithiasis & cholecystitis diagnostics
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Ultrasound RUQ, Upper GI series, oral cholecystogram, HIDA scan,
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cholelithiasis & cholecystitis TREATMENT
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DISSOLVE STONES, stone removal by instrumentation, lithotripsy ( procedure for eliminationg calculus), ultrasound
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UDCA
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medicine that dissolves cholesterol gallstones
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Typical urinary cancer
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adenocarcinoma
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BPH
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benign prostate hyperplasia
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Prostate exam
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men at 50 or 45 if family hx,
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prostate specific antigen
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0.2-4.0 normal, elevated associated with prostate cancer
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5 alpha reductase inhibitor action
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decreases prostate size by preventing testosterone conversion to DHT
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5 alpha reductase inhibitor ex:
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Proscar, Avodart, and Duagen
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Alpha adrenergic receptor blocker
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relax smooth muscle in prostate and bladder to improve flow, "zosin"
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prostate cancer type
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androgen dependent adenocarcinoma
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Prostate cancer diagnostic
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PSA 4-10, elevated PAP, do transurethral ultrasound
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How often screened prostate?
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yearly
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Watchful wait prostate cancer??
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life expectancy less than 10 yrs., another comorbid disease, low grade, low stage tumor
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prostate cancer treatment
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surgery
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prostate cancer surgery S/E
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incontinence, ED, bowel dysfunction
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nerve responsible for erection
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pudendal nerve
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Radical Prostectomy post op care
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High DVT risk, high infection risk if peroneal approach, anti-diarrheal may be given to prevent BM, control pain and bladder spasms
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Prostate Cryosurgery
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freeze cancer cells, transureathral ultrasound probe inserted containing liquid nitrogen
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Gastric perforation S/S
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sharp, severe pain, abd. hard, comfort in side laying knee-chest position
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Gastric Obstruction S/S
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dull pain, acute naseau, vomiting, and distension
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Gastric hemorrhage S/S
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vomiting blood, hemoptysis, coffe ground, black tarry stools
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Appendicitis Patho
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obstruction of appendix, increased pressure, decreased venous drainage, thrombosis, edema, and bacterial invasion of bowel wall
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Where is appendix
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RL quadrant
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Chron's def.
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develops in any part of GI tract, most common is ileum, all thickness of bowel wall
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TPN
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IV nutrition
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When use TPN
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10% body weight deficit, can't take oral fluids or food 7 days after surgery, major infection
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TPN Admin
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Central line if dextrose greater than D20, if less can admisinster peripheral called PPN
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Ulcerative Collitis Surgery
Total Proctocolectomy with ileostomy |
colon and rectum remove, anus closed, terminal ileum brought out and ileostomy formed
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Ulcerative Collitis Surgery
Koch's Pouch |
resivoir mad from loop of ileum, pt. empties at intervals
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Ulcerative Collitis Surgery
Ileoanal reservoir or J pouch |
temporary ileoanal reservoir created in anal canal and forms ileostomy, after healing ileostomy is reversed
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UTI diagnostics
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H&P, urinalysis presence of nitrates, WBC's, & Leukocytes, If suspect obstruction IVP, CT, or ultrasound, Cystoscopy for recurrent
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Quinolones
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"flaxcin"
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Penicillins
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Amoxicillin
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Cephalosporin
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"Cef"
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Sulfomamides
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"sulfa" & "tri"
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Urinary antiseptics
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similar to antibiotics, Macrodantin
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Analgesics
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Pyridium
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Antispasmodics
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Anaspaz
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UTI treatment uncomplicated
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3 days
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UTI treatment complicated
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7-10 days
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Recurrent UTI treatment
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prophylactic or suppressive antibiotics daily 6-7 months for recurrent or reinfect within 2 weeks
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