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130 Cards in this Set
- Front
- Back
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Manifestations of nausea and vomiting.
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Anorexia, electrolyte imbalances,
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Which is more common with severe vomiting...Metabolic acidosis or alkalosis?
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Metabolic alkalosis (from loosing HCl)
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What are the drugs that control nausea and vomiting?
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Anticholinergics, antihistamines,
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What type of foods should a person with n/v eat?
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room temp liquids, decarbonted drinks, dry toast/crackers
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Mallory-Weiss tear
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a tear in the mucosa near the esophagogasric junction, leads to upper GI bleeding
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What consists of the drug therapy for upper GI bleeding?
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Epinephrine, Vasopressin, Octreotide
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How does epinephrine treat upper GI bleeding?
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produces tissue edema and ultimately pressure on the source of the bleeding
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When is vasopressin used?
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produces VC, used for patients that do not respond to other therapies and are poor surgical risks
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What are the S&S of oral cancer?
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Leukoplakia, Erythroplasia, pain, dysphagia, difficulty in moving the jaw
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What is the nutrition therapy for oral cancer?
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PN fluids first 24-48 hours after neck surgery, then tube feedings are usually given via an NG, gastrostomy or Nasointestinal tube
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What is the most common upper GI problem in adults?
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GERD
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Barrett's esophagus
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Precancerous lesion due to GERD
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What should patients know about antacids?
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quick but short lived relief, take 1-3 hours after a meal
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What do PPIs do?
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promote healing and decrease HCl secretion
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Hiatal hernia
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Herniation of a portion of the stomach into the esophagus through an opening in the diaphragm
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What is achalasia?
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Peristalsis of the lower 2/3 of the esophagus is absent
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PPIs have been linked with what problems?
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increase in C. diff and fractures
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What do patients with pernicious anemia need?
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Cobalamin (B12)
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It is important to rule out what problem before having a diagnosis of PUD?
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Zolliger-Ellison
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How do you rule out Zollinger-Ellison?
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Gastric analysis
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How do you determine the presence of H. pylori?
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urea breath test
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How do H2 blockers work?
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block the action of histamine and reduces HCl secretion
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Long term use of antacids can cause what?
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systemic alkalosis
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Magnesium preparations should not be prescribed for who and why?
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Renal failure patients because of magnesium toxicity
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What is the only medication used to prevent the gastric ulcers induced by NSAIDs?
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Misoprostol (Cytotec)
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What is constipation?
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A decrease in frequency of bowel movements from what is "normal" for the patient
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What does the nurse need to do first for acute abd pain?
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complete H&P
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What is a continent ileostomy?
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Kock pouch
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How much feces is excreted with a small bowel obstruction?
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small amount
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How much feces is excreted with a large bowel obstruction?
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None
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What type of diet is encouraged to prevent diverticular disease?
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High fiber and decreased intake of fat
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Patients that had a blood transfusion before what year are at risk for Hepatitis?
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92
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What are the clinical manifestations of Hepatitis?
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rash, angioedema, arthritis, fever, crobulinemia, and malaise,
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What type of stools to patients with hepatitis have?
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light or clay colored
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Esophageal varices
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complex tortuous veins at the lower end of the esophagus, enlarged and swollen as a result of protal hypertension
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Hepatic encephalopathy
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Terminal complication of liver disease
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What are the S&S of hepatic encephalopathy?
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neurologic and mental responsiveness changes
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What is Decadron (Marinol)
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Medical merijuana
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What supplement is used to treat n/v for pregnancy and postop?
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Ginger
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Oral cancer is more common after what age?
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35
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What do you treat thrush with in oral cancer?
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nyscin or amphotericin B
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Stomatitis
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inflammation of the mouth as a result of chemo, really bad breath in increased salivation
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What is the primary factor leading to GERD?
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Incompetent lower esophageal sphincter
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What increases gastric acid secretion?
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Milk
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What class of medication increases LES pressure?
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Cholinergic
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How do you diagnose a hiatel hernia?
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X-ray and confirmed with barium swallow
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What common elderly medications decrease LES pressure?
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nitrates, CCB, antidepressants
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Your patient comes back from nasal surgery with an NG tube. The NG becomes dislodged, what do you do?
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Call MD, do not manipulate
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What is Zollinger-Ellison?
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production of too much acid and leads to ulcers on your pancreas
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What are the S&S of duidenal peptic ulcer?
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burning, cramping pain, pain 2-4 hours after a meal, pain relieved with antacids and food
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What are the S&S of gastric peptic ulcers?
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more common in women and greater than 50 years old, most common cause is NSAIDs
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Cytoprotective drugs do what?
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adhere to the lining and allows healing, makes certain drugs (coumadin, dilantin, tetracycline) less effective
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Because of the increased chance for upper GI bleed, what type of medications are ICU patients put on?
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PPI
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What is the treatment for an upper GI bleed?
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NPO, NG, need rest, good H&P, monitor vitals , 1-2 large bore IV,
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What is the problem with vasopressin?
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Decreases coronary blood flow
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How do you treat constipation?
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education about diet, increase fiber, increase activity, change in medication
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If a woman with acute pain comes in, what is the first thing you do?
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Prego test
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Where does collitis start?
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In the anus and works back
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Where does Chron's start?
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anywhere
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Toxic megacolon
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The colon enlarges to greater than 5cm
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What appearance does Chron's have on the bowel?
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cobble stone
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What problem has ribbon like stools?
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Collitis
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Which irritable bowel problem has bloody diarrhea?
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Collitis
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What is the treatment for inflammatory bowel disease?
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rest the bowel, control inflammation, treat any infection, correct malnutrition, symptom relief
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What medication decreases GI inflammation?
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Aminosalicalates
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What do aminosalicalates do?
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Decreases GI inflammation
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What problem is treated with corticosteroids like prednisone?
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Inflammatory bowel disease
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If a patient with collitis has surgery , what would the nurse expect when he/she comes back
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Colostomy
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What is typically the end result of Chron's disease?
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TPN due to a lack of colon
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What is the standard in colectomies?
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J pouch
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What is the treatment of choice for Chron's?
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Total proctocolectomy with permanent ileostomy
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What is a volvulus?
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Bowel twists on itself
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What are the S&S of colorectral cancer?
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Rectal bleeding, iron deficiency, tarry stools, change in bowel habits
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What is the gold standard of care for colorectal cancer?
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Removal of rectum or anus and sphincters with development of permanent end colostomy
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Who helps the patient pick the area for the stoma in a colostomy?
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Wound nurse
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With a new stoma, edema is common for how long?
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6 weeks
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If someone has a colostomy in the distal end, how long will it take for stool to pass?
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4-5 days
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What is considered a high output ostomy?
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1800 mls/day
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How much fluids should a person with an ileostomy drink a day?
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2-3 liters of fluid
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What is the functional unit of liver?
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Lobules
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What function does the liver serve?
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Metabolizes and detoxifies
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What organ is in charge of producing clotting factors?
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Liver
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What organ is in charge of producing insulin?
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Pancreas
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What drugs can induce Hepatitis?
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INH, Palophane, Methotrexate
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How is Hep A transmitted?
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Fecal-oral
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When is Hep A infectious?
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2 weeks before symptoms and 1 week after jaundice onset
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There is a vaccine for what types of Hepatitis?
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A and B
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How is Hepatitis B transmitted?
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Direct contact with blood and infected dialysis equipment
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What meds are used to treat Hep B?
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Interferon and Adefoir
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What do you need to know about Adefoir?
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Nephrotoxic
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How is Hep C transmitted?
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Direct contact through blood, sex perinatal
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What is the treatment for Hep C?
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Interferon and Riboviron
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Hep D is often found with what other Hep?
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Hep B
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Fulimiant hepatitis
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Sever impairment or necrosis of liver cells which leads to hepatic encephalopathy
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What hepatitis increases risk of fulimiant hepatitis?
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Hep D
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Cryoglobulinemia
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Abnormal proteins found in blood
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What color will the urine look like in a hepatitis patient?
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Dark
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How much fluid should a Hepatitis patient drink a day?
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2-3 liters
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Wilson's disease
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Corneal rings in the eyes
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Hemochromatosis
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Too much iron in the blood
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What are the S&S of cirrhosis
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Jaundice, spider lesions, thrombocytopenia, leukopenia, anemia, cogagulation, ...
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Portal hypertension typically leads to what?
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Ascities
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What medication is given to get rid of ammonia to reduce hepatic encephalopaty?
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Lactulose
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What is the treatment for ascites?
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Na restriciton diuretics an paracentesis
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What should the nurse know about aparacentesis?
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Fluid must be taken out slowly
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What are the nursing interventions for the patient coming back from a paracentesis?
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Take vitals, maintain bed rest until stable
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What is a balloon tamponade?
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Longer balloon like on a catheter and the balloon presses on the esophageal varices to reduce bleeding
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What are the S&S of pancreatitis?
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left upper quad pain, n/v, ileus, lung crackles, hypotension, tachycardia, jaundice, watch for hypocalcemia
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S&S of B12 deficiency
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anemia, pallor, cold finger tips, peripheral neuropathy
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What is the half life of albumin?
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20-22 days
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What is the half life of prealbumin?
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2 days
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What are the complications of GERD?
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Barrett's esophagus, cough, bronchospasm, laryngospasm,
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What type of diet should a GERD patient have?
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High protein low fat
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What meds are used to treat H. pylori?
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Antibiotics and H2R blockers
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What is the most common postoperative complication from PUD?
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Dumping syndrome
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What is dumping syndrome?
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Large bolus of hypertonic fluid enters the intestine and results in fluid begin drawn into the bowel lumen
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When does dumping syndrome begin?
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15-30 minutes after eating
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What are the S&S of dumping syndrome?
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weakness, sweating, palpitations, dizziness, cramps, borborygmi, urge to poop
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What is autoimmune hepatitis?
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Chronic inflammatory disorder of the liver unknown cause
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What are the characteristics of autoimmune hepatitis?
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presence of autoantibodies, high levels of serum immunoglobulins, and frequent associations with other autoimmune diseases
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What is the treatment of autoimmune hepatitis?
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corticosteroids and other immunosuppressive agents, prednisone, imuran
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What does an EGD do?
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Visualizes mucosal lining of the esophagus, stomach, and duodenum
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What nursing interventions need to be done for an EGD?
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NPO 8 hour before, local anestetic sprayed on throat, NPO until gag reflex returns, temp Q13-30 min for 1-2 hours
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What is an ERCP for?
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direct visualization of the common bile and pancreatic ducts
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What nursing interventions are needed for ERCP?
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NPO 8 hours before, Check vitals after, check for signs of perforation
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What is a sign of perforation?
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Sudden temperature spike
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What should you monitor for with Reglan?
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Drowsiness, restlessness, fatigue, and lethargy
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What mediation decreases bleeding and decreases gastric acid secretion?
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Ocetreotide
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Meridia shouldn't be given to a patient with ________.
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Hypertension
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When should you do a mid upper arm circumference?
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With a patient with protein-calorie malnutrition
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