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211 Cards in this Set
- Front
- Back
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What is acute gastritis often caused by?
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-Ingestion of strong acids
-Irritating foods -Overuse of aspirin |
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PUD
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PEPTIC ULCER DISEASE
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To promote fluid balance when treating gastritis, the nurse knows that the minimal daily intake of fluids is what?
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1500mL (1.5L)
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WHAT IS PUD
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A BREAK OR EXCAVATION IN THE MUCOSAL WALL OF THE STOMACH, PYLORUS OR DUODENUM
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Where is the most common site for peptic ulcer formation?
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Duodenum
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GASTRIC ULCERS ARE FREQUENTLY CALLED WHAT
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STRESS ULCERS
EROSIVE GASTRITIS |
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What symptom distinguishes a chronic gastric ulcer from a chronic duodenal ulcer?
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Normal to below-normal secretion of acid.
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15% OF ALL ULCERS ARE WHAT
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GASTRIC ULCERS
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Peptic ulcers occur with the most frequency in those between what ages?
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Between 40 and 60.
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DUODENAL ULCER
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IS CLOSE TO PYLORUS
FUNNEL SHAPED LESIONS EXTENDS INTO MUSCULARIS 85% OF ULCERS |
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What is a frequently prescribed proton pump inhibitor of gastric acid?
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Esomeprazole (Nexium)
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WHERE IS THE LOCATION OF THE GASTRIC/DUODENAL ULCERS #1
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ANTRAL REGION AND LESSER CURVATURE
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What is the percentage of patients with peptic ulcers who experience bleeding?
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15%
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WHAT IS THE INCIDENCE OF OF GASTRIC/DUODENAL ULCERS #1
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PEAK AGE 50-60 YRS; USUALLY NO FAMILY HX
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What characteristics are associated with peptic ulcer pain?
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-Burning sensation localized in the back or midepigastrium.
-Feeling of emptiness that precedes meals from 1-3 hours. -Severe gnawing pain that increases in severity as the day progresses. |
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WHAT IS ASSOCIATED WITH GASTRIC/DUODENAL ULCERS #1
2 |
-STRESS ULCERS AFTER MAJOR TRAUMA
-EMOTIONAL STRESS |
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When is the best time to administer an antacid?
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1-3 hours after the meal.
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WHAT IS THE ACID SECRETION LIKE FOR GASTRIC/DUODENAL ULCERS #1
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NORMAL TO LESS
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A Billroth I procedure is a surgical approach to ulcer management wherby ___________________________________________________.
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a partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.
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WHAT IS THE BACTERIA THAT IS PRESENT IN 60-80% OF CASES #1
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HELIOBACTER PYLORI
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WHEN DO YOU GET PAIN IN GASTRIC/DUODENAL ULCERS #1
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2-3 HRS AFTER MEAL
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What is the most common complication of peptic ulcer disease that occurs in 10-20% of patients?
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Hemorrhage
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WHAT RELIEVES THE PAIN #1
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INGESTION OF FOOD
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What nursing intervention are associated with peptic ulcers?
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-Check blood pressure and pulse rate every 15-20 minutes.
-Frequently monitor hemoglobin and hematocrit levels. -Observe stools and vomitus for color, consistency, and volume. |
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WHEN DOES THE PAIN USUALLY HAPPEN #1
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AT NIGHT
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What immediate nursing interventions would be used if peptic ulcer hemorrhage was suspected?
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-Place patient in recumbent position with his/her legs elevated.
-Prepare a peripheral and central line for IV infusion. -Assess vital signs. |
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Pyloric (gastric outlet) obstruction can occur when the area distal to the pyloric sphincter becomes stenosed by ________, _________, and ________.
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edema, scar tissue, and spasm.
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WHERE IS THE LOCATION FOR #2 GASTRIC/DUODENAL ULCER
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PYLORIC REGION
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What symptoms are associated with pyloric (gastric outlet) obstruction?
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-Anorexia
-Nausea and vomiting -Epigastric fullness |
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WHAT IS THE INCIDENCE OF #2
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PEAK AGE 30-45 YRS
80% OF PEPTIC ULCERS USUALLY FAMILY HISTORY |
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Morbid obesity is a term applied to people who are more than _______ their ideal body weight.
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Twice.
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INCREASED INCIDENCE OF #2 IN WHAT BLOOD TYPE
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O
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What is the average weight loss percentage of previous body weight after bariatric surgery?
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60%
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WHAT ARE THE 4 MOST COMMON DISEASES ASSOCIATED WITH #2
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ALCOHOLIC CIRRHOSIS, COPD, RENAL FAILURE, CHRONIC PANCREATITS
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Why do pulmonary complications frequently follow upper abdominal incisions?
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The patients tend to have shallow respirations in an attempt to minimize incision pain.
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WHAT IS ACID SECRETION LIKE IN #2
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INCREASED
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Describe the immediate intervention that should be used to treat the ingestion of a corrosive acid or alkali.
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Dilute and neutralize the offending agent.
To neutralize a corrosive acid use common antacids such as milk and aluminum hydroxide. To neutralize an alkali, use diluted lemon juice or diluted vinegar. |
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WHAT IS THE BACTERIA THAT CAUSES #2
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H PYLORI 100% OF CASES
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Explain why patients with gastritis due to a vitamin deficiency usually have malabsorption of Vitamin B12.
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Patients with gastritis due to a vitamin deficiency exhibit antibodies against intrinsic factor, which interferes with vitamin B12 absorption.
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WHEN DOES PAIN OCCUR IN #2
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30 MIN-1 HR AFTER A MEAL
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WHAT IS THE PAIN LEVEL LIKE AT NIGHT #2?
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0 NO PAIN
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What two conditions are specifically related to peptic ulcer development?
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1. Hypersecretion of acid pepsin.
2. Weakened gastric mucosal barrier predispose to peptic ulcer development. |
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WHAT RELIEVES THE PAIN IN #2
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VOMITING
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What is the bacillus that is commonly associated with gastric and possibly duodenal ulcers?
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Helicobacter pylori
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WHAT ARE THE TESTS FOR PUD
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ENDOSCOPY
UPPER GI SERIES EGD TEST FOR HELIOBACTER PYLORI |
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List several finding characteristics of Zollinger-Ellison syndrome.
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-Hypersecretion of gastric juice
-Multiple duodenal ulcers. -Hypertrophied duodenal glands -Gastrinomas in the pancreas |
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WHERE ARE THE TWO LOCATIONS OF PUD
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ANTRAL REGION/LESSER CURATURE AND PYLORIC REGION
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Define the term stress ulcer.
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An acute mucosal ulceration of the duodenal or gastric area that occurs after a stressful event.
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WHAT IS THE TREATMENT FOR PUD
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MEDICAL TREATMENT LIKE GERD
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Distinguish between Cushing's and Curling's ulcer in terms of cause and location.
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Cushing's ulcers, which are common in patients with brain trauma, usually occur in the esophagus, stomach, or duodenum.
Curling's ulcers occur most frequently after extensive burns and usually involve the antrum of the stomach and duodenum. |
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WHAT IS THE PHARMACOLOGICAL TREATMENT TO TREAT
(TREAT H PYLORI) |
PROTON PUMP INHIBITOR (PREVACID, PRILOSEC & ACIPHEX)
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Explain the current theory about diet modification for peptic ulcer disease.
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The objective of the ulcer diet is to avoid oversecretion and hypermotility in the GI tract. Avoid overstimulation of meat extractives, coffee, alcohol, and diets rich in milk and cream. Also avoid extreme temperature and spicy foods.
Current therapy recommends 3 regular meals per day if an antacid or histamine blocker is taken. |
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WHAT IS THE ANTIBIOTIC TREATMENT TO TREAT PUD
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ANTIBIOTIC FOR 10-14 DAYS
FLAGYL, AMOXIL OR BIAXIN |
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Name four major, potential complications of a peptic ulcer.
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1. Hemorrhage
2. Perforation 3. Penetration 4. Pyloric obstruction. |
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WHAT IS THE DIET FOR PUD
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SAME AS GERD
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Describe the clinical manifestations associated with peptic ulcer perforation.
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The patient experiences sever upper abdominal pain, vomiting, fainting, and an extremely tender abdomen that can be board like in rigidity; signs of shock will be present (hypotension and tachycardia).
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How does bariatric surgery work?
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Works by restricting a patient's ability to eat and restricting ingested nutrient absorption.
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WHAT ARE THE SURGICAL TREATMENTS FOR PUD
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VAGOTOMY W OR W/O PYLOROPLASTY,
ANTRECTOMY, SUBTOTAL GASTRECTOMY, BILLROTH 1, BILLROTH 2 |
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The stomach pouches created by gastric bypass or bonding surgery can hold up to ______mL of food and fluids.
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30mL
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What is the most common, primary malignant tumor of the duodenum?
Which portions of the duodenum does it involve? |
-Adenocarcinoma
-Second and third portions of the duodenum. |
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WHAT IS BILLROTH 1
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REMOVAL OF THE DISTAL HALF OF THE STOMACH WITH ANASTOMOSIS TO THE DUODENUM
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Describe the pathophysiology of gastritis.
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-Gastritis occurs becuse the gastric mucous membrane becomes edematous and hyperemic.
-Superficial erosion occurs. -Excess mucus is produced along with a scanty amount of gastric juice. -Superficial ulceration can lead to hemorrhage. |
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WHAT IS BILLROTH 2
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REMOVAL OF THE DISTAL PORTION OF THE STOMACH WITH ANASTOMOSIS TO THE PROXIMAL JEJUNUM
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Name four diagnostic tests that can be used to determine the presence of Helicobacter pylori.
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-Biopsy
-Serologic testing for antibodies -A 1 minute ultrarapid urease test -Breath test |
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The pathophysiology of constipation may be related to interference with ______, ________, _________.
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-myoelectric activity of the colon.
-mucosal transport -process involved in defecation. |
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What nursing suggestions can help a person break the constipation habit?
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A low-residue, bland diet.
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WHERE IS THE LOCATION FOR #2 GASTRIC/DUODENAL ULCER
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PYLORIC REGION
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An example of a stimulant laxative that works in 6-8 hours is
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Dulcolax
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WHAT ARE THE PREOP INTERVENTIONS FOR PUD
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TEACHING, EXPLAIN SURGERY, NG TUBE, IV LINE, DB, SPLINTING COUGHING
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What is the classification of moderate diarrhea when referring to the quantity of daily unformed stools?
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Between 3-6 bowel movements a day.
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WHAT ARE THE POSTOP INTERVENTIONS FOR PUD
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RESPIRATIONS, VS, MONITOR NG TUBE, OBSERVE OPERATIVE SITE FOR EXCESSIVE DRAINAGE, PROMOTE COMFORT, PCA USAGE, MONITOR COMPLICATIONS
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When assessing stool characteristics associated with diarrhea, what does the nurse know about the presence of greasy stool?
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Intestinal malabsorption.
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WHAT ARE SOME POSTOP COMPLICATIONS FOR PUD
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HEMORRAGE, GASTRIC DISTENTION, NV, PULMONARY PROBLEMS, FE IMBALANCE, MONITOR BOWEL SOUNDS
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Zollinger-Ellison syndrome is a disorder of malabsorption that _________ pacreatic enzymes
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inactivates
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WHAT ARE DISCHARGE TEACHING FOR PUD
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DIET, MEDS, ACTIVITY,STRESS MANAGEMENT, F/U APPOINTMENTS
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A positive Rovsing's sign is indicative of appendicitis. What does the nurse palpate to assess for this indicator?
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The left lower quadrant.
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BILLROTH 1 & 2 BECOME DEFICIENT IN WHAT?
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VITAMIN B12
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Where is the most common site for diverticulitis?
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Sigmoid.
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WHAT ARE THE SE FOR B12 DEFICIENCY
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NUMBNESS/TINGLING IN HANDS AND FEET
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What is the incidence of diverticulitis in those older than 80 years of age?
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50%
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WHAT IS THE ETIOLOGY FOR GASTRIC CANCER
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UNCOMMON MALIGNANCY 2%
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What is diverticulitis clinically manifested by?
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-A low-grade fever
-A change in bowel habits. -Left lower quadrant pain. |
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WHERE DOES GASTRIC CANCER OCCUR
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ANYWHERE IN THE STOMACH
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What are common clinical manifestations of Crohn's disease?
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Abdominal pain and diarrhea.
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WHAT ARE THE TWO TYPES OF GASTRIC CANCER
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DIFFUE AND INTESTIINAL
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What symptoms can a nurse suspect a diagnosis of regional enteritis (Crohn's disease) when she assesses the patient?
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-Abdominal distention and rebound tenderness.
-Hyperactive bowel sounds in the right lower quadrant. -Intermittent pain associated with diarrhea. |
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What is the nutritional management diet therapy for regional enteritis (Crohn's disease)?
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Foods that are low in residue.
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How is remission of inflammation in ulcerative colitis possible?
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-Antidiarrheal medication.
-Periods of rest after meals. -Steroid therapy (corticosteroids). |
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FEMALES TEND TO GET WHAT TYPE OF CANCER
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DIFFUSE TYPE
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What unique problem is associated in a patient with an ileostomy?
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Regular bowel habits cannot be established.
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WHAT AGE GROUP TENDS TO GET CANCER
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40-70
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What postoperative nursing interventions are used for a patient with a continent ileostomy?
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-Checking to make certain that the rectal packing is in place.
-Irrigating the ileostomy catheter every 3 hours. -Perineal irrigations after the dressings are removed. |
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WHO HAS HIGHER INCIDENCE OF GASTRIC CANCER
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OVERALL MEN INCREASED INCIDENCE HIGHER THAN WOMEN
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What clinical manifestations are associated with small-bowel obstruction?
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Dehydration
Pain that is wavelike Vomiting |
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WHAT ARE THE CAUSES OF GASTRIC CANCER
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DIETARY EXPOSURE, ENVIRONMENTAL FACTORS, GENETIC FACTORS
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What is the 5 year survival rate for cancer of the colon that is detected EARLY?
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About 90%
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WHAT TYPES OF DIETARY EXPOSURE CAUSES GASTRIC CANCER?
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INCREASED SALT, NITRATE PRESERVED FOODS, STARCH & FAT, DECREASED INTAKE OF FRUITS AND VEGGIES
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Why are preoperatively intestinal antibiotics given for colon surgery?
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-To decrease the bulk of colon contents.
-To reduce the bacteria content of the colon. -To soften the stool. |
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WHAT ARE THE ENVIRONMENTAL FACTORS CAUSES GASTRIC CANCER?
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EMPLYOMENT IN METAL PRODUCTS OR CHEMICAL INDUSTRIES
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How far should the enema catheter be inserted into the stoma for colostomy irrigation?
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2-3 inches.
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WHAT ARE SOME OTHER EXPOSURES THAT CAUSE GASTRIC CANCER?
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HISTORY OF GASTRIC ULCERS, GASTRIC POLYPS, PERNICIOUS ANEMIA, H PYLORI, CHRONIC PEPTIC ULCERS
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How far above the stoma should the patient be directed to hold the enema can or bag for colostomy irrigation?
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18-24 inches. (shoulder level)
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WHAT ARE THE GENETIC FACTORS THAT CAUSE GASTRIC CANCER
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FAMILY HISTORY, TYPE A BLOOD
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What is the total quantity of irrigating solution that can be instilled in one session?
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1,500mL
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WHAT ARE THE ASSESSMENTS OF GASTRIC CANCER
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WEIGHT LOSS, DYSPEPSIA, CANT EAT FULL MEAL, CHANGE IN EATING HABITS, DECREASED APPETITE, N, HX OF H PYLORI, HX OF SMOKING/ALCOHOL, CHRONIC BLEEDING (GUIAC STOOLS)
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What are the 3 most common changes in the GI tract that are symptoms of functional disorder or diseases?
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-Constipation
-Diarrhea -Fecal incontinence |
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HOW DO YOU DIAGNOSE GASTRIC ULCERS
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UPPER GI SERIES, UPPER GI ENDOSCOPY WITH BIOPSY & CYTOLOGY STUDIES AND CT EXAM
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Name two diseases of the colon commonly associated with constipation.
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-Irritable bowel syndrome (IBS)
-Diverticular disease. |
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WHAT LAB RESULTS DO YOU EXPECT TO SEE IN GASTRIC ULCERS
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PRESENCE OF LACTIC ACID AND INCREASED LDH IN GASTRIC JUICES
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What is the pathophysiology of constipation associated with interference with 3 major functions of the colon?
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-Mucosal transport.
-Myoelectric activity. -Actual process of defecation. |
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WHAT ARE THE MEDICAL INTERVENTIONS FOR GASTRIC CANCER
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SMALL FREQUENT MEALS W VITAMIN SUPPLEMENTS
TPN (CENTRAL LINE INSERTION) PAIN CONTROL SURGICAL INTERVENTION |
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The recommended dietary intake of fiber is how many grams per day?
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25-30 grams per day.
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WHAT ARE THE SURGICAL INTERVENTIONS R/T GASTRIC ULCER
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PARTIAL GASTRECTOMY BILLROTH1, BILLROTH 2 (GASTROJEJUNOSTOMY), TOTAL GASTRECTOMY
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What is the most common bacteria found in antibiotic-associated diarrhea?
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Clostridium difficile
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WHAT IS A TOTAL GASTRECTOMY
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REMOVAL OF STOMACH (CAUSES PERNICIOUS ANEMIA)
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What are the 4 most common complications of diverticulitis?
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-Peritonitis
-Abscess formation -Fistulas -Bleeding |
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WHAT IS THE SURVIVAL RATE OF GASTRECTOMY
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SURVIVAL RATES AFTER TX 5YR SURVIVAL RATE IS 15%
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WHAT IS THE SURVIVAL RATE IF RESECTED BEFORE INVADES STOMACH WALL?
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5 YR IS 90%
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List 4 common bacteria found in peritonitis.
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E. coli
Klebsiella Proteus Pseudomonas |
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WHAT ARE THE COMPLICATIONS OF SURGERY?
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POST OP HEMORRHAGE, DUMPING SYNDROME, S/S, VITAMIN AND MINERAL DEF, IRON LOSS
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What are the 3 most common causes of small-bowel obstruction?
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-Adhesions
-Hernias -Neoplasms |
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WHAT DO YOU DO TO CORRECT POST OP HEMORRHAGE
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MONITOR FOR S/S OF BLOOD LOSS
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What is the majority of large bowel obstruction caused by?
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Adenocarcinoid tumors.
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WHAT DO YOU DO TO CORRECT DUMPING SYNDROME
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OCCURS AFTER EATING FOODS HIGH IN CHO/ELECTROLYTES
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List the 6 risk factors for colorectal cancer.
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1. Increasing age
2. Family history of colon cancer or polyps. 3. Previous colon cancer or adenomatous polyps. 4. History of inflammatory bowel disease. 5. High-fat, high-protein, low-fiber diet. 6. Genital cancer or breast cancer. |
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WHAT ARE THE S/S OF SURGERY (GASTRIC CANCER)
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DIZZINESS, WEAKNESS, DIAPHORESIS, CRAMPS
VASOMOTOR SYMPTOMS= PALLOR, PALPITATIONS, HA, FEELING WARM, N |
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WHAT DO YOU DO FOR IRON LOSS
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INCREASE OR DECREASE VITAMIN B12
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DISCHARGE PLANNING FOR GASTRIC CANCER SURGERY
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FOLLOW UP CARE
MEDICATIONS WOUND CARE INFECTION PREVENTION PSYCHOLOGICAL SUPPORT/COUSELING SERVICES NUTRITIONAL SUPPORT (DIETICIAN CONSULTATION) |
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BENIGN TUMORS OF THE MOUTH
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LIPOMAS
NEUROFIBROMAS |
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PREMALIGNANT TUMORS OF ORAL CAVITY
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LEUKOPLAKIA
ERYTHRIPLAKIA |
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WHAT IS LEUKOPLAKIA
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PRECANCEROUS, YELLOW WHITE OR GREY LESION <2% MALIGNANT
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WHAT IS ERYTHROPLAKIA
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RED VELVETY PATCH THAT INDICATES EARLY SQUAMOUS CELL CARCINOMA
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WHAT AGE GROUP HAS ERYTHROPLAKIA
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50-60
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WHAT ARE THE MEDICAL MANAGEMENT FOR MALIGNANT TUMORS
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RADIATION TREATMENT
INTERSTITIAL RADIATION CHEMOTHERAPY |
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WHAT IS RADIATION TREATMENT FOR M. TUMORS
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EXTERNAL BEAM THERAPY OR INTERSTITIAL RADIATION THERAPY.
PASSES THROUGH THE SKIN OR MUCOUS MEMBRANE TO TUMOR |
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WHAT IS INTERSTITIAL RADIATION TREATMENT FOR M. TUMORS
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INVOLVES IMPLANTING RADIOACTIVE SEEDS USED FOR SMALL LESIONS THAT HAVE NOT INFLITRATED THE SURROUNDING TISSUES
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WHEN WOULD CHEMOTHERAPY BE USED IN M TUMORS
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ADVANCED CANCER
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WHAT ARE THE NURSING INTERVENTIONS FOR M TUMORS
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AVOID ORAL IRRITANTS
FREQ ORAL HYGIENE ANTIEMETICS SMALL FREQ MEALS SOFT TOOTH BRUSH ANALGESICS BEFORE EATING (30-45 MIN) RELIEVE MOUTH DRYNESS |
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FOR SMALL TUMORS WHAT WOULD THE SURGICAL TX BE
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LOCAL EXCISION, RADIATION OR LASER THERAPY
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FOR EXTENSIVE TUMORS WHAT WOULD THE SURGICAL TX BE
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TRACH INSERTED, REMOVALS OF LG PORTION OF TONGUE AND LYMPH NODES, MANDIBULECTOMY
OOOOOOOOR RADIAL NECK DISSECTION, IN ADDITION REMOVAL OR LYMPTH NODES AND POSSIBLE GRAFT SITES DONE |
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WHAT IS A RADICAL NECK DISSECTION
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EXTENSIVE PROCEDURE REMOVES ALL TISSUES UNDER THE SKIN FROM JAW TO THE CLAVICLE, ALSO THE STEMOCLEIDOMASTOID MUSCLE IS REMOVED
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WHAT ARE THE NURSING INTERVENTIONS FOR SURGICAL MANAGEMENT FOR MOUTH TUMORS
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PATENT AIRWAY, WOUND CARE, TRACHEOSTOMY, MAINTAIN NUTRITION
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WHAT DO YOU NEED TO DO FOR PATENT AIRWAY
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-SUCTION EQUIPMENT AT BEDSIDE, PULSE OX
-SEMI FOWLERS HELPS WITH LYMPHATIC DRAINAGE |
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WHAT DO YOU NEED TO DO FOR WOUND CARE
|
MONITOR FOR BLEEDING, ONE OR MORE JPs; BE CAREFUL HEMORRHAGE CAN BE MASSIVE BC OF THE LG VESSELS THAT SUPPLY THE MOUTH
DRESSING/PACKING METICULOUS ORAL CARE W 1/2 H2O2 |
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WHAT IS THE THE INTERVENTION FOR TRACHEOSTOMY
|
COMMUNICATION TECHNIQUES
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HOW DO YOU MAINTAIN NUTRITION FOR PATIENT WITH A TRACHEOSTOMY
|
TPN
LATER CLEAR LIQUIDS ORAL SUPPLEMENTS |
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WHAT HAPPENS IN A FRACTURED JAW
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JAW IS WIRED ALMOST SHUT, MOSTLY EATS/DRINKS LIQUIDS, CAN EAT SOFT FOOD
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WHAT MUST BE AT BEDSIDE FOR WIRED JAW AND WHY
|
WIRE CUTTERS FOR EMERGENCY
-IF PATIENT VOMITS, NURSE MUST CUT THE WIRES TO PREVENT ASPIRATION |
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WHAT MEDS ARE GIVEN FOR FRACTURED JAW (WIRED SHUT)
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ANTIEMETIC MEDS GIVEN TO PREVENT N/V
FREQUENT MOUTH CARE W MOUTHWASH |
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WHAT ARE THE WESTERN SOCIETY CAUSES OF CANCER
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SMOKING, NUTRITIONAL DEFICIENCIES, ALCOHOL, HOT DRINKS/FOOD
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WHAT ARE THE OTHER PARTS OF THE WORLDS CAUSES OF CANCER
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SOIL CONTAMINANTS, NITROSAMINES, SMOKING OPIUM AND NUTRITIONAL DEFICIENCY
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WHAT IS THE PATHO OF ESOPHAGUS CANCER
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SLOW GROWING BENIGN TISSUE CHANGES-NO SEROSAL LAYER TO LIMIT ITS EXTENSION LYMPH NODE SPREAD IS COMMON, ENCIRCLE THE ESOPHAGEAL WALL-PULMONARY COMPLICATIONS-TRACHEOESOPHAGEAL FISTULAE
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WHAT ARE THE SYMPTOMS OF ESOPHAGUS CANCER
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DYSPHAGIA-MOST COMMON, MILD, INTERMITTENT, BECOMES CONSTANT; ODYNOPHAGIA
INCREASED SALVATION INCREASED MUCOUS IN BACK OF THROAT REGURGITATION INABILITY TO SWALLOW |
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WHAT ARE THE TESTS ORDER FOR ESOPHAGUS CANCER
|
UPPER GI ENDOSCOPY, BARIUM SWALLOW, CT SCAN, CYTOLOGIC EXAM/BIOPSY
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WHAT IS THE TREATMENT FOR ESOPH CANCER
|
RADIATION TX
CHEMO TOTAL RESECTION OF ESOPH ESOPHAGECTOMY |
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WHAT ARE THE NURSING INTERVENTIONS FOR ESOPH CANCER
|
-MAINTAIN NUTRITION
-FEEDING TUBES -DAILY WEIGHTS -I/O -MONITOR CBC CHEM 7 FOR ELECTROLYTE IMBALANCE -CAL CHANNEL BLOCKERS -MONITOR/TEACH GERD -TEACH DIET MODIFICATION -ELEVATE HOB 30* |
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WHAT IS THE DIET MODIFICATION FOR SOMEONE WITH ESOPH CANCER
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NO CAFFEINE, NO CARBONATED BEVERAGES, AVOID EATING 2-3 HRS BEFORE BED
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WHAT DO CAL CHANNEL BLOCKERS DO
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REDUCE SPASMS
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WHAT IS HIATAL HERNIA (DIAPHRAGMATIC HERNIA)
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CARDIAC SPHINCTER BECOMES, ENLARGED, ALLOWING A PART OF THE STOMACH TO PASS INTO THE THORACIC CAVITY
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WHAT ARE THE TWO TYPES OF HERNIA
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SLIDING, ROLLING/PARAESOPHAGEAL
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WHAT HAPPENS IN SLIDING HERNIA
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SLIDES IN AND OUT OF THORAX
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WHAT HAPPENS IN SLIDING HERNIA
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THE UPPER STOMACH AND GASTROESOPHAGEAL JUNCTION ARE DISPLACED UPWARDS INTO THE THORAX; THE STOMACH IS FORCED THROUGH THE OPENING OF THE DIAPHRAGM WHEN THE PERSON RECLINES AND MOVES BACK TO ITS NORMAL POSITION WHEN STANDING
90% OF HH ARE SLIDING WHICH OCCURS WITH CHANGES IN POSITION OR INCREASED PERISTALSIS |
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WHAT HAPPENS IN ROLLING HERNIA
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THE GASTROESOPHAGEAL JUNCTION STAYS BELOW THE DIAPHRAGM BUT ALL OR PART OF THE STOMACH PUSHES THROUGH THE THORAX
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WHAT IS THE INCIDENCE OF HIATAL HERNIA
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UP TO 60% OVER AGE 60 YRS MORE WOMEN
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WHAT ARE THE RISK FACTORS FOR HIATAL HERNIA
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ANYTHING THAT WEAKENS THE DIAPHRAGM AND INCREASES INTRA-ABDOMINAL PRESSURES, OBESITY, PREGNANCY OR ASCITES
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WHAT ARE THE SYMPTOMS OF HIATAL HERNIA
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-HEARTBURN 30-60 MIN AFTER MEALS (WORSE WHEN LYING DOWN)
-GERD -BURNING PAIN THAT MOVES UP AND DOWN |
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WHAT CLASSIFIES GERD
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ODYNOPHAGIA
DYSPHAGIA ACID REGURGITATION (RELEASE OF SALTY SECRETIONS IN THE MOUTH, OR ERUCTATION) |
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HOW IS HIATAL HERNIA RELIEVED
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WITH ANTACIDS
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WHAT ARE THE TESTS DONE WITH HIATAL HERNIA
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X RAY, BARIUM SWALLOW, ENDOSCOPIES, FLUROSCOPY
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WHAT ARE THE MEDICAL TREATMENTS FOR HIATAL HERNIA
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SMALL FREQ MEALS, REMAIN UPRIGHT AFTER MEALS, 30* HOB, RESTRICT DIET, DRINK ADEQUATE FLUIDS W MEALS, EAT SLOWLY, AVOID EXTREME FOODS, NO EATING/DRINKING FOR 3 HR BEFORE BED, LOSE WEIGHT, AVOID TOBACCO
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WHAT ARE THE EXTREME FOODS TO AVOID WITH A HIATAL HERNIA
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SPICES, FATS, ALCOHOL, COFFEE, CHOCOLATE, CITRUS JUICES
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WHAT ARE THE DRUGS TO AVOID WITH A HIATAL HERNIA
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SALICYLATES, PHENYLBUTAZONE, (NSAIDS, IBPROF)-THEY INCREASE BACKFLOW
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WHAT ARE THE MEDICATION MANAGEMENT FOR HIATAL HERNIA
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ANTACIDS
HISTAMINE REC BLOCKERS REGLAN PROPULSID |
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WHAT IS THE SURGICAL TREATMENT FOR HIATAL HERNIA
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NISSEN FUNDOPLICATION
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WHAT IS NISSEN FUNDOPLICATION
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INVOLVES SUTURING THE FUNDUS AROUND THE ESOPHAGUS
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WHAT IS THE POST OP CARE FOR FUNDOPLICATION
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PREVENT RESP COMPLICATION: TURN, COUGH, DB Q1-2 HR
-CHEST TUBE-MONITOR RESP DISTRESS -HOB INCREASE 2 LARGE CLAMPS AT BEDTIME |
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WHAT IS THE BASIC FUNCTION OF THE GALLBLADDER
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STORES 600-800 ML/DAY INTO 40-70ML/DAY
IT CONTRACTS AND RELEASES CONCENTRATED BILED INTO CBD WHEN STIMULATED BY CCK |
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WHAT IS CHOLECYSTITIS
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INFLAMMATION OF THE GB WALL
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WHAT IS ACUTE CHOLYSTITIS
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ASSOCIATED W GALLSTONES; CAUSED BY OBSTRUCTION OF THE CYSTIC DUCT BY A STONE
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WHAT IS AN EMPYEMA
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GALLBLADDER WITH PUS
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WHAT ARE THE COMPLICATIONS FOR GALLBLADDER
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SEPTIC CONDITIONS, ADHESIONS, GANGRENE, PERFORATION, ABSCESS AND FISTULA
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WHAT IS CHOLELITHIASIS
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PRESENCE OF GALLSTONES
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WHAT IS THE INCIDENCE FOR CHOLELITHIASIS
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20 MILLION IN THE US
INCREASES WITH AGE CLASSIC F'S (FEMALE, FAT, FORTY, FAIR, FERTILE) WHITE MORE THAN BLACK DIABETES, OBESITY, CROHNS DISEASE CIRRHOSIS NATIVE AMERICAN |
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WHAT IS THE SYMPTOM OF CHOLELITHIASIS
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PAIN AFTER INDIGESTION OF FAT
R UPPER QUADRANT RADIATES TO R SHOULDER |
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WHAT ARE GALLSTONES
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FORMED BY CRYSTALLINE HARDENING OF BILE CONSTITUENTS, PIGMENTED STONES, SOME FORMED IN THE CBD/HEPATIC DUCTS OF LIVER
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WHAT ARE THE SYMPTOMS OF GALLSTONES
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NO MANIFESTATIONS OF SYMPTOMS IN 50% OF PEOPLE
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WHAT ARE THE TESTS USED FOR GALLSTONES
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BLOOD TESTS ARE REMARKABLE, AND + HIDA SCAN
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WHEN DOES JAUNDICE APPEAR
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ONLY WHEN CBD IS OBSTRUCTED
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WHAT IS THE ASSESSMENT FOR CHOLECYSTITS/CHOLELITHIASIS
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HX OF BLOATING AFTER MEALS, FLATULENCE, BELCHING, INTOLERANCE FOR FATTY FOODS
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WHAT IS PAIN LIKE AUTE VS CHRONIC (CHOLECYSTITS/CHOLELITHIASIS)
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PAIN LASTS FOR SEVERAL DAYS IN ACUTE, VS SEVERAL HOURS IN CHRONIC
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WHAT IS A POSITIVE MURPHYS SIGN
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PAIN ON DEEP INSPIRATION WHEN PRESSING FINGERS UNDER RIBCAGE
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WHAT ARE THE THE SYMPTOMS (CHOLECYSTITS/CHOLELITHIASIS)
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INCREASE IN TEMP AND INCREASE IN WBC
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MILD JAUNDICE OCCURS IN WHAT PRECENTAGE OF PPL (CHOLECYSTITS/CHOLELITHIASIS)
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10%
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HOW DO YOU DIAGNOSE CHOLECYSTITS/CHOLELITHIASIS
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BILIARY U/S
THICKENING OF GB WALL DISTENTION OF GB LUMEN ABDOMINAL XRAY/CT |
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WHAT ARE THE LABS WOUD SEE (CHOLECYSTITS/CHOLELITHIASIS)
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SLIGHTLY ELEVATED ENZYMES; ALKALINE PHOSPHATASE; SERUM DIRECT BILIRUBIN; CBC AND GGT
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WHAT ARE THE ANTIBIOTICS USED (CHOLECYSTITS/CHOLELITHIASIS)
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AMPICILLIN, CEPHALOSPORINS, AMINOGLYCOSIDES
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WHAT ARE THE COMPLICATIONS FOR CHOLECYSTITS/CHOLELITHIASIS
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INCREASE PAIN IN RUQ OR JAUNDICE
DECREASE OR ABSENT BS (PERITONITIS) |
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WHAT ARE THE SURGICAL INTERVENTIONS (CHOLECYSTITS/CHOLELITHIASIS)
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CHOLECYSTECTOMY
LAPAROSCOPY TTUBE LITHOTRIPSY |
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WHAT IS THE NONSURGICAL INTERVENTION (CHOLECYSTITS/CHOLELITHIASIS)
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ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)
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WHAT IS CHOLECYSTECTOMY
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REMOVAL OF GB
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WHAT IS LAPAROSCOPY
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OPEN VS CLOSED (TUBE INSERTED INTO CBD TO ENSURE BILE DRAINAGE)
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WHAT IS LITHOTRIPSY
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EXTRACOPOREAL SHOCK WAVE TREATMENTS FOR SMALL STONES, LESS THAN 4
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WHAT ARE PAIN RELIEVING MEASURES USED (CHOLECYSTITS/CHOLELITHIASIS)
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DEMEROL, ANTACIDS, ANTIEMETICS
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WHAT MED IS CONTRAINDICATED (CHOLECYSTITS/CHOLELITHIASIS)
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MORPHINE (CONTRAINDICATED- MAY INCREASE SPASMS OF THE SPHINCTER OF ODDI)
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WHAT NEEDS TO BE MONITORED (CHOLECYSTITS/CHOLELITHIASIS)
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F/E BALANCE
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WHAT ARE THE POSTOP COMPLICATIONS (CHOLECYSTITS/CHOLELITHIASIS)
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HEMORRHAGE, PNEUMONIA, THROMBOPHLEBITIS, URINARY RETENTION, ILEUS, PERITONITIS
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DIET FOR CHOLECYSTITIS AND CHOLELITHIASIS
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FAT RESTRICTIONS
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LIMIT FATS AND OILS TO WHAT (CHOLECYSTITS/CHOLELITHIASIS)
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3 TSP PER DAY, NO FRIED FOODS, NO MORE THAN 6 OZ OF LEAN MEAT PER DAY
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WHAT IS CHRONIC CHOLECYSTITIS
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ASSOCIATED W GALLSTONES, USUAL SEQUELA TO ACUTE CHOLECYSTITS SEEN IN 5 F'S
FIBROUS TISSUE BEGINS TO REPLACE THE NORMAL MUSCLE AND MUCOSAL TISSUE OF GB; THEN LOSES ITS ABILITY TO CONCENTRATE BILE |
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ASSESSMENT OF CHRONIC CHOLECYSTITIS
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PAIN IS LESS SEVERE, LOW GRADE TEMP, LEUKOCYTE COUNT IN LOWER, INDIGESTION, FAT INTOLERANCE, FLATULENCE
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WHAT ARE THE INTERVENTIONS FOR CHRONIC CHOLECYSTITIS
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LOW FAT DIET
WEIGHT REDUCTION ADMINISTER ANTICHOLINERGICS ANTACIDS |
