N201 Gastroesophageal Reflux And Hiatal Hernia

Front 1

breakdown of food

Back 1

digestion

Front 2

transfer of food products into circulation

Back 2

absorption

Front 3

excreting the waste products of digestion

Back 3

elimination

Front 4

taking in food

Back 4

ingestion

Front 5

two types of secretion of GI tract:

Back 5

mucous
digestive

Front 6

This type of secretion is produced throughout entire length of GI tract. The purpose is to protect and lubricate walls of GI tract

Back 6

mucous secretions

Front 7

This type of secretion in produced in the mouth, stomach, duodenum and jejunum. It's when enzymes and lytes break down ingested food so it may be absorbed.

Back 7

digestive secretions

Front 8

Ingestion of materials can be: (3)

Back 8

oral
enteral
parental

Front 9

Physical and chemical breakdown of food into absorbable substances

Back 9

digestion

Front 10

facilitated by the timely movement of food thru the various organs and secretion of specific enzymes

Back 10

absorption

Front 11

Major hormones assoc. with digestion:

Back 11

gastrin
secretin
cholecystokinin
gastric inhibitory peptide

Front 12

__________:contraction of gallbladder, relax sphincter of Oddi, increasing bile into duodenum, release of pancreatic digestive enzymes

Back 12

cholecystokinin

Front 13

inhibits gastric acid secretion and gastric motility

Back 13

gastric inhibitory peptide

Front 14

gastric acid secretion, increased motility, LES tone

Back 14

gastrin

Front 15

inhibits gastric motility, acid secretion and pancreatic bicarb secretion

Back 15

secretin

Front 16

Pacreozymin is secreted where?

Back 16

by duodenum

Front 17

If someone has dumping syndrome, what nutrient should they NOT get?

Back 17

carbohydrate

Front 18

Nutrients: (6)

Back 18

carbs
fats
proteins
vits
minerals
water

Front 19

who will usually be deficient in nutrients?

Back 19

elderly

Front 20

-Building and maintaining body tissue
-furnishing energy
-regulating body processes

all functions of what?

Back 20

nutrients

Front 21

We can only use feeding tube if:

Back 21

they have functioning GI tract

Front 22

Two types of supplemental nutrition::

Back 22

high calorie oral feedings
tube feeding

Front 23

whats 2 examples of a high calorie oral feeding?

Back 23

milk shake
commercial products (ensure)

Front 24

________ are safer and less expensive then parenteral

Back 24

tube feeding

Front 25

Indicators of potential nutritional problems:

Back 25

-clear liq/full liq
-Iv fluids
-NPO
-Decreased intake of diet or tube feedings
-weight 20% above or below IBW
-alterations in chewing, swallowing, producing saliva, taste or small
-dx cva or ca

Front 26

who should we consult is we have indicator of potential nutritional probs

Back 26

dietician

Front 27

What lab data is important when looking at nutrition?

Back 27

alb
transferring
prealb
nitrogen balance
cbc
lytes
bun
creatining
oncofetalantigens
cea

Front 28

normal alb level:

Back 28

3-5

Front 29

normal transferrin level:

Back 29

220-430

Front 30

normal prealb level:

Back 30

20-40

Front 31

if serum alb is increased:

Back 31

hepatic disease

Front 32

if deficiency in iron:

Back 32

can't absorb food

Front 33

serum creatinine shows:

Back 33

dehydration

Front 34

look at total lymph count for:

Back 34

signs of infection

Front 35

transferrin will be diminished in:

Back 35

chronic illnesses

Front 36

The elderly undergo the following effects of aging regarding the mouth:
1. loss/decay of teeth
2.decreased
3.decreased
4.decreased

Back 36

2. taste buds
3. sense of small/taste
4. volume of saliva

Front 37

The elderly undergo the following effects of aging regarding the esophagus:
1. decreased
2. increased

Back 37

1. peristalsis (gags)
2. reflux

Front 38

The elderly undergo the following effects of aging regarding the stomach:
1. atrophy of
2. decreased _____,_____,______

Back 38

1. gastric mucosa
2. acid secretion, gastric bld flow, absorption

Front 39

DETERMINE
D
E
T
E
R
M
I
N
E

Back 39

disease they have
eating poorly
tooth loss/mouth pain
economic hardship
reduced social contact
multiple meds
involuntary wt loss/gain
needs assis. in self care
elderly >80

Front 40

What's the no. 1 thing ppl dont tell u?

Back 40

economic hardship

Front 41

when doing a symptom assessment remember Pqrst

Back 41

palliation, provocatin
quality
radiation
severity
timing

Front 42

what 4 things are included in physical assess?

Back 42

inspectin
auscultation
percussian
palpation

Front 43

There are several diganostic studies in the upper gi series:

Back 43

barium swallow
endoscopy
gastric emptying studies
gastric pH
gastric analysis
h pylori
cbc
lytes
bun
creat
abg's

Front 44

This involves observing the movement of a contrast medium thru the esophagus and into the stomach by means of a fluroscopy and xray exam. It's used to identify esophageal and stomach disorders

Back 44

barium swallow

Front 45

Diagnostic procedure commonly used in GI evaluation:

Back 45

abd xray
kub
contrast studies
endoscopic procedures
radionuclide scintigraphy

Front 46

ABG'S:
pH

Back 46

7.35-7.45

Front 47

ABG'S: PCO2

Back 47

35-45mmHG

Front 48

ABG'S: HCO3

Back 48

22-26mEq/L

Front 49

ABG'S: PO2

Back 49

80-100 mm HG

Front 50

ABG'S: O2 sat

Back 50

95-100%

Front 51

substance that can donate a hydrogen ion H+

Back 51

acid

Front 52

Power of the H expresses the acidity or alkalinity of a solutions hydrogen ion concentration

Back 52

pH

Front 53

substance that can accpet hydrogen ion

Back 53

base or alkali

Front 54

acid condition of bld ph <7.35

Back 54

acidemia

Front 55

alkaloid condition of bld pH >7.45

Back 55

alkalemia

Front 56

ph less then 7.35
hco3 less then 22
PCO2 normal

Back 56

metabolic acidosis

Front 57

name some causes of met acidosis:

Back 57

shock, drug poisoning/od
severe diarrhea
diamox therapy
dehyration
ammonium cl administration
diabetic ketoacidosis
renal tubular necrosis
utererosigmoidostomy
renal failure, pancreatic drainage

Front 58

To treat met acidosis:
1. correct ______
2. consider ______ replacement
3. monitor:
4. watch for ______

Back 58

1. fluid/lyte imbalance
2. bicarb
3.i&o
4. cardiac arrhythmias

Front 59

Ph ^ 7.45

HCO3 ^

Back 59

met alkalosis

Front 60

this syndrome is produced by condidtions that result in reflux of fastric secretions into the esophagus

Back 60

GERD

Front 61

what is GERD throught to be caused by?

Back 61

dysfunction of LES (lower esophageal sphicter)

Front 62

burning, tight sensations from lower sternum progressing to jaw or throat. also c/o excessive salivation

Back 62

heartburn (pyrosis)

Front 63

what is heartburn (pyrosis) relieved by?

Back 63

milk
alkaline substances
water

Front 64

The following pulmonary symptoms may be seen with Gerd

Back 64

wheezing
coughing
dyspnea (2ndary to microaspiration of gastric contents)

Front 65

The following otolaryngologic symptoms may be seen with gerd

Back 65

hoarseness
sore throat
choking

Front 66

the following may be gastric symptoms of gerd:

Back 66

bloating
n/v

Front 67

step 1 for Gerd:EDUCATE!!
-Avoid what type of foods?

Back 67

high in fat or cholesterol

Front 68

step 1 for Gerd: teach to eat how many meals/day?

Back 68

4-6 small meals

Front 69

step 1 for Gerd: elevate

Back 69

head of bed

Front 70

step 1 for Gerd: avoid CCCCC

Back 70

caffeine
coffee
cigs
chocolate
constrictive clothing

Front 71

Step one for Gerd: acoid heavy lifting, ____ or working in ____________

Back 71

straining
bent over position

Front 72

Step 1 for GERD: avoid drugs that you have to take with food like:

Back 72

ASA, NSAIDS

Front 73

Step 1 for GERD: tell client they really need to

Back 73

lose wt

Front 74

Step 2/3 GERD: add following meds:

Back 74

oral H2 blocker
omeprazole (prilosec)
proton pump inhibitor
anti ulcer
antacid

Front 75

If no relief of GERD in steps 2 or 3, go to step 4: add _________ (_____) and consider surgical antireflux therapy

Back 75

metoclopramide
reglan

Front 76

When should reglan be given in regards to meals?

Back 76

30-60mins before meal

Front 77

what are s/e's of reglan?

Back 77

hallucinations
ataxia

Front 78

GER and GERD in children: Ger differs from gerd in that ger is gastric relux :

Back 78

without injury

Front 79

when does GER become GERD?

Back 79

when complications such as failure to thrive, bleeding or dysphagia develop

Front 80

GERD in children is associated with resp sx such as:

(they can't tell you they have heartburn)

Back 80

apnea
bronchospasm
laryngospasm
pneumonia

Front 81

what is now thought to be the common cause of GER in children?

Back 81

transient relaxation of the LES (lower esophageal sphincter

Front 82

Look for + what with GER?

Back 82

h pylori

Front 83

sx of GER in infants:

Back 83

spitting up
regurgitation
vomiting
excessive crying, irritability, arching of back, stiffening, wt loss, failure to thrive, resp probs (cough wheez stridor) gagging, choking following feeding, hematemesis, melena, anemia

Front 84

sx of GER in children:

Back 84

heartburn
abd pain
non cardiac chest pain
chronic cough
dysphagia
nocturnal asthma
recurrent pneumonia

Front 85

Nursing care for infants with GERD:
1. feed with
2. position?

Back 85

1. thickened formula c rice cereal
2. head elevated, prone or left side position

Front 86

Nursing care for infants with GERD: gerd worsens with

Back 86

supine position

Front 87

Herniation of a portion of the stomach into the esophagus thru an opening in the diaphragm

Back 87

hiatal hernia

Front 88

2 other names for hiatal hernia

Back 88

esophageal
diaphragmatic

Front 89

who is hiatal hernia most common in?

Back 89

elderly
women

Front 90

two types of hiatal hernia

Back 90

sliding/rolling

Front 91

rolling hiatal hernia is aka

Back 91

paraesophageal

Front 92

this is when part of the stomach 'slides' into thoracic cavity in supine position and back when upright. It is the most common type.

Back 92

sliding hernia

Front 93

fundus and greater curvature of stomach roll up thru diaphragm, forming pocket alongside esophagus

Back 93

rolling/paraesophageal hernia

Front 94

what are some precipitating factors for hiatal hernia in adults?

Back 94

obesity
pregnancy
ascites
tumors
tight corsets
kyphosis
intense physical exertion
continual heavy lifting, belts

Front 95

what are the symptoms of hiatal hernia in adults like?

Back 95

same sx as gerd, gi bleeding

Front 96

sx of hiatal hernia in infants in children:

Back 96

same sx as GERD

Front 97

what is the most common type of repair for hiatal hernia?

Back 97

nissen

Front 98

someone with hiatal hernia should have what kind of diet?

Back 98

high protein
low fat

Front 99

tell someone with hiatal hernia to avoid what 4 things?

Back 99

smoking
caffeine
etoh
tight clothing at waist

Front 100

teach someone with hiatal hernia this about eating:

Back 100

small freq. meals/feedings

Front 101

Client teaching: hiatal hernia: do not lie down for __-__ hrs after meals, sleep with

Back 101

2-3 head elevated

Front 102

What lab test is most valuable in determining nutritional status of an elderly client?

Back 102

prealb

Front 103

to have a tube feeding (PEG), the requirements must include:

Back 103

functioning gi tract

Front 104

client is bloating, several day hx of vomiting, most as risk for:

Back 104

metabolic alkalosis

Front 105

c/o burning sensation in throat, dysphagia, cough, most important hx to obtain is:

Back 105

diet hx
wt loss/gain

Front 106

if someone just underwent surgery to repair hiatal hernai (nissen) what type of diet should they have

Back 106

soft, no veggies, no carb drink, sm freq meals