Nclex Ch04 U02-04: Stomach Complications

Front 1

3 S&S of HIATAL HERNIA.

Back 1

hiatal hernia:

1. heartburn
2. regurgitation
3. dyspepsia

Front 2

What is a hiatal hernia?

Back 2

hiatal hernia: when the opening through the diaphragm where the esophagus passes becomes enlarged, and part of the UPPER STOMACH comes up into the lower portion of the thorax

Front 3

Which meds are given to tx hiatal hernia?

Back 3

hiatal hernia meds:

1. H2 receptor blockers (Tagamet, Zantac)
2. Antacids
(Amphogel, Milk of Magnesia)
3. Cytoprotective agents
(Carafate)

Front 4

How does one tx a hiatal hernia?

Back 4

hiatal hernia tx:

1. FUNDOPLICATION: surgery to tighten the cardiac sphincter

Front 5

What pt teaching should the nurse do for a pt w/ hiatal hernia regarding eating habits?

Back 5

hiatal hernia teaching:

1. small, frequent meals
2. do NOT lie down for a least 1 hour after meals
3. elevate the HOB 4-8 in when sleeping
4. do NOT eat before going to bed to prevent reflux of food

Front 6

S&S of PYLORIC STENOSIS in infants (5)

Back 6

S&S of PYLORIC STENOSIS-infants:
1. projectile vomiting
2. irritability
3. palpable olive-shaped tumor in the epigastrium
4. infant always hungry
5. infant fails to gain weight

Front 7

2 S&S of PYLORIC STENOSIS in adults?

Back 7

1. epigastric fullness
2. peristaltic waves

Front 8

What is the clinical picture of PYLORIC STENOSIS in adults?

Back 8

narrowing or obstruction of the pyloric sphincter, caused by scarring from healing ulcers

Front 9

What is the clinical picture of PYLORIC STENOSIS in infants?

Back 9

obstruction caused by hypertrophy or hyperplasia of the PYLORUS

Front 10

When is the onset of pyloric stenosis often seen in infants?

Back 10

symptoms appear in the 2nd-4th week after birth, then regurgitation develops into projectile vomiting

Front 11

Which babies are most at risk for pyloric stenosis?

Back 11

white, male, full-term infants

Front 12

In adults w/ pyloric stenosis, what is the most common obstruction caused by?

Back 12

peptic ulcer

Front 13

What impact does inflammation & edema have on the size of the opening of the pyloric sphincter?

Back 13

can reduce the size of the opening until there is a complete obstruction

Front 14

3 possible surgical interventions for pyloric stenosis?

Back 14

1. pyloromyotomy (infants): incision through circular mus of the pylorus

2. vagotomy & antrectomy: removal of GASTRIN-secreting portion of the stomach & severing vagus nerve

3. vagotomy & pyloroplasty or gastroenterostomy: establishes gastric drainage & severing vagas

Front 15

What is the pre-operative goal for pyloric stenosis?

Back 15

prevent regurgitation and vomiting

Front 16

What are possible fluid and electrolyte abnormalities that can occur w/ pyloric stenosis if the patient vomits or regurgitates?

Back 16

1. alkalosis
2. hypokalemia

Front 17

What is the role of the NGT in pre-op prep in a pt w/ pyloric stenosis?

Back 17

gastric decompression

Front 18

What are possible complications of pyloric stenosis (4)

Back 18

1. alkalosis
2. hypokalemia
3. dehydration
4. shock

Front 19

What is the diet of a pt who is post-op from a surgery to tx pyloric stenosis?

Back 19

small frequent feedings of glucose water or electrolyte solution 4-6 hr post-op

Front 20

If clear fluids are retained post-op from pyloric stenosis tx, when can you initiate formula?

Back 20

24 hr postop

Front 21

S&S of GASTRITIS?

Back 21

GASTRITIS:

1. uncomfy feeling in ab
2. headache
3. anorexia, N, V (bloody)
4. hiccupping

Front 22

What is gastritis?

Back 22

acute or chronic inflammation of stomach

*may be exacerbated by alcohol abuse

Front 23

What type of diet should a pt w/ gastritis be on?

Back 23

NPO, slowly progressing to bland diet

Front 24

Which meds are prescribed for gastritis?

Back 24

antacids to relieve pain

Front 25

2 major ulcer types

Back 25

1. chronic duodenal ulcer
2. chronic gastric ulcer

Front 26

What is an ulcer?

Back 26

an excavation formed in the MUCOSAL WALL, caused by erosion that may extend to muscle layers or through the muscle to the peritoneum

Front 27

Which infectious agent is often a/w ulcers?

Back 27

H. pylori

Front 28

Do ulcers have a familial tendency?

Back 28

yes

Front 29

3 common sites for ulcers?

Back 29

1. gastric
2. duodenal
3. marginal

Front 30

What age group is most susceptible to chronic duodenal ulcers?

Back 30

30-60 (younger than gastric)

Front 31

Risk factors for chronic duodenal ulcers? (8)

Back 31

chronic duodenal ulcers:

1. blood type O
2. COPD
3. chronic renal failure
4. alcohol
5. smoking
6. cirrhosis
7. stress
8. **MALE (3:1)

Front 32

What impact do chronic duodenal ulcers have on gastric secretion?

Back 32

chronic duodenal ulcers: HYPERsecretion

Front 33

When is pain often felt in chronic duodenal ulcers?

Back 33

2-3 hr AFTER A MEAL

nighttime, often in early sleeping hours

Front 34

For which ulcer does food intake relieve pain?

Back 34

chronic duodenal ulcers

Front 35

chronic duodenal ulcers in terms of vomiting?

Back 35

vomiting rare w/ chronic duodenal ulcers

Front 36

chronic duodenal ulcers in terms of hemorrhage?

Back 36

hemorrhage less likely w/ chronic duodenal ulcers

Front 37

chronic duodenal ulcers in terms of malignancy?

Back 37

rare w/ chronic duodenal ulcers

Front 38

Usual age in pt w/ chronic gastric ulcers?

Back 38

chronic gastric ulcers:50+

Front 39

male: female ratio for pt w/ chronic gastric ulcers?

Back 39

chronic gastric ulcers: 1:1

Front 40

Risk factors for chronic gastric ulcers (5)

Back 40

1. gastritis
2. alcohol
3. smoking
4. NSAIDS
5. stress

Front 41

impact of chronic gastric ulcers on gastric secretion?

Back 41

normal to hypOsecretion

Front 42

when does pain occur in chronic gastric ulcers?

Back 42

chronic gastric ulcers: .5-1 hr after a meal, or when fasting

Front 43

does ingestion of food help ease the pain of chronic gastric ulcers?

Back 43

NO

Front 44

vomiting in relation to chronic gastric ulcers?

Back 44

chronic gastric ulcers: frequent vomiting.

VOMITING helps relieve pain of chronic gastric ulcers.

Front 45

hemorrhage in relation to chronic gastric ulcers?

Back 45

chronic gastric ulcers: hemorrhage more likely

Front 46

malignancy in relation to chronic gastric ulcers

Back 46

chronic gastric ulcers are a/w occasional malignancy

Front 47

4 goals for living w/ ulcers

Back 47

1. avoid oversecretion & hypermotility in the GI tract
2. dietary modification
3. reduce stress
4. stop smoking

Front 48

How should a pt w/ ulcers modify his diet?

Back 48

eat 3 meals per day

*small frequent feedings are NOT necessary if the pt is taking antacids or histamine blocker

Front 49

What dietary components should a pt w/ ulcers avoid?

Back 49

1. extremes in T (too hot, too cold)
2. coffee, alcohol, caffeinated drinks
3. milk & cream

Front 50

What is the impact of smoking on ulcer repair?

Back 50

inhibits

Front 51

5 antiulcer meds?

Back 51

1. antacids (Maalox)
2. Histamine receptor site antagonist (cimetidine, ranitidine)
3. anticholinergics (pro-banthine)
4. cytoprotective agents (carafate)
5. PPIs (prilosec)

Front 52

Which meds should a pt w/ an ulcer take 1 hr BEFORE MEALS?

Back 52

1. antacids(may also be taken 1 hr after)
2. cytoprotective agents

Front 53

Which med should a pt/ w/ an ulcer take 30 min before meals?

Back 53

anticholinergics

Front 54

When should a pt w/ an ulcer take a histamine receptor site antagonist?

Back 54

with meals

Front 55

What is the diagnostic work-up involved in dx an ulcer?

Back 55

1. upper GI series
2. endoscopy
3. CAT scan

Front 56

4 surgical tx for ulcers?

Back 56

1. gastrectomy
2. vagotomy
3. Billroth I
4. Billroth II

Front 57

What is a gastrectomy?

Back 57

removal of stomach and attachment to upper portion of duodenum

Front 58

What is a vagotomy?

Back 58

cutting the vagus nerve (decreases HCl secretion)

Front 59

What is a Billroth I?

Back 59

partial removel (1/3-1/2 of the stomach), and anastomosing it with the DUODENUM

Front 60

What is the Billroth II?

Back 60

removal of the distal segment of the stomach and antrum, and anastomosing it with the JEJUNUM

Front 61

4 important actions a nurse should perform for a patient s/p sugery for ulcer tx?

Back 61

1. assess VS
2. inspect dressings
3. provide gastric decompression as ordered
4. encourage deep breathing

Front 62

Which vitamin is required for life s/p a surgery to tx ulcers?

Back 62

VITAMIN B12 via the parenteral rout

Front 63

In addition to Vitamin B12, which element is also important post-op a surgery for ulcers?

Back 63

FE SUPPLEMENTS

Front 64

4 ways to observe for peristalsis in a pt s/p an ulcer tx surgery?

Back 64

1. levin tube
2. salem sump
3. listen for bowel sounds
4. record passage of flatus/stool

Front 65

What is the significance of the LEVIN TUBE s/p an ulcer tx surgery?

Back 65

single-lumen tube at low suction

Front 66

What is the significance of a SALEM SUMP s/p an ulcer tx surgery?

Back 66

double-lumen tube for drainage

Front 67

What are 4 actions a nurse should take for a pt who has a salem sump?

Back 67

1. prevent nostril irritation
2. libricate tube around nares w/ water-soluble jelly
3. control excessive nasal secretions
4. observe drainage for VOLUME & BLOOD

Front 68

What is dumping syndrome?

Back 68

rapid passage of food from stomach, causing diaphoresis, D, hypOtension

* s/p an ulcer tx surgery

Front 69

What are 6 preventative measures for dumping syndrome s/p an ulcer tx surgery?

Back 69

1. restrict fluids w/ meals (drine 1 hr ac or 1 hr pc)
2. eat in a semi-recumbent position
3. lie down 20-30 min after eating
4. eat smaller, frequent meals
5. low carbs & fiber diet
6. antispasmotic meds