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54 Cards in this Set
- Front
- Back
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treatment: H. Pylori
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-difficult
-PPI plus 2 atb -PPI + clarithromycin and amoxicillin -PPI + bismuth subsalicylate, tetracycline, metronidazole |
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treatment: NSAID-induced ulcers
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-d/c NSAIDS if possible
-if not possible, PPI bid to promote healing |
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s/s PUD
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dull gnawing pain/burning sensation of epicastric area
heartburn burping regurgitation vomiting |
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s/s duodenal ulcer
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pain 1-3 hours after eating
pain relieved with eating black tarry stools |
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s/s gastric ulcer
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pain 30 min-1 hr after eating
pain not relieved by eating vomiting anorexia weight loss bright red hematemesis |
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classic symptom of PUD
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pain
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complications PUD
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-hemorrhage
(10-20%) -gastric outlet obstruction -perforation -stomach ca |
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patho/etiology: perforation in PUD
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penetration of ulcer through mucosal wall
gastric/duodenal contents enter peritoneum causes inflammation, peritonitis |
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chemical peritonitis
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immediate
c/b Hcl acid, pepsin, bile, pancreatic fluid |
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bacterial peritonitis
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follows chemical peritonitis in 6-12 hrs
c/b gastric contaminants enter normally sterile peritoneal cavity |
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s/s perforation
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immediate severe upper abd pain radiating throughout abd and poss to shoulder
abd rigid, boardlike absent bowel sounds poss s/s shock: diaphoresis, tachy, shallow, rapid resp |
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s/s perforation in elderly
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may not be present
mental confusion nonspecific symptoms delays dx/tx, increases mortality rate |
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Diagnostic testing:PUD
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EGD
endoscopy Upper GI barium series fecal antigen/occult blood blood tests |
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Treatments: PUD
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anti ulcer meds
PPI H2 receptor agonists surgery balanced meals at regular intervals avoid foods causing discomfort stress reduction/rest stop smoking caregiver education |
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Nursing Dx: PUD
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pain
disturbed sleep pattern imbalanced nutrition: less than body requirements deficient fluid volume |
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s/s hemorrhage: PUD
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weakness, fatigue, dizziness, orthostatic hypotension, hematemesis, melena, hematochezia, hypovolemic shock
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hematochezia
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bright red blood in stool
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ulcerative colitis definition
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an IBD that causes chronic inflammation and ulcers to superficial lining of rectum and colon
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ulcerative colitis patho
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diffuse and continuous pattern of inflammation, multiple ulcerations, shedding lining of colon
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IBD definition, types
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inflammatory bowel disease
bowel d/o causing chronic inflammation/ulceration of small or large intestines -ulcerative colitis -Crohn's disease |
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IBD causes
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infectious agents
autoimmunity genetic and environmental factors |
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s/s ulcerative colitis
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rectal bleeding
diarrhea w/blood and mucus 10-20 stools/day LLQ pain/cramping anorexia wt loss urgent need to defecate anemia vomiting dehydration fatigue malnourished arthritis uveitis |
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uveitis
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Uveitis is inflammation of the uveal tract—the iris, ciliary body, and choroid. Most cases are idiopathic, but identifiable causes include various infections and systemic diseases, many of which are autoimmune. Symptoms include decreased vision, ocular ache, redness, photophobia, and floaters.
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diagnosis: ulcerative colitis
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h & p
sigmoidoscopy with bx colonoscopy with bx barium enema or UGI stool samples CBC BMP |
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complications: ulcerative colitis
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-hemorrhage
- r/f toxic megacolon -perforation -increased r/f colorectal ca |
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toxic megacolon
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Toxic megacolon is a life-threatening complication of other intestinal conditions that causes rapid widening (dilation) of part of the large intestine within one to a few days
The rapid widening of the colon may cause the following symptoms: Abdominal pain Abdominal distention Abdominal tenderness Dehydration Fever Rapid heart rate Shock Treatment Fluids and electrolytes will be given to help prevent dehydration and shock. The process that leads to megacolon can be treated medically first. However, this is usually not enough to reverse the megacolon. If rapid widening is allowed to continue, an opening (perforation) can form in the colon. Therefore, most cases of toxic megacolon will require surgery, such as colectomy or removal of the entire colon. Antibiotics may be given to prevent sepsis (a severe infection). Toxic megacolon occurs as a complication of inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease, and infections of the colon. The term "toxic" means t |
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def: Crohn's disease
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IBD that causes chronic inflammaiton/ulcers to multiple area of GI tract (ileum)
extends through all layers of mucosa |
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patho: Crohn's disease
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-edema, swelling, thickening, scarring of mucosa
-ulcers form, are separated by normal tissue -bowel walls thicken, narrow intestinal lumen |
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s/s Crohn's disease
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*RLQ pain
palpable RLQ mass fever malaise fatigue cramps malnutrition weight loss diarrhea abscesses fistulas fissures steatorrhea |
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steatorrhea
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excess fat in feces
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diagnosis: Crohn's disease
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-H & P
-sigmoidoscopy -colonoscopy w/bx -barium enema -UGI series -stool samples -CBC -BMP |
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complications: Crohn's disease
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-intestinal obstruction
-fistulas -abscess formation -malabsorption -colon cancer |
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Treatment options: IBD
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nutrition, meds, surgery
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Nutritional therapy:IBD
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-NPO (if acute)
-po fluids -high protein, high calorie, low res diet -iron -vitamins/minerals |
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Meds for IBD
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aminosalicylates: anti inflammatory
-Sulfalazine (azulfadine)-topical on colonic mucosa to inhibit inflammatory process corticosteroids: reduce inflammation, induce remission -Hydrocortisone (rectal) -IV for severe -po for less severe, long term therapy immunomodulators: for patients not responding to other tx/chronic steroid therapy may allow w/d from steroids, maintain remission, facilitate healing. Long term use. -Mercaptopurine (Purinethol, 6-MP) -Azathioprine (Imuran) -Cyclosporine (Sandimmune) |
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surgery: Crohn's
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-ileostomy
-colectomy-removal of colon -continent ileostomy -restorative proctocolectomy with ileal pouch anal anastomosis (IPAA): -surgical treatment of choice -colon and rectum removed -pouch formed from ileum connected to anal canal |
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CAM therapy: IBD
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-peppermint, chamomile tea
-accupressure -body massage -reflexology -aromatherapy -stress reduction techniques -slippery elm -fenugreek -devil's claw -Mexican Yam -Tormentil -Wei tong ning |
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slippery elm
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Slippery elm contains mucilage, a substance that becomes a slick gel when mixed with water. It coats and soothes the mouth, throat, stomach, and intestines; it also contains antioxidants that help relieve inflammatory bowel conditions. Slippery elm also causes reflux stimulation of nerve endings in the gastrointestinal tract leading to increased mucus secretion. The increased mucus production may protect the gastrointestinal tract against ulcers and excess acidity.
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fenugreek
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Fenugreek is used both as an herb (the leaves) and as a spice (the seed).Other bioactive constituents of fenugreek include MUCILAGE
Several human intervention trials demonstrated that the antidiabetic effects of fenugreek seeds ameliorate most metabolic symptoms associated with type-1 and type-2 diabetes in both humans and relevant animal models by reducing serum glucose and improving glucose tolerance.[9] Fenugreek is currently available commercially in encapsulated forms and is being prescribed as dietary supplements for the control of hypercholesterolemia and diabetes by practitioners of complementary and alternative medicine. |
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Devil's claw
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also called grapple plant, wood spider and most commonly Devil's Claw, is a plant of the sesame family, native to South Africa. It got its name from the peculiar appearance of its hooked fruit. The plant's large tuberous roots are used medicinally to reduce pain and fever, and to stimulate digestion.The two active ingredients in Devil's Claw are harpagoside and beta-sitosterol. It is claimed that these possess anti-inflammatory properties. The British Herbal Pharmacopoeia recognises Devil's Claw as having analgesic, sedative and diuretic properties. Most studies involve chronic use rather than acute treatment of pain.
Devil's Claw is also claimed to be beneficial for treating diseases of the liver, kidneys, gallbladder and bladder, arthritis and rheumatism. It is said to help alleviate problems with and improve the vitality of the joints, as well as stimulating appetite and aid digestion, increase cholesterol and fatty acids in the blood. Devil's Claw has been recommended for treating diabetes, hardening |
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Mexican Yam
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Mexican yam or barbasco de placa (Dioscorea mexicana) is a species of yam in the genus Dioscorea. It ranges from the state of Veracruz in Mexico south to Panama. It is notable for its production of diosgenin, which is a precursor for the synthesis of hormones such as PROGESTERONE
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Tormentil
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Common Tormentil (P. erecta) was similarly used in European folk medicine, and also to treat diarrhea and other gastrointestinal ailments. It is rich in flavonoids, saponins, tannins, as well as phenol and the glycoside tormentilline, and has been shown to be bacteriostatic and virostatic.
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CAM therapy effectiveness:IBD
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Herbal remedies used by patients for treatment of inflammatory bowel disease include slippery elm, fenugreek, devil's claw, Mexican yam, tormentil and wei tong ning, a traditional Chinese medicine.
Fenugreek is not a superoxide scavenger, while Mexican yam did not inhibit radical generation by inflamed biopsies. Slippery elm, fenugreek, devil's claw, tormentil and wei tong ning merit formal evaluation as novel therapies in inflammatory bowel disease. similar to aminosalicylates |
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wei tong ning
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antioxidant, antiinflammatory properties. Chinese herb
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RN diagnosis: Crohn's
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pain
diarrhea disturbed body image imbalanced nutrition: less than body requirements teaching is important |
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GI Meds (list)
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PPI
H2 receptor blockers antacids cytoprotectives antiulcer atb for H. pylori |
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PPI:
def used for: how it works: |
-proton pump inhibitors
-used for short-term therapy for PUD, GERD -reduces acid secretions of stomach by blocking enzyme that secretes HCl |
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PPI:
examples S/E |
Omeprazole (Prilosec)
Esomeprazole (Nexium) Lansoprazole (Prevacid) Rabeprazole (Aciphex) -abd pain, diarrhea, n/v, dizziness -used with atbs for tx of H.Pylori |
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PPI: RN implications
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-can be given w/antacids
-works better than H2 receptor agonist -give 30 min prior to breakfast -don't chew, crush, or break -check liver, gastrin levels in long-term therapy -encourage smoking cessation -no breastfeeding |
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H-2 Receptor agonist:
how it works: what used for: |
-blocks H-2 receptor sites which increase stomach acid secretions
-suppresses amount of secretions and the acidity of secretions -used for GERD, PUD, heartburn |
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H-2 receptor antagonist: examples, S/E
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-Cimetidine (Tagamet)
-Famotidine (Pepcid) -Nizatidine (Axid) -Ranitidine (Zantac) S/E: dizziness, drowsiness, confusion, h/a, Vit B-12 deficiency |
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H-2 receptor antagonist: RN implications
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-do not use w/antacids
-assess kidney/liver function -monitor for s/s anemia -encourate pt to see MD if using OTC meds -give before or w/meals |
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Antacids:
how they works used for |
-neutralize stomach acids
-difficult to keep regimen: --must be taken regularly --cause constipation or diarrhea --interfere w/absorption of iron, digoxin, some atbs, other drugs -may supplement other antiulcer meds |
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Antacids: RN implications, S/E
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S/E:
diarrhea (Al/Mg++ based) constipation (Ca++ based) -may take with H-2 receptor agonist, simethicone -monitor stools -s/s hypermagnesemia: Muscle and generalised weakness Decreased reflexes (Neuromuscular depression) Hypotension, disordered cardiac rhythm (cardiac arrythmias) Drowsiness, decreased alertness and concentration, decreased rate of breathing/respiratory paralysis, CNS depression, coma -encourage MD f/u -chew tabs, shake liquids -take 1 hr after meals, 2 hrs before other meds -follow rec dose |
