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58 Cards in this Set
- Front
- Back
GERD
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Syndrome caused by reflux of gastric acids into the lower eosphagus causing mucosal damage
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What is GERD?
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NO one cause can be singled out
is the result of the esophageal defences being overwhlemd by the gastric contents coming into the lower eosphagus causing inflammation and irriation |
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What can cause GERD?
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Hiatal Hernias
incompetent lower eosphageal sphinter primary decreased esophageal clearence ability to clear food and liquids from esophgus into stomach decreased gastric emptying |
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CM of GERD
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* MOST COMMON*
Heart burn felt intermitten (if everyday seek tx) dyspesia pain or discomfort upper abdomen midline noncardiac chest pain regurgitation hot, bitter, sour liquid into throat or mouth *Respiratory s/s coughing wheezing dyspnea *Otolaryngologic s/s hoarseness sour throat lump in throat choking |
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Esophagitis
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inflammtion of the esophagus
Chronis will form scar tissue and cause stricture COMPLICATION OF GERD |
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Complications of GERD
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Esophagitis
Barret's esophagus cough bronchospasm laryngospasm cricopharyngeal spasm asthma chronic bronchitis pneumonia dental erosion |
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Barret's Esophagus
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Complication of chrnoic GERD
esophageal metaplasia- cells changes due to abnormal stimulus Flat epithelia cells in the lower esophagus changes to columnar due to continual inflammation Consider precanerous lesion biopsy confirms metaplasia surveillance endoscopy every 2-3 years |
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How to dx GERD
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H&P
s/s and response to behavioral and drug therapies Endoscopy assess compentency of LES , inflammation,scars, and strictures Barium swallow protrusion og gastric fundus Biopsy and cytologis spec cancer vs. Barrett's Esophageal manometric studies measure pressures in the esophagus and LES |
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Drug therapy for GERD
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Proton pump inhibitors
Histamine receptor blockers |
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Surgical treatment for GERD
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Nissan fundoplication
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Nursing management of GERD
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Hob 30 degrees
No lying down 2 to 3 hours after meals Avoid late night eating Avoid alcohol and caffeine Avoid acidic foods |
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What is gastritis
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Inflammation of the gastric mucosa
Common problems affecting the stomach Result of a breakdown in the mucosal barrier Can be acute or chronic |
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Risk factors for gastritis
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Drugs
NSAIDs Inhibit prostaglandin synthesis Diet Alcohol and spicy foods |
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microorganism that causes gastritis
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Can be fungal bacterial or viral
Most common bacteria H. Pylori |
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What is nausea
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Feeling of discomfort and conscious desire to vomit
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What is vomiting
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Forceful ejection of partially digested food and secretions enter
GI tract becomes overly irritated excited or distended Works as a protective mechanism Expels spoiled or irritated foods and liquids |
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What part of the CNS have to do with vomiting?
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Parasympathetic and sympathetic nervous systems are activated
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What does the parasympathetic nervous system do for vomiting
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stimulates relaxation of the lower esophageal sphincter
increases gastric motility increases in salivation |
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What is the sympathetic nervous system do during vomiting
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Causes tachycardia tachypnea and diaphoresis
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Treatment for nausea and vomiting
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If treated in a hospital;
NPO and IV fluids NG tube connected to suction to decompress the stomach Used with persistent vomiting and possible bowel obstruction Decrease stimulus development Vitals Intake and output Positioning to prevent aspiration Assess for dehydration, fluid/electrolyte imbalance |
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Foods that help with nausea
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High in potassium
Tea, bananas, cheese, whole milk Avoid foods that stimulate peristalsis Orange juice, caffeine, high fiber foods, extremely hot or cold fluids |
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Gerontolgical considerations for nausea and vomiting
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Increase car risk of cardiac and renal insufficiency
Risk for fluid and electrolyte imbalance Excessive replacement can have the opposite effect Risk for fluid volume excess or overload Antiemetic therapy Reduce dose and monitor efficacy Susceptible to CNS effects High risk for aspiration |
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What are the origins of upper GI
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Venous
capillary arterial |
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What defines the severity of an upper GI bleed
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The origin
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What are sites common for upper GI bleeds
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Esophagus
stomach duodenum |
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Causes of upper GI bleeding in the esophagus
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Chronic esophagitis
GERD caused by drugs alcohol and/or smoking Mallory Weiss- tear in the mucosa Caused by retching or vomiting Esophageal varices Secondary to cirrhosis of the liver Merging of blood vessels from the vena cava into the lower esophagus Torturous and engorged Inelastic Increase in pressure = irritation possible eruption = lots of blood loss |
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Causes of stomach and duodenal GI bleeding
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H pylori
NSAID drug use stress-related tumors vascular lesions gastric cancer |
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emergency assessment for GI bleeding
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Systematic evaluation every 15 to 30 minutes
BP pulse characteristics of the pulse cap refill neck vein distention signs and symptoms of shock respiratory status abdominal assessment history of BleEding weight loss blood transfusion reaction medication religious concerns Labs CBC BUN electrolytes glucose ABGs |
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Treatment for upper GI
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IV lines
preferably two packed RBCs isotonic fluids LR or NS ( only NS can run with blood) 02 therapy catheter gastric lavage |
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Diagnostic studies for upper GI bleeding
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Endoscopy
angiography barium swallow |
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Nursing management for upper GI bleeds
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Avoid irritants
prompt treatment of upper respiratory infections accurate intake & output hourly monitor for fluid overload ECG NG tube care avoid beats mouthwash or ingestion of things with a red tint monitor stools |
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What is the Nissen fundoplication
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It reduces the reflex of gastric contents by enhancing the integrity of the lower esophageal sphincter
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Antireflux procedure post op care Nissen fundoplication
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NPO
IV fluids NG tube until peristalsis returns |
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Stretta procedure
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Balloon tipped for needle catheter delivers radio frequency energy to the smooth muscle of the lower esophageal sphincter
Increases collagen contraction to form a barrier against reflux |
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What is Achalasia
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Absence of peristalsis in the lower two thirds of the esophagus
fluids and food accumulate in the lower esophagus resulting in dilation of the lower esophagus |
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Achalasia assessment
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Dysphasia
substernal pain halitosis inability to burp regurgitation of sour tasting food liquids weight loss globulus sensation lump in throat |
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Treatment of Achalasia
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Dilation
Dilation of the esophagus pneumatic dilation of the lower esophageal sphincter balloon tip dilator passes orally Surgery esophagomyotomy Division of muscle fibers in the esophagus Allows for swallowing without obstruction |
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Medications that treat achalasia
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Medical therapy is less effective than invasive procedures
Endoscopy with Botox injections in the lower esophageal sphincter Anticolinergics, calcium channel blockers and long-acting nitrates help relax smooth muscle |
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What is peptic ulcer disease
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Erosion of the GI mucosa
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Peptic ulcer disease affects what areas
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Lower esophagus
Stomach Duodenum |
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Acute peptic ulcers are
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Short lived
superficial erosion with minimal inflammation |
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What are chronic peptic ulcers
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Lasting for months & intermittently throughout the life
usually a erodes muscular wall |
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Where does peptic ulcer disease occur commonly
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In the lesser curvature of the stomach
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What bacteria is usually a causative factor of peptic ulcer disease
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H pylori
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What else causes peptic ulcer disease
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ASA
NSAIDs corticosteroids alcohol smoking chronic gastritis |
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What are the clinical manifestations of gastric peptic ulcer disease
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Asymptomatic is common
Burning or gaseous feeling one to two hours after meals food aggravates earliest symptoms may be a complication such as perforation |
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What are the clinical manifestations of a duodenal peptic ulcer
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Burning or cramp like
may manifest as back pain to 24 hours after meals relieved by antacid and sometimes food |
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Who is at risk for peptic
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People with COPD
cirrhosis chronic pancreatitis hyperparathyroidism chronic kidney disease smokers alcoholics |
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What are some life-threatening complications of peptic ulcer disease
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Hemorrhage
erosion of the granulation tissue erosion of the major blood vessels Perforation most lethal ulcer penetrates mucosal wall spillage of gastric or duodenal content into the peritoneal cavity sudden and severe abdominal pain *abdominal is bored like or rigid respirations are shallow and rapid absent bowel sounds nausea and vomiting present *peritonitis can usually occur within 6 to 12 hours |
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What are some complications of peptic ulcer disease
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gastric outlet obstruction
Caused by Edema, inflammation pylorospasms and scarred tissue Over time the stomach wall hypertrophy Long lasting obstruction causes stomach to dilate Pain progresses relief from belching or vomiting Manifestations; swelling in upper abdomen loud peristaltic waves visible peristaltic waves possible palpable stomach |
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Diagnostic testing for peptic ulcer disease
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Endoscopy
barium contrast studies CBC liver enzymes stool sample amylase |
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What is the goal for peptic ulcer disease
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Decreased gastric acidity
enhance mucosal defence minimize harmful effects on the mucosa |
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Collaborative care for patient with peptic ulcer disease
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Adequate rest
quiet environment decreased stressors discontinue ASA's, NSAIDs eliminate or decrease smoking and alcohol |
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Nutritional therapy for a patient with peptic ulcer disease
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Bland diet
6 small meals per day decreased stressing foods and fluids caffeine avoid alcohol avoid hot and spicy foods limit high roughage foods limit protein intake NG tube IV fluids and electrolytes |
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Medication for disease
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Histamine blockers
tagamet zantac pepcid Proton pump inhibitors prilosec protonix nexium Antibiotics Antacids Cytoprotective drug therapy carafate |
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Nursing care for a patient with peptic ulcer disease
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NPO
NG tube IV fluids regular mouth care cleansing and lubricating nares vital signs rest teaching about diet and lifestyle changes |
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What to look for in case of hemorrhage with peptic ulcer disease
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Change in vital signs
Increase in amount and redness of asiprate Sudden pain is decreased check NG tube for blood clots |
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What to look for in case of perforation with peptic ulcer disease
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Sudden and severe pain
Rigid board-like abdomen NPO immediately |