Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
160 Cards in this Set
- Front
- Back
|
what are our fat Sol. Vits?
|
All
Dogs Eat Kible |
|
|
What 3 parts of the body make up the upper GI?
|
mouth
esophagus stomach |
|
|
what are our H2O Vit.?
|
Beachs
Canals |
|
|
how many callories is fat, COH, proteins, and ETOH?
|
COH 4
proteins 4 ETOH 7 Fat 9 |
|
|
normal Lab values for albumin, prealbumin, protein transferrin
BUN and Creatinine |
Albumin 3.8-4.5 g/dl
Prealbumin 20 mg/dl Protein 6-8 g/dl BUN 7-18 Creatinine 0.6-2.4 |
|
|
Which shows a better nutritional status Albumin or Prealbumin?
|
Prealbumin is more current (Albumin stays in the system 20-22 days, Prealbumin stays in for 2 days)
|
|
|
Why don't we see Prealbumin used more often?
|
it's expensive
|
|
|
Why is Transferrin important?
|
it aids in Iron transport
|
|
|
What happens to Protein with declining nutritional states?
|
it decreases
|
|
|
BUN and Creatinine will be increased or decreased with poor portein intake?
|
decreased
|
|
|
What else could cause problems with nutrition?
|
The Pt's own medication (an antibiotic that makes somebody nauses)
|
|
|
what is another name for oral cancer?
|
Oropharyngeal
|
|
|
Where can oral cancer occur?
|
lips
mouth tongue floor of mouth bucaal mucosa palates phryngeal walls tonsils |
|
|
What type of oral cancer is the most common and how can it been seen in charts?
|
Squamous cell carcinoma
"SCC" in chart |
|
|
What are the leading predisposing factors?
|
Tobacco
ETOH poor dental care HPV the sun (lips) |
|
|
What are the 3 tx's of oral cancer?
|
Surgery
Chemo Radiation |
|
|
as we age what slows down in our GI function?
|
our GI function slows
we don't eat as much salivary glands and taste centers change and we tend to crave sweets |
|
|
Which fills you up faster fats or COH?
|
fats
|
|
|
which is better for you simple COH or complex?
|
complex
|
|
|
how can we look with poor nut.?
|
Skin (dry, hard)
nails (brittle, yellow) mucos (dry) muscles (wasting) enery (tired) hair (falling out) Wt changes |
|
|
what is done for muscle measurements?
|
anthroprometric measurements
|
|
|
what is Leukoplakia?
|
white patch in mouth?
|
|
|
what does Leukoplakia a sign of?
|
precancerous lesion
|
|
|
Esophageal cancer involves what?
|
The esophagus
|
|
|
what are the two PF for E.C.?
|
Tobacco
ETOH |
|
|
what are the two types of cancerous cells involved?
|
Adeno carcinoma
Squamous cell carcinoma |
|
|
Achalasia is what?
|
delayed emptying of esophagus
|
|
|
how would the PT descibe Achalasia
|
I eat, but nothing moves down
|
|
|
T/F
Symptoms of E.C. are mainly early |
F, symptoms or signs don't present until the cancer is advanced
|
|
|
what are the S/S of E.C.?
|
Pain
Wt loss |
|
|
how is E.C. diagnosised?
|
Barium swallow
Endoscopy CT MRI |
|
|
Can glucophage be given during Barium swallow?
|
Yes
|
|
|
What type of condition can also cause E.C.?
|
Barretts esophagus
|
|
|
What happens in Barretts?
|
Erosion to the esophagus cells are changed and become cancerous
|
|
|
What are the tx's for EC?
|
Surgery:
Esophagectomy Esophagogastrostomy Esophagoenterostomy |
|
|
What is done in Esophagectomy?
|
complete removal of the esophagus
|
|
|
What is done in Esophagogastrostomy?
|
a portion is removed and the rest is connected to the stomach
|
|
|
What is done in Esophagoenterostomy?
|
a graph from the colon is taken to replace the diseased porton of the esophagus
|
|
|
what is anastamosis?
|
the new place where the esophagus is connected to the stomach
|
|
|
what is the porblem with the anastamosis?
|
leaking can occur
|
|
|
how can the surgery be done?
|
either thoracic or abdominal thoracic
|
|
|
what will be in place if it is done through the thoracic?
|
A chest tube is place
|
|
|
What are the other 2 tx's?
|
Chemo
Radiation |
|
|
What care should be given to E.C.?
|
good oral care
yearly screening |
|
|
What occurs to the stomach during and after surgery?
|
The stomach see's the surgery as an invasion so it sets off the inflammatory response
|
|
|
So what happens to peristalsis after surgery?
|
it stops
|
|
|
What does the stomach release after surgery?
|
inflammatory response releases emzymes and mucos
|
|
|
So no peristalsis and a build up of fluid what happens?
|
Pt becomes nauses and vomits
|
|
|
So what is done to prevent vomiting?
|
placement of an NG tude for suction
|
|
|
What is normal draingage after surgery?
|
bloody drainage 8-12 hrs afterwards
|
|
|
what can an RN do with the NG tube?
|
NOTHING
DON'T move it DON'T replace it DON'T flush it |
|
|
how long should the PT lay flat?
|
Don't place the PT flat, HOB up
|
|
|
what type of feeding is normally started first?
|
clear liquids (30-60ml) if the stomach is okay
TPN if stomach isn't okay |
|
|
What is in a clear liquid?
|
anything that can be seen through
|
|
|
is milk clear liquid?
|
No
|
|
|
apple juice a clear liquid?
|
yes
|
|
|
OJ is a clear liquid?
|
No, it has pulp
|
|
|
Jello a clear liquid?
|
Yup
|
|
|
Broth a clear liquid?
|
Yes
|
|
|
is a popscile a clear liquid?
|
Yes, you can see through it at room temp
|
|
|
what are 2 examples of full liquids?
|
milk, OJ
|
|
|
What is the main determining factor in what feeding plan to use?
|
the stomach, "If the gut works use it"
|
|
|
Why is stageing important?
|
treatment for a stage I is different from a stage IV
|
|
|
GERD is what?
|
reflux of gastric contents into the lower esophagus
|
|
|
Is GERD a mechanical problem or erosive problem?
|
mechanical, the L.E.S. isn't closing correctly
|
|
|
What are some PF's for GERD?
|
Tobacco
ETOH chocolate obesity |
|
|
What are some functional reasons for GERD?
|
weak LES
decreased esophagus clearence Hital Hernia impaired esophagal motility delayed emptying |
|
|
manifestations of GERD are?
|
heart burn (pyrosis)
Dyspepsia (painful swallowing) regurgitation (tastes hot, bitter, sour) |
|
|
Complications of GERD are?
|
Esophagitis
Esophageal stricture Barretts Esophagus |
|
|
Esophagitis is what?
|
inflammation of the esophagus if an area is so inflammed it can tear.
|
|
|
What is it called if there is a tear due to GERD?
|
Mallory-Weiss tear
|
|
|
Narrowing or stricture formation due to scars or inflammation which causes swallowing problems is what?
|
Esophageal stricture
|
|
|
a esophageal metaplasia which is a precancerous lesion that increases the risk of cancer, normal squamous epithelium is replaced with columnar epithelium
|
Barrett's Esophagus
|
|
|
How is GERD diagnosised?
|
UGI endoscopy
Barium swallow motility studies PH monitoring capsule endoscopy |
|
|
how is Barium swallow used?
|
Contrast is drank and it will show up on X-Ray. (Increase fluids and use of lax's because if barium isn't cleaned all the way out, it will solidify and cause a fecal impaction)
|
|
|
motility studies is done how?
|
a radioactive material is added to food then ate and then stomach is scanned to see how long it takes the stomach to empty
|
|
|
PH monitoring is used how?
|
a PH probe is placed in the stomach to measure PH over a 24 hour period
|
|
|
What is the capsule endoscopy?
|
a small camera is injested and it takes pictures as it travels through the GI, then the camera is discarded in feces
|
|
|
What are some teachings for GERD?
|
HOB up 4-6 in.'s
avoid eating late at night drink fluids inbetween meals (so not to over load the stomach) small meals stop or reduce smoking and ETOH wait 2-3 hr's before laying down after eating Wt loss the diet should be high in Protein and low in fat |
|
|
What meds are used to tx GERD?
|
H2 receptor blockers
antacids cholinergics PPI cytoprotective |
|
|
Why are H2 blockers used to tx GERD?
|
They decrease the secretion of HCL
Tagament Zantac Pepcid |
|
|
Why are antacids used to tx GERD?
|
They neutralize HCL and should be taken 1-3 hrs before eating
Gaviscon Maalox Mylanta |
|
|
What is the complication of taking antacids so much?
|
Metabolic Alkalosis
|
|
|
Why are Prokinetic's used to tx GERD?
|
They aid in the motility of the stomach
Reglan |
|
|
Why are Cholinergic's used to tx GERD?
|
They increase the LES pressure giving it the ability to close
Urecholine |
|
|
Why are PPI's used to tx GERD?
|
They block the proton pump which releases HCL into the stomach
Nexium Prevacid Prilosec Protonix Aciphex |
|
|
Why are cytoprotective's used to tx GERD?
|
They form a protective lining over the stomach
Gaviscon Carafate |
|
|
If medications aren't working what else can be done for GERD?
|
Surgery
|
|
|
What are 2 types of surgery?
|
Nissen Fundoplication
Stretta |
|
|
Nissen Fundoplication is what?
|
the fundus of the stomach is wrapped around the distal esophagus and sutured to itself (it prevents food from moving upward)
|
|
|
What happens in the Stretta?
|
Radiofrequency is used to form a collagen barrior at the top of the stomach (non invasive)
|
|
|
What other complication of GERD is there?
|
The Hiated Hernia
|
|
|
What happens with a Hiated Hernia?
|
a portion of the stomach is pushed through the LES and diaphragm and into the esophagus.
|
|
|
what are the PDF for a HH?
|
age
obesity pregnancy ETOH smoking eating large meals |
|
|
what is a common manifestation?
|
pain while laying down, it goes away while sitting or standing
|
|
|
a common cause of PUD is what?
|
H.Pylori bacteria that breaks down the mucosal layer
|
|
|
PUD is what?
|
an ulcer that is formed in the stomach that eats through the protective lining of the stomach
|
|
|
PUD is a mechanical or erosive problem?
|
Erosive
|
|
|
What agents help break down the protective lining?
|
ASA
NSAIDS Steriods Smoking |
|
|
What are the 3 types of Ulcers?
|
Gastric
Duodenal Stress |
|
|
Gastric Ulcers are?
|
in the lesser curvature
|
|
|
what are the manifestations of Gastric Ulcers?
|
burning and pressure (they make the most gastric juices)
Back and Upper abdominal pain Pain 1-2 hrs after eating N/V Wt loss |
|
|
Duodenal Ulcers are?
|
caused by H. Pylori, associated with other diseases
|
|
|
What are the manifestations of Duodenal Ulcers?
|
Burning/Cramping
Mid-epigastric and upper abd. pain Pain 2-4 hr's after meals in the middle of the night relief from antacides or food some N/V |
|
|
Stress Ulcers are?
|
Ulcers fromed from major insults to the body (shock-hypotension, burns, injury)
|
|
|
What 2 drug classes are used in the prevention of PUD?
|
H2 blockers
PPI's |
|
|
What diagnostic tests are used in PUD?
|
Endoscopy with biopsy
Esophagogastroduodenoscopy (EGD) Camera capsule |
|
|
What diet tx's are there for PUD?
|
lifestyle changes
no spicy foods, ETOH, carbonated beverages, food high in roughage |
|
|
What are some examples of food high in roughage?
|
raw fruit
salads vegetables |
|
|
What should a person with PUD do to minimize roughage irritation?
|
take time to chew them, then they aren't as irritating
|
|
|
What is the meal plan?
|
6 small meals a day
|
|
|
What is the nursing care of a PT with PUD in the hospital after bleeding?
|
Pain will decrease in 3-9 wks
no ASA, NSAIDS take tylenol decrease stress |
|
|
What are the meds for PUD?
|
same as for GERD
antacids H2 blockers PPI |
|
|
What 3 additional meds are there?
|
Anticolingerics (decrease HCL)
Antibiotics (tx H. Pylori) Cytoprotective (protect the lining) |
|
|
What are the Antibiotics?
|
Amoxicillin
Flagyl Tetracycline Biaxin |
|
|
What are the Cytoprotectives?
|
Carafate
Pepto-Bismol |
|
|
What is the most common cause of stomach cancer?
|
Adenocarcinoma
|
|
|
Who is most likely to get stomach cancer?
|
African Americans
Hispanics Asian |
|
|
Is stomach cancer found early or late?
|
Late
|
|
|
Post Op drainage is what?
|
No moving of NG tube
bloody drainage first 24hrs. after 24 the fluids will be yellowish, greenish, brownish |
|
|
What RN care is involved?
|
monitor Output
keep tube patent assess abd. wound listen for bowel sounds (absent is normal, should return within a few days) |
|
|
What is shown when the Pt can pass gas?
|
Peristalsis has returned
|
|
|
When should the Pt get out of bed?
|
after 24 hrs.
|
|
|
What 3 complications could occur from stomach surgery?
|
DVT
Dumping syndrome Postprandial hypoglycemia |
|
|
What is Dumping Syndrome?
|
it's when food moves through the stomach so quickly it "dumps" into the intestins
|
|
|
What are S/S of Dumping?
|
Weakness
Dizzy Palpitations |
|
|
When does it occur?
|
15-30 min after a large meal containg of COH, fats, proteins, or hyperosmolar meals
|
|
|
What is Post Prandial Hypoglycemia?
|
it's uncontrolled gastic emptying of a bolus of fluid high in COH and to much insulin is realsed
|
|
|
When does it occur?
|
2 hrs. after eating
|
|
|
what are S/S of PPH?
|
sweating
weakness mental confusion palpitations tachycardia anxiety |
|
|
What are the 5 types of stomach surgery?
|
Vagotomy
Billroth 1 Billroth 2 Pyloroplasty Antrectomy |
|
|
What is done in Vagotomy?
|
severing of the vagus nerve, either totally or selectively
|
|
|
What is done in Billroth 1?
|
removal of the distal 2/3 of stomach
anastomosis of the gastric stump to DUODENUM |
|
|
What is done in Billroth 2?
|
romoval of the distal 2/3 of stomach
anastomosis of the gastric stump to JEJUNUM |
|
|
What is done in a Pyloroplasty?
|
enlargement of the pyloric sphincter
|
|
|
What is done in a Antrectomy?
|
removal of part of the stomach
|
|
|
What are 2 major complications of stomach surgery?
|
Hemmorrhage
GI bleed |
|
|
Hemmorrhage happens how?
|
erosin of tissue and blood vessels
it can be sudden or insidious (occult) severity depends on if it's a arterial, venous, or capillary bleed |
|
|
What are 3 manifestations of hemmorrhage bleeding
|
Hematemesis (vomiting)
Melena (black tary stool) Occult (hidden blood in stool) |
|
|
What are some things an RN will monitor?
|
Hypovelemic shock
IV placed V/S (ortho) LOC fluid replacement output check stool (for blood) |
|
|
What are the tx. for for hemmorrhage?
|
Lab test (H&H Q4 or Q6)
blood replacement assessment of Abdomin |
|
|
What is Perferation?
|
contents leaking into peritoneal cavity
|
|
|
How will the Pt act and look?
|
-PT will complain of abd pain
-stomach will be board like hard and ridged -Pt may also complain of shoulder pain -Knees will be drawn up -shallow, grunting respirations |
|
|
What should the RN do?
|
-V/S Q15-30 min
-Stop all oral or NG drugs and feedings -IV rate should stay the same or increased |
|
|
What else will be given during a perferation?
|
antibiotics due to peritonitis which could kill somebody in 6-12 hrs.
|
|
|
What is gastic outlet obstruction?
|
intitially stomach hypertrophies then after a while it dilates and antony occurs
|
|
|
What 3 things could a Pt do if they have gastric outlet obstruction?
|
Pain
Belching Vomiting (projectile) |
|
|
What are the ranges for Obesity?
|
25-29.9 Over Wt
30-40 obese 40< morbid obese |
|
|
of "apple" and "pear" shaped which is worst?
|
apple
|
|
|
What are the health risks for Obesity?
|
-Cardovascular
-Respirations -Diab. M -Muscloskeletal -GI/Liver -Cancer -Psychosocial |
|
|
What are some WT loss things that can happen?
|
Nut. therapy
Exercise Behavior mod Support Groups Drug therapy |
|
|
What surgeries can be done?
|
Bariatric band surgeries
Malabsorptive surgeries |
|
|
Who can have these surgeries?
|
people who are morbidly obese
or have comorbity diseases due to obesity |
|
|
PreOP teaching is what?
|
This is a lifelong change
smaller meals and meals that aren't high in COH |
|
|
What is done in the band surgery?
|
a band is placed over the fundus of the stomach to only allow 15-30 mls of fluid in
|
|
|
What is the gold standard procedure in malabsorptive?
|
Roux-en-Y Gastric Bypass
|
|
|
What is done in Malabsorptive surgery?
|
the surgeon will bypass various lenghts of small intestins so less food is absorbed
|
|
|
Post Op care include
|
NG tube in place
open airway DVT's (SCD's in place) longterm implications and lifestyle changes |
|
|
What else would the Post Op bariatric Pt be on?
|
LMW Heparin
small meals life long Vit's and Protein suppliments |
|
|
what could happen with a Type 2 Diabetic?
|
They may not need to take oral meds, due to the wt loss (could happen in 3-4 days)
|
