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76 Cards in this Set
- Front
- Back
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What are some clinical manifestations of GERD
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Dyspepsia, regurgitation, eructation, flatulence, hypersalvation, chronic cough, asthema atypical chest pain, bloating, N/V
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What can be a contributor of GERD
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Helicobactor
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What are some assessment procedures of GERD
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24-ambulatory monitoring
EGD Esophageal manomentry |
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What are some factors that contribute to Decreased esophageal sphincter pressure
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Fatty foods
Caffeine(coffee, tea, cola) chocolate citrus fruits smoking, alcohol Calcium Channel Blockers, Nitrates, anticholinergic, |
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what is esophageal manomentry
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(motility testing)may be performed when the diagnosis is uncertain, water filled catheter inserted in the nose or mouth and slowly withdrawn while measurements of the LES pressure and peristalsis are recorded.
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What are some non-surgical interventions for GERD
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dont eat after 7pm
eat 4-6 small meals remain upright for 2 to3 hrs after eating elevate head of bed 6 to 12 in DEC weight CPAP for sleep apnea DEC sedatives, NSAIDS, oral contraceptives, nitrates, CCB, anticholinergic agents |
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Drug therapy for GERD
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Histamin receptor antagonists
antacids proton pump inhibitors prokinetic drug |
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Surgical management for GERD
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Endoscopic (stretta and Gastroplication)
Laparoscopic Nissen Fundoplication (gold Standard |
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What are some clinical manifestations of sliding hernias
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heartburn
regurgitation chest pain dysphagia belching symptoms worsen after eating/supine |
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what is an assessment for Hiatal hernia
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barium swallow study with fluoroscopy
ECD |
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what are some teaching of hiatal hernia
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avoid eating in the late evening
sleep head of bed elevated refrain from tight clothing dec weight avoid vigurous exercise/straining |
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Drug therapy for hiatal hernia
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antacids
histamine receptor antagonists |
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surgical management of hiatal hernia
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laparoscopic nissesn fundoplication(gold standard)
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what are some clinical manefistations of gastritis
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abdominal tenderness, epigatric pain
bloating dyspepsia melena hemorrhage |
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nonsurgical procedures of gastriris
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EGD(gold standard)
Rapid urease testing cytologic exam |
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prevention of gastritis
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eat well balanced diet
avoid alcohol use caution with large doses of aspirin, nsaids, corticoisteroids avoid excess, teat, coffee, caffine manage stress |
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drug therapy for gastritis
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H2 receptor antagonists
proton pump inhibitors mucosal barrier antacids Proton pump inhibitors vit. B 12 |
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surgical management of gastritis
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partial gastrectomy
pyloroplasty vagotomy total gastrectomy |
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what is the four major things to do for a peptic ulcer
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provide pain releif
eradicate helicobactor pylori infection heal ulceration prevent reaccurence |
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drug treatment for peptic ulcers
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antibiotics
proton pump inhibitors h2 receptor antagonists prostaglandin analogues antacids mucosal barrier |
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gastritis
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use caution with large doses of aspirin, NSAIDS, corticoisteriods
Avoid contaminated water/food(lead, nickle) |
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malnutrition 3 differ types
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marasmus
kwashiorkor marasmic-kwashiorkor |
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marasmus
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body fat and protein are wasted, serum proteins are often preserved
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kwashiorkor
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lack of protein quality with adequate levels.
(weight is normal, not enough protein) |
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marasmus-kwashiorkor
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combination of the two
(protein and energy malnutrition) chronically starved patient |
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bolus feeding
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shake up administer through tube q4h
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re-feeding syndrome
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can cause electrolyte shift (insulin resumes with re-feeding)
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helicobactor pylori treatment
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proton pump inhibitor
metronidazole and tetracycline biasions and amocillion |
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what do you want to be cautious with when giving an H2 blocker
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nizatidine-used cautiously with RF,
observe for dysrhythmias mix only with apple juice |
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H2 receptor atagonists
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zantac
pepcid axid |
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antacids
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dont give within 1 to 2 hrs with any other meds
avoid wintergreen gum |
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lactose intolerance causes
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bloating, cramping, diarrhea from a lack of the enzyme lactoase
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a bulging pulsating mass present in the abdomen may be a sign of a
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aortic aneurysm
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lab assessments to determine malnutrition
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DEC. hemoglobin
DEC. hematocrit 3.5-5.0 normal serum alubmin(a plasma protein) 15-36 normal prealbumin transferrin(iron transport protein) normal <200 cholesterol <1500 total lymphocyte count |
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antacids- Used for gerd and hiatal hernias
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1.Mylanta, -INC ph by deactivating pepsin
2.Maalox-Inc ph by deactivating pepsin 3.Sodium Bicarbonate (Gaviscon)- buffers acid in stomach *give 1hr b4 meals, 2-3hr after(works best on empty stomach) |
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H2 blockers(histamine receptor antagonists)-Used for GERD AND HIATAL HERNIAS
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zantac (ranitidine)
pepcid(Famotidine) Axid (mizatidine) DEC. acid secretions admin. with meals and at bedtime |
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PPIs -used for GERD and HIATAL HERNIAS
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prilosex(omeprazole)
prevacid(lansoprazole) achiphex(rabeprazole) protonix(pantoprazole) nexium(esomeprazole) dec gastric production take before meals do not crush works in small intestine used for sever GERD, long acting -interfere with calcium absorption and protein digestion |
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prokinetics-used for gerd and hiatal hernias
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reglan (metoclopromide)
INC gastric emptying take drugs before meals and at bedtime |
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Drugs used for stomach disorders
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H2 blockers
mucosal barriers antacids PPI prostaglandin analogs antibiotics |
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prokinetic drugs can affect
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nuero-
causing restlessness, anxiety ataxic, hullucinations |
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what medication do you not crush, chew, or give with any other IV's
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Proton pump inhibitors
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what medication do you teach to wear with sunscreen
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rabeprazole
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mucosal barrier
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carafate
sulcrate (protect stomach mucosa) single dose at bedtime.do not crush |
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prostaglandin
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"zole"
omeprazole lansoprazole rabeprazole pantoprazole esomeprazole (decreases gastric secretion and enhances resistance to mucosal injury when taking NSAIDS) take with food, avoid magnesium containing antacids. |
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antimicrobial
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treat helicobactor pylori
biaxin amoxil flagyl tetracycline |
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what are some things that put clients at risk for GI problems
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smoking
socioeconomic factors herbal preparations use of NSAIDS |
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the perietal cells secrete
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Hydrocloric acid and instrisic factor
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in older adults you want to increase_______bc of a dec in HCL acid
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encourage bland foods high in vitamins and iron
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what foods can yield a false positive on a fecal occult blood test
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raw veg., fruits, red meats, vit.
(anticoagulants should be discontinued 7 days before testing) |
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Radiographic imaging
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plain film-(x-ray)can reveal abnormalities, masses, tumors, obstuctions
acute abdominal series-used if a perforation is expected |
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Drugs used for a EGD sedation
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midazolam, fentanyl, propofol,
atropine sulfate-used to dry secretions spayed to inactivate the gag reflex and facilitate passage of tube |
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in older adults the peristalsis decreases, encourage them to
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eat foods high in fiber and drink 1500ml of fluid
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lactose intolerance causes
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bloating, cramping and diarrhea
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endoscopy
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a direct visualization of the GI tract using a flexible firberoptic endoscope
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ultrasonography
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high-frequency waves passed through body via a transductor,patient drinks 1 to 2 L of fluid before test
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endoscopic ultrasonography
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provides images of the GI wall and high-resolution images of the digestive organ
useful for diagnosing tumors of the GI system |
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gastroplication procedure
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physician tightens the LES using sutures near the spincter
-uses moderate sedation 45 min procedure 1-2 days absent from work |
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post op instruction after endoscopic therapies or stretta procedure
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remain on clear liquids for 24 hrs after procedure
increase to soft diet avoid NSAIDS and aspirin for 10 days use clear liguid meds whenever possible do not allow NG tube for up to a month |
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post op instruction for laparoscopic Nissen Fundoplication
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stay on soft diet for a wk
remain on antireflux meds for at least a month do not drive for a wk after surgery walk everyday report fever above 101 |
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post op care after EGD
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vitals q15 min
NPO until gag reflex returns instruct not to drive for 12 hr after monitor for s/s of perforation(bleeding, fever, pain) |
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gastric analysis
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NPO 12 hr before test
NG tube insertion teach patients to avoid tobacco, alcohol, drugs 24 hr before test |
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1.inc levels of gastric secretion suggest
2. dec level of gastric secretion suggest |
1.ellison syndrome
2.gastric cancer |
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drugs-lifestyle changes with esophageal problems
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decrease sedatives, NSAIDS, oral contraceptives, nitrates, ccb
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what are the certain medications that irritate gastritis
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corticoisteroids, chemo, arithromicin, NSAIDS, aspirin
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hypovolemia management
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monitor serum electrolytes,
insert 2 large bore iv(fluids, and blood) volume replacement should be started immediatly ortho. hypotension if common check vitals q15min |
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Dietary guidelines for americans
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consume less than 300mg per day
reduce intake of solid fats and added sugars reduce daily sodium intake to less that 2300 mg (older adults red sodium to <1500mg) |
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lacto-vegetarian
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eats milk, chess, and dairy foods but avoids, meat, fish, poultry, and eggs
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lacto-ovo-vegetarian
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includes eggs in diet
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vegan
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only eats plant foods
(can dev. anem9ia as a result of vit b12 deficiency, therefore include fortified breakfast cereal , meat substitute) |
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nutrition screening
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height and weight, weight history,
usual eating habits, ability to chew and swallow and recent changes in food and appetite or food intake |
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nutritional status
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reflects balance between nutrient requirements and intake
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anthropometric measurements
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height and weight and assessment of body fat
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normal BMI score
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18.5-25
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nasoenteric tube
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keofeed, entriflex, dobbhoff
NG tube Nasoduodenal tube(used for short term(<4wk) |
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enterostomal feeding tubes
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long-term feeding
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the most common electrolyte imbalances associate with eternal nutrition therapy is
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hyperkalemia and hyponatremia
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