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193 Cards in this Set

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when is parental nutrition used?
When patients gi tract cannot be used. provides all the nourishment the patient needs
What are the 2 kinds of parental nutrition
Partial/peripheral or total
When is partial nutrition given
When short term nutritional support is needed either because the patient cant or wont eat.
Where is partial nutrition given?
Peripherally usually through one arm
What is the percentage of glucose in partial nutrition
10% max
What kind of line is used with total nutrition?
Central line or PICC line
What is the solution for total nutrition determined by?
the patients needs
What are some possible complications with the insertion of a total nutrition line?
Pneumothorax, hemothorax, air embolism, nerve injury, malpositioned catheters.
What are some possible complications while the catheter is in place?
Catheter movement, ohlebitis, thrombosis, infection, Fluid and electrolyte imbalances
What is some nursing care for patients on TPN?
-TPN must be ordered for each bag to be hung
- must be administered via an infusion pump
-Must to infused at a constant rate
-When initiating and dc infusion must gradually start and stop (start at 1/2 order for one hour and stop at 1/2 order for one hour.
What is some nursing care for patients on TPN?
-If next TPN bag in not available hang d10w (hospital policy)
-Accuchecks every 6 hrs
-Solution bag must be changed every 24hrs
-Check for compatibility with other meds
-Cannot give blood or blood products with TPN
-Monitor labs
-monitor daily weights
-use aseptic technique when caring for the catheter site.
What is peritonitis?
Local or generalized inflammation of the peritoneum
what is the primary cause of peritonitis?
Caused by acute bacerial infection that develops as the result of contamination though the vascular system.
what is the secondary cause of peritonitis?
caused by bacterial invasion due to an acute abdominal disorder ( gangerous bowel, perforated viscera
what are some clinical manifestations of peritonitis?
-Pain and tenderness of abdomen, rebound tenderness
-RIDGID BOARDLIKE ABDOMEN
-abdominal distention
- paralytic ileus- decreased bowel sounds
- increased WBC count
what are some clinical manifestations of peritonitis?
-Increased temp
- Nausea and vomiting
- hiccups due to irritation of the diaphragm
-sings of shock- tachycardia, decreased BP, olguria, restlessness, pallor
What is the treatment of peritonitis?
-Surgery to correct underlying prblems
-Antibiotics
-correction of electrolyte imbalances
-TPN
-patients are usually critically ill
-
What are 2 examples of inflammatory bowel diseases (IBD)?
Crohns disease, ulcerative collitis
What is the ediology of IBD?
Unknown but linked to the following-
-Family history
-Infectious diseases and autoimmune disorders
-Environmental stimuli
-aggrevated by smoking cessation
What is the peek period of onset for UC and CD
UC- 15-25 years and 55-65 years
CD- 15-40
What is the pathophysiology of UC
it is a diffuse, sontinuous inflammatory process characterized by edema and shallow mucosal ulcerations.
Where does UC start and end?
It begins in the rectum and proceeds continuously back twards the cecum
The mucosa of the colon may develop superficial bleeding points and then may become ulcers
jj
This inflammation over a period of time causes the mucosa to thicken and scar which results in loss of elasticity and the development of pseudopolyps
jj
What is the pathophysiology of crohns disease
The inflammatory process may occur anywhere along the GI tract but is often involves the terminal ileum
It affects all layers of the mucosa
JJ
it has a cobblestone apperance where the inflamed areas are separated from the normal tissue
jj
fistulas may develop causing perforation
jj
What are the symptoms of UC
-DIARRHEA 10-20 stools a day
- stools contain mucous, pus, blood
-may have cramping prior to stool
- electrolyte imbalances
-tenesmus- uncontrolled straining
what are the symptoms of crohns disease
-5-6 large semi solid stools a day
- May contain mucus and pus but no blood
-Steatorrhea
-abd colicky pain relieved with bm
-right lower quadrant pain which mimics apendicitis
what are some symptoms of both UC and Crohns disease?
Anorexia, weakness, weightloss, leukocytosis, iron deficency anemia
How do you diagnosis IBD?
-Hx of symptoms, severity and symptoms
-stool specimens to RO infectious disorders
- lab test- CBC, ESR, albumin
-Barium enema
-upper GI
-Sigmoidoscopy or colonoscopy
What medicines are used to treat IBD
Sulfazalazine, steroids, immunosuppressive therapy, antibiotics
What are sulfasalazines used for?
To treat mild to moderate forms of UC and Crohns disease. unsure exactly how it works but is thought to decrease inflammation with bacterial suppression
What are steroids used for?
anti-inflammatory agent. not recommended for long term therapy due to the adverse effects of steroids. often given during periods of excerbations.
What kind of diet is imporntant to treat IBD
low fiber, may need to restrict diary products, may restrict raw fruit and vegetables, spicy foods, alcohol, and caffeine. may need TPN.
T or F, diet control is more imporntant for comfort than for treatment?
true
What are some indications for surgery for patients with IBD?
Perforation, toxic megacolon, hemorrage rewuiring transfusion, cell dysplasia or cancer, failure of medical therapy
What is a proctocolectomy with ileostomy?
Removal of the colon, rectum and anus with permanent closure of the anus. terminal end of the ileum is brought out thru the abd wall.
Is a proctocolectomy with ileostomy a cure for UC?
Yes
What is a total colectomy with continent ileostomy?
a newer procedure in which stool is stored in a pouch until evacuated by the patent
What is a total colectomy with ileoanal anastomsosis?
Removal of the colon and rectum with the ileum being sutured into the anal canal
What is a total colectomy with ileoanal reservoir?
the rectal sphincter is left intact and a J-pouch is created. patient has no ostomy,
What is the surgery for crohns disease
Segmental resection
What is segmental resection?
bowel is resected from 5-10cm above and below the visible disease.
Is a segmental resection a cure for crohns disease? Why?
no because the disease has the potential to reappear.
Can a segmental resection be done laparoscopically?
yes
What is nursing care for clients with IBD? -Promote comfort-
-Promote comfort- assess duration, severity, character and relationship of pain, stool, flatus to dringing and eating.
What is nursing care for clients with IBD? Controll diarrhea
Keep record of severity, frequency, character of each BM, good skin care to anal area after each stool , monitor F and E, and I and Os.
What is nursing care for clients with IBD? promote nutrition
May be on TPN or enteral feedings, ow-residue, high protein, high caloric diet during periods of exacerbation, well balanced, high protien, increased caloric diet during periods of remission.
What is nursing care for clients with IBD?
Restrict raw fruits and veggies
What is nursing care for clients with IBD? Promote Coping
Emotional stress can influence the severity and frequency of exacerbations, encourage the patient to be an active participant in all decisions, allow pt to verbalixe, support groups
What is the pre op care for patients undergoing surgery for IBD?
Assess level of knowledge, visit with ET nurse, Allow time for verbalization, nutritional assessment- is TPN needed?, bowel cleansing program
What is the post op care for patients that have had surgery for IBD?
NPO, NG tube, maintain F and E, I and O, Skin integrity, monitor nutrition, assess stoma.
What is an intestinal obstruction?
The blockage of movement or intestinal contents through the large or small intestines
What are the 2 kinds of obstruction?
mechanical( something is blocking the bowel) or paralytic (peristalsis stops)
What is the pathophysiology of bowel obstruction? 1
The obstruction occurs. peristaltic activity proximal to the obstruction increases while the body tries to move the obstruction. eventually the proximal intestines dilates and peristalsis stops.
What is the pathophysiology of bowel obstruction? 2
When this happens large ammounts of fluid moves into the distended gut resulting in malabsorption of fluid and gas resulting in a decreased blood flow to the gut and edema resulting in an increased production of gas and multiplication of bacteria. This results in F and E imbalances.
What does the clinical manifestation of an intestinal obstruction deoend on?
The site of the obstruction.
What does the bowel sounds sound like early on.
Loud, high pitched, and frequent
What does the bowel sound like later on?
Become absent
What are some clinical manifestations of a bowel obstruction?
May have profuse, nonfecal vomiting and upper abd pain. May have fecal type vomiting, cramping, poorly localized abd pain and distention.
If you have a complete bowel obstruction what will the bowel sound like?
No bowel sounds with no passage of gas or stool
T or F, The signs and symptoms of dehydration are similar to the S and S of a bowel obstruction.
True
What are some interventions for bowel obstruction?
NG tube, IV fluids, surgery for mechanical obstruction, correct electrolyte imbalances
What is the nursing care for a patient with a bowel obstruction?
-Monitor F and E
- Monitor temp
-Monitor urinary output
-Listen for bowel sounds
-Maintain NG tube care
-Promote ventilation
- Providee comfort- admin analgesics with caution
-Prepare for surgery
What is PUD??
An impairment of gastric mucosal defenses so that they no longer protect the epithelium lining from the effects of acid and pepsin
What is the etiology of PUD?
-Unsure of exact cause
- genetic factors
-environmental factors
-drug effects
-infection with H. pyloric bacteria must be present for ulcers to develop except in situations where the ulcers are caused by NSAIDS
What is the pathophysiology of gastric ulcers?
These have normal gastric acid secretion and normal rate of emptying. They have increased diffusion of gastric acid back into the tissue and impaired mucosa protection
What is the pathophysiology of duodenal ulcers?
Have normal diffusion of gastric acid back into the tissue. Have increased gastric acid secretions especially between meals and increased emptying. often associated with H. pyloric infections
what are stress ulcers?
Ulcers that occur after a medical crisis or trauma. Associated with increased hospital stay and increase mortality.
What are some clinical manifestations of ulcers?
May be asymptomatic.both types c/o fullness, epigastric discomfort, vague nausea, distention, bloating, anorexia, weightloss, dyspepsis, sharp, burning, gnawing sensation.
In gastric ulcers when does pain typically occur?
1-2 hrs after meals
with gastric ulcers, what makes the pain worse?
antacids
In duodenal ulcers when does the pain occur?
90 mins to 3 hours after meals and at night.
With duodenal ulcers what makes pain be relieved?
Food and antacids
how is a diagnosis made for ulcers?
based on symptoms
What other ways can ulcers be diagnosed?
gastric analysis for presence of acid oversecretion, biopsy for gastric cancer, presence of H. pyloric bacteria, may also have hgb and hct and barium enema done.
what are the goals of drug therapy with ulcers?
-Pain relief
-Eradicate H. pylori infection
-heal ulcers
-prevent recurrence
What are the medications used to treat ulcer disease?
- Antacids
- PROTON PUMP INHIBITORS
-H2 antagonists
What type of medication is usually tried first for ulcers?
Antacids
What are antacids used for?
symptom control
What is the action of antacids?
Work by neutralizing hydrochloric acid preventing it from irritating the lining of the GI tract and allowing the mucosal lining to heal. At low doses they promote gastric mucosal defensive mechanisms forming a protective barrier against HCL.
What is the disadvantage of antacids?
They have to be taken so frequently. 1 and 3 hours after meals and at bed time.
What do antacids interact with?
-Anymed that binds to tthe antacid and therefore is not available to be absorbed.
-Any med that is changed based on the PH of the stomach
-Any med that is changed by the pH of the urine.
What are examples of antacids?
Maalox. Magnesium based (MOM). Calcium based (TUMS)
What is some patient education about antacids?
-Assess for CHF, hypertension, NA restrictions, Fluid imbalances, GI obstructions, renal disease, pregnancy.
-Do not use sodium bicarbonate for antacid bc of the risk of alkalosis.
- Do not take other meds within 1-2 hours
- Take with glass of water
-Monitor bowel activity (may cause constipation)
What is the action of proton pump inhibitors?
Work to block the secretion of acid by blocking the ability of the hydrogen ions to move out of the parietal cells which is the last step in the acid secretory process.
What are examples of proton pump inhibitors?
Lansoprazole, pantoprazole, esomeprazole
What is the action of H2 antagonists?
Work by binding to and blocking the histamine receptors on the parietal cells and therefore suppressing acid production in the stomach
What are H2 antagonists used for the treatment of?
Gastric ulcers, GERD, hypersecretory conditions, duodenal ulcers, and upper GI bleeds
What are some side effects of H2 antagonists?
Headache , lethargy, confusion, abd pain, rash, thrombocytopenia
What are H2 antagonists contraindicated in?
Pts with renal failure because one of the side effects is an elevated BUN/creatinine
Who should you use H2 antagonists with caution in?
The elderly and the confused.
What are some interactions for H2 antagonists?
-Absorption may be impaired in pts who smoke
- Should be taken 1 hr before antacids
-Tagament may bind with other meds that are metabolized by the liver.
What are some examples of H2 antagonists?
Cimetindine, famotidine, rantidine
What is the action of sucralfate?
Works by binding itself to the base of the ulcer or erosions and forms a protective coat over the ulcer. this prevents pepsin from being able to access the ulcer which assists in the healing of the ulcer
What is sucralfate used for?
Ulcers, erosions, PUD
What are some side effects of sucralfate?
Constipation, nausea, dry mouth
What are some interactions for sucralfate?
should not be taken with any other med because the absorption of the med by be impaired. should be taken on an empty stomach.
What is the treatment for H. pyloric bacteria?
Diet, surgery, Pepto bismol, amoxicillin, tetracycline, flagyl
Does a bland diet assist in the healing of ulcers?
No
What foods should be restricted?
Ones that cause discomfort
when is surgery done for patients with h. pyloric bacteria?
For the managment of acute complications and for ulcers that are resistant to standard treatment.
What are the types of surgery for ulcers?
Vagotomy, antrectomy as billroth 1 or 2, subtotal gastrectomy, gastroenterostomy, pyloroplastomy
What is a vagotomy?
Reduces acid production by decreasing the cholinergic stimulation of the parietal cells and limiting the response to gastrin by cutting the vagus nerve
What is an antrectomy?
Removal of as much as 505 of the lower stomach by making an incision into the walls of the stomach.
Which surgery is considered the most effective surgical method for ulcer control?
Antrectomy
What is a billroth 1?
Antrectomy-Procedure where the remaining gastric segment is sewn to the duodenum.
What is a billroth 2?
Antrectomy- Procedure where the remaining gastric segment is sewn to the jejunum
What is the treatment for H. pyloric bacteria?
Diet, surgery, Pepto bismol, amoxicillin, tetracycline, flagyl
Does a bland diet assist in the healing of ulcers?
No
What foods should be restricted?
Ones that cause discomfort
when is surgery done for patients with h. pyloric bacteria?
For the managment of acute complications and for ulcers that are resistant to standard treatment.
What are the types of surgery for ulcers?
Vagotomy, antrectomy as billroth 1 or 2, subtotal gastrectomy, gastroenterostomy, pyloroplastomy
What is a vagotomy?
Reduces acid production by decreasing the cholinergic stimulation of the parietal cells and limiting the response to gastrin by cutting the vagus nerve
What is an antrectomy?
Removal of as much as 505 of the lower stomach by making an incision into the walls of the stomach.
Which surgery is considered the most effective surgical method for ulcer control?
Antrectomy
What is a billroth 1?
Antrectomy-Procedure where the remaining gastric segment is sewn to the duodenum.
What is a billroth 2?
Antrectomy- Procedure where the remaining gastric segment is sewn to the jejunum
What is a subtotal gastrectomy?
Removes as much as 75% of the distal stomach with either a billroth 1 or 2.
What is a gastroenterostomy
Neutralizes gastric acid by allowing regurgitation of alkaline secretions from the duodenum
What is a pyloroplasty?
Surgery to enlarge opening of pylorus to facilitate emptying of stomach contents
What is post op care for patient having ulcer surgery?
-Maintain pt airway
-Provide adequate nutrition (TPN)
-Prevent post op problems
How can you prevent some of the post op problems?
-T,C, DB
-Bleeding- monitor NG drainage
-Dumping syndrome
-acute gastric dilation
-NG problems- need an MD order to reposition
Recurrent ulceration
What is the reason for dumping syndrome to occure?
Due to the rapid emptying of food directly into the jejunum
What are the S and S or dumping syndrome?
Weakness, faintness, palpitations, diaphoresis, feeling of fullness, discomfort, nausea,
How can you prevent dumping syndrome?
Eat moderate fat, high prtein diet with limited carbs, avoid simple sugars, DISCORAGE FLUIDS WITH MEALS
When does dumping syndrome occur?
90 mins to 3 hrs after eating
What is the cause of late symptoms in dumping syndrome?
Release of an excessive ammt of insulin due to rapid emptying of the food into the jejunum
What are some meds for dumping syndrome?
Pectin- Dry powder may prevent
Octreotide (Sandostatin)- given in severe cases
what is some patient education for dumping syndrome?
-Avoid liquids with meals
-eliminate caffeine and alcohol
- stop smoking
- lie flat after eating
What are some complications of ulcer disease?
-Hemorrhage
-Perforation
-Obstruction
-intractable disease
What are some S and S of a hemorrhage?
tarry stools, coffee ground emesis, bright red bleeding, ad cramping and discomfort, signs of shock
What is the treatment of a hemorrhage?
Notify MD, NG lavage, Fluid and blood replacement, IV meds
What are some S and S of perforation
Severe sharp abd pain, rigid abd with rebound tenderness, tachycardia, tachpnea, and diaphoresis
what is the treatment for perforation?
Notify MD, surgery
Why do obstructions occur with ulcers?
Due to repeated cycles of ulceration and healing
What is Gastritis?
Inflammation of the gastric mucosa- will be either erosive or non erosive and either acute or chronic
what is the etiology for Gastritis?
- H. pyloric infections
-NSAIDs
-Radiation therapy
- ingestion of corrosive substances
-stress
-NPO status
What are some meds for dumping syndrome?
Pectin- Dry powder may prevent
Octreotide (Sandostatin)- given in severe cases
what is some patient education for dumping syndrome?
-Avoid liquids with meals
-eliminate caffeine and alcohol
- stop smoking
- lie flat after eating
What are some complications of ulcer disease?
-Hemorrhage
-Perforation
-Obstruction
-intractable disease
What are some S and S of a hemorrhage?
tarry stools, coffee ground emesis, bright red bleeding, ad cramping and discomfort, signs of shock
What is the treatment of a hemorrhage?
Notify MD, NG lavage, Fluid and blood replacement, IV meds
What are some S and S of perforation
Severe sharp abd pain, rigid abd with rebound tenderness, tachycardia, tachpnea, and diaphoresis
what is the treatment for perforation?
Notify MD, surgery
Why do obstructions occur with ulcers?
Due to repeated cycles of ulceration and healing
What is Gastritis?
Inflammation of the gastric mucosa- will be either erosive or non erosive and either acute or chronic
what is the etiology for acute Gastritis?
- H. pyloric infections
-NSAIDs
-Radiation therapy
- ingestion of corrosive substances
-stress
-NPO status
what is the etiology for chronic gastritis?
-Autoimmune disorders
-H.pylori infection
-situations of sustained inflammation
-irritation via smoking, radiation therapy, alcohol.
- surgical procedures such as a billroth 2
what are the clinical manifestations of gastritis?
-May be asymptomatis
-Pain in the epigastric area- rapid onset with acute with chronic pain complaints vague
-Anorexia
-Cramping
-N/V
-Bleeding-acute
-Dyspepsia-acute
-Pernicious anemia- chronic
What are the 3 types of gallbladder disease?
-Cholelithiasis-Stone formation
-Cholecystitis- inflammation of the gall bladder usually caused by gall stones
-choledocholithiasis-stone formation in the common bile duct
What is the etiology of gallbladder disease?
-Anything that increases the components of the gall stone such as cholesterol, bile salts, calcium, billrubin, protiens
-Anything that upsets the balance of cholesterol in the bile has the potential to cause a stone to develop. things that can upset the balance are age, obesity, effect of hormones, GI stasis
What are the clinical manifestations of gallbladder disease?
-May be asymptomatic
-Indigestion ofter consuming a high caloric fatty diet
-Sudden onset of pain in the RUQ
-more gas than normal after eating
-With cholecystitis- fever and chills
-With choledocholithias- jaundice, decreased urine urobilinogen, clay colored stools
What are the clinical manifestations of gallbladder disease?
-Anorexia
-N/V
-Dyspepsia
-feeling of fullness
-rebound tenderness
What are some clinical manifestations in gallbladder disease with obstruction
-Sudden onset of pain in the midepigastrium
-Pain that spreads to the back, under the scauula, and to the right shoulder
-tacycardia
-diaphoresis
-inability to be still
How do you diagnosis gallbladder disease?
RO other diseases, ultrasound with show edema of gallbladder wall and fluid
what is the medical managment for gallbladder disease?
Pain control, NPO-IV, antibiotics (if cholecystisis is present), Vitamin K- if jaundice is present and PT is prolonged
What is a percutaneous transheptic billary catheter?
Catheter that opens up the hepatic duct so that bile can flow- used when surgery is not possible
what is the etiology for chronic gastritis?
-Autoimmune disorders
-H.pylori infection
-situations of sustained inflammation
-irritation via smoking, radiation therapy, alcohol.
- surgical procedures such as a billroth 2
what are the clinical manifestations of gastritis?
-May be asymptomatis
-Pain in the epigastric area- rapid onset with acute with chronic pain complaints vague
-Anorexia
-Cramping
-N/V
-Bleeding-acute
-Dyspepsia-acute
-Pernicious anemia- chronic
What are the 3 types of gallbladder disease?
-Cholelithiasis-Stone formation
-Cholecystitis- inflammation of the gall bladder usually caused by gall stones
-choledocholithiasis-stone formation in the common bile duct
What is the etiology of gallbladder disease?
-Anything that increases the components of the gall stone such as cholesterol, bile salts, calcium, billrubin, protiens
-Anything that upsets the balance of cholesterol in the bile has the potential to cause a stone to develop. things that can upset the balance are age, obesity, effect of hormones, GI stasis
What are the clinical manifestations of gallbladder disease?
-May be asymptomatic
-Indigestion ofter consuming a high caloric fatty diet
-Sudden onset of pain in the RUQ
-more gas than normal after eating
-With cholecystitis- fever and chills
-With choledocholithias- jaundice, decreased urine urobilinogen, clay colored stools
What are the clinical manifestations of gallbladder disease?
-Anorexia
-N/V
-Dyspepsia
-feeling of fullness
-rebound tenderness
What are some clinical manifestations in gallbladder disease with obstruction
-Sudden onset of pain in the midepigastrium
-Pain that spreads to the back, under the scauula, and to the right shoulder
-tacycardia
-diaphoresis
-inability to be still
How do you diagnosis gallbladder disease?
RO other diseases, ultrasound with show edema of gallbladder wall and fluid
what is the medical managment for gallbladder disease?
Pain control, NPO-IV, antibiotics (if cholecystisis is present), Vitamin K- if jaundice is present and PT is prolonged
What is a percutaneous transheptic billary catheter?
Catheter that opens up the hepatic duct so that bile can flow- used when surgery is not possible
What is the primar treatment for symptomatic GB disease?
Cholecystectomy- Can be open or laparoscopic
What is a T- Tube
Used if the common bile duct is explored. Used to maintain the patency of the CBD to ensure that there is drainage of bile into the duodenum until any swelling is resolved. must be left unclamped. should be connected to a closed drainage system and should be emptied every shift.
what is a hernia?
Protrusion of an organ or structure from its normal cavity
when do hernia's develop?
With muscle weakness and increased intraabdominal pressure RT heavy lifting, obesity, or pregnancy
What are the types of hernias?
Reducible-protruding structure requires manipulation to return to proper position.
irriducible or incarcerated- cannot be returned to proper position
strangulated- emergency situation where blood flow to the protruding segment is decreased
What are the types of abdominal hernias?
Indirect/direct inguinal- hernia that has moved into the inguinal canal
Femoral- protrudes into the femoral ring
Umbilical hernias- may be eiher congential or acquired
Incisional or ventral hernia- hernias at sites of previous surgeries
What are the clinical manifestations of hernias"?
-Lump which may appear suddenly or always be present
-Vague feeling of discomfort
-dragging feeling in the abdomen
what are some interventions for hernias?
-Surgery
-no coughing
-
What is GERD
any group of conditions that results from esophageal reflux
when does GERD occur?
when the gastric content or intraabdominal pressure increases or when the esophageal sphincter tone decreases
what are the clinical manifestations of GERD
-Vary from patient to patient
-HEART BURN
-substernal or retrosternal pain
-Pain that may radiate upward into the neck, jaw or back
-pain that starts 20 mins to 2 hours after eating
-dysphagia
-burping and farting
-nocturnal coughm wheezing and hoarsness
What is the diagnosiic test for GERD?
-24 Hour pH monitoring which records the number, duration, and severity of the reflux episodes through an electrode which is placed in the lower exophageal sphincter and is then attached to a transnasal cath.
What are some meds for GERD?
-antacids
-H2 inhibitors
-proton pump inhibitors
- antacid plus alginic acid- Gaviscon- a med that neutralizes gastric acid and forms a viscous foam that prevents reflux
Is surgery usually done on pts with GERD?
Not unless the symptoms are severe and the patient does not respond to other treatments
What is the patient education for patients with GERD
-eat 4-6 meals per day
-low fat, adequate protein diet
-reduce intake of caffiene
-limit or eliminate alcohol
- chew food completely
- do not eat before bedtime
-loss weight if necessary
What is the patient education for patients with GERD
-Stop smoking
-Avoid cnstrictive clothing
- avoid activities that cause bending over or lifting heavy objects
-reverse trendelenberg position
What is dysphagia?
Difficulty swallowing- may be due to swallowing incoordination, pharyngeal weakness, esophageal disorders
What is achalasia?
-Occurs when the lower exophageal muscles and sphincter fail to relaz appropriately in response to swallowing.
what are the clinical manifestations f achalasia?
Gradual onset of dysphagia, pain, regurgitation, weitght loss
What is appendicitis?
an acute inflammation of the appendix
what is the etiology of appendicitis?
No cclear cut cause but usually occurs when the lumen of the appendix becomes blocked.
What are the clinical manifestations of appendicitis?
-RLQ pain
-Pain a McBurneys point
-Nausea and vomiting
- anorexia
-Rebound tenderness
-Side lying position with knees drawn up
-Increased temp, wbc, neutrophils (shift to the left)
what is a potential complication of appendicitis
Perforation