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Chapter 49
Unit 7: Nursing care of clients with gastrointestinal disorders
| Question | Answer |
|---|---|
| Peptic ulcer disease (Pg. 549) what is a peptic ulcer? | Erosion of the mucosal lining of the stomach or duodenum -mucous membranes can be eroded enough= exposed to gastric acid & pepsid; bleeding and perforation |
| Perforation extending through all the layers of the stomach or duodenum can cause... | Peritonitis |
| Individual who has a peptic ulcer has ___ | PUD |
| Different types of ulcers: | Gastric, duodenal, stress |
| Causes: | H.pylori infection, NSAIDs/steroids, stress, hypersecretion, type O blood, excess alcohol, chronic kidney or pulmonary, zollinger-ellison syndrome |
| S/S: dyspepsia, pain, wt, blood | -dyspepsia (heartburn, N/V, bloating) -pain depends on ulcer -wt loss, bloody emesis (hematemesis) or stools (melena) |
| Pain w gastric ulcer; | 30-60 mins after a meal, rare at night, food exacerbates |
| Pain w duodenal ulcer; | 1.5 to 3hr after a meal, night, relieved with food ingestion |
| Epigastric pain w/ ulcers, occurs upon ___ | palpation |
| LU épi pain w/ | gastric ulcer |
| RU epi pain w. | duo ulcer |
| Lab testing: H.pylori testing -gastric samples collected through -C 13 urea breath test; how done | -Endoscopy to test for H.pylori -client exhales into collection container (baseline), drinks carbon-enriched urea solution, then asked to exhale again *NPO prior to test |
| If H.pylori is present what happens in the C 13 urea test? | Solution will break down & carbon dioxide will be released |
| more lab testing; IgG serologic testing | H.pylori presence based on antibody assays can do stool samples too |
| Dx procedures; EGD | definitive dx; obtains gastric samples to detect H.pylori as well Avoid certain meds (Pg. 550) |
| Medications for ulcers: Antibiotics: Metronidazole (Flagyl), amoxicillin (Amoxil), clarithrymycin (Biaxin), tetracycline (Achromycin V) | Eliminates H.pylori combination of 3-2 abx my be administered |
| H2 receptor antagonists; Ranitidine hydrochloride (zantac), famotidine (pepcid) | suppresses the secretion of gastric acid by blocking h2 receptors in parietal cells lining the stomach -can be used to prevent stress ulcers in client's NPO after major surgery, burns, septic or ^ ICP *IV in acute |
| PPI's Pantoprazole (protonix), esomeprazole (nexium) | Reduce gastric secretion by irreversibly inhibiting the enzyme that produces gastric acid -take omeprazole prior to eating in the morning -avoid alcohol & NSAIDs |
| Antacids: Aluminum caebonate, magnesium hydroxide (milk of mag) | given 1-3 hrs after meals to neutralize gastric acid -give 1 hr apart from other meds to avoid reducing absorption of other meds |
| Mucosal protectant; sucralfate (carafate) | Give 1 hr before meals & at bedtime s/e constipation |
| Diet restricting acid producing foods: | milk products, caffeine, decaffeinated coffee, spicy foods, NSAIDs |
| Surgical interventions for peptic ulcers: Gastrectomy: antrectomy & gastrojejunostomy | All or part of the stomach is removed by laparoscopic or open approach *antrectomy (antrum is removed) *Gastrojejunnostomy (lower portion excised, etc. (pg. 552) |
| Surgical interventions for peptic ulcers: Vagotomy | severs only the nerve fibers that disrupt acid production |
| Surgical interventions for peptic ulcers: Pyloroplasty | Opening between the stomach & small intestine is enlarged to increase the rate of gastric emptying |
| Nursing monitoring for surgical interventions: | semi-fowlers for lung expansion -scant blood may be seen in NG drainage 12-24hr post op -BS -take it and mineral supplements |
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mary.scott260!
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