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Dx/MGMT GI Disorders
ANCC Board review
| Question | Answer |
|---|---|
| This organism is present in >90% of duodenal ulcers and >75% gastric ulcers | H. pylori |
| True or false Peptic ulcer disease (PUD) is more common in women? | False: 3:1 in men vs women |
| True or false smoking >1/2 ppd smokers are more likely to have occurrences of PUD | True |
| What medications are contributory to PUD? | NSAIDS, ASA, and glucocorticoids |
| These Ulcers are common among those who are ages 30-55 | Duodenal |
| These Ulcers are common among those who are ages 55-65 | Gastric |
| ___________ ulcers have relief with eating | Duodenal |
| ___________ ulcers worsen with eating | Gastic |
| Melena is | Dark tarry stool |
| hematemesis | vomiting bright red blood |
| Those with PUD may nate the following on labs | anemia |
| First Line therapy for PUD is | H2 Blockers (tidine drugs) |
| 2nd line therapy for PUD is | H2 blockers BID |
| 3rd line therapy for PUD | PPI therapy (prazoles) |
| When giving Mucosal protective agents the NP educates the patient to give them ________ | at least 2 hours apart from other medications |
| Bismuth subsalicylate (Pepto-Bismal) has direct antibacterial action against ________ | H. pylori |
| Misoprostol (cytotec) is used for the following ____________ and may cause______ | prophylaxis against NSAID ulcers/ stimulation of uterine contraction and induction of abortion |
| H. pylori eradication therapy must be _______ | combination therapy: 2 antibiotics + PPI or bismuth |
| MOC is _______ | H. Pylori eradication Metronidazole 500mg BID w/meals Omeprazole 20mg BID b4 meals Clarithromycin 500mg bid with meals x7 days |
| AOC is ________ | H. Pylori eradication Amoxicillian 1gm daily Omeprazole 20mg BID Clarithromycin 500mg bid x7 days |
| MOA is __________ | H. Pylori eradication Metronidazole (flagyl) 500mg BID w/meals Omeprazole 20mg BID Amoxicillin 1g bid with meals |
| When using a Bismuth regimen for H pylori eradication the dosing is _______ | QID |
| BMT | Bismuth subsalicylate 2tabs QID Metronidazole 250mg QID Tetracycline 500mg QID |
| BMTO | Bismuth subsalicylate 2tabs QID Metronidazole 250mg QID Tetracycline 500mg QID Plus Omeprazole 20mgBID |
| In hospital MGMT of PUD | IV access CBC, PT/PTT, BMP O2 Endoscopy, GI sonography FC NPO GI consult/surgical eval |
| A quiet, rigid abdomen with rebound tenderness is representative of a ______ | Perferation |
| Causes of Gerd? | Incompetent lower esophageal sphincter (LES) and Delayed gastric emptying |
| S/S of Gerd | Retrosternal "burning" bitter taste in mouth Excessive salivation Frequently occurs at night and/or in recumbent position May have symptom relief from antacids, H2O or food |
| Diagnostics for GERD | EGD can be considered to R/O Barrett's esophagus or PUD |
| Non pharmacologic mgmt for GERD | Stop smoking weight los if obese avoid ETOH, caffeine, spices Elevate HOB |
| Pharmacologic MGMT of Gerd | Antacids PRN H2 blockers in high does nightly or divided BID dosing PPI if H2 are ineffective GI/surgical consult PRN |
| Hep A transmission | contaminated Food/H2O body secretion exhange |
| HEP B transmission | Blood borne DNA virus transmitted via blood and blood products sexual activity and mother fetus |
| HEP C transmission | Blood Borne RNA virus source of infection often uncertain Traditionally associated with blood transfusions 50% of cases from IV drug use |
| Pre-icteric S/s of Hep infection | fatigue malaise anorexia NV HA aversion to smoking/ETOH |
| Icteric (Acute) S/s Hep infection | Weight loss Jaundice purritus RUQ pain clay colored stools (unable to conjugate billy rubin) low grade fever may be present Hepatoslenomegaly may be present |
| The ALT and AST would be (elevated/decreased) in Hepatitis | elevated |
| You would expect the pt with a HEP infection to have _____ to __________ WBC | Low to normal |
| Serology for an Active Hep A infection would be | Anti-HAV, IgM (immediate) |
| The following serology indicates what: Anti-HAV, IgG | Recovery from a HEP A infection. The IgG is an antibody to HEP that implies previous exposure and confers immunity |
| you run serology on a pt and get the following results: HBsAg, HBeAG, Anti-Hbc, IgM. You know this to represent __________ | Active HBV infection HBeAG indicates circulating HBV and viral replication IgM defines an acute infection |
| You run serology on a pt and get the following results: HBsAg, Anti-Hbc, Anti-HBe, IgM, IgG | Chronic HBV infiection Anti-Hbe signifies diminished viral replication Chonic state is indicated by the presence of Anti-Hbe, IgM, IgG |
| A recovered HBV serology would be | ANti-HBc, Anti-HBsAg All markers are gone |
| The serologies for Acute and chronic hepatitis infections are | Identical Anti-HCV, HCV RNA |
| What test is used to differentiate between active and chronic HCV | polymerase chain reaction (PCR) |
| MGMT of HEP infections | AVOID ETOH and drugs detoxified by the liver Increase fluids 3 to 4L daily no/low protein diet |
| Your pt has a prolonged PT >15 seconds with know HCV infection. The acute care np would prescribe ___________ to reduce PT time | Vitamin K |
| Lactulose is used on the treatment of | Hepatic encephalopathy (increased ammonia levels) |
| Your pt have a low grade fever and LLQ tenderness to palpitation. Labs show WBC of 12000 and ESR of 40. you suspect | Diverticulitis |
| why is plain abdominal film ordered when a pt has diverticulitis | look for evidence of free air |
| S/S Cholecystitis | often precipitated by large or fatty meal sudden onset of severe epigastrium/right hypochondriac pain Vomiting may provide relief |
| Deep pain on inspiration while fingers are placed under the right rib cage | Murphy's sign |
| RUQ pain to palpation is a sign of | Cholecystitis |
| Other signs of Cholecystitis | Muscle guarding/rebound pain Fever |
Created by:
EL92578
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