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Ch 38 MIV
Ch 38: Disorders affecting digestion 1
| Question | Answer |
|---|---|
| what two signs are common just before vomiting? | Tachycardia and increase salivation |
| it is a major risk of vomiting according to Maslow? | Airway: week patients or immobile patients are at risk for aspirating vomit |
| Drug therapy for nausea | antiemetics |
| Centrally active antiemetics include: | anticholinergics, antihistamines, phenothaizines, marijuana derivatives |
| Antiemetics classified as 5-HT receptor antagonists affect what part of the body | small instestines, peripheral and central nervous systems |
| What is a common side fx of Centrally acting antiemetics? | DROWSINESS (common), tachycardia, hypotension, constipation, urinary retention, dry mouth |
| antiemetics are contraindicated for what medical conditions? | Glaucoma, MI, bowel or urinary, and pregnancy |
| Green colored vomit | contains bile |
| bright red vomit | bleeding in the esophagus or stomach or red food and liquid |
| dark brown vomit resembling dark coffee grounds | blood has been in the stomach long enough to react to secretions |
| signs of deficient fluid volume | tachycardia, hypotension,oliguria, confusion, poor skin turgor |
| Vomit: Interventions for meals | During regular meals, encourage patient to take fluids between meals not with meals |
| risk for aspiration interventions for patients who are vomiting | side lying, suction equipment near, monitor resp rate, breath sounds, dsypnea |
| What root is effective w/ upset stomach? what is contraindicated about this root | ginger root; anticoagulants antiplatelet's are enhanced |
| the opening in the diaphragm through which the esophagus passes is called: | esophageal hiatus |
| hiatal hernia is the protrusion of the___esophagus___upward through the diaphragm into the chest. | Lower esophagus, stomach |
| name two types of hiatal hernias | sliding hernia and paraesophageal hernia |
| which type of hernia has the gastroesophageal junction above the hiatus? | sliding |
| explain what happens to sliding hernias when a patient stands up and sits down. | Stomach slides up when the patient reclines, slides back into place when standing or sitting up |
| sliding hernias are commonly associated with what other condition? Why? | GERD; esophageal sphincter is weak and permits gastric fluids to back low = inflammation of esophagus |
| do all patients with hiatal hernias have GERD | no, AND not all patients with Gerd have hiatal hernias |
| paraesophageal hernia: describe | portion of the stomach goes up pass diaphragm thru a second opening |
| complications of hiatal hernias | bleeding, ulcerations, aspiration |
| complications unique to paraesophageal hernia | strangulation of the hernia = deprived of blood |
| what does LES stand for? and where is it in the body? | lower esophageal sphincter; area where the esophagus and stomach join ( by diaphragm) |
| causes of hiatal hernia | may be caused by weakness of muscles of the diaphragm in the LES area; but exact cause is unknown |
| risk factors hiatal hernia | excessive intra-abdominal pressure, trauma, long-term bed rest in a reclining position |
| S/Sx of hiatal hernia | none to: feelings of fullness,dysphagia, eructation, regurgitation and heartburn |
| what is eructation | belching |
| feeling of burning and tightness rising from the lower sternum to the throat | heartburn |
| hiatal hernia Dx: | barium swallow, CAT scan, esophagoscopy, esophageal manometry |
| esophageal manometry measures to___in the stomach and esophagus. | Pressure |
| esophageal manometry:What position is the pt in initially? Then what happens? | sitting; tube in nose to stomach, -> supine, pt swallows liquids or gelatin. |
| hiatal hernia treatment: | drug therapy, diet, avoiding pressure, surgery |
| hiatal hernia medical treatment: drug therapy includes what classes? | antacids, H2 receptor blockers, proton pump inhibitors |
| H2 blockers: give it's function and a specific drug, drug name ends in? | reduce secretion of gastric acid and promotes healing of ulcers; Zantac; ends in dine |
| Side Fx of H2 blockers | diarrhea, muscle pain, rash, confusion, drowsiness |
| H2 blocker cimetidine can cause? | impotence, gynocomastia, impairs metabolism of common drugs |
| nursing interventions of H2 receptor antagonists | give with or after meals; Zantac/ranitidine do not give same time w/ antacids |
| proton pump inhibitors: give action, and a drug name, what does the drug end in | inhibit gastric acid secretions; all Ps like prilosec; ends in zole |
| proton pump inhibitors side effects | nausea, diarrhea, headache |
| proton pump inhibitors nursing interventions: advise patients to swallow capsule___. | whole |
| which proton pump inhibitor capsule can be opened? How do you administer it? | Prevacid/lansoprazole; give with applesauce |
| what drugs order to increase the tone of the LES? | Bethanechol chloride/Urecholine |
| hiatal hernia: when a surgery necessary? | severe bleeding or narrowing of the esophagus occurs |
| data hernia surgical: name to surgical options | fundoplication, Angelqchik prosthesis |
| fundoplication strengthens the ____ by _____ the fundus of stomach around the ____ and anchoring it ____ the diaphragm | LES; suturing, esophagus, below |
| Angelchik device is tied around the ____ _____, anchored below the ____ | distal esophagus; diaphragm |
| What is the risk w/ Fundoplications if incisions are made in the chest or abdomen | respiratory complications |
| what causes pain in hiatal hernias? What is it nursing intervention? | Reflux of acid into inflamed esophagus; administer medications that increase LES pressure, neutralize acid, and reduce acid secretions |
| hiatal hernias: to reduce the risk of aspiration, food and fluids should not be taken for how many hours? before or after bedtime? | no food or fluids to three hours before bedtime |
| I had a hernia is: how should the patient's sleep? What is place on the legs of the HOB? | 6-12 inch elevation; wood if no mechanical or electrical bed |
| What foods should pt. w/ hiatal hernia avoid? | foods that decreasae LES pressure (fatty foods); and foods that cause irritation of inflamed esophagus |
| give examples of foods that decrease LES pressure and foods that cause irritation. | LES pressure = fatty foods, caffeine (coffee, tea, cola), alcohol; irritation = spicy/acidic |
| S/Sx of GERD: | pain radiating to neck, jaw, back, pain occuring after meals, belching, dysphagia intermittent |
| GERD is relieved by what class of meds | antacid |
| what activities causes Gerd | lifting, straining, supine |
| medical treatments for Gerd | same as hiatal hernia = H2 receptor blockers, proton pump inhibitors, prokinetic agents |
| inflammation of the lining of the stomach | gastritis |
| give three classifications of gastritis | acute,chronic type A, chronic type B. |
| pathophysiology of gastritis. Main culprit of gastritis | mucosal barrier to protect system from auto digestion breaks down; H. Pylori |
| Chronic Gastritis type A causes decrease production of acid and intrinsic factor. Intrinsic factor is neede for? | absorption of B12 which is essential for maturation of RBCs = pernicious anemia |
| S/Sx of gastritis | stomach is on fire, anorexia, feeling full, pain in the stomach area, vomiting |
| in people who abuse alcohol, what may be the only symptom for gastritis? | Hemorrhage |
| gastritis: some patients have only mild indigestion or no symptoms unless what develops? | Pernicious anemia |
| what is the best means of diagnosing gastritis? | Gastroscopy to visualize and biopsy |
| lab tests for gastritis | occult blood in the feces, low H&H, low gastric lvl |
| gastritis: H. pylori is confirmed by | breath, urine, stool, serum tests, or gastric tissue biopsy |
| the medical management of acute gastritis is concerned with treatment of the___ and ___replacement | symptoms, fluid replacement |
| Medical treatment - acute gastritis: | medications that reduce gastric acidity: antacids, H2 receptor blockers, proton pump inhibitors |
| H. pylori is treated with | 1 or 2 antibiotics ( amoxicillin/clarithromycin) and prilosec |
| Chronic gastritis: medical management focus on? | eliminating the cause (H. pylori, alcohol, NSAIDS, stress) and treatment of pernicious anemia |
| chronic gastritis: what medicine is used to reduce inflammation? What medicine must be given regularly to prevent pernicious anemia? And what route? | Corticosteroids; vitamin B 12; injections |
| a patient a gastritis is being served six small feedings per day. The nurse knows to give the antacid when? | After meals when reflux is common |
| maroon or tarry black appearance in stool means what | bleeding in stomach |
| why must you avoid tobacco? | Stimulates aspirations |
| why shouldn't you take aspirin or NSAID's when you have gastritis | increases the risk of hemorrhage, aggravates gastritis |
| patient teaching for gastritis (usually applies to all conditions) | eat small meals, avoid: fatty foods, caffeine, alcohol, spicy foods, no smoking, relieve stress, know drug dosage, schedule, adverse effects |
| Simplified pt. teaching: | eat small, know drugs, avoid irritation foods,relieve stress, elevate HOB if reflux, no alcohol no smoking |
| loss of tissue from the lining of the digestive tract | peptic ulcer |
| Peptic ulcer: pathophysiology | mucous barrier fails = pepsin & HCl injured tissue |
| Peptic ulcer: acute and chornic ulcers - which affect superficial and which affect deep tissue | acute = superficial; chronic = deep/muscle layers |
| Peptic ulcer: name two classifications | gastric or duodenal |
| gastric or duodenal: more common in older men, working class, type A blood, substance abusers, severe stress | gastric |
| gastric or duodenal: more common in younger, type O., chronic illness | duodenal |
| gastric or duodenal: compared depth of injury | gastric = shallow; duodenal = deep |
| gastric or duodenal: compare secretions | gastric = unchanged or decreased; duodenal = increased |
| gastric or duodenal: S/Sx of gastric is burning where? Pain when after meals? relivied by? | upper left quadrant, ribs, back; 1-2 hrs; food and fluids |
| gastric or duodenal: S/Sx of duodenal is burning where? Pain when after meals?relieved by? | upper middle abd under xiphoid and back; 2-4hrs; antacids or food |
| gastric or duodenal:complications | hemorrhage, perforation, obsruction |
| gastric or duodenal:causes | aspirin and NSAIDs; H. pylori (main cause), stressful events: shocks, burns, trauma (stress ulcer) |
| what is a stress ulcer | ulcer developing from stressful conditions i.e. burns, trauma, shock |
| Peptic ulcer complications: explain how they are life threatening | hemmorhage = bleed to death; perforation = causes peritonitis; obstruction = scaring of pylorus causes vomiting = severe fluid and elec imabalances |
| Peptic ulcer Dx | barium swallow, gastroscopy, esophagogastroduodenoscopy; blood, stool, breath, anitbodies test for H. pylori |
| Peptic ulcer treatment include | diet, drug, stress management |
| which is the most commonly used antiulcer drug | H2 blockers: ends in dine, Tagamet, Pepcid, Zantac, axid |
| what classes of drugs are given for peptic ulcers | pump inhibitors, H2 blockers, prostaglandins; if H. pylori = antibiotics, pump, H2, bismuth |
| what is needed to prevent the development of resistance strains in peptic ulcers | multiple antibiotics |
| why is antacid not used for peptic ulcers | no different from H2 BUT H2 has less side fx |
| when antacids are ordered for peptic ulcers, when are they given | one and three hours after meals and at bedtime |
| diet therapy for the ulcers | same recommendations but avoid meat broth as well |
| peptic ulcer hemorrhage treatment: what tube is used? | NG tube |
| peptic ulcer hemorrhage treatment: if saline lavage is ordered what position is pt.? | left side |
| peptic ulcer hemorrhage treatment: how many mL of saline? cold or room temp | 50-200 mL cold or room temp but room temp is recommended |
| peptic ulcer hemorrhage treatment: what is given to constrict blood vessels? what route | vasopressin; IV |
| peptic ulcer hemorrhage treatment:what is arterial embolization | use pt blood to seal arteries and stop hemorrhage |
| peptic ulcer hemorrhage treatment: what meds are given | H2 and antacid at intervals |
| peptic ulcer perforation treatment: initial action | gastric decomp, IV fluids, antibiotics |
| peptic ulcer perforation treatment: if not closed? | surgical is done |
| peptic ulcer obstruction treatment: caused by | edema and spasms |
| peptic ulcer obstruction treatment: what is done | NG tube decomp, IV fluids |
| peptic ulcer obstruction treatment: what is done to NG tube after 72 hours | clamped |
| peptic ulcer obstruction treatment: if no evidence of obstruction what is done? if obstruction still exists what is done? | oral fluids; surgery |
| Peptic ulcer hemorrhage treatment: main intervention | monitor water intoxication: headache, coma, tremors, sweating, anxiety |
| Peptic ulcer pain: if drug therapy is not working or pain worsens what should you do? | contact physician |
| Why is rest prescribed for pain in peptic ulcer patients? | physical activity stims gastric secretions |
| What type of diet is prescribed for peptic ulcer | low fiber, limited protein and calcium |
| Pt is seen w/ rigid abdomen and tender. Pt. draws knees up toward chest. what does this indicate | perforation r/t peptic ulcer and is now causing peritonitis |
| Peptic ulcer interventions for hemorrhage and perforation | are almost the same: physician, then VS, NPO, IV, NG tube decomp, I&O |
| what is the most prominent sign of obstruction | persistent vomiting |
Created by:
Jgar2007
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