Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Nursing 3 Test 3
Peptic Ulcer Disease
| Question | Answer |
|---|---|
| The term peptic ulcer is used to describe... | both gastric and duodenal ulcers |
| peptic ulcer disease | an erosion of the gastrointestinal mucosa resulting from the digestive action of hydrocholoric acid and pepsin, can be acute or chronic |
| HCL | Hydrochloric acids. |
| HCL secretes... | 1-3 liters each day. helps breakdown food, activates pepsinogen & kills microbes |
| parietal cells secrete | HCL and Intrinsic factor |
| Intrinsic Factor is essential for the absorption of | B-12 |
| Pathophysiology of Gastric ulcers | commonly found in the greater curvature of stomach,more superficial;leasions are round,oval or cone shaped,peak age 50-60, normal to low gastric secretion,normal or delayed emptying rate of stomach,increased w/an incompetent pyloric sphincter(bile reflux) |
| pathophysiology of duodenal ulcers | penetrating;usually occurs in the first 1-2 cm of duodenum, peak age:35-45 yrs old, increased gastric acid secretion-if not buffered w/food can cause irritation, increased rate of gastric emptying |
| pathophysiology of duodenal ulcers | increased acide and decreased buffering by food results in a large acid load in the duodenum |
| incidence of peptic ulcer disease | approximately 60-70 million americans are affected by a digestive disease, PUD:10% of americans |
| gastric ulcers are more commen in which sex? | females |
| duodenal ulcers are 2-3 times more likely to occur in which sex? | males |
| risk factors for PUD | H.pylori |
| Helicobacter pylori | culprit is urease produced by H.pylori which increases ammonia>H2 ions>damage to mucosa |
| H.pylori is found in what percentage of gastric ulcer pt's | 60-80% |
| H.pylori is found in what percentage of duodenal ulcer pt's | 95% |
| H.pylori is transmitted via | oral-fecal route |
| over half the population have H.pylori but this doesn't guarantee they will develop... | PUD |
| Social class for duodenal ulcer | high stress job, community leaders, lack of sleep & relaxation |
| social class for gastric ulcer | low socioeconomic class, manual or unskilled labor |
| stressful situations decrease | mucous production |
| stress situations cause blood vessels to | constrict |
| stressful situations increase | gastric secretion, which increases curling's ulcer(burns, mult trauma esp r/t prolonged stress) |
| cigarette smoking increases | bile reflux from the duodenum into the stomach by decreasing the secretion of bicarbonate ions from the pancreas |
| HCO3 | bicarbonate ions, neutralizes acid and is secreted from the pancreas |
| which blood group has more duodenal ulcers | O, and at an increase of 35% |
| why does blood group O have more duodenal ulcers | have stomach cells w/receptors that attract H.pylori(explains why it runs in families) |
| prevention of PUD | methods to increase relaxation & sleep, improve nutrition, decrease smoking, decrease alcohol intake, enteric coated ASA, take meds w/milk or food |
| nursing assessment of pt w/PUD | pain:may have little or no pain, earliest symptoms may be a serious complication |
| nursing assessment of pt with gastric ulcer | burning, left epigastric pain usually after food(w/in 1 hr), made worse by or unrelated to food, anorexia, wt loss(about 40%), great indivial variation |
| nursing assessment of pt with duodenal ulcer | pain may be described as "burning,cramping or pressure-like"(back pain), midepigastric area(below xyphoid process), pain occurs 2-4 hrs after eating, often associated w/other diseases(COPD,pancreatic dx,chronic renal failure),pain relief w/antacids & food |
| medications for PUD | adrenocorticosteroids, indomethacin |
| adrenocorticosteroids | increase susecptibility of mucosa |
| indomethicin | decreases mucosal resistance(both drugs inhibit prostaglandin synthesis) |
| caffeine and alcohol increase | acid production |
| ASA and NSAID suppress | mucous secretion |
| syptoms of PUD | vomiting(not typical in PUD), partially undigested and digested food, bile coffee ground emesis(old blood), bright red blood, bleeding-from erosion of blood vessels |
| Melena | black,tarry stools, dark colored caused by enzymes in the GI tract that oxidizes the blood passed in stools |
| Hematochezia | bright red blood from the rectum |
| guiac test positive | stool tested for occult blood |
| serum test for H.pylori looks for | immunoglobulin G antibodies to H.pylori antigen |
| breath test for urease activity is when... | drink carbon enriched urea & exhale into a bag(if H.pylori is present, it breaks down the compound and releases CO2 |
| finding CO2 in a breath test indicates | H.pylori diagnosis |
| breath test is also useful to see if | rx is working for H.pylori |
| Upper Gi series | barrium contrast studies(inject radiopaque batrium and visualized under fluoroscopy) |
| gastric analysis | aspiration of gastric contents to assess gastric acidity |
| lab values in a pt with GI bleeding | decreased Hct & Hgb, increased PT or PTT occur with prolonged bleeding, electrolyte imbalances r/t fluid loss,vomiting |
| complications of GI bleeding | hemorrhage, perforation, gastric outlet obstruction |
| hemorrhage | most common:results from penetration of the ulcer into an artery or vein |
| clinical manifestations of hemorrhage | occult blood, tarry stools, coffee ground emesis, hematemesis, shock symptoms(pallor,diaphoresis,hypotension,weak thready pulse,palpitations) |
| treatment for hemorrhage | replace lost fluids, hourly urine output, monitor central venous pressure(CVP line), iced saline lavage or tap water(constricts blood vessels) |
| perforation | most serious erosion of the ulcer through muscular walls providing an opening from GI tract into peritoneal cavity-peritonitis |
| clinical manifestations of perforation | pain(sudden,severe,upper abd,shoulder pain), rigid abdomen, absent bowel sounds, rapid shallow respirations, leukocytosis, x-ray air under diaphragm |
| treatment for perforation | gastric decompression, fluids, antibiotics, surgery |
| complication:pyloric obstruction | results from edema, inflammation and pylorospasm or by scar tissue from a healed ulcer, causes complete or partial obstruction |
| clinical manifestations of pyloric obstruction | long history of ulcer pain, projectile vomiting, wt loss, constipation, swelling in upper abdomen, borborygmus(rumbling in bowels) |
| borborygmus | rumbling in bowels |
| treatment for pyloric obstruction | gastric decompression,fluids,antacids & liquids after 72 hrs if obstruction decreased, surgery if obstruction persists |
| surgery for PUD | rare, subtotal gastrectomy |
| subtotal gastrectomy | removes acid secreting portion of stomach |
| types of subtotal gastrectomy | biliroth I and biliroth II |
| biliroth I | suture to duodenum |
| biliroth II | suture to proximal jejunum |
| more surgery for PUD | vagotomy and pyloroplasty |
| vagotomy | severing the vagus nerve, totally(truncal) or selectively to eliminate the acid secreting stimulus to gastric cells |
| pyloroplasty | enlargement of the pyloric sphincter |
| post op nusing care | nasogastric tube(assess drainage,assess patency,montitor for abdominal distention,never irrigate), assess dressings, bowel sounds, resumption of previous diet(may take up to a yr before resuming 3 meals/day) |
| goals of drug therapy | reduction of secretions, neutralization or buffering of acid, protection of the mucous barrier by decreasing the activity of pepsin and hydrochloric acid |
| 5 major durg classes for PUD | antibiotics, alkaline antacids,H-2 receptor antagonists(hydrogen ions-very acidic), proton pump inhibitors, cytoprotective, misc drugs |
| antibiotics | combination therapy with several antibiotics to destroy H.pylori(gram negative bacterium), the primary cause of PUD |
| examples of antibiotics used | amoxicillin, clarithromycin(biaxin), metronidazole(flagyl) |
| antacids | previously considered "mainstay" therapy, better results with H2 receptors |
| examples of antacids | aluminum antacids(amphogel),magnesium antacids(milk of magnesia),calcium carbonate(TUMS),sodium carbonate(alka seltzer),aluminum magnesium combinations(maalox) |
| action of antacids | neutralizes acidity, inhibits proteolytic action of pepsin, increase pH to >5 |
| side effects of antacids | diarrhea(magnesium preparations),constipation(aluminum preparations) |
| nursing implications for antacids | monitor stools, low sodium preparations, after meals & hs, may interfere w/absorption of other drugs |
| nursing actions for antacids | take 1-3 hrs after meals & hs, rationale:neutralizing effects of antacids taken on an empty stomach last 20-30 mins(quickly evacuated). taken after meals, its effects last as long as 3-4 hrs |
| histamine H2 receptor antagonists action | blocks histamine on H2 receptors |
| examples of histamine H2 receptor antagonists | cimetidine(tagament), ranitidine(zantac), famotidine(pepcid) |
| side effects of histamine H2 receptor antagonists | dizziness,h/a, diarrhea, constipation, somnolence, confusion, disorientation, hallucinations, gynecomastia |
| nursing implications for histamine H2 receptor antagonists | watch drug interactions, take w/food, >60 yrs old reduce dose of tagament |
| proton pump inhibitors(PPI) action | blocks the enzyme responsible for secreting of hydrochloric acid from parietal cells |
| PPI examples | esomeprazole, lansoprazole, omeprazole, pantaprazole,rabeprazole |
| side effects of PPI's | diarrhea, h/a, muscle pain, fatigue. if rash develops,stop tx. |
| esomeprazole | nexium |
| lansoprazole | prevacid |
| omeprazole | prilosec |
| pantoprazole | protonix |
| PPI's are more effective than H2R blockers in reducing | gastric acid and promoting healing |
| cytoprotective drug actions | decreases acid secretion & increases production of protective mucus |
| examples of cytoprotective drug actions | sucralfate(carafate) |
| side effects of cytoprotective drugs | constipation |
| nrusing implications for cytoprotective drugs | give 1 hr ac & hs |
| pepto bismol(bismuth subsalicylate) | antidiarrheal drug, decreases synthesis of intestinal prostaglandins, contains salicylate so contraindicated in children & those w/hypersensitivity reactions to ASA |
| anticholinergic action | blocks action of acetylcholine on smooth muscles(thus decrease gastric motility and inhibits gastric secretions) |
| examples of anticholinergics | dicyclomine hydrochloride(bentyl), propantheline bromide(probanthine) |
| side effects of anticholinergics | blurred vision, tachycardia, constipation, urinary retention,(can't see pee, can't spit, can't shit) |
| nursing implications for anticholinergics | monitor output and pulse, impaired sweating |
| reglan action | increases gastric contractions & peristalsis but relaxes pyloric sphincter thus accelerating gastric emptying |
| side effects of reglan | drowsiness, fatigue, restlessness |
| nursing implications for reglan | safety precautions, caution in diabetes & pregnant & nrusing mothers |
| Nursing diagnosis: pain | take meds at prescribed times, have antacids available, avoid ulcerogenic drugs(asa & nsaids), eat at regular intervals, avoid snacking, avoid alcohol, caffeine, and cigarette smoking |
| nursing diagnosis: anxiety | avoid stressful situations, psychological counseling, recognize stress, develop coping mechanisms, relaxation techniques |
| nursing diagnosis: altered tissue perfusion | vital signs, nasogastric tube, IV, I&O, blood transfusion |
| nursing diagnosis: altered nutrition, less than | drugs have replaced the role of diet in tx of PUD, regularity of melatimes & individualization of diet impt, avoid food & drugs that cause indigestion(caffeine,coffee,chocolate,pepper,alcohol), empasis on high quality protein, ascorbic acid & iron |
| diet following gastrectomy | loss of reservoir for food, absence of pepsin & hydrochloric acid, proteins digested by enzymes of small intestines,m may be increased intestinal motility, iron less readily absorbed |
| dumping syndrome | rapid entry of ingested food into jejunum |
| s/s of dumping syndrome | vertigo, tachycardia, sweating r/t rapid fluid shift, syncope |
| dietary interventions for pt with dumping syndrome | meals divided into 5 or 6 feedings, emphasis on foods high in protein, moderate in fat, carbs are kept low, limit fluids taken with meals |
| medications for dumping syndrome | antacids |
| magnesium hydroxide | milk of magnesia; s/e: diarrhea |
| aluminum hydroxide | amphogel; contains significant amt of sodium;therefore use with caution in pateints with CHF, kidney dx or HTN |
Created by:
jbittner
Popular Nursing sets