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MCAI-FINALS--2b

Upper GI

QuestionAnswer
what is the purpose of large intestine absorbs water and electrolytes, elimination, synthesis of Vit K and Vit B.
what is the most important function of large intestine absorption of water and electrolytes
What is pancreas exocrine responsibilities contributes to digestion
what is pancreas endocrine responsibilities insulin production, glucagon production, somatostatin, ploypeptides.
what is the responsibility of small intestine digestion and absorption
what does liver metabolizes carbo, fats, protein
What is the difficulty with GI issues it mimics chest pain, lung problem, and muscle pain, and ruling out process
How do we know the specific diet of the pt in order to get more info r/t chest pain but pt may have GI problem? keep a journal what they are eating, when the symptom arise, and what they doing about it.
how to separate CV symptoms against GI ask pt about daily stressor, ETOH, NSAID meds systemic effect (Coumadin, Aspirin, ibuprofen, cox2 inhibitors)
what test rule out CV problem troponin test, higher indicative of CV problem.
what is the type of stool to confirm GI problem tarry stool, test is fecal occult test (guaiac) to determine presense of blood.
GI issues risk factors pregnant, obese, smoking
what to check on the vomit to see if there is pressence of bleeding dark and coffee ground color in emesis, if exist, it could be an occurrence of old bleeding.
what gold standard dx test standard for GI issues? endoscopy.
What problems are r/t chest pain to rule out GI problem SOB, GI,pain in lungs, muscle pain (intercostal muscle)-type of activity, STRESS, heart burn, troponin test
What dx test can be done to confirm GI problem? endoscopy, barium swallow, ultrasound, manometric studies (esophageal motility to determine pressure gradients)
type of substance swallowed by the patient in conjuction to X-ray test. It iluminates the possible problem with the GI tract. barium swallow referred as GI series
what are the treatment options for GI problems. Proton pump inhibitor (PPI), H2R blockers, antacids, chollinergics, promotility. Wait 30 mins to one hour for med action
What are H2Blockers? Histamine2-Blockers are agents use for Ulcers and GERD (Tagamet, Pepcid, Zantac)
Samples of PPI meds omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole(Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium)
Sample of antacid meds aluminum (Amphojel), Calcium Carbonate (Tums), aluminum-mg (Riopan, Maalox), combinations (Gelusil, Mylanta)
Non pharmacological for GI problem pain and comfort such as diet change, no spicy food, don't eat before sleeping -coz pressure, no cofee, no tob, no ETOH, med take with food , lose weight, no too tight clothing, sleeping habits, try to sleep upright, elevate hob, small frequent meal.
Pharmacologic gold standard for tx of GI problem PPI (-zole)- decrease production of histamine
When is histamine release inside GI damage cell release histamine.
What is antacid for ? to treat reflux.
what is hiatal hernia? is herniation of a portion of the stomach into the esophagus through an opening (or hiatus) in the diaphram
what is rolling (paraesophageal ) hernia stomach roll up above the diaphram
what is sliding hiatal hernia stomach slides up above the diaphram
What are s/s of hiatal hernia acid reflux, nocturnal attacks (esp. if person eaten before sleeping)
In what case hiatal hernia becomes in emergency situation strangulated hernia - stuck in wrong compartment, oxygen will be deprive it becomes surgical emergency
what are the complications of hiatal hernia? GERD, esophagitis, hemorrahge from erosion, stenosis, ulcerations of the herniated portion, strangulation and regurgitation with tracheal aspiration.
other facts about hiatal hernia it could be asymptomatic, increases with age, more women experience it than men
What can be ordered for symptoms chest pain, jaw and back of the throat pain, lose weigth, sitingup right, hob 30 deg. Best scenario eating small frequent meal, Blood test-albumin level ( imbalance nutrition)
What is the greate test to check nutritional status albumin test level
If dehydrated what electrolyte level NA increase. (Na inversely porportion to water ex. Inc. water, dec Na)
If vomitting what will find in electrolyte level K loss (is possible due to NG tube suction )
Why doctor order wall suction? evaucate air that is accumulated and protect the integrity of the incision.
What is the effect of continous wall suction K will decrease, erode mucosa, blood in NG output (do hemocult or guaiac blood test), check gastric content.
Gold standard in checking NG tube placement pH level test. Aspirate from stomach should be acidic. KUB usually finding the place of tube before feeding.
if ther is blood in the aspirate in the NG check CBC
Can CBC indicates dehydration? Hct will be elevated upon dehydration.
What are the risk for gastric reflux? 1. damage mucous of esophagus (lower portion). The epihelial cell can change to squamos cell will later on become BARRETTE esophagus 2. dental erosion. 3. pulmonary complication (gastric enters trachea and into pulmonary system - could be deadly)
What is Barrett's esophagus? esophageal metaplasia and epithelial cells altered. It's a precancerous lesion that increases the patient's risk for esophageal cancer.
Types of ulcer gastric ulcer and duodunal ulcer.
why ulcer develop? due to higher acid production.
What are the two surgical intervention for Hiatal Hernia? 1. Nissen, fundoplication (wrap stomach around esophagus) , if med doesn't work 2. Eiatal hernia repair.
what cause of acid reflex 1. heartburn/ dyspepsia (pain and feeling of fullness), 2. acute pain 3., regurgitation, and lump in the throat (pain in jaw and neck)
dx text for acid reflex measure pressure test.
Med that coat stomach to protect stomach mucosa and protect ulcer from irritation. Sucralfate (Carafate) - PPI
Is GERD a disease No. It is a symptom
What is GERD a backward flow of gastric contents into lower esophagus.
What is oral candidiasis yeast-like fungus or yeast in the mouth.
What's med for oral candidiasis Nystatin (swish and swallow) . For people with immunocompromised.
What is the causes of oral candidiasis? antibiotics, inhaled steroids, immunosuppression (HIV/AIDS, radiation /chemo theraphy, and meds (Glucocoritcoids)
Reason for difficulty swallong esophageal obstruction, esophageal cancer. Other causes: stroke, dimentia, neuromascular problem, alzhiemers
What they look like if they are dysphagia chocking sensation and fullness sensation. Feels like panic, diophoretic, nervous
What to do if pt have dysphagia avoiding food that expands (bread), fluid, chew a lot,
How dysphagia dx? Speech pathologist evaluate (NPO H2O or juice), videofluoroscopy (continues video image), and endoscopy
What are the nursing care for patient with dysphagia? 1. keep client NPO, elevate HOB, support fluid / nutrition through other means, pain control and support medical / surgical treatement of disorder.
Dysphagia may lead to aspiratin and pneumonia and malnutrition and dehydration.
what to do with the food for dysphagia patient? food in liquid texture, pureed, and thickened (like casturd).
risk factor of GERD? incompetent LES, Food, med, pregnancy, obesity, tobacco, hiatal hernia.
what happens if somebody can't meet their caloric need? G (gastric) or J (jejunum, further down GI) tube, longer method to feed somebody. It bypassess GI system.
Who is the best person to check the pt's caloric needs dietitian
what are the causes of gastritis (upset stomach , inflammation of gastric mucosa) med, diet, microorganism (may be from food we eat)
Care for pt with gastritis. eliminating cause, symptomatic cause: dehydrated, vomiing, antiemetics, Freq. VS if concerned about bleeding (CBC , Hgb, Hct) ,and GI medications.
Most of gastric ulcer cause by what kind of microorganism. H. Pylori
meds for gastric ulcer series of antibx
Concern about peptic ulcer development 1. ulceration can cause bleeding (blood loss). 2. perforation (non sterile content leaking into sterile part of the body. That's dangerous)
Difference of Gastric and Duodenal Ulcer Lesion: smooth / penetrating, location: antrum, fundus/ 1st 2cm of duodenum, gatric secretion: normal to dec / inc; incidence: more women/ more men, but more women if menopausal, related to: incompetent pyloric sphincter and bile reflux / chronic disease.
where is the pain r/t gastric ulcer pain in high lef epigastrium and back upper abdomen
where is the pain r/t duodenal ulcer pain in midepigatrium and upper abdomen; back pain with posterior ulcers.
What is stress ulcer stress result from hospitalization trauma, post-operative, and NG tube.
meds gold standard for stress ulcer PPI (-zole)- decrease production of histamine
meds for stress ulcer antacids, antibx, h2r inhibitors, ppi, cytoprotective[Sucralfate (Carafate) - PPI ]
peptic ulcer complications perforation (most deadly can cause peritonitis-non sterile to sterile ), hemorrhage, gastric outlet obstruction, fever, elevated HR and blood count.
what perforation of peptic ulcer complication can lead to? septic shock.
what are the s/s of perforation? hypovolemic shcok, boardlike abd, shoulder pain (phrenic nerve from diagphram), N&V, shallow , rapid respirations, absent bowel sound (Peritonitis degree), depends upon the spillage amount. Palpation (pain and very hard rigid, and distended.)
What are the implications of uppger GI hemorrhage? HOB (check contraindication first - vital signs , if bp is too low, don't put bed up), if vomitting, put them on their side (aspiration risk), IV, NPO, Blood product, NG tube)
what if pt is hypovolemic what do you expect will doctor order? administer normal saline IV , 500 ml bolus (D5 most common used)
how do we know how much blood fluid lose? Hgb and Hct test
what nursing intervention for Upper GI hemorrhage VT q15min, pt comfort management, and prepare for dx procedure or surgery.
What is esophageal varices? a complex of tortuous veins at the ends of esophagus, which are enlarged and swollen as a result of portal HTN. They quite fragile
Complication of liver cirrhosis that can cause sudden and severe hemorrhaging? esophageal varices. (NG tube would be very dangerous)
If somebody has a history of history of liver cirrhosis or alcoholism, what do you do if doctor ask you to put NG tube? ask the physician to put the NG tube. It would be very dangerous when the esophageal varices bleed and pt would die..
what are the complications of live cirrhosis? esophageal varices and gastric outlet obstruction
What heppen if pt have gastric outlet obstruction? have pyloric spincter problem, dilated stomach (spincter issue-stomach work so hard, so it grows large), residual (500 ml or greater) , hypertrophy, and atonic (loses paristalsis).
what are the causes of gastric outlet obstruction pyloric narrowing, cancer, duodenal ulcer inflammation / edema and pyloric strictures
what are the manifestation of gastric outlet obstruction? projectile vomiting (the stomach can't move the food forward, so it will go backwards) + visible gastric peristalsis, gastric residual of > 500ml, long h/o gastric pain, thirsty, weight loss, and constipation because nothing is going through
what are the treatment for gastric outlet obstruction? Sx, not emergency, NG tube/suction, meds to reduce inflammation, improve nutritional status, possible blood transfusion, and comfor and rest.
What are the post-op care for pt with upper GI Sx NPO, keep the NG tubes patent of functioning (can get clog or stopped), IV fluid replacement, pain management, mobilize, clear liquids after removal of NG tube, educate the patient.
What's the problem of gastrectomy (removal of portion of stomach) will get Vit B12 deficiency. Instrinsict factor is affected. And also problem with iron absorption.
Late post-op complications of gastrectomy dymping syndrome: occurs within 15 to 30 mins. (weakness, diaphoresis, tachycardia, dizziness, orthostatic hypotension, Nausea, pain, and diarrhea.
What is the main cause of dumping syndrome symptoms food directly dump into the lower GI, high carbohydrate will cause fluid will come out of intra vascular space. This problem occurs soon after eating.
what to look out for by the pt when they are experiencing dumping syndrome? risk for fall and injury, lie down, not eating a large meal, eat more protien, eliminate drinking fluid with meal because they become hypo glycemic.
what will happen if pt is Vit B12 deficient? pernicious anemia, they need inj.
What is Anastomosis? suture of stomach to duedunom.
what is the problem will arise after stomach anastomosis? deminish iron absorption.
what mimics black stool? small amount of iron will cause black stool and pepto bismal.
How many days NG tube will remain? If there is a lot of output, not take NG tube out. Watch for return of peristalsis (or passing gas) . About 3 days to 5 days. (waiting for anastomosis to heal)
What is pyrosis? heartburn
Created by: rt-study