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210 ch. 37
Gastric/Duodenal Disorders
| Question | Answer |
|---|---|
| What is minimal fluid intake/output | intake: 1.5ml/day output: 30ml/day |
| what is normal IV fluid amt given per day if NPO? | 1L of 5% dextrose = 170 calories of carbs |
| Drug therapy for Peptic Ulcer dis and what major action: Amoxicillin, Clarithromycin, Metronidazole, Tetracycline | antibiotics for H pylori |
| what are key nsg considerations? | |
| Drug therapy for Peptic Ulcer dis and what major action: tagamet, pepcid, axid, zantac | histamine (H2) receptor antagonists...decr hcl production by stomach by blocking action of h2 receptors of parietal cells... nsg considerations |
| Drug therapy for Peptic Ulcer dis and what major action: all the azoles... nexium, prevacid,prilosec, protonix Pepto-Bismol | Proton pump inhibitors...decr gastric acid secretion by slowing Antidiarrheal: suppress h pylori and helps heal mucosa |
| Drug therapy for Peptic Ulcer dis and what major action: misoprostol(cytotec), carafate | protaglandin analogue...protect gastric mucosa from ulcer causing agents, incr mucus production and bicarb levels |
| What seen in gastric ulcer? risk factors? | gastric: over 50y/15% r peptic ulcer/normal to low hcl secretion/wt loss/pain 1/2-1h after meal, not at night/vomiting/hematemesis risks: h pylori,alcohol,smoking,nsaids,stress |
| what is seen in duodenal ulcer? risk factors? | duo: 30-60y/80% peptic ulcers/hypersecretion of hcl/wt gain/pain 2-3h after meal, at night, ingest food helps/no vomit/not usually hemorrhage, melena more common than hematemesis risk factors: h pylori,alcohol,smoking,cirrhosis, stress |
| What syndrome is suspected with peptic ulcers? | (ZES) Zollinger-Ellison..epigastric pain, hypersecretion of gastric juice,duodenal ulcers,tumors in "gastric triangle" |
| what ulcers are common in head/brain injuries? Burn pts? | Cushing's ulcers- deeper, more penetrating than stress ulcers Burns: Curling's ulcer, 72h after burns |
| Duodenal ulcers can show up as referred pain where? | middle back or midepigastrium...perforated shows in upper shoulder |
| Drug regimen to heal peptic ulcers | H2 receptor antagonists: ranitidine/cimetidine/famotidine/nizatidine PPIs:..azoles |
| 1st line h pylori therapy? 2nd line? | 1st: PPI plus 2 antibiotics 10-14 days 2nd: pepto-bismol+antibiotic+PPI |
| What are nsg actions wtih gastric obstruction (GOO) | NG tube to decompress, residual of >400 signifies obstruction |
| nausea/vomiting/distended abd/ abd pain signify what gastric complication? | gastric obstruction |
| cool skin/confusion/incr HR/labored breathing signify what gastric complication? | gastric hemorrhage |
| severe abd pain/rigid and tender abd/vomiting/elevated temp/incr HR signify what gastric complication? | penetration or perforation in gastric area |
| What defines morbid obesity | more than 2x or >100lbs ideal body wt and BMI >30 |
| Bariatric surgery works what two ways to be successful? | restricitve - restrict pt ability to eat malabsortive - interfere wtih nutrient absorption |
| The Roux-en-Y gastric bypass is recommended for long term wt loss. What two ways does it work? | restrictive and malabsorptive 20-30ml capacity |
| Gastric binding and vertical banded gastroplasty are what procedures? | restrictive 10-15ml/15-20ml capacity |
| what is the biliopancreatic diversion with deodenal switch procedure? | 100-200ml capacity gastric restriction and intestinal malabsorption |
| What are Sister Mary Joseph nodules? | palpable nodules around umbilicus r sign of gastric cancer |
| Tx for stomach Ca | Billroth I- limited resection of stomach Billroth II - remove 75% of stomach and resection VitB12 injections required for life if total gastrectomy |
| Risk Factors for stomach Ca | 1.Diet high in smoked, salted or pickled foods and low in fruits/veg 2. Chronic inflammation 3.H pylori infec, pernicious anemia, smoking, low stomach acid, gastric ulcers |
| Hemorrhage, dietary deficiencies, bile reflux, dumping syndrome are risk factors for | gastric surgery pt |
| Gastric surgery pt can resume oral food only after what two things r present | bowel snds, removal of NG tube. Food gradually added until pt can eat six small meals/day and drink 120ml fluid b/n meals |
| If gastric retention occurs what s/s will show? What is nsg intv? | abd distention, nausea, vomiting, regurgitation Suture lines may be too tight, so put pt on NPO and NG tube w/ low intermitten suction to not disrupt sutures |
| Why does dumping syndrom happen wtih gastric surgeries that connect stomach to jejunum? | Foods high in carb and electrolyte must be diluted to be absorbed by jejunum. Passage from stomach is too rapid for this, so fluid drawn into jejunum from blood |
| What teaching is important to avoid dumping syndrome | Low Fowler's at mealtime and 30 min after. Take antispasmodics to delay emptying of stomah Fluids 1h b4/1h after meal Meals should have more dry than wet foods Keep carb amt low/sm meals Vit B12 injections |
| With excessive gastric bleeding after surgery, what nsg actions can be performed? | NG lavage, give blood/blood products, monitor hemodynamics |
| What are early signs of dumping syndrome | fullness/weakness/faintness/dizziness/palpitations/diaphoresis/cramping/diarrhea |
Created by:
palmerag
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