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210 ch. 37

Gastric/Duodenal Disorders

QuestionAnswer
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