Chapter 46: Mgt With Gastric and Duodenal Disorders - ML8

Omeprazole (Prilosec)

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. Ranitidine (Zantac) Cimetidine (Tagamet) Famotidine (Pepcid) Omeprazole (Prilosec)

Ingestion of strong acids Irritating foods Overuse of aspirin

A nursing student is caring for a client with gastritis. Which of the following would the student recognize as a common cause of gastritis? Choose all that apply. Ingestion of strong acids Participation in highly competitive sports Overuse of aspirin DASH diet Irritating foods

Curling's ulcer

A patient sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this patient? Curling's ulcer Peptic ulcer Esophageal ulcer Meckel's ulcer

Amount of hydrochloric acid (HCL) secretion in the stomach

The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction. Amount of hydrochloric acid (HCL) secretion in the stomach Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) Presence of H. pylori Patient's age

Metronidazole

is an antibiotic, specifically an amebicide.

Dumping syndrome

is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated (i.e., with defecation).

Chronic renal failure

is associated with duodenal ulcers.

more susceptible to peptic ulcers than those with blood type A, B, or AB.

People with blood type O are

O

Peptic ulcer disease occurs more frequently in people with which blood type? A B AB O

Curling ulcer

Which ulcer is associated with extensive burn injury? Cushing ulcer Curling ulcer Peptic ulcer Duodenal ulcer

Correcting nutritional deficits

A client with gastric cancer is having a resection. What is the nursing management priority for this client? Discharge planning Correcting nutritional deficits Preventing deep vein thrombosis (DVT) Teaching about radiation treatment

Famotidine (Pepcid)

is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion.

Tetracycline

may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk.

Duodenum

The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following? Duodenum Esophagus Pylorus Stomach

Gastric carcinoma except removal of the tumor.

There is no successful treatment. If the tumor can be removed while it is still localized to the stomach, the patient may be cured. If the tumor has spread beyond the area that can be excised, cure is less likely.

duodenal ulcer is characterized by

A hypersecretion of stomach acid

sign/symptom of possible hemorrhage from an ulcer

The nurse interprets hematemesis. Other signs include tachycardia, hypotension, and oliguria/anuria.

Nasogastric tube (NG tube)

decompress the stomach.

gastric ulcer evidences

hyposecretion of stomach acid.

Hemorrhage

, the most common complication, occurs in 10% to 20% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena..

32.7

A client weighs 215 lbs and is 5' 8" tall. What would the nurse calculate this client's body mass index (BMI) as being? 19.5 24.8 32.7 44.9

Smoking cessation Avoidance of alcohol Following a regular schedule for rest, relaxation, and meals

A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. Substitution of coffee with decaffeinated products Smoking cessation Eating whenever hungry Avoidance of alcohol Following a regular schedule for rest, relaxation, and meals

metronidazole (Flagyl).

A metallic taste accompanies administration of

recovering from gastric surgery

After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.

Gastric cancer

Diet seems to be a significant factor: a diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk .The typical patient is between 50 and 70 years of age. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop

15 to 30 minutes after eating.

Early manifestations of dumping syndrome occur

GI disorders

Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.

Chronic gastritis caused by

Helicobacter pylori is implicated in the development of peptic ulcers.

Proton Pump Inhibitors (PPIs)

Lansoprazole and esomeprazole

Peptic Ulcer Disease Treatment

Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are Ranitidine (Zantac) Cimetidine (Tagamet) Famotidine (Pepcid): H2 receptor antagonists that need to be used for 6 weeks.

dumping syndrome

Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down.

Mental confusion

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? Mental confusion Bradycardia Bradypnea Hypertension

Signs and symptoms of perforation

Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (boardlike) abdomen; and hypotension and tachycardia, indicating shock.

Diarrhea

Symptoms associated with pyloric obstruction include all of the following except: Anorexia Diarrhea Nausea and vomiting Epigastric fullness

octreotide (Sandostatin)

The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is octreotide (Sandostatin) vasopressin (Pitressin) omeprazole (Prilosec) ranitidine (Zantac)

Inhibit gastric acid secretions.

The client has been taking famotidine (Pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily to achieve which of the following? Inhibit gastric acid secretions. Neutralize acid in the stomach. Shorten the time required for digestion in the stomach. Improve the mixing of foods and gastric secretions.

"I have learned some relaxation strategies that decrease my stress."

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? "I should stop all my medications if I develop any side effects." "I can buy whatever antacids are on sale because they all have the same effect." "I should continue my treatment regimen as long as I have pain." "I have learned some relaxation strategies that decrease my stress."

Assess the client's abdomen and vital signs.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the intial appropriate action by the nurse? Irrigate the client's NG tube. Assess the client's abdomen and vital signs. Notify the health care provider . Place the client in the high-Fowler's position.

Indicators of pyloric obstruction

are nausea, vomiting, distended abdomen, and abdominal pain.

Dehiscence of the surgical wound is characterized

by pain and a pulling or popping feeling at the surgical site.

Treatment of hemorrhage includes

complete rest for the GI tract, placing the client in a recumbent position with the legs elevated, blood transfusions, and gastric lavage with saline solution.

Peptic ulcers occur mainly in the

gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.

risk factors for peptic (gastric and duodenal) ulcers

include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers.

Peritonitis

presents with a rigid, boardlike abdomen, tenderness, and fever.

Omeprazole (Prilosec)

Which medication classification represents a proton (gastric acid) pump inhibitor? Omeprazole Sucralfate Famotidine Metronidazole

Sucralfate (Carafate)

is a cytoprotective drug.

formula for BMI,

Using the the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703.

After a total gastrectomy,

a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia. Visiting clergy for emotional support is normal after receiving a cancer diagnosis. This action should be encouraged by the nurse. It's appropriate for the client to call the physician if he experiences signs and symptoms of intestinal blockage or obstruction, such as abdominal pain. Because a client with a total gastrectomy will receive enteral feedings or parenteral feedings, he should weigh himself each day and keep a record of the weights.

Pyloric obstruction

also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.

Most gastric cancers are adenocarcinomas

can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.

Zollinger-Ellison syndrome (ZES)

consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. Diarrhea and steatorrhea may be evident. The client may have co-existing parathyroid adenomas or hyperplasia and may therefore exhibit signs of hypercalcemia.

Signs of hemorrhage following surgery include

cool skin, confusion, increased heart rate, labored breathing, and blood in the stool.

Omeprazole

decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells.

Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs

when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.

Liver Pancreas Duodenum

A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. Liver Pancreas Bladder Duodenum Lungs

Age 55 years Previous infection with H. pylori

A client has a family history of stomach cancer. Which factor would further increase the client's risk for developing gastric cancer? Select all that apply. Caucasian ancestry Female gender Age 55 years High intake of fruits and vegetables Previous infection with H. pylori

Perforation of the peptic ulcer

A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? Ineffective treatment for the peptic ulcer A reaction to the medication given for the ulcer Gastric penetration Perforation of the peptic ulcer

"Is it possible that you are overusing aspirin." "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods."

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." "It is a hereditary disease." "It is probably your nerves."

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A sectioned portion of the stomach is joined to the jejunum. The antral portion of the stomach is removed and a vagotomy is performed. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. The vagus nerve is cut and gastric drainage is established.

Ulcers ,inflammatory changes, and lesions

Barium study of the upper GI tract may show; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies.

Most clients are asymptomatic during the early stage of the disease.

Which is a true statement regarding gastric cancer? Most clients are asymptomatic during the early stage of the disease. Women have a higher incidence of gastric cancer. The prognosis for gastric cancer is good. Most cases are discovered before metastasis.

Diet

Which of the following appears to be a significant factor in the development of gastric cancer? Diet Age Ethnicity Gender

gastric cancer

Most clients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer. The prognosis is poor because the diagnosis is usually made late because most clients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.

Signs of bleeding

include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

severe form of acute gastritis is caused by

ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.

Famotidine (Pepcid)

is a histamine-2 receptor antagonist.

"Be sure to wear sunscreen while taking this medicine."

A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? "Take the medication with milk." "Expect a metallic taste when taking this medicine, which is normal." "Be sure to wear sunscreen while taking this medicine." "Do not drive when taking this medication."

Six small meals daily with 120 mL fluid between meals

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? Six small meals daily with 120 mL fluid between meals Three meals and 120 ml fluid daily Six small meals and 120 mL fluid daily Three meals and three snacks and 120 mL fluid daily

Acute gastritis

A client reports to the clinic, stating that she rapidly developed headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. For dinner, she ate buffalo chicken wings and beer. Which of the following medical conditions is most consistent with the client's presenting problems? Acute gastritis Duodenal ulcer Gastric cancer Gastric ulcer

Dumping syndrome

A client who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the client reported cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the nurse educate the client about regarding this event? Gastric outlet obstruction Dumping syndrome Bile reflux Celiac disease

Hemorrhage

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed? Hemorrhage Penetration Perforation Pyloric obstruction

Endoscopy

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Barium study of the upper gastrointestinal tract Endoscopy Gastric secretion study Stool antigen test

"I will have to take vitamin B12 shots up to 1 year after surgery."

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? "I will weight myself each day and record the weight." "I will have to take vitamin B12 shots up to 1 year after surgery." "I'm going to visit my pastor weekly for a while." "I will call my physician if I begin to have abdominal pain."

Vasomotor symptoms associated with dumping syndrome

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect? Dehiscence of the surgical wound Vasomotor symptoms associated with dumping syndrome Peritonitis A normal reaction to surgery

alcohol abuse and smoking.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: alcohol abuse and smoking. alcohol abuse and a history of acute renal failure sedentary lifestyle and smoking. a history of hemorrhoids and smoking.

typical client with gastric cancer

Between 40 and 70 years, but can occur in younger people. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop . A diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk . Other factors related to the incidence include chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, subtotal gastrectomy more than 20 years ago, and genetics.

Duodenal ulcers

Clients with Type O blood are at higher risk for which of the following GI disorders? Gastric cancer Duodenal ulcers Esophageal varices Diverticulitis

Pyloric obstruction, also called gastric outlet obstruction (GOO), signs

The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

Peptic Ulcer Disease

The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.

Hematemesis

The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage? Hematemesis Bradycardia Hypertension Polyuria

Hematemesis

The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage? Bradycardia Polyuria Hypertension Hematemesis

Place the patient in a recumbent position with the legs elevated.

The nurse is caring for a patient who is suspected to have developed a peptic ulcer hemorrhage. Which action would the nurse perform first? Place the patient in a recumbent position with the legs elevated. Prepare a peripheral and central line for intravenous infusion. Assess vital signs. Call the physician.

Hemorrhage

The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: Hemorrhage Intractable ulcer Perforation Pyloric obstruction

Peptic ulcers

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition? Pernicious anemia Systemic infection Peptic ulcers Colostomy

gram-negative bacteria.

The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: stress and anxiety. gram-negative bacteria. alcohol and tobacco. ibuprofen and aspirin.

Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. Constipation Hypocalcemia Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas

Removal of the tumor

Which of the following is the most successful treatment for gastric cancer? Palliation Radiation Chemotherapy Removal of the tumor

DASH diet

is an accronym for Dietary Approaches to Stop Hypertension.

Zollinger-Ellison syndrome (ZES)

hypersecretion of acid may be controlled with high doses of H2 receptor antagonists. These clients may require twice the normal dose, and dosages usually need to be increased with prolonged use. Octreotide (Sandostatin), a medication that suppresses gastrin levels, also may be prescribed.

Less invasive diagnostic measures for detecting H. pylori

include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.

acute gastritis may have a rapid onset of symptoms,

including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccuping, which can last from a few hours to a few days. Often caused by dietary indiscretion—a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms.

Clients with gastric cancer commonly have

nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority. Discharge planning before surgery is important, but correcting the nutritional deficits is a higher priority. Radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Preventing DVT isn't a high priority before surgery, but it assumes greater importance after surgery.

peptic ulcer disease nonpharmacologic ways to prevent recurrence

reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.

Intractable ulcer

refers to one that is hard to treat, relieve, or cure

Billroth I procedure involves

removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.

Signs of penetration and perforation are

severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate.

Signs and symptoms of perforation includes

sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

The nurse should include that the most common cause of peptic ulcers

is gram-negative bacteria (Helicobacter pylori).

Chronic gastritis

is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia.

Curling ulcer

is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

"I have learned some relaxation strategies that decrease my stress."

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? "I should stop all my medications if I develop any side effects." "I should continue my treatment regimen as long as I have pain." "I have learned some relaxation strategies that decrease my stress." "I can buy whatever antacids are on sale because they all have the same effect."

Nasogastric tube (NG tube)

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? Pelvic x-ray Stool specimen Nasogastric tube insertion Oral contrast

Acute gastritis is often caused by

dietary indiscretion—a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy.

Perforation

is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning.