GI disorders

The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience

pain 2 to 3 hours after a meal

How do you tell if it is a duodenal or gastric ulcer?

pain location (upper- gastric, lower- duodenal) Melena- duodenal Gastric- Hematemesis CBC q6h on H&H (may seem normal on admission but this is because the person is dehydrated)

What are the clinical manifestations of peritonitis

pain over area presence of a cause rebound tenderness abdominal distension abdominal rigidity fever anorexia N&V increased pulse and BP decreased bowel sounds usually caused by abdominal surgeries trauma ulcer appendix or diverticulum

what are the signs of appendicitis

pain, mcBurney's point, Rovsing's sign, low grade fever and anorexia

How to diagnose peritonitis

parancentesis history CBC xray of peritoneal area

what are the symptoms for upper diverticula

sour taste in mouth, halitosis, and regurgitation

Where does esophogeal cancer spread to first?

the lymph nodes very fatal disease

Gastric cancer survival rate

this is a very deadly cancer it is diagnosed late and spreads fast

what causes gastritis

usually a virus, this is acute, the patient should avoid: tea, coffee, alcohol, milk and spicy foods

A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client?

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

A nurse is receiving report from the emergency room regarding a new client being admitted to the medical-surgical unit with a diagnosis of peptic ulcer disease. The nurse expects the age of the client will be between

40-60 years old

Cancer of the esophagus is most commonly diagnosed with: A. Esophagogastroduodenoscopy (EGD) with biopsy and brushings B. X-ray C. Barium swallow D. Fluoroscopy

A. Esophagogastroduodenoscopy (EGD) with biopsy and brushings

H Pylori Treatment (detailed)

Antibiotics: Tetracycline, Amoxicillin, Metronidazole, Clarithoromycin Histmaine Antagonists (H2 Blockers) blocks gastric acid production: Tagamet, Zantac, Axid, Pepcid Proton Pump inhibitors- gastric acid inhibitors: Prilosec, Prevacid, Nexium, Protonix Anti ulcers- Maalox, Mylanta, Tums Cytoprotective: Carafate: provides barrier within uler crater, coats area, given before meals (aluminum hydroide and sulfated sucrose absorbs bile inhibits the enzyme pepsin,and blocks back diffusion of H+ ions. Adhererence of the paste-like complex protect damaged mucosa against further destruction form ulcerogenic secretions and drugs)

The nurse administered a full strength feeding with an increased osmolality through a jejunostomy tube to a client. Immediately following the feeding, the client expelled a large amount of liquid brown stool and exhibited a blood pressure of 86/58 and pulse rate of 112 beats/min. The nurse A. Discuss with the nutritionist about increasing the osmolality of the tube feeding B. Increase the amount of feeding at the next feeding C. Consult the physician about decreasing the tube feeding to half-strength D. Administer the feeding at a cooler temperature

C. Consult the physician about decreasing the tube feeding to half-strength

What are the differences between chron's and ulcerative colitis

Chron's Mouth to anus-skips (can occur anywhere from mouth to anus) Fistulas: common Weight loss: common Rectal bleeding: rare Surgery: palliative (cannot be cured, more than likely will come back Ulcerative colitis Starts in rectum-spreads in contiguous pattern (only in colon) Fistulas rare Weight Loss: rare Rectal bleeding: common Surgery: cure with colectomy

A 77-year-old female patient experienced an ischemic stroke 6 days ago and has a nasogastric (NG) tube in place to facilitate tube feeding. The care team has arranged for many of the patient's medications to be made available in liquid form but not all of her medications are available in liquid form. As a result, the nurses have been crushing some of the patient's pills and administering them with warm tap water. Which of the following medications should not be administered in this manner? A. Tylenol with codeine B Levothyroxine (Synthroid) C. Metoprolol (Lopressor) D. Enteric-coated ASA

D. Enteric-coated ASA

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? A. "I'll eat three large meals every day without any food restrictions B. I'll lie down immediately after a meal." C. "I'll gradually increase the amount of heavy lifting I do D. I'll eat frequent, small, bland meals that are high in fiber

D. I'll eat frequent, small, bland meals that are high in fiber

diagnosis of esophageal cancer

DX: Ba swallow, endoscopy, cytologic examination, direct bx., CT scan

What medications do you take for c-diff

Do not take anti- diarrheal medications (you want to get all of the bacteria out and it comes out through the poop) Antibiotics- by mouth vancomycin, flagyl, Dificid They will be on isolation contact if the patient gets C diff a lot they will need a fecal transplant. This is when someone else's feces is put into the person with the c-diff's intestines to help them get normal flora.

what causes esophogeal cancer?

GERD alcohol smoking Environmental factors Smoking tobacco or opium Nutritional deficiencies: diets low in vitamin A and vegetalbes ETOH Hot foods and hot drinks Contaminants in the soil and food Nitrosamines-smoked meats

What are the differences between duodenal and gastric ulcers?

Gastric Pain worse with eating, malnourished, blood in puke Duodenal pain on an empty stomach, well nourished, malignant, Melena

what is the leading cause of peptic ulcer disease?

Heliocobacter pylori it is treated by antibiotics because h. pylori is a bacteria

What are the three major complications of Peptic Ulcer Disease?

Hemorrhage Perforation (eats away at the intestines and stomach and then makes it to where stomach contents go into the peritoneal cavity) Gastric outlet obstruction

Nursing care going along with peritonitis

Identify the cause Surgery to close the perforation maintain fluid and electrolyte balance and decrease GI distension (NG suction, NS IV solution, Potassium supplement, Listen to bowel sounds strict I&O, look for signs and symptoms of dehydration decrease the infectious process by giving antibiotics Prevent DVT from happening because they are immobile

How to manage a hemorrhage from ulcer

Management-depends on amount and rate of blood loss Rest the bowel Fluid volume replacement Q6h H & H Blood products hgb<8-8.5 (may consider transfusion if hgb gets this low. EGD: can find location of tiny bleeds and cauterize it Surgery: If >1liter of blood loss (if very big bleed)

Peptic Ulcer Disease Perforation

Most lethal complication of peptic ulcer Common in large penetrating duodenal ulcers that have not healed and are located on posterior mucosal wall Requires immediate surgery

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?

NPO

Peptic Ulcer Disease

Obstruction due to: edema inflammation tumor pylorospasm fibrous scar tissue formation these all contribute to narrowing of pylorus

What causes Gastric Cancer

People usually have it at ages 40-70 Men have it more often than women Diet is a significant factor Chronic inflammation of the stomach Smoking Previous subtotaly gastrectomy identified in later stages of disease Surgery plus chemotherapy

How to diagnose C-difficile

Stool sample testing

Peptic ulcer treatment

Stop any meds that may contribute NSAIDs, ASA Coumadin, Plavix (check about restarting in patient's with Stents) Stop smoking/ETOH Rest the stomach (NGT) Diet: avoid foods that increase acidity ie fatty foods, avoid caffeine and ETOH, small meals, weight control, no smoking, < stress

treatment of esophageal cancer

Surgery (best chance of cure) Esophagectomy-removal of all or part Esophagogastrostomy-gastric pull-up (pull stomach up into the thoracic cavity) Esophagoenterostomy (colon interposition) (take part of colon and make it the new esophagus) Radiation-alone, with chemo, or with surgery Chemotherapy-5FU, Platinol

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease?

To keep gastric pH at 3.0 to 3.5

What causes acute infectious diarrhea

Viral: norovirus (college cruises) Bacteria: Salmonella Parasitic: Giardia (traveler's diarrhea)

The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency?

Vitamin B12

What tests are done to dx appendicitis

WBC (would be elevated) UTI R/O pregnancy US CT

Risk factors of PUD

Well water use of steroids and non-steroidal anti-inflammatory drugs- NSAIDS Anti coagulants Cigarette smoking Increased ETOH and Caffeine use aggravate gastric ulcers and duodenal ulcers Type "O" blood type stress

what is the most common cause of Diverticula

Zenker's esophageal Pulsion Diverticula

The most common symptom of esophageal disease is A. Odynophagia B. Nausea C. Vomiting D. Dysphagia

a

Vomiting results in which of the following acid-base imbalances? A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Respiratory alkalosis

a

Tube feedings are given to a patient after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which of the following measures should the nurse include in the care plan to reduce the risk of aspiration A. Change the tube feeding container and tubing every 24 hours B. Avoid cessation of feedings C. Place patient in semi-fowlers position during and 60 minutes after the tube feeding D. Administer 30-60 ml of water before and after administering all medications

c

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to A. helping the client cope with body image changes B. ensuring adequate nutrition C. maintaining a patent airway D. preventing injury

c. maintaining a patent airway

what diet do people with acute infectious diarrhea have

clear liquids (pedialite, gatorade)

A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which of the following explanations from the nurse would be most accurate? a) "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." b) "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems." c) "Caffeine increases the fluid volume in your system, which irritates your digestive organs." d) "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."

d) "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."

Which of the following appears to be a significant factor in the development of gastric cancer?

diet

what are symptoms of esophageal cancer

dysphage odynophagia- pain with swallowing

what causes appendicitis

fecalith, tumor, infection inside appendix

What medications do people with acute infectious diarrhea take

imodium and anti-diarrheals

What is peritonitis

inflammation in the peritoneal cavity

is esophogeal cancer more likely in men or women?

men 3x also higher in african american and asian