NUR221 TEST 7 INFLAMMATION - peptic ulcer disease

The nurse is teaching a client with ulcerative colitis about maintaining a healthy lifestyle. Which statement indicates the client understands the nurse's instructions? "I'll have to stop smoking." "I can eat popcorn for an evening snack." "I may have coffee with my meals." "I'm allowed to have alcohol as long as I only drink wine.

"I'll have to stop smoking." *Tobacco, caffeine, and alcohol are gastrointestinal stimulants and should be avoided by clients with ulcerative colitis. High-fiber foods such as popcorn and nuts are not allowed because of potential gastrointestinal irritation.

A client diagnosed with ulcerative colitis also experiences obsessive-compulsive anxiety disorder (OCD). In helping the client understand their illness, the nurse should respond with which statement? "It's possible that your desire to have everything be perfect has caused stress that may have worsened your colitis, but there is no proof that either disorder caused the other." "The perfectionism and anxiety related to your obsessions and compulsions have led to your colitis." "There is no relationship at all between your colitis and your OCD. They are separate disorders." "Your ulcerative colitis has made you perfectionistic, and it has caused your OCD."

"It's possible that your desire to have everything be perfect has caused stress that may have worsened your colitis, but there is no proof that either disorder caused the other."

Peptic Ulcer Disease Symptoms

-Dyspepsia: dull, gnawing, burning pain, mid epigastric pain that radiates to the back -Gastric ulcer - pain with food/30-60 minutes after meal -Duodenal - No pain with food. -May have GI bleeding - hematemesis, melena 30-50% of ppl with bleeding ulcers have no abdominal pain -weight loss

Upper Gastrointestinal Endoscopy

A procedure that allows your doctor to look at the interior lining of your esophagus, your stomach, and the first part of your small intestine (duodenum) through a thin, flexible viewing instrument called an endoscope. Risk: bowel perforation, peritonitis, sepsis Report: Peritonitis s/s --Fever ↑100.3 --Rebound tenderness --Rigid or board-like abdomen --↑pain, tenderness --Restlessness --↑RR, HR Expected post procedure: -BP Δ's -delayed gag reflexes *Keep NPO until gag reflex returns

Peptic Ulcer Disease Nursing Process

A: pain, vomit, stool characteristics D: acute pain, anxiety, imbalanced nutrition P: Pain relief, anxiety, nutrition I: ↓Pain, diet Δ's to ↑nutritional status E: Monitor for adverse effects, therapeutic effects

Peptic Ulcer Disease Assessment and Diagostic

PHYSICAL ASSESSMENT: Pain, epigastric tenderness, abdominal distention DIAGMOSTICS: upper endoscopy & biopsy -less invasive: --serologic studies for H.pylori antibodies --stool antigen test, hemoccult stool test --urea breath test BLEEDING ULCER -- need serial CBC's to monitor blood loss --transfusion.

Peptic Ulcer Medications

Antibiotics: metronidazole (flagyl), amoxicillin, clarithromycin (biaxin) PPIs: lansoprazole (prevacid),omeprazole (prilosec) Bismuth Salts: Pepto Bismol - coats stomach H2 Receptor Antagonists: ranitidine (zantac), famotidine (pepcid)

Peptic Ulcer Disease Risk Factors

Same for men & women ↑age NSAID use H.pylori Smoking, alcohol COPD Cirrhosis Chronic Kidney Disease Zollinger-Ellison Syndrome

H.pylori

Helicobacter pylori bacterial infection → peptic ulcers

Peptic Ulcer Disease Perforation

MEDICAL EMERGENCY Sudden onset Severe, sharp, right upper abdominal pain -may be referred to the shoulder (phrenic nerve irritation) Extreme RUQ tenderness N&V, hypotension, tachycardia (shock) High risk for peritonitis -death

Peptic Ulcer Disease Medical Management

Medications - reduce gastric secretions Antibiotics - H.pylori Manage gastric acidity. Lifestyle changes: ↓spicy food, ↓alcohol, smoking cessation Surgical interventions: intractable ulcers, perforation, hemorrhage, obstruction

The nurse is caring for a client with an exacerbation of ulcerative colitis. What should the nurse instruct the client to do? Maintain a high-fiber diet. Obtain frequent rest periods. Avoid lifting more than 5 lb (2.3 kg). Use antidiarrheal medications regularly.

Obtain frequent rest periods. *It is important for the client to have frequent rest periods. Repeated episodes of diarrhea interrupt sleep patterns, and poor nutrition may also cause the client to feel weak. If the client is experiencing a severe exacerbation of ulcerative colitis, bed rest may be prescribed. Antidiarrheal medications can be used selectively in ulcerative colitis but are not recommended for regular use as they can lead to colonic dilation. The client should maintain a low-residue, high-calorie, caffeine-free diet. It is not necessary to limit weight lifting.

A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. What should the nurse tell the client? "Long-term use of steroids will prolong periods of remission." "Steroids are used in severe flare-ups because they can decrease the incidence of bleeding." "The side effects of steroids outweigh their benefits to clients with ulcerative colitis." "Ulcerative colitis can be cured by the use of steroids."

Steroids are used in severe flare-ups because they can decrease the incidence of bleeding. *Steroids are effective in the management of the acute symptoms of ulcerative colitis. Steroids do not cure ulcerative colitis, which is a chronic disease. Long-term use is not effective in prolonging the remission and is not advocated. Clients should be assessed carefully for side effects related to steroid therapy, but the benefits of short-term steroid therapy usually outweigh the potential adverse effects.

Peritonitis s/s:

Sudden severe abdominal pain in the area of the underlying disorder, acutely tender, distended, rigid abdomen, pallor, excessive sweating, cold skin, absent bowel sounds, n/v, dehydration, fever, hypotension, and cloudy peritoneal dialysis fluids

Barrett's esophagus

a condition that occurs when the cells in the epithelial tissue of the esophagus are damaged by chronic acid exposure - GERD

A client is admitted with a diagnosis of ulcerative colitis. What should the nurse assess the client for? constipation bloody, diarrheal stools steatorrhea alternating periods of constipation and diarrhea

bloody, diarrheal stools *Diarrhea is the primary symptom of ulcerative colitis. It is profuse and severe; the client may pass as many as 15 to 20 watery stools per day. Stools may contain blood, mucus, and pus. The frequent diarrhea is often accompanied by anorexia and nausea.

A health care provider and nurse are discussing treatment options with a client diagnosed with severe ulcerative colitis. When providing client teaching during early treatment, the symptoms of which diagnosis would be discussed? bowel herniation bowel perforation bowel outpouching gastritis

bowel perforation *Bowel perforation, obstruction, or hemorrhage and toxic megacolon are common complications of ulcerative colitis that may require surgery.

Stress ulcers (Curling ulcers)

develop in association with major physiological stress (burns, head injury, trauma, sepsis, ARDS, liver failure, surgery, hemorrhage) -mucosal ischemia -aggravated by: --hypotension, sepsis, hypoxia ***DECREASED PERFUSION

Zollinger-Ellison Syndrome (ZES)

disorder of excess acid secretion in the stomach resulting in peptic ulcer disease Inherited Very rare Malignant Tumors in the pancreas & duodenum secrete gastrin → hyperacidity → peptic ulcer disease

Peritonitis

inflammation of the peritoneum -rebound tenderness, muscular rigidity, laying still w/fast shallow breaths, distended abdomen/ascites, fever -Sudden severe abdominal pain

GERD

gastroesophageal reflux disease SYMPTOMS -Dyspepsia (heart burn) -worse pain = lying down CAUSES -weak/damaged LES/Lower Esophageal Sphincter AVOID -Fried foods, Fatty Foods, Citrus (acidic), Dairy -chocolate, peppermint, spearmint NO tobacco, NO caffeine, NO alcohol -AVOID eating before laying down - sit up at least 3 hours -Elevate HOB at night -Eat small meals - do not over eat RISK FACTORS -stress, obesity-BMI 30+ (p - ressure on LES) -hiatal hernia PHARMACOLGY -↓acid, prevent burn -antacids - fast, immediate relief - short relief -NO NSAIDS PROCEDURES -Upper GI endoscopy - when diet Δ's fail -EGD - if ulcers suspected

A client has been placed on long-term sulfasalazine therapy for treatment of ulcerative colitis. The nurse should encourage the client to eat which foods to help avoid the nutrient deficiencies that may develop as a result of this medication? green, leafy vegetables eggs milk products citrus fruits

green, leafy vegetables *In long-term sulfasalazine therapy, the client may develop folic acid deficiency. The client can take folic acid supplements, but the nurse should also encourage the client to increase the intake of folic acid in his diet. Green, leafy vegetables are a good source of folic acid. Citrus fruits, eggs, and milk products are not good sources of folic acid.

The nurse is instructing the client with ulcerative colitis about the best diet to maintain nutrition for tissue healing while avoiding foods that will exacerbate ulceration. Which diet would be most appropriate? high-calorie, low-protein low-fat, high-fiber high-protein, low-residue low-sodium, high-carbohydrate

high-protein, low-residue *Clients with ulcerative colitis should follow a well-balanced high-protein, high-calorie, low-residue diet, avoiding such high-residue foods as whole-wheat grains, nuts, and raw fruits and vegetables. Clients with ulcerative colitis need more protein for tissue healing and should avoid excess roughage. There is no need for clients with ulcerative colitis to follow low-sodium diets.

A 58-year-old client with osteoarthritis is admitted to the hospital with peptic ulcer disease. Which findings are commonly associated with peptic ulcer disease? Select all that apply. localized, colicky periumbilical pain nausea and weight loss tachycardia epigastric pain that is relieved by antacids history of nonsteroidal anti-inflammatory drug (NSAID) use low-grade fever

history of nonsteroidal anti-inflammatory drug (NSAID) use epigastric pain that is relieved by antacids nausea and weight loss

A client with severe inflammatory bowel disease is receiving total parenteral nutrition (TPN). When administering TPN, the nurse must take care to maintain the ordered flow rate because giving TPN too rapidly may cause air embolism. constipation. dumping syndrome. hyperglycemia.

hyperglycemia *Hyperglycemia may occur if TPN is administered too rapidly, exceeding the client's glucose metabolism rate. With hyperglycemia, the renal threshold for glucose reabsorption is exceeded and osmotic diuresis occurs, leading to dehydration and electrolyte depletion. Although air embolism may occur during TPN administration, this problem results from faulty catheter placement, not overly rapid administration. TPN may cause diarrhea, not constipation, especially if administered too rapidly. Dumping syndrome results from food moving through the GI tract too quickly; because TPN is given I.V., it can't cause dumping syndrome.

Duodenal Ulcer

intestinal -Pain ↓with food --2-3 hours p̄ meals -worse at night -weight gain -melena - dark, tarry stool D-Duodenal Ulcer D-Doesn't have pain with food

A nurse is reviewing instructions for a low-residue diet with a client who has an acute exacerbation of colitis. To evaluate the client's understanding of the diet, the nurse asks the client to plan a menu. Which food selections by the client indicate an understanding of a low-residue diet? cream soup and crackers, peas, and orange juice lean roast beef, white rice, and tea with sugar stewed chicken, baked potatoes, and milk baked fish, macaroni with cheese, and milk

lean roast beef, white rice, and tea with sugar *A low-residue diet decreases the amount of fecal material in the lower intestinal tract. This is necessary in the acute phase of ulcerative colitis to prevent irritation of the colon. Orange juice contains cellulose, which is not absorbed and irritates the colon. Cream soup and milk contain lactose, which is irritating to the colon.

The nurse is planning care for a client with ulcerative colitis. Which is an expected outcome of nursing care? The client: experiences decreased frequency of constipation. accepts that an ileostomy will be necessary. verbalizes the importance of restricting fluids. maintains an ideal body weight.

maintains an ideal body weight. *An expected outcome for a client with ulcerative colitis is maintaining an ideal body weight. It would not be appropriate to restrict fluid intake; the client should strive to remain well hydrated. Ulcerative colitis produces episodic diarrhea, not constipation. It is not inevitable that the client with ulcerative colitis will need an ileostomy. The decision to perform surgery depends on the extent of the disease and the severity of the symptoms.

The nurse is planning care for a client who is being treated for an exacerbation of ulcerative colitis. Which goal is the priority? maintaining adequate nutrition promoting rest and comfort promoting self-care and independence managing diarrhea

managing diarrhea *Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by halting the exacerbation. The client may receive antidiarrheal agents, antispasmodic agents, bulk hydrophilic agents, or antiinflammatory drugs.

urinary casts

proteins secreted by damaged kidney tubules indicate inflammation of kidney tubules

Gastric Ulcer

stomach -Pain ↑with food --30-60 minutes after meals -weight loss -hematemesis G-Gastric Ulcer G-Gut pain WITH food

A client who has ulcerative colitis has persistent diarrhea and has lost 12 lb (5.5 kg) since the exacerbation of the disease. Which approach will be most effective in helping the client meet nutritional needs and allow healing? continuous enteral feedings total parenteral nutrition (TPN) eating six small meals a day following a high-calorie, high-protein diet

total parenteral nutrition (TPN) *Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the bowel. To maintain the client's nutritional status, the client will be started on TPN. Enteral feedings or dividing the diet into six small meals does not allow the bowel to rest. A high-calorie, high-protein diet will worsen the client's symptoms.

What is an appropriate nursing goal for a client who has ulcerative colitis? verbalizes the importance of small, frequent feedings accepts that a colostomy is inevitable at some time in his life maintains a daily record of intake and output uses a heating pad to decrease abdominal cramping

verbalizes the importance of small, frequent feedings *Small, frequent feedings are better tolerated by clients with ulcerative colitis as they lessen the amount of fecal material present in the gastrointestinal tract and decrease stimulation.

Esophagogastroduodenoscopy

visual examination of the esophagus, stomach, and duodenum - sedated procedure Risk: bowel perforation, peritonitis, sepsis Report: Peritonitis s/s --Fever ↑100.3 --Rebound tenderness --Rigid or board-like abdomen --↑pain, tenderness --Restlessness --↑RR, HR Expected post procedure: -BP Δ's -delayed gag reflexes *Keep NPO until gag reflex returns

Peptic Ulcer Disease

‣Excavation Area that Froms in the mucosa of the stomach, pylorus, duodenum, or in the esophagus ‣Erosion can extend through the muscle layer into the peritoneum ‣mostly in the duodenum ‣Chronic gastric ulcers occur in the lesser curvature ‣Esophageal ulcers d/t hydrochloric acid backflow -GERD