GI - PUD, GERD, Hiatal Hernia

What are the manifestations of a sliding hernia?

- Heartburn - Dysphagia - Feeling full (Might have no manifestations)

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? "Lie down after meals to promote digestion." "Avoid coffee and alcoholic beverages." "Take antacids with meals." "Limit fluid intake with meals."

"Avoid coffee and alcoholic beverages."

What is the tx of peritonitis?

- Antibiotics - IV fluids - Decrease abd. distention

What is some lifestyle changes education that should be taught to someone with freq. GERD?

- Less tight clothes (Which increase risk aspiration) - Losing weight, not bending over (Decreases pressure) - Alcohol and tabaco cessation

What are the characteristics of a chronic peptic ulcer?

- Long duration (Months or years) - 4x as common as an acute ulcer - See erosion through muscular wall with formation of fibrous tissue

What are the s/s of pyloric obstruction due to ulcer?

- N/V - Constipation - Epigastric fullness - Anorexia - Bloating - Wt loss (Later sign)

What is included in the abdominal assessment when assessing ulcers?

- Nausea - Bowel movements (Characteristics) - Family hx - Vomiting (What does it look like [Coffee grounds])

What is a paraesophageal hiatal hernia?

All parts of the stomach push through the diaphragm

What is a common complication of an ulcer?

Anemia

Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply. Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. Avoid beer, especially in the evening. Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. Elevate the head of the bed on 6- to 8-inch blocks. Elevate the upper body on pillows.

Avoid beer, especially in the evening. Elevate the head of the bed on 6- to 8-inch blocks. Elevate the upper body on pillows.

What is GERD?

Back flow of gastric contents into esophagus that causes symptoms and mucoso injury

What is a common sign that you may see with a duodenum ulcer?

Dark tarry stool

The nurse is teaching a client with gastroesophageal reflux disease (GERD) about how to reduce reflux. What should the nurse include in the teaching? Select all that apply. Encourage the client to eat frequent, small, well-balanced meals. Inform the client to remain upright for at least 2 hours after meals. Encourage the client to eat later in the day before bedtime rather than early in the morning. Instruct the client to avoid alcohol or tobacco products. Instruct the client to eat slowly and chew the food thoroughly.

Encourage the client to eat frequent, small, well-balanced meals. Inform the client to remain upright for at least 2 hours after meals. Instruct the client to avoid alcohol or tobacco products. Instruct the client to eat slowly and chew the food thoroughly.

What is a ulcer?

Erosion of mucous membrane that forms an excavation in the stomach, jejunum, duodenum, or esophagus.

The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply. Making neurovascular checks every 4 hours Frequently monitoring hemoglobin and hematocrit levels Observing stools and vomitus for color, consistency, and volume Checking the blood pressure and pulse rate every 15 to 20 minutes Inserting an indwelling catheter for incontinence

Frequently monitoring hemoglobin and hematocrit levels Observing stools and vomitus for color, consistency, and volume Checking the blood pressure and pulse rate every 15 to 20 minutes

What is a surgical intervention that might be done for a patient that has GERD?

Fundoplication

What infection is associated with most ulcers?

H. Pylori

What condition does GERD sometimes feel like?

Heart attack

How do you tx pyloric obstruction due to ulcer?

Insert GI tube to decompress he stomach, provide fluids and electrolytes. Balloon dilation or surgery may be required.

With duodenal ulcers how much acid does someone usually secrete? More, less, or normal?

More acid than normal

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

Peptic ulcers

Though for patient with more extreme cases, what should you monitor for after surgical correction of a hiatal hernia?

Post op belching, vomiting, gagging, abd. distention, and epigastric pain

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an): Extension of the esophagus through an opening in the diaphragm. Involution of the esophagus, which causes a severe stricture. Protrusion of the upper stomach into the lower portion of the thorax. Twisting of the duodenum through an opening in the diaphragm.

Protrusion of the upper stomach into the lower portion of the thorax.

with gastric ulcers how much acid does someone usually secrete? More, less, or normal?

Secretes normal or less acid than usual.

What is the erosion of an ulcer the result of?

The digestive action of HCL acid and pepsin

How is someones weight effected with a gastric ulcer?

They lose weight

What is dumping syndrome?

This is when the stomach empties quickly after eating and the client experiences uncomfortable to severe side effects.

How does the pain from a stomach ulcer effect the patient?

Waking up in the middle of the night with pain.

The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience vomiting. hemorrhage. pain 2 to 3 hours after a meal. weight loss.

pain 2 to 3 hours after a meal.

What are the s/s of a GI bleed?

- Increased HR - Low BP - Weakness - Pale - Melena - Hematemesis - Abd. mass - Bloating

How does someone with a gastric ulcer describe the pain?

Dull or achy

Which is more common gastric or duodenum ulcers?

Duodenum

What are the s/s of peritonitis?

- Increased HR & BP - Dehydration - aPain - Decreased bowel sounds - Fever - n/v - Anorexia - Rebound tenderness - Board-like abdomen - Abd. distention and rigidity - Increased WBC

What are the manifestations of a paraesophageal hernia?

- Intolerance to food - Vomiting - Nausea - Hemorrhage - Obstruction - Volvulus - Strangulation

How do you treat a GI bleed?

- Iv fluids - NG tube w/saline (washing ulcer out) - Oxygen - Tx potential shock - Maybe endoscopic coagulation or surgical intervention

What is some patient education for someone with ulcers?

- No ASA or NSAIDs - Avoid spicy/acidic foods - Complete antibiotics - How to give antacids by themselves

What are some risk factors for a hiatal hernia

- Old age - Female - Increase in abdominal pressure

What meds do you use for treating H. Pylori?

- PPI (4-6 wks [Watch for bone fractures]) - H2 receptor blocker (6-8 wks) * Finish meds even if feeling better

What are some ways we can manage GERD?

- PPIs or H2s agents - Scope to observe - Esophageal stretch

What might be included in the assessment of a patient with a ulcer?

- Pain (how is it relieved) - Daily intake (72 hours) - Lifesyle habits (Smoking) - Meds (NSAIDs, anticoagulant, steroids) - Abdominal assessment

What are some risk factors of GERD? (x12)

- Pregnancy - Obesity - Overeating - Hiatal Hernia - Anticholinergics - IBS - COPD - Peptic ulcers - Tobacco use - Coffee drinking - Alcohol use - Gastric infection (H. Pylori)

What are some ways that GERD is diagnosed? (x4)

- Pt complaints - Esophageal pH monitor - Degree of acid reflex - Endoscopy

What are some possible reasons that frequent reflux might be occurring with GERD?

- Pyloric sphincter is not closing - Pyloric stenosis - Motility disorder - Hiatal Hernia

What are the treatments for an uncomplicated peptic ulcer?

- Releive pain - Avoid NSAIDs - Treat H. Pylori infection

What are some things that might cause a stress ulcer?

- Shock - Sepsis - Surgery - Trauma - Burns (Curlings) - Head injury w/increased intracranial pressure (Cushings)

What is the nursing care for peritonitis?

- IVs & electrolyte balance - decrease infection process - Prevent complications (Immobility, fluid imbalance, and pulmonary problems)

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

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

What does the usual med tx look like for a pt with an ulcer? And how long is this usally prescribed?

- 2 antibiotics + PPI and some bismuth salts - Carafate to coat stomach before eating - 10-14 days

What are some complications of GERD? (x7)

- Barretts Esophagus - Strictures - Ulcerations in pharynx and esophagus - Laryngeal damage - Adenocarcinoma - Pulmonary complications - Dental erosion

What are some important labs to do for a pt that has an ulcer?

- Biopsy - Stool for occult blood - CBC-RBC - Hemoglobin -Hematocrit

What are the early manifestations of dumping syndrome about 15-30 minutes after eating?

- Bloating - Diarrhea - Low BP - Dizzy

What is Barrett's esophagus? (x3)

- Chronic irritation from acid that leads to dysplasia - Squamous to columnar cells of the lower esophagus (usually). - PRE-MALIGNANT! Ass. w/ adenocarcinoma

What pt teachings would you give someone with an uncomplicated peptic ucer?

- Diet (Low fiber, high protein, avoid extreme temps, smaller frequent meals, lower caffeine intake) - Smoking cessation - Lowering alcohol consumption

What are some overall manifestations of ulcers?

- Dull gnawing pain or burning in the mid-epigastrium - Heartburn - Possibly vomiting - Wt loss or gain - Constipation or diarrhea.

What are some ways to medically manage peptic ulcers?

- EGD (Visualize how deep and large ulcer is) - Biopsy - Blood tests (Infection [H. Pylori] and anemia) - Blood transfusion - Surgical interventions (If it doesn't heal after 12-16 weeks, hemorrhage, perforates, or created obstruciton)

What are the s/s of hemorrhage for a peptic ulcer?

- Faint - Dizzy - Nausea - Low bp - High HR - Tachypnea

What are the s/s of anemis?

- Fatigue - Weakness - Dyspnea - HA - Chest pain - Cognitive impairment - pallor - dizziness - Tachycardia - palpation - bounding pulse

What is some patient teaching that should be done for someone that has a hiatal hernia?

- Frequent small meals - Dont recline 1 hr after eating - Elevate HOB 4-8 inches

What are the clinical manifestations of GERD? (x12)

- Heartburn (pyrosis) - Dyspepsia (Indigestion) - Regurgitation - Hyper-salvation - reflux when laying down - Esophagitis - Dry cough worse at night - Difficulty swallowing (Dysphagia) - Voice changes - Pulmonary problems - Ear infection - Esophagus narrowing (Scarring at lower ind)

What are some risks that might happen as a result of a hernia?

- Hemorrhage - Obstruction - Strangulation causing necrosis of tissue

What are som complications to anticipate with peptic ulcers?

- Hemorrhage - GI bleeding - Perforation - Pyloric obstructions - Dumping syndrome

What are the late manifestations of dumping syndrome about 1-3 hours after eating?

- Hypoglycemia - Tachycardia - Hypotension - Sweating - Dizziness - Abd. cramping

What are some dietary education factors that should be taught to someone with freq. GERD?

- Sit upright after you eat - Elevated HOB when sleeping to 30 degrees (Decreases risk of aspiration) - Smaller meals - Eat 3 hours before bedtime - Decrease intake of dairy products, coffee, spearmint/peppermint, carbonated drinks, acidic foods (Tomatoes, fruits, and juice)

What is some patient education for dumping syndrome?

- Small meals - Dont drink fluid with meals - High protein and fiber and low carbs

What are some risk factors for ulcers?

- Smoking - Drinking - NSAID usage - Zollinger-Ellision Syndrome

What are some signs of perforation?

- Sudden severe upper abd. pain - Referred pain to the shoulder (Especially right) - Vomiting - Fainting - Extremely tender and rigid abdomen

What are the characteristics of an acute peptic ulcer?

- Superficial erosion and minimal inflammation - Short duration (Resolves quickly)

What are the diagnosis measures for detecting H. Pylori?

- Urea breath Test - Stool antigen tets - Serologic testing for antibodies against H. Pylori antigen

What is a hiatal hernia diagnosed?

- x-ray - Barium swallow - EGD - Esophageal manometry - Chest CT scan

How long after eating does the pain happen for a duodenum ulcer?

2-3 hours after eating (eating may decrease pain)

How long after eating does the pain happen with a gastric ulcer?

30 mins to 1 hour after eating

A client with peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which complication will the nurse suspect is occurring with this client? Bleeding from the ulcer Evidence of ulcer healing Medication adverse effects Allergic response to the medication

Bleeding from the ulcer

What is a esophageal stretch?

Devices expanded in esophagus that breaks down scar tissue (Strictures)

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

Hemorrhage

Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? Select all that apply. Lansoprazole (Prevacid) Rabeprazole (AcipHex) Esomeprazole (Nexium) Famotidine (Pepcid) Nizatidine (Axid)

Lansoprazole (Prevacid) Rabeprazole (AcipHex) Esomeprazole (Nexium)

A client with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the client may be prescribed what drug? Metoclopramide Omeprazole Lansoprazole Calcium carbonate

Metoclopramide

How is ones weight effected with a duodenum ulcer?

Not usually effected, pt is well nourished.

What is a hiatal hernia?

Opening in the diaphragm through which the esophagus passes, becomes enlarged, and part of the stomach moves up the lower portion of the thorax.

The nurse reviews data collected during a client assessment. Which lifestyle modifications will the nurse discuss with the client to prevent the development of gastroesophageal reflux disease (GERD)? Select all that apply. Smoking cessation Limit the intake of alcohol Avoid eating before bedtime Engage in intermittent fasting Achieve a BMI of 22

Smoking cessation Limit the intake of alcohol Avoid eating before bedtime Achieve a BMI of 22

The nurse is reviewing the chart of a client with swallowing problems. Which factors would raise suspicion that the client has cancer of the esophagus? Select all that apply. Smoking history of 20 years Male gender Previous treatment for gastroesophageal reflux disease European American Age 72 years

Smoking history of 20 years Male gender Previous treatment for gastroesophageal reflux disease

A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply. Tachycardia Hypotension Mild epigastric pain A rigid, board-like abdomen Diarrhea

Tachycardia Hypotension A rigid, board-like abdomen

A client is diagnosed with gastroesophageal reflux disease (GERD) and Barrett esophagus with minor cell changes. Which of the following principles should be integrated into the client's subsequent care? The client will require an upper endoscopy every 6 months to detect malignant changes. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. Small amounts of blood are likely to be present in the stools and are not cause for concern. Antacids may be discontinued when symptoms of heartburn subside.

The client will require an upper endoscopy every 6 months to detect malignant changes.

What is the recommended med for ulcers at home?

Tylenol

The nurse is caring for a client with a duodenal ulcer. Which assessment findings indicate to the nurse that the client is experiencing perforation from the ulcer? Select all that apply. Vomiting Tender and rigid abdomen Sudden drop in blood pressure Pulsating mass in the left abdominal region Abdominal pain referred to the right shoulder

Vomiting Tender and rigid abdomen Sudden drop in Abdominal pain referred to the right shoulder

Which statement correctly identifies a difference between duodenal and gastric ulcers? Malignancy is associated with duodenal ulcer. Weight gain may occur with a gastric ulcer. A gastric ulcer is caused by hypersecretion of stomach acid. Vomiting is uncommon in clients with duodenal ulcers.

Vomiting is uncommon in clients with duodenal ulcers.

What causes GERD on a patho level?

Weak lower esophageal sphincter plus an increase in pressure.

What is a sliding hernia?

When it slides up and back down (Hernia comes and goes)

What is a perforation of an ulcer?

When the erosion of an ulcer goes through and into the peritoneal cavity

What is fundoplication surgery?

Wraps the top of the stomach around the lower esophagus, so food can still come in but has a harder time to go out.

How can you diagnose peritonitis?

x-ray