Exam 5

esophagogastrostomy

tumor removal -chest tube/feeding tube -anatomic leak can lead to peritonitis. -deep breathing, incentive spirometry, walking.

duodenal ulcers

upper portion of the duodenum, deep, sharp lessons that penetrate into the muscle. high gastric acid secretion.

Liver/Spleen Scan

uses IV injection of a radioactive material that is taken up primarily by the liver and secondarily by the spleen. The scan evaluates the liver and the spleen for tumors or abscesses, organ size and location, and blood flow.

endoscopy

visual examination of a body cavity or canal using a specialized lighted instrument called an endoscope, numbing for gag reflex, eat when it returns.

endoscopic retrogade cholangiopancreatography

visualization of the pancreases, contrast dye is used. Semi-prone position.

hemorrhoid

internal or external prevent constipation is best defense, diet high in fiber and fluids.

Irritable bowel syndrome

teaching: fiber daily, 8-10 glasses of H2O, chew slowly. stress reduction

diagnostic assessment for PUD

test for H pylori, chest and abdomen x ray (if perforation suspected), EGD and nuclear medicine test (GI bleed suspected)

etiology of gastric cancer

- infection w/ H. pylori is the largest risk factor for gastric cancer - Pts w/ pernicious anemia, gastric polyps, chronic atrophic gastritis, and achlorhydria are 2 to 3 times more likely to develop gastric cancer - eating pickled foods, salted fish, salted meats, processed foods, high consumption of salt, low intake of fruits & veggies - Genetic - Gastric surgery / GERD

surgical/nonsurgical management for hernias.

-elevate HOB, eat small frequent meals, antacids, PPI. -weight loss prior to surgery, quit smoking. _teach about activity restrictions, 3-6 weeks post op. nutrition modifications.

Stomatits

-inflammation of the mouth -most common: ulcers, herpes, noninfectious. -secondary: Candida albicans.

ultrasonography

A noninvasive technique involving the formation of a two-dimensional image used for the examination and measurement of internal body structures and the detection of bodily abnormalities

Which patient statement alerts the nurse to preform a thorough GI history and focused assessment?

A. I don't like the taste of spicy foods B. I got dentures four years ago C. I experience occasional constipation D. I take ibuprofen three times daily for arthritis D

when administering a new GI medication to an older patient, the nurse anticipates what?

A. a higher than normal dose may be needed B. close monitoring is needed because toxic levels may develop C. older adults always require a lower than normal dose than younger patients. D. nausea and vomiting may develop rapidly and are common side effects in older adults. B

After abdominal surgery, which question should the nurse ask the patient to determine whether peristaltic movement is returning?

A. have you passed flatus B. are you hungry C. do you have nausea D. is your pain level manageable A

Which assessment variable requires immediate nursing intervention post esophagectomy?

A. respiratory rate of 28 B. BP of 170/88 C. temp of 38 celcius D. pain assessment of 6 out of 10. A (pulmonary toileting)

the nurse is caring for a patient with a long history of osteoarthritis. which risk factors will the nurse teach the patient that may contribute to development of GERD?

A. weight of 130 lbs. B. walks 20 minutes once daily. C. frequently takes NSAIDS for pain D. consumes foods with calcium supplementation. C

risk factors of PUD

Alcohol Smoking Anticoagulant medications Stress Caffeine NSAID's dietary

etiology and risk of gastritis

H pylori, long term NSAID use is high risk. local irritation form radiation therapy. ingestion of corrosive materials. autoimmune causes (pernicious anemia)

complications of ulcers

Hemorrhage- hematemesis Perforation- surgical emergency Pyloric obstruction- manifested by vomiting caused by stasis and gastric dilation. Intractable disease- the patient no longer responds to conservative management, or recurrences of symptoms interfere with ADLs

hiatal hernias

Sliding or paraesophageal -heartburn, pain, dysphagia. -pain will worsen after meal or when lying supine. -barium swallow study with fluoroscopy.

abdominal hernias

Weakness in muscle wall Heavy lifting, obesity, pregnancy Become problem when they become strangulated Most common type is indirect inguinal hernia in men

gastric cancer

adenocarcinomas, may be asymptomatic, more common in males.

colorectal cancer

adenocarcinomas, over 50, genetic, family history

assessment of gastritis

anorexia, cramping and N/V assess for abdominal tenderness and bloating, hematemesis, melon and heartburn. -diagnostic assessment: EGD, cytologic examination, rapid urease testing (detect H pylori)

treatment options for GERD

antacids, histamine blockers (famotidine), proton pump inhibitors(omeprazole, pantoprazole)

What makes the LES more loose?

anticholinergics, chocolate, fatty foods, coffee, nitrate, NSAIDS

GERD

back flow of stomach contents into the esophagus because the sphinchter doesn't close all the way. -hiatal hernias increase the risk. -Barrets esophagus and esophageal stricture are concerns. Pre malignant and scarring.

health promotion for gastritis

balanced diet, regular exercise, stress reduction, limit foods and drinks that cause distress (caffeine, chocolate, mustard and pepper) avoid NSAIDS and aspirin

diagnostic assessment for GERD

barium swallow, EGD, pH monitoring.

stress ulcers

bleeding caused by gastric erosion, occur after sepsis, head injury, burns, being NPO or major surgery.

assessment of colorectal cancer

bleeding or change in stool, lab tests are fecal occult blood test, carcinoembryonic antigen, sigmoidoscopy and colonoscopy.

managing upper GI bleeding

blood loss is high morbidity and mortality. fluid replacement, blood products may be ordered. to help control bleeding: NGT placement, lavage, endoscopic therapy, IR procedures, acid suppression.

esophageal tumors

can be benign, most are malignant. -more than half metastasize. -risk factors are smoking and obesity, men, age, alcohol and tobacco use. -barretts esophagus results form acid and pepsin exposure. -may report dysphagia, painful swallowing

Gastric ulcers

develops near acid secreting mucosa, causes gastric emptying to be delayed.

assessment of PUD

epigastric tenderness, indigestion, board like abdomen and rebound tenderness. Gastric: aggravated by food Duodenal: 90 t0 3 hours after eating. take ortho BP and s/s of dehydration.

esophagogastroduodenoscopy (EGD)

examination of the lining of the esophagus, stomach, and duodenum with a flexible endoscope for diagnostic and/or therapeutic purposes, such as biopsy, excision of lesions, removal of swallowed objects, dilation of obstructions, stent placement, measures to control hemorrhage, etc.

interventions for gastritis

fluid replacement, eliminating causative factors (h pylori), H2 receptor agonists, PPI, vitamin B12

etiology of peptic ulcer

h pylori and NSAIDS.

Gastritis

inflammation of the stomach -erosive vs. non erosive -acute heals after several months. -chronic, healing does not occur, walls and lining thin and atrophy.

Oral cavity disorders: Premalignant lesions

leukoplakia: white plaques. erythroplakia: red plagues.

Oral cancer:

major risk factor is age, tobacco and alcohol use.

interventions for PUD

management of pain, eliminate h pylori, heal ulceration and stop recurrence. -PPI triple therapy, reduce stress.

colonoscopy

moderate anesthesia, left side knees to chest, bowel prep.

Peptic ulcer disease

mucosal lesson of the stomach or duodenum.

assessment for bowel obstruction

no passage of stool abdominal distention peristaltic waves high pitched bowel sounds diagnostic: H/H, creat and BUN, Ct and MRI

Interventions: oral cavity infections

oral hygiene -avoid commercial mouth washes, rinse mouth every 2-3 hours with a sodium bicarb solution or warm saline food selection -cool liquids, foods high in protein and vitamin C. Drug therapy -antimicrobials, immune modulators, symptomatic topical agents.

management for bowel obstruction

paralytic iléus: NPO, nasogastric tubes, IV fluid placement. exploratory laparotomy.

colostomy care

pink moist and beefy red.

interventions for gastric cancer

radiation and chemo, gastrectomy.

prevention and control of colorectal cancer

radiation, chemo, surgical management.

classifications of abdominal hernias

reducible, irreducible and strangulated. Treatment can be Truss or minimally invasive inguinal hernia repair.

Candida albicans

secondary to long term antibiotic therapy -very painful, fungal infection -nistatin, swish and swallow for 2 minutes.

Heath promotion and maintenance of GERD

small frequent meals, limiting spicy fatty foods, sit upright and hour after eating. sleep in right side lying to promote gas exchange, don't wear tight clothes.

small bowel capsule endoscopy

swallow capsule, 8 hours. water only 8-12 hours before, NPO after 2 hr. capsule comes out in stool.