Med Surg Ch 47

A patient is schedule for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

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

What does the term "stress ulcer" mean?

A stress ulcer refers to acute mucosal ulceration of the duodenal or gastric area that occurs after a stressful event.

A patient taking metronidazole (Flagyl) for the treatment of H. pylori states that the medication is causing nausea. What suggestion can the nurse provide to the patient to alleviate this problem?

Take the medication with meals to decrease the nausea.

The nurse is educating a patient about the discharge medication. When should the nurse instruct the patient to take the antacid medication?

1 to 3 hours after the meal.

The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows what minimal daily intake of fluids is required?

1.5L

Clarithromycin (Biaxin)

Antibiotics

Bismuth subsalicylate (Pepto Bismol)

Antidiarrheal

How does bariatric surgery work?

Bariatric surgery works by restricting a patient's ability to eat and by restricting ingested nutrient absorption.

A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic with peptic ulcer pain that the nurse should inquire about? (select all that apply)

Burning sensation localized in the back or mid-epigastrium, feeling of emptiness that precedes meals from 1 to 3 hours, severe gnawing pain that increases in severity as the day progresses.

A patient has a BMI ranger greater than 40kg/m2. What would this patients obesity classification be?

Class III

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

Curling's ulcer

What is the difference between Cushing and Culring's ulcer in terms of cause and location?

Cushing's ulcers, which are common in patients with brain trauma, usually occur in the esophagus, stomach, or duodenum. Curling's ulcers occur most frequently after extensive burns and usually involve the antrum of the stomach and duodenum.

A patient is complaining if diarrhea after having bariatric surgery. What non-pharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea?

Decrease the fat content in the diet.

The nurse is educating a patient with peptic ulcer disease about the disease process. What decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum?

Drinking carbonated beverages.

A patient 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 patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event?

Dumping syndrome

The most common site for peptic ulcer formation is the _________.

Duodenum

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)

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.

______ is the bacillus commonly associated with the formation of gastric, and possibly duodenal, ulcers.

Helicobacter Pylori

The most common complication of peptic ulcer disease that occurs in 10% to 20% of patients is _______.

Hemorrhage

_______, _________, __________, and _______ are some of the major potential complications of a peptic ulcer.

Hemorrhage, perforation, penetration, pyloric obstruction

Famotadine (Pepcid)

Histamine-2 receptor antagonist

Name 2 conditions that are specifically related to peptic ulcer development.

Hyper secretion of acid pepsin and a weakened gastric mucosal barrier predispose to peptic ulcer development.

List several findings characteristic of Zollinger-Ellison syndrome.

Hyper secretion of gastric juice, multiple duodenal ulcers, hypertrophied duodenal glands, and gastricnomas (islet cell tumors) in the pancreas.

A patient has been diagnosed with acute gastritis and asks the nurse what could have cause 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.

A frequently prescribed proton pump inhibitor of gastric acid is _______.

Nexium

Explain why patients who have gastritis due to vitamin deficiency usually have malabsorption of vitamin B12.

Patients with gastritis due to vitamin deficiency exhibit antibodies against intrinsic factor, which interferes with vitamin B12 absorption.

A patient is in the hospital for the treatment of peptic ulcer disease. The nurse finds the patient vomiting and complaining of a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?

Perforation of the peptic ulcer

The nurse is caring for a patient who is suspected to have developed a peptic ulcer hemorrhage. What action would the nurse perform first?

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

The stomach pouch created by gastric bypass surgery can hold up to ______mL of food and fluids.

30

Peptic ulcers occur with the most frequency in those between the ages of ______ and _______.

40; 60

The average adult weight loss after bariatric surgery is about ______% of previous body weight.

60

Describe the priority intervention that should be used to treat the ingestion of a corrosive acid or alkali.

Dilute and neutralize the offending agent. To neutralize a corrosive acid, use common antacids such as milk and aluminum hydroxide. To neutralize an alkali, use diluted lemon juice or diluted vinegar.

Misoprostol (Cytotec)

Prostaglandin

Pantoprazole (Protonix)

Proton pump inhibitors

A patient has a Class II classification of obesity. What level of health risk does this pose for the patient?

Severe risk.

Explain the theory about diet modification for peptic ulcer disease.

The objective of the ulcer diet is to avoid over secretion and hyper motility in the gastrointestinal tract. Extremes of temperature should be avoided, as well as overstimulation by meat extractives, coffee (including decaf), alcohol, and diets rich in milk and cream. Current therapy recommends 3 regular meals per day if an antacid or histamine blocker is taken.

Describe the clinical manifestations associated with a peptic ulcer perforation.

When peptic ulcer perforation occurs, the patient experiences severe upper abdominal pain, vomiting, fainting, and an extremely tender abdomen that can be board-like in rigidity; signs of shock will be present (hypotension and tachycardia).