Med-Surg Exam 4

Calcium Range Ca+

8.2-10.2

What is the main cause of PUD?

H. pylori

prolonged or severe esophagitis can lead to

scarring and stricture formation

the goals of treatment for patients with PUD

1. eradicate the bacteria 2. reduce acid levels in the digestive system to relieve pain and promote healing

Sodium Range Na+

135-145 mEq/L

Chron's/UC an examination of stool specimens reveals steatorrhea or excessive fat and occult blood and WBCs

chrons

Chron's/UC early pathology: transmural thickening

chrons

What do the stools look like for Crohn's disease?

watery, no visible blood, but may have occult blood

Potassium Range K+

3.5-5.3 mEq/L

this disorder is a known precursor of cancer of the esophagus

Barrett's esophagus

Common side effects for these acid reducers Proton Pump Inhibitors: esomeprazole (Nexium) lansoprazole (Prevacid) omeprazole (Prilosec)

Headache nausea diarrhea

Common side effects of these acid reducers Histamine H2 Antagonists: cimetidine (Tagamet) famotidine (Pepcid) nizatidine (Axid) ranitidine (Zantac)

Headache somnolence diarrhea

a disease in which the esophageal lining becomes more like the intestinal mucosa, occurs in a small percentage of clients who have chronic GERD

Barrett's esophagus

What do the stools of patients with ulcerative colitis look like?

Bloody, may have puss, semi-formed, mucous may be present

A _______ helps your health professional diagnose conditions, such as infection, anemia, and several other disorders

CBC

A ________helps your health professional check any symptoms, such as fatigue, weakness, or bruising, that you may have

CBC

Chron's/UC Diagnostic Study Findings Flexible sigmoidoscopy: may be unremarkable unless accompanied by perianal fistulae

Chron's

Chron's/UC late pathology: deep penetrating granulomas

Chron's

can be a risk factor for developing Barrett's espophagus

Chronic GERD

Chron's/UC course: prolonged variable

Chrons

Chron's/UC Clincal manifestations location: illeum, right colon (usually) bleeding: usually not, but may occur perianal involvement: common fistulae: common rectal involvement: about 20% diarrhea: less severe

Chrons

Common side effects of antacids aluminum hydroxide (AlternaGEL) calcium carbonate (Tums) magnesia (mangesium hydroxide or oxide) sodium bicarbonate

Constipation Diarrhea electrolyte imbalance with chronic use

S/S of bowel obstruction include:

Crampy abdominal pain that comes and goes Loss of appetite Constipation Vomiting Inability to have a bowel movement or pass gas Swelling of the abdomen

Intended use for these acid reducer GI motility agents: metoclopramide (Reglan)

Diabetic gastroparesis GERD prevention of nausea and vomiting by rapid transit out of stomach

Safety warnings for nurses of antacids aluminum hydroxide (AlternaGEL) calcium carbonate (Tums) magnesia (mangesium hydroxide or oxide) sodium bicarbonate

Do not give oral drugs within 1-2 hrs consider cardiac status and sodium restrictions when using sodium bicarbonate

Intended use for these acid reducers Proton Pump Inhibitors: esomeprazole (Nexium) lansoprazole (Prevacid) omeprazole (Prilosec)

Erosive esophagitis GERD H. pylori eradication NSAID associated gastric ulcers by suppressing gastric acid secretion

Enterocutaneous fistula

Fistula between bowel and skin; can be seen in Crohn's disease due to transmural inflammation (not seen in UC)

GERD/PUD? If a patient complains of a burning sensation rising from the stomach into the chest or towards the neck, it is most likely due to

GERD

GERD/PUD? symptoms such as heartburn or regurgitation may often be exacerbated by alcohol and certain foods, including those containing caffeine, garlic, and peppermint, as well as fatty foods. These foods and alcohol often cause relaxation of the lower esophageal sphincter, allowing the refluxate to enter into the esophagus from the stomach, thus causing heartburn or regurgitation.

GERD

This disease occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit, causing symptoms with or without associated esophageal mucosal injury (ie, esophagitis)

GERD

Transthoracic and transabdominal fundoplications are performed for ______________________ disease, including partial (anterior or posterior) and circumferential wraps. Open and laparoscopic techniques may be used.

GERD

this results from an inability of the LES (lower esophageal sphincter or cardiac sphincter) to close fully, allowing the stomach contents to flow freely into the espohagus

GERD

Intended use of these acid reducers Histamine H2 Antagonists: cimetidine (Tagamet) famotidine (Pepcid) nizatidine (Axid) ranitidine (Zantac)

Gastric/duodenal ulcers GERD gastric hypersecretory conditions GI bleeding heartburn by inhibiting H2 receptor in stomach

Intended use for these agents used to eradicate H. pylori of duodenal ulcers: bismuth metronidazole tetracycline (Pylera)

H. pylori eradication in pts with duodenal ulcer

The following medications are used in the management of gastroesophageal reflux disease:

H2 receptor antagonists (eg, ranitidine, cimetidine, famotidine, nizatidine) Proton pump inhibitors (eg, omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole) Prokinetic agents (eg, metoclopramide) Antacids (eg, aluminum hydroxide, magnesium hydroxide)

S/S of hemorrhage

Hypotension Weak and rapid pulse Cool and clammy skin Rapid breathing Restlessness Reduced urine output

The most common causes of intestinal obstruction are:

Intestinal adhesions Colon cancer Hernias Inflammatory bowel diseases, such as Crohn's disease Diverticulitis Twisting of the colon (volvulus) Impacted feces In children, the most common cause of intestinal obstruction is telescoping of the intestine (intussusception).

Safety warnings for nurses of these acid reducers Histamine H2 Antagonists: cimetidine (Tagamet) famotidine (Pepcid) nizatidine (Axid) ranitidine (Zantac)

Should not take maximum dose for more than 2 weeks without medical consultation

S/S of PUD

Nausea, abdominal pain and distention, recurrent pain in the epigastric region, wt. loss, poor appetite, bloating, vomiting.

the most common surgical procedure performed for GERD is

Nissen fundoplication a procedure that tightens the LES by wrapping the gastric fundus around the lower esophagus and suturing it into place

GERD/PUD? characterized by a gnawing or burning sensation and that occurs after meals—classically, shortly after meals with gastric ulcers and 2-3 hours afterward with duodenal ulcers.

PUD

GERD/PUD? is often improved when a patient either has an empty stomach or consumes food to satiety, because eating to fill the stomach may often relieve peptic ulcer symptoms.

PUD

GERD/PUD? typically manifested by symptoms including pain or discomfort localized in the center part of the abdomen.

PUD

Most patients with ____________ disease are treated successfully with cure of H pylori infection and/or avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs), along with the appropriate use of antisecretory therapy.

PUD

Rapid testing for H pylori infection is essential in all patients with?

PUD

diagnostic tests for bowel obstruction

Physical exam. X-ray. Computerized tomography (CT). Ultrasound. Air or barium enema.

a lipid compound secreted in the stomach, promotes the production of mucus, which contains buffering substances and mechanically bars penetration by stomach acids

Prostglandin E.

Safety warnings for nurses for these acid reducers Proton Pump Inhibitors: esomeprazole (Nexium) lansoprazole (Prevacid) omeprazole (Prilosec)

Rapid IV administration can cause cardiac arrhythmia long-term use may be associated with bone fractures

Intended use for these miscellaneous acid reducers: sucralfate (Carafate)

Short-term duodenal ulcer treatment

Hypernatremia S/S

Thirst ^ temp sticky mucous membranes dry mouth flushed skin lethargy restlessness oliguria ^ irritability hallucinations seizures pulmonary edema *monitor neuro

Chron's/UC Clincal manifestations location: rectum, left colon bleeding: common- severe perianal involvement: rare-mild fistulae: rare rectal involvement: almost 100% diarrhea: severe

UC

Chron's/UC Diagnostic Study Findings Barium studies, video capsule endoscopy and double balloon endoscopy, CT scan, MRI, small bowel imaging: diffuse involvement no narrowing of colon no mucosal edema stenosis is rare shortening of colon

UC

Chron's/UC Therapeutic management: corticosteroids aminosalicylates (sulfasalazine) useful in preventing recurrence bulk hydrophilic agent antibiotics proctocolectomy, with ileostomy rectum can be preserved in only a few pts "cured" by colectomy

UC

Chron's/UC course: exacerbations, remissions

UC

Chron's/UC early pathology: mucosal ulceration

UC

Chron's/UC late pathology: minute mucosal ulcerations

UC

the most common esophageal diverticulum

Zenker's diverticulum

Eradication therapy for H.Pylori

a combination of antibiotics for at least 2 weeks

Comprehensive Metabolic Panel (CMP-14) with eGFR is a

a group of 14 laboratory tests ordered to give information about the current status of your liver, kidneys, and electrolyte and acid/base balance. current status of your blood sugar and blood proteins also.

a circumscribed loss of tissue in an area of the GI tract that is in contact with hydrochloric acid and pepsin

a peptic ulcer

What is a diverticulum?

a sac or pouch in one or more layers of the wall of an organ or structure

how does a nurse check for bowel obstruction during an assessment?

auscultate, will hear nothing

what is the usual treatment of chronic gastritis?

avoidance of irritating substances, such as alcohol, NSAIDs, avoid spicy foods, high-fat foods, and caffeine

what is a fistula in Chron's disease?

an inflammatory channel containing blood, mucus, pus, or stool

Hyponatremia S/S

anorexia nausea vomiting, weakness or twitching lethargy confusion nonelastic skin turgor swelling of optic nerve HA seizures *monitor neuro

What is the worst thing that could happen with regurgitated acid?

aspiration -> pneumonia

Safety warnings for nurses for these miscellaneous acid reducers: sucralfate (Carafate)

best option for pregnant women with GERD symptoms

In mild cases of Zenker's diverticulum, the standard treatment recommended is?

bland, soft, semisoft, or liquid diets

Hyperkalemia S/S

bradycardia arrhythmias nasuea intestinal cramping diarrhea anxiety muscles weakness, numbness or prickly sensations flaccid paralysis peaked T waves cardiac arrest pt looks sedated *monitor cardiac

Chron's/UC Diagnostic Study Findings Barium studies, video capsule endoscopy and double balloon endoscopy, CT scan, MRI, small bowel imaging: regional, discontinuous skip lesions narrowing of colon thickening of bowel wall mucosal edema stenosis, fistulae

chron's

Chron's/UC Diagnostic Study Findings Colonoscopy: distinct ulcerations separated by relatively normal mucosa in ascending colon

chron's

Chron's/UC Therapeutic management: corticosteroids aminosalicylates (sulfasalazine [Azulfidine]) antibiotics parenteral nutrition partial or complete colectomy, with ileostomy or anastomosis rectum can be preserved in some pts recurrence is common

chron's

a pt with this disorder, the bowel is described as having a "cobblestone" appearance because of the the deep ulcerations that form amid the edamatous tissue in a longitudinal and transverse manner

chron's disease

gross features include the presence of small irregular ulcers which may result from deep but discrete ulcers of the gi mucosa; the ulcers can be longitudinal or transverse

chron's disease

Common side effects for these miscellaneous acid reducers: sucralfate (Carafate)

constipation

the causes of gastritis

dietary indiscretions reflux of duodenal contents use of aspirin, steroids, NSAIDs, alcohol, or caffeine; cigarette smoking ingestion of poisons or corrosive substances food allergies infection gastric ischemia secondary to vasoconstriction caused by a stress response H. pylori may contribute to chronic gastritis

this results from a congenital or an acquired weakness of the esophageal wall

diverticula

S/S of GERD

epigastric pain dyspepsia pyrosis (burning sensation in the esophagus) regurgitation dysphagia odynophagia (painful swallowing) esophagitis aspiration pneumonia respiratory distress hematemesis (vomited blood) melena (tarry stools) *Sometimes occult (hidden) bleeding can cause iron-deficiency anemia

halitosis

foul-smelling breath

A history of nausea, vomiting, or regurgitation should alert the physician to evaluate for delayed?

gastric emptying

What is GERD?

gastroesophageal reflux disease a disease that causes regurgitation of stomach acid in the espophagus

S/S of Zenker's Diverticulum

halitosis dysphagia belching difficulty or pain when belching, regurgitating, or coughing auscultation of the middle to upper chest may reveal gurgling sounds

most peptic ulcers develop in the duodenum; where else may they develop?

lower end of the esophagus, stomach, or in the jejunum

men or women are more likely to have zenker's diverticulum?

men

Safety warnings for nurses for these agents used to eradicate H. pylori of duodenal ulcers: bismuth metronidazole tetracycline (Pylera)

metronidazole is carcinogenic (potential to cause cancer) in mice, avoid if possible capsules must be swallowed whole with full glass of water

Intended use of antacids aluminum hydroxide (AlternaGEL) calcium carbonate (Tums) magnesia (mangesium hydroxide or oxide) sodium bicarbonate

neutralizes gastric acid to relieve heartburn and sour stomach

Safety warnings for nurses for these acid reducer GI motility agents: metoclopramide (Reglan)

monitor for EPS and tardive dyskinesia

Hypocalcemia S/S

muscle cramps and tremors tetany decreased BP tingling or numbness of fingers, toes, around mouth bronchospasm carpopedal spasms ^ DTR prolonged QT interval on EKG + Chvostek's sign + Trousseau's sign *monitor neuro & bones

Common side effects for these agents used to eradicate H. pylori of duodenal ulcers: bismuth metronidazole tetracycline (Pylera)

nausea diarrhea abdominal pain

Common side effects for these acid reducer GI motility agents: metoclopramide (Reglan)

restlessness dizziness fatigue

Hypercalcemia S/S

severe constipation anorexia nausea vomiting polydipsia lethargy fatigue HA polyuria decreased DTR muscle weakness bone fractures without trauma confusion slurred speech psychosis ileus development *monitor neuro & bones

In severe cases of Zenker's diverticulum, the standard treatment is?

surgical removal of the diverticulum

CBC gives what information?

the numbers and kinds of cells in the blood, especially red blood cells, white blood cells, and platelets.

Chron's/UC Diagnostic Study Findings Colonoscopy: friable mucosa with pseudopolyps or ulcers in descending colon

uc

Chron's/UC Diagnostic Study Findings Flexible sigmoidoscopy: abnormal inflamed mucosa

uc

Hypokalemia S/S

weak - rapid irregular pulse decreased BP anorexia nausea vomiting decreased deep tendon reflexes fatigue muscular weakness, cramps, numbness abdominal distention decreased peristalsis ileus may complain of seeing yellow haloes around objects if hypokalemia is caused by digoxin toxicity flat T waves *monitor cardiac