MDC II exam 2
Why do obesity and hiatal hernias increase the risk for the development of GERD?
they increase intra-abdominal pressure
T/F: Prostaglandins provide protective mucosal barriers that protects stomach from auto-ingestions
true
What condition do these parameters indicate? pH: 7.3 pCO2 52 HCO3 22
uncompensated respiratory acidosis pH is low so it is acidic. pCO2 is high, making it acidic. hCO3 is 22, within normal range.
What is the pH normal reference range?
7.35 to 7.45
Drugs used to treat GERD
Antacids histamine blockers proton pump inhibitors
bicarbonate levels are controlled by which organ?
the kidneys
Pharmacologic management of Gastritis
- H2 receptor antagonists (Famotidine, Cimetidine) - proton pump inhibitors (omeprazole) - Mucosal battier fortifiers (sucralfate)
Etiology and genetic risk of gastritis
- alcohol and caffeine increase risk - NSAIDS and corticosteroids increase risk - can be caused by H. pylori bacteria
Gastritis prevention
- avoid alcohol - reduce stress - limit foods and spices that cause gastric distress - exercise to promote peristalsis
Key features of GERD
- belching, heartburn, hoarseness, coughing
Gastritis true statements
- can be scattered or localized - classified by cause, cellular changes, or distribution - acute and chronic gastritis do NOT increase risk of gastric cancer
Surgical procedures to treat hiatal hernias by reinforcement of LES
- can result in temporary dysphagia - wrap portion of stomach fundus around distal esophagus to anchor and reinforce (fundoplication) - procedure may be laparoscopic or open
Common causes of esophageal trauma include....
- chemical exposure - foreign objects - trauma ulcers - straining - seizures
signs and symptoms of esophageal cancer
- dysphagia - weight loss - voice changes -halitosis - chronic hiccups - odynophagia (painful swallowing)
differentiate gastric and duodenal ulcers
- gastric: normal acid with delated emptying - duodenal: too much acid with normal movement
Esophageal tumors
- often large and and well-established when diagnosed - pickled and fermented foods are linked to malignant tumors - grow rapidly
Non surgical management of esophageal cancer includes....
- photodynamic therapy - radiation therapy -chemotherapy - esophageal dilation
Explain Barret's epithelium
- substitution of columnar epithelial instead of squamous cells - Resistant to acids - considered pre-malignant
Life style changes to control acid reflux
- weight loss - eliminate fatty foods - avoid alcohol and tobacco (number of meals eaten per day dose not matter) - stay upright after eating for at least one hour
Zollinger-Ellison syndrome symptoms
-Peptic ulcers (not responding to tx) -Dyspepsia -GERD -Diarrhea, foul smelling -stomach pain
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 any nausea?" D."Is your pain level manageable?"
A). Passing gas is evidence of peristaltic movement
As the patient prepares for discharge, the nurse provides education about behaviors that reduce symptoms and aggravate peptic ulcers. Which teaching does the nurse provide? (Select all that apply.) A.Sit upright 30 to 60 minutes after meals. B.Spices should be added to food to enhance flavor. C.Extreme vomiting should be reported to your physician. D.H. pylori can be a concern in patients with peptic ulcers. E.The goal of initial intervention is to control symptoms and prevent further complications.
A, C, D, E
Which diagnostic results does the nurse recognize that support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply.) A.Low hemoglobin (Hgb) B.Low white blood cell (WBC) level C.Low hematocrit (Hct) D.Positive for H. pylori bacteria E.Low potassium of 3.4 mEq/L
A, C, and D Low hemoglobin and low hematocrit are signs of bleeding. H. Pylori is a common cause of ulcers
A 72-year-old man has recently been diagnosed with oral cancer. He has been undergoing both radiation and chemotherapy. While visiting his oncologist, he mentions to the nurse that he has lost all of his hair and that his mouth is very dry. He also states that he is certain he has a cavity, because one of his teeth is hurting. What teaching will the nurse provide to decrease the incidence of dry mouth? A. consuem eight glasses of water daily. B. See the dentist immediately to get the tooth filled. C. Brush with a combined mixture of baking soda and salt. D. Increase dietary intake of grapefruits and oranges, which are high in vitamin C.
A. Consume eight glasses of water daily.
Which assessment variable requires immediate nursing intervention post esophagectomy? A. Respiratory rate of 28 B. Blood pressure of 170/88 C. Temperature of 38.1º C D. Pain assessment of 6 on a scale of 0 to 10
A. Respiratory rate of 28 airway complications are top priority
An EGD confirms that the patient has PUD. Three hours later, the patient is admitted to the medical unit for workup and further testing. On admission the patient reports midline epigastric tenderness and indigestion (dyspepsia). The patient is prescribed triple therapy. Which drugs does the nurse prepare to administer? A.Proton pump inhibitor (PPI) and two antibiotics B.Antibiotic and two PPIs C.Histamine antagonist, antacid, and PPI D.Antacid, PPI, and prostaglandin analogue
A. proton pump inhibitor and two antibiotics. Antibiotics can treat an H. Pylori infection and PPIs reduce acid to allow ulcers to heal
Which nursing intervention is the priority in the care of a patient with a hiatal hernia? A.Providing nutrition education B.Promoting regular exercise C.Providing medication education D.Instructing the patient on signs and symptoms of intestinal strangulation
A.Providing nutrition education
A patient is scheduled to start chemotherapy. What oral cavity problem does the nurse teach the patient that may occur? A.Stomatitis B.Candidiasis C.Xerostomia D.Oral abscess
A.Stomatitis
A person with a pH of 7.55 is acidotic or alkalotic?
Alkalotic
An older patient with poor oral hygiene was admitted after a fall in which he sustained a fractured hip. What is the priority nursing intervention? A.Initiate oral care every 4 hours. B.Implement aspiration precautions. C.Request a consult with a registered dietitian. D.Use swabs to moisten the mouth as needed.
B. Implement aspiration precautions.
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. Nausea and vomiting may develop rapidly and are common side effects in older adults
B.Close monitoring is needed because toxic levels may develop.
The most common base in the human body is_____.
Bicarbonate
_____ work to bring fluids as close as possible to the normal body pH range of 7.35 to 7.45.
Buffers
The nurse is reviewing the standing orders for a patient who was admitted for evaluation of chest pain. The patient has a history of chronic obstructive pulmonary disease (COPD) and his laboratory results and assessment reveal that he has mild respiratory acidosis. The nurse would question which order? A.Encourage oral fluids B.Keep head of bed elevated C.Oxygen therapy at 4 L/min as needed D.Bedrest with bathroom privileges only
C) Oxygen therapy at 4L/ Min as needed. Oxygen therapy is often ordered for respiratory acidosis. However, COPD patients have a difficult time off-loading carbon dioxide and giving too much oxygen can cause these patients to have a decrease in respiratory drive, leading to respiratory arrest.
The nurse is caring for a patient with peptic ulcer disease (PUD). Which patient statement requires nursing teaching? A."When I eat out, I avoid spicy foods." B."I sit up for at least an hour after I eat my meals." C."My doctor said to take ibuprofen for my aches and pain." D."After I quit work, my stress level decreased substantially."
C. A."My doctor said to take ibuprofen for my aches and pain." NSAIDs can cause stomach irritation and ulcers
What is the nursing priority in the management of a patient with a newly active upper GI bleed? A. Obtain vital signs. B. Notify the physician. C. Apply oxygen by nasal cannula. D. Type and cross-match the patient for blood products.
C. Apply oxygen by nasal cannula. Oxygen will assist with delivery of oxygen to the tissues. Vital signs are then needed to evaluate the severity of the patient's bleed and hypovolemic status, which can then be reported to the physician. A type and cross match, although important, can take place afterward.
A patient in the ED has been experiencing upper abdominal pain after meals for the past several months. She reports pain after napping or sleeping at night. She has been taking OTC antacids with some relief. The nurse understands that which assessment finding places the patient at risk for peptic ulcer disease? A.GERD 4 years ago B.Weight loss of 35 lbs C.Use of NSAIDs to control arthritis pain D.Recent discontinuation of prednisone (Deltasone)
C. use of NSAIDS to control arthritis pain NSAID use and H. Pylori bacteria are the most common causes of ulcers
Twenty minutes later after a careful assessment of the patient, the nurse notes that the patient's SaO2 is 89% and he has crackles scattered bilaterally. The oncologist decides to admit the patient to an acute care oncology unit, and within the hour, he is transported to a hospital unit. What is the priority nursing intervention upon admission? A.Start IV normal saline for rehydration. B.Ask the oncologist for a dental consult. C.Apply oxygen at 2 L per nasal cannula. D.Perform frequent oral care with normal saline.
C.Apply oxygen at 2 L per nasal cannula. Airway is always top priority
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 gastroesophageal reflux disease (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.Frequently takes NSAIDs for pain
What drugs can decrease lower esophageal sphincter pressure (LES pressure) and cause acid reflix?
CA channel blockers, NSAIDs, nitrates, sedatives, oral contraceptives, and anticholinergics
__________is a gas that forms carbonic acid when combined with water
Carbon dioxide
The following parameters indicate which acid-base imbalance? pH 7.44 PCO2 39 HCO3 30
Compensated Metabolic Alkalosis
The nurse is evaluating the lab work of a patient who has uncontrolled metabolic acidosis. Which lab result would result from this condition? A) pH 7.4 B) PaO2 98 mm Hg C) bicarbonate 38 mEq/ L D) serum potassium 5.7 mEq/L
D) serum potassium 5.7 mEq/L. Serum potassium increases during acidosis to try to buffer the acidic conditions.
Which patient statement would cause the nurse to suspect that she may have Zollinger-Ellison syndrome (ZES)? A."I can't lie flat for awhile after I've eaten." B."I feel much better after taking Zantac (ranitidine)." C."Occasionally I have pain in my left lower quadrant." D."The stomach pain hurts, but the foul-smelling diarrhea is worse."
D. "The stomach pain hurts, but the foul-smelling diarrhea is worse."
A 68-year-old patient with a history of arthritis and hypertension is admitted reporting progressive epigastric cramping, dyspepsia, nausea, and dark, sticky stools for 3 days. Which order will the nurse question? A. Guaiac stool sample x2 B. Stool sample for bacterial testing C.IV fluids, normal saline at 125 ml/hr D. Naproxen (Naprosyn) 500 mg twice daily
D. Naproxen (Naprosyn) 500 mg twice daily Long term NSAID use causes a high risk for acute gastritis, ulcers, stomach bleeding
Which patient statement alerts the nurse to perform 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. large amounts of aspirin or NSAIDs can cause peptic ulcer disease and GI bleeding.
A 23-year-old female patient reports having red, raised lesions at the base of her tongue and on the inside of her mouth for the past 3 weeks. What priority assessment question should the nurse ask? A."Do you smoke cigarettes?" B."What type of work do you do?" C."Have you seen a dentist recently?" D."Do you have a history of human papillomavirus?"
D."Do you have a history of human papillomavirus?" HPV can cause mouth lesions
T/F: Alkalosis decreases the sensitivity of excitable tissues.
False, Alkalosis increases sensitivity of excitable tissues. Ex: it causes over reaction of reflexes
T/F: PET scans are used to definitely diagnose esophageal cancer
False, endoscopies are mostly used
T/T: E. Coli is the largest risk factor for gastric cancer.
False, the greatest risk factors are H. pylori, obesity, smoking, red meat, alcohol, and low socioeconomic status
T/F: alcohol use and obesity are primary risk factors for esophageal cancer.
False. Primary risk factors are having Acid reflux, being male, smoking and tobacco use
Backward flow of stomach contents into the esophagus causes which upper GI disorder?
GERD
Paraesophageal hernia
Gastric fundus and possible portions of stomach's greater curvature move into the chest beside the esophagus
A nurse is caring for a client who has metabolic alkalosis. As the client compensates for this ac id-base imbalance, which of the following mechanisms should the nurse expect the client's body to use?
Hypoventilation. Hypoventilation is the mechanism that helps clients compensate for metabolic alkalosis.
DKA and renal failure are common causes of which acid-base imbalance?
Metabolic acidosis
A client is in acidosis. What lab test is a priority to monitor?
Potassium
A patient is brought into the ED with respiratory depression. The patient has a history of COPD. What acid-base imbalance is most likely?
Respiratory Acidosis. The patient likely has a build-up of CO2, causing respiratory acidosis.
A client comes into the ED with a high fever and is hyperventilating. His ABG results are pH 7.51, PaCO2 28 mm Hg, and HCO3 24 mEq/L. The nurse should identify that the client has which acid-base imbalance?
Respiratory Alkalosis. Because the client is breathing rapidly, he is exhaling excessive amounts of carbon dioxide. This loss of carbon dioxide decreases the hydrogen ion level of the blood, causing the pH to increase and resulting in respiratory alkalosis.
Gastritis treatment
Treat acute gastritis with supportive care and treat chronic gastritis based on the cause (change in life style, drug therapy)
T/F: Acids are normally found in the body as a result of metabolism.
True
T/F: Chronic gastritis results in decreased function of parietal (acid-secreting) cells and loss of intrinsic factor.
True
T/F: Compensation is the body's attempt to restore its pH level to homeostasis.
True
T/F: clients with esophageal cancer are at an increased risk for aspiration and compromised nutrition
True
T/F: nonsurgical management of hernias is similar to GERD (with drugs, nutrition, and lifestyle)
True
A nurse is inserting an NG tube for a client who is beginning enteral feedings. What action should the nurse take to verify tube placement before administering initial feeding?
Verify tube placement with radiography
A client comes into the ED with respiratory acidosis. What type of medication would the nurse likely administer?
bronchodilators
When assessing a client with acidosis, what system should the nurse address first?
cardiovascular
Most duodenal ulcers occur in the _____ of the duodenum
the upper portion
a decrease in bicarbonate will do what to the pH?
decrease it (make the body more acidic)
What is dumping syndrome?
delivery of a large amount of hyperosmolar chyme into the small bowel, usually after vagotomy and a gastric drainage procedure (pyloroplasty/gastrojejunostomy); results in autonomic instability, abdominal pain, and diarrhea
Too much acid with normal movement can cause...
duodenal ulcers
What are some common causes of respiratory alkalosis?
fear, hyperventilation, anxiety
A base binds hydrogen ions in solution and decreases the amount of ____ ______ _____ in solution.
free hydrogen ions
normal acid levels with delayed emptying can cause...
gastric ulcers
Types of ulcers
gastric, duodenal, stress
Acids are substances that release _____when dissolved in body fluids
hydrogen ions
Zollinger-Ellison syndrome
hypersecretion of gastric acid that produces peptic ulcers as a result of pancreatic tumors
dumping syndrome treatment
increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis. Wait 1 hr after meals to drink
What pH levels are typically fatal?
less than 6.9 or greater than 7.8
A client has acute alcohol intoxication. What acid-base imbalance is the client at risk for?
metabolic acidosis.
What condition do these parameters indicate? pH 7.49 PCO2 49 HCO3 31
partially compensated metabolic alkalosis
what causes a stress ulcer?
physiological stress like sepsis, shock, and trauma
Barrett's epithelium
replacement of the squamous cell epithelium of the lower esophagus with new tissue that is more resistant to acid but is considered premalignant. (almost similar to scar tissue that is thicker and tougher)
Retention of CO2 causes which acid-base imbalance?
respiratory acidosis
A patient comes into the ED with delirium and confusion. He has a history of severe sleep apnea. Which acid-base imbalance is he most at risk for?
respiratory acidosis can be caused by sleep apnea
A patient comes into the ED with difficulty breathing. He has a history of severe COPD. Which acid-base balance is he most at risk for?
respiratory acidosis, his body cannot of load carbon dioxide through the lungs, resulting in acidic conditions
Where are peptic ulcers located?
stomach lining or duodenum
