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GERD, GI Bleeding, and peptic ulcers
Terms in this set (68)
Gerd is defined as:
Result of backward flow (reflux) of GI content into the esophagus
What signs and symptoms would a pt with Gerd present?
Heart burn, dyspepsia, regurgitation, eruction, flatulence, hypersalvation, dysphagia, chronic cough
Which diagnositic test is most accurate in diagnosing GERD?
24- hour ambulatory pH monitoring
When sleeping, how far should of the head of the bed be elevated in a patient with GERD?
What position should a pt with GERD sleep in?
left lateral decubitis position
What should the nurse teach a pt with GERD?
avoid lifting heavy objects, wear nonbinding clothes,reduce weight, stop smoking and alcohol consumption
What drugs are used to treat GERD?
Antacids ( mylanta, maalox
Histamine receptor antagonists - pepcid, zantac
Proton pump inhibitors - protonix, nexium
Prokinetic drugs: reglan
Antacids, names and how they work?
decreasing level of gastric contents
Histamine receptor antagonists names and how they work?
decrease acid production
What is the name and action of Proton pump inhibitors ?
provide effective, long lasting inhibition of gastric acid secretion
Prokinetic drugs name and action?
increase gastric emptying and improve lower esophageal sphincter pressure and esophageal peristalsis
When using Antacids, what should you be careful of?
Watch patients with cardiac issues because of sodium content. Antacids can mess up the electrolyte balance. Also know that they are short acting
What is a gastric analysis?
Measurement of the hydrochloric acid and pepsin content for evaluation of aggressive gastric and duodenal disorders ( Zollinger-Ellison syndrome)
How many hours will the pt be NPO for a Gastric analysis?
What is the primary pigment in bile?
A radiographic examination of the large intestion, usually ordered when a patient with blood or mucus in the stool or a change in bowel habits
How many hours are only clear liquids given before a Barium Enema?
12 to 24 hours, NPO the night before, also a bowel cleansing is done.
After a barium enema
expel the barium, drink plenty of fluids, stool will be chalky white for 24-72 hours
Where does a upper GI series and small bowel series detect disorders?
visulaization from the oral part of the pharynx to the duodenojejunal junction. Used to detect disorders of structure or function of the esophagus, stomach, or duodenum
After a upper series and small bowel series, the nurse should
give the pt plenty of fluids,
administer mild laxative or stool softner; stools may be chalky white for 24-72 hours
Where does a esophagogastroduodenoscopy detect disorders?
esophagus, stomach, duodenum
A nurse will instruct a pt to be NPO for how many hours before a esophagogastroduodenoscopy?
6 to 8 hours
What sedation will be used in an esophagogastroduodenoscopy?
After the esophagogastroduodenoscopy vitals should be done ?
every 30 mins, and pt will be NPO until gag reflux returns
Visual examination of the liver, gall bladder, bile ducts, and pancreas to identify the cause and location of an obstruction is known as a ?
Endoscopic retrograde cholangiopancreatography
After an ERCP vitals should be done?
every 15 mins, NPO for 6 to 8 hours before the test
After a ERCP the pt is instructed to report
abdominal pain, fever, nausea, or vomiting that fails to resolve. The patient should remain in NPO status until the gag reflex returns
After the ERCP procedure, the pt should be monitored for
cholangitis, perforation, sepsis, and pancreatitis
An endoscopic examination of the entire large bowel is known as?
The pt recieving a colonoscopy should be on a liquid diet for how many hours before?
12 to 24 hours
After the colonoscopy, the nurse should observe for signs of ? and instructs the patient that a feeling of ? may be expected
perforation or hemorrhage.
Instructs the patient that a feeling of fullness, cramping, and passage of flatus can be expected several hours after the test
A endoscopic examination of the rectum and sigmoid colon is known as
The pt should be positioned on the ? side during a Proctosigmoidoscopy ?
left side in the knee chest posture
The patient is informed that ? may be experienced as a result of air instilled into the rectum during a Proctosigmoidoscopy ?
mild gas pain and flatulence and bleeding my occur if a biopsy specimen is obtained
Peptic ulcer disease is defined as?
a mucosal lesion of the stomach or duodenum caused when gastric mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin.
Where do duodenal ulcers occur?
in the first portion of the duodenum
How do duodenal ulcers present?
deep, sharply demarcated lesions that penetrate through the mucosa and submucosa into the muscularis propria
Stress ulcers are defined as
acute gastric mucosa lesions occurring after an acute medical crisis or trauma
What are stress ulcers associated with?
head injury, major surgery, burns, respiratory failure, shock, and sepsis
What is the principal manifestation of a stress ulcer?
bleeding caused by gastric erosion
What is the main way to treat a stress ulcer?
What is a pyloric obstruction?
manifested by vomiting, caused by stasis and gastric dilation
What are the clinical manifestations of a peptic ulcer?
epigastric tenderness usually located between the midline between the umbillicus and the xiphoid process
A pt complaining of a sharp, burning, gnawing pain and sensation of abdominal pressure or fullness or hunger, is probably experiencing?
a peptic ulcer
Ulcer drug reimen promotes
relief of pain by eradicating helicobacter pylori infection and promoting healing of the gastric mucosa
What is the treatment for Helicobacter pylori?
2 antibiotics and 1 ppi
Proton pump inhibitor
Metronidazole and tetracycline
Clarithromycin and amoxicillin
What are the names and function of hyposecretory drugs?
function-reduce gastric acid and secretion
- proton pump inhibitors
-h2 receptor antagonists
Name the proton pump inhibitors
What is the function of H2 receptor antagonists?
block histamine-stimulated gastric secretion
- may be used for indigestion and heartburn
- block the action of h2 receptors of the parietal cells, thus inhibiting gastric acid secretion
What are the most commong h2 receptor antagonists?
zantac, pepcid, and axid
What is the name and function of Prostaglandin analogues?
reduce gastric acid secretion and enhance gastric mucosal resistance to tissue injury
What does misoprostol (cytotec) help prevent?
Nsaid induced ulcers
What test must a pt recieving cytotec have before?
What is a significant adverse of effect of misoprostol (cytotec)?
What is the function of antacids?
Buffer gastric and prevent the formation of pepsin; they are effective in accelerating the healing of duodenal ulcers
For optimal effect of antacids, a pt should
take about 2 hours after meals
What is the function of mucosal barrier fortifiers?
protective coat that prevents further digestive action of both acid and pepsin
What type of nutrition therapy should a pt with a peptic ulcer recieve?
avoid bedtime snacks
avoid alcohol and tobacco
How is perforation managed?
immediately by replacing fluid, blood, and electrolytes:
- administering antibiotics
-Keeping patient NPO
What does vagotomy eliminate?
Acid secreting stimulus to gastric cells and decreases the response of parietal cells
Pyloroplasty facilitates what?
emptying of stomach contents
What is zollinger-ellison syndrome?
manifested by upper GI tract ulceration, increasted gastric acid secretion, and the presence of a non beta cell islet tumor of the pancreas, called a gastrinoma
Patients with zollinger-ellison syndrom may complain of?
peptic ulcer disease symptoms and may have diarrhea and steatorrhea (greasy stools)
The nurse is teaching the patient about zantac prescribed for gastritis. Which statement by the patient indicates effective teaching by the nurse?
This drug will block the secretions of my stomach
Which drug does the nurse identify as a proton pump inhibitor?
A pt should avoid using antacids with?
What action does a nurse take when administering Maalox?
give the med 2 hours after pts meal
do not give other drugs within 1 to 2 hours of antacids
Assess pt history of renal disease
assess pt for a history of heart failure
observe the pt for the side effect of diarrhea
Which statement made by the pt recieving sucralfate (carafate) indicates that teaching has been effective
I will take this drug on an empty stomach