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Test 2- Acute GI part 2
Terms in this set (150)
What is stomatitis?
Characterized by single or multiple ulcerations of the oral mucosa that appear as inflammation and denudation of the oral mucosa, impairing the protective lining of the mouth
What are some primary causes of stomatitis?
1) Aphthous stomatitis (canker sores)
2) herpes simplex
3) Vincents angina
What is Aphthous stomatitis also known as?
What is herpes simplex cause?
inflammation and ulceration caused by the herpes simplex virus
What is Vincent's angina?
Acute bacterial infection of gingivae
What are some secondary causes of Stomatitis?
Bone marrow disorders
Chemotherapy, radiation therapy
What is Candidiasis?
Fungal infection of the mouth, throat, and or the esophagus resulting from an overgrowth of normal flora
What are some risk factors for candidiasis?
-Recent antibiotic use
-Immunosuppression or compromise
What is ICS?
What are the clinical manifestations of Candidiasis?
-Creamy white patches in the mouth and throat
-Painful cracks at the corners of the mouth
-Change in taste
-Cervical and submandibular lymphadenopathy
what is lymphadenopathy?
Enlarged swollen lymph nodes
What interventions can be done for Candidiasis?
Use soft bristled toothbrush or disposable swab.
What dietary changes should be made for Candidiasis?
-Make sure to have good glucose control as thrush likes high sugar content that's why diabetic patients are predisposed to this
What drug therapies can be used for Candidiasis?
Nystatin-seish and swallow for antifungal
What is Enteral Nutrition?
Method of infusing nutrient solutions directly into GI tract.
When would you give a client Enteral Nutrition?
-Failure to thrive
What are some nursing measures to be made for Enteral Feedings?
-HOB at least 30 degrees
-Check placement before injecting a solution
How could you promote GI motility for enteral feeding?
Wha is Parenteral nutrition?
Complete nutrition given IV
What is TPN composed of?
Carbs, proteins, fats, electrolytes, vitamins
How is Parenteral nutrition administered?
Central line, PPN, PICC
What type of solution is TPN?
Hyperosmolar and hyperosmotic
What are some nursing measures for Parenteral nutrition?
-Maintain correct rate
-Monitor blood glucose
-Monitor IV site
Can parenteral nutrition be administered without a pump>
Where should you never administer TPN?
Groin triple lumen
Why should you monitor for infection?
Bacteria like high sugar content solution
How often should nutrition tubing be changed?
every 24 hours
Why do you wean off of TPN when starting a tube feed?
the person may become hypoglycemic if you stop tube feed completely
How is C. Dif transmitted?
Ingestion of spores
Where does C. dif germinate?
in small intestion
What do C dif toxins lead to?
What are the toxins for C. Diff?
Toxin A and B
What do Toxins A and B cause?
Inflammation and mucosal drainage.
What is Toxin B major toxin for?
What are some risk factors for C. Diff?
1) antimicrobial exposure
2) Acquisition of C. diff
3) Advanced age
4) Underlying illness
6) Feeding tubes
7) Gastric acid suppression
What are the clinical manifestations for C. Diff?
-Loss of appetite
-Abdominal pain or tenderness
How do you diagnose C. Diff?
-Verification of the presence of toxins A and B in stool culture 3 times
How do you prevent the spreading of C. diff?
What type of isolation is a C. diff patient placed in?
What should you not give a C. Diff patient ?
What antimicrobial therapy is given for C. Diff?
What indicates effective therapy of C. Diff?
Stool free of C-diff toxin
What causes GERD
The backward flow of gastrointestinal contents into the esophagus thereby exposing the esophageal mucosa to irritating effects of gastric or duodenal contents, resulting in inflammatory changes of the esophageal mucosa
What could cause GERD?
-Inappropriate relaxation of Lower esophageal sphincter
-Irritation from refluxed material
-Delayed gastric emptying
-abnormal esophageal clearance
What is dyspepsia?
Where does dyspepsia occur?
Substernal or retrosternal
What does dyspepsia feel like?
Burning sensation that moves up and down chest in a wavelike motion. If pain is present it can radiate to neck or jaw
When does pain with GERD typically worsen?
Bending over or recumbent position
When does severe GERD pain generally occur?
after each meal and persists for 20 minutes to 2 hours.
How do you relieve GERD pain?
Ingestion of fluids or antacids and sit in upright position
What are some clinical manifestation of GERD?
-Coughing or hoarseness
What does an EGD do for GERD?
What is Barrett's esophagus?
Abnormal tissue that developes as a result from the constant reosion from the gastrointestional content
What does having Barrett's esophagus put you more at risk for?
What are the goals in treating GERD?
To relieve symptoms, treat esophagitis, and prevent further complications
What medications are given for GERD patients?
Why are antacids given to GERD patients?
Makes gastric contents more alkaline
When should you take antacids?
1 hour before a meal and 2-3 hours after
What are some major side effects of antacids?
constipations or diarrhea
What are some examples of antacids?
Maalox or mylanta
Examples of H-2 blockers?
Examples of PPI
What do PPIs do ?
inhibit gastric secretion through the inhibition of hte proton pump in gastroparietal cells
What are some diet changes a person with GERD should incorporate?
-Small frequent meals
-No carbonated beverages
What are some lifestyle changes for GERD?
Position head on multiple pillows during sleep
What is another name for a Hiatal hernia?
What occurs during a hiatal hernia?
Protrusion of the stomach through the esophageal hiatus of the diaphragm into the thorax
What are some symptoms of hiatal hernia?
symptoms similar to GERD
What is Type I Hiatal hernia?
-Esophagogastric junction portion of the fundus of the stomach slides upward through the esophageal hiatus
What occurs in Type II hiatal hernia?
Stomach rolls outward
What are some risk factors for Hiatal hernia?
What are the clinical manifestations of a Hiatal Hernia?
Feeling of fullness
symptoms worsen after meals
breathlessness after eating
How do you diagnose a hiatal hernia?
Barium swallow study
What preoperative care is there for hiatal hernia?
What does the NG tube contents look like after hiatal hernia repair?
Dark brown initially then becomes yellow-green within the first 8 hours post op
When can oral intake start after hiatal hernia repair?
After peristlsis is re-established
What should be avoided after hiatal hernia repair?
caffeinated, carbonated, alcohol
why does gas bloat syndrome occur?
Advancing the diet too quickly giving them large amounts of gas and making them feel very bloated
What is Gastritis?
Inflammation of the gastric mucosa
What are some is seen in Acute Gastritis?
What layers are effected in chronic gastritis?
What can cause Gastritis?
-Irritating food, spicy, alcohol, smoking
-Environmental irritation and stress
What are some s/sx of Acute gastritis?
What are some S/sx of chronic gastritis?
-Vague complaint of epigastric pain
-Intolerance of fatty and spicy food
What causes Pernicious anemia?
destruction of parietal cells negatively effect secretion of intrinsic factor
What is intrinsic factor critical for?
Vitamin B12 absorption
How do you diagnose Gastritis?
EGD with biopsy and H. Pylori culture
What are some drug therapies for gastritis?
H2 blocker, PPI, Antacid
What is given to patients with chronic gastritis?
What drugs should people with gastritis avoid?
NSAID and Aspirin
What diet therapy is there for gastritis?
-Avoid trigger food
-soft bland diet
-small frequent meals
What surgical management is there for gastritis?
Total partial gastrectomy
What are the 3 types of peptic ulcers?
What could cause gastric ulcers?
Acid, pepsin, H. pylori
Where are gastric ulcers located ?
What is gastric emptying like with gastric ulcers?
Normal gastric acid secretion but delayed stomach emptying
What are some risk factors for Gastric ulcers?
Where are duodenal ulcers located?
first portion of the duodenum
What causes duodenal ulcers?
normal diffusion of acid back into the stomach with an increase secretion of gastric acid and stomach opening
What are some risk factors for Duodenal ulcers?
type o blood
What are some risk factors for peptic ulcers?
Bacterial infection with H. Pylori
What are some S/sx of peptic ulcers?
Where is pain with a gastric ulcer?
upper epigastium with localization to the left of midline
When does pain for gastric ulcer occur
30-60 minutes after meals
Where is pain from duodenal ulcers located?
To the right of epigastrum
When does pain from duodenal ulcer occur ?
90 min - 3 hours after eating
What can relieve pain from duodenal ulcer?
What should be monitored in a GI bleed?
What diagnostic tests can be done for Peptic ulcers?
Fecal occult blood testing
Barium enemas for duodenal ulcers
H. pylori testing
What tests can be done for H. pylori?
-Urea breath test
What are the goals in treating H. pylori?
Provide pain relief
eradicate H pylori
What is used to treat H. pylori?
What drugs are involved in triple therapy?
Tetracyclin or clarithymycin and amoxixillin
Bismuth compound or PPI
How often should triple therapy be taken?
4 times a day for 14 days
What is an example of a mucosal barrier fortifier?
Carafate or Sucralfate
What does a mucosal barrier fortifier do?
Coats the stomach and lining preventing any further digestive action
When should Sucralfate (Carafate) be given?
1 hour before a meal
What are some features of a Gastrointestinal bleed?
-tarry or frank blood in stool
Mental status changes
how do you treat a bleeding peptic ulcer?
Saline lavage by NG tube until clear
What should be done if saline lavage does not run clear?
Get person in for surgery
What are some surgical interventions for peptic ulcers?
partial gastric resection
cutting vagus nerve to decrease HCL production
Parital removal of stamach and anastomosis with duodenum
removal of the distal segment of stomach and antum with anastomosis with jejunum
What is post operative care for Peptic ulcer?
education of dumping syndrom
What are signs of dumping syndrome?
diaphoesis, diarrhea, hypotension
What are some things that can be done to prevent dumping syndrome?
-restricting fluids during meals
-semi recumbent positioning
-lie down 20-30 min after meals
-smaller frequent meals
-low CHO and iber
What is Irritable bowel syndrome?
Chronic gastrointestinal disorder characterized by the presence of chronic or recurrent diarrhea, constipation, and or abdominal pain and bloating
What is another term for IBS>
What are some physical factors of IBS?
ingestion of coffee or gastric simulants
What is manning criteria for IBS?
-Abdominal pain relieved by defacation or associated changes in stool frequency or consistancy
-sensation of incomplete evacuation of bowel
-presnece of mucus in stool
Where is pain in an IBS flare up?
What are some dietary modifications for IBS?
-avoid trigger foods
-increase fiber 30-40g per day
Drug therapy for IBS?
Acute inflammation of the apendic
What can cause appendicitis to occur?
lumen of appendix is obstructed
Where is pain felt in appendicitis?
S/sx of appendicitis
-abdominal pain that is mild or cramping occuring in the epigastric periumbilical area initially
-Abdominal tenderness with palpation
What point signifies appendicitis?
What diagnostics are there for appendicitis?
CBC with diff
Nonsurgical management for appendicitis
-Hydration via IVF
-Analgesics as prescribed
-ice therapy for pain
Surgical management for appendicitis
laparoscopic removal of appendix
presence of many abnormal pouchlike herniations in the wall of the intestines
Inflammation of one or more diverticula
Where do diverticula commonly occur? s
What occurs in diverticular disease?
musculature of the colol hypertrophies, thickens, and becomes rigid and herniation of the mucosa or submucosa occur
What are some risks for diverticular disease?
diets small in fiber
Clinical manifestations for diverticular disease
-may be asymptomatic
-crampy abdominal pain llq
-constipation with alternating dirrhea
Diagnostics for Diverticular disease
-CBC with diff
-Colonoscopy or sigmoidoscopy
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