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69 Cards in this Set
- Front
- Back
3 S&S of HIATAL HERNIA.
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hiatal hernia:
1. heartburn 2. regurgitation 3. dyspepsia |
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What is a hiatal hernia?
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hiatal hernia: when the opening through the diaphragm where the esophagus passes becomes enlarged, and part of the UPPER STOMACH comes up into the lower portion of the thorax
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Which meds are given to tx hiatal hernia?
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hiatal hernia meds:
1. H2 receptor blockers (Tagamet, Zantac) 2. Antacids (Amphogel, Milk of Magnesia) 3. Cytoprotective agents (Carafate) |
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How does one tx a hiatal hernia?
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hiatal hernia tx:
1. FUNDOPLICATION: surgery to tighten the cardiac sphincter |
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What pt teaching should the nurse do for a pt w/ hiatal hernia regarding eating habits?
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hiatal hernia teaching:
1. small, frequent meals 2. do NOT lie down for a least 1 hour after meals 3. elevate the HOB 4-8 in when sleeping 4. do NOT eat before going to bed to prevent reflux of food |
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S&S of PYLORIC STENOSIS in infants (5)
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S&S of PYLORIC STENOSIS-infants:
1. projectile vomiting 2. irritability 3. palpable olive-shaped tumor in the epigastrium 4. infant always hungry 5. infant fails to gain weight |
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2 S&S of PYLORIC STENOSIS in adults?
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1. epigastric fullness
2. peristaltic waves |
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What is the clinical picture of PYLORIC STENOSIS in adults?
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narrowing or obstruction of the pyloric sphincter, caused by scarring from healing ulcers
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What is the clinical picture of PYLORIC STENOSIS in infants?
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obstruction caused by hypertrophy or hyperplasia of the PYLORUS
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When is the onset of pyloric stenosis often seen in infants?
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symptoms appear in the 2nd-4th week after birth, then regurgitation develops into projectile vomiting
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Which babies are most at risk for pyloric stenosis?
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white, male, full-term infants
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In adults w/ pyloric stenosis, what is the most common obstruction caused by?
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peptic ulcer
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What impact does inflammation & edema have on the size of the opening of the pyloric sphincter?
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can reduce the size of the opening until there is a complete obstruction
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3 possible surgical interventions for pyloric stenosis?
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1. pyloromyotomy (infants): incision through circular mus of the pylorus
2. vagotomy & antrectomy: removal of GASTRIN-secreting portion of the stomach & severing vagus nerve 3. vagotomy & pyloroplasty or gastroenterostomy: establishes gastric drainage & severing vagas |
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What is the pre-operative goal for pyloric stenosis?
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prevent regurgitation and vomiting
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What are possible fluid and electrolyte abnormalities that can occur w/ pyloric stenosis if the patient vomits or regurgitates?
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1. alkalosis
2. hypokalemia |
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What is the role of the NGT in pre-op prep in a pt w/ pyloric stenosis?
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gastric decompression
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What are possible complications of pyloric stenosis (4)
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1. alkalosis
2. hypokalemia 3. dehydration 4. shock |
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What is the diet of a pt who is post-op from a surgery to tx pyloric stenosis?
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small frequent feedings of glucose water or electrolyte solution 4-6 hr post-op
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If clear fluids are retained post-op from pyloric stenosis tx, when can you initiate formula?
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24 hr postop
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S&S of GASTRITIS?
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GASTRITIS:
1. uncomfy feeling in ab 2. headache 3. anorexia, N, V (bloody) 4. hiccupping |
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What is gastritis?
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acute or chronic inflammation of stomach
*may be exacerbated by alcohol abuse |
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What type of diet should a pt w/ gastritis be on?
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NPO, slowly progressing to bland diet
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Which meds are prescribed for gastritis?
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antacids to relieve pain
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2 major ulcer types
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1. chronic duodenal ulcer
2. chronic gastric ulcer |
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What is an ulcer?
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an excavation formed in the MUCOSAL WALL, caused by erosion that may extend to muscle layers or through the muscle to the peritoneum
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Which infectious agent is often a/w ulcers?
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H. pylori
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Do ulcers have a familial tendency?
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yes
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3 common sites for ulcers?
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1. gastric
2. duodenal 3. marginal |
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What age group is most susceptible to chronic duodenal ulcers?
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30-60 (younger than gastric)
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Risk factors for chronic duodenal ulcers? (8)
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chronic duodenal ulcers:
1. blood type O 2. COPD 3. chronic renal failure 4. alcohol 5. smoking 6. cirrhosis 7. stress 8. **MALE (3:1) |
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What impact do chronic duodenal ulcers have on gastric secretion?
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chronic duodenal ulcers: HYPERsecretion
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When is pain often felt in chronic duodenal ulcers?
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2-3 hr AFTER A MEAL
nighttime, often in early sleeping hours |
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For which ulcer does food intake relieve pain?
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chronic duodenal ulcers
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chronic duodenal ulcers in terms of vomiting?
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vomiting rare w/ chronic duodenal ulcers
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chronic duodenal ulcers in terms of hemorrhage?
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hemorrhage less likely w/ chronic duodenal ulcers
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chronic duodenal ulcers in terms of malignancy?
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rare w/ chronic duodenal ulcers
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Usual age in pt w/ chronic gastric ulcers?
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chronic gastric ulcers:50+
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male: female ratio for pt w/ chronic gastric ulcers?
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chronic gastric ulcers: 1:1
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Risk factors for chronic gastric ulcers (5)
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1. gastritis
2. alcohol 3. smoking 4. NSAIDS 5. stress |
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impact of chronic gastric ulcers on gastric secretion?
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normal to hypOsecretion
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when does pain occur in chronic gastric ulcers?
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chronic gastric ulcers: .5-1 hr after a meal, or when fasting
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does ingestion of food help ease the pain of chronic gastric ulcers?
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NO
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vomiting in relation to chronic gastric ulcers?
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chronic gastric ulcers: frequent vomiting.
VOMITING helps relieve pain of chronic gastric ulcers. |
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hemorrhage in relation to chronic gastric ulcers?
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chronic gastric ulcers: hemorrhage more likely
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malignancy in relation to chronic gastric ulcers
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chronic gastric ulcers are a/w occasional malignancy
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4 goals for living w/ ulcers
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1. avoid oversecretion & hypermotility in the GI tract
2. dietary modification 3. reduce stress 4. stop smoking |
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How should a pt w/ ulcers modify his diet?
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eat 3 meals per day
*small frequent feedings are NOT necessary if the pt is taking antacids or histamine blocker |
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What dietary components should a pt w/ ulcers avoid?
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1. extremes in T (too hot, too cold)
2. coffee, alcohol, caffeinated drinks 3. milk & cream |
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What is the impact of smoking on ulcer repair?
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inhibits
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5 antiulcer meds?
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1. antacids (Maalox)
2. Histamine receptor site antagonist (cimetidine, ranitidine) 3. anticholinergics (pro-banthine) 4. cytoprotective agents (carafate) 5. PPIs (prilosec) |
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Which meds should a pt w/ an ulcer take 1 hr BEFORE MEALS?
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1. antacids(may also be taken 1 hr after)
2. cytoprotective agents |
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Which med should a pt/ w/ an ulcer take 30 min before meals?
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anticholinergics
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When should a pt w/ an ulcer take a histamine receptor site antagonist?
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with meals
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What is the diagnostic work-up involved in dx an ulcer?
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1. upper GI series
2. endoscopy 3. CAT scan |
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4 surgical tx for ulcers?
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1. gastrectomy
2. vagotomy 3. Billroth I 4. Billroth II |
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What is a gastrectomy?
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removal of stomach and attachment to upper portion of duodenum
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What is a vagotomy?
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cutting the vagus nerve (decreases HCl secretion)
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What is a Billroth I?
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partial removel (1/3-1/2 of the stomach), and anastomosing it with the DUODENUM
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What is the Billroth II?
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removal of the distal segment of the stomach and antrum, and anastomosing it with the JEJUNUM
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4 important actions a nurse should perform for a patient s/p sugery for ulcer tx?
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1. assess VS
2. inspect dressings 3. provide gastric decompression as ordered 4. encourage deep breathing |
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Which vitamin is required for life s/p a surgery to tx ulcers?
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VITAMIN B12 via the parenteral rout
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In addition to Vitamin B12, which element is also important post-op a surgery for ulcers?
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FE SUPPLEMENTS
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4 ways to observe for peristalsis in a pt s/p an ulcer tx surgery?
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1. levin tube
2. salem sump 3. listen for bowel sounds 4. record passage of flatus/stool |
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What is the significance of the LEVIN TUBE s/p an ulcer tx surgery?
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single-lumen tube at low suction
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What is the significance of a SALEM SUMP s/p an ulcer tx surgery?
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double-lumen tube for drainage
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What are 4 actions a nurse should take for a pt who has a salem sump?
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1. prevent nostril irritation
2. libricate tube around nares w/ water-soluble jelly 3. control excessive nasal secretions 4. observe drainage for VOLUME & BLOOD |
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What is dumping syndrome?
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rapid passage of food from stomach, causing diaphoresis, D, hypOtension
* s/p an ulcer tx surgery |
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What are 6 preventative measures for dumping syndrome s/p an ulcer tx surgery?
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1. restrict fluids w/ meals (drine 1 hr ac or 1 hr pc)
2. eat in a semi-recumbent position 3. lie down 20-30 min after eating 4. eat smaller, frequent meals 5. low carbs & fiber diet 6. antispasmotic meds |