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234 Cards in this Set
- Front
- Back
What is reverse peristalsis?
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Vomiting
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Functions of the GI tract?
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Motility
Secretions (saliva, mucous, digestive enzymes, acids) Ingestion (mouth, esophagus) Digestion & Absorption (stomach, small intestine, large intestine) Excretion (rectum & anus) |
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What influences motility?
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Stretching of the GI tract, neurotransmitters, hormones and drugs
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What causes vomiting?
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Stimulants to the medulla trigger receptors in the stomach & duodenum or by activating the chemoreceptor trigger zone (CTZ) in the brain
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What do salivary glands secrete?
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Saliva
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What do goblet cells secrete?
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Mucous
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What do parietal cells secrete?
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HCl
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What do chief cells secrete?
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Pepsinogen
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What do enteroendocrine cells secrete?
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Gastrin
Histamine Endorphins Serotonin Cholescystokinin Somatostatin |
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What is one of the main things the colon does?
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Absorb H2O
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The rate of gastric emptying must match the duodenal buffering ability or what may happen?
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acid may damage duodenal mucosa
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What prevents regurgitation of duodenal contents into the stomach?
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Pylorus
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What happens if a person has no intrinsic factor?
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They can't absorb Vit B-12 and can get pernicious anemia
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Colonic Secretions?
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Electrolyte solution - bicarbonate to neutralize acidic chyme
Mucous - protect colon mucosa from acidic solution |
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What is the timing from ingestion to cecum?
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4 hrs
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What is the timing from cecum to evacuation?
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12 hrs
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1/4 of fecal material stays in rectum for how long?
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3 days
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What are the local gastrointestinal reflexes that STIMULATE movement?
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gastroenteric reflex
gastrocolic reflex duodenal-colic reflex |
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What are the local gastrointestinal reflexes that INHIBIT movement?
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Ileogastric reflex
intestinal-intestinal reflex peritoneointestinal reflex renointestinal reflex vesicointestinal reflex somatointestinal reflex |
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How is swallowing stimulated?
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By food bolus stimulating pressure receptors in the back of the throat & pharynx. It then sends impulses to medulla.
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How can the nurse stimulate the swallowing reflex in a pt?
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By temperature change or textured foods (icing the tongue w/ an ice cube or popsicle, ice chips)
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Effects of aging on digestion?
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* Altered ability to chew r/t loss of teeth, ill-fitting dentures, gingivitis (sore gums)
*Loss of senses of smell & taste (everything tastes bland) *Decreased peristalsis in esophagus *Gastroesophageal reflux (acid goes up into esoph) *Decreased gastric secretions (*Slowed intestinal peristalsis *Lowered glucose tolerance (might lead to diarrhea) *Reduction in appetite & thirst sensation (get dehydrated easily) *Loss of appetite assoc w/ depression & loneliness *Physical handicaps (can't cook nutritious foods anymore) *Low income *Malnutrition *Increased risk for drug-nutrient interactions Gas |
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Screening & assessment of nutritional health?
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List foods & beverages over 24 hrs, Food Guide Pyramid, Dietary Reference Intakes, Recommended Daily Allowance, Weight: same, gain, loss
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Symptoms seen w/ GI problems
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N/V (#1 chief complaint on admission)
Indigestion Abdominal Pain Weight & appetite change Diarrhea Constipation |
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Which is more accurate for anthropometric measures: Body Mass Index or Skin Fold Tests
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BMI
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Body Mass Index
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A method for determining the ideal body weight of an individual
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Formula BMI?
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Weight (kg)/Height (m2)
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What lab tests are run to assess nutritional status?
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Nutritional Anemias (iron deficiency anemia is the most common cause of anemias in the world)
Serum Proteins Nitrogen Balance (if too much nitrogen, not getting enough protein) Fecal Analysis |
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Flat plate of the abdomen
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X-ray of the abdomen
Uses: abnormal gas or fluid collections, strictures |
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Barium Swallow of Upper GI Series
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Permits radiological visualization of the esophagus, stomach, duodenum and jejunum
Requires fasting 6-8 hours |
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Nursing Assessment after barium swallow?
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Assess abdomen for distention
Observe stool to determine whether the barium has been eliminated |
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How long should the nurse keep pt on NPO status after barium swallow?
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Until somone (speech therapist, radiologist, MD) has evaluated the test results
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After barrium swallow, what is the nurse looking for regarding the stool?
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Stool will be white initially and will return to its normal brown within 72 hours. If not, contact physician!
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After barium swallow, distended abdomen and constipation could indicate?
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Barium impaction. Notify the physician immediately!
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Indications for EGD?
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Direct visualization of GI tract; detect abnormalities
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Patient Care Pre and Post EGD?
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To reduce risk of aspiration, pt should be in left lateral position for procedure
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How long to withhold fluids from pt after EGD?
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Until local anesthesia wears off and GAG REFLEX returns
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Main indication for colonoscopy?
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Screening for cancer or pre-cancer conditions; remove polyps and take biopsies
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Pre-procedure for EGD?
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Clear liquids
Colon cleansings |
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Major causes of dental decay?
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Plaque
Tobacco Use |
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Periodontal Dz caused by?
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Plaque; Bacterial colonization
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Candidiasis seen in?
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Immunosuppressed pts (AIDS pts, transplant pts)
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Premalignant tumors of the oral cavity?
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Leukoplasia
Erythroplakia |
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Malignant tumors of the oral cavity usually assoc w/ ?
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Alcohol and tobacco abuse
Ingestion of smoked meats |
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Leukoplakia and Erythroplakia?
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Precancerous lesions
Result from chronic irritation of the mucosa Physical, chemical or thermal factors |
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Nursing care of the surgical pt w/ malignant tumors of oral cavity?
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Most important thing is to MAINTAIN AIRWAY!
Wound Care Monitor for Bleeding Assess communication Assess nutrition (oral, enteral or parenteral) May have PEG Tube. Can't use NG tube |
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Dysphagia
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Difficulty swallowing
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What causes dysphagia?
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mechanical obstructions
cardiovascular abnormalities neurologic diseases (CVA) |
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What is the nursing consideration that is important in pt w/ dysphagia?
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Place pt in High Fowler's position.
Have pt tilt chin toward chest (flexion) to swallow (chin tuck technique) Also place food in "good side" not affected by stroke and rub side of neck to stimulate |
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Achalasia
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A disorder characterized by progressively increasing dysphagia.
Narrowing of esophagus Great difficulty in swallowing Expression of "something stuck in my throat" Commonly occurs in people in their 20's and 30's Equal in men and women |
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Achalasia Etiology and Risk Factors?
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No known cause, idiopathic
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Achalasia Pathophysiology?
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Impaired motility of lower 2/3 of esophagus
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Clinical Manifestations of Achalasia?
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Dysphagia
Substernal pain Difficulty of food passing through LES Exacerbated by URI, emotional disturbance, overeating and pregnancy |
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Achalasia Medical Management?
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Esophageal dilation w/ Bougie dilators
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Medical Management of Hiatal Hernia?
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Same as GERD
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Surgical Management of Hiatal Hernia?
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Nisson Fundiplication
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Teaching for Pt w/ Hiatal Hernia ?
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-Eat small, frequent meals, chew slowly
-Drink adequate fluids -Increase dietary protein -Avoid extreme hot and cold foods -Do not eat 3 hrs before retiring -Elevate HOB 6-8" during sleep -Sit up at least 30 mins after eating -Avoid lifting, straining, bending, and tight or constrictive clothing -Avoid tobacco, salicylates (aspirin) and NSAIDS (ibuprofen) |
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Esophageal disorders
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Regurgitation: ejection of small amounts of gastric content w/o nausea
Pain (odynophagia): pain occurs throughout the day and can be confused w/ angina Heartburn (Pyrosis), Indigestion, Dyspepsia: Symptoms relieved by standing or eructating |
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Diverticulum
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Outpouching of the esophagus due to weakened area or trauma
Risk for infection due to food being trapped in the diverticulum Diagnosed w/ barrium swallow |
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Gastroeophageal Reflux Disease (GERD)
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Backward flow of gastric contents into esophagus. Leads to gradual breakdown of the esophageal mucosa & causes reflex esophagitis
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Cause of GERD?
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Inappropriate relaxation of the LES (lower esophageal sphincter)
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GERD treatment ?
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Diagnose w/ EGD
Decrease reflex w/ Meds: PPIs (proton pump inhibitors) Nexium, Protonix Decrease Reflux w/ lifestyle & diet changes |
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Pt teaching for GERD ?
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-Eat small frequent meals
-Drink adequate fluids -Eat slowly, chew thoroughly -Avoid fatty foods, milk, chocolate, mints, caffeine, carbonated drinks, citrus fruits and juices, tomato products, pepper seasoning, and alcohol -Avoid extreme hot or cold foods, spices -Lose weight -Avoid eating 3 hrs before retiring -Elevate HOB -Avoid tobacco, salicylates and phenylbutazone |
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Esophageal Cancer Etiology and Risk Factors ?
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3 times more in men than women
Higher in AAs and Asians than white men Cause unknown Heaving smoking Nutritional deficiencies Ingestion of alcohol, hot foods, and hot drinks Contaminants in soil & food Ingestion of smoked meats or meats cooked over very high heat Irritation from GERD, hiatal hernia or achalasia |
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Esophageal Cancer Clinical Manifestations ?
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Dysphagia or Odynophagia
Dysphagia becomes constant |
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Esophageal Varices
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Dilation of the esophagogastric veins.
Result from portal hypertension. Portal venous blood pressure increases cause esophageal veins to swell and distend. A MEDICAL EMERGENCY when they rupture. Can be caused from alcoholism |
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Oral Feeding Swallowing Techniques for pts w/ dysphagia ?
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Go Slow
Raise bed to High Fowler's position (90 degrees) Place food in unaffected side of mouth When food reaches the pharynx, pt should tilt chin down to decrease the risk of aspiration. COVERS up the tracheal opening Massaging throat on affected side helps stimulate tactile areas & initiate swallowing. Have SUCTION AVAILABLE - and HAVE IT SET UP BEFORE THEY BEGIN EATING!! |
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Indications for Enteral Feeding ?
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Neurologic & Psychiatric
Oropharyngeal & Esophageal Surgeries AIDS Burn Pts Chemotherapy Radiation therapy |
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Reasons for GI Intubation ?
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Decompress Stomach
Lavage (for OD) Dx GI motility Administer meds Administer feedings Treat obstruction Compress a bleeding site Aspirate gastric contents for analysis |
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Types of Enteral Feedings ?
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Oral
Nasogastric Nasoduodenal Nasojejunal Gastrostomy Juejunostomy |
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NG tube insertion steps
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Wash hands/don gloves
Examine nostril; select most patent Establish cue w/ pt to use to stop you momentarily Measure from tip of nose to earlobe to xiphoid process. Mark the tube. Coil end to soften Lubricate tube & insert through nostril to back of throat. Aim tube toward back of throat and down. Have pt swallow sips of water to assist tube insertion (Remember upper 1/3 of esophagus is voluntary muscle) Tape the tube in place |
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Most COMMON way nurses verify placement of NG tube
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Auscultation of air introduced via syringe into the tube (will hear gurgle)
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Most ACCURATE method for NURSES to check placement of NG tube?
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pH test of aspirate
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Most ACCURATE method to check placement of NG tube ?
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Radiography - most accurate, BUT requires physician's order
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Signs NG tube placement is incorrect and could be going into lungs ?
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Coughing, choking or cyanosis
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Assessment of NG tube ?
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Pain
Change in secretions (bright red blood is bad) metabolic alkalosis (can be from suctioning) Monitor potassium levels (can be decreased and cause cardiac problems) |
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Methods of Administration for Enteral Feedings ?
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Bolus
Intermittent Continuous |
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Less aspiration risk with which method of administration of enteral feeding ?
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Continuous
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Bolus ?
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300-500 ml several times/day in 60 ml increments over 10-15 mins
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Intermittent ?
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Formula is placed in a gravity bag & dripped in over 30-60 mins
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Continuous Feeding?
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Feeding administered via infusion pump over 24 hrs ranging from 50-150 ml.
Less gastric distention and aspiration |
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Benefits of Enteral Nutrition ?
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Maintain & support gut
integrity & function Prevent atrophy of gut mucosa Reduction of infectious complications Reduced cost SAFER ADMINISTRATION |
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Enteral Nutrition Contraindicated for ?
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Intestinal obstruction
Paralytic Ileus Severe pseudo-obstruction Severe diarrhea intestinal ischemia Fistulas or tumor of proximal GI tract Acute, severe pancreatitis Malabsorption syndrome |
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How long can an open system of enteral feeding hang?
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Only 4 hours
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Closed system of enteral feeding?
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Change 24-48 hours
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Nursing intervention to maintain enteral access ?
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Flush according to protocol or change pt's position
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Can enteric-coated or time-released tablets or capsules be crushed to be administered via enteral feeding tube?
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No
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When administering meds via enteral feeding tube it's important to do what ?
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Flush tube with 30 mls of water before & after giving each medication
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Goals of Tube Feeding ?
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Nutritional Balance
Normal Bowel Elimination Reduced risk of aspiration Adequate hydration Individual Coping Knowledge & skill in self care Prevention of complications, eg aspiration! |
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When providing meds via suction and feeding tubes ?
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If tube is on suction, clamp tube before administering med and leave clamped for 30 minutes
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Indications for Parenteral Nutrition ?
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Used when pt cannot be fed orally or by tube feeding or when the GI tract is not functional
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Parenteral Nutrition
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Peripheral: when using less than 10 days
Central venous (subclavian, PICC line): when needed for long term |
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TPN (total parenteral nutrition) contents ?
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Carbohydrates
Fat Emulsions Amino Acids Fluid, Electrolytes, Vitamins, Trace Elements |
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Parenteral Nutrition Clinical Indications ?
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Malabsorptive syndrome
Severe prolonged radiation enteritis Motility disorders Intestinal Obstruction Perioperative nutrition for severe malnutrition Critically ill pt when enteral therapy is CI |
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Nursing Management for Parenteral Nutrition?
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Assessment of:
Infusion bag for correct ingredients Appearance of solution (no precipitate!) Condition of the venous access site (irritation?) Monitor blood glucose levels Rate of infusion (if too fast, can cause fluid overload) Reactions to the solution |
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Complications of Parenteral Nutrition ?
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Bacterial Growth
Risk for infection D/C feedings too rapidly: hypoglycemia Displacement of tube |
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Digestive Disorders ?
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Gastritis
Peptic Ulcer Disease Gastric Cancer |
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Clinical Manifestations of Gastrointestinal Disorders
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Pain
Anorexia N/V Bleeding (ulcer gets eroded) Belching & Flatulence Indigestion |
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Gastritis (Acute)
Etiology and Risk Factors |
Ingestion of corrosive, erosive or infectious substance
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Clinical Manifestations of Acute Gastritis
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It is severe
N/V tenderness cramping belching diarrhea develops w/i 5 hrs if cause is contaminated food |
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Gastritis (Chronic)
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Three forms:
Superficial: reddened edematous mucousa Atrophic: occurs in all layers of stomach (usually seen w/ gastric ulcer or cancer) Hypertrophic: produces a dull & nodular mucosa (esp. in elderly) |
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Chronic Gastritis
Etiology & Risk Factors |
Helicobacter pylori bacteria (causes 90% of peptic ulcers)
Gastric surgery |
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Peptic Ulcer Disease
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Three Types:
Duodenal ulcers - highest incidence; hyper secretion of acid; rapid emptying of stomach Gastric ulcers - Stress-induced and Drug induced - frequently called stress ulcers or stress erosive gastritis. Can occur after an acute medical crisis; severe trauma or major illness; ingestion of a drug (aspirin, NSAIDS, steroids, alcohol; severe burns; sepsis or shock |
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Peptic Ulcer Disease
Clinical Manifestations |
Aching, burning, cramp-like, gnawing
|
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Difference between GASTRIC ulcer and DUODENAL ulcer?
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In gastric ulcer, food may CAUSE pain and vomiting may RELIEVE the pain
In duodenal ulcer, there is pain with EMPTY STOMACH and it is RELIEVED by eating |
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N/V occur more with which type of ulcer?
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Gastric
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Pt teaching with peptic ulcer disease ?
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*Understand the cause of the ulcer
*Healing is rapid when irritating effect is removed *Understand what must be done to lessen the stimulation *Eliminate the irritating substance from diet *Understand the imp of continuing the med until healing complete (may be after pain has been relieved) ****Recognize that once the maintenance therapy stops, the ulcer MAY RECUR **Use acetaminophen instead of aspirin |
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What is dumping syndrome ?
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Rapid emptying of the stomach contents into the small intestine
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Dumping syndrome characterized by what ?
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Diaphoresis, weakness, palpitations, syncope and possibly diarrhea.
Early symptoms occur 5-30 mins. after meals |
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Management of dumping syndrome ?
|
-Decrease amount of food at each meal
-High protein, high fat, low carb, dry diet -Remain in semi-Fowler's position for 1 hr after feeding -Avoid fluids 1 hr before & 2 hrs after meals -Medications: Sedatives and antispasmodic agents to delay emptying Tube feeding: instill the minimal amount of water needed to flush the tubing before and after feeding |
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What is the main thing to know about gastric cancer?
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There are no clinical manifestations in the early stages.
Pain usually from METASTASIS |
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Viral and Bacterial Infections - Gastroenteritis
Symptoms |
Diarrhea, abdominal pain, cramping, vomiting, fever, anorexia, distention,
Causes: contaminated food and water |
|
Gastroenteritis Transmission ?
|
Oral-fecal route: person to person and ingestion of contaminated food
Common sources: eggs (Salmonella), undercooked meats (e. coli), food poisoning: (staphylococcus aureus) |
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Appendicitis - Etiology and Risk Factors
|
A fecalith (fecal calculus or stone) that occludes the lumen of appendix
Kinking of appendix Swelling of bowel wall Fibrous conditions in the bowel wall External occlusion of the bowel by adhesions |
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Clinical Manifestations of Appendicitis ?
|
Classic symptoms: begins w/ acute abd pain that comes in waves. Then becomes steady.
Starts in epigastrium or periumbilical region then shift to RIGHT LOWER QUADRANT. Pt guards area by lying still & drawing the legs up to relieve tension of the abd muscles. |
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IMPORTANT to know about Appendicitis ?
|
Pt may feel she/he needs a laxative.
*** TAKING A LAXATIVE MAY LEAD TO RUPTURE*** |
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Is there medical treatment for appendicitis?
|
No, only surgical management which is an appendectomy
|
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What is the nursing care for a pt pre-op for appendicitis?
|
Keep pt NPO in case they are rushed to surgery
Withhold pain meds (they may mask symptoms) Start IV infusion |
|
Peritonitis - Etiology and Risk Factors ?
|
Major source of inflammation is from the GI tract
Normal flora of intestine when it enters the sterile peritoneal cavity (e. coli most common) Ruptured gallbladder, perforated peptic ulcer, penetrating wounds |
|
Peritonitis Clinical Manifestations ?
|
Pain localized or generalized
Shallow respirations Rigidity of abd muscles Pain that increases w/ pressure or motion N/V Absence of bowel sounds WBC elevated X-ray shows edema and free air or fluid in the abd cavity |
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Complications of Peritonitis ?
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ARDS (Adult respiratory distress symptoms)
Sepsis and shock |
|
With sepsis....
|
Closely monitor fluid balance (assess VS, bowel sounds (make sure they HAVE bowel sounds!), urine output, skin turgor, weight.
|
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Signs of sepsis that should be immediately reported....?
|
Drop or rise in temp
Drop in BP |
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Inflammatory Bowel Disease (IBD) - Two Types
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Crohn's Disease
Ulcerative Colitis |
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In Crohn's....the pain is
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aggravated by walking, sitting and defecation
|
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In ulcerative colitis.....the pain is ?
|
There is tenderness in the left lower quadrant, guarding and abd distention
|
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Crohn's is......
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transmural (goes thru all 3 layers)
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Ulcerative colitis involves....
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only the mucosa and submucosa
|
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Crohn's is....
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considered an autoimmune disease
|
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Ulcerative colitis is.....
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Bacterial in origin
|
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Crohn's is....
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relapsing; develops discontinuously
|
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Ulcerative colitis....
|
spans entire length of colon
|
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Crohn's is most common in
|
the terminal ileum
|
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Ulcerative colitis starts....
|
in the rectum and distal colon, spreading upward
|
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Crohn's - Clinical Manifestations
|
Diarrhea (less severe than Ulcerative Colitis)
Stool soft or semi liquid Urgency to expel stool may awaken pt at night Malabsorption assoc w/ steatorrhea may develop |
|
Ulcerative Colitis - Clinical Manifestions
|
Predominant manifestation is rectal bleeding (because it starts in the rectum)
Liquid stools w/ tenesmus and may contain blood, mucus and pus May have 20+ stools a day Tenderness in left lower quadrant, guarding and abdominal distention Emotional stress, physical exertion, respiratory infections and over fatigue may cause an attack |
|
Surgical Treatment for Ulcerative Colitis ?
|
Surgery is the only cure
|
|
Surgical Treatment for Crohn's Disease ?
|
Surgery for complications only
|
|
What would make you notify MD immediately in assessing post-op stoma?
|
If stoma becomes pale, dusty or cyanotic (means it's not getting blood flow; tissue could become necrotic and fall back into abdomen)
|
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Foods that reduce odor with an ostomy ?
|
Spinach, yogurt and buttermilk
|
|
Foods to avoid with an ostomy ?
|
eggs, fish, onions, cabbage and some greens
|
|
How should skin be cared for in pt w/ ostomy?
|
Should be washed and rinsed with each changing of pouch
|
|
What foods could block stoma and should be avoided?
|
Mushrooms and nuts
|
|
What is a polyp ?
|
A mass of tissue that protrudes into the lumen of the bowel
|
|
Polyps can be classified as.....
|
Neoplastic (ie, adenomas and carcinomas)
Non-neoplastic (ie, mucosal and hyperplastic) |
|
Benign tumor types
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Sessile
Pedunculated |
|
Polyps are dangerous because....
|
they can mask the presence of a malignant tumor
they may serve as the focus for bowel obstruction or intussusceptions |
|
Average age of onset for cancer of the small bowel ...?
|
53-58 years
|
|
What is the most common GI cancer......?
|
Colorectal cancer
|
|
Colorectal Cancer
Etiology and Risk Factors ? |
Low-residue, high-fat and highly refined foods
Genetic mutations DIET is the MAJOR factor |
|
Percentage of adematous polyps that develop into colorectal cancer....?
|
95%
****This is why colonoscopies are so important!**** |
|
Clinical manifestations of colorectal cancer......?
|
Rectal bleeding
Change in bowel habits Abdominal Pain Weight Loss Anemia Anorexia Tumors |
|
Hernias -- Etiology ?
|
Muscle weakness
Poor wound healing after abdominal surgery Umbilical hernias occur more in obese or pregnant pts **All associated w/ heavy lifting and straining |
|
Reducible hernia
|
Contents of hernia can be replaced in the abdomen
|
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Incarcerated (irreducible) hernia
|
Contents of the sac cannot be reduced or replaced by manipulation
|
|
Strangulated hernia
|
Pressure from the hernia ring muscle cuts off the blood supply to the herniated segment of bowel
|
|
Diverticular Disease - Etiology ?
|
Low fiber diet
|
|
Diverticulitis
|
Undigested food blocks the diverticulum, leading to a decrease in blood supply to the area and predisposing the bowel to infection
|
|
Treatment for Diverticular Disease ?
|
Strict adherence to a high-fiber diet;
Prevention of constipation Surgery is indicated when complications occur, hemorrhage, obstruction, abscesses and perforation |
|
Bowel Obstructions ?
|
Partial or complete impairment of the forward flow of intestinal contents
|
|
Intestinal obstruction has a high mortality rate if not diagnosed and treated within ____ ?
|
24 hrs
|
|
Bowel obstructions lead to local changes of ______ ?
|
loss of fluids, electrolytes and plasma
bacterial proliferation perforation |
|
Bowel obstruction - systemic effects are _____ ?
|
Reduction in extracellular fluid
Reduction in circulating blood volume Toxemia Peritonitis Can lead to sepsis - temp will go up or down and BP wil go down |
|
What is the most GI disorder in the western world?
|
Irritable Bowel Syndrome
|
|
Irritable Bowel Syndrome - Etiology and Risk Factors ?
|
Diets high in fat, fresh fruits, gas-producing foods, carbonated beverages and alcohol
Smoking, lactose intolerant, high stress, problems w/ sleep and rest |
|
Irritable Bowel Syndrome - Clinical Manifestations ?
|
Abdominal Pain
Altered Bowel Function Constipation or diarrhea Hypersecretion of colonic mucus, dyspeptic manifestations (flatulence) Nausea Anorexia Anxiety or Depression |
|
With anorexia, medical management must include treatment of ______________ ?
|
Psychological as well as nutritional components
|
|
Anorexia Nervosa
|
A condition of self-generated weight loss; usually seen in adolescent girls and young women; preoccupation w/ personal body weight and appearance
|
|
Bulimia Nervosa
|
Less serious than anorexia nervosa; pts maintain nearly normal weight. Go through periods of binging and vomiting, or taking laxatives.
Bulimia is usually done in secret and is a form of depression |
|
Acid-Controlling Drugs
|
Antacids
H2 Antagonists Proton Pump Inhibitors Suracalfate (does not affect HCl. Coats and protects the gastric mucosa) |
|
Roles of Hydrochloride Acid
|
*Maintains the pH of the stomach at pH 1-4
*Helps digest food *Aids in body's defense against microbials |
|
Three Primary Cells of the Gastric Gland and what they secrete.....?
|
Parietal Cells - HCl
Mucoid Cells - Mucous Chief Cells - Pepsinogen |
|
Parietal Cell Receptors
|
Acetylcholine (Ach)
Histamine Gastrin *When the parietal cell receptors are occupied (w/ Ach, Histamine, Gastrin), the parietal cell will secrete HCl When the parietal cell receptors are blocked, HCl secretion is decreased |
|
Drug Cautions of Acid-Controlling Drugs
|
Monitor for electrolyte disturbances; monitor for drug-drug interactions.
|
|
Should antacids be given before or after the administration of other drugs?
|
1-2 hours before or after
|
|
If pt takes too much antacid, they become.....______?
|
Alkalotic
|
|
What are some harmful stimulants of hydrochloric acid?
|
Large, fatty meals
Consumption of excessive amounts of alcohol Emotional stress |
|
What do H2 Antagonists do ?
|
The H2 blockers compete w/ histamine for binding sites on the surface of parietal cells
|
|
_______ is the most popular drug for treatment of many acid-related disorders and why?
|
Tagamet
Patient acceptance Safety profile Very few side effects |
|
Problems may occur with H2 Blockers and __________ ?
|
Theophylline (taken for respiratory distress)
Warfarin Lidocaine Phenytoin |
|
___________ decreases the effectiveness of H2 blockers
|
Smoking
|
|
H2 antagonists should be taken ______ hrs BEFORE antacids
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1
|
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Proton Pump Inhibitors - Mechanism of Action
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Irreversibly bind to the H+/K+ ATPase
Prevents the movement of H+ ions out of the parietal cell into the stomach Blocks ALL gastric acid secretion from the parietal cells |
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_____ is the only proton pump inhibitor that can be administered IV in hospital?
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Protonix (pantoprazole)
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|
Proton pump inhibitors are the most ideal drug for hypersecretion of acid because _________ ?
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its effects are confined to the parietal cells; NO systemic effects
|
|
How is Helicobacter pylori treated ?
|
with Prilosec and Prevacid
|
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Aluminum Antacids
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AlternaGEL - constipating
|
|
Magnesium Antacids
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Milk of Magnesia, Maalox, Mylanta - usually combined with Al to counteract the diarrhea side effect
|
|
Calcium carbonate Antacids
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Oystercal, Tums - may result in kidney stones, constipation , rebound hyperacidity
|
|
Sodium bicarbonate Antacids
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Highly soluble with a quick onset but a short duration. May lead to metabolic alkalosis
|
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Stomach is very ________. If there is a break in the mucosal barrier and acid can get to the epithelial cells, it causes burning
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acidic
|
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Patient Teaching for Aluminum Antacids
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Increase fluids, fiber and exercise
|
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Patient Teaching for Magnesium Antacids
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Causes a laxative effect (diarrhea)
Can lead to DEPENDENCY Caution in pts w/ renal failure. Kidney cannot excrete Mg and this leads to TOXICITY |
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What drugs are combinations of Al & Mg ?
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Gaviscon, Maalox, Mylanta, Di-Gel
|
|
Patient Teaching for Calcium Antacids
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Can be constipating
Causes rebound hyperacidity Can lead to kidney stones |
|
Patient Teaching for Sodium bicarbonate Antacids
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Quick onset with short duration
May lead to metabolic alkalosis |
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Other Patient Teaching with Antacids
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*Always take as prescribed
and take before meals *Be sure that chewable tablets are well chewed *Do not open, chew, or crush capsules *Give all antacids w/ at least 8 oz of water to enhance absorption |
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If an antacid causes an INCREASE in abdominal pain, what should the pt do?
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Contact the physician
|
|
When should Tagamet be given ?
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With meals and if antacids are also given, they should be given 1 hour before or after the Tagamet
|
|
Antipeptic Agent: Sucralfate (Carafate)
|
Cytoprotective. Binds to the base of ulcers and erosions. Does not inhibit acid secretions like the others.
Almost no systemic toxicity Most common side effect - constipation and nausea |
|
Carafate may impair absorption of ________ (drug-drug interaction)
|
Tetracycline
|
|
Prostaglandin
|
Misoprostol (Cytotec)
Use: Prevention of NSAID-induced ulcers in adults at high risk for development of gastric ulcers. |
|
________ (_________) cannot be given to pregnant women
|
Prostaglandins (Carafate).
It is an abortifacient. |
|
Saliva substitute
|
MouthKote, Salivart.
Helps in conditions that cause dry mouth: stroke, radiation therapy, chemotherapy. Not absorbed systemically Most Common Adverse Effect - Electrolyte absorption leading to increased levels of magnesium, sodium or potassium |
|
Pancrelipase
|
Creon, Pancrease - Aid in digestion & absorption of fats, proteins, and carbohydrates, conditions that result in a lack of pancrelipase. Not absorbed systemically
|
|
Purpose of Laxatives ?
|
--Relief of constipation
--Prep for GI procedures |
|
Constipation
|
Abnormally infrequent and difficult passage of feces through the lower GI tract
|
|
________ are among the most commonly misused OTC medications.
|
Laxatives
|
|
Causes of constipation
|
- Metabolic & endocrine d/o's (diabetes mellitus, hypothyroidism)
- Neurogenic d/o's (Parkinson's, spinal cord injury) |
|
What drugs have constipating adverse effects?
|
Opiates, calcium channel blockers
|
|
_____% of Americans eat 5 servings of fruits & vegetables a day
|
11%
|
|
How does lifestyle contribute to constipation ?
|
Poor bowel habits
Diet Lack of physical exercise psychological (won't have BM except at home; withholding BM if psych disorders) |
|
Stimulant Laxatives
|
- Results in increased peristalsis, increased fluid in the colon, increased bulk
|
|
Which type of laxative class is most likely to cause dependence ?
|
Stimulant laxatives
|
|
Bulk-forming Laxatives
|
Composed of water-retaining natural and synthetic cellulose derivatives
|
|
Main danger for bulk-forming laxatives (ESP. w/ the elderly)
|
Take with liberal amounts of water to prevent esophageal obstruction and/or fecal impaction
|
|
Stimulant Laxative Prototype
|
Ducolax (bisacodyl)
|
|
Emollient Laxatives
|
- By lubricating the fecal material and intestinal walls they prevent water from leaking out of the intestines which softens and expands the stool
Prototype - Mineral Oil |
|
How long should mineral oil enema stay in body to be most effective ?
|
1 hour at least
|
|
Hyperosmotic Laxatives
|
- Increase fecal water content
- Results in distention, increased peristalsis and evacuation - Site of action limited to large intestine Lactulose (Chronulac, Duphalac, Enulose) Polyethylene glycol (GoLytely, CoLyte) |
|
Which adverse effect is common to ALL classes of laxatives ?
|
Electrolyte imbalances
|
|
When are laxatives contraindicated ?
|
- Acute surgical abdomen
- Appendicitis symptoms (right lower quadrant) - Fecal impaction - Intestinal obstructions - Undiagnosed abdominal pain |
|
Important pt teaching for laxatives ?
|
Swallow tablets whole with at least 8 oz of H2O
|
|
Long-term use of laxatives or cathartics often results in_______?
|
Decreased bowel tone and may lead to dependency
|
|
______ increases emptying of the stomach; increases GI secretions and motility. Does not cause diarrhea or stimulate the intestines
|
metoclopramide (Reglan)
|
|
Reglan is used to ______
|
empty stomach rapidly eg, emergency surgency
|
|
Acute diarrhea has _____
|
sudden onset, lasts for 3 days to 2 weeks
|
|
Chronic diarrhea lasts _____
|
for over 3-4 weeks and is associated w/ fever, loss of appetite, N/V, weight reduction and chronic weakness
|
|
Side effect of Reglan ?
|
Tardive Dyskinesia
|
|
Anti-Diarrheal Categories
|
1. Adsorbents
2. Anticholinergics 3. Opiates 4. Intestinal flora modifiers |
|
Adsorbent anti-diarrheals
|
- coat walls of GI tract
- cause constipation, dark stools and black tongue Prototype: Bismuth subsalicylate (Pepto-Bismol) |
|
Anticholinergic anti-diarrheals
|
- Decrease peristalsis and the muscular tone of the intestine. Can cause urinary retention
Prototype: Atropine |
|
Intestinal Flora Modifier anti-diarrheals
|
Products obtained from bacterial cultures
- Most comon: Lactobacillus acidophilus |
|
Opiate anti-diarrheals
|
- Decrease bowel motility
- May cause constipation - Causes drowsiness Prototype: loperamide (Imodium) |