Term
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Definition
GERD is gastroesophageal reflux disease. It is technically not a disease but merely a syndrome. It is the reflux of stomach contents into the lower esophagus, generally after meals.
[image] |
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Term
| What are the risk factors for GERD? |
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Definition
GERD is commonly seen in patients with hiatal hernias, patients with incompetent lower esophageal sphincters (LES)***, and patients with delayed gastric emptying. Patients who are obese, who smoke or who frequently eat spciy, greasy foods are most at risk for GERD. Other foods that are associated with GERD are peppermint, chocolate, tomatoes, onions and foods and drinks containing caffeine.
***Most common |
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Term
| What are the signs and symptoms of GERD? |
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Definition
Post meal bloating, dysphagia, heartburn, regurgitation, dyspepsia/pyrosis, emesis, and wheezing or a nocturnal cough. Pain is often excerbated by a prone position.
Other S/S: Bad breath, bitter/sour taste in mouth, and A.M. hoarseness. |
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Term
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Definition
| The most common means of diagnosis is a trial dose of PPI's (generally a high dose). If this treatment is effective in managing the symptoms, the diagnosis of GERD is made. Sometimes barium swallow x-rays or upper endoscopies are performed. Motility and pH studies may also be performed. However, they are less common. It is important to note that these "diagnostic tests" are more focused on complications of the GERD rather than mere diagnosis. |
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Term
| What are possible complications of GERD? |
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Definition
| Esophagitis and ulcerations are possible complications which can lead to hemorrhage and/or stricture (obstruction) and scarring of the esophagus. Barrett's esophagus is also a possible complication. Barrett's esophagus is characterized by the presence of precancerous, dysplasic cells. If untreated, it can lead to esophageal cancer, as can untreated esophagitis. Aspiration due to chronic night time reflux, bronchospasms, and laryngospasms are other possible respiratory complications of GERD. Malnutrition and dehydration are also possible. Dental erosions are also common due to increased oral acidity. Adenocarcinoma is another possible complication. |
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Term
| How do PPI's work with GERD? |
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Definition
They irreversibly bind the the gastric proton pumps in the parietal cells. This prevents atp from binding and prevents the cells from pumping protons into the stomach and removing potassium. This drastically decreases the acidity of the stomach and thus helps with the symptoms of GERD. Prototype drugs include omeprazole (Prilosec), lansoprazole(Prevacid) , and pantoprazole (Protoniz). These drugs carry few s/e. They are mild (headache, diarrhea, constipation, etc.)
note: -azole ending refers to the complex nitrogen containing 5-member aromatic ring structures of all of these drugs
nexium is merely the s-enantiomer of omeprazole |
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Term
| What is the nurse's responsibility in diagnosing GERD? |
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Definition
| The primary concern is obtaining and accurate and complete health history and physical exam. The nurse must ask the patients to characterize the pain and define how long it lasts and what aggravating and alleviating factors are. The nurse is then responsible for preparing patients for any diagnostic tests they might be receiving and caring for them after the test is done. |
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Term
| What are the nurse's responsibilities for preparing a patient for an Upper GI? |
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Definition
| The patient needs to be told that they must be NPO before the endoscopy. If the patient is diabetic, special attention must be paid to the patient. Typically, they should be taken first thing in the A.M. Barring that, the patient must be given long acting insulin. The patient will be placed under twilight drugs (fentanyl-conscious sedation) and the endoscope will then be placed down their esophagus. During the study, the physician will be looking for possible complications. Once the procedure is over, you must test the gag reflex and assess the vital signs frequently. You also most constantly ensure that the patient has a patent airway. (pulse ox, RR, resp assess) The patient's LOC must also be assessed. Proper pain assessment and management is also an important nursing duty. |
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Term
| What are the nurse's responsibilities during a Barium Swallow? |
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Definition
| The patient needs to be NPO. The patient must swallow the Barium. The most important nursing responsibility is giving laxatives and monitoring fecal output after the procedure. The Barium must come out. |
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Term
| Describe the role of patient positioning in GERD care. |
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Definition
| Laying in a prone position exacerbates the patient's pain. In the hospital, it is the nurse's responsibility to assure the patient's bed is raised at a 30deg angle even while sleeping. The nurse must educate the patient on how to position themselves while sleeping at home. THey may raise the head of their bed with cinderblocks or sleep in a recliner. |
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Term
| Describe the role that dietary changes play in GERD therapy. |
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Definition
| It is the nurse's responsibility to educate the patient about necessary dietary changes with GERD. The patient should avoid fatty foods, spicy foods, and aforementioned "trigger" foods. Patients need to increase their protein intake. Patients need to drink fluids between meals and not with meals. Patients need to eat small frequent meals but need to avoid milk and snacks at night. |
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Term
| What kinds of drugs are used in GERD therapy? |
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Definition
1. Antacids
2. Proton Pump Inhibitors
3. H2 antagonists |
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Term
| What are the nursing implications for proton pump inhibitors? |
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Definition
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Term
| What are the nursing implications for Antacids? |
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Definition
| Acid base imbalance and rebound GERD. Rebound GERD occurs with prolonged use of antacids. The body begins to overproduce acid. |
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Term
| What role does surgery play in GERD therapy? |
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Definition
| Surgical procedures are a last resort in the treatment of GERD. The various procedures focus on maintaing or correcting the integrity of the LES. The most common procedure is the Nissen fundoplication. Stretta device placement, Toupet fundoplication, Hill gastropexy, and Belsey fundoplication are other surgical treatments for GERD. |
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Term
| What is a Nissen fundoplication? |
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Definition
[image]
The most common surgical treatment for GERD. This is the repair of a hiatal hernia achieved by wrapping the fundus around the stomach and is sutured on itself. It improves the integrity of the LES. The Nissen fundoplication is a total (360deg) fundoplication. |
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Term
| What is a Stretta device? |
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Definition
[image]
The Stretta device is an endoscopic treatment for GERD. It involves the placement of a cath in the LES. The surgeon then sends radio waves through the cath that heat the surrounding tissues causing them to tighten and disrupting the nerves that cause the LES to relax. * **Curon Med is OOB so this procedure isn't avail. anymore*** |
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Term
| What is a Toupet fundoplication? |
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Definition
| A partial fundoplication (270deg posterior wrap). It has fewer complications than the Nissen. |
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Term
| What is a Belsey fundoplication? |
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Definition
| A partial fundoplication (270deg anterior transthoracic). It has less complications than the Nissen fundoplication. |
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Term
| What is a Hill Gastroplexy? |
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Definition
| It is the surgical suturing of the GEJ to the median arcuate ligament. This surgery results in a 180deg wrap. However, it is often less successful than other fundoplication procedures. |
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Term
| What are the expected outcomes of a patient undergoing GERD therapy? |
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Definition
| Reduction in or absence of episodes of pyrosis; ability of patient to remember and employ necessary lifestyle changes for control of GERD symptoms |
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Term
| What are the nursing management responsbilities when caring for a GERD patient? |
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Definition
Patient education re cessation of smoking and avoidance of aggravating factors (incl sleeping laying down); weight loss
Monitor for pharma s/e
For post-op pt: surgical wound care, pain mgmt, spirometer/deep breathing/splinting pillow/painmeds!, ivf till peristalsis, and NG or chest tube care;lax to avoid straining; high protein high fiber high cal diet and small meals
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Term
| What are possible nursing diagnoses of a GERD patient? |
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Definition
Acute pain/chronic pain
Nausea
Disturbed sleep pattern
Risk for Imbalanced Nutrition
Risk for aspiration
Impaired Swallowing
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Term
| What is peptic ulcer disease? |
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Definition
It is an umbrella term which needs to be further classified by the location (gastric or duodenal) of the ulcer and the degree/duration of mucosal involvement (acute or chronic).
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Term
| What is the pathophysiology of peptic ulcer disease? |
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Definition
| The mucosal barrier of the upper GI tract fails to withstand the imbalance between defense factors (mucus and bicarb) and aggressive factors (HCl, H. pylori, and drugs). |
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Term
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Definition
| Duodenal ulcers which account for 80% of PUD are caused by H. pylori (90%), stress, and increased HCl secretion. Gastric ulcers which account for 20% of PUD are caused by H. pylori (50%), drugs, and chronic gastritis (often due to etoh abuse). |
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Term
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Definition
Endoscopy (EGD) w biopsy (see if it's h. pylori, check for gi carcinoma, see the level of erosion)
Barium Swallow (Upper GI)
X-ray studies (ineffective)
Test for H. Pylori (blood, breath, fecal, tissue)
Gastric Analysis
CBC (monitor for enzymes and anemia)
Liver enzyme Test
Guiac Test
Amylase Test
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Term
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Definition
Both gastric and duodenal ulcers are characterized by dull, gnawing epigastric pain. However the similarity ends there.
Gastric ulcers:
Pain occurs 30-60 minutes after meals, occurs rarely at night, is exacerbated by food, and can be referred to the back and shoulders.
Duodenal ulcers:
Pain occurs 1.5-3.0hr after meals, occurs at night, and is relieved by eating. |
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Term
| What kind of ulcer can occur due trauma or surgery? |
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Definition
| A physiologic stress ulcer. It is an acute ulcer that results from surgery or physical trauma. It is very serious, can cause extensive burns, and repairing it can be a complicated surgery. It can lead to a perforated bowel. The best way to manage physiologic stress ulcers is to prevent them! |
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Term
| What are the potential complications of PUD? |
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Definition
Perforation! (this is LETHAL and is characterized by sudden and severe pain, rigidness of abdomen, absence of bowel signs, shallow breathing, n&v, bacterial peritonitis within 4-6h if untreated)
Anemia (slow/insidious onset; can be due to bleeding or decreased nutrient absorption due to ciliary destruction in GI mucosa)
Hemorrhage (most common; characterized by sudden and severe shock and hematemesis and melena)
Gastric Outlet Obstruction (@ pylorus; d/t repeated injury, inflammation and scarring(fibrous tissue build-up is inflexible; s/s are stomach and epigastric fullness, n&v)
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Term
| What causes mucosal erosion in the GI? |
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Definition
H. Pylori
Aspirin and NSAIDs
Corticosteroids
Lipid soluble cytotoxic drugs |
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Term
| How does H. pylori result in ulcers? |
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Definition
generates urease. Urea --urease--> co2+nh3 (inflammation of stomach) ---pres. of h2o-->nh4 + oh- ---rx w prev co2 --> bicarb--> incr stomach pH -->incr survival of h pylori
inflammation incr. susceptibility to mucosal erosion
h. pylori often found in antrum to avoid parietal cells (acid secretion) in corpus |
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Term
| How do NSAIDs and aspirin cause ulcers? |
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Definition
| They inhibit COX1 synthesis. COX1 produces PGE2 which stimulates EP3 receptors that protect the mucus cells from desctruction via stomach acid. Thus without COX1 there is not EP3 receptor stimulation and the stomach mucus is susceptible to acid erosion. |
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Term
| How do corticosteroids cause ulcers? |
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Definition
| They "decrease the rate of mucosal cell renewal." (little scientific evidence of this in humans unless its prolonged usage) |
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Term
| How do lipid-soluble cytotoxic drugs cause ulcers? |
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Definition
| Lipid soluble drugs are able to pass through the cell membranes and produce their cytotoxic effects on the cells, resulting in erosion of the stomach lining |
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Term
| Describe the prevalence of gastric ulcers. |
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Definition
| They can occur in any portion of the stomach but are most common in the antral junction (h. pylori!!). THey are less common than duodenal ulcers in western countries. They are more prevalent in women and generally occur after the age of 50. |
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Term
| What are gastric ulcers specifically caused by? |
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Definition
Chronic gastritis
Bile Reflux
Nicotine Use
Etoh abuse
Drugs (NSAID cortico asa) |
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Term
| Describe the prevalence of duodenal ulcers. |
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Definition
More likely to occur between ages 35 and 45. Account of about 80% of all peptic ulcers and there is a familial tendency. They are more likely to occur with blood type O. They generally occur in individuals with increased hcl secretion and those with h. pylori. They are common with COPD, liver cirrhosis, chronic pancreatitits, and chronic renal failure patients.
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Term
How can physiologic stress ulcers (stress-related mucosal disease) be prevented?
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Definition
| Put patient on nexium or other ppi during hospitalization. |
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Term
| How can you tell the difference between gastric and duodenal ulcers? |
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Definition
With gastric ulcers it will be higher in the epigastrium, will occur 1-2h after meals and will feel more burning or gaseous. Duodenal ulcers will cause midepigastric pain betneath the xiphoid process and possibily back pain if the ulcer is in the posterior duodenum. The pain will occur 2-4 h after meals and will occur, disappear, recur, etc.
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Term
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Definition
| Patients need to recieve adequate rest and dietary modification, along with cessation of smoking and etoh use. They often will require drug therapy. Some patients may need treatment re stress management. All patients will need long term follow up care. |
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Term
| What kinds of drugs are used to treat PUD? |
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Definition
H2 antagonists
PPIs- should only be used until healed
Antibiotics- until h. pylori is resolved; have to be careful for superinfection and pseudomembraneous colitis; be sure patient takes whole regimen
Antacids
Anticholinergics- slows gastric motility and lowers hcl production
Cytoprotective therapy- carafate (sucralfate) |
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Term
How is nutritional therapy implicated in PUD treatment?
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Definition
avoidance of trigger foods
bland diet
6 small meals a day during symptomatic phase
It is important to get your patient a nutrition consult to help them understand. |
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Term
| What should the nursing assessment for a patient with PUD include? |
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Definition
Health history and physical exam
Medication Usage
Q re pyrosis
Q re weight loss (intentional?)
Characterization of stool (black, tarry?)
Feel for epigastric tenderness during exam
n&v
abnormal lab val's
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Term
| What are some possible nursing diagnoses for PUD? |
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Definition
Acute pain
Ineffective therapeutic regimen management
Nausea
Knowledge Deficit |
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Term
| What acute nursing interventions need to be made for PUD patients? |
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Definition
These are used with a patient who is hemorrhaging, has a perforated bowel, or an obstruction:
Vitals
ABC's
Fluids (IV; be careful with older population w fluid overload; electrolyte imbalance w obstruction)
NG tube w intermittent suction (decompress the stomach)
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Term
| How is PUD treated and diagnosed in older populations? |
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Definition
| Ulcers are more common in those over 60 due to incr use of NSAIDs. They may present with gastric bleeding or a decreased hemtocrit. The treatment is similar to that in younger adults but more emphasis is placed on prevention. |
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Term
| Describe the epidemiology of gall bladder disease. |
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Definition
| Occurs more frequently in females, in those older than 40, and in obese people. It's common in the US and occurs in 10-20% of adults. |
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Term
| Describe the two main gall bladder disorders. |
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Definition
Cholecystitis is an inflammation of the lining or the entire wall of the gall bladder. It is characterized by edema and scarring of the wall.
Cholelithiasis is an obstruction of the gall bladder's cycstic duct due to stones. |
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Term
| What are the s/s of cholecystitis? |
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Definition
Indigestion
Moderate or severe pain- after fatty meal
RUQ tenderness
N&V
Fever
Leukocytosis
Jaundice
Fat Forty Fertile- Risk for gall stones |
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Term
| What are the s/s of cholelithiasis? |
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Definition
Generally asymptomatic until stones cause inflammation
Sudden onset of RUQ pain; radiates to the right scapula or shooulder
Sometimes occurs after eating a fatty meal
Jaundice
Pancreatitis
Normal GI upset (N&V, etc) |
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Term
| How are gall bladder disorders diagnosed? |
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Definition
ERCP
Ultrasound*** best way
Serum Bilirubin
IV cholangiogram (bile is removed and dye is injected to view biliary and hepatic ducts
Percutaneous transhepatic cholangiography
Liver function Test- Incr in alkaline phosphatase
WBC |
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Term
| What are possible complications of gall bladder disorders? |
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Definition
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Term
| What is acute pancreatitis? |
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Definition
| An acute life threatening inflammatory process caused by gallbladder disease, alcoholism, trauma, or ercp. Acute pancreatitis can also be idiopathic in origin. |
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Term
| What are the s/s of acute pancreatitis? |
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Definition
Severe abdominal pain, LUQ
Pain aggravated by food
N&V
Abdominal distension
Leukocytosis
Hypotension
Tachycardia
Jaundice |
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Term
| What is chronic pancreatitis? |
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Definition
It is the progressive destruction of the pancreas with fibrotic replacement of pancreatic tissue.
Calcifying or obstructive |
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Term
| What are the s/s of chronic pancreatitis? |
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Definition
Crampy midepigastric pain
Mild jaundice
Dark urine
Steatorrhea
Diabetes mellitus |
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Term
| How is chronic pancreatitis diagnosed? |
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Definition
Xrays
Arteriography
ERCP
MRCP
CT/MRI/US
Secretin stimulation test
Lab values:
increased alkaline phosphatase
serum amylase and lipase may be slightly increased
increased serum bilirubin
mild leukocytosis
elevated sed rate
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Term
| What are possible complications of chronic pancreatitis? |
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Definition
Pancreatic insufficiency
Ascites
Pancreatic pseudocysts
Cancer
Diabetes Mellitus
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Term
| What are the s/s of pancreatic cancer? |
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Definition
Abdominal pain
Rapid jaundice
Weight loss
Symptoms of diabetes mellitus |
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Term
| How is pancreatic cancer diagnosed? |
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Definition
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Term
| What are the early and late symptoms and the prognosis for oral cancer? |
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Definition
| Early symptoms include patches on the proximal tongue, sores that bleed easily and won't heal, and problems with the lower lip. Later symptoms include dysphagia, slurred speech, and difficulty moving the jaw. The prognosis is a 53% 5 year survival rate with treatment. Diagnosis is generally done via biopsy. |
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Term
| What are risk factors for oral cancer? |
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Definition
Smoking (esp pipe)
UV light exposure
Etoh abuse
Chronic irritants |
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Term
| What are the s/s of gastric cancer? What is the prognosis? |
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Definition
Generally are met's before symptoms occur. (generally to peritoneal cavity)
Anemia
Symptoms of PUD
The 5 year survival rate is only 10%. |
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Term
| How is gastric cancer diagnosed? |
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Definition
endoscopic biopsy
CEA
CA 19-19 (not necessarily diagnosis but for monitoring) |
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Term
| How is gastric cancer managed? |
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Definition
| Surgery is helpful in 40% of the cases. Surgical procedures include Bilroth1, Bilroth 2, and total gastrectomy. Bowel sterilization is important with surgical procedures. This is done via an oral or retention enema of neomycin. Chemo and radiation are also used. |
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Term
| Describe the basics of esophageal cancer. |
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Definition
| It is rare but there has been a 200% increase over the past 10 years. Smoking, excessive etoh use, and Barrett's esophagus are risk factors. Progressive dysphagia and pain are symptoms (pain comes later). Its generally diagnosed via EGD with biopsy. There's usually a 20% chance of 5 year survival. |
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Term
| How is gall bladder disease treated? |
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Definition
Symptomatic treatment- demerol is better than morphine for pain due to its reduction of sphincter spasms (cause the pain)
Oral solution therapy- not effective
Dissolution therapy with lithotripsy-
Removal via Laporoscopy - laporoscopic cholecystectomy
Open cholecystectomy
During surgery inflate with CO2 for visualization- causes right shoulder pain
May have a t-tube placed during surgery
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Term
| What are important postop considerations for the gall bladder patient? |
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Definition
Treatment of right shoulder pain due to residual co2
Positioning- depends on placement of t-tube- need to be in atleast fowler's
Treatment of drain site
Pulmonary Hygiene
Ambulation
Advance diet
Pain management |
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Term
| What are possible nursing diagnoses for the gall bladder patient? |
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Definition
Knowledge deficit
Imbalanced nutrition
Ineffective breathing pattern
Risk for fluid volume deficit
Acute pain
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Term
| What are your nursing responsibilities for the gall bladder patient? |
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Definition
relieve pain
relieve n/v
provide comfort
maintain fluid balance
educate
monitor for side effects
relief for pruritis
freq assessment
wound care |
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Term
| How should chronic pancreatitis be treated? |
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Definition
Prevent attacks and treat as acute pancreatitis when attack does occur
Prevention of shock
Monitor pancreatic secretions
Monitor electrolyte imbalance
Supportive care
Prescribe a bland low fat diet
Control pt's diabetes
Cessation of etoh use
Bile salts
Pancreatic enzyme replacement
Relief of pain
Acid neutralizing/inhibiting drugs |
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Term
| What is the difference between primary and secondary malnutrition? |
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Definition
Primary is due to dietary lifestyle choices.
Secondary is due to pathologic conditions, eating disorders, underfeeding, and side effects of certain medications. It is often seen in the frail elderly. |
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Term
| Who's at risk for malnutrition? |
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Definition
Chronic diseases
Hypermetabolism
Diarrhea
NG tube drainage
Dysphagia
Chronic etoh abuse
NPO for 10 days (5 in elderly)
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Term
| What health risks are associated with obesity? |
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Definition
Type II DM
Htn
Stroke
Gallbladder disease
Sleep apnea
Osteoarthritis
Cancer
Morbid obesity
Obesity hypoventilation syndrome |
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Term
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Definition
| foods, medications,eating disorders emotions,post-op, pregnancy inner ear dysfunction |
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Term
| What are possible complications of nausea? |
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Definition
| dehydration, nutritional deficits, weight loss bradycardia/hypotension(from valsalva maneuver), gastritis/hematemesis, esophageal ulceration Aspiration/asphyxiation Mallory-Weiss Tear |
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Term
| What NTs cause vomitting and what do they stimulate? |
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Definition
| Serotonin, dopamine, acetylcholine, and histamine stimulate the vomiting center in the medulla which sends signals to the stomach muscles and causes emesis |
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Term
| What role do transmitter antagonists play in the treatment of nausea? |
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Definition
| They block central stimulation of the vomiting center in the brain (CTZ, vestibular). There are 4 different types. The first 2 act on the CTZ and are serotonin antagonists and dopamine antagonists. The second 2 act on the vestibular center and are anticholinergics and antihistamines. |
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Term
| What are extrapyramidal side effects? |
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Definition
They are s/e that can occur within 24 hrs of taking antiemetic transmittor agonists. They cause a syndrome known as pseudo parkinsonism. Symptoms include:
–Stooped posture, shuffling gait, tremors at rest, pillrolling,
–Acute Dystonia: facial grimacing, upward eye mvmt, muscle spasms of tongue, face, neck, arching of back
–Tardive Dyskinesia: protrusion and rolling of tongue, smacking of lips, chewing
–Facial dyskinesia, involuntary movements of body and extremities
–Akathisia: restless, pacing, feet in constant motion – rocking back and forth
–Cardiac: prolonged QT interval
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Term
| What s/e are associated with anticholinergics? |
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Definition
decreased motility (leads 2 constipation)
decr salivation (dry mouth)
incr hr
decr bp
pupil dilation and blurred vision (caution in glaucoma)
decr bladder tone(leads to urinary incontinence)(caution in prostate)
reduction in muscle tone (leads to muscle weakness)
sedation |
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Term
| What are substance p or nk antagonists? |
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Definition
They are a class of antiemetic drugs that block the vomiting center directly without effecting NT's. They are presently only used for the prevention of or delay in nausea due to cancer treatments. S/e incl anorexia, dehydration, incr liver enzymes, fatigue, constipation and diarrhea.
Prototype: Aprepitant |
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Term
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Definition
A class of antiemetic drugs known as non-phenothiazines. They block dopamine in the CTZ, desensitizing the CTZ to stimulation from the GI tract. They stimulate GI peristalsis causing stomach emptying and increased tone of the LES (prevents reflux).
Prototype: Reglan aka metoclopramide
s/e: drowsiness, dizziness, eps |
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Term
| How are glucocorticoids used in antiemetic therapy? |
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Definition
| They are used as adjunctive therapy to reduce gastric inflammation. The prototype drug is decadron (dexamethasone). |
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Term
| What role does THC play in antiemetic therapy? |
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Definition
| Tetrahydrocannabanoids are synthetic derivatives of marijuana that depress the CTZ and are antiemetics and appetite stimulants. They are used in cancer patient treatment and in AIDS treatment. The prototype drug is marinol (dronabinol). |
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Term
| What role do benzodiazopenes play in antiemetic therapy? |
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Definition
| They do not play a direct role in preventing nausea. They do however decrease anxiety which may be contributing to n&v. The prototype drug is ativan (lorazepam). |
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Term
| List the nursing implications for patients recieving pharmacologic antiemetic therapy. |
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Definition
Assess n&v history (incl precipitating factors and meds)
Monitor for adverse s/e
-patient education re orthostatic hypotension
-patient education re drowsiness and effect on daily tasks
-patient education re etoh avoidance
Monitor for therapeutic effects
Give drugs atleast 1-3 hrs before chemo |
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Term
| How do H2 antagonists work with GERD? |
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Definition
| H2 antagonists inhibit histamine2 from attaching to h2 receptors in the parietal cells via competitive binding. This causes acid not to be secreted and reduces the effect of gastrin and acetylcholine on parietal cells. Thus the stomach is less acidic and the symptoms of GERD are lessened. |
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Term
| What are the prototype h2 antagonists? |
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Definition
Cimetidine (Tagamet)***
Ranitidine (Zantac)
Famotidine (Pepcid)
Very few side effects: hypotension, headache, diarrhea, constipation, etc.
***impotence and gynecomastia
their structures are more simplistic than the ppi's. may only contain one ring structure. |
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Term
| What are the nursing implications assoc. w ppis and h2 antagonists? |
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Definition
Assess for allergies
Assess for impaired renal/hepatic fxn
Take 1h before or 2h after antacids
30-60m before meals=optimal |
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Term
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Definition
| They neutralize HCl and pepsin and reduce mucosal erosion . This decrease in hcl increases the gastric pH. |
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Term
| Describe the prototype antacids, their dosing, s/e, and their nursing implications. |
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Definition
Mg: Milk of Magnesia (diarrhea)
Al: Amphogel, Altemagel (constipation)
Combo: Maalox, Mylanta
Taken 1-3 hrs before meals and before bedtime up to 7 times q day as a routine NOT PRN
NI:
Assess for allergies and relevent hx (preggo or renal failure)
Antacids w high Na content contraindicated in heart failure/htn
Patient education re thorough mastication of chewable tabs
Patient educaiton re not taking with milk or meals
Patient education re effect on absorption of other meds (take 1 hr apart) |
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Term
| What role do antibiotics play in PUD therapy? |
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Definition
Effective in those caused by h. pylori. Two antibiotics must be used.
1. Amoxicillin: s/e: gi upset, diarrhea
2. Biaxin: s/e: gi upset, d, metallic taste
3. Tetracycline
4. Metronidazole (Flagyl): used to prevent resistance
They need to be given bid for 10-14 days. Patient education re continuing for the full course. |
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Term
| What OTC drug should be given with antibiotics as part of h. pylori therapy? |
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Definition
Peptobismol (bismuth subsalicylate) bc it disrupts the cell wall of the bacteria. S/e: black tongue/black stool
!!!!Don't use if allergic to aspirin!!!!
**Think salicylic acid---salicylate** same fxnal group |
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Term
| What prototype drug helps protect the mucosal lining of the stomach? |
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Definition
| Sucralfate or carafate. Combines w protein to form a viscous cover over ulcer, protecting it from acid. Should be taken on an empty stomach atleast 30m before meals. Its effective for 6 hrs. It can interfere with the absorption of other meds and thus should be taken atleast 2 hr apart. |
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Term
| What should be given as therapy for overproduction of pancreatic enzymes? |
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Definition
A somastatin analogue such as octreotide (Sandostatin) suppresses pancreatic enzymes
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Term
| What should be given to treat a pancreatic enzyme deficiency? |
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Definition
Pancrelipase (Pancrease). Take with all meals/snacks
s/e: diarrhea cramping nausea |
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