s/s of gastric ulcers
L epigastric pain
HCL- normal or hyposecretion
Pain 1/2-2 hours after meals
Eating may Increase Pain
s/s of duodenal ulcers
pain 2-3 hours after meals
food may Decrease pain
mid back and mid epigastrium burning cramping pain
Common risk factors of PUD
conditions a client might have that can cause n&v
SRA's examples and end in?
End in SETRON
what do SRA's do?
block effect of serotonin on vagal nerves
block dopamine receptors
Dopamine Antagonist drugs examples
and end in ??
End in ZINE
Antihistamines used for what? and cause what?
motion sickness and cause drowsiness, dry mouth, and protect from sun!
type of antihistamines
Nonpharmalogical tx for n/v
fluid and electrolyte replacement
alcohol swab to nose
n/v with pain is associated with?
n/v with out pain is associated with?
ingestion of toxins
What is GERD?
back flow of gastric contents into espophagus
What causes GERD?
relaxation of lower sphincter
incompetent lower esophageal sphincter
increased pressure within stomach
S/S of GERD
pain after eating
Endoscopy- see if tumors, inflammation, or scarring is there. NPO for
atleast 6 hours before test
With barium swallow, what should you ask patient
allergies to shellfish
after barium swallow what should you tell your patient
stools may be chalky white and to drink lots of fluids after test
What is the Esophageal manometry?
It measures lower esophageal sphincter pressure and peristalsis
Most accurate method of testing for GERD?
What foods irritate GERD?
What do PPI's do?
& end in ???
reduce gastric secretions
(pantaprozole, omeprazole, esomeprazole, lansoprazole)
What do H2 blockers do?
& end in ??
reduce gastric acid reduction
end in INE
(ranitidine, famotidine, nizatidine) pepcid , zantac
Which med works more rapidly for GERD?
Anti ulcer agents do what?
when should you take these
coats stomach and allows the mucosa to heal
Take on an EMPTY stomach
pepcid, zantac, prilosec
do not crush!
increase fluids and fiber
Mallow, mylanta, tums, gaviscon
Primary tx for GERD
avoid tight fitting clothes
sleep on R side
upright for 2 hrs after eating
don't eat 3 hours prior to bedtime
no bedtime snack
With EGD, what do you want to make sure of?
Make sure patients gag response has returned prior to providing oral
fluids or food following the procedure
Long term consequences of GERD
upper resp., sinus, or ear infections
What is barrets esophagus
gastric fluids that leads to esophagitis
What happens if GERD becomes chronic?
body will continue to heal inflamed tissue eventually replacing
normal esophageal epithelium with pre malignant tissue
common causes of acute gastritis
ingestion of gastric irritants
acute gastritis is relieved with?
having a bm
common cause of chronic gastritis
irreversible changes of the gastric mucosa
complications of a peptic ulcer
risk factors of a PUD
smokers and people who take nsaids
S/S of gastritis
primary disorders for a GI Bleed
blood in the g i tract stimulates peristalsis leading to what?
stools may be black and tarry
hemorrhage from PUD s/s
coffee ground emesis
COW HAD HVO
obstruction from PUD s/s
perforation from PUD s/s
no bowel sounds
rapid shallow respirations
severe and sudden abd. pain that radiates to shoulder
what is H pylori?
bacteria that lives in the stomach
What is the treatment for H-pylori?
2 antibiotics & 1 PPI(end in ZOLE)
antibiotics used for H pylori
metronidazole, amoxicillin, clarithromycin, tetracycline
s/s of dumping syndrome
n/v, epigastric pain with cramping, borborygmi(loud hyperactive BS)
diarrhea, dizziness, flushing
How is dumping syndrome managed?
sm. frequent meals
drink at separate times than eating
increase fat and protein
surgeries to treat GERD, gastritis, PUD
Bilroth 1 & 2
causes of dumping syndrome
Nutritional aspects to assist with IBS
Increase Fiber- add bran
Limit lactose, fructose, gas causing foods, caffeine
Gas causing foods are?
nursing care for fecal incontinence
nursing care for appendicitis
with appendicitis what is the pain?
RLQ pain with rebound tenderness.. when you press on stomach it feels
good but when you let go it hurts
2 major dangers with appendicitis
no lax or enema!
post op care for appendicitis
no heat to abdomen
nursing care for gastroentreritis
restrict solid intake
teach about FVD, diarrhea
pre op instructions for colonoscopy
clear liquid 24 hours- no red liquids
Ulcerative colitis what do you see
bloody mucus diarrhea
Crohns disease what do you see
no blood, slowly progressive
For Ulcerative Colitis what area of colon is involved?
For crohns what area of colon is involved?
ileum and ascending colon
complications of crohns disease
Complications of ulcerative colitis
perforation and colon cancer
what is ulcerative colitis relieved by?
going to the b/r
High residue diet?
unpeeled raw apples
dried beans(navy pinto, kidney)
raw veggies-carrots celery tomatoes
whole grain bread or crackers
low residue diet
cooked apples, apricots, cherries, peaches pears bananasa
roasted baked or broiled meet
cooked or canned veggies
milk limited to 2 cups per day
TX for crohns disease and ulcerative colitis
bowel gets really large with little peristalsis. its dilated and
stops moving. get dissension and pain LLQ and change in stools
With ileostomy what should you instruct pt to do
watch for dehydration
chew food well
what is a huge factor with ileostomy and what can it lead to?
Hypocalcemia and lead to metabolic acidosis
Functions of the liver
gets rid of ammonia
What is the most common thing cirrhosis is caused by
what is cirrhosis
Fibrosis of liver tissue leading to decreased mass, impaired liver
function, and altered blood flow
S/S of Cirrhosis
aching pain in epigastric area or RUQ
diarrhea or constipation
What is splenomegaly?
With splenomegaly what would you see?
Blood cell destruction
What is ascites?
accumulation of plasma rich fluid in the abdominal cavity
S/S of ascites
hypoalbuminemia-decreases colloidal osmotic pressure of plasma
hyperaldosteronism- sodium and water retention
enlarged thin walled veins that form in the submucosa of the esophagus
s/s of esophageal varies
eating high roughage foods
impaired production of clotting
what are we worried about with esophageal varices
loss of brain function when liver doesn't remove toxins from the blood
s/s of portal encephalopathy
factors precipitating portal encephalopathy
high serum ammonia level
imbalanced blood flow (renal failure)
s/s hepatorenal syndrome
What labs would be associated with cirrhosis
increased ALT,AST, ALP
low rbc, hemoglobin, hematocrit
prolonged ptt time
bilirubin levels elevated
what diuretics would they use and for what?
spironolactone(aldactone)- reduce ascites
furosemide(lasix)-promotes excretion of potassium
What laxatives would they use and for what?
Lactulose-reduces the amount of ammonia and pulls water into the
bowel increasing stools
for hepatic encephalopathy
anti infective agents to use and use for what?
they reduce intestinal bacteria and decrease ammonia production in bowel
use for cirrhosis
nutritional aspects that could assist with management of cirrhosis
restrict sodium intake to 2g/day
restrict fluids to 1500 ml/day
diet with adequate calories and protein
vitamin supplements(vit b12, thiamin, folate)
s/s of pancreatitis
severe epigastric and abdominal pain radiates to back
decreased bowel sounds
cold clammy skin
how is pancreatitis pain relieved by
sitting up and leaning forward
What is pain usually caused by in pancreatitis
fatty meal or excessive alcohol intake
Signs of bleeding in pancreatitis
Turners sign(bruising in the flanks)
bruising around the umbilicus (cullers signs)
TX for pancreatitis
pancreatic enzyme replacement- pancrelipase
hold oral food and fluids (ng usually placed)
when can a person return to reg foods after pancreatitis and what
kind of diet
when amylase levels are normal
low fat diet and no alcohol!
what complementary tx is used for pancreatitis?
low salt, low fat
Qigong- gently exercise, meditation and controlled breathing
magnetic field therapy
(all therapies should be prescribed by a trained practitioner)
Why is a beta blocker given? and for what?
nadolol- (end in olol) reduce portal hypertension and prevent
bleeding of esophageal varices
LATER s/s of cirrhosis
changes in mental responsiveness and memory
spider angiomas( face neck shoulders)
collateral veins visible on abd. wall
what is gynecomastia
swollen man boobs
what is capet medusa
visible veins of abdomen
what is asterixis
liver flap.. muscle tremor that interferes with ability to maintain a
fixed position of the extremities and causes involuntary jerking movements
s/s of inussusception
palpable abd mass
currant jelly stools
when should intussusception be treated and how
within 24 hours and treat with barium enema or surgery
s/s of diarrhea in kids
decreased amount of wet diapers
dry mucous membranes
tx for diarrhea in kids
With bowel training what should you avoid
With chronic pancreatitis what med do you NOT give
narcotics due to addiction
What is carafate and what is it used for?
It is an Anti ulcer that coats the stomach or ulcer to prevent
What do antacids do?
buffers that neutralize the stomach acid
Name some antacids
When do you give antacids?
1-3 hours after meals
What do promotility agents do?
increases upper GI motility and gastric emptying to decrease GERD
example of promotility agent?
Side effects of promotility agent in elderly
tardive dyskinesia symptoms
What do prostaglandin analogs do?
cytoprotective agent that promotes ulcer healing by increasing mucous
production, bicarbonate secretions and inhibits acid secretions
Ex. of prostaglandin analogs?
end in prostil or prostol
What is Billroth 1?
lower 2/3rds of stomach attached to duodenum
remove portion of stomach and attach to jujenum
removal of entire stomach
with a GI bleed what levels are increased?
Meds used to treat gerd, gastritis, and PUD?
anti ulcer agents
TX of H pylori?
combination of antibiotics and PPI
Dumping syndrome post op care
cough deep breathe
post op for dumping syndrome what does ng look like?
bright red at 1st then darkens
1st 36-48 hours yellowish green
pain management for dumping syndrome post op?
it reduces spasms in the sphincter of ode
Foods high in Fiber?
normal functions of the liver
Metabolize proteins, carbs and fats Metabolize
drugs Metabolize steroid hormones Glycogen
storage Vitamin and mineral storage Bile production
Fat absorption Bilirubin elimination
Detox Ammonia conversion to urea
Synthesis of blood components Albumin Clotting
s/s of ascites?
Doctor may put hand on stomach to feel a "wave"
- Abdominal Distention - Shortness of breath - S/S of
dehydration - Weight Gain
Tx for Ascites?
Sodium & Fluid restriction - Paracentesis -
Trans-jugular intrahepatic portosystemic shunt (TIPS)
Actions prior to a pt having a parancentisis
Tx for esophageal varices
Restoration of hemodynamic stability always Priority! - Restore
volume - Medications
- Vasoconstrictors ex-Somatostatin -
Endoscopy-banding/ligation - Sclerosing - Balloon
tamponade (Minnesota, Sengstaken-Blakemore)
What is Portal Encephalopathy aka hepatic encephalopathy and
what causes it?
s/s of encephalopathy?
Mental confusion progressing to coma - Muscle tremors -
Asterixis (dorsiflexion movements of hands and feet, or hyperextend
arms & dorsiflex the wrists) - EARLY S/S
- impaired judgement,
- slurred speech.
tx for encephalopathy?
Reduce Ammonia - Low protein diet 40-60 grams daily -
Decrease bacterial production of ammonia
What med would you give to decrease bacterial production of ammonia?
What does lactulose do ? and what toxicities can it cause?
reduces ammonia and watch for nephrotoxic and neurotoxic.
monitor renal, hearing and neurological functions
nutritional aspects for hepotorenal?
- Sodium <2 grams /day - Fluid restrict-generally 1500ml /
day - Protein <60 grams/day - Moderate fat -
High carb & calorie-to promote healing - Vitamins-vitamin
b12 might be ordered - Minerals
From contaminated food, water, shellfish. Risks -
International travel , close contact with infected person.
2 week incubation. Risk of spread decreases when jaundice
Bloodborne Risks � IV drugs, multiple sex partners,
work with blood can develop acute, chronic, fulminant
(rapid progression) or carrier hepatitis. Carrier more likely if
acquired at birth. Additional prodromal symptoms are
urticarial, arthralgia, serum sickness, glomerularnephritis
Can lead to primary liver cancer
Hep E Fecal contamination of water Person to
person transmission rare Causes fulminant, fatal
hepatitis in pregnant women
Nursing Care for Paracentesis?
NURSING CARE FOR PARACENTESIS monitor BP
during procedure weigh before and after
measure abdominal girth at level of umbilicus get
baseline set of vitals have patient void before
procedure to minimize risk of bladder puncture
position: seated, Fowler surgical vitals after
procedure (15 x 4, 30 x 2)
TX for Esophageal Varices
ligation � rubber bands on varices occlude flow
sclerosis � injected agent induces inflammation and
clotting NG tube prior to procedure Lavage with NS
prior to endoscopy improves visualization Balloon tamponade
treatment � balloon at end of NG tube presses on varices
Risk of aspiration Risk of airway obstruction