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67 Cards in this Set
- Front
- Back
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Describe characteristics of peptic ulcer disease.
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*flares up & settles down
*from trauma, infection, stress *usually chronic *familial |
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What groups are at risk for peptic ulcer disease? Select all that apply:
a. smokers b. alcoholics c. blood group O d. older adults |
a. smokers
c. blood group O d. older adults |
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Why are older adults more prone to develop peptic ulcers?
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Older adults tend to use NSAID's more to treat arthritis. NSAID's increase the likelihood of developing ulcers because they erode the mucosal barrier.
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When is pepsinogen converted to pepsin?
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When HCl is present and pH is between 2 and 3 (acidic).
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What does the gastric mucosal barrier do?
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Protects the stomach from autodigestion & gastric juices.
* Mucosa can repair itself and is renewed every three days. * Barrier prevents acid from getting to underlying layers. |
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True or False: Food prevents gastric acid secretion.
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True. Food acts as a natural antacid.
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When this gets through the impared mucosal barrier, tissue is injured, cells are inflammed, and cells are destroyed. Antihistamines are released.
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Hydrochloric Acid (HCl)
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Which of the following destroy gastric mucosa? Select all that apply:
a. alcohol b. NSAIDs c. prednisone d. H.pylori infection e. smoking |
b. NSAIDs (aspirin).
c. prednisone (corticosteroid). d. H.pylori infection |
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True or False: Prostaglandins increase blood flow to the affected, inflammed mucosa.
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True.
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How is H.pylori contracted?
a. fecal-oral route b. person to person |
a & b. H.pylori is transmitted both through the fecal-oral route and person to person route.
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The patient is infected with H.pylori. What do you expect the patient to produce? Select all that apply.
a. bicarbonate b. urea c. ammonia d. oxygen e. carbon dioxide |
a. bicarbonate (HCO3)
b. urea c. ammonia e. carbon dioxide |
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Which of the following cause gastric ulcers?
a. gastric acid b. pepsin c. H.pylori infection d. aspirins e. corticosteroids f. vesperine g. theodur h. caffeine i. chronic alcohol abuse j. smoking k. hot, rough, spicy foods. |
a-k. all of those produce gastric ulcers.
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Where do gastric ulcers occur?
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In the lesser curvature of the stomach.
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Where duodenal ulcers occur?
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In the upper part of the pylorus.
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Which of the following cause duodenal ulcers?
a. H. pylori infections b. alcohol abuse c. smoking d. estrogen e. high gastric acid secretion. |
a. H.pylori infections
d. high gastric acid secretion. |
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This type of ulcer is an acute gastric mucosal lesion that occurs after trauma or medical crises.
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Stress Ulcers.
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These types of peptic ulcers occur as a result of burns:
a. Curling's ulcer b. Ischemic ulcer c. Cushing's ulcer |
a. Curling's ulcer occurs in response to burns.
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This ulcer is the result of sepsis.
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c. Ischemic ulcer occurs from sepsis.
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This type of ulcer is the result of increased intracranial pressure.
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b. Cushing's ulcer.
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How are stress ulcers prevented? Select all that apply.
a. Pepto-Bismol b. Protonix c. Pepcid d. Maalox |
b. Protonix
c. Pepcid prevent stress ulcers. both are given IV. |
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Where do stress ulcers commonly occur?
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In the stomach and proximal duodenum.
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What are common side effects of stress ulcers?
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a. longer hospital stay
b. increased mortality rate c. progress to massive hemorrhage |
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This is the main manifestation of acute stress ulcers.
a. nausea and vomiting b. bleeding from gastric erosion c. melena d. anemia |
b. bleeding from gastric erosion.
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Who are duodenal ulcers most common in?
a. women, age 20-50 b. men, age 15-30 c. men, age 40-50 d. children |
c. men, age 40-50
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True of False: Melena is more common in duodenal ulcers.
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True. Melena is more common in duodenal ulcers.
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Describe symptoms of gastric/duodenal ulcers perforation.
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a. sharp, sudden pain spreading over entire epigastric area.
b. tender, rigid, board-like abdomen. |
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What position for the patient with perforation is best to relieve pain?
a. supine b. fetal c. prone d. trendelenburg e. semi-fowlers. |
b. fetal. knee-to-chest position is best to relieve pain caused by perforation. it decreases tension on abdominal muscles.
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What increases hydrochloric acid production?
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a. NSAIDs
b. Theodur c. Caffeine d. Corticosteriods. |
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The patient had intermittent pain that was relieved by food but now that pain is constant and radiates to the back and upper quadrants. What is the likely diagnosis?
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Peptic Ulcer Perforation.
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The patient has pain in the upper gastric area to the left of the midline that is aggravated by food. What is the likely diagnosis?
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Gastric Ulcer.
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The patient has pain in the right epigastrum that occurs 90 minutes to 3 hours after eating. He says it's worse after he eats onions and has coffee. What is the likely diagnosis?
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Duodenal Ulcer.
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What are labs for peptic ulcers?
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H&H
stool for occult blood |
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What imaging is done for peptic ulcers?
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EGD (Esophagogastroduodenoscopy).
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Describe the common drug regimen for treating H.pylori?
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Triple Therapy:
1. proton pump inhibitor (Prevacid) with 2. 2 antibiotics: Flagyl & Tetracycline or Biaxin & Amoxicillin |
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What do hyposecretory drugs do?
a. decrease gastric production b. reduce gastric acid secretions c. coat the ulcer |
b. reduces gastric acid secretions.
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What are examples of Hyposecretory Drugs?
a. Proton Pump Inhibitors b. H2 Antagonists c. Prostaglandin Analogues. |
a. Proton Pump Inhibitors
b. H2 Antagonists c. Prostaglandin analogues. |
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What is the drug of choice for treating acid disorders? Give examples.
a. ppi's b. antacids c. pepto-bismol |
a. Proton Pump Inhibitors
Prilosec Prevacid Aciphex Nexium Protonix |
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Give Examples of H2 receptor antagonists?
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Zantac
Pepcid Axid |
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Give examples of Prostaglandin Analogues? What do they do and what are side effects?
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Cytotec. prevents NSAID induced ulcers. Side effect: causes uterine contraction. Tell women it makes muscle cramps worse.
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What is a mucosal barrier fortifier?
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Sulcrafate (Carafate).
prevents digestive action of acid and pepsin. Doesn't prevent secretion. protective coating. |
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What should you teach the patient taking Carafate?
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1. take on an empty stomach 1 hour before eating and at bedtime.
2. common side effect is constipation. |
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What types of foods/drinks should be avoided in peptic ulcer diease?
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* caffeine
* all types of coffee due to peptides. * alcohol * tobacco |
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Treatment for perforation:
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* replace fluid, blood, electrolytes
* antibiotics * NPO * monitor I&O * hourly vital signs |
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True or False: A Vagotomy destroys all vagus nerve action and gastric, intestinal, and gallbladder action.
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True: It cuts vagus nerve.
It destroys gastric, intestinal, gallbladder action, and acid production. |
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Who is a vagotomy indicated for?
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recurrent ulcer disease
acid reduction combined with pyloroplasty |
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True or False: The Pyloroplasty enlarges the pylorus by removing the sphincter.
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True.
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This surgery resects the antrum and anastamoses the remainder of the stomach to the duodenum.
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Billroth 1. Gastroduodenostomy.
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This surgery resects the antrum and anastamoses the remainder of the stomach to the jejunum.
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Billroth 2.
Gastrojejunostomy. |
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This surgery severs the entire vagal nerve trunk below the diaphragm.
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Truncal Vagotomy.
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What does severing the vagal innervation to the stomach do?
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It removes the stimulus that causes the parietal cells to produce hydrochloric acid.
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What are the advantages of Truncal Vagotomy?
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reduces amount of gastric acid produced.
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What are the disadvantages of Truncal Vagotomy?
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delays gastric emptying
increased risk of diarrhea gallstone formation |
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Define Dumping Syndrome.
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food bypasses jejunum & duodenum
*postprandial *food dumps into jejunum *hypertonic fluid enters intestine * decreases plasma volume *lumen distens and increases motility |
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What is the most common symptom of dumping syndrome and when does it occur?
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5-30 minutes after eating
*epigastric pain *hypovolemia *tachycardia *diaphoretic *borborygmus *intense need to go to bathroom *hyperglycemia |
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How should the nurse instruct the patient with dumping syndrome to prevent hyperglycemia?
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*high protein
*high fat *low carb *small, frequent meals *eat lying down *lie down after you eat |
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How long does dumping syndrome last after surgery?
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6 months to 1 year.
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Where in the intestines is iron stored?
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duodenum and jejunum.
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What type of anemia is associated with peptic ulcer disease?
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Pernicious Anemia (lack of B12).
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What should the nurse include in discharge teaching for the patient with peptic ulcer disease?
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*ulcers can come back
*watch food and diet |
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What types of meats should be included in the diet for dumping syndrome?
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8 oz or more per day of any lean meat.
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What types of starches should be included in dumping syndrome?
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Potatoes, rice, pasta, starchy vegetables.
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How should vegetables be prepared for someone with dumping syndrome?
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two or more cooked vegetables.
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How many fruits should the patient with dumping syndrome have?
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limit 3 per day.
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What types of drinks should patients with dumping syndrome consume?
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diet drinks.
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What types of fats should be consumed by the patient with dumping syndrome?
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margarine,oils, butter, bacon, salad dressings.
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What are symptoms common with dumping syndrome?
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tachycardia
orthostatic hypotension dizziness flushing diaphoresis decreased blood pressure |
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When should the patient with dumping syndrome have a drink? What should be avoided?
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between meals. Milk should be avoided and sweet sugar should be avoided.
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