AMS1

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Author:
alyn217
ID:
164561
Filename:
AMS1
Updated:
2012-07-31 11:58:02
Tags:
AMS1T3 PUD
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Description:
Peptic Ulcer Disease
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  1. What is PUD?
  2. Etiology of PUC
    • Acidic Environment
    • H. Pylori (heliobacter pylori)
    • Medications (ASA, NSAIDS, Steroids)
    • Lifestyle Factors
    • Other Factors
  3. SnSs of gastric vs. peptic ulcer
    Test
    • Duodenal-80%
    • Intermittent, dull pain 2-5 hrs. post meal
    • Burning/Cramping pain
    • Pyrosis (Heartburn)
    • Nighttime pain
    • Relieved by eating or taking antacids
    • Periodic/episodic
    • Perforation/Hemorrhage/Obstruction
    • Gastric
    • Pain 1-2 hrs. after meal
    • Burning or bloated
    • Nausea/Vomiting
    • Early Satiety/Weight loss
    • Associated with NSAID use
    • Food aggravates pain
    • Perforation/Hemorrhage/ Obstruction
  4. Diagnostics for PUD
    • H/P
    • Upper GI X-ray with contrast
    • Esophagogastroduodenoscopy (EGD)
    • Occult Blood
    • H. Pylori Tests (Urease)
    • CBC
    • Liver Enzymes
    • Serum Amylase
    • H/H
  5. Collaborative care for PUD
    • Rest
    • Diet Modifications
    • Multiple meals
    • No smoking or Etoh
    • Drug therapy- PPI, H2 Blocker, antacids, antibiotics
    • Stress reduction
    • Blood transfusion
    • Surgery
    • Nutritional therapy
  6. Complications for pt w/PUD
    • Hemorrhage-- Most Common
    • Perforation--Most Lethal
    • Gastric Outlet Obstruction
  7. Nursing maangement of hemorrhage
    Signs/Symptoms





    Change in vital signs






    Pain decreases





    Management





    Maintain NPO






    Anticipate procedure/surgery






    Post-surgical might see bleeding in the NG aspirate






    Important to maintain patency of NG tube
  8. Nursing management of bowel perforation
    • SnSs
    • Sudden severe abdominal pain
    • Boardlike abdomen
    • Drawing up of knees
    • Shallow/grunting respirations
    • Diminished/absent bowel sounds
    • Management
    • Notify MD urgently
    • Anticipate surgery
    • Make NPO
    • IV Fluids
    • NG tube
    • Pain Meds
    • Antibiotics
  9. Nursing amangement of gastric outlet obstruction
    • SnSs
    • Abdominal pain (worse later in day)
    • Vomiting (old food, projectile, offensive odor)
    • Management
    • NG tube to decompress stomach
    • Keep NG tube patent (irrigate, reposition)
    • Measure gastric residuals
    • IV fluids/electrolytes
    • Meds-PPI, H2 blocker if ulcer related
    • I&O
    • Pyloric obstruction=balloon dilation
  10. PUD surgical TX
    • Billroth I (gastroduodenostomy): partial 2/3 gastric resection and reanastomosis to duodenum
    • Billroth II (gastrojejunostomy): partial 2/3 gastric resection and reanastomosis to jejunum
    • Vagotomy: severing of vagus nerve-decrease gastric acid secretion
    • Pyloroplasty: urgical enlargement of pyloric sphincter-facilitates easy passage of contents out of stomach. Usually done after vagotomy b/c vagotomy decreases gastric motility and gastric emptying
  11. Gastrectomy post-op care
    • NG tube: assess patency, drainage (color, amount, odor)
    • --ESSENTIAL FOR NG TUBE TO REMAIN PATENT!
    • ----Rupture of sutures
    • ----Leakage of gastric contents into peritoneal cavity
    • ----Abscess formation
    • ----Hemorrhage
    • GI Assessment
    • Incision
    • Pain control
    • IV fluids
    • C&DB (splinting), IS, other general Post-op care
  12. PUD post-Gastrectomy complications
    • Dumping Syndrome (test)
    • --Bolus of Hypertonic Fluid in intestines
    • --Sudden shift of fluid from plasma to intestines
    • --Weak, diaphoretic, dizzy, palpitations
    • Postprandial Hypoglycemia
    • --Bolus of high carbs into intestines
    • --Release of excessive amt of insulin
    • Bile Reflux Gastritis
    • --Pyloric surgery allows bile reflux
    • --Pain after meals, vomiting helps
    • --Questran (cholestyramine)-binds bile salts
  13. What is Dumping Syndrome?
    Test
  14. Nursing assessment of pt with PUD
    • Tarry stools
    • Signs of anemia
    • Nutritional status
    • Weight
    • Complications
    • Pain status
    • Pain relief effectiveness
    • Pharmacological effectiveness
  15. Why might elderly population be more at risk for PUD?
    Delayed gastric emptying & increased NSAID use.

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