MedSurg Test 5 2nd Semester

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BCnurses2014
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MedSurg Test 5 2nd Semester
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2013-11-01 16:16:10
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MedSurg Test 2nd Semester
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MedSurg Test 5 2nd Semester
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  1. Peptic ulcer disease definition:
    Ulcerated lesion in the mucosa of the stomach or duodenum
  2. Types of peptic ulcers:
    • Gastric
    • Duodenal
  3. Stomach defense systems:
    • Mucous layer: coats stomach; first line of defense
    • Bicarb: neutralizes acid
    • Prostaglandins: keeps blood vessels dilated; thought to stimulate mucus and bicarb
  4. Risk factors for peptic ulcer disease:
    • Gender: duodenal PUD increasing in older women
    • Family hx of PUD
    • Smoking
    • Acidic drinks
    • Medications
    • H. pylori infection
    • Age: duodenal 30-55; gastric 55-70
  5. Drugs that may contribute to PUD:
    • Theo-Dur
    • Caffeine: stimulates hydrochloric acid production
    • Corticosteroids
    • NSAIDs
  6. s/s of gastric PUD:
    • Pain that occurs 30-60 minutes after meals
    • Pain is made worse by the ingestion of food
    • May be malnourished

    Risk for malignancy
  7. s/s of duodenal ulcers:
    • Pain that occurs 2-3 hours after meals; often awakens pt between 1-2 am
    • Pain relieved by ingestion of food

    Very little risk for malignancy
  8. Stress ulcer definition:
    Acute gastric mucosal lesions associated with major surgery, head injury, burns, respiratory failure, shock, and sepsis
  9. s/s of general PUD:
    • Epigastric tenderness
    • - Gastric: epigastrium; left of midline
    • - Duodenal: mid to right of epigastrium
    • Sharp, burning, aching, gnawing pain
    • Dyspepsia (indigestion)
    • N/V
    • Belching
  10. Complications of PUD:
    • Hemorrhage
    • Perforation
    • Narrowing and obstruction (pyloric)
  11. How is PUD diagnosed?
    • Esophagogastrodueodenoscopy (EGD) - most common
    • Upper gastrointestinal series (UGI)
    • Urea breath testing
  12. Goals for PUD patient:
    • Pain relief
    • Eradicate H. pylori infection
    • Heal ulcer
    • Prevent recurrence
  13. Diet therapy for PUD:
    • Bland diet may relieve symptoms
    • Avoid coffee, bedtime snacks, alcohol, and tobacco
  14. Key features of GI bleeding:
    • GI:
    • - Coffee ground vomit
    • - Tarry stools
    • - Nausea
    • CV:
    • - Low BP
    • - Increased weak, thready pulse
    • - Decreased H&H
    • Neuro:
    • - Vertigo, dizziness, syncope, lightheadedness
    • Older adult:
    • - Acute confusion
  15. Non-surgical tx of GI bleeding:
    • Endoscopic therapy
    • Acid suppression
    • NG tube placement and saline lavage
  16. Post-op care for GI surgery:
    • NG tube: care and management, I/O
    • Monitor for post-op complications
    • Pain management
  17. Post-op complications of GI surgery:
    • Bleeding
    • Duodenal stump leak
    • Gastric retention
    • Dumping syndrome
    • Anemia
    • Malabsorption of fat
  18. What is dumping syndrome?
    • Early: diarrhea 30 minutes after meals
    • Late: diarrhea 90 minutes to 3 hours after meals
  19. s/s of dumping syndrome:
    Vertigo, tachycardia, syncope, sweating, pallor, palpitations, weakness, diarrhea
  20. How is dumping syndrome controlled?
    • Decrease carb intake
    • Eat slowly
    • Avoid fluids during meals
    • Increase fat
    • Eat small frequent meals
  21. Hiatal hernia definition:
    Protrusion of the stomach upward into the mediastinal cavity through the esophageal hiatus of the diaphragm
  22. Sliding hiatal hernia:
    Part of the stomach moves up through the hiatus of the diaphragm
  23. Paraesophageal hiatal hernia:
    The fundus and possible portions of the stomach's greater curvature, rolls through the esophageal hiatus and into the thorax beside the esophagus
  24. How are hiatal hernias diagnosed?
    • Barium swallow
    • CXR
    • Endoscopy with biopsy
    • CBC
    • Stool for quiac
  25. Key features of sliding hiatal hernia:
    • Heartburn
    • Regurgitation
    • Chest pain
    • Dysphagia
    • Belching
  26. Key factors of paraesophageal hernia:
    • Feeling of fullness and breathlessness after eating
    • Feeling of suffocation
    • Chest pain that mimics angina
    • Symptoms worse in recumbent position
  27. Hiatal hernia risk factors:
    Increased intra-abdominal pressure: obesity, pregnancy, bending, coughing, weight lifting

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