Upper GI

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Upper GI
2010-02-24 00:19:32
Upper GI Med Surg 2 Exam 2

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  1. What problems can result in nausea and vomiting?
    • GI Disease
    • Pregnancy
    • CNS Problems
    • MI
    • Drug Toxicity
    • Anxiety
    • Surgery
  2. What are some nausea and vomiting complications?
    • Dehydration
    • Electrolyte Imbalance
    • Alkalosis
    • Aspiration
  3. Drugs that treat nausea and vomiting:
    • Prochloroprazine (Compazine)
    • (suppress chemoreceptors)

    • Metoclopromide (Reglan)
    • (empties stomach)

    • Promethazine (Phenergan)
    • (Sedative)

    • Ondanseton (Zofran)
    • (Blocks serotonin with vagus nerve)
  4. Two main risk factors of oral cancer:
    • Tobacco
    • Alcohol
  5. Erythroplakia vs. Leukoplakia:
    Erythroplakia - Red lesion, non-tender

    Leukoplakia - White lesion, painless

    (Both are pre-cancerous)
  6. What is the number one nursing priority in the post-op care of a radical neck dissection?
    What needs to be at the bedside?

    Trach tube, suction, ambu bag, obturator
  7. GERD increases with ________ and can be caused by ___________ and ___________

    Incompetent lower esophageal sphinctor

    Hiatel hernia
  8. Three common S/S of GERD:
    • Heartburn
    • Reflux
    • Esophagitis
  9. GERD complications:
    • Esophageal strictures
    • Barrett's Esophagus
    • Bronchospasm
    • Aspiration
  10. How do these factors make GERD worse:

    Recumbent position?
    Large meals?

    Pressure in stomach
  11. Alcohol, caffeine, nicotine and mint make GERD worse because _____________
    They relax the esophageal sphincter
  12. What is the diagnostic procedure for GERD?

    • Pre-op: NPO, consent
    • Post-op: Vitals, monitor LOC, NPO til gag reflex comes back
  13. What medications are used to treat GERD?
    • Proton Pump Inhibitors (Prilosec, Nexium)
    • (Give before meals)

    H2 Blockers (Pepcid, Zantac)
  14. When should you give H2 Blockers when you already gave a proton pump inhibitor?
    12 hours apart
  15. What is achalasia?
    Spasm of lower esophageal sphincter and dilation of lower esphagus
  16. Achalasia-

    • Dysphagia
    • Pain
    • Aspiration

    • Dilation
    • Surgery
    • Botox
  17. What are the components of the triple therapy to treat H Pylori?
    • Amoxicillin
    • Clarithyromycin (Biaxin)
    • PPI
  18. Peptic Ulcer Disease -

    • Pain after meals
    • Associated with NSAIDs

    • Pain between meals
    • Relieve with food/antacids

    Transiet ischemia from hypotension, burns, trauma
  19. Diagnostics for peptic ulcer disease:
    • Endoscopy
    • Biopsy
    • Labs (Hg for anemia, Plt for bleeding, BUN for renals)
  20. How do you treat peptic ulcer disease?
    • Proton pump inhibitor
    • Sucralfate (Carafate)

    Lifestyle modification

    Surgery (rare)
  21. S/S of perforation:
    • Board-like abdomen
    • Severe pain radiating to shoulder
    • No bowel sounds
  22. What is dumping syndrome?
    Uncontrolled chyme into the intestines pulls fluid into the gut causing hypotension and diarrhea
  23. S/S of upper GI bleed:
    • Hematemesis
    • Coffee groups emesis
    • Melena
    • Syncope
    • Anemia
  24. Upper GI bleed sources:
    • Esophageal varices
    • Peptic ulcer disease
    • Drugs (NSAID, ASA, Corticosteroids)
    • Stress ulcer
  25. How do you manage an upper GI bleed?
    • Proton Pump Inhibitor
    • Sandostatin

    • Fluid replacement
    • Transfusions
  26. What gauge IV catheter should be place for a patient with an upper GI bleed?
    • 18 gauge
    • (may need to replace large volumes)
  27. What patients are at highest risk of fluid overload from multiple transfusions?
    • Renal failure
    • CHF
    • Elderly

    (monitor edema, lung sounds, LOC)
  28. A patient with diagnosis of peptic ulcer disease reports vomiting coffee grounds material. What should the nurse do first?

    A. Notify the physician
    B. Test the next stool for occult blood
    C. Take vital signs
    D. Insert an NG tube
    C. Take vitals

    D - has to be ordered
  29. A 62-year-old man with weight loss, difficulty chewing, and malaise has been diagnosed with squamous cell carcinoma of the oral cavity. Information obtained from the patient during the nursing history that the nurse identifies as the most significant risk factor for oral cancer is:

    A. Use of tobacco
    B. Poor oral hygiene
    C. Chronic sun exposure
    D. Recurrent herpes simplex infection
    A. Use of tobacco

    • B - not a risk for cancer
    • C - not a oral cancer, just lip
  30. A 70 year old female presents to the emergency department for evaluation of melena. Which of the following does the nurse identify as a significant risk factor for upper GI bleed?

    A. A high fat diet
    B. Use of Ibuprofen for osteoarthritis
    C. Chronic constipation
    D. Eating spicy foods
    E. All of the above
    • B. Use of ibuprofen for osteoarthritis
    • (It is an NSAID)