Risk Factors
A major risk factor for PUD because bacteria can survive a long time because they colonizing. This effects 50% of those older than 60.
Helicobacter pylori (H. Pylori)
Harding, 2023, page 1067-1068
The discomfort for gastric ulcers is located __________ and occurs _________ after meals.
the discomfort is generally high in the epigastrium and occurs about 1 to 2 hours after meals. Food tends to worsen the pain.
Harding, 2023, page 1069
What diagnostic study is the gold test for diagnosing H.Pylori?
Endoscopy.
Harding, 2023, page 1069
Patients can be in ambulatory care clinics for PUD. Aspirin and non selective NSAIDs are stopped for ________________ weeks. When aspirin must be continued, it can be administers with ___________, ______, or _________.
Patients can be in ambulatory care clinics for PUD. Asprin and non selective NSAIDs are stopped for 4 to 6 weeks. When aspirin must be continued, it can be administers with a PPI, H2 receptor blocker, or misoprostol.
Harding, 2023, page 1069
A patient presents to the emergency room for an acute exacerbation of GI bleeding. What interenvetions should the nurse expect in the plan of care. (Multiple answers)
NPO, Nasogastric tube to suction, IV PPI, Bed rest, IV fluid replacement, blood transfusions, stomach lavage (possible)
Harding, 2023, page 1070 (46.13) and 1072-1073
The patient has a chronic pain condition, COPD, and Atrial fibrillation, the nurse knows expects what type of medication would put the patient at risk for developing PUD?
Non Steroidal Anti inflammatory Drugs (NSAIDs), steroids, and anticoagulants.
Harding, 2023, page 1068
In duodenal ulcers, when food is present it helps to buffer the acid. Symptoms occur generally _______________ after a meal. They cause pain that is located in a patient's _____________.
In duodenal ulcers, when food is present it helps to buffer the acid. Symptoms occur generally 2 to 5 hours after a meal. They cause pain that is located in a patient's back. Bear in mind that all patient's may not have pain, some may have the feeling of fullness, bloating, nausea, and vomiting.
Harding, 2023, page 1069
What are the other non invasive tests done for
H. pylori?
Urea breath test and stool antigen tests. A barium contrast study may be used to diagnose gastric outlet obstruction, gastrin levels.
Harding, 2023, page 1069
Medications are a key part of therapy. What is the goal of the drug therapy?
It focuses on reducing gastric secretion and if needed eliminating H. pylori infections. They are treated with a PPI and antibiotics.
Harding, 2023, page 1070
What should the nurse educate the patient and caregiver on related to PUD?
Avoid acidic foods, avoid cigarettes, reduce or stop alcohol use, Avoid OTC drugs unless approved by the HCP. (NSAIDs), Do not interchange brands of PPI, antacids, or H2 blockers you can buy OTC, follow prescribed drug therapy, Report any of the following: increased N/V, epigastric pain, bloody emesis or tarry stools. Learn about stress management, share concerns about lifestyle changes with chronic illness.
Harding, 2023, page 1073 46.16
What lifestyle factors can cause acute mucosal lesions?
Alcohol, coffee, smoking, psychological distress, stress and depression.
Harding, 2023, page 1068
Gallstones may cause a range of symptoms and severity depends upon if the stone is stationary or mobile and whether obstruction is present. The tenderness is located where?
Right upper quadrant (RUQ)
Harding, 2023, page 1167
A CBC will show?
Anemia from a bleeding ulcer. and elevated WBC count due to inflammation from ch
Harding, 2023, page 1069
What medication is prescribed to prevent gastric ulcers caused by NSAIDs and LDA.
Misoprostal (a synthetic prostaglandin analog. It has a protective and some antisecretory effect on gastric mucosa.
Harding, 2023, page 1070
What type of diet should the patient with gallbladder disease follow?
Eat smaller frequent meals with some fat to promote gallbladder emptying. If obesity is a problem, a diet with reduced calorie. The diet should be low in saturated fats like butter, shortening or lard, and high in fiber and calcium.
Harding, 2023, page 1169
Biliary tract problems are a common health issue and 10% of Americans have cholecystitis caused by gall stones. The incident of gallbladder disease is especially high in the Native American Population. What are the non modifiable risk factors?
Women over 40 years of age.
Harding, 2023, page 1166
Pain often occurs _______ after a high-fat meal or when the patient lies down. The pain can be excruciating and accompanied by tachycardia, diaphoresis, and prostration. The pain may be referred to _____________ and __________.
Pain often occurs 3 to 6 hours after a high-fat meal or when the patient lies down. The pain can be excruciating and accompanied by tachycardia, diaphoresis, and prostration. The pain may be referred to right shoulder and scapula.
Harding, 2023, page 1167
What test is used to diagnosis gallstones?
Ultrasound.
Harding, 2023, page 1168
What is the cytoprotective drug that provides mucosal protection?
Sucralfate. It is most effective at a low pH, it is to be given at least 60 minutes before or after an antacid. Adverse effects are minimal and binds to certain medications.
Harding, 2023, page 1070
The patient is recovering s/p sedation for either and endoscopy and/or ERCP. What is the potential problem that the nurse should be concerned about?
Aspiration. Due to the patient receiving numbing medication for the throat.
Video displayed during class.
Chlocycstectomy or removal of the gallbladder is among the most common surgeries done in the United States. What are some modifiable risk factors
Weight, sedentary lifestyle, oral contraception in younger women (it produces cholesterol) or estrogen therapy for older women.
Harding, 2023, page 1166
When the obstruction occurs in the common bile duct, the kidneys will excrete bilirubin causing the urine to be_________________.
When the obstruction occurs in the common bile duct, the kidneys will excrete bilirubin causing the urine to be dark amber to brown. The patient may appear jaundiced.
Harding, 2023, page 1167
This test is not recommended in patient with renal impairment or allergy to contrast medium. This test will allow for visualization of the gallbladder, cystic duct, common hepatic duct, and common bile duct.
ERCP.
Harding, 2023, page 1168
What is the drug therapy for gallbladder disease?
Analgesics, anticholingergics (antispasmodics), bile salts that provide relief of itching, and fat-soluble vitamins due to malabsorption.
Harding, 2023, page 1169
90% of the cholecystectomies are done laproscopically. Pelase describe the restrictions between laproscopically and open cholecystectomy.
Patients are discharged the day of or day after surgery. They can usually resume normal activities and return to work within 1 week. With an incisional or open cholecystectomy the patient should avoid heavy lifting for 4 to 6 weeks and to remain on a low fat diet for 4 to 6 weeks. However most patient's can tolerate a regular diet.
Harding, 2023, page 1168-1169 and 1171