GIS: Peptic Ulcer Disease (PUD) – [NCSBN] – Flashcards
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Is ulceration that penetrates the mucosal wall of the GI tract causing erosion. An ulceration of the mucous membrane of the esophagus, stomach, or duodenum due to the action of the acid gastric juice. [NCSBN]
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Peptic Ulcer Disease (PUD)
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_______________ ulcers occur in the lesser curvature of the stomach. _____________ ulcers occur in the duodenum. _______________ ulcers occur in the esophagus.
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Gastric Duodenum Esophagus
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_______________ (bacteria) is the number one cause of peptic ulcer disease (PUD). Antibiotics are used to combat it!
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Helicobacter Pylori (H. Pylori)
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The incidence is higher if the patient is _____________ years old or older in peptic ulcer disease (PUD). [NCSBN]
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50
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Risk factors for peptic ulcer disease (PUD) include the medication classes of _____________________ and ______________________.
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NSAIDs/Corticosteroids
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________________ is a medication that is a risk factor of peptic ulcer disease (PUD). ________________ is a risk factor as well as increased _______________. [NCSBN]
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Aspirin/Caffeine/Stress
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The pathophysiology of peptic ulcer disease (PUD) disrupts ________________ layer and acid diffuse back into mucosa. [NCSBN]
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Mucosal
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What signs and symptoms (S/S) of peptic ulcer disease (PUD)? [NCSBN]
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Pain Burning/Gas Pain N/V Bleeding Hematemesis
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Is the pain of peptic ulcer disease (PUD) worse with food? T/F [NCSBN]
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True
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Pain in peptic ulcer disease (PU) is in ________________ upper epigastric area. [NCSBN]
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Left
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What are some signs and symptoms (S/S) of duodenal ulcers? [NCSBN]
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Excess Hydrochloric Acid Rapid Gastric Emptying Familial Tendency Stress Type O Blood Type Ages 25 to 50
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The location of duodenal ulcers is ____________ to ____________ cm below pylorus. Arteriosclerotic changes in adjacent blood vessels. _________________ nerve stimulation causes tissues to release _________________, which increases secretion of hydrochloric acid. [NCSBN]
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0.5/2/Vagus/Gastrin
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Duodenal ulcers are relieved by food intake. T/F [NCSBN]
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True
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What 2 signs and symptoms (S/S) occur int duodenal ulcers? [NCSBN]
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Pain Melena
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What is melena? [NCSBN]
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Black tarry stool that occurs with digested blood.
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Heartburn occurs during the night or when the __________________ is empty. [NCSBN]
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Stomach
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Normal _______________ acid secretion is responsible for pepic ulcer disease (PUD). [NCSBN]
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Gastric
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Where is the most common site of peptic ulcer disease (PUD)? [NCSBN]
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The junction of fundus and pylorus.
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Risk factors for peptic ulcer disease (PUD) include __________________ and ________________. 2 risk factors for every drug.
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Alcohol/Smoking
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________________ is a risk factor in peptic ulcer disease (PUD). Blood type ___________ is also a risk factor.
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Genetics/O
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There are 3 primary characteristics of peptic ulcer disease (PUD).
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Big Bad Police: Bloating Belching Mid Epigastric Pain
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Describe the characteristic of pain in peptic ulcer disease (PUD)?
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Radiates to the back and relieved by antacids.
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Pain in peptic ulcer disease (PUD) is associated with the type of food eaten. T/F
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False. Pain is NOT associated with the type of food eaten.
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How do we determine where the peptic ulcer is? What diagnostic tests?
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Esophagogastroduodenoscopy (EGD) Barium Swallow Gastric Analysis Endoscopy Gastroscopy
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What does gastric analysis determine?
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It indicates increased levels of stomach acid.
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When assessing pain it is important to determine _______________ onset; what _________ intake affects pain. It is also important to determine how ______________ are relieved.
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Symptoms/Food/Symptoms
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It is important to administer ______________ healing agents every _______ hour/s in peptic ulcer disease (PUD) patients. Name one agent.
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Mucosal/1/Sucralfate (Carafate)
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It is important in peptic ulcer disease (PUD) patients to monitor stools for what? We also monitor the ___________, ____________, and _____________ of stools.
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Blood (Melena)/Color/Quantity/Consistency
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In eating, with peptic ulcer disease (PUD), we encourage ______________ and ______________ meals. No ____________ snacks are encouraged. We avoid ______________ and a beverage. [NCSBN]
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Small/Frequent/Bedtime/Caffeine
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What are some preventative complementary and alternative medicine for ulcers? [NCSBN]
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Vitamin supplements A, E, and K and licorice.
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__________________ medicine includes dietary and lifestyle changes.
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Guided imagery, creative visualization, hypnotherapy, meditation and yoga Homeopathy Traditional Chinese medicine, including massage therapy to focus on balancing qi in the stomach, spleen, and/or liver meridians Acupuncture
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What are some complementary or alternative therapies used in peptic ulcer diseases (PUD)? [NCSBN]
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Ayurvedic Medicine Guided Imagery Creative Visualization Hypnotherapy Meditation Yoga Homeopathy Traditional Chinese Medicine Acupuncture
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_____________________ use of anacardium, argentum nitricum, and nux vomica. [NCSBN]
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Homeopathy
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Including massage therapy to focus on balancing qi in the stomach, spleen, and/or liver meridians. [NCSBN]
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Traditional Chinese Medicine
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If uncontrolled __________________ occurs or a ____________________ occurs we prepare the client for one of three surgeries. What are they?
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Bleeding/Perforation Gastric Resection Vagotomy Pyloroplasty
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Surgical removal of part or all of the stomach.
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Gastric Resection
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The surgical cutting of the vagus nerve to reduce acid secretion in the stomach.
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Vagotomy
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The lower portion of the stomach, the pylorus, is cut and re-sutured to relax the muscle and widen the opening into the intestine.
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Pyloroplasty
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What can occur after surgery in a client with peptic ulcer disease (PUD) and is very dangerous? It can occur ________ to ________ minutes after eating.
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Dumping Syndrome/5/30
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With dumping syndrome entry of ______________________ food or fluids into the jejunum enhances the problem by pulling water (H2O) out of the bloodstream.
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Hypertonic
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Dumping syndrome is characterized by 4 mental changes. What are they?
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Vertigo Syncope Sweating Pallor
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Dumping syndrome is characterized by 2 cardiac changes. What are they?
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Tachycardia Hypotension
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Dumping syndrome is minimized by a ___________ protein, ___________ fat, and ____________ carbohydrate diet.
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High/Low/Low
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Dumping syndrome is exacerbated by consuming ____________ with foods. What kind of position after meals can help reduce problems?
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Liquids
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What kind of position after meals can hep reduce dumping syndrome problems?
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Lying Down
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What 4 drug classes increase the risk of peptic ulcer disease (PUD)?
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NSAIDs Salicylates Corticosteroids Anticoagulants
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What are 7 signs and symptoms (S/S's) of gastrointestinal (GI) bleeding that should be reported to the health care provider (HCP)?
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Dark/Tarry Stools Coffee Ground Emesis Bright Red Rectal Bleeding Fatigue Pallor: Conjunctival, mucous membranes, or nail beds. Abdominal Pain: Mass or bruit. Hypotension: Rapid pulse, decreased RR, and cool extremities.
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_____________ can exacerbate peptic ulcer disease (PUD).
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Stress
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What is the most common cause of gastrointestinal (GI) bleeding?
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Peptic Ulcers
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What also can be present in peptic ulcer disease (PUD)?
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Heartburn
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What is another name for heartburn?
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Dyspepsia
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The client is _________ before a gastroscopy; EGD; or endoscopy and cannot resume normal eating or drinking until the ______________ _____________ returns?
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Nothing by Mouth (NPO)/Gag Reflex
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Watch for _________________ by assessing signs and symptoms (S/S's) of pain, bleeding, or swallowing problems.
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Perforation
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Perforation after surgery could be present if the patient has ________________, _________________, or _________________ problems.
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Pain/Bleeding/Swallowing
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What do you avoid after peptic ulcer disease (PUD) tests?
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Smoking Chewing Gum Eating Mints
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What causes increased stomach motility and increased stomach secretions which can cause increased chances of aspiration?
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Smoking
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Antacids are prescribed for peptic ulcer disease (PUD). Why take antacids? Are oral preparations taken on an empty stomach?
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Antacids are taken because they coat the stomach. They are taken on an empty stomach at bedtime to protect the ulcer, but oral preparations are not taken on an empty stomach. They work by NEUTRALIZING or reducing acidity of gastric contents.
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What decreases acid secretions?
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Proton Pump Inhibitor's (PPI's)
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There are many side effects of proton pump inhibitors (PPI's), name one visual sign and symptom (S/S).
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Blurred Vision
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These drugs are NOT removed by hemodialysis.
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Proton Pump Inhibitor's (PPI's)
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What 3 medications compose a gastrointestinal (GI) cocktail?
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Donnatal Vicious Lidocaine Mylanta II
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What is the purpose of a gastrointestinal (GI) cocktail?
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It is an anti-inflammatory drug mix.
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____________________ is a medications that forms a barrier over the wound so acid can't get on the ulcer.
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Sucralfate (Carafate)
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Patient teaching for peptic ulcer disease (PUD) includes decreasing avoiding _________________ extremes and avoiding ________________ foods. These guides need to be followed for one year.
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Temperature/Spicy
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What is the difference between gastric ulcers and duodenal ulcers?
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Gastric ulcers are malnourished while duodenal ulcers are well nourished.
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Describe malnourished ulcer pain?
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Pain usually occurs half an hour to 1 hour after meals. Food does not help in pain relief. Vomiting helps, the patient could vomit blood!
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Describe duodenal ulcer pain?
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Night time pain is common. Pain occurs 2 to 3 hours after meals. Food helps control pain. Blood can be seen in stools.
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What is dumping syndrome?
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The stomach empties too quickly after eating and the client experiences many uncomfortable to severe side effects.
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Dumping syndrome is usually secondary to what?
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Gastric bypass Surgery Gastrectomy Gall Bladder Disease.
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What are 6 signs and symptoms (S/S's) of dumping syndrome?
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Fullness Weakness Palpitations Cramping Faintness Diarrhea
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What 2 kinds of positions does the nurse place a patient with dumping syndrome in while eating versus after eating?
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Semi-Recumbent Lie Down
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Can the client have fluids with meals in dumping syndrome?
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No
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Avoid what kind of foods with dumping syndrome? Why?
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Foods high in carbs and electrolytes because they empty too fast.
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Gastric protectorates form a barrier against _________ and _________.
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Acid/Pepsin
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These drugs suppress gastric acid secretions and alleviates heartburn symptoms.
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H2 Histamine Antagonists
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What respiratory drugs are contraindicated with peptic ulcer disease (PUD)?
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Bronchodilators
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What are some complications of peptic ulcer disease (PUD)? [NCSBN]
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Hemorrhage Perforation Peritonitis Paralytic Ileus (Obstruction) - scarring may obstruct
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Peritonitis results in severe abdominal pain and what? [NCSBN]
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"Board" Like Abdomen
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What diagnostic tests can be used for peptic ulcer disease (PUD)? [NCSBN]
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Endoscopy Esophagogastroduodenoscopy w/Biopsy Gastric Analysis Upper Gastrointestinal (GI) Series Occult Blood Complete Blood Count (CBC)
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Non-pharmacological measures of peptic ulcer disease (PUD) include what? [NCSBN]
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NPO (Nothing by Mouth) Nasogastric Tube (NG)
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Pharmacological: - Anti-infectives: - H2 Receptor Antagonists: - Anticholinergics: - Antacids: - Cytoprotective: - Proton Pump Inhibitors: - Prokinetics:
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Pharmacological: - Anti-infectives: Clarithromycin/Metronidazole - H2 Receptor Antagonists: Cimetidine/Ranitidine/Hydrochloride/Famotidine/Nizatidine - Anticholinergics: Dicyclomine/Hydrochloride - Antacids: Aluminum Hydroxide/Aluminum Magnesium Hydroxide (combinations) Calcium Carbonate - Cytoprotective: Sucralfate - Proton Pump Inhibitors: Omeprazole/Lansoprazole - Prokinetics: Metoclopramide
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What are some major complications of peptic ulcer disease (PUD)? [NCSBN]
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Vagotomy Pyloroplasty Subtotal Gastrectomy Billroth I (Gastroduodenostomy) Billroth II (Gastrojejunostomy) Total Gastrectomy
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In peptic ulcer (PUD) the nurse administers intraarterial ___________________, intravenous (IV) fluids, and blood replacement for hemorrhages. [NCSBN]
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Vasopressin
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__________________ eliminates stimulation of gastric cells. __________________ widening pylorus to improve gastric emptying. [NCSBN]
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Vagotomy/Pyloroplasty
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In pharmacology treatment what does the nurse use? [NCSBN]
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"Please Make Tummy Better" P: Proton Pump Inhibitor M: Metronidazole T: Tetracycline B: Bismuth Subsalicylate
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Post-operative complications include dumping syndrome. [NCSBN]
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Rapid gastric emptying of the stomach.
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What signs and symptoms (S/S) are associated with dumping syndrome associated with Billroth II surgeries? [NCBSN]
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Tachycardia Palpitations Syncope Diaphoresis Diarrhea Nausea Abdominal Distention
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Dumping syndromes signs and symptoms (S/S) subside after several _______________. [NCSBN]
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Months
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Pain associated with peptic ulcer disease (PUD) include slow _______________, low _____________________, high ________________ and high _______________. [NCBSN]
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Eating/Carbohydrate/Protein/Fat
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In peptic ulcer disease (PUD) the patients avoid ________________ with _________________. [NCSBN]
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Liquids/Meals
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Pernicious anemia is secondary to the loss of what? [NCSBN]
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Intrinsic Factor
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The patient is aware that _____________________ can cause delirium in the elderly and increases the bioavailability of many drugs including beta blockers, morphine, and famotidine. [NCSBN]
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Cimetidine
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Name 2 adverse reactions to antacids.
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Diarrhea Constipation
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If the client has had renal disease and is taking ____________ products, renal insufficiency can occur with electrolyte readjustment.
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Magnesium (Mg)
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When should the client take antacids?
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Several times a day after meals.
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2 contributing factors of peptic ulcers include _____________, a medication, and ______________, a condition.
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Steroids Stress
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_____________, a habit, interferes with drug actions and should be avoided.
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Smoking
