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What problems can result in nausea and vomiting?
- GI Disease
- Pregnancy
- CNS Problems
- MI
- Drug Toxicity
- Anxiety
- Surgery
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What are some nausea and vomiting complications?
- Dehydration
- Electrolyte Imbalance
- Alkalosis
- Aspiration
-
Drugs that treat nausea and vomiting:
- Prochloroprazine (Compazine)
- (suppress chemoreceptors)
- Metoclopromide (Reglan)
- (empties stomach)
- Promethazine (Phenergan)
- (Sedative)
- Ondanseton (Zofran)
- (Blocks serotonin with vagus nerve)
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Two main risk factors of oral cancer:
-
Erythroplakia vs. Leukoplakia:
Erythroplakia - Red lesion, non-tender
Leukoplakia - White lesion, painless
(Both are pre-cancerous)
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What is the number one nursing priority in the post-op care of a radical neck dissection?
What needs to be at the bedside?
Airway
Trach tube, suction, ambu bag, obturator
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GERD increases with ________ and can be caused by ___________ and ___________
Age
Incompetent lower esophageal sphinctor
Hiatel hernia
-
Three common S/S of GERD:
- Heartburn
- Reflux
- Esophagitis
-
GERD complications:
- Esophageal strictures
- Barrett's Esophagus
- Bronchospasm
- Aspiration
-
How do these factors make GERD worse:
Recumbent position?
Large meals?
Gravity
Pressure in stomach
-
Alcohol, caffeine, nicotine and mint make GERD worse because _____________
They relax the esophageal sphincter
-
What is the diagnostic procedure for GERD?
Endoscopy
- Pre-op: NPO, consent
- Post-op: Vitals, monitor LOC, NPO til gag reflex comes back
-
What medications are used to treat GERD?
- Proton Pump Inhibitors (Prilosec, Nexium)
- (Give before meals)
H2 Blockers (Pepcid, Zantac)
-
When should you give H2 Blockers when you already gave a proton pump inhibitor?
12 hours apart
-
What is achalasia?
Spasm of lower esophageal sphincter and dilation of lower esphagus
-
Achalasia-
S/S:
Treatment:
-
What are the components of the triple therapy to treat H Pylori?
- Amoxicillin
- Clarithyromycin (Biaxin)
- PPI
-
Peptic Ulcer Disease -
Gastric:
Duodenal:
Stress:
- Pain after meals
- Associated with NSAIDs
- Pain between meals
- Relieve with food/antacids
Transiet ischemia from hypotension, burns, trauma
-
Diagnostics for peptic ulcer disease:
- Endoscopy
- Biopsy
- Labs (Hg for anemia, Plt for bleeding, BUN for renals)
-
How do you treat peptic ulcer disease?
- Proton pump inhibitor
- Sucralfate (Carafate)
Lifestyle modification
Surgery (rare)
-
S/S of perforation:
- Board-like abdomen
- Severe pain radiating to shoulder
- No bowel sounds
-
What is dumping syndrome?
Uncontrolled chyme into the intestines pulls fluid into the gut causing hypotension and diarrhea
-
S/S of upper GI bleed:
- Hematemesis
- Coffee groups emesis
- Melena
- Syncope
- Anemia
-
Upper GI bleed sources:
- Esophageal varices
- Peptic ulcer disease
- Drugs (NSAID, ASA, Corticosteroids)
- Stress ulcer
-
How do you manage an upper GI bleed?
- Proton Pump Inhibitor
- Sandostatin
- Fluid replacement
- Transfusions
-
What gauge IV catheter should be place for a patient with an upper GI bleed?
- 18 gauge
- (may need to replace large volumes)
-
What patients are at highest risk of fluid overload from multiple transfusions?
(monitor edema, lung sounds, LOC)
-
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
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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
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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)
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