Nursing 2 u2013 Exam 1 Study Guide.docx - 1 Nursing 2 Exam...

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Nursing 2 – Exam1, Study GuideOral ulcersoCauses:Trauma (biting cheek/tongue), burns, spicy/hot food, ETOH, smoking, allergy, infectionCancer patients at HIGH risk for oral ulcersoTreatment:Chlorohexidine mouthwash (relieves sx, reduces healing time)Topical steroids (promotes faster healing/resolution)oPatient education/Prevention:Remove the irritant, good oral hygieneAvoid spicy/acidic foods, ETOH, stop smoking, remove irritant/allergen from dietGERDoWhat is it?Gastric juices move up into the esophagusdue to:Weak LES(lower esophageal sphincter)Pressure changesafter meals, pregnancy, bending downoSigns/Sx:#1 = Pyrosis (heartburn)Barrett’s Esophagus= inflammation/damage/ulceration of esophagus due to untreated GERD. Can lead to adenocarcinoma/esophageal cancers. Upper GI, Barium Swallow or UpperEndoscopy to R/O.o“Red Flag” Symptoms:Weight loss, dysphagia, anemia, abnormal masses, vomiting or bleeding, continual epigastricpain, sx unrelieved by PPI’soAssessment:Does your pain get worse after meals?Do you have pain when bending over?Any trouble swallowing? Hoarse voice?Diagnostics:Endoscopy, pH Monitoring, Symptom HistoryoTreatment:1.PPI’s (-prazole)Ex: omeprazole, pantoprazoleDecreases the volume of HCL producedTake 30min – 1hour before meals#1 line of defense – MOST EFFECTIVE2.H2 Blockers (-tidine)Ex: ranitidine, cimetidineTake 1x dailyBlocks the release of HCL/HistamineTreats MILD symptoms. #2 line of defense3.Antacids (Ca+ Carbonate)Ex: Tums, MaaloxNeutralizes stomach acidMonitor for signs of Metabolic Alkalosis4.Surgery“Anti-Reflux Surgery” to tighten LES sphincter“Nissen fundoplication” (more invasive surgery)1
Hiatal HerniaoCauses:Part of the stomach protrudes through the esophageal hiatus/diaphragm.Obesity, pregnancy, overeating, age (anything that puts extra pressure on the diaphragm or that weakens it)oSigns/Sx:GERD symptoms are common, otherwise patient is asymptomaticMost common complaint is Pyrosis (heartburn)oTestsBarium Swallow(barium + applesauce are swallowed and then patient is monitored via fluoroscopy. If hernia is present, the barium will pool in the out-pouching).Fluoroscopy: continuous x-ray done to see if aspiration/deviation occurs when eating or drinkingUpper Endoscopy (you can visually see the out-pouching with scope inserted into the esophagus)oTreatment:SurgeryoPatient Education:Avoid eating 2-3 hours before bed/laying downEat small meals (don’t overeat)STOP: smoking, ETOH, caffeine, acidic foodsPeptic Ulcer Disease (PUD)oWhat is it?Caused by dyspepsia (indigestion) which erodes the mucosal lining of the stomach/duodenum#1 cause = H. pylori#2 cause = NSAIDs on empty stomachoSigns/Sx:#1 Symptom = Burning/abdominal painBurning pain is often relieved by eating or antacidsPain wakes patient up in the middle of the night

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