Exam 3 study guide
Viral hepatitis
A and E
- Fecal oral route
B,C,D : Sex blood contaminated equipment D-
is B dependent. You need B before D.
Gastric surgery
Post op
• PCA pump x 24 hours, then PO (liquid) opioids • If NG tube
present:
• Monitor patency
• NEVER REPOSITION!
• Removed day #2 if +flatus
• Patient and staff safety is priority when moving the patient.
• Beds should be wide and weight rated. No bedrails touching the
patient’s body.
• Watch lines and tubes as they can cause skin breakdown.
• Semi Fowler’s
• DVT prophylaxis
• Abd binder used to prevent wound opening.
Exam 3 study guide
Viral hepatitis
,Diet
• Clear liquids in one-ounce cups first: start with water
• 24-48 hours after clear liquids are tolerated, start adding pureed
foods, juice, and thin soups for the 1st 6 weeks
Bariatric surgery: complications
• Anastomotic Leaks (can cause death): Back, shoulder,
or abdominal pain
Restlessness, ↑HR, ↓ urine output
• Vitamin B12 deficiency
Pt should receive regular B12 injections
Report any anemia symptoms or numbness/tingling (due to
decrease b12)
Gastroesophageal Reflux Disease (GERD)
•Backflow of acidic stomach contents into
esophagus
•Caused by excessive relaxation of LES
Risk factors
• Weight gain
• Fatty foods
• Caffeinated/carbonated beverages
• ETOH/smoking
• Medications: ????? nitrates- because they vasodilate everything,
anticholinergic- slow gi motility, nicotine, progesterone, beta
agonist.
• Hiatal hernia
• Pregnancy
• Others????
• Ng tube
• Normal ph for esaphogus is 7
, • Gi content is is ph 3
Symptoms/Physical Exam
¢ Most common symptom is heartburn: Worse after eating
¢ CP
¢ Dysphagia
¢ Odynophagia -painful swallowing
¢ “Metallic” taste in mouth
¢ Regurgitation (into pharynx)
¢ Poor dentition
¢ Cough
¢ Hoarseness
¢ Wheezing
¢ *Extraesophageal symptoms (can affect the airway)
Diagnosis
¢ Clinical-based on s/s
¢ Esophagogastroduodenoscopy (Barret’s Esophagus)
¢ 24 hour Ph monitoring and manometry in the esophagus ph should
be 7
¢ Hiatal Hernia: Upper GI series, CT
Treatment
Lifestyle management
¢
Elevate HOB
Diet modification: Avoid coffee, ETOH, fatty foods, smoking
Weight loss
Exam 3 study guide
Viral hepatitis
, No tight clothing
Avoid eating 3 hrs before bedtime, esp if pt has night-time
symptoms
Sleep left lateral decubitus position: Moves stomach
contents away from LES
¢ Medical:
H2 blockers: Mild famotidine – neutralize acid
PPI’s: Mod to severe anything that ends in “zole” - Shut
off acid producing pumps.
¢ Surgical: Nissen Fundoplication page 1087
Complications
- Difficulty swallowing – due to edema require surgical intervention
PEPTIC ULCER DISEASE
¢ Due to focal ulceration of stomach or duodenal tissue
¢ Very common cause of epigastric pain (AFTER eating)
Gastric: During/briefly after eating; a/w weight loss
Duodenal: A few hours after eating wakes pt at night ¢
Physiology:
Gastric Ulcer: Stomach secretes acid when you eat, irritates
ulcer
Duodenal: Ulcer far off in duodenum; when acid comes into
contact with duodenum, they get pain. Feels better when
they eat.
¢ Causes:
NSAID use, H. Pylori steroids, chemotherapy.
ICU Setting: Anything that causes physiologic stress.
Steroids and chemotherapy
¢ Symptoms:
Viral hepatitis
A and E
- Fecal oral route
B,C,D : Sex blood contaminated equipment D-
is B dependent. You need B before D.
Gastric surgery
Post op
• PCA pump x 24 hours, then PO (liquid) opioids • If NG tube
present:
• Monitor patency
• NEVER REPOSITION!
• Removed day #2 if +flatus
• Patient and staff safety is priority when moving the patient.
• Beds should be wide and weight rated. No bedrails touching the
patient’s body.
• Watch lines and tubes as they can cause skin breakdown.
• Semi Fowler’s
• DVT prophylaxis
• Abd binder used to prevent wound opening.
Exam 3 study guide
Viral hepatitis
,Diet
• Clear liquids in one-ounce cups first: start with water
• 24-48 hours after clear liquids are tolerated, start adding pureed
foods, juice, and thin soups for the 1st 6 weeks
Bariatric surgery: complications
• Anastomotic Leaks (can cause death): Back, shoulder,
or abdominal pain
Restlessness, ↑HR, ↓ urine output
• Vitamin B12 deficiency
Pt should receive regular B12 injections
Report any anemia symptoms or numbness/tingling (due to
decrease b12)
Gastroesophageal Reflux Disease (GERD)
•Backflow of acidic stomach contents into
esophagus
•Caused by excessive relaxation of LES
Risk factors
• Weight gain
• Fatty foods
• Caffeinated/carbonated beverages
• ETOH/smoking
• Medications: ????? nitrates- because they vasodilate everything,
anticholinergic- slow gi motility, nicotine, progesterone, beta
agonist.
• Hiatal hernia
• Pregnancy
• Others????
• Ng tube
• Normal ph for esaphogus is 7
, • Gi content is is ph 3
Symptoms/Physical Exam
¢ Most common symptom is heartburn: Worse after eating
¢ CP
¢ Dysphagia
¢ Odynophagia -painful swallowing
¢ “Metallic” taste in mouth
¢ Regurgitation (into pharynx)
¢ Poor dentition
¢ Cough
¢ Hoarseness
¢ Wheezing
¢ *Extraesophageal symptoms (can affect the airway)
Diagnosis
¢ Clinical-based on s/s
¢ Esophagogastroduodenoscopy (Barret’s Esophagus)
¢ 24 hour Ph monitoring and manometry in the esophagus ph should
be 7
¢ Hiatal Hernia: Upper GI series, CT
Treatment
Lifestyle management
¢
Elevate HOB
Diet modification: Avoid coffee, ETOH, fatty foods, smoking
Weight loss
Exam 3 study guide
Viral hepatitis
, No tight clothing
Avoid eating 3 hrs before bedtime, esp if pt has night-time
symptoms
Sleep left lateral decubitus position: Moves stomach
contents away from LES
¢ Medical:
H2 blockers: Mild famotidine – neutralize acid
PPI’s: Mod to severe anything that ends in “zole” - Shut
off acid producing pumps.
¢ Surgical: Nissen Fundoplication page 1087
Complications
- Difficulty swallowing – due to edema require surgical intervention
PEPTIC ULCER DISEASE
¢ Due to focal ulceration of stomach or duodenal tissue
¢ Very common cause of epigastric pain (AFTER eating)
Gastric: During/briefly after eating; a/w weight loss
Duodenal: A few hours after eating wakes pt at night ¢
Physiology:
Gastric Ulcer: Stomach secretes acid when you eat, irritates
ulcer
Duodenal: Ulcer far off in duodenum; when acid comes into
contact with duodenum, they get pain. Feels better when
they eat.
¢ Causes:
NSAID use, H. Pylori steroids, chemotherapy.
ICU Setting: Anything that causes physiologic stress.
Steroids and chemotherapy
¢ Symptoms:
