NURS 5333 Test 3 Study Guide: Questions &
Answers (Gastro and Diverticulitis)
PUD - Risk Factors - Causes of peptic ulcers:
(Ans-
Helicobacter pylori (H. pylori) infection; Nonsteroidal anti-inflammatory
drug (NSAID) and corticosteroid use; Severe stress; Hyper-secretory
states; Type O blood; Excess alcohol ingestion; Chronic pulmonary or
renal disease; Zollinger-Ellison syndrome (combi-nation of peptic ulcers,
hypersecretion of gastric acid, and gastrin secreting tumors).
radiation therapy
PUD What are red flag symptoms?
(Ans-
refer these patients for endoscopy ...Onset after the age of 55,
progressive dysphagia, blood in the stool, melena, hematemesis,
anemia, persistent or recurrent vomiting, severe abdominal pain,
weight loss, anorexia or family history of gastric malignancy. Remember
that NSAID induced ulcers are often silent. Perforation or bleeding may
be the initial presentation
,PUD prevention
(Ans-
Drink alcohol in moderation; Smoking cessation; Use stress
management techni-ques; Avoid NSAIDS instead use tylenol or NSAIDS
with low dose PPI. OR NSAID combination with a PPI or
misoprostol(post partum bleeding drug)
PUD Signs/Symptoms?
(Ans-
1. Gnawing epigastric pain
2. Relief of pain with eating (duodenal)
3. Pain worsens with eating (gastric)
PUD Duodenal vs gastric?
(Ans-
Signs and symptoms of duodenal ulcer: mid epigastric pain, gnawing or
burning, non radiating recurring pain that is often episodic relieved by
food or antacids.
With H. Pylori infection, this is present again in 95% of duodenal and
70% of gastric ulcers and annual risk of duodenal ulcer in those with H.
Pylori infection is greater than or equal to one percent
, PUD Diagnostics?
(Ans-
CBC, H. pylori testing and then consider endoscopy if this isn't improved
in eight to 12 weeks
PUD Treatment? Which regimens have high antibiotic resistance?
(Ans-
first line treatment of peptic ulcer disease PPIs have a higher efficacy
than H2 blockers and 95% of duodenal ulcers heal on PPI therapy within
about four weeks. Omeprazole, lansoprazole, rabeprazole,
esomeprazole, pantoprazole and dexlansoprazole
treat with these for about four to eight weeks.
H2 blockers, ranitidine, nizatidine, cimetidine, famotidine and you
would also treat with these for 4 to 8 weeks as well. H2 blocker dosages
need to be decreased if the creatinine clearance is less than 50 MLs per
minute.
PPIs decrease bone density so you want to obtain a DEXA scan if a
patient has been on PPIs long term also cause hypomagnesemia check a
CMP panel associated with increased risk of clostridium difficile and
short term PPI use associated with the development of community-
acquired pneumonia PPIs do not appear to decrease the efficacy of
clopidogrel.
Answers (Gastro and Diverticulitis)
PUD - Risk Factors - Causes of peptic ulcers:
(Ans-
Helicobacter pylori (H. pylori) infection; Nonsteroidal anti-inflammatory
drug (NSAID) and corticosteroid use; Severe stress; Hyper-secretory
states; Type O blood; Excess alcohol ingestion; Chronic pulmonary or
renal disease; Zollinger-Ellison syndrome (combi-nation of peptic ulcers,
hypersecretion of gastric acid, and gastrin secreting tumors).
radiation therapy
PUD What are red flag symptoms?
(Ans-
refer these patients for endoscopy ...Onset after the age of 55,
progressive dysphagia, blood in the stool, melena, hematemesis,
anemia, persistent or recurrent vomiting, severe abdominal pain,
weight loss, anorexia or family history of gastric malignancy. Remember
that NSAID induced ulcers are often silent. Perforation or bleeding may
be the initial presentation
,PUD prevention
(Ans-
Drink alcohol in moderation; Smoking cessation; Use stress
management techni-ques; Avoid NSAIDS instead use tylenol or NSAIDS
with low dose PPI. OR NSAID combination with a PPI or
misoprostol(post partum bleeding drug)
PUD Signs/Symptoms?
(Ans-
1. Gnawing epigastric pain
2. Relief of pain with eating (duodenal)
3. Pain worsens with eating (gastric)
PUD Duodenal vs gastric?
(Ans-
Signs and symptoms of duodenal ulcer: mid epigastric pain, gnawing or
burning, non radiating recurring pain that is often episodic relieved by
food or antacids.
With H. Pylori infection, this is present again in 95% of duodenal and
70% of gastric ulcers and annual risk of duodenal ulcer in those with H.
Pylori infection is greater than or equal to one percent
, PUD Diagnostics?
(Ans-
CBC, H. pylori testing and then consider endoscopy if this isn't improved
in eight to 12 weeks
PUD Treatment? Which regimens have high antibiotic resistance?
(Ans-
first line treatment of peptic ulcer disease PPIs have a higher efficacy
than H2 blockers and 95% of duodenal ulcers heal on PPI therapy within
about four weeks. Omeprazole, lansoprazole, rabeprazole,
esomeprazole, pantoprazole and dexlansoprazole
treat with these for about four to eight weeks.
H2 blockers, ranitidine, nizatidine, cimetidine, famotidine and you
would also treat with these for 4 to 8 weeks as well. H2 blocker dosages
need to be decreased if the creatinine clearance is less than 50 MLs per
minute.
PPIs decrease bone density so you want to obtain a DEXA scan if a
patient has been on PPIs long term also cause hypomagnesemia check a
CMP panel associated with increased risk of clostridium difficile and
short term PPI use associated with the development of community-
acquired pneumonia PPIs do not appear to decrease the efficacy of
clopidogrel.
