exam 2 chapter 22 Flashcards Preview

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Flashcards in exam 2 chapter 22 Deck (70)
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31

gerontologic considerations

more vulnerable to complications
F&E imbalances
glucose intolerance
decrease ability to handle large volumes
increased risk of aspiration

32

what is the primary factor in GERD

incompetent LES

33

what is the results of incompetent LES

results in decrease pressure in distal portion of esophagus.

34

what happens when there is a decrease pressue in the distal portion of the esophagus

gastric contents move from stomach to esophagus.
it can be due to certain foods (caffeine, chocolate) and drugs (anticholinergics.

35

meal size and number for a patient with GERD

6-8 small males a day

36

symptoms of GERD

heartburn(pyrosis)

37

most common clinical manifestation of GERD

buring
tight sensation felt beneath the lower sternum and spreads upward to throat or jaw
felt intermittenly
relieved by milk, alkaline substances, or water

38

what are some complications with GERD

1. Barrett's esophagus; replacement of normal squamous epithelium with columner epithelium.
s&s none, to bleeding, to perforation
monitor every2 to 3 years by endoscopy.
2. Respiratory
due to irritation of upper airway by secretions
3. Dental erosion

39

Drug there for GERD

1. step up
start with antacids and OTC H2R blockers and progress to prescription H2R blockers and finally PPIs
2. Step down
start with PPIs and titrate down to prescription H2R blockers and finally OTC H2R blockers and antacids

40

Histamine (H2) receptor blockers for GERD

remember (tidines)
Famotidine (Pepcid)
Ranitidine (Zantac)
Cimetidine (Tagamet)
Nizatidine (Axid)

Suppress secretion of gastric acid (HCl)

41

when is the best time for the patient to take H2 for GERD

HS (hours of sleep)
to decrease vagally induced histamine release in the stomach

42

caution with cimetidine

increases bioavailability of many drugs ( beta blockers, morphine, theophyllin, warfarin, dilantin.
passes the blood brain barrier (causes CNS effects)
reacts with antacids

43

Proton pump inhibitors (PPI) for GERD

REMEMBER (THE PRAZOLES)
omeprazole (Prilosec)
Esomeprazole (Nexium)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Lansoprazole (Prevacid)

44

PPIs

suppress gastric acid secretion
promotes esophageal healing
may be beneficial in decreasing esophageal strictures
Tx of active ulcer
take 30 minutes before 1st meals of the day
Side Effects: headache, diarrhea, abd pain, nausea

45

Drug therapy for GERD; Antacids

quick but short lived relief
Neutralize HCl acid
take 1 to 3 hours after meal before bedtime
Allow 1-2 hour between administration of other medications

Aluminum hydroxide preparations (Maalox, alu-cap)
slow-acting
contain lots of NA (caution: renal, CHF, hypertentsion)
may cause constipation

46

Antacids
Calcium carbonate (Mylanta, Tums)

Rapid acting
may cause constipation
SE: belching and flatulence (the release of carbon dioxide in the stomach)

47

Magnesium hydroxide (Milk of magnesia)

rapid acting
may cause diarrhea
caution in renal (toxicity)
often given in combo with aluminum prep

48

what is vitamin B12 important for

health of peripheral and central nervous system
brain health
nerve health
RBC production
happines

49

True or false
evidence that C.difficile is higher risk if patient is on PPIs

True
acid zaps food born pathogens

50

what happens when acid production is blocked

decreases intrinsic factor

51

Treatment of B12 deficiency

diet ( citrus fruits, dried beans, green leafy veggies, liver, buts, organ meats.
B12 injection weekly at first and monthly for lifelong.

52

which surgical intervention may be necessary if medical management of GERD is unsuccessful

Nissen fundoplication : wrapping of a portion the gastric fundus around the sphincter area of the esophagus.

53

herniation of portion of the stomach into esophagus through an opening or hiatus in diaphragm

Hiatal Hernia
AKA: diaphragmatic and esophageal hernia

54

most common type of hiatal hernia
stomach slides into thoracic cavity when supine, goes back into abdominal cavity when standing upright

Sliding or type 1 hiatal hernia

55

Paraesophageal Hiatal hernia

Esophageal junction remains in place, but fundus and greater curvature of stomach roll up through diaphragm.
no reflux
pt usually feels a sense of fullness after eating or chest pain

56

causes of hiatal hernia

structural changes: weakening of muscles in diaphragm.
Increased intraabdominal pressure
obesity
pregnancy
heavy lifting
tumors
ascites

57

what are some risk factors for esophageal cancer

smoking
excessive alcohol intake
Barrett's esophagus
GERD
diets low in fruits and veggies
central obesity

58

what is noted in the latter stages of esophagus cancer

obstruction of the esophagus
possible perforation into the mediastinum and erosion into the great vessels.

59

what will be the Dx for an EGD that reveals an esophageal lining that is red rather than pink?

Barrett's Esophagus

60

saclike outpouching of one or more layers of esophagus

Esophageal diverticula