ADH1 FINAL (GI + Bone)

GERD contributing factors: (7)

1. Excessive ingestion of food that relax LES

   • spicy, chocolate, peppermint, citrus, caffeine, alcohol, fatty

2. Frequent abd distention

3. Increased abdominal pressure

4. Meds relax LES/ Cause gastric acid

5. Hiatal Hernia

6. gastritis d/t H. Pylori

7. Lying flat

Clinical manifestations for GERD: (12)

1. Odynophagia

2. Dyspepsia

3. Pyrosis

4. Radiating pain (back, neck jaw)

5. Feeling of heart attack

6. Throat irritation

7. Chest congestion/ wheezing

8. Increased flatus/ eructation (burps)

9. Pain worsens w/ position

10. Pain after eating 20mins-2 hrs

11. Pain relieved w/ water, sitting up, taking antacids

12. Dental cavities

Whats 2 preferred diagnostics test for GERD??

1. EGD

2. upper endoscopy

GERD medical management: (2)

1. PPI 8 weeks once daily for Intermittent symptoms

2. PPI 8 weeks twice daily moderate/ partial response to tx plan

GERD nursing management: (6)

1. No eating B4 bed

2. No foods/ drinks decreasing LES pressure —spicy, citrus, chocolate, alc. etc

3. No tight clothes

4. No vigorous/ straining exercises

5. Elevate HOB

6. Good oral hygiene

PUD risk factors: (5)

1. Chronic NSAID/ Corticosteroid use

2. H. Pylori infx

3. Blood type O

4. Excessive stomach acid secretion

5. Excessive alcohol

PUD general clinical manifestations: (5)

1. Dull aching pain

2. Burning in mid-epigastrium area/ back

3. Heartburn

4. V

5. Bleeding

Diagnostics for PUD: (4)

1. Upper endoscopy

2. H.Pylori tests

   • Biopsy

   • Fecal antigen test

   • Urea breath test

   • Serological antibody—blood test

3. Stool culture

4. Bleeding ulcer

   • Periodic CBCs

   • Fecal Occult

Specific clinical manifestations of perforation/ penetration: (5)

1. Severe upper abd pain referred to shoulder

2. V

3. Collapse

4. **Tender Board-like abd**

   • blood is present

5. s/s Impending **shock **(hypotension/ tachycardia)

How does primary osteoporosis occur and its risk factors? (7)

genes/ environment

1. Thin, lean body build

2. Female (decreased estrogen)

3. Low Ca and Vitamin D

4. High Phosphorus, Low protein

5. Excessive caffeine

6. Hx malabsorption

7. Lack physical exercise/ immobile

What causes secondary osteoporosis?

Comorbidities/ chronic med usage

Comorbidities of Osteoporosis: (5)

1. Hyper/Hypo-thyroidism

2. DM

3. RA

4. Cushings

5. Bone cancer

Meds leading to Osteoporosis: (4)

1. Loop diuretics

2. Thyroid

3. Corticosteroids

4. Anticonvulsants

Clinical manifestations Osteoporosis: (6)

1. Reduced height (2-3 in)

2. Back pain after lifting/ bending

3. Pain on palpation of affected area

4. Restriction in mvmt + spinal deformity

5. Hx of fractures (wrist, femur)

6. Kyphosis of dorsal spine

Diagnostics test for Osteoporosis:

1. DEXA scan—bone desity

   • gives precise measurement of bone to help predict future bone fractures

Meds to treat osteoporosis: (2)

1. Calcium supplements

2. Vitamin D

OA main patho problem:

Noninflammatory deterioration of articular cartilage

Clinical manifestations of OA: (5)

1. Outgrowths on hands: Nodes on fingers from bone spurs

2. Stiffness + joint pain

3. Tenderness when touching joint site w/ bony outgrowths

4. Experience crepitus

5. Only in joints: pain is asymmetrical

Surgical Intervention for OA: (3)

1. Total Joint Arthroplasty/ replacement

2. Osteotomy

3. Intra-articular Injection

Nursing management OA: (7)

1. Assess psychosocial impact

2. Assess need for assistive devices

3. Balance activity w/ rest

4. Heat v Cold Therapy— for discomfort

5. Adhere to exercise regimen consistently

6. Healthy weight

7. Interprof care

RA patho:

Chronic, progressive inflammatory disease attacks joints making inflamed synovitis

7 S’s Of RA:

1. Sunrise stiffness (severe pain > 30 mins-1 h+)

2. Symmetrical

3. Systemic

4. Synovium (inflamed)

5. Soft, tender, warm in joint

6. Swelling in joint

7. Stages

2 surgical interventions for RA:

1. Total Joint Replacement/ Arthroplasty

2. Synovectomy

RA Meds: (3)

1. NSAIDs

2. Corticosteroids

3. DMARDs

What members of Interprofessional team would be consulted for RA pt? (3)

1. Rehab—PT/OT:

   • PT: gross motor (walking, ROM)

   • OT: fine motor (ADLs)

2. Dietitian: meal planning (small frequent meals)

3. Case Manager: set up home health nurse to determine home mods (DMEs)