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RECAP MEDSURG QUIZ 1

Gastroesophageal Reflux Disease (GERD)

  • Definition: Characterized by burning sensation, gas coming up, regurgitation, burning, dry cough, sore throat, and drug irritation.

  • Symptoms: Patients may experience a bitter taste in the mouth, hoarseness, a full feeling in the throat, and a sensation of food being stuck.

  • Medications: Examples include omeprazole and pantoprazole.

  • Carafate (Sucralfate):

    • Mechanism of Action: Coats the stomach lining to protect against ulcer disease.

    • Administration: Taken orally as a "swish and swallow" medication.

    • Patient Teaching: Instruct patients not to eat 1 hour before taking the medication and to wait 1 hour after taking it before eating again.

H. Pylori and Peptic Ulcer Disease (PUD)

  • H. Pylori: A bacterium, recognized as the main cause of peptic ulcer disease.

  • Diagnostic Testing: The urea breath test is used to detect H. Pylori.

  • Patient Education for PUD: Patients should be advised to:

    • Stop smoking.

    • Limit caffeine intake.

    • Avoid NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) as they can irritate the stomach and contribute to bleeding, ulcer formation, and perforation.

  • Complications of Ulcers:

    • Infection

    • Bleeding: Of significant concern, leading to potential hemorrhagic shock.

    • Perforation: Classic signs include abdominal distention.

  • Warning Signs: Vomiting blood is a critical symptom that requires immediate attention to stop the bleeding.

Candidiasis (Oral Thrush)

  • Medication Administration (e.g., Nystatin):

    • Method: Swish and swallow.

    • Duration: Swish for 30 seconds.

    • Important Note: Do not swish and spit, as this wastes medication and reduces its effectiveness.

Glossitis

  • Definition: Inflammation of the tongue.

Acute Cholecystitis

  • Definition: Inflammation of the gallbladder.

  • Causes: Can be caused by hemorrhage, alcohol consumption, certain medications, or obstruction (e.g., gallstones).

  • Medications: Antiemetics and antispasmodics (e.g., dicyclomine).

  • Clinical Manifestations: May include steatorrhea, dark urine, and pain in the left upper quadrant.

Diagnostic Tests: Barium Enema/Swallow

  • Post-Procedure Care and Patient Education:

    • Fluids: Instruct patients to increase their fluid intake significantly to help flush the barium out of the system.

    • Stool Appearance: Expect chalky stools for up to 48 hours post-procedure. Patients do not need to report chalky stools within 24 to 48 hours, as this is an expected finding.

Gastroparesis

  • Definition: Delayed emptying of the stomach, characterized by the stomach contents becoming "paralyzed."

  • Symptoms: Can cause pain.

General GI System Testing Preparation

  • NPO Status: Patients must be NPO (nothing by mouth) for 6 to 8 hours prior to a GI procedure, with the exact duration dependent on the specific procedure.

  • Consent: Ensure the patient fully understands the procedure and has signed the consent form.

  • Allergies: Always check for patient allergies.

Liver Biopsy

  • Procedure: Performed by accessing the intercostal space.

  • Patient Positioning (During Procedure):

    • A pillow can be placed under the abdomen, or a rolled towel can be used.

  • Post-Procedure Care:

    • Immobilization: Patients should lie in position for 2 hours.

    • Assessment: Assess the patient for bleeding every 15 minutes (or every 30 minutes if specifically ordered) for a period of 42 hours (implies initial frequent monitoring, then less frequent monitoring over this duration).

Gastric Surgery and Dumping Syndrome

  • Dumping Syndrome: A common complication after gastric surgery where stomach contents rapidly empty into the small intestine.

  • Prevention Strategies:

    • Fluids with Meals: Avoid consuming fluids with meals to prevent rapid emptying.

    • Meal Frequency: Encourage six small, frequent meals throughout the day.

  • Post-Gastric Surgery Supplementation: Patients may require supplements for Vitamin K and Iron.

Medical Terminology: Indicated vs. Contraindicated

  • Indicated: Means a particular action or medication is appropriate and should be performed by the nurse, fitting within the scope of practice.

  • Contraindicated: Means a particular action or medication should not be performed or given, as it could cause harm or problems for the patient.

Gastric Surgery: Medication Precautions

  • NSAIDs: Absolutely contraindicated after gastric surgery.

  • Rationale: NSAIDs can induce bleeding, irritate the stomach lining, increase the risk of perforation, and contribute to ulcer disease even if a full gastrectomy was not performed. They are considered detrimental to the GI tract.

  • Proton Pump Inhibitors (PPIs): Medications such as omeprazole, pantoprazole (