NUR 2063/NUR 2063Exam 2 Blueprint Fall 2021 (1)

NUR 2063
Exam 2 Blueprint Fall 2021 (1)

GI disorders

• Dysphagia Difficulty swallowing o Causes Nero disease: Parkinson’s,
dementias, muscular dystrophy, Huntington’s, ALS, MN, Guillain Barre
Syndrome. Other: Congenital issues/cerebral palsy, Esophageal stenosis,
esophageal diverticula, tumors, stroke, achalasia
• Vomiting – why and consequences Why: protect against substance, reverse
peristalsis, increase intracranial pressure, severe pain. Consequences: lead to
fluid, electrolyte, pH imbalance, aspiration o Emesis types and why the emesis
would be a problem Hematemesis: blood in vomit (protein),
Yellow/green: presence of bile. Deep brown: fecal matter. Undigested food o
Treatment of vomiting disorders Antiemetic med., fluid replacement, correct electrolyte
imbalance, restore acid-base
• Esophageal disorders o Hiatal hernia Stomach section protrudes through
diaphragm
 Causes: Weakening of diaphragm muscle, trauma, congenital defects. Manifestation:
Indigestion; heartburn; frequent belching; nausea; chest pain; strictures; dysphagia; and
soft abdominal mass. diagnosis: H & P; barium swallow; upper GI Xrays; EGD, treatment:
eat small meals, sleep elevated, antacid
o GERD
 Causes: Certain foods: chocolate, caffeine, carbonated beverages, citrus fruit,
tomatoes, spicy or fatty foods, peppermint , Alcohol consumption; nicotine, Hiatal
hernia, Obesity; pregnancy, Certain medications – such as corticosteroids; beta
blockers; calcium-channel blockers; anticholinergics, NG intubation, Delayed gastric
emptying
 Manifestations: Heartburn, Epigastric pain, Dysphagia, Dry cough, Laryngitis
Pharyngitis, Food regurgitation, Sensation of lump in throat

 Diagnosis: H & P; barium swallow; EGD; esophageal pH monitoring
 Treatments: Avoid triggers; avoid restrictive clothing, Eat small frequent meals; high
Fowler’s positioning, Weight loss; stress reduction; Antacids; acid reducing agent;
mucosal barrier agents, Herbal therapies (licorice, chamomile), Surgery
 Complications : Esophagitis; strictures; ulcerations; esophageal cancer; chronic
pulmonary disease
o Gastritis/gastroenteritis
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, Acute: Can be mild, transient irritation or can be severe ulceration with hemorrhage,
Usually develops suddenly, Likely to also have nausea & epigastric pain
 Chronic: Develops gradually
 May be asymptomatic but usually accompanied by dull epigastric pain and a sensation
of fullness after minimal intake
 Complications : peptic ulcer; gastric cancer; hemorrhage

 H. pylori: Most common cause of chronic gastritis
 Bacteria embeds in mucous layer; activates toxins & enzymes that cause inflammation
 Genetic vulnerability & lifestyle behaviors (smoking, stress) may increase susceptible
 Other causes : Organisms through food/water contamination, LT NSAID use, Excess
alcohol use, Severe stress, Autoimmune conditions
 Manifestations of GI bleeding : Indigestion; heart burn, Epigastric pain; abdominal
cramping, N/V; anorexia, Fever; malaise, Hematemesis, Dark, tarry stools = ulceration &
bleeding
• GI tract disorders o Peptic ulcer disease
 Duodenal : Most commonly associated with excess acid or H.pylori infections, Typically
present with epigastric pain relieved by food
 Gastric: Less frequent; more deadly, typically associated with malignancy and NSAIDs,
Pain worsens with food
 Symptoms:
 Curling’s ulcer from what: associated with burns
 Cushing’s ulcer from what: associated with head injuries
 Complications of ulcers: GI hemorrhage; obstruction; perforation; peritonitis
 Manifestations: Epigastric or abdominal pain, Abdominal cramping, Heartburn;
indigestion, N/V
 Diagnosis: same as gastritis
 Treatment: Same as for gastritis, Surgical repair may be necessary for perforated or
bleeding ulcers, Prevention is crucial – may need prophylactic medications (ex:
acidreducers) for at-risk clients
o Gallbladder disorders
 Cholelithiasis: Gallbladder stones
 Cholecystitis: Inflammation or infection in the biliary system caused by calculi
 Manifestations: Biliary colic; abdominal distension; N/V; jaundice; fever; leukocytosis
 Diagnosis: H & P; abdominal Xray; gallbladder US; laparoscopy
 Treatments: Low-fat diet, medications to dissolve calculi, Antibiotic therapy, NG tube
with intermittent sxn, Lithotripsy, Choledochostomy, Laparoscopic surgery
o Liver disorders


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,  Hepatitis – infectious: A, B, C, D, E vs. noninfectious: Giant cell hepatitis, Ischemic
hepatitis, Non-alcoholic fatty liver hepatitis, Autoimmune hepatitis, Toxic & drug-
induced hepatitis, Alcoholic hepatitis
 Transmission of viral hepatitis: If it’s a Vowel, it comes from the Bowel. All others are
blood
 Define: acute: Proceeds through 4 stages—asymptomatic stage then 3 symptomatic
stages chronic: Characterized by continued liver disease > 6 months, Symptom severity
and disease progression vary by degree of liver damage, Can quickly deteriorate with
declining liver integrity fulminant: Uncommon, rapidly progressing form that can quickly
lead to
 Liver failure, hepatic encephalopathy, or death within 3 wks

• Diagnosis: H & P, Serum hepatitis profile, Liver enzymes, Clotting studies, Liver
biopsy, Abdominal US
• treatment for viral hepatitis: treat with interferon & antiviral mediations
 Cirrhosis
• Common causes: Hep C and chronic alcohol abuse most common cause in U.S.
Hepatitis and all factors that can lead to hepatitis
• What happens to liver: Leads to fibrosis, nodule formation, impaired blood
flow, and bile obstruction  liver failure
• Manifestations: Portal hypertension, Varicosities, Bleeding –slow or severe,
Muscle wasting, Bile accumulation, Clay-colored stools, Dark urine, Ulcers/GI
bleeding, Encephalopathy, Spontaneous bacterial peritonitis
• Diagnosis & treatments: H & P; liver biopsy; abdominal Xray; liver enzymes;
EGD; clotting studies; stool exam for occult blood  Hepatic encephalopathy:
o Pancreatitis
 Causes: Cholelithiasis, Alcohol abuse, Biliary dysfunction, Hepatotoxic drugs, Metabolic
disorders, Trauma, Renal failure, Endocrine disorders, Pancreatic tumors, Penetrating
peptic ulcer
 What happens to the pancreas in the disorder? pancreatic enzymes to leak into the
pancreatic tissue and initiate autodigestion - -results in edema, vascular damage,
hemorrhage & necrosis
 Acute pancreatitis importance & complications: Acute respiratory distress syndrome
(ARDS), DM, Infection, Septic or hypovolemic shock, Disseminated intravascular
coagulation (DIC), Renal failure, Malnutrition, Pancreatic cancer
Pseudocyst – pancreatic fluids & necrotic debris accumulate & eventually rupture,
Abscess
 Manifestations: Upper abdominal pain that radiates to the back, worsens after
eating, somewhat relieved by leaning forward or pulling knees to chest, N/V
Mild jaundice, Low-grade fever, BP and pulse changes

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