Medsurge 242 Med-Surg Final Exam Study Questions-1

Med Surg Final Exam Study Questions 1) What does GERD stand for? a.Gastro-esophageal reflux disease b.What occurs in this disease? i. Backflow (reflux) of GI contents in esophagus 2) What is peptic ulcer disease? a.When mucosal defenses don’t protect stomach lining (epithelium) from acid and pepsin 3) What does LES stand for? a.Lower esophageal sphincter b.Where is the LES located? i. Where the esophagus joins the stomach c. What is its purpose? i. To keep the flow of contents/food moving down d.What does it do when contracted? i. Prevent reflux of stomach contents into the esophagus e.What does it do when relaxed? i. Cause GERD (regurgitation) 4) What causes most gastric/duodenal (do-odd-en-al) ulcers? How? a.An H. pylori infection; secretes ammonia, making stomach more alkaline b.What chain of events could this lead to? i. Hydrochloric acid injuring the epithelium (lining) or bile backing up into the stomach which breaks down/erodes the mucosal barrier, causing the stomach to bleed 5) What drugs could cause mucosa in the stomach to break down? a. NSAIDs and aspirin 6) What is a hiatal (high-ate-al) hernia? a.When part of the stomach pushes upward through the diaphragm and into the esophagus b.What are the 2 types? Describe them. i. Sliding – where the stomach and esophagus connect slides above the hiatus/diaphragm, Rolling – part of the stomach (fundus) rolls through the hiatus/diaphragm and into the chest 7) What does EGD stand for? How does it relate to GERD? a.Esopho-gasto-duoden-oscopy; it’s used to diagnose or evaluate GERD (reflux esophagitis and Barrett’s esophagus) b.What would you tell a patient about this procedure? i. That they will be moderately sedated and that someone will have to drive them home 8) What is a complication of Barrett’s esophagus? a.Esophageal cancer 9) Describe a duodenal ulcer. a.Deep, sharp lesion penetrating through to the muscle b.How does it happen? i. High levels of gastric acid secretion and increase stomach emptying (which reduces the duodenum’s buffer effect) 10) Which GU diagnostic value is influenced by dehydration? a. BUN 11) What is the most sensitive indicator of glomerular filtration? a.Serum creatinine 12) In what 3 ways is GERD controlled? a.Nutrition therapy (diet), drug therapy (medications), lifestyle changes b.What dietary advice would someone with GERD be given? Why? (get the gist) i. (Why) because it will limit foods that decrease LES pressure that causes heartburn and delays gastric emptying; limit chocolate, spicy food, carbonated beverages, fatty foods, caffeine, alcohol, eat 4-6 small meals , avoid eating 3 hours before bedtime c. What lifestyle changes could be made for someone with GERD? (get the gist) i. Elevate head while sleeping, sleep on their right side, decrease smoking an alcohol, wear loose-fitting clothing, lose weight, avoid medications that cause GERD d.What drug therapy could be utilized for a patient with GERD? What does each med do? i. Antacids – raise the pH (lowers acidity) in the stomach, Histamine blockers – reduce gastric acid secretion, proton pump inhibitors – inhibits secretion of gastric acid 13) What GI problem could mimic cardiac pain? a. GERD 14) What is the main nitrogenous waste product filtered by the glomerulus? 15) What signs and symptoms could be experienced for someone with a hiatal (high- ate-al) hernia? a.Heartburn, chest pain, dysphagia (difficulty swallowing), belching 16) What does a serologic test test for? a.H. pylori b.When would a hematocrit and hemoglobin test be used? i. If someone tested positive for occult blood in the stool or has venous bleeding from a peptic ulcer ii. What would these levels look like? 1. Decreased/low 17) What is the most accurate test for diagnosis of peptic ulcer disease? a. EGD (esophago-gastro-duoden-oscopy) 18) What patient teaching could a nurse do for someone with a hiatal (high-ate-al) hernia? a. Avoid eating late at night, avoid foods associated with reflux, lose weight, sleep with head elevated, sit upright for hours after eating, void straining, avoid tight clothing