NR 507 Week 8 Final Exam Review - Made this for the final and really helped me ace it!

Final Review GERD- Lower Esophageal Sphincter (LES) dysfunction. S/S: Heartburn (burning in chest), regurgitations, dysphagia, and chest pain. Treatment: lifestyle modifications-HOB elevated, avoid citrus, alcohol, caffeine, carbonation, avoid eating before bedtime, smoking cessation as it weakens the sphincter. Medications: Antacids, if it doesn’t improve, EGD. NP roe in GERD management is to evaluate the effectiveness of treatment. Warning signs of GERD: age over 50, dysphagia, odynophagia (pain on swallowing), N/V, wt loss, melena, feeling full after little food. Esophageal Stricture- chronic inflammation and the development of scar tissue that thickens the wall of the esophagus. Risk factors: GERD, esophagitis, radiation therapy, ingestion of caustic substances like strong acids or bases, and tumors. S/S: dysphasia, sensation of food sticking to the throat, pain when swallowing, food regurgitation, unintentional weight loss. Diagnosis: Barium swallow or EGD. Treatment: Meds to reduce inflammation, dilation of stricture, and addressing underlying cause. Appendicitis- involves obstruction of the lumen or the opening of the appendix which leads to a cascade of events resulting in inflammation, infection, and, if untreated, potential perforation. Patho: luminal obstruction -> increased luminal pressure -> compromised blood flow (ischemia) -> bacterial overgrowth (E. coli) -> acute inflammation (pus formation) -> Perforation S/S: Periumbilical pain, RLQ pain, fever and leukocytosis, N/V Diagnosis: WBC > 10,000 and increased neutrophils and CRP, abd. ultrasound, CT scan, MRI Treatment: appendectomy Risk is colon CA among those aged 50-74 y/o Hiatal Hernia- Major risk factor for GERD. Diaphragmatic weakness Factors: aging, obesity, pregnancy, increased intra-abdominal pressure (chronic coughing or Valsalva maneuver), structural abnormalities of diaphragm Treatment: lifestyle modification, eating small and frequent meals, meds (antacids, PPI;s, prokinetic agents), surgery to repair (usually w/ severe S/S). Duodenal Ulcer- Most common peptic ulcer Usually caused by H. pylori 95-100% of the time (bacteria that stimulates gastrin secretion leading to gastric acid hypersecretion) Disruption of the balance between aggressive and defensive factors: Aggressive: Gastric acid, pepsin, H. pylori, NSAIDS Defensive: Mucus-bicarbonate layer, prostaglandins, cellular repair mechanisms S/S: Pain begins 30min-2hrs after eating when the stomach is empty, not unusual for pain to occur in the middle of the PM and disappear by AM. Exam findings: anemia, dehydrated, pain in upper abd., guarding, rigidity, distention Pain is usually relieved by ingestion of food or antacids. Diagnosis: EGD (Gold standard), H. pylori testing, imaging studies Treatment: lifestyle mods, meds, treat H. pylori if that’s the reason Gastric Ulcer- Pain is relieved w/ food Risk factors: h. pylori, NSAIDS, smoking, alcohol, stress, fam hx, obesity, age >65 Peptic Ulcer Disease (PUD)- a break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum. Least likely to occur in the Large Intestine Erosion- superficial ulcers, don’t penetrate Ulcer- damages blood vessels S/S: epigastric pain 1-3 hrs after eating, pain relieved by eating Zollinger-Ellison syndrome causes increased risk of peptic ulcers d/t increase in gastric acid Diagnosis: EGD(GOLD STANDARD), lab tests (CBC, stool, serum urea and e-), H/ pylori testing, abd. Ultrasound, CT (emergency) Treatment: Meds and lifestyle mods Ulcerative Colitis- Distruption