100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
Previously searched by you
NURS 6550 Midterm Exam Study Guide/ NURS6550 Midterm Exam Study Guide / NURS 6550N Midterm Exam Study Guide / NURS6550N Midterm Exam Study Guide (Latest-2021)(Graded A Guide)$20.49
Add to cart
nurs 6550 midterm exam study guide nurs6550 midterm exam study guide nurs 6550n midterm exam study guide nurs6550n midterm exam study guide latest 2021
Written for
Walden University
NURS 6550 / NURS6550
All documents for this subject (16)
Seller
Follow
QUIZHUB
Reviews received
Content preview
NURS 6550 Midterm Exam Study Guide
Gastrointestinal System
Evaluation, differential diagnosis, treatment options, and complications
o Dyspepsia: acute, chronic, or recurrent pain in the upper abdomen
Etiology:
1. Food or drug intolerance, functional with no obvious cause,
luminal GI tract dysfunction, H-pylori infection, pancreatic
disease, biliary tract disease or other conditions such as DM,
thyroid disease, CKD, pregnancy or gastrointestinal ischemia.
Symptoms:
1. Epigastric pain or burning, postprandial fullness, bloating, nausea
or vomiting
2. If there is weight loss, persistent vomiting, severe pain or
hematemesis then endoscopy warranted.
Labs:
1. >50 years – CBC, BMP, LFT, calcium and thyroid function tests
2. <50 years with uncomplicated dyspepsia use noninvasive strategies
1st; H-pylori fecal test
Upper Endoscopy:
1. Use for pts over the age of 50 who have new dyspepsia associated
with weight loss, dysphagia, recurrent vomiting, bleeding or
anemia.
Other tests:
1. Patient with persistent symptoms or progressive weight loss, check
for celiac disease, stool for parasites, or abdominal imaging such as
CT or ultrasound
Treatment:
1. Empiric
, Proton pump inhibitor x 4 weeks, may have to use long
term if symptomatic after stopping
If H-pylori positive, then antibiotic therapy warranted
2. Functional dyspepsia
Life style changes (limiting alcohol and caffeine intake),
small low-fat meals
Pharmacologic
Oral PPI (omeprazole 20 mg or pantoprazole 40mg)
for 4-8 weeks
Low dose antidepressants (desipramine or
nortriptyline) have been effective in some patients
Alternative therapies: hypnotherapy, psychotherapy,
peppermint, caraway
o Nausea / vomiting
Variety of causes
Acute without pain
1. Food poisoning, infectious gastroenteritis, drugs or illness
Acute with pain:
1. Peritoneal irritation, acute gastric or intestinal obstruction, or
pancreaticobiloiary disease
Persistent Vomiting:
1. Pregnancy, gastric outlet obstruction, gastroparesis, intestinal
dysmotility, psychogenic disorders, and central nervous system or
systemic disorders
2. Vomiting undigested food hours later is indicative of gastroparesis
or a gastric outlet obstruction
3. All patients with acute or chronic symptoms need to be asked
about neurological symptoms
Examinations:
1. Serum electrolytes for vomiting: hypokalemia, azotemia, or
metabolic alkalosis
, 2. Abdominal CT for pain
3. Gastroparesis: confirmed by either nuclear scintigraphic studies or
C-octanoic acid breath tests
4. LFT’s for pancreaticobiliary disease
5. CT or MRI for central nervous system cause
Treatment:
1. General:
most cause self-limiting, clear liquids, small quanitities or
dry foods (crackers), ginger.
If severe, may require hospitalization with IV 0.45 with
20mEq potassium. NG tube for obstruction
2. Antiemetic Medications
Serotonin 5-HT receptor agonists: ondansetron,
granisteron, dolasetron
Corticosteriods: dexamethasone
Neurokinin receptor antagonists: Aprepitant and rolapitant
are used with corticosteroids and serotonin antagonists for
prevebtion of acute or delayed nausea and vomiting
Dopamine Antagonists: promethazine, prochlorperazine.
Can have sedative effects
Antihistamines and anticholinergics: meclizine,
dimenhydrinate or transdermal scopolamine. Used in
vertigo, motion sickness and migraines. May induce
drowsiness
Cannabionoids: Dronabinol contains THC used as an
appetite stimulant.
o Constipation: Most common in elderly and in women
Etiology:
1. Primary – structural abnormalities, systemic disease. Normal
colonic transit site is 35 hours
, 2. Secondary – medications (anticholinergics or opioids), colonic
lesions, endocrine disorders, electrolyte abnormalities
(hypercalcemia or hypokalemia)
Signs/Symptoms
1. Digital rectal exam: for anatomic abnormalities
2. Laboratory studies: CBC, BMP, calcium, glucose, thyroid
Special examinations:
1. Those not responding to routine medical management may need to
have a anorectal manometry. This will show if the patient is having
pelvic floor dyssynergia.
Treatment:
1. Dietary and Lifestyle: fluids, fiber, exercise, changing toileting
habits such as timing, or positioning
2. Laxatives:
Osmotic Laxatives: Magnesium hydroxide, lactulose,
polyethylene glycol. Safe for acute and chronic cases.
Increase water into the colon. Generally, work within 24
hours
Stimulant laxatives: Prescribed as a “rescue” agent or used
3-4 times per week. Bowel movement within 6-12 hours for
PO or 15-60 mins rectal. Bisacodyl, senna, cascara
Chloride secretory agents: Lubiprostone or linaclotide
which increase intestinal fluid and accelerate colonic
transit.
Opioid receptor antagonists: Methylnaltrexone
(subcutaneous injection), used for those on chronic opioids
that can inhibit peristalsis
3. Refer: Refer patients with alarm symptom’s and over the age of 50
for a colonoscopy.
o Diarrhea
Acute
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller QUIZHUB. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $20.49. You're not tied to anything after your purchase.
