Nursing 2 Exam 1, Study Guide

Oral ulcers oooGERD oooooNursing 2 – Exam 1, Study Guide Causes:  Trauma (biting cheek/tongue), burns, spicy/hot food, ETOH, smoking, allergy, infection  Cancer patients at HIGH risk for oral ulcers Treatment:  Chlorohexidine mouthwash (relieves sx, reduces healing time)  Topical steroids (promotes faster healing/resolution) Patient education/Prevention:  Remove the irritant, good oral hygiene  Avoid spicy/acidic foods, ETOH, stop smoking, remove irritant/allergen from diet 1 What is it?  Gastric juices move up into the esophagus due to:  Weak LES (lower esophageal sphincter)  Pressure changes after meals, pregnancy, bending down Signs/Sx:  #1 = Pyrosis (heartburn)  Barrett’s Esophagus = inflammation/damage/ulceration of esophagus due to untreated GERD. Can lead to adenocarcinoma/esophageal cancers. Upper GI, Barium Swallow or Upper Endoscopy to R/O. “Red Flag” Symptoms:  Weight loss, dysphagia, anemia, abnormal masses, vomiting or bleeding, continual epigastric pain, sx unrelieved by PPI’s Assessment:  Does your pain get worse after meals?  Do you have pain when bending over?  Any trouble swallowing? Hoarse voice?  Diagnostics: Endoscopy, pH Monitoring, Symptom History Treatment: 1. PPI’s (-prazole)  Ex: omeprazole, pantoprazole  Decreases the volume of HCL produced  Take 30min – 1hour before meals  #1 line of defense – MOST EFFECTIVE 2. H2 Blockers (-tidine)  Ex: ranitidine, cimetidine  Take 1x daily  Blocks the release of HCL/Histamine  Treats MILD symptoms. #2 line of defense 3. Antacids (Ca+ Carbonate)  Ex: Tums, Maalox  Neutralizes stomach acid  Monitor for signs of Metabolic Alkalosis 4. Surgery  “Anti-Reflux Surgery” to tighten LES sphincter  “Nissen fundoplication” (more invasive surgery)