What are some common causes of 

chronic gastritis?
-alcohol
-radiation therapy
-smoking
-pyloric sphincter surgeries (reflux of alkaline secretions into the stomach)
-Crohn's disease
-graft vs. host disease
-uremia

Atrophic gastritis is caused by what?

-exposure to toxis substances (benzene, lead, nickel)
-H.pylori
-autoimmune factors

What two types of cancer can atrophic gastritis lead to?

gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma (MALT)

True or False:

A balanced diet, regular exercise, and stress-reduction techniques can help prevent
gastritis

(limiting:
-caffeine
-chocolate
-mustard
-pepper
-hot spices
-alcohol
-tobacco)

(stress reduction techniques:

-aerobic exercise
-meditation
-reading
-yoga)

What are the key features associated with acute gastritis?

-epigastric pain/discomfort/tenderness
-nausea & vomiting
-hematemesis
-melena
-dyspepsia (heart burn)
-anorexia
-gastric hemorrhage
-feeling of fullness
What are the key features associated with chronic gastritis?
-upper abdominal discomfort
-nausea & vomiting
-anorexia
-epigastric pain relieved by food
-intolerance of fatty/spicy food
-pernicious anemia

What is the gold standard for diagnosing gastritis?

EGD

What is a visual examination of the esophagus, stomach, and duodenum?

EGD

If GI bleeding is found during an EGD, what can the physician do?

inject sclerotherapy or other type agent to stop the bleeding

True or False:

If a patient has an esophageal stricture, it can be dilated during an EGD

True or False:

Gastric lesions and celiac disease cannot be diagnosed using an EGD

In regards to an EGD, what should you teach your patient?

-NPO 6-8 hrs before test
-usual drug therapy can be taken morning of test (diabetics get special instructions)
-avoid NSAIDs/anticoags for several days before the test
-tell patient flexible tube will be passed down esophagus while under moderate sedation
-anesthetic will suppress gag reflex so swallowing will be difficult
-remove dentures
-patient should have someone drive them home
-patient should avoid driving 12-18 hours post EGD
-hoarse voice/sore throat may persist for several days after test (may use throat
lozenges)
-may experience bruising around eyes which usually goes away in a week

For an EGD is the head of the bed elevated or no?

Yes

What is inserted into the patient's mouth to protect the teeth and prevent biting down on
the endoscope during an EGD?
bite block
How long does an EGD procedure typically last?
20-30 min

What is the endoscopy nurse's role during an EGD?

monitor rate, depth of respirations and O2 sat

(shallow breaths decrease the amount of CO2 exhaled)

If the patient's respiratory rate falls below 10/min or if the exhaled CO2 level falls below
20% during an EGD, what does the nurse do?
uses a stimulus (sternal rub) to encourage deeper/faster respirations

After and EGD, how often are VS assessed?

every 30 min until sedation wears off

True or False:

Side rails of hospital beds are raised after an EGD test while the sedation is wearing off

After an EGD test, how long does the patient remain NPO?
until gag reflex returns (typically 30-60 min)

What does rapid urease testing detect?

H.pylori infection

What is the approach to the management of chronic gastritis?

-elimination of causative agents (primary)
-treatment of underlying disease
-avoidance of toxic substances
-health teaching

What is the primary treatment approach when dealing with chronic gastritis?
eliminating causative factors (H.pylori)

What type of drugs are usually prescribed to block gastric secretions in patients with
gastritis?
H2 receptor atagonists (famotidine)

What drug is a mucosal barrier fortifier prescribed for patients with gastritis?

Sucralfate

What type of drugs are used as buffering agents for patients with gastritis?
Antacids

What type of drugs are prescribed for patients with gastritis to suppress gastric acid
secretion?
PPIs

True or False:

Patients with chronic gastritis may require injections of vitamin B12 for the treatment (or
prevention) of pernicious anemia

What drugs are associated with gastritis episodes and should be avoided?
-corticosteroids
-erthromycin
-aspirin
-NSAIDs

What is a mucosal lesion of the stomach or duodenum?

peptic ulcer

What results when mucosal defenses become impaired and no longer protect the
epithelium from the effects of acid and pepsin?
PUD

What are the 3 types of ulcers associated with PUD?

-gastric
-duodenal
-stress

What are most gastric and duodenal ulcers caused by?

H.pylori infection

True or False:

H.pylori is believed to be spread through contaminated food or water or contact with

stool, vomit, saliva of an infected person

What does H.pylori do to the pH of stomach acid?

neutralizes it

Where do gastric ulcers typically develop?

antrum of the stomach (lesser curvature of the stomach near the pylorus) near acid-
secreting mucosa

What happens to gastric emptying in patients with gastric ulcers?

Delayed

True or False:

Gastric ulcers have a higher incidence in women over the age of 50

True or False:

Duodenal ulcers are deep and usually penetrate through the muscle layer of the
stomach

What is the main feature of a duodenal ulcer?

high gastric acid secretion (pH levels are low - excess acid)

True or False:

Duodenal ulcers have a higher incidence in men but are increasing in women,
especially post-menopausal women between 35-45 y.o

What type of ulcers are associated with normal gastric acid secretion, delayed

gastric emptying, and increased diffusion of gastric acid back into the stomach
tissues?
gastric ulcers

What type of ulcers are associated with increased secretion of gastric

acid, increased gastric emptying, and normal diffusion of acid back into stomach
tissues?
duodenal ulcers

Protein-rich meals, calcium, and vagus nerve excitation have what effect on acid
secretion?
stimulatory effect

What type of mucosal lesion occurs after an acute medical crisis or trauma, such as
sepsis or head injury?
stress ulcer

Curling's ulcer is associated with what?

Burns

Sepsis is associated with what type of ulcers?

ischemic ulcers

Increased intracranial pressure is associated with what type of ulcer?

cushing's ulcers

What is the main manifestation of acute stress ulcers?

bleeding caused by gastric erosion

What are the most common complications of PUD?

-hemorrhage (most serious)
-perforation
-pyloric obstruction
-intractable disease

Hemorrhage tends to occur more in older adults and with what type of ulcer?
gastric ulcer

What are the key features associated with upper GI bleeding?

-bright red or coffee ground vomit
-melena
-decreased BP
-increased HR
-weak peripheral pulses
-acute confusion
-vertigo
-dizziness/lightheadedness
-syncope
-decreased Hgb and Hct

True or False:

Hematemesis usually indicates bleeding at or above the duodenojejunal junction

Melena is more common in patients with what type of ulcer?

duodenal ulcer

If your patient complains of sudden, sharp pain that begins in the midepigastric region
then spreads over the entire abdomen, what most likely happened?
Perforation

Describe the pain/signs associated with perforation.

abdomen is tender, rigid, and boardlike (peritonitis)
-patient assumes fetal position to decrease tension
-severely ill within hours
-bacterial septicemia and hypovolemic shock follow
-peristalsis diminishes
-paralytic ileus develops

True or False:

Peptic ulcer perforation is a surgical emergency and can be life threatening

What is manifested by vomiting caused by stasis and gastric dilation?

pyloric obstruction (caused by scarring, edema, inflammation)
What are symptoms of pyloric obstruction?
-abdominal bloating
-nausea
-vomiting
-metabolic alkalosis if vomiting persists
-hypokalemia

What is the most commonly reported symptom associated with PUD?

dyspepsia (indigestion/heartburn)

If perforation is present, what will the initial auscultation of bowel sounds be?
hyperactive, but diminishes as it progresses

What symptom of PUD is typically described as sharp, burning, or gnawing pain?

Dyspepsia

What type of ulcer pain is located to the left of the midline and is aggravated by food?
gastric ulcer

What type of ulcer pain is located to the right of or below epigastrium and occurs 90
min to 3 hours after eating and often awakens the person at night?
duodenal ulcer

How should you assess for fluid volume deficit that occurs from bleeding?
take orthostatic BP and monitor for signs and symptoms of dehydration and dizziness

Which type of peptic ulcer usually occurs in patients with type O blood?

duodenal ulcer

What type of ulcer pain typically occurs 30-60 min after a meal?
gastric ulcer

What type of ulcer pain is relieved by the ingestion of food?

duodenal ulcer

Hematemesis is more common than melena with what type of ulcer?

gastric ulcer

Melena is more common than hematemesis with what type of ulcer?

duodenal ulcer

True or False:

H.pylori can be tested from the patient's blood, breath, or stool

What is the most common method for testing/confirming H.pylori infection?

serologic testing

If the special carbon atom is found in the urea breath test, what does this finding
indicate?
positive for H.pylori

what is the major diagnostic test used for PUD?

EGD

What procedure involves injecting the patient with a contrast medium to scan for the
presence of GI bleeding?
nuclear medicine scan

True or False:

The expected outcome for PUD is that the patient is expected to report pain control as
evidenced by no more than 3 on a scale of 0-10

Interventions to manage the pain involved with PUD focus on what?

drug therapy and diet changes

The primary purposes of drug therapy in the treatment of PUD are what? (there's 4)
1. provide pain relief
2. eliminate H. pylori infection
3. heal ulcerations
4. prevent recurrence

What is the common drug regimen for the treatment of H.pylori?

PPI-triple therapy for 10-14 days:
-PPI (lansoprazole)
-two ab'tics (metronidazole + tetracycline) or (clarithromycin + amoxicillin)

What is the drug class of choice for treating patients with acid-related disorders?
PPIs

Which drug class increases pH of gastric contents by deactivating pepsin?

antacids (give 2 hr after meal and at bedtime)

(do not give other drugs within 1-2 hr of antacids)

assess pt. history of RENAL disease and HEART FAILURE

Although it is necessary to assess patient history of RENAL disease before
administering antacids, which antacid is okay to give to patients

WITH renal disease?

aluminum hydroxide

Which drug class decreases gastric acid secretion by blocking histamine receptors

in parietal cells?
H2 antagonists (blockers)

When should you administer H2 blockers?

single dose at bedtime for GI ulcers, heartburn, and PUD

What histamine blocker(s) can be given IV for the prevention of surgical stress

ulcers?
IV famotidine and IV ranitidine

Which drug binds with bile acids and pepsin to pepsin to protect stomach
mucosa?
Sucralfate

(do not give within 30 min of giving antacids or other drugs)

(give 1 hr before and 2 hr after meals and at bedtime)

Which drug class suppresses gastric acid secretion and is indicated for short-term
and long-term use for PUD, symptomatic heartburn, and H.pylori treatment?
PPIs

give 30 min before the main meal of the day

True or false:

Omeprazole may be dissolved in a sodium bicarbonate solution and given through any
feeding tube & the capsule CAN be opened

True or false:

PPIs should be discontinued immediately if signs of hemorrhage appear

FALSE - PPIs should NOT be stopped abruptly to prevent rebound activation of the
proton pump

True or False:

If taken on an empty stomach, antacids are quickly evacuated and the neutralizing
effect is reduced

Which antacid triggers gastrin release which causes rebound acid secretion, therefore is
not recommended for acid inhibition?
calcium carbonate (TUMS)
Why should flavored antacids be AVOIDED?
flavoring increases the emptying time of the stomach so desired effect is negated

True or False:

Food itself acts as an antacid by neutralizing stomach acid for 30-60 min

It is okay to have bedtime snacks with PUD as long as you sleep with HOB elevate 6
inches
false --> bedtime snacks stimulate gastric acid secretion

True or False:

Many herbs, such as powders of slippery elm, marshmalow root, quercetin, and licorice
are commonly used by patients with gastritis and PUD

What are some common herbs and vitamins used for therapy in gastritis and PUD?
-cranberry
-DGL
-ginger
-probiotics
-slippery elm
-vitamin C

Your patient presents with active upper GI bleeding. What should you do first?
-maintain ABC
-start two large-bore IV lines for replacing fluids and blood
-monitor VS, Hct, and O2 sat

Upper GI bleeding often requires the PCP or nurse to insert a large-bore NG tube to:
-determine presence or absence of blood in the stomach
-assess the rate of bleeding
-prevent gastric dilation
-administer lavage

Gastric lavage requires NG tube with instillation of a room temp solution in volumes

of 200-300 ml
true (no evidence whether sterile saline or sterile water is better than tap water)

During gastric lavage, the solution and blood are repeatedly withdrawn manually until
when?
until returns are clear or light pink and without clots
How should the patient be positioned during a gastric lavage?
lie on left side

What are the three ways in which a physician will stop the bleeding by endoscopic
therapy via EGD?
1. inject chemicals into the bleeding site
2. treat bleeding area with heat, electric current, or laser
3. close the affected blood vessels with a band or a clip

Aggressive acid suppression is used to prevent what?

Rebleeding

How is perforation managed?

-immediately replacing fluid, blood, electrolytes
-administering antibiotics
-keeping the patient NPO
-maintain nasogastric suction to drain gastric secretion and thus prevent further
peritoneal spillage

-monitor intake/output and check VS at least every hour

-monitor for signs of septic shock (fever, pain, tachycardia, lethargy, anxiety)

The nurse has been assigned to provide care for 4 clients at the beginning of the day
shift. In what order does the nurse assess these clients?

a) a client planned for EGD at 1 pm

b) a client requesting pain meds 2 days after partial gastrectomy
c) a client with PUD experiencing a sudden onset of acute stomach pain
d) a client who is NPO for tests to rule out gastric cancer
c, b, a, d

When taking history of a client with a gastric ulcer, which assessment findings does the
nurse expect? (SATA)

a) vomiting
b) weight loss
c) epigastric pain at night
d) relief of epigastric pain after eating
e) melena

A nurse teaches a client experiencing heartburn to take 1 ½ oz of Maalox when

symptoms appear. How many milliliters should the client take?
________________________ mL.
.
45 mL
The nurse has been assigned to provide care for four clients at the beginning of the day
shift. In what order should the nurse assess these clients?
1. The client awaiting hiatal hernia repair at 11 am.
2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for
tests.
3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain.
4. A client who is requesting pain medication 2 days after surgery to repair a fractured
jaw.

The nurse is caring for a client who has just had an upper GI endoscopy. The client's
vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse
assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later,
the UAP reports the client, who was previously afebrile, has developed a temperature of
101.8 ° F (38.8 ° C). What should the nurse do in response to this reported assessment
data?
1. Promptly assess the client for potential perforation.
2. Tell the assistant to change thermometers and retake the temperature.
3. Plan to give the client acetaminophen (Tylenol) to lower the temperature.
4. Ask the assistant to bathe the client with tepid water.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with
a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the
midepigastric region along with a rigid, boardlike abdomen. These clinical
manifestations most likely indicate which of the following?
1. An intestinal obstruction has developed.
2. Additional ulcers have developed.
3. The esophagus has become inflamed.
4. The ulcer has perforated.

The body reacts to perforation of an ulcer by immobilizing the area as much as possible.
This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a
medical emergency requiring immediate surgical intervention because peritonitis
develops quickly after perforation. An intestinal obstruction would not cause
midepigastric pain. The development of additional ulcers or esophageal inflammation
would not cause a rigid, boardlike abdomen.
When obtaining a nursing history on a client with a suspected gastric ulcer, which signs
and symptoms should the nurse expect to assess? Select all that apply.
1. Epigastric pain at night.
2. Relief of epigastric pain after eating.
3. Vomiting.
4. Weight loss.
5. Melena.

The nurse is caring for a client who has had a gastroscopy. Which of the following signs
and symptoms may indicate that the client is developing a complication related to the
procedure? Select all that apply.
1. The client has a sore throat.
2. The client has a temperature of 100 ° F (37.8 ° C).
3. The client appears drowsy following the procedure.
4. The client has epigastric pain.
5. The client experiences hematemesis.

A client with peptic ulcer disease tells the nurse that he has black stools, which he has
not reported to his physician. Based on this information, which nursing diagnosis would
be appropriate for this client?
1. Ineffective coping related to fear of diagnosis of chronic illness.
2. Deficient knowledge related to unfamiliarity with significant signs and symptoms.
3. Constipation related to decreased gastric motility.
4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.

A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected
outcome of this drug?
1. Heal the ulcer.
2. Protect the ulcer surface from acids.
3. Reduce acid concentration.
4. Limit gastric acid secretion.

A client with a peptic ulcer reports epigastric pain that frequently awakens her during the
night. The nurse should instruct the client to do which activities? Select all that apply.
1. Obtain adequate rest to reduce stimulation.
2. Eat small, frequent meals throughout the day.
3. Take all medications on time as ordered.
4. Sit up for one hour when awakened at night.
5. Stay away from crowded areas.

A client with peptic ulcer disease reports that he has been nauseated most of the day
and is now feeling light-headed and dizzy. Based upon these findings, which nursing
actions would be most appropriate for the nurse to take? Select all that apply.
1. Administering an antacid hourly until nausea subsides.
2. Monitoring the client's vital signs.
3. Notifying the physician of the client's symptoms.
4. Initiating oxygen therapy.
5. Reassessing the client in an hour.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be
followed after discharge. The nurse should explain that the diet will most likely consist of
which of the following?
1. Bland foods.
2. High-protein foods.
3. Any foods that are tolerated.
4. Large amounts of milk.

Diet therapy for ulcer disease is a controversial issue. There is no scientific evidence
that diet therapy promotes healing. Most clients are instructed to follow a diet that they
can tolerate. There is no need for the client to ingest only a bland or high-protein diet.
Milk may be included in the diet, but it is not recommended in excessive amounts.
The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by
papers from his briefcase and arguing on the telephone with a coworker. The nurse's
response to observing these actions should be based on knowledge that:
1. Involvement with his job will keep the client from becoming bored.
2. A relaxed environment will promote ulcer healing.
3. Not keeping up with his job will increase the client's stress level.
4. Setting limits on the client's behavior is an important nursing responsibility.

A client with a peptic ulcer has been instructed to avoid intense physical activity and
stress. Which strategy should the client incorporate into the home care plan?
1. Conduct physical activity in the morning so that he can rest in the afternoon.
2. Have the family agree to perform the necessary yard work at home.
3. Give up jogging and substitute a less demanding hobby
4. Incorporate periods of physical and mental rest in his daily schedule.

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer.
The client understands proper drug administration of ranitidine when she says that she
will take the drug at which of the following times?
1. Before meals.
2. With meals.
3. At bedtime.
4. When pain occurs.

A client has been taking aluminum hydroxide (Amphojel) 30 mL six times per day at
home to treat his peptic ulcer. He tells the nurse that he has been unable to have a
bowel movement for 3 days. Based on this information, the nurse would determine that
which of the following is the most likely cause of the client's constipation?
1. The client has not been including enough fiber in his diet.
2. The client needs to increase his daily exercise.
3. The client is experiencing an adverse effect of the aluminum hydroxide.
4. The client has developed a gastrointestinal obstruction.

A client is taking an antacid for treatment of a peptic ulcer. Which of the following
statements best indicates that the client understands how to correctly take the antacid?
1. "I should take my antacid before I take my other medications."
2. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid."
3. "My antacid will be most effective if I take it whenever I experience stomach pains."
4. "It is best for me to take my antacid 1 to 3 hours after meals."

Which of the following would be an expected outcome for a client with peptic ulcer
disease? The client will:
1. Demonstrate appropriate use of analgesics to control pain.
2. Explain the rationale for eliminating alcohol from the diet.
3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months.
4. Eliminate contact sports from his or her lifestyle.

diarrhea is defined as
increase in frequency of stools, more than 3 a day, an increase in the amount of stool or
abnormally liquid stool.

an increase in the amount of stool is what range

more than 200 g a day

when determining if someone is having diarrhea because our bowel patterns very
significantly depending on the individual, what is the most important thing
change in consistency

diarrhea can be caused in three ways:

1) increased intestinal secretions
2) decreased mucosal absorption
3) increase in mobility

diarrhea lasting less than 2 weeks is considered?

Acute

acute diarrhea is often associated with

infection and self-limiting
viral/bacterial infections which may place an individual at risk for acute diarrhea include
1) food poisoning
2) shigellosis (enterobacteria)
3) dysentery

dystentery is
infection of the intestine which causes severe diarrhea which has blood and mucus

diarrhea lasting longer than 4 weeks is considered?

Chronic

chronic diarrhea is associated with

medication use or diseases
medications which place an individual at risk for diarrhea include
 1) thyroid hormone replacement
2) stool softeners and laxatives
3) antibiotics
4) chemotherapy
5) antacids

antibiotics place an individual at risk because

they will kill all bacteria including the normal flora in the gut which can cause irritation
and diarrhea

chemotherapy places an individual at risk because

it acts on killing rapidly reproducing cells like those of the intestine

there are certain metabolic disorders that are associated with diarrhea
1) diabetes
2) addison's disease
3) tube feedings (hyperosmotic solutions)

when an individual is on tube feedings that are hyperosmotic this places them at risk
because
they have large amounts of proteins which causes hypersectrion into the intestines

the most frequent underlying disease processes associated with diarrhea are
IBS, inflammatory bowel disease, and lactose intolerance

signs and symptoms of diarrhea include

urgency, abdominal cramping, distention, borboygmus, anorexia and thirst.
the patient may also experinece
incontinence
borborygmus is
intestinal rumbling

watery stools are characteristics of disorders associated with

small bowel

loose, semisolid stools are associated more with disorders of

large bowel

large