Thyroid medication is used to treat hypothyroidism and myxedema.
Antithyroid medication are used to treat hyperthyroidism and graves disease.
Methimazole, propylthiouracil, strong iodine solutions (Lugol’s solution),
potassium iodide and iodide 131 are antithyroid medication.
Nurse instruct the client to take antithyroid medication with meals to
avoid gastrointestinal upset.
Client do not stop antithyroid medication abruptly because it increased
risk of thyroid storm.
Propylthiouracil causes the agranulocytosis.
Hypoparathyroidism results in low calcium level treated with calcium
and vitamin D supplements.
Vitamin D increase the absorption of calcium.
Instruct the client using antihypercalcemic agent to avoid foods rich
in calcium such as green leafy vegetables, dairy products, shellfish and soya.
Nurse instruct the client not to take other medications within 1 hour
of taking a calcium salt.
Nurse instruct the client taking a corticosteroid not to stop the
medication abruptly because this could result in adrenal insufficiency.
Corticosteroids are contraindicated in client with hypersensitivity,
psychosis and fungal infection.
Instruct the client take corticosteroids medication in the early morning
best. Take food high in potassium.
Nurse avoid androgen in men with known prostate and breast carcinoma.
Oestrogen are steroids that stimulate female reproductive tissue.
Progestin are steroids that specifically stimulate the uterine lining.
Oestrogen are contraindicated in client with breast cancer, endometrial
hyperplasia, endometrial cancer, history of thromboembolism, or pregnant and
lactational women.
Progestin are contraindicated in client with thromboembolic disorder,
breast tumor or hepatic disease.
Contraceptive are contraindicated in women with hypotension,
thromboembolic disorder, cardiovascular and coronary artery disease or
oestrogen dependent cancer and pregnancy.
Antibiotics may decrease the absorption of oral contraceptive so client
need extra birth control precautions.
Insulin is contraindicated in client with hypersensitivity.
Oral hypoglycemic medication are contraindicated in type 1 diabetes
mellitus.
Beta adrenergic blocking agents may mask signs of hypoglycemia associated
with hypoglycemic medication.
Sulfonylureas can cause a disulfiram type of reaction when alcohol is
ingested.
Oral hypoglycemic medication are prescribed for client with type 2
diabetes mellitus.
Oral hypoglycemic medication: (a) Sulfonylureas: e.g. Acetohexamide, chlorpropamide, glimepiride,
flipside, tolbutamide and tolazamide. (b) Biguanides: e.g. Metformin (c) Alfa glucosidase inhibitor: e.g. Acarbose, Miglitol. (d) Thiazolidinedione's: e.g. pioglitazone and rosiglitazone. (e) Meglitinides: e.g. Nateglinide and Repaglinide. (f) Gliptins: e.g. sitagliptin.
Sulfonylureas stimulate the beta cells to produce more insulin.
Biguanides suppresses hepatic production of glucose and increase and
increase insulin sensitivity.
Alfa glucosidase inhibitors delay the absorption of ingested
carbohydrates resulting in smaller increase blood glucose level after meals.
Alfa glucosidase inhibitor will not cause hypoglycemia when given
alone.
Thiazolidinedione's lower the blood glucose level by decreasing hepatic
glucose production and improving target cell response to insulin.
Nurse instruct the client not to ingest alcohol with sulfonylureas.
Nurse inform the client that insulin may be needed during stress,
surgery or infection.
Client take meglitinides and alpha glucosidase inhibitors with the
first bite of meal.
Insulin primarily acts in liver, muscles and adipose tissue.
Insulin is prescribed for client with type 1 and type 2 diabetes
mellitus.
Rapid acting insulin: duration of action 3 to 5 hours and peak action 1
to 3 hours.
Short acting insulin: duration of action 5 to 8 hours and peak action 2
to 4 hours.
Intermediate acting insulin: duration of action 16 to 24 hours and peak
action 4 to 12 hours.
Long acting insulin: duration of action 24 hours.
Nurse avoid exposing insulin to extremes in temperature.
Insulin should not be frozen or kept in direct sunlight or a hot car.
Before injection insulin should be at room temperature.
The main area for insulin injection is the abdomen, arms posterior
surface, thighs anterior surface and hips.
Insulin injected into the abdomen may absorb more evenly and rapidly
than at other sites.
Systemic rotation of insulin injection site prevent client from
lipodystrophy so client instructed not to use the same site more than once in a
2 to 3week period.
Heat, massage, and exercise increase insulin absorption and may result
hypoglycemia.
Insulin glargine (long acting) cannot be mixed with any other types of
insulin.
Injection of insulin in scar tissue delay the absorption.
Most insulin syringes have a 27 to 29-gauge needle that is about ½ inch
long.
The usual concentration of insulin 100 units/ mL.
Before taking insulin dose nurse swirl insulin vial gently or rotate
between palms to ensure that the insulin and ingredients are well mixed.
When mixing insulins draw up regular insulin (short acting) first.
Regular insulin may be mixed with NPH or Lente insulin.
Lispro insulin may be mixed with Humulin N or Humulin-U (Ultralente).
Insulin Aspart protamine may be mixed with NPH insulin only.
Insulin zinc suspensions may be mixed only with each other and regular
insulin, not with other types of insulin.
Administer a mixed dose of insulin within 5 to 15 minutes of
preparation; after this time the regular insulin binds with the NPH insulin and
its action is reduced.
Regular insulin is only insulin that can be administered intravenously.
Exenatide a synthetic hormone used in client with type 2 diabetes
mellitus by SC route.
Pramlintide is a synthetic form of amylin, a naturally occurring
hormone secreted by pancreas used for clients with type 1 and 2 diabetes
mellitus.
Glucagon is a hormone secreted by pancreas islets alpha cells.
Glucagon used to treat insulin induced hypoglycemia when the client is
semiconscious or unconscious and unable to ingest liquid.
Asterixis (Liver flap) is a coarse tremor characterized by rapid,
nonrhythmic extensions and flexions in the wrist and fingers.
Billroth I: Partial gastrectomy with remaining segment brings
anastomosed to the duodenum; also called gastroduodenostomy.
Billroth II: Partial gastrectomy with the remaining segment being
anastomosed to the jejunum; also called gastrojejunostomy.
Cholecystectomy is the removal of gallbladder.
Cholecystitis is an inflammation of gallbladder.
Choledocholithotomy is the incision into the common bile duct to remove
gallstones.
Cirrhosis is a chronic progressive disease of the liver characterized
by diffuse degeneration and destruction of hepatocytes. Repeated destruction of
hepatic cells causes the formation of scar tissue.
Crohn’s disease is an inflammatory disease that can occur anywhere in
the gastrointestinal tract but most often affects the terminal ileum; leads to
thickening and scaring, narrowed lumen, fistulas, ulcerations, and abscesses.
Cullen’s sign is bluish discoloration of the abdomen and periumbilical area
seen in acute hemorrhagic pancreatitis.
Diverticulosis is outpouching or herniations of the intestinal mucosa
that can occur in any part of the intestine but most common in the sigmoid
colon.
Portal hypertension is common cause of esophageal varices.
Fetor hepaticus is the fruity, musty breath odour associated with
severe chronic liver disease.
Gastric resection (antrectomy) is removal of the lower half of the
stomach, usually including a vagotomy.
Gastrectomy (esophagojejunostomy and esophagoduodenostomy) is removal
of stomach with attachment of the esophagus to the jejunum or duodenum.
Hiatal hernia is a portion of the stomach that herniates through the
diaphragm and into the thorax.
Increased abdominal pressure such as pregnancy, ascites, obesity, tumors,
and heavy lifting are the causes of hiatal hernia.
Hiatal hernia is also called esophageal and diaphragmatic hernia.
Kock ileostomy (continent ileostomy) is an intraabdominal pouch constructed
from the terminal ileum.
Murphy's sign is a sign of gallbladder disease consisting of pain on
taking a deep breath when the examiner’s fingers are on the approximate location
of the gallbladder.
Escape of pancreatic enzyme into the surrounding tissue are cause of
pancreatitis.
Turner’s sign is a grey-blue discoloration of the flanks seen in acute
hemorrhagic pancreatitis.
Saliva contains the enzyme amylase (ptyalin).
Pepsin is the chief coenzyme of gastric juice, which converts proteins
into proteases and peptones.
Intrinsic factor is necessary for the absorption of vitamin B 12.
Gastrin controls gastric acidity.
The jejunum is about 8 feet long.
Ileum is about 12 feet long.
Small intestine terminates in the cecum.
Amylase digests starch into maltose.
Maltase reduces maltose into monosaccharide glucose.
Lactase splits lactose into galactose and glucose.
Sucrase reduces sucrose into fructose and glucose.
Nucleases split nucleic acids into nucleotides.
Enterokinase activates trypsinogen into trypsin.
Large intestine is about 5 feet long.
The ileocecal valve prevents contents of the large intestine from
entering the ileum.
Liver is the largest gland in the body, weighing 3 to 4 pounds.
Liver stores 200 to 400 mL of blood.
Liver stores vitamin A, D, and B or iron.
The presence of fatty materials in the duodenum stimulates the liberation
of cholecystokinin, which causes contraction of the gallbladder and relaxation
of the sphincter of Oddi.
Pancreas secretes sodium bicarbonate to neutralize the acidity of the
stomach contents that enter the duodenum.
The stools of client are chalky white in client after fluoroscopy to
barium swallow.
Nurse instruct the client to increase oral fluid intake to help pass
the barium after barium study.
Histamine or pentagastrin may be administered simultaneously to stimulate
gastric secretion in gastric analysis study.
Upper gastrointestinal fiberoscopy is also known as esophagogastroduodenoscopy.
During esophagogastroduodenoscopy the client is positioned on the left
side to facilitate saliva drainage and to provide easy access of the endoscope.
During esophagogastroduodenoscopy atropine sulphate may be administered
to reduce secretions and glucagon may be administered to relax smooth muscles.
In anoscopy the client is placed in the knee-chest position or left
lateral position.
In proctoscopy and sigmoidoscopy, the client placed on the left side
with the right leg bent and placed anteriorly.
Colonoscopy is performed with the client lying on the left side with
the knees drawn up to the chest.
The client receiving enemas is at risk for fluid and electrolyte imbalance.
Laparoscopy is also called peritoneoscopy.
Cholecystography is performed to detect gallstones and assess the ability
of gallbladder to fill, concentrate its contents, contract and empty.
Endoscopic retrograde cholangiopancreatography (ERCP) is examination of
the hepatobiliary system is performed via a flexible endoscope.
Endoscopic ultrasonography provides images of the GI wall and digestive
organ.
Following endoscope procedure nurse monitors for return of gag reflex
before giving any oral substance.
The rapid removal of fluid from the abdominal cavity during paracentesis
leads to decreased abdominal pressure which can cause vasodilation and
resultant shock.
Nurse measures abdominal girth, weight and baseline vital signs before
paracentesis.
In liver biopsy the client is placed in the supine or left lateral
position during the procedure to expose the right side of the upper abdomen.
After liver biopsy place the client on the right side with a pillow under
the coastal margins to decrease the risk of hemorrhage and instruct the client
to avoid coughing and straining.
Urea breath test detects the presence of helicobacter pylori, the
bacteria that cause peptic ulcer disease.
H. Pylori can also be detected by assessing serum antibody levels.
In urea breath test the client consumes a capsule of carbon labelled
urea and provides a breath sample 10 to 20 minutes later.
Client with gastroesophageal reflex disease avoid peppermint, chocolate,
coffee, fried and fatty foods, carbonated and alcoholic beverages or cigarette
smoking.
Client avoid to take anticholinergics and NSAIDS drug in gastroesophageal
reflex disease.
Client with gastroesophageal reflex disease avoid eating 2 hours before
bedtime, and wearing tight clothes and elevate the head of the bed on 6 to 8-inch
blocks.
Fundoplication is performed if medical treatment fails in client with
gastroesophageal reflex disease.
Client with gastritis avoid irritating food such as spicy and highly
seasoned foods, caffeine, alcohol and nicotine.
A peptic ulcer is an ulceration in the mucosal wall of the stomach,
pylorus, duodenum or esophagus.
The most common peptic ulcers are gastric and duodenum ulcer.
The predisposing factors of gastric ulcer stress, smoking, use of corticosteroids,
NSAIDS, alcohol, infection with H. Pylori.
Complications of gastric ulcer is hemorrhage, perforation and pyloric
obstruction.
Gnawing, sharp pain in or left of the midepigastric region occurs 30 to
60 minutes after a meal is features of gastric ulcer. Hematemesis is more common
than melena.
Burning pain occurs in the midepigastric area 1½ to 3 hours after a
meal and during night is a features of duodenum ulcer. (client awakens in
night). Melena is more common than hematemesis.
In duodenum ulcer pain is relieved by the ingestion of food.
In gastric ulcer pain is accentuated by ingestion of food.
In gastric ulcer nurse administer mucosal barrier protectants 1 hours
before each meal.
H2 receptor antagonists, proton pump inhibitors decrease gastric acid
secretion or antacids neutralize gastric secretion in peptic ulcers.
Infection with H pylori, alcohol intake, smoking, stress, caffeine, use
of aspirin, corticosteroids and NSAIDS are risk factors of duodenum ulcer.
Bleeding, perforation, gastric outlet obstruction and intractable
disease are complications of duodenum ulcer.
Bland diet with small frequent meals prescribed in peptic ulcer.
Dumping syndrome is the rapid emptying of the gastric contents into the
small intestine that occurs following gastric resection.
Client with dumping syndrome avoid sugar, salt and milk.
Client with Dumping syndrome eat a high protein, high fat and low
carbohydrates diet.
Client with Dumping syndrome eat small meals and avoid consuming fluids
with meals. Take antispasmodic to delay gastric emptying.
Intrinsic factor necessary for intestinal vitamin B12 absorption.
Gastric disease and surgery can result in a lack of intrinsic factor.
Severe pallor, fatigue, weight loss, smooth beefy red tongue,
paresthesia of the hands and feet; disturbance with gait and balance are signs of pernicious anemia.
Bariatric surgery is reduction of gastric capacity that may be
performed on a client with morbid obesity to produce permanent weight loss.
Types of bariatric surgery: Vertical banded gastroplasty, circumgastric
banding and gastric bypass (Roux-en-Y gastric bypass)
After bariatric surgery client avoid alcohol, high protein foods, food
high in sugar and fat.
After bariatric surgery client eat slowly and chew food well.
Acute cholecystitis is associated with cholelithiasis.
Chronic cholecystitis results when inefficient bile emptying and gallbladder
muscle wall disease.
Acalculous cholecystitis occurs in the absence of gallstones and caused
by bacterial invasion.
In cholecystitis occurs epigastric pain that radiates to the scapula 2
to 4 hours after eating fatty foods and may persist for 4 to 6 hours.
In Murphy's sign client cannot take a deep breath when the examiner’s
fingers are passed below the hepatic margin because of pain.
Client with chronic cholecystitis to eat small and low-fat meals.
Cholecystectomy is the removal of the gallbladder.
Choledocholithotomy requires incision into the common bile duct to
remove the stone.
After gallbladder stone surgery nurse monitors client for respiratory complications
and encourage for coughing and deep breathing.
A T-tube is placed after surgical exploration of the common bile duct.
A T-tube preserves the patency of the duct ensures drainage of the bile
until edema resolves and bile is effectively draining into the duodenum.
After placement of T-tube position the client in a semi-Fowler position
to facilitate drainage.
Cirrhosis of liver is a chronic progressive disease of the liver
characterized by diffuse degeneration and destruction of hepatocytes.
Repeated destruction of the hepatic cells causes the formation of scar
tissue.
Laennec’s cirrhosis, postnecrotic cirrhosis, biliary cirrhosis and
cardiac cirrhosis are the types of liver cirrhosis.
Laennec’s cirrhosis is alcohol induced and nutritional.
Postnecrotic cirrhosis is a complication of hepatitis or exposure to
hepatotoxins.
Biliary cirrhosis is results from biliary obstruction.
Cardiac cirrhosis is associated with severe right-sided congestive
heart failure.
Portal hypertension, ascites, bleeding esophageal varices, coagulation
defects, jaundice, portal systemic encephalopathy and hepatorenal syndrome are
complications of liver cirrhosis.
Caput medusae is the dilated abdominal veins.
Asterixis (flapping tremor) is seen in liver cirrhosis.
Asterixis is a coarse tremor characterized by rapid, nonrhythmic
extensions and flexions in the wrist and fingers.
Esophageal varices is the dilated and tortuous veins in the submucosa
of the esophagus.
Portal hypertension is the main cause of esophageal varices.
Endoscopic injection (sclerotherapy), endoscopic variceal ligation and
shunting are used to treat esophageal varices.
In sclerotherapy injection of sclerosing agent into and around bleeding
varices.
Endoscopic variceal ligation procedure involves ligation of the varices
with an elastic rubber band.
In shunting portacaval shunt, distal splenorenal shunt, mesocaval
shunting and transjuglar intrahepatic portosystemic shunt (TIPS) are perform to
correct esophageal varices.
Portacaval shunting involves anastomosis of the portal veins to the inferior
vena cava.
Distal splenorenal shunt involves anastomosis of the splenic vein to
the left renal vein.
Mesocaval shunting involves a side anastomosis of the superior
mesenteric vein to the proximal end of the inferior vena cava.
Transjuglar intrahepatic portosystemic shunt is the shunting between the portal and systemic venous system in
the liver to relieve portal hypertension.
Preicteric, icteric and posticteric are the stages of the viral
hepatitis.
Flu-like symptoms, malaise, fatigue, anorexia, nausea, vomiting,
diarrhoea, pain and serum bilirubin or enzyme level are elevated in preicteric
stage.
Jaundice, pruritus, dark and tea color urine, clay color stool and decrease
in preicteric phage symptoms are features of icteric phage.
Increase energy levels, subsiding of pain, minimal to absent GI symptoms
and serum bilirubin and enzyme level returns to normal are features of
posticteric phage.
In viral hepatitis alanine aminotransferase, aspartate aminotransferase
and total bilirubin level increase but alkaline phosphatase level may be normal
or mildly elevated.
Alanine aminotransferase was formerly called serum glutamic pyruvic
transaminase (SGPT).
Aspartate aminotransferase was formerly called serum glutamic
oxaloacetic transaminase (SGOT).
Hepatitis A formerly known as infectious hepatitis.
Hepatitis A is transmitted by faecal-oral route, person-to-person
contact parenteral route, contaminated fruits, vegetables, contaminated water
and milk or poorly washed utensils.
The incubation period is 2 to 6 weeks of hepatitis A.
Strict and frequent handwashing is key to preventing the spread of all
types of hepatitis.
Hepatitis B is called serological hepatitis.
IV drug user, client going long-term hemodialysis and health care
personnel are great risk for hepatitis B.
Hepatitis B is transmitted by blood and body fluid contact, infected
blood products, infected saliva and semen, contaminated needles, sexual
contact, parenteral, perinatal period or blood and bloody fluids contact at
birth.
6 to 24 weeks are incubation period of hepatitis B.
Infection with hepatitis C is common among IV drug users and is the major
cause of post transfusion hepatitis.
Hepatitis C risk factors are similar to those for hepatitis B because
hepatitis C is transmitted parenterally.
5 to 10 weeks are incubation period of hepatitis C.
Hepatitis D occurs with hepatitis B and causes infection only in the presence
of active hepatitis B infection.
Prevention of hepatitis B virus infection with vaccine also prevent
hepatitis D virus infection because hepatitis D virus depends on hepatitis B
virus for replication.
7 to 8 weeks are incubation period of hepatitis D.
Coinfection with the delta agent (hepatitis D virus) intensifies the acute
symptoms of hepatitis B.
Hepatitis E is waterborne virus. Risk of infection is same as for hepatitis
A.
Hepatitis G is non-A, non-B, non-C hepatitis.
Autoantibodies are absent in hepatitis G.
Risk factors of hepatitis G are similar to those for hepatitis C.
Hepatitis G virus does not appear to cause significant liver disease.
Client with hepatitis not to donate blood.
Client avoid kissing and sexual contact until hepatitis B surface
antigen test result is negative.
Client with hepatitis perform frequent strict handwashing, do not share
clothes, towel, eating and drinking utensils, toothbrush, and razors.
Client with hepatitis must not prepare food for other family members.
Abdominal pain, including a sudden onset at a midepigastric or left
upper quadrant location with radiation to the back is seen in pancreatitis.
In pancreatitis pain aggravated by a fatty meal, alcohol or lying in a
recumbent position.
Cullen’s sign is the discoloration of the abdomen and periumbilical
area. Turner’s sign is the bluish discoloration of the flanks. Both signs are
indicative of pancreatitis.
Steatorrhea and foul-smelling stools that may increase in volume are seen in pancreatic insufficiency.
Fat and protein intake limited in chronic pancreatitis.
Ulcerative colitis is an ulcerative and inflammatory disease of the
bowel that results in poor absorption of nutrients.
Ulcerative colitis is commonly beginning in the rectum and spreads
upward the cecum.
Acute ulcerative colitis results in vascular congestion, hemorrhage,
edema and ulceration of the bowel mucosa.
Chronic ulcerative colitis causes muscular hypertrophy, fat deposits and
fibrous tissue with bowel thickening, shortening and narrowing.
Severe diarrhoea that may contain blood and mucus. Malnutrition, dehydration
and electrolyte imbalances are features of ulcerative colitis.
In ulcerative colitis the diet usually a low fibre, high protein with
vitamin and iron supplements given.
Total proctocolectomy with permanent ileostomy, Kock ileostomy
(continent ileostomy), ileoanal reservoir and ileoanal anastomosis (ileorectostomy)
are surgical procedures to treat ulcerative colitis.
Normal stoma color is pink to bright red and shiny, indicating high
vascularity.
Pale pink stoma indicates low hemoglobin and hematocrit level.
Purple-black stoma indicates compromised circulation and requires
physician’s notification.
Empty the colostomy pouch when it is one-third full.
Crohn’s disease is an inflammatory disease that occurs anywhere in the
GI tract but most common affects the terminal ileum.
Crohn’s disease is characterized by remissions and exacerbation.
Nurse irrigating the colostomy pouch by 500 to 1000 ml of lukewarm
water.
Nurse hang the irrigation bottom of bag is at the level of the client’s
shoulder or slightly higher.
Client clamp the irrigation bag tubing if cramp occurs; release the
tubing as cramping subside.
Frequent colostomy irrigation leads to fluid and electrolyte loss.
Nurse perform irrigation same time in day and preferably 1 hours after
a meal.
Fever, cramp-like and colicky pain after meals, diarrhoea, abdomen
distension, nausea, vomiting weight loss, anemia, dehydration and electrolyte
imbalances with malnutrition are features of Crohn’s disease.
In appendicitis the pain occur in the periumbilical area that descends to the
right lower quadrant.
In appendicitis the abdominal pain that is most intense at McBurney’s
point.
Rebound tenderness, abdominal rigidity, low grade fever, elevated WBC
nausea and vomiting or client in side-lying position with abdominal guarding and
legs flexed are features of appendicitis.
Client with appendicitis nurse position the client in a right side-lying
or low to semi-Fowler position to promote comfort.
Avoid the application of the heat to the abdomen of the client with
appendicitis. Heat can cause rupture of the appendix leading to peritonitis, a life-threatening
condition.
Nurse apply ice packs to the abdomen for 20 to 30 minutes every hour
prescribed in appendicitis.
Diverticulosis is an outpouching or herniation of the intestinal mucosa.
Diverticulosis is occurred in any part of the intestine but is most
common in the sigmoid colon.
Left lower quadrant abdominal pain that increase with coughing,
straining or lifting is features of diverticulitis.
Hemorrhoids are dilated varicose veins of the anal canal.
Hemorrhoids are caused by portal hypertension, straining, irritation
or increased venous or abdominal pressure.
Bright red bleeding with defecation, rectal pain, rectal itching is sign
of hemorrhoids.
Apply cold packs to the anal-rectal area followed by Sitz bath is
prescribed in hemorrhoids.
Nurse provide high-fibre diet and fluid or stool softeners for client with
hemorrhoids.
Ultrasound, sclerotherapy, circular stapling, band ligation or simple
resection of the hemorrhoids (hemorrhoidectomy) are surgical treatment of
hemorrhoids.
After hemorrhoids surgery nurse assists the client to a prone or side-lying
position to prevent bleeding.
Application of Witch hazel soaks and topical anesthetics are prescribed
in client with hemorrhoids.
To prevent interaction with other medications nurse, allow 1 hour
between antacid administration and other medications administration.
Antacids should be taken 1 to 3 hours after each meal and at bedtime.
Aluminium compound, magnesium compound, calcium compound and sodium
bicarbonate are used as antacids.
Aluminium hydroxide is used to treat hyperphosphatemia; therefore, it can
cause hypophosphatemia.
Constipation is most common side effect of aluminium hydroxide.
Magnesium hydroxide is a saline laxative and most common side effect is
diarrhoea.
Calcium carbonate cause constipation and milk-alkali syndrome (the
client should avoid milk and vitamin D supplements)
Sodium bicarbonate cause systemic alkalosis in client with renal impairment.
Misoprostol and sucralfate are gastric protectants.
Misoprostol administers with meals.
Sucralfate creates protective barrier against acid and pepsin.
Sucralfate administered orally, should be taken on an empty stomach.
Pirenzepine is muscarinic cholinergic receptors agent suppresses acid
secretion.
Histamine 2 receptor antagonists suppresses secretion of gastric acid,
alleviate symptoms of heartburn, prevent stress ulcer and reduce recurrence of
all ulcers or promote healing in GERD.
Cimetidine, ranitidine famotidine and nizatidine are H2 receptor
antagonists.
Cimetidine and antacids should be administered at list 1 hour apart
from each other.
Esomeprazole, pantoprazole, lansoprazole, rabeprazole and omeprazole
are proton pump inhibitors drugs.
Triple therapy and quadruple therapies are used to treat helicobacter
pylori infection.
Triple therapy: Esomeprazole, amoxicillin and clarithromycin.
Quadruple therapies are two types: (a)Esomeprazole, metronidazole,
tetracycline and bismuth subsalicylate. (b) Ranitidine, metronidazole, tetracycline
and bismuth subsalicylate.
Metoclopramide is prokinetic agent used to treat GERD and paralytic
ileus.
Metoclopramide can cause parkinsonian reaction if this occurs
discontinued the medication.
Bile acid sequestrants used to treat hypercholesterolemia in adult.
Bile acid sequestrants should be used cautiously in client with suspected
bowel obstruction or severe constipation because they can worsen these conditions.
Colesevelam, cholestyramine and colestipol are bile acid sequestrants
drug.
Lactulose is drug used to treat portal systemic encephalopathy including
precoma and coma; also used in the treatment of chronic constipation.
Lactulose promote peristalsis and bowel evacuation, expelling ammonia
from the colon and thus lowering the ammonia level.
Pancreatin and pancrelipase are pancreatic enzyme.
Client should take pancreatic enzyme with all meals and snacks.
A deficiency of pancreatic enzymes can compromise digestion especially
the digestion of fats.
Antiemetics can cause drowsiness; therefore, a priority intervention is
to protect the client from injury.
The client receiving a laxative, need to increase fluid intake to
prevent dehydration.
Larynx is also called the voice box.
Larynx contains two pairs of vocal cords the false and true.
The opening between the true vocal cords is the glottis.
The right bronchus is slightly wider, shorter, and more vertical than
the left bronchus.
The bronchioles contain no cartilage and depend on the elastic recoil
of the lung for patency.
Type II alveolar cells in the walls of the alveoli secrete surfactant.
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