NCLEX-RN Topic 3: Peptic Ulcer Disease

DUODENAL ULCER

Incidence:Age 30–60

Male: female _ 2–3:1

80% of peptic ulcers are Duodenal

Signs, Symptoms, and Clinical Findings
Hypersecretion of stomach acid
(HCl)

May have weight gain

Pain occurs 2–3 hours after a meal; Pain relieved by eating; often awakened between 1–2 AM; ingestion of food relieves pain

Vomiting uncommon

Hemorrhage less likely than with gastric ulcer, but if present melena more common than hematemesis More likely to perforate than gastric ulcers

Malignancy Possibility: Rare

Risk Factors: H. pylori, alcohol, smoking, cirrhosis, stress



GASTRIC ULCER

Incidence: Usually 50 and over

Male: female _ 1:1

15% of peptic ulcers are gastric

Signs, Symptoms, and Clinical Findings
Normal—hyposecretion of stomach acid (HCl)

Weight loss may occur

Pain occurs 1⁄2 to 1 hour after a meal; Pain is exacerbated by food; rarely occurs at night; may be relieved by vomiting; ingestion of food does not help, sometimes increases pain

Vomiting common

Hemorrhage more likely to occur than with duodenal ulcer; hematemesis more common than melena

Malignancy Possibility: Occasionally

Risk Factors: H. pylori, gastritis, alcohol, smoking, use of NSAIDs, stress

NCLEX-RN Topic 2: Dumping Syndrome

• Dumping syndrome: is a common complication of gastric resection when the pylorus is bypassed and is a postprandial problem of rapid dumping of food into the jejunum without proper mixing and duodenal digestion
  
  ü Early manifestations: occur 15 to 30 minutes after eating and including vertigo, tachycardia, syncope, sweating, pallor, palpitations; believed to be caused by a rapid shift of extracellular fluid into the bowel to dilute the hypertonic chime thereby causing a decrease in blood volume
  
  ü Late manifestations occur 2 to 3 hours postprandial and include epigastric fullness, distension, diarrhea, abdominal cramping, nausea and high pitched bowel sounds; these symptoms are caused by excessive release of insulin in response to a rapid rise in blood glucose due to high carbohydrate bolus entering the jejunum
  
  ü Dumping syndrome can be minimized by a low-carbohydrate, high protein, high-fat diet; suggest also that client avoid drinking fluids and meals and lie down after eating; antispasmodics or sedatives may be ordered to delay gastric emptying
  
  Billroth I (gastroduodenostomy): a partial gastrectomy where the distal portion of the stomach (including the antrum) is removed and the remainder is anastomosed to the duodenum; the gastrin producing cells in the antrum are removed as well as some of the parietal cells (acid pepsinogen secreting cells)
  
  ü preoperative and postoperative care is the same as for any client having gastric surgery
  ü dumping syndrome is a common complication of this procedure
  
  Billroth II (gastrojejunostomy): a partial gastrectomy where the lower portion of the stomach is removed and the proximal remnant is anastomosed to the jejunum; used to treat gastric and duodenal ulcers
  
  ü preoperative and postoperative care is the same as for any client having gastric surgery
  ü dumping syndrome is a common complication of this procedure
  
  
  

NCLEX-RN Topic 1: Alport Syndrome

Alport syndrome is a genetic disorder characterized by glomerulonephritis, endstage kidney disease, and hearing loss. Alport syndrome can also affect the eyes. The presence of blood in the urine (hematuria) is almost always found in this condition.

Alport Syndrome is an inherited disease of the kidney that can also affect the inner ear (cochlea) and eye. It is estimated to effect at least 1 in 5,000 people. It is caused by genetic mutations that affect the type IV collagen family of proteins. Type IV collagen is a major part of important tissue structures called basement membranes that are present in all tissues including the kidney, inner ear, and eye. Generally, Alport Syndrome affects boys more than girls because 80% of the time the disease is passed on by a mutation on the X chromosome (called X-linked Alport Syndrome).

Manifestations:

• Hematuria which is usually microscopic
• Brown, pink, or red urine (gross hematuria) for several days, associated with a cold or flu
• Protein in the urine (proteinuria) and high blood pressure
• Hearing loss
• Anterior lenticonus may have a slow progressive deterioration of vision requiring patients to change the prescription of their glasses frequently. This condition may also lead to cataract formation
• Some people with Alport Syndrome have abnormal pigment of the retina called dot-and-fleck retinopathy, but this does not result in any abnormalities of vision
• Recurrent corneal erosion is another eye problem

Alport Syndrome Treatment

There is no treatment that has been proven to prevent the development of kidney failure in people with Alport Syndrome. It is very important for people with Alport Syndrome to be examined regularly by a Nephrologist, so that effects of kidney disease, such as hypertension (high blood pressure), can be identified early and treated. Regular hearing and vision evaluation is also important.

Medication

Data from studies suggest the benefits from angiotensin-converting enzyme (ACE) inhibitors in reducing proteinuria (protein in the urine) and progression of renal disease.

ACE inhibitors that have been used to treat Alport Syndrome patients include, but are not limited to:
Enalapril (Vasotec)
Fosinopril (Monopril)
Lisinopril (Zestril, Prinivil)

Quinapril (Accupril).

Angiotensin receptor blockers (ARBs) have also been used in patients with proteinuria as ARBs were shown to delay progression to kidney failure.

ARBs that have been used to treat Alport Syndrome patients include, but are not limited to:
Losartan (Cozaar)

Candesartan (Atacand).