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Nutrition, GERD, PUD
Parenteral and Enteral and GERD and PUD
| Question | Answer |
|---|---|
| enteral nutrition | have functioning GI tract but person does not consume enough calories or are at risk for aspiration - tube feeds administered into stomach, duodenum, or jejunum |
| advantages of enteral | easily administered, does not have to be sterile, safer than parenteral, more physiologically efficient, less effective |
| indications for enteral nutrition | anorexia, orofacial fracture, head / neck cancer, neuro or psych conditions, extensive burns, chemo/ radiation |
| pros of small bore enteral nutrition tubes | flexible, small and more comfortable |
| cons of a small bore enteral nutrition tube | prone to obstruction, more difficult to use, clog easier, easy to dislodge |
| pros of large bore (NG/ OG) tube | less likely to clog, easier to place |
| cons of large bore ( NG/ OG) tube | more likely to damage mucosa, may not be able to place in small intestine |
| EN nursing management | check tube placement by x-ray, assess bowel sounds, assess tube patency before each use, daily weights, I&O, pump tubing change q24 hour, decrease aspiration by HOB 30-45 degrees |
| EN complications | tube obstruction, improper placement, aspiration, diarrhea, dehydration |
| EN gerontologic considerations | more vulnerable to : fluid and electrolyte imbalances, aspiration, glucose intolerance, decreased ability to handle large volumes |
| parenteral nutrition | administration of nutrients directly into the bloodstream |
| types of PN | central line TPN- hypertonic peripheral (PPN)- isotonic |
| goal of PN | meet nutritional needs and allow growth of new body tissue |
| indications for PN | chronic severe diarrhea and vomiting, GI obstruction, severe anorexia, severe malabsorption, short bowel syndrome, GI tract anomalies |
| PN composition | base solutions contain dextrose and protein in form of amino acids prescribed electrolytes, vitamins, and trace elements IV fat emulsions are added |
| re-feeding syndrome | fluid retention, fluid and electrolyte imbalances, low phosphorus - cardiac, neurologic, paresthesia |
| metabolic complications of PN | hyperglycemia, and pre-renal asotenia |
| PN nursing management | site care, labs (CBC, BUN), daily weight, hypo/hyperglycemia, CAUTI, assess effectiveness |
| patient teaching for PN | catheter or tube care, mixing and handling of tubing and solution, side effects and complications |
| risk factors for GERD | lower esophageal sphincter is incompetent --> decreased LES pressure, increased intra-abdominal pressure |
| clinical manifestations of GERD | heartburn, dyspepsia, regurgitation, chest pain but relieved by antacids, wheeze and cough, lump in throat, hoarseness, over salivation |
| esophagitis | inflammation of esophagus, frequent complication of GERD, repeated exposure |
| Barrett's esophagus | reversible change from one cell type to another, caused by abnormal stimulus, s/s vary |
| respiratory complications with GERD | bronchospasm, frequent / chronic cough, asthma, bronchitis, pneumonia |
| lifestyle modifications with GERD | avoid triggers, stop smoking, decrease stress |
| nutritional therapy for GERD | drink fluids between meals, small frequent meals, chew gum, avoid foods that decrease LES pressure |
| drug therapy for GERD | proton pump inhibitors - omeprazole, pantoprazole (Protonix) histamine (H2) receptor blockers (famotidine, pepcid) antacids (mylanta) |
| nursing management for GERD | positioning (HOB above 30 degrees), small frequent meals, avoid alcohol, smoking, caffeine, acidic foods, lose weight |
| PPI side effects | cdiff, fractures of hip, wrist and spine |
| peptic ulcer disease | erosion of GI mucosa resulting from digestive action of HCl acid and pepsin |
| acute peptic ulcer disease | superficial erosion, minimal inflammation and short duration |
| chronic peptic ulcer disease | long duration, can involve muscular wall, abrasion present continually for months or intermittent throughout life |
| gastric PUD | superficial lesions, round, oval located in the antrum or body of the stomach |
| clinical manifestations of gastric PUD | burning or gaseous pressure in epigastrum, pain 1-2 hr after meals |
| duodenal PUD | penetrating lesion, located in first 1-2 cm of duodenum |
| clinical manifestations of duodenal PUD | burning, cramping pressure-like pain across midepigastrum and upper abdomen, pain 2-5 hours after meals, periodic and episodic, pain relived with antacids and food |
| stress related mucosal disorder | acute ucler that develops after major physiologic wall insult --> trauma, surgery, burns |
| prevention of stress related mucosal disorder | PPIs, H2 blocker, monitoring, CBC |
| risk factors for PUD | smoking, H. Pylori, drugs, alcohol, emotional factors |
| perforation of ulcer | sudden severe abdomen pain, rapid shallow respirations, rigid abdomen, weak pulse, N/V |
| gastric outlet obstruction | pain will worsen at the end of the day, projectile vomit, dehydration, decreased PO intake |
| conservative treatment for PUD | rest, avoid alcohol, and drugs |
| drug therapy for PUD | PPIs, H2 receptor blockers, antacids and antibiotics if H.Pylori is found |
| surguical treatment for PUD | only indicated with continual bleeding or if massive amount of loss |
| PUD gerontologic considerations | monitor NSAID use first indicators of PUD- frank gastric bleeding, decreased hematocrit, educate on diet and meds, report abdominal discomfort |
| what foods decrease LES pressure | alcohol, caffeine, fatty foods, chocolate, peppermint and spearmint |
Created by:
ebrewer12
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