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Chapter 48

Unit 7: Nursing care of clients with gastrointestinal disorders

Esophagus (Pg. 538) -what kind of muscle -where does it start/end -sphincters -Smooth muscle tube -Throat to the stomach -UES and the LES (prevent reflux of food & fluids into the mouth or esophagus
Esophageal disorders: (2) GERD & Esophageal varices
GERD (Pg.538) Characterized by.. Gastroesophageal reflux disease -gastric content & enzyme back flow into the esophagus -irritate esophageal tissue (delay in clearance & acidic exposure)
Primary tx of GERD: Diet & lifestyle changes, advancing to med use & surgery
3 types of meds used to tx GERD Antacids, h2 receptor antagonists, PPI
Risks to GERD: wt, age, sleep, tubes obesity, older age (delayed gastric emptying & weak LES), sleep apnea, NG tube (open sphincter)
Contributing factors to GERD: -what kind of food relax the LES.. Fatty & fried foods, chocolate, caffeine, peppermint, spicy foods, tomatoes, citrus fruits & alcohol
Other contributing factors to GERD: overeating, pregnancy, obesity, bending at waist, ascites, tight waist clothing -stress, hiatal hernia, lying flat
What kind of meds relax the LES: theophylline, nitrates, ccb, anticholinergics, dizepam (valium) -NSAIDs (increase gastric acid)
S/S: -pain type & worsens with dyspepsia, regurgitation, wave-like pain and may radiate, pain worsens w/ position, pain after eating
S/S of GERD; throat irritation causing.. chronic cough & laryngitis
S/S GERD; -salivation, taste in mouth -chest pain -gas & burping -how is pain relieved -Hypersalivation, bitter taste in mouth -chest pain caused by esophageal spasm -increased gas & eructation -pain relieved by sitting up, drinking water or taking antacids
How are s/s of GERD considered dx? Occur 4-5x/week on a consistent basis
DX procedures for GERD: EGD Nursing action post Esophagogastroduodenoscopy; moderate sedation, observes tissue damage -Verify gag reflex has returned
DX procedures for GERD: 24-hr ambulatory esophageal pH monitoring -nursing actions * most accurate method to dx!! Small catheter is placed through nose into E & pH readings are recorded in relation to food, position & activity -nursing: keep journal of foods & fluids consumed, & activity
DX procedures for GERD: Esophageal manometry Records lower esophageal sphincter pressure -keep a diary as well
DX procedures for GERD: Barium swallow test to identify a ____ Hiatal hernia; could cause GERD
Medications for GERD: Antacids -med contraindication Aluminum hydroxide (Mylanta); neutralizes excess acid -contra to levothyroxine
When is acid secretion the highest? 1-3 hrs after eating & at bedtime
When should a client take an Antacid? When acid secretion is the highest -1 hr before or after other meds are given
H2 receptor antagonists (Pg. 540) onset & duration compared to antacids Ranitidine (Zantac), famotidine (pepcid) & nizatidine (Axid) -Reduce secretion of acid -longer onset than antacids but longer duration
When should client's take H2 receptor antagonists? With meals & at bedtime
nizatidine (Axid) should not be mixed with what? Vegetable-based juices
Proton pump inhibitors (PPI's) Pantapraxole (protonix), omeprazole (prilosec), esomeprazole (Nexium), lansoprazole (prevacid) -reduces gastric acid by inhibiting the cellular pump necessary for gastric acid secretion
PPI sustained release capsules can open and sprinkle into applesauce, food, etc.
Prokinetics: Metoclopramide hydrochloride (Reglan) -Increases motility of the esophagus & stomach
GERD therapeautic procedures: -stretta procedure Uses radio frequency energy w endoscope to reduce vagus nerve activity on LES (tightens/contracts it)
Surgical interventions: GERD Fundoplication Fundus of stomach is wrapped around & behind the esophagus through a laproscope to create a physical barrier
Diet client education for GERD: -avoid ___ meals, remain ___ after eating, avoid eating before ___ large meals, upright, bedtime
Lifestyle education for GERD: clothing, wt, bed, which side to sleep on avoid tight clothing around abdomen, lose wt if obese, elevate HOB 6-8in w/ blocks (pillows not recommended), sleep on right side
Complications of GERD Aspiration & barrett's epithelium and esophageal adenocarcinoma
Reflux of gastric fluids leads to _____ Esophagitis.. can lead to premalignant epithelial tissue (barrett's) or malignant
Esophageal varices -What are they? Swollen, fragile blood vessels in the esophagus -can hemmorhage
Esophageal varices risk factors? Portal htn, alcoholic cirrhosis, viral hepatits, older age
S/S of varices: May be asymp until start to bleed; hematemesis and melena -triggering by valsalva, lifting heavy objects, sneezing/coughing, alcohol .. hypotension, tachycardia if bleeding
Varices labs: LFTs, H&H
Varices dx: Endoscopy
Meds for Varices: Non-selective BB & vasocontrictors
Nonselective BB Propranolol (inderal) Decrease HR & consequently reduce hepatic venous pressure -prophylactically
Vasoconstrictors IV terlipressin (synthetic vasopressin) & natural somatostatin increases portal inflow -not given w CAD
Created by: mary.scott260!