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Chapter 48
Unit 7: Nursing care of clients with gastrointestinal disorders
| Question | Answer |
|---|---|
| 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!
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