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Med Surg Ch 33
Nursing care of patients with upper GI disorders
| Question | Answer |
|---|---|
| What happens with prolonged nausea and vomiting | dehydration and electrolyte imbalance |
| What is priority nursing care during vomiting | protection of the airway; place pt on his side; elevate the head of the bed |
| Ginger and nausea | can be effective aid in relieving nausea in cancer pts receiving chemotherapy, in pregnant pts, and in postoperative pts |
| What can prolonged anorexia with inadequate nutritional intake lead to | serious electrolyte imbalances, which can lead to cardiac arrhythmias |
| S/S of Bulimia Nervosa | enamel erosion of front teeth and staining; metabolic alkalosis |
| Oral health care | important to overall health; often neglected in daily care |
| Oral hygiene with chlorhexidine gluconate | prevents pneumonia; reduces ventilator-associated pneumonia |
| Xerostomia | dry mouth |
| What can Xerostomia lead to | rampant tooth decay |
| What should be done before any radiation therapy of the head or neck area | thorough oral exam and any needed restorative dental procedures should be completed |
| What contains lubricants and other compounds to protect the teeth after radiation therapy | artificial saliva substitutes |
| Stomatitis | inflammation of oral cavity |
| Stomatitis causes | self-induced trauma; stress; exposure to irritating foods; canker sores and cold sores |
| Treatment for stomatitis includes | topical tetracycline, topical anesthetic |
| Oral cancer nursing care postoperatively: major concerns | airway patency; communication; nutritional needs; airway must be monitored and secretions controlled to prevent occlusion and aspiration |
| Sliding hiatal hernia | stomach slides up into the thorax cavity when pt is supine and usually slides back into the abdomen cavity when the pt is upright |
| GERD therapeutic Interventions | low fat, high protein diet; small, frequent meals; drink fluid between meals instead of with meals; avoid late evening snack and avoid fluid intake 2-3 hours before bedtime |
| Antacids | Mylanta, Tums, Gaviscon |
| H2 Receptor Antogonists | Tagamet, Pepcid, Zantac, Axid; for mild to moderate symptoms |
| Proton Pump Inhibitors | Nexium, Prevacid, Protonix, Aciphex; Reduce acid in the stomach; used for frequent, severe symptoms and Barrett’s esophagus |
| Prokinetic Agents | Reglan, Maxolon, Not first choice meds due to side effects; Improve gastric emptying and function of LES |
| Nursing interventions for pt with acute pain related to GERD | sleep with head of bed elevated 4-6 inches; eat small meals; avoid lying down for 2 hrs. after eating; avoid smoking and alcohol; avoid foods that cause discomfort |
| GERD patient education | lose weight; low-fat, high-protein diet; avoid caffeine, milk products, spicy foods |
| Chronic Gastritis Type A | autoimmune gastritis; occurs in fundus of stomach; asymptomatic; do not secrete enough intrinsic factor and as result can’t absorb Vit. B12 which leads to pernicious anemia |
| Chronic Gastritis Type B Pathophysiology | affects antrum and pylorus; from infection with Helicobacter pylori; most common type of gastritis |
| Test to diagnose peptic ulcer disease | EGD |
| Therapeutic Interventions for peptic ulcer disease | Antibiotics; Proton Pump Inhibitors; Histamine H2 Antagonists; Bismuth Subsalicylate |
| Proton pump inhibitor and peptic ulcer disease | stop final step of gastric acid secretion to reduce mucosal erosion and aid in healing ulcers |
| Histamine H2 Antagonists and peptic ulcer disease | decrease acid secretion but not as powerful as PPI |
| PPI (‘azole) and peptic ulcer disease | Give before meals; capsule swallowed whole, do not crush, chew, open, notify PHCP of bleeding, diarrhea, headache, abdominal pain |
| What complication should you watch for with peptic ulcer disease | s/s of bleeding |
| With peptic ulcer disease, if obstruction is due to scar tissue what can correct the problem | pylorplasty |
| Stress ulcers; preventive treatment | quick trauma care to restore oxygen; early feeding (within 24 hrs.); placement of NG tube to test gastric pH - keep above 5 – and enteral feeding; Antacids, Histamine Blockers, Sucralfate |
| Signs of gastric bleeding: commonly from peptic ulcers | hematemesis; melena; when blood mixes with hydrochloric acid and enzymes of stomach, a dark, granular material resembling coffee grounds is produced |
| Gastroduodenostomy (Billroth I) | distal stomach removed; anastomosed to duodenum; treats gastric problems |
| Gastrojejunostomy (Billroth II) | More distal stomach removed; anastomosed to jejunum; treats duodenal problems |
| Intake and Output: NGT | do not irrigate the tube in the immediate pot operative period; do not reposition the tube |
| What s/s must be reported to the physician | enlarged abdomen; epigastric pain; tachycardia; hypotension; feeling of fullness; hiccups; repeated gagging |
| After gastric surgey, what do you irrigate with (not immediately post operatively) | saline |
| Dumping syndrome | result of rapid entry of food into the jejunum without proper mixing of food with digestives juices |
| What does dumping syndrome cause | decrease in circulating blood volume and produces symptoms usually in 5-30 minutes after eating or being fed |
| S/S of dumping syndrome | Dizziness, sweating, nausea, diarrhea, feeling of fullness, abdominal cramping |
| Dumping syndrome treatment | eat small frequent meals; high in protein and fat, low in carbohydrates; avoid fluids 1 hr. before meals, during meals and for 2 hrs after meals; pt can lie down to delay gastric emptying; s/s may improve up to 6 months after gastric surgery |
| Pernicious anemia treatment | Lifelong replacement of Vit. B12 will be required |
| Complication of gastric surgery | pyloric obstruction |
| Pyloric obstruction | As obstruction increases it becomes more difficult for the stomach to empty and symptoms worsen |
| What does pyloroplasty do | widens the exit of the pylorus to improve emptying of stomach |
Created by:
laotracuata
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