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Med Surg Ch 33

Nursing care of patients with upper GI disorders

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