Alterations in Nutrition. Gastroesophageal Reflux Disease Peptic Ulcer Disease Cholecystitis/Gastric Surgery. Upper GI. Gastroesophageal Reflux Disease(GERD). Occurs when contents of the stomach including stomach juices (flow back) into the esophagus. Causes for GERD.
Gastroesophageal Reflux Disease
Peptic Ulcer Disease
Pain after eating
Pain is worsened when the patient bends over at the waist or reclines.Signs and Symptoms of GERD
Intra-abdominal pressureWhy does Hiatal Hernia happen?
BelchingWhat are the symptoms of Hiatal Hernia ?
Bloating or indigestion soon after eating.
Vague pain in the upper abdomen.
Blood in vomits or blood in the stoolSymptoms of gastric carcinoma
removal of the distal 1/2 to 2/3 of the stomach.
Removal of the gastrin producing cells area of the stomach.
Surgical enlargement of an opening between stomach and duodenum to improve gastrin emptying.
Vagotomy severing all or part of the vagus nerve to significantly reduce the parietal cell acid secretion.Other gastric surgeries:
Epigastric pain with cramping.
Loud, hyperactive bowel sounds (borborygmi)
Symptoms of hypovolemia and reflex sympathetic stimulation: dizziness flushing, Diaphoresis
tachycardiaWhat might be the manifestation of Dumping syndrome
Pain:gnawing,burning,aching or hunger like in the epigastric region
Pain occurs when the stomach is empty,2-3 hours after a meal or during the night.
May have heartburn, regurgitation or vomiting.Manifestation of Peptic Ulcer Disease
Stool for occult blood
Upper GI series less costly than gastroscopy and able to see 80% to 90% of ulcers (misses small and superficial ulcers)
Gastroscopy is definitive tool for diagnosis of PUD.Lab and Diagnostic testing used for peptic ulcer disease
Proton pump binds the acid secreting enzyme (H+ K+ ATPase) that function as proton pump disabling it for 24hrs
H2- receptor antagonists which inhibits histamine binding to the receptors on the gastric parietal cell to reduce acid secretion.
Zantac, Pepcid, Tagamet and AxidMedications that decreased the gastric acid content in PUD
Sulcrafate-bids to protein in the ulcer base forming a protective barrier.
Bismuth compounds stimulate mucosal bicarbonate and prostaglandin production.
Prostaglandin analogs promote healing by stimulating mucous and bicarbonate secretions and by inhibiting acid secretion (Misoprostol)
Antacid stimulate gastric mucosal defenses.Agents that protect the mucosa in PUD
Usually two antibiotics with either bismuth or proton pump. protective barrier.
Tetracycline or (Amoxicillin)
The regimen to treat H. Pylori is usually taking for 14 days.
NU 230 students are responsible for understanding the actions, nursing implications, adverse effects and drug interaction of the drug classes to treat PUD.Eradication of H. Pylori in PUD
Multiple lesions protective barrier.
Not usually painful
Gastric bleeding 2 or more days after the stressor.
Bleeding typically minimal but may be massive.
High mortality rate.Characteristics of stress ulcers:
Assess location, quality, acuity,frequency and duration. protective barrier.
Administer antiacids, H2-receptor antagonists, proton pump inhibitors or mucosal protective agents.
Provide adjunctive relief therapy such as distraction,relaxation (back rub, change position) and breathing exercises.
Teach life style management techniques.Pain : nursing interventions
Assess the patient current diet, including pattern of food intake, eating schedule, and food that precipitate pain.
Arrange a nutritional consult.
Monitor for symptoms of fullness, anorexia, nausea or vomiting.
Monitor lab values related to nutritional deficit.
B12 levelsAlteration in nutrition
Monitor vital signs closely. intake, eating schedule, and food that precipitate pain.
Orthostatic blood pressure at the beginning of shift
Maintain Accurate I &O (foley may be needed)
Monitor stool and gastric drainage for occult and overt blood.
Maintain IV therapy with fluid volume and electrolytes replacement.
Insert NGT and lavage if needed.Fluid volume deficit
Monitor laboratory data for hemoglobin, hematocrit, and serum electrolytes.
Replace decreased HCT with whole blood or RBCS
Assess abdomen for distention, BS, and tenderness q4hrs and record.Fluid volume deficit
Family History serum electrolytes.
Native American, Caucasian, Mexican American
Females(oral contraceptive use and pregnancy)
Patients on TPN
Certain disease (see text, p.512)Who is at risk for gallstones?
Stones in cystic duct serum electrolytes.
causes gallbladder to distend, result in in severe cramping , colicky pain.
Secondary infection combined with severe inflammation and edema result in duct blockage and abdominal pain.
Obstruction of the common bile duct.
May result in bile reflux into the liver producing jaundice, pain hepatic damage, pancretitis or sepsisCholethiasis
Epigastric pain serum electrolytes.
Right upper abdominal pain.
Intolerance to fat containing foodsClinical manifestation of cholelithiasis
Family history of gallbladder stones serum electrolytes.
use of oral contraception
Diseases or conditions
Mexican AmericansFactors that increase the risk for cholelithiasis
Fever serum electrolytes.
Abdominal muscle guarding with rebound tenderness and rigidity
Elevated Alkaline phosphatase
Elevated amylaseSigns and symptoms that might be present with cholecystitis
Complete blood count serum electrolytes.
Serum amylase and lipase to check for pancretitis.
oral dye is use to assess the gallbladder’s ability to concentrate and excrete bile.Diagnosis studies in cholecystitis
Pharmacology with oral bile acids. serum electrolytes.
Diet therapy with low fat diet and weight loss.
Surgery: it depend on the stone location and severity of the complications
.Treatment of cholethiasis
The major pharmacological interventions are aimed at curing gallstones involves a group of agents oral bile acid call dissolvers.
is for cholesterol stones less than 20mm in diameter.
Pt. Need to have hepatic enzymes monitor closely
watch for diarrheaPharmacology
Chenodeoxycholic (Chenodiol) which work by decreasing cholesterol in the diet.
Other pharmacologic agents are use for palliative relief such as
Antibiotics -to decrease bacteria count and associate inflammation and edema.
Dietary fats are a stimulus for gallbladder contraction cholesterol in the diet.
Patients need to be put on a low fat diet.
If bile flow is reduced because of obstruction fat soluble vitamins A, D, E, and K and bile salts needs to be replaced.
Examples of high fat food to avoid : deep fried foods, whole milk etc..Diet therapy
The type of surgical procedure performed for the client with gallstones depends on were the stones are located and severity of complications.
If the stones are located only in the Gallbladder a simple Cholecystectomy is performed.
Conventional surgical methods.
Laparascopic laser surgerySurgery
When stones are lodged within the ducts, a Cholecystectomy with common bile duct exploration and T- tube insertion may be indicated.Surgery
Inserted after common bile duct exploration a T-tube maintain patency of the duct and promotes bile passage while the edema decreases.Surgery
Lithotrypsy or Percutaneous stone dissolution. With extracorporal shock wave lithotrypsy (ESWL). The physician uses ultrasound to align the stones with the source of shock waves and computerized lithotripter.
Percutaneous stone dissolution is a treatment option for patients who are a high risk for post surgical problems using a fluoroscopy the MD ,may position a catheter via the biliary system. Dissolution agents are then instill.Treatment alternatives
Teach clients to avoid fat in their diets cholecystitis
fat stimulate gallbladder contractions and is a stimulus for pain .
Administer prescribed medications such as Dicyclomine (Bentyl) used to decrease spasm and relax muscle.
If pain is not relieved by these methods administer prescribed narcotics
Check for elevation of temperature q4hrs.
Assist the patient to semi Fowler’s position.Pain related to gallbladder problems
Patients may have problems with effective breathing and gas exchange because of abdominal incision.
Institute a regiment of turning, deep breathing and coughing at least every 2 hrs.
Use incentive spirometer every hour while awake.
OOB ambulating as soon as possible.Risk for impair gas exchange
Infections may arrive from various sources. exchange because of abdominal incision.
Asses for signs of systemic and localized infections during the post period.
Asses wound q4hrs
Performed abdominal assessment q4hrs.
Monitor labs QD
Administer prescribe antibiotics as order.
Use aseptic technique when doing invasive procedures,Risk for infection