
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.
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Gastroesophageal Reflux Disease
Peptic Ulcer Disease
Cholecystitis/Gastric Surgery
Chest pain
Regurgitation
Pain after eating
Dysphagia
Belching
Sore throat
Hoarseness
Pain is worsened when the patient bends over at the waist or reclines.
Signs and Symptoms of GERDChest pain
Occult bleeding
Regurgitation
Dysphasia
Belching
What are the symptoms of Hiatal Hernia ?Bloating or indigestion soon after eating.
Vague pain in the upper abdomen.
Heartburn
Nausea/vomiting
Poor appetite
Blood in vomits or blood in the stool
Symptoms of gastric carcinomaremoval of the distal 1/2 to 2/3 of the stomach.
Antrectomy:
Removal of the gastrin producing cells area of the stomach.
Pyloroplasty:
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:Vomiting
Epigastric pain with cramping.
Diarrhea
Loud, hyperactive bowel sounds (borborygmi)
Symptoms of hypovolemia and reflex sympathetic stimulation: dizziness flushing, Diaphoresis
tachycardia
What might be the manifestation of Dumping syndromePain: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 DiseaseH. Pylori
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 diseaseProton 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 Axid
Medications that decreased the gastric acid content in PUDBismuth 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 PUDTetracycline or (Amoxicillin)
Metronidazole
Bismuth subsalicylate
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 PUDSuperficial
Usually fundus
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: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 interventionsArrange a nutritional consult.
Monitor for symptoms of fullness, anorexia, nausea or vomiting.
Monitor lab values related to nutritional deficit.
Albumin
Iron studies
B12 levels
Alteration in nutritionOrthostatic blood pressure at the beginning of shift
Maintain Accurate I &O (foley may be needed)
Weigh QD
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 deficitReplace decreased HCT with whole blood or RBCS
Assess abdomen for distention, BS, and tenderness q4hrs and record.
Fluid volume deficitNative 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?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 sepsis
CholethiasisHeartburn
Right upper abdominal pain.
Jaundice
Intolerance to fat containing foods
Clinical manifestation of cholelithiasisFemale gender
pregnancy
use of oral contraception
Hyperalimentation
Aging
Diseases or conditions
Native Americans
Caucasians
Mexican Americans
Factors that increase the risk for cholelithiasisIncrease WBCs
Abdominal muscle guarding with rebound tenderness and rigidity
Elevated bilirubin
Elevated Alkaline phosphatase
Elevated amylase
Signs and symptoms that might be present with cholecystitisSerum amylase and lipase to check for pancretitis.
Serum bilirubin
Gallbladder scans
oral cholecystogram
oral dye is use to assess the gallbladder’s ability to concentrate and excrete bile.
Diagnosis studies in cholecystitisDiet therapy with low fat diet and weight loss.
Surgery: it depend on the stone location and severity of the complications
.
Treatment of cholethiasisUrodeoxycholic (UDCA)
is for cholesterol stones less than 20mm in diameter.
Pt. Need to have hepatic enzymes monitor closely
watch for diarrhea
PharmacologyOther pharmacologic agents are use for palliative relief such as
Antibiotics -to decrease bacteria count and associate inflammation and edema.
Pain medications
PharmacologyPatients 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 therapyIf the stones are located only in the Gallbladder a simple Cholecystectomy is performed.
Conventional surgical methods.
Laparascopic laser surgery
SurgeryPercutaneous 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 alternativesfat 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 problemsInstitute 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 exchangeAsses for signs of systemic and localized infections during the post period.
Temperature q4hrs
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