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
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
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
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
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
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
Arrange a nutritional consult.
Monitor for symptoms of fullness, anorexia, nausea or vomiting.
Monitor lab values related to nutritional deficit.
B12 levelsAlteration in nutrition
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
Replace decreased HCT with whole blood or RBCS
Assess abdomen for distention, BS, and tenderness q4hrs and record.Fluid volume deficit
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
Abdominal muscle guarding with rebound tenderness and rigidity
Elevated Alkaline phosphatase
Elevated amylaseSigns and symptoms that might be present with cholecystitis
is for cholesterol stones less than 20mm in diameter.
Pt. Need to have hepatic enzymes monitor closely
watch for diarrheaPharmacology
Other pharmacologic agents are use for palliative relief such as
Antibiotics -to decrease bacteria count and associate inflammation and edema.
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
If the stones are located only in the Gallbladder a simple Cholecystectomy is performed.
Conventional surgical methods.
Laparascopic laser surgerySurgery
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
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
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
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