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36 Cards in this Set
- Front
- Back
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dynophagia
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pain on swallowing
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pain on swallowing
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dynophagia
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pyrosis
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heartburn
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heartburn
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pyrosis
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vagatomy syndrome
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- aka dumping syndrome
- when food passes stomach too quickly, and is "dumped" into duodenum - diarrhea and abdominal cramping and distension - occurs post-vagatomy |
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vagatomy
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- resection (cutting) of vagus nerve to reduce acid secretions into the stomach
- causes dumping syndrome |
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dry mouth
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xerostomia
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xerostomia
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dry mouth
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hematemesis
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vomiting blood
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vomiting blood
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hematemesis
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achalasia
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- difficulty swallowing due to impaired peristalsis and/or failure of esoph sphincter to open
- may treat with pneumatic dilation, botox to relax sphincter |
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hiatal hernia
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- when hiatus of diaphragm (opening that allows esophagus to pass) enlarges, and portions of stomach move through it
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kinds of hiatal hernia
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sliding or type I - gastroesophageal junction slides up and down through diaphragm's hiatus
paraesophageal hernia - stomach pushes through diaphragm not includeing the esophagus |
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which hernia usually includes reflux
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sliding, although 50% are asymptomatic
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ss of sliding hernia
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- heartburn, regurgitation, dysphagia
- 50% asymptomatic |
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ss of paraesophageal hernia
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- sense of fullness or chest pain after eating
- or no symptoms - reflux uncommon since sphincter is intact |
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pt. is diagnosed with hiatal hernia. teaching?
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- frequent small feedings allows food to pass through easily
- don't lie down within 1hr of eating to prevent reflux - elevate HOB 4-8 inch |
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How to avoid reflux with GERD?
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diet
- low fat - no caffeine, beer, milk, soda - no peppermint or spearmint behavior - avoid eating/drinking 2hrs b4 bedtime - elevate HOB 6-8 inch and elevate upper body on pillows too |
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surgical treatment for GERD
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Nissen fundoplication - wrapping gastric fundus around GE sphincter
stretta procedure |
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medical treatment for GERD
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• Antacids (neutralize) or H2 Blockers (reduce production) may be used like pepcid and zantac
• Proton pump inhibitors decrease release of gastric acid like nexium, protonix and prilosec but these meds could cause intragastric bacterial growth and could risk infection • Prokinetic agents accelerate gastric emptying like urecholine. Motilium and reglan |
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methods of clearing an obstructed feeding tube
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- air insufflation
- digestive enzymes - coke works too |
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air insfullatino
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- a method of clearing an obstructed feeding tube
1. inject 20mL air, pull plunger back 2. repeat if ineffective |
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when should you declog obstructed feeding tube?
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asap b/c as you wait, obstruction hardens and becomes more difficult to remove
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how to confirm placement of feeding tube?
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(for first time, xray should be used)
- measure tube - aspirate and assess color - pH - air auscultation has proven to be ineffective |
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EGD
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esophagogastroduodenoscopy
- to detect disorders, infections, neoplasms - may evaluate motility, secretions, tissue specimens also can be therapeutic - remove bile duct stones - dilation procedures - laser therapy for neoplasms - control bleeding |
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roux-en-Y nursing management
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- type of gastric bypass surgery in which the fundus of stomach is stapled to form a pouch, and jejunum is anastomosed to that pouch
educate - post op diet - 6 small feedings totaling 600-800 cal.day - eating too fast or high calorie liquids/soft foods results in dumping syndrome, and painful esoph distention |
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all PN must be through a
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pump
pn = parental nutrition |
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TPN vs TNA vs PPN
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TPN consists of two bags
- yellow bag - 50% glucose, elec, vit minerals - white bag - lipids TNA - total nutrtion admixture - combines two bags into one (aka 3 in 1) PPN - admin thru peripheral vein, acts as supplementation for oral intake - 10% glucose + lipids |
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D50 - where can you place the IV?
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- cannot place any solution above 10% dextrose into peripheral veins because they irritate the intima of small veins --> phlebitis
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prep for admin of TPN
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- assess bag for separation, oily, precipitate
- assess for bubbles - since it is bag of glucose, pathogens attracted - may produce these things |
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PN is not available. What should one do?
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- must administer d10W to avoid rebound hypoglycemia
- peripheral |
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TPN is administered by what route?
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- central venous IV
- due to the highly concentrated solution, anything over 10% dextrose requires a large, flowing vessel (ie subclavian) |
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kinds of CVAD
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= central venous access devices
- nontunneled central catheters - tunelled catheter ie hickman catheter - PICC - peripherally incerted central catheters |
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nontunneled vs tunneled vs PICC
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nontunneled
- does not tunnel through skin - for short term use, less than 6w - may be triple, double, single lumen tunnel - tunnels through skin before going into subcl, then to sup vena cava - reduces risk of ascending infection - long term use - single or double lumen PICC - moderate term use - several days to months - cephalic vein to sup vena cava |
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triple lumen catheter
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- a nontunneled central catheter
-most distal port is for blood/viscous fluids - middle port for TPN only - proximal port for blood or meds |
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transmission based precausions
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Airborne
- pt placed in neg pressure room - keep door closed, wear N95 - ie TB and varicella Droplet Precautions - wear face mask, door my remain open since transmission is limited to close contact - ie pertussis flu mycoplasma pneumoniae Contact precautions - gowns and gloves - ie antibiotic resis bact - MRSA, herpes, scabies, Cdiff |
