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25 Cards in this Set
- Front
- Back
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esophagoGASTROECTOMY
(esophageal cancer) |
resection of LOWER esophageal section w/ proximal portion of stomach, followed by anastamosis of remaining portions of esophagus.
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esophagoGASTROSTOMY
(esophageal cancer) |
resection of portion of esophagus w/ anastomosis TO STOMACH
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esophagoENTEROSTOMY
(esophageal cancer) |
resection of portion of esophagus w/ anastomosis TO COLON
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Gastrostomy
(esophageal cancer) |
Insertion of cathether in stomach & suture to abdominal wall
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Esophagus Carcinoma
Interventions |
Monitor respirations and patients difficulty in carrying out breathing exercises. I&O, daily weights, types of food patient can swallow. Tube feedings if gastrostomy.
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Prognosis of Cancer of Esophagus
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Well advanced by the time symptoms appear (12-18 months). High mortality rates affected by following issues:
1) old age 2) metastasize 3. metastasize to lymph nodes 4) tumor close to heart and lungs, making them susceptible |
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Achalasia
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also called cardiospasm. inability of muscle to relax, particularly cardiac sphincter. Decreased motility & dilation of lower portion of esophagus. Abscence of peristalsis. Little or no food can enter the stomach. In extreme cases, the dilated portion holds as much as a liter or more of fluid. Prevalent in 20-50 yrs/age
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Cause of Achlasia
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Unknown. nerve degeneration, esophageal dilation, and hypertrophy are thought to contribute to the disruption of the esophagus's normal neuromuscular activity.
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Achalasia Manifestations
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PRIMARY SYMPTOM OF ACHALASIA IS DYSPHAGIA. Sensation of food sticking in lower portion of esophagus. As condition progresses, c/o regurgitation of food, which relieves prolonged distention of esophagus. Substernal chest pain as well.
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Achalasia Assessment
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Loss of weight, poor skin turgor, weakness
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Achalasia DX Tests
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Radiologic studies show esophageal dilation @ cardioesophageal junction. DIAGNOSIS IS CONFIRMED BY MANOMETRY, WHICH SHOWS ABSCENCE OF PERISTALSIS.
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Achalasia Medical Management
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Drug therapy and forceful dilation of narrowed area of esophagus. Anticholinergics, nitrates, and calcium channel blockers reduce pressure in lower esophageal sphincter.
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Achalasia Dilation
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First empty esophagus. Dilator with a deflated balloon is passed down to sphincter. Balloon is inflated and remains for 1 minutes (may need to be re-inflated 1 or 2)
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Achalasia Preferred Surgical Approach
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Cardiomyotomy. Muscular layer is incised longitudinally down to (but not through) mucose. Two thirds of incision is esophagus, and the remaining one third is in stomach; this permits mucosa to expand so food can pass easily into stomach.
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Achalasia Nursing Interventions
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- Elevate bed while sleeping and avoid bending or stooping.
- Encourage fluids with meals to increase lower esophageal sphincter pressure & push food into stomach. - Monitor liquid diet for 24hr AFTER dilation. - Monitor for signs of esophageal perforation (chest pain, shock, dyspnea, fever) after dilation. |
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Signs of Esophageal Perforation
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chest pain, shock, dyspnea, fever
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Achalasia DIET
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High calorie, High protein diet. High fiber to avoid constipation and natural laxatives.
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Gastritis Etiology
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Inflammation of lining of stomach. Acute gastritis is a TEMPORARY inflammation assosciated with alcoholoism, smoking & stressful physical problems (burns, surgery, food allergies, viral, bacterial or chemical toxins, chemotherapy, radiation therapy) Changes in mucosal lining interfere with acid and pepsin secretion. Usually single incident that resolves when offending agent removed.
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Gastritis Manifestations
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Fever, epigastric pain, nausea, vomiting, headache, coating of tongue, loss of appetite. IF B/C OF FOOD: intestines usually affected and diarrhea may occur.
SOME PATIENTS MAY HAVE NO SYMPTOMS |
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Gastritis Assessment
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S: anorexia, nausea, discomfort after eating, and pain.
O: vomiting, hematemesis (vomiting blood), and melena caused by gastric bleeding |
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Gastritis DX Tests
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Stool occult.
WBC differential increases related to certain bacteria. serum electrolytes elevated hematocrit r/t dehydration |
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Gastritis Medical Management
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Antiemetics, antacids & cimetidine or ranitidine. Antibiotics. IV fluids to correct fluid & electrolyte imbalances. Patients who experience GI bleeding from hemorrhagic gastritis require fluid & blood replacement and NG lavage.
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Gastritis Interventions
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I&O.
Withold foods & fluids until signs & symptoms subside. Monitor tolerance to oral feedings and IV feedings as prescribed. Clear liquids are increased to diet as tolerated. Keep NPO or on restricted food & fluids as ordered. Advance as tolerated Monitor for fluid & electrolyte imbalance Maintain IV feedings I&O |
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Gastritis Patient Education
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1) effects of stress on mucosal lining of stomach
2) how salicylates, NSAID's, and some foods may be irritating 3) alcohol & tobacco |
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Peptic Ulcers
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Ulcerations of mucous membrane or deeper structures of GI tract. Result from acid and pepsin imbalances. Most commonly occur in stomach and duodenum.
Affects men more than women. Stomach is normally protected from autodigestion by the gastric mucosal barrier. |
