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50 Cards in this Set
- Front
- Back
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What is the difference between GER and GERD?
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GER is backward flow of gastric contents into the esophagus
GERD is identified when the patient experiences symptoms of GER and DAMAGE is caused to the esophagus |
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GERD is not a disease but a syndrome. What does the irritation in the esophagus lead to?
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erosion, ulcers and strictures of the esophagus
can lead to cancer or aspiration pneumonia |
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What are the strictures in GERD caused from?
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they are scar tissue from the constant irritation and healing....the esophagus gets stiff
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When is aspiration pneumonia caused from GERD most likely to happen?
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at night
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What are the four causes of GERD? (the etiologies)
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1. structural changes to LES (lower esophageal sphincter)
2. increased abdominal pressure 3. changes in gastric secretions 4. increased gastric volume |
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Describe the changes in gastric secretions that lead to GERD?
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increased pepsin, trypsin, and bile salts
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What can cause the increased abdominal pressure that leads to GERD?
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obesity, pregnancy, ascites and lifting heavy objects
(ascites from fluid...cirrhosis) (valsalvas maneuver) |
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What are some dietary or behavioral causes of GERD?
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smoking
chocolate overeating alcohol fatty foods (slower gastric emptying) peppermint, spearmint caffeine (tea and coffee) **peppermint and spearmint relax the LES |
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What are the predisposing conditions that lead to GERD?
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-bad LES
-hiatal hernia -decreased esophageal clearance -decreased gastric emptying -acidic gastric secretions |
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What is the deal with decreased gastric emptying and GERD?
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When stuff hangs out in the stomach for an extended period of time, the ph will lower to 2-3 and reflux in the esophagus and cause irritation
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The number one clinical manifestation of GERD is...
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pyrosis (heartburn)
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Where will someone feel the heartburn or tightness related to GERD?
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between sternum and jaw
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A person with GERD may experience dysphagia. why?
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scar tissue replaced normal elastic tissue and leads to difficulty swallowing
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Other than heartburn and dysphagia, what other clinical manifestations may be experienced with GERD?
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respiratory aspiration
regurgitation (baby barf) |
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What does EGD stand for?
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esophagastrodostomy
(might be spelled wrong) |
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What type of disorders are identified with a EGD?
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hiatal hernia
GERD esophageal CA gastric ulcers |
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What are the nursing responsibilites for EGD?
(preop) |
-NPO for 8 hours
-Make sure consent is signed and in chart -Preoperative meds are given (diazepam, midazolam or meperidine) -Explain the local anesthetic used on throat before insertion of scope -Tell patient they will be sedated during procedure |
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What are the post op nursing responsibilities for EGD?
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Remain NPO until gag reflex returns (gently tickle back of throat)
Use warm saline gargles for sore throat Check temp q 15-30 minutes for 1-2 hours (sudden temperature spike is a sign of performation) not likely |
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What is an esophagoscopy?
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endoscope examination of the esophagus
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What is a gastroscopy?
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Examination of teh stomach using gastroscope
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What is a bronchoscopy?
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looking at the bronchial tree using a scope
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What is the procedure of a barium swallow test?
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patient swallows barium and under fluoroscopy radiologists can see UGI, abnormalities of the stomach and duodenum, CA of the esophagus, stomach and ulcers
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What does a patient need to do during a barium swallow test?
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drink the barium, roll all around (to spread the barium)
and be aware they are going to poop SNOW POOPIES. (white poop) |
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What are the nursing responsibilities for barium swallow study?
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NPO for 8-12 hours
Make sure they don't smoke Prevent impaction due to barium by increasing fluids and medicating with laxatives |
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How long may the stool be white from a barium swallow study?
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72 hours
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What are the two direct problems with GERD that can be NDs?
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chronic pain
impaired swallowing |
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How do you treat the impaired swallowing associated with GERD?
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small bites, chew thoroughly and avoid eating bulky foods (bread & steak)
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What are some PCs associated with GERD?
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PC: esophagitis
PC: esophageal stricture PC: pneumonia PC: pyrosis |
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What should be included in nutritional counseling when talking to a patient that is experiencing GERD?
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avoid alcohol, coffee, chocolate and caffeine
Lose weight Don't eat late, don't eat fatty foods and don't eat BIG MEALS. Raise HOB 4-6 inches to alleviate symptoms |
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There are several types of drugs that are used to treat GERD. List the "general" types.
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antacids
H2Receptor antagonists Anti secretory agents |
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Name some antacids and their mechanism of action.
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Maalox
Mylanta -increase pH of stomach contents -increase esophageal spincter tone |
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What are the side effects of antacids?
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magnesium type - diarrhea
aluminum type - constipation anorexia systemic alkalosis |
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What are the nursing implications of antacids?
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-shake well
-use with caution (b/c of Na) in patient with renal failure -ADMINISTER 1-3 hours after meals -Mg preps - contraindicated in renal failure |
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What is another name for the group of drugs called histamine antagonists?
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H2 receptor blocks
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Name some H2 receptor blocks (histamine antagonists).
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Tagamet (cimetidine)
Zantac (ranitidine) Pepcid (famotidine) Axid (Nizatidine) |
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In order to remember the generic names for H2 blockers, remember that the suffix in their names all end in -________.
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-idine
I dine on too much food which causes GERD for me. |
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What is the action of H2 blockers ?
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Inhibits the action of histamine at the H2 receptor sites of the parietal cells decreasing gastric acid secretion
(raises pH) (decreases gastric acid secretion) |
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Anytime you decrease gastric acid secretion, what happens to the stomach pH?
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It goes up...becomes less acidic and more alkaline
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What is a common misconception about histamine antagonists (H2 receptor blocks)?
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It is not uncommon for people to think that they are antihistamines
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When do you administer H2 receptor blocks?
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with meals
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What are some side effects of H2 receptor blocks?
(she didn't mention any of these in particular in class) |
thrombocytopenia
aplastic anemia increase in BUN and creatinine dermatitis dizziness |
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What are the names of some proton pump inhibitors?
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Prilosec (omeprazole)
Prevacid Protonix Nexium Aciphex |
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How do proton pump inhibitors work in regard to GERD?
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decrease gastric secretions by acting directly on the surface of parietal cells
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What is Reglan's role in the treatment of GERD?
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it increases gastric emptying so decreases reflux
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What are the side effects of Reglan?
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restlessness, drowsiness, fatigue, extra pyramidal reactions
(And you NEVER use this drug if an obstruction of if performation is suspected) |
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What type of drug is Reglan?
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a GI stimulant
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Another drug that is a GI stimulant is Propulsid (Cisapride). How does it help GERD patients?
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increases the resting tone of LES
accelerates gasric emptying |
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Cholinergics are used to treat GERD. WHY?
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because they increase the gastroesophagspinchter pressure
prevent reflux (BUT THEY INCREASE secretions so they can be a bad thing) |
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How do you administer cholinergics?
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on an empty stomach
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What is atropine?
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the antidote for an overdose of cholinergics
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