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58 Cards in this Set

  • Front
  • Back
GERD
Syndrome caused by reflux of gastric acids into the lower eosphagus causing mucosal damage
What is GERD?
NO one cause can be singled out
is the result of the esophageal defences being overwhlemd by the gastric contents coming into the lower eosphagus causing inflammation and irriation
What can cause GERD?
Hiatal Hernias
incompetent lower eosphageal sphinter
primary
decreased esophageal clearence
ability to clear food and liquids from esophgus into stomach
decreased gastric emptying
CM of GERD
* MOST COMMON*
Heart burn
felt intermitten (if everyday seek tx)
dyspesia
pain or discomfort upper abdomen midline
noncardiac chest pain
regurgitation
hot, bitter, sour liquid into throat or mouth
*Respiratory s/s
coughing
wheezing
dyspnea
*Otolaryngologic s/s
hoarseness
sour throat
lump in throat
choking
Esophagitis
inflammtion of the esophagus
Chronis will form scar tissue and cause stricture
COMPLICATION OF GERD
Complications of GERD
Esophagitis
Barret's esophagus
cough
bronchospasm
laryngospasm
cricopharyngeal spasm
asthma
chronic bronchitis
pneumonia
dental erosion
Barret's Esophagus
Complication of chrnoic GERD
esophageal metaplasia- cells changes due to abnormal stimulus
Flat epithelia cells in the lower esophagus changes to columnar due to continual inflammation
Consider precanerous lesion
biopsy confirms metaplasia
surveillance endoscopy every 2-3 years
How to dx GERD
H&P
s/s and response to behavioral and drug therapies
Endoscopy
assess compentency of LES , inflammation,scars, and strictures
Barium swallow
protrusion og gastric fundus
Biopsy and cytologis spec
cancer vs. Barrett's
Esophageal manometric studies
measure pressures in the esophagus and LES
Drug therapy for GERD
Proton pump inhibitors
Histamine receptor blockers
Surgical treatment for GERD
Nissan fundoplication
Nursing management of GERD
Hob 30 degrees
No lying down 2 to 3 hours after meals
Avoid late night eating
Avoid alcohol and caffeine
Avoid acidic foods
What is gastritis
Inflammation of the gastric mucosa
Common problems affecting the stomach
Result of a breakdown in the mucosal barrier
Can be acute or chronic
Risk factors for gastritis
Drugs
NSAIDs
Inhibit prostaglandin synthesis
Diet
Alcohol and spicy foods
microorganism that causes gastritis
Can be fungal bacterial or viral
Most common bacteria
H. Pylori
What is nausea
Feeling of discomfort and conscious desire to vomit
What is vomiting
Forceful ejection of partially digested food and secretions enter
GI tract becomes overly irritated excited or distended
Works as a protective mechanism
Expels spoiled or irritated foods and liquids
What part of the CNS have to do with vomiting?
Parasympathetic and sympathetic nervous systems are activated
What does the parasympathetic nervous system do for vomiting
stimulates relaxation of the lower esophageal sphincter
increases gastric motility
increases in salivation
What is the sympathetic nervous system do during vomiting
Causes tachycardia tachypnea and diaphoresis
Treatment for nausea and vomiting
If treated in a hospital;
NPO and IV fluids
NG tube
connected to suction to decompress the stomach
Used with persistent vomiting and possible bowel obstruction
Decrease stimulus development
Vitals
Intake and output
Positioning to prevent aspiration
Assess for dehydration, fluid/electrolyte imbalance
Foods that help with nausea
High in potassium
Tea, bananas, cheese, whole milk
Avoid foods that stimulate peristalsis
Orange juice, caffeine, high fiber foods, extremely hot or cold fluids
Gerontolgical considerations for nausea and vomiting
Increase car risk of cardiac and renal insufficiency
Risk for fluid and electrolyte imbalance
Excessive replacement can have the opposite effect
Risk for fluid volume excess or overload
Antiemetic therapy
Reduce dose and monitor efficacy
Susceptible to CNS effects
High risk for aspiration
What are the origins of upper GI
Venous
capillary
arterial
What defines the severity of an upper GI bleed
The origin
What are sites common for upper GI bleeds
Esophagus
stomach
duodenum
Causes of upper GI bleeding in the esophagus
Chronic esophagitis
GERD caused by drugs alcohol and/or smoking
Mallory Weiss- tear in the mucosa
Caused by retching or vomiting
Esophageal varices
Secondary to cirrhosis of the liver
Merging of blood vessels from the vena cava into the lower esophagus
Torturous and engorged
Inelastic
Increase in pressure = irritation possible eruption = lots of blood loss
Causes of stomach and duodenal GI bleeding
H pylori
NSAID drug use
stress-related
tumors
vascular lesions
gastric cancer
emergency assessment for GI bleeding
Systematic evaluation every 15 to 30 minutes
BP
pulse
characteristics of the pulse
cap refill
neck vein distention
signs and symptoms of shock
respiratory status
abdominal assessment
history of BleEding
weight loss
blood transfusion reaction
medication
religious concerns

Labs
CBC BUN
electrolytes
glucose
ABGs
Treatment for upper GI
IV lines
preferably two
packed RBCs
isotonic fluids
LR or NS ( only NS can run with blood)
02 therapy
catheter
gastric lavage
Diagnostic studies for upper GI bleeding
Endoscopy
angiography
barium swallow
Nursing management for upper GI bleeds
Avoid irritants
prompt treatment of upper respiratory infections
accurate intake & output
hourly monitor for fluid overload
ECG
NG tube care
avoid beats mouthwash or ingestion of things with a red tint
monitor stools
What is the Nissen fundoplication
It reduces the reflex of gastric contents by enhancing the integrity of the lower esophageal sphincter
Antireflux procedure post op care Nissen fundoplication
NPO
IV fluids
NG tube
until peristalsis returns
Stretta procedure
Balloon tipped for needle catheter delivers radio frequency energy to the smooth muscle of the lower esophageal sphincter
Increases collagen contraction to form a barrier against reflux
What is Achalasia
Absence of peristalsis in the lower two thirds of the esophagus
fluids and food accumulate in the lower esophagus
resulting in dilation of the lower esophagus
Achalasia assessment
Dysphasia
substernal pain
halitosis
inability to burp
regurgitation of sour tasting food liquids
weight loss
globulus sensation lump in throat
Treatment of Achalasia
Dilation
Dilation of the esophagus
pneumatic dilation of the lower esophageal sphincter
balloon tip dilator passes orally
Surgery
esophagomyotomy
Division of muscle fibers in the esophagus
Allows for swallowing without obstruction
Medications that treat achalasia
Medical therapy is less effective than invasive procedures
Endoscopy with Botox injections in the lower esophageal sphincter
Anticolinergics, calcium channel blockers and long-acting nitrates help relax smooth muscle
What is peptic ulcer disease
Erosion of the GI mucosa
Peptic ulcer disease affects what areas
Lower esophagus
Stomach
Duodenum
Acute peptic ulcers are
Short lived
superficial erosion with minimal inflammation
What are chronic peptic ulcers
Lasting for months & intermittently throughout the life
usually a erodes muscular wall
Where does peptic ulcer disease occur commonly
In the lesser curvature of the stomach
What bacteria is usually a causative factor of peptic ulcer disease
H pylori
What else causes peptic ulcer disease
ASA
NSAIDs
corticosteroids
alcohol
smoking
chronic gastritis
What are the clinical manifestations of gastric peptic ulcer disease
Asymptomatic is common
Burning or gaseous feeling one to two hours after meals
food aggravates
earliest symptoms may be a complication such as perforation
What are the clinical manifestations of a duodenal peptic ulcer
Burning or cramp like
may manifest as back pain to 24 hours after meals
relieved by antacid and sometimes food
Who is at risk for peptic
People with COPD
cirrhosis
chronic pancreatitis
hyperparathyroidism
chronic kidney disease
smokers
alcoholics
What are some life-threatening complications of peptic ulcer disease
Hemorrhage
erosion of the granulation tissue
erosion of the major blood vessels
Perforation
most lethal
ulcer penetrates mucosal wall
spillage of gastric or duodenal content into the peritoneal cavity
sudden and severe abdominal pain
*abdominal is bored like or rigid
respirations are shallow and rapid
absent bowel sounds
nausea and vomiting present
*peritonitis can usually occur within 6 to 12 hours
What are some complications of peptic ulcer disease
gastric outlet obstruction
Caused by
Edema, inflammation pylorospasms and scarred tissue
Over time the stomach wall hypertrophy
Long lasting obstruction causes stomach to dilate
Pain progresses
relief from belching or vomiting
Manifestations;
swelling in upper abdomen
loud peristaltic waves
visible peristaltic waves
possible palpable stomach
Diagnostic testing for peptic ulcer disease
Endoscopy
barium contrast studies
CBC
liver enzymes
stool sample
amylase
What is the goal for peptic ulcer disease
Decreased gastric acidity
enhance mucosal defence
minimize harmful effects on the mucosa
Collaborative care for patient with peptic ulcer disease
Adequate rest
quiet environment
decreased stressors
discontinue ASA's, NSAIDs
eliminate or decrease smoking and alcohol
Nutritional therapy for a patient with peptic ulcer disease
Bland diet
6 small meals per day
decreased stressing foods and fluids
caffeine
avoid alcohol
avoid hot and spicy foods
limit high roughage foods
limit protein intake
NG tube
IV fluids and electrolytes
Medication for disease
Histamine blockers
tagamet
zantac
pepcid
Proton pump inhibitors
prilosec
protonix
nexium
Antibiotics
Antacids
Cytoprotective drug therapy
carafate
Nursing care for a patient with peptic ulcer disease
NPO
NG tube
IV fluids
regular mouth care
cleansing and lubricating nares
vital signs
rest
teaching about diet and lifestyle changes
What to look for in case of hemorrhage with peptic ulcer disease
Change in vital signs
Increase in amount and redness of asiprate
Sudden pain is decreased
check NG tube for blood clots
What to look for in case of perforation with peptic ulcer disease
Sudden and severe pain
Rigid board-like abdomen
NPO immediately