Chapter 39 Upper Digestive Tract Disorders

Front 1

A&P of the digestive tract: Where teeth, tongue, and salivary glands begin food digestion

Back 1

mouth

Front 2

A&P of the digestive tract: -Muscular structure shared by the digestive and respiratory tracts. - it joins the mouth and nasal passages to the espophagus

Back 2

Pharynx

Front 3

A&P of the digestive tract: Long muscular tube that passes through the diaphragm into the stomach

Back 3

Esophagus

Front 4

A&P of the digestive tract: Chrurns and mixes food c gastric secretions into a semiliquid mass called chyme

Back 4

Stomach

Front 5

-Teeth are mechanically worn down with age. -The jaw may be affected by osteoarthritis. -A significant loss of taste buds with age. -Xerostomia (dry mouth). -Walls of esophagus and stomach thin with aging, and secretions lessen. -Production of hydrochloric acid and digestive enzymes decreases. -Gastric motor activity slows

Back 5

Age-Related Changes (7)

Front 6

-a detailed description of the present illness. -Complaints include weight changes, problems with food ingestion, symptoms of digestive disturbances, or changes in bowel elimination.

Back 6

Chief complain and hx of present illness

Front 7

-recent surgery, trauma, burns, or infections. -Serious illnesses such as diabetes, hepatitis, anemia, peptic ulcers, gallbladder disease, and cancer, ulcerative colitis, crohn's disease, liver dysfunction. -Alternative methods of feeding or fecal diversion. -prescription and OTC meds. -food allergy or intolerance

Back 7

health hx/medical hx

Front 8

-information about general dietary habits should include the daily pattern of food intake. -Attitudes and beliefs about food, and changes in dietary habits related to health problems. -Effects of chief complaint on usual functioning. -Note whether the patient is able to obtain and prepare food, and eat independently

Back 8

Functional assessment

Front 9

-head and neck. -Inspect the mouth

Back 9

Physical Examination

Front 10

Diagnostic Tests and Procedures: Radiographic studies

Back 10

-UGI or GI series. -Small bowel series. -Barium enema

Front 11

Diagnostic Tests and Procedures: Endoscopic examinations

Back 11

Upper GI: Esophagoscopy, gastroscopy, gastroduodenoscopy, esophagogastroduodenoscopy, endoscopic retrograde cholangiography

Front 12

Diagnostic Tests and Procedures: Laboratory Studies

Back 12

-Blood & UA test for H. pylori. -Nutritional status (Albumin) -Stool analysis (occult blood, OCP, Fecal fat test)

Front 13

Delivered by gravity flow or by infusion pump. -Critical to confirm tube is in the duodenum before administering feelings. -Radiographic confirmation is most reliable -Observation of aspirated material and assessment of pH are reliable. -placement checked every shift. -Fowler position to reduce chance of aspiration. -Assess for residual before each feeding.

Back 13

Tube Feedings.

Front 14

TUBE __________. -Obtain correct formula. -May be diluted when first started. -Stop feeding if pt has nausea or pain. -Rinse tube after each bolus feeding; give extra prescribed water. -Dumping syndrome may occur with rapid feedings of concentrated formula. -Syringe feedings. -Infusion pump

Back 14

feedings

Front 15

Gastrointestinal _____________. -For the relief or prevention of distention. -Levin and gastric sump tubes. -Use prescribed suction apparatus. -Monitor patency of the tube. -Irrigations may be ordered occasionally.

Back 15

Decompression

Front 16

Gastrointestinal Decompression: -Monitor the suction output. -Assess for return of peristalsis. -Provide comfort measures to nasopharynx and throat. -Tape _____ securely to the nose to keep it from being pulled out.

Back 16

tube

Front 17

TPN: Bypasses digestive tract by delivering nutrients directly to the _________________. -Catheter inserted into large vein feeds into the superior vena cava to allow dilution of concentrated feeding. -Solution contains glucose, amino acids, vitamins, and minerals.

Back 17

bloodstream

Front 18

TPN: -_________ technique for site care to prevent infection. -Monitor for signs of infection. -Monitor flow rate to prevent circulatory overload, changes in blood glucose or excessive diuresis. -Monitor for blood sugar changes. -Label TPN lines and don't use to administer drugs. -Keep tubing differentiated between TPN lines from small-bore enteral feeding tubes

Back 18

sterile

Front 19

Gastrointestinal Surgery: -The digestive tract is usually cleansed. -Diet limited to liquids 24 hours before surgery. -IV fluids. -Oral antibiotics. -NG tube inserted and attached to suction.

Back 19

GI Surgery: Preoperative Nursing Care

Front 20

GI Surgery: -be sure surgical suction is draining. -inspect, describe, and measure drainage. -abd for distention and bowel sounds. -administer IVF's. -Strict I & O records.

Back 20

GI Surgery: Postoperative Nursing Care

Front 21

-Nausea, decreased sense of taste or smell, mouth disorders, and medications. -Emotional problems such as anxiety, depression, or disturbing thoughts.

Back 21

Anorexia Causes

Front 22

-provider assesses for malnutrition. -weight may be monitored over several weeks. -complete hx and phys exam. -serum hemoglobin, iron, total iron-binding capacity, transferrin, calcium, folate, B12, zinc. -thyroid function tests

Back 22

Anorexia Medical diagnosis

Front 23

-Correctable causes of anorexia are treated, but sometimes no physical cause is found. -Nutrional supplements

Back 23

Anorexia Medical Treatment

Front 24

-Record chronic and recent illnesses, hospitalizations, medications, and allergies. -Family hx. -The functional assessment reveals patterns of activity and rest, usual dietary patterns, current stressors, and coping strategies-all can affect appetite

Back 24

Anorexia Assessment

Front 25

-Assist with oral hygiene before and after meals. -teach proper oral hygiene. -relieve nausea before presenting a meal tray. -before serving meal tray, remove bedpans/emesis basins from sight, conceal drains and drainage collection devices, deodorize room if necessary. -Socialization during mealtime. -respect food likes and dislikes. -position pt comfortably c easy access to food

Back 25

Anorexia interventions

Front 26

-pts c paralysis, arthritis, neuromuscular disorders, confusion, weakness, or visual impairment are likely to need assistance. -Medical diagnosis and treatment: -identifying problems, prescribing treatment. -pts often referred to phys therapy and occupational therapy

Back 26

Feeding problems

Front 27

-Assess each pt's ability to feed self. -Determine nature of pt's difficulty and identify remaining abilities. -Assess visual acuity, ROM and muscle strength in both arms, and ROM and grip strength in both hands; ability to follow instructions

Back 27

Feeding problems: Assessment

Front 28

-proper positioning and arrangement of the meal tray. -Provide assistive devices. -open milk cartons, cut meat, butter bread, and season food.

Back 28

Feeding problems: Interventions

Front 29

-A general term for inflammation of the oral mucosa. -Medical treatment is directed toward determining the cause and eliminating it; a soft, bland diet may be ordered

Back 29

Stomatitis

Front 30

-Bacerial infection that causes a metallic taste and bleeding ulcers in the mouth, foul breath, and increased salivation. -Topical antibiotics and mouth washes to treat infection; rest, a nutritious diet, and good oral hygiene

Back 30

Vincent Infection

Front 31

-Caused by the herpes simplex virus type 1. -Ulcers and vesicles in mouth and on lips. -Occur with upper respiratory tract infections, excessive sun exposure, or stress. -Antiviral agents as treatment

Back 31

Herpes Simplex

Front 32

-may be caused by a virus. -characterized by ulcers of the lips and mouth that recur at intervals. -Topical or systemic steroids may be used

Back 32

Aphthous Stomatitis ("canker sore")

Front 33

-yeastlike fungus causes the oral condition known as thrush or candidiasis. -Bluish-white lesions on the mucous membranes. -pts at high risk include those on steroid or long-term therapy. -treated with oral or topical antifungal angents

Back 33

Candida Albicans

Front 34

-pain location, onset, and precipitating factors. -record any known illnesses and treatments, including drugs and radiation therapy. -describe habits, including diet, oral care practices, alcohol intake, and use of tobacco. -assess pts stress level. -inspect lips and oral cavity for redness, swelling, and lesions

Back 34

Candida Albicans Assessment

Front 35

-gental oral hygiene, prescribed mouthwashes. -the teth and tongue can be cleansed c a soft bristle toothbrush, sponge, or cotton-tipped applicator. -Medications must be given as ordered

Back 35

Candida Albicans Interventions

Front 36

Disorders of the teeth and gums: -a destructive process of tooth decay. -treatment: removal of decayed part of tooth, followed by filling the cavity.

Back 36

Dental Caries

Front 37

Disorders of the teeth and gums: -Begins with gingivitis. -Gums red, swollen, painful, and bleed easily. -Primarily from inadequate oral hygiene. -treatment in early stage: dental care for teeth cleaning and correction of contributing problems. -Untreated, abscesses develop around the roots, teeth loosen, extraction necessary.

Back 37

Periodontal Disease

Front 38

-squamous cell carcinoma. -Basel cell carcinoma.

Back 38

Oral Cancer

Front 39

-Cancer of the lip related to prolonged exposure to irritants, including sun, wind, and pipe smoking. -Factors that increase the risk of cancers inside the mouth include tobacco and alcohol use, poor nutritional status, and chronic irritation

Back 39

Oral Cancer Risk Factors

Front 40

Tongue irritation, loose teeth, and pain the tongue or ear. -Malignant lesions may appear as ulcerations, thickened or rough areas, or sore spots. -Leukoplakia: hard, white patches in the mouth; premalignant

Back 40

Oral Cancer S/S

Front 41

-biopsy of suspicious lesions. -Treatment includes surgery, radiation, or chemotherapy, or a combination of these

Back 41

Oral cancer Medical diagnosis and treatment

Front 42

-hx of prolonged sun exposure, tobacco use, or alcohol consumption. -assess for difficulty swallowing or chewing, decreased appetite, weight loss, change in fit of dentures, and hemoptysis. -the phys exam should focus on exam of the mouth for lesions. -assess the neck for limitation of movement and enlarged lymph nodes

Back 42

Oral cancer Assessment

Front 43

-ineffective breathing pattern. -Acute pain. -Imbalanced nutrition: less than body requirements. -Impaired verbal communication. -Disturbed body image. -Risk for infection. -Ineffective peripheral tissue perfusion

Back 43

Oral Cancer Interventions

Front 44

-Inflammation of the parotid glands. -causes painful swelling of the salivary glands below the ear next to the lower jaw; pain increases during eating. -Treated with antibiotics, mouthwashes, and warm compresses; surgical drainage or removal may be necessary.

Back 44

Parotitis

Front 45

-Progressively worsening dysphagia. -Failure of the lower esophageal muscles and sphincter to relax during swallowing. -treatment includes drug therapy, dilation, and surgical measures

Back 45

Achalasia

Front 46

Pathophysiology: -no known cause, but predisposing factors are cigarette smoking, excessive alcohol intake, chronic trauma, poor oral hygiene, and eating spicy foods.

Back 46

Esophageal Cancer Pathophysiology

Front 47

S/S: -progressive dysphagia. -Pain with swallowing. -Obstruction

Back 47

Esophageal Cancer S/S

Front 48

-Barium swallow, computed tomography, esophagoscopy, and endoscopic ultrasonography

Back 48

Esophageal Cancer Medical Diagnosis

Front 49

-Surgery, radiation, chemotherapy, or various combinations. -types of surgery. -feeding tube and TPN

Back 49

Esophageal Cancer Medical and surgical treatment

Front 50

-Dysphagia, pain, and choking. -Hoarseness, cough, anorexia, weight loss, and regurgitation. -The functional assessment documents the use of alcohol and tobacco and dietary practices

Back 50

Esophageal Cancer Assessment

Front 51

-Acute pain. -Imbalanced nutrition: Less than body requirements. -Anxiety. -Risk for injury. -impaired gas exchange. -Deficient knowledge

Back 51

Esophageal Cancer Interventions

Front 52

sometimes referred to as ?

Back 52

queasiness

Front 53

Forceful expulsion of stomach contents through the mouth

Back 53

vomiting

Front 54

-nausea, vomiting, projectile vomiting, regurgitation

Back 54

Nausea and Vomiting

Front 55

-significant losses of fluids and electrolytes. -aspiration

Back 55

Nausea and Vomiting complications

Front 56

Antiemetics, IV fluids, oral fluids may be limited to clear liquids or withheld, NG tube

Back 56

Nausea and Vomiting Medical Treatment

Front 57

-Onset, frequency, and duration of present illness. -Conditions under which nausea and vomiting occur. -amount color, odor, and contents of the vomitus. -Surgeries, chronic illnesses, allergies, and medications. -general appearance; record vital signs, height/weight. -assess pulse and BP, tissue turgor, mental status, and muscle tone. -Inspect, auscultate, and palpate the abd for distention, bowel sounds, and tenderness.

Back 57

Nausea and vomiting assessment

Front 58

Imbalanced nutrition. deficient fluid volume. risk for aspiration

Back 58

Nausea and vomiting interventions

Front 59

Pathophysiology: protrusion of lower esophagus and stomach up through the diaphragm and into the chest

Back 59

Hiatal Hernia patho

Front 60

sliding, rolling

Back 60

types of hiatal hernias

Front 61

Causes: Weakness of muscles of the diaphrahm in the area where the esophagus and stomach join, exact cause not known. -factors are excessive intraabdominal pressure, trauma, and long-term bedrest in a reclining position. -intraabdominal pressure is increased by obesity, pregnancy, abd tumors, ascites, and repeated heavy lifting or strain.

Back 61

Hiatal Hernia causes

Front 62

s/s: many people have no symptoms at all; others report feelings of fullness, dysphagia, eructation, regurgitation, and heartburn

Back 62

Hiatal Hernia s/s

Front 63

Barium swallow exam c fluoroscopy. -esphagoscopy. -esophageal manometry

Back 63

hiatal hernia medical diagnosis

Front 64

-Drug therapy, diet, and measures to avoid increased intraabdominal pressure. -Surgery: fundoplication and placement of synthetic angelchik prosthesis

Back 64

Hiatal hernia medical treatment

Front 65

-Document symptoms. -record factors that trigger symptoms as well as measures that aggravate or relieve them. -Patients dietary habits, use of alcohol and tobacco, and medication hx

Back 65

hiatal hernia assessment

Front 66

-chronic pain. -risk for aspiration. -imbalanced nutrition: Less than body requirements

Back 66

Hiatal Hernia interventions

Front 67

-turning, coughing, and deep-breathing. -pt might have NG tube in place and connected to suction for a day or two. -until bowel function returns, the pt is given only IV fluids. -tell the pt to expect mild dysphagia for several weeks

Back 67

Hiatal hernia postop care

Front 68

-backward flow of gastric contents from the stomach into the esophagus.

Back 68

GERD

Front 69

Patho: -abnormalities around the lower esophageal sphincter (LES), gastric or duodenal ulcer, gastric or esophageal surgery, prolonged vomiting, and prolonged gastric intubation. -eventually causes esophagitis.

Back 69

GERD patho

Front 70

s/s: painful burning sensation that moves up and down, commonly occurs after meals, and is relieved by antacids

Back 70

GERD s/s

Front 71

-suggested by the s/s. -endoscopy, biopsy, gastric analysis, esophageal manometry 24-hour monitoring of esophageal pH, and acid perfusion tests

Back 71

GERD medical diagnosis

Front 72

-drug therapy may include H2-receptor blockers, prokinetic agents, and proton pump inhibitors. -if medical care unsuccessful, surgical fundoplication

Back 72

GERD Medical Treatment and nursing care

Front 73

Patho: -inflammation of the lining of the stomach. -Mucosal barrier that normally protects the stomach from auto digestion breaks down. -Hydrochloric acid, histamine, and pepsin cause tissue edema, increased capillary permeability possible hemorrhage. -H. pylori thought to be prime culprit

Back 73

Gastritis patho

Front 74

s/s: Nausea, vomiting, anorexia, a feeling of fullness, and pain in the stomach area.

Back 74

Gastritis s/s

Front 75

Gastroscopy, laboratory studies to detect occult blood in the feces, low blood hemoglobin and hematocrit, and low serum gastrin levels; H. pylori can be confirmed by breath, urine, stool, or serum tests, or by gastric tissue biopsy

Back 75

Gastritis Medical diagnosis

Front 76

Oral fluids and foods withheld until the acute symptoms subside; IV fluids administered. Medications to reduce gastric acidity and relieve nausea. Analgesics for pain relief and antibiotics for H. pylori. Surgical intervention may be needed.

Back 76

Gastritis Medical Treatment

Front 77

pts present illness. pain, indigestion, nausea, and vomiting. Determine the onset, duration, and location of pain. Note factors that trigger or relieve the symptoms. Document chronic illnesses, current and recent medications.

Back 77

Gastritis Assessment

Front 78

Acute pain. Imbalanced nutrition: less than body requirements. Deficient fluid volume. Ineffective coping

Back 78

Gastritis Interventions

Front 79

patho: loss of tissue from lining of the digestive tract. Classified as gastric or duodenal.

Back 79

Peptic Ulcer Patho

Front 80

Causes: contributing factors: drugs, infection, stress. Most ulcers are caused by the microorganism H. pylori.

Back 80

Peptic ulcer causes

Front 81

s/s: burning pain. Nausea, anorexia, weight loss.

Back 81

Peptic ulcers s/s

Front 82

Hemorrhage, perforation, or pyloric obstruction

Back 82

Peptic ulcers complications

Front 83

Barium swallow exam, gastroscopy, and esophagogastroduodenoscopy. H. pylori can be detected by antibodies in the blood or stool, and by breath test.

Back 83

Peptic ulcer medical diagnosis

Front 84

Drug therapy, diet therapy, managing complications

Back 84

Peptic ulcer Medical treatment

Front 85

•Pain, including location, aggravating factors, and measures that bring relief; relationship between pain and food intake•Recent serious illnesses, previous peptic ulcer disease, and a medication history•Functional assessment: patient’s usual diet, use of alcohol and tobacco, activities, sleep patterns, and stressors•Vital signs; height and weight; skin and mucous membranes for turgor and moisture•Inspect abdomen for distention and palpate for tenderness•Auscultate for bowel sounds

Back 85

Peptic ulcer Nursing care of the pt managed medically

Front 86

Chronic pain. Imbalanced nutrition: Less than body requirements. Risk for injury. Ineffective coping.

Back 86

Peptic Ulcer Nursing care of pt managed medically. Interventions

Front 87

Nursing care of the patient managed surgicallyAssessment•Pain, nausea, and vomiting•Measure vital signs at frequent intervals•Note the amount and type of IV fluids, and check the infusion site for swelling or redness•Document patency of the nasogastric tube as well as the color and amount of drainage•Breath sounds Inspect abdomen for distention and auscultate for bowel sounds, inspect the wound dressing for bleeding•Monitor urine output and palpate for bladder distention

Back 87

Peptic Ulcer. Nursing care of pt managed surgically. Assessment

Front 88

Nursing care of the patient managed surgically Interventions•Risk for injury•Imbalanced nutrition: Less than body requirements•Decreased cardiac output

Back 88

peptic ulcer. nursing care of pt managed surgically interventions

Front 89

Patho: begins in the mucous membranes, invades the gastric wall, and spreads to the regional lymphatic, liver, pancreas, and colon. No specific s/s in the early stages. Late s/s are vomiting, ascites, liver enlargement, and an abd mass

Back 89

Stomach cancer patho

Front 90

Risk factors: H. pylori infection, pernicious anemia, chronic atrophic gastritis, and achlorhydria, type A blood and a family hx. Cigarette smoking, alcohol abuse, and a diet high in starch, salt, pickled foods, salted meats, and nitrates

Back 90

Stomach cancer risk factors

Front 91

Gastroscopy, endoscopic ultrasound, upper GI series, CT, PET scan, MRI, laparoscopy. Lab studies include hemoglobin and hematocrit, serum albumin, liver function tests, and carcinoembryonic antigen.

Back 91

Stomach cancer Medical Diagnosis

Front 92

Surgery, chemo, and radiation therapy. Early research into gene therapy and immune based therapy.

Back 92

Stomach cancer medical treatment

Front 93

-inform about NG tube and IVF's. Teach coughing, deep breathing, and leg exercises. Identify/support pts coping methods. Include sources of support, such as family members or a spiritual counselor

Back 93

Stomach cancer Preop care of pt with stomach cancer

Front 94

comfort, appetite, and nausea and vomiting. monitor weight changes and determine dietary preferences. Identify the pts support system and coping strategies.

Back 94

stomach cancer postop care

Front 95

acute pain. imbalanced nutrition: less than body requirements. ineffective coping.

Back 95

Stomach cancer interventions (post op)