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96 Cards in this Set
- Front
- Back
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What is acute gastritis?
What are some causes? |
inflammation of the gastric mucosa from breakdown from HCL & pepsin;
nsaids, asa, steroids, alcohol, spicy foods, smoking, burns, sepsis, shock, renal failure, trauma: NGT, endoscopy |
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How is acute gastritis treated?
How is it dx? |
-eliminate cause: if N/V: rest, NPO, IV fluids, antimetics,
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Nausea and Vomiting
Clinical Manifestations |
If vomiting prolonged
Dehydration Water, electrolytes lost Loss of extracellular fluid leading to circulatory collapse Metabolic alkalosis can occur-gastric loss or Metabolic acidosis if small intestine contents lost (less common) |
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Characteristics of Vomiting
Color |
“Coffee grounds”-bleeding in stomach
Blood changes to dark brown as result of interaction with HCL Bright red blood-active bleeding Green-bile |
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Antimuscarinics: Atnicholinergic
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Scopolamine-patch for N/V
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Antihistamines
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Benadryl-can be given IV
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Phenothiazines
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Compazine-given IM
antipychotic & N/V |
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Antimuscarinics
Antihistamines Phenothiazines These classes have anitcholinergic effects Common contraindications with these classes: What are the common S/E? |
Do not give to client with glaucoma, BPH (urinary retention), pyloric/bladder neck obstruction, biliary obstruction
Common side effects: Dry mouth, constipation, hypotension, sedative effects |
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Metroloperamide (Reglan)
S/E: |
Antimetic ; decrease symptoms of gastric stasis; manage esophageak reflux, NV
take 30 mins ac & HS -Side effects of Reglan: hallucinations, tremors, dyskinesias, sleepiness |
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Used for Chemotherapy/radiation, migraine & induced vomiting
5-HT receptors-antagonists to serotonin receptors |
Ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet)
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Gingivitis
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Etiology-
Neglected oral hygiene Stress Manifestations Bleeding during tooth brushing Pus Loosening of teeth (peridonitis) Treatment Prevention, Dental care, dental rinses, flossing |
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Vincent’s Infection (Trench Mouth)
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Etiology-
Bacteria/Neglected oral hygiene Stress Manifestations Ulcerations that bleed Increased saliva with metallic taste Halitosis Treatment Prevention, Dental care, dental rinses H2O2, topical antibiotics (Flagyl), stress management |
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Oral Candidiasis (Thrush)
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Etiology-
Candidiasis albicans Immunosuppression Manifestations White patches in oral cavities Treatment Nystatin swish and swallow Amphotericin B |
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Herpes Simplex (Cold Sore)
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Etiology-
Herpes simplex I or II Stress exacerbates Manifestations Vesicle formation Treatment-antivirals Zovirax |
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Aphthous Stomatitis (Canker Sore)
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Etiology-
Chronic form of infection secondary to trauma, stress Manifestations Painful ulcers of lips Treatment Topical/systemic corticosteroids Topical antibiotic |
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Motilium (domperidone)
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S/E: tiredness so take @ HS & take 30 mins ac
inability to cross blood brain barrier |
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Parotiditis
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Etiology-
Staph, Strep Manifestations Pain in gland/ear Lack of saliva Purulence Treatment Antibiotics Mouthwashes Lollipops to stimulate saliva production |
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Stomatitis
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Stomatitis
(Inflammation of the Mouth) Etiology- Side effect of chemotherapy Trauma pathogens Manifestations Excessive salivation Halitosis Sore mouth Treatment Remove cause Soothing mouth wash solutions Bland diet |
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nursing interventions for n/v
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nutritional therapy- replace fluids w/ electrolytes and glucose until able to tolerate p.o. intake
NG tube to decompress the stomach NPO to rest GI tract clear liquids once symptoms have subsided, avoid hot or cold |
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Oral Cancer-oropharyngeal
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Common sites
Lower lip- most favorable prognosis Lateral border of tongue Buccal mucosa Etiology Tobacco use Chronic irritation UV light-Cancer of the lip |
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Manifestations of Oral Cancer
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Leukoplakia—”Smoker’s patch”- white patch-<15% become cancerous
Erthroplakia-red patch >50% become cancerous Sore that does not heal/bleeds easily -1st sign of carcinoma Late Pain especially moving jaw Dysphagia Cancer of the lip-induration Pain in tongue when eating |
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Diagnostic/Treatment of Oral Cancer
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Diagnosis
History and Physical Biopsy of lesion/cytology- only way to diagnose if cancer exists Toluidine test-blue dye is taken up by the cancer |
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Best diagnostic study for oral cancer
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Biopsy of the suspected lesion w/ cytologic exam
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treatment for oral cancer
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chemo
radiation surgery- hemiglossectomy, glossectomy, mandibulectomy, resections of buccol mucosa and floor of mouth. when prognosis is poor, or cancer is inoperable, palliative tx is best mangement |
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Surgery for Oral Cancer
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Radical Neck dissection
Involves removal of lymph nodes, may have removal of sternocleidomastiod and other associated muscles, jugular veins, mandible, submaxillary gland etc.. Need tracheostomy JP drains |
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Nursing Care of the Radical Neck Dissection Client
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Airway monitoring
Monitor for bleeding Nutritional considerations Parenteral- 1st 24-48 hrs Feeding tube-PEG, NG, or nasointestinal tube Tracheostomy care Psychosocial-self image Pain management be able to communicate when tolerated, small amounts of water are given: close observation for choking and aspiration |
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Gastroesophageal Reflux (GERD)
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Not a disease, but a syndrome
Clinically symptomatic condition resulting in reflux of gastric contents into lower esophagus Happens when the defenses of the lower esophagus are overwhlemed by the reflux of stomach acidic contents into the esophagus |
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Gastroesophageal Reflux (GERD)--Etiology
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Combination of factors
Hiatal hernia-common factor Incompetent LES-primary factor Decreased esophagus clearance Decreased gastric emptying Medications Results in esophageal irritation and inflammation- esophagitis |
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Gastroesophageal Reflux (GERD) Clinical Manifestations
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Varies from individual
Heartburn (pyrosis)-most common Burning, tight sensation Can spread to jaw May wake person from sleep R/O cardiac causes first Heartburn usually relieved with milk, alkaline substances Wheezing, coughing, dyspnea, hoarseness Lump in throat Regurgitation-hot, bitter, sour liquid coming from mouth Stomatitis N/V dyspepsia, htpersalivation |
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Gastroesophageal Reflux (GERD) Complications
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Esophagitis
Esophageal stricture/scarring Barrett’s Esophagus—precancerous lesion for esophageal cancer/adenocarcinoma Bronchospasm Aspiration pneumonia Dental erosion |
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Gastroesophageal Reflux (GERD) Diagnostic Studies
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History and Physical
Barium swallow EGD Use of Proton pump inhibitors as trial- inhibits the secretion of H ions |
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Nursing Considerations for the Client with GERD
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Smoking cessation
Avoid food that decrease LES pressure fatty foods- decrease gastric emptying Chocolate Peppermint Coffee Tea Milk- Avoid late night snacks- dont eat for 3hrs before bedtime Small, frequent meals- to prevent overdistention |
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Nursing Considerations for the Client with GERD
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HOB 30 degrees- dont lie down for 2-3 hrs after eating
take fluids btw meals IV therapy Weight reduction Medication education Advance diet |
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Pharmacological Intervention for GERD
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Medications to:
Improve LES function Increase esophageal clearance Decrease volume and acidity of reflux Protect esophageal mucosa |
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Pharmacological Intervention for GERD Two approaches
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Step up”—from antacids, H2blockers, PPI
“Step down” from PPI, H2 blockers, antacids |
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Antacids Maalox, Mylanta, Milk of Magnesia
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quick, short lived relief of heartburn
Partially neutralizes gastric acid Does not coat stomach Usually mixture of aluminum (causes constipation) and magnesium (causes diarrhea) Caution: magnesium solutions with renal disease Decrease absorption of Digoxin, tetracycline, INH May have to separate medication admin and antacids by one hour Give 1 to 3 hours after meals and at bedtime for maximum effect |
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H2 Blockers
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Block histamine, decrease hcl secretions, promote esophageal healing in 50% of pts
Rantidine (Zantac),Cimetidine (Tagamet), Famotidine (Pepcid), Nizatidine (Axid) Decrease secretion of HCl acid by stomach-works on parital cells in stomach May increase toxicity of Coumadin, Theophylline, Dilantin Side effects: confusion |
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Proton Pump Inhibitors (PPI)
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Omeprazole (Protonix), Esomeprazole (Nexium)
Inhibit proton pump mechanism- responsible for secretion of H ion, stop HCL production May increase effects of Dilantin, Coumadin Give on empty stomach S/E- HEADACHE Promotes esophageal healing |
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Antiulcer Medication
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Sucralfate (Carafate)
Cytoprotective agent Adheres to an ulcer site Give 1 hour before meals and at bedtime Do not crush/Liquid form available Side effect: constipation, dizziness |
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Prokinetic (Reglan)
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Facilitates gastric emptying
Side effect: Hallucinations, anxiety, restlessness, insomnia, tiredness |
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Surgical/Endoscopic Therapy for GERD
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Surgical- laproscopically
Antireflux procedures- enchancing the integrity of LES Nissen fundoplication Endoscopic Stretta procedure-induces collagen formation, forms barrier against reflux On clear liquids for 24 hrs and then soft diet for 2 wks: if N/V occurs contact physician, NO nsaids for 10 days post op |
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Hiatal Hernia
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Herniation of portion of stomach into esophagus through opening in diaphragm
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Hiatal Hernia
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Types
Sliding- most common- stomach slides up into thoracic cavity when in supine and usually goes back into abd cavity when standing upright Paraesophageal/rolling- esophagastric junction remians in the normal position but the fundus and the greater curvature of stomach roll up through the diaphragm forming a pocket along side the esophagus |
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Etiology of Hiatal Hernia
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Structural changes
Obesity Pregnancy Heavy lifting |
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Clinical Manifestations of Hiatal Hernia
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May be asymptomatic
Heartburn- after meal, when lying down Dysphagia Reflux with lying down Pain, burning when bending over |
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Hiatal Hernia
Diagnostic studies |
Barium swallow-
Endoscopy Surgical intervention Nissen fundoplication- fundus of stomach is wrapped around distal esophagus and sutured to itself |
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Complications of Hiatal Hernia
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GERD
Hemorrhage from erosion Stenosis of esophagus Ulcerations- from the herniated portion of the stomach Strangulation of hernia-necrosis, incarceration Regurgitation Increased risk for respiratory disease- dyspnea to acute broncho constriction |
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Esophageal Cancer
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Prognosis is poor due to delayed medical seeking
Rare malignancy Barrett’s Esophagus-risk for malignancy Etiology >50 of age Unknown Risk factors Smoking Excessive ETOH Achalasia (delayed emptying of lower esophagus) Majority of tumors located in middle and lower portions of esophagus |
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Clinical Manifestations of Esophageal Cancer
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Usually late
Progressive dysphagia/ globus sensation- initially occurs w/ meat then with soft foods and eventually with liquids Pain- late stage Sore throat Hoarseness Weight loss Regurgitation of blood tinged esophageal contents- when esophageal stenosis is severe |
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Complications of Esophageal Cancer
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Hemorrhage
Esophageal perforation Esophageal obstruction |
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Diagnostic Studies Esophageal Cancer
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Barium swallow with fluoroscopy
Endoscopy Bronchoscopy CT MRI |
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Nursing Considerations for the Client with Esophageal Cancer
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Poor prognosis
Combination of surgery, chemotherapy, radiation Surgery Esophagectomy- Remove esophagus, graft to resect Esophagogastrostomy Resect esophagus to stomach Esophagoenterostomy Resect esophagus to colon Dilation of esophagus Parenteral fluids for nutrition Pain management |
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Post-op Nursing Considerations for the Client with Esophageal Cancer
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NGT-bloody drainage 8 to 12 hours then turns to greenish
Do not reposition NGT Airway assessment-T,C,D,B Semi-Fowler’s |
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Esophageal Diverticula
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Saclike outpouching of one or more layers of the esophagus
Zenker’s diverticulum Most common of esophageal diverticulum Located above the upper esophageal sphincter Symptoms Dysphagia Weight loss Regurgitation Chronic cough Aspiration |
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Esophageal Diverticula
Treatment Clients learn to empty esophagus by applying pressure Limit foods (blenderize) Endoscopic Surgery |
Clients learn to empty esophagus by applying pressure
Limit foods (blenderize) Endoscopic Surgery |
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Esophageal Stricture
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Most common-formation of scar tissue from:
Strong acid/alkaline ingestion Reflux Treatment Dilation via endoscopy using bougies Balloon dilation Calcium Channel blockers can help to relax smooth muscle |
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Achalasia
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Peristalsis of the lower two thirds of the esophagus resulting in:
Dilation of the lower esophagus Symptoms Dysphagia Halitosis Regurgitation of sour foods Symptoms similar to GERD |
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Achalasia
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Goal of tx is to relieve symptoms: dysphagia and regurtitaion: improve esophageal empyting, and prevent megaesophagus
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Achalasia
Diagnosis |
Endoscopy
Treatment Dilation Surgery Bland diet Esophageal dilation Heller myotomy (reduces LES pressure) Anticholinergics Calcium channel blockers Botox? |
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H. Pylori
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Client may be asymptomatic
Believed to be acquired in childhood and survives Can play a major role in gastritis, peptic ulcer, duodenal ulcer H. Pylori secretes urease that protects it from being destroyed in acid environment |
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Antibiotics Used to Treat H. Pylori
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Amoxicillin
Flagyl (metronidazole) Tetracycline Biaxin (Clarithromycin) Pepto bismol- has an antibiotic affect on H Pylori |
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Manifestations of Gastritis
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Acute gastritis
Anorexia Nausea Vomiting Epigastric tenderness Feeling of fullness Chronic gastritis May be asymptomatic Loss of intrinsic factor lead to s/s of B 12 deficiency--anemia |
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Diagnostic Studies of Gastritis
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History and Physical/ Social history
ETOH Smoking Endoscope H. Pylori testing CBC Stool for occult blood Cytology Gastric analysis-decreased or absent HCL Antibodies to parietal cells and intrinsic factor |
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Nursing Care of the Client with Acute Gastritis
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May be NPO or NGT
IV fluids Antiemetics VS, check for bleeding Antacids H2 blockers Proton pump inhibitor Tritec-Proton pump inhibitor plus bismuth Look out for Hemorrhage |
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Nursing Care of the Client with Chronic Gastritis
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Eliminate specific cause i.e. ETOH
Eradicate H. Pylori Different protocols Antibiotics i.e. Amoxicillin Proton pump inhibitor Antiinfectives i.e. Flagyl Six small meals a day Antacids No Smoking |
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Upper GI Bleed—Pathophysiology
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Can be sudden or gradual
Severity depends on what type of bleed Arterial Bright red (not in contact with stomach) Large amounts “Coffee ground”-In stomach for some time Longer the passage of blood through intestine, the darker the stool |
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Upper GI Bleed—Pathophysiology
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Massive GI bleed
1500 ml or 25% of intravascular blood volume Hematemesis-bright red blood or “coffee grounds” Melena-Black, tarry stools, slow bleeding from upper GI Occult bleed-small amounts of blood in vomit, stool, etc. not detectable by sight |
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Upper GI Bleed—Etiology
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Medications-ASA, NSAID’s, steroids
Esophagus-Esophageal varicies, Esophagitis, Mallory-Weiss tear Gastric Cancer Hemorrhagic gastritis Peptic ulcer disease Polyps Stress ulcer Blood dyscrasias Renal failure |
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Esophageal Bleeding
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Mallory-Weiss tear
Caused by severe retching and vomiting Tear occurs at the junction of the esophagus and stomach Esophageal varicies Usually secondary to cirrhosis of the liver Anything that increase pressure i.e. coughing can start massive bleed |
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Stomach and Duodenal Bleed
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Bleeding ulcers-majority of upper GI bleeds
Physiological stress ulcers Burns Surgery Medications |
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Emergency Treatment for the Client with an Upper GI Bleed
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VS (frequent), cap refill, urinary output
Abdominal assessment Presence/absence of bowel sounds Rigid, boardlike abdomen-emergency, can indicate perforation H&P CBC, BUN, Chemistry, ABG’s, coagulation studies, liver studies Multiple IV lines with large guage Fluids (LR) |
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Emergency Treatment for the Client With an Upper GI Bleed
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Type and cross/transfuse
O2 Foley CVP line Gastric lavage To OR or Endoscopy |
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Diagnostic Studies/Treatment for Upper GI Bleed
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Endoscopy
Can coagulate/thrombose area Surgery Angiography Medications Proton pump inhibitors H2 blockers Pitressin- vasoconstriction, increase BP Sandostatin |
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Pharmacological Intervention for Upper GI Bleed
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Pitressin
Creates vasoconstriction Continuous IV drip Titrate for effectiveness Sandostatin Suppresses secretion of HCL |
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Peptic Ulcer Disease
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Erosion of the GI mucosa from the digestive action of HCL acid and pepsin
Types Acute-superficial erosion/minimal inflammation Chronic-Long duration, erosion through muscular wall, fibrous tissue formation Both gastric and duodenal ulcer fall into this category |
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Peptic Ulcer Disease—Etiology
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Peptic ulcers only develop in acid environments
Cause of disease same as for upper GI bleed |
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Peptic Ulcer Disease Pathophysiology
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Pesinogen converts to pepsin in acid environment
Mucosal barrier impaired from previously mentioned causes H. Pylori can also destroy mucosal barrier As mucosal layer is impaired, increase in bloodflow Increased vasodilation Tissue damage occurs Emotions increase secretion of HCL |
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Gastric Ulcers
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Most commonly found on less curvature of stomach
Superficial lesion Gastric secretion normal to low Greater in women 50-60 years old |
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Clinical Manifestations/Complications of Gastric Ulcers
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Burning or gastric pressure in high epigastrum
Pain 1-2 hours after meals N/V Weight loss Complications Hemorrhage Perforation |
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Duodenal Ulcer
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Majority of all peptic ulcers
More in men 35-45 years High acid secretion Disease that increase risk of developing duodenal ulcers COPD Cirrhosis Pancreatitis Renal Failure Hyperparathyroidism Zollinger-Ellison syndrome- rare condition of severe peptic ulceration, gastric acid hypersecretion, elevated serum gastrin levels, and gastrinoma of the pancreas or duodenum. |
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Duodenal Ulcer
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Penetrating lesion usually found in first 1-2 cm of duodenum
Greater in men Associated with stress Increase with ETOH, smoking |
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Zollinger-Ellison Syndrome
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Severe peptic ulceration
Gastric acid hypersecretion Increased serum gastrin levels Gastrinoma of the pancreas/duodenum |
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Clinical Manifestations of Duodenal Ulcers
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Burning, cramping across midepigastrum and upper abdomen
Back pain Pain 2-4 hr after meals and midmorning, middle of night Relief with food antacids N/V |
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Complications of Peptic Ulcer Disease
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Hemorrhage
Perforation-most lethal, severe abdominal pain that spreads throughout abdomen, shoulder pain, absent bowel sounds Obstruction |
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Diagnostic Studies of Peptic Ulcer Disease
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Endoscopy
Tests for H.Pylori Invasive Tissue specimens Rapid urease test Nonivasive IgG Urea breath test (by product of H.Pylori) Barium swallow/X-rays- not accurate |
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Treatment of Peptic Ulcer Disease
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Discontinue medications if possible that exacerbate condition
No smoking/ETOH Avoid spicy/acid foods, black pepper, small frequent meals Medications H2 Blockers Cytotec (antisecretory and cytoprotective) Cytoprotective agents (Carafate) Antacids Antibiotics for H. Pylori Treat stress Antidepressants? Surgery |
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Treatment of Peptic Ulcer Disease-Surgery
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Not usual course of treatment
Gastroduodenostomy (Biliroth I)-Partial gastrostomy Gastrojejunostomy (Biliroth II) –antrum and pylorus removed, preferred method for duodenal ulcer Vagotomy-sever Vagal nerve Pyroplasty-enlarge pyloric sphincter |
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Peptic Ulcer Disease Post op Complications
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Avoid Dumping syndrome by:
Small meals, no liquids with meal Dry foods, low carbs, moderate protein, fats Avoid Postprandial hypoglycemia by: If hypoglycemic occurs, candy Follow diet for dumping syndrome Bile reflux gastritis Notify Health care provider if epigastric distress similar to pre op |
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Gastric Cancer
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Adenocarcinoma of the stomach wall
Usually men in advanced stage Etiology Unknown ? High spice, high smoked foods Pathophysiology Nonspecific mucosal injury Predisposing factors Atropic gastritis H.Pylori at early age Gastric Polyps Pernicious anemia Achlorhydria |
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Clinical manifestations of Gastric Cancer
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Usually late in disease process
Signs/symptoms of anemia Pallor SOB Fatigue Signs/symptoms of peptic ulcer disease Burning pain, alleviated by antacids Weight loss Dysphagia Later Papable mass in abdomen Enlarged hard lymph nodes |
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Acute exacerbation of Peptic Ulcer Disease
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Frequent VS
NGT Several IV lines (Large bore) Crystalloid/colloid solutions (LR) CBC, Chemistries, ABG’s O2 Type and Cross Match Emergency care as per client needs Perforation-OR |
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Diagnostic Studies of Gastric Cancer
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H&P
Upper GI barium Endoscopy-biopsy/cytology/US CBC, Chemistries, Stool specimens Tumor markers-CEA, CA 19-9 |
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Treatment of Gastric Cancer
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Surgery removal of tumor
Chemo/radiation ? Success Treat symptoms Pain Correct anemia |
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Food Poisoning
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Types
Acute gastroenteritis Neurological symptoms from botulism |
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Responsible Microorganisms of Food Poisoning
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Staph
Onset-30 min-7hr Symptoms-N/V, diarrhea Prevent: Refrigerate foods Clostridium Onset-8-24 hr Symptoms-Nausea with no vomiting, diarrhea Prevent: Correct preparation of meat Salmonella Onset-8hr-days Symptoms-n/V fever Prevent: Proper preparation of poultry, pork, beef Botulism Onset: 12-36 hr Symptoms: GI, CNS symptoms Prevent: Correct processing of canned foods |
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Responsible Microorganisms of Food Poisoning
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E. Coli
Onset: 8hr-1wk Symptoms: Bloody stools, hemolytic uremic syndrome, profuse diarrhea |
