Brunner's Ch 45: Management of Patients with Oral and Esophageal Disorders Flashcards
Edited to remove oncology questions.
A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barretts esophagus with minor cell changes. Which of the following principles should be integrated into the patients subsequent care?
A) The patient will require an upper endoscopy every 6 months to detect malignant changes.
B) Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage.
C) Small amounts of blood are likely to be present in the stools and are not cause for concern.
D) Antacids may be discontinued when symptoms of heartburn subside.
A) The patient will require an upper endoscopy every 6 months to detect malignant changes.
In the patient with Barretts esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.
A patient has been diagnosed with achalasia based on his history and diagnostic imaging results. The nurse should identify what risk diagnosis when planning the patients care?
a. Risk for Aspiration Related to Inhalation of Gastric Contents
b. Risk for Imbalanced Nutrition: Less than Body Requirements Related to Impaired Absorption
c. Risk for Decreased Cardiac Output Related to Vasovagal Response
d. Risk for Impaired Verbal Communication Related to Oral Trauma
a. Risk for Aspiration Related to Inhalation of Gastric Contents
Achalasia can result in the aspiration of gastric contents. It is not normally an acute risk to the patients nutritional status and does not affect cardiac output or communication.
A nurse is providing health promotion education to a patient diagnosed with an esophageal reflux disorder. What practice should the nurse encourage the patient to implement?
a. Keep the head of the bed lowered.
b. Drink a cup of hot tea before bedtime.
c. Avoid carbonated drinks.
d. Eat a low-protein diet.
c. Avoid carbonated drinks.
For a patient diagnosed with esophageal reflux disorder, the nurse should instruct the patient to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. Protein limitation is not necessary.
A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD? A) Pyloric sphincter B) Lower esophageal sphincter C) Hypopharyngeal sphincter D) Upper esophageal sphincter
B) Lower esophageal sphincter
The lower esophageal sphincter, also called the gastroesophageal sphincter or cardiac sphincter, is located at the junction of the esophagus and the stomach. An incompetent lower esophageal sphincter allows reflux (backward flow) of gastric contents. The upper esophageal sphincter and the hypopharyngeal sphincter are synonymous and are not responsible for the manifestations of GERD. The pyloric sphincter exists between the stomach and the duodenum.
An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body? A) Haloperidol B) Prostigmine C) Epinephrine D) Glucagon
D) Glucagon
Glucagon is administered prior to removal of a foreign body because it relaxes the smooth muscle of the esophagus, facilitating insertion of the endoscope. Haloperidol is an antipsychotic drug and is not indicated. Prostigmine is prescribed for patients with myastheniagravis. It increases muscular contraction, an effect opposite that which is desired to facilitate removal of the foreign body. Epinephrine is indicated in asthma attack and bronchospasm.
A patient with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the patient may be prescribed what drug? A) Metoclopramide (Reglan) B) Omeprazole (Prilosec) C) Lansoprazole (Prevacid) D) Famotidine (Pepcid)
A) Metoclopramide (Reglan)
Metoclopramide (Reglan) is useful in promoting gastric motility. Omeprazole and lansoprozole are proton pump inhibitors that reduce gastric acid secretion. Famotidine (Pepcid) is an H2receptor antagonist, which has a similar effect.
Results of a patient barium swallow suggest that the patient has GERD. The nurse is planning health education to address the patients knowledge of this new diagnosis. Which of the following should the nurse encourage?
A) Eating several small meals daily rather than 3 larger meals
B) Keeping the head of the bed slightly elevated
C) Drinking carbonated mineral water rather than soft drinks
D) Avoiding food or fluid intake after 6:00 p.m.
B) Keeping the head of the bed slightly elevated
The patient with GERD is encouraged to elevate the head of the bed on 6- to 8-inch (15- to 20-cm) blocks. Frequent meals are not specifically encouraged and the patient should avoid food and fluid within 2 hours of bedtime. All carbonated beverages should be avoided
A patient seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education?
A) Drinking beverages after your meal, rather than with your meal, may bring some relief.
B) Its best to avoid dry foods, such as rice and chicken, because theyre harder to swallow.
C) Many patients obtain relief by taking over-the-counter antacids 30 minutes before eating.
D) Instead of eating three meals a day, try eating smaller amounts more often.
D) Instead of eating three meals a day, try eating smaller amounts more often.
Management for a hiatal hernia includes frequent, small feedings that can pass easily through the esophagus. Avoiding beverages and particular foods or taking OTC antacids are not noted to be beneficial.
