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NU 340 > Ch. 46 > Flashcards

Ch. 46 Flashcards

1
Q

GERD stands for

A

gastroesophageal reflux disease

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2
Q

most common upper GI disorder in the US

A

GERD

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3
Q

__ % of adults in North America have reflux disorder

A

18-28%

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4
Q

GERD occurs as a result of

A

backward flow of the stomach contents into esophagus

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5
Q

causes of GERD

A
  • no single causative agent
  • NG tube
  • genetic connection: fam hx
  • lifestyle: alc, caffeine, smoking
  • Barrett’s epithelium
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6
Q

Barret’s esophagus

A
  • With Barretts esophagus, body substitutes Barrett epithelium instead of normal squamous cell
  • New tissue is more resistant to acid, but is premalignant, increased risk for esophageal cancer
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7
Q

normal healing of GERD (type of epithelium)

A

Normal healing of GERD with squamous cell epithelium

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8
Q

GERD prevention

A
  • healthy eating habits
  • limit fried, fatty, spicy foods and caffeine
  • sit upright for one hour after eating
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9
Q

GERD assessment: history (sx)

A
  • heartburn
  • morning hoarseness
  • coughing or wheezing at night
  • when do they experience these symptoms? usually report 1-2 hrs after meal
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10
Q

GERD assessment: s/sx

A
  • may be asymptomatic at first
  • dyspepsia, dysphagia
  • auscultate lungs for crackles (should have clear sounds with GERD, listen for crackles to ensure food is not backing up into the lungs)
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11
Q

GERD assessment: psychosocial

A
  • preference of what patient likes to eat
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12
Q

GERD assessment: diagnostics

A
  • upper endoscopy (UGD) (conscious sedation used, need vs monitor, someone to drive home; scope into esophagus; more invasive but confirmatory dx)
  • ambulatory esophageal pH monitoring: 24 hr reading of the pH levels (how acidic the esophagus is; no sedation)
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13
Q

priority patient problems of GERD

A
  • potential for compromised nutrition status due to dietary selection
  • acute pain due to reflux of gastric contents
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14
Q

GERD interventions: nutrition

A
  • balanced nutrition
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15
Q

GERD interventions: for minimizing pain

A

non-surgical mangement:
- lifestyle changes: no caffeine, alc, smoking, fried/spicy foods
- drug therapy
- endoscopic therapies

surgical management

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16
Q

Acid reflux diet: foods to avoid

A
  • coffee
  • wine
  • fast food
  • soft drinks
  • tomatoes (acidic)
  • dairy
  • spices
  • peppermint
  • citrus (oranges, grapefruit)
  • chocolate
  • garlic
  • onion
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17
Q

Acid reflux diet: foods that are okay to eat

A
  • ginger
  • leafy greens
  • brown rice
  • coconut
  • banana
  • pear
  • apple
  • avocado
  • fennel
  • celery
  • berries
  • melon
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18
Q

GERD care coordination

A
  • make appropriate dietary selections
  • adhere to drug therapy
  • teach signs of esophageal restriction and Barrett esophagus
  • RDN
  • local support groups
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19
Q

GERD meds include (classes)

A
  • proton pump inhibitors
  • H2 receptor blockers
  • antacids
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20
Q

GERD meds: proton pump inhibitors

A

the “-prazole” meds
- omeprazole
- pantoprazole
- lansoprazole

21
Q

GERD meds: H2 receptor blockers

A

end in “-tidine”
- rantidine
- famotidine
- cemetidine

22
Q

GERD meds: antacids

A
  • maalox and mylanta
23
Q

antacids

A
  • increase gastric pH by neutralizing acid
  • aluminum base =
  • magnesium base =
  • take 1-3 hours AFTER meals
  • taken PRN (as needed)
24
Q

histamine-receptor blocks (H2R blockers)

A
  • block action of histamine on H2 receptors
  • decreases HCl acid secretion
  • decreases conversion of pepsinogen to pepsin
  • increase ulcer healing
  • taken before meals
25
Q

proton pump inhibitors (PPIs)

A
  • main treatment for GERD
  • block HCl acid secretions
  • promote ulcer healing
  • DO NOT CRUSH OR CHEW (PO)
  • must be given IV for short-term use (usually given PO)
  • promote rapid healing, but reoccurrence common with cessation
  • can interfere with calcium absorption
  • taken in morning, empty stomach
  • maintenance med; pretty much on it forever
26
Q

main treatment for GERD

A

proton pump inhibitors (PPIs)

27
Q

GERD evaluation

A
  • adhere to appropriate diet, medication therapy, and lifestyle modifications
  • experience minimized or absence of pain
28
Q

hiatal hernia

A
  • Protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest
29
Q

hiatial hernia assessment: sx

A

many people are asymptomatic; others have sx similar to GERD
- heartburn regurgitation
- dysphagia

sx often increase after meal or when lying supine

30
Q

hiatal hernia assessment: diagnostics

A
  • barium swallow study with fluoroscopy: barium illuminates the hernia
  • EGD
  • high resolution manometry with esophageal pressure topography
31
Q

hiatal hernia non-surgical interventions

A
  • drug therapy
  • nutrition therapy: no spicy, greasy foods
  • lifestyle changes: caffeine, alc, smoking
32
Q

hiatal hernia surgical interventions

A
  • LNF- laproscopic nissen fundoplication
    (sm incision in abdomen; monitor s/sx of infection)
  • may need to lose weight before surgery
33
Q

hiatal hernia care coordination

A
  • nutrition modifications
  • stool softeners or bulk laxatives (more so post-op)
  • daily incisional inspection
  • signs to report to the HCP
  • avoid sick people (don’t want pt to cough bc of abdominal incision)
34
Q

diarrhea is caused by

A
  • pathogens: infections; gastroenteritis
  • medical conditions: inflammatory GI diseases
  • food intolerance: lactose, gluten
35
Q

diarrhea sx

A
  • frequent liquid stool
  • hyperactive BS
  • abdominal tenderness, distention
36
Q

diarrhea diagnostics

A
  • stool culture (for patients with suspected infectious disease, ie C Diff)
37
Q

diarrhea collaborative care (goals of care)

A
  • stop sx
  • hydration: worried about hypovolemia
  • treat underlying cause (infectious: ABT; anti-inflammatories for inflammatory d/o)
38
Q

acute infectious diarrhea: assessment

A
  • s/sx of dehydration
  • skin turgor
  • tachycardia
  • dry mucous membranes
  • low BP (hypotension) (mostly older population)
39
Q

acute infectious diarrhea: nursing diagnoses

A
  • Deficit fluid volume r/t excessive fluid loss
  • Decrease CO r/t decreased plasma volume
  • Impaired oral mucous membranes r/t inadequate oral secretions
  • Risk for falls r/t orthostatic hypotension
  • Confusion (acute or chronic) r/t neuro changes (d/t electrolyte changes from being dehydrated)
40
Q

clostridium difficile

A

aka c. diff
- bacteria that causes severe diarrhea
- commonly starts 4-9 days after beginning antibiotics (s/e of ABT)

41
Q

c. diff: dx tests

A
  • stool testing (culture)
42
Q

c. diff: treatment

A

drug therapy
- vancomycin PO
- metronidazole

43
Q

c. diff: interventions

A
  • private room/contact isolations
  • contact precautions (gloves & gown)
  • hand washing with soap and water
44
Q

constipation

A
  • Stool moves slowly through GI tract
  • Many factors can cause
    -Muscles used to move bowels are not coordinated

can be caused by:
- use of opioids
- post-op/anesthesia
- sedentary lifestyle
- diet: not enough fiber/fluids
- taking iron supplements

45
Q

constipation: s/sx

A
  • hard stools
  • straining with BM
  • sense of rectal fullness or blockage
  • incomplete evacuation
46
Q

constipation: complications

A
  • hemorrhoids (from straining)
  • bowel obstruction
47
Q

constipation: diagnostics

A
  • barium enema
  • sigmoidoscopy/ colonoscopy
48
Q

constipation: interventions

A
  • nutrition and lifestyle therapy
  • not being sedentary/exercising
  • increasing fluid intake
  • increasing fiber intake/ high fiber diet
  • drug therapy
49
Q

constipation: drug therapy

A
  • bulk-forming: metamucil
  • stool softener: docusate
  • stimulants: senna
  • osmotic solutions: miralax
  • saline laxatives: milk of magnesia (MOM)
  • lubricants: fleets

(all oral agents; except fleets)
- try high fiber diet first, then PO meds, then fleet enema or suppository as the last resorts

NU 340 (26 decks)

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