Ch. 46 Flashcards
GERD stands for
gastroesophageal reflux disease
most common upper GI disorder in the US
GERD
__ % of adults in North America have reflux disorder
18-28%
GERD occurs as a result of
backward flow of the stomach contents into esophagus
causes of GERD
- no single causative agent
- NG tube
- genetic connection: fam hx
- lifestyle: alc, caffeine, smoking
- Barrett’s epithelium
Barret’s esophagus
- 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
normal healing of GERD (type of epithelium)
Normal healing of GERD with squamous cell epithelium
GERD prevention
- healthy eating habits
- limit fried, fatty, spicy foods and caffeine
- sit upright for one hour after eating
GERD assessment: history (sx)
- heartburn
- morning hoarseness
- coughing or wheezing at night
- when do they experience these symptoms? usually report 1-2 hrs after meal
GERD assessment: s/sx
- 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)
GERD assessment: psychosocial
- preference of what patient likes to eat
GERD assessment: diagnostics
- 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)
priority patient problems of GERD
- potential for compromised nutrition status due to dietary selection
- acute pain due to reflux of gastric contents
GERD interventions: nutrition
- balanced nutrition
GERD interventions: for minimizing pain
non-surgical mangement:
- lifestyle changes: no caffeine, alc, smoking, fried/spicy foods
- drug therapy
- endoscopic therapies
surgical management
Acid reflux diet: foods to avoid
- coffee
- wine
- fast food
- soft drinks
- tomatoes (acidic)
- dairy
- spices
- peppermint
- citrus (oranges, grapefruit)
- chocolate
- garlic
- onion
Acid reflux diet: foods that are okay to eat
- ginger
- leafy greens
- brown rice
- coconut
- banana
- pear
- apple
- avocado
- fennel
- celery
- berries
- melon
GERD care coordination
- make appropriate dietary selections
- adhere to drug therapy
- teach signs of esophageal restriction and Barrett esophagus
- RDN
- local support groups
GERD meds include (classes)
- proton pump inhibitors
- H2 receptor blockers
- antacids
GERD meds: proton pump inhibitors
the “-prazole” meds
- omeprazole
- pantoprazole
- lansoprazole
GERD meds: H2 receptor blockers
end in “-tidine”
- rantidine
- famotidine
- cemetidine
GERD meds: antacids
- maalox and mylanta
antacids
- increase gastric pH by neutralizing acid
- aluminum base =
- magnesium base =
- take 1-3 hours AFTER meals
- taken PRN (as needed)
histamine-receptor blocks (H2R blockers)
- block action of histamine on H2 receptors
- decreases HCl acid secretion
- decreases conversion of pepsinogen to pepsin
- increase ulcer healing
- taken before meals
proton pump inhibitors (PPIs)
- 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
main treatment for GERD
proton pump inhibitors (PPIs)
GERD evaluation
- adhere to appropriate diet, medication therapy, and lifestyle modifications
- experience minimized or absence of pain
hiatal hernia
- Protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest
hiatial hernia assessment: sx
many people are asymptomatic; others have sx similar to GERD
- heartburn regurgitation
- dysphagia
sx often increase after meal or when lying supine
hiatal hernia assessment: diagnostics
- barium swallow study with fluoroscopy: barium illuminates the hernia
- EGD
- high resolution manometry with esophageal pressure topography
hiatal hernia non-surgical interventions
- drug therapy
- nutrition therapy: no spicy, greasy foods
- lifestyle changes: caffeine, alc, smoking
hiatal hernia surgical interventions
- LNF- laproscopic nissen fundoplication
(sm incision in abdomen; monitor s/sx of infection) - may need to lose weight before surgery
hiatal hernia care coordination
- 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)
diarrhea is caused by
- pathogens: infections; gastroenteritis
- medical conditions: inflammatory GI diseases
- food intolerance: lactose, gluten
diarrhea sx
- frequent liquid stool
- hyperactive BS
- abdominal tenderness, distention
diarrhea diagnostics
- stool culture (for patients with suspected infectious disease, ie C Diff)
diarrhea collaborative care (goals of care)
- stop sx
- hydration: worried about hypovolemia
- treat underlying cause (infectious: ABT; anti-inflammatories for inflammatory d/o)
acute infectious diarrhea: assessment
- s/sx of dehydration
- skin turgor
- tachycardia
- dry mucous membranes
- low BP (hypotension) (mostly older population)
acute infectious diarrhea: nursing diagnoses
- 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)
clostridium difficile
aka c. diff
- bacteria that causes severe diarrhea
- commonly starts 4-9 days after beginning antibiotics (s/e of ABT)
c. diff: dx tests
- stool testing (culture)
c. diff: treatment
drug therapy
- vancomycin PO
- metronidazole
c. diff: interventions
- private room/contact isolations
- contact precautions (gloves & gown)
- hand washing with soap and water
constipation
- 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
constipation: s/sx
- hard stools
- straining with BM
- sense of rectal fullness or blockage
- incomplete evacuation
constipation: complications
- hemorrhoids (from straining)
- bowel obstruction
constipation: diagnostics
- barium enema
- sigmoidoscopy/ colonoscopy
constipation: interventions
- nutrition and lifestyle therapy
- not being sedentary/exercising
- increasing fluid intake
- increasing fiber intake/ high fiber diet
- drug therapy
constipation: drug therapy
- 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
