Chapter 54 Flashcards
GERD
A result of persisepnt backward flow of stomach contents into the esophagus.
Chronic condition of exposing the esophagus irritating effects of gastric or duodenum contents resulting in inflammation.
Most common cause of GERD
Excessive relaxation of the LES causing reflex of gastric contents into the esophagus
Who is at risk of developing GERD
Overweight/obese
Hital Hernia
H pylori
Increased intra abdominal pressure
How can patient with GERD develop cancer.
By the body replace columnar cells with damaged squamous cell known as Barrett’s Epithelium
Esophageal Stricture
Narrowing of the esophagus opening due to scarring.
Can lead to difficulty swallowing
What is normal PH of the stomach
1.5-2.0
What Factors contribute dcreased LES pressure
Caffeinated beverages
chocolate
citrus fruits tomatoes and tomato products
smoking, use of other tobacco products or alcohol
calcium channel blocker’s nitrates cholinergic drugs
peppermint spearmint
high levels of estrogen and progesterone
nasogastric tube
What are the two main symptoms of Gerd?
Dyspepsia (indigestion)
And
Regurgitation
What would be the diagnosis of a patient presenting with asthma morning hoarseness pneumonia reflux heartburn and atypical chest pain?
Severe reflux that reaches the pharynx or the mouth or pulmonary aspirations
What are some additional signs and symptoms of Gerd?
Water brash (hyper salvation)
Dysphagia ( difficultly swallowing)
Odynophagia painful swallowing)
pyrosis (heartburn)
Globus (filling up something in the back of the throat) Nausea pharyngitis Coughing Hoarness belching Epigastric pain
Factors that increase intraabdominal gastric pressure
Pregnancy
wearing tight belt
Girdle
Ascites
Signs of indigestion signs and symptoms
Abdominal discomfort feeling uncomfortable full Nausea burping Worsens bends over strains or lies down severe may radiate to the neck or jaw referred to the back
Patient reports to ED severe GERD and discomfort. He last ate two hours ago. He felt worse when lying down The pain went to his neck and jaw felt nausea and feeling uncomfortable.
What is the nursing teaching for prompt relief?
Drink fluids
take antacids
maintain an upright 1-2 hours after eating
What are some complications older adults may experience because of Gerd due to physiological changes?
Atypical chest pain ear nose and throat infections pulmonary problems; aspiration pneumonia sleep apnea Asthma Barretts esophagus esophageal erosion
Diagnostic Test for Gerd?
Barium swallow
EGD
PH monitor examination (most accurate)
48 hour Bravo Esophageal pH test
A small capsule is temporarily attached to esophagus
Patients asked diary of activities and update
the PH is continuously monitored and recorded
a wireless monitoring device may be used f
Priority collaborative problems with the current patients
Potential for compromised nutrition
acute pain
Patient teaching nutritional therapy for GERD
Limit; peppermint chocolate fatty food and fried foods
Caffeine/carbonated beverages
restrict spicy and acidic foods;orange juice and tomatoes
use my fitness pal
Limit foods that increase the gastric acid or cause pain
do not snack in the evening
do not eat 2-3 hours before bed
eat slowly and chew food thoroughly to prevent Belching
Patient teaching of lifestyle changes with the GERD
Elevate the head of the bed 6 to 12 inches;use blocks or wedge pillow
sleep on the right side to promote gas exchange
swallow frequently to clear esophagus
weight reduction
avoid constructive clothing lifting heavy objects or straining and working in a bent over a stooped position to
Chew chewable antacids completely and followed with a glass of water
What drugs lower LES and cause reflux?
Oral contraceptives anticholinergic agents sedatives NSAID such as ibuprofen nitrates calcium channel blocker’s
Long-term use Protein pump inhibitor’s may cause what?
Community acquired pneumonia
G.I. infection such as CDiff
What 2 protein pump inhibitor’s can be administered by IV form for short term treatment or prevention of stress ulcers?
Pantoprazole (protonix)
Esomepraxole (nexium)
What is the main treatment for severe Gerd?
Protein pump Inhibitors
End in prazole
Action of PPIs?
Long acting inhibitors of gastric acid secretion by affecting the protein pump of parietal cells
Reduce gastric acid secretion the long acting except omeprazole
Histamine receptor antagonists action?
long acting and decrease acid and promote healing of the inflamed esophageal tissue so comfort is improved.
Reduce gastric secretions
Antacids use?
Occasional use of heartburn discomfort not for long term use
Antiacid action?
Elevating the pH level of gastric contents there by deactivate and pepsin.
Neutralize HCI
Reduce pepsin
Why shouldn’t antacids be used long-term
Their length of action is short
nighttime effectiveness is the minimum
increase LES pressure
Joint commission core measures to decrease LES pression
Teach patient that smoking and alcohol us should be avoided. Explore smoking cessation and make appropriate referrals activation about his or her use of alcohol beverages and if your puppy left the patient help find alcohol
5 Sliding hiatal hernia key feature
Heartburn chest pain dysphagia ( difficultly swallowing) Regurgitation belching
Five key features of paraesophegal hernia
Fill of fullness after eating
breathlessness after eating
feeling of suffocation
chest pain that mimic angina
worsening of manifestations in a lying or recumbent position
regurgitation is usually not present
Risk associated with having a paraesophageal hernia
Twisting of the G.I. structure (Volvulus)
obstruction (blockage) is high
strangulation (stricter) is high
development of iron deficiency anemia is common due to slow bleeding
Large bleeding or hemorrhage is rare
Four positioning teaching for hitial hernia?
Sleep at night with the head of the bed elevated 6 inches
remain upright for several hours after eating
avoid training or excessive vigorous exercise
refrain from wearing clothing that is tight or constructive around the abdominal
What is the most important role of gthe nurse for caring for a patient with a hernia?
“Health teaching” encourage the patient to ….
avoid eating in the late evening
avoid foods associated with
teach the patient and family follow a restricted diet and exercise
reduce weight is beneficial because obesity increases enter abdominal pressure and worsens both the hernia and the symptoms of reflux
Preoperative care for surgical management of hernia
If not urgent instruct patient to lose weight
smoking or significantly reduce smoking
reinforce the surgeons instructions and prepare the patient for what to expect after surgery
Operative procedure for a hernia
Fundoplication= Re-enforcement of the LES surgeon wraps a portion of the stomach or fund around the distal
LNF=Minimum invasive with less complications some patients are not a candidate
Paraesophageal repair = One large incision or several 1/2 incision made in ab. Hernia is reinforced with mesh.
Operative procedure for Trans thoracic space hernia repair?
nasogastric tube inserted and will remain several days
oral intake will be started gradually with clear liquids after peristalsis
Teach deep breathing and use of incentive spirometer
informed that breathing will be painful
teach patient about postoperative pain and meds
Post operative risk for LNF procedure or paraesophageal for your repair via laparoscopically
The nursing care priority is to observe for complications of bleeding and provide health teaching patient at high risk of bleeding and infection
