GERD Flashcards
what is the most common manifestation of the GI disease
nausea and vomitting
what is the feeling of discomfort in epigastric area with a conscious desire to vomit
nausea
what is forceful ejection of partially digested food and secretions (emesis) from upper GI tract
vomiting
what are the clinical manifestations of vomiting
- metabolic alkalosis:from loss of gastric HCL
- metabolic acidosis: from loss of bicarbonate if contents from small intestine are omitted
- weight loss from fluid loss can occur
what does a fecal odor and bile indicated in emesis
a lower intestinal obstruction
color of emesis aids in determingin
presence and source of any bleeding
ex: coffee grounds looks would be blood
bright red blood indicates active bleeding and what are the 3 things that could be associated with this
mallory-weiss tear
esophageal varices
gastric or duodenal ulcer or neoplasm
what could we use for drug therapy
serotonin receptor antagonists phenothiazines anticholinergics antihistamines prokinetic
what does serotonin receptor antagonists do and the side effects
blocks serotonin which causes nausea and vomitting
examples: ondansetron - zofran
s/e: constipation, headache, fatigue
what does phenothiazines do and the side effects
blocks dopamine receptors that trigger nausea and vomiting
s/e: dry mouth, hypotension, section, rashes, constipation
what does anticholinergics do and side effects
block neurochemicals that trigger nausea and vomitting
example: scopolamine trasndermal (transderm-Scop)
s/e: dry mouth, sleepiness
what do antihistamines do and side effects
blocks histamine receptors that trigger nausea and vomiting
example: diphenhydramine-benadryl
s/e: dry mouth, hypotension, sedation
what do pro kinetic do and the s/d
increases gastric motility
example: metoclopramide- reglin
s/e: like parkinson, tremors, anxiety, hallucinations
what would be some nutritional therapy with nausea and vomiting
IV therapy to replace fluids, electroclytes, glucose NG tube to decompress stomach clear liquids have symptoms subside -5-15 ml fluid every 15-20 mins -no hot/cold liquids -room temp carbonated drinks are okay -warm tea begin with dry toast, crackers high carbohydrate, low-fat food next because easiest to digest ex: baked potato, yellow, cereal with milk eat slowly and in small amounts
what are some non drug therapy for nausea and vomiting
acupuncture or acupressure
botanicals -ginger or peppermint
relaxation breathing exercises
what is GERD
common problem
chronic symptom of mucosal damage
no one single causes
what is the primary factor in GERD
incompetent LES
- results in decrease pressure in distal portion of esophagus
- can be due to certain foods (caffeine, chocolate) and drugs (anticholeniergics)
what are symptoms of GERD
heartburn (pyrosis) -MOST COMMON
dyspepsia - indigestion, upset stomach
regurgitation- bitter, ot, sour liquids coming into throat or mouth
sometimes respiratory symptoms and otolaryngologic symptoms
what are clinical manifestation of GERD related chest pain
burning or squeezing
radiating to back, neck, jaw or arms
more common ini older adults with GERD
received with antacids
what are some complications with GERD
esophagitis
barretts esophagus
respiratory
dental erosion
what is esophagitis
inflammation of esophagus
if repeated exxposure then scar formation, esophageal stricture, and dysphasia
what is barretts esophagus
usually a precancerous lesion
replacement of flat epithelial cells with columnar epithelium
diagnosed 5-20% of patients with chronic reflux
must be monitored every 2-3 years by endoscopy since it can lead to cancer
what are respiratory complications with GERD
from irritations of upper airway by secretions
- cough
- bronchospasm
- laryngospasm
- cricophayngeal spasm
from aspiration
-potentional for asthma, bronchitis and pneumonia
what are the dental erosion complications with GERD
from acid reflux into mouth
especially on posterior teeth
what are some diagnostic studies
history and physical examination
upper GI endoscopy- LES competence, degree of inflammation, scarring, strictures, obtain biopsy
Barium- can detect protrusion of gastric funds
esophageal lmanometric studies- measures pressure in esophagus and LES
what are some lifestyle modifications with GERD
avoiding triggers
maintain appropriate weight
smoking cessation
stress managment
what are some nutritional therapy with GERD
avoid foods that decrease LES pressore or irritate the esophagus
small, frequent meals
avoid late evening meals
brink fluids between meals
chew up and oral lozenges to help with secretion to keep things moving
what is drug therapy with GERD
proton pump inhibitors histamine 2 receptor blockers acid protective chonlinergic pro kinetic drug antacids
what is a drug alert with proton pump inhibitors
long term use or high doses may increase risk of fractures of hip, wrist, spine b/c effects calcium reabsorption
associated with increase risk for C diff in hospitalized patients
what is proton pump hibitors
-promote esophageal healing in 80% to 90% of patients
example: omeprazole, pantroprazole
s/e: headhache
what are histamine 2 receptor blockers
decrease secretion of HCL acid
reduce symptoms and promote esophageal healing in 50% of patients
example: clmetidine, famotidine, ranitidine
s/e: headache, abdominal pain, constipation, diarrhea
what is acid protective
used for cyoprotective properties
example: sucralfate
s/e constipation
what is cholinergic
increase LES pressure
improve esophageal and gastric emptying
example: bethanechol
s/e: lightheadedness, stomach cramps, diarrhea
what are pro kinetic drugs
promote gastric emptyign
reduce risk of gastric acid reflux
example : metoclopramide (reglan)
what is antacids
quick but short lived relief
neutralize HCL acid
taken 1-3 hours after meals/bed
example: maalox, mylanta
when would we do surgery for GERD
failure of conservative therapy medication intolerance barretts metaplasia esophaeal strcitue and stenosis choriinc esophagitis
what are some surgery options
nissen and toupet fundoplicaitons
LINX relux management system - titanium beads with magnetic core, when swallow the ring opens
what should we do for people with GERD
do not lie down for 2-3 hours after eating stress reduction techniques weigh reduciton small, frequent meals avoid factors that cause reflux
what are postoperative care goals with GERD
prevent respiratory complications
maintain fluid/electorlyte blance
prevent infection
what should we look for with post op respiratory assessment
respiratory rate/rhythm and pulse rate/rhythm signs of pneumothorax -dyspnea -chest pain -cynosis
what are some things to do post op with GERD
deep breathing techniques accurate I/O observing fluid/eelectorlyte imbalance pain meds meds to prevent nausea/vomiting
how should we introduce liquids and foods
when peristalsis return we give only fluids
then solids gradually
then normal diet
avoid: gas forming foods and chew throughly, carbonated drinks and straws b/c air
After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective?
A“I can have a glass of low-fat milk at bedtime.”
B“I will have to eliminate all spicy foods from my diet.”
C“I will have to use herbal teas instead of caffeinated drinks.”
D“I should keep something in my stomach all the time to neutralize the excess acids.”
C
