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210 exam 2 > GERD > Flashcards

GERD Flashcards

1
Q

what is the most common manifestation of the GI disease

A

nausea and vomitting

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2
Q

what is the feeling of discomfort in epigastric area with a conscious desire to vomit

A

nausea

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3
Q

what is forceful ejection of partially digested food and secretions (emesis) from upper GI tract

A

vomiting

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4
Q

what are the clinical manifestations of vomiting

A
  • 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
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5
Q

what does a fecal odor and bile indicated in emesis

A

a lower intestinal obstruction

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6
Q

color of emesis aids in determingin

A

presence and source of any bleeding

ex: coffee grounds looks would be blood

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7
Q

bright red blood indicates active bleeding and what are the 3 things that could be associated with this

A

mallory-weiss tear
esophageal varices
gastric or duodenal ulcer or neoplasm

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8
Q

what could we use for drug therapy

A 
serotonin receptor antagonists 
phenothiazines
anticholinergics
antihistamines
prokinetic
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9
Q

what does serotonin receptor antagonists do and the side effects

A

blocks serotonin which causes nausea and vomitting
examples: ondansetron - zofran
s/e: constipation, headache, fatigue

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10
Q

what does phenothiazines do and the side effects

A

blocks dopamine receptors that trigger nausea and vomiting

s/e: dry mouth, hypotension, section, rashes, constipation

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11
Q

what does anticholinergics do and side effects

A

block neurochemicals that trigger nausea and vomitting
example: scopolamine trasndermal (transderm-Scop)
s/e: dry mouth, sleepiness

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12
Q

what do antihistamines do and side effects

A

blocks histamine receptors that trigger nausea and vomiting
example: diphenhydramine-benadryl
s/e: dry mouth, hypotension, sedation

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13
Q

what do pro kinetic do and the s/d

A

increases gastric motility
example: metoclopramide- reglin
s/e: like parkinson, tremors, anxiety, hallucinations

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14
Q

what would be some nutritional therapy with nausea and vomiting

A 
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
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15
Q

what are some non drug therapy for nausea and vomiting

A

acupuncture or acupressure
botanicals -ginger or peppermint
relaxation breathing exercises

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16
Q

what is GERD

A

common problem
chronic symptom of mucosal damage
no one single causes

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17
Q

what is the primary factor in GERD

A

incompetent LES

  • results in decrease pressure in distal portion of esophagus
  • can be due to certain foods (caffeine, chocolate) and drugs (anticholeniergics)
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18
Q

what are symptoms of GERD

A

heartburn (pyrosis) -MOST COMMON
dyspepsia - indigestion, upset stomach
regurgitation- bitter, ot, sour liquids coming into throat or mouth

sometimes respiratory symptoms and otolaryngologic symptoms

19
Q

what are clinical manifestation of GERD related chest pain

A

burning or squeezing
radiating to back, neck, jaw or arms
more common ini older adults with GERD
received with antacids

20
Q

what are some complications with GERD

A

esophagitis
barretts esophagus
respiratory
dental erosion

21
Q

what is esophagitis

A

inflammation of esophagus

if repeated exxposure then scar formation, esophageal stricture, and dysphasia

22
Q

what is barretts esophagus

A

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

23
Q

what are respiratory complications with GERD

A

from irritations of upper airway by secretions

  • cough
  • bronchospasm
  • laryngospasm
  • cricophayngeal spasm

from aspiration
-potentional for asthma, bronchitis and pneumonia

24
Q

what are the dental erosion complications with GERD

A

from acid reflux into mouth

especially on posterior teeth

25
Q

what are some diagnostic studies

A

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

26
Q

what are some lifestyle modifications with GERD

A

avoiding triggers
maintain appropriate weight
smoking cessation
stress managment

27
Q

what are some nutritional therapy with GERD

A

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

28
Q

what is drug therapy with GERD

A 
proton pump inhibitors
histamine 2 receptor blockers 
acid protective
chonlinergic
pro kinetic drug
antacids
29
Q

what is a drug alert with proton pump inhibitors

A

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

30
Q

what is proton pump hibitors

A

-promote esophageal healing in 80% to 90% of patients
example: omeprazole, pantroprazole
s/e: headhache

31
Q

what are histamine 2 receptor blockers

A

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

32
Q

what is acid protective

A

used for cyoprotective properties
example: sucralfate
s/e constipation

33
Q

what is cholinergic

A

increase LES pressure
improve esophageal and gastric emptying
example: bethanechol
s/e: lightheadedness, stomach cramps, diarrhea

34
Q

what are pro kinetic drugs

A

promote gastric emptyign
reduce risk of gastric acid reflux
example : metoclopramide (reglan)

35
Q

what is antacids

A

quick but short lived relief
neutralize HCL acid
taken 1-3 hours after meals/bed
example: maalox, mylanta

36
Q

when would we do surgery for GERD

A 
failure of conservative therapy
medication intolerance
barretts metaplasia 
esophaeal strcitue and stenosis
choriinc esophagitis
37
Q

what are some surgery options

A

nissen and toupet fundoplicaitons

LINX relux management system - titanium beads with magnetic core, when swallow the ring opens

38
Q

what should we do for people with GERD

A 
do not lie down for 2-3 hours after eating
stress reduction techniques
weigh reduciton
small, frequent meals
avoid factors that cause reflux
39
Q

what are postoperative care goals with GERD

A

prevent respiratory complications
maintain fluid/electorlyte blance
prevent infection

40
Q

what should we look for with post op respiratory assessment

A 
respiratory rate/rhythm and pulse rate/rhythm 
signs of pneumothorax
-dyspnea
-chest pain
-cynosis
41
Q

what are some things to do post op with GERD

A 
deep breathing techniques
accurate I/O
observing fluid/eelectorlyte imbalance
pain meds
meds to prevent nausea/vomiting
42
Q

how should we introduce liquids and foods

A

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

43
Q

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.”

A

C

210 exam 2 (9 decks)

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