GERD

Question 1

what is the most common manifestation of the GI disease

Answer 1

nausea and vomitting

Question 2

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

Answer 2

nausea

Question 3

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

Answer 3

vomiting

Question 4

what are the clinical manifestations of vomiting

Answer 4

• 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

Question 5

what does a fecal odor and bile indicated in emesis

Answer 5

a lower intestinal obstruction

Question 6

color of emesis aids in determingin

Answer 6

presence and source of any bleeding

ex: coffee grounds looks would be blood

Question 7

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

Answer 7

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

Question 8

what could we use for drug therapy

Answer 8

serotonin receptor antagonists 
phenothiazines
anticholinergics
antihistamines
prokinetic

Question 9

what does serotonin receptor antagonists do and the side effects

Answer 9

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

Question 10

what does phenothiazines do and the side effects

Answer 10

blocks dopamine receptors that trigger nausea and vomiting

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

Question 11

what does anticholinergics do and side effects

Answer 11

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

Question 12

what do antihistamines do and side effects

Answer 12

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

Question 13

what do pro kinetic do and the s/d

Answer 13

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

Question 14

what would be some nutritional therapy with nausea and vomiting

Answer 14

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

Question 15

what are some non drug therapy for nausea and vomiting

Answer 15

acupuncture or acupressure
botanicals -ginger or peppermint
relaxation breathing exercises

Question 16

what is GERD

Answer 16

common problem
chronic symptom of mucosal damage
no one single causes

Question 17

what is the primary factor in GERD

Answer 17

incompetent LES

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

Question 18

what are symptoms of GERD

Answer 18

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

sometimes respiratory symptoms and otolaryngologic symptoms

Question 19

what are clinical manifestation of GERD related chest pain

Answer 19

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

Question 20

what are some complications with GERD

Answer 20

esophagitis
barretts esophagus
respiratory
dental erosion

Question 21

what is esophagitis

Answer 21

inflammation of esophagus

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

Question 22

what is barretts esophagus

Answer 22

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

Question 23

what are respiratory complications with GERD

Answer 23

from irritations of upper airway by secretions

• cough
• bronchospasm
• laryngospasm
• cricophayngeal spasm

from aspiration
-potentional for asthma, bronchitis and pneumonia

Question 24

what are the dental erosion complications with GERD

Answer 24

from acid reflux into mouth

especially on posterior teeth

Question 25

what are some diagnostic studies

Answer 25

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

Question 26

what are some lifestyle modifications with GERD

Answer 26

avoiding triggers maintain appropriate weight smoking cessation stress managment

Question 27

what are some nutritional therapy with GERD

Answer 27

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

Question 28

what is drug therapy with GERD

Answer 28

``` proton pump inhibitors histamine 2 receptor blockers acid protective chonlinergic pro kinetic drug antacids ```

Question 29

what is a drug alert with proton pump inhibitors

Answer 29

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

Question 30

what is proton pump hibitors

Answer 30

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

Question 31

what are histamine 2 receptor blockers

Answer 31

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

Question 32

what is acid protective

Answer 32

used for cyoprotective properties example: sucralfate s/e constipation

Question 33

what is cholinergic

Answer 33

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

Question 34

what are pro kinetic drugs

Answer 34

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

Question 35

what is antacids

Answer 35

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

Question 36

when would we do surgery for GERD

Answer 36

``` failure of conservative therapy medication intolerance barretts metaplasia esophaeal strcitue and stenosis choriinc esophagitis ```

Question 37

what are some surgery options

Answer 37

nissen and toupet fundoplicaitons | LINX relux management system - titanium beads with magnetic core, when swallow the ring opens

Question 38

what should we do for people with GERD

Answer 38

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

Question 39

what are postoperative care goals with GERD

Answer 39

prevent respiratory complications maintain fluid/electorlyte blance prevent infection

Question 40

what should we look for with post op respiratory assessment

Answer 40

``` respiratory rate/rhythm and pulse rate/rhythm signs of pneumothorax -dyspnea -chest pain -cynosis ```

Question 41

what are some things to do post op with GERD

Answer 41

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

Question 42

how should we introduce liquids and foods

Answer 42

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

Question 43

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.”

Answer 43

C