Nursing Care Of Patients With Upper GI Disorders Flashcards
Nausea
Vague but unpleasant sensation of sickness or queasiness. It may or may not be accompanied by (and possibly relieved by) vomiting.
Vomiting
The forceful expulsion of the contents of the upper GI tract resulting from contraction of muscles in the gut and abdominal wall.
Dysphagia
Difficult or painful swallowing
Achalasia
A disorder of unknown etiology that is characterized by impaired peristalsis of the smooth muscle of the esophagus and impaired relaxation of the lower esophageal sphincter (LES)
Gastric Mucosal Barrier
A protective barrier consisting of lipids, bicarbonate ions, and mucous gel that protects the stomach lining from the damaging effects of gastric juices.
Hematemesis
Vomiting blood
Hematochezia
Frankly bloody stools
Melena
Black, tarry stools
Occult blood/bleeding
Blood or bleeding that is hidden or not readily apparent
Peptic Ulcer Disease (PUD)
A break in the mucous lining of the gastrointestinal tract where it comes in contact with gastric juice, is a chronic health problem.
Peptic Ulcers
A break in the mucous lining of the gastrointestinal tract where it comes in contact with gastric juice; may affect any area of the gastrointestinal tract exposed to acid-pepsin secretion, including the esophagus, stomach, and duodenum.
Ulcer
A break in the gastrointestinal mucosa, develops when the mucosal barrier is unable to protect the mucosa from damage by hydrochloride acid and pepsin, the gastric digestive juices.
Steatorrhea
Excess fat in the feces
Erosive (Stress-Induced) Gastritis
A severe form of acute gastritis, occurs as a complication of other life threatening conditions, such as shock, severe trauma, major surgery, sepsis, burns, and head trauma.
Curling’s Ulcer
Named after Thomas Curling, a British physician, who first described them in 1842. Acute ulcerations of the stomach or duodenum that form following a burn injury.
Cushing’s Ulcer
Stress ulcers occurring as sequelae of head injury or central nervous system surgery.
Anorexia
Loss of appetite
Partial gastrectomy
Involves removal of a portion of the stomach, usually the distal half to two-thirds.
Total gastrectomy
Removal of the entire stomach; the surgeon constructs the anastomosis from the esophagus to the duodenum or jejunum
Dumping Syndrome
Complication of partial gastrectomy characterized by nausea, weakness, sweating, palpitation, syncope, sensation of warmth, and occasional diarrhea.
Gastritis
Inflammation of the stomach lining, results from irritation of the gastric mucosa.
Gastroesophageal Reflux
The backward flowing of gastric contents into the esophagus.
Stomatitis
Inflammation and ulcers of the oral mucosa, is a common disorder of the mouth.
Zollinger-Ellison Syndrome
Peptic ulcer disease caused by gastrinoma, or gastric-secreting tumor of the pancreas, stomach, or intestines.
What are the structures of the upper gastrointestinal tract?
The upper gastrointestinal tract includes the mouth, esophagus, stomach, and proximal small intestine (duodenum and jejunum).
Which components of the upper gastrointestinal tract are responsible for food digestion?
The stomach and upper intestinal tract ( duodenum and jejunum) are responsible for the majority of food digestion.
What are nausea and vomiting without abdominal pain associated with?
Nausea and vomiting without abdominal pain are commonly associated with food poisoning, infectious gastroenteritis, gallbladder disease, or ingestion of toxins (drugs and alcohol).
What conditions are indicated with nausea and vomiting with severe abdominal pain?
When associated with severe abdominal pain, nausea and vomiting may indicate a serious disorder such as peritonitis, acute gastrointestinal obstruction, or pancreatitis.
What region of the brain is associated with nausea and vomiting?
Nausea, an unpleasant subjective sensation, occurs when the vomiting center of the medulla of the brain are stimulated.
____________________ of the abdomen is a common stimulus for nausea.
Distention of the abdomen is a common stimulus for vomiting.
The vomiting center of the brain can be stimulated by input from several different sources:
1) The GI tract, produced by distention, irritation, or infection; 2) the vestibular system of the ear; 3) higher central nervous system (CNS) centers in response to certain sights, smells, or emotional experiences; 4) chemoreceptors outside the blood brain barrier that are stimulated by drugs, chemotherapeutic agents, toxins, systemic disorders, and pregnancy; 5) disorders such as acute myocardial infarction and heart failure commonly produce nausea and vomiting, possibly due to direct stimulation of the vomiting center by hypoxia; 6) increased intracranial pressure (due to intracranial bleeding or a tumor) produces vomiting that may or may not be accompanied by nausea.
What condition commonly precedes nausea?
Anorexia commonly precedes nausea, just as nausea frequently precedes vomiting.
Pathophysiology of Vomiting
Vomiting, a response that requires coordinated movements of the thorax and abdominal wall, the gut, the pharynx, and the muscles of the mouth and face, is coordinated by the brain stem.
Emesis
Vomitus, produced when inspiratory muscles of the thorax (including the diaphragm) and abdomen contract, increasing intrathoracic and intra-abdominal pressures. The gastroesophageal sphincter relaxes, and the larynx moves upward to facilitate oral expulsion of gastric content.
What are the autonomic nervous system manifestations of nausea?
In addition to the subjective sensation of queasiness, nausea frequently is accompanied by autonomic nervous system manifestations such as pallor, sweating, tachycardia, and increased salivation.
What is the protective role of salivation with regards to nausea and vomiting?
Increased salivation is a reflex to protect the teeth from stomach acid.
Vomiting also affects the parasympathetic nervous system in which ways? What facial nerve is stimulation during vomiting?
Vomiting, which stimulates the vagus nerve and parasympathetic nervous system, may be accompanied by dizziness, light-headedness, hypotension, and bradycardia.
List the potential complications of vomiting.
Potential complications of vomiting include dehydration, hypokalemia, metabolic alkalosis (from loss of hydrochloric acid from the stomach), aspiration with resulting pneumonia, and ruptures or tears of the esophagus.
List the potential serious physical effects of vomiting.
Vomiting can have several potentially serious physical effects. PONV can delay healing and postpone discharge. Strong contractions of the abdominal wall and thoracic skeletal muscle can lead to increased postoperative pain. Pressure may burst wounds, increase stress on the eye following ophthalmic surgery, and dangerously increase intracranial pressure in cases of intracerebral hemorrhage or injury.
What are the possibly serious consequences of chronic and prolonged vomiting?
Chronic and prolonged vomiting may cause pitting and erosion of tooth enamel, causing dental decay.
Identify the diagnostic tests that involve nausea and vomiting.
Diagnostic tests may include serum electrolytes; pregnancy test, if indicated; liver, pancreatic, and renal function studies; and imaging studies (flat plate of the abdomen and abdominal CT scan) to detect GI obstruction. An upper endoscopy may be performed; CT scan or MRI of the head may be order if an intracranial problem is suspected. Gastrointestinal motility studies may be indicated when other diagnostic studies are negative for an anatomic cause of N/V.
Medications to treat Nausea and Vomiting
Serotonin receptor antagonists, dopamine antagonists, antihistamines, cannabinoids, corticosteroids (off label use), benzodiazepine, neurokinin receptor antagonists.
Serotonin Receptor Antagonists
Widely used drugs available for patients experiencing nausea and vomiting due to chemotherapy. They are effective when given only once or twice a day, an additional advantage.
Examples of serotonin receptor antagonists
Dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran), palonosetron (Aloxi)
Pharmacotherapy of Serotonin Receptor Antagonists
The serotonin receptor antagonists suppress nausea and vomiting by blocking the effect of serotonin on vagal afferent nerves that stimulate the vomiting series. Their primary uses are to prevent and treat nausea and vomiting associated with chemotherapy, radiation therapy, and surgery.
Nursing Responsibilities of Serotonin Receptor Antagonists
Administer 30 to 60 minutes prior to chemotherapy or surgery as directed. May be given orally or intravenously (push or infusion, follow the directions specific to the drug used). Monitor liver function and clotting studies; report abnormal levels to the physician.
Health Education for the Patient and Family for Serotonin Receptor Antagonists
Take this drug exactly as directed; this drug may be taken without regard to food intake; headache is a common side effect for these drugs, use acetaminophen or other mild analgesics as directed by your physician
Dopamine antagonists
Dopamine antagonists are effective at treating nausea and vomiting, however can produce extrapyramidal effects, sedation, and hypotension.
Examples of Dopamine Antagonists
Chlorpromazine (Thorazine); Prochlorperazine (compazine); thiethylperazine (torecan); promethazine (phenergan); haloperidol (haldol); droperidol (inapsine); metoclopramide (Reglan)
Pharmacotherapy of Dopamine Antagonists
These drugs act by blocking the dopamine receptors in the chemoreceptor trigger zone (CTZ). Their primary use is to suppress the nausea and vomiting associated with surgery, cancer chemotherapy, and toxins. The major adverse effects associated with these drugs are sedation, hypotension, and extrapyramidal reactions. Older adults are more sensitive to the effects of these drugs; a lower dose is often indicated.
Nursing Responsibilities of Dopamine Antagonists
Administer orally and parenterally as ordered before surgery or before meals and procedures known to produce nausea and vomiting. These drugs may interact with a number of other medications, often increasing their sedative and hypotensive effects. Administer with caution to older adults, closely monitoring for adverse effects such as confusion, agitation, or changes in vital signs. Monitor for evidence of extrapyramidal symptoms, including tremors, restlessness, hyperactivity, anxiety, impaired coordination, notify physician if symptoms develop.
Health Education for the Patient and Family for Dopamine Antagonists
Use the drug as ordered, do not increase your dose without consulting your primary care provider. These drugs may cause drowsiness; avoid using other CNS depressants such as alcohol when taking these drugs. Change positions from lying to sitting to standing slowly because these drugs can cause light-headed was or dizziness. Promptly report changes in coordination, tremors, difficulty speaking or swallowing, or weakness to your physician.
Antihistamines
Primarily used to treat nausea and vomiting arising from vestibular center stimuli (motion sickness).
Examples of Antihistamines
Buclizine (bucladin-s); cyclizine (Merazine); dimenhydrinate (Dramamine); diphenhydramine (Benadryl); hydroxyzine (vistiril, atarax); meclizine (antivert)
Pharmacotherapy of Antihistamines
Antihistamines are primarily used to treat the nausea and vomiting associated with motion sickness. They act by blocking histamine and acetylcholine receptors in the neural pathway from the inner ear to the vomiting center in the brainstem.
Nursing Responsibilities of Antihistamines
Do not administer these drugs to patients for whom anticholinergi drugs are contraindicated; people with narrow angle glaucoma, urinary retention, or bowel obstruction. May be administered orally, parenterally, or rectally, depending on the preparation and the patient’s ability to tolerate oral preparations. Use caution in patients who are taking other CNS depressants or antihistamines, TCAs, or MAOIs.
Health Education for the Patient and the Family for Antihistamines
These drugs frequently cause drowsiness. Use caution when operating machinery or performing tasks requiring mental alertness. Avoid using alcohol or other substances that cause drowsiness or sedation while taking these drugs. This medication may cause dry mouth. Sips of water, ice chips, hard candies, or sugarless gum can be used for comfort. Use sunscreen and protective clothing to protect from sunburn while using these drugs.
