Nutrition Flashcards
Populations at risk for PUD
- Age 65 and older
- Men and women
Population at risk for GERD
- Obesity
- cigarette smoking
Population at risk for gallbladder disease
4 F’s
Female
Fat
Forty
Fertile
AST/ ALT
0-35
Liver dysfunction
Amylase and Lipase
Amylase: < 120
Lipase: < 160
Pancreatitis
Ammonia
10-80
Increase = liver dysfunction
Bilirubin
< 1
Liver dysfunction, bile duct obstruction
Albumin
3.5-5
Decease= liver dysfunction/ Malnutrition
Peptic ulcer disease (PUD)
Erosion of mucous membranes forms and excavation in the stomach, pyloric, duodenum or esophagus
PUD is caused by
- H. Pylori infection (most common)
- NSAIDS
- stress
PUD risk factors
- excessive secretion of stomach acid
- smoking and alcohol
- fam history
- chronic NSAID usage
PUD clinical manifestations
Dull, gnawing pain or burning sensation on the back or mid epigastric area
PUD gastric ulcer signs
- pain occurs immediately or 30 mins-1hr after eating
- weight loss
- pain worse during day
- eating increase pain
PUD duodenal ulcer signs
- pain occurs 2-3 hr after meals
- awake w/ pain at night
- food temporarily relieve pain
- most common form
- well nourished
Stress ulcers
- ulcer occurs after a physiological stressful event
• burns, shock, severe sepsis - once Patel t is better, the ulcers reversed
PUD assessment / diagnostic test
- CBC: (anemia) for bleeding peptic ulcer
- LFTs ( liver function test)
• ALT/ AST, amylase/lipase
• to rule out other possible diseases - CT: rule out other disease
- Upper endoscopy w/ biopsy (diagnostic)
- start w/ lest invasive first ( lab, CT, EDG)
PUD medications
- Antibiotics: H. Pylori
- PPI: inhibit acid production in stomach
- H2 Blocker: block histamine which trigger acid production in stomach
- Bismuth Salts: coats the ulcer and protects it from stomach acid
- Cytoprotective agents: inhibit gastric secretion and promote healing of ulcers
Antibiotics
- for PUD
Will eradicate H. Pylori
- Clarithromycin + Amoxicillin or Metronidazole
- use more than one
Cytoprotective agent
- for PUD
Mucosal healing
- misoprostol
- sucralfate
- 1hr before meals
Antacids
- for PUD
Used to neitralize stomach acid
- calcium carbonate
- don’t give with other meds ( 1hr before or after)
- don’t give with meals (2hr after)
Diet for PUD
- 3 regular meals a day
- limit coffee, caffeine, and alcohol
- avoid extremes in food (hot/cold)
- keep dairy of food eaten ( to determine triggers)
PUD health promotion
- avoid NSAIDS
- take antacids 1-3 hr after meals
- report any bleeding or tarry stool
- smoking cessation
PUD complication Internal bleeding (Hypovolemic shock) signs and symptoms
Symptoms:
- Hematemesis ( vomit blood)
- melena ( black tarry stool)
Early signs:
- ⬆️ HR, RR , BP may still be norm
Late signs:
- ⬇️ BP, rapid RR (over 30) ⬆️ HR over 120
PUD complication perforation signs
- Emergency
Sudden onset of symptoms:
- detect changes in fitness or distention of abd ( rigid, board like)
- sharp upper abd pain, may refer to shoulder
- VS change just like in hypovolemic shock
- can turn into peritonitis
GERD
- mucosal damage by reflux of stomach acid into lower esophagus
- is the most common upper GI problem
GERD most common cause
- incompetent loser esophageal sphincter (LES)
- this normally acts as reflux barrier but when not working properly contents move in esophagus when patient is supine or had increase intraabdominal pressure
Factors affecting LES pressure
- alcohol
- chocolate
- drugs
- fatty foods
- nicotine
- peppermint/ spearmint
- pregnancy
- tea/ coffee (caffeine)
Complications of GERD
1) Esophagitis
2) Barrett’s Esophagus (BE)
- changes in epithelial cells in esophagus
- is a precancerous lesion that increases patients risk for esophageal cancer
3) Respiratory
- cough
- bronchospasm/ laryngospam
* all due to gastric secretions irritating upper airway
GERD Diagnostic Studies
- typically diagnosed based on symptoms in patients response to drug therapy
- endoscopy can be used to determine LES competence and degree of inflammation in the patient’s unresponsive to drug therapy or complications of Gerd are expected
Lifestyle modification for GERD
- HOB elevated 2-3 after meals
- no supine after meals
- smoking cessation
Drug therapy for GERD
Most common-
- PPI
- H2 blockers
Adjunctive therapy -
- antacids: quick, short lived relief
- prokinetic agent (metoclopramide)
• accelerates gastric emptying
GERD nutrition
- no specific diet, avoid foods that decrease LES pressure
- avoid late evening meals/nighttime snacking
GERD surgical therapy
- reserves for patients with complications
- Nissan and Toupet Fundoplications: are common laparoscopic antireflux surgery
• usually outpatient - goal is to reduce reflects by enhancing the integrity of the LES
- LINX reflux management system: option for patients who have symptoms despite med management
• ring of small flexible magnet enclosed in titanium beads and connect by titanium wires
• ring strength the LES- help keep closed
Upper GI Bleed cause
Gastritis and hemorrhage form PUD most common cause
Upper GI bleed signs and symptoms
- melena
- bright red or dark coffee ground vomit
- N/ V
- dizziness or fainting
- Vital changes: ⬆️ HR ⬇️ BP
Upper GI bleed diagnosis and treatment
1) Hemoglobin and Hematocrit - evaluate extent of blood loss
2) upper endoscopy within 24 hr to confirm diagnosis and locate source
3) administer IV PPI for acid suppression
Upper GI bleed nursing interventions
- NGT to distinguish fresh blood for “coffee ground”- aid in removal of clots and prevent N/ V through suction of gastric contents
- Hemoccult stool
- Hourly I/O
Gallbladder disease - cholecystitis signs
- fever and leukocytosis
- jaundice
- N/V
- Anorexia
- Fat intolerance ( fatty stool “steatorrhea”)
- feeling of fullness
- abdominal distention
Pain:
RUQ or right shoulder- may radiate to back, increase with deep breathe (MURPHY SIGN)
Gallbladder disease Cholelithiasis signs
Pain : RUQ or epigastric region and may radiate to shoulder
- NV
Cholelithiasis effect on pancreas
If stone blocks common bile duct ( biliary obstruction) it may block the pancreatic duct
Patient would experience pancreatitis
Cholelithiasis- common bile duct obstruction
May cause build up of bilirubin in the blood due to liver not being able to ride the bile
This can lead to additional symptoms of jaundice
See a increase in LFT, Bilirubin and alkaline phosphatase labs
If stone block cystic duct- gallbladder become distended, inflamed and infected
Diagnostic test for gallbladder disease
1) abdominal ultrasound (DX of choice)
2) abd x-ray / abd CT scan
3) endoscopic retrograde cholangiopancreatography ( ERCP) vidize biliary structures and pancreas via endoscopy
Treatment for gallbladder disease
- most patients are asymptonatic and don’t need surgery
1) ERCP - can be use to remove stone
2) cholecystectomy (used most often)
3) Extracorporel shock wave lithotripsy ( ESWL)
- non surgical - good option for Patients who can’t undergo surgery
Post op care cholecystectomy
Pain, R, skin, Nutrition
1) pain
- analgesia
- ambulation
- abd binder or splinting w/ pillow
2) Resp status
- turn, cough, deep breath
- IS
- early ambulation
- VTE prophylaxis
3) Skin - drains ( t-tube, JP drain)
4) Nutrition
- once resume norm diet- low fat, high carb/ protein immediately post op
- once home- healthy diet, avoid fats
- 4-6 wk post op- resume norm diet
Complication from cholecystectomy
Bleeding / Hemorrhage
- monitor VS
- inspect surgical site For drainage or bleeding
- GI assessment for • tenderness and rigidity of abd • N/V • abd distention • temp elevation
Education post cholecystectomy
1) activity
- light exercise immediately
- avoid lifting object > 5 lb for 1-2 wk
- if lap: shower after 1-2 d (open procedure longer)
2) wound care
- check daily for infection
- dermaband (lap) don’t scrub, lightly wash w/ soap and water ( dermaband will crust over and fall off we wounds are healing) don’t pull off!!!
3) pains
- medication
- lap procedure will feel CO2 pain in chest shoulder and upper back- get up walking
Obesity risk
- greater risk mortality (6-20 y decrease)
- as BMI ⬆️ risk for cancer ⬆️
- ⬆️ type 2 diabetes
- ⬆️ HTN and asthma
- twice as likely to be diagnosed with Alzheimer’s
Lifestyle modification for obesity
Multicomponent behavior interventions:
- weight loss goals
- increase physical activity
• 150 min of moderate- intense exercise per wk or 75 mins of vigorous- intense - addressing barriers to change ( issues with not losing weight)
- improve diet
• calories deficit if 500-1000 per day
• DASH or Mediterranean diet
Pharmacotherapy for obesity
- Antiobesity med: meant to be supplement with changes in diet and exercise, not replace !
- these meds should only be use for up to 12 wk
- can cause severe N/V
Complications of obesity
- obstructive sleep apnea
- heart failure
- hypertension
- DTV and PE risk
- difficult finding venous access due to adipose tissue
- medication change
- pressure ulcer and skin breakdown
Bariatric surgery factors
- restrict ability to eat
- perform only after non surgical attempts fail
1) selection factors
- body weight ( try to lose some)
- patient history
- support network
- ability to perform ADL
2) exclusion factors
- current drug or alcohol abuse
- Cushing (bc it causes obesity)
- severe psychiatric illness
Post Bariatric surgery dietary restrictions
- SLOW progression from clear liquid-> full liquid -> soft-> regular
- typically go home on clear liquid
Bariatric surgery pain relief
- PCA : morphine, hydromorophone
Bariatric surgery anastomotic leak signs
Fever
Abd pain
Tachycardia
Leukocytosis - can lead to sepsis
Bariatric surgery bowls habit
- diarrhea is more common post surgery
- constipation may result from general anesthesia and post op opioids
• may be placed on docusate
- once BS and oral intake resume-> 6 small feeding of a total of 600-800 cal a day • eat slow! Stop when full! • may be B12 or iron supplements • don’t drink liq w/ meals • avoid milk and sugars
Bariatric surgery potential complications
- hemorrhage
- dumping syndrome
- dysphagia : most sever 4-6 wk post op (can’t swallow)
- bowel or gastric outlet obstruction: NO NGT!!! May disrupt the surgical suture line and cause anatomotic leak or hemorrhage
Dumping syndrome signs
15 -2 hr after eating
- tachycardia
- dizziness
- sweating
- N/V
- bloating or abd cramping
- diarrhea
Dumping syndrome effect of blood glucose
Blood glucose rises rapidly, followed by increased insulin secretion -> results and reactive hypoglycemia
Polar palpitations headaches feeling of warmth dizziness or drowsiness
EDG
- Allows direct visualization of a Esophagus gastric and duodenum mucus through an endoscope
Preoperative:
- NPO for eight hours prior to exam
- verify consent
- explain use of local anesthesia - spray down throat
Post Op:
- NPO until gag reflex returns
- warm saline gargles -> relief of sore throat - -check temperature every 15 to 30 minutes (spike in temp is sign of proliferation)
Colonoscopy
Moderate sedation
- entire colon
- position change freq during
- allow for biopsy and removal of polyps
Pre-op:
- bowel prep- evening before
- drink cleansing south on evening before
- 4-6 he beige drink second
- stool will be clear to clear yellow
Post-op:
- abd cramp expected bc of air
- passing gas= good
- monitor for rectal bleeding and perforation (abd distention)
