Nutrition & Elimination (Gas#9&10) Flashcards
Major enzymes & secretions in the mouth
saliva, salivary amylase
Major enzymes & secretions in the stomach
Hydrochloric acid, pepsin, intrinsic factor
Major enzymes & secretions in the small intestine
Amylase, Lipase, Trypsin
When assessing eating habits of a pt, how many hours do you refer to?
72 hours
When do you want to use a Guaiac test?
use this test for increased risk of stress ulcer, it detects the presence of fecal occult blood
What can you see when doing an endocopy?
esophagus, stomach, duodenum
Preparation for Endoscopy
sign consent, take out dentures, glasses, jewelry, NPO 8-12 hrs, throat spray, maybe IV conscious sedation, maybe narcotic analgesic, not scheduled after drinking barium for a min of 2 days
Do you have to be NPO for an Endoscopy?
Yes 8-12 hrs
Post procedure Endoscopy
No eating/drinking until gag reflex returns, vs, observe for signs of perforation, expect belching, asses LOC
Signs of perforation after an Endoscopy
bleeding, elevated temp, pain, dyspnea, subcutaneous emphysema
What does an upper GI series show?
tumors, hernias, ulcers, diverticula in the esophagus, esophagus varices, strictures, rate of peristalsis
What kind of contrast media is used with an upper GI series?
barium, air
why is a laxative & fluids given after a upper GI series?
to remove barium which can cause an obstruction
pre procedure upper GI series
low residual diet 2-3 days prior, NPO & no smoking 8-12 hrs prior, can take 1-2 hrs
Do you expect & not expect after an upper GI series
you expect light (grayish) stools for several days & if there is no BM in 2-3 days, call DR b/c that could mean the barium has caused an impaction
When does a cleft lip usually occur?
2nd month in embryonic development
where does a cleft palate open into?
the nasal passage
when would you asses a cleft palate
with a gloved finger before first feeding
what problems do babies have with a cleft palate?
difficulty maintaining suction & swallowing
Feeding instructions for parents with a baby with cleft lip/cleft palate
small frequent feedings, there will be a choking noise, burp often(after q ounce) because they swallow more air, don’t feed longer than 45 minutes
Hygiene instructions for parents with a baby with cleft lip/cleft palate
give h20 after eating, use bulb syringe to remove formula from mouth, DO NOT PLACE ON ABDOMEN
nipple selection for baby with cleft lip/cleft palate
easily compressed nipples (orthodontic, preemie, newborn nipples, haberman feeder, rechet feeder
bottle selection for baby with cleft lip/cleft palate
bottle can be squeezed
when would a cleft lip be repaired?
2 wks-3months
when would a soft cleft palate be repaired?
3-6 months
when would a hard cleft palate be repaired?
12-18 months; before speech affected
Post op care for cleft lip/cleft palate repair
do NOT place on abdomen, HOB elevated to prevent aspiration, suction equip & endotracheal tube, careful feeding (place on unaffected side) guard suture line!!
what are parents with babies who have cleft lip/palates taught to use/o to guard suture lines?
elbow/vest restraints, logan bow or adhesive straps, minimize crying, clean suture line
Biggest risk factor for CA?
tobacco & alcohol
oral cancer manifestations
painless sore in mouth that doesn’t heal, any lesion present for more than 2 wks:hard, difficulty chewing, speaking, blood tinged mucus
s/s of oral cancer of the larynx
pain with swallowing (esp hot liquids), lump in neck, halitosis
Pre-op care for a total laryngectomy because of cancer of the larynx (surgery is palliative care)
prepare for no speech, trach, plan for post-op communication, involve speech therapist
After a radical neck dissection, which cranial nerve is involved and what do you want to remember
XI (11 which controls swallowing, shoulder drop); Do not put pt in supine because of shoulder drop
oral cancer post-op care
have ET tube handy, maybe enternal/TPN feeding, once eating, allow to feed self in privacy first, may need artificial saliva, humidifier, anticholinergic for drooling, stop smoking!, shoulder drop
Post op radical neck dissection care
put call bell within reach! (they wont be able to speak), watch for swallowing, bleeding probs, wound drains & pressure dressing, put in fowler’s, may have difficulty lifting & moving head, suction carefully ( watch suture lines)
post op air way management for a laryngectomy because of cancer of the larynx (surgery is palliative care)
TCDB, HOB elevated to reduce pressure on suture lines, ambu bag & extra laryngectomy at bedside
post op wound care for laryngectomy because of cancer of the larynx (surgery is palliative care)
like trach (at least q 8 hrs), wound drains to suction in order to reduce hematoma formation, if bleeding occurs get help
when can a laryngectomy tube be removed?
when stoma is healed after 6-8 wks
why wont a pt who had a laryngectomy aspirate?
because trach is no longer attached to GI tract
stoma care after a laryngectomy
do not get wet, cover for showers, shaving, no swimming, stop smoking, mouth to stoma for CPR, dont lay flat
Most common complication of GERD
Esophagitis
Esophagitis & what is it caused by
inflammation of the esophagus; caused by GERD, Burns, swallowing corrosive solutions, NG tube, Excess vomiting, Radiation
Esophagitis treatment
treat underlying condition
Esophagus cancer causes
chronic trauma: GERD, stricture, alcohol, smoking
Esophagus cancer s/s
usually none until well advanced, dysphagia with liquids then with solids, lump in throat, regurgitation, halitosis, aspiration pneumonia, anorexia, WT LOSS (40-50 lbs in 2-3 months), chronic cough, anemia
Esophagus cancer diagnostics
Barium swallow, bronchoscopy (b/c this usually metastasis to lungs), CT?MRI
Treatment for Esophagus cancer
radiation, palliative, chemo, stent placement to keep esophagus open, surgery (esophagus is replaced by intestine)
Nursing management for cancer of the esophagus
elevate HOB, increase calories & protein because they need energy for treatment, TPN or PEG
Gastritis
irritant breaks down stomachs protective mucus
s/s of gastritis
dyspepsia, vomiting, diarrhea (gastroenteritis), possible bleeding (black stools)
whats a big concern with gastritis
bleeding
Causes of gastritis
NSAIDS, steroids, contaminated food, alcohol
treatment of gastritis
start NPO then clear liquids then bland diet if they cant tolerate it they will show s/s of gastritis, reduce nicotine, alcohol, caffeine, IV fluids prn, treat hemorrhage (gastric lavage with saline); antiemetics& antacids
medications for treatment of gastritis
anti-emetics, antiacids
Chronic gastritis & cause
prolonged inflammation, irreversible atrophy of mucosa & parietal cells caused by H. pylori
treatment of chronic gastritis
healthy lifestyle, B12 injec. b/c they have no intrinsic factor, anticholinergic, antacids, treat H. Pylori infection, NPO until able to tolerate food (then clear liquids etc.), may need NG tube
Gastroesophageal Reflux Disease (GERD)
gastric acids rise into esophagus
s/s of Gastroesophageal Reflux Disease (GERD)
heartburn, regurgitation, pain after eating & at night, belching, sore throat, hoarseness, anemia
Gastroesophageal Reflux Disease (GERD) treatment
change in lifestyle behavior: reduce nicotine, alcohol, caffeine, fatty/spicy foods, eat small frequent meals, avoid laying down for 2 hrs after meals, avoid eating 3 hours before bed
Gastroesophageal Reflux Disease (GERD) rules on eating
small frequent meals, avoid laying down for 2 hrs after meals, avoid eating 3 hours before bed
Antacids that contain magnesium
Maalox, Gaviscon, Gelusil, Mylanta, Riopan
Maalox, Gaviscon, Gelusil, Mylanta, Riopan
Antacids that contain magnesium
Antacids that contain Aluminium
Aludrox, Amphojel, Tums
Aludrox, Amphojel, Tums
Antacids that contain Aluminum
side effect of antacids that contain magnesium
diarrhea
side effect of antacids that contain aluminum
constipation
Proton Pump Inhibitors action
stops acid production
Prilosec (omeprazole) & Prevacid (lansoprazole) are what are what are they used for?
Proton Pump Inhibitors, used for GERD, do not use for more than 8 wks short term use only
Nexium (espmeprazole) is what & how long can you use it
Proton Pump Inhibitor; long term daily
Proton Pump Inhibitor; long term daily
Nexium (espmeprazole)
short term proton pump inhibitors
Prilosec (omeprazole) & Prevacid (lansoprazole)
H2 Antagonists action
block histamine2 (decreases gastric acid secretions
Pepcid (Famotidine), Zantac (ranitidine), Axid (nizatidine)
H2 Antagonists
H2 Antagonists
Pepcid (Famotidine), Zantac (ranitidine), Axid (nizatidine)
when should you take H2 Antagonists?
before meals
Reglan (etoclopramide), Urecholine (bethanechol), Motilium (dompendone)
GI stimulants
GI stimulants
Reglan (etoclopramide), Urecholine (bethanechol), Motilium (dompendone)
When do you take GI stimulants?
take before meals & an hour before sleep
are GI stimulants for long term or short term use?
short term use only
whats a side effect of reglan to remember
it can cause extraparadial effects so dont give to someone with parkinson
Carafate (sucralfate)
provides protective coating to ulcer sites, inhibits pepsin activity in gastric secretions, take on empty stomach with water
Peptic ulcer disease
break down of mucosal barrier in esophagus, stomach, pylorus or duodenum causing exposure to hydrochloric acid & pepsin
Peptic ulcers are caused by
NSAIDS, H.Pylori, acid hypersecretion
Peptic ulcer risk factor
40-60 yrs old, family hx, blood type O, smoking, alcohol
Peptic ulcer s/s
relieved by eating food & antacids,melena (tarry stools), vomiting, burning hunger-like pain, pain may radiate to back, pain when stomach is empty
Peptic ulcer treatment
2antibiotics, bisuth, PPI, stop nicotine, alcohol, caffeine, NSAIDS, eat REGULARLY
Peptic ulcer nutrition
low fat, low CHO diet, teaching nutrition is big, avoid liquids with meals because it promotes feeling full
biggest complication of Peptic ulcer disease
hemorrhage
s/s of Peptic ulcer hmorrhage
hypovolemia (faint, hypotension, tachycardia),
if its a small peptic ulcer bleed patient will be vomiting or pooping?
pooping it
if its a large peptic ulcer bleed patient will be vomiting or pooping it?
vomiting
surgical treatment for peptic ulcer hemorrhage?
2/3 or 3/4 of stomach can be removed & may need a vagotomy
s/s of peptic ulcer perforation
sudden increase in abdominal pain, rigid abdomen, shock
treatment of peptic ulcer perforation
antibiotics, surgery, assess for peritonitis
Cancer of the stomach is caused by
H.Pylori, blood type A, increased nitrates in diet
Post op gastrectomy
expect some bloody NG drainage but notify dr if bright red, after NG is out ay have dysphagia if had vagotomy
early Dumping syndrome
a large amount of fluid at once
early dumping syndrome initial s/s, as circulating blood decreases s/s, & when does it occur
n/v, diahrrea, abdominal pain, ascirculating blood decreases youll get weakness, dizziness, tachycardia, occurs within 10-20 mins
late Duping Syndrome
rapid absorption of carbs causes a quick spike in blood sugar levels , body compensates by over secreting insulin causing bs levels to drop
late Dumping Syndrome s/s & when does it occur
shakiness, sweating, confusion, weakness, FAINTING, occurs 1-3 hrs
treatment of Dumping Syndrome
eat small frequent meals, eat protein & fat at each meal, avoid concentrated sugars, restrict lactose
Pyloric Stenosis
hypertrophy of pyloric sphincter which leads to edema which leads to inflammation which leads to obstruction
Pyloric Stenosis s/s
projectile vomiting after eating, still hungry after vomiting, palpable mass in RUQ, rapid dehydration,
When does Pyloric Stenosis usually occur & what happens if mom had it
occurs 4-6 weeks, if mom had it baby has 20% of getting it
Pyloric Stenosis treatment
IV fluids, surgery (pyloromyotomy)
important things to remember with Post op Pyloric Stenosis surgery (pyloromyotomy)
small feedings place on right side with head elevated, **incision is near diaper line
How is Pyloric Stenosis identified
ultrasound, barium swallow
