PUD and GERD Flashcards
FUNCTIONS OF THE DIGESTIVE SYSTEM
- ingestion
- mechanical processing
- digestion
- secretion
- absorption
- excretion
THE STOMACH
- holding tank for food
- food is exposed to stomach acids and digestive
- saturates food with gastric juices
- excretes hydrochloric acid
- PH 2.0
- absorbs H2O, alcohol, sugars, salt, electrolytes, and some drugs
ALTERATION IN GATSRIC DIGESTION
- gastroesophageal reflux disease (GERD)
- hiatal hernia
- peptic ulcer disease(PUD)
- gastric cancer
GERD
- caused by gastric acid flowing upward into the esophagus
- incompetent lower esophageal sphincter
- acid becomes an irritant destroying esophageal lining
DEGREE OR REACTION
HEARTBURN
- most common symptom
- burning chest pain behind breast bone
- moves upward toward throat
- worse after eating, lying down or bending down
GERD- LIFESTYLE VARIBLES
- relaxed lower esophageal sphinter
- being overweight
- over eating
- caffine/alcohol
- smoking
- stress
- ulcer disease
- gastritis
- NSAID’s (aspirin and ibuprofen)
- certain foods (citrus,peppermint, chocolate, fatty/spicy food)
GERD DIAGNOSIS
-UPPER GI SERIES (barium swallow) ingestion of barium followed by x-rays
ESOPHAGOGASTRODUODENOSCOPY(EGD)
- endoscope used
- direct visualization
- can perform biopsy
- oral anesthetic
- observe for return of “gag reflux”
ESOPHAGEAL MANOMETRY
- determines the strength of the muscles in the esophagus
- small nasal tube
PH MONITORING
- small nasal tube
- rest above LES
- lasts 12-24 hours
BERSTEIN TEST
-mild acid placed in the esophagus
GERD TREATMENT DETERMINED BY
- age, overall health and medical history
- extent of condition
- tolerance to specific meds, procedures and therapies
- expectation for the course of the condidtion
- patient opinion or preference
GERD TREATMENT
- diet and lifestyle changes
- quit smoking
- medications
- observe food intake and food types
- eat smaller portions
- avoid overeating
- watch alcohol consumption
GERD TREATMENT PART 2
- don’t lie down right after eating
- decrease fluid intake
- lie on left side, elevate HOB 30 degrees
- lose excess weight
- surgical correction (nissen fundoplication)
- non surgical correction(stretta procedure)
STRETTA PROCEDURE
- done on the LES
- use of radiofrequency
- tiny cuts leading to scar tissue
GERD MEDICATIONS : ANTACIDS
-neutralize stomach acid
-OTC
-tablet or liquid form
fast pain relief
sodium bicarbonate
calcium bicarbonate
aluminum bydroxide
magnesium hydroxide
GERD MEDICATIONS:
H2 RECEPTOR BLOCKERS
- OTC or by prescription
- blocks histamine
- reduces acid and pain
zantac (ramotadine)
Pepcid (famontdine)
tagment (cimedine)
axid ( nizatidine)
GERD MEDICATIONS: PROTON PUMP INHIBITORS
- blocks the enzyme in the stomach that produces acid
- promotes healing of the stomach and esophagus
prevacid (lansoprazole) aciphex ( rabeprazole) Prilosec (omeprazole) protonix (pantoprazole) nexium ( esomeprazole)
GERD MEDICATIONS: PROKINETIC AGENTS
- assists the stomach to empty more rapidly
- may help tighten the LES
- prescription
reglan (metoclopramide)
GERD MEDICATIONS: ANTISPASMOTICS
- relaxes smooth muscles of intestine
- works to decrease digestion
- prescription
bentyl, dibent (dicyclomine)
levsin , cystospaz(hyoscyamine)
GERD MEDS: CYTOPROTECTIVE AGENTS
- protects lining of stomach and intestine
- doesn’t decrease amount of acid
- used to prevent ulcer formation
pepto bismol ( bismuth ssubsalicylate)
Carafate(sucrafate)
cytotec(misoprostol)
GERD COMPLICATIONS
- esophagitis
- esophageal stricture
- barrett’s esophagus (considered precancerous)
- hiatal hernia
NURSING DIAGNOSES
- altered nutrition
- pain(acute vs chronic)
- altered sleep pattern
- knowledge deficit
- risk for fluid volume imbalance
- risk for impaired swallowing
GERD NURSING MANAGEMENT
-patient and family teaching foods smoking cessation stress avoidance medications and side effects importance of following medical regime s&s to report to physician possible pre and post operative care
HIATAL HERNIA CLASSIFICATIONS
sliding- stomach moves back and forth through hiatus of the diaphragm
paraesophageal or rooling:- greater curvature of the stomach move above diaphragm forming a pocket
PRIMARY PREVENTION OF HIATAL HERNIA
- unknown
- weakening of diaphragm muscles
- increased intra-abdominal pressure
- increased age
- trauma
- poor nutrition
- obesity
- forced recumbent positioning
HIATAL HERNIA DEGREE OD REACTION
- may be asymptomatic
- heartburn
- nocturnal heartburn
- dysphagia
- mimics gallbladder disease
PRECIPTATING FACTORS OF HIATAL HERNIA
- large meals
- alcohol
- smoking
COMPLICATIONS OF HIATAL HERNIA
GERD hemmorrage esophageal stenosis ulceration strangulation regurgitation with aspiration
HIATAL DIAGNOSIS TEST
-EGD and barium swallow
SECONDARY PREVENTION SECONADARY PREVENTION
CONSERVATIVE THERAPY
- lifestyle modifications
- medications
SURGICAL THERAPY
-nissen fundoplication
NURSING DIAGNOSES (NIESSEN FUNDOPLICATION)
- knowledge deficit
- chronic pain
- altered nutrition
- risk for aspiration
- altered skin integrity
- risk for impaired swallowing
PEPTIC ULCER DISEASE
- erosion of the GI mucosa from the action of HCL and pepsin
- includes gastric and duodenal ulcers
PUD risk causes
- lifestyle
- NSAIDs
- physical stress
- corticosteroids
- stress
- alcohol
- caffine
- smoking
- vagal nerve stimulation
- overactive acid and pepsin secretion
PHASES OF PUD
- erosion
- acute ulcer
- perforated ulcer
PUD ETIOLOGY
-HELICOBACTER PYLORI( H.PYLORI)
- 80-90% of all ulcers
- bacterium infection
- weakens the stomach’s protective mucus
PUD DEGREE OF REACTION
MAY BE ASYMPTOMATIC UNTIL SERIOUS COMPLICATIONS OCCUR
- heartburn
- gnawing/burning pain
- acid,bitter, slimy taste in mouth
- belching/indigestion
- nausea/vomiting
- weight loss and poor appetite
- feeling tire and weak
PUD COMPLICATIONS : HEMORRAGE
- most common
- black,tarry stools(melena)
- occult blood
- emesis( coffee ground or fresh)
PUD COMPLICATIONS: GASTRIC OUTLET OBSTRUCTION
-narrowing of pylorus
scar tissue
pylorspasm
edema/inflammation
- vomiting projectile
- contains food particles
- offensive odor
PUD COMPLICATIONS : PERFORATION
- most lethal complication
- requires surgery
- causes peritonitis
- S&S onset sudden and dramatic
- sudden,severe upper abdominal pain
- abdomen muscle contract- rigid and board like
- respirations shallow and rapid
- absent bowel sounds
PUD DIAGNOSTIC PROCEDURES
-ENDOSCOPY : direct visualization
- H.PYLOR TESTING
sputum, urine, blood, tissue, breath
*urea breath shows active infection
-OCCULT BLOOD
PUD TREATMENTS
- LIFESTYLE MODIFICATIONS
- bland diet and 6 small meals a day
- protein neutralizes but stimulates gastric secretions
- adequate physical /emotional rest
- strict adherence to prescribes meds
- antibiotic therapy for H.Pylori( may use two or more antibiotics)
- stop ASA and NSAIDs
PUD DRUG THERAPY
CARAFATE (SUCRAFATE)
- slurry
- give on empty stomach 1hour before meals and bedtime
- PEPTO BISMOL
- promotes healing
- partially effective against H.Pylori
- may blacken stools
- CYTOTEC (MISOPROSTOL)
- for pts taking ASA or NSAIDS
- prevents gastric ulcers induced by the above
PUD SURGERY
20% of ulcer patients indications: -obstruction -perforation - hemorrhage -ulcers unresponsive to treatment -multiple ulcer sites -possible malignancy
PUD VAGOTOMY
- selective
- reduces acid
- decreases gastric motility
- often combined with billroth I and II
- truncal (total)
PUD PYLORPLASTY
- surgical enlargement
- aids gastric emptying
- can do balloon angioplasty
PUD SURGERY
- billroth I
- billroth II
- Gastrojejunostomy
- for gastric outlet obstruction
- food bypasses the obstruction
POST OP COMPLICATIONS
DUMPING SYNDROME
-results of large portion of stomach and pyloric pginter removal
POSTPRANDIAL HYPOGLYCEMIA
- form of dumping syndrome
- large bolus of carbs dumps into small intestine
BILE REFLUX GASTRITIS
-related to surgery on pyloric sphincter
PREOPERATIVE TEACHING
NPO status the procedure itself IV therapy NG tube Pain relief answering all patient questions C and DB, IS use, incisional splinting
POSTOPERATIVE PATIENT CARE
- promote comfort
- promote effective airway management and gas exchange
- monitor I and O
- NG drainage: amount ,color, odor
- bright red in beginning, then coffee ground
- becomes yellow green after 36-48hrs
POSTOPERATIVE PATIENT CARE
- abdominal dressing: drainage, bleeding, odor
- always at risk for ulcer redevelopment
- adequate rest, nutrtion with avoidance of stressors
- emphasize avoidance of med not prescribed by MD, alcohol and smoking
NURSING DIAGNOSIS
- fluid volume deficit
- acute pain
- impaired skin integrity
- knowledge deficit
- fear/anxiety
- risk for ineffective breathing pattern
- risk for infection
- risk for electrolyte imbalance
