UGI Flashcards
Oral and oropharyngeal cancer: cause
Alcohol and tobacco
Sun and Wind exposure
Generally squamous cell
Oral and oropharyngeal cancer: s/s
typically no symptoms until late - then a painless sore or mass that will not heal
As cancer progresses, patient may have difficulty swallowing or talking
Oral and oropharyngeal cancer: assessment
airway
secretions
Oral and oropharyngeal cancer: neck dissection
May have a trach
Xerostomia
Stomatitis
Bleeding
Concerned about airway - if tracheal compression occurs client will need trach
Perforations of esophagus: cause
stab, bullet, trauma, chemical injury
Perforation of the esophagus: assess / things you might see
Excruciating pain Dysphagia Leukocytosis Severe hypotension Crepitus
Perforation of esophagus: intervention
IV fluids (to increase BP) Broad spectrum antibiotics
Perforation of esophagus: nutrition
Enteral jejunal or parenteral
NPO for 7 days
Nasal jejunal tube is placed by provider because we do not want to rupture anything further
Foreign bodies
- Issue as the foreign body can cause damage to the GI tract
- Surgery to retrieve the ingested, may cause perforation
Chemical burns - things to remember
Do not induce vomiting
Medical team only to insert NG tube
NPO
May cause perforation
What are s/s of heartburn, gastritis and ger(d)
Heaviness, belching, vomiting, flatulence, boating, and pain
Gastritis: patho
inflammation of the stomach mucosa
Gastritis can lead to what
hemorrhage, pyloric stenosis from scarring, or perforation
Gastritis: acute causes
contaminated foods, OD, medications
Gatritis: chronic causes
smoking, H. pylori (can lead to gastritis and cancer), medications, alcohol
How is H. Pylori often treated
2 weeks of PPI and Flagil
Gastritis: assessment
N/V, feeling full, anorexia, epigastric tenderness, gastric hemorrhage, belching, anemia from lack of B12
Gastritis: testing
H. Pylori (stool)
RBC (scope)
Gastritis: interventions
NPO - may need NG
IV fluids for dehydration
Clear liquids
Gastritis: potential and actual complications
Peptic ulcer
Pernicious anemia
H. Pylori gastritis - cancer
Gastritis: medications
PPI
Histamine blockers
Gastritis: education
- Diet - foods to avoid (fatty, peppermint, chocolate, coffee, alcohol)
- stop smoking
- small meals
GER(D): patho
Back flow of gastric contents into esophagus
- pepsin and HCL irritate and lead to inflammation
GER(D): factors that can predispose
Incompetent sphincter
Delayed emptying
Hiatal hernia (part of stomach pouches up and food and chemicals settle there)
Obesity
GER(D): assessments / signs and symptoms
Heartburn - pain in upper abdomen Fullness throat Coughing/wheezing Dry throat Diet (ETOH, smoking)
GER(D) testing
Scope
Biopsy r/t barretts v cancer
Nuclear scan
Manometry
GER(D): interventions
Elevate head at night
GER(D): potential and actually complications
Esophagitis Barrett’s esophagus Respiratory involvement laryngospasms bronchospasms asthma- pneumonia
GER(D): meds
PPI
Histamine Blockers
Urecholine- decrease pressure on sphincter – improve emptying
Antacids
GER(D): education
Don’t eat 2 hours before bed
Small frequent meals
Diet changes how to take antacids
Avoid caffeine, fatty foods, peppermint, ETOH
Peptic ulcer disease
Ulceration in gastric mucosa
- gastric (stomach), duodenal or esophageal
- acute vs. chronic
Peptic ulcer disease: factors
H pylori requires antibiotic therapy NSAID and corticosteroids smoking & alcohol Stress Diet
What can happen to the stomach is peptic ulcer disease gets really bad
can scar and stenos
Peptic ulcer disease: assessment
Pain - meal related
If get relief from eating – duodenal
If get pain with eating – gastric
Vomiting- color consistency
- coffee ground emesis (blood partially digested)
BP & HR to evaluate for hypotension and perforation
Obstruction
Peptic ulcer disease: tests
Hpylori Stool occult blood (want to know if there is bleeding) Scope (go in and look) Barium- if unable to scope CBC
Peptic ulcer disease: interventions for acute
NPO NG (decompression) IV fluids I&O Analgesics monitor electrolytes Clear liquid and advance Surgery
Peptic ulcer disease: medications
PPI Histamine Blockers Antacids – renal considerations Sucralfate – coats stomach Amoxicillin, clarithromycin, tetracycline-metronidiazole if H pylori along w PPI Bismuth (pepto bismol) coats stomach
Peptic ulcer disease: education
Med adherence
follow up scope
Diet- spicy, peppers, caffeine, carbonated, NSAIDS aspirin should be avoided
Signs of bleeding
Gastric surgery: what
Remove part of stomach and attach it directly to duodenum or jejunum
What are things to consider post gastric surgery?
Lie down after meals
Low fowler position during meals
Avoid carbs
Vitamin B12 and iron supplements because don’t have ability to absorb as much
Will have NG tube when they come back from surgery
Varices
Dilated tortuous veins that are generally found in lower esophagus
Bleeding associated with high mortality
Varices: dx
EGD- esophagastroduodensocopy
types of varices
Esophageal
Gastric
what causes varices?
Cirrhosis –> portal HTN –> varices
Varices: acute management of bleeding
Hemodynamic resusitation
Octreotide
Banding, sclerotherapy
Prophylactic abx
Varices: chronic management of bleeding
BB
Endoscopic variceal ligation
What must the nurse consider when a client has bleeding or a hemorrhage?
fluid volume depletion
Vasoconstrictor with endoscopic therapy
- octreotide or somatostatin
- vasopressin slows hemorrhage and may be used in conjuction with nitro to prevent side fx from vasoconstriction (cardiac iscemia)
Balloon tamponade
Temporary to treat active bleed -- Sengstaken-Blakemore tube ICU Monitor for respiratory complications Patient must not dislodge Can cause esophageal rupture, aspiration and rebleeding Temporary bridge to other treatments
GI bleed: upper
Coffee ground emesis
not as emergent as lower GI bleed
Frank blood
Frank blood
bright red blood, patient is vomiting - you have active bleed
Lower GI s/s
Dark, tarry, high up
Melena - burgundy - midway through
Frank blood - usually much lower
GI bleed: assessment
BP
HR
Vomiting or stool
perfusion - brain and extremities
GI bleed: priority labs/diagnostics
CBC
—> H&H (h&h going to be effected by hydration)
Scope – may need cauterization
Radionuclide
Surgery
GI bleed - priority interventions
Address bleeding-
Fluid replacement
Blood products
Vasopressors
GI bleed: complications
Hypovolemic shock
Exsanguination
GI bleed: medications
Esophageal varices- Octreotide
Norepinephrine (levophed)
And previously listed based on cause
GI bleed: teaching acute phase
What is happening
treatment purpose
support
GI bleed: Discharge
Will reflect underlying cause and teachings for maintenance and follow up care
Bowel perforation: s/s
Sudden severe abdominal pain N/V fever chills swelling and bloating of abdomen
Bowel perforation: intervention
Surgery Fluids NG ABX Drain May have ostomy depending on what is perforated
Peritonitis: patho
inflammation of peritoneum
Life threatening emergency requires prompt surgical intervention
Peritonitis: cause
bacterial infection from GI tract
Peritonitis: s/s
Rigid, distended abdomen
Rebound tenderness
Guarding by the patient
tachycardia HTN dehydration pain decrease bowel sounds "board-like" abdomen increase WBC
Peritonitis: risk factors
Abdominal surgery
Ectopic pregnancy
Perforation (trauma, ulcer, appendix rupture, diverticulum)
peritonitis: management
Fluid/electrolyte replacement NG Respiratory support Abx therapy Monitor bladder pressure to ID compartment syndrome
Peritonitis: complications
septic shock
PEs
Bowel adhesions
Morbid obesity
More than two times ideal body weight
Significant health risks associated with weight
Medications have cardiac risk
Weight loss goals
Positive reinforcement
Address comorbidities
Complications of bariatric surgery
Malabsorption, dumping syndrome Dietary modifications small meals- Eat slowly Supplemental vitamin B12, calcium & iron Dehydration Do not eat and drink at the same time May be on FL 1000 mL/day
