Upper GI Flashcards
Oral and pharynx cancer
-most common: leaps, lateral tongue, floor of mouth
-increased in men
Mgmt of oral cavity dx
-mouth care: increase fluid, synthetic saliva
-adequate food and fluid
-positive self image
-minimize pain: avoid hot, spicy, hard food; oral care; lidocaine or pain med
-prevent infection
Radical neck dissection
Remove all of just about everything
Modified neck dissection
Preserves one or more non lymphatic structure
Nursing interventions for neck dissection
-airway clearance
-pain mgmt
-adequate food/fluid
-communication
-physical mobility
Complication of neck dissection—hemorrhage
-hypovolemic shock
-avoid valsalva
-impending rupture: high epigastric pain
-pressure at site call MD and HOB elevated
Complication of neck dissection—chyle leak
-duct dmg during surgery
-post op when oral fluids begin
-F/E replacement, restrict activity, HOB elevated, stool softener
-octreotide: reduce flow
Complication of neck dissection—nerve injury
-lower facial paralysis
-dysphagia, impaired tongue mvt, vagus nerve injury
-shoulder dysfunction is most common
Measuring NG tube
-placement positioning semi Fowler
-xray after placement or pull back residual
-tip of nose —> ear —> xiphoid process
PEG tube sites and dressing
meticulous skin care
keep clean and dry
Delivering nutrition enterally
-functioning GI tract***
-safe/cheap
-preserves GI, intestinal and hepatic and fat meta, lipoprotein syn
-maintain normal insulin and glucose ratio
-NEVER MIX ANYTHING WITH FEEDING**
Enteral feedings
- check residual and start with 30mL water
-give feeling flush again
-after feeding clamp for 30-6pm in then back on suction
Parenteral nutrition
-inadequate food/fluid within 7 days
-1-3L over 24hrs (needs new order q 24hrs)
-never piggyback into IV fluid
-filter prevents admin of precipitate
-monitor labs
-PPN via peri IV or CPN via CVAD (watch infection)
Complication of PN
-pneumothorax
-air embolus
-clot or displace catheter
-sepsis
-hyperglycemia/rebound hypoglycemia
-fluid overload
Esophagus hiatal hernia
-persistent heartburn, dysphagia, SOB, suffocation feeling after eat
-worsen after eating or lying flat
-rf: high fat diet, tobacco, obese, anti-cholingerics
Esophagis zenker diverticulum
-sour taste
-barium swallow to check location
-bad breath
Complications of GERD
-esophagitis
-Barrett esophagus: precancerous lesion
-respiratory: cough, bronchospasm, larynospasm
-potential for asthma, bronchitis, pneumonia
-dental erosion
Risk factors of gastritis
-drugs: aspirin, NSAID, corticosteroids
-diet: ETOH, spicy
-microorganism: H. Pylori
-enviro: smoking, post radiation
-pathophysiology: burn, CRF, septic
Contributing factors
-H pylori: most common
-medication induced injury: aspirin, NSAID, corticosteroids
-family hx/lifestyle factors: COPD, liver cirrhosis, ETOH, caffeine, stress
PUD—hemorrhage
-common cause of upper GI bleed (bright red or coffee ground)
-shock (IV, hemodynamic, blood therapy)
-NG tube
-assess: faint, dizzy, nausea, VS (tachycardia, hypotension, tachypnea)
-H&H, stool for blood, UO
Tx: endoscopy within 12 hrs, surgery, arteriography with embolization
PUD—perforation
-no warning
-results: sepsis, multi organ failure
-sudden sev abd pain, persistent and intense, trauma shoulder
-vomit faint,
TENDER,RIGID ABD HYPOTENSION, TACHYCARDIA…shock*
PUD—penetration
-back/epigastric pain not relieved with meds
-surgical intervention
PUD—emergency assessment and mgmt
-ABCs (rapid, shallow)
-EARLY shock: tachycardia, weak pulse, hypotension, cool, pale, anxiety, long cap refill
-abd exam: perforation and peritonitis—tense, rigid, board abd
-fluid/blood replace
-O2
-indwelling catheter: UO best measure for organ perfusion
PUD—post op complications—dumping syndrome
-remove all of large portion of stomach and pyloric sphincter
-decrease stomach control of chyme into small intestine
-occurs at end of meal or 30 min after
-weak, pale, sweat, palpitations, tachycardia, dizzy, abd cramp, borboyrgmi, urge to poop
-lasts no longer than an hour
