Upper GI Flashcards
Abdominal Examination
Inspect, Auscultate, Palpate, Percuss
Diagnostic Tests
Breath tests
DNA testing
Blood work
Endoscopic procedures
Radiology
Gastric analysis
Stool specimen/stool analysis
Ultrasound
Esophagogastroduodenoscopy
Scope looking at the esophagus, stomach, and duodenum
Patient must be NPO for at least 8 hours prior
Hold medications
Local anesthetic used to numb the oropharynx
Midazolam used for conscious sedation
Need to take vital signs before and after, especially temperature (elevated temperature indicates perforation)
Colonoscopy
Need a signed consent
NPO for at least 8 hours prior and a bowel prep is necessary (GoLYTEly)
General anesthesia or conscious sedation
Radiology
UGI: barium swallow
LGI: barium enema
Swallow study
CT-MRI with or without contrast
Gastric Analysis
Sampling the stomach acid
NPO for 8-12 hours prior
NG tube is placed and gastric contents are withdrawn
Occult Blood Tests
Best if patient hasn’t had a lot of red meat, turnips, aspirin, NSAIDs for 72 hours prior to exam
Ultrasound
Noninvasive
NPO for 8-12 hours prior
Treatments for Obstructions
Open the passage
Use of tubes, surgeries
Treatments for Itis-Osis
Medications
Organ rest (NPO)
Nutritional alterations
Treatments for Ulcerations
Stop the bleeding using medications or surgery
General Nursing Diagnoses
Pain: acute or chronic
Altered nutrition
Altered bowel elimination
Altered skin integrity, risk for
Potential for infection
Health care maintenance
Altered breathing patterns
Complication: Hemorrhage
Oral Cancer Risk Factors
Tobacco, alcohol, HPV
Increased incidence in men, persons older than 40 years old, and African Americans
Manifestations of Oral Cancer
Painless mass or sore that does not heal
Any lesion present for more than 2 weeks or that does not heal should be examined and biopsied
Later manifestations include tenderness, difficulty chewing or swallowing or speaking, coughing up blood-tinged sputum, enlarged cervical lymph nodes
Medical Management of Oral Cancer
Surgical resection
Radiation therapy
Chemotherapy
Care of Impaired Oral Mucous Membranes
Preventative oral care
Dental care before surgery or radiation therapy
Frequent gentle brushing or flossing
Patient education related to oral hygiene
Encourage fluid intake to reduce dry mouth
Use of synthetic saliva
Care for Imbalanced Nutrition
Assess nutritional requirements and dietary patterns
Assess patient preferences
Calorie count
Dietary consult
Maintaining an Airway
Frequent assessment
Place in Fowler’s position
Encourage coughing and deep breathing
If patient has tracheostomy, provide tracheostomy care as required
Nutrition for Radical Neck Dissection
Assess nutritional state before surgery and intervene early
Encourage high-density, high-quality intake
Provide oral care before and after eating
Diet may need to be modified to liquid diet or to soft, pureed, and liquid foods
Disorders of the Esophagus
Dysphagia/Achalasia Foreign Bodies GERD Hiatal hernia Perforation Cancer
GERD Etiology and Pathophysiology
Results when defenses of the lower esophagus are overwhelmed
Caused by anything that decreases esophageal clearance (decreased peristalsis) or anything that decreases gastric emptying
Risk factors include smoking, obesity, hiatal hernias
Symptoms of GERD
Heartburn (pyrosis)
Dyspepsia (pain, discomfort, pressure; often mistaken as a heart attack)
Regurgitation
Difficulty swallowing
Hypersalivation
Complications of GERD
Esophagitis
Barrett’s esophagus (precancerous lesion)
Respiratory complications (higher risk of aspiration)
Diagnostic Studies for GERD
History and PE
Barium swallow
Upper GI endoscopy
Biopsy and cytologic specimens
Esophageal manometric studies
Radionuclide tests
Lifestyle Modifications for GERD
Avoid triggers, tight clothes
Elevate the head of the bed
Quit smoking
Nutritional Therapy for GERD
Avoid caffeine, alcohol, orange juice, tomatoes, milk, chocolate, peppermint, spearmint, carbonated beverages
Eat a low-fat diet; small, frequent meals
Remain upright for 2-3 hours after eating
Maintain a healthy weight
Drug Therapy for GERD
Histamine (H2) Receptor Blockers (Cimetidine, Famotidine, Ranitidine, Nizatidine): typically given at bedtime
PPIs (Omeprazole, Lansoprazole, Esomeprazole): given before the first meal of the day, preferably on an empty stomach
Antacids: neutralize the stomach acid, recommended 1 and 3 hours after meals, and before bed
Cholinergics (Bethanecol): increases pressure of lower esophageal sphincter to help it close and stay closed
Prokinetic (Dromperidone, Metaclopramide): helps moves things through the stomach
Nissen Fundoplication
Fundus of stomach is wrapped around lower portion of esophagus
Hiatal Hernia
Occurs when part of the stomach herniates through the diaphragm into the chest cavity
Symptoms and treatment are similar to GERD
Disorders of the Stomach
Gastritis (inflammation of the stomach lining)
Peptic Ulcer Disease
Bariatric Surgery
Acute Gastritis
Rapid onset of symptoms usually caused by dietary indiscretion
May also be caused by medications, alcohol, bile reflux, and radiation therapy
Manifested by abdominal discomfort, headache, lassitude, nausea, vomiting, and hiccuping
Chronic Gastritis
Prolonged inflammation due to benign or malignant ulcers of the stomach or by H. pylori
May be associated with autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux
Manifested by epigastric discomfort, anorexia, heartburn after eating, belching, sour taste in the mouth, nausea/vomiting, and intolerance of some foods. May have a B12 deficiency
Nursing Care of Gastritis
Goals include reduced anxiety, avoidance of irritating foods, adequate intake of nutrients, maintenance of fluid balance, increased awareness of dietary management, and relief of pain
Medical Management of Acute Gastritis
Refrain from alcohol and food until symptoms subside
If due to strong acid or alkali treatment to neutralize the agent, avoid emetics and lavage
Supportive therapy
Medical Management of Chronic Gastritis
Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs
Pharmacologic therapy
Peptic Ulcer Disease
Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus
Risk factors include excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency
Dull gnawing pain or burning in the epigastrium
Potential Complications of PUD
Hemorrhage
Perforation
Penetration
Pyloric obstruction
Nursing Care of PUD
Relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications
Pharmacological Treatment of H. Pylori
PPI, Amoxicillin, Clarithromycin (7-14 day course)
PPI, Bismuth, Tetracycline, Metronidazole/Flagyl (10-14 day course)
Avoid aspirin, NSAIDs, and alcohol
Patient Education of PUD
Misoprostol (Cytotec) is a prostaglandin that is cytoprotective and has antisecretory properties, but should not be taken if pregnant due to teratogenic effects
Avoid triggering foods
Check with physician if generic forms are desired
Take medications exactly as prescribed
Management of Hemorrhage Due to PUD
Assess for evidence of bleeding, hematemesis or melena, and symptoms of shock/impending shock and anemia
Treatment includes IV fluids, NG lavage, oxygen, monitoring VS and UO
May require endoscopic coagulation or surgical intervention
Management of Pyloric Obstruction
Symptoms include nausea and vomiting, constipation, epigastric fullness, anorexia, and weight loss
Insert NG tube to decompress the stomach, provide IV fluids and electrolytes
Balloon dilation or surgery may be required
Management of Perforation or Penetration
Signs include severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board-like abdomen, and symptoms of shock or impending shock
Patient requires immediate surgery
Obesity
BMI above 30
Increased risk for disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life
Potential Complications of Bariatric Surgery
Hemorrhage
Bile reflux
Dumping syndrome
Dysphagia
Bowel or gastric outlet obstruction
Dumping Syndrome
Food passes rapidly into the intestines, resulting in diarrhea
Occurs shortly after eating; patient experiences weakness, faint, palpitations, sweating, stomach cramps, urge to defecate
Need small meals, low carbs, no fluids with meals, and recline/lay down 20-30 minutes after meals
Risk Factors for Gastric Cancer
Diet, chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, previous subtotal gastrectomy, and genetics
Manifestations of Gastric Cancer
Pain (relieved by antacids), dyspepsia, early satiety, weight loss, abdominal pain, loss or decrease in appetite, bloating after meals, nausea, and vomiting
Diagnosis is often late
Optimal Nutrition for Bariatric Surgery
Small, frequent meals of non-irritating foods
Provide foods high in calories and vitamins A and C and iron
Six small feedings low in carbohydrates and sugar, with fluids between meals
Prevention of Complications following Bariatric Surgery
Gastric Retention may require reinstatement of NPO and NG suction (low-pressure)
Bile Reflux: cholestyramine binds with bile acid
Malabsorption of Vitamins and Minerals requires supplementation of iron and other nutrients including B12
Steatorrhea: reduce fat intake and administer loperamide
Delivery Options for Enteral Nutrition
Continuous infusion by pump
Intermittent by gravity
Intermittent bolus by syringe
Cyclic feedings by infusion pump
Nasogastric and Nasointestinal Tubes
Radiopaque
Decreased likelihood of regurgitation and aspiration when placed in the intestine
Can be dislodged by vomiting or coughing
Can be knotted/kinked in the GI tract
Gastrostomy and Jejunostomy Tubes
May be placed in those needing tube feedings for an extended period of time (patient must have intact, unobstructed GI tract)
Can be placed surgically, radiologically, or endoscopically
Placing an Enteral Tube
Feedings can be started when bowel sounds are present, usually 24 hours after placement
Immediately after insertion, tube length from insertion site to distal end should be measured and recorded
Tube should be marked at skin insertion site and insertion length should be checked regularly
HOB 30-45 degrees, tube must be irrigated with water before/after each feeding
Placement should be checked every 8 hours, aspiration of stomach contents (pH < 5)
Complications of Enteral Nutrition
Vomiting
Diarrhea
Constipation
Dehydration
Complications of Gastrostomy or Jejunostomy Feedings
Skin irritation
Pulling out of tube
Gerontologic Considerations for Enteral Feedings
More vulnerable to complications with fluid and electrolyte balances, glucose intolerance, decreased ability to handle large volumes, and increased risk of aspiration
Composition of Parenteral Nutrition
Base solutions contain dextrose and protein in the form of amino acids
Prescribed electrolytes, vitamins, and trace elements are added to customize
IV fat emulsion is added
Methods of Parenteral Nutrition Administration
Central parenteral nutrition through catheter whose tip lies in superior vena cava
Subclavian or jugular vein
Complications of Parenteral Nutrition
Refeeding syndrome
Metabolic problems (increased blood sugars)
Mechanical problems
Infection and septicemia
Refeeding Syndrome
Characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia)
Nursing Management of Parenteral Nutrition
Vital signs every 4-8 hours
Daily weights/I&O
Blood glucose (check initially every 4-6 hours)
Electrolytes/BUN/CBC
Liver enzymes
Dressing changes
Manifestations of Infection and Septicemia
Erythema/tenderness
Exudate at catheter insertion site
Fever, chills
Nausea/vomiting
Malaise
