Upper GI Disorders Flashcards
What history should be included in a GI assessment?
Appetite, weight, stool, pain (musculoskeletal)
What should be included in nutrition history?
Special diets, food allergies, intake, taste changes, pain, dysphagia, ETOH, caffeine intake, medications, genetics
What changes in symptoms should you look for?
BM pattern changes, unintentional weight loss/gain, appetite changes
What should be included in a physical assessment for GI?
BMI, oral care, abdomen
How can musculoskeletal pain indicate a GI issue?
B12 absorption issues
What factors contribute to dental caries?
- plaque
- length of time acid is on teeth
- strength of acids and ability of saliva to neutralize them
- teeth decay susceptibility
- medications
- age-related dryness
What is the hardest substance in the body?
enamel
What medications cause dental caries?
-antidepressants, antiHTN, anti-inflammatory, diuretics
-S/E is usually dry mouth (increases plaque risk)
Elderly considerations for dental caries?
appetite loss, decreased food intake, social isolation, trauma to oral cavity, less vascular oral mucous membranes
What cardiac event can be caused by poor detention?
Risk for mitral valve prolapse (bacteria then can cause infection)
What is a periapical abscess?
Bacterial infection in the dental pulp- enters through a deep cavity of crack in tooth
What are S/S of periapical abscess?
- Severe, constant, throbbing tooth ache that can spread to the jaw, ear, neck (edema, swollen lymph nodes)
- hot/cold sensitive, fever, swelling, foul odor
Causes of periapical abscess?
Poor dental hygiene, high sugar diet, dry mouth
How do you treat a periapical abscess?
drain the abscess, root canal, pull the tooth, antibiotics
What is stomatitis?
General term for an inflamed and sore mouth
What causes stomatitis?
Chemo
Radiotherapy
Loose dentures
Trauma
Poor dental hygiene
Smoking
Infection
Dehydration
Medications
Alcohol
What medications help with stomatitis?
BMX (Benadryl, Maalox, Viscous Lidocaine) soothes mouth until it can heal
What is the purpose of Carafate?
Soothe mucous membranes
What medication is used for thrush?
Nystatin
What medication is used for stomatitis caused by a virus?
Acyclovir
What is TMJ?
Pain or decreased function in the jaw
S/S of TMJ?
Headaches, dizziness, hearing problems, pain, teeth don’t fit together, clicking
How to assess for TMJ?
Place hands on jaw, have the pt. open and close it, feel for clicks/pops
What is the nursing priority for TMJ?
Symptom relief (TMJ derives from associated symptoms)
What is sialidenitis?
Salivary gland inflammation
What causes sialidenitis?
- infection, radiation, decreased immunity, dehydration, poor dentation
- these lead to some kind of blockage of inflammation of salivary glands
What are sialagogues and why are they used?
- hard candy, citrus fruits, sour
- substance that triggers saliva flow
What is important to know with sialidenitis?
AIRWAY- untreated will cause an abscess to form and spread to the mediastinum and neck
What is important to know with sialidenitis?
AIRWAY- untreated will cause an abscess to form and spread to the mediastinum and neck
What is Xerostomia?
a. Protrusion of an organ in the mouth
b.Difficulty swallowing
c.Heartburn
d. Dry mouth
Dry mouth
Which one of these should NOT be part of patient teaching for Stomatitis?
a.Avoid using commercial mouthwash
b.Use lemon-glycerin swabs to keep mouth moist throughout the day
c.Eat soft, bland, non-acidic foods
d.Perform oral hygiene after each meal
Use lemon-glycerin swabs to keep mouth moist throughout the day
S/S of esophageal tumors?
- Often asymptomatic in early stages, usually affects lower 2/3 of esophagus, weight loss (often > 20 lbs), odynophagia, halitosis
How is an esophageal tumor usually treated?
-Treated the same as reflux
-Rarely detected early and often terminal
What is a total radical neck dissection?
Removal of all cervical lymph nodes, sternocleidomastoid muscle, internal jugular vein, and spinal accessory muscle with flap
What is a modified radical neck dissection?
Muscle is left in place (most common)
What is a selective radical neck dissection?
Fewer lymph nodes are removed
What are the important nerves in the neck area and what do they control?
-Marginal nerve: lower lip
-Spinal accessory nerve:shoulder mobility, raising arm over head
-Hypoglossal: tongue movement
-Lingual: tongue sensation
-Vagus: movement of one vocal cord
What should be expected from any surgery?
Swelling, bleeding, drainage
What should be your concern if there is swelling or drainage in the neck?
Airway
True or False?
After a radical neck dissection, when the ET tube or airway has been removed and the effects of the anesthesia have worn off, the patient may be placed in the supine position to facilitate breathing and promote comfort.
True
What is achalasia?
Ineffective or absent peristalsis in the esophagus (lazy esophagus)
What is the primary nursing intervention for achalasia?
Instruct the pt. to eat slowly and drink with meals
What is an esophageal spasm?
-Intermittent tightening of the esophagus
-Mimics heart pain
What is a nutcracker esophageal spasm?
Spasm plus high pressure (looks like a nut)
What is a diffuse esophageal spasm?
Can occur at any time
What medications are used for an esophageal spasm?
calcium channel blockers
smooth muscle relaxants
anticholinergics
tricyclic antidepressants
proton pump inhibitors
-NTG can help by vasodilation
What is the most common hiatal hernia and what is commonly associated with it?
- Sliding (usually asymptomatic)
- GERD
What are nursing interventions for hernias, esophagitis, and GERD?
-HOB up x1 hour after eating
- Small frequent feedings
- Sleeping with blocks under HOB
- Avoid anticholinergics
What is a risk with a hiatal hernia?
- Hemorrhage, obstruction, strangulation, twisting
- Emergencies
What is the Nissen Laparoscopic procedure?
Full blanket around hernia (these pt. can’t throw up)
What are complications with post-op fundoplications?
Dysphagia – supervise first feed
Gas bloat (can’t belch) – avoid straws, soda, gum
Atelectasis/pneumonia
Obstructed NGT (flush!)
What is an esophageal diverticula and what diagnosis it?
- Outpouchings of the esophageal wall forming small sacs from herniation of mucosa and submucosa
- EGD
What is the difference between Mallory- Weiss Syndrome and Boerhaaves Syndrome?
- Mallorys: incomplete tear; pregnant women and bulimia are common causes (red blood in vomit)
- Boerhaaves: Complete tear; 40% mortality rate; blood and air pool in skin (chest pain!); treated with a VAT
What medications are used for swallowed foreign bodies?
Glucagon (relaxes sphincter)
Calcium channel blockers (nifedipine/Procardia)
Carbonated beverage
Bread
Endoscopy
What is GERD and what causes it?
- Backward flow of stomach contents into esophagus (chronic)
- Excessive relaxation of the LES
- Hiatal Hernia
- H-pylori (gastritis and delayed emptying)
- NGT (keeps sphincter open)
What is GERD and what causes it?
- Backward flow of stomach contents into esophagus (chronic)
- Excessive relaxation of the LES
- Hiatal Hernia
- H-pylori (gastritis and delayed emptying)
- NGT (keeps sphincter open)
What should be included in assessment for GERD?
- Symptoms vary with severity
- Pyrosis – radiating to back, neck or jaw
- Pain after eating and at bedtime when supine
- Pain aggravated by activities increasing intra-abdominal pressure
- Regurgitation (aspiration risk)
- ↑ salivary secretion
- Eructation (belching), flatulence (gas), odynophagia (painful swallowing)
- Esophageal strictures – progressive dysphagia
- Bleeding
- Barrett’s Esophagus > precancerous cell changes
What does Barrett’s esophagus look like?
Hyperpigmentation, red and beefy
What are nursing interventions for GERD?
- No chocolate, alcohol, fatty foods, caffeine, carbonated beverages, peppermints, spicy and acidic foods
- Smoking and ETOH cessation support (decreases LES pressure)
- Avoid eating 3 hours before bed
- Elevate HOB 6 inches on blocks
- No tight clothing, lifting or straining, or bending over
- Sleep apnea – wear CPAP
What is gastritis?
Inflammation of the gastric mucosa – occurs when there is a break in protective barriers > mucosal injury > histamine release OR hydrochloric acid injures vessels (edema, hemorrhage, erosion), resulting in inflammation
- B12 absorption is affected
What are the two types of acute gastritis?
- Erosive- usually caused by local irritants (ASA, NSAIDs, corticosteroids, alcohol consumption, caffeine, gastric radiation therapy); can lead to hemorrhage
- Nonerosive – caused by Helicobacter pylori (H. pylori) bacterial infection
What are underlying causes of chronic gastritis?
- H. Pylori (most common) – can lead to peptic ulcer, gastric cancer
- Chemical gastric injury (gastropathy) – long-term drug therapy, reflux of duodenal contents
- Autoimmune disorders (Hashimoto thyroiditis, Addison disease, Graves disease)
**Atrophy can cause ↓ absorption of Vit B12 (pernicious anemia)
What is triple therapy for gastritis?
Triple therapy – PPI + Clarithromycin + Amoxicillin OR Metronidazole
What is quad therapy for gastritis?
Quad therapy – PPI + Bismuth + Tetracycline + Metronidazole
What is peptic ulcer disease?
Excavation (hollowed-out area) that forms in the mucosa of the stomach, pylorus, duodenum or in the esophagus; may extend through the muscle to the peritoneum
What are RF for PUD?
Smoking
Alcohol
Diet
Stress
Genetics
Blood types A & O
Compare gastric vs. duodenal ulcers
- Gastric: 25%, normal to low acid secretion, caused by NSAIDs, blood type A, pain is not relieved or made worse by eating (*won’t eat)
-Duodenal: 75%, normal to high acid secretion, caused by H. Pylori, blood type O, pain gets better while eating then gets worse 2-3 hours later
What kind of stool will be seen with ulcers?
Black
What is the most common site for peptic ulcer formation?
Duodenum
What is the best time to teach a client to take proton pump inhibitors?
30 minutes before a meal
What is the best time to teach a client to take proton pump inhibitors?
30 minutes before a meal
What are the complications of a GI bleed and what should they be monitored for?
Hematemesis: bright red or coffee-ground
Melena: dart tarry stools, common in duodenal ulcers
Hypovolemia → expand intravascular space with isotonic fluids
monitor for shock
- GI and liver go hand-in-hand for shock
What is a perforation complication?
Ulcer becomes deep and wears away entire layers – contents leak into peritoneal cavity or other organs
What are S/S of perforation?
Fluids, blood, electrolytes, antibiotics, NPO, NGT, I&O, monitor for septic shock (fever, pain, ↑HR, ↓BP, lethargic, anxiety)
*surgical emergency
What is peritonitis? S/S?
- GI opens into peritoneal cavity
- Rigid abd., pain, and fever are emergency symptoms
- Fetal position
What is a pyloric obstruction and what will help?
- stricture in pyloric valve of stomach
- not eating, N/V, no poop or gas
- decompress the bowel and put them NPO
*treat like hypokalemic, dehydration, and metabolic alkalosis
