Upper GI (N/V, GERD) Flashcards
Most common manifestation of most GI diseases
N/V
feeling of discomfort in the epigastric region, with a desire to vomit
Nausea
Etiology of GI Disorders
Pregnancy Infectious disease CNS-meningitis, tumors CV-HF, MI Metabolic-DB, Addison’s, RF Side Effects-chemo, opioids, digoxin Post-operative complication Psychological-stress, fear
Complications of severe vomiting
- Electrolyte imbalance
- Potassium, sodium, chloride, hydrogen
- Metabolic alkalosis-loss of gastric hydrochloric acid
- Metabolic acidosis-emesis from the small intestine (less common)
- Pulmonary aspiration in unconscious or decreased gag reflex
- Semi-fowlers or side lying
Most common cause of N/V?
gastroenteritis
When to see MD –
A) Vomiting __ or __
B) No urination
C) Other
A) > 24 hours or > 3x/day
B) for 8 hours
C) Headache, Stiff neck,
Severe abdominal pain
Abdominal Assessment
- Auscultate bowel sounds in all four quadrants
- 5-30/minute normal
- > 30 hyperactive
- <5 hypoactive
- None in 5 minutes absent = Medical Emergency
Partially digested food several hours after eating indicates?
gastric outlet obstruction or delayed emptying
Coffee ground emesis and bright red blood indicates?
upper GI bleed
Medications to treat N/V
Anticholinergics-scapolamine Antihistamines-Hydroxyzine Phenothiazine-prochlorperazine Prokinetic-metoclopraminde Serotonin antagonist-ondansetron
Common side effects of antinausea meds?
Dry mouth, hypotension, sedation, rash, and constipation
Tx for severe cases N/V?
- Hydration with:
- IV fluid
- Electrolytes
- Glucose
- TPN
Gastric Lavage: ______mL of fluid is instilled at a time.
50-100 mL
Process of removing an NG Tube
Instill 50mL of air into tube Ask client to take a deep breath and hold Pinch tube Slowly withdraw Oral care after Document
Nursing Interventions for Patient with NG tube, initiating introduction of food?
- Initiate clear liquids
- Administer broth and Gatorade with caution due to high NA content
- Assess tolerance
- Assess bowel sounds
- Advance to soft bland diet
- Toast, crackers
- Provide oral care
Nondrug Therapy for N/V?
Acupuncture
Herbs – ginger or peppermint
Relaxation breathing exercises
Change in position/activity
Syndrome based on chronic symptoms or mucosal damage secondary to reflux of gastric contents into the lower esophagus
Gastroesophageal Reflux Disease (GERD)
Most common GI problem in adults?
Gastroesophageal Reflux Disease (GERD)
Common causes of Gastroesophageal Reflux Disease (GERD)?
- Hiatal hernia
- decreased esophageal clearance
- esophageal motility
- decreased gastric emptying
- Pregnancy and obesity
- Cigarette and cigar smoking
Most common S/S of GERD?
- Heartburn (pyrosis)
- Dyspepsia
- Regurgitation
Uncommon S/S of GERD?
- Respiratory symptoms
- wheezing, coughing, SOB
- Chest pain
- Otolaryngologic symptoms
How to diagnose GERD?
- H&P-diagnosed by symptoms
- Persistent reflux more than 2x week
- Upper GI endoscopy (EGD) with biopsy
- Barium swallow
- Motility studies
Drug Therapy for GERD?
- H2-receptor blockers-reduce acid production
- Proton pump inhibitor (PPI)-reduce acid production and help heal the espophagus
- Antacids-neutralize the acid, quick short relief, take 1-3 hours before meals and at HS
Teaching Nursing Interventions
- Avoid triggers
- Smoking cessation
- Weight reduction
- Diet
- Elevate HOB bed 6-8 inches
- Stress reduction
Diet Teaching for a patient with GERD?
- Small frequent meals
- Avoid: chocolate, peppermint, tomatoes, coffee, tea, orange juice, red wine
- Avoid milk at HS, late night snacking
- Chewing gum and oral lozenges may decrease symptoms
- Do not lie down after a meal-wait 3 hours
How long should a patient diagnosed with GERD wait to lie down after eating?
3 hours
Complications of GERD
- Esophagitis
- Barret’s esophagus
- Cough, bronchospasm, asthma, pneumonia
- Caused by irritation or aspiration of gastric content
- Dental Erosion
Esophagitis
Esophagitis Inflammation of the esophagus Ulcerations Bleeding Dysphagia
Barret’s esophagus
Pre-cancerous lesions
