week 6 Flashcards
what are the upper GI disorders
gerd
hiatal hernia
esophageal tumour
gi accessory organs disorders
cholecystitis
pancreatitis
liver cirrhosis
hepatitis
what is gerd ?
backward flow of gastric contents into esophagus
what can gerd result from ?
increased abdominal pressure ( obesity , pregnancy, ascites )
LES problems ( food durgs smoking ng tubes )
what are the complications of gerd
barret’s epithelium , resp complications, esophagitis, dental decay, hemorrhage
what are the symptoms of gerd ?
dyspepsia, regurttion, dysphagia, odophagia, coughing, chest pain, pyrosis, belching
true or false. tissue injury, ingestion, swallowing, and stomach issues are common in gerd
true
hiatal hernia : assess for cues
what are the two kinds
sliding hernia and rolling hernia
what is sliding hernia
most common type : occurs the junction between the stomach and esophagus, slides up to thoracic cavity
what is this describing : usually lying down or supine and returns to normal, positioning when standing up
sliding hiatal hernia
what is rolling hernia
esophagus and stomach are in the correct position, but the position of the top of the stomach herniates into the diaphragm, forming a pocket beside the esophagus
symptoms for hiatal hernia would be the same ?
yes
sliding hiatal hernia and rolling hiatal hernia would be affect the functioning of ______ which lead to stomach acid leaking up into the esophagus and causing gerd, is that true ?
yes this is true, LES
gerd and hiatal hernia take action : Non-surgical interventions to minimize pain and allow healing
Optimize nutrition & Lifestyle modification
- Eat several small meals a day & stop eating 3 hrs before bed
- CPAP for sleep apnea
- Avoid smoking and drinking alcohol ( peppermint, chocolate, fatty foods, caffeine, carbonated drinks, spicy/acidic food)
Control symptoms: gerd and hiatal hernia
*Drugs(Antacids,PPIs,H2ReceptorBlockers)
- Avoid drugs that lower LES pressure (oral contraceptives, anticholinergic drugs, sedatives, NSAIDs, nitrates, CCB)
true or false: New research links long term PPl use to CAP, c diff, increased bone fractures, kidney injury, vit deficiencies
true
true or false.multiple pillows, work with gravity acid travelling up
true
GERD & Hiatal Hernia: Take Action
Surgical Interventions
*Performed when medication and lifestyle modification does not control symptoms
what is prep ip
weight loss, quit smoking ( contributes to gerd )
intra op for gerd
open or laparoscopic surgery
post op for surgical intervention for gerd and hiatal hernia
Monitor for bleeding and infection
- Prevent respiratory complications (↑HOB, early ambulation, DB&C-support
incision, pain control) - Prevent DVTs (compression stockings/SCDs)
- NG in situ initially (drainage goes from dark brown →yellowish green)
- Gradual diet progression (watch for dysphagia, aerophagia, inability to belch)
esophageal tumours: assess for cues : define what it is
most tumours are malignant developing from epithelium
what are the risk factors of esophageal tumours
alcohol
malnutrition
obesity
smoking
untreated gerd
assessment : recognizing cues for esophageal tumours
asymptomatic/silent at first
dysphagia
weight loss, odynophagia, hoarseness
nausea and vomiting
esophageal tumors : take action
non surgical intereventions
nutritional and swallowing therpahy
chemo,radiation, or combo of both
esophageal dilation
what undergoes nutritional and swallowing therapy
sit upright, soft foods, if not tolerated tube feeds, daily wts
surgical intervention for esophageal tumor is what ?
esophagectomy
esophagectomy
prep and intra op
pre op : nutrional support, smoking cessation, excellent oral care and resp rehab
intra : open or laparoscopic
what is the post op care for esophagectomy
resp care is the highest priority ( db and c , turning/pain/incisional support )
semi folowers or high fowlers
monitor chest tube ( allow drainage from incision site )
ng care: ensure patency ( watch drainage ) placement
nutriton initially hrough jejenostomy
- DO NOT reposition or irrigate NG unless prescribed in post op for esopahgeal tumors
true
what is the serious complication for esophageal tumor
anatomotic leak - mediastinitis, infection/shock
what is cholecystitis
inflammation of the gallbladder
acute or chronic
what is this describing : often related to gall stones ( obstructed )
inflammation cause bile cystitis
cholecystitis
what is this describing : decreased in blood flow to the gallbladder or conditions that cause bile stasis or lack of
movement or forward flow to bile. this includes conditions like sepsis
burns, tpn, or even
cholecystitis
Cholecystitis: Take Action
Non-Surgical Interventions
Goal: avoid pain d/t cholecystitis:
- Withhold fatty food → low fat, high fibre
- Treat nausea & vomiting (antiemetic)
- IV fluid if dehydrated
- Treat acute pain (Hydromorphone or Morphine)
- Treat mild to moderate pain (Ketoroloac- NSAID, watch for bleeding)
Non-Surgical stone management:
- Extra-corporeal shock wave lithotripsy (ESWL)
- Percutaneous Transhepatic Biliary Catheter (drain)
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Cholecystitis: Take Action
Surgical Interventions: Cholecystectomy (removal of gallbladder)
Laparoscopic Cholecystectomy
- Most common method (gold standard)
- Minimally invasive
- Rarely complications
Post-op Nursing:
* Pain management
* DB&C
* Prevent DVT (early ambulation)
* Monitor/Treat N&V (Ondansetron)
* IV fluids until eating and drinking
* Discharge same day
true or false for laprascopic
true
Open Approach Cholecystectomy
* Used in severe biliary obstruction when ducts need exploration
Post-Op Nursing:
* Jackson Pratt drain
* Antibiotics given to prevent infection * Pain management
* DB&C
* Prevent DVT (early ambulation)
* Monitor/Treat N&V (Ondansetron) * Assess surgical site
* Discharge 1-2 days after surgery
true or false
true
what is pancreatitis
inflammation of the pancreas ( can be life threatening )
can range from mild ( edema ) to severe ( necrotizing )
what is the cause of pancreatitis ?
gallbladder stones and alcohol use
symptoms
acute and chronic
acute : severe abd pain, wt loss, jaundice, tender, rigid abdomen, decreased/absent bowel sounds, grey/blue flanks
what can occur after surgery ?
stomach, duodenum, biliary tract
what are the less common acute symptom of pancreatitis
abdominal trauma and infections
what is chronic pancreatitis ?
episodes of abd pain, ascites, LUQ mass, steatorrhea, wt loss, jaundice, dark urine, DM
what are the complications of pancreatitis?
jaundice, intermittent hyperglycemic, multisystem organ failure, coagulation defects, shock, paralytic ileus
why is paralytic ileus happening due to complication?
ongoing inflammation, blockage, and organ failure
pancreatitis: take action
non surgical management
what is goal ?
manage pain, decrease inflammation, treat complications
pancreatitis : take action
acute pancreatitis what are the interventions ?
drugs, nutritional intervention, fetal position ( knees drawn up ), observe for signs of hypocalcemia, monitor resp status
what undergoes drugs :
nutritional interventions :
drugs : opioids ( might be PCA )
ranitidine and PPI ( decrease gastric secretions )
antibiotics ( acute necrotizing )
what undergoes nutrional interventions for pancreatitis ?
npo ( hold po/fluid make it iv fluid ) allowing rinsing out
oral care is important
ng tube to low suction ( severely ill )
jejunal tube feed ( after 1 to 2 days NPO )
gradually resume food
what is chronic pancreatitis intervention
undergoes drugs
opioids – non opoid analgesics
pancreatic enzymes
ranitidine and PPI ( decrease gastric secretions )
what undergoes nutritional interventions for chronic pancreatitis
TPN
4000-6000 calories/day
Avoid high fat food
alcohol cessation recommended
liver cirrhosis : assess for cues
what is it ?
extensive, irreversible scarring of liver
what are the causes of liver cirrhosis ?
viral hepatitis, nafld, toxic/drug induced, autoimmune , excessive, chronic biliary chronic
what are the early signs of liver cirrhosis
fatigue, weight change, n and v , pain
what are the late stage of liver cirrhosis
jaundice, dry/itchy skin, rashes, purpuric lesions, vascular lesions, ascites/edema, blood in stool/emesis, fector hepaticus, neuro changes, asterixis
what are the complications of liver cirrhosis
portal htn, varices, ascites/edema, hepatic encephalopathy, coagulation dysfunction and anemia
one of our goals is less fluid as evidenced by decreased in ascites, and edema and adequate circulatory volume
what undergoes this ?
manage fluid volume :
low na diet
vitamin supplements - folate, thiamine from iv to po
diuretic ( weight daily, abd circumference, assess peripheral edema )
true or false. peritonitis should be monitored when it comes to liver cirrhosis ( fever, loss of appetite, abd pain, change in mental status )
true
what should be utilized if ascites if affecting the breathing ?
paracentesis
what is TIPS ? or transhepatic portal systemic shunt procedure ?
connects a branch of portal vein to a branch of the hepatic vein
it is known that free of bleeding episdoes but if bleeding occurs we have to sto it quickly : how should we manage the bleeding ?
screening for esophageal varices
beta blockers ( reduce hr and hepatic venous pressure )
treat infections ( major indicators of bleed )
vasoactive drugs for active bleed ( octreotide and vasopressin )
endsocopy is needed to manage the bleeding
such as
ligatation
sclerotherpahy ( injected into veins )
balloon tamponade, stents
true or false. TIPS could also be used in manage of bleeding
true
our goal is to kep liver cirrhosis patients free form acute or chronic confusion, if confusion develops early interevention to maintain safety
what undergoes this
neuro assesment
monitor ammonia levels
— moderate protein ( esp if levels are elevated )
drugs used apringly ( barbituates, opoids, sedatives )
lactulose
- lax effect
-goal is 2-3 stools a day- decreased confusion
-risk for hypokalemia and dehydration
monitor for asterixis and fetor hepaticus
our goal is to also have less discomfort from itchy skin
how should we manage pruritis
avoid warm temp
moisturize skin
avid irritants
cool compresses
corticosteroid creams- sertraline
what is viral hepatitis :
what are the types of viral hepatitis
widespread inflammation of the liver
types : hep a , hep b , hep c
what are the symptoms of viral hepatitis
right upper quadrant pain, fatigue, myalgia, athralgia, malaise, fever, jaundice, dark yellow urine, light clay coloured stool, anorexia, n and v , dry itchy skin
what is the complications of viral hepatitis
depression, polyarthrithis, myalgia, renal insufficiency, cognitive impairment, heart disease
why is upper right quadrant pain happening due to viral hepatitis?
secondary liver enlargement and light clay coloured stool (happening in the liver - causing blockage )
true or false. related to antigen lodge in various parts othe body including the
joints muscles kidneys and even blood vessels, brain and heart
true
viral hepatitis : take action
goal : prevent weight loss from complications of hepatitis
is to promote nutrition
nutrional assesment ( dietician )
diet in high in carbs and calories ( mod in fat and protein )
small fequent meals ( food pt likes )
true or false. we should offer viral hepatitis high calories snacks between meals
true
recall that non pharmacological approaches should control nausea, what are some examples ?
acupuncture, scenery, relaxes
supplemental vitamins could be prescribe to viral hepatitis?
true
viral hepatitis : take action
goal is to reduce fatigue due to infection and decreased metabolic energy production
alternate periods of rest and activity
drugs used sparingly ( antiemetic for nausea )
hep b and c drug management ( antiviral drugs ) — antiviral drugs ( can make ppl more susceptible to infection )
true or false. antiviral can suppress immune system ( avoid large crowds or sick people ) high risk for another infection due to suppress immune system
true
