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Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Chapter 29 Care of Patients with Disorders of the Upper Gastrointestinal.

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Presentation on theme: "Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Chapter 29 Care of Patients with Disorders of the Upper Gastrointestinal."— Presentation transcript:

1 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Chapter 29 Care of Patients with Disorders of the Upper Gastrointestinal System

2 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Theory Objectives Discuss obesity and its management, including bariatric surgery. Compare the signs and symptoms of oral, esophageal, and stomach cancer. Illustrate the cause of gastroesophageal reflux disease (GERD). 1

3 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Theory Objectives (cont.) Explain the etiology and prognosis for Barretts esophagus. Describe the pathophysiology, means of medical diagnosis, and treatment for gastritis. Compare and contrast the treatment and nursing care of the patient with GERD and a patient with a peptic ulcer. 2

4 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Theory Objectives (cont.) Review the difference in the care of the patient with a nasogastric tube for decompression and care of the patient with a feeding tube. Compare the care for a patient receiving total parenteral nutrition with care of the patient receiving enteral feedings. 3

5 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Clinical Practice Objectives Prepare a teaching plan for a patient who has GERD. Plan postoperative care for a patient having gastric surgery. Demonstrate proper care of the patient with a Salem sump tube for gastric decompression. 4

6 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Clinical Practice Objectives (cont.) Manage a tube feeding for the patient receiving formula via a feeding pump. Devise a nursing care plan for the patient with a gastrointestinal disorder. 5

7 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Anorexia Nervosa The patient with anorexia nervosa refuses to eat adequate quantities of food and is in danger of literally starving to death Diagnosis requires extensive interviewing, and treatmentincluding behavior modification and nutrition supportwhich may take months to years 6

8 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Bulimia Nervosa The bulimic patient consumes large quantities of food and then induces vomiting to get rid of it so that weight is not gained Laxatives Some patients with anorexia nervosa also are bulimic Some individuals practice bulimia occasionally without harm 7

9 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Bulimia Nervosa (cont.) It can lead to severe fluid and electrolyte imbalances, starvation, and death Treatment of bulimia includes psychotherapy, antidepressant medication, and behavior modification 8

10 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Obesity Etiology and pathophysiology Signs and symptoms Diagnosis Height and weight chart Waist and hip circumference Body mass index (BMI) 9

11 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Obesity Treatment Bariatric surgery Extensive counseling and assessment Modify lifestyle and stringent regimen required to lose weight and keep weight off Types Gastric restrictive Malabsorptive Gastric restrictive combined with malabsorptive surgery 10

12 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Bariatric Surgery Preoperative care There is greater risk of pulmonary and thrombus formation, as well as death, for the obese patient 11

13 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Restrictive Procedures Laparoscopic adjustable gastric banding is performed by placing an inflatable band around the fundus of the stomach The band is inflated and deflated via a subcutaneous port to change the size of the stomach as the patient loses weight 12

14 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Restrictive Procedures (cont.) For vertical banded gastroplasty, the surgeon creates a small stomach pouch by placing a vertical line of staples A band is placed to provide an outlet to the small intestine 13

15 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Gastric Bypass 14

16 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Vertical Banded Gastroplasty 15

17 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Circumgastric Banding 16

18 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Malabsorptive and Combination Procedures The total gastric bypass procedure causes severe nutritional deficiencies and is no longer recommended The roux-en-Y gastric bypass (RYGB) limits the stomach size, and the duodenum and part of the jejunum are bypassed. This limits the absorption of calories 17

19 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Complications Leakage of stomach contents Gastric stretching Dumping syndrome Nutritional deficiencies iron, vitamin B 12, calcium, and folate 18

20 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Healthy People 2020 Goals Related to Losing Weight and Obesity Increase the proportion of adults who are at a healthy weight Reduce the proportion of adults who are obese Reduce the proportion of children and adolescents who are overweight or obese 19

21 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Assessment Family history Contributing factors Record of eating patterns for a 7-day period Weight and height BMI Skinfold thickness measurement General health assessment 20

22 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Expected Outcomes Patient will make positive statements about decreasing body size Patient will verbalize feelings of self-worth 21

23 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Implementation Diet and exercise plan Lifestyle and preferences Eating and exercise diary Guidance and support Discourage fad diets and emphasize the importance of a well-balanced, nutritious, low- calorie diet Commercial programs on weight reduction 22

24 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Upper GI Disorders Stomatitis Dysphagia Causes Diagnosis Treatment Nursing management 23

25 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Implementation Aspiration Suctioning Nutrition and gastrostomy 24

26 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Cancer of the Oral Cavity Etiology Pathophysiology Signs and symptoms Diagnosis physical examination and biopsy Treatment radiation, chemotherapy, and surgery Nursing management 25

27 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Cancer of the Esophagus Cigarette smoking is a major cause of esophageal cancer in the United States When combined with heavy alcohol consumption, the risk for esophageal cancer greatly increases Esophageal cancer is the second most common cancer in China, but is seen less in North America 26

28 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Cancer of the Esophagus (cont.) Gastroesophageal reflux disease (GERD) is a cause of Barretts esophagus, which is a precancerous condition 27

29 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Cancer of the Esophagus (cont.) Signs, symptoms, and diagnosis Treatment Esophagectomy Nursing management Postoperative care Nutrition 28

30 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Audience Response Question 1 When screening for the presence of risk factors for oral and pharyngeal cancers, the nurse would ask which question(s)? (Select all that apply.) 1. How much alcohol do you consume? 2. Have you had any oral lesions? 3. Do you have family members who have cancer? 4. What do you smoke? 5. Have you been exposed to hepatitis virus? 29

31 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Hiatal Hernia (Diaphragmatic Hernia) Etiology and pathophysiology Signs and symptoms Treatment 30

32 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Treatment of Hiatal Hernia Reduce weight Avoid tight-fitting clothes around the abdomen Take antacids and histamine (H 2 )-receptor antagonists Elevate head of the bed on 6- to 8-inch blocks Take proton pump inhibitors 31

33 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Treatment of Hiatal Hernia (cont.) Instruct not to eat within several hours of going to bed Limit intake of alcohol, chocolate, caffeine, and fatty foods Avoid smoking 32

34 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Nursing Management Teach ways to prevent pain and reflux Encourage weight reduction Remind the patient to stay upright for 2 hours after eating and not to eat for 3 hours before bedtime 33

35 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Nursing Management (cont.) If the head of the bed cannot be raised, a wedge pillow should be used to elevate the upper body; this position helps prevent reflux and assists gravity in maintaining the stomach in the abdominal cavity H 2 or proton pump inhibitors Avoid foods that cause bloating 34

36 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Gastroesophageal Reflux Disease (GERD) Etiology and pathophysiology Signs and symptoms Diagnosis and treatment Nursing management Diet therapy, lifestyle changes, drug therapy, and education Complications 35

37 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Gastroenteritis Caused by food or water contaminated with a virus, a pathogenic bacteria, or parasites Signs and symptoms Management 36

38 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Gastritis Etiology Pathophysiology Signs and symptoms Diagnosis Treatment 37

39 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Treatment for Gastritis Acute versus chronic gastritis Chronic gastritis Antispasmodics Antacids H 2 -receptor antagonist such as ranitidine Proton pump inhibitor Antibiotic therapy for H. pylori 38

40 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Peptic Ulcers Etiology Helicobacter pylori Duodenal ulcers and some pre-pyloric ulcers Gastric ulcers Tension, anxiety, and prolonged stress Drug-induced ulcers 39

41 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Peptic Ulcers (cont.) Pathophysiology Signs and symptoms Daily pattern of pain Gastrointestinal bleeding Diagnosis Endoscopy Gastric acid analysis 40

42 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Peptic Ulcers (cont.) 41

43 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Treatment Antacids Gastric bleeding and normal saline lavage H 2 -receptor antagonist Proton pump inhibitors Presence of H. pylori administration of clarithromycin (Biaxin) plus another antibiotic, an H 2 inhibitor, and a proton pump inhibitor 42

44 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Nursing Management Complications Hemorrhage Perforation Obstruction 43

45 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Surgical Treatment of Peptic Ulcer Pyloroplasty with truncal or proximal gastric vagotomy Subtotal gastrectomy (gastric resection) Total gastrectomy 44

46 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Nursing Care of the Patient Undergoing Gastric Surgery Preoperative care Postoperative care Specific patient teaching Diet restrictions Dumping syndrome 45

47 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Gastric Cancer Etiology Signs and symptoms Pathophysiology Diagnosis Treatment Nursing management 46

48 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Gastric Cancer (cont.) Treatment Surgical intervention Radiation therapy Chemotherapy Adjuvant therapy 47

49 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Common Therapies for Disorders of the Gastrointestinal System Gastrointestinal decompression Enteral nutrition Total parenteral nutrition 48

50 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Small-Bore Feeding Tube Placement 49

51 Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Audience Response Question 2 Regarding the care of enteral feeding tubes, which nursing behavior(s) demonstrate(s) appropriate nursing care? (Select all that apply.) 1. Aspirating contents of jejunostomy tube 2. Gentle flushing of a clogged enteral tube with 30 mL of water 3. Checking for 1-inch play on a gastrostomy tube 4. Monitoring BUN, prealbumin, hematocrit, electrolytes, and glucose 5. Rotating a jejunostomy tube 360 degrees each day 50


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