Presentation on theme: "Theory Objectives Discuss obesity and its management, including bariatric surgery. Compare the signs and symptoms of oral, esophageal, and stomach cancer."— Presentation transcript:
0 Care of Patients with Disorders of the Upper Gastrointestinal System Chapter 29Care of Patients with Disorders of the Upper Gastrointestinal System
1 Theory ObjectivesDiscuss 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).
2 Theory Objectives (cont.) Explain the etiology and prognosis for Barrett’s 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.
3 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.
4 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.
5 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.
6 Anorexia NervosaThe patient with anorexia nervosa refuses to eat adequate quantities of food and is in danger of literally starving to deathDiagnosis requires extensive interviewing, and treatment—including behavior modification and nutrition support—which may take months to years
7 Bulimia NervosaThe bulimic patient consumes large quantities of food and then induces vomiting to get rid of it so that weight is not gainedLaxativesSome patients with anorexia nervosa also are bulimicSome individuals practice bulimia occasionally without harm
8 Bulimia Nervosa (cont.) It can lead to severe fluid and electrolyte imbalances, starvation, and deathTreatment of bulimia includes psychotherapy, antidepressant medication, and behavior modification
9 Obesity Etiology and pathophysiology Signs and symptoms Diagnosis Height and weight chartWaist and hip circumferenceBody mass index (BMI)
10 Obesity Treatment Bariatric surgery Extensive counseling and assessmentModify lifestyle and stringent regimen required to lose weight and keep weight offTypesGastric restrictiveMalabsorptiveGastric restrictive combined with malabsorptive surgery
11 Bariatric Surgery Preoperative care There is greater risk of pulmonary and thrombus formation, as well as death, for the obese patient
12 Restrictive Procedures Laparoscopic adjustable gastric banding is performed by placing an inflatable band around the fundus of the stomachThe band is inflated and deflated via a subcutaneous port to change the size of the stomach as the patient loses weight
13 Restrictive Procedures (cont.) For vertical banded gastroplasty, the surgeon creates a small stomach pouch by placing a vertical line of staplesA band is placed to provide an outlet to the small intestine
15 Vertical Banded Gastroplasty See Figure 29-1 on p. 642.
16 Circumgastric Banding See Figure 29-1 on p. 642.
17 Malabsorptive and Combination Procedures The total gastric bypass procedure causes severe nutritional deficiencies and is no longer recommendedThe 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
18 Complications Leakage of stomach contents Gastric stretching Dumping syndromeNutritional deficiencies—iron, vitamin B12, calcium, and folateWith the RYGB procedure, there is danger of leakage of stomach contents into the abdomen in the early postoperative period. Later, gastric stretching may cause the staple line to break and a leak to occur.Signs and symptoms are tachycardia, dyspnea, or restlessness.An upper gastrointestinal (GI) series or computed tomography scan can diagnose the problem.The band in the vertical banding procedure may erode into the stomach over time and cause leakage. RYGB patients are also at risk for dumping syndrome, which results in nausea, weakness, sweating and diarrhea. These symptoms tend to occur after meals that include concentrated sweets; therefore, RYGB patients should be advised to avoid refined sugars. Other complications of major surgery may occur in the respiratory and cardiovascular systems. About a third of patients who undergo bariatric surgery develop gallstones. Urodeoxycholic acid therapy can be used to treat the gallstones, although poor compliance and cost are issues for this therapy (Patel et al., 2009).All bariatric surgery patients are at risk of nutritional deficiencies. Those with the RYGB procedure are most likely to develop deficiencies of iron, vitamin B12, calcium, and folate. Supplements must be taken for life.
19 Healthy People 2020 Goals Related to Losing Weight and Obesity Increase the proportion of adults who are at a healthy weightReduce the proportion of adults who are obeseReduce the proportion of children and adolescents who are overweight or obese
20 Assessment Family history Contributing factors Record of eating patterns for a 7-day periodWeight and heightBMISkinfold thickness measurementGeneral health assessment
21 Expected OutcomesPatient will make positive statements about decreasing body sizePatient will verbalize feelings of self-worth
22 Implementation Diet and exercise plan Lifestyle and preferences Eating and exercise diaryGuidance and supportDiscourage fad diets and emphasize the importance of a well-balanced, nutritious, low-calorie dietCommercial programs on weight reduction
24 ImplementationAspirationSuctioningNutrition and gastrostomy
25 Cancer of the Oral Cavity EtiologyPathophysiologySigns and symptomsDiagnosis—physical examination and biopsyTreatment—radiation, chemotherapy, and surgeryNursing management
26 Cancer of the Esophagus Cigarette smoking is a major cause of esophageal cancer in the United StatesWhen combined with heavy alcohol consumption, the risk for esophageal cancer greatly increasesEsophageal cancer is the second most common cancer in China, but is seen less in North AmericaBoth substances are irritants to the mucosa of the esophagus. Cigarettes and smokeless tobacco are responsible for 14,530 deaths from esophageal cancer annually (American Cancer Society, 2009).
27 Cancer of the Esophagus (cont.) Gastroesophageal reflux disease (GERD) is a cause of Barrett’s esophagus, which is a precancerous condition
28 Cancer of the Esophagus (cont.) Signs, symptoms, and diagnosisTreatmentEsophagectomyNursing managementPostoperative careNutrition
29 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.)“How much alcohol do you consume?”“Have you had any oral lesions?”“Do you have family members who have cancer?”“What do you smoke?”“Have you been exposed to hepatitis virus?”Correct Answer: 1, 2, 3, and 4
30 Hiatal Hernia (Diaphragmatic Hernia) Etiology and pathophysiologySigns and symptomsTreatment
31 Treatment of Hiatal Hernia Reduce weightAvoid tight-fitting clothes around the abdomenTake antacids and histamine (H2)-receptor antagonistsElevate head of the bed on 6- to 8-inch blocksTake proton pump inhibitors
32 Treatment of Hiatal Hernia (cont.) Instruct not to eat within several hours of going to bedLimit intake of alcohol, chocolate, caffeine, and fatty foodsAvoid smoking
33 Nursing Management Teach ways to prevent pain and reflux Encourage weight reductionRemind the patient to stay upright for 2 hours after eating and not to eat for 3 hours before bedtime
34 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 cavityH2 or proton pump inhibitorsAvoid foods that cause bloating
35 Gastroesophageal Reflux Disease (GERD) Etiology and pathophysiologySigns and symptomsDiagnosis and treatmentNursing managementDiet therapy, lifestyle changes, drug therapy, and educationComplications
36 GastroenteritisCaused by food or water contaminated with a virus, a pathogenic bacteria, or parasitesSigns and symptomsManagement
37 Gastritis Etiology Pathophysiology Signs and symptoms Diagnosis Treatment
38 Treatment for Gastritis Acute versus chronic gastritisChronic gastritisAntispasmodicsAntacidsH2-receptor antagonist such as ranitidineProton pump inhibitorAntibiotic therapy for H. pylori
39 Peptic Ulcers Etiology Helicobacter pylori Duodenal ulcers and some pre-pyloric ulcersGastric ulcersTension, anxiety, and prolonged stressDrug-induced ulcers
40 Peptic Ulcers (cont.) Pathophysiology Signs and symptoms Diagnosis Daily pattern of painGastrointestinal bleedingDiagnosisEndoscopyGastric acid analysis
41 Peptic Ulcers (cont.)See Figure 29-3 on p A, gastric; B, duodenal.
42 Treatment Antacids Gastric bleeding and normal saline lavage H2-receptor antagonistProton pump inhibitorsPresence of H. pylori—administration of clarithromycin (Biaxin) plus another antibiotic, an H2 inhibitor, and a proton pump inhibitor
44 Surgical Treatment of Peptic Ulcer Pyloroplasty with truncal or proximal gastric vagotomySubtotal gastrectomy (gastric resection)Total gastrectomy
45 Nursing Care of the Patient Undergoing Gastric Surgery Preoperative carePostoperative careSpecific patient teachingDiet restrictions Dumping syndrome
46 Gastric Cancer Etiology Signs and symptoms Pathophysiology Diagnosis TreatmentNursing management
47 Gastric Cancer (cont.) Treatment Surgical intervention Radiation therapyChemotherapyAdjuvant therapy
48 Common Therapies for Disorders of the Gastrointestinal System Gastrointestinal decompressionEnteral nutritionTotal parenteral nutrition
49 Small-Bore Feeding Tube Placement See Figure 29-5 on p. 659.
50 Audience Response Question 2 Regarding the care of enteral feeding tubes, which nursing behavior(s) demonstrate(s) appropriate nursing care? (Select all that apply.)Aspirating contents of jejunostomy tubeGentle flushing of a clogged enteral tube with 30 mL of waterChecking for 1-inch play on a gastrostomy tubeMonitoring BUN, prealbumin, hematocrit, electrolytes, and glucoseRotating a jejunostomy tube 360 degrees each dayCorrect Answer: 2 and 4