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Theory Objectives Discuss obesity and its management, including bariatric surgery. Compare the signs and symptoms of oral, esophageal, and stomach cancer.

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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 29 Care of Patients with Disorders of the Upper Gastrointestinal System

1 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).

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 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 treatment—including behavior modification and nutrition support—which may take months to years

7 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

8 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

9 Obesity Etiology and pathophysiology Signs and symptoms Diagnosis
Height and weight chart Waist and hip circumference Body mass index (BMI)

10 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

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 stomach The 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 staples A band is placed to provide an outlet to the small intestine

14 Gastric Bypass See Figure 29-1 on p. 642.

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 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

18 Complications Leakage of stomach contents Gastric stretching
Dumping syndrome Nutritional deficiencies—iron, vitamin B12, calcium, and folate With 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 weight Reduce the proportion of adults who are obese Reduce 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 period Weight and height BMI Skinfold thickness measurement General health assessment

21 Expected Outcomes Patient will make positive statements about decreasing body size Patient will verbalize feelings of self-worth

22 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

23 Upper GI Disorders Stomatitis Dysphagia Causes Diagnosis Treatment
Nursing management

24 Implementation Aspiration Suctioning Nutrition and gastrostomy

25 Cancer of the Oral Cavity
Etiology Pathophysiology Signs and symptoms Diagnosis—physical examination and biopsy Treatment—radiation, chemotherapy, and surgery Nursing management

26 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 Both 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 diagnosis Treatment Esophagectomy Nursing management Postoperative care Nutrition

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 pathophysiology Signs and symptoms Treatment

31 Treatment of Hiatal Hernia
Reduce weight Avoid tight-fitting clothes around the abdomen Take antacids and histamine (H2)-receptor antagonists Elevate head of the bed on 6- to 8-inch blocks Take proton pump inhibitors

32 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

33 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

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 cavity H2 or proton pump inhibitors Avoid foods that cause bloating

35 Gastroesophageal Reflux Disease (GERD)
Etiology and pathophysiology Signs and symptoms Diagnosis and treatment Nursing management Diet therapy, lifestyle changes, drug therapy, and education Complications

36 Gastroenteritis Caused by food or water contaminated with a virus, a pathogenic bacteria, or parasites Signs and symptoms Management

37 Gastritis Etiology Pathophysiology Signs and symptoms Diagnosis
Treatment

38 Treatment for Gastritis
Acute versus chronic gastritis Chronic gastritis Antispasmodics Antacids H2-receptor antagonist such as ranitidine Proton pump inhibitor Antibiotic therapy for H. pylori

39 Peptic Ulcers Etiology Helicobacter pylori
Duodenal ulcers and some pre-pyloric ulcers Gastric ulcers Tension, anxiety, and prolonged stress Drug-induced ulcers

40 Peptic Ulcers (cont.) Pathophysiology Signs and symptoms Diagnosis
Daily pattern of pain Gastrointestinal bleeding Diagnosis Endoscopy Gastric 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 antagonist Proton pump inhibitors Presence of H. pylori—administration of clarithromycin (Biaxin) plus another antibiotic, an H2 inhibitor, and a proton pump inhibitor

43 Nursing Management Complications Hemorrhage Perforation Obstruction

44 Surgical Treatment of Peptic Ulcer
Pyloroplasty with truncal or proximal gastric vagotomy Subtotal gastrectomy (gastric resection) Total gastrectomy

45 Nursing Care of the Patient Undergoing Gastric Surgery
Preoperative care Postoperative care Specific patient teaching Diet restrictions   Dumping syndrome

46 Gastric Cancer Etiology Signs and symptoms Pathophysiology Diagnosis
Treatment Nursing management

47 Gastric Cancer (cont.) Treatment Surgical intervention
Radiation therapy Chemotherapy Adjuvant therapy

48 Common Therapies for Disorders of the Gastrointestinal System
Gastrointestinal decompression Enteral nutrition Total 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 tube Gentle flushing of a clogged enteral tube with 30 mL of water Checking for 1-inch play on a gastrostomy tube Monitoring BUN, prealbumin, hematocrit, electrolytes, and glucose Rotating a jejunostomy tube 360 degrees each day Correct Answer: 2 and 4


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