Care of Patients with Esophageal Problems Chapter 57 Care of Patients with Esophageal Problems Reflux of gastric acid up into the esophagus through the LES in GERD.

Please understand If food can’t reach the stomach, the patient’s nutritional needs aren’t met

Gastroesophageal Reflux Disease Pathophysiology: GI contents backflow from the stomach into the esophagus resulting in inflammation & erosion This may produce strictures Key Features Heartburn (dyspepsia), epigastric pain Belching, flatulence, nausea Regurgitation, coughing, hoarseness, or wheezing at night Hypersalivation Dysphagia Odynophagia (painful swallowing)

Hiatal Hernia Comparison of the normal stomach and sliding and paraesophageal (rolling) hiatal hernias.

Hiatal Hernia (cont’d) Priorities of care Pre-, intra-, postoperative care Collaboration of interdisciplinary team Nutritional needs Community resources

Other Esophageal Disorders Types Esophageal tumors Esophageal diverticula Esophageal trauma Common assessment data Diagnostic testing Surgical vs. nonsurgical management Psychosocial concerns Patient teaching

GERD Treatment Stretta Procedure delivers radiofrequency (RF) energy to the muscle between the stomach and esophagus, which remodels and improves the muscle tissue, resulting in improved barrier function and fewer reflux events. Stretta treats the underlying problem that may cause GERD without surgery.

Video http://www.youtube.com/watch?v=9bnIuKiHdDE

NCLEX REVIEW

Question 1 The patient with a long history of osteoarthritis is at risk for developing gastroesophageal reflux disease (GERD) if he or she: Weighs 220 pounds Frequently takes NSAIDs for pain Consumes foods with calcium supplementation Has limited physical mobility Answer: B Rationale: Some drugs can cause GERD, such as oral contraceptives, anticholinergic agents, sedatives, NSAIDs (e.g., ibuprofen), nitrates, and calcium channel blockers. The possibility of eliminating those drugs causing reflux should be explored with the health care provider. Obesity is a nonspecific risk factor for developing GERD. Limited mobility can decrease gastric emptying, and patients with GERD are encouraged to sit upright after meals to decrease reflux.

Answer Answer: B Rationale: Some drugs can cause GERD, such as oral contraceptives, anticholinergic agents, sedatives, NSAIDs (e.g., ibuprofen), nitrates, and calcium channel blockers. The possibility of eliminating those drugs causing reflux should be explored with the health care provider. Obesity is a nonspecific risk factor for developing GERD. Limited mobility can decrease gastric emptying, and patients with GERD are encouraged to sit upright after meals to decrease reflux.

Question 2 A priority nursing intervention in the care of a patient with a hiatal hernia is: Providing nutrition education Promoting regular exercise Providing medication education Instructing the patient on signs and symptoms of intestinal strangulation Answer: A Rationale: The most important role of the nurse in caring for a patient with a hiatal hernia is health teaching, specifically nutrition management to include weight loss. Education for prescribed medications is an important nursing function, as well as education for signs and symptoms of infection if the patient has a rolling hiatal hernia.

Answer Answer: A Rationale: The most important role of the nurse in caring for a patient with a hiatal hernia is health teaching, specifically nutrition management to include weight loss. Education for prescribed medications is an important nursing function, as well as education for signs and symptoms of infection if the patient has a rolling hiatal hernia.

Question 3 Which assessment variable requires immediate intervention post esophagectomy? Blood pressure of 170/88 Respiratory rate of 28 Temperature of 38.1° C Pain assessment of 6 on a scale of 0-10 Answer: B Rationale: Respiratory care is the highest postoperative priority for patients having an esophagectomy. For those who had traditional surgery, intubation with mechanical ventilation is needed for at least the first 16 to 24 hours. Pulmonary complications include atelectasis and pneumonia. The risk for postoperative pulmonary complications is increased in the patient who has received preoperative radiation. Once the patient is extubated, begin deep breathing, turning, and coughing every 1 to 2 hours. Assess the patient for decreased breath sounds and shortness of breath every 1 to 2 hours. Provide incisional support and adequate analgesia for effective coughing. Blood pressure may be elevated as a sympathetic response to decreased ventilation; temperature may indicate postoperative atelectasis and/or possible infection; and pain should be treated once the airway is secured.

Answer Answer: B Rationale: Respiratory care is the highest postoperative priority for patients having an esophagectomy. Pulmonary complications include atelectasis and pneumonia For those who had traditional surgery, intubation with mechanical ventilation is needed for at least the first 16 to 24 hours.. Once the patient is extubated, begin deep breathing, turning, and coughing every 1 to 2 hours. Assess the patient for decreased breath sounds and shortness of breath every 1 to 2 hours. Provide incisional support