Linda S. Williams / Paula D. Hopper Copyright © F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 33 Nursing Care of Patients with Upper Gastrointestinal Disorders
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nausea and Vomiting Nausea: Urge to Vomit Vomiting: Expelling Stomach Contents Through Esophagus and Mouth
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions None Protect Airway Medications IV Fluids NG Tube Clear Liquids, Dry Toast
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses Nausea Risk for Aspiration Deficient Fluid Volume
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Lack of Appetite
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Eating Disorders Anorexia Nervosa Bulimia Nervosa
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Nervosa Females Age 12 to 18 Years Treatment goal Restore Nutritional Health 18% Die
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Nervosa (cont’d) Symptoms Severe Weight Loss Low Self-esteem Compulsive Dieting Disturbed Body Image
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Nervosa (cont’d) Nursing Care Therapeutic Relationship Vital Signs Daily Weights Intake/Output of Food and Fluids
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Nervosa (cont’d) Complications Poor Nutrition, Electrolyte Imbalances Decreased Vital Signs Osteoporosis Muscle Loss Diabetes
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Bulimia Nervosa Compulsive Eating, Self-induced Vomiting Laxatives “Binge–purge” Young Women Enamel Erosion of Front Teeth Metabolic alkalosis
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Bulimia Nervosa (cont’d) Treatment Goal Restore Nutritional Health Nursing Care Therapeutic Relationship Vital Signs, Daily Weights Intake/Output of Food and Fluids
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Eating Disorders Imbalanced Nutrition: Less Than Body Requirements Body Image, Disturbed
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Obesity Weight 20% or Greater Than Ideal Body Weight BMI Overweight: 25 to 29.9 Kg/m 2 Obese: >30 Kg/m 2
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Body Mass Index (BMI)
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Obesity (cont’d) Caloric Intake Exceeds Energy Expenditure Comorbidites: Diseases Associated with Obesity Morbid Obesity: BMI >40
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Weight Loss Through Exercise and Calorie Restriction Support Groups Behavior Modification
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Surgical Management Types of Bariatric Surgery Restrictive Limits How Much Stomach Can Hold Malabsorption Decreases Calorie/Nutrient Absorption Combination Restrictive and Malabsorption
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Surgical Management (cont’d) Restrictive Laparoscopic Adjustable Gastric Banding Vertical Banded Gastroplasty (VBG) Combination Roux-en-Y Gastric Bypass
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Roux-en-Y Gastric Bypass Vertical Banded Gastroplasty
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications of Gastric Restrictive Surgeries Vomiting Erosion of the Gastric Tissue Breakdown of Staple Line Leaking of Stomach Secretions Infection or Death
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Postoperative Care Clear, Liquid Diet Progresses to Full Liquids, Pureed Foods Regular Foods at 6 Weeks
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnosis: Obesity Imbalanced Nutrition: More Than Body Requirements
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Health Care Important to Overall Health Often Neglected in Daily Care Oral Hygiene with Chlorhexidine Gluconate Prevents Pneumonia Reduces Ventilator-associated Pneumonia
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Health Care (cont’d) Prophylactic Antibiotics Xerostomia (Dry Mouth) Artificial Saliva Substitute Dentures Gingival Recession Fluoride Gel or Rinse
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Health Care (cont’d) Gingivitis Flossing Daily Candida Albicans (Yeast Infection) Nystatin Angular Cheilosis
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stomatitis Inflammation of Oral Cavity Causes Aphthous Stomatitis (Canker Sores) Herpes Simplex Virus Type I (Cold Sores)
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Cancer Risk: Alcohol or Tobacco Use Detected Early, Curable Painless Difficulty in Chewing, Swallowing, Speaking Biopsies Radiation, Chemotherapy, Surgery
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Radical Neck Dissection
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Cancer Nursing Care Referral: Alcohol/Tobacco Cessation Preoperative Teaching Postoperative Airway Communication Nutrition
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Esophageal Cancer Risk: Alcohol or Tobacco Use Detected Late, Metastasizes Difficulty Swallowing, Feeling Full, Pain in Chest, Foul Breath, Food Regurgitation EGD, Biopsy
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Esophageal Cancer (cont’d) Radiation Chemotherapy Surgery Esophagogastrostomy Dacron Esophageal Replacement Esophagoenterostomy
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Esophageal Cancer (cont’d) Nursing Diagnoses Pain Risk for Deficient Fluid Volume Imbalanced Nutrition: Less Than Body Requirements
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia Lower Esophagus/Stomach Slides up Through Hiatus of Diaphragm into Thorax
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d) Occurs In Women Those over 60 Obesity Pregnancy
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d)
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d) Signs and Symptoms None Pain Heartburn Fullness Reflux
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d) Diagnosis X-Ray Fluoroscopy
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Antacids Small Meals No Reclining 1 Hour After Eating Raise Head of Bed 6 to 12 Inches No Bedtime Snacks, Spicy Foods, Alcohol, Caffeine, Smoking
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d) Surgical Management Fundoplication
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Fundoplication
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d) Nursing Care Teaching Preoperative Care Postoperative Dysphagia with Eating
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) Pathophysiology Gastric Secretions Reflux into Esophagus Esophagus Damaged Lower Esophageal Sphincter Does Not Close Tightly
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d) Signs and Symptoms Heartburn Regurgitation Dysphagia Bleeding
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d) Complications Aspiration Scar Tissue Diagnosis Barium Swallow Esophagoscopy
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Lifestyle Changes Medications Antacids H 2 Receptor Antagonists Proton Pump Inhibitors Prokinetic Agents
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d) Esophy X Endoscopic Procedures Fundoplication
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition GERD Complications Esophagitis Barrett's Esophagus (Precancerous) Esophageal Cancer Bronchospasm Larygeospasm Aspiration Pneumonia
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Barrett's Esophagus Precancerous Radiofrequency Ablation
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d) Nursing Diagnosis Acute Pain
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d) Nursing Care Education Lose Weight Low-fat, High-protein Diet Avoid Caffeine, Milk Products, Spicy Foods
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear Pathophyisiology Longitudinal Tear in Mucous Membrane of Esophagus at Stomach Junction Tears from Sudden, Powerful, or Prolonged Force Hiatal Hernia Present
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear (cont’d) Signs and Symptoms Bright Red, Bloody Emesis Bloody or Tarry Stools
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear (cont’d) Diagnosis EGD Hemoglobin and Hematocrit
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear (cont’d) Therapeutic Interventions Self-heal PPI Anti-emetic Avoid Alcohol
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear (cont’d) Nursing Care Report Bleeding Teaching Avoid Alcohol Medications
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Esophageal Varices Dilated Blood Vessels in Esophagus Portal Hypertension Rupture Life-threatening
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis Inflammation of the Stomach Acute or Chronic Abdominal Pain, Nausea, Anorexia Remove Irritating Substance Bland Diet of Liquids/Soft Foods Antacids
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d) Inflammation of Stomach Mucosa Acute Chronic
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d) Pathophysiology Protective Mucosal Barrier Broken Down Autodigestion Severe Perforation Scarring
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d) Signs and Symptoms Abdominal Pain Nausea, Vomiting Anorexia Abdominal Tenderness Feeling Of Fullness
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d) Signs and Symptoms (cont’d) Reflux Belching
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d) Therapeutic Interventions Treat Cause Bland Diet Antacids Anti-emetics
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Gastritis Type A Autoimmune Gastritis Fundus Asymptomatic Leads to Pernicious Anemia
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Gastritis Type B Pathophysiology From Infection with Helicobacter pylori Lower Stomach
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Gastritis Type B (cont’d) Signs and Symptoms Anorexia, Heartburn, Belching, Sour Taste, Nausea/Vomiting Treatment Antibiotics
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease Erosion of GI lining Primary Cause: Bacterium H. pylori Curable Influenced by Smoking
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d) Gastric High Left Epigastric/Upper Abdominal Burning/Gnawing Pain Increased 1 to 2 Hours After Meals or with Food
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d) Duodenal Midepigastric/Upper Abdominal Burning/Cramping Pain Increased 2 to 4 Hours After Meal/ Middle of Night Relieved with Food or Antacids
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d) Signs and Symptoms Anorexia Nausea/Vomiting Bleeding
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d) Diagnosis Helicobacter pylori Upper GI Series EGD
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Antibiotics Proton Pump Inhibitors Histamine H 2 Antagonists Bismuth Subsalicylate Sucralfate (Carafate) Antacids
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d) Treatment Bland Diet Avoid Irritants: Smoking, Caffeine, Alcohol
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d) Complications Bleeding Perforation Obstruction
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d) Nursing Diagnoses Acute Pain Risk for Injury Deficient Knowledge
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stress Ulcers Ischemia Damaging Mucous Barrier Acid Secretions Create Ulcers
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stress Ulcers (cont’d) Preventive Treatment Quick Trauma Care Early Feeding Testing Gastric Ph – Keep Above 5 Antacids, Histamine Blockers, Sucralfate
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Bleeding From Ulcer Perforation, Tumor, Gastric Surgery Occult or Observable Symptoms Vary by Severity Treat Hypovolemic Shock if Present NPO, IV Fluids, Blood, NG Tube, Oxygen
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Bleeding (cont’d) Nursing Diagnosis Deficient Fluid Volume
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer Malignant Lesion in Stomach Second Most Common Cancer Men Greater Than Women H. Pylori Infection Risk Factor Poor Prognosis as Metastasizes
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer (cont’d) Signs and Symptoms No Early Symptoms Late Symptoms Indigestion Anorexia Pain Relieved by Antacids
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer (cont’d) Late Symptoms (cont’d) Weight Loss Nausea and Vomiting Anemia
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer (cont’d) Diagnosis X-Ray Gastroscopy Gastric Fluid Analysis Serum Gastrin
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer (cont’d) Surgery Chemotherapy Radiation
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Subtotal Gastrectomy Partial Removal of Stomach Gastroduodenostomy (Billroth I) Distal Stomach Removed Anastomosed to Duodenum Treats Gastric Problems
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Subtotal Gastrectomy (cont’d)
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Subtotal Gastrectomy (cont’d) Gastrojejunostomy (Billroth II) More Distal Stomach Removed Anastomosed to Jejunum Treats Duodenal Problems
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Total Gastrectomy Total Stomach Removal Extensive Gastric Cancer Anastomosis of Esophagus to Jejunum
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Total Gastrectomy (cont’d)
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Gastric Surgery Acute Pain Fear
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care After Gastric Surgery Monitor Vital Signs Respiratory Status Control Pain Intake and Output Incisional Site
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care After Gastric Surgery (cont’d) NG Tube Care Ambulate Early Monitor Abdominal Status Education
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications of Gastric Surgery Hemorrhage Gastric Distention Dumping Syndrome Nutritional Problems Pernicious Anemia
Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications of Gastric Surgery (cont’d) Steatorrhea Pyloric Obstruction