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Nursing Care of Patients with Upper Gastrointestinal Disorders
Chapter 33 Nursing Care of Patients with Upper Gastrointestinal Disorders
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Nausea and Vomiting Nausea: Urge to Vomit
Vomiting: Expelling Stomach Contents Through Esophagus and Mouth Nausea and Vomiting
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Therapeutic Interventions
None Protect Airway Medications IV Fluids NG Tube Clear Liquids, Dry Toast
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Nausea Risk for Aspiration Deficient Fluid Volume Nursing Diagnoses
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Lack of Appetite Anorexia
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Anorexia Nervosa Bulimia Nervosa Eating Disorders
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Anorexia Nervosa Females Treatment goal 18% Die Age 12 to 18 Years
Restore Nutritional Health 18% Die Anorexia Nervosa
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Anorexia Nervosa (cont’d)
Symptoms Severe Weight Loss Low Self-esteem Compulsive Dieting Disturbed Body Image Anorexia Nervosa (cont’d)
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Anorexia Nervosa (cont’d)
Nursing Care Therapeutic Relationship Vital Signs Daily Weights Intake/Output of Food and Fluids Anorexia Nervosa (cont’d)
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Anorexia Nervosa (cont’d)
Complications Poor Nutrition, Electrolyte Imbalances Decreased Vital Signs Osteoporosis Muscle Loss Diabetes Anorexia Nervosa (cont’d)
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Bulimia Nervosa Compulsive Eating, Self-induced Vomiting Laxatives
“Binge–purge” Young Women Enamel Erosion of Front Teeth Metabolic alkalosis Bulimia Nervosa
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Bulimia Nervosa (cont’d)
Treatment Goal Restore Nutritional Health Nursing Care Therapeutic Relationship Vital Signs, Daily Weights Intake/Output of Food and Fluids Bulimia Nervosa (cont’d)
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Nursing Diagnoses: Eating Disorders
Imbalanced Nutrition: Less Than Body Requirements Body Image, Disturbed
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Obesity Weight 20% or Greater Than Ideal Body Weight BMI
Overweight: 25 to 29.9 Kg/m2 Obese: >30 Kg/m2 Obesity
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Body Mass Index (BMI)
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Obesity (cont’d) Caloric Intake Exceeds Energy Expenditure
Comorbidites: Diseases Associated with Obesity Morbid Obesity: BMI >40 Obesity (cont’d)
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Therapeutic Interventions
Weight Loss Through Exercise and Calorie Restriction Support Groups Behavior Modification Therapeutic Interventions
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Surgical Management Types of Bariatric Surgery Restrictive
Limits How Much Stomach Can Hold Malabsorption Decreases Calorie/Nutrient Absorption Combination Restrictive and Malabsorption Surgical Management
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Surgical Management (cont’d)
Restrictive Laparoscopic Adjustable Gastric Banding Vertical Banded Gastroplasty (VBG) Combination Roux-en-Y Gastric Bypass Surgical Management (cont’d)
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Roux-en-Y Gastric Bypass Vertical Banded Gastroplasty
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Complications of Gastric Restrictive Surgeries
Vomiting Erosion of the Gastric Tissue Breakdown of Staple Line Leaking of Stomach Secretions Infection or Death
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Postoperative Care Clear, Liquid Diet
Progresses to Full Liquids, Pureed Foods Regular Foods at 6 Weeks Postoperative Care
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Nursing Diagnosis: Obesity
Imbalanced Nutrition: More Than Body Requirements
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Oral Health Care Important to Overall Health
Often Neglected in Daily Care Oral Hygiene with Chlorhexidine Gluconate Prevents Pneumonia Reduces Ventilator-associated Pneumonia Oral Health Care
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Oral Health Care (cont’d)
Prophylactic Antibiotics Xerostomia (Dry Mouth) Artificial Saliva Substitute Dentures Gingival Recession Fluoride Gel or Rinse Oral Health Care (cont’d)
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Oral Health Care (cont’d)
Gingivitis Flossing Daily Candida Albicans (Yeast Infection) Nystatin Angular Cheilosis Oral Health Care (cont’d)
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Stomatitis Inflammation of Oral Cavity Causes
Aphthous Stomatitis (Canker Sores) Herpes Simplex Virus Type I (Cold Sores) Stomatitis
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Oral Cancer Risk: Alcohol or Tobacco Use Detected Early, Curable
Painless Difficulty in Chewing, Swallowing, Speaking Biopsies Radiation, Chemotherapy, Surgery Oral Cancer
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Radical Neck Dissection
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Oral Cancer Nursing Care
Referral: Alcohol/Tobacco Cessation Preoperative Teaching Postoperative Airway Communication Nutrition Oral Cancer Nursing Care
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Esophageal Cancer Risk: Alcohol or Tobacco Use
Detected Late, Metastasizes Difficulty Swallowing, Feeling Full, Pain in Chest, Foul Breath, Food Regurgitation EGD, Biopsy Esophageal Cancer
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Esophageal Cancer (cont’d)
Radiation Chemotherapy Surgery Esophagogastrostomy Dacron Esophageal Replacement Esophagoenterostomy Esophageal Cancer (cont’d)
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Esophageal Cancer (cont’d)
Nursing Diagnoses Pain Risk for Deficient Fluid Volume Imbalanced Nutrition: Less Than Body Requirements Esophageal Cancer (cont’d)
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Lower Esophagus/Stomach Slides up Through Hiatus of Diaphragm into Thorax
Hiatal Hernia
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Hiatal Hernia (cont’d)
Occurs In Women Those over 60 Obesity Pregnancy Hiatal Hernia (cont’d)
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Hiatal Hernia (cont’d)
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Hiatal Hernia (cont’d)
Signs and Symptoms None Pain Heartburn Fullness Reflux Hiatal Hernia (cont’d)
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Hiatal Hernia (cont’d)
Diagnosis X-Ray Fluoroscopy Hiatal Hernia (cont’d)
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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
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Hiatal Hernia (cont’d)
Surgical Management Fundoplication Hiatal Hernia (cont’d)
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Fundoplication
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Hiatal Hernia (cont’d)
Nursing Care Teaching Preoperative Care Postoperative Dysphagia with Eating Hiatal Hernia (cont’d)
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Gastroesophageal Reflux Disease (GERD)
Pathophysiology Gastric Secretions Reflux into Esophagus Esophagus Damaged Lower Esophageal Sphincter Does Not Close Tightly
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Gastroesophageal Reflux Disease (GERD) (cont’d)
Signs and Symptoms Heartburn Regurgitation Dysphagia Bleeding
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Gastroesophageal Reflux Disease (GERD) (cont’d)
Complications Aspiration Scar Tissue Diagnosis Barium Swallow Esophagoscopy
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Therapeutic Interventions
Lifestyle Changes Medications Antacids H2 Receptor Antagonists Proton Pump Inhibitors Prokinetic Agents
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Gastroesophageal Reflux Disease (GERD) (cont’d)
Esophy X Endoscopic Procedures Fundoplication
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GERD Complications Esophagitis Barrett's Esophagus (Precancerous)
Esophageal Cancer Bronchospasm Larygeospasm Aspiration Pneumonia
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Barrett's Esophagus Precancerous Radiofrequency Ablation
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Gastroesophageal Reflux Disease (GERD) (cont’d)
Nursing Diagnosis Acute Pain
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Gastroesophageal Reflux Disease (GERD) (cont’d)
Nursing Care Education Lose Weight Low-fat, High-protein Diet Avoid Caffeine, Milk Products, Spicy Foods
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Mallory-Weiss Tear Pathophyisiology
Longitudinal Tear in Mucous Membrane of Esophagus at Stomach Junction Tears from Sudden, Powerful, or Prolonged Force Hiatal Hernia Present Mallory-Weiss Tear
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Mallory-Weiss Tear (cont’d)
Signs and Symptoms Bright Red, Bloody Emesis Bloody or Tarry Stools Mallory-Weiss Tear (cont’d)
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Mallory-Weiss Tear (cont’d)
Diagnosis EGD Hemoglobin and Hematocrit Mallory-Weiss Tear (cont’d)
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Mallory-Weiss Tear (cont’d)
Therapeutic Interventions Self-heal PPI Anti-emetic Avoid Alcohol Mallory-Weiss Tear (cont’d)
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Mallory-Weiss Tear (cont’d)
Nursing Care Report Bleeding Teaching Avoid Alcohol Medications Mallory-Weiss Tear (cont’d)
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Esophageal Varices Dilated Blood Vessels in Esophagus
Portal Hypertension Rupture Life-threatening Esophageal Varices
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Gastritis Inflammation of the Stomach Acute or Chronic
Abdominal Pain, Nausea, Anorexia Remove Irritating Substance Bland Diet of Liquids/Soft Foods Antacids Gastritis
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Inflammation of Stomach Mucosa
Acute Chronic Gastritis (cont’d)
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Gastritis (cont’d) Pathophysiology
Protective Mucosal Barrier Broken Down Autodigestion Severe Perforation Scarring Gastritis (cont’d)
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Gastritis (cont’d) Signs and Symptoms Abdominal Pain Nausea, Vomiting
Anorexia Abdominal Tenderness Feeling Of Fullness Gastritis (cont’d)
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Signs and Symptoms (cont’d)
Reflux Belching Gastritis (cont’d)
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Gastritis (cont’d) Therapeutic Interventions Treat Cause Bland Diet
Antacids Anti-emetics Gastritis (cont’d)
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Chronic Gastritis Type A
Autoimmune Gastritis Fundus Asymptomatic Leads to Pernicious Anemia Chronic Gastritis Type A
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Chronic Gastritis Type B
Pathophysiology From Infection with Helicobacter pylori Lower Stomach Chronic Gastritis Type B
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Chronic Gastritis Type B (cont’d)
Signs and Symptoms Anorexia, Heartburn, Belching, Sour Taste, Nausea/Vomiting Treatment Antibiotics
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Peptic Ulcer Disease Erosion of GI lining
Primary Cause: Bacterium H. pylori Curable Influenced by Smoking Peptic Ulcer Disease
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Peptic Ulcer Disease (cont’d)
Gastric High Left Epigastric/Upper Abdominal Burning/Gnawing Pain Increased 1 to 2 Hours After Meals or with Food Peptic Ulcer Disease (cont’d)
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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 Peptic Ulcer Disease (cont’d)
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Peptic Ulcer Disease (cont’d)
Signs and Symptoms Anorexia Nausea/Vomiting Bleeding Peptic Ulcer Disease (cont’d)
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Peptic Ulcer Disease (cont’d)
Diagnosis Helicobacter pylori Upper GI Series EGD Peptic Ulcer Disease (cont’d)
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Therapeutic Interventions
Antibiotics Proton Pump Inhibitors Histamine H2 Antagonists Bismuth Subsalicylate Sucralfate (Carafate) Antacids
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Peptic Ulcer Disease (cont’d)
Treatment Bland Diet Avoid Irritants: Smoking, Caffeine, Alcohol Peptic Ulcer Disease (cont’d)
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Peptic Ulcer Disease (cont’d)
Complications Bleeding Perforation Obstruction Peptic Ulcer Disease (cont’d)
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Peptic Ulcer Disease (cont’d)
Nursing Diagnoses Acute Pain Risk for Injury Deficient Knowledge Peptic Ulcer Disease (cont’d)
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Stress Ulcers Ischemia Damaging Mucous Barrier
Acid Secretions Create Ulcers Stress Ulcers
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Stress Ulcers (cont’d)
Preventive Treatment Quick Trauma Care Early Feeding Testing Gastric Ph – Keep Above 5 Antacids, Histamine Blockers, Sucralfate Stress Ulcers (cont’d)
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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 Gastric Bleeding
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Gastric Bleeding (cont’d)
Nursing Diagnosis Deficient Fluid Volume Gastric Bleeding (cont’d)
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Gastric Cancer Malignant Lesion in Stomach Second Most Common Cancer
Men Greater Than Women H. Pylori Infection Risk Factor Poor Prognosis as Metastasizes Gastric Cancer
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Gastric Cancer (cont’d)
Signs and Symptoms No Early Symptoms Late Symptoms Indigestion Anorexia Pain Relieved by Antacids Gastric Cancer (cont’d)
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Gastric Cancer (cont’d)
Late Symptoms (cont’d) Weight Loss Nausea and Vomiting Anemia Gastric Cancer (cont’d)
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Gastric Cancer (cont’d)
Diagnosis X-Ray Gastroscopy Gastric Fluid Analysis Serum Gastrin Gastric Cancer (cont’d)
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Gastric Cancer (cont’d)
Surgery Chemotherapy Radiation Gastric Cancer (cont’d)
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Subtotal Gastrectomy Partial Removal of Stomach
Gastroduodenostomy (Billroth I) Distal Stomach Removed Anastomosed to Duodenum Treats Gastric Problems
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Subtotal Gastrectomy (cont’d)
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Subtotal Gastrectomy (cont’d)
Gastrojejunostomy (Billroth II) More Distal Stomach Removed Anastomosed to Jejunum Treats Duodenal Problems
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Total Gastrectomy Total Stomach Removal Extensive Gastric Cancer
Anastomosis of Esophagus to Jejunum Total Gastrectomy
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Total Gastrectomy (cont’d)
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Nursing Diagnoses: Gastric Surgery
Acute Pain Fear
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Nursing Care After Gastric Surgery
Monitor Vital Signs Respiratory Status Control Pain Intake and Output Incisional Site
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Nursing Care After Gastric Surgery (cont’d)
NG Tube Care Ambulate Early Monitor Abdominal Status Education
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Complications of Gastric Surgery
Hemorrhage Gastric Distention Dumping Syndrome Nutritional Problems Pernicious Anemia
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Complications of Gastric Surgery (cont’d)
Steatorrhea Pyloric Obstruction
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