1. Nursing Care of Patients with Upper Gastrointestinal Disorders
The Digestive System
Nursing Care of Patients with Upper Gastrointestinal Disorders

2. Nausea and Vomiting Therapeutic Interventions
Nausea- urge to vomit, Vomiting- expel contents
None- may be self-limited
Protect Airway- prevent aspiration
Medications- benadryl, vistaril, zofran, compazine
IV Fluids
NG Tube
Clear Liquids, Dry Toast

3. Nausea and Vomiting Nursing Diagnoses Nausea Risk for Aspiration
Deficient Fluid Volume

4. Anorexia Nervosa Eating disorder- lack of appetite
Females- Age Years
Severe weight loss, low self-esteem, compulsive dieting, altered body image
Treatment- restore nutritional health
18% Die

5. Anorexia Nervosa (cont’d)
Nursing Care
Therapeutic Relationship
Vital Signs
Daily Weights
Intake/Output of Food And Fluids

6. Bulimia Nervosa Compulsive eating/ self-induced vomiting
Enamel erosion of front teeth, metabolic alkalosis
Treatment: restore nutritional health
Nursing: theraputic relationship
Vital signs
Daily weights
Intake/output of foods and fluids

7. Obesity Weight 20% or Greater Than Ideal Body Weight
Caloric intake exceeds energy expenditure
Comorbidities: diseases associated with obesity
Morbid obesity: BMI above 40, 100 pds overweight

8. Therapeutic Interventions
Weight Loss Through Exercise and Calorie Restriction
Support Groups
Behavior Modification

9. Surgical Management Bariatric Surgery
Limits How Much Stomach Can Hold
Decreased Calorie/Nutrient Absorption
Roux-en-Y Gastric Bypass- food bypasses most of stomach and duodenum and goes to jejunum
Vertical Banded Gastroplasty (VBG)- small stomach pouch is made, when it fills, feeling of fullness even with small meals

10. Roux-en-Y Gastric Bypass Vertical Banded Gastroplasty

11. Complications of Gastric Restrictive Surgeries
Vomiting/ erosion of gastric tissue
Breakdown of Staple Line
Leaking of Stomach Secretions
Infection or Death
Postoperative care-clear liquid diet, progress to full liqs, pureed food, reg diet at 6 weeks

12. Oral Health Care Important to overall health/ often neglected
Oral hygiene with chlorhexidine gluconate
Prevents Pneumonia
Reduces Ventilator Associated Pneumonia
Candidiasis- tx with nystatin swish/swallow

13. Stomatitis Inflammation of Oral Cavity
Aphthous Stomatitis (Canker Sores)
Herpes Simplex Virus Type I (Cold Sores)

14. Oral Cancer Risk: Alcohol or Tobacco Use Detected Early, Curable
Painless
Difficulty in Chewing, Swallowing, Speaking
Biopsies
Radiation, Chemotherapy, Surgery

15. Radical Neck Dissection

16. Oral Cancer Nursing Care
Referral: Alcohol/Tobacco Cessation
Preop Teaching- communication if trach
Post-op
Airway- control secretions
Communication
Nutrition- tube feeding

17. Esophageal Cancer Risk: Alcohol or Tobacco Use
Detected Late, Metastasizes
Difficulty Swallowing, Feeling Full, Pain in Chest, Foul Breath, Food Regurgitation
Dx:EGD, Biopsy
Tx: Radiation, chemo, surgery
Esophagogastrostomy, dacron esophagus replacement or esophagoenterostomy

18. Esophageal Cancer (cont’d)
Nursing Diagnoses
Pain
Risk for Deficient Fluid Volume
Imbalanced Nutrition: Less Than Body Requirements

19. Hiatal Hernia
Lower Esophagus/Stomach Slides up Through Hiatus of Diaphragm into Thorax
Common: women>60, obese, pregnant
s/s hernia: pain, heartburn, full feeling, reflux, possible bleeding, ulceration. s/s worsen lying down.
Dx: x-ray, fluoroscope

20. Hiatal Hernia (cont’d)

21. Hiatal Hernia Therapeutic Interventions
Antacids
Eating small meals
No reclining 1 hour after eating
Raise head of ed 6-12 Inches
No bedtime snacks, spicy foods, alcohol, caffeine, smoking
Surgery- fundoplication: assess for dysphagia with 1st meal

22.   Fundoplication

23. Gastroesophageal Reflux Disease (GERD)
Gastric secretions reflux into esophagus, becomes damaged, lower esophageal sphincter does not close tightly
s/s: heartburn, regurgitation, dysphagia, bleeding
Complications: esophagitis, Barrett’s esophagus cancer, aspiration pneumonia
Barium swallow, esophagoscopy

24. GERD Therapeutic Interventions
Lifestyle changes- exercise, low fat diet
Medications
Antacids- Tums, Mylanta, Gaviscon
H2 Receptor Antagonists- Tagamet, pepcid, Zantac, Axid
Proton Pump Inhibitors- Nexium, prilosec
Prokinetic Agents-Reglan, Maxalon

25. Gastroesophageal Reflux Disease (cont’d)
Nursing Dx: Acute pain
Nursing Education
Lose Weight
Low-Fat, High-Protein Diet
Avoid Caffeine, Milk Products, Spicy Foods
Sleep with HOB > 4-6 inches
Eat small meals, avoid lying down 1-2hrs p eating

26. Mallory-Weiss Tear
Longitudinal tear in mucous membrane of esophagus at stomach junction.
Tears from sudden or prolonged force,usually hiatal hernia present
s/s bright red bloody emesis or bloody stools
Dx with EGD, hemoglobin/hematocrit
Usually self heal, antiemetics, avoid alcohol

27. Gastritis
Inflammation of the stomach, protective mucosal barrier is broken down
s/s: abdominal pain, nausea, anorexia
Remove irritating substance
Bland diet of liquids/soft foods- will recover in 24 hrs
Antacids

28. Gastritis
Inflammation of stomach mucosa, protective mucosa barrier broken down, acute or chronic
s/s: Abd pain, N/V, anorexia, feeling of fullness, abd tenderness, reflux, belching.
Tx cause, bland diet of liquids/soft foods, antacids, antiemetics

29. Chronic Gastritis
Type A- Autoimmune gastritis, occurs in fundus of stomach, often asymptomatic, leads to pernicious anemia.
Type B- infection with Heliobacter pylori, occurs in lower stomach. s/s heartburn, poor appetite, belching, sour taste, N/V. Treatment is antibiotics.

30. Peptic Ulcer Disease
Erosion of GI lining, primary cause is H. pylori, curable. Risk factors include smoking, stress, medications and caffeine
s/s Gastric- high left epigastric/upper abd burning/gnawing pain, > 1-2hrs pc or with food.
s/s Duodenal-Midepigastric/upper abd pain, burning/cramping, > 2-4 hrs after meal/middle of night. Relieved with food or antacids
Dx- upper GI, urea breath test, IgG antibody test

31. Peptic Ulcer Disease Therapeutic Interventions
Antibiotics
Proton pump inhibitors-
Histamine H2 antagonists
Bismuth subsalicylate
Sucralfate (carafate)
Antacids, bland diet
Complications- bleeding, perforation, obstruction

32. Stress Ulcers
The stress response to illness causes< in blood flow to stomach and small intestines, results in ischemia, allows acid secretions to create ulcers.
Preventive treatment- Quick trauma care, early feedings. Test gastric pH- keep > 5, antacids, histamine blockers

33. Gastric Bleeding
Caused by ulcer perforation, tumor, gastric surgery, occult or observable
Symptoms vary by severity
Treat hypovolemic shock if present
NPO, IV Fluids, Blood, NG Tube, Oxygen
Nsg Dx: Deficient fluid volume

34. Gastric Cancer
Malignant Lesion in Stomach, 2nd most common. Seen in men more than women
H. pylori Infection risk factor
Poor prognosis as metastasizes
No early s/s, late s/s like peptic ulcers- indigestion, anorexia, pain relieved by antacids, wt loss N/V
Surgery, chemo, radiation

35. Subtotal Gastrectomy Partial removal of stomach
Billroth I Procedure (gastroduodenostomy)
Distal 75% stomach removed
Anastomosed to duodenum
Billroth II procedure (gastrojejunostomy)
Distal 50% of stomach, anastomosed to jejunum

36. Subtotal Gastrectomy (cont’d)

37. Total Gastrectomy Total Stomach Removal, tx gastric cancer
Anastomosis of esophagus to jejunum
Vagotomy (vagus nerve is cut) may be performed with total gastrectomy. This eliminates vagal stimulation for hydrochloric acid and gastrin hormone secretion and slows gastric motility

38. Total Gastrectomy (cont’d)

39. Nursing Care After Gastric Surgery
Monitor vital signs and resp status
Control pain
Intake and output
Incisional site
Assess bowel sounds, abd distention
NG tube care
Ambulate early
Education

40. Complications of Gastric Surgery
Hemorrhage
Gastric Distention
Nutritional Problems
Pernicious Anemia
Steatorrhea
Pyloric obstruction
Dumping syndrome