1. 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.

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

3. 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)

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

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

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

7. 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.

8. Video

9. NCLEX REVIEW

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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