Gastroessophageal Reflux Disease(GERD)
Backward flow of stomach acid up into the esophagus
S/S of GERD
Burning and pressure behind the sternum, described by patients as heartburn(pyrosis) dry cough, hoarseness, sore throat
GERD medical management
H2 receptor antagonist, proton pump inhibitors, anti ulcer medications, metoclocloppramide(reglan) Nissan fundoplication
Nursing interventions and pt teaching for GERD
Eat 4to6 meals per day, low fat, adequate protein diet, reduce intake of chocolate tea and other food and beverages containing caffeine eat slowly do not eat for 2-3 hrs before bedtime
Nursing interventions and pt teaching for GERD
Remain upright for 1-2 hrs after meals when possible and never eat in bed. Encourage pt to stop smokinh do not bend over, elevate head of the bed. Pt should avoid wearing tight clothing
Carcinoma of the esophagus
Malignant epithial neoplasm that has invaded the esophagus
Risk factors for carcinoma of the esophagus
Alcohol, tobacco, acid reflux and obesity
Clinical manifestations and assessment of carcinoma of the esophagus
Progressive dysphasia over a six month period, chronic cough, vomiting, hoarseness, sensation of food being stuck in the throat.
Medical management of carcinoma of the esophagus
Radiation , chemotherapy, surgery/ palliative
Achalasia
Also called cardiospasm. Inability of a muscle to relax, particularly the cardiac sphincter of the stomach
Primary manifestation of Achalasia
Dysphasia
Treatment of Achalasia
Medications and dilatation
Disorders of the stomach
Gastritis, peptic ulcer disease, cancer of the stomach
Gastritis
Inflammation of the lining of the stomach associated with alcoholism,smoking and stressful physical problems
Manifestations of Gastritis
Nausea, vomiting, fever, diarrhea, headache, and loss of appetite
Gastritis assessment
Anorexia, n�usea, discomfort eating pain, vomiting, hematemesis, melena
Gastritis medical management
Medications, NG tube, Gastric lavage, removal or avoidance of causative factors
Nursing interventions
Monitor I&O keep NPO until symptoms subside administer IV feedings as indicated
Peptic Ulcer Disease
Ulcerations of the mucous membrane or deeper structures of the GI tract.
Peptic Ulcer Disease
Most commonly occur in the stomach and duodenum
Peptic Ulcer Disease
Pain is a characteristic symptom described as dull, burning, boring, or gnawing pain is located in the epigastric region
Peptic Ulcer Disease medical management
Insert an NG tube to monitor gastric content, antacids,H2 receptor blockers, proton pump inhibitors, sucralfate and antibiotics for H. Pylori
Peptic Ulcer Disease NI
NG or intestinal tube placement, intermittent suction, administer medications,assess frequently and monitor vital signs
Cancer of the stomach
Men more commonly affected than woman, rates are highest in Japan, China, southern and Eastern Europe and south and Central America
Cancer of the stomach
The pt may be asymptomatic in early stages of the disease, with more advance stages of the disease the pt may appear pale and lethargic if anemia is present
Cancer of the stomach assessment
Vague epigastric discomfort, early satiety, weight loss, blood in stools, vomiting after eating or drinking and anemia
Cancer of the stomach medical management
Surgery ( dumping syndrome is a possible complication) radiation and chemotherapy
Cancer of the stomach nursing interventions
Improve nutritional status, relieve anxiety improve understanding of drainage tubes closely monitor I&O, maintain TPN remain alert for weight loss
Inflammatory bowel disease
Ulcerative colitis and Crohn's disease
Ulcerative Colitis
Diarrhea that may contain blood mucus and pus
Ulcerative colitis
Abdominal cramps moderate, up to five stools per day Severe 15-20 stools per day. Diagnosed with double barium enema
Ulcerative colitis assessment
Complaints of rectal bleeding and abdominal cramps, lethargy, frustration, weight loss, fever, and tachycardia
Ulcerative colitis nursing interventions
Assess elimination pattern, assess and treat pain, assess nutritional status, assess coping abilities, provide pt education, perform preoperative measures and provide postoperative care
Ulcerative colitis medical management
Inflammatory response modifiers, antibiotics, immune response modifiers, antidiarrheals, nutrition therapy and surgical control
Crohn's disease
Characterized by inflammation of the GI tract. Cause is not known, possible immune link, most commonly occurs during adolescence and early adulthood
Crohn's disease
Mucosa develops a cobblestone appearance, malabsorption is a major issue
Crohn's disease clinical manifestations
Diarrhea,fatigue, abdominal pain, weight loss, fever, and malnutrition
Crohn's disease assessment
Weakness, loss of appetite, abdominal cramps, pain, frequent BMs, diarrhea, fistulas
Crohn's disease medical management
Anti inflammatory medications, corticosteroids, multivitamins, immunosuppressive therapy, dietary modification and surgery
Crohn's disease NI
Provide nutritional education, monitor I & O closely, assess and treat pain, provide bedside commode, provide emotional support
Nursing interventions for the pt with a stoma
Assess skin integrity, assess for allergies to powders or adhesive, provide education on changing pouch, assess peristomal area infection.
Appendicitis
Inflammation of the vermiform appendix, usually acute
Appendicitis
Characterized by rebound tenderness in the right lower quadrant of the abdomen, n�usea anorexia WBC count more than 10,000/mm3
Medical management for appendicitis
Emergency surgical intervention
Acute abdominal inflammations
Appendicitis, diverticulitis and peritonitis
Diverticulosis
Diverticulosis is the presence of pouchlike herniations through the circular smooth muscle of the colon
Diverticulitis
Is the inflammation of one or more of the diverticular sacs, incidence increases after age 40
Diverticulitis
Inflammation can lead to perforation, abscess, peritonis, obstruction, and hemorrhage
Diverticulitis manifestations
Pain, fever, elevated WBC count, left lower quadrant pain, diarrhea, vomiting, nausea
Diverticulitis diagnosis
Diagnose through ultrasound and CT, managed by diet, weight loss, exercise, antibiotics and surgical interventions
Peritonitis
Inflammation of the abdominal peritoneum characterized by severe abdominal pain.
Peritonitis
Assess for severe abdominal pain, nausea and fever
Peritonitis diagnosis
X-ray and labs CT and MRI
Peritonitis treatment
Pain treatment antibiotic administration and sx
External Hernia
A protrusion of a viscus through an abnormal opening or a weakened area in the wall of the cavity within which it is normally contained
External Hernia
Characterized by a visible protruding mass
Manifestations of external Hernia
Pain and nausea
Hernia medical management
Maybe left untreated, or the pt may wear an abdominal binder, surgical correction may be required
Hiatal Hernia
A protrusion of the stomach and other abdominal viscera through an opening, or hiatus, in the diaphragm
Hiatal Hernia
Nursing care similar to that for patients having gastric or thoracic surgery, usually corrected with surgery
Mechanical obstruction
Caused by an occlusion of the lumen of the intestinal tract
Non mechanical obstruction
Caused by something that decreases the muscle action of the bowel may be neurologic or vascular disorders
Intestinal obstruction assessment
Pain, flatus, cramping, Hernia, abdominal distension, tenderness
Intestinal obstruction diagnosis and medical management
Diagnosed by X-ray or CT, labs, treatment includes decompression of the bowel and replacement of electrolytes. If less invasive treatment is not effective, surgery may be required
Intestinal obstruction NI
Monitor fluid status, Monitor electrolytes, assess and treat pain as indicated, if the patient is undergoing surgery provide emotional support, encourage turning, coughing, and deep breathing, manage pain, ambulante as soon as indicated
Colorectal Cancer
Second leading cause of cancer deaths, most girls found in the sigmoid and rectal regions of the colon, causes remain unknown
Colorectal Cancer Risk Factors
Adenomatous polyps, ulcerative colitis, diverticulitis and heredity
Colorectal Cancer
Clinical manifestations are usually nonspecific
Colorectal Cancer assessment
Constipation or diarrhea, excessive flatus , cramping, vomiting, and weight loss
Colorectal cancer nursing interventions
Assess bowel and urinary elimination, monitor fluid and electrolyte balance, assess tissue perfusion, provide adequate nutrition, assess and treat pain, promote gas exchange, prevent infection, and maintain peristomal skin integrity
Fecal incontinence
Has a variety of causes The external sphincter may relaxed, voluntary control of defecation may be disturbed
Fecal incontinence
Distention of the rectum and paralysis
Fecal incontinence medical management and NI
Improve muscle tone and sphincter, bowel training program, assist pt to toilet without delay when needed and provide pt education