Nausea and Vomiting
Nausea
- Urge to Vomit
Vomiting
- Expelling Stomach Contents Through Esophagus and Mouth
Therapeutic Interventions
- None
- Protect Airway
- Medications
- IV Fluids
- NG Tube
- Clear Liquids, Dry Toast
Nursing Diagnoses
- Nausea
- Risk for Aspiration
- De
Anorexia
- Lack of Appetite
Females
- Age 12 to 18 Years
Treatment goal
- Restore Nutritional Health
Symptoms
- Severe Weight Loss
- Low Self-esteem
- Compulsive Dieting
- Disturbed Body Image
Nursing Care
- Therapeutic Relationship
- Vital Signs
- Daily Weights
-
Eating Disorders
- Anorexia Nervosa
- Bulimia Nervosa
Nursing Diagnoses
- Imbalanced Nutrition: Less Than Body Requirements
- Body Image, Disturbed
Bulimia Nervosa
- Compulsive Eating, Self-induced Vomiting
- Laxatives
- "Binge-purge"
- Young Women
- Enamel Erosion of Front Teeth
- Metabolic alkalosis
Treatment Goal
- Restore Nutritional Health
Nursing Care
- Therapeutic Relationship
- Vital Signs, Daily Weights
- I
Obesity
Weight 20% or Greater Than Ideal Body Weight
BMI
- Overweight: 25 to 29.9 Kg/m2
- Obese: >30 Kg/m2
Caloric Intake Exceeds Energy Expenditure
Comorbidites
- Diseases Associated with Obesity
Morbid Obesity
- BMI >40
Therapeutic Interventions
- Weight Loss T
Bariatric Surgery
- Gastric Plication
Laparoscopic gastric plication folds the stomach inwardly, and then sutures hold the folds in place.This reduces the stomach's volume and limits the food that can be ingested at one time.
- Gastric Bypass
The Roux-en-Y gastric bypass i
Nutritional Notes: Supplying Nutrition in Upper Gastrointestinal Conditions
- Bariatric Surgery
Candidates for bariatric surgery should be carefully selected and instructed that the procedure is a tool to assist with weight control, along with behavioral changes, diet and exercise. If the patient overeats, the small pouch can be
Postprandial Hypotension
This refers to a drop in systolic blood pressure of 20 mm Hg or more within 2 hours of beginning a meal. Symptoms are dizziness, weakness, lightheadedness, falls, disturbed speech, and vision changes. Complications are angina pectoris and stroke. Normally
Body Mass Index (BMI)
Weight Loss Surgeries
Gastric Restrictive Surgeries
Complications
- Vomiting
- Erosion of the Gastric Tissue
- Breakdown of Staple Line
- Leaking of Stomach - Secretions
- Infection or Death
Postoperative Care
- Clear, Liquid Diet
- Progresses to Full Liquids, Pureed Foods
- Regular Foods at 6 Weeks
Oral Health Care
Important to Overall Health
Often Neglected in Daily Care
Oral Hygiene with Chlorhexidine Gluconate
- Prevents Pneumonia
- Reduces Ventilator-associated Pneumonia
Prophylactic Antibiotics
Xerostomia (Dry Mouth)
- Artificial Saliva Substitute
Dentures
Ging
Common Concerns in Oral Health and Dental Care
Oral care is important throughout life and has been found to have a link to cardiac health. The importance of daily and ongoing oral care should be considered for all patients, especially older adults.
Patients who have artificial joints or some heart con
Stomatitis
Inflammation of Oral Cavity
Causes
- Aphthous Stomatitis (Canker Sores)
- Herpes Simplex Virus Type I (Cold Sores)
(Book excerpt)
Stomatitis is inflammation of the oral cavity.
- Aphthous Stomatitis (Canker Sores)
Aphthous stomatitis appears as small, whi
Oral Cancer
- Risk: Alcohol or Tobacco Use
- Detected Early, Curable
- Painless
- Difficulty in Chewing, Swallowing, Speaking
- Biopsies
- Radiation, Chemotherapy, Surgery
Nursing Care
- Referral: Alcohol/Tobacco Cessation
- Preoperative Teaching
- Postoperative
Airw
Radical Neck Dissection
Esophageal Cancer
- Risk: Alcohol or Tobacco Use
- Detected Late, Metastasizes
- Difficulty Swallowing, Feeling Full, Pain in Chest, Foul Breath, Food Regurgitation
- EGD, Biopsy
- Radiation
- Chemotherapy
- Surgery: Esophagogastrostomy, Dacron Esophageal Replacement, Esop
Hiatal Hernia
Sliding Hiatal Hernia
- Lower Esophagus/Stomach Slides up Through Hiatus of Diaphragm into Thorax
Paraesophageal Hernia
- Rarer
- Serious as part of the stomach squeezes through the hiatus and is at risk for strangulation
Occurs In
- Women More
- Those ov
Fundoplication
Gastroesophageal Reflux Disease (GERD)
Pathophysiology
- Gastric Secretions Reflux into Esophagus
- Esophagus Damaged
- Lower Esophageal Sphincter Does Not Close Tightly
Signs and Symptoms
- Heartburn
- Regurgitation
- Dysphagia
- Bleeding
Complications
- Aspiration
- Scar Tissue
Diagnosis
- B
GERD Summary
Mallory-Weiss Tear
Pathophyisiology
- Longitudinal Tear in Mucous Membrane of Esophagus at Stomach Junction
- Tears from Sudden, Powerful, or Prolonged Force
- Hiatal Hernia Present
Signs and Symptoms
- Bright Red, Bloody Emesis
- Bloody or Tarry Stools
Diagnosis
- EGD
- He
Esophageal Varices
- Dilated Blood Vessels in Esophagus
- Portal Hypertension
- Rupture Life-threatening
Gastritis
Inflammation of the Stomach
- Acute or Chronic
Abdominal Pain, Nausea, Anorexia
Remove Irritating Substance
Bland Diet of Liquids/Soft Foods
Antacids
Inflammation of Stomach Mucosa
- Acute
- Chronic
Pathophysiology
- Protective Mucosal Barrier Broken Down
Chronic Gastritis Type A
- Autoimmune Gastritis
- Fundus
- Asymptomatic
- Leads to Pernicious Anemia
(Book excerpt)
Type A chronic gastritis is often referred to as autoimmune gastritis and occurs in the fundus. Type A gastritis usually do not secrete enough intrinsic factor from
Chronic Gastritis Type B
Pathophysiology
- From Infection with Helicobacter pylori
- Lower Stomach
Signs and Symptoms
- Anorexia, Heartburn, Belching, Sour Taste, Nausea/Vomiting
Treatment
- Antibiotics
(Book excerpt)
Type B chronic gastritis affects the antrum and pylorus (lower
Stress-Induced Gastritis
GI mucosal damage from ischemia.The stress response to the illness causes reduced blood flow to the stomach and small intestine, resulting in ischemia and damage to the mucosa.
Peptic Ulcer Disease
- Erosion of GI lining
- Primary Cause: Bacterium H. pylori
- Curable
- Influenced by Smoking
Gastric
- High Left Epigastric/Upper Abdominal Burning/Gnawing Pain
- Increased 1 to 2 Hours After Meals or with Food
Duodenal
- Midepigastric/Upper Abdominal Bu
Stress-Induced Gastritis
- At Risk: Critically Ill
- Ischemia Damaging Mucous Barrier
- Acid Secretions Create Ulcerations
Causes of Gastritis
Diet
� Alcohol
� Spicy foods
Microorganisms
� Helicobacter pylori
� Salmonella
Medications
� Aspirin
� Nonsteroidal anti-inflammatory drugs
� Corticosteroids
� Digitalis
� Chemotherapy drugs
Stress
� Physiological
� Psychological Trauma
Other Factors
� Re
Stress Ulcers
Preventive Treatment
- Quick Trauma Care
- Early Feeding
- Prophylactic Antacids, Histamine Blockers
- Sucralfate - Binds to Ulcer Base
Peptic Ulcer Disease Summary 1
Peptic Ulcer Disease Summary 2
Medication Regimen for H. Pylori Infection
Medications Used to Promote Healing on Peptic Ulcers 1
Medications Used to Promote Healing on Peptic Ulcers 2
Medications Used to Promote Healing on Peptic Ulcers 3
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
Nursing Diagnosis
- Deficient Fluid Volume
(Book excerpt)
Bleeding peptic ulc
Gastric Cancer
- Malignant Lesion in Stomach
- Second Most Common Cancer
- Men Greater Than Women
- H. Pylori Infection Risk Factor
- Poor Prognosis as Metastasizes
Signs and Symptoms
- No Early Symptoms
- Late Symptoms:
1. Indigestion
2. Anorexia
3. Pain Relieved by An
Subtotal Gastrectonomy
Partial Removal of Stomach
Gastroduodenostomy (Billroth I)
- Distal Stomach Removed
- Anastomosed to Duodenum
- Treats Gastric Problems
Gastrojejunostomy (Billroth II)
- More Distal Stomach Removed
- Anastomosed to Jejunum
- Treats Duodenal Problems
Total Gastrectomy
- Total Stomach Removal
- Extensive Gastric Cancer
- Anastomosis of Esophagus to Jejunum
Gastric Surgery
Nursing Diagnoses
- Acute Pain
- Fear
Nursing Care Post-Operative
- Monitor Vital Signs
- Respiratory Status
- Control Pain
- Intake and Output
- Incisional Site
- NG Tube Care
- Ambulate Early
- Monitor Abdominal Status
- Education
Complications
- Hemorr
Gastric Bleeding Summary
Gastric Cancer Summary
Subtotal Gastronomy
Nausea and Vomiting - Therapeutic Measures
If it is prolonged, however, dehydration and elec- trolyte imbalances can occur. The loss of hydrochloric acid from the stomach can result in metabolic alkalosis. Emesis that looks like coffee grounds (dark brown) occurs from bleeding in the stomach.
Nursing Process for the Patient with Nausea and Vomiting
The characteristics of the episodes of the nausea and vomiting are noted. Signs of early fluid deficit, such as weakness, headache, muscle cramps, restlessness, inability to concentrate, and postural hypotension, are reported for treatment. Later signs in