Ch. 46 Flashcards
(49 cards)
1
Q
GERD stands for
A
gastroesophageal reflux disease
2
Q
most common upper GI disorder in the US
A
GERD
3
Q
__ % of adults in North America have reflux disorder
A
18-28%
4
Q
GERD occurs as a result of
A
backward flow of the stomach contents into esophagus
5
Q
causes of GERD
A
- no single causative agent
- NG tube
- genetic connection: fam hx
- lifestyle: alc, caffeine, smoking
- Barrett’s epithelium
6
Q
Barret’s esophagus
A
- With Barretts esophagus, body substitutes Barrett epithelium instead of normal squamous cell
- New tissue is more resistant to acid, but is premalignant, increased risk for esophageal cancer
7
Q
normal healing of GERD (type of epithelium)
A
Normal healing of GERD with squamous cell epithelium
8
Q
GERD prevention
A
- healthy eating habits
- limit fried, fatty, spicy foods and caffeine
- sit upright for one hour after eating
9
Q
GERD assessment: history (sx)
A
- heartburn
- morning hoarseness
- coughing or wheezing at night
- when do they experience these symptoms? usually report 1-2 hrs after meal
10
Q
GERD assessment: s/sx
A
- may be asymptomatic at first
- dyspepsia, dysphagia
- auscultate lungs for crackles (should have clear sounds with GERD, listen for crackles to ensure food is not backing up into the lungs)
11
Q
GERD assessment: psychosocial
A
- preference of what patient likes to eat
12
Q
GERD assessment: diagnostics
A
- upper endoscopy (UGD) (conscious sedation used, need vs monitor, someone to drive home; scope into esophagus; more invasive but confirmatory dx)
- ambulatory esophageal pH monitoring: 24 hr reading of the pH levels (how acidic the esophagus is; no sedation)
13
Q
priority patient problems of GERD
A
- potential for compromised nutrition status due to dietary selection
- acute pain due to reflux of gastric contents
14
Q
GERD interventions: nutrition
A
- balanced nutrition
15
Q
GERD interventions: for minimizing pain
A
non-surgical mangement:
- lifestyle changes: no caffeine, alc, smoking, fried/spicy foods
- drug therapy
- endoscopic therapies
surgical management
16
Q
Acid reflux diet: foods to avoid
A
- coffee
- wine
- fast food
- soft drinks
- tomatoes (acidic)
- dairy
- spices
- peppermint
- citrus (oranges, grapefruit)
- chocolate
- garlic
- onion
17
Q
Acid reflux diet: foods that are okay to eat
A
- ginger
- leafy greens
- brown rice
- coconut
- banana
- pear
- apple
- avocado
- fennel
- celery
- berries
- melon
18
Q
GERD care coordination
A
- make appropriate dietary selections
- adhere to drug therapy
- teach signs of esophageal restriction and Barrett esophagus
- RDN
- local support groups
19
Q
GERD meds include (classes)
A
- proton pump inhibitors
- H2 receptor blockers
- antacids
20
Q
GERD meds: proton pump inhibitors
A
the “-prazole” meds
- omeprazole
- pantoprazole
- lansoprazole
21
Q
GERD meds: H2 receptor blockers
A
end in “-tidine”
- rantidine
- famotidine
- cemetidine
22
Q
GERD meds: antacids
A
- maalox and mylanta
23
Q
antacids
A
- increase gastric pH by neutralizing acid
- aluminum base =
- magnesium base =
- take 1-3 hours AFTER meals
- taken PRN (as needed)
24
Q
histamine-receptor blocks (H2R blockers)
A
- block action of histamine on H2 receptors
- decreases HCl acid secretion
- decreases conversion of pepsinogen to pepsin
- increase ulcer healing
- taken before meals
25
proton pump inhibitors (PPIs)
- main treatment for GERD
- block HCl acid secretions
- promote ulcer healing
- DO NOT CRUSH OR CHEW (PO)
- must be given IV for short-term use (usually given PO)
- promote rapid healing, but reoccurrence common with cessation
- can interfere with calcium absorption
- taken in morning, empty stomach
- maintenance med; pretty much on it forever
26
main treatment for GERD
proton pump inhibitors (PPIs)
27
GERD evaluation
- adhere to appropriate diet, medication therapy, and lifestyle modifications
- experience minimized or absence of pain
28
hiatal hernia
- Protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest
29
hiatial hernia assessment: sx
many people are asymptomatic; others have sx similar to GERD
- heartburn regurgitation
- dysphagia
sx often increase after meal or when lying supine
30
hiatal hernia assessment: diagnostics
- barium swallow study with fluoroscopy: barium illuminates the hernia
- EGD
- high resolution manometry with esophageal pressure topography
31
hiatal hernia non-surgical interventions
- drug therapy
- nutrition therapy: no spicy, greasy foods
- lifestyle changes: caffeine, alc, smoking
32
hiatal hernia surgical interventions
- LNF- laproscopic nissen fundoplication
(sm incision in abdomen; monitor s/sx of infection)
- may need to lose weight before surgery
33
hiatal hernia care coordination
- nutrition modifications
- stool softeners or bulk laxatives (more so post-op)
- daily incisional inspection
- signs to report to the HCP
- avoid sick people (don't want pt to cough bc of abdominal incision)
34
diarrhea is caused by
- pathogens: infections; gastroenteritis
- medical conditions: inflammatory GI diseases
- food intolerance: lactose, gluten
35
diarrhea sx
- frequent liquid stool
- hyperactive BS
- abdominal tenderness, distention
36
diarrhea diagnostics
- stool culture (for patients with suspected infectious disease, ie C Diff)
37
diarrhea collaborative care (goals of care)
- stop sx
- hydration: worried about hypovolemia
- treat underlying cause (infectious: ABT; anti-inflammatories for inflammatory d/o)
38
acute infectious diarrhea: assessment
- s/sx of dehydration
- skin turgor
- tachycardia
- dry mucous membranes
- low BP (hypotension) (mostly older population)
39
acute infectious diarrhea: nursing diagnoses
- Deficit fluid volume r/t excessive fluid loss
- Decrease CO r/t decreased plasma volume
- Impaired oral mucous membranes r/t inadequate oral secretions
- Risk for falls r/t orthostatic hypotension
- Confusion (acute or chronic) r/t neuro changes (d/t electrolyte changes from being dehydrated)
40
clostridium difficile
aka c. diff
- bacteria that causes severe diarrhea
- commonly starts 4-9 days after beginning antibiotics (s/e of ABT)
41
c. diff: dx tests
- stool testing (culture)
42
c. diff: treatment
drug therapy
- vancomycin PO
- metronidazole
43
c. diff: interventions
- private room/contact isolations
- contact precautions (gloves & gown)
- hand washing with soap and water
44
constipation
- Stool moves slowly through GI tract
- Many factors can cause
-Muscles used to move bowels are not coordinated
can be caused by:
- use of opioids
- post-op/anesthesia
- sedentary lifestyle
- diet: not enough fiber/fluids
- taking iron supplements
45
constipation: s/sx
- hard stools
- straining with BM
- sense of rectal fullness or blockage
- incomplete evacuation
46
constipation: complications
- hemorrhoids (from straining)
- bowel obstruction
47
constipation: diagnostics
- barium enema
- sigmoidoscopy/ colonoscopy
48
constipation: interventions
- nutrition and lifestyle therapy
- not being sedentary/exercising
- increasing fluid intake
- increasing fiber intake/ high fiber diet
- drug therapy
49
constipation: drug therapy
- bulk-forming: metamucil
- stool softener: docusate
- stimulants: senna
- osmotic solutions: miralax
- saline laxatives: milk of magnesia (MOM)
- lubricants: fleets
(all oral agents; except fleets)
- try high fiber diet first, then PO meds, then fleet enema or suppository as the last resorts
