Chapter 54

Question 1

GERD

Answer 1

A result of persisepnt backward flow of stomach contents into the esophagus.

Chronic condition of exposing the esophagus irritating effects of gastric or duodenum contents resulting in inflammation.

Question 2

Most common cause of GERD

Answer 2

Excessive relaxation of the LES causing reflex of gastric contents into the esophagus

Question 3

Who is at risk of developing GERD

Answer 3

Overweight/obese

Hital Hernia

H pylori

Increased intra abdominal pressure

Question 4

How can patient with GERD develop cancer.

Answer 4

By the body replace columnar cells with damaged squamous cell known as Barrett’s Epithelium

Question 5

Esophageal Stricture

Answer 5

Narrowing of the esophagus opening due to scarring.

Can lead to difficulty swallowing

Question 6

What is normal PH of the stomach

Answer 6

1.5-2.0

Question 7

What Factors contribute dcreased LES pressure

Answer 7

Caffeinated beverages
chocolate
citrus fruits tomatoes and tomato products
smoking, use of other tobacco products or alcohol
calcium channel blocker’s nitrates cholinergic drugs
peppermint spearmint
high levels of estrogen and progesterone
nasogastric tube

Question 8

What are the two main symptoms of Gerd?

Answer 8

Dyspepsia (indigestion)

And

Regurgitation

Question 9

What would be the diagnosis of a patient presenting with asthma morning hoarseness pneumonia reflux heartburn and atypical chest pain?

Answer 9

Severe reflux that reaches the pharynx or the mouth or pulmonary aspirations

Question 10

What are some additional signs and symptoms of Gerd?

Answer 10

Water brash (hyper salvation)

Dysphagia ( difficultly swallowing)

Odynophagia painful swallowing)

pyrosis (heartburn)

Globus (filling up something in the back of the throat)
Nausea
pharyngitis
Coughing  
Hoarness
belching
Epigastric pain

Question 11

Factors that increase intraabdominal gastric pressure

Answer 11

Pregnancy
wearing tight belt
Girdle
Ascites

Question 12

Signs of indigestion signs and symptoms

Answer 12

Abdominal discomfort 
feeling uncomfortable full 
Nausea burping
 Worsens bends  over strains or lies down 
severe may radiate to the neck or jaw 
referred to the back

Question 13

Patient reports to ED severe GERD and discomfort. He last ate two hours ago. He felt worse when lying down The pain went to his neck and jaw felt nausea and feeling uncomfortable.

What is the nursing teaching for prompt relief?

Answer 13

Drink fluids

take antacids

maintain an upright 1-2 hours after eating

Question 14

What are some complications older adults may experience because of Gerd due to physiological changes?

Answer 14

Atypical chest pain 
ear nose and throat infections 
pulmonary problems; aspiration pneumonia 
sleep apnea 
 Asthma
Barretts esophagus 
 esophageal erosion

Question 15

Diagnostic Test for Gerd?

Answer 15

Barium swallow
EGD
PH monitor examination (most accurate)

Question 16

48 hour Bravo Esophageal pH test

Answer 16

A small capsule is temporarily attached to esophagus
Patients asked diary of activities and update
the PH is continuously monitored and recorded
a wireless monitoring device may be used f

Question 17

Priority collaborative problems with the current patients

Answer 17

Potential for compromised nutrition

acute pain

Question 18

Patient teaching nutritional therapy for GERD

Answer 18

Limit; peppermint chocolate fatty food and fried foods
Caffeine/carbonated beverages
restrict spicy and acidic foods;orange juice and tomatoes
use my fitness pal
Limit foods that increase the gastric acid or cause pain
do not snack in the evening
do not eat 2-3 hours before bed
eat slowly and chew food thoroughly to prevent Belching

Question 19

Patient teaching of lifestyle changes with the GERD

Answer 19

Elevate the head of the bed 6 to 12 inches;use blocks or wedge pillow
sleep on the right side to promote gas exchange
swallow frequently to clear esophagus
weight reduction
avoid constructive clothing lifting heavy objects or straining and working in a bent over a stooped position to
Chew chewable antacids completely and followed with a glass of water

Question 20

What drugs lower LES and cause reflux?

Answer 20

Oral contraceptives 
anticholinergic agents 
sedatives
NSAID such as ibuprofen 
nitrates 
calcium channel blocker’s

Question 21

Long-term use Protein pump inhibitor’s may cause what?

Answer 21

Community acquired pneumonia

G.I. infection such as CDiff

Question 22

What 2 protein pump inhibitor’s can be administered by IV form for short term treatment or prevention of stress ulcers?

Answer 22

Pantoprazole (protonix)

Esomepraxole (nexium)

Question 23

What is the main treatment for severe Gerd?

Answer 23

Protein pump Inhibitors

End in prazole

Question 24

Action of PPIs?

Answer 24

Long acting inhibitors of gastric acid secretion by affecting the protein pump of parietal cells

Reduce gastric acid secretion the long acting except omeprazole

Question 25

Histamine receptor antagonists action?

Answer 25

long acting and decrease acid and promote healing of the inflamed esophageal tissue so comfort is improved. Reduce gastric secretions

Question 26

Antacids use?

Answer 26

Occasional use of heartburn discomfort not for long term use

Question 27

Antiacid action?

Answer 27

Elevating the pH level of gastric contents there by deactivate and pepsin. Neutralize HCI Reduce pepsin

Question 28

Why shouldn’t antacids be used long-term

Answer 28

Their length of action is short nighttime effectiveness is the minimum increase LES pressure

Question 29

Joint commission core measures to decrease LES pression

Answer 29

Teach patient that smoking and alcohol us should be avoided. Explore smoking cessation and make appropriate referrals activation about his or her use of alcohol beverages and if your puppy left the patient help find alcohol

Question 30

5 Sliding hiatal hernia key feature

Answer 30

``` Heartburn chest pain dysphagia ( difficultly swallowing) Regurgitation belching ```

Question 31

Five key features of paraesophegal hernia

Answer 31

# Fill of fullness after eating breathlessness after eating feeling of suffocation chest pain that mimic angina worsening of manifestations in a lying or recumbent position *regurgitation is usually not present*

Question 32

Risk associated with having a paraesophageal hernia

Answer 32

Twisting of the G.I. structure (Volvulus) obstruction (blockage) is high strangulation (stricter) is high development of iron deficiency anemia is common due to slow bleeding Large bleeding or hemorrhage is rare

Question 33

Four positioning teaching for hitial hernia?

Answer 33

Sleep at night with the head of the bed elevated 6 inches remain upright for several hours after eating avoid training or excessive vigorous exercise refrain from wearing clothing that is tight or constructive around the abdominal

Question 34

What is the most important role of gthe nurse for caring for a patient with a hernia?

Answer 34

“Health teaching” encourage the patient to .... avoid eating in the late evening avoid foods associated with teach the patient and family follow a restricted diet and exercise reduce weight is beneficial because obesity increases enter abdominal pressure and worsens both the hernia and the symptoms of reflux

Question 35

Preoperative care for surgical management of hernia

Answer 35

If not urgent instruct patient to lose weight smoking or significantly reduce smoking reinforce the surgeons instructions and prepare the patient for what to expect after surgery

Question 36

Operative procedure for a hernia

Answer 36

Fundoplication= Re-enforcement of the LES surgeon wraps a portion of the stomach or fund around the distal LNF=Minimum invasive with less complications some patients are not a candidate Paraesophageal repair = One large incision or several 1/2 incision made in ab. Hernia is reinforced with mesh.

Question 37

Operative procedure for Trans thoracic space hernia repair?

Answer 37

nasogastric tube inserted and will remain several days oral intake will be started gradually with clear liquids after peristalsis Teach deep breathing and use of incentive spirometer informed that breathing will be painful teach patient about postoperative pain and meds

Question 38

Post operative risk for LNF procedure or paraesophageal for your repair via laparoscopically

Answer 38

The nursing care priority is to observe for complications of bleeding and provide health teaching patient at high risk of bleeding and infection