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NSG 2200 > Exam 3/Responses to Stressors Affecting Ingestion > Flashcards

Exam 3/Responses to Stressors Affecting Ingestion Flashcards

1
Q

Esophageal Cancer: Benign tumors

A

*Rare (asymptomatic)

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2
Q

Malignant tumors (esophageal cancer):

A

Not common but is always fatal

  • Five year survival rate at less than 8%
  • Never diagnosed early enough (difficult to diagnose in the early stages)
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3
Q

Esophageal Cancer:Syptoms

A
  • Non-specific
  • Progressive dysphagia
  • Weight loss
  • Chest pain
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4
Q

Screening for esophageal cancer:

A

No routine screening exam

Usually 60-70 y/o

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5
Q

Possible causes of Esophageal Cancer

A
  • Heavy alcohol consumption
  • Smoking
  • Tannins (Found in teas)
  • Nitrosamines (bacon, pepperoni, ham, hotdogs)
  • Barrett’s esophagus
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6
Q

Complications of Esophageal Cancer:

A
  • Hemorrhage
  • Perforation
  • Esophageal stenosis
  • Metastases
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7
Q

Diagnostic tests for Esophageal Cancer:

A
  • Endoscopy
  • Barium swallow with fluoroscopy
  • Bronchoscopy
  • MRI
  • CT
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8
Q

Esophageal Cancer Collaborative Management:

A
  • Medication-chemotherapy, antacids and analgesics
  • Radiation Therapy-Tx of choice for palliation-reduces size which helps with symptoms
  • Dilation
  • Surgery-Dacron graft, resection, esophagectomy with colon interposition
  • Endoscopy with laser therapy, mucosal resections
  • Nutrition- G or J tube
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9
Q

Palliation of dysphagia caused by esophageal cancer:

A

Expanding stent

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10
Q

Nursing assessment for esophageal cancer:

A
  • hx of GERD
  • Tobacco and alcohol use
  • Dysphagia
  • Pain
  • Hoarseness
  • Weight loss
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11
Q

Nursing interventions for esophageal cancer:

A
  • Health promotion
  • Pre-op: TPN, tube feed, oral care, tube teaching
  • Post-op: NG function is critical, resp. complications, position?
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12
Q

Ambulatory and home care for esophageal cancer:

A
  • Long recovery
  • Palliative Care
  • Maintain nutrtion
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13
Q

GERD (Gastroesophageal Reflux Disease)

A

Inappropriate relaxation of the lower esophageal sphincter

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14
Q

Lower esophageal sphincter (LES) does not

A

close properly, and stomach contents splash back up, or reflux into the esophagus.

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15
Q

LES is a :

A

ring of muscle located at the far end of the esophagus as it leads into the stomach. It’s normal function is to act as a physical barrier between the esophagus and the stomach, protecting the esophagus

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16
Q

Other factors of GERD

A
  • Obesity
  • Pregnancy
  • Diabetes
  • Hiatal hernia
  • Certain foods: caffeine, chocolate, Cigarette and cigar smoking
  • Anitcholinergics
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17
Q

Clinical manifestations of GERD:

A
  • Heartburn: burning sensation that may radiate to the back or jaw
  • Regurgitation: a sour or bitter taste perceived in the pharynx
  • Frequent belching, flatulence
  • Dysphagia- pain in upper abdomen
  • Heartburn >2X a week
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18
Q

Complications of GERD

A
  • Esophagitis
  • Esophageal stricture
  • Barrett’s esophagus
  • Respiratory: laryngospasm, bronchospasm, asthma, chronic bronchitis, pneumonia
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19
Q

GERD Diagnostics:

A
  • Barium swallow
  • Endoscopy
  • Manometric studies
  • ph probe
  • Trial PPI
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20
Q

Interdisciplinary Treatment for GERD:

A
  • Lifestyle modifications
  • Nutrition Therapy
  • Surgery
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21
Q

Life style modifications for GERD:

A

Change diet, stop smoking, sleep with bed propped up by blocks

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22
Q

Nutrition Therapy:

A

Avoid foods that aggravate (fatty foods, chocolate, peppermint, tea, coffee, milk, acidic foods)

  • Small frequent meals
  • Avoid late night snacking
  • Weight reduction
  • Sit up after meals
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23
Q

Surgery:

A

Nissen fundoplication

24
Q

The most common surgical procedure performed for treatment of GERD is:

A

a Nissen fundoplication.

25
Q

Fundoplication refers to

A

wrapping the distal esophagus with the uppermost part of the stomach

26
Q

Drug therapy for GERD

A
  • Antacids: occasional heartburn, take 1 hour after meals, take alone
  • Histamine receptor antagonists (Pepcid, Tagamet, Zantac) OTC and prescription strengths, work in 50% frequent relapses.
  • Proton Pump Inhibitors (Nexium, Protonix, Prilosec, Prevacid) used in intervals or in a single large dose at bedtime to prevent reflux
  • Sulcralfate (Carafate) cytoprotective properties
  • metoclopramide (Reglan) promotes gastric emptying
  • Cholinergics (Urecholine) increases esophageal clearance
27
Q

Hiatal Hernia- Two Types

A
  • Sliding hernias

* Rolling hernias

28
Q

Sliding hernias

A

90% of the total. Distal esophagus, gastric junction and a portion of the stomach are displaced upward into the thorax

29
Q

Rolling hernias

A

Gastric junction remains anchored below the diaphragm and the fundus of the stomach rolls into the thorax next to the esophagus

30
Q

Epidemiology: Hernias

A
  • Common
  • 30% in the general population
  • 60% in the over 60 age group
  • Affects women much more than men but incidence increases in both sexes with aging
31
Q

Causes of Hernias:

A
  • Unknown
  • Structural changes
  • obesity
  • pregnancy
  • ascites
  • heavy lifting
  • extreme exercise
32
Q

Clinical manifestations hernias:

A

often asymptomatic or GERD like symptoms

33
Q

Complications of hernias:

A
  • GERD
  • esophagitis
  • hemorrhage from erosion
  • Stenosis
  • Strangulation of the hernia
  • Tracheal aspiration
34
Q

Collaborative care: Hernias

A
  • Conservative: GERD treatment
  • Surgical: herniotomy (excision of the hernia sac), herniooraphy (closure of the hiatal defect), Gastropexy (attach the stomach to the diaphram), Nissen fundoplication
35
Q

Diagnostic GI tests:

A
  • UGI *ERCP-endoscopic retrograde
  • Bariaum Enema cholangiopancreatography
  • Ultrasound *Endoscopy
  • CT *Colonoscopy
  • Radionuclide Imaging *EGD
  • Cholectytography *KUB
  • Cholangiography
36
Q

Abdominal X-rays

A
  • Flat plate of the abdomin

* KUB kidneys, ureters, bladder

37
Q

Cholangiograms:

A

radiograph of the biliary tree

38
Q

IV Cholangiogram:

A

inject dye. Take X-rays at intervals

39
Q

T-Tube Cholangiography:

A

During surgery. Dye injected into the T-Tube

40
Q

Transhepatic Cholangiography:

A

Percutaneous insertion of a needle into the common bile duct. Dye. Injected

41
Q

Computerized Axial Tomopgraphy:

A

rotates 180 degrees. Sensors read amount of radiation each body tissue or organ absorbs. No prep. Unless contrast used. (Flushed sensation, vagal reaction, salty taste, Check for allergies. Contrast indurce nephropathy: check creatinine. Hold NSAIDS and diuretics for 24 hours before and after test. Hold metformin (Glucophage)

42
Q

MRI-

A

magnet and radio waves to make an image. Clearly defines organ structure, detect changes in tissue, vessel integrity. Have pt. complete the safety questionaire. Safety issues: could interfere with pacemakers, ICD . Burns for those with tattoos and transdermal patches or electrodes. Noise. Claustrophobia. Preparation: none unless with contrast. (NPO 2-3 hours, bile duct test)

43
Q

Upper GI

A
  • NPO 6-8 hours before procedure
  • Procedure- drinks barium, fluoroscopy shows the swallow, outlines esophagus and stomach. Can continue to outline small bowel (follow-through). May take hours to get full set of x-rays.
  • Post procedure- no food or water until all x-rays are taken. Give laxative/fluids to eliminate barium.
  • Post procedure- Monitor bowel movements, may be white steaks
  • CONSTIPATION***
44
Q

Colonscopy:

A
  • Rectum through lg. intestine
  • Colorectal cancer screening
  • Remove small polpys
  • Bowel prep
  • Conscious sedation
45
Q

Capsule Endoscopy

A
  • Picture of small intestine
  • Wears recorder belt for 8 hours
  • NPO after midnight. Can have liquids 2-4 hours after the test begins
46
Q

Sigmoid and Protoscopy

A
  • Sigmoid colon, rectum, anus
  • Clear liquids before the test
  • Bowel prep
  • No sedation during the test
47
Q

Endoscopic Retrograde Cholangiopancreatography (ERCP)

A
  • Outline biliary tree
  • Return stones
  • insert stents
  • Sedated
  • Complication: injury to pancreas
  • Post procedure: gag reflex check
48
Q

Angiography

A
  • Blood flow
  • Inject dye through a catheter (femoral usually)
  • Sign a consent
  • NPO 6-8 hours
  • Post-procedure: check pulses
  • Supine 4-6 hours afterward
49
Q

Alternative Nutrition Methods Supplemental, tube feed, TPN

A

**Use in the gut if possible*

50
Q

Intact formulas

A

For functional GI tract: can drink Ensure, Sustacal, Resource

51
Q

Elemental or Predigested Formulas:

A

Flexical, Vital

52
Q

Disease Specific Formulas

A

Pulmnocare, Hepatic, Traumacal

53
Q

Enternal Feedings

A
  • Can be made in a blender or commercial
  • NG, G or J tube
  • Risk?
  • Cantamination
  • Bolus, intermittent, continuous
  • Osmolarity
  • Tube placement: Residuals q 4 hours (hold if greater tan 150-200 ml)
  • Evaluate color
54
Q

Medication administration

A
  • Liquid preferred
  • Crush into a fine powder and add to water
  • No enteric coated or SR/ER
  • Flush before, between and after with water
55
Q

Total Parenteral feedings (TPN) or hyperalimentation

A
  • Carbohydrate- Dextrose 5-70%
  • Protein-Aminosyn-various compositions
  • Fat Emulsion-Liposyn
  • Opyional: Vitamins-Minerals-Heparin-Insulin
  • Three in one: combine CHO, fat, protein
56
Q

Cost for nutrition

A
  • close monitoring of labs
  • Risk for infection
  • Skilled administration: change tubing daily, filter
57
Q

Start with an IV: Central line or PICC

A
  • Pneumothorax puncture lung
  • During central line insertion
  • Will need chest tube

NSG 2200 (4 decks)

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