L9 Flashcards
(22 cards)
Risk factors of gastroesophageal reflux disease (GERD)
Alcohol, smoking, ingesting of fatty food and stimulating food, NG tube insertion
Complications of gastroesophageal reflux disease
Esophagitis —> stricture or ulcer —> Barrett’s esophagus (increase risk of cancer) —> Esophageal adenocarcinoma
Clinical manesfestations of gastroesophageal reflux disease
Dysphasia, dyspepsia, pyrosis (heartburn), respiratory symptoms (wheezing, coughing, dyspnea), otolaryngologic symptoms (hoarseness, sore throat, choking, etc), generalised abdominal pain (epigastric pain, nausea, belching)
GERD diagnostic test
- Ambulatory esophageal pH monitoring
- Endoscopy
- Barium swallow test
Lifestyle modifications for GERD
- Avoid eating food that decreases lower esophageal sphincter pressure and stimulate esophagus
- Small and frequent meal (4-6 hours); ingest slowly and chew throughly
- Avoid lying down 2-3 hours after eating; don’t eat 3 hrs before bed; sleep with head elevated
- Suggest weight reduction; avoid wearing tight clothing
Drug therapy for GERD
- Proton pump inhibitors
- Histamine (H2) receptor inhibitors
- Antacids and acid neutralisers
- Prokinetic
Proton pump inhibitor
Reduce HCl secretion and thus reduce irrigation of esophageal and gastric mucosa
Side effects: headache, abdominal pain, nausea and vomiting, diarrhea, flatulence
Histamine (H2) receptor inhibitors
- reduce HCl secretion
- reduce conversion of pepsinogen into pepsin
- reduce irrigation of esophageal and gastric mucosa
Side effects: headache, abdominal pain, constipation/diarrhea
Antacid and acid neutraliser
- neutralise HCl acid
- take 1-3hr before bed
Side effects of calcium carbonate:
Constipation/diarrhea, hypercalcemia, milk-alkali syndrome, renal calculi
Prokinetic
- block the effect of dopamine
- increase GI motility and emptying
- reduce reflux
Side effects: abdominal pain, diarrhea, GI bleeding, uterine rupture if pregnant
Surgical therapy of GERD
- Nissen fundoplication: increase integrity of LES
- Endoscopic mucosal resection
- Radiofrequency ablation: thicken LES
Pathophysiology of esophageal cancer
Adenocarcinoma, Squamous cell carcinoma —> esophageal mucosa —> muscle layer —> lymphatics —> obstruction —> perforated —> mediastinum and erosion into greater vessels
Clinical manifestation of esophageal cancer
Dysphagia, chest or abdominal pain, weight loss
Monitor for s/s of aspiration during eating or drinking, e.g. coughing, choking —> pneumonia and airway obstruction
Diagnostic test for esophageal cancer
- Endoscopic ultrasound with fine-needle aspiration
- Esophagogastroduodenoscopy
—> for biopsy - Blood tests (CBC, serum albumin, LFT)
Nutrition and swallowing therapy
- Monitor swallowing ability, blood test, BMI, BW, I&O
- Position patient, avoid lying completely flat, remain upright for several hours after meals
- Semisoft food or thickened liquid; liquid nutrition supplement to increase calorie intake
- Enteral feeding or gastrostomy or jejunostomy may be needed
- Consult ST, OT, and dietitian
Complications of surgical therapy for esophageal cancer
Infection, pulmonary complications, cardiac complications, leakage through anastomosis, bleeding
Pre-op nursing care
- Nutrition support: provide high calorie and protein diet
- Oral clean x4 times daily
- Stop smoking 2-4 weeks before the surgery
- Bowel preparation for colon interposition
- Educate patient chest tube maybe needed if enter pleural space
Post-op nursing care
- Monitor vital signs, consciousness, etc
- Keep NPO and IV
- Manage NG tube (no replacement if displacement occur)
- Administer prescribed prophylactic antibiotics
- Monitor for complications e.g. respiratory failure, haemorrhage, anastomotic leak (check by barium swallowing, if anastomotic leak occurs, stop all oral intake and is not resumed), infection/sepsis
Monitor for signs of fever, inflammation, fluid accumulation, tachycardia and tachypnea - Position in semi-Fowler or high Fowler’s position
- Manage pain, wound and drainage system
- Provide incentive spirometry, aspirate NG tube and oral suction
- Once the patient is extubation (remove the chest tube), begin deep breathing, turning and coughing every 1-2 hours
Nursing care for patient with Patient Controlled Analgesic
Assess pain level, consciousness, respiratory status, BP/P
Monitor for side effect of analgesic
Prepare Naloxone for overdose of analgestic
Photodynamic therapy
Light reacts with porfimer to kill cancer cells
Avoid direct sunlight for up to 6 weeks after procedure
