Nursing Care Of Patients With Upper GI Disorders

Question 1

Nausea

Answer 1

Vague but unpleasant sensation of sickness or queasiness. It may or may not be accompanied by (and possibly relieved by) vomiting.

Question 2

Vomiting

Answer 2

The forceful expulsion of the contents of the upper GI tract resulting from contraction of muscles in the gut and abdominal wall.

Question 3

Dysphagia

Answer 3

Difficult or painful swallowing

Question 4

Achalasia

Answer 4

A disorder of unknown etiology that is characterized by impaired peristalsis of the smooth muscle of the esophagus and impaired relaxation of the lower esophageal sphincter (LES)

Question 5

Gastric Mucosal Barrier

Answer 5

A protective barrier consisting of lipids, bicarbonate ions, and mucous gel that protects the stomach lining from the damaging effects of gastric juices.

Question 6

Hematemesis

Answer 6

Vomiting blood

Question 7

Hematochezia

Answer 7

Frankly bloody stools

Question 8

Melena

Answer 8

Black, tarry stools

Question 9

Occult blood/bleeding

Answer 9

Blood or bleeding that is hidden or not readily apparent

Question 10

Peptic Ulcer Disease (PUD)

Answer 10

A break in the mucous lining of the gastrointestinal tract where it comes in contact with gastric juice, is a chronic health problem.

Question 11

Peptic Ulcers

Answer 11

A break in the mucous lining of the gastrointestinal tract where it comes in contact with gastric juice; may affect any area of the gastrointestinal tract exposed to acid-pepsin secretion, including the esophagus, stomach, and duodenum.

Question 12

Ulcer

Answer 12

A break in the gastrointestinal mucosa, develops when the mucosal barrier is unable to protect the mucosa from damage by hydrochloride acid and pepsin, the gastric digestive juices.

Question 13

Steatorrhea

Answer 13

Excess fat in the feces

Question 14

Erosive (Stress-Induced) Gastritis

Answer 14

A severe form of acute gastritis, occurs as a complication of other life threatening conditions, such as shock, severe trauma, major surgery, sepsis, burns, and head trauma.

Question 15

Curling’s Ulcer

Answer 15

Named after Thomas Curling, a British physician, who first described them in 1842. Acute ulcerations of the stomach or duodenum that form following a burn injury.

Question 16

Cushing’s Ulcer

Answer 16

Stress ulcers occurring as sequelae of head injury or central nervous system surgery.

Question 17

Anorexia

Answer 17

Loss of appetite

Question 18

Partial gastrectomy

Answer 18

Involves removal of a portion of the stomach, usually the distal half to two-thirds.

Question 19

Total gastrectomy

Answer 19

Removal of the entire stomach; the surgeon constructs the anastomosis from the esophagus to the duodenum or jejunum

Question 20

Dumping Syndrome

Answer 20

Complication of partial gastrectomy characterized by nausea, weakness, sweating, palpitation, syncope, sensation of warmth, and occasional diarrhea.

Question 21

Gastritis

Answer 21

Inflammation of the stomach lining, results from irritation of the gastric mucosa.

Question 22

Gastroesophageal Reflux

Answer 22

The backward flowing of gastric contents into the esophagus.

Question 23

Stomatitis

Answer 23

Inflammation and ulcers of the oral mucosa, is a common disorder of the mouth.

Question 24

Zollinger-Ellison Syndrome

Answer 24

Peptic ulcer disease caused by gastrinoma, or gastric-secreting tumor of the pancreas, stomach, or intestines.

Question 25

What are the structures of the upper gastrointestinal tract?

Answer 25

The upper gastrointestinal tract includes the mouth, esophagus, stomach, and proximal small intestine (duodenum and jejunum).

Question 26

Which components of the upper gastrointestinal tract are responsible for food digestion?

Answer 26

The stomach and upper intestinal tract ( duodenum and jejunum) are responsible for the majority of food digestion.

Question 27

What are nausea and vomiting without abdominal pain associated with?

Answer 27

Nausea and vomiting without abdominal pain are commonly associated with food poisoning, infectious gastroenteritis, gallbladder disease, or ingestion of toxins (drugs and alcohol).

Question 28

What conditions are indicated with nausea and vomiting with severe abdominal pain?

Answer 28

When associated with severe abdominal pain, nausea and vomiting may indicate a serious disorder such as peritonitis, acute gastrointestinal obstruction, or pancreatitis.

Question 29

What region of the brain is associated with nausea and vomiting?

Answer 29

Nausea, an unpleasant subjective sensation, occurs when the vomiting center of the medulla of the brain are stimulated.

Question 30

____________________ of the abdomen is a common stimulus for nausea.

Answer 30

Distention of the abdomen is a common stimulus for vomiting.

Question 31

The vomiting center of the brain can be stimulated by input from several different sources:

Answer 31

1) The GI tract, produced by distention, irritation, or infection; 2) the vestibular system of the ear; 3) higher central nervous system (CNS) centers in response to certain sights, smells, or emotional experiences; 4) chemoreceptors outside the blood brain barrier that are stimulated by drugs, chemotherapeutic agents, toxins, systemic disorders, and pregnancy; 5) disorders such as acute myocardial infarction and heart failure commonly produce nausea and vomiting, possibly due to direct stimulation of the vomiting center by hypoxia; 6) increased intracranial pressure (due to intracranial bleeding or a tumor) produces vomiting that may or may not be accompanied by nausea.

Question 32

What condition commonly precedes nausea?

Answer 32

Anorexia commonly precedes nausea, just as nausea frequently precedes vomiting.

Question 33

Pathophysiology of Vomiting

Answer 33

Vomiting, a response that requires coordinated movements of the thorax and abdominal wall, the gut, the pharynx, and the muscles of the mouth and face, is coordinated by the brain stem.

Question 34

Emesis

Answer 34

Vomitus, produced when inspiratory muscles of the thorax (including the diaphragm) and abdomen contract, increasing intrathoracic and intra-abdominal pressures. The gastroesophageal sphincter relaxes, and the larynx moves upward to facilitate oral expulsion of gastric content.

Question 35

What are the autonomic nervous system manifestations of nausea?

Answer 35

In addition to the subjective sensation of queasiness, nausea frequently is accompanied by autonomic nervous system manifestations such as pallor, sweating, tachycardia, and increased salivation.

Question 36

What is the protective role of salivation with regards to nausea and vomiting?

Answer 36

Increased salivation is a reflex to protect the teeth from stomach acid.

Question 37

Vomiting also affects the parasympathetic nervous system in which ways? What facial nerve is stimulation during vomiting?

Answer 37

Vomiting, which stimulates the vagus nerve and parasympathetic nervous system, may be accompanied by dizziness, light-headedness, hypotension, and bradycardia.

Question 38

List the potential complications of vomiting.

Answer 38

Potential complications of vomiting include dehydration, hypokalemia, metabolic alkalosis (from loss of hydrochloric acid from the stomach), aspiration with resulting pneumonia, and ruptures or tears of the esophagus.

Question 39

List the potential serious physical effects of vomiting.

Answer 39

Vomiting can have several potentially serious physical effects. PONV can delay healing and postpone discharge. Strong contractions of the abdominal wall and thoracic skeletal muscle can lead to increased postoperative pain. Pressure may burst wounds, increase stress on the eye following ophthalmic surgery, and dangerously increase intracranial pressure in cases of intracerebral hemorrhage or injury.

Question 40

What are the possibly serious consequences of chronic and prolonged vomiting?

Answer 40

Chronic and prolonged vomiting may cause pitting and erosion of tooth enamel, causing dental decay.

Question 41

Identify the diagnostic tests that involve nausea and vomiting.

Answer 41

Diagnostic tests may include serum electrolytes; pregnancy test, if indicated; liver, pancreatic, and renal function studies; and imaging studies (flat plate of the abdomen and abdominal CT scan) to detect GI obstruction. An upper endoscopy may be performed; CT scan or MRI of the head may be order if an intracranial problem is suspected. Gastrointestinal motility studies may be indicated when other diagnostic studies are negative for an anatomic cause of N/V.

Question 42

Medications to treat Nausea and Vomiting

Answer 42

Serotonin receptor antagonists, dopamine antagonists, antihistamines, cannabinoids, corticosteroids (off label use), benzodiazepine, neurokinin receptor antagonists.

Question 43

Serotonin Receptor Antagonists

Answer 43

Widely used drugs available for patients experiencing nausea and vomiting due to chemotherapy. They are effective when given only once or twice a day, an additional advantage.

Question 44

Examples of serotonin receptor antagonists

Answer 44

Dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran), palonosetron (Aloxi)

Question 45

Pharmacotherapy of Serotonin Receptor Antagonists

Answer 45

The serotonin receptor antagonists suppress nausea and vomiting by blocking the effect of serotonin on vagal afferent nerves that stimulate the vomiting series. Their primary uses are to prevent and treat nausea and vomiting associated with chemotherapy, radiation therapy, and surgery.

Question 46

Nursing Responsibilities of Serotonin Receptor Antagonists

Answer 46

Administer 30 to 60 minutes prior to chemotherapy or surgery as directed. May be given orally or intravenously (push or infusion, follow the directions specific to the drug used). Monitor liver function and clotting studies; report abnormal levels to the physician.

Question 47

Health Education for the Patient and Family for Serotonin Receptor Antagonists

Answer 47

Take this drug exactly as directed; this drug may be taken without regard to food intake; headache is a common side effect for these drugs, use acetaminophen or other mild analgesics as directed by your physician

Question 48

Dopamine antagonists

Answer 48

Dopamine antagonists are effective at treating nausea and vomiting, however can produce extrapyramidal effects, sedation, and hypotension.

Question 49

Examples of Dopamine Antagonists

Answer 49

Chlorpromazine (Thorazine); Prochlorperazine (compazine); thiethylperazine (torecan); promethazine (phenergan); haloperidol (haldol); droperidol (inapsine); metoclopramide (Reglan)

Question 50

Pharmacotherapy of Dopamine Antagonists

Answer 50

These drugs act by blocking the dopamine receptors in the chemoreceptor trigger zone (CTZ). Their primary use is to suppress the nausea and vomiting associated with surgery, cancer chemotherapy, and toxins. The major adverse effects associated with these drugs are sedation, hypotension, and extrapyramidal reactions. Older adults are more sensitive to the effects of these drugs; a lower dose is often indicated.

Question 51

Nursing Responsibilities of Dopamine Antagonists

Answer 51

Administer orally and parenterally as ordered before surgery or before meals and procedures known to produce nausea and vomiting. These drugs may interact with a number of other medications, often increasing their sedative and hypotensive effects. Administer with caution to older adults, closely monitoring for adverse effects such as confusion, agitation, or changes in vital signs. Monitor for evidence of extrapyramidal symptoms, including tremors, restlessness, hyperactivity, anxiety, impaired coordination, notify physician if symptoms develop.

Question 52

Health Education for the Patient and Family for Dopamine Antagonists

Answer 52

Use the drug as ordered, do not increase your dose without consulting your primary care provider. These drugs may cause drowsiness; avoid using other CNS depressants such as alcohol when taking these drugs. Change positions from lying to sitting to standing slowly because these drugs can cause light-headed was or dizziness. Promptly report changes in coordination, tremors, difficulty speaking or swallowing, or weakness to your physician.

Question 53

Antihistamines

Answer 53

Primarily used to treat nausea and vomiting arising from vestibular center stimuli (motion sickness).

Question 54

Examples of Antihistamines

Answer 54

Buclizine (bucladin-s); cyclizine (Merazine); dimenhydrinate (Dramamine); diphenhydramine (Benadryl); hydroxyzine (vistiril, atarax); meclizine (antivert)

Question 55

Pharmacotherapy of Antihistamines

Answer 55

Antihistamines are primarily used to treat the nausea and vomiting associated with motion sickness. They act by blocking histamine and acetylcholine receptors in the neural pathway from the inner ear to the vomiting center in the brainstem.

Question 56

Nursing Responsibilities of Antihistamines

Answer 56

Do not administer these drugs to patients for whom anticholinergi drugs are contraindicated; people with narrow angle glaucoma, urinary retention, or bowel obstruction. May be administered orally, parenterally, or rectally, depending on the preparation and the patient’s ability to tolerate oral preparations. Use caution in patients who are taking other CNS depressants or antihistamines, TCAs, or MAOIs.

Question 57

Health Education for the Patient and the Family for Antihistamines

Answer 57

These drugs frequently cause drowsiness. Use caution when operating machinery or performing tasks requiring mental alertness. Avoid using alcohol or other substances that cause drowsiness or sedation while taking these drugs. This medication may cause dry mouth. Sips of water, ice chips, hard candies, or sugarless gum can be used for comfort. Use sunscreen and protective clothing to protect from sunburn while using these drugs.