Test #3 Chapter 57 Care of Patients with Esophageal Problems Flashcards Preview

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Flashcards in Test #3 Chapter 57 Care of Patients with Esophageal Problems Deck (48):
1

Gastroesophageal Reflux Disease (GERD)

Result of reflux (backward flow) of GI contents into the esophagus.

2

****What is the normal pH of the stomach?

pH of stomach 1.5-2.0

3

**** What is the normal pH of the distal esophagus?

pH of distal esophagus is 6.0-7.0-

4

Which is more acidic, the stomach or the distal esophagus?

the stomach is naturally more acidic than the esophagus,

5

What is the etiology of Gastroesophageal Reflux Disease (GERD)

Etiology- Obesity increases abdominal pressure. NG Tube keeps the sphincter open all of the time so it makes them more prone to for GERD.

6

Regurgitation while lying flat at risk for which complication?

Aspiration.

7

If your patient experiences reflux with regurgitation what assessment is a priority?

So priority would be HOB elevated. If you think the patient has aspirated, perform a respiratory assessment. See if they have crackles. They will have an Acid taste in the mouth.

8

What are the nursing interventions for GERD?

eat small meals daily is the most important. (East 4-6 small meals daily)

Do not eat right before bed,
Give yourself 2-3 hours.

Weight loss,
limit alcohol,
caffeine,
and tobacco intake.


Medications: Zantac, Prilosec

9

Which medication is for mild GERD?

Zantac

10

What would you teach your patient about zantac

Zantac can be taken with or without food.

They prefer that you take it at bedtime.

Take it on a daily basis not just with pain.

11

Which medication is for severe GERD?

Prilosec

12

A client is taking Zantac at home to treat GERD. The client understands proper administration of Zantac when she says that she will take the drug at which of the following times?

a) Before meals
b) With meals
c) At bedtime
d) When pain occurs

c) At bedtime

13

A client who has been diagnosed with GERD complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet?

a) Lean beef
b)Air-popped popcorn
c) Hot Chocolate
d) Raw vegetables

c) Hot Chocolate

14

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing GERD?

a) Limit caffeine intake to no more than 6 cups of coffee per day.

b) Do not lie down for 2 hours after eating.

c) Follow a low protein diet.

d) Take medications with milk to decrease irritation.

b) Do not lie down for 2 hours after eating.

15

The nurse should instruct the client to avoid which of the following drugs while taking Reglan?

a) Antacids
b) Antihypertensives
c) Anticoagulants
d) Alcohol

d) Alcohol

(because Reglan has sedation properties)

16

Hiatal Hernias are Also called diaphragmatic hernias.

What are the two main types?

1. Sliding Hernias
2. Rolling Hernias

17

What are Sliding Hernias

Most common, these patients can develop reflux, volvulus rare (Witch is twisting). This one is not as severe. It has more GERD S&S/

18

What are the S&S of sliding hernias?

S&S: Reflux, Dysphagia, Belching--Worse after meals and in supine position


Identify as Sliding Hernia with barium swallow study with fluoroscopy (not on test)

19

What are people with sliding hernias at risk for?

At risk for? Aspiration

20

What are rolling hernias?

These patients do not usually develop reflux but volvulus is more common. Iron deficiency anemia common. (twisting) More complicated

to identify as hiatal hernia barium swallowing study with fluoroscopy

21

****What are the important things to monitor with rolling hernias>

Monitor for S&S of Obstructions. The S&S will manifest itself as? The abdomen will be distended and firm.

22

What are the nursing interventions for rolling hernias?

Nursing Interventions for Rolling Hernias: (The same as sliding hernia) Nutrition, Medications, Lifestyle changes

23

Surgical Management for Rolling Hernias.
What are the 2 types of surgeries?

1. Laparsocopic Nissen Fundoplication

2. Open Fundoplication

24

What is a Laparsocopic Nissen Fundoplication ?

Minimally invasive surgery, little 1/2 inch incisions on the abdomen and they go in to restore the sphincter so it will not be so open and wide.

repairs rolling hernias

25

****What is the post op care for a person that had a Laparsocopic Nissen Fundoplication?

Post-op- Not as invasive since it is Laparsocopic so post op os a little different. What we are going to monitor for post op is bleeding and infection. To monitor for bleeding, check H&H, Vital Signs (HR will increase first), B/P decreases. Abdomen distention. Monitor incision sites. Monitor temperature for infection.

Education- Education will still be the same. Nutrition, Meds, Lifestyle Changes. If they have already lost the weight, educate them to keep it off. They are not in the hospital long.

26

What is a Open Fundoplication?

go in to restore the sphincter to repair rolling hernias. This is not Laparsocopic so it is more dramatic.

27

****What is the post op care for a person that had a Open Fundoplication?

Post-op: chest tubes, NG tube, NPO then advance to clear liquids


Post-op care: Monitor for respiratory complications. NG Tube drainage- frank red blood is never good. Should be brown after surgery and as the day progresses will turn to yellow/green. Pain control is huge with this group because if they are in a lot of pain, they are not going to want to take deep breaths or get up and ambulate. We also do not want them vomiting. Give them nausea medication first, and then their pain medication to avoid this.

Post-op education- teach them to monitor for infection at home. monitor temperature, come back or call the doctor if there is puss draining from the infection site, redness that is growing larger around the incision sites. Little red and tender ok.

28

Which of the following factors would most likely contribute to the development of a client’s hiatal hernia?

a) Having a sedentary desk job
b) Being 5ft 3ins tall and weighing 190lbs
c) Using laxatives frequently
d) Being 40 years old

b) Being 5ft 3ins tall and weighing 190lbs

29


The client asks the nurse whether he will need surgery to correct his hiatal hernia. Which reply by the nurse would be most accurate?

a) “Surgery is usually required, although medical treatment is attempted first.”

b) “Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications and lifestyle changes.

c) “Surgery is not performed for this type of hernia.”

d) “A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned.”


b) “Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications and lifestyle changes.

30

Esophageal Tumors, Some benign, most cancerous. They Grow quickly & Spread quickly, more than 1/2 of them metastasize.

What are the risk factors?

Risk Factors: Tobacco and Alcohol

31

What is the assessment for esophageal tumors?

Assessment: Dysphagia is the main complaint/Odynophagia (painful swallowing) can be apart from dysphagia. Just because you have one does not mean that you always have the other.

32

****What is the diet and nursing interventions for someone who has esophageal tumors?

Diet: Semisoft foods, thickened liquids, nothing hard like a streak

Priority Nursing Interventions for Esophageal Tumors: Protection of the patients airway and preventing aspiration. Make sure that they are sitting up, and eating the proper diet, family is not sneaking them stuff, suction at the bedside.

33

What is the Early Stages of dysphagia

can eat a steak but can eat other items.

34

What is the Late stage of dysphagia

can no longer swallow liquids.

35

What is the Non-Surgical Treatment for Esophageal Cancer?

Chemo, Radiation

Monitor for worsening of dysphagia or odynophagia

36

***** What is the Surgical Treatment for Esophageal Cancer?

Esophagogastrostomy,- they can remove part of the esophagus, it just depends on where the tumor is located and other factors such as the patients age and history ect. once that is removed, they will probably go to ICU first.

****Priority is Airway and Breathing. HOB elevated, suction ready.

37

***What are the Post op nursing interventions for Esophagogastrostomy

****Priority is Airway and Breathing. HOB elevated, suction ready.


Pain control- is very important and will help them their respirations. We want to keep this under control so that they want to cough and deep breath, ambulate early ect..

NG Tube- So as a whole, when it comes to irrigating NG tubes, there may be some that you irrigate and some that you do not. People that have this surgery, we DO NOT irrigate the NG tube. EVER. Initially the drainage will be blood tinged but not bright red blood, then will change to brown, then to green/and yellow by the end of the post-op day. If you see frank red blood, get the vitals and let the doctor know.

Post-op- can develop fistulas, they can also develop abscesses (pockets of puss), worry about respirations, pain control, NG tube drainage, and complications.

38

****TWO MAIN PRIORITIES FOR Esophagogastrostomy

DO NOT irrigate the NG tube. EVER

AIRWAY MOST IMPORTANT

39

****What is the discharge teaching for post Esophagogastrostomy

Discharge Instructions- teach about diet, keep their pain under control. Educate that if they get a cough or a temp to call the doctor. Do not go in large crowds due to risks for infection, Monitor their site for infection.

40

What is your priority nursing intervention with a esophageal cancer patient?

a) Maintaining nutritional intake
b) Preventing aspiration
c) Managing the patients pain
d) Allow ventilating of feelings

b) Preventing aspiration

ABC

41

What are Esophageal Diverticula?

Sacs resulting from herniation of esophageal mucosa into surrounding tissue

42

How are Esophageal Diverticula Diagnosed?

by EGD (esophagogastroduodenoscopy) Where they stick a tube down and look.

43

***** What is the Nutrition for Esophageal Diverticula?

These people do not usually have surgery so we focus on educating them about nutrition.

Types of food to avoid is seeds and nuts. They need to eat small meals and nothing that can get caught in the little sacs. Once they get caught in the sac, it can get infected and it can rupture.

These people need to sleep a little elevated and not flat in the bed. Do not lay down after you eat. GERD types of interventions. Avoid vigorous exercise after meals.

Avoid restrictive clothing.

44

The client understands dietary instructions from the nurse related to esophageal diverticula when he states the following?
a) I should eat semi-soft foods and smaller meals
b) I should avoid any liquids with my meal
c) I should eat two large meals daily
d) It is okay to take a nap after I eat a snack

a) I should eat semi-soft foods and smaller meals

45

What is the Etiology of Esophageal Trauma?

Blunt injuries, chemical burns (most common), surgery, endoscopy, severe vomiting

46

What are the S&S of Esophageal Trauma?

Pain Impaired swallowing and nutrition. it can create problems with the lungs as well. Priority is Airway and Breathing. Could have nausea, vomiting, bleeding, chest pain.These people will be NPO for about a week to rest the area,

47

*****What is the Assessment for Esophageal Trauma?

Promptly assess the client for potential perforation. Pain in abdomen, rigid and distended.

48

The nurse is caring for a client who has just had an upper GI endoscopy. The client’s vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed personnel to take the vital signs. One hour later the UAP reports the client who was previously afebrile, has developed a temperature of 101.8 degrees F. What should the nurse do in response to this reported assessment data?

a) Promptly assess the client for potential perforation.

b) Tell the UAP to change thermometers and retake the temperature

c) Plan to give the client Tylenol as ordered to lower the temperature

d) Ask the assistant to bathe the client with cool water

a) Promptly assess the client for potential perforation.