Upper GI

mattisensept's version from 2017-10-31 06:09

Section 1

Question Answer
nausea feeling of discomfort in epigastrium w/conscious desire to vomit
vomitingforceful ejection of partially digested food & secretions from upper GI tract
etiology gi disorders, pregnancy, infectious disease, CNS disorders, cardio probs, metabolic disorders, drug side effects
clinicallysubjective complaint, accompanied by anorexia, dehydration can rapidly occur, H20 & esentail electrolytes are lost
if gastric HCL lostmetabolic alkalosis
is small intestine metabolic acidosis from NaHC03
collaborative caredetermine underlying cause and treat, contents of emesis, treatment (dugs/nutrition)
nutritional therapy IV (replace), NG (decompress), advance diet, fluids between meals, high carbs (easier to digest)
nursing diagnosis nausea, fluid volume deficit, imbalanced nutrition
if pt. hospitalizedIV fluids & NPO status, NG tube, record I & O, assess for dehydration, maintain quiet, odor free environment, teaching to prevent
goalexperience minimal or no N/V, normal electrolyte levels & hydration status, return to normal pattern of fluid balance & nutrient intake
geronotological considerationsolder pt. more likely to have cardiac or renal insufficiency that places them at greater risk when fluid and electrolyte balance is altered
if CHF caution w/ fluid replacement
unintended weight lossnot normal. cancer or depression?

Section 2

Question Answer
seratonin antagonistsblock actin of serotonin (causes N/V)
phenothiazinesblock dopamine receptors that trigger N/V
antihistaminesblocks histamine receptors that trigger N/V
prokinetic agentsinhibit action of dopamine
anticholinergic block cholinergic pathways to vomiting center
butyrophenone block neurochemicals that trigger N/V
neurokinin-1 receptor antagonist block interaction of substance P at NK-1 receptor preventing N/V
corticosteroids not well understood how it prevents N/V
cannabinoidsinhibit vomiting control mechanism in the medulla oblongata

Section 3

Question Answer
GERDany clinically significant symptomatic condition of histophatological alteration presumed to be secondary to reflux of gastric contents into the lower esophagus
etiology & pathono single cause but predisposing factors--> abnormal relaxation of LES, hiatal hernia, decreased esophageal clearance & gastric emptying
resultacidic gastric secretions reflux and causes irritation and inflammation
clinical manifestations heartburn occurring more than once a week & becoming more severe or occurring @ night and waking a person from sleep
top two complaints burning, tight sensation felt beneath lower sternum & spread upwards
other complaints possiblewheezing, coughing, dyspnea, hoarseness, sore throat, lump in throat, choking
regurgitationhot, bitter, or sour liquid
gastric symptomsearly satiety, post meal bloating, N/V (delayed gastric emptying)
gerontological considerationsincreases w/age, diaphragm weaker, increased obesity, riskier if surgical interventions, harder to get lifestyle change compliance, are @ increased risk of aspiration pneumonia

Section 4

Question Answer
barium swallowmetallic compound that shows up on x-rays, to visualize upper stomach & esop
endoscopy look @ esophagus, stomach & duodenum
biopsy & cytologic specimens diagnose stomach and esophageal carcinoma
esophageal manometric studiesmotility study that measure pressure within esophagus
radionuclide testsmeasures transit time & % of emptying of esophagus (rate of esophageal clearance)

Section 5

Question Answer
life style modificationsstop smoking, elevate HOB, do not lie down 2-3 hours after eating
nutritional therapy avoid acid or acid producing foods, smaller more frequent meals none near bedtime, do not lie down after eating, avoid triggers
proton pump inhibitors decrease HCL acid secretion & irritation, SE: HA, abdominal pain, nausea, diarrhea, vomiting, flavtulence
histaminedecrease conversion of pepsinogen to pepsin and irritation of the esophageal & gastric mucosa. SE: HA/abdominal pain, constipation, diarrhea
protokinetic agentsblock effects of dopamine, increase gastric motility & emptying, reduce reflux. SE: anxiety, hallucinations
antiulcer protectants act to form protective layer. SE: constipation
cholinergicincrease lower esophageal sphincter pressure, improve esophageal emptying, increase gastric emptying, SE: light headedness, syncope, flushing, diarrhea, stomach cramps, dizziness
antacids, acid nebulizersneutralize HCl acid, taken 1-3 hr after meals & @ bedtime
prostaglandin abdominal pain, diahrrhea, GI bleeding, uterine rupture if pregnant

Section 6

Question Answer
hiatal herniaherniation of a portion of the stomach into the esophagus through an opening, or hiatus, in the diaphragm
sliding above diaphragm. part of the stomach slides through the hiatal opening in the diaphragm. occurs when pt is supine
rolling/paraesophagealfundus & greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus
manifestationspossible asymptomatic, can be the same as GERD
nursing careteach pt. to reduce intraabdominal pain by eliminating constricting garments and avoiding lifting and straining
complicationsGERD, esophagitis, hemorrhage, ulcer, stenosis, regurgitation, strangulation

Section 7

Question Answer
esophageal cancer incidence increasesw/age, men>women, blacks and alaska natives
risk factorbarretts esophagus, from esophagus lining damaged from stomach acid
predisposing factors smoking, alcohol, diet low in fruits and veggies, achalasis, exposure to asbestors & metal, hx of GERd,
manifestationssymptoms late in disease, progressive dysphagia, pain (epigastric area, substernally, or in back, may radiate to neck and jaw), sore throat, choking, hoarseness, weight loss is common
really bad complicationshemorrhage (w/erosion thru esophagus to aorta), esophageal perforation (fistula formation into lung of trachea), obstruction of esophagus, metastasis (via lymph system)
diagnosticsbarium swallow w/fluroscopy, endoscopic biopsy (definitive diagnosis), endoscopic ultrasonography (stages disease) bronchoscopic examination, CT & MRI
treatment poor prognosis RT late stage diagnosis, surgery, radiation, chemo, best results w/all 3
post op expect an NG tube (do not reposition), respiratory @ great risk for spiration, cardiac dysrhythmias more likely, , fowlers or semi becauxe of reflux,
nutrition therapy after sx pts, are given parenernal fluids, after BS return --> 30-60ml of water given hourly, gradual progression to small, frequent bland meals, position upright to avoid regurgitation
nursing planachieve optimal nutritional intake, experience relief of symptoms, understand prognosis of the disease, experience a quality of life appropriate to disease progression
health promotionhealth counseling focuses on elimination of smoking & alcohol intake, maintain good oral hygiene & diet, barretts esophagus needs diligent monitoring,
acute interventionnutritional and oral care, high calorie & protein
explain surgical procedureteach about chest tubes, IV lines, NG tubes, gastrostomy tube,
evaluation patent airway, relief of pain, swallow comfortably, adequate nutritional intake, understand prognosis, experience quality of life appropriate to disease progression,