Term
|
Definition
There is no single cause of GERD
Lower esophagus becomes overwhelmed by the reflux of acidic gastric secretions
Lower esophageal sphincter (LES) is the anti-reflux barrier |
|
|
Term
|
Definition
Hiatal hernia
Incompetent LES
Decreased esophageal clearance (decrease in esophongeal clearing-like smoking)
Decreased gastric emptying (elderly, diabetes) |
|
|
Term
|
Definition
|
|
Term
GERD
Clinical manifestation |
|
Definition
Heartburn (pyrosis) **most common
Dyspepsia (epigastric pain)
Hypersalivation
Respiratory symptoms
Wheezing
Coughing
Dyspnea
Hoarseness
Sore throat
Globus sensation (feeling of lump in throat)
Regurgitation
Early satiety
Postmeal bloating
N/V |
|
|
Term
|
Definition
Esophagitis
Barrett’s esophagus
Respiratory complications (atypical)
Bronchospasm
Laryngospasm
Cricopharyngeal spasm
Asthma
Bronchitis
Pneumonia |
|
|
Term
|
Definition
History & Physical
Barium swallow
Endoscopy
Trial of PPI therapy* (pt. are given a trial to see if symptoms get better and go away)
Biopsy and cytology
Manometric studies |
|
|
Term
|
Definition
| Early in the morning, 30 minutes before meals, decrease volume of acid and protect muscosa |
|
|
Term
|
Definition
| Swallowed to make sure everything opened, sets up like concrete, we aren't worried about leaking out |
|
|
Term
|
Definition
| Mix with fluids, check for leak or know there is |
|
|
Term
|
Definition
Lifestyle modification
Nutritional therapy
Drug therapy
Improve LES function
Increase esophageal clearance
Decrease volume and acidity of reflux
Protect esophageal mucosa
Surgical therapy
Endoscopic therapy |
|
|
Term
|
Definition
| Stimulant creates acid production |
|
|
Term
|
Definition
| Fatty foods take longer to break down. Avoid red wine, orange juice, chew gum to produce salvia! |
|
|
Term
| Hiatal Hernia is associated with |
|
Definition
Weakening of the diaphragm
Obesity
Kyphosis
Factors that increase
intraabdominal pressure
Girdles
Pregnancy
Intense physical activity & heavy
lifting on a continual basis
Pregnancy or ascites
Tumors |
|
|
Term
| GERD Nursing diag and inter |
|
Definition
dia-imbalanced nutrition, pain, sleep disturbances
Interventions-assess pain, sleep status, some spit up blood, take UPI's (?) first thing in morning on an empty stomach, eat small meals, after eating sty up 2-3 hrs, bed up 30 degress, avoid smoking stress, late night eating, fatty foods, avoid alcohol and caffeine |
|
|
Term
| GERD Nursing interventions |
|
Definition
Activities: Teaching
Avoid factors causing GERD
Smoking
Stress
Late night eating
Alcohol and caffeinated products
Elevate HOB 30 degrees (4 to 6 inch blocks)
Do not lie down for 2-3 hours after eating
Eat small, frequent meals
Chew food thoroughly |
|
|
Term
| Nissen Fundoplication Nursing interventions |
|
Definition
Activities: Post-op care: Lap/Open Nissen
Prevention of respiratory complications
Maintenance of F/E balance
Prevention of infection
Diet
Nsaids-good for pain, bad for GERDS |
|
|
Term
UGI Bleed (Upper GI Bleed)
DAT STUFF! |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| bloody vomitus or coffee-ground appearance |
|
|
Term
| Approximately 25% persons on chronic NSAIDs develop |
|
Definition
|
|
Term
| 80-85% of pts with massive hemorrhage spontaneously |
|
Definition
|
|
Term
| Stress Related Mucosal Disease (Stress Ulcers) |
|
Definition
| mucosal injury is found in 70-90% of ICU patients (see picture above) |
|
|
Term
| Clinically Important Bleeding |
|
Definition
| Spontaneous decrease of more than 10 mm in SBP (with pt sitting up) or increase of 20 bpm in heart rate or decrease of more than 2 g/dL in hbg. |
|
|
Term
|
Definition
| Physical exam (LOC, Restless,VS, character/rate of pulse, peripheral perfusion, skin color/cold or clammy) |
|
|
Term
| UGI Bleed Diagnosis: Nandas |
|
Definition
| Risk for aspiration r/t active bleeding and altered LOC, Decreased cardiac output r/t loss of blood, Deficient fluid volume r/t acute loss of blood or gastric secretions, Ineffective peripheral tissue perfusion r/t loss of circulatory volume, Anxiety |
|
|
Term
|
Definition
| Prophylaxis through education regarding medications & lifestyle, HOB up to prevent aspiration, Accurate I&O, H&H Q 4-6hr, O2 PRN, Assess stools/emesis/NG, Iced gastric lavage, 2 IV sites (#20 or bigger), avoid red foods/beets, Note bowel sounds, watch for tense rigid abd as may indicate perforation or peritonitis, Endoscopic hemostasis by electrocoagulation, Drug therapy with Octreotide (Sandostatin) to stop bleeding & drugs to protect stomach and decrease acid, Surgical |
|
|
Term
|
Definition
| Peptic Ulcer Disease Accounts for 50% of the cases of UGI bleeds |
|
|
Term
Peptic Ulcer
2 Reasons for ulcers to develop |
|
Definition
Increase Acid Production
Decreased mucosal
Protection |
|
|
Term
| Peptic ulcer disease Types |
|
Definition
Acute or Chronic
Gastric
Duodenal |
|
|
Term
|
Definition
2 reasons: acid up or barrier broken
Ulcers develop in acidic environment*
Stomach protected from autodigestion by the gastric mucosal barrier*
Mucosal surface is renewed every 3 days
Destroyers of mucosal barrier:
H. pylori
ASA and NSAID’s
Corticosteroids
Cytotoxic drugs
Increased vagal stimulation |
|
|
Term
|
Definition
Pain located high in epigastrium
Pain occurs with meal or 1-2 hours after meal (burning/gaseous)
More deadly b/c more common over age 50
Erosion through gastric mucosa causes worsened pain with ingestion of food |
|
|
Term
|
Definition
Pain located midepigastric region below the xiphoid process
Posterior ulcers may cause back pain
Pain may get better with eating and then it occurs again 2-5 hours later after meal (burning or cramp-like)
80% of all peptic ulcers are Duodenal ulcers (increased risk 35-45y/o)
H. pylori found in 90-95% of pts with Duodenal ulcers |
|
|
Term
| PUD Clinical Complications |
|
Definition
Hemorrhage
Most common complication
Erosion of granulation tissue at base of ulcer or through a blood vessel
Duodenal ulcers – greater % GI bleeding
Perforation
Considered most lethal complication
Ulcer penetration through serosal surface with spillage of gastric or duodenal contents into peritoneal cavity
Characterized by sudden onset of severe pain
Gastric Outlet Obstruction
BP is down, tachycardia, look and feel sick
Older they are the worst their prognosis |
|
|
Term
| Gastric outlet obstruction |
|
Definition
Narrowing of pylorus
Long history of ulcer pain
Vomiting common – often projectile
Generalized upper abdominal discomfort
Pain worse at end of day |
|
|
Term
|
Definition
History & Physical
Endoscopy
Lab studies
Antibody tests
Urea breath test
Stomach biopsy
Barium contrast studies |
|
|
Term
|
Definition
Adequate rest
Dietary modification
Smoking cessation
Drug therapy
H2 receptor blockers
PPI’s
Antibiotics (H. pylori)
Antacids
Anticholinergics
Cytoprotective drugs
Stress management |
|
|
Term
|
Definition
Therapy R/T PUD complication: Acute exacerbation
Stomach decompression
IV fluid replacement
Conservative therapy treatment
5 year follow up
Therapy R/T PUD complication: Perforation
Stomach aspiration and decompression
Fluid volume replacement
Antibiotic therapy
Surgical therapy |
|
|
Term
PUD
Collab Care
Therapy R/T PUD complication: Gastric outlet obstruction |
|
Definition
Stomach decompression
Fluid/electrolyte replacement
Endoscopic pyloric dilation
Surgical therapy |
|
|
Term
|
Definition
| Electolyte imbalance, nausea, ineffective health managaement, pain |
|
|
Term
| Peptic Ulcer Disease Nursing Interventions: Non-surgical patient |
|
Definition
Activities:
Monitor VS
Keep pt NPO
NG tube maintenance
IV fluid/electrolyte replacement
Promote physical and emotional rest
Administer prescribed medications
Monitor for complication – hemorrhage, perforation, gastric outlet obstruction
Teaching |
|
|
Term
Collaborative Care (Treatment):
PUD |
|
Definition
Simple closure with omental graft
– repairs perforation
Pyloroplasty and vagotomy
– repairs gastric outlet obstruction
Billroth I and II, vagotomy and pyloroplasty
– to facilitate ulcer removal/reduction |
|
|
Term
| PUD Post-op Complications |
|
Definition
Dumping syndrome
Large bolus of hypertonic fluid enters intestines 15-30 minutes following a meal
Results in decreased plasma volume
Manifestations:
Generalized weakness
Sweating
Palpitations
Dizziness
Abdominal cramping
Urge to defecate -- diarrhea |
|
|
Term
|
Definition
| Postprandial hypoglycemia |
|
|
Term
| Postprandial hypoglycemia |
|
Definition
Variant of dumping syndrome
Dumping of high carbohydrate fluid bolus
Results in hyperglycemia and excessive insulin secretion leading to hypoglycemia
Manifestations – same as with any hypoglycemic reaction
Occurs approximately 2 hours following meals |
|
|
Term
| PUD Nursing Interventions: Surgical patient |
|
Definition
Assessment
Activities:
Routine pre/post-op care/teaching
Monitor VS
NG tube maintenance
Monitor for bowel obstruction
IV fluid/electrolyte replacement
Promote physical and emotional rest
Provide pain relief measures
Teaching |
|
|
Term
Assessment
Activities:
Routine pre/post-op care/teaching
Monitor VS
NG tube maintenance
Monitor for bowel obstruction
IV fluid/electrolyte replacement
Promote physical and emotional rest
Provide pain relief measures
Teaching |
|
Definition
Increased occurrence in elderly R/T increased NSAID use
Pain may not be first sign of ulcer – frank GI bleeding
Higher mortality R/T existing health problems
Treatment same as younger adult with emphasis on preventive measures |
|
|
Term
|
Definition
| Process where the body uses food for energy, growth, and maintenance and repair of body tissues. |
|
|
Term
|
Definition
Carbohydrates
Fats
Proteins
Vitamins and minerals |
|
|
Term
|
Definition
| complex nitrogenous organic compounds |
|
|
Term
|
Definition
tissue growth, repair and maintenance
Body regulatory functions
Energy production
Amino acids-fundamental structure
4 kcal/gm
10-35% daily caloric needs should be protein |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Eat plant food
Dairy products
Eggs |
|
|
Term
|
Definition
Avoid stereotyping
Effects of cultural food choices
Sensitivity to cultural beliefs regarding nutrition and food choice
Teaching |
|
|
Term
| Gerontologic Considerations |
|
Definition
Changes in oral cavity
Changes in digestion and motility
Medical conditions
Changes in musculoskeletal system
Changes in sensory perception
Lifestyle changes |
|
|
Term
|
Definition
Socioeconomic status
Cultural influence
Psychologic disorders
Medical conditions
Medical treatments |
|
|
Term
|
Definition
Phases of starvation
Carbohydrates
Amino Acids – negative nitrogen balance
Body fat (5-9 days)
Generally depleted in 4-6 weeks
Body protein (internal organs and plasma) |
|
|
Term
Clinical Manifestations
Malnutrition |
|
Definition
See Table 40-8, pg. 926 in textbook
Affects all body systems
Most obvious manifestations are noted in:
Skin
Eyes
Mouth
Muscles
CNS |
|
|
Term
Mal Diagnostics
Laboratory studies |
|
Definition
Albumin
Prealbumin
Transferrin-protein that transports iron
Electrolytes
CBC |
|
|
Term
Mal Diagnosis
Anthropometric Measurements |
|
Definition
Height and weight
BMI
Recent weight change |
|
|
Term
|
Definition
Assessment:
Nutritional Screening
Height, Weight, BMI
Diet history |
|
|
Term
Nursing Management – Interventions:
Malnutrition |
|
Definition
Activities:
Daily weights
I & O
Calorie counts
Monitor wound healing
Nutritional supplements
Oral feeding
Enteral nutrition
Parenteral nutrition |
|
|
Term
|
Definition
Oral Feeding:
High calorie oral supplements
Milk shakes
Puddings
Commercial products
Ensure
Boost |
|
|
Term
|
Definition
| Tube inserted into the stomach, duodenum, or jejunum |
|
|
Term
|
Definition
Anorexia
Orofacial fractures
Head/neck cancer
Neurologic or psychiatric conditions
Extensive burns
Chemotherapy or radiation therapy patients |
|
|
Term
| Enteral Nutrition procedures |
|
Definition
Patient position
Tube patency and position
Formula (closed system 24hr or open system 8hr)
Administration of feeding
General nursing considerations |
|
|
Term
|
Definition
Vomiting and/or Aspiration
Diarrhea
Constipation
Dehydration |
|
|
Term
|
Definition
|
|
Term
Parenteral Nutrition
Indications |
|
Definition
: When GI tract cannot be used for the ingestion, digestion, and absorption of essential nutrients.
See table 40-14, pg. 936 in textbook |
|
|
Term
Parenteral Nutrition:
Procedure |
|
Definition
Aseptic technique is critical
PN solution is excellent media for microbial growth
Use of inline filter
0.22 micron filter
1.2 micron filter
Filter and tubing change
PN with lipids
PN with amino acids and dextrose
Rate control |
|
|
Term
Parenteral Nutrition:
Complications |
|
Definition
Infection
Metabolic
Mechanical
-Insertion
-Dislodgement
-Thrombosis of great vein
-Phlebitis |
|
|
Term
| Parenteral Nutrition – Nursing Interventions |
|
Definition
Monitor VS
Daily weights
Monitor lab: glucose, electrolytes and BUN, CBC, and hepatic studies 3 x weekly until stable
Strict aseptic catheter care
Monitor for S/S of infection
Monitor for refeeding syndrome
Strict 24 hour bag changes |
|
|
Term
|
Definition
Most common nutritional problem
Affects nearly 1/3 of population
BMI >30
Second leading cause of preventable disease in U.S.
Estimated healthcare costs R/T obesity are as high as $147 billion annually |
|
|
Term
|
Definition
Classification by fat distribution:
Gynoid obesity
(pear shape)
Android obesity
(apple shape |
|
|
Term
|
Definition
Cardiovascular disease
Respiratory problems
Diabetes mellitus
Musculoskeletal problems
GI and liver problems
Cancer |
|
|
Term
| Gerontologic Considerations Obesity |
|
Definition
More common in older women than men
Exacerbates age-related declines in physical function
Live 6-7 years less than those of normal weight
Contributes to increased urinary incontinence
Increases risk of cancer – breast, colorectal, gallbladder, endometrial, and prostate |
|
|
Term
| Obesity Collaborative Care (Treatment): |
|
Definition
Nutritional therapy
Exercise
Behavior modification
Support groups
Drug therapy
Appetite suppressing drugs-Meridia (not for pt’s w/heart disease or CVA)
Nutrient absorption blocking drugs-Xenical
Surgical therapy |
|
|
Term
| Collaborative Care (Treatment): Surgical Therapy |
|
Definition
Restrictive Surgery
Vertical banded gastroplasty
Adjustable gastric banding *** (pouch holds 10-15ml)
Vertical Sleeve Gastrectomy
Malabsorptive Surgery (pouch holds 100-200ml)
Biliopancreatic diversion with or w/o duodenal switch
Combination – Restrictive and Malabsorptive ***
Roux-en-Y gastric bypass
(pouch holds 20-30ml |
|
|
Term
| Obesity Nursing Management: |
|
Definition
Assessment
Pre-op care
Post-op care
-Oxygenation
-Pain control
-Strict C&DB
-Strict position changes and ROM -exercises
-Monitor for S/S of infection
-NG tube maintenance |
|
|
Term
| Obesity nursing management |
|
Definition
Post-op care (continued)
Skin care
Feeding
First 24 hours
After 24 hours to 2 weeks
2-4 weeks
4-6 weeks
Home Care |
|
|
