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Gastrointestinal Alterations For Medical Surgical Nursing

The document discusses Gastroesophageal Reflux Disease (GERD). It defines GERD as reflux of stomach acid into the esophagus, which causes mucosal damage. Possible causes include an incompetent lower esophageal sphincter, obesity, smoking, and hiatal hernia. Left untreated, GERD can lead to complications like esophagitis, esophageal ulcerations, Barrett's esophagus, respiratory complications, and dental erosion. Diagnostic tests include endoscopy, pH monitoring, and esophagrams. Treatment involves lifestyle modifications, medications like PPIs, and sometimes surgery. Nursing care focuses on patient education to prevent exacerbations and monitor for medication side effects.

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yolondanic
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347 views26 pages

Gastrointestinal Alterations For Medical Surgical Nursing

The document discusses Gastroesophageal Reflux Disease (GERD). It defines GERD as reflux of stomach acid into the esophagus, which causes mucosal damage. Possible causes include an incompetent lower esophageal sphincter, obesity, smoking, and hiatal hernia. Left untreated, GERD can lead to complications like esophagitis, esophageal ulcerations, Barrett's esophagus, respiratory complications, and dental erosion. Diagnostic tests include endoscopy, pH monitoring, and esophagrams. Treatment involves lifestyle modifications, medications like PPIs, and sometimes surgery. Nursing care focuses on patient education to prevent exacerbations and monitor for medication side effects.

Uploaded by

yolondanic
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Gastroesophageal Reflux

Disease
(GERD)
Ch.42 pp. 931-935

GERD

Reflux of stomach acid into


esophagus
Causes mucosal damage

Possible causes

Incompetent LES
Obesity
Cigarette and cigar smoking
Hiatal hernia

GERD

What clinical manifestations may the pt.


with GERD exhibit?

GERD
Complications

Esophagitis
Can lead to strictures, scar tissue, and
dysphagia

Esophageal ulcerations
Barretts esophagus

Precancerous lesion

Respiratory complications
Dental erosion

GERD
Diagnostic Studies
History and Physical
Upper GI endoscopy with biopsy
Esophagram (barium swallow)
Motility Studies
pH monitoring
Radionuclide studies

GERD
Collaborative Care
Lifestyle modification
Nutritional Therapy
Drug therapy
Surgery

GERD
Collaborative Care

Lifestyle modification

Avoid triggers
Weight reduction
Smoking cessation
Manage stress

GERD
Collaborative Care

Nutritional Therapy
Avoid foods /items that decrease LES pressure (Table 427)

Alcohol
Anticholinergics
Chocolate
Fatty foods
Nicotine
Peppermint

Avoid milk
Small frequent meals
Increase saliva production
Avoid late evening meals
Fluid between rather than with meals
Avoid foods that irritate esophagus
Positioning

GERD
Collaborative Care

Drug Therapy
Goals of drug therapy

Decrease volume and acidity of reflux


Improve LES function
Increase esophageal clearance
Protect esophageal mucosa

GERD
Collaborative Care

Drug Therapy
Proton Pump Inhibitors (eg. Prevacid, Prilosec, Protonix,
Nexium)

Histamine (H2)- Receptor Blockers (eg. Tagamet, Pepcid,


Zantac)

Prokinetic Agents (eg. Reglan)


Antiulcer, Protectants (eg. Carafate)
Cholinergics (eg. Urecholine)
Antacids (eg. Amphojel, Tums, Alka-Seltzer, Maalox, Mylanta)
Prostaglandins (eg. Cytotec)

GERD
Collaborative Care

Surgical Therapy

Nissen and Toupet fundoplications


Fundus of stomach wrapped around lower portion
of esophagus

LINX reflux management system

Titanium beads with magnetic core implanted into


LES

Endoscopic Therapy

Endoscopic mucosal resection


Photodynamic therapy
Cryotherapy
Radiofrequency ablation

GERD
Nursing Management

Pt Teaching

Elevation of head of bed 30 degrees


Not lying down for 23 hours after eating
Avoidance of late-night eating
Evaluating effectiveness of medications
Observing for side effects of medications
Avoidance of factors that cause reflux
Stop smoking
Avoid alcohol and caffeine
Avoid acidic foods

Stress reduction techniques


Weight reduction, if appropriate
Small, frequent meals

GERD
Nursing Management

Postop Care

Prevent respiratory complications


Maintain F & E balance
Prevent infection
Respiratory assessment
Deep breathing
Pain management
Meds to prevent N & V
Fluids (peristalsis present) then gradually
progress to solids
Avoid gas producing foods

Ch.43 pp.973-974

Most

common cause of RLQ pain

Opening

of the appendix is obstructed or

blocked
Initial

obstruction associated with:

Fecaliths (most common cause)

Perforation
Peritonitis

Elevation in temperature
Increased pulse

Diagnostics

History and Physical


Laboratory findings

CBC including WBC with


diff.
Serum electrolytes
Abdominal paracentesis
and culture of fluid

Imaging Diagnostics

Abdominal X-ray
Ultrasound
CT scan

Collaborative Care

Appendectomy

Antibiotics
Fluid replacement

Hospitalized

and examined by HCP

Keep pt NPO

DO NOT..
Give laxative or enema
Post-op

management

Early ambulation
Advance diet as tolerated

Ch.43 pp.974-975

Life threatening

Bacterial contamination of peritoneum

Massive fluid shifts

What clinical manifestations may the pt. with


peritonitis exhibit?

DIAGNOSTIC STUDIES

COLLABORATIVE CARE

CBC
WBC
Peritoneal aspiration
Abdominal X-ray
Ultrasound
CT scans

Antibiotics
NG suction
Analgesics
IV fluids
Surgery

What findings should the nurse assess for in the


pt. with suspected peritonitis?

Nursing Diagnosis
Acute pain
Risk for deficient fluid volume

Anxiety

Planning: Pt. goals


Resolve inflammation
Relieve abdominal pain

No complications
Normal nutritional status

Nursing Implementation
IV access
Fluid replacement
Antibiotics

Pain management
Pt. may be positioned with knees flexed
Decrease anxiety
Monitor I & O
Monitor VS
Antiemetics
NPO
NG tube
Oxygen therapy
Post-op care for laparotomy

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