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Chapter 33

Chapter 33. Nursing Care of Patients with Upper Gastrointestinal Disorders. Nausea and Vomiting. Nausea: Urge to Vomit Vomiting: Expelling Stomach Contents Through Esophagus and Mouth. Therapeutic Interventions. None Protect Airway Medications IV Fluids NG Tube

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Chapter 33

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  1. Chapter 33 Nursing Care of Patients with Upper Gastrointestinal Disorders

  2. Nausea and Vomiting • Nausea: Urge to Vomit • Vomiting: Expelling Stomach Contents Through Esophagusand Mouth

  3. Therapeutic Interventions • None • Protect Airway • Medications • IV Fluids • NG Tube • Clear Liquids, Dry Toast

  4. Nursing Diagnoses • Nausea • Risk for Aspiration • Deficient Fluid Volume

  5. Anorexia • Lack of Appetite

  6. Eating Disorders • Anorexia Nervosa • Bulimia Nervosa

  7. Anorexia Nervosa • Females • Age 12 to 18 Years • Treatment goal • Restore Nutritional Health • 18% Die

  8. Anorexia Nervosa (cont’d) • Symptoms • Severe Weight Loss • Low Self-esteem • Compulsive Dieting • Disturbed Body Image

  9. Anorexia Nervosa (cont’d) • Nursing Care • Therapeutic Relationship • Vital Signs • Daily Weights • Intake/Output of Food and Fluids

  10. Anorexia Nervosa (cont’d) • Complications • Poor Nutrition, Electrolyte Imbalances • Decreased Vital Signs • Osteoporosis • Muscle Loss • Diabetes

  11. Bulimia Nervosa • Compulsive Eating, Self-induced Vomiting • Laxatives • “Binge–purge” • Young Women • Enamel Erosion of Front Teeth • Metabolic alkalosis

  12. Bulimia Nervosa (cont’d) • Treatment Goal • Restore Nutritional Health • Nursing Care • Therapeutic Relationship • Vital Signs, Daily Weights • Intake/Output of Food and Fluids

  13. Nursing Diagnoses: Eating Disorders • Imbalanced Nutrition: Less Than Body Requirements • Body Image, Disturbed

  14. Obesity • Weight 20% or Greater Than Ideal Body Weight • BMI • Overweight: 25 to 29.9 Kg/m2 • Obese: >30 Kg/m2

  15. Body Mass Index (BMI)

  16. Obesity (cont’d) • Caloric Intake Exceeds Energy Expenditure • Comorbidites: Diseases Associated with Obesity • Morbid Obesity: BMI >40

  17. Therapeutic Interventions • Weight Loss Through Exercise and Calorie Restriction • Support Groups • Behavior Modification

  18. Surgical Management • Types of Bariatric Surgery • Restrictive • Limits How Much Stomach Can Hold • Malabsorption • Decreases Calorie/Nutrient Absorption • Combination • Restrictive and Malabsorption

  19. Surgical Management (cont’d) • Restrictive • Laparoscopic Adjustable Gastric Banding  • Vertical Banded Gastroplasty (VBG) • Combination • Roux-en-Y Gastric Bypass

  20. Roux-en-Y Gastric BypassVertical Banded Gastroplasty

  21. Complications of Gastric Restrictive Surgeries • Vomiting • Erosion of the Gastric Tissue • Breakdown of Staple Line • Leaking of Stomach Secretions • Infection or Death

  22. Postoperative Care • Clear, Liquid Diet • Progresses to Full Liquids, Pureed Foods • Regular Foods at 6 Weeks

  23. Nursing Diagnosis: Obesity • Imbalanced Nutrition: More Than Body Requirements

  24. Oral Health Care • Important to Overall Health • Often Neglected in Daily Care • Oral Hygiene with Chlorhexidine Gluconate • Prevents Pneumonia • Reduces Ventilator-associated Pneumonia

  25. Oral Health Care (cont’d) • Prophylactic Antibiotics • Xerostomia (Dry Mouth) • Artificial Saliva Substitute • Dentures • Gingival Recession • Fluoride Gel or Rinse

  26. Oral Health Care (cont’d) • Gingivitis • Flossing Daily • Candida Albicans (Yeast Infection) • Nystatin • Angular Cheilosis

  27. Stomatitis • Inflammation of Oral Cavity • Causes • Aphthous Stomatitis (Canker Sores) • Herpes Simplex Virus Type I (Cold Sores)

  28. Oral Cancer • Risk: Alcohol or Tobacco Use • Detected Early, Curable • Painless • Difficulty in Chewing, Swallowing, Speaking • Biopsies • Radiation, Chemotherapy, Surgery

  29.  Radical Neck Dissection

  30. Oral Cancer Nursing Care • Referral: Alcohol/Tobacco Cessation • Preoperative Teaching • Postoperative • Airway • Communication • Nutrition

  31. Esophageal Cancer • Risk: Alcohol or Tobacco Use • Detected Late, Metastasizes • Difficulty Swallowing, Feeling Full, Pain in Chest, Foul Breath, Food Regurgitation • EGD, Biopsy

  32. Esophageal Cancer (cont’d) • Radiation • Chemotherapy • Surgery • Esophagogastrostomy • Dacron Esophageal Replacement • Esophagoenterostomy

  33. Esophageal Cancer (cont’d) • Nursing Diagnoses • Pain • Risk for Deficient Fluid Volume • Imbalanced Nutrition: Less Than Body Requirements

  34. Hiatal Hernia Lower Esophagus/Stomach Slides up Through Hiatus of Diaphragm into Thorax

  35. Hiatal Hernia (cont’d) • Occurs In • Women • Those over 60 • Obesity • Pregnancy

  36. Hiatal Hernia (cont’d)

  37. Hiatal Hernia (cont’d) • Signs and Symptoms • None • Pain • Heartburn • Fullness • Reflux

  38. Hiatal Hernia (cont’d) • Diagnosis • X-Ray • Fluoroscopy

  39. Therapeutic Interventions • Antacids • Small Meals • No Reclining 1 Hour After Eating • Raise Head of Bed 6 to 12 Inches • No Bedtime Snacks, Spicy Foods, Alcohol, Caffeine, Smoking

  40. Hiatal Hernia (cont’d) • Surgical Management • Fundoplication

  41.   Fundoplication

  42. Hiatal Hernia (cont’d) • Nursing Care • Teaching • Preoperative Care • Postoperative • Dysphagia with Eating

  43. Gastroesophageal Reflux Disease (GERD) • Pathophysiology • Gastric Secretions Reflux into Esophagus • Esophagus Damaged • Lower Esophageal Sphincter Does Not Close Tightly

  44. Gastroesophageal Reflux Disease (GERD) (cont’d) • Signs and Symptoms • Heartburn • Regurgitation • Dysphagia • Bleeding

  45. Gastroesophageal Reflux Disease (GERD) (cont’d) • Complications • Aspiration • Scar Tissue • Diagnosis • Barium Swallow • Esophagoscopy

  46. Therapeutic Interventions • Lifestyle Changes • Medications • Antacids • H2 Receptor Antagonists • Proton Pump Inhibitors • Prokinetic Agents

  47. Gastroesophageal Reflux Disease (GERD) (cont’d) • Esophy X • Endoscopic Procedures • Fundoplication

  48. GERD Complications • Esophagitis • Barrett's Esophagus (Precancerous) • Esophageal Cancer • Bronchospasm • Larygeospasm • Aspiration Pneumonia

  49. Barrett's Esophagus • Precancerous • Radiofrequency Ablation

  50. Gastroesophageal Reflux Disease (GERD) (cont’d) • Nursing Diagnosis • Acute Pain

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