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UNCW NSG 326 - NSG 326 AH I WK #12 Problems of Digestion & Absorption Part 1

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NSG 326 Adult Health ISlide 2Slide 3Slide 4Gastroesophageal Reflux Disease (GERD)Slide 6GERD – Risk FactorsGERD – Risk Factors [cont.]GERD – Clinical ManifestationsSlide 10Clinical ManifestationsGERD - ComplicationsSlide 13Diagnostic StudiesSlide 15Collaborative CareCollaborative Care [cont.]Nursing ManagementNursing Interventions for GERDHiatal HerniaSlide 21Slide 22Slide 23Slide 24Slide 25Hiatal Hernia RepairSlide 27Post-Op Hiatal Hernia RepairSlide 29GastritisSlide 31Slide 32Etiology of GastritisRisks/Causes for GastritisClinical Manifestations of GastritisDiagnostics for GastritisSlide 37Slide 38Collaborative Management and Nursing InterventionsCollaborative Management and Nursing Interventions [cont.]Peptic Ulcer Disease [PUD]Slide 42Slide 43Risk Factors of PUDSlide 45Slide 46Complications of Chronic PUDClinical Manifestations of PUDSlide 49Slide 50Diagnostics for PUDDiagnostics for PUD [cont.]Collaborative Management & Nursing InterventionsSlide 54Slide 55Slide 56Slide 57Food PoisoningEscherichia coli O157:H7Slide 60E. Coli OutbreaksSlide 62Symptom ProgressionTreatmentPreventionBacterial Food PoisoningSlide 67NSG 326 Adult Health ISPRING 2011Week #12Problems of Digestion & AbsorptionPart 1Gastroesophageal Reflux Disease (GERD)The esophagus is the tube that carries food from the mouth to the stomachGER happens when a band of muscle at the end of the esophagus – the lower esophageal sphincter (LES) – does not close properlyThis allows stomach contents to leak back, or reflux, into the esophagus and irritate it If GER happens more than twice per week, then the patient may have GERDMost common GI problem seen in adultsGERD – Risk FactorsExcessive indigestion of:Fatty foods – stimulates a hormone that ↓ LES pressure & delays gastric emptyingChocolate – ↓ LES pressureCaffeine (e.g., cola drinks, coffee, tea) – ↓ LES pressurePeppermint – relaxes smooth muscleCarbonated drinks – increases pressure within the stomachCitrus fruits – can lead to esophagitisSpicy tomato drinks – can lead to esophagitisAlcohol – can lead to esophagitisMilk – increases gastric acid secretionGERD – Risk Factors [cont.]Cigarette smokingAssociated with decreased acid clearanceAlso inhibits saliva, a major buffer for the bodyDrugs that lower LES pressure (e.g., narcotics)Eradication of h. pylori infectionObesity, pregnancy, hiatal herniaGERD – Clinical ManifestationsPyrosis – heartburn following ingestion of food/drugs; painful and/or burning sensation in the esophagusDyspepsia – discomfort/pain centered in the upper abdomenRegurgitation – effortless return of food or gastric contents from the stomach into the esophagus or mouthOtolaryngologic symptoms – laryngitis, frequent sinus or ear infections, difficulty swallowingGastric symptoms – belching, bloated feeling after eating, N&VRespiratory symptoms – wheezing, coughing, dyspnea, bronchospasm, pneumonia r/t irritation of the upper airway from gastric secretionsHypersalivation – “water brash”Non-cardiac chest painBleeding r/t breakdown of tissuesLoss of dental enamel r/t erosion with acid reflux in the mouthClinical ManifestationsPyrosis Heartburn from reflux of acidic gastric secretions Burning Substernal to throatDyspepsia Pain or discomfort centered in upper abdomenGERD - ComplicationsEsophagitis (inflammation of the esophagus)Repeated exposure can lead to the formation of scar tissue & stricture of the esophagus, resulting in dysphagia (difficulty in swallowing)Barrett’s esophagus (esophageal metaplasia) – a pre-cancerous lesion; there is a relationship between chronic heartburn and the development of Barrett’s esophagus; increases risk of developing esophageal cancer by 30-foldDiagnostic StudiesBarium swallow/Upper GI series – can detect if there is a protrusion of the upper part of the stomachEndoscopy – useful in assessing LES competency, inflammation, scarring, & stricturesBiopsy – done to differentiate stomach or esophageal carcinoma from Barrett’s esophagusEsophageal manometry – measures pressure in the esophagus & LESMeasurement of esophageal activity (via pH) every hour for 24 hours – with reflux there is acid in the normally alkaline esophagusRadionuclide studies – can detect reflux & esophageal clearanceEmpiric trial of a proton pump inhibitor (PPI) – in patients with GERD, PPI treatment should result in reduction/elimination of symptomsCollaborative CareLifestyle modifications – teach patient to avoid factors that aggravate symptomsStop smokingDiet – does not cause GERD but food can aggravate symptomsAvoid fatty foods, caffeine, tomato-based &/or citrus products, & milk products (especially @ bedtime) Eat small, frequent meals (to prevent over-distension of the stomach); eat slowly & chew foods thoroughlyDrink fluids between (rather than with) meals to reduce gastric distensionCollaborative Care [cont.]Weight reduction (to reduce intraabdominal pressure)Drug therapy – focus is on improving LES function, increasing esophageal clearance, decreasing volume & acidity of reflux, & protecting the esophageal mucosa“Step-up” approach – start with antacids (which neutralize acids & reduce heartburn) & OTC H2R blockers; may have to go to a PPI (last two reduce secretion of acids) “Step-down” approach – start with a PPI, titrate down to prescription H2R blockers, & finally to OTC H2R blockers & antacids Surgical therapyEndoscopic therapyNursing ManagementAssess/Monitor:Clinical Manifestations of GERDPatient’s food diaryPatient’s weightPatient’s response to medicationsNursing Interventions for GERDElevate HOB 30o (on 4-6 inch blocks if @ home; not via pillows)Instruct patient not to lie down for 2-3 hours after eatingTeach patient to avoid foods & activities that cause reflux (patient may want to keep a food diary)Administer medications all-the-while providing medication education If surgery is required, then post-op care is focused on avoiding respiratory complications, maintaining F&E balance, & preventing infectionReassure pregnant patients that their symptoms will most likely resolve after deliveryNursing diagnoses: Pain r/t acid reflux, anxiety, and/or knowledge deficitHiatal HerniaThe esophagus runs through the diaphragm


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UNCW NSG 326 - NSG 326 AH I WK #12 Problems of Digestion & Absorption Part 1

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