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 stomachGER happens when a band of muscle at the end of the esophagus – the lower esophageal sphincter (LES) – does not close properlyThis 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 GERDMost common GI problem seen in adultsGERD – Risk FactorsExcessive indigestion of:Fatty foods – stimulates a hormone that ↓ LES pressure & delays gastric emptyingChocolate – ↓ LES pressureCaffeine (e.g., cola drinks, coffee, tea) – ↓ LES pressurePeppermint – relaxes smooth muscleCarbonated drinks – increases pressure within the stomachCitrus fruits – can lead to esophagitisSpicy tomato drinks – can lead to esophagitisAlcohol – can lead to esophagitisMilk – increases gastric acid secretionGERD – Risk Factors [cont.]Cigarette smokingAssociated with decreased acid clearanceAlso inhibits saliva, a major buffer for the bodyDrugs that lower LES pressure (e.g., narcotics)Eradication of h. pylori infectionObesity, pregnancy, hiatal herniaGERD – Clinical ManifestationsPyrosis – heartburn following ingestion of food/drugs; painful and/or burning sensation in the esophagusDyspepsia – discomfort/pain centered in the upper abdomenRegurgitation – effortless return of food or gastric contents from the stomach into the esophagus or mouthOtolaryngologic symptoms – laryngitis, frequent sinus or ear infections, difficulty swallowingGastric symptoms – belching, bloated feeling after eating, N&VRespiratory symptoms – wheezing, coughing, dyspnea, bronchospasm, pneumonia r/t irritation of the upper airway from gastric secretionsHypersalivation – “water brash”Non-cardiac chest painBleeding r/t breakdown of tissuesLoss of dental enamel r/t erosion with acid reflux in the mouthClinical ManifestationsPyrosis Heartburn from reflux of acidic gastric secretions Burning Substernal to throatDyspepsia Pain or discomfort centered in upper abdomenGERD - ComplicationsEsophagitis (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 StudiesBarium swallow/Upper GI series – can detect if there is a protrusion of the upper part of the stomachEndoscopy – useful in assessing LES competency, inflammation, scarring, & stricturesBiopsy – done to differentiate stomach or esophageal carcinoma from Barrett’s esophagusEsophageal manometry – measures pressure in the esophagus & LESMeasurement of esophageal activity (via pH) every hour for 24 hours – with reflux there is acid in the normally alkaline esophagusRadionuclide studies – can detect reflux & esophageal clearanceEmpiric trial of a proton pump inhibitor (PPI) – in patients with GERD, PPI treatment should result in reduction/elimination of symptomsCollaborative CareLifestyle modifications – teach patient to avoid factors that aggravate symptomsStop smokingDiet – does not cause GERD but food can aggravate symptomsAvoid 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 thoroughlyDrink 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 therapyEndoscopic therapyNursing ManagementAssess/Monitor:Clinical Manifestations of GERDPatient’s food diaryPatient’s weightPatient’s response to medicationsNursing Interventions for GERDElevate HOB 30o (on 4-6 inch blocks if @ home; not via pillows)Instruct patient not to lie down for 2-3 hours after eatingTeach 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 infectionReassure pregnant patients that their symptoms will most likely resolve after deliveryNursing diagnoses: Pain r/t acid reflux, anxiety, and/or knowledge deficitHiatal HerniaThe esophagus runs through the diaphragm
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