UPPER GI DISORDERS Nursing Care of Oral Disorders Oral Assessment Avoid irritants Promote comfort and Manage pain Foods to avoid acidic foods foods difficult to chew or swallow Foods to choose easy to chew and swallow with adequate protein Encourage a supportive nutrition Dietary teaching Give oral analgesia 30 45 min before meals Give small frequent feedings Nursing Care of Oral Disorders continued Oral care Warm saline Avoid harsh mouthwash soft toothettes Relieve mouth dryness Post op interventions Maintain patent airway Monitor for bleeding Administer supplemental nutrition Promote effective forms of communication Esophageal Disorders Dysphagia Difficulty swallowing Clinical manifestation of an esophageal disorder Obstructive cause Motility cause Esophageal Disorders Tumors Congenital defects Hiatal hernia Diabetes Parkinson s disease Stroke Regurgitation incompetent lower esophageal sphincter LES Acute pain gastric vs cardiac Dyspepsia reflux Achalasia incomplete relaxation of Lower Esophageal Sphincter LES o Motor disorder o Cause unknown o motility of lower 2 3 of esophagus o Dysphagia emesis progression of frequency o Management Surgical PEG PEJ tubes LES dilation Relax smooth muscle Small frequent feedings Semi fowlers position head of bed up Gastro esophageal Reflux Disease GERD Symptoms of GERD Backward flow of GI contents into esophagus and stomach acid irritates lining Caused by relaxed Lower esophageal sphincter LES Associated with obesity pregnancy smoking excessive intake of caffeine chocolate and ETOH Heartburn dysphagia salty secretions in mouth Pain is described as burning that moves up and down If severe may radiate to neck back jaw and mimic a cardiac episode Pain relieved by fluids or antacids Treatment of GERD Administer Medications Antacids H2 receptor antagonists proton pump inhibitors Teach about needed Lifestyle changes Small frequent meals Eat slowly and drink fluids between bites Avoid certain foods to acid production such as hot spicy fatty foods alcohol chocolate citrus juices Sleep with HOB 6 8 inches Loose weight if overweight Remain upright 3 hours after meals Medications for GERD Antacids 1 hr ac or 2 3 hr pc Relief 10 30 minutes Neutralizes gastric acid Soothes mucosal lining H2 receptor blockers 1 hr before or after antacids BID Taper to PRN Inhibit histamine in the parietal cells Proton Pump Inhibitors Treatment failure 30 minutes ac daily Control acid secretion Antiemetic cholinergic Increases LES pressure Increases gastric emptying 30 60 minutes ac Hiatal Hernia Part of stomach protrudes through diaphragm into thoracic cavity Type I Sliding upper stomach GE displaced upward into thorax most common Type II Rolling GE junction stays below diaphragm Nursing Care With Hiatal Hernia Surgical Repair Nissen fundoplication or Ant reflux prosthesis Major surgeries requiring opening of abdomen and thorax Recovery time can be extensive Post operative care after surgical intervention Prevent respiratory complications Prevent gas bloat syndrome Care of tubes Esophageal Cancer Squamous cell o Alcohol use o Smoking o HPV Adenocarcinoma o Barrett s Esophagus o Obesity o Ingestion of smoked meats o Vitamin A C deficiency Esophageal Cancer continued Symptoms 5 year survival rate 15 Treatment depends on Tumor size location Metastases Status of patient Clinical Manifestations of GI Dysfunction Pain Anorexia Nausea and vomiting Bleeding Diarrhea Belching and flatulence Indigestion progressive dysphagia a severe sensation of burning squeezing pain while swallowing Pain Acute Gastritis Inflammation of gastric mucosa breakdown in mucous lining Incidence with age At risk Severe N V abd tenderness epigastric burning aching bleeding diarrhea Keep patient NPO until symptoms ease then slowly increase diet Chronic Gastritis Complications bleeding pernicious anemia gastric cancer Heavy smokers Drinkers of ETOH Use of Aspirin and NSAID s Signs Symptoms Type A autoimmune Fundus of the stomach Loss of parietal cells Type B most common H Pylori Peptic Ulcer Disease PUD Gastric surgery Nursing Management of Gastritis Treat symptoms Reduce pain Reduce stress if possible Teach about the causes Encourage medical follow up Promote self care Medication adherence Adequate nutrition avoid smoking ETOH Peptic Ulcer Disease Aggressive v Defensive Factors Aggressive factors Stomach acid H pylori Smoking Alcohol Spicy foods Defensive factors Seen in all parts of upper GI tract 90 caused by Helicobacter pylori bacteria HELIVAX vaccine 2003 Aspirin NSAID s breakdown gastric lining allowing acids to damage mucosa Stress stimulates vagus nerve acid production gastric motility Stress ulcers occur in critically ill patients Mucous Adequate blood flow to stomach lining Balanced diet Symptoms of GI Ulcer Acute pain burning gnawing cramping Gastric ulcer food causes pain vomiting relieves pain Duodenal ulcer pain on empty stomach food eases pain N V most freq in gastric ulcers Bleeding if ulcer erodes through blood vessel see next slide Treatment Goal for GI Ulcer Eliminate h pylori aggresive Decrease acid production aggressive Strengthen mucous barrier defensive Modify diet Coffee ETOH protein foods milk Treat Prevent complications Hemorrhage Perforation Obstruction Medical Treatment of GI Ulcers Triple therapy for H Pylori Biaxin antibacterial Flagyl antibacterial Prilosec proton pump inhibitor Hypo secretory agents H2 receptor blockers Zantac Pepcid etc Prostaglandin analog Cytotec acid mucous Proton Pump Inhibitor PPI Prilosec or omeprazole Antacids neutralize gastric acid Mylanta Mucosal barrier fortifier Carafate increase healing Nursing Care for GI Ulcers Manage pain no ASA NSAID s Promote rest and relaxation stress Encourage small frequent meals Teach about causes prevention discuss stress reduction ASA NSAID steroids and ACTH are ulcer causing Advise patient to discuss with HCP Eat between meals Take H2 antagonists or antacids Subtotal partial removal of stomach Total connect esophagus to jejunum Absorption problems leading to nutritional problems intrinsic factor GI emptying Surgical Treatment for GI Ulcers Only if no response to medical management Goal acid producing capabilities Most done with laparoscopy some open incision Vagotomy selective cutting of vagus nerve Pyloroplasty widening the exit of stomach Gastrectomy Complications After Surgery Ulcer at incision site in stomach Hemorrhage GERD Dumping syndrome Pyloric obstruction Nursing Interventions Support and teaching Care of