AMS1

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Author:
alyn217
ID:
164558
Filename:
AMS1
Updated:
2012-07-31 11:57:28
Tags:
AMS1T3 GERD
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Description:
Gastroesophageal reflux Disease
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  1. Basic info about GERD
    • What?
    • Reflux of gastric contents into lower esophagus
    • Who?
    • 14-20% world’s population??
    • Why?
    • Hiatal hernia
    • Incompetent LES
    • Impaired esophageal motility
    • Decreased gastric emptying
  2. What are some clinical manifestations of GERD
    • Pyrosis (heartburn)
    • Relieved by milk (bad idea because stomach responds by becoming more acidic, antacids, H2O)
    • Respiratory symptoms
    • Otolaryngologic symptoms (hoarse voice due to reflux damaging tissues of the larynx and throat. 
    • Dyspepsia
    • Regurgitation
    • Early satiety
    • Post-meal bloating
    • N/V
  3. Possible complications for pt w/GERD
    • Esophagitis
    • --scar tissue
    • --strictures: pin passage through esophagus
    • --dysphagia
    • Respiratory issues
    • --bronchospasm
    • --laryngospasm
    • --Aspiration=PNA
    • Barrett's esophagus
    • --Asymptomatic to precancerous perforation and mild bleeding
  4. Diagnostic tests for GERD
    • H/P
    • Upper GI
    • Barium Swallow
    • Motility studies
  5. GERD collaborative care
    test!
    • Nutritional Therapy
    • Dietary Restrictions
    • Small frequent meals
    • Avoid bedtime snacks
    • Fluids between meals
    • Sit up after meals, ie don't eat right before bed.
    • Lifestyle Modifications
    • Avoid Triggers
    • Smoking Cessation
    • Weight Reduction
    • Don’t wear tight clothing
  6. Rx for GERD
    • Proton Pump Inhibitors (all end with zole)
    • Esomeprazole (Nexium)
    • Pantoprazole (Protonix)
    • Lansoprazole (Prevacid)
    • Omeprazole (Prilosec)
    • H2-Receptor Blockers (all end with ine)
    • Famotidine (Pepcid)
    • Ranitidine (Zantac)
    • Cimetidine (Tagamet)
    • Nizatidine (Axid)
    • Promotility
    • Metoclopromide (Reglan)
    • Antacids
    • Maalox
    • Mylanta 
    • Cytoprotective: coats stomach
    • Sulcralfate (Carafate)
    • Gaviscon
  7. Nursing management for GERD surgical therapies
    • Nissan Fundoplication
    • Endoscopic Therapy
    • --Photodynamic Therapy (PDT) 
    • --Cryotherapy
    • --Radiofrequency ablation
  8. General nursing intervensions for GERD
    • HOB up 30
    • Sit up 2-3 hours after meals
    • Take PPI prior to first meal of day
    • SE of drugs
    • Postoperative care 
    • Aseptic technique
    • NGT care until BS return
    • IVF & lyte monitoring
    • Prevent Respiratory Complications
    • Meds to control N/V, pain
    • I & O
    • Post-Op Complications?..
  9. Hiatal hernia-->GERD
    • Portion of the stomach herniates into the esophagus through an opening in the diaphragm
    • Patho: weakening of muscle caused by increased intra-abdominal pressure
    • Obesity
    • Pregnancy
    • Acites
    • Tumors
    • Heavy lifting
  10. SnSs of Hiatal hernia
    • Asymptomatic
    • Heartburn after a meal or when supine
    • Pain relieved by sitting or standing
    • Precipitating factors
    • Large Meals
    • Alcohol
    • Smoking
    • Incidence increases with age
  11. Hiatal Hernia complications and Tx

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