Upper GI/Cancer disorders

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  1. Mets (metastisize)
    When cancer spread thru the blood cells and lymph
  2. 90% develop oral cancer from
     Tobacco use
  3. Leukoplakia
    white patches sometimes malignant in mouth or on lips (most common)
  4. erythroleukoplakia
    Red and white patches in mouth or on lips, more likely to be malignant
  5. erythroplakia
    Bright Red patches that often become malignant in mouth or on lips
  6. What is the most common type of oral malignancy
    squamous cell carcinoma
  7. How does squanmous cell carcinoma present
    begins as painless ulceration or lesion with irregular borders (odd shape) lower lip being the most common site but tumors can be on tongue or floor of mouth
  8. Staging oral cancers (what is used to stage them)
    TNM (Tumor, nodes and metastasis) starts at stage 0 (carcinoma insitu?) early form with no mets (from stage 1-4 then IVC means you have mets)
  9. test for staging
    MRI's and CT's
  10. How is chemo delivered
    via IV
  11. what kind of surgery for CA of the lip
    MOHS micrographic surgery
  12. Surgery for CA of jawbone
  13. Surgery for CA hard pallete
  14. Radical neck disection
    take out lesion, take out lymphnodes to see if CA has spread and take surrounding tissues May need trach or skin grafting depending on location of mass
  15. nursing care after surgery
    • priority is open airway
    • prevent aspiration pneumonia
    • keep pat in semi fowlers esp for meals to prevent aspiration
    • moniter daily wts (weight loss is expected but dont want to see excessive wt loss)
    • pt may need temp G-tube if they can't take in food or liquids
    • think of alternatives for communication (dry erase boards or flashcards for ex)
    • provide emotional support
    • pt may need rehab or plastic surgery
    • prevent complications
  16. nursing dx we might see
    • impaired oral mucous membranes
    • inbalanced nutrition: less than body req
    • impaired verbal communication
    • body image
    • risk for ineffective airway clearance
    • risk for aspiration
    • risk for infection
    • knowledge deficeit
  17. who is esophageal CA more commen in
  18. what are the two tyoes of esophageal cancers
    • squamous cell carcinoma
    • adenocarcinoma
  19. adenocarcinoma
    • usually found in lower part of esophagus
    • most common in US
    • Gland cells (normally not inner lining) gland cells will replace squamous cells
  20. Squamous cell carcinoma
    • usually in the upper part of esophagus
    • less common among americans
    • inner layer
  21. age for high risk of esophageal ca
    male 50 or over
  22. treatment of Esophageal CA
    esophagectomy (end to end anastimosis) runs risk of leaking

    radiation and chemo therapy
  23. risk of surgery fo esophageal CA
    • pneumonia
    • bleeding
    • infection
    • leakage
    • respitory distress
    • sepsis
  24. nursing dx for esophageal ca
    • risk for ineffective airway clearance
    • risk for anticipitory grieving
  25. nursing care for ECA
    • airway clearance is priority
    • assesment of mental status
    • nutrition g-tube...temporary
    • good pulmonary hygiene
    • monitoring of cardiac and hemodynamic status
    • prevention of complications
    • psychosocial support
  26. what is biggest risk factor for stomach cancer
    H. pylori
  27. other risk factors for stomach CA
    • genitic predisposition
    • chronic gastritis
    • pernicious anemia
    • gastric polyps
    • foods (smoked foods or nitrates)
  28. 5 layers of stomach (the deeper the layers the worse the prognosis)
    • mucosa (where most cancers will start) 
    • submucosa
    • muscularis propria (moves and mixes stomach contents)
    • suberosa
    • serosa
  29. types of stomach cancers
    • adenocarcinoma (90-95 are malignant tumors)
    • lymphoma (of the immune system tissues found in wall of stomach)
    • gastrrointestinal stromal tumor (rare and start in cells of wall of stomach)
    • carcinoid tumor (start in hormone making cells of stomach, usually do not spread)
  30. early manisfestations of stomach ca
    • vague
    • feeling of satiety
    • anorexia
    • indegestion
    • possible vomiting
    • ulcer-like pain not relieved by antacids
  31. late manifestations of stomach ca
    • weight loss
    • cachetic
    • palpable abdominal mass
    • occult blood in feces
  32. dx of stomach ca
    • CBC for anemia
    • upper GI lesions
    • Ultrasound for mass
    • upper endoscopy to visualize lesions
  33. treatment of stomach ca
    • chemo before surgery and radiation after
    • surgery prior to mets (spread) partial gastrectomy
    • surgery after mets -- total gastrectomy
    • feeding tube
    • palliative care (if CA is advanced, comfort and controlled)
  34. total gastrectomy surgery
    espohagus is then connected directly to small intestine 
  35. partial gasectromy surgery
    remaining portion of stomach is connected to esophagus or small intestine depending on which part was removed
  36. complications of stomach ca
    • dumping syndrome
    • anastomatic leakage
    • vitamin or iron deficiency
    • (folic acid deficiency)
    • (decreased absorbtion of calcium and vitamin D)
    • infection or bleeding (anemia)
    • weight loss
  37. nursing dx for stomach CA
    • inbalanced nutrition less than body req
    • grieving
  38. nursing care for stomach cancer
    • education
    • (dietician for preferred foods)
    • (daily weight)
    • (monitor and control pain)
    • (encourage conversation to prevent denial)
    • Focus on
    • (effects of disease)
    • (Nutritional status)
    • (effects of fatal disease on family or friends)
  39. Gerontologic considerations for ulcers and cancer
    • increases with pts over 60
    • increases w use of NSAIDS
    • first sign of frank gastric bleeding or decreased hematocrit seek medical treatment
    • emphasis placed on prevention
  40. a patient who had stomach CA surgery 2 years ago thinks the ca is back because he is tired all of the time, what is the patient likely experiencing
    vitamin deficiency
  41. major functions of GI
    • injestion of food
    • absorbtion
    • digestion of food (break down)
    • elimination of waste
  42. nutrients from food
    • carbs
    • proteins
    • fats (lipidsa)
    • vitimins
    • Minerals
  43. GI system consist of
    • Alimentary canal
    • mouth
    • pharynx
    • esophagus
    • stomach
    • small intestine
    • large intestine

    • Acessory organs
    • liver
    • gallbladder
    • pancreas
  44. Mouth functions and details
    • Digestion begins (saliva - enzyme mastication (chenical breakdown))
    • Hard pallete (gives tongue hard surface to push food against)
    • soft pallete extends to uvula (when food is swollowed soft pallete rises closing off oral pharynx)
    • prepares food for movement thru pharynx and epigottis into esophagus
  45. pharynx function and details
    • Peristalis begins here
    • passageway for food, fluids and air
    • oropharynx
    • laryngopharynx
  46. esophagus function and details
    • tube that leads to stomach
    • lined with involuntary muscles
    • no digestion or absorbtion takes place here
    • extends thru thorax and diaphram
  47. 4 sections of stomach
    • cardiac
    • fundus
    • body
    • pyloris
  48. stomach functions and details
    • Destendable organ
    • begins chemical digestion with enzymes and acids
    • lower PH level kills off bacteria
    • mechanical digestion
    • protein digestion
    • food mixes with chyme
    • pyloric sphinter which controls emptying into small intestine
  49. Small intestine functions and details
    • 3 sections
    • Duodenum
    • jejunum
    • ileum
    • Food is chemically digested here
    • nearly all food is absorbed in the small intestine
    • where enzymes breakdown carbs, proteins, lipids and acids
    • Fiber, water and bacteria are left over to enter large intestine
  50. Large intestine details and functions
    • frames small intestine on 3 sides and contains
    • cecum
    • appendix
    • colon
    • rectum
    • anal canal
    • eliminates undigestible food
    • valsalva maneuver

    • Primary functions
    • absorbs excess water and electrolytes
    • stores food residue
    • eliminates waste products in the form of feces
  51. Liver function and details
    • heaviest organ in body
    • located in right upper quardrant and almost completely covers the stomach
    • has 2 major lobes (rt and lft) divided by the falciform ligament

    • Major functions
    • Metabolizes carbs, fats, proteins and bilirubin
    • converts ammonia to urea for excretion
    • detoxifies blood
    • synthesizes plasma proteins, non-essential amino acids, Vit A, D, K, and B-12, prothrombin, fibrogen, phopholipids and cholesterol
    • secretes bile for digestion of fats and absorbtion of fatty acids, cholesterol and other lipids
    • stores fat soluble vitamins and iron
  52. Gallbladder details and function
    • under liver
    • acts as storage for bile
    • not needed for digestion
  53. pancreas details and function
    a gland responsible for enzyme production
  54. Bile ducts (look up details in book)
    • Cystic duct (when gallbladder is stimulates it secretes bile into the cystic duct)
    • Hepatic duct
    • Cystic and hepatic together form common bile duct
  55. What is metabolism
    the chemical breakdown and building reactions necessary to produce and provide energy to maintain life
  56. What are Carbs
    the bodys energy/fuel
  57. what are fats
    insulate the body, protect the organs, build some cell structures and provide reserves
  58. what are proteins
    form bulk of cell structure and most functional molecule
  59. what is key metabolic organ
  60. what should we have an understanding of before we start teaching with a patient about GI
    what they think healthy nutrition is and do they have an understanding of what normal GI function is
  61. Nursing assesment of GI system (subjective)
    • diganostic test
    • Dietary history
    • physical activity/exercise
    • sleep rest patterns
    • understanding for healthy nutrition and normal GI function
    • Self-perception/self-concept/current complaint
    • current meds including OTC meds
  62. History
    • Coping and stress management
    • valuse and beliefs
    • genetic considerations
    • digestive concerns
    • Elimination pattern
    • family history
  63. physical assesment (objective)
    • head to toe visual
    • ht and wt norm for age and body type
    • skin condition
    • examine mouth and throat
    • abdomen
  64. correct order for abdominal inspection
    • inspection
    • auscultation
    • percussion
    • palpation
  65. oral assesment
    • inspect and palpate
    • lips (normal for race) look for cheilosis (painful leisons at corners of mouth seen in riboflavin and niacin definciencys)
    • look for cold sores could be from herpes simplex 1
    • tongue (pink smooth and good turgor)
    • bright red could be glossitis (seen in B-12, folic acid and iron definciency)
    • vertigo fissures from dehydration
    • black hairy tongue could be from long term antibiotic therapy
    • check for leukoplakia (small white patches from premalignant condition)
    • Stomatitis (red dry swollen mucousa)
    • buccal mucosa should be moist without lesions
    • candidisis (white patches that bleed when scraped, usually with someone who is immunosuppressed)
    • teeth should look norm
    • gums should be even color with no swelling
    • swelling and easy bleeding could indicate gigivitis...could be from gum disease or vit C deficiency
    • note odor of breath
    • acetone breath could indicate uremia
    • fruity breath could be from DKA
    • foul smelling breath could be from liver disease, respitory infection or poor oral hygiene
  66. abdomen inspection
    • check contour should be concave or rounded
    • skin integrity should be intact
    • look at striae (stretch marks)
    • venous pattern
    • aortic pulsation
    • scaphois (sunken abdomen) could be from malnutrition or when fat is replaced by muscle
  67. what to listen for in abdomen
    • hyperactive/high pitched bowel sounds could be (borborygmus)
    • massive diarhhea could be onset of bowel obstruction
    • listen for bruits (blowing sound due to restriction of blood flow thru vessels)
    • if bruits over liver are could be liver cancer (hepatic carcinoma)
    • friction rub (grating cheese sound) can be heard over liver or spleen if inflammed
    • percus for dullness (could be fluid or tours in abdomen where bowel is displaced or enlarged spleen)
    • If dullness shifts could mean ascites (fluid shifting)
    • palpate all 4 quardrants in belly (check for gaurding) ridged abdomen could be perforated duodonal ulcer
    • rebound pain in rt upper quardrant could be acute cholysistitis (gallbladder)
    • rt lower rebound pain cound be appendicities
    • middle rebound pain is pancreatitis
  68. inguinal area inspect for
    bulges (hernias)
  69. perianal area inspection
    look for anal fissures check anus and rectum, hemorrhoids, prolapsed rectum (reddend doughnut shaped area)
  70. Prolapsed rectum
    doughnut shaped with red tissue
  71. what is melena
    black tarry stool (upper GI bleeding)
  72. what is steatorrhea
    greasy frothy yellow stools (fro fat malabsorbtion)
  73. low hematocrit means
    possible anemia
  74. high hematocrit means
    possible dehydration
  75. low hemoglobin means
  76. high hemoglobin means
    dehydration or tumor growth
  77. low white blood cells leukopenia
    sign of fighting infection
  78. high white blood cells leukocytosis
    inflammation or infections
  79. low platelets
    thrombocytopenia enlarged spleen like in chemo or bone marrow suppression or chronic alcoholic
  80. high platelets
    chronic inflammation thrombocytosis
  81. glucose creatinine (low)
    severe liver disease or low protein diet
  82. high creatinine means
    dehydration or excessive blood loss (shock)
  83. low BUN means
    liver disease, malnutrition or over hydration
  84. high BUN could be from
    CHF, impaired kidney function, heart attack, burn victim or dehydration
  85. low sodium is
    hyponutremia from diarrhea, burns or CHF
  86. high sodium is
    hypernutremia from dehydration or increased salt intake
  87. low chloride
    hypochloremia from sweating, nausea, vomiting
  88. high chloride
    hyperchloremia from dehydration, high sodium, kidney failure or kidney disease
  89. low potassium
    hypokalemia, renal dysfunction, sweating NVD, endocrine issues, hormone issues or poor diet
  90. high potassium
    hyperkalemia from diabetes, bleeding or chemo, or adrenal insufficiency, kidney disease or salt substitutes containing potassium
  91. sodium bi-carb (HCO3) what does it do
    helps to regulate acidity of blood
  92. high bi-carb can be from
    lung disease, vomiting, (metabolic alkalosis)
  93. low bi-carb can be from
    hyper ventilation, alcohol or aspirin use, DKA, thyroid problems of dehydration (metabolic acidosis)
  94. flat plate or KUB is ordered when
    there is complaints or nausea and vomiting
  95. barium swallow is ordered for
    inflammation, ulcers, hernias, foriegn bodies, polyps, tumors, diverticulum...looks at stomach, esophagus and duodenum.  Drink barium and take pics observing movement with fluoroscope
  96. abdominal ultrasound
    bile ducts, pancreas, kidneys, liver, gallbladder
  97. doppler looks at what
    veins, look at fluid, look for asities
  98. Cat scans can look at???
    gallbladder, pancreas and liver
  99. MRI can look at
    organs and structures inside body, head, chest, abdomen, pelvis, vessels, bones, joints and spine
  100. percutaneous transhepatic cholangiogram evaluates
    filling of the ducts (hepatic and cystic duct)
  101. surgical cholangiogram (radiographic visualization)
    gall bladder, liver and bile ducts
  102. Gall bladder series (cholecytography)
    used to detect gall stones, inflammation or tumors and obstruction of cystic ducts
  103. EGD (esophogastroduodenoscopy)
    looks at membranes of esophagus, stomach and duodenum
  104. colonscopy does what
    looks at entire colon, can see polyps, diverticulitis, and masses such as cancer or tumors
  105. ERCP (endoscopic retrograde cholangiopancreatography) does what
    • looks at GI structures and retrieve gall stones, combines endoscopy and xray. if someone has abdominal pain, jaundice or unexplained wt loss
    • but ERCO can cause pancreatitis...can happen after
  106. Biopsy details
    removal of cells and tissues, can tell us if tissue is cancerous or not...can be done with any endoscopy test. can do needle biopsy, or surgical
  107. stomatitis is what
    inflammation of mucous lining of the mouth, cheeks, gums, tongue,lips and floor of mouth...can cause bad breath
  108. causes of stomatitis
    • Usually viral
    • •Poorly fitted dentures
    • •Cheek biting
    • •Chronic mouth breathing
    • •Very hot temperature of food or beverages
    • •Spicy foods
    • •Herpes infections
    • •Nutritional deficiencies
    • •Tobacco use
    • •Fungal infections
    • •Sensitivity to oral products
    • •Chemotherapy agents
  109. Stomatitis symptoms
    • •Pain
    • •Fever
    • •Irritability, restlessness
    • •Blister, curd-like patches, or open sore
    • •Swollen tissue
    • •Bleeding
    • •Drooling
    • •Foul-smelling breath
    • •Difficulty swallowing
    • •Tissue necrosis
  110. stomatitis treatment
    • •Pain control
    • •Antibiotic or Antifungal
    • •Oral hygiene
    • •Correct underlying disorder
    • •Mouth rinses
  111. Stomatitis meds
    • Topical oral
    • ¨Orajel (Oral)
    • ¨Viscous lidocaine (Oral)
    • ¨Ambesol (Oral)
    • ¨Triamcinolone acetonide (Oral)
    • ¨Clotrimazole (Antifungal)
    • ¨Nystatin (Antifungal) swish and swallow

    • Antiviral agents
    • ¨Acyclovir (Zovirax)
    • ¨Famciclovir (Famvir)
    • ¨Valacyclovir (Valtrex)
  112. nursing dx for stomatitis
    • impaired oral mucous membranes
    • access oral membranes and provide oral care
    • Imbalanced nutrition: less than body req
    • access intake, access ability to chew and swallow...encourage high calorie and high protein diet, offer fluids for hydration, and offer analgesics for pain relief
  113. oral trauma from
    • fractured mandible
    • dental disorders
  114. oral inflammation or infection from what
    • herpes simplex
    • stomatitis
    • candida albicans
    • alcohol, tobacco, or chemotherapy agents
  115. what is presbyphagia
    change is swallowing mechanism from age
  116. what is achalasia
    disease of muscles of esophagus
  117. phases of swallowing
    • oral preparatory phase
    • (food is manipulated in oral cavity and masticated (combined w saliva) in prep for swallowing
    • oral propulsive phase
    • tongue transfers food bolus to pharynx triggering pharyngeal swallow
    • pharyngeal phase
    • tongue and pharyngeal structure propel food bolus into esophagus while protecting airway
    • esophageal phase
    • esophageal muscle moves bolus thru esophagus towards stomach
  118. impaired swallowing (what to observe for)
    • food collecting in mouth
    • inability to control tongue movement
    • coughing during meal
    • excessive drooling
    • regurtating or spitting food
    • refusal to eat
  119. Dysphagia
    difficulty or partial inability to swallow as a result of injury to parts of brain that the muscles involved in swallowing or muscles or nerves that control swallowing
  120. Oropharyngeal swallowing difficulities are
    • ¤Difficulty in safe transfer of a liquid
    • or food bolus from the mouth to the esophagus

    • nNeuro damage, stroke, traumatic brain injury,
    • or Parkinson’s
  121. is swallowing voluntary or involuntary
  122. esophageal swallow difficulties are from
    • Difficulity passing food down the esophagus
    • motility dis orders, sphincter abnormalities, or stricture
  123. causes of dysphagia neurological
    • •Parkinson’s Disease
    • •Closed head trauma
    • •Multiple Sclerosis (MS)
    • •Cerebral Vascular Accident (CVA)
    • •Muscular Dystrophy
    • •Poliomyelitis
    • •Amyotrophic lateral sclerosis (ALS)
  124. What is achalasia
    abnormal condition caused by inability of a muscle to relax. from exposure to abestos and metal or hx of swallowing lye...feeling of lump in throat or chest pain after meal...

    TX bland diet, avoid bulky and cold foods, fluids with meals and avoid eating before bed hob elevated
  125. Bezoars are
    • foreign persistent bodies of material accumulated in stomach
    • usually in young women w psych disorders
    • trichotillomania (cause trichobezoars (human hair)
    • prychophagia (from hair eating)

    phytobezoars (vegetable fibers like the fibers on corn)

    pharmacobezoars (medications like enteric coated meds)
  126. causes of bezoars
    • ingestion of hair
    • poor gastric motility
    • yeast bezoars

    • tx
    • removal of mass
    • prevent recurrence by treating disorder
    • barium swallow is test preformed to find mass
  127. what is IBS Pylorospasm
    • (Irritable Bowel Syndrome
    • or IBS)

    • Spasmodic contraction of the pylorus characterized by a combination
    • of abdominal pain and altered bowel function
  128. causes of IBS

    •disturbance in muscle movement of intestine

    •low-fiber diet 

    •emotional stress

    •use of laxatives
  129. symptoms of IBS
    •Diarrhea alternating with constipation for 6 months or more

    •Abdominal pain

    •Abdominal tenderness

    •Abdominal fullness, gas, bloating

    •Abdominal distention



    •Loss of appetite

    •Emotional distress

  130. TX of IBS
    • add bran to diet
    • §Antidepressants (Norpramin, Tofranil, Zoloft, or Prozac)
    • §Antispasmodics/Anticholinergics (Bentyl or
    • Asaspaz)
    • §Probiotics (Yogurt or OTC)
    • §Fiber supplements
    • §Psychotherapy (hypnosis)
  131. DX test for IBS
    • §Examine stools
    • §Occult blood
    • §Ova and parasite
    • §WBCs
    • §Sigmoidoscopy
    • §Colonoscopy
    • §Small-bowel series
    • §Barium enema
  132. pyloric stenosis
    • •an uncommon condition that affects the pylorus
    • •in babies, muscles of the pylorus become abnormally large
    • preventing food from entering the small intestine, if baby has gerd can make dx more difficult...common symptom in baby is projectile vomiting and baby will always be hungry...milk will be curdled when it comes up. can cause changes in bowel movement, wt problems, metabolic alkalosis
  133. dx of pyloric stenosis
    •Serum Electrolytes

    •Ultrasound of stomach

    •Barium swallow
  134. tx of pyloric stenosis
  135. nursing dx for pyloric stenosis
    ¤Deficient Fluid Volume

    • ¤Imbalanced Nutrition: Less than Body
    • Requirements

    ¤Sleep Pattern Disturbance

    ¤Parental anxiety

  136. nursing care for pyloric stenosis
    ¤Meet fluid and electrolyte needs

    ¤Minimize weight loss

    ¤Promote rest and comfort

    ¤Prevent infection

    ¤Supportive care

  137. where is vomiting reflex
  138. Causes of vomiting
    §GI disorders

    §Ear problems


    §Infectious diseases

    §CNS disorders

    §Cardiac problems

    §Metabolic disorders

    §Common side effects of most drugs
  139. Clinical manisfestation
    §Nausea is a subjective complaint


    §Water and electrolytes loss

    §Metabolic alkalosis

    §Metabolic acidosis

    §Pallor, sweating, tachycardia, and increased salivation

    §Dizziness, light-headedness, hypotension, and bradycardia
  140. nursing care of vomiting
    §Assess and monitor vital signs and skin tugor

    §Replenish fluid and electrolytes


    §Clear liquids


    §Advance diet to high carbohydrate

    §Encourage fluid intake between meals rather than with meals

    §Monitor frequency, amount and consistency of emesis or NG suction

    §Administer antiemetic medication
  141. nursing care for N&V
    • §Assess and monitor vital signs and skin tugor
    • §Replenish fluid and electrolytes
    • §IV’s
    • §Clear liquids
    • §Gatorade
    • §Advance diet to high carbohydrate
    • §Encourage fluid intake between meals rather than with meals
    • §Monitor frequency, amount and consistency of emesis or NG suction
    • §Administer antiemetic medication
  142. Considerations of older adults with N&V
    • cardiac and renal status
    • patients with history of CHF
    • Risk for aspiration
  143. What is gastritis
    ¨Inflammation of the stomach lining.

    ¨Irritation of the gastric mucosa.


    • ¤Disruption of the mucosal barrier by a
    • local irritant.


    • ¤Progressive, beginning with superficial
    • inflammation and gradually leads to atrophy of gastric tissues
  144. which gastritis is most common and details
    • acute... from ingestion of gastric irritants
    • aspirin, alcohol, caffeine, foods w certain bacteria...aspirin is most common irritant
  145. Chronic Gastritis details
    ¤Progressive and irreversible



    ¤Cigarette smokers

    ¤H. pylori is most common
  146. Erosive Gastritis (acute) details
    ¤Stress induced

    ¤Due to other life-threatening conditions

    • nShock, severe trauma, major surgery,
    • sepsis, burns, or head trauma

    ¤Ischemia of the gastric mucosa
  147. Acute gastritis symptoms


    ¤Hematemesis (vomiting blood)


    ¤Mild epigastric pain relieved by belching
  148. Chronic gastritis symptoms
    ¤ vague gastric distress

    ¤Epigastric heaviness after meals

  149. DX test for gastritis
    ¤H. pylori

    ¤Gastric analysis

    ¤Lab tests

    ¤Upper endoscopy
  150. Tx for gastritis
    ¤GI rest

    ¤Gastric Lavage

    ¤Natural and herbal remedies (chamomile tea, garlic, ginger mint oil as an aroma therapy)

    do not induce vomiting
  151. Nursing care for gastritis


    ¤Food safety

    • ¤Obstain from eating or drinking during an acute
    • episode

    ¤Pedialyte or sports drinks

    ¤Monitor N/V

    • ¤Monitor VS, skin turgor, and
    • weight

    ¤Monitor urine output
  152. esophagitis details
    • lining of esophagus becomes inflamed
    • can be acute or chronic
  153. causes of esophagitis
    • §Infections
    • herpes simplex
    • candida

    • §Diseases and conditions that weaken the immune system
    • HIV
    • poorly controlled diabetes
    • chemo or steroid use and nsaids
    • iron and potassium
    • doxycycline
    • §Food or environmental allergies
    • milk
    • eggs
    • soy
    • rye
    • beef

    §Chemicals that are swallowed

    • §Pills that become stuck in the esophagus
    • aspirin
    • NSAIDS
    • doxycycline
    • tetracycline

    §Medications and supplements

    §Gastroesophageal reflux disease (GERD)
  154. Symptoms of esophagitis
    • §difficulty swallowing
    • §pain
    • §nausea and vomiting
    • §loss of appetite
    • §tachypnea
    • §chest pain
    • §blood in stools
    • §increased salivation or drooling
  155. Esophagitis text and dx
    §History and Physical

    §Endoscopy with biopsy

    §Upper GI Series


    §Esophageal motility test

    §Other diagnostic tests depending on symptoms
  156. Complications of esophagitis
    • §Narrowing of the esophagus (esophageal stricture)
    • Barretts epithelium
    • §Rings of abnormal tissue in the lining of the esophagus (esophageal
    • rings)

    §Barrett's esophagus
  157. Barretts esophagus
    Premaliginant tissues that puts pt at increased risk for esophageal cancer
  158. GERD
    • ¨a chronic digestive disease that occurs when stomach acid, or
    • occasionally bile, refluxes back into the esophagus (backward flowing of
    • gastric contents)
    • ¨caused by transient relaxation of, 
    • or incompetence of the lower esophageal sphincter, or increased pressure
    • within the stomach
  159. GERD can lead to what if left untreated
    Barretts Esophagus
  160. symptoms of gerd mimic what
    heart problems
  161. Causes of GERD
    §No single cause

    §Predisposing factors

    §Hiatal hernia

    §Esophageal hernia

    §Incompetent lower esophageal sphincter (LES)

    §Decreased gastric emptying

    §Decreased esophageal clearance

    §Acidic gastric secretions reflux causing esophagitis
  162. Clinical manifestations of GERD

    • §A burning or tight sensation directly below the lower sternum that
    • radiates upward

    • §Heartburn that occurs more than once a week and becomes more severe
    • at night should be evaluated





    oSore throat

    oFeeling of “lump in throat”


    • oReports “hot, bitter or sour liquid” regurgitation into throat or
    • mouth

  163. DX studies for GERD
    ØBarium Swallow


    • ØBiopsy and cytologic specimens to differentiate
    • Barrett’s esophagus and cancer cells

    ØEsophageal manometric studies

    • ØRadionuclide tests to detect reflux and rate of esophageal
    • clearance
  164. complications of gerd
    •Barrett’s Esophagus

    •Acute Esophagitis


    •Chronic Esophagitis
  165. nursing management of GERD
    •Patient Teaching

    •   Stop smoking          

    • Do not lie down for 3 hrs after
    • eating

    •Elevate HOB 30 degrees

    •Nutritional Therapy

    • •Avoid acid producing
    • foods

    • •Limit intake of
    • caffeinated drinks and alcohol

    •Watch weight

    •Don’t  overeat

    • •Avoid exercise too
    • soon after eating

    •Avoid bedtime snacks

    •Drug Therapy

    •H2 receptor blockers

    • •Proton pump
    • inhibitors



    •Prokinetic drugs
  166. Barretts esophagus details
    • ¨the tissue lining the esophagus
    • (squamous epithelium)is replaced by tissue that is similar to the lining
    • of the intestine.
    • (columnar) This
    • process is called intestinal metaplasia.

    • ¨Dx by Biopsy, Treated by (endoscopic)
    • phototherapy  or mucosal resection
  167. what is a Food allergy
    • An immune response by the body which creates antibodies as a
    • reaction to certain foods
  168. what is food intolerance
    • Does not involve immune system; body cannot adequately digest a
    • portion of a specific food, usually resulting from absence of digestive enzyme,
    • food sensitivity, recurring stress or chronic digestive condition
  169. Eczema - atopic dermatitis
    • §Allergic response to foods, environment, inhalants, pollens, cow’s
    • milk and eggs (infantile eczema)
    • soy, wheat, fish
    • usually begins at age five and persist into adulthood
    • person will usually have flares

  170. caustive factors that make atopic dermatitis worst
    • pt can have staph under skin
    • long hot baths
    • dry skin
    • stress
    • certain cleaners or soaps
    • detergents
    • sweating
    • wool or dust
  171. Eczema symptoms
    •Red to brownish-gray colored patches

    •Itching, which may be severe, especially at night

    • •Small, raised bumps, which may leak fluid and crust over when
    • scratched

    •Thickened, cracked or scaly skin

    •Raw, sensitive skin from scratching
  172. interventions for eczema
    Focus is on reducing inflammation and relieving itching

    •Eliminate allergen

    •Administer topical corticosteroids

    • •Administer antibiotics, oral corticosteroids, oral antihistamines,
    • and immunomodulators

    •Light therapy (phototherapy)
  173. GI bleeding causes
    ¤Erosion of small blood vessels


    ¤Exposure to toxins

    ¤Infection (H. pylori)

    ¤Inflammatory process

    ¤Ishcemia from systemic diseases
  174. Symptoms of GI bleed
    • ¤Hematemesis
    • ¤Melena
    • ¤Hematochezia
    • ¤Increased BUN
    • ¤Coffee ground emesis
    • ¤Hyperactive bowel sounds
    • ¤Diarrhea
    • ¤GI hemorrhage (with significant blood
    • loss)
    • nDecreased cardiac output
    • nTachycardia
    • nHypotension
    • nPallor
    • nDecreased urine output
    • ¤Hypovolemic shock (if volume is notreplaces)
    • nAcidosis
    • nRenal failure
    • nBowel infarction
    • nAcute coronary syndrome
    • nComa
    • nDeath
  175. GI bleed test/dx

    ¤Blood type and cross match

    • ¤Electrolytes, osmolarity, and
    • BUN

    ¤Coagulation profile

    ¤Liver function

    ¤Upper endoscopy
  176. TX of GI bleed
    ¤IV fluids

    ¤Blood transfusions

    ¤Upper endoscoopy


    nSclerosing agent to bleeding vessel

    ¤Emergency surgery

    ¤Gastric lavage
  177. Nursing care of GI bleed

    ¤Signs and symptom education

    ¤Resolve underlying condition



    nAcid reduces

    nIron supplements
  178. Nursing dx
    • risk for shock
    • risk for bleeding
  179. types of hiatal hernia
    • mixed
    • paraesophageal
    • sliding
  180. Hiatal hernia manifestations
    ¨Reflux or heartburn

    ¨Feeling of fullness

    ¨Substernal chest pain


    ¨Occult bleeding

    ¨Belching or indigestion
  181. Hernia causes
    §Physical injury to upper abdominal area

    §Congenital weakness of diaphragm

    §Having an unusually large hiatus

    • § Increased abdominal pressure from coughing, straining during
    • defecation, pregnancy and delivery, or being overweight

    §Occurs more often over age 50

    §Occurs more often in women who are overweight

  182. Hernia symptoms
    Many people with hiatal hernias are asymptomatic

    qIf symptoms occur they are directly related to gastroesophageal reflux

    strangulated hernia is a medical emergency

    • qPeople with paraesophageal hernias may develop
    • gastritis, or acute/chronic GI bleeding.
  183. Hernia dx
    üBarium swallow


    üEsophageal manometry or motility studies

    üCardiac evaluation

    üEsophageal pH monitoring

    üAbdominal ultrasound
  184. Nursing care of hiatal hernia
    • •Patient
    • Teaching

    •Quit smoking

    • •Elevate HOB at least 6
    • inches

    • •Eat meals at least 3-4
    • hours before bedtime

    •Avoid HS snacks


    • •Lose weight and
    • maintain healthy weight

    • •Eat moderate, small
    • portions

    • •Limit fatty &
    • acidic foods

    •Avoid caffeine

    •Avoid alcohol



    •H2 Blockers

    • •Post-op
    • Care

    •Prevent infection

    • •Avoid heavy lifting or
    • straining
  185. peptic ulcers PUD
    • a break in the mucous lining of the GI tract where it comes in
    • contact with gastric juice
    • ØGastric ulcer

    ØDuodenal ulcer

    ØEsophageal ulcer

  186. Causes of peptic ulcers
    §Helicobacter pylori (H pylori)

    • §Nonsteroidal anti-inflammatory drugs
    • (NSAIDS)

    §Patient history


    §Family history

    §Zollinger-Ellison syndrome
  187. most common complication of PUD Symptoms include
    • •hematemesis (vomiting of fresh blood or
    • “coffee ground” emesis) or

    •hematochezia (bloody stools) or

    •black tarry stools (melena)





    •sweating caused by blood loss
  188. order of complications
    • hemorrhage
    • perforation
    • gastric outlet obstruction
  189. Peptic Ulcer symptoms

    •Location: between sternum and umbilicus

    •Relieved by:  eating or antacids

    •Weight loss

    §Decreased appetite 

    §Bloated feeling

    §Nausea and vomiting

    More vague in elderly
  190. DX test for peptic Ulcer
    §History and physical

    §Endoscopy with biopsy

    §Upper GI

    §Fecal H Pylori

    §Urea Breath test
  191. TX for ulcer
    • nutrition
    • surgery
    • treat complications
  192. nursing care for ulcer
    • §Administer proton pump inhibitor (PPI) or
    • histamine receptor blocker (H2 blocker)

    §Administer antibiotics

    §Patient teaching

    •Stop NSAIDS

    •Stop Smoking

    • •Avoid large amts of
    • alcohol
  193. nursing dx for ulcer
    ¤Acute pain

    • ¤Imbalance Nutrition: Less than Body
    • Requirements

    ¤Risk for Bleeding
  194. Perforation occurs when
    • §Occurs when peptic ulcer penetrates through the stomach wall and
    • cause chemical and bacterial peritonitis
    • Gastric outlet obstruction can result from scarring, spasm, or inflammation

    place pt in fowlers or semi fowlers position if thought to be perforation so liquids pool in pelvic area....pt could end up having surgery
  195. Surgical therapy for perforation
    §Less than 20% need surgical intervention




    •uncontrolled or recurrent bleeding

    •poor response to drug therapy
  196. what is a vagotomy
    surgery for perforation
  197. billroth I is
  198. billroth II
    gastrojejunoctomy for jejunum
  199. what is celiac disease
    • •Genetic or hereditary
    • •Can be triggered by stress
    • •Intolerance to foods containing gluten
    • (wheat,
    • barley, rye and possibly oats)
    • •Low prevalence in United States
    • •Rarely diagnosed among African and Asian
    • populations
    • •Common in children
    • •Early diagnosis and intervention is key
    • to preventing complications
  200. Celiac disease symptoms
    • Fatty foul smelling stools
    • Infants,
    • toddlers, and young children: failure to grow, diarrhea, vomiting, bloated abdomen and behavior
    • changes

    Teens:  delayed onset of puberty

    • Adults:  Fatigue or lack of energy, recurring bloating, gas or abdominal
    • pain, chronic diarrhea or constipation or both, pale, foul-smelling stool,
    • unexplained anemia, bone or joint pain, behavior changes, missed menstrual
    • periods, loss of tooth enamel, infertility, canker sores, and miscarriages.
  201. dx and test for celiac disease
    • fecal fat measurememt
    • duodenal biopsy
    • lab screening
  202. interventions for celiac disease
    • Gluten free diet
    • teach pt abt importance of reading labels on food and meds
  203. what disease is common in ppl with celiac disease
    osteoporosis...watch their bone density
  204. what is lactose intolerance
    •Inability to digest milk sugar

    • •Dairy products are the most common sources of lactose, although
    • some non-dairy processed or baked foods contain smaller amounts


    History and hydrogen breath test

    • •Treatment
    • •complete elimination of
    • lactose-containing foods from diet
  205. What is dumping syndome
    • §Direct result of surgical removal of large portion of stomach and
    • pyloric sphincter

    §Decreased reservoir capacity of stomach

    §Associated with hyperosmolar effect of chyme in jejunum

    §Experienced by one-third –one-half of patients after gastrectomy surgery

    §Management: dietary pattern to delay gastric emptying
  206. Drug therapy...histamine H2 antagonist
    Histamine H2 antagonists

    ¤Inhibits histamine action at parietal cell H2 receptor

    ¤Decreases basal and food stimulated acid secretion

    ¤Inhibits 50-80% of daily gastric acid secretion

    •Ranitidine (Zantac)

    •Cimetidine (Tagamet)

    •Famotidine (Pepcid)

    •Nizatidine (Axid)
  207. Proton pump inhibitors details
    ¤Binds proton pump of parietal cell

    ¤Inhibits >90% of total daily gastric acid production

    ¤PPIs irreversibly bind proton pump


    •Omeprazole (Prilosec)

    •Lansoprazole (Prevacid)

    •Pantoprazole (Protonix)

    •Rabeprazole (Aciphex)

    •Esomeprazole (Nexium)
  208. Sucralfate details
    •binds to the surface of ulcers and coats ulcer

    •directly inhibits pepsin

    •binds bile salts coming from the liver

    •increases prostaglandin production
  209. Antibiotics details
    • (with PPI)
    • Clarithromycin (Biaxin) with amoxicilllin (Amoxil)
    • metronidazole
    • Bismuth subsalicylate with
    •  tetracycline
    •  metronidazole (Flagyl)
  210. Anticholinergics/antispasmodics
    • §relaxes the smooth muscles of the gut, helping to prevent or
    • relieve painful cramping spasms in the intestines
    • §most commonly used to treat irritable bowel syndrome
    • •Bentyl (dicyclomine hydrochloride) 
    • •Anaspaz, Cystospaz-M, Levsin (hyoscyamine sulfate)
  211. antacid details
    • §neutralize stomach acid using a combination of magnesium, calcium,
    • sodium, or aluminum

    • §defend the stomach by increasing acid-buffering bicarbonate and
    • mucus secretion

    §first drugs used to treat heartburn and mild dyspepsia

    • §play a role in symptom relief of peptic ulcer disease, gastritis,
    • etc.
Card Set:
Upper GI/Cancer disorders
2013-04-15 07:07:14
Upper GI Cancer disorders

Upper GI/Cancer disorders
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