Upper Gi disorders 6
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25 terms
Terms | Definitions |
|---|---|
 PUD: Etiology | NSAIDS use Bacterial infection with H. Pylori Other causes: theophylline (Theo-Dur), caffeine, corticosteriod use, risk factors for gastritis same for PUD |
| PUD: History: Assessment | Ask pt about factors that promotes development of PUD: Alcohol intake Tobacco use Certain irritating foods: spicy, acid content Caffeine intake Ask about meds Ask about GI surgeries Ask about pain in relation to eating and sleeping |
| PUD: Clinical Manifestations | Epigastric tenderness usually located at the midline between the umbilicus and the xiphoid process Dyspepsia: typically described as sharp, burning, or gnawing pain Sensation of abdominal pressure or of fullness or hunger |
| PUD Diagnostic Assessment | Hemoglobin & Hematocrit (H & H) Stool specimen for occult blood Blood test to detect H. pyloric (see Gastritis) EGD (see GERD) |
| PUD: Nursing Diagnoses | Acute Pain related to physical (gastric and/or duodenal mucosal) injury. Chronic Pain related to physical (gastric and/or duodenal mucosal) injury. Risk for GI bleeding |
| PUD Four primary goals for drug therapy: Provide pain relief | Eradicate Helicobacter pylori infection Heal ulcerations Prevent recurrence |
| PUD Drug Therapy | Antacids H₂ Receptor Antagonists Proton Pump Inhibitors Mucosal Barrier Fortifiers Antibiotics Prostaglandin Analogues |
| Helicobacter pylori: Treatment | Proton Pump Inhibitor plus 2 antibiotics lansoprazole (Prevacid) plus metronidazole (Flagyl)and tetracycline or clarithromycin (Biaxin) and amoxicillin for 7-14 days. |
| Prostaglandin Analogues: Misoprostol (Cytotec) | Reduce gastric acid secretion and enhance gastric mucosal resistance to tissue injury when pt is taking NSAIDS |
| Prostaglandin Analogues: Misoprostol (Cytotec) Nursing Implications: | Take with food--Protects against NSAID-induced ulcers. Avoid magnesium-containing antacids---Both Cytotec and magnesium-containing antacids can cause diarrhea. Uterine contraction is a significant adverse effect of misoprostol. |
| PUD Nutrition Therapy | Nutrition therapy may be directed toward neutralizing acid and reducing hypermotility. A bland, nonirritating diet is recommended during the acute symptomatic phase. Avoid bedtime snacks. Avoid alcohol and tobacco. Avoid coffee, tea, cola |
| Potential for GI Bleeding | Interventions include: Monitoring and early recognition of complications (critical to the successful management of PUD) Preventing and/or managing bleeding, perforation, and gastric outlet obstruction Possible surgical treatment |
| Upper GI Bleeding: Hypovolemia Management | Monitor vital signs & O₂ Sat Observe for fluid loss from bleeding and vomiting. Monitor serum electrolytes. Monitor Hemoglobin & Hematocrit Insert two large-bore peripheral IV catheters to replace both fluids and blood lost. |
| Hypovolemia Management (Cont'd) | Volume replacement should be started immediately. Blood products may be ordered to expand volume and correct abnormalities in the CBC. Orthostatic hypotension is common in patients with decreased fluid volume. |
| UGI Bleeding: Bleeding Reduction | Monitor for s/s of bleeding. Hematest all secretions. Monitor CBC. Insert NGT to suction. Perform gastric lavage, as appropriate |
| UGI Bleeding: Bleeding Reduction cont. | Endoscopic therapy can assist in achieving hemostasis. Acid-suppressive agents are used to stabilize the clot by raising the pH level of gastric contents. |
| Nonsurgical Management of Other Complications of PUD | Perforation is managed by immediately replacing fluid, blood, and electrolytes: Administering antibiotics Keeping the patient NPO NGT to suction Monitor I & O; Check VS |
| Nonsurgical Management of Other Complications of PUD cont. | Pyloric obstruction treatment is directed at restoring fluid and electrolyte balance and decompressing the dilated stomach. NGT to suction; Clamp after 72 hrs. Treat metabolic alkalosis and dehydration |
| Surgical Management of PUD Two surgical approaches are available: | Minimally invasive surgery (MIS) via laparoscopy to remove a chronic gastric ulcer or treat hemorrhage from perforation Vagotomy (vagus nerve cutting) to control acid secretion Pyloroplasty (open the pylorus) facilitates emptying of stomach contents. |
| Gastric Cancer: Etiology | Strong link between H. pylori and gastric cancer Pernicious anemia, gastric polyps, chronic atrophic gastritis, achlorhydria, Barrett's esophagus, gastric surgery—increases chances |
| Gastric Cancer: Etiology cont | Positive correlation between ingestion of pickled foods, salted meat, processed foods, high consumption of salt 5 yr survival rate is low |
| Gastric Cancer: Health Promotion | Teach pts with gastritis and/or H. pyloric to follow treatment regimen to ensure that gastritis heal and H. pyloric infection is eliminated. Teach about eating well-balanced diet and limit pickled foods, salted food, and processed foods. Teach about avoiding alcohol and tobacco. |
| Gastric Cancer: Clinical Manifestations | Early gastric cancer may be asymptomatic, but indigestion and abdominal discomfort are the most common symptoms. Advanced stage: N/V, obstructive symptoms, iron deficiency anemia, palpable epigastric mass, enlarged lymph nodes, weakness and fatigue, progressive weight loss |
| Gastric Cancer: Other Pertinent Findings | Low Hemoglobin & Hematocrit Anemia Stool positive for occult blood Carcinoembryonic antigen (CEA) elevated EGD for definitive diagnosis Endoscopic Ultrasound to evaluate depth of tumor & lymph node involvement to determine staging of disease. |
| Gastric cancer Nonsurgical Management | Drug therapy: Combination chemotherapy. Radiation therapy: The use of this treatment is limited because the disease is often widely disseminated upon diagnosis. |
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