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Upper GI

Terms in this set (89)

Normal stomach pH
<4, acidic
Normal intestinal pH
>6, basic
What supplies are needed to insert an NG tube?
Water soluble lubricant (only kind you can use)
Syringe
Tape
Drink if patient is allowed/able
What is GI intubation used for?
decompression
obtaining specimens
administration of feedings/medications
A Levine NG tube is what?
Single lumen
Used for administration instead of decompression
A salem sump NG tube is what?
Double lumen
Allows vent for suction
Prevents damage to gastric mucosa
Must keep blue pigtail above patient midline
What is a nasoenteric tube?
Ends in the small intestine
Uses a balloon to float to small intestine
Rules for nasoenteric tubes?
Nurses do not put these in
ONLY low intermittent suction
check pH
Irrigate with NS
What type of fluids must be used for lavage?
Isotonic must be used to avoid throwing off electrolytes
If the patient can't stop coughing after NG insertion what is most likely the problem?
Tube is likely in the lungs
How is a sangstaken-blakemore tube used?
Used to treat esophageal varices by applying pressure
Irrigate with NS
Watch for resp. distress
Give frequent oral hygiene
What does PEG stand for?
percutaneous endoscopic gastrostomy
Signs of tube feeding intolerance
Nausea/Vomiting/Diarrhea
Cramping
Guidelines for tube feeding
Always check placement before administration
Check residual before feeding
Adequately flush before and after
HOB 30-45 degrees
Used crushed or liquid meds
Monitor daily weight, lytes, glucose, I&O
Give with infusion pump
How is tube feeding usually initiated?
Usually started as half strength, small volume, then increased
How long are feeding tubing and bags good for?
24 hours
Guidelines for J-Tubes?
There will be no residual
Decreased aspiration risk
Need continuous feeds
Causes of diarrhea with tube feeding
Running feeds too fast
Feeds are too rich
Causes of constipation with tube feeding
Not enough water
Not enough fiber
What is PPN?
peripheral parenteral nutrition
Goes through peripheral IV
more dilute
What is TPN?
total parenteral nutrition
goes through central line
stronger concentration
Symptoms of dumping syndrome
abdominal fullness
nausea
flushing
sweating
flatulence
abdominal cramps
diarrhea
hyperglycemia followed by hypoglycemia
Pneumothorax caused by TPN
Caused by malposition with insertion of central line
X-Ray must confirm correct line placement before initiating TPN
How is leaking, clotting off, dislodgement, and breakage avoided with TPN?
Frequent observation
Infuse using locked tube connections and a pump
What causes risk for infection in TPN patients? How do we avoid infection with TPN patients?
High glucose solutions= increased bacteria growth
Skin disrupted from line insertion
Must use sterile technique with tubing and dressing changes (according to protocols)
How often are accuchecks done on TPN patients?
every 6 hours
Fluid status assessment for pediatrics/infants
Weight (essential)
Mental status
Pulse quality
Skin turgor
Fontanels (bulging: overload, sunken dehydration)
Mucous membranes
Urine (ask about wet diapers)
Lung sounds (for fluid overload)
What is not a "go to" assessment for fluid status in pediatrics/infants?
Vital signs
Ex: HR and RR may be elevated because patient is crying and stressed, not because of dehydration
Bacterial causes of diarrhea
Salmonella
E. Coli
Viral causes of diarrhea
Rotavirus
Norovirus
What classifies someone as morbidly obese?
>100 lbs over ideal body weight
Incidence of obesity is increased in who?
Women
African Americans
Economically disadvantaged
IBW for both genders
Males: 10-20% body fat
Females: 20-30% body fat
Medications to help with obesity
Amphetamines: high risk for abuse
Sibutramine (Meridia): appetite suppressant, acts on CNS, increases metabolic rate
Orlistat (Xenical): inhibits fat absorption from GI tract
Causes of stomatitis
Trauma to the mouth
Pathogens
Irritants (chemo, nicotine, alcohol)
Not viral
Symptoms of stomatitis
Excessive salivation
Halitosis
Sore mouth
Treatment of stomatitis
Good oral hygiene
Soothing solutions
Soft, bland, cool diet
Predisposing factors to Herpes Simplex breakouts
URI
Stress
Sunlight
Menstruation onset
Treatment of herpes simplex breakouts
Removal/control of predisposing factors
Antiviral agents (acyclovir)
Topical steroids/analgesics
Symptoms of oral candidiasis
Pearly bluish white milk curd lesions(can't wipe off)
Sore mouth
Yeasty halitosis
Decreased intake and fussiness in infants
Treatment of oral candidiasis
Nystatin (take after all other meds)
Good oral hygiene
Main concern with a notch in the vermillion border?
Latching and feeding issues
Not life threatening, palate is intact
Main concerns with unilateral cleft lip and palate?
Tongue cannot suction to roof of the mouth
May lead to recurrent ear or sinus infections
Requires multiple surgeries or prosthesis
Main concerns with bilateral cleft lip and palate?
Tongue cannot suction to roof of the mouth
Will need special nipples or feeding tube
Nurture rooting and sucking with fingers or pacifier if using a feeding tube
Requires multiple surgeries or prosthesis
Main concerns with a cleft palate? (not lip)
Often missed because it is not visible without examining roof of infants mouth
May not need surgery
May be noticed by feeding difficulties
What is erythroplakia?
Red plaque like oral lesions
What is leukoplakia?
White leathery oral patches
Post op care for a patient with jaw wiring?
Position with head up
Wire cutters at bedside
Put in room close to nurses station
Put signs on the call light system
Antiemetics should be ordered
Pureed/liquid/through a straw diet
High risk for constipation
Establish a form of communication (ex:flash cards)
1st step if someone has esophageal trauma or esophagitis
Make them NPO
RN responsibilities when a cleft palate is discovered
Find the cleft palate by oral examination
Assess for more anomalies
Reassure parents
Collaborate with other departments (dietary, speech, etc) to ensure adequate nutrition
Symptoms and the 3 C's of TEF
Excessive salivation and drooling
May stop breathing
Coughing
Choking
Cyanosis
What happens with a proximal and distal atresia but no fistula?
"U-Turn": anything that goes in comes back up causing excessive drooling
Main goal is to prevent aspiration
What happens with a proximal and distal atresia + proximal fistula?
Intake goes directly to lungs
MUST be NPO and will need TPN and surgery
What happens with proximal atresia + distal fistula?
Gastric acids and content can go directly to lungs
NPO
will have G tube to keep stomach empty
A "true TEF" may cause what?
May go unnoticed causing the patient to go home where they will develop respiratory distress
Often choke during swallowing
Often have frequent pneumonias
Diagnostics for hiatal hernias
Barium swallow
Upper endoscopy
Treatment for hiatal hernia
Diet and lifestyle changes
Medications
Surgery if necessary or hernia becomes incarcerated (Nissen Fundoplication)
What is a hiatal hernia?
Part of stomach protrudes through the esophageal hiatus of the diaphragm into the thoracic cavity
What is GERD?
backward flow of gastric contents into the esophagus
What causes GERD?
increased gastric volume (post meals)
position pushing gastric contents close to gastroesophageal juncture (like bending over, laying down)
increased gastric pressure (obesity, tight clothing)
hiatal hernia
Symptoms of GERD
heartburn
regurgitation of sour materials in mouth
pain with swallowing
atypical chest pain
sore throat with hoarseness
Diagnostics for GERD
may be made from history of symptoms/risks
Barium swallow
Upper endoscopy
24 hour ambulatory pH monitoring (NG needed)
Esophageal manometry (NG needed)
Treatment of GERD
eliminate acidic foods
avoid fatty foods, chocolate, peppermint, alcohol
maintain IBW
small meals
stay upright for 2 hours after eating
no food 3 hours before bed
elevate HOB
no smoking
avoid bending
loose fitting clothing
How do H2 blockers work?
decrease acid production
given BID or more often
cimetidine, ranitidine, famotidine, nizatidine
How do proton pump inhibitors work?
reduce gastric secretions, promote healing of esophageal erosion
omeprazole, lansoprazole,
given initially for 8 weeks or 3-6 months
How do promotility agents work?
enhances esophageal clearance and gastric emptying
metoclopramide
Patient teaching for antacids
dont take with other medications, will decrease their absorption
Surgeries for GERD
laparoscopic procedures to tighten lower esophageal sphincter
Nissen Fundoplication (diaphragm muscle and stomach sutured in place)
Treatment for diaphragmatic hernia
Mom will deliver via C-section if diagnosed before birth
NPO
Surgery required
Treatment for esophageal varices
blood transfusion and FFP
vasoconstrictive medications (vasopressin)
upper endoscopy (to do banding)
balloon tamponade (tube inserted by MD applies pressure to control bleeding)
symptoms of esophageal cancer
progressive dysphagia and pain with swallowing
choking, hoarseness, cough
anorexia, weight loss
Diagnostics for esophageal cancer
Barium swallow
esophagoscopy
radiology exams
CBC
Serum albumin
Liver function tests
Treatment for early detected esophageal cancer
surgical resection of affected portion of anastomosis of stomach to remaining esophagus
#1 symptom of gastritis
pain with eating
Treatment of gastritis
small frequent meals
decrease fatty foods
no alcohol or smoking
PPI's like protonix
H2 blockers
Treatment for UGI bleeding
Initiate O2 and IV (large)
Salem sump NG tube, lavage with NaCl
PRBC, FFP, Vit k, platelets if needed
Surgical consult
Prevention of UGI bleeds
stress modification
no alcohol
no smoking
decrease fatty foods
enteric coated meds
Symptoms of gastric peptic ulcers
hurts with eating
weight loss from avoiding eating
nausea/vomiting
pain relieved by vomiting
hematemesis
Symptoms of duodenal peptic ulders
hurts 2-4 hours after eating
wakes pt up in the middle of the night
weight gain
will snack often because pain is relieved by food
melena
Diagnosis of ulcers
history
physical exam
Upper GI
stool specimen
EGD (best option)
Mucosal barrier fortifiers
Sucralfate
Cytotec (not for pregnant women)
Give 1 hour before food
Do not crush
When should antacids be taken?
1 hour before or 2 hours after meals
How do anticholinergics/antispasmodics work?
block acetylcholine- a stimulant of acid secretion
decrease pyloric spasm and motility
can cause dry eyes/mouth, urinary retention
Major side effect of flagyl
metallic taste regardless of route given
Surgery for ulcers
Vagotomy- cutting the vagus nerve
Pyloroplasty- enlarges opening
Antrectomy- remove lower stomach
Gastrectomy
Treatment of dumping syndrome
small frequent meals
high protein
high fat
low carbs
eliminate liquids with meals
lying down
Stress ulcers often occur when?
Medical crisis or trauma
Curlings- burns
Cushings- brain injury
Asymptomatic
Prevention is best
Symptoms of gastric cancer
Often not found until late- poor prognosis
Unexplained weight loss
Abd distention
Discomfort
Hypertrophic Pyloric Stenosis
Obstruction at pyloric sphincter by hypertrophy
Found soon after birth because of severe projectile vomiting
Baby will be hungry and wanting 2nd feeding
Diagnosed with US
Monitor for FTT
Laparoscopic surgery will repair
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