chapter045

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 45: Caring for Clients with Disorders of the Upper Gastrointestinal

Tract


Disorders that Affect Eating: AnorexiaDisorders that Affect Eating: Anorexia• Anorexia: Lack of appetite; Malnutrition

• Pathophysiology and Etiology

– The appetite center

• Location and function; Gluconeogenesis

• Assessment Findings: Signs and Symptoms

– Absence of hunger; Nausea

• Diagnostic Findings

– Reduced hemoglobin level, blood cell counts


Disorders that Affect Eating: AnorexiaDisorders that Affect Eating: Anorexia

• Medical and Surgical Management

– Short-term: No medical intervention

– Various approaches for persistent anorexia

– Psychological and psychiatric treatment

• Nursing Management

– Assessment; Diagnosis; Planning

– Implementation

– Evaluation of Expected Outcomes


• Pathophysiology, Etiology: Common causes, symptoms


– Loss of appetite; Dehydration

• Diagnostic Findings: Low levels of serum sodium and chloride


– IV fluids, electrolytes; Drug therapy


Disorders that Affect Eating: Nausea, Vomiting (N/V)Disorders that Affect Eating: Nausea, Vomiting (N/V)


• Pathophysiology and Etiology: Common causes, symptoms


– Loss of appetite; Dehydration

• Diagnostic Findings: Low levels of serum sodium and chloride


– IV fluids, electrolytes; Drug therapy

Disorders that Affect Eating: Nausea, Vomiting (N/V)Disorders that Affect Eating: Nausea, Vomiting (N/V)



– Assessment

– Diagnosis

– Planning

– Implementation


Disorders that Affect Eating: N/VDisorders that Affect Eating: N/V



– Assessment

– Diagnosis

– Planning

– Implementation


Disorders that Affect Eating: Cancer of the Oral CavityDisorders that Affect Eating: Cancer of the Oral Cavity


Inserting a Nasogastric TubeInserting a Nasogastric Tube


Gastrostomy TubesGastrostomy Tubes• Provides Route

– Nutrition; Medications; Gastric decompression/compression; Lavage; Diagnostics; Treatment

• Placement

– Nasogastric (NG); Orogastric; Nasoenteric

– Surgical placement: Gastrostomy

• PEG tube; G-Tube; Jejunostomy

• Long-term Tube Feedings


Gastrostomy TubesGastrostomy Tubes• Nursing Management

– Assessment

– Diagnosis

– Planning

– Implementation



Esophageal Disorders: GERDEsophageal Disorders: GERD• Gastroesophageal Reflux Disease: Gastric

contents regurgitates

• Pathophysiology; Etiology: Lower esophageal sphincter insufficiency


– Epigastric pain, burning; Regurgitation

• Diagnostic Findings: Barium swallow; Upper endoscopy with biopsy; Capsule; Bronchoscopy

• Medical and Surgical Management: Conservative measures; Medications; Fundoplication; Stretta procedure


Esophageal Disorders: GERDEsophageal Disorders: GERD• Nursing Management

– Assessment

– Diagnosis

– Planning

– Implementation

– Evaluation of Expected Outcome


• Pathophysiology, Etiology: Zenker’s diverticulum; Congenital or acquired esophageal wall weakness


– Foul breath; Difficulty swallowing

• Diagnostic Findings: Barium swallow; Esophagoscopy


– Diet therapy: Bland; Soft; Semisoft; Liquid

– Surgical excision of the diverticulum

Esophageal DiverticulumEsophageal Diverticulum



– Assessment

– Diagnosis

– Planning

– Implementation

– Evaluation of Expected Outcome

Esophageal DiverticulumEsophageal Diverticulum


Hiatal HerniaHiatal Hernia

• Axial (or sliding); Paraesophageal

• Pathophysiology and Etiology: Diaphragm defect; Congenital muscle weakness

• Assessment Findings: Heartburn; Belching or pain after eating

• Diagnostic Findings: Barium swallow; Esophagoscopy

• Medical and Surgical Management: Stretch narrowed esophagus endoscopically


Hiatal HerniaHiatal Hernia


– Assessment

– Diagnosis

– Planning

– Implementation



• Pathophysiology; Etiology: Affects men > women; Squamous cell carcinoma

– Correlation: Alcohol abuse; Smoking


– Beginning, progressive symptoms

• Diagnostic Findings: Barium swallow; Biopsy; EGD; Bronchoscopy; Endoscopic ultrasound; Mediastinoscopy

• Medical and Surgical Management: Surgery; Palliative measures

Esophageal CancerEsophageal Cancer



– Assessment

– Diagnosis

– Planning

– Implementation


Esophageal CancerEsophageal Cancer


• Pathophysiology, Etiology: Helicobacter pylori; Acid production


– Common symptoms, same with bacterial or viral infection

• Diagnostic Findings: CBC; Gastroscopy; Stool test

• Medical and Surgical Management: Diet restriction; IV fluids; Medications: Antiemetics; Antibiotics

Gastric Disorders: GastritisGastric Disorders: Gastritis



– Assessment

– Diagnosis

– Planning

– Implementation


Gastric Disorders: Gastritis Gastric Disorders: Gastritis


Peptic Ulcer Disease Peptic Ulcer Disease • Pathophysiology and

Etiology

– Infection with Helicobacter pylori; Family history; Other risk factors

– Chronic gastric inflammation

• Assessment Findings: Pain (abdomen and back); Bleeding: Hematemesis; Melena


Peptic Ulcer DiseasePeptic Ulcer Disease

• Diagnostic Findings: Upper GI; EGD; Low Hemoglobin, RBC

• Medical and Surgical Management: Eradication therapy; Pain management

– Gastrectomy: Dumping syndrome


– Assessment; Diagnosis

– Planning; Implementation



• Pathophysiology and Etiology: Heredity; Chronic inflammation; Achlorhydria; Chronic ingestion of toxins


– Early: Stool contains occult blood

• Diagnostic Findings: Barium swallow; CT scan; Tissue biopsy; Gastric analysis; Ultrasonography

• Medical; Surgical Management: Subtotal or total gastrectomy; Chemotherapy; Palliative radiation

Stomach CancerStomach Cancer



– Assessment

– Diagnosis

– Planning

– Implementation


Stomach CancerStomach Cancer


End of Presentation

chapter045

Documents

symptoms assessment

surgical management

esophageal disorders

surgical management

diverticulum copyright

anorexia medical

chloride medical

nv pathophysiology