Rasmussen College, Ocala - NUR 2407 Nursing 2 Final exam Study guide.

● GERD ○ What is it? ■ Gastric juices move up into the esophagus due to: ■ Weak LES (lower esophageal sphincter) opens and closes when eating or drinking if not should be closed ■ Pressure changes after meals, pregn ...

● GERD ○ What is it? ■ Gastric juices move up into the esophagus due to: ■ Weak LES (lower esophageal sphincter) opens and closes when eating or drinking if not should be closed ■ Pressure changes after meals, pregnancy, bending down all increase risk of GERD ■ VERY Acidic Signs/Sx: ■ ■ #1 = Pyrosis (heartburn) ■ Coughing at night ■ Bitter taste in mouth, pain with swallowing ■ Esophagitis or pharyngitis (hoarseness) ○ “Red Flag” Symptoms: ■ Weight loss, dysphagia, anemia, abnormal masses, vomiting or bleeding, continual epigastric pain, sx unrelieved by PPI’s ○ Assessment: ■ Does your pain get worse after meals? ■ Do you have pain when bending over? ■ Any trouble swallowing? Hoarse voice? ■ Diagnostics: Endoscopy, pH Monitoring, Symptom History ○ Teaching ■ alcohol/smoking cessation, avoid bending or laying after eating, take aforementioned medications, weight loss (reduces intra-abdominal pressure) ○ Treatment: ■ Treatment: avoid foods/substances that reduce LES tone (Iggy pg. 1088, Table 54-1), elevate HOB, alcohol/cigarette cessation, administration of antacids (Maalox, Mylanta, etc….1 hour before and 2-3 hours after meal), histamine blockers (famotidine, cimetidine, ranitidine, etc.), proton pump inhibitors (omeprazole, pantoprazole, esomeprazole, etc.) ■ 1. PPI’s (-prazole) § Ex: omeprazole, pantoprazole § Decreases the volume of HCL produced § Take 30min – 1hour before meals § #1 line of defense – MOST EFFECTIVE 2. H2 Blockers (-tidine) § Ex: ranitidine, cimetidine § Take 1x daily § Blocks the release of HCL/Histamine § Treats MILD symptoms. #2 line of defense 3. Antacids (Ca+ Carbonate) § Ex: Tums, Maalox § Neutralizes stomach acid § Monitor for signs of Metabolic Alkalosis 4. Surgery § “Anti-Reflux Surgery” to tighten LES sphincter § “Nissen fundoplication” (more invasive surgery) ● Hiatal Hernia ○ Causes: ■ Part of the stomach protrudes through the esophageal hiatus/diaphragm. ■ Obesity, pregnancy, overeating, age (anything that puts extra pressure on the diaphragm or that weakens it) ○ Signs/Sx: ■ GERD symptoms are common, otherwise patient is asymptomatic ■ Most common complaint is Pyrosis (heartburn) ○ Tests ■ Barium Swallow (barium + applesauce are swallowed and then patient is monitored via fluoroscopy. If hernia is present, the barium will pool in the out-pouching). ■ Fluoroscopy: continuous x-ray done to see if aspiration/deviation occurs when eating or drinking ■ Upper Endoscopy (you can visually see the out-pouching with scope inserted into the esophagus) ○ Treatment: ■ Treat GERD ■ Surgery (surgical repair) ○ Patient Education: ■ Avoid eating 2-3 hours before bed/laying down ■ Avoid straining, ■ Elevate HOB 8-12 in when sleeping ■ Avoid alcohol/caffeine/smoking/NSAIDS ■ Eat small meals (don’t overeat) ■ STOP: smoking, ETOH, caffeine, acidic foods, avoid NSAIDS ● ESOPHAGEAL CANCER ○ Highest cancer mortality rate (15% after 5 years) with two main types: ■ Adenocarcinoma- risk factors include smoking, chronic GERD, Barrett’s esophagus ■ Squamous cell carcinoma- risk factors include smoking, alcohol ingestion, ingestion of lye, Fanconi’s anemia ○ Signs/Sx: ■ persistent and progressive dysphagia, severe chest/abdominal pain, regurgitation, hoarseness, anorexia, N/V, weight loss ○ Treatment ■ based on staging of the cancer, would be palliative or curative. Could include esophagectomy or endoscopic mucosal resection. If metastasis has occurred, chemo/radiation would be done prior to surgery. ● DYSPHAGIA ○ Difficulty swallowing is a major concern in the older adult as well as the majority of stroke sufferers ○ Assessment: ■ difficulty swallowing liquids or solids, coughing after eating or drinking, recurrent pulmonary infections, difficulty with speech (dysphonia) that could indicate a motor dysfunction ○ Testing ■ Barium swallow- patient swallows a radioactive dye that can show areas of dysfunction during swallowing ■ Endoscopic evaluation ○ Nursing Management: ■ thickened liquids/foods, HOB 30-45 degrees ○ Depending on the type and severity of dysphagia there are some surgical interventions that can be done to treat the condition ● Peptic Ulcer Disease (PUD) ○ What is it? ■ Caused by dyspepsia (indigestion) which erodes the mucosal lining of the stomach/duodenum ■ #1 cause = H. pylori ■ #2 cause = NSAIDs on empty stomach ■ Smoking, alcohol, family hx ○ Signs/Sx: ■ #1 Symptom = Burning/abdominal pain ■ Burning pain is often relieved by eating or antacids ■ Pain wakes patient up in the middle of the night ■ Bloating, pain in middle of night, weight loss, poor appetite ■ Worse if stomach is empty ○ Tests: ■ Endoscopy ■ H. pylori testing ○ Treatment: ■ OTC Antacids (risks: hypercalcemia, metabolic alkalosis, diarrhea, constipation, Na+ overload ■ PPI’s, H2 Blockers, Metronidazole (Flagyl), Tetracycline (pg. 1359 in book) ■ Cryoprotective agent: Sucralfate ■ Coats stomach & forms a barrier allowing the ulcer time to heal. ■ Take on empty stomach 1-2 hours before meals or 2 hours after meal. ■ Risk: makes it harder for your body to absorb other medications due to the coating on the stomach wall