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Chapter 29

Chapter 29. Care of Patients with Disorders of the Upper Gastrointestinal System. Theory Objectives. Discuss obesity and its management, including bariatric surgery. Compare the signs and symptoms of oral, esophageal, and stomach cancer.

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Chapter 29

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  1. Chapter 29 Care of Patients with Disorders of the Upper Gastrointestinal System

  2. Theory Objectives • Discuss obesity and its management, including bariatric surgery. • Compare the signs and symptoms of oral, esophageal, and stomach cancer. • Illustrate the cause of gastroesophageal reflux disease (GERD).

  3. Theory Objectives (cont.) • Explain the etiology and prognosis for Barrett’s esophagus. • Describe the pathophysiology, means of medical diagnosis, and treatment for gastritis. • Compare and contrast the treatment and nursing care of the patient with GERD and a patient with a peptic ulcer.

  4. Theory Objectives (cont.) • Review the difference in the care of the patient with a nasogastric tube for decompression and care of the patient with a feeding tube. • Compare the care for a patient receiving total parenteral nutrition with care of the patient receiving enteral feedings.

  5. Clinical Practice Objectives • Prepare a teaching plan for a patient who has GERD. • Plan postoperative care for a patient having gastric surgery. • Demonstrate proper care of the patient with a Salem sump tube for gastric decompression.

  6. Clinical Practice Objectives (cont.) • Manage a tube feeding for the patient receiving formula via a feeding pump. • Devise a nursing care plan for the patient with a gastrointestinal disorder.

  7. Anorexia Nervosa • The patient with anorexia nervosa refuses to eat adequate quantities of food and is in danger of literally starving to death • Diagnosis requires extensive interviewing, and treatment—including behavior modification and nutrition support—which may take months to years

  8. Bulimia Nervosa • The bulimic patient consumes large quantities of food and then induces vomiting to get rid of it so that weight is not gained • Laxatives • Some patients with anorexia nervosa also are bulimic • Some individuals practice bulimia occasionally without harm

  9. Bulimia Nervosa (cont.) • It can lead to severe fluid and electrolyte imbalances, starvation, and death • Treatment of bulimia includes psychotherapy, antidepressant medication, and behavior modification

  10. Obesity • Etiology and pathophysiology • Signs and symptoms • Diagnosis • Height and weight chart • Waist and hip circumference • Body mass index (BMI)

  11. Obesity Treatment • Bariatric surgery • Extensive counseling and assessment • Modify lifestyle and stringent regimen required to lose weight and keep weight off • Types • Gastric restrictive • Malabsorptive • Gastric restrictive combined with malabsorptive surgery

  12. Bariatric Surgery • Preoperative care • There is greater risk of pulmonary and thrombus formation, as well as death, for the obese patient

  13. Restrictive Procedures  • Laparoscopic adjustable gastric banding is performed by placing an inflatable band around the fundus of the stomach • The band is inflated and deflated via a subcutaneous port to change the size of the stomach as the patient loses weight

  14. Restrictive Procedures (cont.) • For vertical banded gastroplasty, the surgeon creates a small stomach pouch by placing a vertical line of staples • A band is placed to provide an outlet to the small intestine

  15. Gastric Bypass

  16. Vertical Banded Gastroplasty

  17. Circumgastric Banding

  18. Malabsorptive and Combination Procedures • The total gastric bypass procedure causes severe nutritional deficiencies and is no longer recommended • The roux-en-Y gastric bypass (RYGB) limits the stomach size, and the duodenum and part of the jejunum are bypassed. This limits the absorption of calories

  19. Complications • Leakage of stomach contents • Gastric stretching • Dumping syndrome • Nutritional deficiencies—iron, vitamin B12, calcium, and folate

  20. Healthy People 2020 Goals Related to Losing Weight and Obesity • Increase the proportion of adults who are at a healthy weight • Reduce the proportion of adults who are obese • Reduce the proportion of children and adolescents who are overweight or obese

  21. Assessment • Family history • Contributing factors • Record of eating patterns for a 7-day period • Weight and height • BMI • Skinfold thickness measurement • General health assessment

  22. Expected Outcomes • Patient will make positive statements about decreasing body size • Patient will verbalize feelings of self-worth

  23. Implementation • Diet and exercise plan • Lifestyle and preferences • Eating and exercise diary • Guidance and support • Discourage fad diets and emphasize the importance of a well-balanced, nutritious, low-calorie diet • Commercial programs on weight reduction

  24. Upper GI Disorders • Stomatitis • Dysphagia • Causes • Diagnosis • Treatment • Nursing management

  25. Implementation • Aspiration • Suctioning • Nutrition and gastrostomy

  26. Cancer of the Oral Cavity • Etiology • Pathophysiology • Signs and symptoms • Diagnosis—physical examination and biopsy • Treatment—radiation, chemotherapy, and surgery • Nursing management

  27. Cancer of the Esophagus • Cigarette smoking is a major cause of esophageal cancer in the United States • When combined with heavy alcohol consumption, the risk for esophageal cancer greatly increases • Esophageal cancer is the second most common cancer in China, but is seen less in North America

  28. Cancer of the Esophagus (cont.) • Gastroesophageal reflux disease (GERD) is a cause of Barrett’s esophagus, which is a precancerous condition

  29. Cancer of the Esophagus (cont.) • Signs, symptoms, and diagnosis • Treatment • Esophagectomy • Nursing management • Postoperative care • Nutrition

  30. Audience Response Question 1 When screening for the presence of risk factors for oral and pharyngeal cancers, the nurse would ask which question(s)? (Select all that apply.) • “How much alcohol do you consume?” • “Have you had any oral lesions?” • “Do you have family members who have cancer?” • “What do you smoke?” • “Have you been exposed to hepatitis virus?”

  31. Hiatal Hernia (Diaphragmatic Hernia) • Etiology and pathophysiology • Signs and symptoms • Treatment

  32. Treatment of Hiatal Hernia • Reduce weight • Avoid tight-fitting clothes around the abdomen • Take antacids and histamine (H2)-receptor antagonists • Elevate head of the bed on 6- to 8-inch blocks • Take proton pump inhibitors

  33. Treatment of Hiatal Hernia (cont.) • Instruct not to eat within several hours of going to bed • Limit intake of alcohol, chocolate, caffeine, and fatty foods • Avoid smoking

  34. Nursing Management • Teach ways to prevent pain and reflux • Encourage weight reduction • Remind the patient to stay upright for 2 hours after eating and not to eat for 3 hours before bedtime

  35. Nursing Management (cont.) • If the head of the bed cannot be raised, a wedge pillow should be used to elevate the upper body; this position helps prevent reflux and assists gravity in maintaining the stomach in the abdominal cavity • H2 or proton pump inhibitors • Avoid foods that cause bloating

  36. Gastroesophageal Reflux Disease (GERD) • Etiology and pathophysiology • Signs and symptoms • Diagnosis and treatment • Nursing management • Diet therapy, lifestyle changes, drug therapy, and education • Complications

  37. Gastroenteritis • Caused by food or water contaminated with a virus, a pathogenic bacteria, or parasites • Signs and symptoms • Management

  38. Gastritis • Etiology • Pathophysiology • Signs and symptoms • Diagnosis • Treatment

  39. Treatment for Gastritis • Acute versus chronic gastritis • Chronic gastritis • Antispasmodics • Antacids • H2-receptor antagonist such as ranitidine • Proton pump inhibitor • Antibiotic therapy for H. pylori

  40. Peptic Ulcers • Etiology • Helicobacter pylori • Duodenal ulcers and some pre-pyloric ulcers • Gastric ulcers • Tension, anxiety, and prolonged stress • Drug-induced ulcers

  41. Peptic Ulcers (cont.) • Pathophysiology • Signs and symptoms • Daily pattern of pain • Gastrointestinal bleeding • Diagnosis • Endoscopy • Gastric acid analysis

  42. Peptic Ulcers (cont.)

  43. Treatment • Antacids • Gastric bleeding and normal saline lavage • H2-receptor antagonist • Proton pump inhibitors • Presence of H. pylori—administration of clarithromycin (Biaxin) plus another antibiotic, an H2 inhibitor, and a proton pump inhibitor

  44. Nursing Management • Complications • Hemorrhage • Perforation • Obstruction

  45. Surgical Treatment of Peptic Ulcer • Pyloroplasty with truncal or proximal gastric vagotomy • Subtotal gastrectomy (gastric resection) • Total gastrectomy

  46. Nursing Care of the Patient Undergoing Gastric Surgery • Preoperative care • Postoperative care • Specific patient teaching • Diet restrictions   • Dumping syndrome

  47. Gastric Cancer • Etiology • Signs and symptoms • Pathophysiology • Diagnosis • Treatment • Nursing management

  48. Gastric Cancer (cont.) • Treatment • Surgical intervention • Radiation therapy • Chemotherapy • Adjuvant therapy

  49. Common Therapies for Disorders of the Gastrointestinal System • Gastrointestinal decompression • Enteral nutrition • Total parenteral nutrition

  50. Small-Bore Feeding Tube Placement

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