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UPPER GI TERMS

LEUKOPLAKIA NAUSEA VOMITING ANOREXIA DYSPHAGIA DYSPEPSIA. GASTROSTOMY XEROSTOMIA ACHLORHYDRIA GAVAGE LAVAGE. UPPER GI TERMS. STOMATITIS. INFLAMMATION & BREAKDOWN OF ORAL MUCOSA (MUCOSITIS) OFTEN SIDE EFFECT OF CHEMOTHERAPY &/OR RADIATION

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UPPER GI TERMS

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  1. LEUKOPLAKIA NAUSEA VOMITING ANOREXIA DYSPHAGIA DYSPEPSIA GASTROSTOMY XEROSTOMIA ACHLORHYDRIA GAVAGE LAVAGE UPPER GI TERMS

  2. STOMATITIS • INFLAMMATION & BREAKDOWN OF ORAL MUCOSA (MUCOSITIS) • OFTEN SIDE EFFECT OF CHEMOTHERAPY &/OR RADIATION • MILD REDNESS AND EDEMA THAT CAN LEAD TO PAINFUL ULCERATIONS, BLEEDING, SECONDARY INFECTION • PAIN  POOR HYGIENE, POOR NUTRITION AND ALTERED SPEECH

  3. NURSING CONCERNS • AVOID IRRITATING FOODS • TOPICAL ANTIINFLAMMATORIES • ANALGESICS • HYDRATION • NUTRITION (IV IF NEEDED) • ANTIBIOTICS

  4. FRACTURED MANDIBLE • TRAUMA • USUALLY CLOSED FRACTURE • RIGID PLATE FIXATION • NO CHEW 1 – 4 WEEKS • LIQUIDS • NEED TO TEACH ABOUT GOOD NUTRITION

  5. FOOD POISONING • INGESTION OF CONTAMINATED FOOD OR DRINK • DETERMINE SOURCE & TYPE FOOD • EXAMINE • FOOD • GASTRIC CONTENTS • VOMITUS • SERUM • FECES

  6. ASSESS VS & MUSCULAR ACTIVITY • MAINTAIN RESPIRATORY STATUS • WATCH FOR F&E IMBALANCE • ANTIEMETICS • CLEAR LIQUIDS  SOLIDS

  7. ORAL CANCER • MAJOR RISKS – ETOH & TOBACCO • 95% IN >40YO • MORE YOUNG MEN < 30YO R/T SMOKELESS TOBACCO • MEN > WOMEN • 2% OF ALL CANCER DEATHS

  8. USUALLY SQUAMOUS CELL • TUMOR > 4CM OFTEN RECUR • LIPS, LATERAL TONGUE, FLOOR OF MOUTH MOST COMMON SITES

  9. ASSESSMENTS • FEW SIGNS EARLY • PAINLESS SORE THAT WON’T HEAL • LATER • TENDERNESS • DIFFICULTY CHEWING • DIFFICULTY SWALLOWING • DIFFICULTY SPEAKING • BLEEDING • ENLARGES LYMPH NODES

  10. ORAL EXAM & BIOPSY • TREATMENT • SURGICAL RESECTION • RADIATION • CHEMOTHERAPY • ALL OR ANY COMBO OF ABOVE

  11. NURSING DIAGNOSES • IMBALANCED NUTRITION • DISTURBED BODY IMAGE • PAIN • IMPAIRED VERBAL COMMUNICATION • RISK FOR INFECTION • KNOWLEDGE DEFICIT R/T DISEASE PROCESS & TREATMENT

  12. ASSESS NUTRITIONAL STATUS • ENTERAL OR PARENTERAL NUTRITION • AIRWAY ASSESSMENT • SUCTION PRN • ASSESS WOUNDS • OFFER EMOTIONAL SUPPORT • TEACHING

  13. ESOPHAGEAL CANCER • 4% OF ALL CA DEATHS • 50 – 70 YO • MEN> WOMEN • SPICY DIET • ETOH • SMOKING

  14. ASSESSMENTS DYSPHAGIA CHEST FULLNESS LUMP IN THROAT REGURGITATION WT LOSS WEAKNESS DIAGNOSIS MAINLY BY ENDOSCOPY & BIOPSY TREATMENT SURGERY RADIATION CHEMOTHERAPY

  15. HIATAL HERNIA • SLIDING • 90% OF ALL HIATAL HERNIAS • IN AND OUT OF THORAX • HEART BURN • REGURGITATION • DYSPHAGIA • 50% ASYMPTOMATIC

  16. PARAESOPHAGEAL – ALL OR PART OF STOMACH INTO THORAX NEXT TO GASTROESOPHAGEAL JUNCTION • 10% OF ALL HIATAL HERNIAS • SENSE OF FULLNESS PC • STRANGULATION A REAL CONCERN

  17. ALTERATION IN COMFORT • ALTERATION IN NUTRITION • SMALL, FREQUENT MEALS • LESS IRRITATING FOODS • NO RECLINING PC • HOB ON BLOCKS • SURGERY – NISSAN FUNDOPLICATION

  18. GASTRIC CANCER • ON DECLINE • ABOUT 12,400 DEATHS PER YEAR • MEN > WOMEN • > 40YO • METS OFTEN BEFORE DIAGNOSIS • ADENOCARCINOMAS • OFTEN PENETRATES WALL AND SPREADS TO ADJACENT ORGANS

  19. CAUSATIVE FACTORS • DIET HIGH IN SMOKED FOODS AND LOW IN FRUITS AND VEGGIES • CHRONIC GASTRITIS • PERNICIOUS ANEMIA • ACHLORHYDRIA • GASTRIC ULCERS • H. PYLORI INFECTION • GENETICS

  20. ASSESSMENTS • EARLY – PAIN RELIEVED BY ANTACIDS • LATER • ANOREXIA • N & V • DIARRHEA • WT LOSS • DYSPEPSIA • ABD PAIN • ANEMIA

  21. ENDOSCOPY WITH BIOPSY • BARIUM SWALLOW • SCANS TO DETECT METS • TREATMENT • REMOVAL OF TUMOR • COMPLETE CURE • RADICAL SUBTOTAL GASTRECTOMY • PALLIATIVE RESECTION • CHEMO • PALLIATIVE RADIATION THERAPY

  22. ANXIETY VENTILATION EXPLAIN EVERYTHING PAIN ANALGESICS POSITION CHANGE IMAGERY RELAXATION EXERCISES MASSAGE IMBALANCED NUTRITION SML, FREQ, NON-IRRITATING FOODS HI CAL, VIT, IRON TPN PRN MANAGE DUMPING SYNDROME I & O DAILY WTS LOOK FOR DEHYDRATION ANTIEMETICS NURSING DIAGNOSES & CARE

  23. ANTICIPATORY GRIEVING ANSWER QUES. HONESTLY RECOGNIZE NORMAL EMOTIONAL CHANGES EMPATHY KNOWLEDGE DEFICIT R/T SELF CARE NUTRITION TEACH. TREATMENT PLANS ACTIVITY & LIFESTYLE CHANGES PAIN MANAGEMENT POSS. COMPLICA. BLEEDING OBSTRUCTION PERFORATION WORSENING SYMPS

  24. GASTROESOPHAGEAL REFLUX DISEASE (GERD) • GENERALLY A RELAXATION OF THE LOWER ESOPHAGEAL SPHINCTER (LES)

  25. ASSESSMENTS • HEARTBURN • CHEST PAIN • DYSPHAGIA • LUMP IN THROAT • WHEEZING • HOARSENESS • CHRONIC COUGH • SORE THROAT

  26. ANTACIDS H2 BLOCKERS PROTON-PUMP INHIBITORS SURGERY FUNDOPLICATION LIFESTYLE MODIFICATION STOP SMOKING LESS ETOH LOSE WEIGHT SML MEALS SLEEP WITH HOB UP UPRIGHT PC NO EAT OR DRINK 2 – 3 HRS HS TREATMENT

  27. FOODS TO AVOID • HIGH FAT • PEPPERMINT • CAFFEINE • TOMATO PRODUCTS • CITRUS FRUIT PRODUCTS

  28. H2 BLOCKERS TAGAMET (CIMETIDINE) PEPCID (FAMOTIDINE) AXID (NIZATIDINE) ZANTAC (RANITIDINE) PROTON PUMP INHIBITORS PREVACID (LANSOPRAZOLE) PRILOSEC (OMEPRAZOLE) NEXIUM (ESOMEPRAZOLE) UPPER GI MEDS

  29. PEPSIN INHIBITOR – CARAFATE (SUCRALFATE) • PROSTAGLANDINANALOGUE – CYTOTEC (MISOPROSTOL) • USED WITH NSAID’S • INCREASES GI MUCOUS • DECREASES ACID PRODUCTION

  30. ANTACIDS • ALUMINUM (BASAJEL, AMPHOJEL) • CONSTIPATION MAJOR SE • MAGNESIUM (MAG-OX 400, MAOX) • DIARRHEA MAJOR SE • CALCIUM (TUMS)

  31. ALUMINUM/MAGNESIUM COMBINATION • RIOPAN • MAALOX • WITH SIMETHICONE • MYLANTA • MAALOX PLUS • GELUSIL

  32. TAKE WITH WATER TO MOVE DOWN • TAKE 1 – 3 HOURS AFTER MEALS • DO NOT TAKE WITH ANY OTHER MEDS

  33. ANTIEMETICS • INHIBIT THE CTZ IN MEDULLA • DEPRESS VESTIBULAR APPARATUS SENSITIVITY IN INNER EAR • DROWSINESS & DRY MOUTH MAJOR SIDE EFFECTS

  34. PHENOTHIAZINES (PHENERGAN) • ANTIHISTAMINES (MECLIZINE) • ANTICHOLINERGICS (SCOPOLAMINE) • SEDATIVES (BARBITURATES, VISTERIL) • OTHERS • REGLAN • INAPSINE • KYTRIL • ZOFRAN • TIGAN

  35. GASTRITISINFLAMMATION OF STOMACH MUCOSA • ACUTE CAUSES • FOOD IRRITATION • OVERUSE OF NSAID’S OR ASA • ETOH EXCESS • BILE REFLUX • RADIATION THERAPY • INGESTION OF STRONG ACID OR ALKALI • EMERGENCY!!!!!

  36. CHRONIC CAUSES • BENIGN OR MALIGNANT ULCERS • H. PYLORI BACTERIA • SMOKING EDEMATOUS, HYPEREMIC MUCOSA WITH SUPERFICIAL EROSION LOW ACID PRODUCTION MAYBE ULCERATION  BLEED

  37. ACUTE MAYBE NONE ABD DISCOMFORT N & V ANOREXIA HEADACHE LETHARGY CHRONIC ANOREXIA HEART BURN PC BELCHING SOUR TASTE N & V ASSESSMENTS

  38. ENDOSCOPY WITH BIOPSY • H. PYLORI TESTING • ACUTE USUALLY RECOVER IN 1 DAY • NON-IRRITATING FOODS • NO ETOH • ANTACIDS • DECREASE STRESS • TREAT H. PYLORI

  39. IF PERFORATION OR BLEEDING • NG SUCTION • IF FLUIDS • ANALGESICS • SURG, MAYBE • NEUTRALIZE ACIDS OR ALKALI • ACIDS – ANTACIDS • ALKALI – DILUTE LEMON JUICE OR VINEGAR

  40. NURSING DIAGNOSES • ANXIETY • ALTERED NUTRITION • RISK FOR F & E IMBALANCE • KNOWLEDGE DEFICIT R/T DISEASE PROCESS AND TREATMENT • PAIN

  41. NURSING CARE • ANSWER QUESTIONS • EXPLAIN PROCEDURES • IV THERAPY • MONITOR F & E STATUS • DECREASE CAFFEINE, ETOH, SMOKING • NOTE NG ASPIRATE COLOR • VITAL SIGNS • ANALGESICS • TEACH DIET AND MED THERAPY

  42. PEPTIC ULCER DISEASE • IMBALANCE BETWEEN THE DIGESTING ACTION OF GASTRIC JUICES AND THE CAPACITY OF THE GASTRIC AND DUODENAL MUCOSA TO RESIST DIGESTION. • PUD

  43. DEVELOPMENTAL FACTORS • POOR EPITHELIUM REGENERATION • DECREASED MUCOUS PRODUCTION • POOR BLOOD SUPPLY • INCREASED HCL • AGE • SEX • STRESS LEVEL • BLOOD GROUP (O HAS MOST) • FAMILY HISTORY • SMOKING HISTORY • ETOH • ULCEROGENIC DRUGS

  44. HELICOBACTER PYLORI • PRESENT IN HUGE # IF PUD CASES • DIAGNOSED BY • MUCOSAL CULTURE • BREATH TEST • IMMUNOASSAY OF ANTIBODIES • TREATED WITH • PEPTO BISMOL • AMOXICILLIN OR TETRACYCLINE • H2 BLOCKER • FLAGYL • COMBO OF THESE

  45. USUAL ASSESSMENTS BURNING PAIN NAUSEA DIAGNOSIS ENDOSCOPY BA SWALLOW GASTRIC ANALYSYS

  46. CONSERVATIVE TREATMENT FIRST • SURGERY IF LARGE, BLEEDING, OR NOT RESPONDING TO CONSERVATIVE TREATMENT • VAGOTOMY AND PYLORAPLASTY • SUBTOTAL GASTRECTOMY

  47. ALTERATION IN COMFORT ANTACIDS ANTICHOLINERGICS IN EXTREME CASES H2 BLOCKERS SEDATIVES NO IRRITATING FOODS ALTERATION IN NUTRITION BLAND VS REGULAR DIET NON IRRITATING FOODS SML, FREQUENT MEALS IF SURGERY NURSING DIAGNOSES & CARE

  48. POTENTIAL FOR COMPLICATIONS HEMORRHAGE (ASSESS STOOL AND VOMITUS FOR BLOOD) PERFORATION BOWEL SOUNDS ABD SIZE & TENDERNESS VITAL SIGNS INTRACTABILITY PYLORIC OBSTRUCTION ASSESS FOR N & V ABD SIZE

  49. ALTERED PSYCHOLOGICAL STATUS • STRESS MANAGEMENT • RELAXATION TECHNIQUES

  50. DUMPING SYNDROME • WHEN PYLORIS IS BYPASSED OR ENLARGED THROUGH SURGERY • VASOMOTOR & HYPOGLYCEMIC RESPONSES • LIE FLAT PC • DECREASE CHO INTAKE • INCREASE FAT INTAKE • DECREASE LIQUIDS WITH MEALS

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