Signs and Symptoms and More
Asymptomatic sometimes
indigestion, loss of appetite, nausea, vomiting, and weight loss
Gastric Cancer
What does this description describe: a collection of symptoms that occur when your stomach empties its contents too rapidly into your small intestine. It’s usually associated with gastric surgery. Rapid gastric emptying causes large amounts of undigested food to flood your small intestine. You may experience nausea, abdominal cramping and blood sugar reactions.
Dumping syndrome
Gastric Cancer Treatment
surgical intervention
radiation therapy
chemotherapy
adjuvant therapy
Malabsorptive and Combination Procedures
The roux-en-Y gastric bypass (RYGB) limits the stomach size, and the duodenum and part of the jejunum are bypassed. This limits the absorbtion of calories.
Dysphagia is a primary symptom of esophageal cancer. True or False
A patient with peptic ulcer disease will feel better after eating. True or False
True
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Preoperative care for bariatric surgery?
Anesthesia concerns
-Medicine stays in obese pts longer due to their adipose tissue
-obese pts' at higher risk for resp distress
Complications of Malabsorptive and Combination Procesdures
-leakage of stomach contents
gastric stretching
dumping syndrome
Nutritional deficiencies - iron, vitamin B12, calcium, and folate "FOR LIFE"
Why is a laxative needed after a barium swallow?
Removes the Barium
What are expected findings in esophageal cancer?
Difficulty and pain in swallowing. Hoarseness, cough and regurgitation. Weight loss due
to anorexia or loss of appetite
Gastric Cancer
-Smoked, highly salted, or perserved foods may be a contributor
Two types of Restrictive Procedures for gastric bypass are laparoscopic adjustable gastric banding and vertical banded gastroplasty. What is the meaning of each procedure? How are they different?
Laparoscopic adjustable gastric banding- the band is inflated and deflates via subcutaneous (Sub q)port to change the size of the stomach as the pt loses weight.
Vertical banded gastroplasty- a band is places to provide an outlet to the small intestine
Nursing assessment for a patient experiencing nausea and vomiting.
1. Determine causes of nausea and vomiting.
Assessing the client with the causes of nausea will guide the choice of interventions to be used. Treatment may not be needed if the stimulus is eliminated. The differential diagnosis for nausea and vomiting is broad and includes a number of pathological, anatomic, and metabolic disorders, which need to be considered in the evaluation process.
2. Assess the client’s vital signs.
A postural decrease in blood pressure and an increase in pulse rate with standing suggest significant dehydration; a decrease in blood pressure without any change in pulse rate suggests autonomic neuropathy.
3. Auscultate the client’s abdominal area.
Auscultation may demonstrate increased bowel sounds in obstruction or absent bowel sounds in the ileus. A succession splash detected by listening over the epigastrium while shifting the abdomen side to side suggests gastroparesis or gastric outlet obstruction.
4. Assess nausea characteristics including duration, frequency, severity, precipitating factors, medication history, and previous measures used to relieve the problem.
A thorough assessment and evaluation of nausea can help determine interventions to lessen or ease the problem. With most chemotherapeutic agents, the acute phase begins one to two hours after IV administration, is most severe during the following eight hours, and then gradually improves. Delayed nausea and vomiting can occur 24 hours or more after administration of chemotherapy.
5. Record the client’s hydration status, daily weights, intake, and output, and assess skin turgor.
Nausea is usually correlated with vomiting which can change a client’s hydration status because of fluid loss. Severe vomiting can lead to symptomatic dehydration and electrolyte abnormalities. Chronic vomiting can result in undernutrition, weight loss, and metabolic abnormalities
6. Assist the client in diagnostic testing preparation.
A series of tests may be used to determine the contributing factor (e.g., upper gastrointestinal tract study, abdominal computed tomography scan, ultrasonography). All females of childbearing age should have a urine pregnancy test. Clients with severe vomiting, vomiting lasting over one day, or signs of dehydration on examination should have other laboratory tests, such as electrolytes, BUN, creatinine, glucose, urinalysis, and liver function tests.
7. Review the prenatal vitamins the client is taking, if pregnant.
Having too much iron may cause nausea, and switching to a different vitamin could help. Guidelines state that pregnant women should be prompted to discontinue iron-containing supplements during the first trimester of pregnancy and substitute them with folic acid or vitamins low in iron. Reports on improvement in the severity of nausea and vomiting supported this intervention
8. Review medications that the client takes.
Several dopamine-based agonists developed for the treatment of schizophrenia, Parkinson’s disease, ADHD, depression, and restless leg syndrome evoke nausea and vomiting as common impending adverse effects. Clinically used drugs that prevent the metabolism of acetylcholine such as choline esterase inhibitors also evoke vomiting.
9. Perform a brief neurological exam as appropriate.
A neurologic examination may include assessing carnival nerves (checking for ocular movements suggesting mitochondrial cytopathy, pupillary responses to light, or nystagmus), and observing the client’s gait. Cranial nerve abnormalities and/or long tract signs suggest a CNS cause. Brainstem tumors may present with vomiting and may be accompanied by long tract or cranial nerve signs, although these may be rare.
10. Review serum drug levels.
Serum drug levels may indicate toxicity among clients taking digoxin, theophylline, or salicylates or recreational drug use such as opiates or cannabis.
11. Evaluate the client for eating disorders.
When an underlying cause has not been found after a careful history, physical examination, and testing, clients with persistent symptoms of nausea and vomiting should be evaluated for an eating disorder. Clients at high risk may include young women, competitive athletes, those with a first-degree family member with an eating disorder, and those with significant anxiety, depression, body image disorder, or sexual orientation/ gender expression disorders.
Ibuprofen use is a risk factor for peptic ulcer. True or False?
Risk for bleeding
Sucralfate must be administered ____ hour before breakfast and the evening meal.
1 hour
What is a finding in gastrointestinal perforation?
Severe upper abdominal pain
Interventions to help prevent dumping syndrome.
comparing the differences of bands in reference to:
Laparoscopic adjustable banding
Vertical banded gastroplasty
Laparoscopic adjustable banding- placing an inflatable band around the fundus of the STOMACH
Vertical banded gastroplasty- small stomach pouch created with vertical line of staples
What medications are used to reduce gastric acidity?
. H-2 receptor blockers and proton pump inhibitor
What should be monitored after an upper endoscopy?
Gag reflex
What are findings in a patient with a gastric ulcer?
Nausea and burning pain (1-2 hours after meals)
These examples show that the pt understands the management of GERD.
I should avoid eating meals within 2–3 hr of bedtime. I should avoid the use of tobacco products/smoking in patients with GERD symptoms. I should avoid any “trigger foods” for GERD symptom control. I should elevate my head of bed for nighttime to help prevent GERD symptoms.
Manisfestations of a fecal impaction
What are key points of tube feedings?
a. Radiographic confirmation is the most reliable, assess for residual before each feeding
Radiographic confirmation is the most reliable, assess for residual before each feeding
and put patient in fowlers position