STOMACH CA
What DX TX & labs would you expect the HCP to order for a PT who is expected to have Adenocarcinoma?
WHAT IS... DX TX: upper gi endoscopy w/ biopsy(best), (staging;)Endo-US, CT, MRI, PET., laparoscopy(peritoneal spread)
Labs; CBC, LFT, amylase, tumor markers, stool-occult blood.
WHAT IS... PPI's, Histamine (H2) receptor blockers. Other: antacids, cholinergic, cytoprotective, prokinetics.
What are the s/s of gastritis?
WHAT IS.. Acute;Anorexia, N/V, Epigastric tenderness, Hemorrhage, self-limiting. Chronic; Similar to acute, Asymptomatic, Pernicious anemia
WHAT GERONTOLOGIC CONSIDERATIONS DO YOU HAVE TO CONSIDER W/ PUD?
What is..>>> morbidity and mortality. often take NSAIDS freq, 1st s/s may be GI bleed or <H/H, TX plan is similar with emphasis on teaching and prevention
What is... Obvious; hematemesis (bright red/coffee ground) & melena (black tarry stools)// Occult (non obvious & needs guiac tx)
what s/s would a PT dx w/ Adenocarcinoma present with?
what is...s/s: usually CA spreads b4 s/s occur.
LB loss, lack of appetite, abd pain, indigestion, anemia s/s; fatigue, weak, dizzy, sob (ext cases), stool may be + for occult blood.
Supraclavicular lymph node enlargement= mestastasis, ascites= poor prognostic sign
What GERD PC has an increased risk for esophageal cancer, d/t the cell changes; metaplasia (pre-cancerous lesions)?
WHAT IS...Barrett’s esophagus (BE)- GERD COMPLICATION.
What DZ & D/O cause gastritis...
WHAT IS...autoimmune gastritis,burns,crohn's,hiatial hernia,physiologic stress,renal fail, shock, bile reflux, sepsis
What will the RN teach a PT dx w/ PUD?
What is... no smoking/etoh, LT followup care apts(endoscopic eval 3-6 m.o after dx & tx). TEACH IMPT OF RX ADHERENCE &report recurrence of PAIN/BLOOD in vomit/stool!, stress mgt, NO ASA/NSAIDS for 4-6 wks, diet modifications prn
WHAT DX STUDY IS USED TO DX UPPER GI PROBLEMS?
WHAT IS... ENDOSCOPY
What is the RN role when caring for a PT dx w/ Stomach CA
WHAT IS... early detection, achieve optimal nutritional status & << discomfort, recognize s/s (& unrelieved PUD), emotional support, preop/postop teaching, fluid volume restoration/PRBCS (during preop), teach skincare & antiemetics r/t chemo
What s/s would you expect to see upon assessment of a pt w/ GERD?
WHAT IS...heartburn (pyrosis; burning, tight sensation- similar to angina but relieved w/ antacids), dyspepsia(pain/discomfort in upper abd), regurgitation, nausea, dysphagia, Respiratory s/s; (wheeze, cough, dyspnea, nighttime disturb, hoarseness, sore throat, lump in throat;Globus sensation, >> salvia)
what causes gastritis?
WHAT IS.. may be acute or chronic & diffuse or localized.
CAUSES/RX FX; microrganisms- H. pylori infection; RX USE(ASA,Bisphosphonates, Corticosteroids, Digitatlis, Fe supplements, NSAIDs); certain dietary issues (ETOH/SPICY,); and autoimmune, environmental other factors,DZ/D/O .
Compare & contrast the s/s of both PUD; Gastric ulcer vs Duodenal ulcer
WHAT IS...Gastric Ulcer; s/s; epigastric discomfort 1-2 hrs after meal, burning or gaseous pain (food may worsen- STARVE THE GAS), perforation- (1st s/s in some pts- More common in F >50 y.o, more likely to cause obstruction), occur in any part of stomach (most common in antrum)
Duodenal Ulcer; s/s; burning/cramplike pain in midepi or back (2-5 hrs after meal- FEED THE DUDE) PC; HEMORRHAGE MOST COMMON IN DUODENAL
OTHER- N/V, bloating, early satiety (may be silent- elders & nsaid users)
Describe DUMPING SYNDROME, a gastric surgery post-op PC
WHAT IS...A direct result of surg removal of a lg part of stomach & pyloric sphincter. Gastric chyme---> small intestine as lg hypertonic bolus (normal; enters via sml amts); pulls fluid into bowel lumen causing < plasma volume, distention of bowel lumen, and rapid transit within 15 to 30 min of eating.
-s/s; Weakness, sweating, palpitations, dizziness, cramping, borborygmi (audible abd sounds d/t hyperactive intestinal perstalisis), and defecation urge. Lasts about 1 hour. << with rest after eating.
What is the correct tx for a pt w/ stomach CA?
WHAT IS..combo chemo/surgery pref.
*Surgical; lesion in antrum or pylorus; subtotal gastrectomy{billiroth I or II }. lesions in fundus; total gastrectomy w/ esophagojejunostomy. other depends on metastasis.
Chemo/ Radiation therapy; Can give intraperitoneal for metastasis. Radiation may be done w/ chemo or as a palliative tx for obst or < tumor mass.
Targeted therapy; trastuzumab- kills ca cells, ramucirumab-prevents growth/spread
what are other PC for GERD?
WHAT IS...Esophagitis (Ulcerations -->scar tissue, stricture, and dysphagia), BE, Dental erosion (d/t > acidity in gastric acid), Respiratory (cough, bronchospasm, laryngospasm, ¡cricopharyngeal spasm), Aspiration of gastric secretions--> asthma/pneumonia
WHAT IS...ID cause: eliminate, prevent, or avoid it.
-Supportive care: rest, NPO, IV fluids, antiemetics; monitor for dehydration
-Severe: NGT to monitor for bleeding; lavage, empty stomach. Wash it out w/ h20/medical solution
-Monitor for PC hemorrhage;Monitor VS, heme test vomitus; upper GI bleed strategies
-Admin RX; PPIs or H2 receptor blockers
WHAT 3 PC CAN OCCUR W/ PUD?
WHAT IS...
1)hemorrhage (*common duodenal)
2)perforation (most lethal. sudden/severe abd pain →shoulder/back; no relief, rigid/boardlike abd, absent bowel sounds, n/v, shallow rr, hr > & weak. TX; stop spillage of gastric/duodenal contents -->peritoneal cavity & restore blood volume. NGT; aspiration and gastric decompression.IV fluids and blood; broad-spectrum antibiotics.Other: Central line, PA catheter, ECG, urinary catheter. Small perforations- self-sealing; monitor for obstruction. Large perforations- surgery for closure and suctioning of peritoneal cavity)
3) gastic outlet obstruction ( edema, inflammation, pylorospasm or scar tissue cause obs in distal stomach & duodenum; stomach fills&dilates→pain&discomfort, belching & proj vomiting, constipation, anorexia/ tx; decompress the stomach w/ NGT; ppi/H2 recep-blocker; pain mgt, F&E replacement, surgery/balloon dilation, and improve the patient’s general state of health)
You are a post-op nurse caring for a PT who just had a NGT placed for decompression. How long should you expect bloody drainage for?
WHAT IS...bloody drainage is expected for 2-3hrs (report > 75ml/hr)-->should darken 24hrs postop ----> yellowgreenish 36-48hrs
A PT w/ stomach CA just had surgery, a partial gastrectomy- Billiroth I, what post-op PC should the RN monitor for?
WHAT IS...
-Hemorrhage
-Dumping syndrome
-Postprandial hypoglycemia
-Bile reflux gastritis
What do you teach a pt dx w/ GERD Syndrome?
What is... eat a Low-fat diet- small frequent meals, Avoid ETOH caffeine and smoking-(automatically & immed << LES pressure), maintain upright position 2 to 3 hrs after meals- (avoid tight clothes @ waist & bending over after eating), Avoid eating 3 hours before bed, HOB at 30 degrees/ pillows behind to prop up, Weight reduction, Drug therapy
WHAT IS.. Evaluate and eliminate cause.
-RX ADMIN; ABX-(tx H. pylori), Cobalamin(pernicious anemia)
TEACH Lifestyle modifications; No smoking, 6 small meals/day; nonirritating food Adhere to prescribed drugs
What is the TX goals/plan for PUD?
WHAT IS.. < gastric acidity & > mucosal defense mechanisms. rest, diet mod (prn), rx therapy;(PPI’s & and antibx to tx H. plyori infection; 14 days of PCN {if alg use metronidazole}, H2 receptor blocker, antacids, pain mgt;{ no nsaids/asa 4-6 wk}, Sucralfate;{cytoprotective therapy via protecting esophagus, stomach & duodenum- 1-2hr b4/after antacid}),
What is the role of a post-op RN caring for a PT who underwent gastric surgery?
what is..-F&E balance;IV fluids->oral-> solids, monitor I&O, daily lb's,
-Prevent respiratory complications; respiratory assessment, Splint incision with cough and deep breathing, Analgesia, early ambulation, reposition frequently
-Maintain comfort: pain, nausea/vomiting
-Prevent infection; Monitor VS,Assess wound
-Monitor for PC (especially if obese):Atelectasis, pneumonia, DVT, PE, pneumothorax. Anastomosis leak- tachycardia, dyspnea, fever, abdominal pain, anxiety, restlessness & req immediate tx to prevent sepsis & death! Hemorrhage; VS, NG aspirate
-NGT for decompression;Observe gastric aspirate: color, amount, odor. Bloody drainage expected for 2 to 3 hours- Report excess (greater than 75mL/hr).
-Monitor for clots/obstruction
-Irrigate with NSS to avoid; rupture of sutures,leakage into peritoneal cavity, Hemorrhage and abscess formation.
-NG aspirate should darken within 24 hrs post surgery and change to yellow-green in 36 to 48 hours