GERD & Hiatal Hernia
The most common manifestation of GERD
What is heartburn (pyrosis)?
(pg. 900) - Clinical manifestations of GERD
Heartburn is the burning, tight sensation felt between the lower sternum and spreading up to the throat or jaw and may radiate the back/neck.jaw. May occur after ingesting food or drugs that decrease the lower esophageal sphincter (LES) pressure. GERD-related chest pain can mimic angina.
The two different of type ulcers in PUD (hint: not acute and chronic)
What is gastric and duodenal?
pg. 910 - Types of PUD
Vitals are taken every 15-30 minutes if the patient experiences these complications with a peptic ulcer
What are Hemorrhage and Perforation
pg. 916 and pg. 923 - Complications of PUD, Acute Care of PUD and GI bleeds
These foods are associated with the incidence of stomach cancer
What are smoked foods, salted fish and meats, and pickled vegetables
pg. 919
This is a test to detect small amounts of blood in secretions, vomitus or stools that are not evident by appearance
What is a guaiac test?
pg. 922 Table 41-21
The two most common medications / treatments for symptomatic GERD
What are Proton Pump Inhibitors (PPI's) and H2-receptor Blockers?
(pg.902) - Drug Therapy for GERD
These medications work to decrease the acidity of the reflux and reduce the irritation of the gastric mucosa.
The most common factor associated with the development of peptic ulcers
What is H.pylori?
pg. 911-912 - Etiology and Pathophysiology of PUD
This can occur as a complication in the patient who experiences perforation within 6-12 hours of onset
What is Peritonitis?
pg. 912 - Complications of PUD
patient needs to be started on ______ immediately if perforation occurs
This is a poor prognostic sign in gastric cancer
What is ascites?
pg. 919 - clinical manifestations of stomach cancer
Other CM's include:
Name at least 3 invasive lines that a patient may require during the emergency management phase of an acute GI bleed:
What is IV access with two large bore catheters for fluid and blood replacement, an indwelling urinary foley cath to accurately monitor I's and O's, an NG tube, and a central venous pressure line or pulmonary artery wedge for hemodynamic monitoring
pg. 922 - 924 - emergency assessment and management and the acute care of a patient with an upper GI bleed
Table 41-23 - emergency management of an acute GI Bleed
Patient teaching to a person with a hiatal hernia would include telling them to avoid:
What is lifting or straining?
What are constricting garments / clothing?
pg.904 - Nursing and Interprofessional Management of Hiatal Hernia
Teach the patient to avoid these to prevent further complications.
The type of ulcer that is associated with burning, gaseous pain and occurs 1-2 hours after meals
What are gastric ulcers?
pg.912 - Clinical manifestations of PUD
The patient with an acute exacerbation of a peptic ulcer will most likely have these interventions in place once admitted into the hospital? SATA
A) NG tube for intermittent suction
B) NPO status
C) vitals q4 hours
D) Pain medications
E) IV fluid replacement
What are A, B, D and E
pg. 916 - Acute care for PUD
vitals need to be done initially, and then every hour to detect and treat shock.
This type of anemia is associated with being a risk factor in stomach cancer
What is pernicious anemia?
pg. 919 - Etiology and pathophysiology in Stomach Cancer
When the patient's vomit or stools are dark in color, we can assume it has come in contact with _______ ...
What is gastric acid?
If the blood is bright red, from either end, this means it has not come into contact with stomach secretions, or gastric HCl acid.
pg. 922 - etiology and pathophysiology of an Upper GI bleed
A precancerous lesion that may occur as a complication of chronic GERD
What is Barrett's esophagus?
pg.901 - Complications of GERD
Barrett's esophagus, or esophageal metaplasia, is the reversible change of the esophageal cells from one type to another type because of an abnormal stimulus, primary being GERD.
This drug is given for the short term treatment of ulcers, and should be given at least 60 minutes before or after an antacid.
What is sucralfate?
pg.914 - Drug therapy for PUD
Sucralfate is a cytoprotective drug commonly given in the patient with a peptic ulcer
These are two partial-gastrectomy surgical procedures done in the patient with peptic ulcer disease
What is Billroth I (gastroduodenostomy) and Billroth II (gastrojejunostomy) ?
pg. 917 - surgical therapy for PUD
A gastrectomy is performed on a client with gastric cancer. In the immediate post-op period, the nurse notes bloody drainage from the NG tube. Which of the following is the appropriate nursing intervention?
a) notify the physician
b) measure abdominal girth
c) irrigate the NG tube
d) continue to monitor the drainage
What is D?
pg.918 - Post-op Care in the surgical therapy for PUD (Remember, surgeries for PUD and Stomach Cancer both include gastrectomies)
Observe the gastric aspirate for color, amount and odor. The aspirate (from the NG tube) is usually bright red at first with a gradual darkening within the first 24 hours after surgery.
A patient comes in and has vomited approximately 1000mL of blood. Which order from the provider will you implement first?
a) drawing blood for typing and crossmatch
b) insertion of an NG tube and connecting to suction
c) administration of 1000mL lactated ringers solution
d) give IV H2 receptor blocker
What is C?
Correction of hypovolemia to prevent hypovolemic shock is most important.
Select the appropriate nursing interventions in the care of a patient with GERD (SATA)
A) Recommend weight gain if patient is underweight
B) Encourage smoking cessation
C) Teach pt to avoid coffee, chocolate and peppermint
D) Always keep the patient in High Fowler's position
E) Teach the pt to avoid laying down 2-3 hours after meals
What are B, C and E
pg. 901-904 - Interprofessional Care and Nursing Management in GERD
Patient comes in with sudden, severe, spreading abdominal pain that is not relieved with antacids. You assess the abdomen and it feels rigid. The patient's heart rate is 120, respiratory rate is 28, and bowel sounds are absent. What is this patient most likely experiencing?
What is perforation?
pg.912 - complications of PUD
perforation is the most lethal complication of peptic ulcers, and commonly seen in large duodenal ulcers.
A patient is 3 days post-operative from a PUD surgery and has just had their first meal since being cleared from a fluid diet. Suddenly the patient is complaining of abdominal cramping and feeling very weak. They tell you they just finished eating 30 minutes ago but their stomach won't stop rumbling! What is this patient most likely experiencing?
Dumping Syndrome
pg. 917 - post-op complications in PUD
(look at table 41-18 on pg. 918)
What would the nurse include in the discharge teaching for a patient who had a gastrectomy? SATA
a) measures for pain relief and comfort
b) teaching wound care to the patient or primary caregiver
c) teaching the patient to keep a diet low in proteins and fat
d) referral to a home health nurse if the patient is continuing on chemo or radiation
e) teach the patient that 3 large meals a day is recommended
What is A, B and D
pg. 921 - ambulatory care for stomach cancer and Table 41-18: nutritional therapy / post-gastrectomy dumping syndrome
Which assessment should the nurse perform first for a patient who just vomited bright red blood?
a. Measuring the quantity of emesis
b. Palpating the abdomen for distention
c. Auscultating the chest for breath sounds d. Taking the blood pressure (BP) and pulse
What is D?
The concern with blood loss is hypovolemic shock during GI bleeding. The best way to do this is monitoring the patient's BP and pulse.