Gastrointestinal and Oral Health Nursing

• These notes cover the nursing care of patients with upper gastrointestinal disorders, including anorexia, nausea and vomiting, obesity, gastritis, peptic ulcer disease, gastric bleeding, and gastric cancer
• They also discuss oral health, dental care, and various oral inflammatory disorders

Anorexia

• Characterized by a lack of appetite, a symptom of many diseases, including electrolyte imbalances and cardiac arrhythmias
• Causes range from food odors and medications to stress, psychological problems, and infections
• Nursing actions include encouraging preferred foods, documenting intake and output, and monitoring vital signs, electrolytes, and ECGs

Nausea and Vomiting

• Nausea is the subjective feeling of needing to vomit, while vomiting is the expulsion of stomach contents
• It is a protective reflex, controlled by the brain's vomiting center, triggered by various GI-related or independent conditions like infections, motion sickness, stress, pregnancy, medications, or myocardial infarction
• Emesis resembling coffee grounds indicates stomach bleeding and requires investigation
• Prolonged vomiting can cause dehydration, electrolyte imbalances, and metabolic alkalosis

Therapeutic Measures for Nausea and Vomiting

• Mild cases may resolve without intervention
• Antiemetics and ginger can help ease nausea
• Severe vomiting requires IV fluids and possibly nutrition
• An orogastric or nasogastric tube with suction may be needed to decompress the stomach
• After vomiting resolves, a diet of clear liquids can be advanced as tolerated
• Aspirations can be prevented by placing at-risk patients on their side during episodes

Nursing Process for Nausea and Vomiting

• Requires documenting episode characteristics, medical conditions, medications, and treatments to diagnose the cause
• Monitor for weakness, thirst, dizziness, confusion, and postural hypotension
• Provide a quiet, odor-free, visually clean environment
• Administer antiemetics
• Provide frequent oral care
• Advise patients to avoid trigger foods or fluids
• Identify patients at risk for aspiration
• Maintain a clear airway and lung sounds

Obesity

• Diagnosed using ideal height-weight charts, waist circumference, and body mass index (BMI)
• Waist circumferences greater than 35 inches for women and 40 inches for men indicate abdominal obesity
• BMI values of 25-30 indicate overweight and over 30 indicate obesity
• Caused by caloric intake exceeding energy expenditure, leading to increased health risks such as heart disease and cancer
• Initial treatment involves education on healthy diet, exercise, and calorie restriction
• Support groups and mobile apps can help patients succeed

Bariatric Surgery

• An option for individuals with a BMI above 40, or between 35 and 40 with obesity-related diseases
• These procedures limit stomach capacity and/or decrease nutrient absorption

Types of Bariatric Surgeries

• Sleeve Gastrectomy: Removes ~75% of the stomach, reducing its volume and decreasing ghrelin production
• Gastric Bypass (Roux-en-Y): Creates a small stomach pouch and bypasses part of the small intestine to reduce calorie absorption
• Biliopancreatic Diversion with Duodenal Switch: Creates a small tubular pouch, bypassing most of the small intestine
• Adjustable Gastric Banding: An inflatable band is placed around the upper stomach to create a smaller pouch; rarely used due to modest weight loss and revision needs
• Intragastric Balloon (IGB): A balloon is endoscopically inserted into the stomach and filled with saline for 6 months to restrict intake

Complications of Bariatric Surgery

• NV, bloating, heartburn, staple disruption, obstruction, dumping syndrome, gout, gallstones, kidney stones, and osteoporosis may occur
• Deficiencies in protein, vitamins, and minerals can result
• Band slippage, intestinal leakage, or balloon leak/perforation can occur

Postoperative Care after Bariatric Surgery

• Keep the head of the bed elevated to ensure adequate lung expansion
• Start with a clear liquid diet of 30 mL at a time, slowly increasing it
• The diet progresses to full liquids, pureed foods, and regular foods after ~6 weeks
• Long-term follow-up and maintenance diet are needed
• Reconstructive surgery can be considered after at least 1 year to remove excess skin

Nursing Process for Obesity

• Includes measurements of height, weight, and BMI and physical examination
• Assess eating and exercise patterns, physical limitations, social interaction issues, and personal challenges
• Establish a desired weight goal and track progress
• Modify eating habits in collaboration with a dietitian
• Establish and maintain increased activity
• Discuss realistic weight loss goals of 1–2 pounds per week
• Reinforce preoperative teaching if surgical interventions are planned

Special Equipment for Bariatric Patients

• Larger hospital bed, wheelchair, or walker
• Patient lifting devices
• Extra pillows to ease breathing
• Larger hospital gowns and blood pressure cuff

Oral Health and Dental Care

• Good oral health care is important to overall health, which can be affected if oral problems interfere with eating and drinking
• Respiratory illness and cardiac disease are associated with pathogens in the mouth
• Regular mechanical oral hygiene is needed to remove plaque and prevent infections
• Functional limitations may interfere with self-care for oral hygiene
• Suction toothbrushes are available for patients who cannot control secretions
• The nurse should note any signs of oral inflammation or infection requiring prompt treatment
• Regular dental care is important to prevent infections

Oral Inflammatory Disorders: Aphthous Stomatitis (Canker Sores)

• Small, white, painful ulcers that can last for several days to 2 weeks
• Managed with topical corticosteroids and anesthetics

Oral Inflammatory Disorders: Herpes Simplex Virus Type 1 Infection (HSV-1)

• Presents as painful cold sores or fever blisters
• Managed with viscous lidocaine for pain relief and oral or topical acyclovir

Oral Cancer

• Can occur anywhere in the mouth or throat and is often curable if detected early
• Most commonly found in patients who use alcohol or any form of tobacco
• Signs and symptoms include non-healing sores, difficulty chewing/swallowing/speaking, and swollen cervical lymph nodes
• Treatment involves surgery with radiation and/or chemotherapy and radical or modified neck dissection

Esophageal Cancer

• Often detected in advanced stages due to its location near many lymph nodes, leading to obstruction, perforation, or fistula development
• Risk factors include tobacco/alcohol use, obesity, HPV, and Barrett’s esophagus
• Signs and symptoms include dysphagia, weight loss, chest pain after eating, and regurgitation
• Diagnosis involves upper endoscopy and biopsy
• Treatment includes surgery, radiation, chemotherapy, laser therapy, and electrocoagulation

Hiatal Hernia

• Occurs when the stomach slides up through the hiatus of the diaphragm into the thorax
• Occurs most commonly in smokers and those who are obese, older than age 50, or pregnant
• Diagnosed by x-ray studies, endoscopy, and fluoroscopy
• Therapeutic measures include lifestyle changes such as elevating the head of the bed 6–12 inches to prevent reflux
• Surgical management is considered with complications such as volvulus, strangulation, or perforation

Gastroesophageal Reflux Disease (GERD)

• Occurs when gastric secretions reflux into the esophagus
• Primarily caused by conditions that affect the ability of the lower esophageal sphincter to close tightly, such as hiatal hernia
• Symptoms include heartburn, regurgitation, hoarseness, and sore throat
• Diagnosed via upper endoscopy, esophageal manometry, and pH monitoring
• Lifestyle changes are recommended first, then medications, and finally surgery
• Complications include asthma, aspiration pneumonia, bronchospasm, laryngospasm, esophagitis, and Barrett’s esophagus

Mallory-Weiss Tear

• Longitudinal tear in the mucous membrane of the distal esophagus at the stomach junction
• Occurs from a sudden powerful or prolonged force due to coughing, vomiting, seizures, prolapse of the stomach into the esophagus, or cardiopulmonary resuscitation (CPR)
• Risk factors include alcohol use and hiatal hernia
• Symptoms include bright red, bloody emesis or bloody or tarry stools
• Treatment includes proton pump inhibitors (PPIs) and monitoring hemodynamic stability

Gastritis

• Inflammation of the stomach mucosa associated with gastric mucosal injury
• Can be acute or chronic
• Causes include alcohol, endoscopic procedures, microorganisms, and medications
• Major symptom is abdominal pain, often with nausea and vomiting
• Treatment includes avoiding causes, antacids, PPIs, and H2-receptor antagonists

Chronic Gastritis

• Classified as autoimmune or environmental
• Autoimmune gastritis attacks the parietal cells, decreasing acid production and intrinsic factor, causing difficulty absorbing vitamin B12, leading to pernicious anemia
• Environmental gastritis is associated with H. pylori infection and possibly dietary factors, smoking, alcohol consumption, and chronic bile reflux
• H. pylori infection is treated with antibiotics, PPIs, and/or H2-receptor antagonists

Stress-Induced Gastritis

• Critically ill patients may develop GI mucosal damage from ischemia
• The stress response causes reduced blood flow to the stomach and small intestine, resulting in ischemia and damage to the mucosa
• Preventive treatment with PPIs (oral or IV) is used for acutely ill patients with a high risk for GI bleeding

Peptic Ulcer Disease (PUD)

• Condition in which the lining of the stomach or duodenum is eroded, usually from infection with H. pylori or use of NSAIDs
• Most patients are asymptomatic and may not experience symptoms until complications develop
• Upper abdominal pain or discomfort is the most common symptom
• H Pylori can be diagnosed via biopsy, urease test, or urea breath test
• Treatment options used to cure H. pylori include triple or quadruple therapy with two antibiotics and a PPI or H2-receptor antagonist

Complications of Peptic Ulcer Disease

• Bleeding, perforation of stomach or duodenum wall, and obstruction
• Perforation is suspected if the patient has an ulcer and develops acute, sharp, severe abdominal pain
• Obstruction may be due to scar tissue because of repeated ulcerations and healing in a patient with chronic PUD

Gastric Bleeding

• May be caused by ulcer perforation, tumors, gastric surgery, or other conditions
• Bleeding peptic ulcers are the most common cause of blood loss into the stomach or intestine
• Blood loss can be hidden (occult) blood in the stool, observable vomited blood (hematemesis), or black tarry stools (melena)
• Severe blood loss may result in hypovolemic shock
• the goal of treatment for a massive GI bleed is to prevent or treat hypovolemic shock and prevent dehydration, electrolyte imbalance, and further bleeding

Gastric Cancer

• Refers to malignant lesions in the stomach
• More common in men than in women
• H. pylori bacteria and family history can play a role
• Often diagnosed late because symptoms don't appear until the disease is advanced
• Symptoms include weight loss, ulcer-type pain, nausea, dysphagia, melena, and early satiety
• Diagnosis is made via upper endoscopy with biopsies

Gastric Surgery

• Two types of surgical interventions are typically used to treat upper GI diseases: subtotal gastrectomy (partial removal of the stomach) and total gastrectomy (total removal of the stomach)
• Patients may have an NG tube inserted during surgery
• The drainage from the NG tube is monitored for color and amount
• Common complications include surgical site leak, gastric distention, dumping syndrome, nutritional problems, steatorrhea, and pyloric obstruction

Notes on nursing care for upper gastrointestinal disorders such as anorexia, nausea, vomiting, and peptic ulcer disease. Also includes oral health, dental care, and oral inflammatory disorders. Nursing actions include monitoring vital signs and encouraging preferred foods.