GERD Symptoms and Patient Teaching

GERD (Gastroesophageal Reflux Disease)

• Symptoms: dyspepsia (burning/heartburn), worsened pain while lying down, weight loss, regurgitation, dysphagia, bleeding, and loss of tooth enamel
• Patient teaching: avoid bedtime snacks, eat small frequent meals, avoid caffeine, milk products, spicy foods, and citrus
• Treatment: antacids, H2 blockers (e.g. tidine), and PPI (Prazole)
• Lifestyle modifications: drink fluids between meals, avoid lying down after eating, and elevate the head of the bed (HOB) 4-6 inches

Cholecystectomy (Gallbladder Removal)

• Surgical procedure: laparoscopy and T-tube placement in the common bile duct
• Post-operative care: monitor drainage (yellowish-brown color), keep tube under the surgical site, and turn off suction to assess bowel sounds
• Patient teaching: avoid atelectasis by taking deep breaths and coughing only when medicated, and encourage early ambulation
• Complications: impaired gas exchange and fluid deficit

Cirrhosis

• Symptoms: RUQ pain, fatigue, and ascites (fluid accumulation in the abdomen)
• Patient teaching: limit activity, rest, and decrease fluid intake
• Treatment: diuretics (e.g. Lasix) to reduce abdominal swelling, and paracentesis for ascites
• Complications: encephalopathy ( Asterixis, confusion, and increased ammonia levels)

Liver Biopsy

• Procedure: left side lying position during biopsy, and right side lying position post-operatively
• Complications: bleeding and encephalopathy

Esophageal Varices

• Treatment: vasoconstrictors (e.g. Propranolol) to decrease varices, and vitamin K for clotting
• Patient care: protect airway, monitor vital signs, and maintain a side-lying position

GI Perforation

• Assessment: hard, rigid board-like abdomen, abdominal pain radiating to the shoulder, restlessness, and apprehension
• Treatment: avoid applying heat, and consider surgical intervention

Appendicitis

• Symptoms: located in the RLQ, positive McBurney's point (pain in RLQ when touched), Rovsig's point (pain in LLQ when RLQ palpated), rebound tenderness, and radiating pain
• Treatment: IV and antibiotic therapy, and surgical intervention
• Complications: perforation and peritonitis

Gallstones

• Symptoms: same as cholecystectomy
• Treatment: laparoscopy and T-tube placement in the common bile duct
• Patient teaching: same as cholecystectomy

Ileal Conduit/Colostomy

• Procedure: removal of the colon, and creation of an ileostomy or colostomy
• Stoma care: monitor for pink, moist, and healthy stoma, and check for discoloration and abnormalities every 8 hours
• Diet: eat small, frequent meals, and avoid fatty foods, seeds, and broccoli
• Complications: impaired gas exchange and fluid deficit

Gastroenteritis

• Definition: inflammation of the GI tract
• Types: autoimmune (Chronic Type A) and PUD (Chronic Type B)
• Symptoms: heartburn, belching, sour taste, nausea, and vomiting
• Treatment: PPI and 2 antibiotics

Peptic Ulcer Disease (PUD)

• Symptoms: gut pain 1-2 hours after meals, radiating to the shoulder area, and weight loss
• Treatment: PPI and 2 antibiotics
• Complications: perforation, hard, rigid abdomen, and bleeding

Medication Classification and Patient Teaching

• Antacids: neutralize stomach acid, take 1 hour before or after meals, and not with other medications
• H2 blockers (e.g. tidine): decrease acid production, take 30 minutes before meals, and can cause confusion
• PPI (e.g. Prazole): prevents final transportation of hydrogen ions, take in the morning, and can cause bone breakdown
• Cytoprotective drugs (e.g. pepto-bismol, sucralfate): used as a bandaid, take on an empty stomach, and can cause constipation and abdominal discomfort

Ostomy Assessments

• Vital signs: monitor for pink, moist, and healthy stoma
• Skin around the stomach: monitor for irritation
• Stoma shrinks over time, which is normal

Dumping Syndrome

• Definition: rapid entry of food into the jejunum
• Symptoms: dizziness, increased heart rate, sweating, nausea, abdominal cramps, and diarrhea
• Treatment: avoid fluids 1 hour before and 2 hours after eating

Fundoplication

• Procedure: wraps the upper part of the stomach around the esophagus to form a collar-like structure
• Goal: prevent acid back-up and air hiatal hernia
• Post-operative care: elevate the head of the bed (HOB) 6-10 days, and monitor for dysphagia