Nursing Care for Esophageal Disorders

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Questions and Answers

What are the two main types of esophageal disorders that nurses should be knowledgeable about?

Gastroesophageal reflux disease (GERD) and esophageal varices.

Describe the primary mechanism that leads to irritation of the esophageal tissue in GERD.

Irritation occurs due to the backflow of gastric content and enzymes into the esophagus, which exposes the tissue to corrosive fluids.

List two lifestyle changes that can help in the management of GERD.

Maintaining a weight below a BMI of 30 and avoiding smoking.

What long-term complications can arise from untreated GERD?

Untreated GERD can lead to esophageal inflammation, tissue breakdown, and potentially adenocarcinoma of the esophagus. Signup and view all the answers

How do the upper and lower esophageal sphincters function in relation to gastrointestinal health?

They prevent the reflux of food and fluids into the esophagus, allowing proper passage to the stomach. Signup and view all the answers

Which food items can exacerbate esophageal disorders like GERD?

A. Coffee, B. Tomatoes, D. Chocolate Signup and view all the answers

Following fundoplication surgery, what is an appropriate action a client should take after eating?

C. Elevate the head of my bed on blocks. Signup and view all the answers

What is the primary action of antacids in managing GERD symptoms?

Antacids neutralize gastric acid. Signup and view all the answers

What lifestyle factors can contribute to the relaxation of the lower esophageal sphincter (LES)?

Excessive ingestion of fatty foods, chocolate, caffeine, and alcohol can contribute to LES relaxation. Signup and view all the answers

Why should a client not eat three large meals a day after fundoplication?

Large meals can increase pressure on the stomach and worsen reflux. Signup and view all the answers

How can obesity impact gastric emptying and LES tone in patients with esophageal disorders?

Obesity can delay gastric emptying and weaken LES tone due to increased abdominal pressure. Signup and view all the answers

Which medication class decreases acid secretion and can be used for GERD treatment?

Histamine2 receptor antagonists. Signup and view all the answers

What symptoms may indicate chronic gastroesophageal reflux disease (GERD) in patients?

Symptoms include dyspepsia after eating, wavelike pain radiating to the neck or jaw, and regurgitation. Signup and view all the answers

What is a risk factor for developing GERD related to lifestyle?

Obesity. Signup and view all the answers

Why might individuals with hiatal hernias experience delayed esophageal clearance?

Hiatal hernias displace the LES into the thorax, which can impair its function and esophageal clearance. Signup and view all the answers

Name a subjective data point that might indicate GERD in a client.

Heartburn. Signup and view all the answers

What role do medications like theophylline and nitrates play in esophageal disorders?

These medications relax the LES, making it susceptible to reflux and exacerbating symptoms. Signup and view all the answers

What is the effect of proton pump inhibitors on gastric acid production?

They decrease gastric acid production. Signup and view all the answers

In managing esophageal disorders, how might positioning after eating affect symptoms?

Lying flat can worsen symptoms due to increased gastric pressure on the LES. Signup and view all the answers

What immediate relief strategies can patients employ for esophageal pain?

Drinking water, sitting upright, or taking antacids can provide immediate relief of esophageal pain. Signup and view all the answers

How can chronic overeating contribute to the symptoms of esophageal disorders?

Chronic overeating can cause prolonged abdominal distention, increasing pressure on the LES and leading to reflux. Signup and view all the answers

Why is cimetidine no longer considered a first-line treatment for older adult clients?

Cimetidine has a higher risk profile and interacts with over 60 medications in older adults. Signup and view all the answers

What specific nursing consideration should be taken when prescribing PPIs?

Sustained release capsules may be opened and sprinkled on food or mixed with applesauce or juice for clients with swallowing difficulties. Signup and view all the answers

What is a critical client education point for those prescribed rabeprazole?

Clients should wear sunscreen daily to protect against potential photosensitivity. Signup and view all the answers

What monitoring is essential for clients taking prokinetic medications like metoclopramide?

Monitor for extrapyramidal side effects such as abnormal, involuntary movements. Signup and view all the answers

Describe the purpose of the Stretta procedure.

The Stretta procedure uses radiofrequency energy to decrease vagus nerve activity, helping the lower esophageal sphincter (LES) muscle tighten. Signup and view all the answers

In the context of lifestyle modifications, what is one recommended change for clients with esophageal disorders?

Clients should lose weight if applicable to reduce pressure on the abdomen. Signup and view all the answers

What dietary adjustments should clients with esophageal disorders make?

Clients should avoid offending foods, large meals, and eating before bedtime. Signup and view all the answers

What positioning advice should be given to clients after eating to assist with esophageal disorders?

Clients should remain upright after eating to help prevent reflux. Signup and view all the answers

What is a common expected finding in a client who has GERD?

Tooth erosion is an expected finding. Signup and view all the answers

Which dietary component should a client with GERD avoid due to its effect on the lower esophageal sphincter?

Coffee should be avoided. Signup and view all the answers

After a fundoplication, what is one key instruction for the client regarding sleep position?

The client should elevate the head of the bed. Signup and view all the answers

Why should tomatoes be avoided by a client with GERD?

Tomatoes relax the lower esophageal sphincter. Signup and view all the answers

What incorrect finding might a client with GERD report related to taste?

A bitter taste in the mouth is not usually reported as expected. Signup and view all the answers

Identify a food that does not need to be limited for clients suffering from GERD.

Bananas do not need to be limited. Signup and view all the answers

What is one dietary component that negatively impacts GERD by relaxing the lower esophageal sphincter?

Chocolate should be avoided. Signup and view all the answers

What should a client be instructed to avoid after eating following a fundoplication?

The client should avoid large meals. Signup and view all the answers

Study Notes

Overview of Esophageal Disorders

Esophagus is a smooth muscle tube from throat to stomach.
Two sphincters: upper esophageal sphincter (UES) and lower esophageal sphincter (LES) prevent reflux.
Disorders include gastroesophageal reflux disease (GERD) and esophageal varices.

Gastroesophageal Reflux Disease (GERD)

Common condition with backflow of gastric content and enzymes into the esophagus.
Corrosive fluids irritate the esophageal tissue and delay clearance, increasing tissue exposure to acidity.
Untreated GERD can lead to complications such as inflammation, dysphagia, and esophageal adenocarcinoma.

Health Promotion and Disease Prevention

Maintain BMI below 30, stop smoking, limit alcohol and tobacco use.

Risk Factors for GERD

Obesity, older age, sleep apnea, nasogastric tube presence.
Foods that relax LES: fatty foods, chocolate, coffee, peppermint, spicy foods, tomatoes, citrus fruits.
Prolonged abdominal distention and increased abdominal pressure.
Medications: theophylline, nitrates, calcium channel blockers, anticholinergics, diazepam.
Stress and debilitating conditions can weaken LES tone.
Hiatal hernia can contribute to GERD.

Subjective Data in GERD Assessment

Symptoms: dyspepsia after specific foods, regurgitation, wavelike pain radiating to neck/jaw/back.
Pain exacerbated by certain positions and lasts 20 min to 2 hr after eating.
Throat irritation, chronic cough, hypersalivation, bitter taste due to regurgitation.
Atypical chest pain from esophageal spasms, increased flatus and eructation.
Pain relief with water, sitting upright, or taking antacids.
Frequent manifestations (4-5 times/week) indicate diagnosis.

Medication Management for GERD

Antacids, H2-receptor antagonists, proton pump inhibitors (PPIs) utilized based on severity.
Cimetidine is less preferred in older adults due to its interaction risks.
PPIs reduce gastric acid production, can be mixed with food for patients with swallowing difficulties.

Therapeutic Procedures

Stretta procedure applies radiofrequency energy to tighten LES muscle tissue.
Fundoplication for patients not responding to conservative treatments: stomach fundus wrapped around esophagus.

Client Education on GERD Management

Dietary: Avoid known trigger foods, large meals, and eating before bedtime.
Post-eating: Remain upright and elevate head of the bed by 6-8 inches.
Lifestyle: Avoid tight-fitting clothes, maintain weight, and engage in regular exercise.

Post-Operative Care Following Fundoplication

Elevate head of bed to reduce reflux.
Avoid large meals and tight clothing.
Understand that sleeping on the right side may need to be avoided.

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Description

Explore the nursing care techniques essential for managing clients with esophageal disorders in this comprehensive quiz. Delve into the structure and function of the esophagus, the types of disorders, and effective nursing interventions. Enhance your understanding of gastrointestinal health and patient care related to these conditions.