Upper GI Disorders: Nursing Interventions

• The chapter excerpt provides an overview of upper gastrointestinal disorders and their nursing care.
• Focus is on nursing interventions like medication administration, airway protection, dietary modifications, and patient education.
• Potential complications include bleeding and aspiration.

Nausea and Vomiting

• Nausea is the urge to vomit.
• Vomiting involves expelling stomach contents through the esophagus and mouth.
• Nursing care includes protecting the airway, medications, IV fluids, NG tube, clear liquids, and dry toast.
• Nursing concerns include nausea and risk for aspiration.

Obesity

• Defined as weight >20% than ideal body weight.
• Waist circumference for women is >35 inches and for men is >40 inches.
• Overweight: BMI of 25 to 29.9 kg/m².
• Obese: BMI >30 kg/m².
• Morbid obesity: BMI >40.
• Caloric intake exceeds energy expenditure.
• Comorbidities include gallbladder disease, heart disease, hypertension, sleep apnea, type 2 diabetes, and depression.
• Therapeutic interventions include weight loss through diet, exercise, support groups, behavior modification, and bariatric surgery.
• Nursing diagnosis: Imbalanced Nutrition: More Than Body Requirements.

Surgical Management

• Restrictive surgery limits how much the stomach can hold.
• Malabsorption surgery decreases calorie/nutrient absorption.
• Combination surgery is both restrictive and malabsorptive.
• Types of weight loss surgeries: adjustable gastric band, gastric plication, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.
• Complications of gastric restrictive surgeries: vomiting, erosion, breakdown of staple line, leaking of stomach secretions, infection, or death.
• Postoperative care includes oral health care.

Oral Health Care

• Important to overall health and often neglected.
• Mechanical oral hygiene prevents pneumonia and reduces ventilator-associated pneumonia.
• Antibiotic prophylaxis is needed for some conditions.
• Conditions include angular cheilosis, dental implants, dentures, gingival recession (treat with fluoride), gingivitis (treat with flossing), thrush (treat with Nystatin), and xerostomia (treat with saliva substitutes).

Oral Inflammatory Disorders

• Aphthous stomatitis (canker sores) is inflammation of the oral cavity.
• Triggers include dental work, vitamin deficiencies, H. pylori, and stress.
• Herpes simplex virus type one (cold sores) may be provoked by fever or stress.
• Oral acyclovir reduces occurrences.

Gastroesophageal Reflux Disease (GERD)

• Gastric secretions reflux into the esophagus, damaging it due to a lower esophageal sphincter that does not close tightly.
• Signs and symptoms: heartburn, regurgitation, sour taste, dysphagia.
• Diagnosis: barium swallow, esophagoscopy, pH monitoring.
• Respiratory complications: asthma, aspiration pneumonia, bronchospasm, laryngospasm.
• GERD may lead to Barrett’s esophagus (precancerous).

Barrett's Esophagus

• GERD can change the epithelium of the esophagus, leading to a precancerous condition.
• Increases the risk of esophageal cancer.
• Radiofrequency ablation removes Barrett’s tissue.
• Therapeutic interventions: lifestyle changes, medications (antacids, H2-receptor antagonists, PPIs).
• Other interventions include transoral incisionless fundoplication (TIF) using EsophyX, endoscopic procedures using radiofrequency waves, and fundoplication.
• Nursing concerns: acute pain.
• Nursing care: education on weight loss, low-fat/high-protein diet, avoiding caffeine, milk products, and spicy foods.

Mallory-Weiss Tear

• A longitudinal tear in the mucous membrane of esophagus at the stomach junction due to sudden, powerful, or prolonged force along with hiatal hernia.
• Signs and symptoms: bright red, bloody emesis and bloody or tarry stools.
• Diagnosis: EGD, hemoglobin and hematocrit.
• Therapeutic interventions: self-healing, PPIs, antiemetics, bleeding control (epinephrine, endoclips), and avoid alcohol.
• Nursing care: report bleeding, teaching to avoid alcohol and understand medications.

Esophageal Varices

• Dilated blood vessels in the esophagus.
• Rupture can be life-threatening.

Gastritis

• Inflammation of the stomach (acute or chronic) leading to abdominal pain, nausea, and anorexia.
• Irritating substances should be removed, and antacids may be taken.
• Pathophysiology: breakdown of the protective mucosal barrier leading to autodigestion; severe cases can cause perforation or scarring.
• Signs and symptoms include abdominal pain, nausea, vomiting, anorexia, abdominal tenderness, feeling of fullness, reflux, and belching.
• Therapeutic interventions: treat cause, avoid alcohol and irritating foods, antacids, antiemetics.

Chronic Gastritis

• Type A: autoimmune, in the fundus, asymptomatic, leads to pernicious anemia.
• Type B: from infection with H. pylori in the lower stomach.
• Signs and symptoms: anorexia, heartburn, belching, sour taste, nausea/vomiting.
• Treatment: antibiotics.

Stress-Induced Gastritis

• Stress ulcers in critically ill patients due to ischemia damaging the mucous barrier and acid secretions create ulcerations.
• Treatment includes quick trauma care, early feeding, prophylactic antacids/histamine blockers, and sucralfate to bind to the ulcer base.

Peptic Ulcer Disease

• Erosion of gastrointestinal lining.
• Primary cause: H. pylori.
• Increased risk with smoking and NSAID use.
• Gastric ulcers: high left epigastric, upper abdominal burning/gnawing pain that increases 1 to 2 hours after meals or with food.
• Duodenal ulcers: midepigastric, upper abdominal burning/cramping pain that increases 2 to 4 hours after meal/middle of night and is relieved with food or antacids.
• Signs and symptoms: anorexia, nausea/vomiting, bleeding.
• Complications: bleeding, perforation, obstruction.
• Diagnostic tests: urea breath test, immunoglobulin G antibody detection test, upper gastrointestinal series, EGD.
• Therapeutic interventions: antibiotics, PPIs, H2-receptor antagonists, bismuth subsalicylate, sucralfate, antacids.
• Treatment: avoid irritants like spicy foods, smoking, caffeine, and alcohol.
• Nursing concerns: acute pain, risk for injury, deficient knowledge.

Gastric Bleeding

• From ulcer perforation, tumor, or gastric surgery being either occult or observable.
• Signs and symptoms vary by severity.
• Mild: slight weakness or diaphoresis.
• Severe: hypovolemic shock, weak pulse, chills, palpitations.
• Treat hypovolemic shock if present.
• Therapeutic interventions: NPO, IV fluids, urinary catheter, NG tube, oxygen.
• Nursing concerns: deficient fluid volume.

Overview of upper gastrointestinal disorders with a focus on nursing care. Key interventions include medication administration, airway protection, and dietary modifications. It also covers complications like bleeding and aspiration with related therapeutic measures.