Management of Gastric and Duodenal Disorders PDF

Management of Patients With Gastric And Duodenal Disorders ROSELLE JOY C. BALAQUIT, RN, MAMSN, DHCM(c) LEARNING OBJECTIVES: At the end of the learning experience, the students will be able to: compare the etiology, clinical manifestations, and management of...

Management of Patients With Gastric And Duodenal Disorders ROSELLE JOY C. BALAQUIT, RN, MAMSN, DHCM(c) LEARNING OBJECTIVES: At the end of the learning experience, the students will be able to: compare the etiology, clinical manifestations, and management of acute gastritis, chronic gastritis, and peptic ulcer; and describe the pharmacologic, dietary and surgical treatment of patients with gastric cancer. GASTRITIS A common GI problem Can be chronic or acute affects women and men equally and is more common in older adults Nonerosive gastritis (acute and chornic) - caused by infection with Helicobacter pylori (H. pylori) Erosive gastritis (acute and chronic) caused by: ✓ long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen [Motrin]) ✓ alcohol abuse ✓ Recent exposure to radiation therapy GASTRITIS A common GI problem Can be chronic or acute affects women and men equally and is more common in older adults Nonerosive gastritis (acute and chronic) - caused by infection with Helicobacter pylori (H. pylori) Acute Gastritis: Dietary indiscretion Overuse of certain medications Excessive alcohol intake Bile reflux Radiation therapy Ingestion of strong acid or alkali May be a sign of an acute systemic infection GASTRITIS CHRONIC GASTRITIS: Can be caused by benign or malignant ulcers Helicobacter pylori (nonerosive) Autoimmune diseases Dietary factors PATHOPHYSIOLOGY: Edema and hyperemia Decreased secretion Superficial erosion Hemorrhage GASTRITIS CLINICAL MANIFESTATIONS: Acute form: Abd. Discomfort Headache Lassitude N/V Anorexia Hiccuping (few hours to few days) Erosive gastrirtis (melena or hematochezia) Chronic form: Anorexia Heartburn p meals Belching, n & v, sour taste Vitamin B12 deficiency- diminished intrinsic factor by the parietal cells GASTRITIS ASSESSMENT AND DX FINDINGS: Achlorhydria/ Hypochlorhydia to Hyperchlorhydia Endoscopy, upper GI radiographic studies,, histologic exam, Diagnostic measures for H-Pylori GASTRITIS MEDICAL MANAGEMENT: Refrain from alcohol or food until sx subsides Control of bleeding Diluting/neutralizing offending agent (Ingestion of acid and alkalis) Emetics and lavage NGT Gastric resection CHRONIC GASTRITIS: Diet modification, Promoting rest, reduce stress, pharmacologic therapy, Pharmacologic Therapy for Peptic Ulcer Disease and Gastritis NURSING PROCESS AND THE PATIENT WITH GASTRITIS ASSESSMENT: Patient History Ask about the presenting signs and symptoms 72 dietary recall Any methods used to treat the symptoms NURSING DIAGNOSIS: Anxiety related to treatment Imbalanced nutrition, less than body requirements, related to inadequate intake Risk for imbalanced fluid volume related to insufficient fluid loss subsequent to vomiting Deficient knowledge Acute pain NURSING PROCESS AND THE PATIENT WITH GASTRITIS PLANNING AND GOALS: Reduced anxiety Avoidance of irritating foods Fluid balance Relief of pain Dietary management NURSING INTERVENTIONS: Reduce anxiety Optimal nutrition Promote fluid balance Relieve pain NURSING PROCESS AND THE PATIENT WITH GASTRITIS EVALUATION: Exhibits less anxiety Avoids eating irritating foods or drinking carbonated beverages Maintains fluid balance Adheres to medical regimen Maintains appropriate weigh Reports less pain PEPTIC ULCER DISEASE A peptic ulcer is an excavation that forms in the mucosal wall of the stomach, in the pylorus, and duodenum, or in the esophagus. Depth of erosion is variable Occurs mostly in people between 40 and 60 y/o Results from infection with H. Pylori Excessive secretion of HCL may also be the cause GASTRIC AND DUODENAL ULCERS DUODENAL VS. GASTRIC ULCER INCIDENCE SIGNS AND SYMPTOMS MALIGNANCY POSSIBILITY RISK FACTORS RISK FACTOR AND PATHOPHYSIOLOGY: Risk factor: Familial tendency, use of NSAIDs, Alcohol ingestion, excessive smoking, Zollinger-Ellison syndrome PATHOPHYSIOLOGY: Erosion is caused either by increased activity of pepsin and HCL or decreased resistance of the mucosa ZES is suspected in unresponsive peptic ulcer STRESS ULCERS can also be the cause: Ischemia, increased acid and pepsin production, reflux Cushing and Curling types CLINICAL MANIFESTATIONS: May be asymptomatic Dull, gnawing pain/burning sensation in the midepigastiric area or in the back Eating usually relieves pain Pyrosis Vomiting, constipation, diarrhea, bleeding ASSESSMENT AND DX FINDINGS: Physical findings Upper GI barium study Endoscopy Stool analysis Biopsy, and histology with culture Urea breath test MEDICAL MANAGEMENT: PHARMACOLOGIC: Antibiotics (TAMCB) Proton-pump inhibitors (OLR) Bismuth salts H2 receptor antagonists (CRFN) Octreotide Cytoprotective agents Stress reduction and rest Dietary modification SURGICAL MANAGEMENT: Vagotomy with or without pyloroplasty Vagotomy Truncal Selective Proximal gastric vagotomy Billroth I and Billroth II NURSING PROCESS AND PEPTIC ULCER ASSESSMENT: Chief complaint Ask about the nature of the pain 72 hour dietary recall Lifestyle habits Vital signs Physical exam NURSING PROCESS AND PEPTIC ULCER NURSING DIAGNOSES: Acute pain related to the effect of gastric acid secretion on damaged tissue Imbalanced nutrition related to changes in diet Potential Complications: Hemorrhage Perforation Penetration Gastric Outlet Obstruction NURSING PROCESS AND PEPTIC ULCER GOALS: Relief of pain Reduced anxiety Nutrition maintenance Absence of complications NURSING PROCESS AND PEPTIC ULCER NURSING INTERVENTIONS: Relieving pain Avoid caffeine and aspirin Relaxation techniques NURSING PROCESS AND PEPTIC ULCER NURSING INTERVENTIONS: Reducing anxiety NURSING PROCESS AND PEPTIC ULCER NURSING INTERVENTIONS: Monitoring and managing potential complications: HEMORRHAGE Usually manifested by: Monitor the patient for signs of hypotension Monitor Hgb and Hct NURSING PROCESS AND PEPTIC ULCER NURSING INTERVENTIONS: Monitoring and managing potential complications: HEMORRHAGE Treat the bleeding! Replacing blood that was lost IV line, CVP insertion, blood component therapy NG Tube insertion Monitoring Lavage monitoring UO Proper positioning NURSING PROCESS AND PEPTIC ULCER NURSING INTERVENTIONS: Monitoring and managing potential complications: HEMORRHAGE TAE Selective embolization NURSING PROCESS AND PEPTIC ULCER NURSING INTERVENTIONS: Monitoring and managing potential complications: PERFORATION AND PENETRATION Perforation S/sx: Intractable pain radiating to the right shoulder Tender, rigid, board-like abdomen Vomiting, htn, tachycardia, fainting Penetration S/Sx: Back and epigastric pain Surgery Post Op: Monitoring NURSING PROCESS AND PEPTIC ULCER NURSING INTERVENTIONS: Monitoring and managing potential complications: PYLORIC OBSTRUCTION (GOO): S/Sx: Nausea and vomiting, constipation, epigastric fullness, weightloss Management: Insertion of Ng Tube Upper GI endoscopy Balloon dilatation of the pylorus Surgery: Vagotomy, antrectomy, gestrojejunostomy and vagotomy GASTRIC CANCER Incidence: MEN>WOMEN Japan has higher incidence Diet: Significant factor Other factors: Chronic inflammation of the stomach Pernicious anemia Achlorhydria Gastric ulcers H. Pylori infection Genetics GASTRIC CANCER CLINICAL MANIFESTATIONS: Early stages: Asymptomatic Early symptoms seldom definitive: Pain relived with antacids Progressive: Anorexia, dyspepsia, weightloss, abdominal pain, constipation, anemia, nausea and vomiting GASTRIC CANCER MEDICAL MANAGEMENT: REMOVAL OF THE TUMOR Gastrectomy (Total/subtotal) Chemotherapy Radiation therapy PATIENTS UNDERGOING GASTRIC SURGERY ASSESSMENT: Pt. and family knowledge Patient’s nutritional status Assess for presence of bowel sounds Palpate the abdomen Assess for complication postop PATIENTS UNDERGOING GASTRIC SURGERY NURSING DIAGNOSIS: Anxiety related ton surgical intervention Acute pain related to surgical incision Deficient knowledge about surgical procedures and postoperative course Imbalanced nutrition, less than body requirements, related to poor nutrition before surgery and altered GI system after surgery PATIENTS UNDERGOING GASTRIC SURGERY NURSING INTERVENTIONS: Relieve anxiety Relieve pain Analgesics No sedation! Maintain NG tube Resume enteral intake Recognize obstacles to adequate nutrition: Dysphagia and gastric retention Bile reflux Dumping syndrome Vitamin and mineral deficiencies