Upper and Lower GI

What are the key concerns for Stomatitis?

• Pain

• Imparied nutrition

• Inflammation in mouth that makes it painful to eat

What are te key concerns for GERD?

• Pain

• Altered nutrition

• Stomach acid coming up and burning can make you not want to eat

What are the key concerns for Gastritis (acute and chronic)?

• Pain

• Infection (sometimes)

• UGIB

• Can be life threatening

What are the key concerns for UGIB?

• Hypovalemia (gets rid of blood volume) → shock → death

• Can be life threatening

What are the key concerns for Peptic Ulcer Disease?

• Pain

• Infection (often)

• UGIB

• Perforation (perforates wall of organ and abdominal contents enter abdominal cavity instead of staying in GI tract

• Peritonitis

• Can be life threatening

What are the key concerns for Peritonitis?

• Sepsis → shock → death

• Can be life threatening

What is the etiology of stomatitis?

• Infection (such as Candida albicans: aka “thrush” or “candidiasis”

  • Overgrowth of normal bacteria in mouth??

• Idiopathic (such as with aphthous ulcers: aka “canker sores”

• Increased risk among certain populations

What is the assessment process for stomatitis?

• History

• Pain, redness, lesions, coating of oral mucosa (specifcally candidiasis)

• Effect on eating, swallowing, breathing, communication

What would be part of an oral care plan/nursing diagnosis for stomatitis?

• Impaired tissue integrity

• pain

• deficient knowledge

What should you implement with stomatitis for impaired tissue integrity?

• Avoid commercial mouthwashes (harsher chemicals, may contain alcohol)

• Oral care Q2 and after meals

• Ensure proper fit of dentures. and remove dentures (if necessary/applicable)

• Pharmacologic:

  • clotrimazole lozenges or nystatin (swish and spit) for candidiasis

  • chlorhexidine (swish and spit) for bacterial infections

What should you implement with stomatitis for pain?

• Rinse mouth frequently with warm saline or sodium bicarbonate solution

• Oral hygiene with soft brush or gauze

• Soft foods, cold/cool liquids

• Topical analgesis (such as OTC or viscous lidocaine)

What should you implement with stomatitis for deficient knowledge?

• Teach pt the interventions listed in the left columns

What is GERD?

• lower esophageal sphincter is open allowing reflux (normall it is closed and keeps stomach contents where they belong)

What are risk factors for GERD?

• Obesity

• H-pylori (due to gastritis & poor gastric emptying)

• Pregnancy

• Certain medications (NSAIDs, prednisone, anticholinergics) or foods

• Tobacco and alcohol use

• NG tube (doesn’t allow LES to fully close)

What are symptoms of GERD?

• Chest/epigastric pain (acid coming up, typically misunderstood??), dyspepsia (“indigestion”), regurgitation, coughing at night, pyrosis (“heartburn”), dysphagia (acid/heartburn can impact ability to swallow if chronic)

• Development of esophageal strictures or Barrett Esophagus (more ulcerations in esophagus)

Medical Diagnosis vs. Nursing Diagnosis (OCP) for GERD

• Medical Diagnosis: no definitive diagnostic test exists

• Nusing Diagnosis: imapired comforot (pain), imbalanced nutrition, deficient knowledge

What are medical interventions for GERD?

• Pharmacologic therapy: antacids (aluminum hydroxide), histamine blockers (phamotidine, ranitidine), proton pump inhibitors (protonics, omeprazole)

• Endoscopic Management → Stretta procedure OR Surgical management → Lap Nissen Fundoplication

What do you want to make sure your patients are aware about with taking antacids for GERD?

• Chronic use can mess with electrolytes and cause over production of stomach acid

What is the Stretta procedure?

• Endoscopic procedure for GERD

• Controlled heat is given to the LES and causes the muscle tissue to gently swell, tighten, and thicken over time through natural healing and fibrosis, helping restore the body's natural barrier against stomach acid

What is the Lap Nissen Fundoplicaiton procedure?

• Surgical procedure for GERD

• Wraps the top of the stomach around the lower esophagus to reinforce the weak valve causing acid reflux

What are nursing interventions you can implement for GERD?

• Focus on teaching!

• Idenitfy and eliminate trigger foods

• Small, frequent meals rather than large meals (causes less production of stomach acid)

• Wait 3 hrs after eating before lying down

• Sleep with elevated HOB

• Limit or avoid alcohol and tobacco products

• Identify methods to lose wieght and refer to appropriate resources

• Provide education related to prescribed medications

What is omeprazole for GERD?

• Proton pump inhibitor

• MOA: suppress gastric acid secretion through suppression of an ezyme

• Have pt’s rake capsule whole, do not crush

• Give 30min before the main meal of the day. The proton pump is activated by the presence of food, so this allows for the med to start working before the PP is activated.

What is ranitidine for GERD?

• H2 receptor antagonist (blocker)

• MOA: decrease gastric acid secretions by blocking histamine recptors in parietal cells

• Give single dose at bedtime, as bedtime administation suppresses nocturnal acid production

What is aluminum hydroxide for GERD?

• Antacid

• “Tums”

• MOA: increase pH of gastric contents by deactivating pepsin

• Give 1hr after meals and at bedtime

• DO NOT give other drugs within 1-2 hrs of antacids (neutralizing what you need to help break down other meds)

What are risk factors for acute gastritis?

• Use of coffee/caffeine, alcohol, nicotine

• Overuse of ASA, NSAIDS, or corticosteroids

• Radiation therapy

• Stress

• Exposrue to food borne infectious organisms

What are risk factors for chronic gastritis?

• H. pylori infection (most common cause)

• Radiation therapy

• Crohn’s Disease

• Long term alcohol or nicotine use

What are symptoms for acute gastritis?

• N/V

• Epigastric pain

• Hematemesis or Melanie (possible)

What are symptoms for chronic gastritis?

• Few symptoms

• May have N/V, epigastric pain

What are complicaitons of acute gastritis?

• Gastrointestinal bleeding

What are complications of chronic gastritis?

• May result in pernicious anemia (lack of B12)

• Increased risk for gastric cancer (chronic inflammation in any place increases risk of cancer and mutations)

How do you medically diagnosis gastritis?

• Esophagogastroduodenoscopy (EGD) via endoscope, with biopsy

What are nursing diagnoses/OCP focuses for gastritis?

• Nausa

• Impaired comfort

• Knowledge defecit

• Risk for imablanced fluid/electrolytes, gastrointestinal bleeding

What are medical interventions for gastritis?

• Medications- Acute: Same as for GERD, mucosal barrier fortifier- Sucralfate (1hr before pt eats bc it coats esophagus/stomach which helps fortified mucosal barrier in upper GI tract)

• Medications- Chronic: Vitamin B12 injections if anemia, antibiotics if H-pylori

What are nursing interventions for gastritis?

• Chronic and Acute: Eliminate causative factor(s), Avoid toxic substances (alcohol and nicotine)

• Acute: Limit intake of high acid foods and caffeine, bland diet and smaller/more frequent meals as tolerated, usually resolves on own within a few days, monitor for GI bleeding (hematesis or melena, signs of shock- tachycardia, hypotension)

What is peptic ulcer disease?

• Open sores in the lining of the stomach or upper small intestine

• Stomach acid and digestive juices eat away at the lining when the protective mucus layer breaks down

What are the types of peptic ulcer disease?

• Duodenal

• Gastric

• Stress (due to medical crisis/trauma)

What are risk factors for peptic ulcer disease?

• Helicobacter pylori bacteria (most common cause)

• Stress, alcohol and nicotine use, family history

• NSAIDS, cotricosteroids

What are symptoms of peptic ulcer disease?

• Often asymptomatic

• Epigastric pain, N/V (sometimes)

• If bleeding: hematemesis, melon, low HgB/Hct or symtpoms of hypvalemia

What are possibly complications of peptic ulcer disease?

• GI bleeding

• Perforation (abd. cavity doesn’t have anything to protect from stomach contentss like GI tract does so this is a problem)

• Peritonitis

How do you medically diagnose peptic ulcer disease?

• H-pylori tests (Serum, breath, stool)

• Fecal occult blood test (FOBT) to evaluate bleeding

• Esophagogastroduodenoscopy (EGD)- most accurate (visually looking at source)W

What is the nursing diagnosis/focus for OCP for peptic ulcer disease?

• Imapired comfort

• Risk for perforation, peritonitis, gastrointestinal bleeding

What are medical interventions for peptic ulcer disease?

• Administer medications:

  • Same meds as for gastritis

  • Antimicrobials if H-pylori: metronidazole (flagyl) and tetracycline

What are nursing interventions for peptic ulcer disease?

• Monitor for signs of GI bleeding

• Patient education: avoid alcohol and nicotine, stress management, diet as tolerated- small meals, bland foods, avoid foods that cause discomfort

Why are risk factors for GI bleeding?

• Peptic Ulcer Disease (PUD)

• Impaired coagulation

What are symptoms of a GI bleed?

• Hematemesis OR blood or black stools; may have sharp abdominal pain (can develop quickly and enough blood that is clotting in GI tract = problem)

  • Bright red = fresh, probably colon bc it is close to exit

  • Black blood = old, probably upper GI tract

• Low HgB/Hct (no longer in blood vessels, now in GI tract)

• Symptoms of hypovolemia: tachycardia, hypotension, diaphoresis, syncope, decreased urine output

What are complications of GI bleeding?

• Hypovolemic shock → death

Why is an upper GI bleed more serious that a lower?