Timby Ch. 45 Caring for Clients with Disorders of the Upper GI Tract

Anorexia

Lack of appetite

Hypothalamus

The appetite center.

Glycogenolysis

Conversion of glycogen to glucose

Water soluble vitamins.

The body doesn't store these vitamins. Vitamins B, C, and folic acid

Fat soluble vitamins

The body stores these vitamins, but requires fat to do so. Vitamins A, D, E, and K

Common causes of N/V

Drugs, infections and inflammatory conditions of the GI tract, intestinal obstruction, systemic infections, lesions of the CNS, food poisoning, emotional stress, early pregnancy, and uremia

medulla

Vomiting center. Particularly sensitive to parasympathetic neurotransmitters released in response to gastric irritation.

Valsalva maneuver

Accompanied the forceful expulsion of stomach contents, causes dizziness, hypotension, and bradycardia

Prolonged vomiting leads to this

Low levels of serum sodium and chloride. Bicarbonate levels may rise to compensate for the loss of chloride and accumulation of metabolic acids. The hematocrit value, if high, is secondary to the hemo concentration that accompanies dehydration

Deficient fluid volume

Related to prolonged vomiting and decreased intake of oral fluids

Causes of oral cancer

HPV infection, repeated irritation from rough teeth, dentures, or fillings, and poor oral and dental hygiene

What should be at the bedside after oral surgery?

Suction equipment, administration of oxygen, and tracheostomy tray.

Why shouldn't clients use straws after oral surgery?

It causes the client to swallow air which can distend the stomach

Gastric decompression

Removal of gas and fluids from the stomach

Nasogastric intubation

Tube passes through the nose into the stomach via esophagus

Orogastric intubation

Tube passes through mouth into the stomach

nasoenteric tube

Tube passes through the nose, esophagus, and stomach to the small intestine

Gastrostomy

Tube enters the stomach through a surgically created opening into the abdominal wall

Jejunostomy

Tube enters jejunum or small intestine through a surgically created opening into the abdominal wall

Levin nasogastric tube

Single lumen NG tube

Gastric sump Salem

Double lumen NG tube

Sengstaken-Blakemore (rubber) tube

Triple lumen NG tube used for esophageal varices

Andersen (like Miller-Abbott; rubber) nasoenteric decompression tube

Used for temporary management of early mechanical obstruction. One lumen is tungsten weighted; other is used as a vent

Dobbhoff or Keofeed II (polyurethane or silicone rubber)

Nasoenteric tube used mostly for feeding

Risk for diarrhea

Related to hypertonic feeding solutions, lack of dietary fiber, high carbohydrate and electrolyte content.

Size of GI tube for intubation

16 or 18 French

Bolts tube feedings

Allows Introduction of 250-400mL formula through the tube in 15-30 minutes. It's administered by syringe or gravity flow

Intermittent tube feedings

Allows delivery of between 250 & 400mL of formula over 30-60 minutes. It's delivered by gravity flow system or an electronic feeding pump.

Percutaneous endoscopic gastrostomy (PEG)

When an endoscope is introduced orally and advanced into the stomach so that the physician can see the correct location for the tube.

GERD (gastroesophageal reflux disease)

Common disorder that develops when gastric contents flow upward into the esophagus

Cause of GERD

Inability of the lower esophageal sphincter (LES); also called the cardiac sphincter, to close fully allowing the stomach contents to flow freely into the esophagus.

Symptoms of GERD

Epigastric pain or discomfort (dyspepsia), burning sensation in the esophagus (pyrosis), and regurgitation. Difficulty swallowing (dysphagia), painful swallowing (odynophagia), inflammation of the lining of the esophagus (esophagitis), aspiration pneumonia, and respiratory distress. Since the esophagus is anatomically close to the heart, client may think they're having a heart attack.

Nursing management for GERD

Eat smaller meals and avoid foods & beverages that increase gastric acidity (black and red pepper, regular & decaffeinated coffee, alcohol) and avoid items that lower pressure in the LES (alcohol, chocolate, peppermint, licorice, citrus fruits, caffeine, high fat foods), and stop smoking.

Zenkers diverticulum

Most common esophageal diverticulum that occurs at the pharyngeal esophageal juncture. Men are more likely to have this than women.

Axial or sliding hernia

When the junction of the stomach and esophagus and part of the stomach slide in and out through the weakened portion of the diaphragm.

Paraesiphageal hernia

When the fungus is displaced upward, with greater curvature of the stomach going through the diaphragm next to the gastroesophageal junction

Dumping syndrome

Clients with a gastrojejunostomy are at risk for developing this. It produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea. It results from the rapid emptying of large amounts of hypertonic chyme into the jejunum. It can cause hypovolemia and the drop in blood pressure can produce syncope.

Vagotomy

A branch of the vagus nerve is cut to reduce gastric acid secretion

Pyloroplasty

The pyloric is repaired or reconstructed to expand the stomach outlet narrowed by scarring or improve gastric motility and emptying

Gastrodudodenostomy (Billroth I)

Part of the stomach is removed; while the remaining portion is connected to the duodenum. Usually, a vagotomy also is performed

Gastrojejunostomy (Billroth II)

Same as Billroth I, except the remaining portion is connected to the jejunum in cases of extensive dudodenal inflammation or perforation

Total gastrectomy

The entire stomach is removed

Extreme obesity

A body mass index (BMI) of 40 or higher. Client usually weigh 100lb more than their ideal body weight