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Chapter045 Presentation Transcript

  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 45: Caring for Clients with Disorders of the Upper Gastrointestinal Tract Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Disorders that Affect Eating: Anorexia • Anorexia: Lack of appetite; Malnutrition • Pathophysiology and Etiology – The appetite center • Location and function; Gluconeogenesis • Assessment Findings: Signs and Symptoms – Absence of hunger; Nausea • Diagnostic Findings – Reduced hemoglobin level, blood cell counts Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Disorders that Affect Eating: Anorexia • Medical and Surgical Management – Short-term: No medical intervention – Various approaches for persistent anorexia – Psychological and psychiatric treatment • Nursing Management – Assessment; Diagnosis; Planning – Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Disorders that Affect Eating: Nausea, Vomiting (N/V) • Pathophysiology, Etiology: Common causes, symptoms • Assessment Findings: Signs and Symptoms – Loss of appetite; Dehydration • Diagnostic Findings: Low levels of serum sodium and chloride • Medical and Surgical Management – IV fluids, electrolytes; Drug therapy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Disorders that Affect Eating: Nausea, Vomiting (N/V) • Pathophysiology and Etiology: Common causes, symptoms • Assessment Findings: Signs and Symptoms – Loss of appetite; Dehydration • Diagnostic Findings: Low levels of serum sodium and chloride • Medical and Surgical Management – IV fluids, electrolytes; Drug therapy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Disorders that Affect Eating: N/V • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Disorders that Affect Eating: Cancer of the Oral Cavity • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Inserting a Nasogastric Tube Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Gastrostomy Tubes • Provides Route – Nutrition; Medications; Gastric decompression/compression; Lavage; Diagnostics; Treatment • Placement – Nasogastric (NG); Orogastric; Nasoenteric – Surgical placement: Gastrostomy • PEG tube; G-Tube; Jejunostomy • Long-term Tube Feedings Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Gastrostomy Tubes • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Esophageal Disorders: GERD • Gastroesophageal Reflux Disease: Gastric contents regurgitates • Pathophysiology; Etiology: Lower esophageal sphincter insufficiency • Assessment Findings: Signs and Symptoms – Epigastric pain, burning; Regurgitation • Diagnostic Findings: Barium swallow; Upper endoscopy with biopsy; Capsule; Bronchoscopy • Medical and Surgical Management: Conservative measures; Medications; Fundoplication; Stretta procedure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Esophageal Disorders: GERD • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcome Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Esophageal Diverticulum • Pathophysiology, Etiology: Zenker’s diverticulum; Congenital or acquired esophageal wall weakness • Assessment Findings: Signs and Symptoms – Foul breath; Difficulty swallowing • Diagnostic Findings: Barium swallow; Esophagoscopy • Medical and Surgical Management – Diet therapy: Bland; Soft; Semisoft; Liquid – Surgical excision of the diverticulum Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Esophageal Diverticulum • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcome Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Hiatal Hernia • Axial (or sliding); Paraesophageal • Pathophysiology and Etiology: Diaphragm defect; Congenital muscle weakness • Assessment Findings: Heartburn; Belching or pain after eating • Diagnostic Findings: Barium swallow; Esophagoscopy • Medical and Surgical Management: Stretch narrowed esophagus endoscopically Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Hiatal Hernia • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Esophageal Cancer • Pathophysiology; Etiology: Affects men > women; Squamous cell carcinoma – Correlation: Alcohol abuse; Smoking • Assessment Findings: Signs and Symptoms – Beginning, progressive symptoms • Diagnostic Findings: Barium swallow; Biopsy; EGD; Bronchoscopy; Endoscopic ultrasound; Mediastinoscopy • Medical and Surgical Management: Surgery; Palliative measures Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Esophageal Cancer • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Gastric Disorders: Gastritis • Pathophysiology, Etiology: Helicobacter pylori; Acid production • Assessment Findings: Signs and Symptoms – Common symptoms, same with bacterial or viral infection • Diagnostic Findings: CBC; Gastroscopy; Stool test • Medical and Surgical Management: Diet restriction; IV fluids; Medications: Antiemetics; Antibiotics Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Gastric Disorders: Gastritis • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Peptic Ulcer Disease • Pathophysiology and Etiology – Infection with Helicobacter pylori; Family history; Other risk factors – Chronic gastric inflammation • Assessment Findings: Pain (abdomen and back); Bleeding: Hematemesis; Melena Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Peptic Ulcer Disease • Diagnostic Findings: Upper GI; EGD; Low Hemoglobin, RBC • Medical and Surgical Management: Eradication therapy; Pain management – Gastrectomy: Dumping syndrome • Nursing Management – Assessment; Diagnosis – Planning; Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Stomach Cancer • Pathophysiology and Etiology: Heredity; Chronic inflammation; Achlorhydria; Chronic ingestion of toxins • Assessment Findings: Signs and Symptoms – Early: Stool contains occult blood • Diagnostic Findings: Barium swallow; CT scan; Tissue biopsy; Gastric analysis; Ultrasonography • Medical; Surgical Management: Subtotal or total gastrectomy; Chemotherapy; Palliative radiation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Stomach Cancer • Nursing Management – Assessment – Diagnosis – Planning – Implementation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins