The document provides information on preoperative and postoperative nursing care for gastric surgery patients. It discusses monitoring vital signs, pain management, ambulation, diet, and complications like hemorrhage, gastric distention, and nutritional problems. It also covers oral health issues like stomatitis, herpes, and candida infections as well as disorders like dental caries, gingivitis, and oral cancer. Esophageal cancer signs, diagnosis, treatments including radiation, chemotherapy and surgery are outlined.

1. Linton GI Ch 38 Powerpoint 4 Mrs. Powell

2. Gastrointestinal Surgery PREOP NURSING CARE: Radiographic exams done Prep Monitor Vital Signs NPO for specified period IV fluids may be ordered Antibiotics may be ordered NG tube may be inserted before or during surgery

3. POSTOPERATIVE CARE Acute Pain Fear—re disease, surgery and outcome

4. Nursing Care After Gastric Surgery Monitor Vital Signs Respiratory Status (atelectasis results from guarding and shallow breathing) Control Pain (helps ability to cough/db) Intake and Output IV fluids; Foley catheter Incisional Site—observe for drainage/bleeding

5. Nursing Care After Gastric Surgery (cont’d) NG Tube Care Monitor suction; Inspect, describe and measure drainage Do not irrigate or reposition unless ordered to do so Ambulate Early-quicker recovery by improving respiratory and GI function Monitor Abdominal Status Prevent distention Education—incision care, activity, diet, meds

6. Complications of Gastric Surgery Hemorrhage—s/s restlessness, cold skin, increased pulse and respirations, decreased Temp and B/P; Altered LOC; vomiting blood Gastric Distention—s/s enlarged abd, epigastric pain, tachycardia, hypotension; c/o feeling full; hiccups/gagging; (monitor NG tube) Nutritional Problems—NPO until return of bowel function; may need TPN; introduce foods gradually Pernicious Anemia—if some/all of stomach removed (intrinsic factor reduced/absent); s/s anemia, weakness, sore tongue, numbness/tingling, gastric upset

7. Complications of Gastric Surgery (cont’d) Steatorrhea (fat in stools)—result of rapid gastric emptying Pyloric Obstruction—result of scarring, edema, inflammation; s/s vomiting, fullness, distention, nausea after eating, anorexia, weight loss Dumping Syndrome—rapid entry of food into jejunum w/out mixing w/ digestive juices; rapid shift of fluid as fluids leave blood to dilute high concentration of electrolytes and sugars; s/s after eating: dizziness, tachycardia, fainting, sweating, nausea, diarrhea, feeling of fullness, abd cramping. Then blood sugar rises, excessive insulin released causing hypoglycemia 2hrs later. Treatment: small, frequent meals high in protein and fat and low in carbs

8. DRUG THERAPY TABLE P 746-749

9. Anorexia Lack of Appetite: common symptom of many diseases Can be caused by noxious odors, meds, emotional stress, fear, psychological problems, infections Prolonged anorexia: electrolyte imbalances, which can lead to cardiac dysrhythmias Assess for evidence of malnutrition: glossitis (inflammation of the tongue), cheilosis (cracked lips), edema, jaundice, and muscle wasting Treatment: Eating, Tube Feeding, IV infusion

10. Anorexia (cont) Accurate I/O Monitor VS Electrolytes Electrocardiograms Monitor IV and TF rates

11. Eating Disorders Anorexia Nervosa Bulimia Nervosa

12. FEEDING PROBLEMS Assess each pt’s ability to feed him/herself independently Encourage patients to be as independent in feeding as possible Proper positioning, assistive devices Provide mouth care; record I/Os

13. Oral Health Care Important to Overall Health Nutritional needs; respiratory illness and cardiac disease associated w/ pathogens in the mouth Often Neglected in Daily Care Oral Hygiene with Chlorhexidine Gluconate Prevents Pneumonia Reduces Ventilator Associated Pneumonia Inexpensive way to promote pt health

14. Oral Health Aging changes, disease, and treatment can result in oral inflammation and infection Immunocompromised, AIDS, chemotherapy, vitamin deficiencies more at risk Cadidiasis Note any oral s/s of inflammation or infection for prompt treatment—preserve oral comfort and nutrition

15. Oral Inflammation and Infections STOMATITIS Inflammation of the oral mucosa Poorly fitting dentures, excessive tobacco or alcohol use, poor oral hygiene, inadequate nutrition, pathogenic organisms, radiation therapy, drug therapy, or disorders of the kidney, liver or blood Eliminate the cause, antibiotics or antiviral agents Soft, bland diet

16. Vincent’s Infection Bacterial infection Metallic taste, bleeding ulcers in mouth, foul breath, increased salivation Topical antibiotics and mouthwashes; good oral hygiene

17. Herpes Simplex Type I Painful “cold sores” or “fever blisters” on face, lips, inside mouth, cheeks, nose or conjunctivae Last a few days, continue to recur May be provoked by fever or stress Upper respiratory tract infections, excessive sun exposure Acyclovir ointment used to ease pain; does not cure lesions Oral acyclovir may reduce recurrences Topical steroids Lesions infectious, use Standard precautions when applying ointment or giving oral care

18. Apthous Stomatitis (canker sore) Small, white, painful ulcers on inner cheeks, lips, tongue, gums, palate or pharynx Several days-2 weeks Self induced trauma i.e. biting lips and cheeks, stress, exposure to irritating foods Topical tetracycline several X daily shortens healing time Topical anesthetic i.e. benzocaine or lidocaine provides pain relief and allows eating Topical or systemic steroids

19. Candida Candida Albicans (Yeast Infection)—Thrush or candidiasis High risk: steroids, long-term antibiotics Nystatin

20. Disorders of Teeth and Gums Dental caries—tooth decay Periodontal Disease—Gingivitis Gingivitis—gums bleed; Progressive: bone loss may occur (periodontitus) Flossing Daily

21. Oral Cancer Squamous cell carcinomas lips, buccal mucosa, gums, floor of mouth, tonsils, tongue Basal cell carcinoma—lips S/S tongue irritation, loose teeth, pain, lesions, leukoplakia (hard white patches) Diagnosed by biopsy

22. Oral Cancer (cont) Treatment based on individualized diagnosis Radiation, chemotherapy, and surgery Radical or modified neck dissection performed if CA metastasized to cervical lymph nodes

23. Oral Cancer—Nursing Care Impaired Oral Mucous Membrane Mouth Care Ineffective Breathing Pattern Monitor respiratory status frequently r/t edema, secretions Suction Acute Pain Medications, relaxation, imagery Imbalanced Nutrition: Less Than Body Requirements Soft or Liquid Diet, Feeding Tube, TPN

24. Oral Cancer—Nursing Care (cont) Impaired Verbal Communication Assist pt to communicate Disturbed Body Image Risk for Infection Monitor for s/s of infection; antibiotics Ineffective Tissue Perfusion r/t grafts

25. Parotitis Painful swelling of salivary glands below ear At risk: Pts unable to take oral fluids for a prolonged time Treatment: antibiotics, mouthwashes, warm compresses, possible surgery

26. Achalasia Progressively worsening dysphagia (difficulty swallowing) Failure of the lower esophageal muscles and sphincter to relax during swallowing Treatment: Medications, Dilation, Surgery

27. Esophageal Cancer Risk: Alcohol or Tobacco Use Detected Late Location near many lymph nodes that allow it to metastasize to liver and lung Obstruction of esophagus may occur, w/ possible perforation or fistula development that may cause aspiration Lesion may extend to aorta

28. Signs and Symptoms Appearance of s/s usually means that CA is in late stages Difficulty Swallowing, Feeling Full, Pain in Chest after eating, Foul Breath, Food Regurgitation, Weight Loss Diagnosis: Barium swallow, Esophagoscopy, Biopsy Endoscopic examination of mediastinum used to determine if spread to lymph nodes and surrounding structures

29. Esophageal Cancer (cont’d) Radiation Chemotherapy Surgery Esophagogastrostomy—esophageal resection Dacron Esophageal Replacement—prosthesis Esophagoenterostomy—use of a section of colon to replace esophagus If inoperable tumor, esophageal dilation or stent placement can be done to relieve dysphagia and allow food to pass through esophagus

30. Esophageal Cancer (cont’d) Nursing Diagnoses p.757-758 Pain Risk for Deficient Fluid Volume Imbalanced Nutrition: Less Than Body Requirements Evaluation: goals met if pt reports pain relieved and fluid volume and nutritional needs met