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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
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
Disorders that Affect Eating: AnorexiaDisorders 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
Disorders that Affect Eating: AnorexiaDisorders 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
• 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
Disorders that Affect Eating: Nausea, Vomiting (N/V)Disorders that Affect Eating: Nausea, Vomiting (N/V)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• 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
Disorders that Affect Eating: Nausea, Vomiting (N/V)Disorders that Affect Eating: Nausea, Vomiting (N/V)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcomes
Disorders that Affect Eating: N/VDisorders that Affect Eating: N/V
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcomes
Disorders that Affect Eating: Cancer of the Oral CavityDisorders that Affect Eating: Cancer of the Oral Cavity
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Inserting a Nasogastric TubeInserting a Nasogastric Tube
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gastrostomy TubesGastrostomy 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
Gastrostomy TubesGastrostomy Tubes• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcomes
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Esophageal Disorders: GERDEsophageal 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
Esophageal Disorders: GERDEsophageal Disorders: GERD• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcome
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• 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
Esophageal DiverticulumEsophageal Diverticulum
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcome
Esophageal DiverticulumEsophageal Diverticulum
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hiatal HerniaHiatal 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
Hiatal HerniaHiatal Hernia
• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcomes
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• 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
Esophageal CancerEsophageal Cancer
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcomes
Esophageal CancerEsophageal Cancer
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• 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
Gastric Disorders: GastritisGastric Disorders: Gastritis
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcomes
Gastric Disorders: Gastritis Gastric Disorders: Gastritis
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Peptic Ulcer Disease 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
Peptic Ulcer DiseasePeptic 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
• 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
Stomach CancerStomach Cancer
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Nursing Management
– Assessment
– Diagnosis
– Planning
– Implementation
– Evaluation of Expected Outcomes
Stomach CancerStomach Cancer
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
End of Presentation