Disease
(GERD)
Ch.42 pp. 931-935
GERD
Possible causes
Incompetent LES
Obesity
Cigarette and cigar smoking
Hiatal hernia
GERD
GERD
Complications
Esophagitis
Can lead to strictures, scar tissue, and
dysphagia
Esophageal ulcerations
Barretts esophagus
Precancerous lesion
Respiratory complications
Dental erosion
GERD
Diagnostic Studies
History and Physical
Upper GI endoscopy with biopsy
Esophagram (barium swallow)
Motility Studies
pH monitoring
Radionuclide studies
GERD
Collaborative Care
Lifestyle modification
Nutritional Therapy
Drug therapy
Surgery
GERD
Collaborative Care
Lifestyle modification
Avoid triggers
Weight reduction
Smoking cessation
Manage stress
GERD
Collaborative Care
Nutritional Therapy
Avoid foods /items that decrease LES pressure (Table 427)
Alcohol
Anticholinergics
Chocolate
Fatty foods
Nicotine
Peppermint
Avoid milk
Small frequent meals
Increase saliva production
Avoid late evening meals
Fluid between rather than with meals
Avoid foods that irritate esophagus
Positioning
GERD
Collaborative Care
Drug Therapy
Goals of drug therapy
GERD
Collaborative Care
Drug Therapy
Proton Pump Inhibitors (eg. Prevacid, Prilosec, Protonix,
Nexium)
GERD
Collaborative Care
Surgical Therapy
Endoscopic Therapy
GERD
Nursing Management
Pt Teaching
GERD
Nursing Management
Postop Care
Ch.43 pp.973-974
Most
Opening
blocked
Initial
Perforation
Peritonitis
Elevation in temperature
Increased pulse
Diagnostics
Imaging Diagnostics
Abdominal X-ray
Ultrasound
CT scan
Collaborative Care
Appendectomy
Antibiotics
Fluid replacement
Hospitalized
Keep pt NPO
DO NOT..
Give laxative or enema
Post-op
management
Early ambulation
Advance diet as tolerated
Ch.43 pp.974-975
Life threatening
DIAGNOSTIC STUDIES
COLLABORATIVE CARE
CBC
WBC
Peritoneal aspiration
Abdominal X-ray
Ultrasound
CT scans
Antibiotics
NG suction
Analgesics
IV fluids
Surgery
Nursing Diagnosis
Acute pain
Risk for deficient fluid volume
Anxiety
No complications
Normal nutritional status
Nursing Implementation
IV access
Fluid replacement
Antibiotics
Pain management
Pt. may be positioned with knees flexed
Decrease anxiety
Monitor I & O
Monitor VS
Antiemetics
NPO
NG tube
Oxygen therapy
Post-op care for laparotomy