UPPER GI TERMS
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LEUKOPLAKIA
NAUSEA
VOMITING
ANOREXIA
DYSPHAGIA
DYSPEPSIA
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GASTROSTOMY
XEROSTOMIA
ACHLORHYDRIA
GAVAGE
LAVAGE
STOMATITIS
• INFLAMMATION & BREAKDOWN OF
ORAL MUCOSA (MUCOSITIS)
• OFTEN SIDE EFFECT OF
CHEMOTHERAPY &/OR RADIATION
• MILD REDNESS AND EDEMA THAT CAN
LEAD TO PAINFUL ULCERATIONS,
BLEEDING, SECONDARY INFECTION
• PAIN  POOR HYGIENE, POOR
NUTRITION AND ALTERED SPEECH
NURSING CONCERNS
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AVOID IRRITATING FOODS
TOPICAL ANTIINFLAMMATORIES
ANALGESICS
HYDRATION
NUTRITION (IV IF NEEDED)
ANTIBIOTICS
FRACTURED MANDIBLE
• TRAUMA
• USUALLY CLOSED FRACTURE
• RIGID PLATE FIXATION
• NO CHEW 1 – 4 WEEKS
• LIQUIDS
• NEED TO TEACH ABOUT GOOD NUTRITION
FOOD POISONING
• INGESTION OF CONTAMINATED FOOD
OR DRINK
• DETERMINE SOURCE & TYPE FOOD
• EXAMINE
– FOOD
– GASTRIC CONTENTS
– VOMITUS
– SERUM
– FECES
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ASSESS VS & MUSCULAR ACTIVITY
MAINTAIN RESPIRATORY STATUS
WATCH FOR F&E IMBALANCE
ANTIEMETICS
CLEAR LIQUIDS  SOLIDS
ORAL CANCER
• MAJOR RISKS –
ETOH & TOBACCO
• 95% IN >40YO
• MORE YOUNG MEN
< 30YO R/T
SMOKELESS
TOBACCO
• MEN > WOMEN
• 2% OF ALL CANCER
DEATHS
• USUALLY SQUAMOUS CELL
• TUMOR > 4CM OFTEN RECUR
• LIPS, LATERAL TONGUE, FLOOR OF
MOUTH MOST COMMON SITES
ASSESSMENTS
• FEW SIGNS EARLY
• PAINLESS SORE THAT WON’T HEAL
• LATER
– TENDERNESS
– DIFFICULTY CHEWING
– DIFFICULTY SWALLOWING
– DIFFICULTY SPEAKING
– BLEEDING
– ENLARGES LYMPH NODES
• ORAL EXAM & BIOPSY
• TREATMENT
– SURGICAL RESECTION
– RADIATION
– CHEMOTHERAPY
– ALL OR ANY COMBO OF ABOVE
NURSING DIAGNOSES
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IMBALANCED NUTRITION
DISTURBED BODY IMAGE
PAIN
IMPAIRED VERBAL COMMUNICATION
RISK FOR INFECTION
KNOWLEDGE DEFICIT R/T DISEASE
PROCESS & TREATMENT
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ASSESS NUTRITIONAL STATUS
ENTERAL OR PARENTERAL NUTRITION
AIRWAY ASSESSMENT
SUCTION PRN
ASSESS WOUNDS
OFFER EMOTIONAL SUPPORT
TEACHING
ESOPHAGEAL CANCER
• 4% OF ALL CA DEATHS
• 50 – 70 YO
• MEN> WOMEN
• SPICY DIET
• ETOH
• SMOKING
• ASSESSMENTS
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DYSPHAGIA
CHEST FULLNESS
LUMP IN THROAT
REGURGITATION
WT LOSS
WEAKNESS
• DIAGNOSIS MAINLY
BY ENDOSCOPY &
BIOPSY
• TREATMENT
– SURGERY
– RADIATION
– CHEMOTHERAPY
HIATAL HERNIA
• SLIDING
– 90% OF ALL HIATAL HERNIAS
– IN AND OUT OF THORAX
– HEART BURN
– REGURGITATION
– DYSPHAGIA
– 50% ASYMPTOMATIC
• PARAESOPHAGEAL – ALL OR PART OF
STOMACH INTO THORAX NEXT TO
GASTROESOPHAGEAL JUNCTION
– 10% OF ALL HIATAL HERNIAS
– SENSE OF FULLNESS PC
– STRANGULATION A REAL CONCERN
• ALTERATION IN COMFORT
• ALTERATION IN NUTRITION
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SMALL, FREQUENT MEALS
LESS IRRITATING FOODS
NO RECLINING PC
HOB ON BLOCKS
SURGERY – NISSAN FUNDOPLICATION
GASTRIC CANCER
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ON DECLINE
ABOUT 12,400 DEATHS PER YEAR
MEN > WOMEN
> 40YO
METS OFTEN BEFORE DIAGNOSIS
ADENOCARCINOMAS
OFTEN PENETRATES WALL AND
SPREADS TO ADJACENT ORGANS
CAUSATIVE FACTORS
• DIET HIGH IN SMOKED FOODS AND
LOW IN FRUITS AND VEGGIES
• CHRONIC GASTRITIS
• PERNICIOUS ANEMIA
• ACHLORHYDRIA
• GASTRIC ULCERS
• H. PYLORI INFECTION
• GENETICS
ASSESSMENTS
• EARLY – PAIN RELIEVED BY ANTACIDS
• LATER
– ANOREXIA
–N&V
– DIARRHEA
– WT LOSS
– DYSPEPSIA
– ABD PAIN
– ANEMIA
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ENDOSCOPY WITH BIOPSY
BARIUM SWALLOW
SCANS TO DETECT METS
TREATMENT
– REMOVAL OF TUMOR
– COMPLETE CURE
• RADICAL SUBTOTAL GASTRECTOMY
– PALLIATIVE RESECTION
– CHEMO
– PALLIATIVE RADIATION THERAPY
NURSING DIAGNOSES & CARE
• ANXIETY
– VENTILATION
– EXPLAIN EVERYTHING
• PAIN
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ANALGESICS
POSITION CHANGE
IMAGERY
RELAXATION
EXERCISES
– MASSAGE
• IMBALANCED
NUTRITION
– SML, FREQ, NONIRRITATING FOODS
– HI CAL, VIT, IRON
– TPN PRN
– MANAGE DUMPING
SYNDROME
– I&O
– DAILY WTS
– LOOK FOR
DEHYDRATION
– ANTIEMETICS
• ANTICIPATORY
GRIEVING
– ANSWER QUES.
HONESTLY
– RECOGNIZE NORMAL
EMOTIONAL CHANGES
– EMPATHY
• KNOWLEDGE DEFICIT
R/T SELF CARE
– NUTRITION TEACH.
– TREATMENT PLANS
– ACTIVITY & LIFESTYLE
CHANGES
– PAIN MANAGEMENT
– POSS. COMPLICA.
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BLEEDING
OBSTRUCTION
PERFORATION
WORSENING SYMPS
GASTROESOPHAGEAL REFLUX
DISEASE (GERD)
• GENERALLY A
RELAXATION OF
THE LOWER
ESOPHAGEAL
SPHINCTER (LES)
ASSESSMENTS
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HEARTBURN
CHEST PAIN
DYSPHAGIA
LUMP IN THROAT
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WHEEZING
HOARSENESS
CHRONIC COUGH
SORE THROAT
TREATMENT
• ANTACIDS
• H2 BLOCKERS
• PROTON-PUMP
INHIBITORS
• SURGERY
– FUNDOPLICATION
• LIFESTYLE
MODIFICATION
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STOP SMOKING
LESS ETOH
LOSE WEIGHT
SML MEALS
SLEEP WITH HOB UP
UPRIGHT PC
NO EAT OR DRINK 2
– 3 HRS HS
FOODS TO AVOID
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HIGH FAT
PEPPERMINT
CAFFEINE
TOMATO
PRODUCTS
• CITRUS FRUIT
PRODUCTS
UPPER GI MEDS
• H2 BLOCKERS
– TAGAMET
(CIMETIDINE)
– PEPCID
(FAMOTIDINE)
– AXID (NIZATIDINE)
– ZANTAC
(RANITIDINE)
• PROTON PUMP
INHIBITORS
– PREVACID
(LANSOPRAZOLE)
– PRILOSEC
(OMEPRAZOLE)
– NEXIUM
(ESOMEPRAZOLE)
• PEPSIN INHIBITOR –
CARAFATE
(SUCRALFATE)
• PROSTAGLANDIN
ANALOGUE –
CYTOTEC
(MISOPROSTOL)
– USED WITH NSAID’S
– INCREASES GI MUCOUS
– DECREASES ACID
PRODUCTION
ANTACIDS
• ALUMINUM (BASAJEL, AMPHOJEL)
– CONSTIPATION MAJOR SE
• MAGNESIUM (MAG-OX 400, MAOX)
– DIARRHEA MAJOR SE
• CALCIUM (TUMS)
• ALUMINUM/MAGNESIUM
COMBINATION
– RIOPAN
– MAALOX
– WITH SIMETHICONE
– MYLANTA
– MAALOX PLUS
– GELUSIL
• TAKE WITH WATER TO MOVE DOWN
• TAKE 1 – 3 HOURS AFTER MEALS
• DO NOT TAKE WITH ANY OTHER MEDS
ANTIEMETICS
• INHIBIT THE CTZ IN MEDULLA
• DEPRESS VESTIBULAR APPARATUS
SENSITIVITY IN INNER EAR
• DROWSINESS & DRY MOUTH MAJOR
SIDE EFFECTS
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PHENOTHIAZINES (PHENERGAN)
ANTIHISTAMINES (MECLIZINE)
ANTICHOLINERGICS (SCOPOLAMINE)
SEDATIVES (BARBITURATES, VISTERIL)
OTHERS
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REGLAN
INAPSINE
KYTRIL
ZOFRAN
TIGAN
GASTRITIS
INFLAMMATION OF STOMACH
MUCOSA
• ACUTE CAUSES
– FOOD IRRITATION
– OVERUSE OF NSAID’S OR ASA
– ETOH EXCESS
– BILE REFLUX
– RADIATION THERAPY
– INGESTION OF STRONG ACID OR ALKALI
– EMERGENCY!!!!!
• CHRONIC CAUSES
– BENIGN OR MALIGNANT ULCERS
– H. PYLORI BACTERIA
– SMOKING
EDEMATOUS, HYPEREMIC MUCOSA WITH
SUPERFICIAL EROSION
LOW ACID PRODUCTION
MAYBE ULCERATION  BLEED
ASSESSMENTS
• ACUTE
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MAYBE NONE
ABD DISCOMFORT
N&V
ANOREXIA
HEADACHE
LETHARGY
• CHRONIC
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ANOREXIA
HEART BURN PC
BELCHING
SOUR TASTE
N&V
• ENDOSCOPY WITH BIOPSY
• H. PYLORI TESTING
• ACUTE USUALLY RECOVER IN 1 DAY
– NON-IRRITATING FOODS
– NO ETOH
– ANTACIDS
– DECREASE STRESS
– TREAT H. PYLORI
• IF PERFORATION OR BLEEDING
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NG SUCTION
IF FLUIDS
ANALGESICS
SURG, MAYBE
• NEUTRALIZE ACIDS OR ALKALI
– ACIDS – ANTACIDS
– ALKALI – DILUTE LEMON JUICE OR VINEGAR
NURSING DIAGNOSES
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ANXIETY
ALTERED NUTRITION
RISK FOR F & E IMBALANCE
KNOWLEDGE DEFICIT R/T DISEASE
PROCESS AND TREATMENT
• PAIN
NURSING CARE
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ANSWER QUESTIONS
EXPLAIN PROCEDURES
IV THERAPY
MONITOR F & E STATUS
DECREASE CAFFEINE, ETOH, SMOKING
NOTE NG ASPIRATE COLOR
VITAL SIGNS
ANALGESICS
TEACH DIET AND MED THERAPY
PEPTIC ULCER DISEASE
• IMBALANCE BETWEEN THE
DIGESTING ACTION OF GASTRIC
JUICES AND THE CAPACITY OF THE
GASTRIC AND DUODENAL MUCOSA TO
RESIST DIGESTION.
• PUD
DEVELOPMENTAL FACTORS
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POOR EPITHELIUM REGENERATION
DECREASED MUCOUS PRODUCTION
POOR BLOOD SUPPLY
INCREASED HCL
AGE
SEX
STRESS LEVEL
BLOOD GROUP (O HAS MOST)
FAMILY HISTORY
SMOKING HISTORY
ETOH
ULCEROGENIC DRUGS
HELICOBACTER PYLORI
• PRESENT IN HUGE # IF PUD CASES
• DIAGNOSED BY
– MUCOSAL CULTURE
– BREATH TEST
– IMMUNOASSAY OF ANTIBODIES
• TREATED WITH
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PEPTO BISMOL
AMOXICILLIN OR TETRACYCLINE
H2 BLOCKER
FLAGYL
COMBO OF THESE
• USUAL
ASSESSMENTS
– BURNING PAIN
– NAUSEA
• DIAGNOSIS
– ENDOSCOPY
– BA SWALLOW
– GASTRIC ANALYSYS
• CONSERVATIVE TREATMENT FIRST
• SURGERY IF LARGE, BLEEDING, OR
NOT RESPONDING TO CONSERVATIVE
TREATMENT
– VAGOTOMY AND PYLORAPLASTY
– SUBTOTAL GASTRECTOMY
NURSING DIAGNOSES & CARE
• ALTERATION IN
COMFORT
– ANTACIDS
– ANTICHOLINERGICS
IN EXTREME CASES
– H2 BLOCKERS
– SEDATIVES
– NO IRRITATING
FOODS
• ALTERATION IN
NUTRITION
– BLAND VS REGULAR
DIET
– NON IRRITATING
FOODS
– SML, FREQUENT
MEALS IF SURGERY
• POTENTIAL FOR
COMPLICATIONS
– HEMORRHAGE
(ASSESS STOOL
AND VOMITUS FOR
BLOOD)
– PERFORATION
• BOWEL SOUNDS
• ABD SIZE &
TENDERNESS
• VITAL SIGNS
– INTRACTABILITY
– PYLORIC
OBSTRUCTION
• ASSESS FOR N & V
• ABD SIZE
• ALTERED PSYCHOLOGICAL STATUS
– STRESS MANAGEMENT
– RELAXATION TECHNIQUES
DUMPING SYNDROME
• WHEN PYLORIS IS BYPASSED OR
ENLARGED THROUGH SURGERY
• VASOMOTOR & HYPOGLYCEMIC
RESPONSES
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LIE FLAT PC
DECREASE CHO INTAKE
INCREASE FAT INTAKE
DECREASE LIQUIDS WITH MEALS
NG DECOMPRESSION
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EVACUATES FLUIDS AND AIR
PREVENTS VOMITING
TENSION ON SUTURES DECREASED
OBSTRUCTION PREVENTED
• GASTRIC – LEVIN OR SALEM SUMP
• NASOENTERIC – MILLER-ABBOTT,
HARRIS, CANTOR
NURSING CARE
• USUALLY INTERMITTENT LOW SUCT.
• SECURE TO NOSE/FACE
• SECURE TO GOWN TO PREVENT TENSION
AND ACCIDENTAL REMOVAL
• IRRIGATE Q2 – 6 HRS WITH NS (20CC)
• MEASURE ASPIRATE AS PART OF I & O
• ORAL AND NASAL CARE
• ASSESS FOR FLUID VOL DEPLETION
• ASSESS RESPIRATORY STATUS
GASTROSTOMY CARE
• USUALLY LONG TERM
• REGURGITATION AND ASPIRATION
LESS DUE TO GE SPHINCTER INTACT
• PEG – PERCUTANEOUS ENDOSCOPIC
GASTROSTOMY
• LPGD – LOW PROFILE GASTROSTOMY
DEVICE
NURSING DIAGNOSES
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IMBALANCED NUTRITION
RISK FOR WOUND INFECTION
INEFFECTIVE COPING
DISTURBED BODY IMAGE
KNOWLEDGE DEFICIT R/T HOME CARE
NURSING ACTIONS
• FEEDINGS CONTINUOUS OR BOLUS
• SMALL AMTS AT FIRST; INCREASE
GRADUALLY
• VERIFY TUBE PLACEMENT
• MEASURE RESIDUAL (IF PEG)
• WASH SURROUNDING SKIN DAILY WITH
SOAP & WATER
• INSPECT SKIN FOR BREAKS,
EXCORIATIONS, DRAINAGE, LEAKS
• TEACH SELF CARE
GASTRIC BYPASS
SURGERY
• BARIATRIC SURGERY
• FOR MORBID OBESITY
• AFTER ALL OTHER WEIGHT LOSS
ATTEMPTS FAILED
• GASTRIC BYPASS (ROUX-EN-Y)
• VERTICLE BANDED GASTROPLASTY
• OPEN OR LAPOROSCOPICALLY
• MORE SURGICAL RISKS R/T OBESITY
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PERITONITIS
STOMAL OBSTRUCTION
STOMAL ULCERS
ATELECTASIS & PNEUMONIA
DVT & PE
N & V  METABOLIC DISTURBANCES
– NEED PSYCHOLOGICAL COUNSELLING
– REGAIN IS A REAL CONCERN
– INCREASED RISK FOR NUTRITIONAL DEFICITS
COMMON OUTCOMES FOR ALL
UPPER GI CONDITIONS
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ADEQUATE NUTRITION
ADEQUATE FLUID BALANCE
ACCEPTABLE LEVEL OF COMFORT
ADEQUATE COPING ABILITIES
INTACT SKIN AND MUCOUS MEMBRANES
DESIRABLE BODY WEIGHT
INCREASED KNOWLEDGE OF DISEASE AND CARE
FREE OF COMPLICATIONS
PERFORMS SELF-CARE ACTIVITIES
ADJUSTS TO LIFE-STYLE CHANGES