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generally results from infection by opportunistic viruses, fungi, or bacteria in pt's who are immunocomprimised
secondary stomatitis
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foods such as coffee, potatoes, cheese, nuts, citrus fruits, and gluten may be causative factors
stomatitis
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plays a large role in the formation of recurrent stomatitis
malnutrition
-
Interventions for stomatitis
- health promotion through careful oral hygiene and food selection
- soft bristled tooth brush
- rinse mouth every 2-3 hrs with Bicarb
- avoid alcohol rinse
-
protrusion of the stomach through the esophogeal hiatus of the diaphragm into the chest
hiatal hernia
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major concern is the development of esophageal reflex.
result of weakening diaphragm
occurs when esophagogastric junction and a portion of the fundus of the stomach slide upward through esophageal hiatus into chest
sliding hernia
-
risk for volvulus(twisting), obstruction, and strangulation are high
fundus rolls into the thorax beside the esophagus
paraesophageal (rolling) hernia
-
Assessment of possible paraesophageal hernia
ask about:
- heartburn
- regurgatation
- pain
- dysphagia
- belching
- worsening of symptoms after eating
-
nonsurgical interventions of a hernia
- drug therapy (antacids)
- nutrition
- lifestyle changes
- avoid eating late at night
- lose weight
-
minimally invasive surgery commonly used for hiatal hernia repair
laproscopic nissen funoplication
-
NG inserted for several days
deep breathing is important but painful postop
teaching for LNF
-
normal drainage for ng tube postop LNF
frequency of assessment post op
- dark brown with old blood
- should become yellow/green within 8 hrs post op
every 4-8 hrs
-
Eating and diet post op for LNF
clear fluids may begin when peristalsis is reestablished
near normal diet within 4-6 weeks
stomach is smaller, so meals need to be so
-
a chronic disorder requiring ongoing management
GERD
-
surgical treatment for GERD
LNF
-
act by elevating the pH level of gastric contents, deactivating pepsin in pt's with GERD
what do you teach about a pt taking this around meal time?
-
decrease acid production in pt's with GERD
histamine receptor antagonists
-
can interfere with calcium absorption and protein digestion and therefore reduce available calcium
provide effective, long-acting inhibition of gastric acid secretion
Proton pump inhibitors (PPI's)
-
Diet teaching for a pt with GERD
avoid foods that decrease LES such as:
- chocolate
- alcohol and tobacco
- fatty foods
- caffeine
- pop
- spicy and acidic foods
-
PT teaching for GERD
large meals increase the V and P in stomach, delaying gastric emptying
many small meals rather than few big
no food for at least 3 hrs before bed
-
nursing diagnosis of GERD
- acute pain
- risk for aspiration due to inadequate LES function
- impaired swallowing
-
lifestyle changes for a pt with GERD
- elevate head of bed when sleeping
- sleep in left lateral decubitus position
- stop smoking and drinking
- reduce weight
- refrain from heavy lifting
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