Digestion begins in the mouth, stomach and small intestine, esophagus
Lack of appetite. Prolonged anorexia leads to malnutrition. Common symptom of many diseases.
Patho/Eti= The appetite center located in hypothalmus. Location & function glyconeogenesis. Pleasant or noxious food odors, effects of drugs, emotional stress, fear, psychological problems, or illnesses may affect appetite.
What medical interventions and nursing management is used for Anorexia?
Short term anorexia (less than 1wk) no medical intervention
Persistent anorexia requires various approches examples= high calorie diet, high calorie supplemental feedings, tube feedings, and TPN, Psychological support, psychiatric treatment.
Nurse: (this also depends on if diarrhea/constipation due 2 liquid supplements are given 2 client)
Monitor weight daily
Complete medical history including drug/food allergies, dietary habits
Keep record of client's bowel movements
If client experiences diarrhea or constipation, consult dietitian about changing supplement
Dilute formula temporarily until client adjusts 2 concentrated contents
Increase dietary fiber
Give prescribed stool softeners 2 ease bowel movements & frequency.
Nausea & Vomiting *read pg 650 nursing care plan*
Disorder that affects eating usually common and often coexisting problems
Patho/Eti= Drugs, infections & inflammatory conditions of GI tract, intestinal obstruction, systemic infections, lesions of the CNS, food poisoning, emotional stress, early pregnancy, uremia
S/S= Increased salivation & peripheral vasoconstriction, which causes cold, clammy skin and tachy cardia. Unpleasant feeling, loss of appetite, dehydration, refusal 2 eat, retching. Prolonged N/V weakness, weight loss, nutritional deficiency, dehydration, electrolyte & acid-base imbalances may result
Dx= Low levels of serum sodium and chloride.
Medical intervention= IV fluids, electrolytes, Drug therapy, temp resticting food intake until cause of vomiting is eliminated
Tell client eat small meals & eat and drink slowly
Dry salty foods, like crackers & pretzels may relieve nausea
Fried food, spicy food and foods with strong odors avoid
Cold food may be preferable to hot foods
Cancer of the Oral Cavity
When cancer affects the oral cavity, cells in the lips, mouth, or pharnyx undergo malignant changes. If oral cancer is detected early the rate of cure is fairly good
Patho/Eti= linked 2 smoking, chewing tobacco, drinking alcohol in excess. Lip cancer is linked w/ pipe smoking, prolonged exposure 2 wind and sun.
S/S= may distort a client's appearance, difficult 2 chew or cause local pain or produce dysphagia, usually asymptomatic, then lesion, lump or other abnormality of lips or mouth, pain soreness and bleeding follow, Lesion on the tongue affects eating or tasting food, pain & numbness follow.
Medical Management= Tx depends on location, type of tumor, extent stage of involvement, client's physical condition.
Hemorrhage=transfusion, ligation of bleeding vessels, antianxiety drugs
Continuous Tube Feedings=Lower rates (1.5ml/min over long time usually 12-24hrs), gravity flow or electronic feeding pump
Cyclic Tube feedings=Continuously for 8-12hrs during sleep followed by 12-16hr pause, ensure adequate nutrition during weaning form tube 2 oral feeding, alternate w/ food intake until client can take most nutritional orally
Gastroesophageal Reflux disease is common disorder that develops when gastric contents flow upward into the esophagus.
Avoid items that lower pressure in LES (alcohol, chocolate, peppermint, licorice, citrus fruits, caffeine, high fat foods)
Losing weight, avoid tight fitting garments
Avoid food & drinks for several hours b4 bedtime
Pregos GERD usually goes away after delivery
Teach clients important 2 prevent GERD cuz leads 2 worse conditions like esophageal sticture formation & esophageal cancer
Diverticulum=sac or pouch in one or more layers of the wall of an organ or structure. Esophageal diverticula are found @ the junction of the pharynx and the esophagus or in the middle or lower portion of the esophagus.
Patho/Eti=Zenker's diverticulum; congenital or acquired esophageal wall weakness
S/S=Foul breath, difficulty swallowing
Dx=Barium swallow, esophagoscopy
Medical & surgical management=
Diet therapy=Bland, soft, semisoft, liquid
Surgical excision of the diverticulum
Teach oral hygiene will not alleviate the foul breath
Consult w/ dietitian
a hiatal or diaphragmatic hernia is protrusion of part of the stomach into the lower portion of the thorax. There are Two types.
Axial or Sliding- junction of the stomach & esophagus and part of the stomach slide in & out thru the weakened portion of the diaphragm.
Paraesophageal-Fundus is displaced upward w/ greater curvature of the stomach going through the diaphragm.
Patho/Eti=Diaphragm defect, Congenital muscle weakness; common more in women, multiple pregnancies, obesity, loss of muscle strength & tone that occurs w/ aging.
S/S=Heartburn, Belching or pain after eating & lying down. May report increased symptoms when bending @ the waist. Sliding hernias are often associated w/ reflux.
Dx=Barium swallow; Esophagoscopy
Medical management=Stretch narrowed esophagus endoscopically
Nurse=Read care plans on pgs662-664
Cancer of the Esophagus
Patho/Eti= Affects more men than women. Squamous cell carcinoma. Major cause of esophageal cancer is chronic irritation of the esophagus from any source like alcohol abuse, cigarette smoking, peeps w/ GERD, habitual ingestion of hot liquids or foods, poor or inadequate oral hygiene, nutritional dificiencies.
S/S= Peeps usually don't experience symptoms until the diseas has progressed 2 interfere w/ swallowing & passage of food, leading 2 weight loss.
Medical management=Surgery Esophagectomy, Peeps not a candidate 4 surgery are treated w/ pallative measurements.
Consult with dietitian b4 measures 4 weight reduction or gain
Small frequent meals
If they hv difficulty swallowing get soft foods or high caloric, high protein semi-liquid foods
Avoid gasy foods like souffles, carbonated drinks 2 reduce bloating
Avoid drinking from straws or narrow necked bottles 2 reduce volume of air trapped in esophagus or stomach
Give liquid supplements btween meals
INOPERABLE peeps nutritional needs are by nasogastric or gastrostomy feedings or TPN
Care 4 skin @ the tube insertion site, prevent infection
Maintain tube patency
Teach client & family 4 self-care or home after discharge
Turn client and perform deep breathing and coughing every 2hrs
Support surgical incision 4 couging & deep breathing
Use incentive spirometer
Ambulate client 2 help mobilize secretions, increase depth of respirations, and promote expulsion of intestinal gas
Avoid gastric distention
Don't give oral nourishment until bowel sounds resume and are active
Give oral liquids 2 thin secretions
Minimize dyspnea give frequent small meals and dont lie down right after eating
NOTIFY DR. OF SYMPTOMS STEADY WEIGHT LOSS, DIFFICULTY SWALLOWING SOFT FOODS, ABD BLEEDING, OR OTHER NEW PROBLEMS.
inflammation of the stomach lining(gastric mucosa) It may be acute or chronic
Path/Eti=Helicobacter pylori, Acid production
S/S= same as bacterial or viral infection, complaints of epigastric fullness, pressure, pain, anorexia, nausea&vomiting, diarrhea, fever, ABD pain, blood in emesis, darkening of stool color, CBC shows anemia, Stool testing shows RBCs
Dx=CBC, Gastroscopy, Stool test
Medical management= diet restriction, IV fluids, Medications, Antiemetics, Antibiotics
Avoid irritating substances like alcohol & NSAIDs, spicy foods, high fat foods, carreine
Observe the color of vomitus, stool of the client
Teach about diet, drug therapy, and follow up appts.
Peptic Ulcer Disease= ulceration that penetrates the mucosal wall of any portion of the GI tract in contact w/ hydrogen chloride (HCI)
Path/Eti=Infection w/ Helicobactor pylori, family history, chronic use of NSAIDS, cigarette smoking and physiologic stress like intracranial pressure(curling's ulcer), burns (Chushing's ulcer), sepsis,
S/S= Pain ABD & back, bleeding, hematemisis, Melana(dark tarry feces)
pain occurs 1 to several hours after eating and disturbs sleep, eating food may help the pain. unexplained weight loss.
Dx=Upper GI; EGD, Low hemoglobin & low RBCs
Perforation(always demands surgery)
Nursing management for PUD clients
Determine sypmtom onset & how many symptoms are relieved
Monitor color, quantity, consistency of stools and emesis, and test for occult blood
Administer medications as prescribed, usuall 1 to 2hrs after meals and @ bedtime
Encourage small, frequent meals w/ no bedtime snack
Avoid beverages containing caffeine or alcohol or irritating foods
Administer mucosal healing agents (antiulcer drugs) @least 1hr b4 meals
Cancer of the stomach
Its a malignancy. Most common in natives of Japan, as well as African Americans & Latinos
Path/Eti=Heredity, Chronic inflammation, Achlorhydria(absence of free hydrochloric acid in stomach), Chronic ingestion of highly salted, smoked, or pickled foods, Nitrates and nitrites, nitrogen-based chemical additives in cured meats, tabacco & alcohol abuse.
S/S=early symptoms are vague, as the tumor enlarges symptoms include feeling of fullness after eating, anorexia, weight loss, anemia, Stool usually contains occult blood, Pain is late symptom.