Med Surge

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.

S/S=Absence of hunger, Nausea

Dx findings=Reduced Hemoglobin level, blood cell counts

• 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.

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

• Nurse:
• 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

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
• Surgical tx= tumor excision, radiation therapy, chemotherapy, intersititial implants, neck dissection. advanced diseas tx is palliative only.

• Nurse:
• Same as any client w/ cancer
• mantain patent airway
• Promote adequate fluid and food intake
• Have ways for client 2 communicate if tx impaired ability 2 communicate
• Get speech pathologist 4 communication problems
• If coming from surgery place in FLAT either on ABD or side with head turned 2 side 2 facilitate drainage from the mouth
• Postition the head of bed elevated, makes it easier 4 client 2 breath deeply and cough up secretions
• Have suction equipment, oxygen, tracheostomy @ bedside
• Don't irrigate mouth unless client is awake and alert
• CLIENTS SHOULD NOT USE STRAW IT CAUSES THE CLIENT 2 SWALLOW AIR WHICH CAN DISTEND THE STOMACH
• Modify diet 2 client's ability 2 chew & swallow

• Provides:
• Nutrition, Medications, Gastric decomression/compression, Lavage, diagnostics, tx

• Placement:
• Nasogastric (NG)- tube passes through nose into stomach via esophagus
• Orogastric intubation-tube passes through mouth into stomach
• Naosenteric intubation-tube passes thru nose, esophagus, stomach, small intestine

• Long term feedings
• Gastrostomy-tube enters the stomach thru a surgically created opening into the ABD wall. Long term feedings
• PEG; G-Tube; Jejunostomy(tube enters jejunum or small intestine through a surgically created opening into ABD wall.

• Administered by bolus, intermittent, cyclic, or continuous methods
• *continous feedings are used cuz decrease the risk of aspiration*

Bolus tube feedings=250-400ML (usually w/in 15-30mins), gravity flow system

Intermittent Tube feedings=250-400ml (usually w/in 30-60mins), gravity flow or electronic feeding pump

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.

Patho/Eti=Lower esophageal sphincter insufficiency aka cardiac sphincter

S/S=Epigastric pain, burning, regurgitation, difficulty swallowing, aspiration pneumonia, respiratory distress, vomited blood, tarry stools, sometimes peeps think they are having a heart attack.

Dx=Barium swallow, Upper endoscopy w/ biopsy, capsule, bronchoscopy

Medical interventions=Conservative measurements, medications, fundoplication, Stretta procedure.

• Nurse=
• Diet & lifestyle change 2 reduce reflux symptoms
• Avoid foods & drinks that increase gastric acididty(black&red pepper, regular & decaffeinated coffee, alcohol)
• Avoid items that lower pressure in LES (alcohol, chocolate, peppermint, licorice, citrus fruits, caffeine, high fat foods)
• Losing weight, avoid tight fitting garments
• Elevate HOB
• Stop smoking
• 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

• Nurse=
• 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

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.

Dx=Barium swallow, biopsy, EGD, Bronchoscopy, Edoscopic ultrasound, Mediastinoscopy

Medical management=Surgery Esophagectomy, Peeps not a candidate 4 surgery are treated w/ pallative measurements.

• Nurse=
• 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

• After SURGERY:
• 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

• Nurse=
• 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

• Potential complications:
• Hemorrhage
• Perforation(always demands surgery)
• Obstruction
• Cancer

• 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

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.

Dx=Barium swallow, CT scan, tissue biopsy, Gastric analysis, USG

Medical management= Surgical management: Subtotal or Total gastrectomy, Chemotherapy, Palliative radiation

• Nurse=
• Teach public especially ethnic groups & family history of stamach cancer
• Teach Dietary changes 2 reduce predisposition for this disease.
• Instruct high risk broups like peeps who had vagotomy they must take medications 2 reduce hydrochloric acid formation and know warning sighs of cancer.
• Monitor weight weekly
• Teach signs of DUMPING SYNDROME=WEAKNESS, DIZZINESS, SWEATING, PALPITATIONS, ABD CRAMPS, DIARRHEA,

defined as BMI of 40+or higher, or body weight of more than 20% of ideal weight. U calculate BMI, divide weight in lbs by height in inches squared, then multiply by 703

path/Eti= Genetic predisposition, learned diet & lifestyle habits, Low resting metabolic rate,

S/S= often weigh 100 more than ideal body weight, have hpertension, heart diseas, and type II diabetes, SOB with activity, poor self esteem and suffer from depression

Medical management