Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
248X: GERD
Pathophysiology and Nursing Care for GERD (Week 9)
| Question | Answer |
|---|---|
| GERD definition | reflux of gastric contents into the esophagus |
| What are the predisposing factors to getting GERD? | relaxation of the LES, increased abdominal pressure, hiatal hernia, decreased gastric emptying |
| What is the primary factor in developing GERD? | relaxation of LES |
| What foods cause the LES to relax? | Fatty foods, caffeine, nicotine, alcohol, peppermint, spearmint, chocolate |
| Why do fatty foods cause the LES to relax? | fat stimulates the release of cholecystokinin which lowers LES pressure |
| What drugs cause the LES to relax? | NSAIDS, CCBs, estrogen, progesterone, valium, MS04 (morphine sulfate), theophylline (bronchodilator), nitrates |
| What would increase abdominal pressure? | obesity, large meals, lying down after meals, frequent heavy lifting using abdominal muscles, pregnancy, chronic coughing |
| Define hiatal hernia. | herniation of a portion of the stomach into the esophagus through an opening, or hiatus, in the diaphragm |
| Define sliding hiatal hernia. | Part of the stomach slides through the hiatal opening of the diaphragm. The stomach slides into the thoracic cavity when the patient is supine and usually goes back into the abdominal cavity when the patient is standing upright. Most common type. (1007) |
| What would cause decreased gastric emptying? | vagotomy, congenital defects, fatty meals, and large meals |
| What creates the pressure difference between the esophagus and the stomach? | Circular muscle around the the LES remains contracted and is relaxed only when swallowing. The diaphragm creates a wall that helps maintain a higher pressure in the esophagus (thoracic cavity) |
| What do the oxyntic glands release? Where are they located? | They are located in the body and fundus. They release hydrochloric acid, pepsinogen, intrinsic factor, and mucus |
| What do the pyloric glands secrete? Where are they located? | Located in the antrum of the stomach. They release mucus, some pepsinogen, and hormone gastrin |
| Why would a vagotomy result in decreased gastric emptying? | The stomach is innervated by the vagus nerve, if cut then the motility is decreased and the stomach doesn't empty. |
| Why would a fatty meal influence gastric emptying? | Cholecystokinin is released to breakdown fat, it slows gastric emptying. |
| Whay would a large meal influence gastric emptying? | ???Increased pressure? Distended stomach? |
| What is the most common GI problem in adults? | GERD |
| What is the most common symptom of GERD? How is it described? | Heartburn (pyrosis).A burning, tight sensation that is felt imtermittently beneath the lower sternum and spreads upward to the throat or jaw; common to occur once a week; occurs 20 minutes-2 hours after eating |
| Define water brash. | Hypersalvation- a common symptom of GERD |
| When should of heartburn be evaluated? | *experienced mild symptoms for 5 years or longer *have difficulty swallowing *if occurs more than once a week *rated as severe *occurs at night and wakes pt. up |
| Define dypepsia. | Pain or discomfort centered in the upper abdomen (mainly in or around the midline as opposed to the right or left hypochondrium) |
| Define rugurgitation. | Effortless return of food or gastric contents from the stomach into esophagus or mouth, a common manifestation of GERD |
| What causes the symptoms to worsen? | laying down or bending over (an increase in intra-abdominal pressure) |
| Define globus. | sensation of something in the back of the throat, a symptom of GERD |
| Define odynophagia. | Severe sensation of burning squeezing pain while swallowing. |
| Define dysphagia. | Difficulty swallowing, results from altered nerve function or disorders that produce narrowing of the esophagus. Symptom of GERD and r/t inflammation forming fibronic tissue. |
| What are the respiratory symptoms of GERD? | nocturnal cough, wheezing, and hoarseness |
| How is GERD related to esophageal cancer? | continued presence of gastric acid in the esophagus changes the cell structure, making the GERD patient predisposed to esophageal cancer |
| Define Barrett's esophagus. | Replacement of normal squamous epithelium with columnar epithelium, a precancerous lesion |
| What are the symptoms to Barrett's esophagus? | None to perforation |
| How often must Barrett's esophagus be monitored? How is it monitored? | Monitored ever 1-3 years by endoscopy. |
| What is the first diagostic method done for a patient with possible GERD? | Patient reccomended to use a PPI for a short amount of time, PPI should result in a marked reduction or elimination of symptoms. (Lewis 1005) |
| Describe barium swallowing as a diagnostic study for GERD. | Barium can detect if there is a protrusion of the upper part of the stomach. |
| Describe endoscopy as a diagnostic study for GERD. | Endoscopy is used to assess the LES competence; degree of inflammation, scarring, strictures, and can biopsy for cancer. |
| Describe manometric studies as a diagnostic study for GERD. | Used to measure the pressure in the esophagus and LES |
| Describe 24 hr pH monitoring as a diagnostic study for GERD. | Probes are used to determine if there is acidity in a normally alkaline esophagus. |
| Describe radionuclide tests as a diagnostic study for GERD. | Used to detect reflux of gastric contents and the rate of esophageal clearance. |
| What non-pharmacological treatments deal with managing the relaxed LES? | elevate HOB 30*. do not lie down for 2-3 hours after eating, avoid late night eating, stop smoking |
| Why should GERD patients avoid tight-fitting clothes? | Tight clothes increases the abdominal pressure. |
| Why is a decrease in high-fat foods beneficial for a patient with GERD? | Fatty foods stimulate the release of cholecystokinin which decreases LES pressure, fatty foods also decrease the rate of gastric emptying. |
| Why are fluids between meals rather than during meals beneficial for a patient with GERD? | It reduces stomach distension, creating a change in the pressure gradient. |
| Why is avoiding milk products at night beneficial for a patient with GERD? | Milk increases acid production. |
| Why are small frequent meals beneficial for a patient with GERD? | Prevents overdistension of the stomach |
| What causes an immediate reduction in LES pressure? | smoking, alcohol, and caffeine |
| What is the purpose of surgical intervention? | to reduce reflux of gastric contents by enhancing the integrity of the LES |
| Describe the Nissen fundoplication. | fundus of stomach is wrapped around distal esophagus and sutured to itself, most common type of surgery |
| Describe the gas-bloat syndrome and treatment for it. | Patient can't blech. Patient must avoid gas-forming foods and no drinking through a straw. |
| When is surgery necessary for GERD? | conservative therapy fails, hiatal hernia is present, esophageal stricture and stenosis, chronic esophagitis, bleeding |
| Most surgical procedures are done _________. | laparoscopically |
| What are the three post-op focuses after GERD surgery? | prevention of respiratory complcations, maintence of fluid/electrolyte balance, prevention of infection |
| When and why would you be concerned about respiratory complications following GERD surgery? | If an open abdominal incision is used, resp. complications can occur due to the high abdominal incision |
| What are the signs of pneumothorax? | dyspnea, chest pain, cyanosis, decreased or absent breath sounds |
| Why would you want to prevent nausea and vomitting for a post-op patient? | retching may cause dehiscence |
| What can the patient consume after peristalisis returns after surgery? | only fluids initially, then gradually to solids (prevention of distension), normal diet is gradually resumed |
| What are examples of gas-forming foods? | carbonated beverages, drinking from a straw, broccoli, cabbage, cauliflower, beans, onions |
| What s/s are expected or should be reported following a GERD surgery? | first month of after surgery may have mild dysphagia which should resolve as edema subsides....should report persistant symptoms such as heartburn and regurgitation (may have been wrapped too loose.) |
| What nursing actions are done r/t maintaince of f/e balance? | Accurate I&O, watch f/e labs and manifestations for imbalance |
| What do antacids do? | produces a quick but short-lived relief of heartburn, they act by neutralizing HCL acid |
| When should antacids be taken? | 1-3 hours after meals and at bedtime, good for patients with mild, intermittent heartburn |
| List some examples of antacids. | Gelusil, Maalox, Mylanta |
| What do H2-receptor blockers do? | it decreases the secretion of HCl acid by the stomach, they reduce symptoms and promote esophageal healing in 50% of patients |
| List some examples of H2-receptor blockers. | Tagament, pepcid, axid, and zantac (-tidine) |
| What do PPI's do? | decrease gastric acid secretion, but are more effective since they work on the proton pump that secretes the H+ ions; promotes esophageal healing in 80-90% of patients. |
| List examples of PPI's. | Nexium, Prevacid, Prilosec, Protonix, Aciphex (-prazole) |
| What is the action of Sucralfate (Carafate)? | It is an anti-ulcer drug that is used for GERD patients due to it's cytoprotective properties |
| What is the purpose of cholinergic drugs? | used to increase LES pressure, improve esophageal emptying in the supine position, and increase gastric emptying; use is limited since they also stimulate HCl acid secretion |
| List an example of a cholinergic drug. | bethanechol (Urecholine) |
| What is the purpose of prokinetics? | motility drug that promotes gastric emptying and reduces the risk of gastric acid reflux |
| List an example of a prokinetic. | metoclopramide (Reglan) |
| How does Glaviscon work? | aliginate plus antacid creates a foam barrier that protects against the esophagus opening |
Created by:
erachuy23
Popular Nursing sets