Transcript Caring for Clients with Disorders of the Upper

Caring for Clients with
Disorders of the Upper
Gastrointestinal Tract
Disorders that Affect Eating
Anorexia
Lack of appetite; Malnutrition
Pathophysiology and Etiology
The appetite center
Stimulates or suppresses appetite
Location and function; Gluconeogenesis
Assessment Findings: Signs and Symptoms
Absence of hunger; Nausea;
Hypovitaminosis
Assessment Findings: Diagnostic Findings
Reduced hemoglobin level and blood cell
counts
Anorexia nervosa
Is an eating disorder characterized by
unrealistic fear of weight gain, selfstarvation, and conspicuous distortion of
body image.
Two subtypes of anorexia nervosa
—a restricting type, characterized by strict
dieting and exercise without binge eating
—binge-eating/purging type, marked by
episodes of compulsive eating with or
without self-induced vomiting and the use
of laxatives or enemas.
Causes & Symptoms
Anorexia is a disorder that results from the
interaction of cultural and interpersonal as
well as biological factors. While the precise
cause of the disease is not known, it has
been linked to the following:
Social Influences
Occupational Goals
Genetic and Biological Influences
Psychological Factors - Inability to interpret
the body's hunger signals accurately due to
early experiences of inappropriate feeding.
Diagnosis
Anorexics develop emaciated bodies, dry or
yellowish skin, and abnormally low blood pressure.
There is usually a history of amenorrhea (failure to
menstruate) in females,
abdominal pain
Constipation
lack of energy
The patient may feel chilly or have developed
lanugo, a growth of downy body hair.
If the patient has been vomiting, she may have
eroded tooth enamel
Weight loss - 15% below normal
Treatment
Nutritional Therapy
Alternative treatments should serve as complementary to a
conventional treatment program. Alternative therapies for
anorexia nervosa include:
Herbal therapy - may help reduce anxiety and depression
which are often associated with this disorder:
chamomile (Matricaria recutita)
lemon balm (Melissa officinalis)
hydrotherapy
AromatherapyMedications
Medications, including antidepressants, anti-anxiety drugs,
selective serotonin reuptake inhibitors, and lithium
carbonate. One study of Prozac showed it helped the patient
maintain weight gained while in the hospital.
Bulimia nervosa
Is an eating disorder and psychological condition in
which the subject engages in recurrent binge
eating followed by feelings of guilt, depression,
and self-condemnation and intentional purging to
compensate for the excessive eating.
Purging can take the form of vomiting, fasting,
inappropriate use of laxatives, enemas, diuretics
or other medication, or excessive physical
exercise.
The cycle damages bodily organs. Bulimia is
common especially among young women of normal
or nearly normal weight.
Diagnosis
Recurrent episodes of binge eating. An episode of
binge eating is characterized by both of the
following:
Eating, in a fixed period of time (e.g., within
any two-hour period), an amount of food that is
definitely larger than most people would eat.
A sense of lack of control over eating during the
episode (e.g., a feeling that one cannot stop
eating or control what or how much one is
eating).
Self-induced vomiting; misuse of laxatives,
diuretics or other medications; fasting; or
excessive exercise.
The binge eating and inappropriate compensatory
behaviors both occur, on average, at least once a
week for three months.
Types of Bulimia
Purging Type is the more common type of bulimia,
and involves any of self-induced vomiting,
laxatives, diuretics, enemas, or ipecac, to rapidly
extricate the contents from their body.
Non-Purging Type occurs in only approximately 6%8% of bulimia cases, as it is a less effective means
of ridding the body of such a large number of
calories. It involves doing excessive exercise or
fasting after a binge, to counteract the large
amount of calories previously ingested.
Causes
of Bulimia
Bulimia is related to deep psychological issues and
feelings of lack of control.
Sufferers often use the destructive eating pattern
to feel in control over their lives.
They may hide or hoard food and overeat when
stressed or upset.
They may feel a loss of control during a binge, and
consume great quantities of food (over 20,000
calories.
There are higher rates of eating disorders in groups
involved in activities that emphasize thinness and
body type, such as gymnastics, dance and
cheerleading, figure skating.
Treatment
Several residential treatment centers offer
long term support, counseling, and
symptom interruption.
The most popular form of treatment
involves therapy, often group psychotherapy
or cognitive behavioral therapy. Anorexics
and bulimics typically go through the same
types of treatment and are members of
these same treatment groups.
Anti-depressants or anti-psychotics.
Disorders that Affect Eating: Anorexia
Medical and Surgical Management
Short-term: No medical intervention
Various approaches for persistent anorexia
Psychological and psychiatric treatment
Nursing Management
Monitoring weight daily
Obtaining medical and allergy history
Additional nursing measures for altered
bowel patterns
Disorders that Affect Eating: Nausea
and vomiting
Pathophysiology and Etiology
Common causes and symptoms
Assessment Findings: Signs and Symptoms
Loss of appetite and dehydration
Assessment Findings: Diagnostic Findings
Low levels of serum sodium and chloride
Medical and Surgical Management
IV fluids, electrolytes, and drug therapy
Nursing Management
Assessing medical, allergy, and dietary
history, and bowel patterns
Nursing Process: The Client with
Nausea and Vomiting
Assessment
Obtain medical, dietary, drug, and allergy
history- details of food intake
Monitoring signs of fluid volume deficit
Diagnosis, Planning, and Interventions
Deficient fluid volume
Imbalanced nutrition
Evaluation of Expected Outcomes
Oral intake and output; Maintained weight,
serum electrolyte levels and other
laboratory test results
Obesity
Is an abnormal accumulation of body
fat, usually 20% or more over an
individual's ideal body weight. Obesity
is associated with increased risk of
illness, disability, and death
Causes of Obesity
Results from an excess of energy (caloric) intake
over expenditure, but this statement does not
explain why some individuals can eat as much as
they like without gaining weight while others
remain overweight despite constant dieting.
Studies of genetically obese animals and those with
damage to the part of the brain called the
hypothalamus suggest that individuals may balance
body weight around a “setpoint” that is
maintained—without conscious control—by
variations in metabolic rate in response to caloric
intake.
Variations in the prevalence of obesity among
population groups suggest a genetic basis for the
condition.
Treatment
Involve keeping a food diary and developing a better
understanding of the nutritional value and fat content of
foods. It may also involve changing grocery shopping habits
(e.g. buying only what is on a prepared list and going only on
a certain day), timing of meals (to prevent feelings of hunger,
a person may plan frequent small meals), and actually
slowing down the rate at which a person eats.
Understanding what psychological issues underlie a person's
eating habits. For example, one person may binge eat when
under stress, while another may always use food as a reward.
In recognizing these psychological triggers, an individual can
develop alternate coping mechanisms that do not focus on
food.
How people spend their time. Making activity and exercise an
integral part of everyday life is a key to achieving and
maintaining weight loss. Starting slowly and building
endurance keeps individuals from becoming discouraged.
Varying routines and trying new activities also keeps interest
high.
Other weight-loss medications available
with a doctor's prescription include:
Sibutramine (Meridia)
Diethylpropion (Tenuate, Tenuate Dospan)
Mazindol (Mazanor, Sanorex)
Phendimetrazine (Bontril, Prelu-2)
Phentermine (Adipex-P, Fastin, Ionamin,
Oby-Cap)
Surgical Treatment
Lipectomy – liposuction
Jaw wiring
Gastric Stapling ( Gastric Partitioning,
Gastroplasty)
Bypass Procedure
Disorders that Affect Eating
Cancer of the Oral Cavity
Cancer cells; Effects on oral cavity
Pathophysiology and Etiology
Causes for oral and lip cancer
Consequences
Squamous cell carcinoma
Assessment Findings: Signs and Symptoms
Early symptoms: Lesion; Lump; Changes;
Pain; Soreness; Bleeding; Leukoplakia;
Biopsy of the lesion
DISORDERS OF THE MOUTH
CARIES - Decay of a bone or tooth,
especially dental caries.
Candidiasis is an infection caused by a
species of the yeast Candida, usually
Candida albicans.
Candida may cause mouth infections
in people with reduced immune
function, or in patients taking certain
antibiotics.
Candidiasis
Treatment
Treatment of candidiasis is primarily
accomplished through the use of antifungal
drugs.
Oral candidiasis is usually treated with
prescription lozenges or mouthwashes.
Some of the most-used prescriptions are
nystatin mouthwashes (Nilstat or Nitrostat)
and clotrimazole lozenges.
Disorders that Affect Eating: Cancer
of the Oral Cavity
Medical and Surgical Management
Transfusions and antianxiety agents
Tumor excision
Radiation therapy and chemotherapy
Tracheostomy and tube feedings
Nursing Management
Addressing communication problems
Post-operative care after oral surgery
Promoting effective coping skills
Nutritional management
Disorders that Affect Eating: Cancer
of the Oral Cavity
Nursing Management (Cont’d)
Gastrointestinal Intubation for Feedings or
Medications
Reason
Types of GI intubation
Procedure
Route of administration
Selecting type of tube
Nursing Process: The Client Receiving
Tube Feedings
Assessment
Reason for tube feedings
Evaluating renal function and digestive
issues
Diagnosis, Planning, and Interventions
Client receiving tube feedings and
medications; Objectives; Fluid volume
deficit – hydration; Infection
Imbalanced nutrition: Dietary intake
Aspiration and risk for Diarrhea
Nursing Process: The Client Receiving
Tube Feedings
Evaluation of Expected Outcomes
Maintains weight, clear lungs and normal
bowel patterns
Gastrointestinal Intubation for decompression
Larger GI tube
Gastric sump tube
Gastrostomy Tubes for Long-Term Feeding
Gastrostomy; Endoscopically
Nursing Process: The Client Receiving
Tube Feedings
Fig. 51-1 Measuring length of nasogastric
tube for placement into stomach
Nursing Process: The Client Receiving
Tube Feedings
Gastrostomy Tubes for Long-Term Feeding:
General considerations
Surgical placement; Gastrostomy;
Laparotomy; PEG – Procedure
Gastric feedings; Passage of food into the
small intestine
Gastrostomy feeding devices
Gastrostomy Tubes for Long-Term Feeding:
Nursing Management
Precautions before and during PEG
Preparation of client’s skin
Monitor: Vital signs and client’s tolerance
of the procedure
Disorders of the Esophagus
Gastroesophageal Reflux Disease
Gastric contents flow upward
Pathophysiology and Etiology
Inability of lower esophageal sphincter to
close
Assessment Findings: Signs and Symptoms
Epigastric pain, burning sensation, and
regurgitation
Disorders of the Esophagus:
Gastroesophageal Reflux Disease
Assessment Findings: Diagnostic Findings
Barium swallow findings; Upper
endoscopy with biopsy; Capsule;
Bronchoscopy
Medical and Surgical Management
Conservative measures and medications
Fundoplication (tucking of fundus) and
Stretta procedure
Nursing Management
Dietary management; Lifestyle changes
Patient education
What is the Stretta Procedure?
Delivers precise radiofrequency (RF)
waves to the gastro esophageal (GE)
junction to restore lower esophageal
sphincter function. Once the lower
esophageal sphincter function is
restored it will act as a barrier to
prevent the upward flow of gastric
contents into your esophagus.
Disorders of the Esophagus: Esophageal
Diverticulum
Pathophysiology and Etiology
Zenker’s diverticulum ( pharynx)
Congenital or acquired weakness of
esophageal wall
Assessment Findings: Signs and Symptoms
Foul breath and difficulty in swallowing
Barium swallow and esophagoscopy
Disorders of the Esophagus: Esophageal
Diverticulum
Medical and Surgical Management
Diet therapy: Bland; Soft; Semisoft;
Liquid
Surgical excision of the diverticulum
Nursing Management
Educate about diet and lifestyle changes
Advise pregnant clients that symptoms of
GERD usually resolve after delivery
Disorders of the Esophagus
Hiatal Hernia
Axial or sliding and paraesophageal
(A
protrusion of a portion of the stomach)
Pathophysiology and Etiology
Defect in diaphragm
Congenital muscle weakness
Assessment Findings
Heartburn, belching or pain after eating
Barium swallow and esophagoscopy
Medical and Surgical Management
Narrowed esophagus stretched
endoscopically
Nursing Process: The Client with an
Esophageal Disorder
Assessment
Evaluate appetite, pain, weight and use of
medications
Diagnosis, Planning, and Interventions
Postoperative care
Imbalanced nutrition
Pain related to pressure or reflux of gastric
secretions
Evaluation of Expected Outcomes
Consumes adequate nutrients
Relief from epigastric pain
Disorders of the Esophagus: Cancer of
the Esophagus
Pathophysiology and Etiology
Affects men more often than women
Tumor usually is squamous cell carcinoma
Correlation with esophageal cancer,
alcohol abuse, and cigarette smoking
Assessment Findings
Beginning and progressive symptoms
Barium swallow, biopsy, EGD, bronchoscopy
and endoscopic ultrasound or
mediastinoscopy
Disorders of the Esophagus: Cancer of
the Esophagus
Medical and Surgical Management
Palliative measures, endoscopic laser
surgery or esophageal dilatation
Surgery
Nursing Management
Focusing on nutritional needs
Caring for client with tube feedings
Postoperative care after surgery
Patient education
Gastric Disorders: Gastritis
Pathophysiology and Etiology
Causes; Helicobacter pylori (Bacterium
commonly infecting the gastric
mucosa in patients with ulcers.
Result of acid production
Assessment Findings
Common symptoms
Symptoms with bacterial or viral infection
Complete blood count, stool test and
gastroscopy
Gastric Disorders: Gastritis
Medical and Surgical Management
Restricted eating and IV fluids
Avoidance of irritating substances
Various drugs: Antiemetics; antibiotics
Nursing Management
Evaluate response to dietary modifications
and prescribed medications
Observe color and characteristics of
vomitus or stool
Patient education
Gastric Disorders: Peptic Ulcer
Disease
Pathophysiology and Etiology
Infection with Helicobacter
pylori
Family history and other risk
factors
Development of ulcers
Chronic gastric inflammation
Assessment Findings
Abdominal pain and back
pain
Bleeding- hematemesis and
melena
FIG 51-4
Gastric ulcer
Gastric Disorders: Peptic Ulcer Disease
Assessment Findings: Diagnostic Findings
Esophagogastroduodenoscopy
Gastric washing
Low Hemoglobin and RBC
Medical and Surgical Management
Eradication therapy,Gastrectomy
Nursing Management
Assessment of pain and dietary history
Nutritional management; Bowel patterns
Nursing Process: The Client with a
Gastric Disorder
Assessment
Information on current symptoms, past
gastric problems and treatments or surgery
Signs of abdominal pain, malnutrition, and
dehydration
Diagnosis, Planning, and Interventions
Risk for deficient fluid volume
Deficient knowledge
Evaluation of Expected Outcomes
Fluid intake and output; Nutritional intake
Gastric Disorders: Cancer of the
Stomach
Pathophysiology and Etiology
Stomach malignancies
Heredity and chronic inflammation
Achlorhydria and chronic ingestion of
toxins
Assessment Findings
Early symptoms: Stool contains occult
blood
Barium swallow, CT scan, tissue biopsy,
gastric analysis and ultrasonography
Gastric Disorders: Cancer of the
Stomach
Medical and Surgical Management
Subtotal or total gastrectomy
Chemotherapy
Palliative radiation
Nursing Management
Client and family teaching
Instructing high risk groups
Surgery for gastric cancer
Nursing Management
General Nutritional Considerations
Limiting high fat foods and liquid
Intermittent cyclic and bolus tube feedings
Use of medium-chain triglycerides (MCT)
General Pharmacologic Considerations
H2 antagonists, antacids and sucralfate
Patient education
Avoiding sodium bicarbonate
Nursing Management
General Gerontologic Considerations
Factors leading to anorexia
Oropharyngeal dysphagia
Modification of diet
Greater risk for:
Aspiration
Superficial gastritis and gastric ulcers
Hiatal hernia
Pernicious anemia (inability to absorb
vitamin B12)
End of Presentation