GERD & esophageal cancer powerpoint – Flashcards
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What condition has a back flow (reflux) of gastric contents (hydrochloric acid) through the lower esophageal sphincter and into the esophagus?
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Gastroesophageal reflux disease (GERD)
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what surgery treats GERD?
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fundoplication (creates a better sphincter) post op: make sure to elevate HOB to limit reflux. sleep on right side, avoid large meals
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Persistent reflux may cause what condition?
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reflux esophagitis (inflammation of the esophageal mucousa)
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What are some causes of GERD?
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-smoking, alcohol, drugs -obesity, ascites -hiatal hernia -long term NG intubation more than 5 days -pyloric surgery -over distention of stomach, slow emptying
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Factors that INCREASE sphincter tone are all ________in acid
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low
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What are some food factors that INCREASE sphincter tone in GERD patients?
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-protein -carbohydrates -nonfat milk -low dose ethanol "PCNL"
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Factors that DECREASE sphincter tone are all _____in acid
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high
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what factors DECREASE sphincter tone in GERD patients?
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-fat -whole milk -orange juice -tomatoes -chocolate -high dose ETOH -cigarette smoking carbonated drinks & sparkling water
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A patient shows signs of dysphagia and odynophagia, as well as, heart burn. What do you suspect?
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GERD
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What is odynophagia?
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painful swallowing
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What tests diagnoses GERD?
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-*barium swallow fluoroscopy (indicates reflux) -*esophagoscopy (shows reflux) -endoscopy -*biopsy -bernstein test (acid perfusion test) -esophageal manometry
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what test uses NS or acid through an NG tube that is inserted into the lower esophagus to reproduce pain?
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Bernstein test acid is placed into esophagus to determine if pain is caused by esophagus reaction or is cardiac related pain stimulated by infusion of acid into esophagus indicates esophagitis
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what nursing interventions do we need to do before a patient does a Bernstein test?
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-NPO 8 hours prior -withold any meds that interfere with acid production or ability to sense pain
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What is an endoscopy (EGD) used for?
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Confirms pathological changes in the mucosa
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What 4 drugs would you give to GERD patients for treatment?
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-Prokinetic drugs: metoclopramide -PPIs: omeprazole -H2 Blocker: famotidine -Antacids
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A patient needs help with peristalsis and has GERD, what drug would you give?
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metoclopramide prokinetic drug take 30 mins before meals
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What drug will help block histamine that causes gastric acid in GERD patients?
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H2 blockers: famotidine
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What nursing interventions will you instruct patients with GERD to do?
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-eat small portion meals 2-3 hours before bedtime -low fat, high fiber, avoid irritants like spicy or acidic foods, caffeine, ETOH -HOB elevated 6-12"
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How should GERD patients eat their meals?
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small portions and eat meals 2-3 hours BEFORE bedtime
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What does HCL acid break down?
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bad food and bad bacteria
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What does Pepsin do?
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break down proteins
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What condition happens as a result of repeated exposure to stomach acid and is caused by GERD?
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Barrett's esophagus
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Barrett's esophagus puts you at a high risk of developing what?
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esophageal cancer
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Damage to the lining of the lower esophagus from repeated stomach acid occurs in what condition?
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barrett's esophagus
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A patient states that it "feels like I have a mass in my throat and food gets stuck. My neck, jaw and shoulder hurts too!" The nurse notes that they have terrible breath, excessive salivation, thirst and hiccups. The patient is also an alcoholic and loves drinking hot tea and hot food. What do you suspect?
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esophageal cancer
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What does an NG tube do if they have dysphagia?
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it reduces secretions and avoids aspiration
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How does esophageal cancer get worse?
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the high lymphatic network makes the tumors spread quickly
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What happens if you abruptly stop TPN?
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makes the patient either hypo/hyperglycemic we must NOT stop it abruptly. We cycle them for 16 hours or do a 24 hour continuous
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What post op esophageal cancer nursing interventions do we provide?
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-Do NOT manipulate NG to LIWS for about 5 days. Only flush if ordered -Low fowlers at first, then fowlers to prevent reflux -provide high calories, high protein, pureed food prn
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what is the major thing we must monitor for post op esophageal cancer surgery?
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airway clearance
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What should you educate the patient if they had a stent placed to keep their esophagus opened?
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food restrictions for the rest of your life because you do not want to clot it back up
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what surgery do we for esophageal cancer?
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esophagastrectomy (pull up)
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Give what drug to decrease secretions before a scope test?
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atropine
