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Appetite Center

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located in the hypothalamus

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Anorexia Diagnostic Findings

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Hemoglobin level and blood cell counts is reduced. Serum albumin, electrolyte, and protein levels is low, with accompanying cardiac dysrhythias

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Elevated U wave

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potassium deficiency

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Client with Anorexia

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Formulate a nutritional plan with the client and dietitian that promotes weight gain - 600 calories per meal

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Vomiting Center

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is located in the medulla

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What is the most common symptom of esophageal disease?

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dysphagia

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Call Physician

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if urine output is below 500 mL/day or serum electrolyte levels are abnormal. Such findings indicate severe dehydration and the need for IV replacement fluids

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Gastrostomy

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tube enters the stomach through a surgically created opening in the abdominal wall

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Oral Cancer is Caused by

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smoking, chewing tobacco, alcohol. Lip cancer is associated with pipe smoking and prolonged exposure to wind and sun. As cancer cells in the oral cavity increase, the mass may distort a client's appearance; exert pressure on surrounding tissue, making it difficult to masticate, cause local pain; or produce dysphagia (difficulty swallowing)

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The Most Common Oral Cancer is

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Squamous Cell Carcinoma. Other causes: Human papillomavirus (HPV). Repeated irritation from rough teeth, dentures, or fillings. Poor oral and dental hygiene

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A new PEG Tube

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May have a slight amount of bleeding, mucus or both, report any prolonged drainage. Inspect for irritation, infection, drainage, or gastric leakage

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The Early Stages of Oral Cancer is

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Asymptomatic. At first, the client may notice a lesion, lump, or other abnormality of the lips or mouth. Clients may also have difficulty swallowing and/or persisitent hoarseness

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Nursing Management of the Client with Oral Cancer

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The focus and attention, is on maintaining a patent airway, promoting adequate fluid and food intake, and supporting communication that the tumor or treatment may have impaired

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After Oral Surgery

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there should be equipment for suctioning, administration of oxygen, and tracheostomy at the client's bedside. If the client does not have a tracheostomy, a tracheostomy tray must be nearby for emergency use because respiratory distress or airway obstruction requires immediate attention

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Post Oral Cancer Surgery

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Clients should not use a straw because it causes the client to swallow air, which can distend the stomach

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Nutritional Management Client with Oral Cancer Post Surgery

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Because oral tissues are sensitive, the client should avoid hot and cold liquids and spicy foods. The nurse can consult with the physician about prescribing a topical anesthetic mouthwash containing lidocaine (Xylocaine), which numbs the tissues or a analgesic for pain

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Placement of GI Tube

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Once placement is confirmed with an x-ray, then the nurse aspirate stomach contents to further confirm placement. The pH level should be below 5.5

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Nasogastric Intubation

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tube passes through nose into stomach via esophagus

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Orogastric Intubation

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tube passes through mouth into stomach

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Nasoenteric Intubation

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tube passes through the nose, esophagus, and stomach to the small intestine

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Tube Feedings

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ensure that the lungs remain free of liquid, and intake and output are appropriate for the client's age and size. Additional objectives include providing adequate nutrition, promoting appropriate stool patterns (amount, consistency, and frequency), and preserving intact skin and nasal mucosa. Keep mucous membranes moist because they tend to dry from mouth breathing and restricted oral fluids

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Client on Tube Feeding - Hydration

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The client is at risk not only for dry mouth but also fluid volume deficit resulting from insufficient fluid intake. Observe for signs and symptoms of dehydration. If urine output is less than 500 mL/day, administer formula and additional water as ordered

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Tube Feedings - Infections

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keep the feeding formula refrigerated , keep feeding formula room temperature before administering; hang continuous formula-feeding containers with only the volume necessary for 4-6 hours; flush the tubing with water before adding more formula and after giving a bolus or intermittent feeding or medications; discard any premixed formula after 24 hours

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Tube Patency and Bacteria Control

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Administering 15-30 mL of water before and after medications and feedings (every 4-6 hours with continuous feedings). This ensures tube patency and decreases the risk of bacterial infection and crusting or blockage of the tube

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Larger GI Tube

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is used to relieve abdominal distention caused by problems after surgery, episodes of acute upper GI bleeding, or symptoms associated with intestinal obstruction, or for diagnostic purposes. It is inserted by following the same procedure as is used for insertion of a feeding tube

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Gastric Sump Tube

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have a double lumen, one of which serves as a vent, allowing a small amount of air to be drawn in when the tube is connected to suction. Sump tubes decrease the possibility of the stomach wall adhering to and obstructing the tube openings during gastric decompression

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Time-release tablets

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cannot be crushed because too much drug is released quickly which could cause overdose

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Enteric-coated tablets

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cannot be crushed

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Simple Compressed Tablets

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crush and dissolve in water

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Bolus Tube Feedings

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deliver formula in 15-30 minutes

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Intermittent Tube Feedings

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delivery over 30-60 minutes

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Continuous Tube Feedings

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administered at lower rates 12-24 hours

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Nasogastric Tube

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measure from the tip of nose to the tip of earlobe and then to the tip of the xiphoid process

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Bolus feedings

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are not given through tubes inserted below the pylorus because such placement causes abdominal cramping and diarrhea

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Percutaneous Endoscopic Gastrostomy PEG

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an endoscope is introduced orally and advanced into the stomach so the physician can see the correct location of the tube

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Bolus Feedings

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are not given through tubes inserted below the pylorus because such placement causes abdominal cramping and diarrhea

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Accidental Removal of the Gastrostomy Device

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needs immediate replacement

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Gastroesophageal reflux disease (GERD)

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Disorder when gastric contents flow upward into the esophagus. Gastroesophageal reflux is a disease only when it is excessive or causes undesirable symptoms such as pain or respiratory distress

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GERD

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Results from an inability of the lower esophageal sphincter LES; also called the cardiac sphincter to close fully, allowing the stomach contents to flow freely into the esophagus. Obesity and pregnancy increase susceptibility to GERD

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Symptoms of GERD

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epigastric pain or discomfort (dyspepsia), burning sensation in the esophagus (pyrosis), and regurgitation. Other symptoms include difficulty swallowing (dysphagia), painful swallowing (odynophagia), inflammation of the lining of the esophagus (esophagitis), aspiration pneumonia, and respiratory distress

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Treating GERD include

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weight loss, maintaining an upright position following meals, elevating the head of the bed when sleeping, avoiding food and fluids 2 to 3 hours before bedtime

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The most common surgical procedure performed for GERD

answer

Fundoplication: a procedure that tightens the LES by wrapping the gastric fundus around the lower esophagus and suturing it into place

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LINX Device

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titanium beads connected with titanium wires to form a ring; it is surgically implanted around the LES to prevent reflux. The magnetic attraction of the beads is strong enough to prevent acid reflux but also allows for the passage of food

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Fundoplication

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Closely observe the client having Fundoplication for abdominal distention and nausea because many clients cannot belch or vomit after undergoing this procedure

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Diverticulum

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is a sac or pouch in one or more layers of the wall of an organ or structure

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The Most Common Esophageal Diverticulum

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Zenker's diverticulum. Diverticula result from a congenital or an acquired weakness of the esophageal wall. They trap food and secretions, which then narrow the lumen; interfere with the passage of food into the stomach and put pressure on the trachea. The trapped food decomposes in the esophagus causing esophagitis or mucosal ulceration

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Esophageal Diverticulum Findings

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Foul breath, difficulty or pain swallowing, belching, regurgitating or coughing. Auscultation may reveal gurgling sound

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Esophageal Diverticulum Nursing

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Explains that oral hygiene will not alleviate the foul breath. Arrange for dietary modification

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Hiatal or Diaphragmatic Hernia

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Is a protrusion of part of the stomach into the lower portion of the thorax. A hiatal hernia results from a defect in the diaphragm where the esophagus passes through it

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Findings for Hiatal Hernia

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heartburn, belching, nausea, substernal or epigastric pressure or pain after eating or when lying down. Increased symptom when bending at waist. Treatment is the same as GERD

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Cancer of the Esophagus

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Clients do not experience symptoms until the disease has progressed to interfere with swallowing and passage of food. There are two types: squamous and adenocarcinoma. As the cancer advances the mass occupies space and interferes with swallowing. Risks factors hot liquids or foods, chewing tobacco

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Omeprazole

answer

decreases gastric acid

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Which is one of the first clinical manifestations of esophageal cancer?

answer

Difficulty in swallowing. As the tumor grows and the obstruction becomes nearly complete, even liquids cannot pass into the stomach. Other clinical manifestations may include sensation of a mass in the throat

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A nurse is caring for a client who underwent a Subtotal Gastrectomy. To manage Dumping syndrome, the nurse should advise the client to:

answer

A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying

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Tube Placement

answer

Confirm placement of the tube prior to each medication administration. Each time liquids or medications are administered, and once a shift for continuous feedings, the tube must be checked to ensure that it remains properly placed

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Which of the following is an accurate statement regarding cancer of the esophagus?

answer

Cancer of the esophagus is associated with ingestion of alcohol and the use of tobacco

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Why should you check for tube placement in the stomach as well as residual volume?

answer

Prevent aspiration

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A nurse is providing teaching for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after. The nurse suspects

answer

dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include: vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down

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The most common symptom of esophageal disease is which of the following?

answer

Dysphagia- vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain on swallowing

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Tube placement is checked every

answer

shift

question

During periods of reduced food consumption

answer

most people have a sufficient reserve of stored glycogen, which provides energy through a process of glycogenolysis

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Gluconeogenesis

answer

Hormones such as glucagon, glucocorticoid stimulate the liver to carry out gluconeogenesis. Reabsorption by the kidneys can temporarily maintain electrolyte balance

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Bumpers are too tight

answer

may cause pressure ulcer on the abdomen

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Buried Bumper Syndrome

answer

the internal bumper becomes buried in the abdominal wall leading to GI bleeding, perforation or peritonitis

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Standard Roux-en-Y gastric bypass (RYB)

answer

Stapling the stomach and dividing the upper jejunum, rerouting the upper half (Roux limb) and attaching it to the stomach pouch

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Laparoscopic Gastric Banding (LAGB)

answer

Restricts food intake in the stomach by creating a small pouch from the top of the stomach and narrowing the passage into the lower part through the use of an inflatable band

question

Sleeve Gastrectomy

answer

Surigical removal of the left half of the stomach, thus reducing the size

question

Dumping Syndrome

answer

Is common after gastric surgery. It is a group of symptoms that may result from having part of your stomach removed or from other surgery involving the stomach. Symptoms: abdominal cramping or pain, nausea, vomiting, diarrhea, flushing

question

Which of the following surgical procedures for obesity utilizes a prosthetic device to restrict oral intake?

answer

Gastric banding

question

When should the nurse instruct the patient to take the antacid medication?

answer

1 to 3 hours after meals

question

A patient comes to the clinic complaining of pain in the epigastric region. How do you determine if the patient has a peptic ulcer?

answer

Find out if the patient has pain relief after eating. Pain relief after eating is associated with duodenal ulcers

question

Gastritis

answer

inflammation of the stomach lining. Caused by reflux of duodenal contents, aspirin, steroids, NSAIDs, alcohol, caffeine, cigarette, food allergies. Helicobacter pylori may contribute to chronic gastritis. Client complains of epigastric fullness, pressure, pain, anorexia, nausea, and vomiting. Clients may describe seeing blood in emesis or a darkening of their stool. CBC may reveal anemia from blood loss. Test for H. pylori

question

Autoimmune Gastritis

answer

When the body attacks the lining of the stomach and erodes the protective layer. This can be associated with Vit B 12 deficiency

question

Gastritis Nursing Management

answer

Observe the color and characteristics of vomitus or stool

question

Peptic Ulcer Disease - eating food may relieve the pain

answer

Loss of tissue in an area of the GI tract that is in contact with hydrochloric acid and pepsin. Most occur in the duodenum. The highest risk for PUD is infection with gram-negative bacterium H pyori. Transmission of the bacterium is by fecal-oral or oral-oral pathways. H. pylori is present in the gastric or duodenal mucosa of clients with PUD. Clients complain of abdominal pain, and describe it as "burning". Pain also occur one to several hours after meals and disturbs sleep

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