Summary RNSG 1441 COMMON CONCEPTS OF ADULT HEALTH

Hiatal hernia :Pg 1012 & and other hernias 1. Patho: condition known as hiatus or hiatal hernia, the opening in the diaphragm through which the epiglottis passes becomes enlarged, and part of the upper stomach tends to move up into the lower portion of thorax. Types: - *Sliding(most common 90%)- the upper stomach slides in and out of the thorax. - *Rolls(paraesophageal)- all of the stomach pushes through the diaphragm beside the epiglottis - Abdominal- protrusion of organs or structure through the wall of the cavity in which it is naturally contained - Inguinal-Loop of intestine enters the inguinal canal(sometimes into the scrotal sack) - Umbilical- orifice did not close; babies, obese women, cirrhosis, ascites d/t pressure. - Ventral(incisional)- weakness in abd wall; post-surgery. - Femoral- below inguinal ligament; most frequent in women d/t changes in women’s body. 2. S/S - Heartburn, regurgitation, dysphasia, or Asymptomatic. 3. Management - Avoid large meals, have small feedings that pass easily - Do not recline while eating (lay down) or for one hour after eating - Elevate HOB 6-8 in - Bland diet; avoid coffee, alcohol, smoking, caffeine - Eat 2 hours before hs - Avoid tight clothes at waist - Wt reduction Peptic ulcer (PUD)pg 1047 1. Patho: Erosion of mucus membrane in the esophagus, stomach, pyloris, and duodenum. The erosion is d/t an increase in concentration or activity acid-pepsin or to decrease in the normal resistance to the mucosa. Can happen d/t chronic use of NSAID, ASA, steroids, H pylori, Bacteria 2. S/S a. Dull, gnawing pain; burning in mid-epigastric area of back; heartburn with belching -Relieved by eating -Vomiting with gastric outlet obstruction -Morning decrease in pain d/t flow of gastric acid is low b. Hemorrhage: -coffee ground emesis -Dark tarry stools(melena) -Abd distention -Pyloric obstruction 3. Management a. Rest and stress reduction b. Stop smoking c. Diet (key to success) -Avoid extreme temps of food -Avoid alcohol, coffee, caffeine(coke, tea, chocolate) milk/cream (stimulate acid production) -Eat regular meals -Avoid ASA, NSAID(ulceragenic) 4. Meds; - Antacids; malox, tums, Rolaid’s - Anticholinergic (anti-spasmodic) - H2 Blockers; Tagamet, Pepcid