NUR 170 -exam #4 copy.
● Gastroesophageal Reflux Disease (GERD)
○ Patho: backflow of gastric contents into the esophagus.
○ Causes: imcompenent weaken lower esophageal sphincter, increased intraabdominal
pressure - (pregnancy, overeating, obesity, HH), pyloric stenosis, certain medications
(antihistamines, CCBs sedatives), or mobility disorder.
○ Risk factors: diets that are chronically low in fresh produce. affects all ages- but
elderly are more prone to complications , food irritants - Caffeine, chocolate, citrus,
tamoties, smoking/tobacco, CCBs, nitrates, mint, alcohol. Medications:
anticholinergics (delay gastric emptying), high estrogen/ progesterone, NG tube
placement.
○ s/s: Pyrosis (heartburn), epigastric pain, dyspepsia (indigestion), pain and difficulty
swallowing (dysphagia), hypersalivation, bitter taste in mouth, regurgitation (aspiration
risk), Dry coughing/wheezing (worst at night), belching, nausea, pharyngitis, dental
caries (serve).
○ eledery s/s: atypical chest pain, ear, nose throat infections, pulmonary problems
(aspiration pneumonia, sleep apnea, asthma) more at risk for developing severe
complications- HH and med s/e, barrett's esophagus or erosion
○ Labs:
○ Diagnostics: esophagogastroduodenoscopy (EGD)endoscopy - assess esophagus for s/s
of narrowing and ulcers. Esophageal manometry - assesses function and ability of
esophagus to squeeze food down and how LES closes. . pH monitoring - measures
acid amount in esophagus for 24 hours (small tube stays in esophagus during.
○ Interventions: nutrient therapy is usually enough.
■ Eat 4-6 small meals a day. Low fat - high fiber
■ Limit or eliminate fatty foods, coffee, tea, cola, carbonated drinks , mint,
chocolate
■ Reduce or eliminate from your diet any food that increases gastric
■ acid and causes pain
■ Limit or eliminate alcohol and tobacco, and reduce exposure to
■ secondhand smoke**Smoking and alcohol decrease LES pressure and irritate
tissues.**
■ Do not eat 2-3 hours before bed
■ Eat slowly and chew your food thoroughly to reduce belching
■ Remain upright 1-2 hours after meals, if possible
■ Elevate HOB 6-12 inches using wooden blocks, or elevate your
■ head using foam wedges. Never sleep flat in bed.
■ If you are overweight, lose weight.
■ Do not wear constrictive clothing.
■ Avoid heavy lifting, straining, and working in a bent-over position.
■ Chew “chewable” antacids thoroughly, and follow with a glass of water
■ Do not take anticholinergics (dalay stomach emptying), NSAIDs (contains
acetylsalicylic acid).
■ Surgery: laparoscopic nissen fundoplication (LNF),
○ Medications: Take antacids (calcium carbonate) (when taking wait 1-2 hours before taking
H2 blocker, antibiotics, or caratate) , H2 receptor antagonist (IV Famotidine)(reduces
gastric acid)
, PPIs (IV protonix) (reduces acid, helps esophagus heal, can be given long term, long
term use complication = bone fractures; most common in elderly). Prokinetics ( oral
metoclopramide)
○ Surgical: extreme cases only - fundoplication, wrapping gastric fundus around
sphincter area of esophagus.
○ Complications: Esphogitis - where the esophagus cells start to erode and become
inflamed due to acid. Barrett's esophagus - results from exposure to acid and pepsin
(sometimes nitrosamines) which changes the cells DNA making them precancerous.
Strictures- build up scar tissue in the esophagus causing narrowing. Laryngopharyneal
reflux - acid going into the pharynx going into respiratory system causing lung
infections, ear infections, coughing. complications are most common in eledery.
,NUR 170 -exam #4 copy.
● Hiatal Hernia
,NUR 170 -exam #4 copy.
● Increases risk of GERD because of increase of intra abdominal pressure. It's a hernia that is
formed at the top of the stomach near the LES putting pressure on it causing it to not
operate properly.
● Types s/s:
○ Sliding: heartburn, regurgitation, chest pain, dysphagia, belching.
○ Paraesophageal: feeling of fullness or breathlessness after eating, feeling of
suffocation. Chest pain that mimics angina, s/s worse in recumbent position.
● Patho: (esophageal/ diaphragmatic hernia) portion of stomach herniates through diaphragm into
thorax.
● Risk factors: Herniation results from weakening of muscles of diaphragm aggravated by
that increase abdominal pressure (pregnancy, ascites, obesity, tumors, heavy lifting)
● Complications: ulceration, hemorrhage, regurgitation and aspiration of stomach contents,
strangulation, and incarceration of the stomach in the chest with necrosis, peritonitis,
mediastinitis.
● Interventions: The most important role of a nurse is health teaching for HH. small frequent
meals, avoid eating at night, avoid food irritants. Sleep with the head of the bed elevated 6
inches, remain upright for several hours, avoid straining or excessive exercise, and avoid restrictive
clothing. Teach patients and families that they need to follow a strict diet and exercise and
should reduce body weight to reduce intra abdominal pressure.
● Medications: avoid anticholinergics (delay stomach emptying)
● Herniation
● Patho: weakness in abdominal muscle wall through which a segment of bowel protrudes
● Causes: congenital or acquired muscle weakness and increased intra abdominal pressure
contribute to hernia formation.
● Types:
● Assessment: patient should be lying down and then assess when patient is standing. If hernia
is reducible it may disappear when the patient is lying flat. Listen for bowel sounds (absence
= GI obstruction)
● Interventions: truss- pad with firm support for people who can’t have surgery. Herniorrhapy
- replaces contents of the hernia sac into the abdominal cavity and closing the opening.
Hernioplasty - reinforces the weakened muscular wall with a mesh patch.
○ Pre/post care: avoid coughing - but deep breath. Inguinal repair - wear scrotal support
and elevate scrotum with pillow in bed. Avoid bowel or bowel distension by -
stimulating voiding techniques (standing them up), avoid constipation ( avoid
straining during healing)
● Intestinal obstruction = compromises elimination
● Patho: an obstruction can be partial or complete and can occur in either the small or large
intestine.
● Types and s/s:
○ Small: abdominal discomfort or pain by visible waves in middle abdomen, upper or
epigastric abdominal distention, nausea, profuse vomiting, obstipation, sever F&E
imbalances, metabolic alkalosis.
○ Large: intermittent lower abdominal cramping, lower abdominal distention,
no vomiting, constipation or ribbon like stools, sometimes metabolic
acidosis.
○ Diagnostics: no definitive test to confirm. CT scan , abdominal ultrasound
● Interventions: decompress GI tract by inserting a gastric tube (oral or nasal) ** must
check placement, patency, output every 4 hours. Assess for peristalsis by auscultating for
bowel sounds with suction off** monitor nasal skin around the tube.
● It is a surgical emergency when this is an obstruction with compromised blood flow.
● Perforation: Sudden change in abdominal pain from dull to sharp or local to generalized
may indicate a perforation. Inform MD ASAP of pain, VS & o2 sat. perforation is an
emergency.
, NUR 170 -exam #4 copy.
Peptic Ulcer Disease
● Patho: Ulcer formation in the upper GI that affects lining of the stomach . The ulcers form due to
gastric acid and pepsin and breakdown of defenses (prostaglandins - release bicarbonate,
control acid amount secreted; bicarbonate of the mucosa = protect lining of the stomach) that
protect the stomach lining which signals to the parietal cells to release more HCL acid which
erodes the stomach lining further. .
● Gastroesophageal Reflux Disease (GERD)
○ Patho: backflow of gastric contents into the esophagus.
○ Causes: imcompenent weaken lower esophageal sphincter, increased intraabdominal
pressure - (pregnancy, overeating, obesity, HH), pyloric stenosis, certain medications
(antihistamines, CCBs sedatives), or mobility disorder.
○ Risk factors: diets that are chronically low in fresh produce. affects all ages- but
elderly are more prone to complications , food irritants - Caffeine, chocolate, citrus,
tamoties, smoking/tobacco, CCBs, nitrates, mint, alcohol. Medications:
anticholinergics (delay gastric emptying), high estrogen/ progesterone, NG tube
placement.
○ s/s: Pyrosis (heartburn), epigastric pain, dyspepsia (indigestion), pain and difficulty
swallowing (dysphagia), hypersalivation, bitter taste in mouth, regurgitation (aspiration
risk), Dry coughing/wheezing (worst at night), belching, nausea, pharyngitis, dental
caries (serve).
○ eledery s/s: atypical chest pain, ear, nose throat infections, pulmonary problems
(aspiration pneumonia, sleep apnea, asthma) more at risk for developing severe
complications- HH and med s/e, barrett's esophagus or erosion
○ Labs:
○ Diagnostics: esophagogastroduodenoscopy (EGD)endoscopy - assess esophagus for s/s
of narrowing and ulcers. Esophageal manometry - assesses function and ability of
esophagus to squeeze food down and how LES closes. . pH monitoring - measures
acid amount in esophagus for 24 hours (small tube stays in esophagus during.
○ Interventions: nutrient therapy is usually enough.
■ Eat 4-6 small meals a day. Low fat - high fiber
■ Limit or eliminate fatty foods, coffee, tea, cola, carbonated drinks , mint,
chocolate
■ Reduce or eliminate from your diet any food that increases gastric
■ acid and causes pain
■ Limit or eliminate alcohol and tobacco, and reduce exposure to
■ secondhand smoke**Smoking and alcohol decrease LES pressure and irritate
tissues.**
■ Do not eat 2-3 hours before bed
■ Eat slowly and chew your food thoroughly to reduce belching
■ Remain upright 1-2 hours after meals, if possible
■ Elevate HOB 6-12 inches using wooden blocks, or elevate your
■ head using foam wedges. Never sleep flat in bed.
■ If you are overweight, lose weight.
■ Do not wear constrictive clothing.
■ Avoid heavy lifting, straining, and working in a bent-over position.
■ Chew “chewable” antacids thoroughly, and follow with a glass of water
■ Do not take anticholinergics (dalay stomach emptying), NSAIDs (contains
acetylsalicylic acid).
■ Surgery: laparoscopic nissen fundoplication (LNF),
○ Medications: Take antacids (calcium carbonate) (when taking wait 1-2 hours before taking
H2 blocker, antibiotics, or caratate) , H2 receptor antagonist (IV Famotidine)(reduces
gastric acid)
, PPIs (IV protonix) (reduces acid, helps esophagus heal, can be given long term, long
term use complication = bone fractures; most common in elderly). Prokinetics ( oral
metoclopramide)
○ Surgical: extreme cases only - fundoplication, wrapping gastric fundus around
sphincter area of esophagus.
○ Complications: Esphogitis - where the esophagus cells start to erode and become
inflamed due to acid. Barrett's esophagus - results from exposure to acid and pepsin
(sometimes nitrosamines) which changes the cells DNA making them precancerous.
Strictures- build up scar tissue in the esophagus causing narrowing. Laryngopharyneal
reflux - acid going into the pharynx going into respiratory system causing lung
infections, ear infections, coughing. complications are most common in eledery.
,NUR 170 -exam #4 copy.
● Hiatal Hernia
,NUR 170 -exam #4 copy.
● Increases risk of GERD because of increase of intra abdominal pressure. It's a hernia that is
formed at the top of the stomach near the LES putting pressure on it causing it to not
operate properly.
● Types s/s:
○ Sliding: heartburn, regurgitation, chest pain, dysphagia, belching.
○ Paraesophageal: feeling of fullness or breathlessness after eating, feeling of
suffocation. Chest pain that mimics angina, s/s worse in recumbent position.
● Patho: (esophageal/ diaphragmatic hernia) portion of stomach herniates through diaphragm into
thorax.
● Risk factors: Herniation results from weakening of muscles of diaphragm aggravated by
that increase abdominal pressure (pregnancy, ascites, obesity, tumors, heavy lifting)
● Complications: ulceration, hemorrhage, regurgitation and aspiration of stomach contents,
strangulation, and incarceration of the stomach in the chest with necrosis, peritonitis,
mediastinitis.
● Interventions: The most important role of a nurse is health teaching for HH. small frequent
meals, avoid eating at night, avoid food irritants. Sleep with the head of the bed elevated 6
inches, remain upright for several hours, avoid straining or excessive exercise, and avoid restrictive
clothing. Teach patients and families that they need to follow a strict diet and exercise and
should reduce body weight to reduce intra abdominal pressure.
● Medications: avoid anticholinergics (delay stomach emptying)
● Herniation
● Patho: weakness in abdominal muscle wall through which a segment of bowel protrudes
● Causes: congenital or acquired muscle weakness and increased intra abdominal pressure
contribute to hernia formation.
● Types:
● Assessment: patient should be lying down and then assess when patient is standing. If hernia
is reducible it may disappear when the patient is lying flat. Listen for bowel sounds (absence
= GI obstruction)
● Interventions: truss- pad with firm support for people who can’t have surgery. Herniorrhapy
- replaces contents of the hernia sac into the abdominal cavity and closing the opening.
Hernioplasty - reinforces the weakened muscular wall with a mesh patch.
○ Pre/post care: avoid coughing - but deep breath. Inguinal repair - wear scrotal support
and elevate scrotum with pillow in bed. Avoid bowel or bowel distension by -
stimulating voiding techniques (standing them up), avoid constipation ( avoid
straining during healing)
● Intestinal obstruction = compromises elimination
● Patho: an obstruction can be partial or complete and can occur in either the small or large
intestine.
● Types and s/s:
○ Small: abdominal discomfort or pain by visible waves in middle abdomen, upper or
epigastric abdominal distention, nausea, profuse vomiting, obstipation, sever F&E
imbalances, metabolic alkalosis.
○ Large: intermittent lower abdominal cramping, lower abdominal distention,
no vomiting, constipation or ribbon like stools, sometimes metabolic
acidosis.
○ Diagnostics: no definitive test to confirm. CT scan , abdominal ultrasound
● Interventions: decompress GI tract by inserting a gastric tube (oral or nasal) ** must
check placement, patency, output every 4 hours. Assess for peristalsis by auscultating for
bowel sounds with suction off** monitor nasal skin around the tube.
● It is a surgical emergency when this is an obstruction with compromised blood flow.
● Perforation: Sudden change in abdominal pain from dull to sharp or local to generalized
may indicate a perforation. Inform MD ASAP of pain, VS & o2 sat. perforation is an
emergency.
, NUR 170 -exam #4 copy.
Peptic Ulcer Disease
● Patho: Ulcer formation in the upper GI that affects lining of the stomach . The ulcers form due to
gastric acid and pepsin and breakdown of defenses (prostaglandins - release bicarbonate,
control acid amount secreted; bicarbonate of the mucosa = protect lining of the stomach) that
protect the stomach lining which signals to the parietal cells to release more HCL acid which
erodes the stomach lining further. .
