Med/Surg Exam 4
Gastrointestinal (Chapters: 52, 54, 55, 56, 57, 58, 59, 60)
Gastric Disorders: ALL GI PATIENTS ARE NPO
1. GERD- Gastro esophageal reflux disease
a. Backflow of gastric contents into esophagus
b. Cause erosion of the esophagus because of the acid entering from the stomach.
i. Stomach acid = less than 4
2. Hiatal Hernia – protrusion of the stomach allowing stomach contents to enter the esophagus.
a. People with GERD are at high risk for hiatal hernia. Requires frequent testing. A patient
can have GERD without having a hiatal hernia but if the patient has a hiatal hernia- they
will have GERD.
b. Symptoms:
i. Pain (mid sternal)
ii. N/V
iii. Pyrosis= heartburn
iv. Dyspepia= indigestion
c. Risk Factors:
i. Obesity
ii. Smoking
iii. Asthma
iv. Pregnancy
v. Infants
vi. Elderly
vii. People taking NSAIDs
d. Treatment:
i. *Goal: Manage symptoms*
ii. Lifestyle changes
1. Avoid tight clothing
2. No smoking
3. Avoid laying down for 30 minutes after eating
4. Avoid going to sleep for 3 hours after eating
a. Position: right side with head slightly elevated ~30% (prop
with pillows- keep upper body in a slight incline)
i. Do this because of the was the stomach curves
iii. Nutrition:
1. Eat a bland diet (AKA “low residue”)
a. Avoid eating 3 larger meals per day
b. Eat 4-6 small frequent meals a day
i. This will reduce the amount of acid produced in the
stomach
2. Avoid: spicy foods, alcohol, caffeine, chocolate
iv. Medication
1. Antacids: TUMS or Rolaids (FIRST)
a. Neutralizes the acidity of the stomach AFTER eating
2. Mucosal Lining- Carafate
a. Coats the stomach BEFORE eating
i. Take 30 minutes prior to eating
3. Histamine receptor antagonists (H2 blockers=“-deens”)
Decreases gastric acid secretions in the top of the stomach by
Will take one or the other- blocking histamine receptors in parietal cells
They both stop gastric
acid. PT will become
alkalotic if they take both.
,1
, a. Ranitidine (Zantac)
4. Proton pump inhibitors - PPI
a. Decreases gastric acid secretions at the bottom of the
stomach
b. Omprazole (Prilosec)
c. Will take one or the other
i. Shuts off the acid in the stomach
5. Prokinetic drugs
a. Increases gastric emptying
b. Metoclopramide (Reglan)
e. Interventions:
i. Relieve symptoms
ii. Treat esophagitis
iii. Prevent complications
1. Risk of Aspiration
a. Wheezing, coughing
i. Lungs assessment
1. Listen for crackles on the lungs
ii. Increases risk of pneumonia
iv. Severe pain (epigastric area under the zyphoid process)
1. Peptic Ulcer Disease:
a. Result of severe GERD in the fundus or the duodenum
b. Gastric and Duodenal
i. Located where the stomach empties out
c. Causes:
i. H. Pylori-
1. Eats stomach lining
a. PT will need to be put patient on an antibiotic
i. Takes 6-8 weeks to heal
ii. NSAIDs Steroids and chemo meds as well
iii. Severe stress
d. Signs & Symptoms: (same as GERD and HH)
i. Pain determines which type
1. Gastric Ulcer Pain: As soon as the patient eats
2. Duodenum Ulcer Pain: 1-1 ½ hours after patient eats
ii. Epigastric Pain
iii. Indigestion
1. Sharp, burning, or gnawing
iv. Nausea and vomiting
e. Treatment:
i. Same is GERD/HH
f. Diagnosis:
i. By EGD
2. Complications of GERD/ HH/Peptic Ulcer Disease
a. Hemorrhage
i. Bleeding ulcer within the stomach
b. Perforation and peritonitis (rupture in the stomach of duodenal lining resulting in
stomach content entering the sterile lining of the stomach causing an infection
i. Nursing priority: Watch for signs of peritonitis in all GI patients.
1. Firm/solid board-like rigid abdomen. Rebound tenderness
*Suddenly worse abd pain!!* a. Prep for surgery NPO
2. Check vitals- low B/P, high heart rate – indicates an active bleed.
ii. Requires surgery
Will need B12, Iron, Calcium supplements for life with gastrectomy
2
Gastrointestinal (Chapters: 52, 54, 55, 56, 57, 58, 59, 60)
Gastric Disorders: ALL GI PATIENTS ARE NPO
1. GERD- Gastro esophageal reflux disease
a. Backflow of gastric contents into esophagus
b. Cause erosion of the esophagus because of the acid entering from the stomach.
i. Stomach acid = less than 4
2. Hiatal Hernia – protrusion of the stomach allowing stomach contents to enter the esophagus.
a. People with GERD are at high risk for hiatal hernia. Requires frequent testing. A patient
can have GERD without having a hiatal hernia but if the patient has a hiatal hernia- they
will have GERD.
b. Symptoms:
i. Pain (mid sternal)
ii. N/V
iii. Pyrosis= heartburn
iv. Dyspepia= indigestion
c. Risk Factors:
i. Obesity
ii. Smoking
iii. Asthma
iv. Pregnancy
v. Infants
vi. Elderly
vii. People taking NSAIDs
d. Treatment:
i. *Goal: Manage symptoms*
ii. Lifestyle changes
1. Avoid tight clothing
2. No smoking
3. Avoid laying down for 30 minutes after eating
4. Avoid going to sleep for 3 hours after eating
a. Position: right side with head slightly elevated ~30% (prop
with pillows- keep upper body in a slight incline)
i. Do this because of the was the stomach curves
iii. Nutrition:
1. Eat a bland diet (AKA “low residue”)
a. Avoid eating 3 larger meals per day
b. Eat 4-6 small frequent meals a day
i. This will reduce the amount of acid produced in the
stomach
2. Avoid: spicy foods, alcohol, caffeine, chocolate
iv. Medication
1. Antacids: TUMS or Rolaids (FIRST)
a. Neutralizes the acidity of the stomach AFTER eating
2. Mucosal Lining- Carafate
a. Coats the stomach BEFORE eating
i. Take 30 minutes prior to eating
3. Histamine receptor antagonists (H2 blockers=“-deens”)
Decreases gastric acid secretions in the top of the stomach by
Will take one or the other- blocking histamine receptors in parietal cells
They both stop gastric
acid. PT will become
alkalotic if they take both.
,1
, a. Ranitidine (Zantac)
4. Proton pump inhibitors - PPI
a. Decreases gastric acid secretions at the bottom of the
stomach
b. Omprazole (Prilosec)
c. Will take one or the other
i. Shuts off the acid in the stomach
5. Prokinetic drugs
a. Increases gastric emptying
b. Metoclopramide (Reglan)
e. Interventions:
i. Relieve symptoms
ii. Treat esophagitis
iii. Prevent complications
1. Risk of Aspiration
a. Wheezing, coughing
i. Lungs assessment
1. Listen for crackles on the lungs
ii. Increases risk of pneumonia
iv. Severe pain (epigastric area under the zyphoid process)
1. Peptic Ulcer Disease:
a. Result of severe GERD in the fundus or the duodenum
b. Gastric and Duodenal
i. Located where the stomach empties out
c. Causes:
i. H. Pylori-
1. Eats stomach lining
a. PT will need to be put patient on an antibiotic
i. Takes 6-8 weeks to heal
ii. NSAIDs Steroids and chemo meds as well
iii. Severe stress
d. Signs & Symptoms: (same as GERD and HH)
i. Pain determines which type
1. Gastric Ulcer Pain: As soon as the patient eats
2. Duodenum Ulcer Pain: 1-1 ½ hours after patient eats
ii. Epigastric Pain
iii. Indigestion
1. Sharp, burning, or gnawing
iv. Nausea and vomiting
e. Treatment:
i. Same is GERD/HH
f. Diagnosis:
i. By EGD
2. Complications of GERD/ HH/Peptic Ulcer Disease
a. Hemorrhage
i. Bleeding ulcer within the stomach
b. Perforation and peritonitis (rupture in the stomach of duodenal lining resulting in
stomach content entering the sterile lining of the stomach causing an infection
i. Nursing priority: Watch for signs of peritonitis in all GI patients.
1. Firm/solid board-like rigid abdomen. Rebound tenderness
*Suddenly worse abd pain!!* a. Prep for surgery NPO
2. Check vitals- low B/P, high heart rate – indicates an active bleed.
ii. Requires surgery
Will need B12, Iron, Calcium supplements for life with gastrectomy
2
