371 Exam 4.docx - Module 11 \u2013 Upper Gastrointestinal System Obesity Nursing Care\/Management Upper GI(Esophageal Disorders Interprofessional Care(GERD

371 Exam 4.docx - Module 11 u2013 Upper Gastrointestinal...

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Module 11 – Upper Gastrointestinal System & Obesity : Nursing Care/Management Upper GI (Esophageal Disorders) : Interprofessional Care (GERD) : Most patients can successfully manage the condition through lifestyle modifications & drug therapy; when this is ineffective, surgery is an option Lifestyle Modification : Teach patients to avoid factors that trigger symptoms Recommend weight reduction if the patient is overweight Encourage patients who smoke to stop Nutritional Therapy : Some patients may need to avoid foods that decrease LES pressure, such as chocolate, peppermint, fatty foods, coffee, & tea, which predispose them to reflux Certain foods (tomato-based products, orange juice, cola, red wine) may irritate the esophagus Tell patients to avoid late evening meals, nocturnal snacking, & milk, especially at bedtime Small, frequent meals & drinking fluids between meals helps prevent overdistention of the stomach Increased saliva production by chewing gum & oral lozenges may help with mild symptoms TABLE 41-9 – Patient & Caregiver Teaching (GERD) : 1. Explain the reason for a low-fat diet 2. Encourage the patient to eat small, frequent meals to prevent gastric distention 3. Explain the reason for avoiding alcohol, smoking (causes an almost immediate, marked decrease in lower esophageal sphincter pressure) & beverages that contain caffeine 4. Advise the patient to not lie down for 2-3 hours after eating, wear tight clothing around the waist, or bend over (especially after eating) 5. Have the patient avoid eating within 3 hours of bedtime 6. Encourage the patient to sleep with the head of the bed elevated on 4- to 6-in. blocks 7. Provide information about drugs, including reason for their use & common side effects 8. Discuss strategies for weight reduction if appropriate 9. Encourage the patient & caregiver to share concerns about lifestyle changes & living with a chronic problem Drug Therapy : Focuses on decreasing the volume & acidity of reflux, improving LES function, increasing esophageal clearance, & protecting the esophageal mucosa Proton pump inhibitors (PPIs) & histamine (H 2 )-receptor blockers are the most common & effective treatments for symptomatic GERD o Therapy should start with once a day dosing, before the first meal of the day o Long-term use of PPIs has been associated with decreased bone density, chronic hypochlorhydria, & an increased risk of pneumonia
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o Long-term use or high doses may increase the risk of fractures of hip, wrist, & spine o Patients should take the lowest dose for the shortest duration needed to treat their condition o Use is associated with an increased risk of new & recurrent C. dificile infection on hospitalized patients Antacids produce quick but short-lived relief of heartburn o Most effective taken 1-3 hours after meals & at bedtime Surgical Therapy : Reserved for patients with complications, including esophagitis, medication intolerance, stricture, Barrett’s esophagus, & persistent severe symptoms Nursing Management – GERD : Encourage patients to follow the necessary regimen
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