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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 optionLifestyle Modification: Teach patients to avoid factors that trigger symptomsRecommend weight reduction if the patient is overweightEncourage patients who smoke to stop Nutritional Therapy: Some patients may need to avoid foods that decrease LES pressure, such aschocolate, peppermint, fatty foods, coffee, & tea, which predispose them to refluxCertain 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 symptomsTABLE 41-9– Patient & Caregiver Teaching (GERD): 1.Explain the reason for a low-fat diet2.Encourage the patient to eat small, frequent meals to prevent gastric distention3.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 bedtime6.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 effects8.Discuss strategies for weight reduction if appropriate9.Encourage the patient & caregiver to share concerns about lifestyle changes & living with a chronic problemDrug Therapy: Focuses on decreasing the volume & acidity of reflux, improving LES function, increasing esophageal clearance, & protecting the esophageal mucosaProton pump inhibitors (PPIs) & histamine (H2)-receptor blockers are the most common & effective treatments for symptomatic GERDoTherapy should start with once a day dosing, before the first meal of the day oLong-term use of PPIs has been associated with decreased bone density, chronic hypochlorhydria, & an increased risk of pneumonia
oLong-term use or high doses may increase the risk of fractures of hip, wrist, & spineoPatients should take the lowest dose for the shortest duration needed to treat their conditionoUse is associated with an increased risk of new & recurrent C. dificileinfection onhospitalized patients Antacids produce quick but short-lived relief of heartburnoMost 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 symptomsNursing Management – GERD: Encourage patients to follow the necessary regimen