Week 9: gastrointestinal disorders

● Gastroesophageal Reflux Disease (GERD)

○ Backflow of gastric and duodenal contents into the esophagus
○ Reflux is caused by an incompetent lower esophageal sphincter (LES), pyloric
stenosis, or motility disorder
○ Assessment
■ Heartburn, epigastric pain, dyspepsia, nausea, regurgitation, pain &
difficulty with swallowing, hypersalivation
○ Interventions
■ Teach pt about avoiding factors that decrease LES pressure or cause
esophageal irritation such as peppermint, chocolate, coffee, fried or fatty
foods, carbonated beverages, alcoholic beverages and cigarette smoking
■ Instruct pt to eat a low-fat, high-fiber diet and to avoid eating & drinking 2
hours before bedtime, wear loose fitting clothes, and elevating the head of
the bed on 6-8 inch blocks
■ Avoid use of anticholinergics, NSAIDs, and other meds containing
acetylsalicylic acid
● Gastritis
○ Inflammation of the stomach or gastric mucosa
○ Acute gastritis is caused by the ingestion of food contaminated with
disease-causing microorganisms or food that is irritating or too highly seasoned,
the overuse of aspirin or other NSAIDS, excessive alcohol intake, bile reflux, or
radiation therapy
○ Chronic gastritis is caused by benign or malignant ulcers or the bacteria ​H. pylori
and may also be due to autoimmune diseases, dietary factors, medications,
alcohol, smoking, or reflux
○ Assessment
■ Acute: abdominal discomfort, anorexia, nausea, and vomiting, headache,
hiccupping, reflex
■ Chronic: anorexia, nausea, and vomiting, belching, heartburn after eating,
sour taste in the mouth, vitamin B12 deficiency
○ Interventions
■ Acute
● Foods & fluids may be withheld until symp[toms subside,
afterward and as prescribed, ice chips can be given, followed by
clear liquids, and then solid food
■ Monitor for signs of hemorrhagic gastritis such as hematemesis,
tachycardia and hypotension and notify the HCP if these signs occur
■ Teach pt to avoid irritating foods
■ Instruct pt for the use of antibiotics and other medications
● Peptic Ulcer Disease
○ Ulceration in the mucosal wall of the stomach, pylorus, duodenum, or esophagus
in the portions accessible to gastric secretions; erosion may extend through the
muscle
○ Assessment
■ Gastric
● Gnawing, sharp pain in or to the left of the midepigastric region,
occurs 30-60 minutes after a meal
● Hematemesis is more common than melena
■ Duodenal
● Burning pain occurs in the midepigastric area 1.5-3 hours after a
meal and during the night (often awakens the pt)
● Melena is more common than hematemesis
● Pain is often relieved by the ingestion of food
○ Interventions
■ Monitor vital signs, and signs of bleeding
■ Administer small, frequent bland feedings during the active phase
■ Administer H2-receptor antagonists or proton pump inhibitors as
prescribed to decreased the secretion of gastric acid
■ Administer antacids as prescribed to neutralize gastric secretions
■ Administer anticholinergics as prescribed to reduce gastric secretions
■ Administer anticholinergics as prescribed to reduce gastric motility
■ Administer mucosal barrier protectants as prescribed 1 hour before each
meal
■ Administer prostaglandins as prescribed for their protective and
antisecretory actions
■ Client education
● Avoid consuming alcohol and substances that contain caffeine or
chocolate
● Avoid smoking
● Avoid aspirin or NSAIDs
● Obtain adequate rest and reduce stress
● Dumping syndrome
○ Rapid emptying of the gastric contents into the small intestine that occurs
following gastric resection
○ Assessment
■ Symptoms occurring 30 mins after eating
■ Nausea & vomiting, feelings of abdominal fullness and abdominal
cramping, diarrhea, palpitations & tachycardia, perspiration, weakness,
and dizziness, borborygmi
○ Client education
■ Avoid sugar, salt, and milk
■ Eat a high protein, high-fat, low carb diet, eat small meals and avoid
consuming fluids with meals, lie down after meals, take antispasmodic
meds as prescribed