Disorders of the upper GI

can start in the mouth or present as a burning in the Throat all the way down to the upper abdominal area. Sometimes cardiac chest pain can present as a gastric disorder so it is important to get a medical diagnosis.

Endoscopy is a routine, outpatient procedure in which the inside of the upper digestive system is examined.

The procedure is commonly used to help identify the causes of:

Abdominal or chest pain

Nausea and vomiting

Heartburn

Bleeding

Swallowing disorders

Endoscopy can also help identify inflammation, ulcers and tumors.

An endoscope is a thin, flexible tube with a tiny camera on the end.

Three separate X-ray examinations may be done:

Barium Swallow, an examination of the canal in the throat that leads from the mouth to the opening of the stomach
Upper GI (UGI), an examination of the stomach
Small-bowel series, an examination of the small intestine
Three different types of tests are available to detect H pylori:

– Blood tests: These tests detect the bacteria by measuring antibodies to the bacteria. Antibodies are proteins produced by the immune system to defend against an “invader” such as H pylori. The blood test is inexpensive and can be done in a medical office. The down side is that it can be positive in a person who had an ulcer before and was already treated for it.

– Breath test: This test detects H pylori by measuring carbon dioxide in the breath of a person who has drunk a special liquid. H pylori bacteria break down the liquid, increasing the amount of carbon in the blood. The body gets rid of this carbon by breathing it out as carbon dioxide. This test is more accurate than the blood test but is more difficult to carry out. It is often used after treatment to check whether H pylori bacteria have been eradicated.

– Tissue tests: These tests are used only if an endoscopic biopsy has been done, because a sample of tissue from the stomach is needed to detect the bacteria.

During the care of the client with oral conditions and GI disorders a nurse may need to place a gastrointestinal intubation tube for feedings or medications, and decompression.

There are several types of tubes, here are a few examples:

– Levin (plastic or rubber)

– Gastric Sump Salem (plastic)

– Moss

– Sengstaken-Blakemore (rubber)

Nasoenteric Decompression Tubes

– Miller-Abbott (rubber)

– Harris

– Cantor (rubber)

– Baker (plastic)

Nasoenteric Feeding Tubes

– Dobhoff or Keofeed II (polyurethane or silicone rubber)

References:

http://www.charlotteradiology.com/

Timby, p. 365, 825,839, 844

E. H. VNS

Basic signs and symptoms of CONDITIONS OF THE MOUTH

List common management and implement appropriate nursing actions for each

Cold sores are painful sores that are red and crusted on your patient’s lip or on the outer edges of lips. Cold sores are caused by a herpes simplex virus. Explain to patient that cold sores usually go away on their own. Advise to use analgesics, such as acetaminophen, and cold sore medications, such as Acyclovir and Abreva, can help relieve the discomfort.

Canker sores are small open and painful sores that are white or yellowish with a red border on the inner lips or cheek, gums or tongue which are caused by a virus. Explain to patient these sores usually heal on their own. To relieve patient discomfort, advise to rinse with salt water or diluted hydrogen peroxide, or apply an over-the-counter oral gel. Patient may also use an analgesic such as acetaminophen or ibuprofen to relieve pain. Advise to see their doctor if their symptoms don’t improve.

Thrush are creamy white patches on the tongue, inner cheek or gums that are painful when scraped which are caused by a yeast infection. Explain to patient this condition usually goes away on its own. Advise patient to eat unsweetened yogurt with live cultures to restore the natural balance of bacteria in their body. They should gargle with salt water and use analgesics, such as acetaminophen, to relieve discomfort. If patient’s symptoms get worse or don’t improve, advise to see their doctor. He or she may prescribe an antifungal medicine, such as Nystatin.

Leukoplakia are painless white or gray sores that may have a hard, raised coating on the tongue, the inside of the cheeks, or gums. This condition is common in smokers. Advise patient to see their doctor. Patient should stop smoking or using other tobacco products to help prevent oral cancers. Advise to see their dentist if sharp or rough teeth or dental work are causing irritation.

References:

http://www.nlm.nih.gov/medlineplus/mouthdisorders.html

http://familydoctor.org/online/famdocen/home/tools/symptom/509.printerview.html

Brandee – SVN

Common disorders of the SALIVARY GLANDS and usual management

Salivary glands may become obstructed. Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed. Sialolithiasis is a condition where tiny salivary stones form in the glands. The stones, called sialoliths, are made of calcium. Some stones do not cause any symptoms, but some block the ducts. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands. If untreated for a long time, the glands may become abscessed. Another possible cause of obstruction could be that the duct system of the major salivary glands, which connects the glands to the mouth, may be abnormal. These ducts can develop small constrictions, which decrease the salivary flow, leading to infection and obstructive symptoms.

Another common disorder of the salivary glands is infection. The most common salivary gland infection in children is mumps. Mumps, a viral infection, involves the parotid glands. Mumps occurs most often in children who have not been immunized, but may also occur in adulthood. Infections also occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria. Sialadenitis is a painful infection of a salivary gland. Staphylococcus, streptococcus, Haemophilus influenzae or anaerobic bacteria are usually the cause. The condition is common with elderly adults who have salivary gland stones, but infants can also develop sialadenitis during the first few weeks of life. Sialadenitis can become a severe infection if not treated properly.

Tumors are also a common disorder of the salivary glands. Most salivary tumors are benign. The parotid is the most common gland for salivary tumors to grow. Pleomorphic adenomas are the most common parotid tumor. It grows slowly and is benign.

A pleomorphic adenoma begins as a painless lump at the back of the jaw, just below the earlobe. These are more common in women.

Benign pleomorphic adenomas can also grow in the submandibular gland and minor salivary glands, but less often than in the parotid. Warthin’s tumor is the second most common benign tumor of the parotid gland.

It is more common in older men and can grow on both sides of the face. Cancerous (malignant) tumors are rare in the salivary glands and usually occur between ages 50 to 60. Some types grow fast and some are slow-growing.

http://www.entnet.org/HealthInformation/salivaryGlands.cfm

Gastrointestinal Cancers:

Cancer of the Oral Cavity – As cancer cells in the oral cavity increase, the mass may distort a client’s appearance; exert pressure on surrounding tissue, making it difficult to masticate, cause local pain, or produce difficulty swallowing.

NURSING MANAGEMENT:

Maintain a patent airway
Promote adequate fluid and food intake.
Supporting communication that the tumor or treatment may have impaired; substitute written forms is speech is impaired.
Administer prescribed antiemetics.
Promote effective coping and therapeutic grieving at this time
Modify diet according to the client’s ability to chew and swallow.

Cancer of the esophagus – affects men more than women; it is a squamous cell carcinoma, although some tumors are classified as adenocarcinomas. As the cancer advances, the mass occupies space and interferes with swallowing.

NURSING MANAGEMENT:

1. Improve nutrition and stabilize weight; encourage small, frequent meals.

Client needs soft foods or high calorie, high protein semi liquid foods
Elevate head of bed during and after meals to minimize dyspnea.
Adhere to therapeutic regimen.

Cancer of the stomach – is a malignancy characterized by either an enlarged mass or ulcerating lesion that expands or penetrates several tissue layers.

NURSING MANAGEMENT:

Teaching the public especially susceptible ethnic groups or clients with a family history.
Diet modification to reduce the predisposition for this disease; limit high fat foods.
Therapeutic regimen to reduce hydrochloric acid formation.
Liberal fluid intake.

List the nursing responsibilities of clients undergoing radical neck surgery.

Client will have a permanent tracheal stoma; keep stoma clean.
Client has no voice; keep pen and paper on bedside as an alternative way of communication. Call light must be within reach.
Ability to swallow remains; offer liquids to keep client hydrated.
Continue exercises for neck muscles to help increase circulation and hasten recovery of the surgery site.

Nursing implications for clients undergoing intermaxillary fixation:

VII. POSTOPERATIVE CONSIDERATIONS

A. MMF Precautions at Bedside

1. Patient requires instruction as to care and precautions

2. Wire cutters should be carried with patient in case of airway problems (oral swelling, vomiting)

3. Suction at bedside

B. Oral Hygiene

1. Brushing

2. Oral rinses (Cepacol or Peridex)

C. Diet Consult

High-calorie, high-protein full liquids; feeding tube and syringe

V111. FOLLOW-UP

A. Use of dental wax may decrease the lip trauma induced by the arch bars.

B. The arch bars should be removed only after the fractures are healed and stable.

References:

www.lib.uiowa.edu

www.cancer.gov

www.cancer.org

www.nyp.org

Timby, p. 365, 825,839, 844

Cory- SVN

Common Esophageal Disorders:

GERD (gastroesophageal reflux disease): Results from disorders of the lower esophageal sphincter where stomach acid enters the esophagus, damaging the esophageal lining and causing chronic heartburn, pain or regurgitation.

Esophageal Dysphagia:

Difficulty moving food from your mouth into your upper esophagus which results in food to “stick” in the esophagus on its way to the stomach.Circopharyngeal Incoordination: A dysfunction of the upper esophageal sphincter. The sphincter opens incorrectly, increasing the risk of food entering the respiratory system and causing lung disease.

Achalasia: A motor disorder that affects the smooth muscles of the esophagus, causing dysphagia and relaxation of the lower esophageal sphincter, which increases the risk of esophageal damage due to contact with stomach contents.

Diverticula: Abnormal esophageal pockets. Food may become trapped in diverticula, increasing the risk of esophageal infection. Food trapped in diverticula may also be regurgitated when affected individuals lie down.

Esophagus Cancer: A malignant tumor of the esophagus. It often begins in the lower third of the esophagus.

What is a Hiatal Hernia?

A hiatal hernia also known as diaphragmatic hernia is an anatomical abnormality in which a part of the stomach protrudes through the diaphragm and up into the lower portion of the thorax

There are two types of hiatal hernias:

1) Axial or sliding: The junction of the stomach and esophagus and part of the stomach slide in and out through the weakened portion of the diaphragm.

2) Paraesophageal: The fundus is displaced upward, with greater curvature of the stomach going through the diaphragm next to the gastroesophageal junction.

Treatment:

A combination of medications and lifestyle changes such as weight loss and exercise may be the treatment for minor cases. Patients who do not respond to a rigid medical regimen are treated surgically by stretching the narrowed esophagus endoscopically or by restoring the stomach to its proper position and repairing the diaphragmatic defect.

Nursing Responsibility:

- Intubation for gastric decompression to prevent stomach distention and avoid pressure on the surgical site.

- Encourage patient to eat frequent, small, well-balanced meals.

- Instruct patient to eat slowly and to chew food thoroughly.

- Tell patient to avoid very hot or cold fluids or spicy foods.

- Record daily weight (particularly in the morning before breakfast).

- Instruct patient to avoid alcohol or tobacco products.

- Inform client to remain upright for at least 2 hours after meals.

- Discourage patient from eating 2-3 hours before bedtime.

- Tell patient to avoid activities that may involve the Valsalva maneuver

(e.g., lifting heavy objects, straining for bowel movement).

- Instruct patient to take medications as prescribed.

- Keep surgical site clean and dry.

- Provide patient comfort.

References:

www.healthlink.mcw.edu

www.nlm.nih.gov

www.cancer.gov

Book: Introductory Medical-Surgical Nursing By: Barbara K. Timby and Nancy E. Smith

*** S. L. SVN