Chapter 55 Care of Patients with Stomach Disorders

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Chapter 55 Care of Patients with Stomach Disorders From Monahan, F. D. , Neighbors,

Chapter 55 Care of Patients with Stomach Disorders From Monahan, F. D. , Neighbors, M. , Sands, J. K. , Marek, J. F. , & Green, C. J. (2007). Phipps’ Medical-Surgical Nursing: Health and Illness Perspectives, 8 th Ed. St. Louis: Mosby. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Learning Objectives Develop a teaching plan for patients about complementary and alternative therapies to

Learning Objectives Develop a teaching plan for patients about complementary and alternative therapies to address gastritis and peptic ulcer disease (PUD) Identify the need for end-of-life care for patients with advanced gastric cancer Describe the purpose and adverse effects of drug therapy for gastritis and PUD Prioritize evidence based interventions for patients with GI bleeding 2 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2

Introduction What are the primary areas of concern for the patient with any stomach

Introduction What are the primary areas of concern for the patient with any stomach disorder? Major stomach disorders Ø Ø Gastritis Peptic ulcer disease • • • Ø Gastric Duodenal Stress Gastric cancer 3 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3

Ulcer Formation 4 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint

Ulcer Formation 4 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4

Peptic Ulcers 5 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint

Peptic Ulcers 5 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5

Benign Gastric Ulcer 6 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an

Benign Gastric Ulcer 6 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6

Duodenitis 7 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of

Duodenitis 7 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7

Duodenal Ulceration 8 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint

Duodenal Ulceration 8 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8

Vagotomy 9 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of

Vagotomy 9 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9

Gastrectomy 10 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of

Gastrectomy 10 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10

A patient in the ED has been experiencing upper abdominal pain after meals for

A patient in the ED has been experiencing upper abdominal pain after meals for the past 2 months. She also notices that when she takes a nap or sleeps at night, she has pain. Eating seems to decrease the pain. She has been taking OTC antacids with some relief. The nurse understands that which assessment factor places the patient at risk for peptic ulcer disease? A. B. C. D. GERD 4 years ago Weight loss of 35 pounds Use of NSAIDs to control arthritis pain Use of prednisone (Deltasone) for inflammation 11 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11

(Cont. ) Which diagnostic results support the diagnosis of peptic ulcer disease (PUD)? (Select

(Cont. ) Which diagnostic results support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply. ) A. B. C. D. E. Low hemoglobin (Hgb) Low white blood cell (WBC) level Low hematocrit (Hct) Positive for H. pylori bacteria Low potassium of 3. 4 m. Eq/L 12 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12

(Cont. ) An EGD confirms that the patient has PUD. Three hours later, the

(Cont. ) An EGD confirms that the patient has PUD. Three hours later, the patient is admitted to the medical unit for workup and further testing. On admission the patient reports midline epigastric tenderness and indigestion (dyspepsia). The patient is prescribed triple therapy. Which drugs will the nurse expect to be prescribed for the patient at this time? A. B. C. D. Proton pump inhibitor (PPI) and two antibiotics Antibiotic and two PPIs Histamine antagonist, antacid, and PPI Antacid, PPI, and prostaglandin analogue Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 13

(Cont. ) Which patient statement would cause the nurse to suspect that she may

(Cont. ) Which patient statement would cause the nurse to suspect that she may have Zollinger-Ellison syndrome (ZES)? A. “I can’t lie flat for awhile after I’ve eaten. ” B. “I feel much better after taking Zantac (ranitidine). ” C. “Occasionally I have pain in my left lower quadrant. ” D. “The stomach pain hurts, but the foul-smelling diarrhea is worse. ” 14 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14

(Cont. ) As the patient prepares for discharge, the nurse provides education about behaviors

(Cont. ) As the patient prepares for discharge, the nurse provides education about behaviors that reduce symptoms and aggravate peptic ulcers. Which teaching does the nurse provide? (Select all that apply. ) A. B. C. D. E. Sit upright 30 to 60 minutes after meals. Spices should be added to food to enhance flavor. Extreme vomiting should be reported to your physician. H. pylori can be a concern in patients with peptic ulcers. The goal of initial intervention is to control symptoms and prevent further complications. 15 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15

Chapter 55 Audience Response System Questions Copyright © 2016, 2013, 2010, 2006, 2002 by

Chapter 55 Audience Response System Questions Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 16

Question 1 What is the approximate annual mortality rate associated with peptic ulcer disease

Question 1 What is the approximate annual mortality rate associated with peptic ulcer disease (PUD) in the United States? A. B. C. D. 700 deaths 1500 deaths 3000 deaths 4500 deaths 17 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17

Question 2 A 64 -year-old patient with a history of arthritis and hypertension is

Question 2 A 64 -year-old patient with a history of arthritis and hypertension is admitted with progressive epigastric cramping, dyspepsia, nausea, and dark sticky stools for 2 days. Which order should the nurse question? A. B. C. D. Guaiac stool sample 2 Stool sample for bacterial testing IV fluids, normal saline at 125 ml/hr Naproxen (Naprosyn) 500 mg twice daily 18 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18

Question 3 What is the nursing priority in the management of a patient with

Question 3 What is the nursing priority in the management of a patient with an active upper GI bleed? A. B. C. D. Obtain vital signs. Notify the physician. Apply oxygen by nasal cannula. Type and cross match the patient for blood products. 19 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19