Nur 4206 The Patient with Digestive Disorders,By Linda Self,GI Changes associated with Aging,Atrophy of the gastric mucosa resulting in hypochlorhydria Decreased peristalsis which results in constipation Calcification of pancreatic vessels occurs with a decrease in lipase production Diminished size of liver with resultant decreased enzyme activity. Decreased enzyme activity depresses drug metabolism which leads to an accumulation of drugs.,Lab Assessment of the GI System,CBC Clotting factors Serum electrolytes Serum enzymes such as AST (aspartate aminotransferase) and ALT (alanine aminotransferase) Amylase and lipase Bilirubinprimary pigment in bile which is normally conjugated and excreted by the liver. NH3used to rebuild amino aacids or is converted to urea for excretion. Elevations are seen in conditions that cause hepatocellular injury such as cirrhosis. Tumor markersCA 19-9 and CEA are evaluated to monitor the success of cancer therapy and to assess for the recurrence of cancer in the GI tract.,Diagnostic Testing,EGD ERCP (endoscopic retrograde cholangiopancreatography) Colonoscopy Gastric analysisNG, may give Histalog sc. Fifteen minute intervals samples are taken for one hour. Depressed levels of gastric secretion suggest the presence of gastric carcinoma. Increased levels indicate Zollinger-Ellison syndrome and duodenal ulcers.,Candidiasis,Fungal infection resulting from overgrowth of the Candida albicans, a normal flora. Seen in individuals receiving antibiotics, chemotherapy, steroids, radiation or antirejection medication. Also common among HIV-infected individuals,Interventions,Anti-infective agents such as abx or antifungals. Tetracycline syrup, chlorhexidine, acyclovir Analgesics such as lidocaine viscous, benadryl elixir, opioids Meticulous oral hygiene using soft toothbrush, frequent care, rinsing with H2O2, warm saline, baking soda or a combination Select soft, bland and nonacidic foods,Malignant Tumors,90% are Squamous cell Risk factors are increasing age, tobacco use, and alcohol ingestion Poor dietary habits, poor oral hygiene and infection with HPV increase the likelihood Common signs and symptoms incude unusual lumps or thickening of the buccal mucosa, sores that do not heal Seen more commonly in the 6th and 7th decades of life African Americans have a higher rate of oral cancer,Oral cancers,Basal cells occur primarily on the lip Do not tend to metastasize but can aggressively involve the skin of the face Biopsy is the definitive method for diagnosis of oral cancers An aqueous solution of toluidine blue can be applied to oral lesions to screen for malignancy,Treatment,Surgical excisionlocal excision, glossectomy, partial mandibulectomy, commando procedure which includes excision of a segment of the mandible in conjunction with a radical neck dissection Radiation Chemotherapy Combination,Role of the Nurse. Helps to:,Maintain patent oral airway through removal of oral secretions Maintain nutritional status by eating foods that are well tolerated, nutritious and provide adequate calories Maintain integrity of the oral mucous membrane Communicates needs to family, friends and personnel Maintain comfort,Patients with Esophageal Problems,Gastroesophageal Reflux Disease Is the backward flow of gastrointestinal contents into the esophagus Results in reflex esophagitis Severity of s/s is not proportional to the extent of reflux Inflammation and erosions result in substitution of columnar epithelium (Barretts epithelium). This tissue is considered premalignant,Factors contributing to decreased lower esophageal sphincter pressure,Fatty foods Caffeinated beverages Chocolate Nicotine Calcium channel blockers Nitrates Peppermint Alcohol Anticholinergic drugs High levels of estrogen and progesterone NG tube placement,GERD,Affects 35-45% of population More common in those over 45 years of age Probably underestimated Higher in females More often Caucasians Severe esophagitis is more prevalent in male Caucasians,Management,Treated by diet, medication, and lifestyle modifications Dietrestrict spicy and acidic foods; eat small meals, avoid carbonated beverages, avoid eating before bedtime, avoid or reduce fatty foods Lifestyle changeselevate HOB, sleep in left lateral decubitus position, smoking cessation, avoidance of alcohol, weight reduction, remain upright for 1-2 hours after eating, avoid heavy lifting, straining and working in a bent-over position,Drug Therapy in GERD,Antacids except in renal failure Histamine Receptor AntagonistsZantac, Axid, and Tagamet. Tagamet is shorter-acting and has multiple drug interactions (warfarin, theophylline, phenytoin, nifedipine, erythromycin, others) Proton Pump InhibitorsPrilosec, Prevacid, Aciphex. Reserved for severe GERD that is refractory to the Histamine receptor blockers. These agents can decrease gastric acid by 90%. Sometimes have to go to Bid dosing for 4-8 weeks.,Drug Therapy in GERD,Prokinetic drugs such as Reglan which increase gastric emptyi