GI I

• Stomatitis


  inflammation/infection of mouth
• cause of Stomatitis 


  irritation(trauma, dentures, tobacco/etoh,chemo)

  poor nutrition-B complex

  poor oral care

  bacteria

  stress

  yeast (thrush, candidiasis)

  kidney,liver blood issue
• Stomatitis complication

  anorexia
• Stomatitis Dx


  pain

  poor appetite

  redness

  sweling

  lesions

  secretions in oral cavity
• Stomatitis TX


  gentle oral care

  suction on standby

  soft,bland food ( no tabcoo,ETOH,spicy food)

  Swish and swallow

  ontments

  solutions

  lozenges

  Lidocaine

  antifungal/antibacterial
• Oral Cancer


  most life threatening disorder affecting mouth

  Squamous cell-flat scaly epithelial cells

  Basal cell-deep level dermis (lip)
• causes of Oral Cancer


  Chronic irritation

  sun/wind

  smoking/tobacco/ETOH

  Poor nutrition

  B deficiency=beefy red tongue
• Oral Cancer symptoms 


  Pain in tongue/ear

  loose teeth

  difficulty swallowing/anorexia

  decreased appetite/altered taste

  hemoptysis

  Leukoplakia (white, hairy, pre malignant)

  lymph nodes swollen (esp in neck)
• Oral Cancer-Dx


  CT

  MRI (mets in neck common)

  biopsy

  surgery (resection)

  grafting

  radiation/chemo
• Oral cancer care

  oral care - extreme caution

  Airway (mouth, bleeding,swelling)

  Communication (be patient, call light)

  Pain

  TPN

  infection control

  body image issue

  ineffective tissue perfusion (esp at graft site)
• Esophageal Cancer

  Rare

  lethal

  common mid to lower esophagus

  extensive lymph and blood supply (extensive mets)

  High risk bleeding!
• cause of Esophageal cancer

  no known cause but predisposing factors

  • Spicy food
  • poor nutrition
  • poor oral hygiene
  • chronic trauma
  • chronic irritation (hiatal hernia, alcoholism,smoker)
• esophageal cancer complications

  liver lung mets

  hemorrhage

  perforation

  obstruction

  fistula with trachea (aspiration)
• esophageal cancer sympt

  1st

  • substernal burning
  • substernal pain w/ swallowing
  • weight loss
  • regurgitation

  later symptom

  • Progressive dysphagia (prim symptom)

  obstruction is late sign!
• Esophageal cancer Dx

  Biopsy

  esophagoscopy

  barium swallow
• GI nursing alert

  No repositioning or irrigation of NG tube after Gastric/ esophageal surgery

  this will threaten suture line
• Esophageal cancer Tx

  G/J tube for feeding

  TPN

  radiation/chemo

  palliative techniques (enlarge opeing for swallowing)

  • dilation
  • stents
  • radiation
  • laster tx w/ endoscope
• Esophagectomy

  Removal of all/part of esophagus

  replaced with Dacron graft
• EsophagogastROSTomy

  replace esophagus with part of the stomach
• EsophagogastRECtomy

  removal of cancer in esophagus

  removes surrounding lymph nodes

  removes top portion of stomach
• EsophagoENTEROstomy

  replace the esophagus with segment of colon
• Esophageal cancer care

  Pain

  nutrition (teach pt to tilt slightly forward ti help food go down)

  increase kcal,PRO

  may need adjust consistency

  Liquid meds

  mointir weights/infection/meds/hemorrhage/fistulas

  monitor lab work (albumin and prealbumin)

  airway

  Watch for aspiration
• TPN risk

  infection

  blood sugar

  dehydration

  site care (central line)

  Never run anything with it except lipids (lower than TPN)
• Food poisoning-Staph Aureus

  onset: 1-6hr

  duration 24hr

  Dirty Hands!
• FP-Staph Aureus symptoms

  N/V

  diarrhea

  cramps

  weakness
• FP-Staph Aureus Tx

  bedrest

  reestablish F&E balace
• Food poisoning-Salmonella

  onset: 10-12 hr

  duration-2-3 days

  inadequately cooked meats
• FP-Salmonella symptoms


  n/v

  diarrhea

  chills

  fever
• FP- Clostridium Botulinum

  onset 18-36 hr

  duration months

  Fatal

  improperly processed food

  honey

  dust
• Fp-CB sympt

  neuro NOT GI

  weakness of voluntary muscles

  decreased LOC

  muscle weakness

  dysphagia

  abnormal pupil response

  descending paralysis
• FP-CB Tx

  antitoxin

  IV

  Tube feeding

  tracheostomy
• N/V complication

  post op dehiscence

  aspiration

  metabolic alkalosis

  nutritional deficit

  F&E imbalance
• N/V Tx

  restrict oral fluid until stops

  antiemetics

  Iv fluids

  Ng tube

  TPN (severe)
• GI bleeding

  not disease but symptom
• Upper GI bleed

  from mouth to outflow of stomach

  accounts for 400,00 hospital cases each year
• lower GI bleed

  from outflow of stomach to anus

  can be so small only detected by lab test

  so large is can cause shock
• causes of GI bleed

  Anticoag

  ulcers

  tumors

  trauma

  inflammation
• GI bleed care

  Iv fluids ( life line, may need two)

  Lavage

  blood administration

  H2 antagonist(pecid/zantac)

  PPIs (priosec,protonix)

  scope

  surgery

  monitor for shock
• Hiatal Hernia

  Frequently cause of GERD

  lower esophagus and stomach protrudes into thoracic cavity
• Hiatal hernia complication

  ulcers

  bleeding

  aspiration