1
Q
what are some education tips we can tell patients to maintain a HEALTHY ORAL CAVITY?
A
- always eating a well-balanced diet + proper hydration
- managing stress levels
- weekly self-examinations of the mouth/assess for any changes
- **dentures; should be in good shape/fit
- brushing and flossing daily
- avoiding ALCOHOL-BASED mouthwash
- avoiding drugs that INCREASE inflammation
- regular dentist visits
2
Q
pathophysio of GERD
A
considered to the BACKWARD FLOW of stomach contents into the esophagus
- very common upper GI disorder in the USA
3
Q
what are some FOODS to avoid when a patient has GERD?
A
avoiding;
- fried foods
- spicy or fatty foods
- citric foods
- caffeine
- large meals
- processed/salty foods
better alternatives;
- increased grains, fruits and veggies
**sitting upright for ONE HOUR after eating
**eating more smaller and frequent meals
4
Q
what are the typical SIGNS & SYMPTOMS of GERD?
A
- heartburn
- morning hoarseness
- coughing or wheezing at night
- belching
- chest discomfort
- regurgitation
- dysphagia
- dyspepsia; indigestion–discomfort or pain in the upper abdomen
5
Q
diagnostic assessments for GERD
A
- upper endoscopy (EGD)
- ambulatory esophag. pH monitoring
6
Q
what are potential problems for GERD?
A
- potential for compromised nutrition status
- acute pain; reflux of gastric contents
7
Q
important management tips for GERD
A
- appropriate dietary selections
- adhere to proper drug therapies
- going to local support groups
- talking to a RDN; registered dietitian nutritionist
8
Q
untreated GERD complications
A
- esophagitis; inflammation of ESOPHAGUS
- strictures; increased SCAR TISSUE
- barrett’s esophagus / barrett epithelium; damage to the esophageal lining - cellular changes
- esophageal cancer
- respiratory problems; chronic coughing or pneumonia
- dental erosion; wearing away of tooth enamel
9
Q
gastritis
A
- inflammation of the gastric mucosa
- can be erosive vs. nonerosive / acute vs. chronic
causes; - H. pylori
- long-term usage of NSAIDs
10
Q
gastritis health promotion/prevention
A
- having a BALANCED DIET
- regular exercise
- reducing STRESS
- limits on /spicy/fatty/alcohol/tobacco»_space; gastric distress
11
Q
peptic ulcer disease
A
- mucosal defenses are IMPAIRED; the epithelium is NOT PROTECTED from the effects of acid or pepsin
- also caused by H. pylori
- causes creation of DUODENAL, GASTRIC, and STRESS ULCERS
12
Q
what are the complications of gastric ulcers?
A
- HEMORRHAGES (most serious complication)
- perforation
[ulcer erodes; stomach contents leak into the abdominal cavity] - pyloric obstruction
- intractable disease
13
Q
signs & symptoms of GI bleed
A
- weak radial pulse
- increased heart rate
- decreased blood pressure
- decreased urinary output
- hematemesis
- dizziness
**remember GI bleeding is a LIFE-THREATENING EMERGENCY!
14
Q
PUD signs & symptoms
A
- epigastric tenderness/pain
- rigid + board-like abdomen + rebound tenderness»_space; s/s of PERITONITIS **caused due to possible perforation of ulcer
15
Q
diagnostic assessments for PUD
A
- H. pylori testing
- Hb & Hct & occult blood testing
- EGD; Esophagogastroduodenoscopy
[scope that goes through the mouth > helps to look at the stomach & duodenum] - nuclear medicine scan
16
Q
drug/nutrition therapies for PUD
A
- PPIS, H2, antacids
- antibiotics for H. pylori infections
- increased fiber diet
- fruits (non-acidic) **melons, pears, apples
- probiotics
- lean proteins **tofu, chicken, fish
17
Q
stoma
A
type of opening for waste elimination often seen in;
- colostomies
- ileostomies
- urostomies
18
Q
stoma - healthy
A
- bright red/pink
[good blood circulation] - moist & shiny
- round/oval shape
- soft & smooth
- consistent output & normal consistency
[solid form - colostomy; liquid form - ileostomy] - intact surrounding skin
- no pain
19
Q
stoma - unhealthy
A
- pale/bluish color
[poor blood circulation] - dry/excessive moisture/discharge
[lack of circulation/necrosis/infection] - retraction/protrusion
- hard or firm
- no output/excessive output/discharge (purlent)
- blistered/irritated/red surrounding skin
- pain around area
20
Q
what happens if a patient is having difficulty accepting/managing new colostomy?
A
- giving the patient the opportunity to reflect on their feelings
- asking what difficulties they are having/active listening
- validating patients’ feelings/ telling them they’re not alone
- offering suggestions ex. support groups, detailed descriptions/teaching on how to manage leaks or stoma hygiene
21
Q
crohn’s disease signs & symptoms
A
- unintentional weight loss
- different stool characteristics
- low-grade fevers
- abd. pain (RLQ)
- diarrhea
- tachycardia
- anemia**
- distention
- masses
- visible peristalsis
22
Q
acute pancreatitis signs & symptoms
A
- severe abd. pain (mid-epigastric/LUQ)
- jaundice
- cullen’s sign **blue-gray discoloration **ecchymosis around periumbilical area
- bleeding *pancreatic ecchymosis
- hypoactive bowel sounds
- increased HR + temp/decreased BP
- tender abdomen
23
Q
cholecystitis
A
obstruction & inflammation of the gallbladder ; often due to presence of cholelithiasis/gallstones
24
Q
signs & symptoms of cholecystitis
A
- abdominal pain (RUQ) & radiating pain towards right shoulder/scapula
- N & V
- bloating
- jaundice
- loss of appetite
25
s/s of malnutrition in OLDER ADULTS
- hx of chronic illnesses or conditions
- constipation
- decreased appetite
- dry mouth
- a ''failure to thrive"
- impaired eyesight
- drugs
- dentition *development * cutting of teeth
- weight loss
- dysphagia/pain with chewing
[considered to be a common issue for older adults--can cause *undernutrition, *dehydration, *aspiration pneumonia]
26
s/s of malnourishment
- changes in appetite; diarrhea/constipation
- significant weight changes
- muscle wasting
- fatigue/weakness
- delayed wound healing/frequent infections
- dry skin/pale skin
- swollen gums/mouth sores
- difficulty concentrating
27
psychosocial risk factors for undernutrition
- ability/inability for preparation of meals **fatigue/memory/fxn. decline
- decreased enjoyment in food
- depression
- low income
- loneliness
- proximity of sources to nutrient-dense foods
- transportation access
28
typical tubes used for total enteral nutrtion
- nasogastric tube (NG) *in the stomach
- nasojejunal tube (NJT) **used less often -- in the small intestines
29
what are some complications of TEN (total enteral complication) and the tubes?
- **always make sure the patient is safe! always the priority
- clogging of the tube/obstruction
- tube misplacement or dislodgement
- abdominal distention & N/V
- fluid & electrolyte imbalances
30
precautions before using G or J tube
- assessing skin around site **often is the PRIORITY ASSESSMENT BEFORE USE!!
- if the tube CANNOT BE MOVED -- notify HCP; potential retention disk can have been embedded in the tissue
- always covering site with STERILE dressings * changing dressing at least once a day
31
what happens if our tubes are clogged?
- can try flushing with around 30 mL of water / gentle pressure
- can try prevention of clogs by ordering/asking for alternatives - liquid meds
32
nutrition assessment overview
- asking the patient of their nutrition hx (preferences, specific diets)
- food & fluid I & Os
- their access to appropriate sources of nutrition
- lab data
- food-drug interactions
- their mental feelings about food/psychosocial assessment
- health history
33
what is obstructive sleep apnea (OSA)?
- have PARTIAL or COMPLETE airway collapse occur due to UPPER AIRWAY OBSTRUCTION of the SOFT PALATE or TONGUE
- have interrupted ventilation & sleep
- hypoxia occurs > decreased gas exchange > increases Co2 + decreases pH
34
risk factors for OSA
- obesity
- large uvula
- shorter neck
- smoking or alcohol habits
- larger tonsils or adenoids
- oropharyngeal edema
- persistent daytime sleepiness
- snoring
- hx of GERD or HTN
- family hx of OSA
35
if OSA is left untreated, what can occur?
patients have HIGHER RISKS for heart dz, strokes, HTN, DM2, dementia
36
osa interventions/treatments
- want to reduce obstruction as much as possible!
- sleep position changes/position fixing changes
- weight loss
- CPAP; (continuous positive airway pressure) .
- drug therapies; stimulants for daytime sleepiness & resp. stimulants for apnea + topical nasal steroids
- surgeries; UPPP (Uvulopalatopharyngoplasty)** most common
37
ppd skin test
skin test used to indicate EXPOSURE to TB or a dormant disease
- does NOT indicate if there is an ACTIVE dz of TB
38
how to prevent INFLUENZA and COVID-19?
- proper and consistent vaccinations
- HANDWASHING
- very transmissible; person-to-person contact - wearing PPE/masks
- isolation at home
- vaccination; recommended 3 months after recovery [COVID-19]
39
types of pneumonia
- CAP; community
- HAP; hospital
- VAP; ventilator
40
best way to prevent VAP
- ORAL CARE
- elevation of HOB
- suctioning & tube drainages
- hand hygiene
41
physical assessment of PNA
- assessing general apperance; cyanotic/MM?
- respiratory assessment; RR/pulse ox
- dysrhythmias
- crackles or diminished lung sounds
- vaccination status; hx
42
negative vs positive ppd test
negative
- no swelling/small red area between 0 -4 mm
positive
- raised/firm/swollen induration or bump
- > 5 mm; HIV patients/immunosuppressed
- > 10 mm; healthcare workers/immigrants
43
lab assessments for PNA
- BUN
- CBC
- gram cultures/c&s of sputum
- creatinine
- lactate levels; assessing for muscule damage--higher levels can indicate respiratory depression--can lead to SEPSIS
44
how to treat/manage PNA?
- cessation of smoking
- control of bacterial or viral infection; antibiotics & oxygen therapy
- cough suppression/bronchodilators/iv fluids
45
what can also be caused by PNA/need to look out for?
- want to prevent SEPSIS
severe sepsis/septic shock;
- elevated RR/HR
- decreased spo2
- HYPOTENSION
- positive shock index (HR/SBP>1)
- elevated or low temperature
- altered mentation
- signs of compromised end-organ perfusion (eg, cool or mottled skin, decreased capillary refill, decreased urine output, ileus)
- laboratory results showing organ system dysfunction
46
what is TB?
- respiratory dz caused by *Mycobacterium tuberculosis*
- transmitted via aerosolization
- can have secondary TB--reactivation of the dz from previous infected person
47
s/s of TB
- progressive fatigue
- lethargy
- nausea/anorexia/weight loss
- irregular menses
- low-grade fevers
- coughing; mucopurulent sputum or blood streaks
- dull aching chest pain
48
education of TB
- want to improve nutrition
- educate patient of TB route of infection; coughing or sneezing
- treatment and medication adherence;
traditional regimen is around > 6 months; have [typical intensive phase for 2 months/continuation phase for at least 4 months]
- monitoring of regular checkups & support
49
meds for TB
- medications; ISONIAZID, RIFAMPIN, PYRAZINAMIDE, & ETHAMBUTOL
50
ppe/precautions for TB
AIRBORNE PRECAUTIONS;
- private room w/ negative pressure
- N95 mask/proper fit testing
- proper gloving/gown/hand hygiene
- proper ventilation & disinfectants
NURS 220
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