Gastroesophageal reflux disease Essays

Gastroesophageal reflux disease Essays Gastroesophageal reflux disease Essay Gastroesophageal reflux disease Essay This essay will explore two case studies based around orthopedic and gastrointestinal nursing. Claire is a 61 year old female who has been admitted with a Tip/Fib fracture of her right leg and a left Coles fracture, with a past history of osteoarthritis and recently osteoporosis. Justine is a 33 year old male admitted with Castro esophageal reflux disease plus or minus peptic ulcer disease prepping for a gastropod and oscilloscope. Clinical presentations and nursing management as well as disease processes will be made evident throughout. (a) Arthritis is the common word used to describe inflammation of joints in the unman body. Osteoarthritis is the most common form of this, known for creating wear and tear. The physiology affects all joint tissues and in particularly, cartilage, causing structural and biochemical modifications before finally destroying. Most commonly affects weight bearing joints such as hips, knees, and spine but can affect others if previous injury or excessive st ress has occurred. (Possess et al. 2014) Osteoporosis is a complex condition in which the skeletal systems bone strength is compromised leading to increased fragility and bone fractures. This occurs when bones lose minerals quicker than the body can replace them, for example, calcium. Therefore bone density and strength decreases, holes form and bones are susceptible to breakage. (Becker, 2008) (b) Examples of modifiable risk factors include dietary intake involving varied fruit and vegetables for example a calcium rich diet including dairy products or spinach. Other methods of obtaining sufficient calcium include supplements in the form of tablets. Increasing the level of physical activity such as weight bearing exercises and activities to strengthen bones is very important and reduces the risk of development or disease progression. Cache, 201 2) Non-modifiable risk factors for osteoporosis include advanced age in both men and women with an increased risk factor associated with genetics and family history. All ethnic groups are effected but in particularly European and Asian ancestries are predisposed. People who have had a bone fracture are twice a likely to have another fracture when compared with someone of the same age and sex. Cache, 2012) c) Clinical manifestations in relation to Claimers diagnosis of Osteoarthritis in both her hip and knees would have most commonly included pain and stiffness of the joints. Muscle weakness especially in the knee on ambulation as well as swelling of the joints may be present. Reduced range of motion and creaking of the joints may have been noted on further assessment. (Steinberg et al. , 2014) d) Osteoporosis is often not manifested until a fracture occurs however, Claire was diagnosed before her current fractures presented. : She may have accessed health services recently with a minor fracture and ongoing pain or possibly reduction in her height. Back pain is a classic symptom possibly affecting Claire, fractures also occur more easily when osteoporosis is present Becker, 2008) e) The post-operative care of a Coles fracture includes elevating the wrist above the elbow and encouraging Claire to make passive movements with her fingers and thumb regularly. This reduces edema and promotes venous return as well as rotating the shoulder to prevent stiffness and contractors. Apply ice regularly for the first 24 hours to reduce pain and swelling and commence half hourly neuromuscular observations for the first four hours post operatively to monitor for any signs of post-operative complications such as pain, numbness and poor capillary return. (Brown and Edwards, 012) Claimers Tip/Fib fracture with external fixation will have half hourly neuromuscular observations for the first four hours to monitor for post pop complications. These may include a fat embolism, severe pain, redness and swelling or numbness for example. Monitor external fixation sites for signs of infection and compartment syndrome whilst assessing neuromuscular observations or if Claire is complaining of pain and pressure in her leg. (Brown and Edwards, 201 2) f) Immediately assess neuromuscular observations to see if the pain is associated with numbness or tingling, capillary return and the amount of sieve movement present when compared with previous assessments. Administer pain relief, possibly OMG of Undone orally or 2. OMG of Morphine subcutaneously dependent on PR medications charted and allergy status. Notify doctor to review quickly as post pop complications such as acute carpal tunnel syndrome or complex regional pain syndrome may be occurring. Monitor general observations to ensure all aspects of the patients current State are noted. Median nerve compression may also be present due to the surgery that has been completed approximately eight hours earlier. (Alter, 008) g) Acute carpal tunnel syndrome occurs when the median nerve gets squeezed inside of the carpal tunnel located in the wrist, also known as nerve entrapment. The carpal tunnel is a channel formed by the wrist bones arranged in a circle like shape. Nerves and blood vessels pass through the channel from the wrist to the hand. Anything that effects pressure inside the carpal tunnel can cause compression of the median nerve, in turn leading to carpal tunnel syndrome. Symptoms include pain, numbness and tingling known as median enumerator. Open decompression of the carpal tunnel is he treatment used in an acute carpal tunnel syndrome case. (Never and Alias, 201 2) Complex regional pain syndrome, also known as CROPS is a chronic pain condition which Often affects one Of the limbs, usually after an injury or trauma especially triggered by a fracture. CROPS is thought to be triggered by injury to, or a glitch in the peripheral and central nervous systems either occurring when damaged by the fracture and after surgery. CROPS is described as sustained or extreme pain with symptoms occurring from mild to dramatic changes in skin color, temperature or swelling in the area affected. (Harden et al. 2013) 2 (a) Castro-esophageal reflux disease also known as GORED, is a disorder whereby the reflux of gastric contents is forced into the esophagi causing complications and symptoms reducing quality of life. Usually caused by changes in the barricade between the stomach and the esophagi. This includes abnormal relaxation of the lower esophageal sphincter, which would normally hold the top of the stomach closed. Therefore forcing gastric juices upwards and can also be caused by a withal hernia. Common symptoms of GORED include persistent heartburn and acid regurgitation which may be relieved by antacid medication. Pain in the chest may also occur along with hoarseness in speaking and difficulty swallowing. Morocco, 2008) A peptic ulcer is known as a break or an ulceration in the protective mucosa lining of the stomach or duodenum. Factors that cause peptic ulcers include, gastric juices and medications listed as Nan-steroidal anti- inflammatory drugs or Englands which aggravate the mucosa lining. Symptoms related to this disease include epigenetic discomfort, loss of appetite and weight loss. An ulcer can cause structural changes such as penetration through the muscular wall of the stomac h or duodenum into an adjacent organ for example the pancreas or liver. Perforation can also occur most commonly on the surface of the duodenum creating an opening in the free space of the abdominal cavity. (Rumanians and Salinas, 2007) b) Epigenetic pain and reflux are a common clinical manifestation which Justine has been experiencing in relation to suffering with recurrent bouts of GORED more common than usual. He is relieved with the use of over the counter antacids. Intolerance to fatty foods may have recently occurred as Justine regularly consumes this as well as having returned from overseas ill. Stress ay be playing a role due to Justine obtaining a new promotion with increased stress in his life. (Rumanians and Salinas, 2007) c) The common causative agent of peptic ulcer disease is the continual use of non-steroidal anti-inflammatory drugs also known as Englands. Especially when taken on an empty stomach can cause ulceration. Englands are a class of analgesic medication used to reduce pain, fever and inflammation and can cause sub mucosa erosion. (Blair and Belt, 2006) Proton pump inhibitors reduce gastric acid secretion by inhibiting certain enzymes called the proton pump in the parietal cells. In simple terms, proton pump inhibitors decrease the production of acids by blocking the specific enzyme in the wall of the stomach which is in charge of producing these acids. The reduction of acid decreases the production Of ulcers and allows any present ulcers in the esophagi, stomach or duodenum to heal effectively. Examples of these drugs include Pantaloon and Comparable relieving ulceration and reflux in peptic ulcer disease. (Tasmania and Havana, 2010) 3 (a) In preparation for a bowel related surgery or oscilloscope, oral bowel preparation will be administered slowly or if not tolerated, a instigators tube ay need to be inserted. The nurse will monitor all input and output on a fluid balance chart, the patient may be nil by mouth or on clear fluids. All stools will need to be visualized in a bedpan until clear, rectal enemas may be ordered by the doctor as a secondary method to clear out faces. The patient will be showered, placed in a gown, measured for compression stockings also known as DEEDS and paper underwear. All theatre paperwork will be filled out in relation to procedure, correct identification labels by two, labeled in red if allergies are present. Baseline observations and weight will be written on anesthetic chart prior to handover to theatre staff. Any pain issues will be managed with analgesia prior to procedure dependent on fasting status and type of procedure and intravenous therapy may be ordered. (Rapier and Houston, 2006) (b) View blood and stool in the toilet and if significant, notify doctor to review patient immediately as this is not a normal occurrence and something sinister is likely to be occurring internally. Justinian back to bed and monitor his vital signs and maintain fluid balance chart. An increased heart rate and low urine output may indicate significant blood loss. Monitor for further uncontrolled rectal bleeding and commence Intravenous therapy (0. % Normal Saline) if ordered by the treating doctor prior to oscilloscope/ gastropod. This will replace any bodily fluids lost through bleeding, stools, urination and sweat. Recommence bowel prep if the doctor requests, so as to be prepared for scopes. (Grapnel, Burbank and Aboard, 2008) c) Half hourly observations of blood pressure, heart rate, temperature and o xygen saturation levels for two hours due to sedation during procedure. Maintain fluid balance chart, measuring all input and output and managing pain if occurring. Monitor for ongoing rectal bleeding, measuring and visually inspecting all stools in a bed pan. Monitor for signs of perforation such as abdominal cramps or distension. Patient is to remain nil by mouth until gag reflex returns, warm saline gargles can be used to relieve sore throat from gastropod. Monitor temperature as a sudden spike becoming febrile can indicate perforation. (Brow and Edwards, 2012) Conclusion: It can be seen throughout this case study the differentiating nursing care and assessment of orthopedic and gastrointestinal patients. Pathologically of disease processes and clinical presentations related to understanding signoras and treatment is evident.