___________________________________________________ Chapter 39 Upper Digestive Tract Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 39.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss some examples of postprocedure
nursing care.
• Discuss stool examination. What patient
education is needed when this test is
ordered?
• Discuss gastrointestinal intubation. What are
some important considerations for successful
tube feedings?
• Discuss the nursing care of a patient
receiving total parenteral nutrition.
• Lead a class discussion based on the
following scenario:
• A 71-year-old woman who underwent
PRACTICE
• Divide the class into groups and assign to
each group a specific diagnostic test or
procedure. Have each group create a plan to
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
type of patient instructions a patient/family
should be provided for a selected number of
diagnostic tests. Ask students to provide
constructive comments on each other’s
posts.
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 39.1
2
DISCUSS
• Discuss age-related changes to the digestive
tract. What factors are involved in changes
POST & COMMENT
• Post the following discussion topic online
and have students comment. Have student
3
DISCUSS
• Discuss the causes and treatment of oral
inflammation and infections of the oral cavity.
• Discuss the causes, medical diagnosis, and
treatment of anorexia.
• Discuss the risk factors and signs and
symptoms of oral cancer. Describe the
PRACTICE
• Divide the class into groups and assign a
digestive disorder to each. Have each group
the classroom for reference.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to prepare a video or social media
discussion devoted to teaching the public
about the signs of oral cancer. Ask students
to provide constructive comments on each
___________________________________________________ Chapter 39 Upper Digestive Tract Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 39.1
4
DISCUSS
• Discuss various ways to improve a patient’s
appetite and relieve nausea.
• Discuss nursing care of the patient with
inflamed oral cavity tissues.
PRACTICE
• Divide the class into groups, and ask the
person playing the role of the nurse to
provide instructions to family members on
assisting a person during meals.
• Divide the class into groups and ask the
person playing the role of the nurse to
provide instructions for a patient who had an
esophageal stent placed.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss how
you would cope with esophageal surgery
which would result in removal of the
Critical Thinking Question
An 84-year-old patient experienced a cerebrovascular accident (CVA) a week ago, and has
been unresponsive since that time. The patient has a nasogastric tube inserted and tube
feedings have been prescribed. The patient’s husband visits very frequently and tells the
nurse, “She has never been able to sleep while propped up like that. Can’t you please lower
the head of the bed?” How can the nurse explain these actions to the husband? What other
measures can the nurse take to prevent aspiration of the tube feedings into the lungs?
Discussion Guidelines: The nurse will need to provide empathy and understanding to the patient’s
Instructor Notes/Student Feedback
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Introduction to Medical-Surgical Nursing, 6th ed.
Textbook Objectives Covered
4. Assist in developing nursing care plans for patients receiving treatment for upper digestive
disorders. (Cont.)
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: medical-surgical staff nurse
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying digestive tract disorders, including:
• Anatomy and physiology of the digestive tract
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
Student Preparation
Assignments 2 hours
3
READ – Textbook (pp. 807-819)
REVIEW
• Figure 39-9: Hiatal hernia (p. 807)
• Figure 39-10: Nissen fundoplication for hiatal hernia repair (p. 808)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 7, 8, 9 (p. 820)
ANSWER – Study Guide
• Part IIF: 5-7, 9, 13, 14 (pp. 250-251)
• Part IIIH: 2, 5, 7-10 (pp. 252–253)
___________________________________________________ Chapter 39 Upper Digestive Tract Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
4
READ – Textbook (p. 815)
REVIEW
• Nursing Care Plan: Patient with a Peptic Ulcer (p. 815)
ANSWER – Study Guide
• Part IIIG: 4 (p. 252)
• Part IIIH: 1, 3, 4, 6 (pp. 252-253)
Lecture Outline 20 minutes
3
Slide 46
Hiatal Hernia
• Pathophysiology
• Protrusion of lower esophagus and stomach up through the diaphragm and into the
chest
• Types of hiatal hernias
• Sliding
• Rolling
• Causes
• Weakness of muscles of the diaphragm in the area where the esophagus and
TALKING POINTS:
• What are possible complications of a hiatal hernia?
• Hiatal hernia develops in about half of all people older than 60 years of age.
Hiatal Hernia (cont.)
• Signs and symptoms
TALKING POINTS:
• Heartburn is a feeling of burning and tightness rising from the lower sternum to the throat.
• What may trigger the symptoms of heartburn?
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Slide 48
Hiatal Hernia (cont.)
• Medical diagnosis
• Barium swallow examination with fluoroscopy
• Esophagoscopy
• Esophageal manometry
• Medical treatment
TALKING POINTS:
• Drug therapy includes antacids and sometimes drugs such as H2-receptor blockers (e.g.,
4
Slide 49
Hiatal Hernia (cont.)
• Assessment
• Document symptoms
• Record factors that trigger symptoms as well as measures that aggravate or relieve
them
Hiatal Hernia (cont.)
• Postoperative care
• Turning, coughing, and deep-breathing
3
Slide 51
GERD
• Backward flow of gastric contents from the stomach into the esophagus
• Pathophysiology
• Abnormalities around the lower esophageal sphincter (LES), gastric or duodenal
TALKING POINTS:
• Acid regurgitation, intermittent dysphagia, and belching are common.
• When are symptoms likely to occur?
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Introduction to Medical-Surgical Nursing, 6th ed.
3,
4
Slide 52
GERD (cont.)
• Medical diagnosis
• Suggested by the signs and symptoms
• Endoscopy, biopsy, gastric analysis, esophageal manometry, 24-hour monitoring of
esophageal pH, and acid perfusion tests
• Medical treatment and nursing care
3
Slide 53
Gastritis
• Pathophysiology
• Inflammation of the lining of the stomach
• Mucosal barrier that normally protects the stomach from autodigestion breaks down
TALKING POINTS:
• Gastritis is commonly classified as acute, chronic type A, and chronic type B.
• What may occur with a lack of intrinsic factor?
Gastritis (cont.)
• Medical diagnosis
• Gastroscopy
Slide 55
Gastritis (cont.)
• Medical treatment
• Oral fluids and foods withheld until the acute symptoms subside; IV fluids
administered
4
Gastritis (cont.)
• Assessment
• Patient’s present illness
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Introduction to Medical-Surgical Nursing, 6th ed.
Gastritis (cont.)
• Interventions
3
Slide 58
Peptic Ulcer
• Pathophysiology
• Loss of tissue from lining of the digestive tract
• Classified as gastric or duodenal
• Causes
TALKING POINTS:
• What substances in the stomach cause injury when there is no mucous barrier?
Peptic Ulcer (cont.)
• Signs and symptoms
TALKING POINTS:
• When does the pain of a peptic ulcer usually occur?
Slide 60
Peptic Ulcer (cont.)
• Medical diagnosis
• Barium swallow examination, gastroscopy, and esophagogastroduodenoscopy
• H. pylori can be detected by antibodies in the blood or stool, and by a breath test
• Medical treatment
TALKING POINTS:
• Drug therapy is intended to relieve symptoms, heal the ulcer, cure H. pylori infections,
and/or prevent recurrence.
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Introduction to Medical-Surgical Nursing, 6th ed.
4
Slide 61
Peptic Ulcer (cont.)
• Nursing care of the patient managed medically
• Assessment
• Pain, including location, aggravating factors, and measures that bring relief;
relationship between pain and food intake
Slide 62
Peptic Ulcer (cont.)
• Nursing care of the patient managed medically
• Interventions
• Chronic pain
• Imbalanced nutrition: Less than body requirements
• Risk for injury
• Ineffective coping
Slide 63
• Breath sounds; inspect the wound dressing for bleeding
• Inspect abdomen for distention and auscultate for bowel sounds
Peptic Ulcer (cont.)
• Nursing care of the patient managed surgically
• Assessment
• Pain, nausea, and vomiting
Slide 64
Peptic Ulcer (cont.)
• Nursing care of the patient managed surgically
• Interventions
• Risk for injury
• Imbalanced nutrition: Less than body requirements
• Decreased cardiac output
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3
Slide 65
Stomach Cancer
• Pathophysiology
• Begins in the mucous membranes, invades the gastric wall, and spreads to the
regional lymphatics, liver, pancreas, and colon
TALKING POINTS:
• Cancer of the stomach is diagnosed in more than 22,000 people in the United States each
year.
Stomach Cancer (cont.)
• Risk factors
Slide 67
Stomach Cancer (cont.)
• Medical diagnosis
• Gastroscopy, endoscopic ultrasound, upper GI series, CT, PET scan, MRI,
laparoscopy
TALKING POINTS:
Stomach Cancer (cont.)
• Postoperative care of the patient with stomach cancer
• Assessment
___________________________________________________ Chapter 39 Upper Digestive Tract Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
Activities
Classroom Choose from below to make 30 minutes
Online
3
DISCUSS
• Discuss the pathophysiology and signs and
symptoms of gastritis. Describe the medical
diagnosis and treatment.
• Discuss the pathophysiology, causes, signs
PRACTICE
• Ask students to form two groups and each
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss diet
changes recommended to prevent gastric
cancer. Ask students to provide constructive
4
DISCUSS
• Discuss the preoperative and postoperative
nursing care of the patient having
gastrointestinal surgery.
• Invite a medical-surgical staff nurse to speak
to the class about the preoperative and
postoperative care of patients with digestive
• Discuss nursing care of the patient with
gastritis. What are some important elements
of a patient teaching plan?
• Discuss the nursing care of patients with
peptic ulcers managed medically and
surgically. What are some common
interventions for these types of patients?
PRACTICE
• Ask students to role-play a nurse providing
preoperative teaching for a patient who will
be undergoing surgery for stomach cancer.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss how
having surgery for stomach cancer would
affect your life. For example, how would you
manage a tube feeding while working or
going to school? How would you eat a
26 Chapter 39 Upper Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Critical Thinking Question
A nurse is caring for a patient who has vomiting, ascites, liver enlargement, and an
abdominal mass. The health care provider suspects the patient has stomach cancer. Which
diagnostic tests will the patient likely undergo? How can the nurse support the patient
emotionally while the patient is awaiting the diagnosis?
Discussion Guidelines: The patient is likely to undergo gastroscopy to examine the interior of the
stomach and to take specimens for microscopic study. The patient could also undergo an
___________________________________________________ Chapter 39 Upper Digestive Tract Disorders 27
Introduction to Medical-Surgical Nursing, 6th ed.
39
Assessments for
Disorders of the Upper Digestive Tract
CHAPTER OBJECTIVES
Lesson 39.1:
1. Identify the nursing responsibilities in the care of patients undergoing diagnostic tests and procedures
for disorders of the upper digestive tract.
3. Describe the pathophysiology, signs and symptoms, complications, and medical treatment of selected
upper digestive disorders.
Lesson 39.2:
3. Describe the pathophysiology, signs and symptoms, complications, and medical treatment of selected
upper digestive disorders. (Cont.)
4. Assist in developing nursing care plans for patients receiving treatment for upper digestive disorders.
(Cont.)
1
Study Guide
• Part ID: 1-8 (p. 249)
Evolve Student Resources
• NCLEX Review: 1, 7
• Prioritization: 4
28 Chapter 39 Upper Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
3
Study Guide
• Part IA: 1-8 (p. 247)
• Part IB: 1-8 (p. 248)
• Part IC: 1-10 (p. 248)
Evolve Instructor Resources
• Test Bank: 3-6, 11, 15, 17–19
• Open Book Quiz: 3-9
Evolve Student Resources
4
Study Guide
• Part IIIG: 2, 4 (p. 252)
Evolve Instructor Resources
• Test Bank: 7, 9, 10, 13, 14, 23