“Gastroesophageal Reflux Disease (GERD) or Achalasia” plus 1 more nursing article(s): NursingCrib.com Updates

Gastroesophageal Reflux Disease (GERD) or Achalasia

Posted: 29 Oct 2010 08:17 PM PDT

achalasia 300x240 Gastroesophageal Reflux Disease (GERD) or Achalasia

Gastroesophageal reflux is passage of the gastric contents into the esophagus. It is considered a normal physiologic process occurs in healthy infants and children. However, when complications develop from the reflux of gastric contents back into the esophagus or oropharynx, it becomes more of a pathologic process known as gastroesophageal disease (GERD). If left untreated it will cause the esophagus to become enlarged and eventually stop functioning.

Diagnostic Evaluation:

Barium Swallow – involves drinking a barium-containing liquid followed by an X-ray study to help identify structural changes in the esophagus, and is performed to evaluate any anatomic reasons for the symptoms the patient is experiencing.
Esophageal manometry – which involves passing a small tube, or catheter, into the stomach to measure pressures along the esophagus can confirm a diagnosis of achalasia.

Signs and symptoms:

Recurrent vomiting and regurgitation
Weight loss or poor appetite
Irritability in infants
Chronic cough
Wheezing
Stridor
Asthma
Apnea
Hoarseness
Sore throat
Halitosis (mostly in older children)
Heartburn and chest pains
Abdominal pain
Hematemesis
Dysphagia
Chronic sinusitis
Otitis media
Poor dentition (caused by acid erotion)

Medical Management:

Appropriate positioning such as elevating the head of the bed and keeping the infant or child upright for 30 minutes after feeding
Smaller, more frequent feedings may be helpful
Medications maybe prescribed to decrease the acid production and stabilize the pH of the gastric contents
Nissen fundoplication – the surgical approach that is done if GERD cannot be medically managed effectively or requires long-term medication
Heller myotomy – a surgical treatment of choice. The lower esophageal sphincter muscle is cut so that food can pass easily from the esophagus into the stomach.
Pneumatic dilation – a small balloon is passed under fluoroscopy to the esophageal sphincter and inflated. This expansion causes the lower esophageal sphincter muscle to stretch and weaken.
Botox injection – Botox is injected into the lower esophageal sphincter to relax the muscle and allow food to pass more freely into the stomach.

Nursing Management:

Assess the onset and progression of the symptoms
Give infants smaller, more frequent feedings using a nipple that controls flow well.
Thickening of the formula with products such as rice or oatmeal cereal can significantly help keep formula and gastric contents down
Keep infant upright for 30 to 45 minutes after feeding
Maintaining a patent airway.
Assist in diagnostic procedures as well as surgical procedures prescribed.

Chronic Kidney Disease

Posted: 29 Oct 2010 05:48 PM PDT

Chronic Kidney Disease could be known if the following criteria has met:

Kidney damage for equal or more than 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR
GFR <60 mL/min/1.73m2 for greater than or equal 3 months, with or without kidney damage

Stages of Chronic Kidney Disease

This is according to National Kidney Foundation

Stage	Description	GFR (mL/min/1.73m²)
1	Kidney damage with normal or increased GFR	Greater than or equal 90
2	Kidney damage with mild decrease of GFR	60-89
3	Moderate decrease of GFR	30-59
4	Severe decrease of GFR	15-29
5	Kidney Failure	Less than 15 (dialysis)

Risk Factors

Diabetes – most common cause of chronic kidney disease worldwide; obesity is an additional factor for diabetes
Hypertension – systolic hypertension is of particular concern. Beginning at around age 50, systolic blood pressure rises and continues to rise with age.
Autoimmune disease
Systemic infection
Urinary stones or lower urinary tract obstruction
Exposure to certain toxic drugs – cyclosporins and othe immunosuppressive agents and corticosteriods

Diagnostic Evaluation:

Urinalysis reveal that casts found in urine are helpful in determining the type of kidney disease
Blood analyses may include levels of createnine, blood urea nitrogen, serum electrolytes and pH
Ultrasonography can detect a tumor or hydronephrosis
Computed tomography and magnetic resonance imaging demonstrate vessel disorders
Kidney arteriography and venography can show damage to kidney vasculature
Proteinuria screening – persistent proteinuria is usually the first indicator of kidney damage.

Signs and symptoms:

swelling, usually of the lower extremities
fatigue
weight loss
loss of appetite
nausea or vomiting
a change in urination (change in volume and frequency)
change is sleep pattern
headaches
itching
difficulties in memory and concentration

Complications:

Cardiovascular disease – hypertension may also contribute to the development and increase the risk of stroke
Anemia – when kidneys are damaged there is a decrease in erythropoietine, a hormone that stimulates production of red blood cells
Bone disease – disorders of calcium and phosphorus metabolism may develop early
Malnutrition – alteration of the body’s response to insulin as well as other metabolic functions (such as erythropoietin formation and vitamin D matebolism)
Decreased functional status and well-being – includes complex regimen, adverse effects and the possible or actual loss of job and income

Medical Management:

Peritoneal dialysis
Hemodialysis
Kidney Transplantation

Nursing Management:

Proper assessment for risk factors that might cause a rapid decline
Encourage self-management such a blood pressure monitoring and glucose monitoring
Administer prescribe medications ( ion exchange resin, alkalizing agents, antibiotics, erythropoietin, folic acid supplements)
Maintain strict fluid control
Encourage intake of high biologic value protein (eggs, dairy products and meats)
Encourage adequate rest