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ursing Care of Clients with Upper Gastrointestinal Disorders I. Care of Clients with
Disorder of the Mouth A. Disorder includesλ inflammation, infection, neoplastic lesions
B. Pathophysiology 1. Causes include mechanical trauma, irritants such as tobacco,
chemotherapeutic agents 2. Oral mucosa is relatively thin, has rich blood supply, exposed
to environment C. Manifestations 1. Visible lesions or erosions on lips or oral mucosa 2.
Pain Nursing Care of Clients with Upper Gastrointestinal Disorders D. Collaborative
Care 1.Direct observation to investigate anyλ problems; determine underlying cause and
any coexisting diseases 2.Any undiagnosed oral lesion present for > 1 week and not
responding to treatment should be evaluated for malignancy 3.General treatment includes
mouthwashes or treatments to cleanse and relieve irritation a.Alcohol bases mouthwashes
cause pain and burning b.Sodium bicarbonate mouthwashes are effective without pain 4.
Specific treatments according to type of infection a.Fungal (candidiasis): nystatin “swish
and b.Herpetic lesions: topical or oralλ swallow” or clotrimazole lozenges acyclovir
medical management
The diagnosis and therapy for nonvariceal upper gastrointestinal bleeding (UGIB) has
evolved over the past 3 decades from passive diagnostic esophagogastroduodenoscopy
with medical therapy until surgical intervention was needed to active intervention with
endoscopic techniques followed by angiographic and surgical approaches if endoscopic
therapy failed. Variceal hemorrhage is not discussed in this article because the underlying
mechanisms of bleeding are different and require different therapies.
Endoscopy2
Post-initial endoscopy2
• Score <3 is associated with low risk of re-bleeding or death and can be
considered for early discharge.
• Full Rockall score >3 indicates patients need further close observation as an
inpatient.
• Careful monitoring is needed after endoscopy for UGIB (pulse, blood pressure,
urine output). It is imperative to identify re-bleeding or continuing bleeding.
• Repeat endoscopy (within 24 hours) is needed if the initial endoscopy was sub-
optimal, e.g. poor visualisation or in patients in whom re-bleeding is likely to be
life-threatening.
• Occasionally major re-bleeding may be an indication for surgical intervention
without further endoscopy.
• If patients are stable 4-6 hours after endoscopy they should be put on a light diet,
as there is no benefit in continued fasting.