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Nursing Diagnosis: Risk for aspiration related to esophageal inflammation secondary to esophagitis.

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Nursing Diagnosis: Risk for aspiration related to esophageal inflammation secondary to esophagitis.

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Nursing Interventions:

1. Assess swallowing ability and observe for signs of aspiration.

R: To detect early signs such as coughing, drooling, or voice changes indicate impaired swallow and increased aspiration risk.

2. Position patient in Fowler’s position during and 30–60 minutes after meals.

R: To minimize reflux and decreases the gastric contents entering the airway.

3. Provide small, frequent meals.

R: To reduce gastric distention and reflux, thereby lowering aspiration risk.

4. Avoid foods that trigger reflux such as caffeine, spicy/fatty foods.

R: To reduce aspiration risk as these increase aspiration risk.

5. Administer medications as prescribed such as antacids.

R: To reduce gastric acidity, lowering aspiration risk.

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Nursing diagnosis :

Risk of hypovolemic shock related to active bleeding.

Interventions:

1. Assess patient vital sign especially pulse rate and patient physical condition such as skin color.

R: to detect early sign of hypovolemic shock.

2. Monitor patient fluid status strictly such as using I/O chart.

R: to ensure patient is in balanced fluid status.

3. Administration of blood transfusion or IV therapy as doctor order.

R: to restore the fluid to prevent hypovolemic shock.

4. Administration of oxygen therapy as prescribed.

R: to provide enough oxygen needed and reduced the symptoms of tachycardia.

5. Monitor patient for sign and symptoms of active GI bleed such as melena stool and hematemesis.

R: to take action quickly if patient having large volume of blood loss continously.

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Pain related to tumor growth and pressure on surrounding tissues

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Pain related to tumor growth and pressure on surrounding tissues

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1. Assess pain level regularly using a numerical pain scale

Rationale:

Provides an objective measure of pain intensity, helps monitor progression and evaluates the effectiveness of interventions.

2. Apply cold or warm therapy depending on the patient’s condition.

Rationale:

To relaxes muscles or reduce swelling on effected area.

3. Administer prescribed analgesics (opioids, NSAIDs).

Rationale:

Pharmacological therapy reduces pain by blocking pain pathways or decreasing inflammation caused by tumor pressure.

4. Assist patient to find a comfortable position that minimizes pressure on affected areas.

Rationale:

Proper positioning reduces strain on tissues and can significantly decrease pain caused by tumor compression.

5. Educate patient about deep breathing exercise.

Rationale:

To reduce muscle tension and improve the patient’s lung expansion.

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Risk for Bleeding related to fragile esophageal varices. 

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Risk for Bleeding related to fragile esophageal varices. 

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Nursing Interventions:

1. Gather information about the patient’s medical history, particularly any underlying liver disease or conditions predisposing to esophageal varices, such as cirrhosis or portal hypertension.

R: To assess patient’s risks of bleeding

2. Monitor for signs of active bleeding or shock, such as hemodynamic instability, rapid heart rate, and low blood pressure.

R: To ensure patient is not having any bleeding, internal or external

3. Maintain a patent intravenous (IV) line and have blood products (packed red blood cells, fresh frozen plasma, platelets) readily available in case of acute bleeding.

R: This is to avoid patient having extreme blood loss in case of bleeding

4. Instruct the patient to avoid activities that may increase intra-abdominal pressure, such as heavy lifting or straining during bowel movements.

R: To reduce the risk of bleeding from occuring

5. Administer prescribed medications, such as non-selective beta-blockers or vasoconstrictors

R: Reduce the risk of bleeding by decreasing the portal pressure

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Nursing Diagnosis:

Impaired Swallowing related to oesophageal edema, mucosal irritation, or variceal enlargement.

1. Assess swallowing ability every shift, including coughing, choking, and ability to manage saliva.

R: Helps to determine the severity of swallowing impairment and risk of aspiration.

2. Keep the patient nil by mouth during acute bleeding episodes or if swallowing is severely impaired.

R: Prevents irritation of varices and reduces risk of aspiration during unstable periods.

3. Position patient in high Fowler’s (≥ 45°) during meals and for the 30 to 45 minutes after.

R: An upright position uses gravity to promote safe swallowing and prevent aspiration.

4. Provide soft, bland, non-irritating foods once oral intake resumes such as avoiding spicy, rough, or acidic foods.

R: Gentle foods reduce oesophageal irritation and to help prevent bleeding of fragile varices.

5. Administer prescribed medications such as proton pump inhibitors (PPIs) or sucralfate as ordered by doctor.

R: PPIs reduce gastric acidity and irritation, while sucralfate coats mucosa and protects varices.

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Nursing diagnosis: Knowledge deficit about the disease process (GERD) as evidenced by presence of preventable complications like eosophagitis.

Nursing interventions:

1. Assess level of understanding of patient about the prevention of GERD.

R: To evaluate patient's knowledge about the disease process and readiness for prevention of the disease.

2. Provide clear and concise health education to the patient about the etiology and complications of untreated GERD.

R: To promote patient's self-awareness and prevent further health complications.

3. Educate the patient to avoid irritating foods like spicy and caffeine (chocolate).

R: To prevent further damage to the patient's esophageal lining and cause discomfort to the patient.

4. Educate patient and family members to follow the diet modification as prescribed.

R: To avoid recurring GERD while able to maintain balanced nutritional intake.

5. Instruct patient to practice healthy eating habits such as eating on time.

R: To promote self-managmenet after discharge and prevent relapse of gastric reflux.

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Nursing Diagnosis

Imbalanced nutrition related to pain and difficulty swallowing.

Nursing Interventions

1. Provide small, frequent meals
R:Reduces discomfort during swallowing and helps increase total daily intake.

2. Offer soft, semi-solid, or pureed foods
R:Easier to swallow and prevents further irritation of the esophagus.

3. Avoid irritant foods (spicy, acidic, caffeine, alcohol, carbonated drinks)
R:Prevents worsening inflammation and reflux, allowing better tolerance of meals.

4. Keep patient upright during and 30–60 minutes after meals
R:Reduces reflux and promotes safer swallowing.

5. Collaborate with a dietitian for a tailored nutrition plan
R:Ensures adequate calories, protein, and supplements to prevent malnutrition.

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Identify ONE (1) nursing diagnosis related to today's discussion, and explain 5 nursing interventions with rationales for the selected nursing diagnosis.

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Identify ONE (1) nursing diagnosis related to today's discussion, and explain 5 nursing interventions with rationales for the selected nursing diagnosis.