WEEK 8: NURSING DIAGNOSIS

Last week of the blog y'all! So here in our wrap up blog post we are going to talk about nursing diagnosis that are relevant to gastroparesis. Now that we know all about gastroparesis we can jump into the mind of a nurse and see how he/she would approach this disease. Nursing diagnoses really help nurses get their thoughts about the disease down on paper while identifying interventions and goals for each diagnosis. So here are some diagnoses that are relevant...

The first nursing diagnosis might sounds something like: altered nutrition status related to inability to ingest foods. The outcome for this diagnosis would be the patient verbalizes and demonstrates selection of foods and meals that will stop any further weight loss. It would be important for a nurse to monitor weight loss and find out what foods the patient loves. The nurse would also need to explore the attitudes of the patient toward eating food while acknowledging fears/anxiety around the disease.

The second nursing diagnosis may be: ineffective coping related to a new diagnosis of a serious illness. The expected outcome for this diagnosis would be the patient identifies available resources and support systems. The nurse will encourage and support you through the process of identifying people and community resources through this time of change.

The third diagnosis might sound like: health seeking behavior related to new condition and diagnosis. The goal for this patient would be the patient engages in desired behaviors to promote a healthier lifestyle. This might include identifying foods the patient feels comfortable eating or discussing how medications will work. The key to this nursing assessment is judging and monitoring what stage of change the patient is currently at.

The fourth applicable nursing diagnosis is: body image disturbance related to alterations in the function of the gastrointestinal system. The expected outcome for this diagnosis is that the patient will demonstrate enhanced body image and self-esteem as evidenced by ability to talk about and care for themselves.

The fifth and last nursing diagnosis might be: fluid volume deficit related to inadequate fluid intake. The patient goal for this diagnosis would include the patient experiences adequate fluid volume as evidenced by appropriate urine output, normal skin turgor, and consistency of vital signs.

We did it everyone! We went through an eight week study and blog focused on gastroparesis! I hope you feel more knowledgable about this disease! Thank you for joining me along this journey!

References 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014.

Hasler, W. L. (2011). Gastroparesis: pathogenesis, diagnosis and management. Nature Reviews Gastroenterology & Hepatology, 8(8), 438-454. doi:10.1038/nrgastro.2011.116

WEEK 7: NURSING TREATMENT

Welcome back to the blog guys! We have learned so much about gastroparesis and now it is time to focus on nursing care and treatment. Why nursing care you ask? Well, I am about to graduate from nursing school in 4 months and I want to learn as much as possible about great nursing care. Why should you care about nurses? Well nurses are your best friend when you are in the hospital. Nurses are your advocate, your support, your counselor, and your caretaker. Nurses are here to see you succeed. So lets find out what nursing treatment looks like.

One of the things that nurses will talk to you about is your nutrition. Nurses can help you figure out ways to get calories and good nutrition into your daily routine. Talk to your nurse about ideas they have. Get creative with them. Nurses can initiate a referral with a dietician or they can point you to some valuable resources in your community. Use your nurses' knowledge and experience to find a routine that works for you.

Another topic that nurses will talk to you about are the medications you will be prescribed. Nurses know all about medications, side effects, uses, and when you should call the doctor. Use your nurse as a resource. Ask them questions. Let them know what you are nervous about or what seems unclear. Nurses will take the time to explain each medication to you.

Lastly, and possibly most importantly, nurses can talk to you about how you are feeling. Nurses are great at giving emotional support. What about this diagnosis is difficult for you? Are you feeling sad? It might be difficult but nurses are great people to be honest about your feelings with. They are a safe person to share your feelings with and they will definitely spend their time listening to you and giving guidance. Nurses can do a lot for you if you let them.

Next week is our last blog post! Sad face!! However, it is a post about nursing diagnosis and care plans. Very helpful for people like me and for nurses all around. For you, it might be a way to see into a nurses' brain. Talk to you next week!

References 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014.

Hasler, W. L. (2011). Gastroparesis: pathogenesis, diagnosis and management. Nature Reviews Gastroenterology & Hepatology, 8(8), 438-454. doi:10.1038/nrgastro.2011.116

WEEK 6: TREATMENT OPTIONS

Hey everyone! Week six of the blog! Whoo! We are getting closer to being masters on gastroparesis. Now that we know what gastroparesis is, how it will affect us, and how it is diagnosed, let's talk about treatment. What are we going to do once we get this diagnosis? The treatment for this diagnosis is pretty simple and is mostly focused on treating the symptoms of the disease.

First, treating gastroparesis begins with identifying the disease. If diabetes is causing gastroparesis, your health care provider will work with you to control your diabetes and treat the disease. This step is often done with medication adjustment, blood sugar control, and modifications in diet and/or exercise.

One of the first things providers will work with you on involves finding foods that are easy for you to digest. Maybe you can drink flavored water or eat yogurt. Maybe, like me, ice cream hits the spot or maybe you can drink smoothies. It took me a long time to find food that I could eat without being sick and it is important to find these foods early on in your diagnosis so your weight doesn't drop. Meat and potatoes are hard to digest and will make you feel fuller faster- try to avoid foods like this.

Next step in treatment is to look at medications. Metoclopramide (Reglan) is used to increase the rate food is emptied from the stomach by increasing peristalsis. This can decrease nausea, early satiety, and meal discomfort. Metoclopramide has some serious side effects and should never be taken longer than 12 weeks consecutive. High doses or long term use can lead to the development of a movement disorder which can be irreversible. The most common side effects include abdominal pain, chills, dizziness, rapid heartbeat, skin rash, diarrhea, drowsiness, and restlessness.

To treat the symptoms of gastroparesis your health care provider will most likely prescribe you an anti-emetic to control nausea and vomiting. Zofran is most commonly used. The most common side effects of Zofran are constipation, dizziness, rapid heartbeat, fever, headache, and weakness.

If medications and diet adjustments are not enough to keep your weight up and promote personal thriving within the diagnosis, your provider may talk to you about a feeding tube. Feeding tubes may be permanent or temporary and will be used to bring nutrition into your body.

Wow that was a lot of information! Let's talk about me and my journey to see how treatment worked in my life. Once I was diagnosed with gastroparesis my provider prescribed Metoclopramide for me and Zofran. I took Metoclopramide twice a day and Zofran as needed for nausea. I didn't stay on Metoclopramide for more than four days. I was restless, itchy an drowsy all at the same time. There was no way I could stand the side effects. Good thing is that this drug isn't necessary for treatment. It may help with the symptoms by Metoclopramide will not fix your gastroparesis.  However, that doesn't mean you will react to Metoclopramide the same way I did! On the other hand, Zofran saved my life!! I took Zofran whenever I was nauseous and I immediately felt better. This allowed me to sit through dinner without being completely miserable. If I wanted to try eating something and I got sick, I could take some Zofran and feel comfortable again within 20 minutes. Zofran was my answer to prayer!!

Again, I hope you don't feel discouraged about gastroparesis after this post. Take with you the fact that gastroparesis IS manageable and you CAN recover. Medications and diet adjustment can help you manage the disease and you will become comfortable with what your body is telling you. Your gut is your best indicator of what is happening. Join me next week as we travel into the nursing care for people with gastroparesis and again let me know if you have any questions!

References 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014.

Hasler, W. L. (2011). Gastroparesis: pathogenesis, diagnosis and management. Nature Reviews Gastroenterology & Hepatology, 8(8), 438-454. doi:10.1038/nrgastro.2011.116

Morrison, G., & Weston, P. (2015). Gastroparesis associated with diabetes: Symptoms, diagnosis and treatment. Journal Of Diabetes Nursing, 19(1), 12-18.

WEEK 5: SIGNS AND SYMPTOMS

Well welcome back to our fifth week of learning about gastroparesis. This week we are going to focus on the symptoms of the diagnosis. Why not the signs you ask? Well the signs of the disease are non-specific meaning there is no specific indicator for gastroparesis. We talked about this last week too but often gastroparesis is diagnosed by ruling out other disease processes. So we will focus on the symptoms you are feeling that most commonly lead to the diagnosis of gastroparesis. 

The most common symptoms of gastroparesis are

• Heartburn
• Nausea 
• Vomiting
• Feeling full quickly when eating 
• Abdominal bloating 
• Poor appetite and weight loss 
• Poor blood sugar control 

Good news and bad news. Let's start with the good news!! The good news is these are the symptoms at the beginning, middle, and end of the disease. There is no progression- it is, what it is. Bad news is that these symptoms are TERRIBLE. Talk about feeling uncomfortable all the time. And never going out to eat with friends again. Or just being that awkward person that goes out to eat and doesn't order anything. Or you try and eat to be a normal person again and you feel nauseous. Sounds fun doesn't it. Keep your eyes focused on the end. You can recover from this diagnosis. I did!!

These symptoms make sense what you think about what gastroparesis is doing to your body. Gastroparesis means the stomach is not emptying or is emptying really slowly so there is residual food build-up in the GI system. Even if you didn't have gastroparesis and you tried to eat when you were already full you would probably feel sick. That is the life of a person who has gastroparesis. The good news is that since your stomach is almost always full you really never get hungry. Meaning you don't miss food even though you aren't eating anything. 

For me, the onset of gastroparesis began with nausea. Then I noticed I became overly full after only eating a couple bites of food. Not normal for me at all...I am Italian and I love my food :) Abdominal bloating was constant and I began to lose weight fast. After living with gastroparesis for about six months I found that I could eat ice cream and cereal- things that were easy to digest. I would eat ice cream for dinner just for the calories!! Doesn't sound too bad does it! I think in total I lost 35 pounds. The doctor was worried for my weight and I had to stop exercising. Most of the time I didn't have any energy to exercise anyways. 

Well I hope this has been helpful and not too depressing! Gastroparesis is not fun to live with but it is manageable. Keep your head high and do what you can to prevent rapid weight loss and constant nausea. Please let me know if you have any questions or want to hear more about my story. Thanks for joining me on this journey!!

References 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014.

Hasler, W. L. (2011). Gastroparesis: pathogenesis, diagnosis and management. Nature Reviews Gastroenterology & Hepatology, 8(8), 438-454. doi:10.1038/nrgastro.2011.116

Morrison, G., & Weston, P. (2015). Gastroparesis associated with diabetes: Symptoms, diagnosis and treatment. Journal Of Diabetes Nursing, 19(1), 12-18.

WEEK 4: DIAGNOSIS

Welcome back to week four of my blog! We have already learned a lot about gastroparesis and this week we are going to learn about how gastroparesis is diagnosed. What tests do doctors do? Is there really any way to diagnose gastroparesis? And how was I diagnosed?

Health care providers will ask about your signs and symptoms (more on this next week) and lots of diagnostic tests to determine if you have gastroparesis or not. These tests are not helpful in specifically identifying gastroparesis but they are useful in ruling out other diagnoses that may present similarly to gastroparesis. Gastroparesis is a unique diagnosis in the fact that a simple blood test or diagnostic test will not identify the disease. Gastroparesis is instead diagnosed by ruling out other diseases and identifying common signs and symptoms of the disease progression. Confused? We will talk more in a bit.

Providers will probably want to do some blood work specifically focused on liver and gallbladder enzymes. If you have difficulty processing/digesting fats or protein you might have some of the same signs and symptoms as gastroparesis. Providers can see if your liver and gallbladder are functioning well by looking at the blood work analysis. If these results are normal they will probably move to diagnostic exams.

Often the first diagnostic test the provider will want to do is an endoscopy. This procedure is used to visually examine your upper digestive system- the esophagus, stomach and the beginning of the small intestine. The provider uses a small camera attached to a long and flexible tube to visualize the areas while you are sedated. This test is performed to rule out acid reflux and peptic ulcers. Here is a picture of what an endoscopy looks like to give you an idea!

Next, the provider may order an ultrasound of the abdomen. This is a non-invasive exam that is sensitive to blockages in the intestines, abnormalities in any of the abdominal organs, and signs of inflammation. The ultrasound looks at all the organs and functional parts of the abdomen and it relatively stress free for the patient. Here is a picture that simplistically shows what an ultrasound will look like during the procedure.

Other commonly used diagnostics include an upper gastrointestinal series and a gastric emptying study. An upper GI series involves drinking a white, chalk like substance that coats the GI system and shows abnormalities during an X-ray. A gastric emptying study involves eating a small meal that contains a radioactive material (not as scary as it sounds). A scanner is used to detect the movement of the material though your GI system. This can be an important study in identifying the rate at which food is moving through the stomach.

What did the diagnosis phase look like for me? Well it took about 3 months to officially be diagnosed with gastroparesis. After having constant symptoms for a month my doctor did blood work, an endoscopy, and ordered an abdominal ultrasound. Not all at the same time but over a period of time- all the while monitoring my symptoms. None of my tests were abnormal. So now what?! The absence of abnormalities in any of these tests led my provider to the diagnosis of gastroparesis. Make sense now?

Okay guys that is it for this week! I hope you learned a lot about how to diagnose gastroparesis this week and next week we will continue on the the most common signs and symptoms of gastroparesis. Let me know if you have any questions!

References 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014.

Hasler, W. L. (2011). Gastroparesis: pathogenesis, diagnosis and management. Nature Reviews Gastroenterology & Hepatology, 8(8), 438-454. doi:10.1038/nrgastro.2011.116

WEEK 3: ETIOLOGY AND PATHOPHYSIOLOGY

Hey guys! Welcome back to week 3 and our journey with gastroparesis! This week we are going to talk more about what gastroparesis is and how in the world you can get this diagnosis. I hope our general overview of what the disease is has been helpful and after this week it should make even more sense. It is the beginning of tying all the pieces together. I am also going to begin my story and share some of my experiences moving through this disease. But first etiology...

Although multiple conditions have been associated with gastroparesis, the majority of cases are idiopathic, diabetic, or post surgical. What in the world does that mean?! Idiopathic means with a spontaneous or unknown origin and we already talked about the link between diabetes and gastroparesis last week. After a surgical procedure our gastrointestinal system is slow to get back up to speed and gastroparesis can be a consequence of this slow moving organ. Most cases of gastroparesis are idiopathic or occur spontaneously. 

For me, the onset of gastroparesis was sudden and unexpected. I would say with an idiopathic etiology. It started one day out at dinner when I feel nauseous all of a sudden. Food poisoning I thought? But then it happened the next day with lunch. Nauseous again? I wasn't hungry for dinner that night either. I tried eating breakfast on day 3...nausea. Something was weird here. I definitely wasn't pregnant, maybe a virus? But then my symptoms began to become more regular. Every time I tried to eat I was nauseous and I was really never hungry. Time for me to head to the doctor! 

My story represents the typical beginning of gastroparesis for many. The onset was sudden and I had no idea what was going on. Fortunately, the disease does not progress more than this. Gastroparesis literally means paralysis of the stomach. Now the nausea and unexplained fullness make sense! Starting to put things together now. 

Okay guys that is it for this week. I hope gastroparesis is starting to make more sense as we put all the pieces of the puzzle together. Next week we are going to talk about how gastroparesis is diagnosed so stay tuned for some interesting stuff!! 

References 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014.

Hasler, W. L. (2011). Gastroparesis: pathogenesis, diagnosis and management. Nature Reviews Gastroenterology & Hepatology, 8(8), 438-454. doi:10.1038/nrgastro.2011.116

WEEK 2: EPIDEMIOLOGY

Welcome back to our blog about gastroparesis! Today we are going to focus on answering questions about risk factors, distribution, and those affected with gastroparesis in the Unites States.  In general, these questions refer to the epidemiology of the disease. So here we go...

In 2007 it was found that 24 out of 100,000 people in the United States are diagnosed with gastroparesis. This disease affects 4 times more females then men and is found more often in diabetics than non-diabetics. Within the diabetic group diagnosed with gastroparesis it is more common in Type 1 than Type 2 diabetics.

No deaths have been attributed to gastroparesis and gastroparesis is not associated with increased mortality- good news! However when gastroparesis is associated with diabetes it is important to modify insulin, exercise, and/or diet to rectify these health needs. This is the same with any co-occuring diseases or diagnoses.

Gastroparesis can affect all modalities of your life including your physical, emotional, mental, social, and bodily functions. And let me tell you from personal experience that being diagnosed with gastroparesis is NOT fun...but it IS manageable.

So let's get personal. I was diagnosed with gastroparesis 2 years ago and my road to recovery has been long but I made it through. Looking back I can't believe that I was one of those  0.024% of people that is diagnosed with this disease. I am a female so I did have an increased risk but I do not have diabetes or any other disease often associated with diabetes. How unlucky am I?! The good news is there is no increased risk of death and you can recover from gastroparesis. I am one of those people.

Join me next week to learn more about what gastroparesis is and how it comes about. Thanks for joining me along this journey! And just for fun here is a picture of what gastroparesis can do to your tummy!

Camilleri, Michael, Adil Bharucha, and Gianrico Farrugia. "Epidemiology, Mechanisms, and Management of Diabetic Gastroparesis." Clinical Gastroenterology and Hepatology. N.p., n.d. Web. 06 Apr. 2015.
Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014.