Alterations In GI Flashcards
Chronic Gastric ulcers
Assessment:
50 years old and older (no diff male/female)
Normal gastric ph
Pain 1/2 to 1 hr after meals or when fasting, relieved by vomiting
Hematemesis
May be malignant
Eating does not relieve, may make pain worse
Risk factors: gastritis, alcohol, smoking, NSAIDs, stress
Chronic duodenal ulcer
Assessment 3:1 Male, 30-60yr old Low gastric pH/hypersecretion Paint 2 to 3 hours after meals, nighttime Food intake relieves pain Vomiting rare, hemorrhage less likely Usually not malignant
Risks: blood group type o, copd, chronic renal failure, alcohol, smoking cigarettes, cirrhosis, stress
Ulcers- implementations
Eat 3 meals per day Avoid coffee, alcohol, caffine Avoid cream, milk Avoid extremes in temp Reduce stress Stop smoking
Surgical intervention-- Gastrectomy Vagotomy- (decreased HCL secretion) Billroth I - partial removal stomach Bulletin II- removal of distal segment of stomach and Antrum; anastomosis with jejunum
Dumping syndrome
Implementation Restrict fluid with meals Lie down for 20-30 min after eating Small, frequent meals Low carb, low fiber
Pyloric stenosis
Assessments:
Infants: irritability, always hungry, fails to gain weight
Projective vomiting
palpable all of shape tumor in epigastrium (infants )
peristaltic waves,
epigastric fullness
Pyloric stenosis implementations
Preop Iv fluids Check skin tugor, fonanelles, uop Gastric decompression with NG tube Correct fluid and electrolytes ( alkalosis, hypokalemia, dehydration) Monitor for shock
Gastritis
Npo, rest stomach
Progress to bland diet
Antacids
Referral if alcohol abuse
H pylori
Problem with gastric ulcers
Chrons disease
Usual onset 20-30 and 50-80
Frequent fatty stools
Rare malignancy
Rectal bleeding- occasional: mucus, pus, fat in stool (steathorrhea)
Abdominal pain- after meals, colicky pain
Diarrhea- rare, 5-6 unformed stools per day.
Nutritional deficit, weight loss, anemia, dehydration
Fever
Anal abscess
Course of disease- prolonged
Slowly progressive
NC- high-protein, high calorie, low fat and low fiber diet
May require TPN to rest bowel
Analgesics, antihilinergics, sulfonamides, corticosteroids, antidiarrheals
Ulcerative colitis
30-50, fat NOT present in stool, blood, mucous present
Rectal bleeding common
Abdominal pain pre-defecation
Diarrhea 10-20 liquid stools/day, often bloody
Fistula formation rare
Involves mucosa layer, begins in rectum, continuous segments affected, remission and relapses
Appendicitis
Pre- umbilical abdominal pain, shifts to right lower quadrant (mcburneys point)
Anorexia, nausea, vomiting, localized tenderness, muscle guarding, low grade fever
15-20000 WBCs
Age 11-30
Implementation- no heating pads, laxatives, enemas (preop)
Maintain Npo status until blood lab reports received, Iv fluids to prevent dehydration
No analgesics until cause of pain is determined
Ice bag to abdomen to alleviate pain
Sudden cessation of pain- perforation- emergency
Hirschsprung’s disease
Ganglionic disease of the intestinal tract; inadequate motility causes mechanical obstruction of intestine
Diagnostic- radiographic contrast studies
Assessment:
- failure to pass meconium, refusal to suck
Child: failure to gain weight, foul stools, constipation
Abdominal distention
Implementation- foster infant/ parent bonding
Implementation: preop
Enemas
Low fiber, high protein, high-calorie diet; TPN
Measure girth at umbilicus
Oral antibiotics
Implementation postop
Monitor fluid and electrolytes, stoma care
Abdominal hernia
Protrusion of organ through wall of cavity where normally contained
Assessment
Lump in abdomen, may dissapear when supine
Strangulated- severe abdominal pain, nausea, vomiting, distention
Abdominal hernia- reducible
Can be reinserted by manipulation
Abdominal hernia- irreducible
Cannot be reinserted by manipulation
Incarcerated hernia
Intestinal flow is completely obstructed
Strangulated hernia
Blood flow to intestines obstructed (emergency)
Abdominal hernias
Implementation– assess respiratory system pre-op
Turn, deep breath, no cough
Relieve urinary retention
Ice packs for swollen scrotum
No pulling, pushing, heavy lifting for 6 weeks
Mechanical obstruction
Physical blockage of lumen of intestines
Hernia, tumors, adhesions, volvulus(twisting of bowel)
Non mechanical obstruction
Paralytic ileus
Absence of peristalsis Abdominal trauma/surgery Spinal injuries Peritonitis, acute appendicitis Wound dehiscence (breakdown)
Intestinal obstruction
Assessment: Nausea, Vommiting High pitched bowel sounds ABOVE obstruction; absent or decreased bowel sounds below Abdominal pain and distention A absence of stool or gas (obstipation)
Ileostomy
Assessment/ nursing considerations
Liquid, semi-liquid, soft returns
Slightly odorous, hight corrosive drainage
Wear appliance At all times
Koch pouch- remove contents 2-4 times/day with catheter
Low-residue diet; no corn or nuts
Incontinent stomas, meaning no knowing when they will have stool
Transverse colostomy
Assessment/nursing considerations Soft to fairly firm returns Very foul smelling, corrosive drainage Pouch worn continuously Usually single- loop colostomy Diet not restricted after first 6 weeks
Descending or Sigmoid colostomy
Assessment/nursing considerations
Firm stool
Foul smelling, fairly corrosive drainage
MAy wear pouch, or regulate with colostomy irritations
Diet not restricted after first 6 weeks
Irrigating colostomy
Insert 3 inches
Warm water infused 5-10 min, allow drainage 10-15 min
Cirrhosis
Replacement of Normal liver tissue with widespread fibrosis
Alcoholic cirrhosis
Biliary cirrhosis- result of chronic biliary obstruction and infection
Post necrotic cirrhosis- result of previous viral hep
Assessment of cirrhosis
Indigestion, nausea, vomiting, flatulence, constipation, diarrhea, anorexia, weight loss, esophageal varices, hematemesis, ascites, anemia, jaundice, puritus, dark urine, clay colored stools
