digestive tract disorders part 3 Flashcards
Inflammation of the lining of the stomach
Gastritis
Cause of GAstritis
Mucosal barrier that normally protects the stomach from autodigestion breaks down
Hydrochloric acid, histamine, and pepsin cause tissue edema, increased capillary permeability, possible hemorrhage
Helicobacter pylori thought to be prime culprit
dietary indescretions, reflux of duodenal contents, use of aspirin, steroids, NSAIDS, alcohol, caffeine, cigarettes, food allergies, infection
S/S of Gastrtis
Nausea may or may not be present, vomiting, anorexia, a feeling of fullness, and pain in the stomach area,
pressure,
client may see blood in their emesis or note darkening of their stool color
medical diagnosis of gastritis
Gastroscopy
Laboratory studies to detect occult blood in the feces, low blood hemoglobin and hematocrit, and low serum gastrin levels ( may detect anemia) ; H. pylori can be confirmed by breath, urine, stool, or serum tests, or by gastric tissue biopsy
Medical treatment of gastritis
Oral fluids and foods withheld until the acute symptoms subside; IV fluids administered
Medications to reduce gastric acidity and relieve nausea
Analgesics for pain relief and antibiotics for H. pylori
Surgical intervention may be needed
some clients may wish to avoid spicy food/ high fats and caffeine
avoidance of alcohol and NSAIDS
Nursing assessement of Gastritis
Patient’s present illness
Pain, indigestion, nausea, and vomiting (observe color)
Determine the onset, duration, and location of pain
Note factors that trigger or relieve the symptoms
Diet, use of alcohol and tobacco, activity/rest patterns
Patient’s general appearance for signs of distress
Compare vital signs, height, weight to previous readings
Note the skin color and check turgor
Inspect abdomen for distention; palpate for tenderness
Auscultate abdomen for increased bowel sounds
nursing interventions of gastritis
Pain
Imbalanced Nutrition: Less Than Body Requirements
Deficient Fluid Volume
Ineffective Coping
Loss of tissue from lining of the digestive tract
Classified as gastric or duodenal
most occur in the duodenum by may develop at the lower end of the esophagus
Peptic Ulcer
Cause of peptic ulcer
Contributing factors: drugs, infection, stress
Most ulcers are caused by the microorganism H. pylori
when the normal balance between factors that promotes mucosal injury and factors that protect the mucosa is disrupted
S/S of peptic ulcer
Burning pain that occur 1-7h after meals , abdominal pain
Nausea, anorexia, weight loss , disrupted sleep,
single greatest risk is development of PUD is infection w/ gram negative bacterium H pylori
complications with peptic ulcer
Hemorrhage, perforation, or pyloric obstruction
medical diagnosis of peptic ulcer
Barium swallow examination, gastroscopy, and esophagogastroduodenoscopy
H. pylori can be detected by antibodies in the blood or stool so we need to eradicate the bacteria, reduce the acid levels, and by a breath test
medical treatment of peptic ulcer
Drug therapy
Diet therapy
Managing complications
Begins in the mucous membranes, invades the gastric wall, and spreads to the regional lymphatics, liver, pancreas, and colon
No specific signs or symptoms in the early stages
enlarged mass or ulcerating lesion that expands or penetrates several tissue layers
stomach cancer
The most common type of stomach cancer that rises from the granular cells in the inner layer of the stomach
adenocarcinoma
cause of stomach cancer
H. pylori infection, pernicious anemia, chronic atrophic gastritis, and achlorhydria, type A blood, and a family history
Cigarette smoking, alcohol abuse, and a diet high in starch, salt, pickled foods, salted meats, and nitrates
s/s of stomach cancer
Late signs and symptoms are vomiting, ascites, liver enlargement, and an abdominal mass, pain
early signs, feeling of fullness, Indigestion, heartburn, n/v, anorexia, weight loss, fatigue, and anemia, stool contain occult blood
medical diagnosis of stomach cancer
Gastroscopy, endoscopic ultrasound, upper GI series, CT, PET scan, MRI, laparoscopy
Laboratory studies include hemoglobin and hematocrit, serum albumin, liver function tests, and carcinoembryonic antigen
medical treatment of stomach cancer
Surgery, chemotherapy, and radiation therapy
Preoperative care of the patient with stomach cancer
Inform about the nasogastric tube and IV fluids; teach coughing, deep breathing, and leg exercises
Identify/support patient’s coping methods
Include sources of support, such as family members or a spiritual counselor, in the preoperative care
Postoperative care of the patient with stomach cancer
Assessment
Comfort, appetite, and nausea and vomiting
Monitor weight changes and determine dietary preferences
Identify the patient’s support system and coping strategies
Interventions
Pain
Imbalanced Nutrition: Less Than Body Requirements
Ineffective Coping
is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. It happens when the small intestine expands too quickly due to the presence of hyperosmolar (having increasedosmolarity) contents from thestomach. This causes symptoms due to the fluid shift into the gut lumen with plasma volume contraction and acute intestinal distention
Dumping syndrome
“Early” dumping begins concurrently within ? min from ingestion of a meal
15 to 30 minutes
“Late” dumping happens ? hours after eating.
one to three hours
S/s of early and late dumping syndrome
Symptoms of early dumping include nausea,vomiting,bloating, cramping, diarrhea, dizziness, and fatigue.
Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types. The syndrome is most often associated withgastric bypass(Roux-en-Y) surgery.
In addition, people with this syndrome often suffer from What?, because the rapid “dumping” of food triggers thepancreasto release excessive amounts ofWhat?into the bloodstream. This type of hypoglycemia is referred to as ?
low blood sugar, or hypoglycemia
insulin
“alimentary hypoglycemia.”
Strangulated hernia, tumor, paralytic ileus, stricture, volvulus (twisting of the bowel), intussusception (telescoping of the bowel into itself), and postoperative adhesions is the cause of what
Intestinal Obstruction
s/s of Intestinal Obstruction
Vomiting (possibly projectile), abdominal pain, and constipation
Blood or purulent drainage passed rectally
Abdominal distention, especially with colon obstruction
complications of intestinal obstruction
Fluid and electrolyte imbalances and metabolic alkalosis
Gangrene and perforation of the bowel
Nursing assessment of intestinal obstruction
Symptoms, including pain and nausea
Onset and progression of symptoms
Hernia, cancer of the digestive tract, and abdominal surgeries
Ask when the patient’s last bowel movement was and if the characteristics were nor
cause of appendicitis
Inflammation of the appendix
A ruptured appendix allows digestive contents to enter the abdominal cavity, causing peritonitis
S/S of appendicitis
Pain at McBurney’s point, midway between the umbilicus and the iliac crest
Temperature elevation, nausea, and vomiting
Elevated WBC count (10,000-15,000/mm3 )
Peritonitis: absence of bowel sounds, severe abdominal distention, increased pulse and temperature, nausea/vomiting; rigid abdomen
medical treatment of appendicitis
Nothing by mouth
A cold pack to the abdomen may be ordered
Laxatives and heat applications should never be used for undiagnosed abdominal pain
Immediate surgical treatment indicated
Ruptured appendix: surgery may be delayed 6-8 hours while antibiotics and IV fluids given
nursing assessment of appendicitis
Location, severity, onset, duration, precipitating factors, and alleviating measures in relation to the pain
Previous abdominal distress, chronic illnesses, surgeries; record allergies and medications
Temperature; abdominal pain, distention, and tenderness; presence and characteristics of bowel sounds
Preoperative interventions of appendicitis
Semi-Fowler or side-lying position with the hips flexed
Until physician determines the diagnosis, analgesics may be withheld
If rupture suspected, elevate patient’s head to localize the infection
Postoperative interventions of appendicitis
Administer antibiotics, intravenous fluids, and possibly gastrointestinal decompression
Assist the patient in turning, coughing, and deep breathing; incentive spirometry
Splint the incision during deep breathing
Early ambulation
Assess abdominal wound for redness, swelling, and foul drainage
Wound care as ordered or according to agency policy
is a procedure in which a needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid for diagnostic or therapeutic purposes…Ascitic fluid may be used to help determine its etiology as well as to evaluate for infection or presence of cancer.
Paracentesis
Inflammation of peritoneum caused by chemical or bacterial contamination of the peritoneal cavity
Peritonitis
s/s of peritonitis
Pain over affected area, rebound tenderness, abdominal rigidity and distention, fever, tachycardia, tachypnea, nausea, and vomiting
medical treatment of peritonitis
Gastrointestinal decompression, intravenous fluids, antibiotics, and analgesics
Surgery to close a ruptured structure and remove foreign material and fluid from the peritoneal cavity
assessment of peritonitis
Onset, location, and severity of the pain and any related symptoms
Record a history of abdominal trauma, including surgery
Record vital signs
Inspect abdomen for distention and auscultate for the presence of bowel sounds
