exam 5- gi Flashcards
GI System organs
mouth,
pharynx,
esophagus,
stomach,
small intestine,
large intestine,
liver,
gallbladder,
pancreas
Subjective data for gi system
focused or part of total health assessment –
nutrition, diet screening.
Dietary habits and history of gi symptoms,
normal weight,
any weight loss,
meds,
current health history,
socioeconomic status
Objective data-
physical assessment –
ht
weight,
bmi,
oral, abdominal assessment,
bowel sounds and last bowel movement, passing flatus
Barium Swallow/upper GI Series
look for
drink
observing
diet
cannot take
eliminate by
stool
Diagnostic Tests- Esophagus & Stomach
-looks for inflammation, ulcerations, hernia and polyps.
Pts drink 16-20 ounces of barium-
observing movement of barium contrast by bronchoscope.
diet may be altered a few days before.
Pts cannot take narcotics or anticholinergics 24 hrs before /
/ after study- eliminate barium by increasing fluids for 48 hrs,
stool may be light in color
Esophageal Acidity –
diagnoses
inserted
normal
Diagnostic Tests- Esophagus & Stomach
diagnoses lower esophageal sphincter issues and chronic reflux.
A catheter with a ph probe is inserted
normal is between 5-6
Gastric Emptying Studies
evaluates
Diagnostic Tests- Esophagus & Stomach
–evaluates ability of stomach to empty liquids or solid
MRI
identify
no
need
Diagnostic Tests- Esophagus & Stomach
–identify sources of bleeding,
no metal implants,
need to lay flat and still
EGD- esophagogastroduodenoscopy –
direct
looking
pts need
monitored
local
check
Diagnostic Tests- Esophagus & Stomach
direct visualization of esophagus, stomach, duodenum-
looking for polyps or ulcers,
pts need to be npo,
monitored for anesthetic care/
/ local anesthetic is used in the throat
check gag reflex prior to giving them anything
Barium Enema –
used to identify
contrast
colon must be
liquids prior
give what after
increase
Diagnostic Tests- Intestines
used to identify abnormalities of the colon or rectum,
contrast medium and rectal area is looked through scope,
colon must be clear of fecal content,
clear liquids prior ,
given laxatives and enemas after,
increase fluids
Colonoscopy -,
entire/looking
pts
liquids
taking/tolerating
if coming in
after education
Diagnostic Tests- Intestines
entire colon, looks for polyps, tumors, bleeding , strictures,
pts are npo
are clear liquids,
taking oral bowel prep, must be able to tolerate oral prep,
if coming in for n/v or gi complaints bowel prep may be challenging/
/ after procedure educate on abdominal cramping and flatus for a few hrs
Guaiac Fecal Occult Blood
checking
Diagnostic Tests- Intestines
– checking fecal matter for hidden blood
Stool Culture –
what looking at
Diagnostic Tests- Intestines
looking at form, consistency, color and odor
Lower GI Series –
drink
film
must tolerate
increase
change
Diagnostic Tests- Intestines
drink contrast medium,
films are taken and can be used with upper gi series or barium swallow,
must be able to tolerate bowel prep to get rid of fecal matter,
increase fluids
changes in stool color
Ultrasound –
what is it
checks
Diagnostic Tests- Gallbladder, Pancreas, Liver
high frequency sound waves that pass through the body structures
to check for abnormalities
Cholangiogram
contrast
evaluates
Diagnostic Tests- Gallbladder, Pancreas, Liver
–contrast medium is injected into the common bile duct
to evaluate filling
CT -
what is it
might need
Diagnostic Tests- Gallbladder, Pancreas, Liver
360 view of body structures,
might need oral contrast,
Endoscopic Retrograde Cholangiopancreatography (ERCP)-
visualizes
retrieves
Diagnostic Tests- Gallbladder, Pancreas, Liver
visualizes gi structures
, retrieves gallstones from bile duct and dilate structures
Magnetic Resonance Cholangiopancreatography (MRCP)-
non
evalautes
no
lie
Diagnostic Tests- Gallbladder, Pancreas, Liver
non invasive mri
evaluate biliary and pancreatic ducts
, no metal implants,
lie flat and still
Liver Biopsy –
rules out
monitor/no
pts
preop
check
needle
after biopsy
Diagnostic Tests- Gallbladder, Pancreas, Liver
used to rule out metastatic cancer, liver cirrhosis
, monitor anticoagulants prior, no aspirin and ibuprofen a week prior to biopsy,
pts are npo,
vitals preop,
check bleeding times,
needle is inserted into upper right quadrant,
after biopsy pts are laying on right side to maintain pressure
Stomatitis-
common
oral mucosa
mucosal lining
Common disorder of mouth
Inflammation, ulcers of the oral mucosa
Thin, fragile mucosal lining is damaged leading to significant pain and discomfort
Stomatitis-
causes
infections
t
i
nd
ca
Viral, bacterial or fungal infections,
trauma,
irritants,
nutritional deficiencies,
chemo agents
who’s at risk for Stomatitis-
immune compromised patients,
chemo pts,
frail elderly pts,
HIV,
corticosteroids
dentures
Stomatitis-
diagnosis
DV
C
sm
les
direct visualization and physical exam ,
cultures,
smears for systemic illness,
lesions spreading down into esophagus
Stomatitis-
manifestations-pain/inability
leads to
oral pain,
inability to eat, drink or swallow,
leads to complications of malnutrition and fluid and electrolyte imbalances ,
treatment
Oral hygiene
–soft toothbrush,
avoid alchhol based mouthwashe
medications Stomatitis-
Coating agent
contain
dont
-coat the mouth
Often contain lidocaine –
don’t want to swallow,
- Fungal meds stomatitis
treats what
med+considerations
oral antifungl meds-
treat thrush or candidas
Nystatin- oral suspension//swish and swallow
Oral antifungals- fluconazole, ketoconazole
Medications- Viral
meds
stomatitis
Topical/oral antiviral –
acyclovir, valacyclovir
Stomatitis- type–Cold sore, Fever Blister
causes
manifestation
treatment
Causes–Herpes Simplex Virus
manifestations–Burning, vesicular lesion
treatment–Resolves on own
Antiviral - “cyclovir”
stomatitis type–Aphthous ulcer- Canker Sore
causes
manifestations
treatment
causes–unknown; herpes virus
manifestations- Shallow white/yellow erosions with red ring
treatement- Topical steroid, numbing agents
Candidiasis (thrush)- stomatitis
causes
manifestasions
treatments
causes–Candida Albicans
manifestations-White, curd-like patches
treatment-antifungals- nystatin, fluconazole, ketoconazole
Stomatitis- health promotions
identify
education(eliminate/if chemo/ )
Identify risk factors –oral care, poor denture use,
Educate –eliminate spicy/hot foods, if on chemo, avoid irritants like alcohol and tobacco
Priorities of Care
hygiene
maintain
Oral hygiene, prevention, treatment
Maintain adequate nutrition- hydration
GERD-
what is it
what results from
Backward flowing of gastric contents
Results from relaxation of esophageal sphincter and increased pressure from stomach
GERD contributing factors
increased
p
hh
environmental
increased gastric volume and pressure
positioning
hiatal hernia
environmental/diet-smoking, alcohol, coffee, chocolate
GERD-
Manifestation
other manifestations
Heartburn –usually after meals, when bending over
Atypical chest pain, Sore throat , Hoarseness
gerd
complications of manifestations
Esophageal strictures, leading to dysphagia
Barrett’s esophagus –cell wall changes leading to cancer risk
GERD- Diagnosis
Barium Swallow; evaluate GI track
Upper endoscopy; direct visualization, Bx
Bernstein Test; Saline & acid solution mimicking symptoms
24-hour pH monitoring
Esophageal manometry; pressure measurement of sphincters & peristalsis
PPIs
drug
how work
before
do not
meds
GERD- Treatment
–drug of choice,
reduce acid secretion,
before meals,
do not crush, -
omeprazole and pantoprazole
H-2 Receptor Blockers –
how work
what meds
GERD- Treatment
reduce acidity of gastric juices.
Famotidine, rimantadine,
Anti-ulcer Agent –
how work
when take
GERD- Treatment
react with gastric acid to fomr thick coating or paste, coats damaged gastric tissues and promotes healing,
1hr before meals and bedtime,
antacids
how work
what med
when take
GERD- Treatment
buffer/neutralize gastric acids, relieve pain and prevent damage,
tums,
sperate 2 hrs from other meds
motility Agent-
how work
what med
GERD- Treatment
stimulate gi tract motility and gastric emptying,
metoclopramide/reglan
nutrition and lifestyle
GERD- Treatment
Ideal body weight & diet selection
surgery
how work
GERD- Treatment
Lap/Nissen Fundoplication
Increases pressure in lower esophagus , inhibiting reflux
health history
priority
education
GERD- Nursing Care
Heath history, symptoms- manifestations, what foods are irritants, positioning issues,
Priority- symptom relief
Educate; irritants to avoid –stay away from meds that irritate gi tract like aspirin and nsaids, naproxin
Hiatal Hernia-
portion of stomach that protrudes through diaphragm, increases with age
Hiatal Hernia-
manifestations
Reflux,
fullness,
chest pain,
dysphagia,
bleeding,
belching,
indigestion
Hiatal Hernia-
diagnosis
barium swallow
upper scope
Hiatal Hernia-
treatment-similar
surgery why
keys to prevention-(ideal, remain, no)
Similar to GERD
Surgery- if conservative treatment is unsuccessful
Keys to prevention
1-ideal body weight
2-remain upright for 2 hrs after eating
3- no eating before bedtime
Peptic Ulcer Disease-
what is
gi tract-where
results
Break in mucous lining of GI tract where is comes in contact with gastric juices
GI Tract- duodenum most common
Results in peptic ulcers
Peptic Ulcer Disease-
risk factors
asprin & NSAID use –inc risk of bleeding
Age, history of ulcers
Smoking
H. Pylori infection
Peptic ulcer disease manifestations
classis symptoms
pain (indigestion), epigastric, below sternum area
Pain-food-relief pattern- pain 2-3 hrs after meals and in middle of night which is relieved by eating
Peptic ulcer disease manifestations
vague symptoms
hemorrhage
obstruction
perforation
Peptic ulcer disease manifestations
Zollinger-Ellison Syndrome
what is it
what does/leads to
Gastrin secreting tumor-
hypersecretion of gastric acid leading to ulceration
Peptic Ulcer Disease- diagnosis
upper gi endoscopy-
fecal analysis
gastic analysis
Upper GI Endoscopy & biopsy- rule out ulcer and provides direct visualization of ulcers and surrounding tissues
Fecal Analysis-stool analysis and looking for h pylori
Gastric Analysis- for suspected seilinger Ellison syndrome,
Peptic Ulcer Disease- Treatment
therapy
discontinue
receptor-promote
__protectant +meds
Antibiotic Therapy- 14 days & PPI
Discontinuation of NSAIDs
PPIs & H2 receptor
PPI’s faster healing relief
Mucosa protectant
Sucralfate, bismuth compounds, antacids
Peptic Ulcer Disease-
Treatment Cont
nutriton
surgery
Nutrition
Balanced meals, regular intervals
No smoking -slow healing
Surgery
Needed due to complications of PUD –if hemorrhage , perforation or obstruction
Hemorrhage
goal
what does nurse do
Peptic Ulcer Disease- Complication Management
Goal restore circulation
NPO, PPI’s via IV, iv fluids, blood transfusion, ng tube
obstruction
due to
gastric decompression
Peptic Ulcer Disease- Complication Management
Due to repeated inflammation, healing, scarring, edema
Gastric decompression- ng tube, iv
Perforation-Peritonitis
risk
positioning
needs
Peptic Ulcer Disease- Complication Management
Risk contamination, treat with ng tube and antibiotics,
Positioning semi fowlers so contaminates pool in lower abdomen/ pelvis
Surgery
Peptic Ulcer Disease-
health promotion-avoid
priorities in care
_avoid nsaids, aspirin
Priorities in care reducing discomfort, nutritional status, identifying and preventing compliacations
Gastritis-
what is
most often from
3 kinds
Inflammation of stomach lining
Most often from gastric irritants such as : aspirin, alcohol, caffeine or contaminated foods
Acute, Chronic, Erosive
acute gastritis
local
why is it
what causes
*Local irritant
*Acid and pepsin comes in contact with gastric tissues-
inflammation, irrigation, superficial erosion
acute gastritis manifestations
*Anorexia, N&V, melena, pain, hematemesis, shock
chronic gastritis overview
progressive
h
autoimmune
Progressive disorder, atrophy of gastric tissues
H. Pylori gastritis
Autoimmune gastritis- intrinsic factors affected, unable to absorb B 12- pernicious anemia
chronic gastritis
manifestations
Vague, asymptomatic
Fatigue & Anemia
erosive gastritis overview
induced
ischemia
maintain
Erosive, stressed induced- trauma, shock, burns, head injury, major surgery
Ischemia of gastric tissue from massive vasoconstriction
Maintain pH with medications to prevent acid secretion
erosive gastritis manifestations
Painless gastric bleeding couple days after stressor
Gastritis- Diagnosis -why
h pylori
gastric analysis
hh rbc
b12
upper endoscope
H. Pylori Testing-source of inflammation
Gastric Analysis-gastric content
H&H, RBC-anemia
B 12 levels-perniscous anemia-unable to absorb b 12
Upper Endoscope-gastric mucosa
medications
Gastritis- Treatment
PPIs,
H2 receptor blockers,
sucralfate,
antibiotics
NPO status
slow intriduction
keep hydrated
Gastritis- Treatment
Slow introduction clears-full liquids-general
keep hydrated- iv fluids
gastric lavage
why used
___via lavage
nursing considerations-do not
Gastritis- Treatment
Used with poisonous or corrosive ingestion
Dilution and removal via lavage
Nursing Considerations do not induce vomiting, further damage could occur
complementary therapy
Gastritis- Treatment
Herbal & aromatherapy-
chamomile tea, garlic, ginger, mint
health promotion
assessment
priorities in care
gastritis nursing care
Health Promotion
Prevention, safe food preparation
Assessment
Health and history, symptoms, risk factors
Priorities in care
Pain management, healing of tissue, nutritional status
Dumping Syndrome-
common complication following what
patho- quick/stimulated/ increased/ leading to
Common complication following gastrectomy or gastric bypass
patho
Quick food bolus, drawing fluid into duodenum
Peristalsis is stimulated
Intestinal motility is increased
Leading to dumping and
Systemic symptoms
systemic symptoms
dumping syndrome
tachycardia,
hypotension,
flushing,
, diaphoresis
dizziness
Dumping Syndrome-
management
meals
separate
rest in after
Small, frequent meals
Liquids and solids separate
Rest in recumbent/semi-recumbent 30-60 minutes after meals
Pyloric Stenosis-
what is
what does it cause
Pyloric sphincter muscle doesn’t empty properly and is unable to pass fluid
causes projectile vomiting
pyloric stenosis
assessment(4-6 weeks/ watch for)
treatment(/ww/s)
Assessment
4-6 weeks of age, vomiting after feedings, projectile vomiting
Watch for s/s of dehydration
Treatment
Watch & wait
Surgery
Irritable Bowel Syndrome
aka
what looks like
manifestations
aka spastic bowels
Abdominal pain, bloating, constipation and/or diarrhea
Manifestations: change in bowel habits, frequency, form, passage of mucous
Irritable Bowel Syndrome- Diagnosis
ss
gs
bs
be
b
Stools samples
, GI scope,
bowel series,
barium enema,
biopsy
Irritable Bowel Syndrome- Treatment
meds
Bulk forming laxative-
Anticholinergic- reduce spastic bowel and decrease bowel motility
Anti-diarrhea-
Antidepressants- ssri or tricyclics
Education for irritable bowel syndrome
additional
avoid
; dietary habits- additional fiber ,
avoid trigger foods like dairy, caffine and soda
Appendicitis-
inflammation
obstruction
pressure leading to
perforation =
Inflammation of the appendix
obstruction of proximal lumen
Pressure builds, leading to inflammation, edema, infection
Perforation= peritonitis
mcbunreys point Appendicitis-
tenderness
relief/release
Localized and rebound tenderness at “McBurney’s point”
relief of pain when direct palpitation followed by pain on release
Appendicitis-
Diagnosis
treatment
surgery
Ultrasound, CT scan, WBC
Hydration, antibiotic therapy, pain medications PRN
surgery- appendectomy
Gastroenteritis-
what is it
culprit
how do infectious organisms enter body
What is it? Inflammation of the stomach and small intestine
Culprit bacteria, viruses, parasites or toxins
Infectious organisms enter body in contaminated food or water- food poisoning
manifestations
Gastroenteritis-
Anorexia, n/v, abdominal pain, cramping, diarrhea
complication-due to
how treat
gastroenteritis
Electrolyte imbalances due to vomiting
IV fluid - hydration stabilization
Gastroenteritis- diagnosis
Labs,
stool samples,
lower GI Scope
Gastroenteritis- treatment
meds- what types
nutrition-what give
gastric lavage-what does
Medications - Antibiotics, antidiarrheal
Nutrition
fluid supplements, oral electrolytes,
Gastric Lavage
washes out stomach and lining
Inflammatory Bowel Disease-
two conditions
ulcerative colitis
Crohns
Ulcerative Colitis
what is it
Chronic inflammatory bowel disorder of the mucosa and submucosa of distal colon and rectum
Ulcerative Colitis
diarrhea->
ranges
cramping/releif
manifestations
Diarrhea blood in mucus with abdominal pain
Ranges from mild-severe
Left lower quad cramping- relieved by defecation
ulcerative colitis complications
TM
P
MH
CC
Toxic megacolon,
perforation,
massive hemorrhage,
colorectal cancer
Chrons
what is it
Chronic, relapsing inflammatory process affecting GI tract (Ileum & Ascending colon)
chrons manifestations
persistant
pain
persistent diarrhea, no blood or mucus
Right lower quad pain, periumbilical
chrons complications
O
F
AF
M
CC
Obstruction,
fistulization,
abscess formation,
malabsorption,
colon cancer
Ulcerative Colitis & Crohn’s-
inspection
stools
C__/H_
elevated
low
diagnosis
Inspection of bowel (Scope, barium x ray)
Stools examination blood and mucus
CBC, H&H
Elevated Sedimentation rate & C-Reactive proteins
Low Albumin
Ulcerative Colitis & Crohn’s-
meds
nutrition
surgery
Medications- steroids
Nutrition-
Fiber moderation- fiber contraindicated with intestinal strictures, inflammation and scaring
Surgery- colectomy, ostomy or illesotomy
Ulcerative Colitis & Crohn’s-
Health Promotion-
educate
need
monitor
monitor
educate on need for supplemental vitamins
need to be on steroids for exacerbations
monitor weight and nutrition
monitor daily bowel movements
Diverticular Disease
what is it
2 kinds
Outpouching of colon, occurring in rows- anywhere in intestinal tract
2 kinds-
Diverticulosis
Diverticulitis
Diverticulosis
presence
complications
Presence of diverticula, often asymptomatic
Complications- Hemorrhage, diverticulitis
Diverticulitis
inflammation
what settle
complications
Inflammation in and around the diverticula
Undigested food and bacteria settle
Complications:
Perforation-fever and pain complaints
Diverticular Disease-Manifestations
pain
con/inc
other manifestations
Pain- left side, ranges from mild to severe
Constipation or increased stools
N/V, fever
Diverticular Disease
complications
obs
form
hem
narrow
Bowel obstruction,
fistula formation,
hemorrhage
, bowel narrowing
Diverticular Disease- diagnosis
enema
ray
oscopy
scan
labs
Barium Enema,
x rays,
sigmoidoscopy/colonoscopy
, CT scan
Labs- H&H, WBC’s, guaiac stool
Diverticular Disease- Treatment
what meds
inc what
nutrition-high, avoid,bowel rest
Antibiotics
Hydration
Nutrition-
high fiber,
avoiding small seeds, shells, popcorn
bowel rest-slow gradual feeding
surgery diverticular disease
treats
2 stage procedure
To treat peritonitis, hemorrhage, resection (
2- stage procedure) –temporary colosotmy
Diverticular Disease-
education
assessment
priority
Education- diet
assessment- subjective/ objective- pain, history, bowel sounds, tenderness, blood stool
Priority preventing complications- pain and anxiety
Malabsorption Syndromes-
condition
diseases of intestines
Condition where intestinal mucosa ineffectively absorbs nutrients
Diseases of intestines- Crohn’s, gastric bypass, celiac, lactose intolerant
manifestations Malabsorption Syndromes-
Anorexia,
bloating,
weight loss,
weakness,
fatigue,
difficulty concentrating
Polyps-
what is it
most/some
asymptomatic-how found
What is it?? –mass of tissue that arise from bowel wall
Most benign, some malignant
Asymptomatic found on routine screens or painless rectal bleeding
complications with large polyps
o
p
sc
Obstruction,
pain
stool changes
Colorectal Cancer-
what improves survival rate
what type of growth
no symptoms until when
Early diagnosis and treatment improved survival rate
No symptoms until advanced
Growth slow
risk factors of colorectal cancer
Age,
polyps
, family history,
IBD,
radiation,
diet,
obesity,
smoking, alcohol use
manifestations
advanced disease manifestations
complications
colorectal cancer
manifestations-Rectal bleeding, change in bowel habits
advanced disease manifestations-pain, anorexia, weight loss
complications-bowel obstruction and perofration
Colorectal Cancer- Prevention
lifestyle habits(inc/dec/ healthy/ do what)
age 50
Lifestyle habits- inc vegetables, decrease red meat, healthy weight, exercise
At age 50; start screening measures
colorectal cancer diagnosis
use what
use if suspected metastasis
what labs
gi Scope; tissue biopsy
Ct/ MRI- if suspected metastasis
labs; CBC, guaiac, Tumor marker
Surgical Resection->
Laser photocoagulation->
colostomy placement reason
Colorectal Cancer- Surgery
Surgical Resection; lymph node is removed
Laser photocoagulation-light beam, to destroy tumor
Colostomy placement- diversion
colostomy naming
line going left
junction of line to small intestine
upwards
side
down
by anus
Colorectal Cancer- Surgery
Colostomies take name of the portion of colon from which they come from
line going left- illeostomy
ceconstomy - junction of line to small intestion
ascending -upwards
transverse-side
descending-down
sigmoid-by anus
Colostomy-
assessing
L/t
S-surrounding
O-consitency
Assess location and type of colostomy
Assess stoma, surrounding skin
Assess output- consistency of drainage depends on stoma location
Colorectal Cancer- Radiation
used with
reduces
shrink
Used with surgical resection for tumors
Reduces recurrence of pelvic tumors
Shrink to allow for surgery
Consistency changes –look up
Ascending
Transverse
Descending
Sigmoid
Ascending
Transverse
Descending
Sigmoid
Colorectal Cancer- chemo
reduces
Reduces rate of tumor reoccurrence/ Metastasis
Intestinal Obstructions-
what is it
mechanical obstructions (1/2/3)
Gas and fluid accumulation, distending the bowel- does what
what is it-Failure of intestinal contents to move through
mechanical obstructions
1-scars
2. adhesions
3. tumors or inflammatory obstruction
Gas and fluid accumulation, distending the bowel- compromises blood flow leads to necrosis
Small Bowel Obstruction
caused by
- adhesions
- scar tissue
- hernia
small bowel obstructions
manifestations
early /late on
Cramping,
n/v
fecal matter
, early on high pitched bowel sounds, later on silent bowels
Small Bowel Obstruction- Complications
Hypo
pvent
nec
perf
Hypovolemia(/ic shock) renal insufficency
Pulmonary ventilation
Necrosis from Strangulation- no blood supply
Perforation - can lead to septic shock
Large Bowel Obstruction
occurance
area
Less frequent occurrence;
sigmoid area- cancer of bowel
manifestations of large bowel obstructions
normal manifestations
late signs-not common
what types of sounds
constipation , colicky abdominal pain
Deep, cramping; vomiting late sign- not all that common
High pitched, tinkling bowel sounds with rushes/gurgles
complications of large bowel obstructions
colon dialation
->
Colon Dilation increasing pressure which impairs circulation and can lead to
Gangrene, perforation, peritonitis, diaphragm involvement
Bowel Obstruction- Diagnosis
X ray, CT
Labs (WBC/ Electrolytes/ ABGs )
Bowel Obstructions- Treatment
conservative treatment
decompresion
npo status
pain meds
ng
type of meds
dvt
Decompression- NG tube, IV fluids
NPO status watch fluid status, urine output
Pain medications, nausea medications
NG- Collects unwanted fluid & gas while allowing bowels to rest
Antibiotics
DVT prevention -Ambulation
Bowel Obstructions- Treatment surgery
required if
does what to treat
Required if conservative treatment fails, or complete obstruction, strangulation
Remove obstructing cause- treat the problem
preop bowel surgery
marking
tube
perform
Marking of stoma site
NG tube placement and management
Perform bowel prep as ordered
postop bowel surgery
monitor
assess
support
managing
complications
Monitor bowel sounds
Assess surgical site dressing and drainage-CHECK bleeding
Emotional Support depression, loss of interst in actiivtes
Managing post-op problems- pain, gas pain, nausea
Complications- peritonitis
Bowel Obstructions- Priorities
imbalances
treating
observe
managing problems
discharge education
Fluid and electrolyte imbalances
Treating infection
Observe dressing and drainage
Managing post-op problems- pain, gas pain, nausea encourage ambulation
Discharge education- normal bowel movements
Peritonitis-
inflammation
sterile
caused by
Inflammation of peritoneum
Sterile peritoneal cavity becomes contaminated
Caused by bacteria
Abdomen/GI Symptoms
peritonitis
Pain
Tenderness with rebound
Board-like rigid abdomen
Diminished/absent bowel sounds
Distention
n/v
Systemic Symptoms
peritonitis
f
t
t
r
c
o
Fever
Tachycardia
Tachypnea
Restlessness
Confusion
Oliguria
Peritonitis- Treatment
meds
surgery
nutrition
decompression
Medications - (Antibiotics Pain control)
Surgery -(Identify cause of contamination and fix/ Peritoneal lavage )
Nutrition (IV fluids, parenteral nutrition)
Decompression
Ng tube- Relieve distention, promote bowel rest
Hernias-
what is it
how classified/classifications
What is it?? Defect in abdominal wall that allows abdominal contents to protrude outwards
Classified by location
Inguinal, umbilical, incisional/ventral
Inguinal hernia
males->
indirect->
direct->
Males; bulge/lump with lifting/strain, sometimes dull ache
Indirect- improper closure of the tract as the testes descend at birth
Direct- acquired from weakness of posterior inguinal wall
umbilical hernia
women ->
enlarge/pain->
Women; Pregnancy and obesity
Enlarge steadily, sharp pain with coughing/straining
incisional hernia
where at
what looks like
often
At previous surgical sites, or abd muscle tear
Bulge;
often asymptomatic
hernia manifestations
abdominal contents
abdominal contents protrude through abdominal wall and form sac
Reducible hernia:
abdominal contents
returns
abdominal contents move through sac with increased abdominal pressure
returns to abdominal cavity when pressure returns to normal
complications of hernias
low risk w
incarcerated
obs/stra
Risk is low with reducible
Incarcerated- if contents can not be returned to abdominal cavity
Obstruction, strangulation (severe pain, distention, n/v,)
Hernias- Treatment
exam
how treated
what looking for for nursing care
Physical examination
Treated with surgery
Suturing opening, put mesh inside
Nursing Care
History of symptoms, looking for bulge
Hemorrhoids-
manifestations
diagnosis
meds do what
Manifestations pain, rectal bleeding
Diagnosis- Patient history, physical exam
Medications- to improve constipation, reduce straining
Hemorrhoids- Treatment
Sclerotherapy
Hemorrhoidectomy
Sclerotherapy –chemical irritant injected to cause scarring
Hemorrhoidectomy –surgical removal
Anorectal Surgery-
why sensitive
used for what
Sensitive- sensory nerves, painful procedure
Hemorrhoids, Anal Fissure, Anorectal Abscess, Anorectal Fistula
nursing care anorectal surgery
what after stools
no what
observing what
returnof gi function
Dietary support/teaching
Limit pressure and positioning on surgical site
Sitz bath after stools
No rectal medications
Observe dressing/drainage
Return of GI function-start fluid intake
Dietary support/teaching-high fiber diet, and fluid intake
Limit pressure and positioning on surgical site -low head of bed, supine position, don’t elevate hob
Cholecystitis-
what is it
acute obstruction
difference between Cholecystitis /Cholelithiasis
Inflammation of gallbladder
Acute obstruction of cystic duct by stone
Cholecystitis inflamttion of actual gall bladder
Cholelithiasis presence of stone
Cholecystitis Manifestations
onset
temp
pain where
Abrupt onset,
low grade temp,
Right quad pain radiates to back, right shoulder/scapula
chronic manifestations of Cholecystitis-
repeated bouts or gallbladder irritation
Cholecystitis-
diagnosis
CBC, bilirubin, amylase & lipase
Ultrasound
X-ray
Gallbladder Scans
Cholecystitis- meds
does what
meds
antibiotics usage
Reduce cholesterol content of stones; gradual dissolution
Ursodiol, chenodiol
Antibiotics- infection, reduce edema, inflammation
Cholecystitis-
surgical Treatment
nutrition
dietary
avoid
Laparoscopic Cholecystectomy
Nutrition- Reduce food intake during attack
Dietary low texture diet that’s bland
Avoid obesity, hyperlipidemia, high cholesterol, high fat foods
Hep a
trasmission
what else
Fecal-Oral-
contaminated food/ water/ shellfish/ direct contact with and infected person-sex
Hep b
trasmission
what else
Blood/body fluids
Perinatal
High risk group, iv drug users, multiple sex partners, exposed to blood products-oral contraceptives do not provide protection
Hep c
trasmission
what else
Blood/body fluids
Injection drug users is primary risk-asymptomatic long after exposure//hand hygiene and ppe for healthcare providers
Hep d
trasmission
what else
Blood/body perinatal
Only causes infection in pts with hep b
Hep e
trasmission
what else
Fecal Oral
Fecal contamination of water supply, oral contraceptives do not provde protection
Hepatitis- Diagnosis
assessment
increase in what labs
presence of what
what kinda biopsy
Assessment –inflammation of liver
Labs; liver function tests
ALT, AST, ALP, Bilirubin -increase
Presence of antigens and antibodies
Liver biopsy
