gastro-intestinal illness Flashcards
what does a general GI assessment include
abdominal assessment
vitals
pain
medications
allergies and intolerance
recent travel
diet and stool patterns
weight
intake and output
what are diagnostic tools for GI symptoms
stools samples - occult blood test
CBC, electrolytes and ABG
ultrasounds, barium X-rays, CT, colonoscopy
what is the nurses role while prepping a patient for a radiology bowel series
NPO 8-12 hours before procedure no gum or smoking
Explain procedure and explain how to take barium
for lower GI series you must clear colon with laxatives
after the series, fluids and laxatives to help pass the barium
what is the nurses role in prepping for endoscopy
NPO 8 hours before
bowel prep
manage cramping post procedure and monitor risk for perforation
what is the nursing role in prepping for an ultrasound
NPO for 8-12 hours before
what is the nurses role in prepping for a CT and MRI
Explanation of the procedure
determine if there is an iodine sensitivity and increase fluids after procedure
MRI - contraindicated in patients with metal implants and pregnancy
Ativan or sedatives prior if patient is claustrophobic
what are the main goals of functionality when it comes to GI symptoms
relieving the symptoms
normal bowel elimination patterns
prevention of complications
maintenance of optima nutrition and weight
absence of skin breakdown
promote effective coping skills
what could cause nausea
GI disorders
pregnancy
infectious diseases
CNS disorders
cardio disorders
metabolic disorders
food poisoning and toxins
adverse effects of drugs
stress
when a patient presents with nausea and vomiting, what are good assessment questions to ask?
blood, mucous or vomit
appetite changes
weakness, fatigue or chills
abdominal tenderness or pain
has this ever happened before
what are certain meds that can cause N/V
opioid, chemo, antibiotics, iron, aspirin and laxatives
for nausea and vomiting, what clinical presentation with the patient have
vital signs - decreased BP and increase HR
lethargy, sunken eyes, dry mucous membranes and pallor
decrease urine output and increased concentration
hypoactive bowel sounds
tender abdomen with fluids air or mass?
what diagnostic assessments should be reviewed for nausea
CBC, CHEM 7, iron studies, pregnancy test, upper GI series and gastric emptying studies
what are patient goals when managing nausea
- minimal to no nausea
- normal fluid and electrolyte balance
- acid base balance
- maintain body weight
- adequate nutrients
what are comfort measures for nausea
low stimuli environment
avoid unnecessary procedures
oral care
head of bed elevated and avoid sudden changes
nursing interventions for support of nausea
- NG tubes
- signs of dehydration
- Ins and outs
- calorie count
- daily weights
- monitor labs
- reffed slowly
how should you re-feed someone with nausea and vomiting
NPO 30-60 min post vomit
clear fluids
dry starches
protein-rich
dairy
cold/room temperature drinks while sitting upright
avoid spicy and fatty foods and avoid hunger
signs and symptoms of constipation
abdominal pain and distention
indigestion
rectal pressure
decrease appetite and straining
dry hard stool
causes of constipation
insufficient dietary fiber
inadequate fluids
medications
lack of exercise
laxative abuse
pharmacological management of constipation
bulk forming
Metamucil
stoll softeners
enema
suppositories
lifestyle modification for constipation
increase fibre 20-30 g a day
3L of water each day
warm water or caffeine in the morning
exercise induced peristalsis
what is patient education regarding constipation
- defecate when the urge arises
- scheduled bowel routine
- avoid excessive use of laxatives and enemas
management of bowel obstruction
enema
digital disimpaction
surgical
what is management of hemorrhoids
prevention constipation
witch hazel discomfort
sitz bath
steroids creams
ice and heat
surgical removal
management of Diverticulitis
antibiotics
antipyretics
NPO
IV hydration
surgery
NG tubes
what causes diarrhea
malabsorption
celiac disease
inflammatory bowel disease
radiation treatment
infection, foods, medications, hormonal
irritable bowel syndrome, gastrectomy, neurological disorders
what are the priority concerns for diarrhea
dehydration - tachycardia, hypotension, dry mm
electrolyte imbalance
acid base imbalance
quality of life
interventions for diarrhea
treat the underlying cause
rehydration
nutrition - avoid caffeine, carbonated beverage or very hot or cold food
anti-diarrheal
probiotic
hand hygiene
monitoring weight and I/O
what is Irritable bowel syndrome
chronic abdominal pain and altered bowel habits
treatment of IBS without meds
- identify stressors
- frequent small meals
- increase physical activity
- food diary and bowel habits
- skin care and protection around anal area
what should the nurse promote for nutrition with diarrhea
- drink isotonic fluids
- probiotics
- eat foods with sodium and potassium
- eat foods with soluble fibre
- sitting upright when eating then 30-60 min
what is malabsorption syndrome
results from impaired absorption of fats, carbs, proteins, minerals and vitamins
causes malabsorption syndrome
- biochemical or enzyme deficiencies
- bacterial proliferation
- disruption of small intestine mucosa
-disturbed lymphatic and vascular circulation - surface area loss
what are clinical manifestations of IBS
- diarrhea
- steatorrhea
- flatulence
- malnutrition
abdominal distention or pain
What is the main treatment for celiac disease
- no gluten for life and corticosteroids PRN
key features of ulcerative colitis
- affects rectum and colon
- continuous lesion
- unknown cause
- intermittent exacerbation-remission
- can be cured through total colectomy
what are complication associated with UC
- hemorrhage
- colonic dilation
- perforation
- toxic mega-colon: hyperactive inflammatory response and colon become inactive
Nursing intervention for fluid and electrolyte balance
- Weights, I/O
- hemodynamic status
- IV fluids
- appropriate oral fluids
- electrolyte replacements
nursing interventions for maintaining skin integrity
- inspect skin and mucous membranes
- clean the perineum with water alone
- keep perineum dry
- sitz bath
- witch hazel compresses
- alcohol skin barrier
signs and symptoms of Chron’s disease
- stomach cramping
- pain
- chronic diarrhea
- weight loss
- fatigue
what are complications of Chron’s
- strictures or obstruction
- perforation, peritonitis, malabsorption, fistulas, accesses
short bowel syndrome
what is short bowel syndrome
rapid intestinal transit with impaired digestion/absorption with fluid and electrolyte loss
what is drug therapy for chron’s
5-aminosalicylates
glucocorticoids
immuno-modulators
biologic therapies
what is nutritional therapy for chron’s
high calories
high vitamin and high protein
low residue
dairy free
what situations is surgery indicated for Chron’s
- drainage of abdominal abscess
- failure to respond to conservation therapy
- fistulas
- inability to decrease corticosteroids
- intestinal obstruction
- massive haemorrhage
- perforation
- severe anorectal disease
- suspicion of carcinoma
soluble fiber
dissolves in water and slows down the passage of stools (FOR DIARRHEA)
insoluble fiber
dosen’t dissolve in fluid, absorbs them and sticks to other material to form stool (constipation)
what is the nurses main concerns when it comes to ostomies
fluid balance
nutrition
skin integrity
infection
patient knowledge and self-efficacy
what do you assess for skin integrity with ostomies
assess stoma colour
surrounding tissue healing and maceration
ensure appropriate fitting device
empty bag when 1/2 full or less
use non-alkaline cleanser
apply skin barrier
diet education for ostomies
chew thoroughly
avoid gassy foods
drink lots of fluids
low residue if risk of food getting stuck in the stoma
