Gastrointestinal Flashcards
Pancreatitis: Pathophysiology
Auto digestion of the pancreas. Pancreas has two seperate functions - Endocrine (Insulin) and Exocrine (Digestive Enzymes). There is acute and chronic pancreatitis - mostly caused by alcoholism.
There are a lot of enzymes in the pancreas! They are usually inactive in a healthy person. In the case of an alcoholic, it creates alot of scar tissue/gallstone that occludes and stops enzymes from escaping. Then they begin to digest the pancreas.
Pancreatitis: Signs and Symptoms/Diagnosis
Different degrees of severity.
Pain increases with eating
Abdominal distention/ascites because they are losing protein rich fluids like blood and enzymes into the abdomen
Abdominal mass - Swollen pancreas
RIGID BOARD LIKE ABDOMEN with guarding or bleeding- there is damage to the blood vessels because of the enzymes. Bleeding can lead to peritonitis.
Bruising around umbilical area (Cullen’s Sign) and flank area ( Grey Turners sign)
Fever ( inflammation)
N/V
Jaundice
Hypotension = because of bleeding or Ascites
Diagnosis Serum Lipase is REALLY UP WBC UP Blood Sugar UP ( Damages insulin) ALT, AST UP (Jaundice) PT, aPtt is longer ( Risk for bleeding and CLOTS) Bilirubin UP Hb/Hct Down or UP ( Can be down because of bleeding) and UP because of Not enough volume/dehydration/concentrated blood
Pancreatitis Treatment
Goal: Control Pain
Decrease Gastric Secretions ( NPO, NGT to suction, bed rest) - You want the stomach empty and dry
PCA narcotics, morphine, dilaudid and fentanyl
Steroids: Will decreases inflammation - but can cause diabetes or Cushings in the long term
Anti-cholinergics ( Dry up the stomach)
Benztropine, Atropine
GI protectants:
Panto, Rantidine, Antacids
Maintain Fluid and electrolyte imbalances
Maintain nutritional status (Ease into diet)
INSULIN: Because there is no insulin production, there is uncontrolled blood glucose due to steroids, TPN is packed with glucose
Daily Weights
Eliminate alcohol
Refer to AA
4 Major Functions of the Liver
Detoxifying the body
Helps your blood to clot
Uncontrolled Blood Glucose due to steroids
TPN is packed with Glucose
Cirrhosis: Pathophysiology/ Signs & Symptoms
Liver cells are destroyed and are replaced with scar tissue which alters the circulation of the liver. This causes the BP in the liver to go up, causing portal hypertension.
Firm, Nodular Liver Abdominal pain - Capsule has stretched Chronic dyspepsia ( GI upset) Change in bowel Habits Ascites Splenomegaly ( When the spleen is enlarged, the immune system is invovled) Decreased Serum Albumin Increased ALT and AST Anemia ( Risk for bleeding) Can progress to hepatic encephalopathy/ coma (Build up of Ammonia causes toxicity/sedation and coma)
Cirrhosis: Diagnosis & Treatment
Ultrasound, CT, MRI
Liver Biopsy - potential for hemorrhage
Clotting studies and vitals completed pre-procedure
Client is positioned at the edge of the bed, arm extended above head
Exhale and hold breath to get the diaphragm out of the way
Post procedure, Lie on right side with a towel roll over the puncture site. Worry about low BP and increased pulse.
Treatment
Antacids, vitamins, diuretics
No more alcohol
I&O and Daily weight
Rest
PREVENT BLEEDING (BLEEDing PRECAUTIONS)
Measure abd. girth –> Changes in girth indicate fluid loss
Monitor for jaundice - good skin care
Avoid NARCOTICS - the liver cannot metabolize drugs well when it is sick
Diet - Decrease protein (because protein increases ammonia, thus decreasing LOC) and low sodium for the ascites
Paracentesis
Removal of fluid from the peritoneal cavity ( ascites).
Have the client void - an empty bladder means less chance of puncturing
Sit client up to facilitate drainage
Vital signs
ANY TIME YOU PULL FLuiDS you can throw someone into shock
Protein breakdown
Protein breaks down into AMMONIA and the LIVER converts AMMONiA into UREA which is excreted by the kidneys
Hepatic Coma: Patho/Signs & Symptoms/Treatment
When you eat protein, it breaks down into ammonia and the liver converts it to Urea. Urea can be excreted through the kidneys without difficulty. When the liver becomes impaired, it can’t make this conversion.
Urea then builds up in the blood and LOC decreases
Minor Mental changes/motor problems Diffucult to rouse Asterixis - Tremor of the hand Handwriting changes Reflexes will decrease EEG slow FETOR - stinky ammonia breath Anything that will increase the ammonia level will aggravate the problem Liver people tend to be GI bleeders
Treatment Lactulose (decreases serum ammonia) Cleansing enemas (get blood out of the GI. Blood breaks down into ammonia) Decreased Protein in diet Monitor serum ammonia
Bleeding Esophageal Varices Patho/Treatment
Patho : High Blood pressure in the liver forces new circulation to form, such as in the stomach, esophagus and rectum. When you see an alcoholic client that is GI bleeding, it is usually esophageal varices. There isn’t a problem until it ruptures. Pt will be coughing up red blood. Could also have delirium tremens from being alcoholic.
Treatment
Replace blood/fluid
VS
CVP
Oxygen ( anytime some one is HYPOXIC, oxygen is needed)
Octreotide (Lowers BP in the liver, Prevents fistulas/constipation and vasoconstrictors other areas)
Balloon Tamponade
Cleansing enema to clear out the blood
Lactulose to decrease ammonia
Saline lavage to get blood out of the esophagus
Serotonin Blocker Antiemetics : Ondansetron (Zofran), Granisetron (Kytril), Dolasetron, Netupitan/ palonosetron (Akymzeo)
Common Uses:
Post-op nausea and vomiting, Chemotherapy
Contraindications: Hypersensitivity
Torsades de
pointes
PO/IV Interactions: Use with apomorphine can lead to unconsciousness, hypotension. Do NOT use together. Decrease ondansetron effect with rifampin, phenytoin.
moA: Suppress nausea and vomiting by blocking the serotonin receptors in the afferent vagal nerve terminals in the upper GI tract.
Advantages: Do not block the dopamine receptors;
therefore, they do not cause extrapyramidal
symptoms as do the phenothiazine
antiemetics.
Side Effects: Headache Diarrhea Dizziness Fatigue
Adverse Effects:
Transient elevation of AST and ALT.
Bronchospasm
Interventions:
Monitor ECG for QT prolongation in clients with cardiac disease or
receiving other medications that prolong QT.
Education:
Report diarrhea, constipation, rash, changes in respirations.
Antacids: Magnesium carbonate (Gaviscon), Magnesium hydroxide (Milk of Magnesia), Calcium Carbonate (Tums)
Common uses: Heartburn Gastritis Peptic Ulcer disease GERD Indigestion Prophylaxis with burns Hypomagnesemia
Contraindications: Renal failure
PO Interactions: Risk of side effects of anticoagulants. Blocks absorption of other medications when given simultaneously
MoA: Antacids work by counteracting or neutralizing the acid in the stomach. The neutralization makes the stomach contents less corrosive.
Side Effects:
Diarrhea
Loss of appetite
Adverse: Hives Itching Dyspnea Tightness in chest Edema of face, mouth, tongue Hypermagnesemia
Interventions:
Give either 30 minutes before or 1 hour after other medications to
prevent decreased absorption and effectiveness of medications
Education:
Take with or without food. Follow with a full glass (240 mL)
water or other liquid.
Balloon Tamponade
Sengstaken-Blakemore Tube is a type of balloon tamponade tube
It is an infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage. It should not be used for more than 12 hours. Many of the safety implications for the tube can be applied to other oropharynyx or naso pharynx tubes.
To hold pressure on the bleeding varices.
Assess if tube placement is moving or altered. It could occlude the airway because the balloon is inflated. Deflate balloon/cut tube to restablish airway. ACT QUICKLY.
Peptic Ulcers: Patho/S&S/Diagnosis
Classification:
Gastric ulcers: Malnourished, pain is usually 30 mins to 1 hour after meals - food doesn’t help but vomiting does - they vomit blood and have decreased weight
Duodenal Ulcers: Well nourished; night time pain is common and occurs 2 - 3 hours after meals, Food helps and there is blood in the stools
Common Cause of GI bleeding, It can be in the esophagus or in the stomach or duodenum. Erosion is present.
Burning Pain usually in the mid epigastric area/back and heart burn
Gastroscopy NPO pre-procedure Sedated NPO until gag reflex returns Watch for perforation by watching for pain/distention, bleeding or if they are having trouble swallowing
Upper GI
Looks at the esophagus and stomach with dye
NPO past midnight
No smoking, chewing gum or mints. Remove the nicotine patch too.
Smoking increases stomach motility, which will affect the test and it also increase stomach secretions which increases the chance of aspiration
Peptic Ulcers: Treatment/Teaching
Medications:
Antacids: Liquid to coat the stomach. Take when the stomach is empty and at bedtime. When the stomach is empty, acid can get onto the ulcer so take antacids to protect the ulcer.
PPI: Decrease the acid secretions.
H2 Antagonist: Rantinidine.
GI cocktails
Antibiotics for H.Pylori: Clarithromycin, amoxicillin, tetracycline and metronidazole
Sulcrafate forms a barrier over the wound to protect the ulcer from acid
Teaching: Decrease Acid Stop Smoking Eat what you can tolerate; Avoid temp extremes and extra spicy foods, avoid caffeine Need to be followed for one year
Hiatal Hernia: Patho/S&S/Treatment
Hole in diaphragm = stomach is where it shouldn’t be
Main cause is a large abdomen - Lots of intrabdominal pressure. Can also be caused by cogenital abnormalities, trauma and straining
LOTS OF REFLUX
Heartburn, Pain after eating, regurgitation, Dysphagia (difficulty swallowing)
Treatment: (Keep the stomach down) Small frequent meals Sit up 1 hour after meals HOB up Surgery Teach lifestyle and healthy diet
Dumping Syndrome: Patho/S&S/Treatment
The stomach empties too quickly after eating and the client experiences many uncomfortable to severe side effects - Usually secondary to gastric bypass, gastrectomy or gall bladder disease.
Fullness, Weakness, Palpitations, Cramping, Faintness, Diarrhea
Treatment:
Semi recumbent with meals. Lie down on left side to keep food in the stomach
No drinks with meals ( drink in between meals)
Meals should be small and frequent rather than large
Avoid Foods high in calories and electrolytes - Carbs and electrolytes empty fast
Ulcerative Colitis and Crohn’s Disease: Patho and S&S
UC - ulcerative inflammatory bowel disease that is just in large intestine
Crohn’s Disease: inflammation and erosion of the illeum but can be found anywhere on the large intestine
S&S
Diarrhea, Rectal bleeding, Weight Loss, Vomiting, Cramping, Dehydration, Blood in Stools, Anemia, Rebound tenderness (indicates peritoneal inflammation) and Rever.
Ulcerative Colitis and Crohn’s Disease: Diagnosis
CT
Colonoscopy
Clear liquid diet for 12 -24 hours pre-procedure
NPO 6 - 8 hours pre procedure
Avoid NSAIDS for several days because of chances of ulcers and bleeding
Laxative or enemas until stools are clear
GoLytely
Drink it very cold with no straw to prevent sucking down air
Sedated for the procedure
Post-op: watch for perforation. We are going to assume the Worst! signs are pain and unusual discomfort.
Barium Enema
Done if colonoscopy is incomplete because of adhesions
Ulcerative Colitis and Crohn’s Disease: Surgery/Post op care
Ulcerative Colitis:
Total colectomy (ileostomy is formed)(Don’t Irrigate, but keep fluid and water on track)
Kocks ileostomy or J pouch
Kocks has a nipple valve that opens and closes to small intestines
J pouch removes the colon and attaches the ileum to the rectum
Crohn’s (try to not do surgery)
May remove only the affected area. The client may end up with an ileostomy or with a colostomy, It just depends on the area affected.
ileostomy Post op care:
Drains liquid - no irrigation needed. Avoid foods hard to digest and rough foods as they increase motility. Electrolyte replacement drink in the summer. At risk for kidney stones because they are always a little dehydrated.
Colostomy care:
Water and nutrients are being absorbed and stool is forming as waste moves through the colon.
Ascending and Transverse –> Semiformed
Descending or Sigmoid –> Semiformed or formed. Irrigate only descending and sigmoid for regularity. Same time everyday and after a meal due to peristalisis
Appendicitis: Patho/S&S/Diagnosis/Treatment
Related to a low fiber diet #1 thing to worry about is rupture. Generalized pain initially, eventually localizes in right lower quadramt. (McBurneys Point) Rebound tenderness N/V Get a good history Anorexia
Bowel contents leak into the abdomen
High WBC
U/s, CT
Do not give enemas or laxatives because you are worried about perforation
Treatment
Surgery
Via laproscope unless perfed. You never want pressure on the suture line - the position of choice is semifowlers
TPN
Keep refridgerated; Warm for admin Central line needed Filter needed Nothing else should go through that line Discontinue gradually to avoid hypoglycemia Daily weight May have to start taking insulin Glucose monitoring every 6 hours Check urine for glucose and ketones ( protein can't leak out unless there is kidney damage) Do not mix ahead - mixture changes everyday Can only be hung for 24 hours Change tubing with each new bag IV bag may be cover with dark bag to prevent breakdown Needs to be on a pump Home TPN - emphasize handwashing MOst frequent complication - infection
Inserting a Central Line
Have Saline available for flush; do not start fluids until positive confirmation of placement
POsition in supine trandelenburg to distend the veins
If air gets into the line, you want to position the on the left size
When changing tubing, you avoid getting air into the line by clamping it off, valsalva, taking a deep breath and humming
XRAY checks for position to and ensure lung is not collapsed
Cannaboids - Dronabinol (Marinol)
Anti-emetic
Chemotherapy
Contraindications:
Pregnancy
Breastfeeding
Psychiatric disorders
PO/ 30mins to 1 hour
Interactions: Increased CNS depression
with other CNS depression
medications
MoA: The mechanism of action of Marinol is not completely understood. It is thought that cannabinoid receptors in neural tissues
may mediate the effects of dronabinol and other cannabinoids. Animal studies with other cannabinoids suggest that Marinol’s
antiemetic effects may be due to inhibition of the vomiting control mechanism in the medulla oblongata.
Side Effects: Euphoria Anxiety Drowsiness Visual disturbances
Adverse Effects:
Orthostatic hypotension
Seizures
Paranoia
Intervention: Monitor hydration, nutritional status. I&O Monitor BP and heart rate throughout therapy. Monitor closely for side effects. Capsules should be refrigerated.
Education:
Rise slowly from a sitting or lying position.
Do not use alcohol or drive while taking this medication.
Capsules should be refrigerated, not frozen.
Call for assistance when ambulating.
Antacids: Magnesium carbonate (Gaviscon), Magnesium hydroxide (Milk of Magnesia), Calcium Carbonate (Tums)
Common Uses: Heartburn Gastritis Peptic Ulcer disease GERD Indigestion Prophylaxis with burns Hypomagnesemia
Contraindicated: Renal Failure/ Hypermegnesiemia
PO Interactions: Risk of side effects of anticoagulants. Blocks absorption of other medications when given simultaneously
MoA: Antacids work by counteracting or neutralizing the acid in the stomach. The neutralization makes the stomach contents less
corrosive.
Side Effects: Diarrhea
Loss of appetite
Adverse: Hives Itching Dyspnea Tightness in chest Edema of face, mouth, tongue
Interventions:
Give either 30 minutes before or 1 hour after other medications to
prevent decreased absorption and effectiveness of medications.
Education:
Take with or without food. Follow with a full glass (240 mL) water or other liquid.
Emollient Laxative: polyethylene glycol
Common uses: Bowel cleansing prior to colonoscopy and barium enema X-ray examination.
Contraindications: Gastrointestinal obstruction Gastric retention, Bowel perforation, Toxic colitis, Megacolon / ileus.
PO/30 - 60 minutes
Interactions: Oral medication administered
within one hour of the
start of administration of
GoLYTELY for Oral Solution may be flushed from the gastrointestinal tract and not absorbed
MoA: GoLYTELY for Oral Solution induces a diarrhea which rapidly cleanses the bowel, usually within four hours. The osmotic activity
of polyethylene glycol 3350 and the electrolyte concentration result in virtually no net absorption or excretion of ions or water.
Accordingly, large volumes may be administered without significant changes in fluid or electrolyte balance.
Advantages: Cleanses the bowel thoroughly so that
diagnostic tests can be performed
efficiently
Side Effects: Severe bloating, distention or abdominal pain (may have to discontinue if doesn’t resolve)
Interventions: Observed closely with clients that have impaired swallowing or GERD during the administration of GoLYTELY for Oral Solution. NO STRAW.
Education: Prepare the solution per the instructions on the bottle. It is more palatable if chilled. For best results, no solid food should be
consumed during the 3 to 4-hour period before drinking the solution, but in no case should solid foods be eaten within 2
hours of taking GoLYTELY for Oral Solution.
H2 Antagonists (Histamine 2 Receptor Blockers) : Cimetidine (Tagamet), Famotidine (Pepcid), Ranitidine (Xantac), Nizatidine (Axid
Common Uses: Peptic ulcer disease GERD Esophagitis GI Bleeding Prophylaxis with burns
contraindications: Severe renal and liver disease
PO/IV Interactions: Cimetidine potentiates the effects of warfarin, phenytoin, theophylline, and lidocaine. Smoking decreases the effectiveness of H2 Antagonists.
MoA: Blocks the H2 receptors of the parietal cells in the stomach, thus reducing gastric acid secretion and concentration.
Advantages: Overall low incidence of adverse effects
Side Effects: Headache Confusion Dizziness Vertigo Constipation Diarrhea Pruritis Depression Decreased libido
Adverse:
Hepatotoxicity
Cardiac dysrhythmias
Blood dyscrasias
Interventions
Give at least 1 hour before antacids for optimal effect.
Administer IV in 20-100 mL of solution.
EDucation:
Take at least 1 hour before antacids for optimal effect.
Smoking decreases the effectiveness of H2 Antagonists.
Avoid foods that cause gastric irritation.
Laxative (hyperosmotic/ammonia detoxicant) : Lactulose
(Constulose, Enulose,
Generiac, Kristalose,
Duphalac)
Common uses: Bowel prep – diagnostic/surgical procedures. Hepatic encephalopathy
Contraindications: Clients on a lowgalactose diet. (Galactose is a component of lactulose)
PO/Rectal/24 hours Interactions: Neomycin, antiinfective(oral) and antacids decrease effects of lactulose
MoA: Creates a hyperosmotic (acidic) environment that draws water into the colon and produces a laxative effect. It also reduces
ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and
cannot be reabsorbed in to the systemic circulation
Ease of use and works within 24 hours
Side Effects: Nausea/Vomiting, Diarrhea, Flatulence, Distention/Bloating
Adverse : Hypernatremia, Abd bloating and Rectal irritation
Interventions:
Administer with a full glass of fruit juice, water or milk to increase palatability of oral form.
Give on an empty stomach to increase effect.
Assess stool for amount, color and consistency.
Monitor glucose levels if diabetic.
Education:
Teach client causes of constipation such as lack of fiber in the
diet, fluids or exercise.
Non-Stimulant Anorexiants : Lipase Inhibitor:
Orlistat (Xenical),
OTC strength (Alli)
Obesity Contraindication: Cholestasis Malabsorption syndromes PO
Interactions: Increases effects of warfarin
Decreases absorption of
fat soluble vitamins.
MoA: Inhibits gastric and pancreatic lipases reducing fat absorption by 30%. The fats are excreted in feces.
Advantages: DOC for weight loss
Side effects: Oily spotting Flatulence Fecal incontinence Steatorrhea Headache Insomnia Anxiety Depression Abdominal cramping Nausea/Vomiting
Adverse Effects: Hypoglycemia Hepatic failure Hepatitis Pancreatitis
Interventions:
Assess weight status before therapy.
Assess thyroid function, BMI, glucose, weight weekly
Education:
Lessen dietary fat intake to decrease side effects.
Take multivitamin containing fat-soluble vitamins 2 hrs before
or after medication.
Psyllium taken with each dose or at bedtime may decrease GI
symptoms.
Proton Pump Inhibitors: Pantoprazole (Protonix),
Omeprazole (Prilosec),
Esomeprazole (Nexium),
Lansoprazole (Prevacid)
Common uses: GERD Peptic ulcer Esophagitis. Prophylaxis with burns
PO/IV Interactions: May decrease theophylline levels. Food decreases peak levels. Can enhance the action of digoxin, oral anticoagulants, phenytoin.
MoA: Suppress gastric acid secretion by inhibiting the hydrogen/potassium adenosine triphosphatase (ATPase) enzyme system located in the gastric parietal cells. They block the final step of acid production.
Side Effects: Headache Dizziness Blurred vision Fatigue Thirst Dry mouth Increased appetite Anorexia Diarrhea
Adverse Effects:
Elevated AST, ALT
Pancreatitis
Rhabdomyolysis
Interventions:
Monitor liver function studies.
Monitor glucose levels in diabetic clients.
Education:
Report severe diarrhea; black, tarry stools; abdominal pain.
Hyperglycemia may occur in diabetic clients.
Continue taking even if feeling better.
Splenic Sequestrian Crisis
Splenic sequestration is a potentially life-threatening condition that’s most commonly seen as a complication of sickle cell disease (SCD). It happens mostly in children. The condition causes your child’s spleen to get bigger and lowers the amount of oxygen-carrying red blood cells in her body.
Pain on the left side of your child’s belly is the most common. Others include:
An enlarged spleen, which can be felt through her skin
Weakness
Pale skin
Rapid breathing or heartbeat
Irritability
Unusual drowsiness
Splenomegaly can lead to hypovolemic shock
Pyloric Stenosis
Pyloric stenosis, also called infantile hypertrophic pyloric stenosis, is a condition caused by an enlarged pylorus. The pylorus is a muscle that opens and closes to allow food to pass through the stomach into the intestine. When this muscle becomes enlarged, feedings are blocked from emptying out of the stomach.
Pyloric stenosis can lead to forceful vomiting, dehydration and weight loss. Babies with pyloric stenosis may seem to be hungry all the time.
Surgery cures pyloric stenosis.
Symptoms
Vomiting after feeding. The baby may vomit forcefully, ejecting breast milk or formula up to several feet away (projectile vomiting). Vomiting might be mild at first and gradually become more severe as the pylorus opening narrows. The vomit may sometimes contain blood.
Persistent hunger. Babies who have pyloric stenosis often want to eat soon after vomiting.
Stomach contractions. You may notice wave-like contractions (peristalsis) that ripple across your baby’s upper abdomen soon after feeding, but before vomiting. This is caused by stomach muscles trying to force food through the narrowed pylorus.
Dehydration. Your baby might cry without tears or become lethargic. You might find yourself changing fewer wet diapers or diapers that aren’t as wet as you expect.
Changes in bowel movements. Since pyloric stenosis prevents food from reaching the intestines, babies with this condition might be constipated.
Weight problems. Pyloric stenosis can keep a baby from gaining weight, and sometimes can cause weight loss.
Wernicke’s Syndrome
Most serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence and stupor. Death will occurred.
Korsakoff’s Syndrome
Syndrome of confusion and loss of recent memory. Often seen when the client is coming of out Wernickes.
Alcohol Use Disorder
Individuals are considered to have a substance use disorder when the use of the substance interferes with the ability to fulfill obligations such as work school or home
Alcohol is a depressant
Treatment: Keep on the light Encourage close frens to visit Provide a quiet environment Walk and talk to the Orient the client frequently Visual illusions Seizure precautions Anxiolytics : Don't be afraid to five- the client has a tolerance to alcohol and a cross tolerance to other CNS depressants.
Alcohol Use Disorder
Individuals are considered to have a substance use disorder when the use of the substance interferes with the ability to fulfill obligations such as work school or home
Alcohol is a depressant
Treatment: Keep on the light Encourage close frens to visit Provide a quiet environment Walk and talk to the Orient the client frequently Visual illusions Seizure precautions Anxiolytics : Don't be afraid to five- the client has a tolerance to alcohol and a cross tolerance to other CNS depressants. Sedatives like benzos are used because they not only sedate but have short half life. WELL HYDRATED and replace electrolytes Usually low in thiamine, mag, ca, k and phos. can lead to wernickes and korsakoffs.
Alcohol Withdrawal Nursing Considerations
Observe for defense mechanisms. Major ones are denial and rationalization. Disulfram is a deterrent to drinking. -Must sign consent Stay away from all forms of alcohol Must have support once detox is over
Inguinal Hernia
An inguinal hernia is the protrusion of abdominal contents through the inguinal canal, which appears as a bulge in the lateral groin. Herniation occurs spontaneously or results from increased intraabdominal pressure (eg, heavy lifting). Inguinal hernias occur most commonly in male clients and are usually repaired with minimally invasive surgery. If intestinal strangulation develops, the client requires emergency treatment to prevent bowel ischemia or perforation. Strangulation symptoms include abdominal distension, severe pain, nausea, and vomiting.
To prevent hernia reoccurrence after surgical repair, the client is taught to avoid activities that increase intraabdominal pressure (eg, coughing, heavy lifting) for 6-8 weeks. If sneezing or coughing are unavoidable, the client should splint incisions and keep the mouth open while sneezing.
Lactase Deficiency ( Lactose Intolerance)
experience varying degrees of gastrointestinal symptoms after ingesting milk products, including flatulence, diarrhea, bloating, and cramping. This is due to a deficiency of the enzyme lactase, which is required for digestion of lactose. Treatment includes restricting lactose-containing foods in the diet. These clients may also take lactase enzyme replacements (eg, Lactaid) to decrease symptoms. Supplementation of calcium and vitamin D is recommended due to insufficient intake of fortified milk.
Milk and ice cream contain the highest amounts of lactose and should be restricted depending on the client’s individual tolerance . Some dairy products, including aged cheeses and live-culture yogurts, contain little to no lactose and can be tolerated by most clients with lactase deficiency.
Lactase deficiency is not an immune reaction (allergy) to milk products. Rather, the gastrointestinal symptoms are due to a deficiency of the enzyme lactase and the resultant inability to digest lactose.
Educational objective:
Clients with lactase deficiency can prevent unpleasant gastrointestinal symptoms by avoiding lactose-containing dairy products (eg, milk, ice cream), eating cheese or yogurt in moderation, and supplementing with lactase enzymes. Vitamin D and calcium supplementation is also recommended.
Refeeding syndrome
is a potentially lethal complication of nutritional replenishment in significantly malnourished clients and can occur with oral, enteral, or parenteral feedings. After a period of starvation, carbohydrate-rich nutrition (glucose) stimulates insulin production along with a shift of electrolytes from the blood into tissue cells for anabolism. The key signs of refeeding syndrome are rapid declines in phosphorous, potassium, and/or magnesium (mnemonic PPM). Other findings may include fluid overload, sodium retention, hyperglycemia, and thiamine deficiency.
Actions to prevent refeeding syndrome include the following:
Obtaining baseline electrolytes
Initiating nutrition support cautiously with hypocaloric feedings
Closely monitoring electrolytes
Increasing caloric intake gradually
