Gastrointestinal, Hepatic, & Pancreatic Disorders Flashcards
Gastrointestinal, Hepatic, and Pancreatic Disorders: Contributing Factors
1.History of autoimmune disorder
2.Alcohol use disorder
3.Dietary patterns
4.NSAID use
5.Age
6.Family history
7.Previous abdominal surgery
8.Allergies
9.Musculoskeletal impairment (e.g., CVA, MS)
10.Obesity
11.Smoking
12.Sedentary lifestyle
13.Stress
Gastrointestinal, Hepatic, and Pancreatic Disorders: Lab Profiles–hepatic or pancreatic disease
1.Albumin
2.Ammonia: liver’s ability to break down protein by-products
3.Bilirubin: measured directly in the blood
4.Cholesterol
a.)Total cholesterol
b.)LDL (“bad”)
c.)HDL (“good”)
d.)Triglycerides
5.Liver Enzymes
a.)ALT/SGPT
b.)AST/SGOT
c.)ALP
6.Pancreatic Enzymes
a.)Amylase
b.)Lipase
c.)Prothrombin time
Laboratory Profiles: GI parasites, bacteria, or bleeding
1.Stool Sample
a.)Inspect for color, consistency.
b.)Tests:
–Ova and parasites
–Clostridium difficile (C. diff)
–Urobilinogen
–Fecal fat (steatorrhea)
–Fecal nitrogen
–Food residues
–Cytotoxic assay (preferred over stool culture)
2.Fecal Screening Tests (may be obtained at home and mailed in):
a.)Fecal Occult Blood Test
–Recommended annually to detect colon cancer.
–Instruct to avoid red meat, aspirin, turnips, and horseradish at least 72 hr prior to testing to avoid false positive results. Ingestion of vitamin C-rich foods or supplements may result in a false negative.
–NSAIDs and anticoagulants should be discontinued 7 days prior to testing.
b.)Fecal immunochemical test (e.g., Hemosure, Hematest II SENSA, HemoQuant)
c.)Stool DNA
Endoscopy
-allows direct visualization of tissues, cavities, and organs using a flexible fiber-optic tube
1.Colonoscopy: exam of the entire large intestine
a.)Bowel prep to clear fecal contents (1- to 3-day prep)
b.)Clear liquid diet 12 to 24 hr before procedure
c.)NPO except water 6 to 8 hr before procedure
d.)IV sedation
e.)Monitor post-procedure for excessive bleeding or severe pain.
Endoscopic retrograde cholangiopancreatography (ERCP):
-exam of liver, gallbladder, bile ducts, and pancreas
1.NPO 6 to 8 hr before procedure.
2.Avoid anticoagulants, aspirin, or 3.NSAIDs for several days before test.
4.Assess for allergies to x- ray dye.
5.IV sedation.
6.May have colicky abdominal discomfort.
7.Monitor for severe pain, fever, nausea, or vomiting (indicates perforation).
Paracentesis
-needle inserted through abdominal wall into peritoneal cavity, withdrawing fluid accumulated due to ascites
1.Have client void.
2.Obtain baseline vital signs.
3.Position upright.
4.Administer mild sedation.
5.Administer prescribed IV fluids or albumin to restore fluid balance (as much as 4 L to 6 L of fluid is slowly drained from the abdomen).
6.Monitor vital signs.
7.Record weight before and after procedure.
8.Measure abdominal girth before and after procedure.
9.Assess laboratory profile before and after procedure: albumin, amylase, protein, BUN, creatinine.
Enteral Feeding Tubes
-delivery of a nutritionally complete feeding directly into the stomach, duodenum, or jejunum
1.Small-Bore Nasogastric Feeding Tubes
a.)Obtain x-ray to determine placement.
b.)Assess gastric pH before each feeding; every 4 hr for continuous feeding.
c.)Maintain a semi-Fowler’s position while feeding is infusing.
d.)Assess residual in the stomach and refeed the residual, unless it exceeds the maximum.
e.)Provide nose and mouth care.
f.)Replace tube every 4 weeks.
g.)KEY POINT: If residual exceeds 100 mL for intermittent feedings, or 2 hr worth of a continuous feeding, hold or stop the feeding; do NOT refeed aspirate; notify the provider.
2.Small-bore nasointestinal/jejunostomy tubes: inserted through the skin and occasionally sutured in place for long-term feeding
a.)Obtain x-ray to determine placement (prior to initial feeding).
b.)Assess length of exposed tubing (tube migration).
c.)Assess placement prior to feeding using intestinal pH.
d.)Maintain a semi-Fowler’ s position.
e.)Assess residual (greater volume indicates upward migration).
Monitor for Complications:
a.)Refeeding syndrome can be life-threatening.
b.)Bleeding
c.)Infection
d.)Tube misplacement/dislodgement, aspiration: Immediately remove any tube suspected of being dislodged or misplaced.
e.)Abdominal distention, nausea, vomiting, diarrhea, constipation
f.)Fluid imbalance: Hyperosmolar preparations can lead to dehydration.
g.)Electrolyte imbalance: the most common are hyponatremia and hyperkalemia
4.Percutaneous Endoscopic Gastrostomy (PEG)
a.)Assess skin integrity.
b.)Assess residual volume.
c.)Allow feeding to infuse slowly (raise/lower syringe).
d.)Flush with 30 mL warm water before and after feeding.
e.)Maintain semi-Fowler’s position 1 to 2 hr after feeding.
Parenteral Nutrition
-IV administration of a hypertonic intravenous solution made up of glucose, insulin, minerals, lipids, electrolytes, and other essential nutrients. Used when the client cannot effectively use the GI tract for nutrition
- or Peripheral Parenteral Nutrition (PPN)
a.)Used when client can eat, but cannot take in enough nutrients to meet needs
b.)Administered through a large distal arm vein or PICC line
2.Total Parenteral Nutrition (TPN)
a.)Used when the client requires intensive nutritional support for an extended time period
b.)Delivered through a central vein
Contributing Factors:
1.Gastrointestinal mobility disorders
2.Inability to achieve or maintain adequate nutrition for body requirements
3.Short bowel syndrome
4.Chronic pancreatitis
5.Severe burns
6.Malabsorption disorders
Nursing Interventions:
1.Confirm placement by chest x-ray.
2.Monitor central line insertion site for local infection.
3.Maintain strict surgical asepsis for dressing change (every 72 hr).
4.Change tubing and remaining TPN every 24 hr.
5.Monitor for signs of systemic infection.
6.Monitor glucose, electrolytes, and fluid balance.
7.Prevent air embolism.
8.Use infusion pump.
9.Keep 10% dextrose/water available.
10.For clients receiving fat emulsions, monitor for fat overload syndrome: fever, increased triglycerides, clotting problems, and multi-system organ failure; discontinue infusion and notify provider immediately.
Gastroesophageal Reflux Disease
-A condition in which the lower esophageal sphincter (LES) does not close properly, allowing stomach contents to back up into the esophagus.
Contributing Factors:
1.Older adults
2.Obesity
3.Smoking
4.Heavy alcohol use
5.Ingestion of very large meals
6.Obstructive sleep apnea
Manifestations:
1.Dyspepsia
2.Regurgitation
3.Eructation
4.Flatulence
5.Coughing, hoarseness, wheezing
6.Water brash
7.Dysphagia
8.Odynophagia
Nursing Interventions:
1.Teach client dietary management.
a.)Limit or eliminate foods that decrease LES pressure: chocolate, caffeine, fried and/or fatty foods, alcohol, carbonated beverages, spicy and acidic foods.
b.)4 to 6 small meals per day
c.)Eat slowly and chew thoroughly.
d.)Eating nothing for at least 3 hr before going to bed
2.Teach to elevate the head of bed 6 to 12 inches.
3.Teach to sleep on right side.
4.Refer to smoking, alcohol cessation programs PRN.
5.Encourage maintenance of proper weight.
6.Teach to wear loose clothing.
7. Endoscopic procedures
Medications:
1.Histamine blockers: famotidine, ranitidine
2.Antacids
3.Proton pump inhibitors: omeprazole, esomeprazole, or pantoprazole may be administered IV short term.
Hiatal Hernia: Contributing Factors, Manifestations, Interventions, Medications, Client Education, Therapeutic Measures
-A portion of the stomach protrudes through the esophageal hiatus of the diaphragm into the chest.
Contributing Factors:
1.High-fat diet
2.Caffeinated beverages
3.Tobacco products
4.Medications: Ca ++ channel blockers, anticholinergics, nitrates
5.Obesity
Manifestations:
1.Regurgitation
2.Persistent heartburn and dysphagia
3.Belching
4.Epigastric pain
5.Dysphagia
6.Breathlessness or feeling of suffocation after eating
7.Chest pain that mimics angina
8.Symptoms worsen after a meal or when supine
Nursing Interventions:
1.Prepare for barium swallow with fluoroscopy.
2.Assess diet history.
3.Encourage small frequent meals.
4.Avoid eating 3 hr prior to bedtime.
5.Sit upright 1 to 2 hr after meals.
6.Elevate head of bed.
7.Encourage weight reduction for clients with BMI greater than 25.
8.Avoid straining or vigorous exercise.
9.Wear loose clothing around abdomen.
10.Monitor for complications.
a.)Bleeding or esophageal ulcers
b.)Barrett’s esophagus
c.)Aggravation of asthma, chronic cough, and pulmonary fibrosis
Medications:
1.Antacids
2.Histamine2 receptor antagonists
3.Prokinetic agents
4.Proton pump inhibitors
Client Education:
1.Dietary medication regimen
2.Precautions to prevent aspiration
Therapeutic Measures:
Hiatal hernia—fundoplication if other measures ineffective
Peptic Ulcer Disease: Contributing Factors, Manifestations, Interventions, Medications, Therapeutic Measures, Client Teaching
-Ulcerations in the stomach or duodenum as a result of mucosal tissue destruction; high risk of perforation and bleeding. May be referred to as gastric, duodenal, or esophageal ulcer, depending on location.
Contributing Factors
1.NSAIDs
2.Corticosteroids
3.H. pylori infection
4.Uncontrolled stress
5.Smoking
6.Caffeine
7.Alcohol
8.Type O blood
9.Age between 40 and 60 years
Manifestations:
1.Dyspepsia
2.Dull, gnawing, burning, midepigastric and/or back pain with localized tenderness
3.Symptoms worsen with empty stomach
4.Relief noted with antacids
5.Belching
6.Bloating
7.Vomiting of undigested food that may or may not be proceeded by nausea
8.Melena
9.Decreased hematocrit and hemoglobin
Nursing Interventions:
1.Refer to smoking and/or alcohol cessation programs PRN.
2.Encourage stress-relieving techniques such as biofeedback, meditation, relaxation exercises.
3.Teach dietary modifications.
a.)Avoid very cold and very hot foods.
b.)Eat three regular meals per day (small, frequent feedings are not necessary if an antacid or histamine blocker is taken).
c.)Avoid caffeine, alcohol, decaffeinated coffee, milk, and cream (diet is very individual—some may be able to tolerate these foods better than others).
4.If other methods are not effective, prepare client for surgery (e.g., pyloroplasty, antrectomy).
Medications:
1.Triple therapy for 10 to 14 days: two antibiotics—metronidazole or amoxicillin and clarithromycin—plus a proton pump inhibitor (preferred treatment)
2.Quadruple therapy that adds bismuth salts to the previous
3.Mucosal healing agents
4.Stool softeners
5.Antacids
6.Histamine2 receptor antagonists
7.Prokinetic agents
8.Proton pump inhibitors
Diagnostic Tests:
1.EGD
2.Chest and abdominal x-ray
3.Hematocrit and hemoglobin
4.Stool specimen
Client Education:
1.Symptom management
2.Medication therapy
3.Nutrition therapy
4.Stress reduction
Irritable Bowel Syndrome (IBS): Contributing Factors, Manifestations, Interventions, Medications, Therapeutic Measures, Client Teaching
-Chronic disorder with recurrent diarrhea, constipation, and/or abdominal pain and bloating (most common digestive disorder seen in clinical practice)
Contributing Factors:
1.Smoking
2.Caffeine
3.NSAIDs
4.Stress
5.Mental or behavioral illness
High-fat diet
6.Female gender
7.Family history
8.Dairy products
9.Alcohol
Manifestations:
1.Weight loss
2.Fatigue and malaise
3.Erratic bowel patterns
4.Abdominal pain relieved by defecation
5.Abdominal distention
6.Mucus with passage of stool
7.Colicky abdomen with diffuse tenderness
Nursing Interventions:
1.Encourage a diet high in fiber.
2.Encourage regular exercise such as walking and yoga.
3.Teach stress-reduction techniques.
4.Teach to eat at regular times.
5.Teach to eat slowly and chew thoroughly.
6.Teach importance of adequate fluid intake, but discourage fluids with meals.
7.Encourage a food diary to identify triggers.
Medications:
1.Bulk agents (such as psyllium)
2.Antidiarrheals
3.Antidepressants
4.Anticholinergics
5.Antispasmodics
6.Probiotics
7.Complementary Agents
a.)Peppermint oil
b.)Artichoke leaf extract
c.)Caraway oil
Diagnostic Tests:
1.Endoscopy
3.Chest and abdominal x-ray
3.Test for H. pylori
Client Education:
1.Keeping diary to identify triggers
2.Avoidance of causative agents
3.Symptom management
4.Medication therapy
5.Nutrition therapy
6.Stress reduction
Chron’s Disease: Contributing Factors, Manifestations, Interventions, Medications, Therapeutic Measures, Client Teaching
-Inflammation of the GI tract that extends through all layers. It can occur anywhere in the intestinal tract, but most commonly occurs in the distal (terminal) ileum. It is characterized by the “cobblestone” appearance of ulcers that are separated by normal tissue.
Contributing Factors:
1.Family history
2.Jewish ancestry
3.Bacterial infection
4.Smoking
5.Adolescents or young adults (ages 15 to 40)
6.Living in an urban area
Manifestations:
1.Abdominal pain (right lower quadrant); does not resolve with defecation; pain is aggravated by eating
2.Low-grade fever
3.Diarrhea, steatorrhea
4.Weight loss (may become emaciated)
5.Formation of fistulas (abnormal tracts between bowel and skin/bladder or vagina)
6.Usually, there is no bleeding (which helps differentiate from ulcerative colitis).
7.Low-grade fever, leukocytosis
8.May be accompanied by arthritis, skin lesions, conjunctivitis, and/or oral ulcers
9.“String sign” on x-ray: indicates constriction in a segment of the terminal ileum
10.Decreased hematocrit and hemoglobin, elevated ESR
Nursing Interventions:
1.Promote adequate rest periods.
2.Record color, volume, frequency, and consistency of stools.
3.Monitor and prevent fluid deficit.
4.Nutrition therapy includes high-calorie, protein, low-fiber, no dairy.
5.Provide supportive care.
6.Monitor for complications:
a.)Intestinal obstruction
b.)Perianal disease
c.)Fluid electrolyte imbalances
d.)Malnutrition
e.)Fistula, abscess
7.If the above measures are not effective, prepare for surgery: bowel resection with possible ileostomy or stricturoplasty.
8.Refer to support group.
Medications:
1.Steroids
2.Anti-infective: metronidazole
3.Aminosalicylates (5-ASAs)
4.Immune modulators: infliximab, adalimumab, certolizumab, and natalizumab
5.TPN
Therapeutic Measures:
1.Bowel resection ( possible ileostomy)
2.Stricturoplasty
3.Laboratory profiles: Hct, hemoglobin, C-reactive protein, WBC, ESR
4.Abdominal x-ray
Client Education:
1.Refer to support group.
2.Dietary
3.Health promotion and relaxation
Ulcerative Colitis:Contributing Factors, Manifestations, Interventions, Medications, Therapeutic Measures, Client Teaching
-Recurrent ulcerative and inflammatory disease of the superficial mucosa of the colon. It usually begins in the rectum and spreads proximally through the entire colon. It is characterized by contiguous ulcers.
Contributing Factors:
1.Family history
2.Jewish ancestry
3.Isotretinoin (Accutane) use
4.Young and middle-age adults (females 15 to 25 years; males 55 to 65 years)
5.Caucasian ethnicity
6.Low-fiber diet
Manifestations:
1.Liquid, bloody stool (10 to 20 per day)
2.Low-grade fever
3.Abdominal distention along the colon
4.High-pitched bowel sounds
5.Rebound tenderness indicates perforation/peritonitis
6.Passage of mucus and pus from the bowel
7.Left, lower quadrant abdominal pain
8.Anorexia and weight loss
9.Vomiting and dehydration
10.Sensation of an urgent need to defecate
11.Hypocalcemia, anemia
12Associated arthritis, conjunctivitis, skin lesions, and/or liver problems
–KEY POINT: Bleeding is common with ulcerative colitis. This helps differentiate it from Crohn’s disease, in which bleeding is rare.
Nursing Interventions:
1.Promote adequate rest periods.
2.Record color, volume, frequency, and consistency of stools.
3.Maintain NPO status during acute phase.
4.Monitor for dehydration; maintain fluid balance.
5.Monitor electrolytes; IV fluids may be indicated for imbalances.
6.Provide dietary management and client education.
a.)Increase oral fluids.
b.)Low-residue, high-calorie, high-protein diet
7.Administer multivitamin and supplemental iron.
8.Refer to support group.
9.If the above measures are not successful, prepare for surgery: proctocolectomy with ileostomy.
Medications:
1.Antidiarrheals (monitor for megacolon)
2.Aminosalicylates (5-ASAs)
3.Immune modulators: infliximab, adalimumab, certolizumab, and natalizumab
4.TPN
5.Corticosteroids (oral, parenteral, topical)
Therapeutic Measures:
1.Surgical management is indicated for bowel perforation, toxic megacolon, hemorrhage, and colon cancer.
a.)Colectomy and ileostomy
b.)Total proctocolectomy with permanent ileostomy
c.)Laboratory profiles: Hct, hemoglobin, C-reactive protein, WBC, ESR
d.)Abdominal x-ray
Client Education:
a.)Refer to support group.
b.)Dietary
c.)Health promotion and relaxation
Diverticular Disease: Contributing Factors, Manifestations, Interventions, Medications, Therapeutic Measures, Client Teaching
1.Includes three conditions that involve numerous small sacs or pockets in the wall of the colon
a.)Diverticulosis: the presence of pouchlike herniations (diverticula) along the wall of the intestines; most common in the sigmoid colon
b.)Diverticular bleeding: results from injury of small vessels near the diverticula
c.)Diverticulitis: inflammation of one or more diverticula
Contributing Factors:
1.Aging
2.Constipation
3.Diet risk: low-fiber, high-fat, and red meat
4.Connective tissue disorders causing weakness in the colon wall
Manifestations (diverticulitis):
1.Alternating diarrhea with constipation
2.Painful cramps or tenderness in the lower abdomen (lower left quadrant)
3.Chills or fever
4. Tachycardia; nausea and vomiting
Nursing Interventions:
1.Dietary management
a.)Diverticulitis: begin with clear liquids; advance to a low-fiber diet.
b.)Diverticulosis: provide a high-fiber diet.
c.)Educate about fiber sources.
d.)Teach to avoid foods with nuts, seeds, or kernels (such as popcorn).
e.)Increase fluid intake to 3 L/day.
f.)Refer for nutritional counseling.
2.Manage pain.
3.Avoid laxatives.
4.Monitor bowel elimination patterns.
5.Monitor for complications (obstruction, hemorrhage, infection).
6.In event of complications, prepare for surgery: colon resection.
Medications:
1.Bulk laxatives (preventive)
2.Metronidazole
3.Trimethoprim/sulfamethoxazole
4.Ciprofloxacin
5.Antispasmodics (oxyphencyclimine)
6.Analgesics (meperidine)
–KEY POINT: Morphine is contraindicated because it can increase pressure in the colon, exacerbating symptoms.
Therapeutic Measures:
Emergency colon resection for peritonitis, bowel obstruction, or abscess
Client Teaching:
1.High-fiber versus low-fiber diet
2.Collaborate with nutritionist.
3.Preventive measures
