GI Flashcards
Gastroenteritis: Assessment
Medical History
Med review (most meds can be constipating)
Diet history
Travel history (H2O)
Physical and abdominal assessment (distention, BP, skin, dehydration, cardiac
Gastroenteritis: Management
Hand washing Isolation (contact isolation) Identify cause F&E replacement (Na+, K+, Cl-, glucose) Food safety measures (turkey) Dietary management *Don't give anti-diarrheals
Gastroenteritis: Medications
Antidiarrheals
Narcotic
Anticholinergic
Probiotics
Diarrhea
Risk for deficient fluid volume (Monitor I&O, BP; watch trends, hydration assessment, might have to do IV infusion; Ringer’s lactate)
Risk for impaired skin integrity (lots of nutrients, barrier creams, might have to sit in sits bath; avoid overuse of soaps)
Diarrhea: Evaluation
Stool frequency Nutritional status Weight Fluid volume status Skin integrity Monitor electrolytes
Diarrhea: Teaching
Teach causes and preventative measure
Infection control (isolate STAT if C.Diff)
Purification of water for travel
Fluid replacement
Chronic diarrhea (may be sign of chronic constipation)
Intestinal Obstruction: Assessment/ Management
Assess for bowel sounds (hypoactive; potential for blockage), distention
Assess for complications
Diagnostic tests
Gastric decompression
Surgery (take out the area where the obstruction is)
Intestinal Obstruction: Nursing Implementation
Monitor dehydration and electrolyte status closely
Strict intake and output (if nothing is going through- NPO)
NG tube care (always ensure proper placement)
IV fluids
Comfort measures and a quiet environment (High/semi fowlers)
Postop care same as for laparotomy
Intestinal Obstruction: Deficient Fluid Volume/ Ineffective Breathing Pattern
Monitor VS and CVP (Central venous pressure)
I&O, urine output, gastric output
Measure abdominal girth
Resp. rate, lung sounds
Resp. support
Intestinal Obstruction: Evaluation
Abdominal girth Bowel sounds Pain Tolerance Fluid volume status Potential complications
Colorectal Cancer
Colon cancer screening guidelines; for the individual at average risk, colonoscopy every 10 years (If polyps are seen during colonoscopy, screening becomes yearly)
Important hereditary condition; familial adenomatous polyposis (FAP) (if family member is diagnosed, you get screened 10 years before they were diagnosed)
Colorectal Cancer: Prognosis
Early detection, better prognosis
Depends on extent of timor invasion, cell type, degree of dysplasia, tumour genetics, presence or absence of metastasis
TNM classification used for metastasis
Colorectal Cancaer: Treatment
Surgical removal
Colostomy
Chemotherapy, radiation, or both
Colorectal Cancer: Assessment
Effects of the disease (not just pt. but whole family)
Treatment (depends on person. May be palliative surgery)
Clients ability to function and maintain ADLs
Colorectal Cancer: Nursing Implementation
Health Promotions: Screening, use of NSAIDs
Acute Interventions: Preop; Similar to care of a client undergoing laparotomy. Postop; After abdominal resection, 2 wounds and a stoma
Ambulatory and home care: Psychological support for client and family
Colorectal Cancer: Complications/ Management
Bowel obstruction
Perforation into neighbouring organs
Annual screening beginning at age 50
Diagnostic tests
Surgery
Adjunctive therapy (chemo)
Colorectal Cancer: Nursing care
Provide emotional support
Teaching
Surgical needs (RT hemicolectomy; LT hemicolectomy; Abd. - perineal resection; laproscopic colectomy; laproscopic)
Colorectal Cancer: Teaching
Prevention American Cancer Society recommendations Regular health examinations Tests and procedures Ostomy care Pain and symptom management
Colorectal Cancer: Nursing Diagnosis
Diarrhea or constipation
Acute pain
Fear
Ineffective coping
Colorectal Cancer: Planning
Goals include appropriate treatment, normal bowel pattern, good quality of life, relief of pain and promotion of comfort
Inflammatory Bowel Diease: Goals of Treatment
Rest the bowel Control inflammation Combat infection Correct malnutrition Alleviate stress Symptomatic relief Improve quality of life
Inflammatory Bowel Disease: Planning
Experience a decrease in number and severity of acute exacerbations
Maintain normal fluid/electrolyte balance
Remain free from pain or discomfort
Comply with medical regimen
Improve QOL
Inflammatory Bowel Disease: Surgical Therapy
Procedures for chronic ulcerative colitis:
Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch)
Total protocolectomy with permanent ileostomy
Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch) or permanent ileostomy
Ulcerative Colitis and Crohn’s Disease: Managemetn
Manage symptoms Control disease process Supportive care Diagnostic tests Medications Dietary management Surgery
Ulcerative Colitis: Treatment
Corticosteroids
Broad spectrum antibiotic
Salicylate analogs
Immunomodulating agents (Azathioprine; Mercaptopurine)
IV followed by oral cyclosporine for refractory
Infliximab (Remicade) for refractory
Crohn’s Disease: Treatment
Prednisone and sulfasalazine
Antibiotics: metronidazole
Azathioprine, 6-mercaptopurine, methotrexate, and biologic therapies (refractory)
Anti-tumor necrosis factor agents infliximab, adalimulab, and certolizumab (refractory)
Crohn’s Diease: Surgical therapy
75% will require surgery
Surgery produces remission, but high recurrence rate
Ileostomy
Colostomy or Ilostomy: Diagnosis
Change in body image Nutritional imbalance Loss of sexuality Possible dehydration Diarrhea Impaired skin integrity Anxiety Ineffective coping Ineffective therapeutic regimen management
Ulcerative Colitis and Crohn’s Disease: Teaching
Disease process, effects, stress Treatment options Medications Complications, management Diet Nutritional supplements Fluids Exercise Teaching for surgery
Malabsorption: Nursing Care
Effects on nutrition and bowel patterns
Nutritional status
Weight, fat fold measurements, lab data, dietary intake
Enteral feeding supplements as prescribed
I&O, daily weights, skin turgor, mucous membranes
Frequency stools
Medications
Skin care
Malabsorption: Management
Find and treat the cause
Malabsorption: Teaching
Daily management Diet Medication regime Reading labels Fluid intake Exercise Daily weights Manifestations to report to physician Dietician or counselor referrals
Malabsorption: Treatment
Gluten-free diet
Supplemental iron, folate, B12, fat soluble vitamins (A, D, E, K)
Oral corticosteroids or other immunomodulating agents for refractory
Hiatus Hernia
Conservative therapy:
Lifestyle modifications
Elevation of bed 30 degrees
Use antacids and H2R blockers
Weight reduction, if overweight (reduce fats in diet, separate fluids from solids)
Surgical therapy (if lifestyle changes don’t work)
Hiatal Hernia: Complicationa
Upper GI bleeding
Erosive esophagitis
If symptoms persist might need surgery
Management: Diagnosis made if able to reduce or manipulate; surgery
Hernia
Risk for ineffective tissue perfusion: Gastrointestinal
- comfort measures
bowel sounds
signs of strangulation
Hernia: Nursing Care/ Teaching
Preoperative assessment
Postoperative care
Risk factors
Surgical intervention
Pain management
Activity restrictions
Nissen Fundoplication
Bring two sides of the stomach together and suture it
Risk of perforation
Have no decreased volume intake of stomach
Do not irrigate because it will cause too much pressure and dehiscence
Peptic Ulcer Disease: Aim of treatment
decrease degree of gastric acidity
Enhance mucosal defense mechanisms
Minimize harmful effects on mucosa
Peptic Ulcer Disease: Overall Goals
Comply with prescribed therapeutic regimen
Experience a reduction or absence of discomfort related to peptic ulcer disease
Exhibits no signs of GI complications
Have complete healing (no S&S)
Lifestyle changes to prevent recurrence
Peptic Ulcer Disease: Medical regimen consists of:
Adequate rest Dietary modification (keep food diary; smaller more frequent meals) Drug therapy Elimination of smoking Long-term follow-up care
Peptic Ulcer Disease: Drug Therapy
Antacids H2R blockers PPIs Antibiotics (add probiotic; finish whole treatment) Anticholinergics Cytoprotective therapy
Peptic Ulcer Disease: Drug Therapy
Antacids
Used as adjunct therapy for peptic ulcer disease
Increase gastric pH by neutralizing acid
Histamine-2 receptor blocks (H2R blockers)
Used to manage peptic ulcer disease
Block action of histamine on H2 receptors
- Decrease HCl acid secretion
- Decrease conversion of pepsinogen to pepsin
- Increase ulcer healing
Peptic Ulcer Disease: Drug Therapy
Proton pump inhibitors (PPI)
Block ATPase enzyme that is important for secretion of HCl acid
Antibiotic therapy (High rate of recurrence if they don’t finish treatment)
Eradicate H. pylori infection
No single agents have been effective in eliminating H. pylori
Peptic Ulcer Disease: Drug Therapy
Anticholinergic drugs
Occasionally ordered for treatment
Decrease cholinergic stimulation of HCl acid
Cytoprotective drug therapy
Used for short-term treatment of ulcers
Tricyclic antidepressants (help block acidity)
Serotonin reuptake inhibitors
Peptic Ulcer Disease: Nutritional Therapy
Protein considered best neutralizing food
- Stimulates gastric secretions
Carbohydrates and fats at least stimulating to HCl acid secretion
- Do not neutralize well
Milk (often interferes with antibiotics) can neutralize gastric acidity and contains prostaglandins and growth factors
- Protects GI mucosa from injury
Peptic Ulcer Disease: Acute Intervention
Patient generally complains of increased pain, N&V, and some bleeding
May be maintained on NPO status for a few days, have NG tube inserted, fluids replaced intravenously
Physical and emotional rest are conducive to ulcer healing
Peptic Ulcer Disease: Acute Exacerbation
Treated with same regimen used for conservative therapy
Stuation is more serious because of possible complications of perforation, hemorrhage, gastric outlet obstruction
Accompanied by bleeding, increased pain and discomfort, N&V
Peptic Ulcer Disease: Acute Exacerbation
Recurrent vomiting, gastric outlet obstruction
- NG tube placed in stomach with intermittent suction for about 24-48 hours
- F&E are replaced by IV infusion until patient is able to tolerate oral feedings without distress
Peptic Ulcer Disease: Acute Exacerbation
Management is similar to that for upper GI bleeding
Blood or blood products may be administered
Careful monitoring of VS, I&O, lab studies, signs of impending shock
Peptic Ulcer Disease: Acute Exacerbation
Endoscopic evaluation reveals degree of inflammation or bleeding and ulcer location
5-year follow-up program is recommended
Peptic Ulcer Disease: Hemorrhage
Changes in VS, increase in amount and redness of aspirate signal massive upper GI bleeding
Increased amount of blood in gastric contents decrease pain because blood helps neutralize acidic gastric contents
Keep blood clots from obstructing NG tube
Peptic Ulcer Disease: Perforation
Sudden, severe abd. pain unrelated in intensity and location to pain that brought client to hospital
Indicated by a rigid, board-like abd.
Severe generalized abd. and shoulder pain
Shallow, grunting respirations
Peptic Ulcer Disease: Perforation
Immediate focus to stop spillage of gastric or duodenal contents into peritoneal cavity and restore blood volume
NG tube is placed into stomach
- Placement of tube as near to perforation site as possible facilitates decompression
Peptic Ulcer Disease: Perforation
Circulating blood volume must be replaced with lactated Ringer’s and albumin solutions
Blood replacement in form of packed RBCs may be necessary
Central venous pressure line, in-dwelling urinary catheter should be inserted and monitored hourly
Peptic Ulcer Disease: Gastric outlet obstruction
Can occur at any time
- Likely in clients whose ulcer is located close to pylorus
Gradual onset
Constant NG aspiration of stomach contents may relieve symptoms
Regular irrigation of NG tube
Peptic Ulcer Disease: Gastric outlet obstruction
Decompress stomach
Correct any existing F&E imbalanced
Improve client’s general state of health
NG tube inserted in stomach, attached to continuous suction to remove excess fluids and undigested food particles
Peptic Ulcer Disease: Gastric outlet obstruction
Continuous decompression allows:
- Stomach to regain its normal muscle tone
- Ulcer can begin to heal
- Inflammation and edema subside
When aspirate falls below 200 ml, within normal range, oral intake of clear liquids can begin
Health Promotion
Identify patients at risk (high stress, elderly)
Early detection and decreased morbidity
Encourage clients to take ulcerogenic drugs with food or milk
Teach clients to report symptoms related to gastric irritation to health care provider
Peptic Ulcer Disease: Surgical therapy
Peptic Ulcer Disease: Surgical Procedures
Gastroduodenostomy (Bilroth I)
Gastrojejunostomy (Bilroth II)
Vagotomy
Pyloroplasty
Peptic Ulcer Disease: Nutritional therapy
Diet should consist of: - Small, dry feedings daily - Low in carbohydrates - Restricted in sugars - Moderate amounts of protein and fat - 30 minutes of rest after each meal Interventions are diet instruction, rest, and reassurance
Appendicitis: Assessment
Location, severity, onset, duration, precipitating facors, and alleviating measures in relation to the pain
Previous abd. distress, chronic illnesses, surgeries; record allergies and medications
Temperature; abd. pain, distention, and tenderness; presence and characteristics of bowel sounds
Appendicitis: Nursing Care/ Teaching
Pain Food Fluids Allergies Medications
Preop teaching: turn, DB&C, pain management
Appendicitis: Complications/ Management
Perforation
Prompt diagnosis and management to prevent perforation
Hospitalization, IV fluids, NPO until diagnosis confirmed
Diagnostic test
Surgery
Appendicitis: Evaluation
Teach wound/ incision care Wound assessment instructions Dressing changes Hand washing What to report to the physician Activity restrictions Driving, return to work Home care nurses
Peritonitis: Assessment
Monitor current status
Progress of recovery
Identify complications
Peritonitis: Nursing Care
Intensive nursing and medical interventions Diagnostic tests Intestinal decompression Antibiotics Surgery
Peritonitis: Evaluation
Pain level Weight Urine output Documentation Wound healing
Peritonitis: Teaching
Wound care, dressing changes Needed supplies Medications S&S further infection Activity restriction
Hepatitis: Assess
Recent flulike symptoms
Medications
Changes in bowel habits, colour of feces and urine
Pain (RUQ)
Changes in colour of skin or sclera (jaundice)
Hx of vaccine
Known or possible exposure to Hep virus (travellers; A, B, C)
Hepatitis: Overall goals
Relief of discomfort
Resumption of normal activities
Return to normal liver function without complications
Hepatitis: Treatment
Most clients are not hospitalized
No cure so treatment is supportive
Client must rest in order to rest liver, promote cellular regeneration and prevent complications
Interferon injections
Hepatitis: Drug Therapy
No specific drug therapies Supportive therapy: - Antiemetics - Diphenhydramine (Benadryl) - Chloral hydrate
Hepatitis: Prevention
Vaccines & immune globulin injections are available to prevent Hep A/B
Vaccines recommended for people at high risk
Immune globulin is used for post exposure prophylaxis, to prevent disease after known contact
Hepatitis: Nursing Diagnoses
Risk for infection
Activity intolerance
Imbalanced nutrition: less than body requirements
Deficient knowledge r/t causes of hepatitis and modes of transmission
Hepatitis: Risk for infection
Use standard precautions & meticulous hand washing
Hep A-contact isolation if decal incontinence is present
Encourage at risk clients to obtain Hep A or B immunizations
Hepatitis: Activity Intolerance
Encourage client to rest as needed to relieve fatigue
Plan nsg activities that promote rest, allowing gradual resumption of activities
Provide or encourage diversional activities based on client’s interests
Encourage visitors to visit for short periods
Place frequently used items close by for easy reach
Hepatitis: Imbalanced nutrition
Encourage diet high in carbs and calories, low in fat
Encourage eating more food when N&V are minimal
Give IV fluids if N&V present. Monitor F&E balance and assess for dehydration
Hepatitis: Deficient knowledge
Assess clients knowledge about disease and modes of transmission
Instruct client with Hep B/C that a chronic form of the disease may develop and they will need monitoring once discharged
If drug or alcohol problem is identified, refer to appropriate persons
Teach client to modify sexual practices as directed
Hepatitis: Teaching
Prevent spread of disease
Vaccination
No sharing personal items
No sexual activity until no longer infectious
