GI Disorders Flashcards
patho of the mouth in digestion
responsible for chewing with mechanical digestion
patho of esophagus in digestion
Is a hollow muscular tube that carries food & liquid from the mouth to the stomach. It does this by peristalsis.
patho of stomach in digestion
- Stores food during eating
- Secretes digestive fluids
- Moves partially digested
food (chyme) into the small intestine
patho of small intestine in digestion
digestion from stomach
absorption of nutrients
patho of large intestine in digestion
absorbs water and electrolytes from food that has not been digested yet
* defecation rids the body of any waste leftover from food and removes it through the rectum and anus
parts involved in digestion
Mouth
Esophagus
Stomach
Small and large intestine
Rectum
factors in a balanced diet
Macronutrients
-Carbohydrates, fats, proteins
Micronutrients
-Vitamins, minerals, electrolytes
Water
healthy diet promotion by the nurse:
Begins with assessment of nutritional status
Education and cultural competence are key
Social determinants of health should be part of assessment
Modifications made to a basic diet to meet the needs of the patient
modified diet
Used when nutrition cannot be maintained orally, but GI function intact
enteral nutrition
nutrition for when the GI tract is not functioning
total parenteral nutrition
types of modified diets
Clear Liquid
Full Liquid
Pureed (blenderized)
Soft (bland, low-fiber)
Mechanical Soft
Dysphagia
advance diet as tolerated:
watch how pt tolerates each diet
wait at least 2-3 hours for response
placement for parenteral nutrition
through central vein
through peripheral vein
placement for routes of enteral nutrition
stomach (nasogastric)
duodenum (nasoduodenal)
jejunum (nasojejunal)
gastrostomy (stomach)
jejunostomy (SI)
how is enteral nutrition administered
via tube to the stomach, duodenum or jejunum
delivery methods for enteral nutrition
Continuous infusion
Cyclic feeding
Intermittent
Bolus
Enteral Nutrition Nursing Considerations
Tube placement verification
Maintain patency
Presence of bowel sounds
Gastric residuals
HOB 30 degrees
Oral care
Enteral Nutrition Complications
Aspiration
N/V and abdominal discomfort
Diarrhea or constipation
Dumping syndrome - feeding too much too fast
Electrolyte imbalances
Nutrition provided via peripheral or central venous routes
Highly concentrated formulas of macronutrients, electrolytes, vitamins, and trace elements
parenteral nutrition
Parenteral Nutrition Nursing Considerations
Monitor solution for “cracking” or separation - always send back
Double nurse verification
Monitor blood sugars Q4-6 hours
Do not administer medications or blood products in same line
If new bag is not available, administer dextrose in water
Maintain sterility
Daily weights (notify MD >1kg/day)
Parenteral Nutrition Complications
Infection and sepsis
Hyperglycemia
Electrolyte imbalances
Fluid overload
Refeeding Syndrome (respiratory, cardiac, and neuro changes)
acute vs chronic peptic ulcer disease
Acute
-Superficial erosion
-Minimal inflammation
-Short duration: resolves quickly when cause is identified and removed
Chronic
-Long duration
-Muscular wall erosion with formation of fibrous tissue
-Present continuously for many months or intermittently throughout person’s lifetime
-More common than acute erosions
2 types of peptic ulcers
duodenal - mucosis is damaged and cannot protect against damage
gastric - lining is disrupted
clinical manifestations of duodenal ulcers
Weight gain
Pain 2-3 hours after eating
pain relieved with eating
Vomiting
Melena
Perforation
clinical manifestations of gastric ulcers
Weight loss
Immediate pain
Vomiting
Hemorrhage
complications of PUD
Hemorrhage (dizzy, hypotension, chest pain)
Perforation (fever, rebound tenderness, hard abdomen)
Penetration
Pyloric Obstruction
medications for PUD
H2R Blockers (ranitidine, famotidine)
PPI (Omeprazole, Pantoprazole)
Antibiotics (amoxicillin, clarithromycin)
Antacids
Bismuth Salts
treatment for PUD
Surgery
Endoscopy
Decompress the bowel
PRBC’s
Electrolyte replacement
nursing diagnosis for PUD
Acute pain
Ineffective health management
Nausea
overall goals for PUD
Adhere to prescribed therapeutic regimen
Experience a reduction in or absence of discomfort
Exhibit no signs of GI complications
Have complete healing
Make appropriate lifestyle changes to prevent recurrence
health promotion for PUD
Identify patients at risk
Lifestyle changes
Teach patient to report to health care provider symptoms related to gastric irritation
Teach patient s/s of hemorrhage, perforation, and obstruction
Acute care for PUD
NPO
NG tube with intermittent suctioning
IV fluid replacement
Explain treatment measures to patient/family
Provide regular mouth care
Cleanse and lubricate nares
Expected outcomes for PUD
Have pain control without the use of analgesics
Verbalize understanding of the treatment regimen
Commit to self-care and management
Have no complications
terms under IBD
Chrons
UC
factors of UC
Start in rectum and through the entire colon
Ulcerations, inflammations and shedding of the epithelium
Mucosa is edematous and inflamed
Abscesses that line the mucosa
Ulcers bleed easily- bloody stools
Narrowing of colon
clinical manifestations for Chrons disease
Steatorrhea
Weight loss
Crampy pain after meals
Joint disorders
Skin lesions
Ocular disorders
Oral ulcers
clinical manifestations for UC
Rectal bleeding
Anemia
Anorexia
Hypoalbuminemia
clinical manifestations for both Chrons and UC
Fever (increased WBC and ESR)
Abdominal pain
Fatigue
Diarrhea
Weight loss
Electrolyte Imbalance
High-pitched bowel sounds
complications of Chrons
Intestinal obstruction/stricture
Malnutrition
Fistulas common
Perforation/peritonitis
Fluid and electrolyte imbalance
complications of UC
Toxic megacolon (colonic distension)
Hemorrhage
Perforation/peritonitis
Fluid and electrolyte imbalance
diagnostic testing for IBD
CBC
-Hgb and Hct
ESR (Erythrocyte sedimentation rate)
Electrolytes
Albumin
WBC
CT scan
Barium series
Sigmoidoscopy/Colonoscopy
surgical options for Chrons
Strictureplasty
Resection (recurrence common)
Intestinal transplant
surgical options for UC
Total Colectomy with Ileoanal Reservoir
Total Proctocolectomy with Permanent Ileostomy
Total Proctocolectomy with continent Ileostomy
medications for IBD
Aminosalicylates – reduce inflammation
-Sulfasalazine - photosensitivity
Corticosteroids – reduce inflammation
-Not for long-term use
Immunosuppressants
-Cyclosporine, methotrexate
Immunomodulators – suppress immune response
-mabs (infliximab), frequently given as infusions
Antidiarrheals
-May increase risk of toxic megacolon
nursing diagnoses for IBD
Diarrhea
Fluid volume deficit
Imbalanced nutrition: less than body requirements
Disturbed body image
overall goals for IBD
Reducing inflammation
Suppression of inappropriate immune response
Rest diseased bowel
Improve quality of life
nursing implementation for IBD
Monitor fluid and electrolytes
Monitor I&Os closely
Assess for s/s dehydration
Teach high protein, high calorie, low fiber diet
Teach s/s of complications
Weight 1 – 2 times weekly
Provide TPN during exacerbations and rest the bowel
evaluation for IBD
Exacerbations decreased and manageable
Effective immune suppression with minimal complications
Patient maintains quality of life
Maintenance of body image
