GI Disorders Flashcards
Appendicits
Diagnostics = Rovsing’s Sign (RLQ pain during LLQ palpation), PAin at Mcburney’s point, rebound tenderness, PSOAS sign (hyperextension of right hip)
Medical Management = Appendecotomy and antibiotics
Nursing Management:
- prevent atelectasis using spirometry
- maintain skin integrity and attain optimal nutrition
- relieve preop and postop pain
- Prevent hypovolemia
- reduce anxiety
- prevent or treat surgical site infection
Peptic Ulcer Disease (PUD)
Gastric Ulcers = pain right after eating, pain during the day
Duodenal Ulcers = pain 2-3 hours after eating, pain at night, relief with eating or antacids
Diagnostics = Upper endoscopy, biopsy (detect H. pylori), rapid urease test (H. pylori), CBC (assess anemia)
Medical Management = PPI, Antacids, Antibiotics, Sucralfate, Vagotomy with pyloroplasty, antrectomy with billiroth I or II
Nursing Management:
- manage pain
- reduce anxiety
- monitor for complications like hemorrhage, perforation, penetration, and gastric outlet obstruction.
- maintain nutrition and fluid status
- may need NG tube inserted
Gastritis
Acute Erosive = ingestion of strong acid
Acute Nonerosive = caused by H. pylori
Chronic = H. pylori and long term chemical gastric injury
Diagnostics = Endoscopy, histologic exam of biopsy, CBC (anemia), H. pylori diagnostics
Medical Management:
- NG intubation, medications, fluids, fiberoptic endoscopy, surgery for perforated tissue, gastric resection or billiroth II for pyloric obstruction (acute)
- Modify diet, rest, reduce stress, avoid alchol/NSAIDs, use medications (chronic)
Nursing Management:
- Reduce anxiety and implement medical management like fluids and NG tube.
- Educate patient on lifestyle mods
Inflammatory Bowel Disease (IBD)
Includes:
- Ulcerative Colitis
- Diverticulitis
Ulcerative Colitis (Chronic)
Diagnostics = Colonoscopy, biopsy, abdominal X-Ray, CT scan, MRI, ultrasound
Medical Management = medications, enteral or parenteral nutrition, partial or complete colectomy with ileostomy or anastomosis
Nursing Management:
- maintain optimal nutrition
- reduce anxiety
- Monitor and manage potential complications like perforation, obstruction, toxic megacolon (mental status change), educate patient on nutritional management, med adherence, follow-up care.
Diverticulitis
Diagnostics = CT scan and clinical manifestations
Medical Management = Clear liquids, then high fiber, low-fat, and antibiotics (uncomplicated = outpatient); NPO, IV fluids, NG suction, Broad-spectrum antibiotics, opioids, low fiber diet, surgery for Hinchey stages (Acute/Complicated = hospital); surgical intervention for abscess, perforation, peritonitis, obstruction (resection)
Nursing Management:
- fluid intake of 2L/day, soft foods with high fiber (prepared cereals; soft-cooked veggies).
- encourage exercise to improve peristalsis and muscle tone.
- Encourage bulk laxatives like psyllium.
- ostomy care
manage NG tube if needed
Small Bowel Obstruction
Mechanical = physical obstruction due to adhesions, hernias, tumors, strictures, intussusception, volvulus
Functional (paralytic ileus) = muscles cannot propel stool
Diagnostics = symptoms, abdominal x-ray, CT scan, electrolytes and CBC (hypocolemia and infection).
Medical Management = Decompression with NG tube, IV fluids, Gastrografin (Gi contrast), surgery for complete mechanical obstruction and strangulation
Nursing Management:
- monitor symptoms indicating worsening or resolving obstruction
- provide emotional support and comfort
- administer IV fluids and electrolytes as prescribed
- prepare patient for surgery if needed
- postop care including wound care
Bowel Perforation
Diagnostics = clinical manifestations: fever, tachycardia, vomiting, sudden severe abdominal pain, signs of peritonitis.
Medical Management = emergency surgery, broad-spectrum antibiotics
Nursing Management:
- recognize signs and symptoms of perforation
- monitor for signs of shock
- prepare patient for surgery
- administer prescribed meds
- provide emotional support
