GI Disorders: Alimentary Tract Flashcards
GI transit time
~30 hours
GI assessment
Inspection, Auscultation, Percussion, Palpation
GI assessment: auscultation
Normal: low to high pitched gurgling, 5 to 30/min
Absent: must listen for 5 mins
- Hypoactive: constipation r/t meds (anesthesia, opioids, anticholinergics), ileus
- Hyperactive: inflammatory bowel disease, infection, meds
- Bowel obstruction: early signs are hyperBS bc system trying to move it, late signs are hypoBS
GI assessment: ausculation using bell
Listen for low-pitched bruits = partial obstruction of vessel
- Don’t palpate area, notify provider
GI assessment: lab values for nutritional status
- Albumin, prealbumin, transferrin
- Prealbumin most accurate (16-30)
- Transferrin bc role in iron binding and transport
Stomatitis
Inflammation & ulceration of mouth lining + other mucous membranes in GI tract
- Secondary: result of infection in immunosuppressed pts
Stomatitis clinical manifestations
- *Severe atypical chest pain
- *Hemorrhage
- *Aspiration pneumonia
- *Morning hoarseness
- Heartburn
- Painful swallowing, regurgitation
- Chronic cough, dental carries
- Adult-onset asthma
- Laryngitis, pharyngitis, bronchitis
Stomatitis medical management (prevention care)
- Sodium bicarb + water or saline
- Topical analgesics
- Moisturizers
Sodium bicarb for stomatitis prevention
- Swish and spit every 4 hours
- Remove loose particles
- Moisturizes
- Thins oral mucous
- Decrease acidity
- Decreases yeast growth
Stomatitis risk factors
- Viral, bacterial, fungal infections
- Chemo / radiation therapy
- Irritants (chew tobacco, alcohol, mouthwash)
- Allergies (metal, meds, dental materials, foods)
- Deficiencies (B vitamins, iron, folate, zinc)
- Systemic diseases (eg. chronic kidney disease, IBD)
Stomatitis assessment
- Vital signs (temp = infection, increased pulse and decreased BP d/t fluid volume deficit)
- Pain
- Oral mucosa: detailed description, erythema, ulcers, location
- Nutrition
- Weight
- I&O: assess for fluid vol deficit
Stomatitis nursing interventions
- Aspiration precaution: suction, HOB 45 elevate, topical analgesics
- Med administration: antimicrobials, antivirals (acyclovir), antifungal (nystatin troche), viscous lidocaine
- Water soluble lubricants for lips/mouth: reduce dryness and cracking
Stomatitis pt teaching
- Mouth care post meals, using soft-bristled toothbrush
- No alc-containing mouthwash or glycerin swabs d/t drying out
- Dentures or other oral devices removed
- Routine dental care
- Saline mouthwashes every 4 hours
- Choose diet accordingly: avoid hard salty acidic spicy foods, high protein to facilitate healing
Gastroesophageal reflux disease (GERD)
Retrograde flow of GI content into esophagus causing inflamm –> slows removal of stomach contents –> increased blood flow (hyperemia), ulcerations (erosions), minor bleeding in esophagus
GERD risk factors
- *Hiatal hernia
- Lower esophageal sphincter hypotension
- Loss of esophageal motility
- Increased states of gastric secretion (Zollinger-Ellison Synd)
- Delayed emptying of gastric contents (diabetes)
- Obesity, pregnancy, eating large meals
- Ascites
- Tight belts or girdles
- NG tube
GERD clinical manifestations
- *Heartburn (dyspepsia)
- *Severe atypical substernal chest pain
- *Regurgitation
- *Dysphagia
- *Aspiration pneumonia
- *Morning hoarseness
- Odynophagia (painful swallow)
- Chronic cough
- Laryngitis, pharyngiits, bronchitis
- Dental carries
GERD complications
- Barret’s esophagus
- Strictures
- Esophageal CA
GERD complication: Barrett’s esophagus
- Squamous epithelium replaced w Barrett’s epithelium
- More resistant to acid
- High propensity for malignancy –> esophageal CA
GERD complication: Strictures
- Scarring and fibrosis in esophagus
- Secondary to healing process after acid exposure
- Results in worsening dysphagia and sensation of food getting stuck
GERD complication: esophageal CA
- Untreated GERD is risk factor
- Smoking and alc
- Barrett’s esophagus
GERD nursing assessment
- Resp symptoms: aspiration, pneumonia, chronic cough, wheez
- Regurgitation: aspiration if lying supine
- *Severe atypical chest pain: caused by esophageal spasm, NEED to rule out cardiac origin
- Hemorrhage
- Dyspepsia, dysphagia, odynophagia
- Eructation, flatulence, bloating
- Nausea
GERD medical management
- PPIs
- H2 blockers
- Prokinetics
- Antacids
GERD nursing intervention
- Meds
- Pt positioning: lying on R side promotes gastric emptying
- Elevate HOB
- Small freq meals (decrease pressure and promote gastric emptying)
GERD pt teaching
- Avoid smoking & alc
- Avoid NSAIDS and ASA (aspirin)
- Wait 2 hrs after eating before lie down
- Limit certain foods (… peppermint, caffeine)
- Med teaching
- Maintain ideal body weight; weight reduction
- Nonrestrictive clothing
Gastritis
Localized, intermittent inflamm of gastric mucosa
Acute gastritis cause
- *Aspirin & NSAIDS
- Chronic ingestion of irritating foods
- Chemo & radiation
- Poison
- Major surgery, trauma, infections
Chronic gastritis causes
- *H.Pylori
- *NSAIDS
- TB, alcohol, bile reflux
Acute gastritis clinical manifestations
- (everything from chronic gastritis)
- Dehydration
- Loss of blood: pallor, tachy, hypotension
Chronic gastritis clinical manifestations
- Epigastric pain
- N/V
- Weight loss
- Decreased appetite
- Changes in stool color
Gastritis medical management
- Proton pump inhibitors
- H2 receptor antagonists
- Antacids
- Sucralfate
- Antacids + sulcralfate (NO solid mass)
- *Vitamin B12 supplements (treat pernicious anemia)
- Triple treatment for H Pylori
Triple treatment for H Pylori
High eradication rate
- PPI
- Clarithromycin (abx)
- Amoxicillin (abx)
Gastritis nursing assessment
- History/CC: heartburn, indigestion, N/V, dyspepsia, food poisoning
- Vital signs: FVD (tachy, decreased BP)
- Abd exam: skin, pallor, coolness, signs of dehydration
- Peripheral pulses: weak pulses due to FVD
- I&O: FVD from vomit or blood loss
Gastritis nursing interventions
- IV fluids & electrolyte administration per order
- Meds: PPI, H2 receptor antagonists, antacids, sucralfate
- N/V management
Gastritis pt teaching
- Report episodes of hematemesis (bright red blood or dark brown, coffee ground appearance)
- Med adherence
- Avoid foods irritant to gastric mucosa: alcohol, caffeine, NSAIDs, spicy foods
Peptic Ulcer Disease risk factors
- H. Pylori
- NSAIDS
PUD clinical manifestations
Gastric ulcer:
- *Exacerbated by eating
- *Little/no relief from antacids
- Epigastric pain
Duodenal ulcer:
- *Exacerbated by fasting
- *Improved w food/antacids
- Burning epigastric pain
- Pain that awakens ppl d/t nocturnal gastric secretions
PUD medications
- Antacids: neutralize acids
- H2 receptor antags: decrease acid prod
- PPI: block acid prod
- Sucralfate: enhance mucosal defenses by binding to necrotic ulcer tiss & serving as barrier
PUD diet management
- Avoid dietary irritants: spices, alc, caffeine
- Meal frequency: 6 small meals per day OR hourly meals
- GI bleed –> NPO
- *Smoking cessation: decreases healing, increase ulcer relapse
PUD complications
- *Gastric adenocarcinoma (H Pylori)
- GI hemorrhage
- Abd or intestinal infarction
- Perforation & penetration into attached structures
- Obstruction
- Peritonitis
PUD assessment
- History: alc, aspirin, NSAID, diet, foods assoc
- VS (tachy, hypotension, orthostatic)
- Weight
- Pain (left epigastric, rhythmic, referred to L shoulder)
- Abd exam
PUD nursing interventions
- IV infusions and administer blood prods as ordered (Hgb < 7 or symptomatic)
- Meds: PPIs before meals, antacids 1-3 hrs post meal
- Prepare pt/family for upper endoscopy/EGD/surgery
- Limit food after evening meal
- Pain documentation
- Assist w gastric lavage: irrigation via NG tube, removes irritating blood from gut, slows bleed
PUD pt teaching
- Med adherence: PPI, H2 receptor antag, antacids, avoid OTC meds for dyspepsia if taking prescription meds
- Avoid eating w/in 2 hrs of bedtime
- Avoid PUD risk factors: NSAID, alc, aspirin, spicy food
Types of Hernias
- Inguinal: intraabd fat/SI protrudes around inguinal canal
- Indirect: congenital, inguinal doesn’t close after birth
- Direct: connective tiss degen weakens muscles
- Femoral: preset below inguinal ligament 40% present as incarcerated
- Umbilical: omentum and fat incarcerates
- Ventral (or incisional): prev abd surgeries, often midline incision in upper area
Incarcerated/Strangulated hernia
- Surgery is more extensive
- May result in temp colostomy
Reducible vs. Irreducible/Incarcerated hernia
- Reducible: contents easily reenter the abd by lying down or gentle pressure
- Incarcerated: contents can’t be placed back into abd cavity (medical emergency)
Hernia nursing assessment
- VS (temp: infection)
- Pain
- I&O
- Surgical site (well approximated)
Hernia
Protrusion of abd contents thru area of weakened muscle in abd wall
Hernia nursing interventions
- Deep breathing, early ambulation
- Administer pain meds as needed; prescription for pain meds upon discharge
- Ice pack to scrotum, elevate scrotum
- Advance diet as ordered, clear liquids to solids
Hernia pt teaching
- Discourage cough, if necessary, splinting (squeeze pillow against abd during cof)
- Avoid heavy lifting for several weeks
- Pain management techniques
- What to observe in surgical incision
Diverticulitis
Small pouchlike protrusions/herniations occuring primarily in colon at weak areas of intestinal wall
Diverticulitis risk factors
- Low fiber, high-fat diet
- Obesity and smoking
- Increasing age and heredity
- Meds (NSAID, Tylenol, Opiates, Corticosteroids)
Diverticulitis clinical manifestations
- Localized abd pain over involved area, usually sigmoid colon
- Fever and leukocytosis
- Diarrhea, constipation, bloating, flatus
- *Older adult: change in mental status
Diverticulosis vs. Diverticulitis
- Diverticulosis: non-infected pouching
- Diverticulitis: infected diverticula
Diverticulitis nursing assessment
- VS (fever = infection, tachy = FVD)
- Pain local vs diffuse (*diffuse pain = rupture)
- GI: bowel sound, character of stool
- *Mental status in older adults
- I&O
- Serum K levels (NG tube loss)
Diverticulitis nursing interventions
- Administer IV fluids
- Administer ordered abx
- NG tube to low intermittent suction to decrease GI motility
- Provide oral care d/t dryness from increased mouth breathing
Diverticulitis pt teaching
- Dietary recs: increased fiber and fluids
- Avoid straining, bending, lifting
- Weight reduction
- Complete abx as ordered to avoid rebound infection
Diverticulitis complications
- *Perforation
- *Peritonitis (as result of perforation)
- *Sepsis
- Bowel obstruction
- Inflammation resulting in fistula formation (colon and pelvic organs)
Inflammatory bowel disease
Broad term for similar chronic diseases of GI tract
- Crohn’s Disease
- Ulcerative Colitis (UC)
IBD cancer risks
- Crohn’s: Small bowel cancer, cholangiocarcinoma
- UC: Colon cancer, cholangiocarcinoma
Characteristics of Crohn’s
- Affect mouth, anus, most commonly in terminal ileum, and then colon
- Affect all layers of intestine: transmural
- Loose, semiformed stool
- 5-6 loose, non-bloody stool
- Fistual, fissure, abscess, stricture: COMMON
- Tenesmus (spasm of rectum): RARE
- Fistulas, nutritional deficiencies
- Recurrence at site of anastomoses
Characteristics of ulcerative colitis
- Colon, rectum. Begins in rectum and advances in continuous process to cecum
- Mucosa and submucosa of colon
- Freq watery stools w blood and mucuous
- 10-20 liquid and bloody stools
- Tenesmus: COMMON
- Hemorrhage, nutritional deficiencies
- Cure w colectomy
IBD Psychosocial issues
- Body image disturbance
- Embarrassment
- Depression and anxiety
- Loss of independence
Crohn’s & surgery
Removal of diseased bowel is not curative, disease often returns in another area of bowel
What leads to surgery for UC?
Ineffective medical management or complications from medical management
Surgical management of IBD
- Total colectomy w ileal pouch anal anastomosis (IPAA): entire colon & rectum removed, pouch created to collect waste, person can defecate normally
- Proctocolectomy w permanent ileostomy
IBD nursing assess
- History: freq diarrhea leading to extreme fluid loss and electrolyte abnormalities (hypokalemia)
- VS: tachy, hypotension, low grade fever
- Weight: decreased intake d/t fear of worsening sympts & malabsorp
- I&O
- Freq and characteristics of stool
- Psychosocial support
- Nutritional intake
IBD nursing interventions
- Administer IV fluids & supplemental potassium as ordered
- EKG monitoring if significant hypokalemia
- Administer blood products & abx as ordered
- Small frequent meals (decrease intestinal motility)
- Rest periods (decrease intestinal motility)
- Pain management: positioning, medications, monitoring for side effects such as constipation
- Skin care: freq diarrhea, presence of ostomy
IBD pt teaching
- Nutrition: vitamin supplements, reducing fat and fiber during exacerbations, fluids
- Meds: schedule of meds, SEs, how they work & purpose
- Regular provider follow up
- Routine colonoscopy
