Module 4 Flashcards
what are the functions of the gi tract
secretion, digestion, absorption, motility, and elimination
Function of the oral cavity
mastication, secreting saliva and enzymes, swallowign
primary function of the esophagus
move food and fluids from the pharynx to the stomach
Upper esophageal sphincter function
UES opens and closes to prevent movement of air into the esophagus during respiration
what is the function of lower esophageal sphincter
prevent reflux of gastric acid
smooth muscles that line the stomach are responsible for
gastric motility
What is dysphagia?
difficulty swallowing
What is dyspepsia
heartburn (acid reflux)
Why should we ask our patients if they have experienced weight loss in our assessment of the gi system
some gi cancers can cause weight loss
What order do we perform an abdominal assessment
inspection, auscultation, light palpation
Questions to ask during GI history and assessment
last bowel movement, diet recall, pain w/eating, nauseated? diarrhea? constipation? vomiting? , dyspepsia, alcohol consumption, caffeine assumption
If appendicitis is suspected, do we perform palpation?
no
Do we auscultate or palpate any abdominal mass?
no ; this can be a life-threatening aneurysm
What order do we inspect the abdomen
RUQ, LUQ, LLQ, RLQ
areas of pain are assessed first or last during assessment?
last
If peristaltic waves are noticed in our patient, what can this indicate? What do we do?
may indicate intestinal obstruction. notify the provider
what do normal bowel sounds sound like
high-pitched, irregular gurgles
what does borborygmus sound like?
increased high-pitched sounds, very loud and gurgling noises
when is borborygmus usually noted
when pt is experiencing diarrhea, gastroenteritis, over a complete intestinal obstruction
When may bowel sounds be diminished or absent
after surgery, peritonitis, paralytic ileus
What order do we auscultate bowel sounds
RLQ, RUQ, LUQ, LLQ
During auscultation, if we hear a bruit (swooshing noise), this can indicate
presence of an aneurysm
If a bruit is heard during auscultation, what should we do?
notify provider immediately
Rigidity, felt during light palpation, may indicate
peritoneal inflammation
What are tympanic percussion sound s
high-pitched, musical sounds heard over air
What are dull percussion sounds
medium-pitched thud sounds heard over fluid
Why do we monitor CBC?
diagnosis of anemia, GI bleeding, and infection
What are AST and ALT
liver enzymes
Elevations in liver enzymes (AST and ALT) can indicate
liver disorder (hepatitis, cirrhosis)
normal range for ALT
4-36 units/L
normal range for AST
0-35 units/L
ammonia levels can be used to detect
liver function
an elevated ammonia level by indicate
hepatic dysfunction/injury (cirrhosis)
Normal range for ammonia
10-80 mg/dL
elevations in serum lipase and amylase may indicate
acute pancreatitis
range for normal amylase
60-120 somogyi units/dL
range for normal lipase
0-160 units/L
Elevation in bilirubin (total) may indicate
liver impairment
normal range for bilirubin
0.3-1.0 mg/dL
what are CA and CEA tests used to identify
cancer (reoccurrence, efficacy of cancer treatment, can also be elevated by benign tumors)
Normal range for CA (cancer antigen)
0-37 units/mL
Normal range for CEA (carcinoembryonic antigen range)
< 5 ng/mL
what is an FOBT
fecal occult blood test
what does the FOBT test for
presence of blood from hemorrhage/gi bleeds
Patient prep for FOBT
no NSAIDs 7 days prior, no red meat or vitamin C (more than 250 mg/day) for 3 days prior
what is a FIT test
fecal immunochemical test (may replace colonoscopy if they are low risk for cancer)
what does a FIT test screen for
looking at stool (look up the thing about the false positives and negatives)
Do drugs or food alter a FIT test
no, so patient adherence is higher
are FIT and FOBT tests taken at home
yes; however, false positives and false negatives are more likely
If a patient receives a positive FIT or FOBT, even if false, what must happen
a colonoscopy
To aid in diagnosis for parasitic infection, stool samples may be used to test for
ova and parasites
stool samples can also be used to test for this disease, which is a potentially dangerous superinfection caused by prolonged antibiotic use
clostridium difficile
X-rays of the abdomen can be used to look for
masses, tumors, obstructions, gas
what is an acute abd series
chest xray, supine abd film, upright abd film
what is an acute ABD series good to look for
hernias because they can be visualized as patient moves
what special considerations should we make for someone receiving a CT with contrast
stop metformin 48 h before to reduce AKI
Patient education for x-ray
no jewelry, belts, zippers, buttons, telemetry leads, medication patches
Patient prep for MRI
remove all metal (includes medication patches and ekg/telemetr leads)
patient education for MRI
MRI machine typically very loud, can cause you to feel claustrophobic
What is an endoscopy
direct visualization of gI tract using a flexible fiberoptic endoscope
An endoscopy evaluates for
ulcerations, bleeding ,inflammation, tumors, cancer
-looks at esophagus, stomach, biliary system, and bowel
During an endoscopy, biopsies may be taken to evaluate for
helicobacter pylori
What is an esophaogastroduodenoscopy (EGD)
visual examination of the esophagus, stomach, and duodenum using endoscope
if gi bleed is found during EGD, the prodder can
cauterize or clip the bleed
if EGD shows esophageal stricture (narrowing of esophageal opening), the provider can
dilate the esophagus
Patient prep for EGD
-avoidance of NSAIDs, anticoagulants, and aspirin for several days (to one week) before
-NPO 6-8 h before
-remove dentures
-client receives moderate sedation from propofol, midazolam, or fentanyl
-atropine to dry secretions
-local anesthetic inactivates gag reflex
After medications are given, positioning for EGD is
head of bed elevated, bite block inserted
Nursing interventions during EGD
monitor respiration, oxygen saturation
Post-op interventions for EGD
-monitor vs q 15-30 mins (side rails of the bed are raised until aesthetic wears off)
-NPO until gag reflex returns
-make sure someone is able to drive them home
Patient education for post-op interventions for EGD
-do not drive for 12-18 hours after procedure
-hoarse voice and sore throat can persist for several days
what is an endoscopic retrograde cholangiopancreatography (ERCP)?
a visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to identify obstructions
What are different procedures that can be done during ERCP?
x-ray images with radiopaque dye, papillotomy to remove gall stones, stents inserted to fix biliary duct stricture, biopsy samples
Pre-op preparation for ERCP
-same as EGD
-obtain IV access
-medication reconciliation
-ask about implantable medical devices
Post- op interventions for ERCP
-assess VS q 15-30 min
-gag reflex check
-discontinue IV fluids
-colicky pain, flatulence can occur
Post-op education for ERCP
-do not drive 12-18 hours
-report abdominal pain, fever, nausea, vomiting that fails to resolve
an abdominal ultrasound is used to evaluate
liver, spleen, pancreas, biliary system
patient prep for abdominal ultrasound
-may have to be NPO
-supine position
-explain patient will have to lie still
what is an endoscopic ultrasonography
ultrasound with endoscope to look at lymph nodes and mucosal tumors
Patient prep and follow-up care for endoscopic ultrasound
same as endoscopy
In older adults, does peristalsis decrease or increase
decrease
Decreased peristalsis in the older adult can lead to
decreased sensation to defecate -> constipation and impaction
Because of the distention and dilation of pancreatic ducts , older adults are more likely to have
decreased lipase levels –> steatorrhea
Because older adults have decreased hydrochloric acidlevels, they are at risk of
decreased absorption of iron and vitamin B12, and increased bacteria
Decreased liver enzyme activity in the older adult leads to
accumulation of drugs –> toxicity
What is GERD
gastroesophageal reflux disease
What happens to the body during GERD
backward flow of stomach contents into the esophagus, known as regurgitation
What puts someone at risk for GERD
overweight, pregnancy, helicobacter pylori infection
GERD can be caused by relaxation of the
lower esophageal sphincter
What can cause the lower esophageal sphincter to relax
caffeine, tea, cola, chocolate, nitrates, citrus fruits, tomatoes, alcohol, smoking, peppermint/spearmint, smoking, calcium channel blockers, anticholinergics, high estrogen, high progesterone, nasogastric tube placement
what do patients report regurgitation tastes like
sour and bitter
Symptoms of GERD
dyspepsia, regurgitation, water brash, dental caries, dysphagia, globus, odynophagia, pyrosis, belching
What are dysphagia, globus, odynophagia
trouble swallowing, feeling something in back of throat, painful swallowing
Symptoms of GERD typically worsen when
patient bends over, strains, or lies down. Pain may radiate to chest, neck, jaw, and back
During the process of healing, the body may substitute normal epithelium with
squamous cell epithelium (known as Barrett’s esophagus)
Barrett’s esophagus:
more resistant to acid but is precancerous
During the healing process and Barrett’s esophagus ______ can occur, which leads to difficulty swallowing
esophageal stricture
How is GERD diagnosed
symptoms, EGD, pH monitoring esophageal manometry
what is pH monitoring in GERD
transnasal catheter placed in esophagus mucosa, monitors pH changes for 24-48 hours
Treatment for GERD consists of
changes in diet and lifestyle, drug therapy
Patient education for GERD
-eliminate foods that affect LES
-encourage small, frequent meals
-avoid eating 3 hours before bed
-sleep propped up
-avoid alcohol and tobacco
-avoid heavy lifting, straining, bending
-avoid restrictive clothing
Drugs used to treat GERD
PPIs (-zole), antacids, H2 blockers (-dine)
What drugs can increase risk for GERD by lowering LES
NSAIDs, oral contraceptives, anticholinergics, sedatives, CCBs
PPIs such as esomeprazole and pantoprazole can be given IV to prevent
prevent stress ulcers
Surgical management for GERD includes
laparoscopic Nissen fundoplication (LNF)
What is a hiatal hernia?
protrusion of the stomach (in part of total) above the diaphragm into the thoracic cavity through the hiatus.
What are the two types of hiatal hernias?
sliding and paraesophageal
What is a sliding hiatal hernia?
portion of stomach and gastroesophageal junction move above the diaphragm.
When do sliding hiatal hernias occur?
usually when patient is in supine position or with increased intra-abdominal pressure
What is a paraesophageal (rolling) hiatal hernia?
when part of the fundus of stomach moves above diaphragm, but the gastroesophageal junction remains below the diaphragm.
symptoms and assessment findings of a sliding hiatal hernia?
Heartburn, reflux, chest pain, dysphagia, belching.
symptoms and assessment findings of a paraesophageal hiatal hernia?
fullness after eating, sense of suffocation, chest pain, worsening of manifestations when reclining.
Assessment findings of hiatal hernia?
FOR BOTH MAYBE
pharyngitis, insrpiatory and expiratory wheeze
Diagnostics for hiatal hernia?
barium swallow with fluroscopy
EGD
Ct of chest with contrast
What does the barium swallow with fluroscopy do?
Allows visualization of the esophagus
Nursing actions for a barium swallow
instruct client to use cathartics to evacuate the barium from the gi tract following the procedure
What happens if a client does not eliminate the barium?
places them at risk for fecal impaction.
What does a egd do?
allows visualization of the esophagus and gastric lining
nursing actions after a egd
verify gag response has returned prior to providing oral fluids or food following the procedure
Ct of chest with contrast does what?
allows visualization of the esophagus and stomach
Nursing actions for ct of chest with contrast
pre: assess for iodine allergy for iv contrast
Post: encourage fluids to promote dye exretion and minimize risk of remal injury
MONITOR BUN/ CREATININE
Treatment for hiatal hernia?
Medications
fundoplication
Laproscopic nissen fundoplication
nuring education for hiatal hernia?
medications for hiatal hernia?
PPI, Antacids
What are the proton pump inhibitors?
end in azole
What do ppi do?
reduce gastric secretion by inhiiting the cellular pump of the gastric parietal cells necessary for gastric acid secretion
nursing actions for PPI
monitor for electrolyte imbalances, and hypoglycemia for clients that have DM
Long term use can result in c.diff, and cap
Client education for PPI
long term use increases risk of fractures, especially in older adults
What are the antacids?
aluminum hydroxide, magnesium hydroxide, calcium carbonate, and sodium bicarbonate
How do antacids work?
neutralize excess acid and increase LES pressure
Nursing actions for antacids
ensure no contraindications with other medications (levothyroxine).
Monitor kidney function for clients taking magnesium hyroxide
Client education for antacids
Take when acid secretion is the highest (1-3 hr after eating) and at bed time. Separate from other medications by 1 hour minimum.
Nutrition education for clients with hiatal hernia?
avoid eating immediately prior before bed, maintain healthy weight, exercise regularly, elevate bed.
What food should patients avoid eating to prevent hiatal hernias?
fatty foods, caffi.ene, fried foods, chocolate, peppermint, spicy foods, tomatoes, citrus fruits and alcohol
What should patients avoid doing to prevent hiatal hernias?
straining, or vigorous exercise. Avoid tight clothing around abdomen.
what does a fundoplication do?
reinforces the LES by wrapping a portion of the fundus of stomach around the distal esophagus.
Laproscopic Nissen Fundoplication
minimally invasive
LNF nursing actions
elevate hob to promote lung expansion
Instruct client to support incision during movement and coughing to minimize strain on suture lines
Client education for LNF
Consume a soft diet for the first week postop.
Avoid carbonated beverages, ambulate early but avoid heavy lifting.
Complications of LNF
Temporary dysphagia, gas bloat syndrome(difficulty burping and distention)
atelectasis and pneumonia
Complications from hiatal hernias?
Volvulus, obstructions, strangulation, iron deficiency anemia.
What is a volvulus?
twisting of the esophagus and or stomach
Obstruction (paraesophageal hernia)
blockage of food in the herniated portion of the stomach
Strangulation (paraesophageal hernia)
Compression of the blood vessels to the herniated portion of the stomach.
Iron deficiency anemia (paraesophageal hernia)
resulting from bleeding into the gastric mucosa due to obstruction
Safety considerations of hiatal hernia?
What is the primary concern for sliding hernias?
esophageal reflux, and associated complication. (1140)
Esophageal tumors are usually
epithelial tissue.
Where are squamous cell carcinomas located in the esophagus?
upper 2/3
What is the most common esophageal cancer?
Adenocarcinomas
Where are adenocarcinomas located in esophagus?
distal end of the esophagus and upper portion of the stomach.
Risk factors for esophageal tumors?
alcohol, diets chronically deficient in fruits and veggies, diets high in nitrites (pickled and fermented foods), obeseity, malnutrition smoking, g.e.r.d
Symptoms of esophageal tumors
dysphagia, weight loss, feeling of food stuck in their throat, hoarseness, changes in bowel habits, Odynophagia
When signs are present for esophageal tumors (usually cancerous) what does this mean?
signs usually only start when the cancer has spread.
What are esophageal tumors referred as?
silent tumors because they will not have symptoms until it is too late.
Assessment for esophageal tumors?
lack of pleasure in eating, anxiety,.
What diagnostics are used for esophageal tumors?
EGD, PET, ct scan,
Treatment for esophageal tumors
nutrition and swallowing therapy
Chemo and radiation.
surgical management of esophageal tumors
Esophagectomy
Pre procedure for esophagectomy
stop smoking 2-4 weeks prior
nutritional and pulmonary strengthening.
post esophagectomy
Stay in semi-fowlers position or high fowlers to support ventilation and prevent reflux.
Ensure patency of chest tube drainage system and monitor for changes in volume or color of the drainage. Placement of NG tube
What is the highest priority for esophagectomy?
respiratory care. Traditional surgery means they need ventilation and intubation fr first 16-24 hours.
What are complications of being intubated for esophagectomy?
atelectasis, and pneumonia.
after extubation, deep breathing, coughing, turning q1-2 hr.
Assess breath sounds and sob q1-2h
Provide inscional support and analgesics to enhance effective coughing.
Nursing interventions for esophagectomy
-monitor ng tube for patency.
Secure ng tube to prevent dislodgement to prevent disturbance at incision anastomosis.
-nutrition
-wound care ( prevent dehiscence)
Why are ng tubes placed after esophagectomy?
decompress stomach to prevent tension on suture line.
when do we resume initial feedings with J tube ?
second day post op.
Do we aspirate for residual in J tube?
NO, this will increase risk for mucosal tearing.
How are feedings introduced?
slowly until the fifth post op day?
What day of post op do we do a barium swallow to assess for anastomotic leaks?
7th.
When can we discontinue the ng tube?
if no anastomotic leaks are seen.
How long are patients on a liquid diet after surgery with no complications?
2 weeks.
NG tube nursing interventions after esophagectomy
check placement 48 hrs.
ensure patent and drainage correct color
provide meticulous oral care and nasal hygiene q2-4 hr
do not irrigate or reposition tube
Observe for leak at anastomosis site
What color should the drainage of the ng tube be by the end of the first post-op day?
YELLOWISH GREEN
will be bloody after insertion
What are signs and symptoms of an anastomosis leak?
fever, fluid accumulation, tachycardia, tachypnea, ams
Patient education for post-surgical esophagectomy
dysphagia and odynophagia may recur because of stricture, reflux, or cancer recurrence.
High protein, soft meals.
Sit up right after eating, and remain up right
Monitor weight.
When should patients report a weight loss to the provider?
if they have a 5lb weight loss or more in one month
What is gastritis?
Inflammation of gastric mucosa (stomach lining).
Do mucosal changes heal after several months with acute gastritis
Yes but not with chronic.
Acute gastritis
exposure to local irritants or other causes.
what is a high risk factor for acute gastritis
long term use of NSAIDS
alcohol, caffiene, coffee.
chronic gastritis appears how
patchy, spread out inflammation of the mucosal lining in stomach.
As chronic gastritis progresses what happens to the lining in the stomach?
thins, and atrophy occurs
with progressive gastric atrophy…
acid-secreting function decreases and the source of the intrinsic factor is lost.
What is an intrinsic factor?
critical for the absorption of vitamin b12. When there is a decrease of this vitamin, pernicious anemia may result.
what is the most common form of chronic gastritis?
h.pylori
Nutrition for gastritis
avoid alcohol
symptoms of acute gastritis
rapid onset of epigastric pain and dyspepsia. Hematemesis melena, nv, gastric hemorrhaging can occur
is gastric hemorrhage an emergency?
yes
what is dyspepsia
epigastric burning sensation.
Chronic gastritis symptoms
n/v upper abdominal discomfort. Periodic epigastric pain may occur after meals and anorexia.
with chronic gastritis has few symptoms except when?
ulceration occurs.
Acute gastritis nursing interventions
blood transfusion and fluid replacement. surgery
partial gastroectomy, pyloroplasty and or vagotomy may be needed when?
patients with major bleeding or ulceration.
chronic gastritis nursing interventions and treatment
elimination of the causative factor, tx of underlying disease, and avoidance of toxic substances
b-12 injections
Medications for gastritis
ppi, h2 receptor antagonist (famotidine), sucralfate (mucosal barrier fortifier), antacids,
Peptic ulcer disease
results when GI mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsid
What causes most ulcers?
h.pylori (oral-oral)
3 types of ulcers
duodenal, gastric, and stress
Where are duodenal ulcers located?
upper portion of the duodenum. They are deep, sharply demarcated lesions that penetrate through the mucosa and submucosa–muscle layer).
What is a main feature of a duodenal ulcer?
high gastric secretion.
patients with these ulcers have low ph levels (excess acid) in the duodenum for long periods.
gastric ulcers develop where?
antrum of stomach near acid-secreting mucosa.
patients can have delayed gastric emptying.
stress ulcers occur when
after trauma or an acute medial crisis like sepsis or a head trauma. Patients who are npo can often get them.
stress ulcers cause
prolonged stay in hospital and increased mortality rates.
Manifestations of stress ulcer
bleeding. MASSIVE HEMORRHAGE
Complications of PUD
hemorrhage, perforation, pyloric obstruction, intractable disease.
hemorrhage most often occurs in which type of ulcers?
stress and gastric.
signs and symptoms of PUD
dyspepsia, epigastric pain and tenderness, at midline between the umbilicus and xiphoid process.
what will we see if a patient has perforation into the peritoneal cavity?
rigid, boardlike abdomen accompanies by rebound tenderness and intense pain.
Initial auscultation of bowel sounds could be hyperactive but will diminish with prolonged infection.
how to test for h.pylori?
stool, blood, breath
diagnostic for pud
EGD,, rapid urease test,
How do we check for gi bleeding?
nuclear medicine scan: injected with contrast media then scanned for bleeding after waiting period. Scan 1-2 days after to check if interventions were effective.
Treatment for PUD
drug therapy, nutritional therapy, procedures, surgical management
drug therapy for PUD
ppi based triple therapy. PPI plus 2 abx for 10-14 days.
Bismoth subsalicylate
Bismuth subsalitcylate teaching
inhibits h-pylori from binding to mucosal lining and stimulates mucosal protection.
NO ASPIRIN.
This medication can cause stool or tongue to be discolored black, this is temp and harmless.
nursing interventions of PUD
management of bleeding, perforation and gastric outlet obstruction
Fluid and electrolyte balance.
prevent hypovolemia: LR, NS, Isotonic fluids. Ng tube placement
gastric cancer
most common type is adenocarcinoma
symptoms of gastric cancer early
chronic dyspepsia
abdominal discomfort, initally relieved with antacids
feeling of fullness
epigastric back, or retrosternal pain
symptoms of gastric cancer advanced
n/v
iron deficiency anemia
palpable epigastric mass
enlarged lymph nodes
weakness/fatigue
progressive weight loss
interventions for gastric cancer
chemo and radiation, drug therapy, and surgery.
drug therapy for gastric cancer
oxaliplatin, fluoruracil, cisplatin, epirubicin. before and after surgery.
common adverse effects of drug therapy for gastric cancer
bone marrow suppression, nausea, vomiting,
Gastrectomy
total or partial.
pre, post procedure
pre: ng tube for suctioning of secretions,
patient teaching regarding gastric cancer
complications of gastrectomy
delayed gastric emptying:
is delayed gastric emptying temporarily resulting from edema at the anastomosis site
yes, resolves within one week with ng suction, fluid/ electrolyte balance.
What is dumping syndrome?
a group of vasomotor symptoms that occur in a patient who eats after gastroectomy.
early signs of dumping syndrome
occurs within 20 minutes of eating, vertigo, tachycardia, syncope, sweating, pallor/ash gray skin, palpitations, desire to lay down.
late dumping syndrome symptoms
1-3 hours after eating, caused by a release of excessive insulin.. Follows by an increase in blood sugar. Dizziness, light-headedness, palpitations, confusion, diaphoresis
nutrition education for dumping syndrome
eliminate liquids at meal times,
decrease the amount of food at mealtime
high protein, low-moderate carb
drug therapy for dumping syndrome
acarbose, somatostain analog.
what does Acarbose do for dumping syndrome?
decrease carb absorption
What do somatostain analogs do for treatment for dumping syndrome?
decreases gastric and intestinal hormone secretion and slows stomach and intestinal transit time
can be prescribed in severe cases.
Delayed gastric emptying goes away how long after gastric surgery?
1 week
what can cause mechanical blockages?
edema at anastomosis and adhesions(obstructions) in the distal loop.
What are the metabolic causes?
hypokalemia, hypoproteinemia, or hyponatremia.
how does edema at the anastomosis resolve?
ng suctioning, maintenance of fluid and electrolyte balance, and proper nutrition.
Intrinsic factor can cause a decrease in which vitamins and minerals?
b12, folic acid, iroin, calcium and vitamin d absorption, impaired calcium metabolism.
How do deficiencies from intrinsic factor occur?
resection and inadequate absorption because of food rapidly entering the bowel.
What happens with Atrophic glossitis
occurs from a vitamin b12 deficiency, causing the tongue to have a shiny, smooth, and beefy appearance.
why do we need to monitor cbc in patients with dumping syndrome?
monitor cbcmegloblastic anemia (low rbc and leukopenia)
How do we fix low rbc and leukopenia in patients with dumping syndrome?
admin b12
Patients can develop anemia in dumping syndrome so what can be given to fix this?
folic acid, or iron.
What are symptoms of incisional infection?
fever, redness, hyperpigmentation, and drainage).
nursing intervention for gastric cancer and gastroectomy
assess ability to cope with disease and possible need for end of life care
symptom management
enlisting family resources and health care resources.
monitor for incisional site infection.
patient education for preventing dumping syndrome (caused by gastrectomy)
eat small frequent meals
avoid drinking liquids with meals
avoid foods that cause discomfort
eliminate caffeine and alcohol
smoke cessation
b12 injections
lie flat for a short amount of time after eating.
gastrectomy interventions
pre: ng placed with suction to remove secretions,
what is a mechanical obstruction
bowel physically blocked by problems outside of the intestine. (adhesions) in the bowel wall (chrons) or intestinal lumen (tumors).
What is a nonmechanical obstruction?
paralyetic illeus, or functional obstruction does not involve a physical obstruction in or outside the intestine. INSTEAD
peristalysis is decreased or absent. Resulting in slowing of the movement or a backup of intestinal contents.
what is ibs?
functional gi disorder that causes chronic or recurrent diarrhea, constipation, and or abdominal pain and bloating.
Different types if ibs?
ibs-d: diarrhea
ibs-c: constipation
or mixed
Medications are different between ibs-d and ibs-c. Do we give laxatives to patients with ibs-d?
no
symptoms of ibs
malaise, fatigue, and changes in bowel patterns, the patient will not lose weight so they will appear well
lower left quadrant of the abdomen intensity and pain.
organ hypersensitivity and nausea.
Big assessment finding in ibs?
mucus in stool
Nursing intervention for ibs
health teaching, drug therapy, stress reduction
treatment for ibs
stress management, diet, medications
ibs dx
hydrogen breath test.
lab work should still be normal(cbc, fobt, ERS alumin)
Hydrogen breath test
environment influence gut bacteria
lots of bacteria will produce a lot of hydrogen.
pre: npo 12h
give small amounts of sugar, take samples over the course of hours.
drug therapy for ibs
Ibs d: loperamide (can cause drowsiness), psyllium (rectal bleeding and vomiting.. monitor electrolyte imbalances) alosetron (use caution in females and only as a last resort)
IBS C: lubiprostone, linaclotide
Linaclotide does what?
tx for ibs-c, by stimulating guanylate cyclase receptors in intestines to increase fluid and promote bowel transit times.
also relieves pain and cramping with ibs.
patients:take once a day 30 minutes before breakfast.
who can take lubiprostone?
women with ibs-c
amitriptyline(tricyclic antidepressant) treat what in ibs?
pain after eating
Alosetron is a ss receptor antagonist can be used?
cautiously in women with ibs-d as a last resort if they do not respond to loperamide, and psyllium.
what do patients taking alosetron need to report?
agree to report sx of colitis or constipation early because this could be a life-threatening bowel complication including ischemic colitis.
nutrition for ibs
probiotics, fiber, increase water, pepprmint oil capsules can reduce sx in patients with ibs.
patient education for ibs
consume 30-40mg of fiber a day
eat regular meals
drink 8-10 glasses of water
chew food slow
relaxation techniques, meditation.
What is a herniation?
weakness in abdomial wall through which a segment of the bowel or other abdominal structure protrudes.
can hernias also penetrate through other areas of the abdominal wall?
yes,
types of hernias
indirect inguinal hernia
direct inguinal hernia
femoral hernia
umbilic hernia
incisional or ventral hernia
what is an indirect inguinal hernia?
Hernia of intestines through the opening of the inguinal cancal
What happens when males have indirect inguinal hernia?
can become large and often descend into the scrotum
What is direct inguinal hernia
pass through a weak point in the abdominal wall
Femoral hernias
protrude through the femoral ring. A plug of fat in the femoral canal enlarges and eventually pulls the peritoneum and often the urinary bladder into the sac.
umbilical hernias
congenital or acquired. Congenital appear in infancy. Acquired directly result from increased intraabdominal pressure. Most common in obeseity
Incisional hernia
occur at site of a previous surgical incision. Those hernias result from inadequate healing of the incision. (most often from postop wound infection, inadequate nutrition and obesity.
Symptoms of hernias
patients report lump or protrusion at involved site. (straining or lifting).
assessment of abdomen laying and standing. If it is reducible it may disappear when patient is laying flat.
Strangulated hernia
comes through the bowels and twists
irreducible hernia
(incarcerated) no matter the position, hernia is still there
reducible hernia
bowel contents can slip back into normal spot
A provider may have them strain or preform the valsalva maneuver to observe for
bulging.
what do absent bowel sounds indicate?
obstruction and strangulation which are medical emergencies.
What is a truss?
a pad made from firm material that is held in place over a hernia to help keep the abdominal contents from protruding into the herinal sac.
Patient education for a truss
assess skin under the truss and apply when waking up in the morning. Protect skin under truss with powder
Herrniorrphay pre-op
npo,
post op hernia repair
avoid coughing, but promote lung expansion by deep breathing, and ambulation
scrotal support and ice bags to prevent swelling. (men)
elevate scrotum with a soft pillow.
men who have gone under an inguinal hernia repair may have
issues voiding, during postop period.
need to stand for a more natural position, allowing gravity to help
urine output less than 30 should be reported.
fluids 1500-2000ml a day (maintain urinary function and prevent constipation and dehydration).
what should patients be educated on at discharge?
symptoms to report: fever, chills, wound drainage, redness/hyperpigmentation
separation of incision, increased pain in the incision.
keep the wound dry, and clean. Showers are permitted within a few days.
strangulation sx
abdominald distention n/v pain, tachycardia, fever
What happens when colorectal cancers expand?
they can perforrate a bowel
Most common areas for metasticies to spread?
liver, lung, brain and bone
What is seeding?
when we open the patient to remove a tumor. Surgeons will cut above and below the cancer site. When this happens, some cancer cells will displace from the portion of the bowel and enters the abdominal cavity.
CRC risk factors?
> 50, genetics, family history, FAP, chrones, ulcerative colitis, smoking, obeseity, inactivity, and alcohol
What is FAP
Familia adenomas polyps. It is a genetic condition where a lot of polyps will form and are almost always malignant.
Patients who have FAP will need surgical interventions when?
before the age of 20.
Signs and symptoms of CRC
change in bowel habits, rectal bleeding, anemia, fatigue, abdominal fullness, pain, unintentional weight loss.
Right sided RCR signs and symptoms
May not have symptoms until they have weight loss that triggers them going to the doctor.
Transverse CRC symptoms
dark red blood mixed in stool, feel like they are going to the bathroom more frequently and abdominal pain
Rectosigmoid CRC symptoms
Bright red blood with stool, narrowing of stool, change in shape, feel like struggling to pass stool.
Screening tools for CRC
colonoscopy, fobt, sigmoidoscopy.
What lab will be elevated in patients with cancer?
CEA
Colonoscopy pre, and post-procedure
Pre: bowel prep, mightnight npo, avoid red, orange, and purple dye, and will have moderate sedation.
Post: ensure gag reflux returns, vitals, assess bowels and abdomen, and assess for fever.
Treatment and medications for CRC
chemo and radiation. Pain management.
Intestinal obstructions (mechanical)
something outside of intestine , scar tissue(adhesions), tumor, intesicion (bowel folds in on itself), swelling, edema, hernia and volvulus.
Nonmechanical obstructions happen because there
is a decreased or absent peristalsis of the bowel.
When do non-mechanical obstructions occur?
happens with gastro surgery because the bowel does not like to be touched. There is always a risk for paraltyic ileus.
How long does a paralytic ileus last?
function may be lost for a few hours to a few days. This can happen for longer.
What can cause paralytic ileus?
Anasthesia
What is important to do post op from gastro surgery?
assess bowel sounds
What will bowel sounds sound like after gastro surgery?
hypoactive at first and they should return to normal within a few hours.
What type of obstructions are more common?
small bowel obstructions
Small bowel obstruction signs and symptoms
mid abdominal pain, cramping, peristaltic wave, distention higher up, upper gastric pain, n,v
What contents are in the emesis with patients that have small bowel obstructions?
Bile, mucus, orange or brown in color, with foul odor. They will have perfuse vomiting for prolonged times.
Partial obstruction signs and symptoms
early diarrhea at first because bowel is not completely closed so bowels will increase secretion trying to move the blockage out.
Complete bowel obstruction
no stool or gas
Large bowel obstruction symptoms
Intermediate lower abdominal cramping. Mild distention in lower abdomen, little to no vomiting and no major fluid or electrolyte imbalances.
Partial obstruction stool will look?
ribbon like
What is a major complication from small bowel obstructions?
fluid and electrolyte imbalances.
What are the symptoms of hypovolemia?
tachycardia and hypotension.
These symptoms can be mild or severe, which can lead to hypovolemic shock.
Acid-base imbalances for Bowel obstructions
These are related to fluid.
High obstruction: loss of gastric hydrochloric acid can lead to METBOLIC ALKOLOSIS
Obstruction at the end of the small intestine…
alkaline fluids are effects so we have metabolic acidosis.
How does sepsis occur with intestinal obstructions?
gut has normal flora. When we have a blockage, food will accumulate at or above the obstruction. When this happens, bacteria will feed on the content.
Abdomen swells and can perf the bowel leading to peritonitis—-sepsis.
What is venous compression?
ischemia, no blood flow, and bowel will die. Necrotic bowel and can lead to sepsis.
Types of ostomies
right sided: ascending
Transverse: emergent bowel, double barrel
Left side: descending
Rectal: sigmoid
Stoma care
Snug but not touching the stomach
thorough skin assessment
red and moist
minimal amount of blood
swelling: measure weekly for 6-8 weeks
Function of ostomy in 2-3 days
Empty 1/3-1/2
stool will be liquid then be more formed
s/s of infection
Exploratory laparotomy
pre: npo, abx in holding. Right labs, pt teach
Post: ambulate, bowel sounds,
If a patient as an open exploratory lap will they have ng tube?
yes
what is appendicitis?
inflammation of the appendix
-happens when the opening gets blocked. (hard fecal matter)
Symptoms for Appendicitis
main symptom, lower right abdominal pain that radiates towards the belly button. This pain is sudden and intense followed by n,v
It is important to ask which symptom occurred first with appendicitis why?
because there is another condition that is similar but sx appear opposite
Risk factors for appendicitis?
Assessment findings for appendicitis
-thorough pain assessment (assess abdomen and flanks)
-assess McBurney point (pain in RLA between the anterior iliac crest and the umbilicus)
-provider assess for muscle rigidity and guarding
What assessment findings would indicate appendicitis has turned into perforation or peritonitis
abdominal pain that increases with cough or movement and is relieved by bending the right hip or the knees
labs and procedures for Appendicitis
-elevation of WBC count
-Ultrasound may show enlarged appendix
-CT scan can diagnose fecaloma
Treatment for appendicits
Appendectomy
-laparoscopy : home same day
-laparotomy (open): hospital 3-5 days, restriction on activity for 4-6 weeks
Nursing care for appendicitis
-keep patient NPO upon arrival incase emergency surgery is needed
-help patient out of bed evening of surgery
-if patient has peritonitis or abscesses wound drains and NG tube monitoring
Medication for appendicitis and patient education
-opioids
-IV antibiotics for peritonitis
Nutrition education for appendicitis
none
Safety considerations for appendicitis
-appendicitis can become peritonitis
-peritonitis complications include gangrene, sepsis, and perforation
What are the contraindications with appendicitis?
No enemas or laxatives: can cause the appendix to rupture because of increased peristalsis of the bowel
no heating pads: increased blood flow can perf it
What is peritonitis?
Inflammation of the peritoneum from infection of peritoneum from punctures, traumas, and etc
What are examples of complications that can happen that can lead to periotonitis?
diverticulitis, PUD, appendicitis, bowel obstruction, or infection from continuous ambulatory peritoneal dialysis
risk factors of peritonitis?
any type of infection in the gastrointestinal system or any punctures that may occur.
Assessment findings and symptoms of peritonitis
rigid, board-like abdomen (hallmark symptom) n/v, rebound tenderness, tachy, fever
Older adult: decreased mental status, and confusion
surgical treatment for peritonitis and interventions
exploratory laparotomy: open,
Surgery may be done if super severe
Nursing actions for surgery
-monitor post-op vital signs
-monitor i/o every q1h immediately after surgery
-monitor surgical dressing for bleeding
-if they need wound irrigation, keep a sterile technique and monitor irrigation input and output to prevent fluid retention.
After surgery, patients have many jp drains because?
we have irrigated solution into the patient so they have an increased fluid volume
Labs for peritonitis
increased wbc
BNP
Potassium, sodium,
bun and creatinin: hydration status: increased
h/h: increased
3rd spacing: hypovolemia,
tachy, hypotension, fever, decreased urinary output: shock
Nonsurgical treatment for peritonitis
vital signs, hypotension, tachy’s, fever, LOC, broad spectrum abx, respiratory status.
Diagnostics
abdominal x-ray, and ultrasound
Nursing care for peritonitis
Client in fowlers or semi-fowlers to promote drainage of peritoneal fluid and improve lung expansion
monitor fluid and electrolyte imbalances.
keep client npo
maintain and monitor ng suction
collaborate with case management and wound care for management needs
Patient education for peritonitis
Maintain adequate rest and resume home activity slowly and as tolerated
no heavy lifting for 6 weeks
Monitor for evidence of return infections and notify provider immediately.
Why do we keep patients in semi-fowlers?
lung expansion
localize drainage to lower abdominal region to decreased spread of infection
decrease abdominal pressure
Medications and nutrition for peritonitis
hypertonic iv fluids and broad-spectrum antibiotics.
Complications and safety complications for peritonitis
literally dont know??? its a complication already?
what is gastroenteritis
inflammation of the stomach and small intestine
-triggered by infection (b/v)
symptoms of gastroenteritis and assessment findings
vomiting and frequent watery stools, nausea, then Abdominal pain!!!!
What question should we put in our assessment for gastroenteritis?
Travel! especially if they have been to Asia, Africa, Mexico, South America, and Central America
What local restaurants have they eaten at? 24-36 hours?
risk factors for gastroenteritis
-immunocompromised, older adult
-cruise vacation, college dormitories, prisons, nursing homes
diagnostics and treatments for gastroenteritis
-supportive treatment
-antibiotics
Nursing care for gastroenteritis
-keep buttocks and perineal area clean dry and intact
-monitor for hypokalemia and hypovolemia
patient education for gastroenteritis
-frequent wiping can irritate the skin so avoid toilet paper, use warm water and can use creams/oil
-protective barrier cream between stools
-sitz bath for ten minutes 2-3 times a day
-prevention of spreading it
-may need to wear pads and diapers for incontinence
medications and nutrition for enteritis
-high amount of oral fluid intake: Gatorade,
-loperamide
-shigellosis:: ciprofloxacin, azithromycin
do not administer antidiarrheals: we want the body to shed the organism, if motility is slowed it will stay in the body.
Complications and safety considerations for gastroenteritis
client at increased risk for fluid and electrolyte imbalances and impaired nutrition
-hypokalemia and hypovolemia
What is ulcerative colitis?
Edema and inflammation primarily in the rectum and rectosigmoid colon
-4 types
-mild, moderate, severe, fulminant
symptoms and assessment findings of ulcerative colitis
abdominal pain and cramping, often in left lower quadrant with pain. Anorexia and weight loss
-diarrhea: 15-20 liquid stool a day
-high pitched bowel sounds
rectal bleeding
risk factors of ulcerative colitis?
Genetics, Caucasians, Jewish heritage, adolescents, and young adulthood, (more in males),
diagnostics and treatment for ulcerative colitis?
sigmoidoscopy, colonoscopy, barium enema, ct scan, mri, stool examination
nursing care for ulcerative colitis
NPO and admin tpn
instruct high protein high calorie low fiber foods
Monitor by colonoscopy since they have increased risk of cancer
-assess client in identifying foods that trigger manifestations
-monitor for potassium deficiency.
Monitor i/o
Patient education for ulcerative colitis
Seek emergency care for indications of bowel obstruction or perferation (fever, abdominal pain, vomiting)
weigh 1-2 times a week
Npo and admin tpn
medications and nutrition for ulcerative colitis
small frequent meals
b12 injections
avoid alcohol and caffeine
iron supplements
high protein, and low fiber (elementals, semi-elemental products).
complications and safety considerations for ulcerative colitis
Bowel obstruction and perferation
What is chrons disease?
Disease in the small intestine anywhere in the gi tract.
symptoms of chrons disease and assessment findings
right lower quadrant pain and cramps
fever, pus and mucus in stool (x5 a day)
steatorrhea
high pitched bowel sounds
Risk factors of Chrons
Genetics, Jewish heritage, adolescents and young adults, tobacco use
Diagnostics and treatments for chrons disease
Endoscopy, Proctosigmoidoscopy, colonoscopy, sigmoidoscopy, ultra sound, x-ray, and ct scan, Barium enema
Barium enema complications and nursing actions?
Monitor post-op for manifestations of bowel perforation (rectal bleeding, firm abdomen, tachy and hypotension)
What are small intestine ulcerations and narrowing consistent with?
chrons disease
Client education for post barium enema for Chrons
Remain npo, and perform bowel preperation before procedure
Cramping and distention during enema.
Chrons nursing care
same for ulcerative colitis
Medications for Chrons
mild to moderate
-5- ASA drugs
Moderate to severe
-azathioprine, 6-mercaptopurine
-these drugs can leadL to serious infections
Others
-BRM’s (infliximab, adalimumab)
-glucocorticoids
-ciprofloxacin, metronidazole for abscesses,infection, and fistulas
Nutrition therapy for Crohns
-poor nutrition can lead to inadequate fistula and would healing, muscle mass, decreass immune response
-TPN
-Ensure or Sustacal nutritional supplements
-avoid GI stimulants (alcohol and caffeine)
Fistula management for crohns
-incision and drainage of abscesses
-3000 calories a day
-infection prevnetion
-skin care
-electrolyte therapy
-TPN
What is diverticulitis?
Inflammation and infection of bowel mucosa are caused by bacteria, food, or fecal matter trapped in more than one diverticula.
symptoms and assessment findings of Diverticulitis
acute onset of abdominal pain often in left lower quadrant, n/v
fever, chills, tachycardia, distention
risk factors for diverticulitis
Occurs the most in older adults and affects males more then females
African Americans
What types of medications are avoided in clients with diverticulitis
laxatives and enemas
Medications for diverticulitis
Antimicrobials: ciprofloxacin, metronidazole, sulfamethoxazole-trimethoprim.
nursing actions for antimicrobials
monitor kidney function and hepatic studies
Client education for antimicrobials
can cause superinfection, observe for thrush, or vaginal yeast infection
urine can darken (harmless effect)
Monitor for cns effects, numbness of extremities, ataxia, and seizures, and notify the provider immediately
Nutrition for diverticulitis
-slowly add fiber into diet
-bulk forming laxatives may be needed
-severe symptoms the patient is NPO
-NG tube if nausea, vomiting is severe
-
Complications and safety considerations for diverticulitis
-herniation
-perforation and abscess
-
Nursing actions for diverticulitis
instruct rest, and take meds as prescribed. opioid analegesics may be used for pain. Ng tube can be inserted
promote normal bowel function and consistency (AVOID laxatives and enemas)
Patient education/nutrition for diverticulitis
clear liquid diet until manifestations subside
low fiber diet
avoid seeds or nuts, popcorn, alcohol
fat should only be 30% of diet.
Complications and safety considerations of diverticulitis
What is a Paralytic illeus?
-usually postsurgical complication where bowels are not passing flatus or stool
-bowel sounds will be absent
What diet do patients with paralytic ileum follow
NPO
Why do patients with paralytic ileum have an NG tube
decompress the bowel by draining fluid and air
symptoms of paralytic Ileus
abdominal bloating and distention, gas, constipations, nausea and vomiting, dehydration
What is cholecystitis?
inflammation of the gallbladder wall.
More risk factors for cholecystitis
rapid weight loss, more common in females, estrogen therapy, oral contraceptives, genetics, older adults, type 2 dm, low-calorie liquid protein diets.
What is the main cause of cholecystitis?
gallstones obstructing the cystic and or common bile ducts causing bile ducts to back up and gallbladder to become inflamed.
signs and symptoms of Cholecystitis
Sharp pain in upper right quadrant, radiating to shoulder
pain with deep inspiration
dyspepsia, belching, flatulence fever
What happens when someone eats high-fat food if they have cholecystitis?
they will have intense pain (increased hr, diaphoresis, n/v) after ingestion caused by biliary colic
Assessment findings in someone with cholecystitis
Jaundice, icterus, clay colored stool, steatorrhea dark urine,
What symptom can be present in chronic cholecystitis and why?
Pruritis, accumulation of bile salts in the skin due to biliary obstruction
Do older clients have the same manifestations for cholecystitis?
no, delirium is the main symptom and localized tenderness. May not have a fever or pain.
What labs will be effected with cholecystitis?
wbc: Increased
Direct/indirect total blood bilirubin can be increased is there is obstruction
amalyase/lipase: increased
AST/LDH/ALP: increased, indicating bile duct is obstructed.
Diagnostic procedures for Cholecystitis
ultrasound/ct/mri, HIDA, ERC, MRC
Nursing care for cholecystitis
Administer analgesics as needed and perscribed
Medications for cholecystitis
analgesics: Opioid as perfered for acute biliary pain
NSAIDS: ketorolac, mild, moderate pain
NSAIDS: monitor for gi bleeding
Bile acid: Chenodiol, ursodiol: graduall
What does bile acid do?
Chenodiol, ursodiol: gradually dissolves cholesterol based gall stones
Nursing actions for bile acids
use caution in clients who have liver conditions or disorders with varices
Client education about bile acid
Report, abd pain, diarrhea, or vomitting.
Med is limited to 2 year of admin and requires a gallbladder ultrasound every 6 months during first year to determine effectiveness.
Therapeutic procedures for cholecystitis
Extracorporeal shock wave lithotripsy, cholecystectomy.
Nursing actions for shock wave lithotripsy for cholecystitis
assist client to lay on a fluid-filled pad for shock wave delivery.
administer analgesia
instruct client pain during the procedure.
Complications for Cholecystitis
Obstruction of the bile duct, Bile peritonitis, postcholecystectomy syndrome.
What can obstruction of the bile duct cause?
ischemia, gangrene, and a rupture of gallbladder wall.
rupture of gallbladder wall can cause a local abscess or peritonitis which requires surgical intervention and admin of broad spectrum abx
Bile peritonitis
occurs if adequate amounts of bile are not drained from surgical site. This is a rare but fatal complication
Nursing actions for Bile Peritonitis
monitor for pain, fever, jaundice
report findings immediately
What is postcholecystectomy syndrome?
Manifestation of gallbladder disease can continue after surgery. The client should report findings similar to those experienced prior to surgery related to pain and nausea.
Manifestations can recur immediately or months later
Nursing actions for postcholecystectomy syndrome?
Assess pain characteristics and other reported findings
Client education for postcholecystectomy syndrome?
Possible further diagnostic evaluation can be needed
What should a normal stoma look like
red and moist
after a colostomy has been performed, what kind of bag is placed on the client
clear pouch system
if a clear pouch system is not being used for a freshly made stoma, what should the care team do
petroleum gauze dressing covered by dry sterile dressing
for 6-8 weeks following surgery, the stoma may appear
edematous with slight bleeding
The nurse caring for a client with a stoma should perform routine assessments of the
skin
Peristomal skin complications
hyperpigmentation, irritant dermatitis, skin stripping, candidiasis
The colostomy bag should be emptied when it is
1/2 or 1/3 full
Stool from the ascending colon will be
liquid
stool from the transverse colon will be
pasty
stool from the descending colon will be
more solid
for a retracted stoma, what can we use to help the pouch fit correctly
stoma belt
The largest complication of stoma (occurs immediately following post op)
necrosis
During the first 6-8 weeks, why does the stoma need to be measured weekly
it is decreasing in size gradually
How big of an opening should be cut on the wafer paper to ensure proper fit of the colostomy bag
1/8 to 1/16 in larger
Before putting on the colostomy bag, the patient should
clean the skin with soap and water. do not moisturize!
What can the patient do to eliminate odors of the colostomy pich
charcoal filters, pouch deodorizers, breath mint
We should educate patients with colostomy/ileostomy NOT to do this relieve odor
aspirin
What types of foods should someone with a colostomy avoid
foods with casings, coconuts, celery, nuts, seeds
Which ostomy patients can use irrigation
sigmoid colostomy
what is sigmoid colostomy irrigation
when they train to empty @ a certain time. increases quality of life
What is an anastomotic leak
stool leaking into abdominal cavity instead of ostomy bag.
In ileostomies, resection of the terminal ileum can result in
vitamin b12 replacement
Can those with an ileostomy take a laxative
no
Ileostomy patients should consume how much fluid a day
10-12 glasses
What is a cholecystectomy
removal of the gallbladder with laparoscopic or open approach
Hospitalization period for laparoscopic and open cholecystectomy
Laparoscopic: within 24 hours discharge
Open: 1-2 days hospitalization
Nursing actions with laparoscopic approach
immediate postoperative care
During open cholecystectomy, the surgeon can place what?
JP drain in gallbladder bed, T-tube in common bile duct
Care of a Jackson Pratt tube inserted during cholecystectomy
-monitor and record drainage (serosanguineous stained with green-brown bile)
-antibiotics to decrease risk of infections
Care of a T-tube inserted during cholecystectomy
-instruct client to report absence of drainage
-inspect the surrounding skin of infection or bile leakage
-elevate the T-tube above abdomen
-clamp tube 1 hr before and after meals
-monitor and record amount of drainage
-assess stools for color (stools clay-colored)
-document response to food
-monitor for bile peritonitis
Client education for laparoscopic cholecystectomy
-ambulate frequently to minimize free air pain
-monitor incision for infection and dehiscence
-pain control
-indications of bile leak
-resume activity gradually as tolerated
Client education for open approach cholecystectomy
-resume activity gradually
-begin with clear liquids and advance to solid foods
-report sudden increse in drainage, foul odor, pain, fever, jaundice
-take showers until drainage tube removed
-color of stools should be brown within one week
-diarrhea is common
Dietary counseling for cholecystectomy
-adhere to a low-fat diet
-reduce dairy products and avoid fried foods, chocolates, nuts, gravies
-avoid gas-forming foods (broccoli, beans, cabbage)
-consider weight reduction
-take fat-soluble vitamins or bile salts to enhance absorption
complications of cholecystectomy
-obstructions, bile peritonitis, postcholecystectomy syndrome
Obstruction of the bile duct can cause
-ischemia, gangrene, and a rupture of the gallbladder wall
what does rupture of the gallbladder wall look like? What are the interventions?
-local abscess or peritonitis (rigid, birdlike abdomen)
-surgical intervention and antibiotics
What is bile peritonitis and the nursing actions
-bile not drained from surgical site
-pain,fever, jaundice
-report to provider
Postcholecystectomy cause and nursing interventions
-gallbladder disease continues after surgery
-assess pain characteristics and other reported findings
What is a colon resection
removal of part of the colon and regional lymph nodes. can occur with partial or total colectomy
A partial colectomy may result in
colostomy (temporary or permanent)
A total colectomy may result in
ileostomy
Preoperative care for colon resection
-patient is told colostomy is a possibility
-patient is educated on the risk for sexual dysfunction (only if it is low-rectal surgery)
-some surgeons will want bowel prep
-oral or IV antibiotics before if needed
-NGT may be placed for decompression
-IV placement for fluid and electrolytes
Postoperative care for open colon resection
-NG tube
-IV PCA 24-36h
-diet slowly progressed from liquids to solid foods
Postoperative care for laparoscopic colon resection
-solid foods very soon after
-less pain
-fewer postoperative complications
-1-2 day hospital stay
Patient teaching for appendectomy
-often limited until post procedure due to intense pain
Laparoscopic appendectomy
-has few complications
-same day discharge
-usual activities in 1-2 weeks
laparotomy appendectomy
-large abdominal incision
-would drains and NG tube placement if peritonitis or abscesses are found
Nursing interventions for laparotomy appendectomy
-administer IV antibiotics
-help patient out of bed
-may be hospitalized 3-5 days
-usual activity in 4-6 weeks
Preoperativce care for colectomy
-if stoma is planned, inform patient
-administer antibiotic bowel prep (neomycin) if prescribed
-administer cleansing enema or laxative if prescribed
if a hernia is not reducible what needs to happen?
surgery
complications of strangulated hernia
necrosis of the bowel, ischemia and obstruction, lower bowel perf.
