Nursing Care of Pt w/ GI Disorders Flashcards
Fx of the Digestive Tract
- Breakdown of food for digestion
- Absorption of nutrients produced by digestion into the bloodstream
- Elimination of undigested foodstuffs and other waste products
Digestion is
phase of the digestive process that occurs when enzymes mix with ingested food and when proteins, fats, and sugars are broken down into their component molecules.
Absorption
phase of the digestive process that occurs when small molecules, vitamins, and minerals pass through the walls of the small and large intestine and into the bloodstream.
Elimination
phase of the digestive process that occurs after digestion and absorption, when waste products are eliminated from the body
Major enzymes and secretions of the mouth
- saliva
- salivary amylase
Major enzymes and secretions of the stomach
- hydrochloric acid
- pepsin
- intrinsic factor
Major enzymes and secretions of the small intestines
- amylase
- lipase
- trypsin
- bile
Assessment of GI tract
- Include all info related to GI
- pain
- dyspepsia
- gas
- N/V
- constipation/diarrhea
- jaundice etc.
- Psychosocial, spiritual and cultural factors
- Assess knowledge
- need for education
General Assessment includes
- Mouth
- Abdomen
- Stool tests
- Blood tests
Stool tests include
- fecal occult blood tests
- stool examination for
- ova
- parasites
- bacteria
Blood tests include
- CBC
- chemistry
- AST
- ALT
- amylase
- lipase
- bilirubin
- carcinoembryonic antigen (CEA)
Sites for referred abdominal pain
Quadrants of the abdomen
Regions of the Abdomen
Correct order of abdominal assessment
- Inspection
- auscultation
- percussion
- palpation
Dx tests for abdomen
- stool specimens
- breath tests
- abdominal ultrasound
- imaging studies: CT, PET, MRI
- Upper GI tract study
- Lower GI tract study
- GI mobility studies
- Endoscopic procedures
- other
CT scan
CT scan - computed tomography
- Purpose
- to detect tissue densities and abnormalities in the abd, liver, pancrease, spleen and biliary tract
- Client Prep - with or without contrast
- NPO 4 hrs prior if contrast used
- IV access
- Follow-up care
- none specific unless sedation needed
Upper GI radiographic series
- Purpose
- detect abnormalities of the esophagus, stomach or duodenum
- Client prep
- NPO (8hrs)
- PO contrast
- no opioids or anticholinergic meds for 24hrs prior
- Follow-up Care
- drink plenty of fluids to eliminate barium
- Laxative may be given
- Stool may be chalky for 24-72 hrs after exam
Barium Enema
- Purpose
- detect changes in large intestines
- Client Prep
- clear liquids only 12-24hrs prior
- NPO 8hrs prior
- bowel cleansing night before exam
- Follow-up Care
- same as upper GI
Esophagogastroduodenoscopy (EGD)
- Purpose
- visualize the mucosal
- Client Prep
- NPO at least 8hr prior
- Follow-up care
- NPO until gag reflex returns
- check temp frequently for first 2 hrs post-surgery
- begin with clears and advance as ordered
Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Purpose
- visualize the liver, gallbladder, bile ducts and pancreas
- determine obstructions
- Client prep
- same as EGD
- Follow-up care
- Same as EGD
- also, educate on the s/s of possible pancreatitis
S/S of pancreatitis
- nausea
- abdominal pain
- elevated temp
Colonoscopy
- Purpose
- view large bowel for…obtaining bx, removing polyps, evaluate cause of chronic bowel problems, locate source of GI bleeding
- Client prep
- clear liquids 12-24 hrs prior
- NPO 6-8hrs prior
- bowel cleansing night before
- follow-up care
- VS monitoring freq, monitor for s/s of perforation and hemorrhage
- will have lots of gas afterwards (feeling of fullness and cramping)
Interventions for Malnourishment
- NG tube
- G-tube/percutaneous endoscopic gastrostomy (PEG) tube feedings
- TPN
- Central Line
- Incompatible with meds
- Prevent infections
- Glucose monitoring q6h
- Electrolyte imbalances
Appendicitis
Inflammation of the appendix
Causes of appendicitis
- obstruction of the lumen by accumulated
- feces
- foreign bodies
- tumor of the cecum or appendix
- thickening of the mucosa
S/S of appendicitis
- increased WBCs
- peri-umbilical pain (McBurney’s point) eventually shifting to RLQ
- rebound tenderness (Rovsing’s sign)
- kids do not get rebound like adults
- N/V
- anorexia
- possible low-grade fever
Assessment and Dx for appendicitis
- abd assessment
- CBC - elevated WBC
- x-ray
- ultrasound
- ct
Interventions for appendicitis
- IV fluids
- Antibiotics
- Surgical removal
Gastroenteritis
- Inflammation of the stomach and intestinal tract that causes V/D or both
- Most common causes are viruses and bacteria
- Other cause - protozoa
S/S of gastroenteritis
- N/V
- dehydration
- malaise
- abdominal cramps
- fever
Prevention and assessment of gastroenteritis
- handwashing
- principle food handling (eggs and raw meat)
- Assessment - abdomen and hydration
Labs for gastroenteritis
- CBC
- for dehydration and WBC
Treatment of gastroenteritis
- elimination of symptoms
- underlying cause
Parasitic Disorders of the GI tract
- Parasitic Disorders - Helminthes
- Round worm most common
- Others include: flatworms, tapeworms, pinworms, hookworms, and flukes
- Transmission occurs through skin or ingestion of helinthes eggs
Obesity
Weight greater than 20% or greater than ideal body weight
BMI
- Overweight - 25-29.9 Kg/m2
- Obese > 30 Kg/m2
- Class I - 30-34.9 Kg/m2
- Class II - 35-39.9 Kg/m2
- Class III - 40-49.9 Kg/m2 (morbid)
- Super Obesity > 50 Kg/m2
Interventions for Obesity
- Weight loss through exercise and calorie restriction
- support groups
- behavior modification
Comorbidities with Obesity
- Type II diabetes
- Hypertension
- stroke
- hyperlipidemia
- obstructive sleep apnea
- asthma
- breast, prostate and colon cancer
- joint damage etc
Bariatric Surgery
- limits how much the stomach can hold or decrease absorption
- Decreased Calorie/Nutrient Absorption
Complications of Gastric Restrictive Surgeries
- Vomiting
- dumping syndrome
- erosion of the gastric tissue
- breakdown of staple line
- leaking of stomach secretions
- rhabdomyolysis
- infection or death
Postoperative Care
- Airway management
- Clear Liquid Diet
- Progresses to Full Liquids, Pureed Foods
- Regular Foods at 6 Weeks
- Psychosocial support
Obesity
Nursing Diagnoses
- Imbalanced Nutrition: More Than Body Requirements
- Outcomes:
- Establish desired weight goal
- Increase activity level
- Maintain appropriate nutrition
- Identify patterns of eating/modify
Hiatal Hernia
Lower Esophagus/Stomach Slides up through Hiatus of Diaphragm into Thorax
Seen in
- women
- >60
- Obese
- Pregnant
S/S of Hiatal Hernia
- None
- Pain
- Heartburn
- Fullness
- Reflux
Dx of hiatal hernia
- X-ray
- Fluoroscopy
Therapeutic Interventions
- Antacids
- Small meals
- No reclining 1 hour after eating
- Raise head of Bed 6-12
- No bedtime snacks, spicy foods, alcohol, caffeine, smoking
Treatment of Hiatal hernia
- Surgical management
- fundoplication
- Nursng Care
- teaching
- preop care
- postop care
- dysphagia with eating
Gastroesophageal Reflux Disease (GERD)
- Gastric secretions reflux into the esophagus
- esophagus can be damaged
- lower esophageal sphincter does not close tightly
S/S of Gastroesophageal
- Heartburn
- Regurgitation
- Dysphagia
- Bleeding
Complications of GERD
- aspiration
- scar tissue
- esophagitis
- esophageal cancer
- bronchospasm
- larygeospasm
- aspiration pneumonia
Dx of GERD
- Barium Swallow
- Esophagoscopy
Interventions for GERD
- Lifestyle changes
- medications
- antacids
- H2 receptor antagonists
- proton pump inhibitors
- prokinetic agents
- Fundoplication
Nursing care/education for GERD
- Lose weight
- low-fat, high-protein diet
- avoid caffeine, milk products, spicy foods
- medications
Peptic Ulcer Disease
- Erosion of GI lining (prostoglandin needed to form mucosal lining)
- Primarily caused by Bacterium H. pylori
- Curable
- 10% of individuals in US will develop peptic ulcers
- Influenced by smoking
- Gastric and duodenal types
What is the effect of NSAIDS on the stomach lining
It decreases prostoglandin which is needed to form the mucous in the stomach lining that protects it from erosion by stomach acid.
Peptic Ulcer Disease
Gastric
- High left Epigastric/Upper Abdominal burning/Gnawing pain
- Increased 1-2 hours PC or with food
- Will have blood in their stool - Know hemoccult
- Can perforate
- Rebound tenderness
- Guardiing – DON’T TOUCH! IT HURTS
abdominal rigidity - Hyperactive or hypoactive bowel sounds
Peptic Ulcer Disease
Duodenal
- Midepigastric/Upper Abdominal Burning/ Cramping Pain
- Increased 2-4 hours after meal/ middle of the night
- relieved with foods or Antacids
S/S of peptic ulcer disease
- Anorexia
- N/V
- Bleeding
Dx of Peptic Ulcer Disease
- Helicobactor pylori
- Upper GI series - Barium
- EGD (esophagogastroduodenoscopy
- fecal cultures
Interventions for Peptic Ulcer Disease
- Antibiotics
- Proton Pump Inhibitors
- Histamine H2 Antagonists
- Bismuth Subsaicylate - slows growth of H. Pylori
- Sucralfate (Carafate)
- Antacids - raise pH
- Surgical - remove ulcerated area
Tx for Peptic Ulcer Disease
- Bland diet (if it makes them feel better)
- Avoid irritants: Smoking, Caffeine (not EBP), Alcohol, Beer
Nursing Dx for Peptic Ulcer Disease
- Acute Pain
- rate pain
- respond to pain
- smaller/frequent meals
- reduce irrritants
- Risk for Injury
- monitor for blood in vomit/stool
- changes in VS
- monitor labs - bleeding
- Deficient Knowledge
- based on need
Stress Ulcers
- Ischemia Damaging Mucous Barrier
- ischemia - inadequate blood supply to organ
- Acid Secretions Create Ulcers
Preventative Tx for Stress Ulcers
- Quick Trauma Care
- Early feeding - if GI tract is working
- Testing gastric pH - Keep above 5
- Antacids
- Histamine blockers
- Sucralfate
Causes Gastric Bleeding
- Occult or Observable
- From Ulcer perforation, tumor, gastric surgery
- Symptoms vary by severity
Gastric Bleeding Tx
- treat hypovolemic shock if present
- monitor VS
- NPO
- IV fluid
- blood
- NG tube
- oxygen
Diarrhea
- both a diagnosis and a symptom
- Fecal matter & Fluids/Electrolytes pass rapidly
- Decreased absorption
Causes of Diarrhea
- Bacterial/viral infection (acute)
- Food Allergies
- Disease processes
- Removal of gallbladder
- Crohn’s disease
- Ulcerative colitis
- Neurological
- Impaction
- Radiation
- Dumping syndrome
S/S of Diarrhea
- Fever
- Foul smell
- Abdominal cramping
- Distension
- Anorexia
- Intestinal rumbling
Interventions for Diarrhea
- Identify cause
- Replace fluids/electrolytes
- Increase fiber/bulk
- Diphenoxylate (Lomotil)
- Loperamide (Imodium)
- Lactinex restores normal flora
- Antimicrobial agents
Crohn’s Disease
- Inflammatory bowel disease
- Occurs in any part of the intestine
- Remission/Exacerbation cycles
- Cause unknown
- Hereditary component
S/S of Crohn’s Disease
- Abdominal pain or cramping
- Low grade fever
- Weight loss
- Diarrhea/Constipation
- Mucous/Blood in stool
- Fluid/Electrolyte imbalance
Complications of Crohn’s
- Malnutrition
- growth delays in puberty
- Inflammation of
- skin
- joints
- back
- eyes
- liver
- gallbladder
- Perianal Fissures
- Abscesses
- Fistulas
Dx of Crohn’s Disease
- Endoscopy w/ Biopsy
- EGD
- Colonoscopy
- Upper GI/Barium Enema
- CT/MRI/Ultrasound
- CBC
- Electrolytes
- Stool cultures
Interventions for Crohn’s Disease
- Avoid offending foods
- Surgery if necessary
- Elemental formula or TPN if necessary
- Support and Education
- Medications
- Anti-inflammatories
- Mesalamine
- Sulfasalizine
- Antidiarrheal
- Antibiotics
- Metronidazole
- Ciprofloxacin
- Immunosuppressants
- Infliximab
- Adalimumab
- Azathioprine
- Methotrexate
- Corticosteroids
- Prednisone
- Anti-inflammatories
Ulcerative Colitis
- Inflammatory bowel disease
- Large colon and Rectum
- Remissions/Exacerbations cycles
S/S of Ulcerative Colitis
- Abdominal pain
- 5-20 stools/day
- rectal bleeding
- fecal urgency
- anorexia
- weight loss
- cramping
- vomiting
- fever
- dehydration
Interventions for Ulcerative Colitis
- Avoid offending foods
- Surgery if necessary
- Elemental formula or TPN if necessary
- Medications
- Anti-inflammatories
- Antispasmodics
- Dicyclomine
- Hyoscyamine
- Antidiarrheal
- Diphenoxylate and atropine
- Loperamide
- Immunosuppressants
- Corticosteroids
Irritable bowel syndrome
- Altered intestinal motility
- Increased sensitivity to visceral sensations
- bowel mucosa not changed
- Psychological stress/ food intolerances
- more common in women
S/S of Irritable bowel syndrome
- Gas
- bloating
- constipation
- diarrhea
- abdominal pain
- depression
- anxiety
Dx for Irritable bowel syndrome
- Hx
- Physical exam
Interventions for Irritable bowel syndrome
- High fiber and bran diet
- avoid trigger foods
- smaller, frequent meals
- stress management
- behavioral therapy
- exercise
- medications
- antidepressants Antispasmodics
- tegaserod maleate/Zelnorm
Pathophysiology and Etiology of
Abdominal Hernias
- Pathophysiology - protrusion of organ or structure through weakness or tear in the wall of the abdomen
- Etiology - weakness in abdominal wall with increased Intra-abdominal pressure
Types of abdominal hernias
- Inguinal
- Umbilical
- Ventral (incisional)
S/S of abdominal hernias
- None
- Bulging
Complications of abdominal hernias
Strangulated incarcerated hernia
Interventions for abdominal hernias
- None
- observation
- supportive devices
- surgery
- herniorrhaphy
- hernioplasty
Nursing care for abdominal hernias
- Education
- Postop
- limited activity
- walking can resume next day
- moderate activity first 2-6 wks
- no coughing first 2-6 wks
- education
- report any noticeable bulges
- limited activity
