objective 5: GI alterations Flashcards
upper GI
mouth to proximal
lower GI
distal duodenum to anus
accessory components
liver, gallbladder, pancreas
what are factors that promote optimal GI functioning?
Intact oral cavity and oesophagus
Smooth lining of small and large intestine
Adequate perfusion of mesenteric arteries (nutrients and oxygen).
Smooth muscle contraction facilitating gut motility/ peristalsis
Functioning accessory components to facilitate the release of digestive enzymes
Functioning villa to absorb the nutrients in small intestine
Excretion of residual waste to form feces
Bacteria to breakdown residual waste
Functioning colon to reabsorb water
what are the diagnostic tests?
blood tests
stool tests
abdominal ultrasound
imaging studies
CT, MRI, PET
endoscopy
is a type of X-ray that allows part of the body to be studied in motion and recorded on a video monitor to detect abnormalities in the size, shape, position or functioning of upper/lower GI.
fluroscopy
X-ray examination of
the esophagus. Approximate time: 1 hour.
barium swallow
X-ray examination of the stomach.
Approximate time: 1 to 1-1/2 hours.
upper GI series
X-ray examination of the small
intestine (small bowel). Approximate time: 2 to 4 hours.
sm bowel series
X-ray examination of the large intestine
(colon). Barium is introduced gradually into the colon by a
rectal tube. Approximate time: 1 to 1-1/2 hours
barium enema
what is the LPNs role in diagnostic testing?
Order entry into computer
Complete pretest orders
* NPO
* IV access
* Teaching (client/family)
Client optimize (vitals, BW, meds)
Documentation
* Consent/forms
Report
Head to toe assessments (monitoring return of GI and renal
function).
* IV check
* Vitals, ABC, pain
Orders (post procedure protocol)
Family update
what are nursing interventions common to GI alterations?
- Monitoring and encouraging sufficient nutritional intake respecting the diet restrictions ordered.
- Monitoring F/E balance (minimal fluid intake 1.5 L/day unless contraindication, U/O 30 ml/hr)
- Monitoring complications: bleeding, dumping syndrome, bloating, ileus, perforation, infection
- Minimizing pain and discomfort: modifying diet (different for each disorder) and evaluate response
- Monitoring for alterations in bowel patterns and stool characteristics
- Symptom management (Nausea, Vomiting, Diarrhea, Constipation)
- Preparation for and recovery from diagnostic procedures/surgeries
- Education:
- Medications, treatments, self care regimes including lifestyle changes
- Identification and avoidance of irritants (smoking, alcohol, caffeine, NSAIDs)
- Promotion of rest and reduction of stress
- Importance of keeping follow up appointments with HCP
- Most common manifestation of GI diseases
- is the feeling (subjective data)
- is the forceful evacuation of partially digested food and
secretions: know types
nausea and vomiting
what are the consequences of persistent emesis?
- tachycardia, tachypnea and diaphoresis
- severe electrolyte imbalances, loss of extracellular fluid
volume, decreased plasma volume and eventually circulatory
failure - Can cause metabolic acidosis
- Bleeding: coffee grounds or bright blood
- Risk of pulmonary aspiration aspiration pneumonia
what are the upper GI alterations?
Hiatal Hernia
Gastroesophageal
Reflux Disease
Gastritis
Peptic Ulcer Disease
Upper GI Bleeding
- Protrusion of part of the stomach through
the esophageal hiatus of the diaphragm into
the thorax - More common in women and older adults
- Contributing factors: congenital weakness,
multiple pregnancies, obesity, aging (loss of
muscle tone)
hiatal hernia
fundus is
displaced upward forming a pocket
alongside the esophagus
paraoesophageal hernia
stomach slides
up into thoracic cavity when supine and
then goes back down when upright
sliding hernia
A back flow of gastric or duodenal
content from the esophagus
* Some degree of reflux is normal
* Excessive reflux is the result of an
incompetent lower esophageal
sphincter (LES), pyloric stenosis,
motility disorders
* Incidence increases with aging
* No single cause
GERD
- Inflammation of the gastric
mucosa - Most common problems
affecting stomach - May be acute or chronic;
diffuse or local - Chronic gastritis occurs over
time and can be caused by H.
pylori bacterial infection
gastritis
- Can be gastric, duodenal or esophageal
- A hollowed out area like an erosion forms in
the mucosal wall - Acute or chronic
peptic ulcer disease
severe bleed has no time to mix
with gastric juice or be digested in the
intestine therefore is bright red:
* Hematemesis (blood in vomit)
* Hematochezia: Bright red blood per rectum (BRBPR)
acute upper GI bleed
bleeding has an
opportunity to interact with gastric juice
or be digested
* Melena (black, tarry and foul-smelling stools or
dark-colored stools)
* Coffee Ground Emesis – vomiting of blood altered
by stomach acids and enzymes.
chronic (slower) upper GI bleed
what are the lower GI alterations?
Irritable Bowel
Syndrome
Peritonitis
Inflammatory Bowel
Disease
Intestinal
Obstruction
Diverticular
Disorders
Abnormal infrequency, irregularity of
defecation, abnormal hardening, decrease in
stool volume, retention of stool for a
prolonged period with a sense of incomplete
evacuation
constipation
Increased frequency of BM (>3/day), increased
amount of stool >200 ml/d and increase liquidity of
stool
diarrhea
- Chronic functional motility disorder
primarily affecting the colon. Clients
experience intermittent and recurrent
abdominal pain, diarrhea and/or
constipation and/or both - There is no evidence of inflammation or
tissue changes in the intestinal mucosa - Intestinal motility seems to be underlying
problem
IBS
- Localized or generalized inflammatory process
of the peritoneum. - Acute and chronic forms
- Usually caused by bacteria from GI tract or
with women because of the reproductive
orders (E. Coli, Klebsiella, Proteus,
Pseudomonas, Streptococcus)
peritonitis
- Autoimmune disease, idiopathic
inflammation and ulceration - Chronic illness characterized by
exacerbations & remissions
inflammatory bowel disease
low colon and rectum
ulcerative colitis
ileum and
ascending colon, but technically can
occur anywhere along the entire GI
tract
Crohn’s disease
Partial or complete obstruction of small or large bowel
* Two processes can impede bowel content flow:
Mechanical obstruction
Functional obstruction
intestinal obstruction
pressure exertion from tumor, IBD, diverticulitis, volvulus or from abscess/strictures/
adhesions
mechanical obstruction
intestinal musculature cannot
propel bowel contents (neurological disorder,
manipulation during surgery, paralytic ileus)
functional obstruction
is a saclike herniation of the lining of
the bowel that extend through a defect in the
muscle layer
diverticulum
can occur anywhere in the small
intestine but most commonly in sigmoid colon
diverticula
Multiple diverticula with no inflammation -
diverticulosis
Inflamed of infected diverticula
diverticulitis
- Small bowel brought to skin surface and attached to replaceable fecal collection device
- May be permanent or temporary
- Loose large amount of fluid (1-2 L), no control of emptying
ileostomy
- Large bowel brought to skin surface and attached to replaceable fecal collection device
- May be permanent or temporary
- Named according to where in the bowel it is formed. May be created in the ascending,
transverse, descending or sigmoid areas of the colon - Consistency of fecal material depends on location (e.g., sigmoid-formed; ascending-
liquid)
colostomy
what does lower GI bleeds cause?
diverticular disease
IBD
tumors
colon polyps
hemorrhoids
anal fissures
proctitis
Noncancerous (benign) or cancerous tumors of the
esophagus, stomach, colon or rectum can weaken the lining of the
digestive tract and cause bleeding.
tumors
Small clumps of cells that form on the lining of your
colon can cause bleeding. Most are harmless, but some might be
cancerous or can become cancerous if not removed
colon polyps
These are swollen veins in your anus or lower rectum,
similar to varicose veins
hemorrhoids
These are small tears in the lining of the anus.
anal fissures
Inflammation of the lining of the rectum can cause rectal
bleeding.
proctitis
black, tarry and foul-
smelling stools or dark-colored
stools from cecum
melena
Bright red blood
per rectum (BRBPR
hematochezla
- Inflammation of the
appendix, a narrow blind
tube that extends from the
inferior part of the cecum
appendicitis
stones in the gallbladder
cholelithiais
inflammation of the gallbladder
cholecystitis
- shock waves to break stones (in water tank), pieces removed by endoscopy
lithotripsy
a yellowish or greenish yellow
discoloration of body tissues,
results when the concentration of
bilirubin in the blood becomes
abnormally increased.
* symptom rather than a disease
* Hyperbilirubinemia
* first observed in the sclera and
later in the skin
jaundice
a systemic viral infection that causes necrosis and
inflammation of liver cells with characteristic symptoms and cellular
and biochemical changes
viral hepatitis
toxin- and drug- induced
nonviral hepatitis
Diffuse pathological process,
characterized by scar tissue and
conversion of normal liver structure to
abnormal nodules
cirrhosis
occurs when liver cells
attempt to regenerate but in an
unorganized way
fibrosis
- An acute inflammatory process of
the pancreas - Serious disorder
acute pancreatitis
- Is a continuous, prolonged inflammatory
process of the pancreas. The pancreas
becomes progressively destroyed as it is
replaced with fibrotic tissues. Strictures and
calcifications may also occur in the pancreas
chronic pancreatitis
Cancer may occur on the lips or anywhere within the mouth
oral cancer
- malignant neoplasm of the esophagus
- two main types: squamous cell carcinoma and adenocarcinoma
esophageal cancer
- Adenocarcinoma of the stomach wall
- More prevalent in men of lower socioeconomic class, primarily in
urban areas - Usually begins with a nonspecific mucosal injury as a result of aging,
autoimmunity, or repeated exposure to irritants such as bile, anti-
inflammatory agents, or alcohol
gastric cancer
is the entry of oropharyngeal secretions or gastric contents
into the larynx and lower respiratory tract
* It often occurs from secretions in the oral pharynx or reflux of gastric
content entering the throat and going down the trachea
aspiration
- Also known as tube feeding
- Nutrition delivered through the GI tract distal to the
oral cavity via a tube, catheter or stoma - For patient’s with functioning GI tract, but unable
to take in enough orally - Wide variety of enteral formulas, with specific ones
for patients with different diseases (diabetics, liver
disease, etc.) - Infused via intermittent or continuous pump, or by
gravity or bolus by syinge
enteral nutrition
- Refers to the administration of nutrients by a route other
than the GI tract (e.g., the bloodstream) - Customized to meet individual need for each patient
- Used when GI tract cannot be used for ingestion, digestion,
or absorption of essential nutrients - Pharmacy prepares the solution based on dietician and
physician orders - Can be administered through central or peripheral veins
parenteral nutrition
