Upper & Lower GI Disorders Flashcards
Vomiting Characteristics Meaning
- bright red: active bleeding
- coffee look: old blood/lower GI bleeding
- projectile: increased ICP, no nausea
- Fecal odor: backflow of intestinal content; obstruction (lower GI)
N/V Acute Care
- persistent vomiting: hospitalization, IVs, & NPO
- start with clear liquids
- NG may be necessary
- I & O, VS, signs of dehydration
Nausea/Vomiting Non-Pharmacologic Interventions
- quiet, well ventilated, & free of noxious odors
- avoid sudden changes in position
- relaxation
- cleanse face/hands with cool cloth
- mouth care
- antiemetic (HCP prescribed)
- raise head of bed`
Gastritis
gastric mucosal inflammation
- due to gastric mucosal barrier breaking down
- black tarry stools, bloating, pain, nausea, upset stomach, indigestion
Gastritis Assessment
- health history (gastric irritant, smoking, stress, H. pylori, alcohol)
- epigastric tenderness
- GI discomfort (N/V, bloating, anorexia)
GERD
upper GI problem
-reflux of stomach acid into lower esophagus
GERD Management
- elevate head 30 degrees
- don’t lie patient down for 2-3 hrs after eating
- stress & weight reduction
- small, frequent meals
- PPIs
- risks: aspiration & ulcers
Laproscopic Nissen Fundoplication
restores the function of the LES
- postop: prevent respiratory probs, maintain fluids/electrolytes, prevent infections
- postop assess: pneumothorax (chest pain, dyspnea, cyanosis)
Peptic Ulcer Disease
GI mucosal erosion in any part of the GI tract
- assess health history & med usage
- heart burn, weight loss, epigastric tenderness, N/V, tar stools
Peptic Ulcer Disease Health Promotion
- people taking ulcerogenic drugs have increased risk; take with food
- teach patients to report symptoms r/t gastric irritation (epigastric pain)
Peptic Ulcer Disease Acute Care
- NPO, NG tube, IV fluids
- mouth care
- cleaning/lubricating nares
- analysis of gastric contents
- VS initially & hourly to detect shock
- I & O
- physical/emotional rest
- pain meds, sedation
Hemorrhage
Changes in VS & increase in the amount and redness of aspirate signals massive upper GI bleeding
-maintain the patentcy of the NG tube and prevent blood clot blockage. If the tube is blocked, distention results
Perforation
sudden, severe generalized abdominal pain and severe shoulder pain
- rigid/boardlike abdomen
- shallow, grunting respirations
Perforation Care
- check VS every 15-30 min
- stop all oral, NG feedings
- IV fluids may be increased
- provide pain meds
- antibiotic therapy
- surgical/laparoscopic closure
Gastric Outlet Obstruction Care
- Constant NG aspiration
- regularly irrigate tube & reposition the patient from side-to-side
- clamp NG intermittently
- I & O, IVs, electrolyte replacement
2 Most Common Types of IBDs
Crohn’s and Ulcerative Colitis
Crohn’s Disease
- onset: 15-35 yrs & 55-70 yrs
- symptoms: abdominal pain, diarrhea, weight loss, & fatigue
- malnutrition common
Ulcerative Colitis
- onset: 15-35 yrs & 55-70 yrs
- symptoms: stool urgency, fatigue, increased bowel movements, mucous in stool, nocturnal bowel movements, abdominal pain
- bloody stool common
IBD Care
Hemodynamic Stability
Fluid and Electrolyte Balance
Pain Control
Nutritional Support
Skin Integrity Maintenance
What do you monitor for hemodynamic stability?
- labs (CBC)
- VS
- stools for blood
- I & O
IBD teaching
- rest & diet management importance
- perianal care
- drug actions & side effects
- symptoms of recurrence
- when to seek medical care
- ways to reduce stress
Ulcerative Colitis Complications
- perforation
- peritonitis
- increased risk of colon cancer after 10 yrs
Crohn’s Disease Complications
- fistula
- fissure
- abscess
- perforation & peritonitis
- nutritional deficiencies
IBD Expected Outcomes
- decreased # of diarrhea
- freedom from pain & discomfort
- use of coping strategies
- body weight maintained
Peritonitis Assessment
- causes: abdominal surgery, ectopic pregnancy, or perforations
- high WBC & shallow respirations
Peritonitis Diagnoses
- acute pain
- fluid imbalance
- impaired gas exchange
- risk for infection
Peritonitis Care
- IV fluids & antibiotics
- monitor for pain & response to analgesics
- position patient with knees flexed
- I & O, electrolyte status, VS
- antiemetics, NPO, NG
- low flow oxygen
Intestinal Obstruction
- high: severe vomiting, projectile, feces, cramping
- low: slow onset, foul smelling vomiting, colicky, constipation, abdominal distention
Large Intestinal Obstruction
- onset: gradual
- vomiting: late/absent
- pain: persistent, cramping
- BM: obstipation
- distention: increased
Appendicitis Risk Factors
- 10 to 30 yrs old
- obstruction of lumen opening to appendix
Appendicitis Acute Findings
- dull periumbilical pain, moves to RLQ
- anorexia, nausea, vomiting
- low grade fever
- rebound tenderness
- high WBC
- sudden improvement of pain: rupture
Constipation & Fecal incontinence Assessment
- C: Crohn’s disease
- F: perineum for breakdown, IAD, pressure injury
Both: health history, bowel habits/sensation, stool scale, diet, ADLs
Percutaneous Transhepatic Cholangiography (PTC)
X-ray of liver and bile duct after dye is injected directly into liver
Hepatobiliary Scintigraphy (HIDA)
scan of liver, gallblader, & bile ducts
Hepatitis Types
- A & E: bowel
- B: body fluids
- C: circulation
- D: HBV for DNA replication
Hepatitis Assessment
- RUQ pain
- weight loss
- N/V
- low grade fever
Hepatitis A Health Promotion
- person & environmental hygiene
- hand-washing
- vaccination
Hepatitis B Health Promotion
- screen for HBV
- vaccination
- hand-washing & gloves
- condom use
Hepatitis C Health Promotion
- screening of blood, organ, & tissue donors
- infection control precautions
- modifying high-risk behaviors
- screen if born in 1945-1965
Cirrhosis
- end stage of liver disease
- extensive degeneration & destruction of liver cells
Cirrhosis Diagnoses
- chronic confusion
- fatigue
- nausea
- chronic pain
- risk for bleeding, injury, impaired oral mucous membrane, impaired skin integrity
Cirrhosis Implementation
- abstain from alcohol
- adequate nutrition
- paracentesis & balloon tamponade
- PSE
Cholelithasis
gallstones
-risks: high cholesterol, bile/cholesterol balance upset, females/pregnancy, >40 yrs, obesity
Cholecystitis Risk Factors
- inflammation
- E. coli infection
- cancer
- anesthesia
Acute Pancreatitis Symptoms
- hypotension
- low grade fever
- LUQ pain
- tachycardia
- vomiting
Chronic Pancreatitis Symptoms
- distention
- LUQ burning/cramping pain
- clay-colored stool
- jaundice
- weight loss
Pancreatitis Risk Factors
Bile reflux due to biliary tract obstructive disease
Alcohol consumption
Smoking
Hyperlipidemia (HLD)
Pancreatitis Complications
- pseudocyst: accumulation of fluid, enzymes, debris, & exudates
- abscess
Pancreatitis Implementation
- analgesics, opioids
- rest
- decrease pancreatic stimulus
- small frequent meals
- NPO or NG tube
