Week 3 GI Disorders Flashcards
Functions of the Digestive Tract
Breakdown of food for digestion through mastication and peristalsis
Elimination of undigested foodstuffs and other waste products
Absorption of Nutrients
Produced by digestion into the blood stream
Digestion
Occurs when enzymes mix with ingested food and when proteins, fats, and sugars are broken down into their component molecules.
Phase of digestive process that occurs when small molecules, vitamins, and minerals, pass through the walls of the small intestine and large, and into the bloodstream
Absorption
Occurs after digestion when wastes are eliminated
Elimination
Bolus of food from stomach to small intestine
Chyme
Enzymes chewing and swallowing
Saliva and salivary amylase
Mixed and termed Bolus
Gastric function
Hydrochloric Acid, pepsin, gastrin, H+ ions, HCI acid, intrinsic factor
Small Intestine
Chyme- amylase, lipase, trypsin( pancreas), bile( gallbladder/liver)
Assessment Hx for GI
All information related to GI function
Psychosocial, spiritual, and cultural factors
Assess Knowledge, need for pt education, according to certain meds
Right Shoulder Pain
Liver/ gallbladder
Left Shoulder Pain
Spleen
Splenic rupture common in high impact trauma
Blood Pooling in dependent position
Ecchymosis
Bladder Rupture=
MVA
Epigastric Pain
Acid reflux
Pancreas and MI
Left arm and left jaw pain
MI
Cholecystitis =
Positive Murphys Sign
Acute cholecystitis
Positive Murphy Sign
Palpate gallbladder area medial to midclavicular line while the Pt is lying supine. Ask Pt to inhale deeply, which expands lungs and pushes gallbladder against examiner’s fingertips
Positive if pt. ceases inhaling due to pain
If not murphy can still have cholecystitis
MELD
Models for End Stage Liver Disease
Scoring liver transplant list higher the score more severe the liver disease
Child Pugh Score
Helps predict the risk of death in liver disease and suggest how aggressive the tx should be
RUQ Pain
Gallbladder
Cholecysitis
Hepatitis
Peptic Ulcer
Renal Pain
Pneumonia
RLQ Pain
Appendicitis
Intestinal Obstruction
Diverticulitis
Ectopic Pregnancy
Ovarian Cyst
Salpingitis
Endometriosis
Ureteral Calculi
Renal Pain
LUQ Pain
Gastritis
Pancreatitis
Splenomegaly
Renal Pain
MI
Pneumonia
LLQ Pain
Diverculitis
Intestinal Obstruction
Ovarian Cyst
Salpingitis
Ureteral Calculi
Renal Pain
Process of Peristalsis
Under control of nervous system
Contractions occur every 3-12 minutes
One third to one half of food waste is excreted in stool within 24 hours
Diagnostic Tests
Stool Specimen
Breath test- Detect H. Pylori
Abdominal Ultrasonography- advantage= no radiation; used for gallbladder, appendix, kidney stones, ectopic pregnancy
DNA Testing- Colon cancer, Lactose deficiency, IBS
Imaging Studies- CT, PET, MRI, scintigraphy
Upper GI tract- EGD
Lower GI Tract- Colonoscopy- fiberoptic
GI Motility- Barium Swallow- Fluoroscopy
How is colonoscopy performed?
Pt lying on left side with legs drawn up to the chest
Endoscopic Procedures
Endoscopy
Direct visualization of body’s interior through intestinal tract
Fiberoptic scope transmits light- clear image of internal tissue is directed back up the scope to the lens and eyepiece
Shows growth, strictures, ulcers, inflammatory disease
Why we use endoscopy?
Biopsy or excision of polyps or tumors
Dilate Structured areas
Localize and stop active hemorrhaging or bleeding
Remove or crush biliary stones
Common Types of Endoscopy
EGD
ERCP
Gastroscopy
Colonoscopy
Sigmoidoscopy
What is purpose of GI intubation?
Decompress the stomach
Lavage the stomach
Diagnose GI disorders
Administer Meds
Compress the bleeding site
Aspirate gastric contents for analysis
Levin and Gastrin Salem Sump are
NG tubes
Enteroflex and Nasoenteric are
Enteric tubes
Purposes and Advantages of Enteral Feedings
Meet nutritional requirements when oral intake is inadequate or not possible and the GI tract is functioning
Advantages of Enteral Feedings
Safe and cost effective
Preserve GI integrity
Preserve the normal sequence of intestinal and hepatic metabolism
Maintain Fat metabolism and lipoprotein Synthesis
Maintain Normal Insulin and glucagon ratios
Feedings longer than 4 weeks we use ?
Gastrostomy and jejunostomy preferred
Tubes
NG or Nasoenteric tubes
Methods of Feedings
Intermittent Bolus Feedings
Intermittent Gravity Drip
Continuous Infusion
Cyclic Feeding
Nursing Care of the Patient with a NG tube or any other Tubes
Pt education and preparation
Tube Insertion
Confirming Placement
Cleaning tube obstruction
Monitoring Pt
Maintaining Tube function
Oral and Nasal Care
Monitoring, preventing, and managing complications
Tube Removal
Caring for Pt receiving Enteral Feeding
Nutritional status and assessment
Factors or illnesses that increase metabolic needs
Digestive Tract Function
Renal Functions and Electrolyte Status
Medications and other theories that affect nutrition intake and function of the GI
Compare dietary prescription with Pt needs
Nursing Dx for Enteral Feedings
Risk for
Diarrhea
ineffective airway clearance
defecient fluid
ineffective coping
Deficient Knowledge
Imbalanced Nutrition
Maintain Nutrition Balance and Tube Function
Administer feeding at prescribed rate and to pt tolerance
Measure GRV before feedings and every 4-8 hours during continuous feedings
Administer water before and after each feeding and medication
And after checking residual flush with water
Every 4-6 hours and whenever the tube feeding is discontinued or interrupted
Do Not mix meds with feedings
Use a 30 ml or larger syringe
Why? smaller syringe creates too much pressure
Maintain delivery system as required. Avoid bacterial contamination and do not hang for more than 4 hours of feeding in an open system
How to reduce risk of aspiration for tube feedings
Elevate HOB at least 30- 45 degrees
Monitor residual volumes
X Ray Confirmation on initial placement before tube feedings.
What is a TNA ?
Total Nutritional Admixture requires use of filter due to precipitates
IVFE
Intravenous Fat Emulsions do NOT use filter
Parenteral Nutrition
Method to provide nutrition to the body by IV route
Complex mixture containing proteins, carbs, fats, electrolytes, vitamins, trace minerals, and sterile water is administered in a single container
Goal is to improve nutritional status and to attain a positive nitrogen status
May be delivered peripherally or via a central line depending o solutions hypertonicity
Indication for Parenteral Nutrition
Intake insufficient to maintain anabolic state
Ability to ingest food orally or by tube is impaired
Pt is not interested or unwilling to ingest nutrients
Underlying medical condition precludes oral or tube feeding
Preoperative and postoperative nutritional needs are prolonged
Name Delivery Options for Parenteral Therapy
Peripheral Method
Central Method
Nontunneled catheter
PICC
Tunneled Central Catheter
Implanted Ports
Assessment of Pt receiving Paternal Nutrition
Assist in identifying Pt for PN
Nutrition status
Hydration Status
Electrolytes
S/S of hypoglycemia or hyperglycemia - Monitor Blood Glucose
Assess for potential complications
VS, including Temperature every 4 hours or by protocol
Pt with Parenteral Nutrition Nursing Dx
Imbalanced nutrition
Risk for Infection
Risk for excess or deficient Fluid volume
Risk for immobility
Risk of ineffective therapeutic regimen
Collaborative Problems and Potential Complications
Pnemothorax
Clotted or displaced catheter
Sepsis
Hyperglycemia
Rebound Hyperglycemia
Fluid Overload
Always start PN slowly and advance gradually
Prevention of Infection
Appropriate catheter and IV site care
Strict sterile technique for dressing changes
Wear mask when changing the dressing
Assess Insertion site
Assess for indications for infection
Proper IV tubing and tubing care
What will prevent rebound hypoglycemia?
10% dextrose solution
Maintaining Fluid Balance
Use Infusion pump. Flow rate should not be increased or decreased rapidly. If fluid out, hang 10%
Monitor fluid balance and electrolyte levels
I&O
Weights
Monitor blood glucose levels
What are variables that influence Bowel Elimination?
Developmental Considerations
Daily Patterns
Food and fluid
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic Conditions
Medications
Diagnostic Studies
Surgery and Anesthesia
Constipation
Abnormal infrequency or irregularity of defecation; any variation from normal habits may be a problem
What causes constipation?
Meds
Chronic laxative Use
Weakness
immobility
Fatigue
Diet
Inability to create intra abdominal pressure
and lack of regular exercise
Increased risk in older age
Perceived Constipation
Subjective problem in which the person’s elimination pattern is not consistent with what he or she believes is normal.
Manifestations of constipation
Fewer than 3 BMs in a week
Abdominal Distention
Decreased Appetite
Headache
Fatigue
Indigestion
Sensation of incomplete evacuation
Straining at stool
Elimination of small volume, hard, dry stools
Chronic Constipation is usually what?
Idiopathic
Further testing needed for severe, intractable constipation
Assessment and Diagnostic Findings
Thorough History and Physical examination
Barium Enema, sigmoidoscopy, and stool testing
Defecography and colonic transit studies
MRI
Defecogram
Useful for identifying rectal intussusception, rectocele, rectal prolapse, and animus.
Special test that can be very important in helping to determine the cause of a patients symptoms of fecal incontinence or difficult defecating
Defecating Proctogram
Part of intestine slides into an adjacent part of the intestine
Intussception
Often blocks fluids and food from passing through with the telescoping action.
Also cuts off blood supply to part of the intestine that is affected.
Rectocele
Type of prolapse where the supportive wall of tissue between a woman’s rectum and vaginal wall weakens
Rectal Prolapse
rectum slips out to external environment through Anus
Anismus/ Dyssynergic Defecation
Failure of normal relaxation of pelvic floor muscles during attempted defecation- pelvic floor dysfunction
Constipation Complications
HTN
Fecal Impacted
Fissures
Hemorrhoids
Megacolon
Pt Learning Needs
Normal
Establishment of normal pattern
Variations of Bowel Patterns
Dietary Fiber and Fluid intake
Responding the urge to defecate
Exerciser and Activity
Laxative Use
Soluble Fiber
Sticky when wet.
Oats
Insoluble Fiber
Does not absorb water as much.
For example, celery in a glass of water, does not change.
Laxatives that add mass, stimulate peristalsis and defecation. Must be taken with water to avoid obstruction. Most desirable for long term use
Bulk forming
Psyllium Preparations
Decrease surface tension of the fecal mass to allow water and fat to penetrate into the stool by making it softer and easier to expel. Little true laxative effect.
Surfactant Laxatives
Docusate Sodium
Laxatives that lubricate fecal mass and slow colonic absorption of water from fecal mass. Medications may interfere with the absorption of fat soluble vitamins and if aspirated may result in ?
Lubricant Laxatives
Mineral Oil and Fleets, Agoral Plain
Result in Lipid Aspiration Pneumonia
Strongest and most abused laxatives
Stimulant Cathartics
Irritate GI mucosa, pull water into the colon, and stimulate peristalsis. Produce a watery stool and may lead to fluid and electrolyte, and acid base imbalances.
Ex; Biscodyl, Castor Oil, Glycerin, Senna
Increase the osmotic pressure in the intestinal lumen, resulting in retention of water, which distends the bowel and stimulates peristalsis.
Saline Laxatives
Produce semifluid stool and may lead to fluid and electrolyte imbalances.
Ex: Magnesium Citrate, Milk of Mag, Miralax, Fleet, Phosphosoda, Fleets Enema
To relieve constipation in pregnant women, elderly patient whose abdominal and perineal muscles have become weak and atrophied, children with megacolon, pt receiving drugs that decrease intestinal motility
Laxatives and Cathartics
Laxatives and Cathartics
Prevent straining at stool in pt with CAD, HTN, Cerebrovascular disease, and hemorrhoids and other rectal conditions
Empty bowel in preparation for bowel surgery or diagnostic procedures ( colonoscopy, barium enema)
Accelerate elimination of toxic substances from GI tract
Prevent absorption of intestinal ammonia in pt with hepatic encephalopathy - Lactulose
Indications for Use Laxatives and Cathartics
Laxatives and Cathartics also used for…
Obtain a stool specimen for pathologic identification
Accelerate excretion of parasites after anthelminthic drugs have been administered
Reduce serum cholesterol levels ( psyllium products)
Adverse Effects of Laxatives and Cathartics Psyllium or any fibers may result in what
Severe Gas or bloating
Common adverse effects of bisacodyl include abdominal pain and cramping, nausea, diarrhea, and weakness
Miscellaneous Agents for Constipation
Lactulose- osmotic effect, pulling water into the colon and stimulates peristalsis. Also useful in treating encephalopathy by decreasing ammonia.
Often given sodium polystyrene sulfonate in the tx of hyperK to aid in the expulsion of the potassium resin complex
Sorbitol
Aids in treating chronic idiopathic constipation by increasing intestinal fluid secretion, stimulating intestinal motility, and defecation
Lubiprostone
Increased frequency of BMs more than 3 a day, increased amount of stool, and altered consistency of stool( looseness)
Diarrhea
Diarrhea is usually associated with
urgency, perianal discomfort, incontinence, or a combination of these factors
It may be acute or chronic
What can cause diarrhea?
Infections
Meds
tube feeding
metabolic and endocrine disorders
Various disease processes
Rumbling and gurgling sounds made with movement of fluid and gas in intestines
Borborygmus
Feeling that you need to have a BM, even after you already have one
Tenesmus
Manifestations of Diarrhea
Increased frequency and fluid of stools
Abdominal Cramps
Distention
Borborygmus
Painful Spasmodic contractions of anus
Tenesmus
Assessment and Diagnostic Findings of Diarrhea
CBC- WBC infection
Serum Chemistries
Urinalysis
Stool Examination- C. Diff
Endoscopy or barium enema
Possible complications of Diarrhea
Fluid and electrolyte imbalance
Dehydration
Cardiac Dysrhythmias
Pt Learning Needs for Diarrhea
Recognition of need of medical Tx
Rest
Diet and Fluid intake
Avoid irritating foods
Perianal skin care
Medications
May need to avoid milk, fat, whole grains, fresh fruit, and veggies
Lactose intolerance
What is used to treat moderate and severe diarrhea? What does it do?
Oral opioid diphenoxylate with atropine
Slows peristalsis by acting on the smooth muscles of the stomach
Adverse Effects of Diphenoxylate with Atropine
Tachycardia, dizziness, flushing, nausea, vomiting, dry skin, and mucous membranes, and urinary retention
Hypotension and Respiratory depression have occurred with very large doses
These salts have antibacterial and antiviral activity
Bismuth Salts
Bismuth Subsalicylate also has what?
antisecretory and possible anti-inflammatory effects
Ocetreotide Acetate
Synthetic form of somatostatin, hormone produced in the anterior pituitary gland and in the pancreas.
Decreases GI secretion and motility
What can be given for gastric ulcers and GI bleed
PPIs
Octreotide also can be used for given GI bleed
Polycarbophil and psyllium are most often used as what?
Bulk forming laxatives
Used for diarrhea to absorb toxins and water, and decreasing the fluidity of stools
Pancreatin/ Pancreplipase
Used in deficiency of pancreatic enzymes and results in malabsorption of nutrients and steatorrhea which is a loose fatty stool
This used to treat diarrhea due to bile salt accumulation in conditions such as Crohn’s disease or surgical incision of the ileum
Cholestyramine
Colestipol
Selective 5HT3 receptor antagonist indicated in treating women with chronic severe diarrhea predominant in IBS that has not responded to conventional therapy
Alosetron
Assessment of Diarrhea
Determine the duration
number of stools
Consistency, color, odor, any abnormal components
Try to determine the cause
With severe prolonged diarrhea, especially in young children and older adults.
Assess for dehydration, hypoK, and other fluid and electrolyte disorders
