PEPTIC ULCER

PEPTIC ULCER A break in the mucous lining of the

gastrointestinal tract when it comes in contact with gastric juice

peptic ulcer occurs in any area of the gastrointestinal tract exposed to acid- pepsin secretions, including esophagus, stomach or duodenum.

RISK FACTORS H. pylori infection

Low socioeconomic status Crowded, unsanitary living conditions Unclean food or water

Use of NSAIDs Advance age History of ulcer

Cigarette smoking Family history of PUD Psychological stress, alcohol, caffeine consumption

PATHOPHYSIOLOGYMANIFESTATIONS

pain- gnawing, burning, aching or hungerlike located at the epigastric region sometimes radiating at the back

pain occurs when the stomach is empty 2-3 hours after meals and in the middle of the night

Relieved by eating

MANIFESTATIONS OF PUD complications

HEMORRHAGE Occult or obvious blood in the stool hematemesis Weakness, dizziness orthostatic hypotention hypovolemic shock

OBSTRUCTION sensation of epigastric fullness nausea and vomiting electrolyte imbalances metabolic alkalosis

PERFORATION severe upper abdominal pain, radiating to the

shoulder rigid boardlike abdomen absence of bowel sounds diaphoresis tachycardia fever

DIAGNOSTIC TESTS

Upper GI series – using barium as a contrast can detect 80%- 90% of peptic ulcers.

Gastroscopy- allows visualization of the esophagus, gastric and duodenal mucosa and direct inspection of ulcers. Tissue can be obtained for biopsy

MEDICATIONS eradication of H. pylori combination of two

antibiotics – bismuth or proton – pump inhibitors ( omeprazole, metronidazole and clarithromycin or bismuth subsalicylate, tetracycline and metronidazole

medications that decrease gastric acid content include proton pump inhibitors and H2 receptor antagonist

agents that protect mucosa – sucralfate, bismuth, antacids and prostaglandin analogs

TREATMENTS

dietary management Clients are encourage to maintain good

nutrition, consuming balanced meals at regular intervals.

alcohol intake smoking should be discourage as it slows the

rate of healing and increases the frequency of relapses.

Nursing diagnoses and Interventions

PAIN –typically experienced 2-4 hours after eating , a high levels of gastric acid and pepsin irritate the exposed mucosa. assess pain, including location, type, severity,

frequency, and duration and its relationship to food intake

administer proton- pump inhibitors, H2 receptor antagonists, antacids. Monitor foe effectiveness and side effects or adverse reactions.

teach relaxation, stress reduction and lifestyle management techniques.

SLEEP PATTERN DISTURBANCES- night time ulcer pain, typically occurs between 1- 3 am, may disrupt the sleep cycle and result in inadequate rest. the importance of taking the medications as prescribed

( bedtime dose) instruct the client to limit food intake after the evening

meal, eliminating bedtime snacks. (stimulate the production of gastric acid and pepsin)

encourage use of relaxation techniques

IMBALANCE NUTRITION:LESS THAN BODY REQUIREMENTS assess current diet, including pattern of food intake,

eating schedule and food that precipitate pain or being avoided.

refer to dietician for meal planning and meet nutritional needs

monitor for complaints of anorexia, fullness, nausea, and vomiting

monitor laboratory values for indications of anemia or other nutritional deficits.

DEFICIENT FLUID VOLUME- bleeding can lead to hypovolemia and volume deficit, which can lead to decrease in cardiac output and impaired tissue perfusion. monitor stool and gastric drainage ( vomitus or

nasogastric tube) Bright red with possible clots – acute hemorrhage dark red or coffee ground – blood has been in the

stomach for a period of time hematochezia- stool containing blood and clots( acute

hemorrhage melena – black tarry stool ( less acute bleeding)

maintain IVF with volume and electrolyte solutions, administer whole blood or PRBC as ordered.

insert NGT and maintain its position and patency( if ordered may irrigate with sterile normal saline until return flow is clear)

monitor hgb and hct, serum electrolyte BUN and CREA. ( digestion and absorption of blood in the GI tract may result to elevated BUN and CREA.

assess abdomen, including bowel sounds, distention, girth and tenderness.

maintain bedrest with the head of bed elevated

DIVERTICULAR DISEASE

are saclike projections of mucosa through the muscular layer of the colon.

diverticula may occur anywhere in the gastrointestinal tract

affect the large intestine with 90% - 95% occurring in the sigmoid colon.

PATHOPHYSIOLOGY

DIVERTICULOSIS presence of diverticula asymptomatic episodic pain ( usually left- sided), constipation or

diarrhea, abdominal cramping, occult bleeding in the stools, weakness and fatigue

complications include hemorrhage and diverticulitis

DIVERTICULITIS- inflammation in and around the diverticular sac.

undigested food and bacteria collect in the diverticula , forming a hard mass ( fecalith) that impairs he mucosal blood supply, allowing bacterial invasion

mucosal ischemia can lead to perforation, bacterial contamination and can lead to abscess formation or peritonitis.

pain it is usually left- sided and may be mild to severe and either steady or cramping.

constipation or increase frequency in defecation nausea, vomiting and fever may occur abdomen is distended with tenderness and s

palpable mass in the left lower quadrant resulting from inflammatory response

COMPLICATIONS peritonitis abscess formation bowel obstruction( fistula formation and

hemorrhage) severe or repeated episodes can lead to

scarring and fibrosis of the bowel wall

Diagnostic tests

WBC count – leukocytosis ( increase in the number of immature wbc) due to inflammation

hemoccult or guaiac testing barium enema\abdominal x-ray CT scan sigmoidoscopy or colonoscopy

Medications antibiotics – broad spectrum

Metronidazole Ciprofloxacin Septra – bactrim

second- generation cephalosporin analgesic- causes less increase in colonic

pressure stool softener

Dietary Management a high fiber diet is recommended- increases

stool bulk , decreases intraluminal pressure and may reduce spasm.

avoid foods with small seeds like popcorn, berries which could obstruct diverticula

bowel rest is prescribed put patient on NPO with IVF and possibly TPN

feeding is resumed initially clear liquid then soft, low roughage diet

Nursing diagnoses and Interventions

Impaired tissue integrity: gastrointestinal Monitor VS every 4 hours – Tachycardia and

tachypnea may be early indications of increase inflammation and resulting to fluid shift. Fever may indicate increase or spread of inflammation

assess abdomen every 4 hours, measure abdominal girth, auscultating bowel sounds, palpating for tenderness

assess for lower intestinal bleeding maintain IVF, TPN and accurate I and O

pain Ask the client to rate the pain using the pain

scale, document level of pain and note for any changes in location or character of pain

administer prescribed analgesics or PCA, use relaxation, positioning and distractions.

maintain bowel rest and total body rest reintroduce oral foods and fluids slowly,

providing a soft, low fiber diet with bulk forming agents

anxiety assess and document the level of anxiety demonstrate empathy and awareness of the perceived

threat to health attend to physical care needs spend as much time as possible to client encourage supportive family and friends to remain with

the client assist client to use and identify appropriate coping

mechanism

involve the client and family in care decisions

CHOLELITHIASIS/ CHOLECYSTITIS

CHOLELITHIASIS – is the formation of stones within the gallbladder or biliary tract system.

Bile is formed by the liver and stored in the gallbladder. Bile contains bile salts, bilirubin, water, electrolytes, cholesterol, fatty acids and lecithin. In the gallbladder, some of the water and electrolytes are absorbed, food entering the intestine stimulates the gallbladder to contract and release bile through the common bile duct and sphincter of oddi in the intestine. The bile salts in the bile increases the solubility and absorption of dietary fats.

PATHOPHYSIOLOGY RISK FACTORS

age family history of gallstones race obesity, hyperlipidemia rapid weight loss female gender biliary stasis diseases or conditions

CHOLECYSTITIS- is the inflammation of the gallbladder. Acute cholecystitis usually follows obstruction of the

cystic duct by a stone. The obstruction increases pressure within the gallbladder leading to ischemia of the gallbladder wall and mucosa. Ischemia can lead to necrosis and perforation of the gallbladder.

biliary colic- pain involves the entire RUQ and may radiate to the backright scapula or shoulder.

movement or deep breathing may aggravate the pain last longer 12- 18 hours anorexia, nausea and vomiting are common fever with chills

chronic cholecystitis – result from repeated bouts of acute cholecystitis or from persistent irritation of the gallbladder wall by the stones.

bacteria may be present asymptomatic complications include empyema a collection of

infected fluid in the gallbladder, gangrene and perforation with resulting peritonitis or abscess formation

Diagnostic Tests

serum bilirubin – elevated direct bilirubin may indicate obstructed bile flow in the biliary duct

CBC- elevated may indicate infection and inflammation

abdominal x-ray – gall stones with a high calcium content

serum amylase and lipase- possible pancreatitis related to common duct obstruction

UTZ of the gallbladder- accurately diagnose cholethiasis

medications

ursodiol( actigall) and chenodiol ( chenix)- reduce the cholesterol content of gall stones, leading to gradual dissolution

side effects diarrhea and hepatotoxic disadvantages long duration ( 2 years or

more) and a high incidence of recurrent stone formation when treatment is discontinued.

antibiotics

treatment

laparoscopic cholecystectomy ( removal of the gallbladder)

cholecystostomy – drain the gallbladder choledochostomy- remove stones and

position a T tube in the common bile duct

dietary management food may be eliminated during an acute attack NGT is inserted to relieve nausea and vomiting dietary fat intake may be limited

Shock wave lithotripsy

Nursing diagnoses and Interventions

pain Discuss the relationship between fat intake and the

pain- fat entering the duodenum initiates gallbladder contractions causing pain when gallstones are present in the ducts

withhold oral food and fluid during episodes of acute pain

administer analgesic or narcotic analgesia – morphine causes spasm of the colon

place in fowlers position monitor vs including temp.

imbalanced nutrition : less than body requirements assess nutritional status evaluate laboratory results refer to dietician or nutritionist

risk for infection monitor vs including temp assess abdomen every 4 hours assist to cough and deep breath or use of spirometer, splint

abdominal incision with blanket or pillow while coughing place in fowlers position and encourage ambulation administer antibiotics

PANCREATITIS

inflammation of the pancreas, that involves self- destruction of the pancreas by its own enzymes through autodigestion.

characterized by release of pancreatic enzymes into the tissue of the pancreas itself leading to hemorrhage and necrosis.

interstitial edematous pancreatitis- leads to inflammation and edema of pancreatic tissue.

necrotizing pancreatitis – inflammation , hemorrhage and ultimately necrosis of pancreatic tissue.

PATHOPHYSIOLOGY MANIFESTATIONS

ACUTE Abrupt onset of severe epigastric pain and LUQ pain, may radiate to

back nausea and vomiting, fever decrease bowel sounds, abdominal distention, rigidity tachycardia, hypotension,cold clammy skin possible jaundice

CHRONIC recurrent epigastric and LUQ pain, radiates to the back anorexia, nausea, vomiting, weight loss Flatulence, constipation steatorrhea

Diagnostic Tests

UTZ can identify gallstones, pancreatic mass, pseudocyst( abnormal collection of fluid, dead tissue, pancreatic enzymes and blood that can lead to a painful mass in the pancreas)

CT scan – identify pancreatic enlargement, fluid collections

Endoscopic retrograde cholangiopancreatography ERCP – perform to diagnose chronic pancreatitis

endoscopic UTZ percutaneous fine needle aspiration biopsy-

differentiate from cancer

medications narcotic analgesics antibiotics H2 blocker and proton – pump inhibitor –

to neutralize or decrease gastric secretions

synthetic hormone- octreotide( sandostatin) suppresses pancreatic secretion and may relieve pain

fluid and dietary management oral food and fluids are withheld during

acute episodes NGT may be inserted IVF , TPN

surgery endoscopic transduodenal

sphincterotomy- performed if the result of a gallstone lodge in the sphincter of oddi to remove the stone

nursing diagnoses and interventions pain

obstruction of pancreatic ducts and inflammation , edema and swelling of the pancreas caused by pancreatic autodigestion, severe epigastric pain, left upper abdominal or midscapular back pain. Nausea and vomiting

assess pain using the pain scale, location,radiation, duration, and character

NPO and maintain the patency of NGT- gastric secretions stimulate hormones that stimulate pancreatic secretion , aggravating pain. NGT decreases nausea, vomiting, and intestinal distention.

maintain on bed rest assist on comfortable position

Imbalanced nutrition: less than body requirements monitor laboratory values weigh daily maintain stool charting monitor bowel sounds – return of bowel sounds

indicates return of peristalsis administer prescribed IVF to maintain hydration, TPN to

provide fluids, electrolytes and kilocalories

STOMATITIS

inflammation of the oral mucosa, common disorder of the mouth.

may cause viral ( herpes simplex), fungal infections ( candida albicans), mechanical trauma ( cheek biting), irritants like tobacco or chemotherapeutic agents.

manifestations and treatment

1. cold sore, fever blister cause- herpes simplex virus initial burning at site

clustered vesicular lesions on lip or oral mucosa self- limiting acyclovir to shorten course

2. aphthous ulcer (canker sore, ulcerative stomatitis)

unknown, maybe type of herpes virus well circumscribed, shallow erosions with white

or yellow center encircled by red ring less than 1cm in diameter painful

topical steroid ointment amlexanox oral paste (aphthasol) oral prednisone

3. candidiasis (thrush) candida albicans creamy white, curdlikepatches

red, erythematous mucosa fluconazole ( diflucan)

ketonazole( nizoral) clotrimazole troches nystatin vaginal troches

4. necrotizing ulcerative gingivitis ( trench mouth, vincent’s infection)

infection with spirochetes bacilli or systemic infection

acute gingival inflammation and necrosis bleeding, halitosis fever cervical lymphadenopathy

correct any underlying disorders warm, half- strength peroxide mouthwashes oral penicillin

medications TOPICAL ORAL ANESTHETICS

oragel Viscous lidocaine anbesol triamcinolone acetonide This drug reduce the pain. They provide

temporary relief of pain.

nursing responsibilities instruct the client to seek medical attention for

any oral lesion that does not heal within 1 week monitor for oral hypersensitivity reactions, and

discontinue use Apply every 1 -2 hours as needed perform oral hygiene after meals and at

bedtime

TOPICAL ANTIFUNGAL AGENTS clotrimazole nystatin- This drugs help in topical treatment of

candidiasis. Effects are primarily local than systemic

Nursing responsibilities - instruct the client to dissolve lozenges in

the mouth- instruct the client to rinse mouth with oral

suspension for at least 2 minutes and expectorate or swallow as directed

- contraindicated in pregnancy

take medication as prescribed Do not eat or drink 30 mints after medicaiton contact physician if symptoms worsen perform good oral hygiene after meals and at bedtime

remove dentures

ANTIVIRAL AGENT acyclovir (zovirax)

Useful in treatment of oral herpes simplex virus- helps reduce severity and frequency of infection.

start therapy as soon as herpetic lesions are noted

administer with food or on an empty stomach the virus remain latent and can recur during

stressful events, fever, trauma, sunlight exposure

nursing diagnoses and interventions impaired oral mucosal membrane

assess and document oral mucous membranes and the character of any lesions every 4-8 hours

assist with thorough mouth care after meals and bedtime.

assess knowledge and teach about condition, mouth care and treatments. Instruct to avoid alcohol, tobacco and hot spicy or irritating foods.

less than body requirements assess food intake as well as clients ability to chew

and swallow. Weigh daily. Provide straws or feeding syringes.

encourage a high calorie, high protein diet. Offer soft, lukewarm or cool foods or liquids.

OBESITY

an excess of adipose tissue. Adipose tissue is created when the energy consumption exceeds energy expenditure.

0ne – third of the population in the united states is obese, higher in women

health related problems in Obesity arthritis atherosclerosis cancer heart failure diabetes, mellitus type 2 hiatal hernia hypertension low back pain muscle strains and sprains stress incontinence varicosities

risk factors genetic- one obese parent has 40% of

becoming obese physiologic - environmental sociocultural factors

complications- diagnostic tests

Body mass index- identify excess adipose tissue. BMI dividing the weight (in kilogram) by the height in meters squared(m2)

BMI= wt (kg)/ht2(m2)normal= BMI 18.5-24.9kg/m2over wt= BMI 25-29.9kg/m2obese= BMI> 30kg/m2

Morbidly obese =BMI > 40kg/m2

anthropometry- skinfold or fatfold measurements, uses calipers to measure skinfold thickness at various sites of the body

underwater weighing (hydrodensitometry) the most accurate way to determine body fat. Submerging the whole body and then measuring the amount of displaced water

bioelectrical impedance- uses a low energy electrical impulses to determine the percentage of the body fat by measuring the electrical resistance of the body.

other diagnostic test Thyroid profile serum cholesterol- HDL levels are reduced in obese

clients, LDL are very high ECG- detects effects of obesity on the heart, such as

rate, or rhythm disruptions

treatments exercise dietary management behavior modification medications

medications appetite suppressant ( sibutramine meridia) lipase inhibitor orlistat( xenical)

surgery – to reduce stomach capacity gastroplasty vartical banding gastric bypass

maintaining weight loss

behavioral changes strategies for the obese

controlling the environment purchase low- calorie foods shop from a prepared list and on a full stomach keep all foods in the kitchen avoiding eating when

watching television or reading

physiologic responses to food eat slowly by taking small bites eat a salad or hot beverages before meal chew each bite thoroughly and slowly

psychologic responses to food use attractive dinnerware , and prepare a

formal setting for eating use small plates and cups concentrate on conversations and socialization

during meal

nursing diagnoses and interventions imbalanced nutrition: more than body

requirements encourage the client to identify the factors that

contribute to excess food intake establish realistic weight loss goals and exercise/

activity. assess the clients knowledge and discuss well-

balanced diet plans. discuss behavior modification strategies like self

monitoring and environmental mngt.

activity intolerance assess current activity level and tolerance of the

activity. Assess vital signs. medically cleared plan with the client program of

regular, gradually increasing exercise. Consult with a physiologist.

ineffective therapeutic regimen mngt discuss the ability and willingness to incorporate

changes into daily patterns of diet, exercise and lifestyle help the client identify behavior modification strategies

and support system for weight loss and maintenance. establish strategies for dealing with stress eating or

interruptions in the therapeutic regimen

chronic low self- esteem encourage the client to verbalize the

experience of being over weight and validate the clients experience.

Set small goals with the client and offer positive feedback and encouragement

Refer for counselling as appropriate

MALNUTRITION

results from inadequate intake of nutrients. Lack of major nutrients ( calories, carbohydrates, proteins, and fats) or micronutrients such as vitamins and minerals. May be caused by inadequate nutrient intake, impaired absorption and use of nutrients or increased metabolic needs.

conditions associated with malnutrition acute respiratory failure Aging AIDS alcoholism burns COPD eating disorders gastrointestinal disorders neurological disorders renal disease

risk factors age poverty, homeless, inadequate food storage and

preparation facilities functional health problems that limit mobility and vision oral or gastrointestinal problems chronic pain or diseases such as pulmonary,

cardiovascular, renal or endocrine disorders medications or treatments that affects appetite acute problems like infection, surgery or trauma

Manifestations of Specific Nutrient Deficiencies

Calorie Weight loss Weakness , listlessness loss of subcutaneous fat muscle wasting

Protein Thin or sparse hair flaking skin hepatomegaly

Vitamin A night blindness altered taste and smell dry, scaling, rough skin

Thiamine confusion, apathy cardiomegaly, dyspnea muscle cramping and wasting paresthesia,neuropathy ataxia

Riboflavin cheilosis, stomatitis neuropathy, glossitis

Vitamin C swollen, bleeding gums delayed wound healing weakness, depression easy bruising

Iron smooth tongue listlessness, fatigue dyspnea

Collaborative Care The goal for the malnourished client is to

restore ideal body weight while replacing and restoring depleted nutrients and minerals.

treatment may include oral supplementation, tube feedings or TPN.

Diagnostic Tests1. Serum albumin

2. total lymphocyte count

3. serum electrolyte

SPECIALIZED PROCEDURES

1. bioelectric impedance analysis

2. total daily energy expenditure

Medication AdministrationVitamin and mineral supplements> fat- soluble vitamins

vit. Avit. Dvit. Evit. K

Fat soluble vitamins are absorbed in the gastrointestinal tract. Vitamin A and D are stored in the liver. All fat soluble vitamins may become toxic if taken in excess amounts.

nursing responsibilities monitor for manifestations of vitamin excess as

well as for adverse effects from vitamin administration.

monitor carefully for hypersensitivity reactions administer vitamin A with food teach the importance of eating a well balanced

diet

> Water Soluble Vitamins vitamin C( ascorbic acid) vitamin B complex

thiamine B1 Riboflavin B2 Niacin ( nicotinic acid0 Pyridoxin hydrochloride B6 Pantothenic acid Biotin

Used to prevent or treat deficiency problems. Mostly absorbed from the gastrointestinal tract.

nursing responsibilities monitor for responses to replacement therapy monitor for hypersensitivity reactions from

parenteral administration. do not exceed the recommended daily

allowances for specific vitamin.

Minerals sodium potassium magnesium calcium copper fluoride iodine zinc

Minerals are inorganic chemicals that are vital to a variety of physiologic functions. The dosage of prescribed minerals depends on the specific deficiency, route of administration and the clients general health.

nursing responsibilities monitor for manifestations of mineral imbalance prior administration dilute oral mineral

preparations prior to administration of iodine assess for

history of hypersensitivity to iodine or seafood avoid exceeding

nursing diagnoses and interventions imbalanced nutrition: less than body

requirements provide an environment and nursing measures that

encourage eating. Eliminate foul odors, provide oral hygiene before and after meals, make meals appetizing and offer frequent small meals.

provide a rest period before and after meals assess knowledge and provide appropriate teaching

risk for infection monitor temp and assess for manifestations of

infection every 4 hours maintain medical asepsis when providing care and

surgical asepsis when carrying out procedures. teach signs and symptoms of infections, good

handwashing technique and factors that increase the risk for infection

risk for deficient fluid volume monitor oral mucous membranes, urine specific gravity,

levels of consciousness and laboratory findings every 4-8 hours.

weight daily and monitor intake and output if allowed offer fluids frequently in small amounts

risk for impaired skin integrity assess skin every 4 hours turn and position at least every 2 hours . Encourage

passive and active range of motion exercises. keep skin dry and clean. Keep linens smooth, clean and

dry. Provide therapeutic beds, mattresses or pads.

EATING DISORDERS

Characterized by severely disturbed eating behavior and weight management

women are more commonly affected than men ANOREXIA NERVOSA – weight less than 85%

of expected for age and height, and an intense fear of gaining weight

BULIMIA NERVOSA- recurring episodes of binge followed by purge behaviors - self induced vomiting, use of laxatives or diuretics, fasting or excessive exercise

manifestations and complications of anorexia and bulimia

ANOREXIA weight < 85% of normal, muscle wasting fear of weight gain, refusal to eat disturbed body image, excessive exercise amenorrhea skin and hair changes hypotension hypothermia Constipation insomiaa

Complications electrolyte and acid base disturbances reduced cardiac muscle mass, low cardiac

output, dysrhythmias anemia hypoglycemia, elevated serum uric acid osteoporosis delayed gastric emptying abnormal liver function

BULIMIA weight often normal, may slightly overweight binge- purge behavior amenorrhea lacerations of palate, callous on fingers

Complications enlarged salivary glands stomatitis, loss of dental enamel F and E, acid base imbalances dysrhythmias esophageal tears, stomach rupture

nursing diagnoses and interventions Imbalanced nutrition: less than body

requirements chronic low self- esteem disturbed body image ineffective family therapeutic regimen

management

regularly monitor weight, monitor food intake during meals, recording

percentage of meal and snack consumed, maintain close observation for at least 1 hour following meals, do not allow client alone in bathroom

serve balance meals, including all nutrient groups. Increase serving size gradually

serve frequent , small feedings of cold or room temp. foods.

administer multivitamins and mineral supplement to replace losses.

GASTRITIS

inflammation of the stomach lining, results from irritations of the gastric mucosa.

Acute gastritis benign, self limiting disorder associated with the ingestion of gastric irritants such as aspirin, alcohol, caffeine or foods contaminated with certain bacteria. Asymptomatic to mild heartburn to severe gastric distress, vomiting, and bleeding with hematemesis.

Chronic gastritis progressive and irreversible changes in the gastric mucosa. More common in elderly, chronic alcoholics and cigarette smokers. Feeling of heaviness in the epigastic region after meals to gnawing , burning, ulcerlike epigastric pain unrelieved by antacids.

pathophysiology acute gastritis

erosive gastritis chronic gastritis

manifestations acute

Gastrointestinal systemic

Anorexia possible shock Nausea and vomiting Hematemesis Melena Abdominal pain

chronic Gastrointestinal systemic

Vague discomfort after eating anemia

Maybe asymptomatic fatigue

diagnostic tests 1. gastric analysis 2. hemoglobin and hematocrit 3. serum vitamin B124. Upper endoscopy

medications proton –pump inhibitor histamine2 receptor blocker sucralfate eradication of H. pylori infection

treatments acute

gastrointestinal rest is provided by 6 to 12 hours of NPO

slow reintroduction of clear liquids follow by ingestion of heavier liquids and finally gradual reintroduction of solid food.

nausea and vomiting threaten fluid and electrolyte balance, IVF as ordered

gastric lavage

nursing diagnoses and interventions Deficient fluid volume

monitor skin turgor, color and condition and status of the mucous membranes. Provide skin and mouth care frequently

Monitor laboratory values for electrolytes and acid base balance . Report significant changes or deviation from normal

administer oral fluids as ordered administer antiemetics and drugs that relieve

vomiting and facilitate oral feeding

imbalance nutrition: less than body requirements monitor and record food and fluid intake and any

abnormal losses. Monitor weight and laboratory studies such as serum

albumin, hemoglobin and red blood cells arrange for dietary consultation to determine caloric

and nutrient needs and develop plan provide nutritional supplements between meals or

frequent small feeding as needed. maintain tube feeding or TPN

LOWER GASTROINTESTINAL SYSTEM

assessing bowel functions

medical conditions that may influence the clients bowel elimination psychosocial history lifestyle for any pattern of psychologic stress and depression activities of daily living described the frequency and character of stool history of diarrhea, constipation or bleeding from the rectum use of laxatives, suppositories or enemas ostomy clients nutritional status

weight Appetite food preferences food intolerance special diets

nausea and vomiting in related to food intake used of antacids or over the counter

medications, herbal medications history of colon cancer, gallbladder dse. or

malabsorption syndromes

physical assessment

assessment includes inspection of the abdomen and auscultation of the bowel sounds

equipments water soluble lubricants materials for testing the stool disposable gloves

explain

inspection retention of flatus or stool may cause generalized

abdominal distention scaphoid abdomen

auscultate 4 quadrants normal bowel sound every 5-15 seconds, listen for at

least 5 minutes each quadrant high pitched, tinkling, rushing bowel sound may be

heard in client with diarrhea or experiencing onset bowel obstruction

bowel sounds may be absent in later stages of a bowel obstruction

perianal assessment with abnormal findings inspect( wearing gloves)

swollen, painful, longitudinal breaks in the anal area may appear in clients with anal fissures.

dilated anal veins appear with hemorrhoids red mass may appear with prolapsed

internal hemorrhoids doughnut – shaped red tissue at anal area may

indicate prolapsed rectum

palpate anus and rectum movable, soft masses may be polyps hard firm , irregular embedded masses may indicate

carcinoma

inspect feces positive occult blood test may indicate colon cancer, or

gastrointestinal bleeding due to PUD, diverticulosis odor- foul odors may be noted for stools containing

blood or extra fat or in cases with colon cancer

color blood on the stool result from bleeding in the sigmoid colon,

anus,or rectum black tarry stool (melena) occurs with upper GI bleeding grayish or whitish- can result from biliary tract obstruction due to

lack of bile in stool greasy, frothy, yellow stools ( steatorrhea) may appear with fat

malabsorption consistency

hard stools or long, flat stool may result from spastic colon or bowel obstruction due to tumor or hemmoroids

mucousy, slimy feces may indicate inflammation watery, diarrhea stool- appear with malabsorption problem,

ingestion of spoiled foods

ENEMA

Chronic or a fecal impaction may require administration of enema. Enema should be used in acute situations and only on short – term basis. Must be ordered to prepare the bowel for diagnostic testing or examination

Is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and complete evacuation of the lower intestinal tract.

types saline enema using 500ml to 2000ml of warmed

physiologic saline solution is the least irritating to the bowel

tap water enemas use 500ml- 1000ml of water to soften feces and irritates the bowel mucosa , stimulating peristalsis and evacuation

soap sud enemas consist of tap water solution to which soap is added as irritant

phosphate enemas ( fleet) – irritate the mucosa leading to evacuation

oil retention enemas instill mineral or vegtable oil into the bowel to soften the fecal mass

bowel stimulant not unlike laxatives that is orally administered while enemas are administered directly into the rectum, the patient expels feces along with the enema in the bedpan or toilet

enemas may be used to relieve constipation and fecal impaction

cleansing the lower bowel prior to asurgical procedure such as sigmoidoscopy or colonoscopy because of speed and convenience, enema used for this purpose are commonly the more costly

COLOSTOMY

an opening that is made in the colon with surgery. After the opening the colon is brought to the surface of the abdomen to allow stools to leave the body. The opening at the surface is called stoma. The stool leaves the colon through the stoma and drains into flat, changeable, watertight bag or pouch. The pouch is attached to the skin with an adhesive.

indication cancer diverticular disease crohn’s disease trauma or injury

a temporary colostomy may be needed to allow the colon to rest and heal for a period of time. temporary colostomy may be in place for weeks, months, or years. Will eventually be closed and bowel movements will return to normal

Types of colostomy- colostomy types are related to the place on the colon where the surgery is done.

ascending colostomy- this colostomy has a stoma ( opening ) that is located on the right side of the abdomen. The output that drains from this stoma is in liquid form.

transverse colostomy-stoma that is located at the upper abdomen towards the middle or right side. The output that drains from this stoma may be loose or soft.

descending colostomy- stoma that is located on the lower side of the abdomen. The output that drains from this stoma is firm.

Problems stoma retraction- retractions happens when the

height of the stoma goes down to the skin level or below the skin level.

prolapse- bowel becomes longer and protrudes out of the stoma and above the abdomen surface.

stenosis- narrowing or tightening of the stoma at or below the skin level. Mild stenosis can cause noise as stool and gas is passed. Severe stenosis can cause obstruction of stool.