Post on 08-Dec-2015
description
Ma. Victoria J. Recinto, BSN, RN, Ma. Victoria J. Recinto, BSN, RN, USRNUSRN
Philippine General Hospital Philippine General Hospital University of the Philippines-ManilaUniversity of the Philippines-Manila
OverviewOverview
Functions:Functions: digestion digestion absorption absorption eliminationelimination
OverviewOverviewAccessory organsAccessory organsI. I. Salivary GlandsSalivary Glands - for mechanical - for mechanical digestion (amylase: digestion (amylase: ptyalin)ptyalin)
Parotid (below & in front of Parotid (below & in front of ears)ears)oSaliva produced- 1,200-1,500 Saliva produced- 1,200-1,500 ml/dayml/day
SublingualSublingualSubmaxillarySubmaxillary
Salivary GlandsSalivary Glands
MUMPSMUMPSCausative agent: Causative agent: ParamyxovirusParamyxovirus
Signs & SymptomsSigns & Symptoms
swollen parotid glandswollen parotid gland
dysphagiadysphagia
feverfever
chills chills
anorexiaanorexia
MUMPSMUMPS
MUMPSMUMPS
Signs & SymptomsSigns & Symptoms
nausea & vomiting nausea & vomiting
general body general body malaisemalaise
weight lossweight loss
MUMPSMUMPS
Prevent ComplicationsPrevent Complications Male Male
orchitis (puberty stage orchitis (puberty stage sterility)sterility)
virus attacks the sperms virus attacks the sperms produced by Leydig cells produced by Leydig cells at seminiferous tubulesat seminiferous tubules
OrchitisOrchitis
MUMPSMUMPS
FemaleFemalevaginitis vaginitis
cervicitis cervicitis
oophoritisoophoritis
MUMPSMUMPS
Nursing ManagementNursing Management Strict respiratory isolationStrict respiratory isolation
Administer meds as Administer meds as orderedordered
AntipyreticAntipyretic
AnalgesicAnalgesic
AntibioticsAntibiotics
MUMPSMUMPS
Nursing Nursing ManagementManagement
Cool packCool pack
General liquid to soft General liquid to soft dietdiet
APPENDICITISAPPENDICITISInflammation of Vermiform Inflammation of Vermiform
AppendixAppendixsmall structure extending small structure extending from the cecum at the R from the cecum at the R iliac/inguinal regioniliac/inguinal region
produces WBC during fetal produces WBC during fetal life, ceases to function once life, ceases to function once baby is bornbaby is born
APPENDICITISAPPENDICITIS
APPENDICITISAPPENDICITIS
Predisposing Predisposing FactorsFactors Microbial agentsMicrobial agents Fecalith (undigested Fecalith (undigested food particles)food particles)
Intestinal obstructionIntestinal obstruction
APPENDICITISAPPENDICITISSigns & SymptomsSigns & Symptoms (+) rebound (+) rebound
tenderness & tenderness & abdominal abdominal rigidity rigidity
Pain at the Pain at the RR iliac regioniliac region
Position of Position of comfort: side-comfort: side-lying with lying with abdominal abdominal guarding & legs guarding & legs flexedflexed
APPENDICITISAPPENDICITISSigns & Signs & SymptomsSymptoms Low grade Low grade feverfever
Anorexia, Anorexia, N/V, N/V, diarrhea, diarrhea, constipationconstipation
Late SignLate Sign - - tachycardiatachycardia
APPENDICITISAPPENDICITIS
(+) (+) rebound rebound tendernetenderness at ss at McBurneMcBurney’s pointy’s point
APPENDICITISAPPENDICITIS
Diagnostic ProcedureDiagnostic Procedure CBC- mild leukocytosisCBC- mild leukocytosis U/A- U/A- acetone acetone
SurgerySurgery Appendectomy within Appendectomy within 24-48 hrs24-48 hrs
Pre-op Nursing Pre-op Nursing Interventions: Interventions:
APPENDECTOMYAPPENDECTOMYInformed consentInformed consentNPO, IVF, skin prep, NO NPO, IVF, skin prep, NO ENEMA/LAXATIVES! NO ENEMA/LAXATIVES! NO RECTAL TEMP! NO HEAT RECTAL TEMP! NO HEAT APPLICATION!APPLICATION!Position of comfort: R side-Position of comfort: R side-lying or semi-Fowler’slying or semi-Fowler’sIce packs for 20-30 mins qhIce packs for 20-30 mins qhAntipyretics & antibiotics as Antipyretics & antibiotics as orderedordered
Pre-op Nursing Pre-op Nursing Interventions: Interventions:
APPENDECTOMYAPPENDECTOMYMonitor Monitor
VS, I/O, pain level,bowel sounds VS, I/O, pain level,bowel sounds
N: 5-30X/min or q 5-15 sec, N: 5-30X/min or q 5-15 sec, Listen to each quadrants for 5 Listen to each quadrants for 5 mins mins
Borborygmi- > 60 sounds/min- Borborygmi- > 60 sounds/min- hyperactive bowel hyperactive bowel
WOF ruptured appendix & WOF ruptured appendix & peritonitisperitonitis
PERITONITISPERITONITISPeritoneumPeritoneum
Lines the abdominal cavityLines the abdominal cavityForms the mesentery that supports Forms the mesentery that supports
the intestines & blood supplythe intestines & blood supplySigns & Symptoms of PeritonitisSigns & Symptoms of Peritonitis
HR, HR, RR, RR, T & chillsT & chillsPallor, restlessnessPallor, restlessnessProgressive abdominal distention Progressive abdominal distention
& pain& painR guarding of the abdomenR guarding of the abdomen
PERITONITISPERITONITIS
Post-op Nursing Post-op Nursing Interventions: Interventions:
APPENDECTOMYAPPENDECTOMYNPO until bowel function NPO until bowel function returnedreturnedIf appendix has If appendix has ruptured, expect: ruptured, expect:
Penrose drain (with Penrose drain (with profuse output for the profuse output for the 11stst 12 hrs) 12 hrs) Or opened incision to Or opened incision to heal from the inside outheal from the inside out
Post-op Nursing Post-op Nursing Interventions: Interventions:
APPENDECTOMYAPPENDECTOMYPosition: R side-lying or low Position: R side-lying or low Semi-Fowler’s with legs Semi-Fowler’s with legs flexed (to facilitate drainage)flexed (to facilitate drainage)Wound irrigation & dressingWound irrigation & dressingAntipyretics & antibiotics as Antipyretics & antibiotics as orderedorderedMonitor T, incision site for Monitor T, incision site for infection, Penrose drain infection, Penrose drain outputoutput
LIVERLIVER
LIVERLIVER
Largest gland, occupies Largest gland, occupies most of the most of the RR hypochondriac regionhypochondriac region
Weighs 3-4 lb (adult)Weighs 3-4 lb (adult)Covered by fibrous capsule Covered by fibrous capsule (capsule of (capsule of GlissonGlisson)- )- makes the liver scarlet makes the liver scarlet brown, transparent in brown, transparent in naturebnatureb
LIVERLIVERWith R & L lobesWith R & L lobes
Functional unit:Functional unit: liver lobules liver lobulesWith canaliculi (receptacles of With canaliculi (receptacles of bile) produced by the bile) produced by the hepatocyteshepatocytes
Composed of sinusoids Composed of sinusoids (“Processing Plant”)(“Processing Plant”)Lined with Mononuclear Lined with Mononuclear Phagocyte Sytem (Kuppfer Phagocyte Sytem (Kuppfer Cells) which remove pathogens Cells) which remove pathogens in the portal venous bloodin the portal venous blood
LIVERLIVERBlood Supply Blood Supply
Even if the liver Even if the liver receives 30% of receives 30% of CO/min., the portal CO/min., the portal system remains low-system remains low-pressuredpressured
LIVERLIVERBlood Supply Blood Supply
From Hepatic artery & From Hepatic artery & Portal veinPortal vein Sinusoids Sinusoids (capillaries of the liver, (capillaries of the liver, carries admixture of venous carries admixture of venous & arterial blood & arterial blood Provide both O2 & nutrients Provide both O2 & nutrients Drains to Hepatic vein Drains to Hepatic vein IVC IVC
LIVERLIVER
Blood Blood Supply Supply
LIVERLIVER FunctionsFunctions Produce BILE- to Produce BILE- to emulsify fats; gives emulsify fats; gives color to urine color to urine (urobilinogen) & stool (urobilinogen) & stool (stercobilinogen to (stercobilinogen to stercobilin)stercobilin)
LIVERLIVERBILEBILE
Liver secretes 500- 1,000 Liver secretes 500- 1,000 ml of bile/dayml of bile/day
Composed of bilirubin, Composed of bilirubin, plasma electrolytes, plasma electrolytes, water, bile salts, water, bile salts, bicarbonate, cholesterol, bicarbonate, cholesterol, FA & lecithinFA & lecithin
FATE OF HEMOGLOBINFATE OF HEMOGLOBINHemoglobinHemoglobin
HemeHeme GlobinGlobin
UnconjugatedUnconjugated Iron (Ferritin)Iron (Ferritin)Amino acidAmino acid
Indirect BilirubinIndirect Bilirubin (stored in liver)(stored in liver) poolpool
(Fat-soluble)(Fat-soluble)
FATE OF HEMOGLOBINFATE OF HEMOGLOBINUnconjugated/Indirect Bilirubin (Fat-Unconjugated/Indirect Bilirubin (Fat-
soluble)soluble)
Attached to albuminAttached to albuminLiver (with enzyme glucoronyl Liver (with enzyme glucoronyl
transferase)transferase)
Conjugated/Direct Bilirubin (Water-Conjugated/Direct Bilirubin (Water-soluble)soluble)
Excreted in BileExcreted in Bile
Small Intestine Small Intestine KidneysKidneysstercobilinogen to stercobilinstercobilinogen to stercobilin
urobilinogenurobilinogen
LIVERLIVERHepatic DuctsHepatic DuctsDeliver bile to the gall Deliver bile to the gall bladder via cystic ductbladder via cystic duct
Deliver bile to the duodenum Deliver bile to the duodenum via common bile ductvia common bile duct
Common bile duct: with Common bile duct: with pancreatic duct at the pancreatic duct at the ampulla of Vaterampulla of Vater
Sphincter prevents reflux of Sphincter prevents reflux of intestinal contents into the intestinal contents into the common bile duct & common bile duct & pancreatic ductpancreatic duct
LIVERLIVER
FunctionsFunctionsVitamin ADEK synthesisVitamin ADEK synthesisStores & filters blood Stores & filters blood (200-400 ml)(200-400 ml)
Stores Vitamins A, D, B & Stores Vitamins A, D, B & iron iron
Detoxifies drugsDetoxifies drugsDestroys excess estrogenDestroys excess estrogen
LIVERLIVER
FunctionsFunctionsMetabolize Metabolize macronutrients:macronutrients: CHOCHO
glycogenesis glycogenesis glycogenolysis glycogenolysis gluconeogenesisgluconeogenesis
LIVERLIVER
FunctionsFunctions CHON CHON
synthesis of albumin & synthesis of albumin & globulinglobulin
Synthesis of Synthesis of prothrombin & prothrombin & fibrinogenfibrinogen
Conversion of NH4 to Conversion of NH4 to ureaurea
LIVERLIVER
FunctionsFunctionsFATSFATS
synthesis of synthesis of cholesterol to cholesterol to neutral fats or neutral fats or triglyceridestriglycerides
LIVER DISORDER: LIVER DISORDER: CIRRHOSISCIRRHOSIS
Chronic, progressive disease characterized by diffuse damage to cells with fibrosis & nodular regenerationRepeated destruction of hepatic cells causes formation of scar tissue
Types of CirrhosisTypes of Cirrhosis
Postnecrotic CirrhosisPostnecrotic CirrhosisAfter massive liver necrosisAfter massive liver necrosisCx of acute viral hepatitis or Cx of acute viral hepatitis or exposure to hepatotoxinsexposure to hepatotoxins
Scar tissue destroys liver Scar tissue destroys liver lobules & entire lobeslobules & entire lobes
Types of CirrhosisTypes of Cirrhosis
Biliary CirrhosisBiliary CirrhosisFrom chronic biliary From chronic biliary obstruction, bile stasis, obstruction, bile stasis, inflammation resulting inflammation resulting in severe obstructive in severe obstructive jaundicejaundice
Types of CirrhosisTypes of Cirrhosis
Cardiac CirrhosisCardiac CirrhosisAssociated with severe Associated with severe RSHF, resulting RSHF, resulting enlarged, edematous enlarged, edematous congested livercongested liver
Anoxic liverAnoxic liver cell cell necrosis & fibrosisnecrosis & fibrosis
Types of CirrhosisTypes of Cirrhosis
Laennec’s CirrhosisLaennec’s CirrhosisAlcohol-induced, Alcohol-induced, nutritional, portalnutritional, portal
Cellular necrosisCellular necrosis scar scar tissue with fibrotic tissue with fibrotic infiltrationinfiltration
LAENEC’S CIRRHOSISLAENEC’S CIRRHOSIS
LIVER DISORDERSLIVER DISORDERS
Predisposing FactorsPredisposing Factors Chronic alcoholismChronic alcoholism Malnutrition- Malnutrition- primary reason for primary reason for Laennec’s cirrhosisLaennec’s cirrhosis VirusesViruses
LIVER DISORDERSLIVER DISORDERS
Predisposing FactorsPredisposing Factors Toxicity- CCl4Toxicity- CCl4 Hepatotoxic agents Hepatotoxic agents (Acetaminophen, (Acetaminophen, Chlorpromazine, Chlorpromazine, INH, Halothane)INH, Halothane)
LIVER DISORDERSLIVER DISORDERSEarly Signs & SymptomsEarly Signs & Symptoms
Weakness & fatigueWeakness & fatigueAnorexia, early am N/V, Anorexia, early am N/V, hematemesis, wt. losshematemesis, wt. loss
Indigestion, Flatulence, Indigestion, Flatulence, SteatorrheaSteatorrhea
Abdominal pain/tendernessAbdominal pain/tendernessJaundice/Icteric scleraeJaundice/Icteric sclerae
LIVER DISORDERSLIVER DISORDERSEarly Signs & SymptomsEarly Signs & Symptoms
PruritusPruritusPalmar erythemaPalmar erythemaHepatomegalyHepatomegaly bowel soundsbowel soundsLoss of axillary & pubic Loss of axillary & pubic hairhair
LIVER DISORDERSLIVER DISORDERSLate Signs & SymptomsLate Signs & Symptoms
Hema changesHema changesPancytopenia, petechiae, Pancytopenia, petechiae, ecchymosisecchymosis
Spider Spider angiomas/telangiectasiangiomas/telangiectasi
Caput medussae (abdomen)Caput medussae (abdomen)Endocrine changesEndocrine changes
GynecomastiaGynecomastia
Spider angioma & Caput Spider angioma & Caput medussaemedussae
LIVER DISORDERSLIVER DISORDERSLate Signs & Late Signs & SymptomsSymptomsGIT changesGIT changes
Ascites, peripheral Ascites, peripheral edemaedema
Bleeding esophageal Bleeding esophageal varicesvarices
LIVER DISORDERSLIVER DISORDERS
Late Signs Late Signs & & SymptomsSymptoms
CNS CNS changes: changes: AsterixisAsterixis
LIVER DISORDERSLIVER DISORDERSLate Signs & SymptomsLate Signs & Symptoms
Hepatic encephalopathyHepatic encephalopathy
Asterixis (liver flap)-coarse, Asterixis (liver flap)-coarse, flapping hand tremorsflapping hand tremors
LOCLOC
headache, confusion, headache, confusion, deliriumdelirium
Fetor hepaticus (fruity, Fetor hepaticus (fruity, musty breath odor of musty breath odor of chronic liver disease)chronic liver disease)
LIVER DISORDERSLIVER DISORDERS
Diagnostic ProcedureDiagnostic ProcedureLiver EnzymesLiver Enzymes
SGPT/ALT(specific SGPT/ALT(specific for liver disease) & for liver disease) & SGOT (AST)SGOT (AST)
Serum indirect Serum indirect bilirubinbilirubin
LIVER DISORDERSLIVER DISORDERS
Diagnostic ProcedureDiagnostic Procedure Serum cholesterol & Serum cholesterol & NH4NH4
CBC- pancytopeniaCBC- pancytopenia Prolonged PTProlonged PT Hepatic UTZ- fat Hepatic UTZ- fat necrosis of liver lobulesnecrosis of liver lobules
LIVER DISORDERSLIVER DISORDERS Nursing ManagementNursing Management CBR, High Fowler’s CBR, High Fowler’s positionposition
Enteral feeding or TPN as Enteral feeding or TPN as orderedordered
Diet: Diet: Ca+2, Vit (B complex, Ca+2, Vit (B complex, A, C, K, folic acid & A, C, K, folic acid & thiamine) & min, thiamine) & min, to to moderate CHON & fatsmoderate CHON & fats
Meticulous skin careMeticulous skin care
LIVER DISORDERSLIVER DISORDERS
Nursing Nursing ManagementManagement Monitor neuroVS, I/O, Monitor neuroVS, I/O, e+ balancee+ balance
Weight & abdominal Weight & abdominal girth ODgirth OD
Reverse isolationReverse isolation Restrict fluids & NaRestrict fluids & Na
LIVER DISORDERSLIVER DISORDERSNursing ManagementNursing ManagementPrevent ComplicationsPrevent Complications
ASCITES- fluid in peritoneal ASCITES- fluid in peritoneal cavitycavityAdminister meds as Administer meds as orderedorderedLoop DiureticLoop DiureticK+ supplementsK+ supplements
LIVER DISORDERSLIVER DISORDERS
Nursing ManagementNursing ManagementPrevent ComplicationsPrevent Complications
ASCITESASCITES Na+ dietNa+ dietAssist in abdominal Assist in abdominal paracentesisparacentesis
LIVER DISORDERSLIVER DISORDERSParacentesis: transabdominal Paracentesis: transabdominal removal of fluid from the removal of fluid from the peritoneal cavity for analysisperitoneal cavity for analysisPre-opPre-op
Informed consentInformed consentEmpty the bladder (to prevent Empty the bladder (to prevent puncture)puncture)Baseline wt, abdominal girth, VSBaseline wt, abdominal girth, VSPosition: Upright (High Fowler’s) Position: Upright (High Fowler’s) on the edge of the bed with back on the edge of the bed with back support & feet resting on a stoolsupport & feet resting on a stool
LIVER DISORDERSLIVER DISORDERSParacentesisParacentesisPost opPost op
Dry, sterile pressure dressing at Dry, sterile pressure dressing at insertion site, WOF bleedinginsertion site, WOF bleedingMeasure fluid collected, describe Measure fluid collected, describe & record, label & send to lab for & record, label & send to lab for analysisanalysisMonitor VS, abdominal girth & wtMonitor VS, abdominal girth & wtWOF hypovolemia, e+ loss, WOF hypovolemia, e+ loss, encephalopathy, hematuria encephalopathy, hematuria (bladder trauma)(bladder trauma)
LIVER DISORDERSLIVER DISORDERSNursing ManagementNursing Management
Prevent ComplicationsPrevent ComplicationsBleeding esophageal varicesBleeding esophageal varices
Administer meds as orderedAdminister meds as orderedVitamin KVitamin KVasopressin (Pitressin)Vasopressin (Pitressin)BTBT
LIVER DISORDERSLIVER DISORDERSNursing ManagementNursing Management
Bleeding esophageal Bleeding esophageal varicesvaricesNGT decompression NGT decompression via gastric lavagevia gastric lavageMonitor for NGT Monitor for NGT outputoutput
LIVER DISORDERSLIVER DISORDERSNursing ManagementNursing Management
Bleeding esophageal varicesBleeding esophageal varicesAssist in mechanical Assist in mechanical decompression (gastric decompression (gastric intubation)intubation)Sengstaken Blakemore tube Sengstaken Blakemore tube (Esphagogastric balloon (Esphagogastric balloon tamponade)tamponade)
WOF hemorrhageWOF hemorrhagePrepared at bedside: scissorsPrepared at bedside: scissors
Sengstaken Blakemore tubeSengstaken Blakemore tube
LIVER DISORDERSLIVER DISORDERSNursing ManagementNursing Management
Prevent ComplicationsPrevent ComplicationsHepatic Encephalopathy: end-Hepatic Encephalopathy: end-stage hepatic failure stage hepatic failure characterized with altered characterized with altered LOC, neuro Sxs & LOC, neuro Sxs & neuromuscular disturbancesneuromuscular disturbancesAssist in mechanical Assist in mechanical ventilationventilation
Monitor VS, neuro VSMonitor VS, neuro VS
LIVER DISORDERSLIVER DISORDERSNursing ManagementNursing Management
Hepatic EncephalopathyHepatic EncephalopathySide rails upSide rails upAdminister meds as orderedAdminister meds as ordered
Neomycin (Mycifradin): Neomycin (Mycifradin): NH4 NH4 production by N bacterial flora production by N bacterial flora of the bowelof the bowel
Lactulose (Chronulac): Lactulose (Chronulac): promotes excretion of NH4promotes excretion of NH4
No sedatives, narcotics, No sedatives, narcotics, barbiturates & hepatotoxic barbiturates & hepatotoxic meds/substancesmeds/substances
LIVER DISORDERSLIVER DISORDERSNursing ManagementNursing Management
Prevent ComplicationsPrevent ComplicationsHepatorenal syndrome: Hepatorenal syndrome: progressive renal failure progressive renal failure associated with hepatic associated with hepatic failurefailure
Sudden Sudden in U.O., in U.O., serum serum BUN & Crea, BUN & Crea, urine Na urine Na excretion, excretion, urine osmolality urine osmolality
PANCREASPANCREAS Located behind stomachLocated behind stomachAs exocrine gland (80%)As exocrine gland (80%)
Secretes NaHCO3: neutralizes Secretes NaHCO3: neutralizes stomach’s contents entering stomach’s contents entering the duodenumthe duodenum
Secretes pancreatic juices: Secretes pancreatic juices: with enzymes for digesting with enzymes for digesting macronutrientsmacronutrients
PANCREASPANCREASAs endocrine gland (20%)As endocrine gland (20%)
Islets of Langerhans- Islets of Langerhans- secretes insulin (hypogly) secretes insulin (hypogly) & glucagon (hypergly)& glucagon (hypergly)
Secretes Somatostatin: Secretes Somatostatin: with hypogly effectwith hypogly effect
PANCREASPANCREAS
PANCREATITISPANCREATITISAcute or Chronic Acute or Chronic inflammation of pancreas inflammation of pancreas leading to pancreatic edema, leading to pancreatic edema, suppuration, necrosis & suppuration, necrosis & hemorrhage due to hemorrhage due to autodigestion autodigestion
Cause: activation of Cause: activation of proteolytic pancreatic proteolytic pancreatic enzymes (Trypsin, Elastase, enzymes (Trypsin, Elastase, Lipases)Lipases)
PANCREATITISPANCREATITIS
PANCREATITISPANCREATITIS Predisposing FactorsPredisposing Factors
AlcoholismAlcoholismHepatobiliary disorder Hepatobiliary disorder (Cholelithiasis)(Cholelithiasis)
Drugs toxic to pancreas: Drugs toxic to pancreas: steroids, OCP, thiazide steroids, OCP, thiazide diuretics, Rentam (for diuretics, Rentam (for AIDS), ASAAIDS), ASA
Peptic ulcer diseasePeptic ulcer disease
PANCREATITISPANCREATITIS Predisposing FactorsPredisposing Factors
Metabolic disordersMetabolic disorders hyperparathyroidism hyperparathyroidism (hyperCa)(hyperCa)
hyperlipidemia hyperlipidemia (obesity)(obesity)
Ischemic vascular Ischemic vascular diseasedisease
PANCREATITISPANCREATITIS Predisposing Predisposing FactorsFactors Na+ intakeNa+ intakeTraumaTraumaSurgerySurgeryPancreatic TumorPancreatic TumorViral/Bacterial Viral/Bacterial InfectionInfection
ACUTE PANCREATITISACUTE PANCREATITIS Signs & SymptomsSigns & Symptoms
Pain at midepigastric or Pain at midepigastric or LUQ radiating to the back, LUQ radiating to the back, flank & substernal area flank & substernal area with DOB, aggravated by with DOB, aggravated by eating a large fatty meal or eating a large fatty meal or an episode of heavy an episode of heavy alcohol intake or lying in alcohol intake or lying in recumbent positionrecumbent positionLasts for hours & daysLasts for hours & days
ACUTE PANCREATITISACUTE PANCREATITIS Signs & SymptomsSigns & Symptoms
HR & T, HR & T, BP to BP to ShockShock
Shallow respirationShallow respiration Anorexia, N/V, wt. lossAnorexia, N/V, wt. loss bowel sounds bowel sounds (paralytic ileus)(paralytic ileus)
Indigestion/dyspepsiaIndigestion/dyspepsia
ACUTE PANCREATITISACUTE PANCREATITIS Signs & SymptomsSigns & Symptoms
(+) Cullen’s sign- (+) Cullen’s sign- ecchymosis at umbilicusecchymosis at umbilicus
(+) Grey Turner’s sign- (+) Grey Turner’s sign- ecchymosis at flank ecchymosis at flank areaarea
hypocalcemia (due to hypocalcemia (due to extensive lipolysis)extensive lipolysis)
Cullen’s Sign & Grey Turner’s Cullen’s Sign & Grey Turner’s Sign Sign
ACUTE PANCREATITISACUTE PANCREATITIS
Diagnostic ProcedureDiagnostic Procedure WBC, WBC, Hct, Hct, bilirubin, bilirubin,
alkaline phosphatase, alkaline phosphatase, urinary amylase, urinary amylase, CBG CBG
serum Ca+2, Mg+2serum Ca+2, Mg+2Abdominal UTZ & CT scan- Abdominal UTZ & CT scan-
enlarged pancreasenlarged pancreasChest X-ray- pleural effusionChest X-ray- pleural effusion
ACUTE PANCREATITISACUTE PANCREATITIS
Diagnostic Diagnostic ProcedureProcedure serum amylase (serum amylase ( 200 Somogyi units) & 200 Somogyi units) & lipase (lipase ( 1.5 U/ml) 1.5 U/ml)
ACUTE PANCREATITISACUTE PANCREATITIS
Nursing ManagementNursing ManagementNPO, NGT to suction, NPO, NGT to suction, TPN (with vit. & min.) TPN (with vit. & min.) as orderedas ordered Cx: hyperglycemia, Cx: hyperglycemia, air embolism, infectionair embolism, infection
If can eat: diet- If can eat: diet- CHO, CHO, CHON, CHON, fats fats
ACUTE PANCREATITISACUTE PANCREATITISNursing ManagementNursing Management
Administer meds as orderedAdminister meds as orderedNarcotic analgesic- Demerol Narcotic analgesic- Demerol (no Morphine & Codeine SO4- (no Morphine & Codeine SO4- causes spasms of sphincter of causes spasms of sphincter of Oddi aggravating pain)Oddi aggravating pain)
Antacids, H2 blockers: Antacids, H2 blockers: Ranitidine (to Ranitidine (to HCL HCL production & prevent production & prevent activation of pancreatic activation of pancreatic enzymes)enzymes)
ACUTE PANCREATITISACUTE PANCREATITISNursing ManagementNursing Management
Administer meds as orderedAdminister meds as orderedAnticholinergics (to Anticholinergics (to vagal vagal stimulation, stimulation, GI motility, GI motility, inhibit pancreatic enzyme inhibit pancreatic enzyme secretion)secretion)
Smooth muscle relaxantSmooth muscle relaxantVasodilators- NTGVasodilators- NTGCalcium gluconateCalcium gluconate
ACUTE PANCREATITISACUTE PANCREATITIS Nursing ManagementNursing Management
Assume comfortable positionAssume comfortable positionKnee-chest, fetal-likeKnee-chest, fetal-likeStress Management Technique: Stress Management Technique: DBE, yogaDBE, yoga
Prevent Complications: Prevent Complications: chronic hemorrhage, chronic hemorrhage, septicemia septicemia
CHRONIC PANCREATITISCHRONIC PANCREATITIS Signs & SymptomsSigns & Symptoms
Abdominal pain & Abdominal pain & tendernesstenderness
LUQ massLUQ massSteatorrhea Steatorrhea Wt lossWt lossMuscle wastingMuscle wastingJaundiceJaundiceS/Sx of DMS/Sx of DM
CHRONIC PANCREATITISCHRONIC PANCREATITISNursing InterventionsNursing Interventions
Diet: limited fat & CHON, Diet: limited fat & CHON, vit. & min. supplements, no vit. & min. supplements, no heavy meals, no alcoholheavy meals, no alcohol
Administer meds as Administer meds as orderedorderedPancreatic enzymes with Pancreatic enzymes with mealsmeals
Insulin & OHA to control DMInsulin & OHA to control DM
PANCREATITISPANCREATITIS
Health TeachingsHealth TeachingsImportance of avoiding Importance of avoiding
alcoholalcoholImportance of follow-up Importance of follow-up
care/visit with the MDcare/visit with the MDNotify MD if acute abdominal Notify MD if acute abdominal
pain, jaundice, clay-colored pain, jaundice, clay-colored stools, steatorrhea or dark stools, steatorrhea or dark urine developsurine develops
GALL BLADDERGALL BLADDERReceives bile from the liver Receives bile from the liver Stores, concentrates & releases Stores, concentrates & releases
bile to the common bile duct to bile to the common bile duct to the duodenum upon the duodenum upon stimulation (presence of fatty stimulation (presence of fatty foods)foods) gall bladder contracts gall bladder contracts & sphincter of Oddi relaxes& sphincter of Oddi relaxes
Common bile duct: joined Common bile duct: joined cystic & hepatic ductscystic & hepatic ducts
Sphincter of Oddi: guards the Sphincter of Oddi: guards the entrance into the duodenumentrance into the duodenum
GALL BLADDERGALL BLADDERCholecystitis- gall bladder Cholecystitis- gall bladder
inflammationinflammationAcute: caused by gallstonesAcute: caused by gallstonesChronic: r/t inefficient bile emptying Chronic: r/t inefficient bile emptying
& gall bladder muscle disease& gall bladder muscle disease fibrotic & contracted gall bladderfibrotic & contracted gall bladder
Acalculus: (-) gallstones, r/t Acalculus: (-) gallstones, r/t bacterial invasion via the lymphatic bacterial invasion via the lymphatic or vascular systemsor vascular systems
Cholelithiasis- gallstonesCholelithiasis- gallstones
GALL BLADDERGALL BLADDER Predisposing FactorsPredisposing Factors
High riskHigh risk Female, 40 years Female, 40 years old, menopausal, old, menopausal, obeseobese
CholelithiasisCholelithiasis
GALL BLADDERGALL BLADDERSigns & SymptomsSigns & Symptoms
Localized pain at RUQ, (+) Localized pain at RUQ, (+) mass mass
Epigastric pain radiating to Epigastric pain radiating to scapula 2-4 hrs after taking scapula 2-4 hrs after taking heavy meal/fatty foods, heavy meal/fatty foods, persisting for 4-6 hrs, usually at persisting for 4-6 hrs, usually at nightnight
Fatty intolerance, N/V, Fatty intolerance, N/V, indigestion, belching, flatulenceindigestion, belching, flatulence
GALL BLADDERGALL BLADDER
Signs & SymptomsSigns & SymptomsGuarding, rigidity & rebound Guarding, rigidity & rebound tendernesstenderness
Murphy’s sign: can’t take a Murphy’s sign: can’t take a deep breath when examiner’s deep breath when examiner’s finger’s are passed below the finger’s are passed below the hepatic marginhepatic margin
HR, HR, T, S/Sx of dehydrationT, S/Sx of dehydration
GALL BLADDERGALL BLADDER
Signs & Symptoms (Biliary Signs & Symptoms (Biliary Obstruction) Obstruction) JaundiceJaundiceDark orange & foamy urineDark orange & foamy urineSteatorrhea & clay-colored Steatorrhea & clay-colored stoolsstools
PruritusPruritusEasy bruisingEasy bruising
GALL BLADDERGALL BLADDER Diagnostic ProceduresDiagnostic ProceduresCholecystography: to detect gall Cholecystography: to detect gall
stones; to assess the ability of the gall stones; to assess the ability of the gall bladder to fill, concentrate its contents, bladder to fill, concentrate its contents, contract & emptycontract & empty
Pre-opPre-opAsk for hx of allergies to iodine, Ask for hx of allergies to iodine,
seafood or dyeseafood or dyeContrast dye may be given 10-12 hrs Contrast dye may be given 10-12 hrs
prior to test (evening before)prior to test (evening before)NPO after giving of dyeNPO after giving of dyeWOF anaphylactic reaction to dyeWOF anaphylactic reaction to dye
GALL BLADDERGALL BLADDER Diagnostic Procedures: Diagnostic Procedures: CholecystographyCholecystographyPost-opPost-opDysuria is common because Dysuria is common because the dye is excreted in the the dye is excreted in the urineurine
N diet is resumed: fatty N diet is resumed: fatty meal enhances excretion of meal enhances excretion of dyedye
GALL BLADDERGALL BLADDER Diagnostic ProceduresDiagnostic ProceduresEndoscopic retrograde Endoscopic retrograde cholangiopancreatography cholangiopancreatography (ERCP): exam of the (ERCP): exam of the hepatobiliary system via hepatobiliary system via endoscope inserted into the endoscope inserted into the esophagus to the duodenum; esophagus to the duodenum; multiple positions are required multiple positions are required during the procedure to pass during the procedure to pass the endoscopethe endoscope
GALL BLADDERGALL BLADDER Diagnostic Procedure: ERCPDiagnostic Procedure: ERCPPre-opPre-opNPO X several hrs NPO X several hrs Sedation as orderedSedation as orderedPost-opPost-opMonitor VS, return of gag Monitor VS, return of gag reflexreflex
WOF perforation or infectionWOF perforation or infection
GALL BLADDERGALL BLADDER
Diagnostic ProceduresDiagnostic Procedures Oral cholecystogram Oral cholecystogram Gall Bladder Series)- Gall Bladder Series)- (+) gall stones(+) gall stones
Serum alkaline Serum alkaline phosphatasephosphatase
GALL BLADDERGALL BLADDER Nursing ManagementNursing Management Administer meds as orderedAdminister meds as ordered
Narcotic analgesic- Narcotic analgesic- Demerol (no Morphine & Demerol (no Morphine & Codeine SO4)Codeine SO4)
Anticholinergics/ Anticholinergics/ Antispasmodics to relax Antispasmodics to relax smooth musclessmooth muscles Pro-BanthinePro-Banthine AtSO4AtSO4
Anti-emeticsAnti-emetics
GALL BLADDERGALL BLADDER
Nursing ManagementNursing Management Monitor V/S, bowel Monitor V/S, bowel soundssounds
Small, frequent mealsSmall, frequent meals Diet: Diet: CHO, CHO, CHON, CHON, fats, no gas-forming fats, no gas-forming foodsfoods
Meticulous skin careMeticulous skin care
GALL BLADDERGALL BLADDERNon-Surgical InterventionsNon-Surgical InterventionsDissolution therapy (of Dissolution therapy (of cholesterol stones)cholesterol stones)
Meds: Chenodeoxycholic acid Meds: Chenodeoxycholic acid (Chenodiol) or Ursodiol (Chenodiol) or Ursodiol (Actigall) po(Actigall) po
Direct contact with repeated Direct contact with repeated injections & aspirations of a injections & aspirations of a dissolution agent via dissolution agent via percutaneous cathpercutaneous cath
GALL BLADDERGALL BLADDERSurgical Interventions Surgical Interventions
under Exploration under Exploration Laparoscopy/Peritoneoscopy: Laparoscopy/Peritoneoscopy: direct visualization of organs & direct visualization of organs & structures within the abdomen structures within the abdomen using fiberscope; bx can be using fiberscope; bx can be obtainedobtained
Cholecystectomy: gall bladder Cholecystectomy: gall bladder removalremoval
Choledochotomy: common bile Choledochotomy: common bile duct incision to remove stoneduct incision to remove stone
GALL BLADDERGALL BLADDERNursing Interventions: s/p Gall Nursing Interventions: s/p Gall Bladder SurgeryBladder SurgeryCoughing (splint the abdomen) Coughing (splint the abdomen) & DBE, early ambulation& DBE, early ambulation
NPO & NGT to suction, then NPO & NGT to suction, then progressive diet as orderedprogressive diet as ordered
Administer meds as orderedAdminister meds as orderedAntiemeticsAntiemeticsAntipyreticsAntipyreticsAntibiotics Antibiotics
GALL BLADDERGALL BLADDERNursing Interventions: s/p Nursing Interventions: s/p Gall Bladder SurgeryGall Bladder SurgeryMonitor drainage from the Monitor drainage from the T-tubeT-tube
Purpose: preserves the Purpose: preserves the patency of the common bile patency of the common bile duct & ensures bile duct & ensures bile drainage until edema drainage until edema resolves & bile is effectively resolves & bile is effectively draining into the duodenumdraining into the duodenum
GALL BLADDERGALL BLADDERNursing Interventions: Nursing Interventions: s/p Gall Bladder Surgerys/p Gall Bladder SurgerySemi-Fowler’s position, Semi-Fowler’s position, drain system by gravitydrain system by gravity
Avoid irrigation, Avoid irrigation, aspiration or clamping aspiration or clamping the T-tube without the T-tube without MD’s ordersMD’s orders
GALL BLADDERGALL BLADDERNursing Interventions: s/p Gall Nursing Interventions: s/p Gall Bladder SurgeryBladder SurgeryAs ordered, clamp the T-tube As ordered, clamp the T-tube before meals, WOF abdominal before meals, WOF abdominal pain/distention, N/V, pain/distention, N/V, T (if T (if noted, unclamp the T-tube & noted, unclamp the T-tube & notify MD)notify MD)
Monitor amount, color, Monitor amount, color, consistency & odor of drainageconsistency & odor of drainage
Refer sudden Refer sudden in bile output in bile outputPrevent skin irritationPrevent skin irritation
ESOPHAGUSESOPHAGUSCollapsible Collapsible muscular tube about muscular tube about 10 inches long10 inches long
Carries food from Carries food from pharynx to the pharynx to the stomachstomach
Gastroesophageal Reflux Gastroesophageal Reflux Disease (GERD)Disease (GERD)
or Chalasia or Chalasia Backflow of Backflow of gastric & gastric & duodenal contents duodenal contents into the into the esophagusesophagus
GERDGERD
GERDGERDCausesCauses
Incompetent lower Incompetent lower esophageal sphincter (LES)esophageal sphincter (LES)
Pyloric stenosisPyloric stenosisMotility disorderMotility disorderProlonged gastric Prolonged gastric intubationintubation
Ingestion of corrosive Ingestion of corrosive chemicalschemicals
GERDGERDCausesCauses
UremiaUremiaInfectionsInfectionsMucosal alterationsMucosal alterationsSystemic disease Systemic disease (SLE)(SLE)
GERDGERDSigns & Symptoms (mimic Signs & Symptoms (mimic
those of MI)those of MI)Substernal pain (due to Substernal pain (due to frequent regurgitation frequent regurgitation through gastroesophageal through gastroesophageal junction), aggravated by junction), aggravated by postural changes especially postural changes especially when in supinewhen in supine
DyspepsiaDyspepsiaDysphagiaDysphagiaHypersalivation Hypersalivation
GERDGERDComplicationsComplications
Pulmonary Pulmonary aspirationaspiration
EsophagitisEsophagitisEsophageal CAEsophageal CA
ESOPHAGITISESOPHAGITISInflammation of Inflammation of esophageal mucosa, esophageal mucosa, most often results most often results from GERD due to from GERD due to prolonged vomiting prolonged vomiting or an incompetent or an incompetent LESLES
ESOPHAGITISESOPHAGITIS Signs & SymptomsSigns & Symptoms
precipitated by ingestion precipitated by ingestion of fatty foods & alcoholof fatty foods & alcoholHeart burnHeart burnRetrosternal discomfortRetrosternal discomfortRegurgitation of sour, Regurgitation of sour, bitter materialbitter material
ESOPHAGITISESOPHAGITIS Signs & SymptomsSigns & Symptoms
Dysphagia for both Dysphagia for both solids & liquids (r/t solids & liquids (r/t permanent strictures)permanent strictures)
BleedingBleeding IDA IDANocturnal reflux (in Nocturnal reflux (in upright or supine upright or supine position or both)position or both)
GERD & ESOPHAGITISGERD & ESOPHAGITIS Diagnostic ProceduresDiagnostic Procedures
pH in esophagus- 0.8- pH in esophagus- 0.8- 22
Esophageal biopsy- Esophageal biopsy- (+) inflammatory (+) inflammatory changeschanges
GERD & ESOPHAGITISGERD & ESOPHAGITISDiagnostic Procedure: GASTRIC Diagnostic Procedure: GASTRIC
ANALYSISANALYSISEsophageal reflux of gastric Esophageal reflux of gastric
acid may be done by acid may be done by ambulatory pH monitoring; a ambulatory pH monitoring; a probe is placed just above the probe is placed just above the LES & connected to an external LES & connected to an external recording device; provides a recording device; provides a computer analysis & graphic computer analysis & graphic display of resultsdisplay of results
GERD & ESOPHAGITISGERD & ESOPHAGITISDiagnostic Procedure: GASTRIC Diagnostic Procedure: GASTRIC
ANALYSISANALYSISPre-op: NPO X 8-12 hrs, no Pre-op: NPO X 8-12 hrs, no
tobacco & chewing gum X 6 tobacco & chewing gum X 6 hrs, hold meds that can hrs, hold meds that can stimulate gastric secretions X stimulate gastric secretions X 1-2 days1-2 days
Post-op: Resume N activities, Post-op: Resume N activities, place gastric samples in ref if place gastric samples in ref if not tested within 4 hrsnot tested within 4 hrs
GERD & ESOPHAGITISGERD & ESOPHAGITIS Diagnostic ProceduresDiagnostic Procedures
Upper GI study/series Upper GI study/series (Barium swallow): done (Barium swallow): done under fluoroscopy after the under fluoroscopy after the pt drinks Barium SO4pt drinks Barium SO4
Pre-op: NPO after 12 MNPre-op: NPO after 12 MNPost-op: Laxative as ordered, Post-op: Laxative as ordered, Force fluids, WOF passage of Force fluids, WOF passage of chalk-white stools (Barium chalk-white stools (Barium can cause GI obstruction)can cause GI obstruction)
GERD & ESOPHAGITISGERD & ESOPHAGITIS Diagnostic ProceduresDiagnostic Procedures
Barium swallow- poorly Barium swallow- poorly distensible, shortened, distensible, shortened, stricture & or ulcerated stricture & or ulcerated esophagusesophagus
Gastroesophageal Gastroesophageal scintiscan (X-ray to scintiscan (X-ray to document amount of document amount of reflux)reflux)
GERD & ESOPHAGITISGERD & ESOPHAGITISNursing InterventionsNursing Interventions
Position: Position: head of bed head of bed on 6 to 8-inch blockson 6 to 8-inch blocks
Diet: Diet: fat, fat, fiber fiber Avoid caffeine, tobacco, Avoid caffeine, tobacco, carbonated drinks, eating carbonated drinks, eating & drinking 2hrs before & drinking 2hrs before HSHS
No tight clothesNo tight clothes
GERD & ESOPHAGITISGERD & ESOPHAGITISNursing InterventionsNursing Interventions
Administer as orderedAdminister as orderedAntacids, H2 blockers, Antacids, H2 blockers, proton-pump inhibitorsproton-pump inhibitors
Prokinetic meds (to Prokinetic meds (to gastric emptying)gastric emptying)
No anticholinergic No anticholinergic meds! (meds! ( gastric gastric emptying)emptying)
MEDICAL MANAGEMENT Cholinergic Meds
Bethanecol – to esophageal tone & peristaltic activity
Metochlopramide (Reglan/Plasil)- to esophageal pressure by relaxing pyloric & duodenal segments, peristalsis without stimulating secretions
MEDICAL MANAGEMENT Cholinergic Meds
H2 blockers- to gastric acidity & pepsin secretion
Proton-pump inhibitors- gastric acidity
Antacids (Maalox)- to neutralize gastric acid between feedings
SURGICAL MANAGEMENT Nissen Fundoplication Nissen Fundoplication
(under EL)(under EL) Creation of valve Creation of valve
mechanism by mechanism by wrapping the greater wrapping the greater curvature of stomach curvature of stomach (gastric fundus) around (gastric fundus) around the LESthe LES
To create pressure & To create pressure & prevent backflow to prevent backflow to esophagusesophagus
NISSEN FUNDOPLICATION
HIATAL HERNIA or Esophageal or or Esophageal or
Diaphragmatic HerniaDiaphragmatic Hernia A portion of the A portion of the
stomach herniates stomach herniates through the weak through the weak muscles of the muscles of the diaphragm & into the diaphragm & into the thoraxthorax
HIATAL HERNIAHIATAL HERNIA
HIATAL HERNIA Aggravated by factors Aggravated by factors
intraabdominal pressure: intraabdominal pressure: pregnancy, ascites, pregnancy, ascites, obesity, tumors, heavy obesity, tumors, heavy liftinglifting
Cx: ulceration, Cx: ulceration, hemorrhage, hemorrhage, regurgitation, aspiration, regurgitation, aspiration, strangulation, strangulation, incarceration of the incarceration of the stomach in the chest with stomach in the chest with necrosis, peritonitis & necrosis, peritonitis & mediastinitismediastinitis
HIATAL HERNIA Signs & SymptomsSigns & Symptoms
HeartburnHeartburn Regurgitation or Regurgitation or
vomitingvomiting DysphagiaDysphagia Feeling of fullness Feeling of fullness
HIATAL HERNIA Nursing, Medical & Nursing, Medical &
Surgical InterventionsSurgical InterventionsSame as in GERDSame as in GERDSmall frequent Small frequent
meals, minimal meals, minimal amount of fluidsamount of fluids
Avoid reclining for 1 Avoid reclining for 1 hr after eatinghr after eating
STOMACHSTOMACH J - shape J - shape Widest section of alimentary Widest section of alimentary canalcanal
With valvesWith valves Cardiac sphincter - between Cardiac sphincter - between esophagus & stomachesophagus & stomach
Pyloric sphincter- between Pyloric sphincter- between stomach & duodenum, olive-stomach & duodenum, olive-shapeshape
STOMACHSTOMACH
PartsParts CardiaCardia FundusFundus BodyBody Antrum Antrum PylorusPylorus
STOMACHSTOMACH
STOMACHSTOMACHMucous GlandsMucous Glands
Prevent Prevent autodigestion by autodigestion by providing alkaline providing alkaline protective coveringprotective covering
STOMACHSTOMACH CellsCells
Chief/zymogenic cellsChief/zymogenic cells Gastric amylase -Gastric amylase - digests CHOdigests CHO
Gastric lipaseGastric lipase - digests - digests fatsfats
PepsinPepsin - digests CHON - digests CHON RenninRennin - digests milk - digests milk productsproducts
STOMACHSTOMACH
Parietal/Oxyntic cellsParietal/Oxyntic cells Produces Intrinsic Produces Intrinsic Factor (glycoprotein) Factor (glycoprotein) for reabsorption of for reabsorption of Vit B12 for RBC Vit B12 for RBC maturationmaturation
Secretes HCl- aids Secretes HCl- aids in digestionin digestion
STOMACHSTOMACH
Endocrine cells (G-Endocrine cells (G-cells)cells) Stimulates Stimulates gastrin (controls gastrin (controls gastric acidity)gastric acidity)
STOMACHSTOMACH
FunctionsFunctions Mechanical & Mechanical & chemical digestionchemical digestion
Storage of foodStorage of foodCHO & CHON: 2-3 CHO & CHON: 2-3 hrshrs
Fats: 3-4 hrsFats: 3-4 hrs
GASTRITISGASTRITISInflammation of the the stomach Inflammation of the the stomach
or gastric mucosaor gastric mucosaCauses of Acute GastritisCauses of Acute Gastritis
Ingestion of food with bacteria, Ingestion of food with bacteria, fungi, virusfungi, virus
Highly-seasoned/irritating foodHighly-seasoned/irritating foodOveruse of NSAIDsOveruse of NSAIDsAlcoholismAlcoholismBile refluxBile refluxRadiation therapyRadiation therapy
GASTRITISGASTRITISSigns & Symptoms: Acute Signs & Symptoms: Acute GastritisGastritisA/N/VA/N/VAbdominal discomfortAbdominal discomfortHeadacheHeadacheHiccuping Hiccuping
GASTRITISGASTRITISCauses of Chronic GastritisCauses of Chronic Gastritis
Benign or malignant Benign or malignant ulcersulcers
H. pylori H. pylori bacteriabacteriaAutoimmune diseasesAutoimmune diseasesDiet, MedsDiet, MedsSmoking & alcoholismSmoking & alcoholismReflux Reflux
GASTRITISGASTRITISSigns & Symptoms: Signs & Symptoms: Chronic GastritisChronic GastritisA/N/VA/N/VBelchingBelchingHeartburn after eatingHeartburn after eatingSour taste in the mouthSour taste in the mouthVit. B12 deficiencyVit. B12 deficiency
GASTRITISGASTRITISNursing InterventionsNursing Interventions
NPO until Sx subside, then NPO until Sx subside, then progressive dietprogressive diet
WOF hemorrhagic gastritis & notify WOF hemorrhagic gastritis & notify MD: hematemesis, MD: hematemesis, HR, HR, BPBP
Avoid irritating/spicy/highly seasoned Avoid irritating/spicy/highly seasoned foods, caffeine, alcohol & nicotinefoods, caffeine, alcohol & nicotine
Administer as orderedAdminister as orderedAntibioticsAntibioticsBismuth salts (Pepto-Bismol)Bismuth salts (Pepto-Bismol)Vit B12 injections Vit B12 injections
PEPTIC ULCERPEPTIC ULCER Erosion/excoriation of Erosion/excoriation of mucosal & submucosal mucosal & submucosal lining (extending to lining (extending to muscle) due tomuscle) due to Hypersecretion of acid Hypersecretion of acid pepsinpepsin
resistance of mucosal resistance of mucosal barrier to hyperaciditybarrier to hyperacidity
PEPTIC ULCERPEPTIC ULCER
PEPTIC ULCERPEPTIC ULCER Incidence RateIncidence Rate
M- 2-3 X higher riskM- 2-3 X higher risk Low income, laborerLow income, laborer
Predisposing FactorsPredisposing Factors HereditaryHereditary Hx of gastritisHx of gastritis Emotional stressEmotional stress
PEPTIC ULCERPEPTIC ULCER Predisposing FactorsPredisposing Factors
SmokingSmoking AlcoholismAlcoholism CaffeineCaffeine Irregular DietIrregular Diet Rapid EatingRapid Eating
PEPTIC ULCERPEPTIC ULCER Predisposing FactorsPredisposing Factors
Ulcerogenic drugsUlcerogenic drugs ASA ASA Ibuprofen Ibuprofen IndomethacinIndomethacin PhenylbutazonesPhenylbutazones SteroidsSteroids
PEPTIC ULCERPEPTIC ULCER Predisposing Predisposing
FactorsFactors Gastrin-producing Gastrin-producing
tumorstumorsZollinger-Ellison Zollinger-Ellison syndromesyndrome
Microbial invasionMicrobial invasion Helicobacter Helicobacter pyloripylori
PEPTIC ULCERPEPTIC ULCERTypes depending on:Types depending on:SeveritySeverity
Acute- affects Acute- affects submucosal & mucosal submucosal & mucosal liningslinings
Chronic- affects deeper Chronic- affects deeper tissues tissues heals heals scars scars
PEPTIC ULCERPEPTIC ULCERTypes depending on:Types depending on:LocationLocation
Stress ulcerStress ulcerEsophagealEsophagealGastric ulcerGastric ulcerDuodenal ulcer- 90-95% Duodenal ulcer- 90-95% less Bicarbonateless Bicarbonate
PEPTIC ULCERPEPTIC ULCER
Stress UlcerStress Ulcercommon among common among critically-ill ptcritically-ill pt
PEPTIC ULCERPEPTIC ULCERStress UlcerStress Ulcer
Curling’s Ulcer- due to Curling’s Ulcer- due to trauma & major burns trauma & major burns hypovolemia hypovolemia GIT GIT ischemia ischemia resistance of resistance of mucosal barrier to HCl mucosal barrier to HCl acid secretion acid secretion ulceration ulceration
PEPTIC ULCERPEPTIC ULCERStress UlcerStress Ulcer
Cushing’s Ulcer- due to Cushing’s Ulcer- due to head trauma/injury (e.g. head trauma/injury (e.g. CVA) CVA) Vagal stimulation Vagal stimulation hyperacidity hyperacidity ulcerationulceration
PEPTIC ULCERPEPTIC ULCER
GASTRIC GASTRIC VS.VS.
ULCERULCER
AntrumAntrum
30 mins- 1 or 2 hrs 30 mins- 1 or 2 hrs p.c.p.c.
Epigastric painEpigastric pain
(L midepigastric (L midepigastric pain)pain)
DUODENAL ULCERDUODENAL ULCER
Duodenal bulbDuodenal bulb
2-3 or 4 hrs p.c.2-3 or 4 hrs p.c.
Mid-epigastric Mid-epigastric painpain
PEPTIC ULCERPEPTIC ULCERGASTRIC GASTRIC VS.VS.
ULCERULCER
Gaseous pain & Gaseous pain & burningburning
Not relieved by Not relieved by food/antacidfood/antacid
N gastric acid N gastric acid secretionsecretion
DUODENAL DUODENAL ULCERULCER
Cramping & Cramping & burningburning
Relieved by Relieved by food/antacidfood/antacid
Gastric acid Gastric acid secretionsecretion
PEPTIC ULCERPEPTIC ULCERGASTRIC GASTRIC VS.VS.
ULCERULCER
HematemesisHematemesis
Weight lossWeight loss
Stomach CA, Stomach CA,
pyloric obstruction, pyloric obstruction,
hemorrhage, hemorrhage, perforationperforation
60 y/o & 60 y/o &
DUODENAL ULCERDUODENAL ULCER
MelenaMelena
Weight gainWeight gain
Perforation, gastric Perforation, gastric outlet obstruction, outlet obstruction, intractable diseaseintractable disease
20 y/o & 20 y/o &
PEPTIC ULCERPEPTIC ULCERDiagnostic ProceduresDiagnostic Procedures
Upper GI Fiberoscopy Upper GI Fiberoscopy (Esophagogastroduodenoscop(Esophagogastroduodenoscopy)y)
After sedation, an endoscope After sedation, an endoscope is passed down the is passed down the esophagus to view the gastric esophagus to view the gastric wall, sphincters & duodenum; wall, sphincters & duodenum; tissue specimens can be tissue specimens can be obtainedobtained
Upper GI FiberoscopyUpper GI Fiberoscopy
PEPTIC ULCERPEPTIC ULCER Diagnostic Procedures: Diagnostic Procedures:
EsophagogastroduodenoscopyEsophagogastroduodenoscopyPre-opPre-opNPO X 6-12 hrsNPO X 6-12 hrsLocal anesthetic (spray or gargle) along Local anesthetic (spray or gargle) along
with Midazolam IV (conscious sedation)with Midazolam IV (conscious sedation)AtSO4 IV (AtSO4 IV ( secretions), Glucagon (to secretions), Glucagon (to
relax smooth muscles)relax smooth muscles)Position: L-side lying (to drain Position: L-side lying (to drain
secretions & easy access of endoscope)secretions & easy access of endoscope)Prepare emergency equipment at Prepare emergency equipment at
bedsidebedside
PEPTIC ULCERPEPTIC ULCERDiagnostic Procedures: Diagnostic Procedures:
EsophagogastroduodenoscopyEsophagogastroduodenoscopyPost-opPost-opCBR until pt is alertCBR until pt is alertNPO X 1-2 hrs (until gag reflex NPO X 1-2 hrs (until gag reflex
returns)returns)Lozenges, saline gargles or oral Lozenges, saline gargles or oral
analgesics can relive minor sore analgesics can relive minor sore throatthroat
WOF perforation (pain, bleeding, WOF perforation (pain, bleeding, dysphagia, dysphagia, T)T)
PEPTIC ULCERPEPTIC ULCERDiagnostic ProceduresDiagnostic Procedures
Endoscopic exam- extent Endoscopic exam- extent & depth of ulceration& depth of ulceration
Stool- (+) occult bloodStool- (+) occult bloodUpper GI series (Barium Upper GI series (Barium swallow)- (+) ulcerationswallow)- (+) ulceration
PEPTIC ULCERPEPTIC ULCERDiagnostic Procedure: GASTRIC Diagnostic Procedure: GASTRIC
ANALYSISANALYSIS(pH, apperance, vol.): after NGT (pH, apperance, vol.): after NGT
insertion, the entire gastric insertion, the entire gastric contents are aspirated, contents are aspirated, specimens are collected q 15 specimens are collected q 15 mins X 1hrmins X 1hr
Histamine or Pentagastrin SQ Histamine or Pentagastrin SQ (to stimulate gastric secretions, (to stimulate gastric secretions, may produce a flushed feelingmay produce a flushed feeling
Pre & Post-op Care: See GERDPre & Post-op Care: See GERD
PEPTIC ULCERPEPTIC ULCERNursing ManagementNursing Management
Avoid smoking, NSAIDsAvoid smoking, NSAIDsDiet: bland, no caffeine Diet: bland, no caffeine & chocolate, no milk & & chocolate, no milk & its products, give its products, give crackerscrackers
Adequate rest, reduce Adequate rest, reduce stressstress
PEPTIC ULCERPEPTIC ULCERAdminister meds as orderedAdminister meds as ordered
AntacidsAntacidsMaalox- combined with Maalox- combined with S/E than 2 antacids S/E than 2 antacids separatelyseparatelyMAD- Mg containing MAD- Mg containing antacid, S/E- diarrheaantacid, S/E- diarrhea
AAC- Al containing AAC- Al containing antacid, S/E- constipationantacid, S/E- constipation
PEPTIC ULCERPEPTIC ULCER
Nursing ManagementNursing ManagementAdminister meds as Administer meds as orderedordered
H2 blockersH2 blockersRanitidine (Zantac)Ranitidine (Zantac)Cimetidine (Tagamet)Cimetidine (Tagamet)Famotidine (Pepsin)Famotidine (Pepsin)
PEPTIC ULCERPEPTIC ULCERNursing ManagementNursing Management
Administer meds as orderedAdminister meds as orderedMucosal barrier Mucosal barrier protectants: creates a protectants: creates a paste-like substance that paste-like substance that coats the gastric mucosacoats the gastric mucosa
Taken 1 hr a.c.Taken 1 hr a.c.SucralfateSucralfateCytotecCytotec
PEPTIC ULCERPEPTIC ULCERNursing ManagementNursing Management
Administer meds as orderedAdminister meds as orderedAnticholinergics,Anticholinergics,
AntispasmodicsAntispasmodicsAtSO4, BuscopanAtSO4, Buscopan
Sedatives/Tranquilizer Sedatives/Tranquilizer (Valium)(Valium)
PEPTIC ULCERPEPTIC ULCERNursing ManagementNursing Management
Assist in surgical proceduresAssist in surgical proceduresVagotomy- prior to gastric Vagotomy- prior to gastric surgery to surgery to hemorrhage hemorrhage
Pyloroplasty: to Pyloroplasty: to obstruction, to obstruction, to gastric gastric emptyingemptying
PEPTIC ULCERPEPTIC ULCERNursing ManagementNursing Management
SUBTOTAL GASTRECTOMYSUBTOTAL GASTRECTOMYBilroth I Bilroth I (Gastroduodenostomy)(Gastroduodenostomy)Removal of 1/3 to ½ Removal of 1/3 to ½ uppermost stomach & uppermost stomach & anastomosis of the gastric anastomosis of the gastric stump to the duodenumstump to the duodenum
PEPTIC ULCERPEPTIC ULCERNursing ManagementNursing Management
SUBTOTAL GASTRECTOMYSUBTOTAL GASTRECTOMYBilroth II (Gastrojejunostomy)Bilroth II (Gastrojejunostomy)
Removal of 2/3 of stomach Removal of 2/3 of stomach duodenal walls & duodenal walls & anastomosis of the gastric anastomosis of the gastric stump to the jejunumstump to the jejunum
SUBTOTAL GASTRECTOMYSUBTOTAL GASTRECTOMY
PEPTIC ULCERPEPTIC ULCERNursing ManagementNursing Management
GASTRIC RESECTION or GASTRIC RESECTION or Antrectomy: removal of lower Antrectomy: removal of lower half of stomachhalf of stomach
TOTAL GASTRECTOMYTOTAL GASTRECTOMYRemoval of the stomach & Removal of the stomach & attachment of esophagus to attachment of esophagus to the jejunum or duodenum the jejunum or duodenum (Esophagojejunostomy)(Esophagojejunostomy)
PEPTIC ULCERPEPTIC ULCERNursing Management Nursing Management Post-opPost-opMonitor VS, I/O, bowel soundMonitor VS, I/O, bowel soundFowler’s positionFowler’s positionNPO for 1-3 days, NGT to NPO for 1-3 days, NGT to suction (don’t suction (don’t irrigate/remove NGT)irrigate/remove NGT)
PEPTIC ULCERPEPTIC ULCERNursing Management Post-opNursing Management Post-op
Monitor NGT outputMonitor NGT outputImmediately post-op- bright redImmediately post-op- bright red12-16 hrs post-op- greenish12-16 hrs post-op- greenish> 24 hrs- tea-colored, dark red> 24 hrs- tea-colored, dark red
Progressive diet to 6 small, bland Progressive diet to 6 small, bland meals/daymeals/day
PEPTIC ULCERPEPTIC ULCERNursing Nursing Management Post-opManagement Post-opAdminister as orderedAdminister as ordered
IVF & e+IVF & e+AntibioticsAntibioticsAnalgesicsAnalgesicsAnti-emeticsAnti-emetics
PEPTIC ULCERPEPTIC ULCERNursing Management Nursing Management Post-opPost-opPrevent ComplicationsPrevent Complications
Bleeding Bleeding Hemorrhage Hemorrhage Shock Shock
Paralytic ileusParalytic ileusPeritonitisPeritonitis
PEPTIC ULCERPEPTIC ULCERNursing Management Nursing Management Post-opPost-opPrevent ComplicationsPrevent Complications
Pernicious anemiaPernicious anemiaThrombophlebitisThrombophlebitisHypoK, HypoglyHypoK, HypoglyDumping SyndomeDumping Syndome
DUMPING SYNDROMEDUMPING SYNDROME
Rapid Rapid emptying of emptying of hypertrophic hypertrophic food solution food solution (chyme) (chyme) from from stomach to stomach to jejunum jejunum hypovolemiahypovolemia
DUMPING SYNDROMEDUMPING SYNDROME
Signs & Symptoms (occur Signs & Symptoms (occur 30 mins p.c.)30 mins p.c.)N/VN/VAbdominal fullness, crampingAbdominal fullness, crampingDiaphoresisDiaphoresisPalpitation, Palpitation, HR HRWeakness, dizzinessWeakness, dizzinessDiarrheaDiarrheaBorborygmiBorborygmi
DUMPING SYNDROMEDUMPING SYNDROMENursing ManagementNursing Management
Diet: Diet: CHO, CHO, fat, fat, CHON CHONSmall, frequent meals (divided Small, frequent meals (divided into 6 equal parts/day), no into 6 equal parts/day), no fluids with mealsfluids with meals
Avoid sugar, salt, chilled Avoid sugar, salt, chilled solutionsolution
Pt lie flat for 30 mins p.c.Pt lie flat for 30 mins p.c.Antispasmodics as ordered to Antispasmodics as ordered to gastric emptying gastric emptying
SMALL INTESTINESMALL INTESTINE
SMALL INTESTINESMALL INTESTINEDivided into: Divided into:
Duodenum (with openings of the Duodenum (with openings of the bile & pancreatic ducts)bile & pancreatic ducts)
Jejunum (8 ft long)Jejunum (8 ft long)Ileum (12 ft long)Ileum (12 ft long)
Terminates into the cecumTerminates into the cecumFunctions: digestion & absorption Functions: digestion & absorption
of ingested nutrients & waterof ingested nutrients & waterAlterations:Alterations:
MalabsorptionMalabsorptionMaldigestionMaldigestion
SMALL INTESTINESMALL INTESTINEPancreatic intestinal juice enzymesPancreatic intestinal juice enzymes
Amylase: starch Amylase: starch maltose maltoseMaltase: maltose Maltase: maltose glucose glucoseLactase: lactose Lactase: lactose galactose galactose glucoseglucose
Sucrase: sucrose Sucrase: sucrose fructose fructose glucoseglucose
Nucleoses: nucleic acids Nucleoses: nucleic acids nucleotidesnucleotides
Enterokinase: activates trypsinogen Enterokinase: activates trypsinogen trypsin trypsin
SMALL INTESTINESMALL INTESTINEDisordersDisorders
Vomiting, diarrheaVomiting, diarrheaGastroenteritisGastroenteritisMalabsorption syndromeMalabsorption syndrome
Cystic Fibrosis (CF)Cystic Fibrosis (CF)Celiac Disease (Non-tropical Celiac Disease (Non-tropical sprue/Gluten Enteropathy)sprue/Gluten Enteropathy)
Tropical sprueTropical sprueRegional enteritis (Chron’s Regional enteritis (Chron’s Disease)Disease)
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) Or Mucoviscidosis or Or Mucoviscidosis or
Fibrocystic disease of the Fibrocystic disease of the PancreasPancreas
Multisystem disorderMultisystem disorder Incidence: most fatal Incidence: most fatal
genetic disease in genetic disease in Caucasians & EuropeansCaucasians & Europeans
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) Genetic characteristicsGenetic characteristics
Transmitted by autosomal Transmitted by autosomal recessive inheritancerecessive inheritance
Mutation on gene on Mutation on gene on Chromosome 7q31Chromosome 7q31
Deletion of an AA resulting CF Deletion of an AA resulting CF transmembrane conductance transmembrane conductance regulator (CFTR)regulator (CFTR)
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF)
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) PathophysiologyPathophysiology
CFTR: N located on cells of exocrine CFTR: N located on cells of exocrine gl&s (lungs, liver, pancreas, gl&s (lungs, liver, pancreas, intestines, sweat gl&s, RT) intestines, sweat gl&s, RT) regulating electrolytes & water regulating electrolytes & water channelschannels
In CF: inadequate sythesis of In CF: inadequate sythesis of CFTRCFTR pores are lacking for pores are lacking for release of electrolytes at cell release of electrolytes at cell surfacessurfaces affects Cl- transport ( affects Cl- transport ( NaCl in sweat)NaCl in sweat)
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) PathophysiologyPathophysiology
On stimulation: exocrine On stimulation: exocrine ducts release thick, ducts release thick, viscous secreations viscous secreations causing plug causing plug anatomical anatomical & physiologic changes& physiologic changes
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) CharacteristicsCharacteristics
Pancreatic enzyme Pancreatic enzyme deficiencydeficiency fat & Vit fat & Vit ADEK malabsorptionADEK malabsorption
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) CharacteristicsCharacteristics
Large volume of thick, Large volume of thick, viscous bronchial viscous bronchial secretions secretions chronic chronic pulmonary diseasepulmonary disease
NaCl in sweatNaCl in sweat
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) Signs & SymptomsSigns & Symptoms
dry, repetitive cough dry, repetitive cough followed by vomiting; followed by vomiting; thick, sticky sputumthick, sticky sputum
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) Diagnostic TestsDiagnostic Tests
Pilocarpine iontophoresis Pilocarpine iontophoresis sweat test: simplest, most sweat test: simplest, most reliable method reliable method
N: <60mEq/L sweat Cl-N: <60mEq/L sweat Cl- CXR: CXR: diameter of upper diameter of upper
chest, overaerated lungs, chest, overaerated lungs, fibrotic changesfibrotic changes
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) Diagnostic TestsDiagnostic Tests
Pancreatic deficiency: (-) Pancreatic deficiency: (-) trypsintrypsin
Fecal fat test: steatorrhea Fecal fat test: steatorrhea (+) 15-30 g fat/day(+) 15-30 g fat/dayN: 4 g fat/dayN: 4 g fat/day
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) ManagementManagement Gene therapyGene therapy Respiratory: Respiratory:
Tobramycin IV & aerosol: Tobramycin IV & aerosol: prevent P. aeruginosaprevent P. aeruginosa
Coenzyme Q10,N-Coenzyme Q10,N-Acetylcystein: Acetylcystein: mucus mucus viscosityviscosity
CYSTIC FIBROSIS (CF)CYSTIC FIBROSIS (CF) Management: GIManagement: GI
Vit ADEK supplementVit ADEK supplement Ursodeoxycholic acid Ursodeoxycholic acid
(UDCA): (UDCA): bile viscositybile viscosity Correct steatorrheaCorrect steatorrhea
Pancreatic enzyme Pancreatic enzyme replacement therapyreplacement therapy
Lecithin, Taurine, MCTLecithin, Taurine, MCT
CHRON’S DISEASECHRON’S DISEASEOr Regional Enteritis Or Regional Enteritis Idiopathic, chronic, Idiopathic, chronic, relapsing granulomatous relapsing granulomatous inflammatory disease of inflammatory disease of the intestinal tract, the intestinal tract, affecting the terminal ileum affecting the terminal ileum or colonor colon
With periods of remissions With periods of remissions & exacerbations& exacerbations
CHRON’S DISEASECHRON’S DISEASE
Predisposing Predisposing FactorsFactors M=F, depressed & M=F, depressed & dependentdependent
higher in members higher in members of Jewish raceof Jewish race
familial familial predispositionpredisposition
CHRON’S DISEASECHRON’S DISEASE
Predisposing Predisposing FactorsFactorsonset- 15-20 y/o; onset- 15-20 y/o; peak- 55 & 60 y/opeak- 55 & 60 y/o
common in US, common in US, Britain, ScandinaviaBritain, Scandinavia
CHRON’S DISEASECHRON’S DISEASECausesCauses
Infectious (viruses, Infectious (viruses, Pseudomonas spp., Pseudomonas spp., atypical atypical mycobacteria)mycobacteria)
ImmunologicImmunologic
CHRON’S DISEASECHRON’S DISEASECausesCauses
PsychosomaticPsychosomaticDietaryDietaryHormonal Hormonal Unknown Unknown
CHRON’S DISEASECHRON’S DISEASEPathogenesisPathogenesis
Lesions in lymph nodes next to SI Lesions in lymph nodes next to SI Obstruction of lymphatic drainageObstruction of lymphatic drainageLymphoid tissue hyperplasia & Lymphoid tissue hyperplasia & lymphedemalymphedema
Bowel thickeningBowel thickeningBowel lumen narrowingBowel lumen narrowingInflamed & Inflamed & ulcerated mucosa ulcerated mucosa with with grayish- white grayish- white abscesses abscesses fistulafistula formationformation
CHRON’S DISEASECHRON’S DISEASEComplicationsComplications
intestinal intestinal stenosis/stricture due stenosis/stricture due to abscesses to abscesses obstructionobstruction
Fistula developmentFistula development rupture rupture peritonitis peritonitis
CHRON’S DISEASECHRON’S DISEASESigns & SymptomsSigns & Symptoms
Cramplike & Colicky pain Cramplike & Colicky pain in RLQ p.c.in RLQ p.c.
Mild, intermittent diarrhea Mild, intermittent diarrhea with mucus & pus (2-5 with mucus & pus (2-5 stools/day)- dominant stools/day)- dominant featurefeature
SteatorrheaSteatorrhea(+) occult blood in stool(+) occult blood in stool
CHRON’S DISEASECHRON’S DISEASESigns & SymptomsSigns & Symptoms
A/N/V, wt. loss, fever, A/N/V, wt. loss, fever, anemia, malaiseanemia, malaise
Dehydration & e+ Dehydration & e+ imbalance, imbalance, MalnutritionMalnutrition
CHRON’S DISEASECHRON’S DISEASE Diagnostic ProceduresDiagnostic Procedures
CBC- CBC- RBC, RBC, WBC WBC Deranged Serum electrolytesDeranged Serum electrolytesileum biopsy- (+) ileum biopsy- (+) inflammatory changesinflammatory changes
Barium swallow- (+) String Barium swallow- (+) String SignSign
Endoscopic exam- (+) skip Endoscopic exam- (+) skip lesionslesions
CHRON’S DISEASECHRON’S DISEASENursing, Medical Nursing, Medical InterventionsInterventionsSame as in ulcerative Same as in ulcerative colitiscolitis
Surgery is avoided as much Surgery is avoided as much as possible because as possible because recurrence of the disease recurrence of the disease process in the same region process in the same region is likely to occuris likely to occur
LARGE INTESTINELARGE INTESTINEAbout 5 ft long About 5 ft long Absorbs water (1,800 to Absorbs water (1,800 to 3,000 ml) with few 3,000 ml) with few electrolytes, provides for electrolytes, provides for the final water balance in the final water balance in the GISthe GIS
Eliminates wastesEliminates wastesBacterial flora synthesize Bacterial flora synthesize some B Vitamins & Vit. Ksome B Vitamins & Vit. K
LARGE INTESTINELARGE INTESTINEFrom cecum, colon From cecum, colon (subdivided into ascending, (subdivided into ascending, transverse & descending), transverse & descending), sigmoid, rectum & anussigmoid, rectum & anus
Ileoceccal valve: prevents Ileoceccal valve: prevents backflow of LI contents to backflow of LI contents to the ileumthe ileum
Anal sphincters: guard the Anal sphincters: guard the anal canalanal canal
ULCERATIVE COLITISULCERATIVE COLITISChronic inflammatory disease of Chronic inflammatory disease of
the mucous membranes of the the mucous membranes of the coloncolon
Commonly begins in the rectum & Commonly begins in the rectum & spreads upward toward the cecumspreads upward toward the cecum
Bowel fills with bloody, mucoid Bowel fills with bloody, mucoid secretion that produces a secretion that produces a characteristic cramping pain, characteristic cramping pain, rectal urgency & diarrhearectal urgency & diarrhea
With periods of remissions & With periods of remissions & exacerbationsexacerbations
ULCERATIVE COLITISULCERATIVE COLITIS
ULCERATIVE COLITISULCERATIVE COLITISPredisposing FactorsPredisposing Factors
Unknown causeUnknown causeGenetic basis suggestedGenetic basis suggestedAssociated with viruses other Associated with viruses other microorganisms & autoimmunitymicroorganisms & autoimmunity
Peak occurrence: 15-35 y/oPeak occurrence: 15-35 y/oCommon among Whites than in Common among Whites than in other racesother races
ULCERATIVE COLITISULCERATIVE COLITISPathogenesisPathogenesis
ACUTE PHASE ACUTE PHASE edematous colon develop edematous colon develop bleeding lesions & ulcersbleeding lesions & ulcers perforationperforation
CHRONIC PHASECHRONIC PHASEulcerations become scarsulcerations become scars elasticityelasticity malabsorption, bowel malabsorption, bowel thickening, shortening & thickening, shortening & narrowingnarrowing
ULCERATIVE COLITISULCERATIVE COLITISSigns & SymptomsSigns & Symptoms
Abdominal tenderness & Abdominal tenderness & cramping cramping
Severe bloody diarrhea with Severe bloody diarrhea with mucusmucus
Vit. K deficiencyVit. K deficiencyA/, wt. loss, fever, anemia, A/, wt. loss, fever, anemia, malaisemalaise
Dehydration & e+ imbalance, Dehydration & e+ imbalance, malnutritionmalnutrition
ULCERATIVE COLITISULCERATIVE COLITISDiagnostic Procedures Diagnostic Procedures
CBC- CBC- RBC, RBC, WBC WBC Serum albuminSerum albumin Deranged serum Deranged serum electrolyteselectrolytes
serum alkaline serum alkaline phosphatasephosphatase
ULCERATIVE COLITISULCERATIVE COLITISDiagnostic Procedures Diagnostic Procedures
Lower GI study/series (Barium Lower GI study/series (Barium enema)- fluoroscopic & radiographic enema)- fluoroscopic & radiographic exam of LI after rectal instillation of exam of LI after rectal instillation of Barium SO4, may be done with or Barium SO4, may be done with or without airwithout air
Pre-op: Pre-op: fiber diet X 1-2days, CL diet fiber diet X 1-2days, CL diet or laxative at pm, NPO after 12MN, or laxative at pm, NPO after 12MN, cleansing enemas in amcleansing enemas in am
Post-op: Laxative as ordered, Force Post-op: Laxative as ordered, Force fluids, WOF passage of chalk-white fluids, WOF passage of chalk-white stools (Barium can cause GI stools (Barium can cause GI obstruction), Notify MD if no bowel obstruction), Notify MD if no bowel mov’t within 2 daysmov’t within 2 days
ULCERATIVE COLITISULCERATIVE COLITIS
Diagnostic Diagnostic Procedures Procedures Barium enema- Barium enema- sigmoidoscopic appearance sigmoidoscopic appearance of the mucosaof the mucosa
Colon Biopsy & culture to Colon Biopsy & culture to r/o carcinoma & bacterial r/o carcinoma & bacterial diarrheadiarrhea
ULCERATIVE COLITISULCERATIVE COLITIS
ComplicationsComplicationsIntestinal obstructionIntestinal obstructionDehydrationDehydrationFluid & electrolyte Fluid & electrolyte imbalancesimbalances
MalabsorptionMalabsorptionChronic IDAChronic IDA
ULCERATIVE COLITISULCERATIVE COLITISNursing InterventionsNursing Interventions
CBRCBRNPO, IVF or TPN as ordered NPO, IVF or TPN as ordered to progressive diet (CL to to progressive diet (CL to fiber, fiber, CHON, vit. & min.)CHON, vit. & min.)
Avoid gas-forming foods, Avoid gas-forming foods, milk products, wheat grains, milk products, wheat grains, nuts, raw fruits, vegetable, nuts, raw fruits, vegetable, pepper, alcohol & caffeinepepper, alcohol & caffeine
ULCERATIVE COLITISULCERATIVE COLITISNursing InterventionsNursing Interventions
Avoid smokingAvoid smokingMonitor stool color, Monitor stool color, consistency, presence of consistency, presence of bloodblood
WOF perforation, WOF perforation, peritonitis & hemorrhageperitonitis & hemorrhage
ULCERATIVE COLITISULCERATIVE COLITIS
Nursing Nursing InterventionsInterventionsAdminister as orderedAdminister as ordered
Bulk-forming agents: bran, Bulk-forming agents: bran, psyllium, methylcellulosepsyllium, methylcellulose
AntibioticsAntibioticsCorticosteroidsCorticosteroidsImmunosuppressants Immunosuppressants
ULCERATIVE COLITISULCERATIVE COLITISSurgical InterventionsSurgical Interventions
Total proctocolectomy with Total proctocolectomy with permanent ileostomypermanent ileostomyCurative, removal of entire Curative, removal of entire colon, rectum & anus with anal colon, rectum & anus with anal closureclosure
Terminal ileum at RLQ: with Terminal ileum at RLQ: with stomastoma
ULCERATIVE COLITISULCERATIVE COLITISSurgical InterventionsSurgical Interventions
Kock (continent) ileostomyKock (continent) ileostomyIntraabdominal pouch that stores Intraabdominal pouch that stores feces constructed from the terminal feces constructed from the terminal ileumileum
The pouch is connected to the The pouch is connected to the stoma with nipplelike valve; the stoma with nipplelike valve; the stoma is flush with the skinstoma is flush with the skin
Cath. is used to empty the pouch, & Cath. is used to empty the pouch, & a small dressing or adhesive a small dressing or adhesive bandage is worn over the stoma bandage is worn over the stoma between emptyingsbetween emptyings
KOCK’S ILEOSTOMYKOCK’S ILEOSTOMY
ULCERATIVE COLITISULCERATIVE COLITISSurgical InterventionsSurgical Interventions
Ileoanal reservoirIleoanal reservoirA 2-stage procedureA 2-stage procedureInvolves excision of rectal Involves excision of rectal mucosa, an abdominal mucosa, an abdominal colectomy, construction of a colectomy, construction of a reservoir to the anal canal & reservoir to the anal canal & temporary loop ileostomytemporary loop ileostomy
The ileostomy is closed in 3-4 The ileostomy is closed in 3-4 mos. after the capacity of the mos. after the capacity of the reservoir is increasedreservoir is increased
ILEOANAL RESERVOIRILEOANAL RESERVOIR
ULCERATIVE COLITISULCERATIVE COLITISSurgical InterventionsSurgical Interventions
Ileoanal anastomosis Ileoanal anastomosis (Ileorectostomy)(Ileorectostomy)Does not require ileostomyDoes not require ileostomyRequires a large, compliant Requires a large, compliant rectumrectum
A 12- to 15-cm rectal stump is A 12- to 15-cm rectal stump is left after the colon is removed, left after the colon is removed, the SI is inserted into this rectal the SI is inserted into this rectal sleeve & anastomosedsleeve & anastomosed
COLO/ILEOSTOMY PRE-OP CARECOLO/ILEOSTOMY PRE-OP CARE
Consult with enterostomal therapist Consult with enterostomal therapist to identify optimal placement of to identify optimal placement of ostomyostomy
Low-residue diet for 1-2 days pre-opLow-residue diet for 1-2 days pre-opGive intestinal antiseptics & Give intestinal antiseptics &
antibiotics, laxatives & enemas as antibiotics, laxatives & enemas as orderedordered
ILEOSTOMY POST-OP CAREILEOSTOMY POST-OP CARE
Post-op drainage: dark green to Post-op drainage: dark green to yellow (as the pt begins to eat)yellow (as the pt begins to eat)
Expect liquid stoolExpect liquid stoolWOF dehydration & e+ imbalanceWOF dehydration & e+ imbalanceAvoid suppositories through Avoid suppositories through
ileostomyileostomy
COLOSTOMY POST-OP CARECOLOSTOMY POST-OP CAREApply petroleum jelly over the stoma to keep Apply petroleum jelly over the stoma to keep
it moist followed by dry sterile gauze if pouch it moist followed by dry sterile gauze if pouch system is not yet in placesystem is not yet in place
Monitor the stoma for size, unusual bleeding Monitor the stoma for size, unusual bleeding or necrotic tissueor necrotic tissue
Monitor the stoma for color Monitor the stoma for color N: pink or red indicating N: pink or red indicating vascularityvascularityPale: anemia, Violet/Blue/Black: Pale: anemia, Violet/Blue/Black:
compromised circulationcompromised circulation
COLOSTOMY POST-OP CARECOLOSTOMY POST-OP CARECheck pouch system for proper fit & leakageCheck pouch system for proper fit & leakageAscending colon colostomy: expect liquid stoolAscending colon colostomy: expect liquid stoolTransverse colon colostomy: expect loose to Transverse colon colostomy: expect loose to
semiformed stoolsemiformed stoolDescending colon: expect close to N stoolDescending colon: expect close to N stoolEmpty pouch when 1/3 full, remove feces from Empty pouch when 1/3 full, remove feces from
the skinthe skinAvoid gas/odor-forming foodsAvoid gas/odor-forming foods
COLOSTOMY POST-OP CARECOLOSTOMY POST-OP CARE
WOF perineal wound WOF perineal wound infection (if present)infection (if present)
Administer as orderedAdminister as orderedAnalgesics & antibioticsAnalgesics & antibioticsStoma irrigationStoma irrigation
COLOSTOMYCOLOSTOMY
COLOSTOMY APPLIANCECOLOSTOMY APPLIANCE
COLOSTOMY IRRIGATIONCOLOSTOMY IRRIGATIONEnema given through the stoma Enema given through the stoma
to stimulate bowel emptyingto stimulate bowel emptyingDone at the same time each day, Done at the same time each day,
1 hr p.c. by instilling 500-1000ml 1 hr p.c. by instilling 500-1000ml of lukewarm tap water through of lukewarm tap water through the stoma, allowing the water & the stoma, allowing the water & stool to drain into a collection bagstool to drain into a collection bag
COLOSTOMY IRRIGATIONCOLOSTOMY IRRIGATIONIf ambulatory: allow the pt sit on a toiletIf ambulatory: allow the pt sit on a toiletIf bedridden: pt on side-lying positionIf bedridden: pt on side-lying positionHang the irrigation bag with its bottom at the Hang the irrigation bag with its bottom at the
level of the pt’s shoulder or higherlevel of the pt’s shoulder or higherInsert irrigation tube carefullyInsert irrigation tube carefullyBegin the flow of irrigationBegin the flow of irrigationIf cramping occurs, clamp the tubing; release it If cramping occurs, clamp the tubing; release it
as cramping subsidesas cramping subsidesAvoid frequent irrigations with waterAvoid frequent irrigations with water fluid & fluid &
e+ imbalancee+ imbalance
COLOSTOMY IRRIGATIONCOLOSTOMY IRRIGATION
COLOSTOMY IRRIGATIONCOLOSTOMY IRRIGATION
DIVERTICULOSIS & DIVERTICULOSIS & DIVERTICULITISDIVERTICULITIS
DIVERTICULOSIS: DIVERTICULOSIS: outpouching of herniation of outpouching of herniation of the intestinal mucosa, can the intestinal mucosa, can occur in any part of the occur in any part of the intestine (most common in the intestine (most common in the sigmoid colon)sigmoid colon)
DIVERTICULITIS- DIVERTICULITIS- inflammation of one of the inflammation of one of the diverticula when these diverticula when these perforatesperforates peritonitis peritonitis
DIVERTICULOSIS/DIVERTICULITISDIVERTICULOSIS/DIVERTICULITIS
DIVERTICULOSIS & DIVERTICULOSIS & DIVERTICULITISDIVERTICULITIS
Signs & SymptomsSigns & SymptomsLLQ pain esp. when LLQ pain esp. when coughing, straining or coughing, straining or liftinglifting
N/V, flatulence, N/V, flatulence, TTAbdominal distention, Abdominal distention, cramps & tendernesscramps & tenderness
Palpable, tender rectal Palpable, tender rectal massmass
Blood in stoolsBlood in stools
DIVERTICULOSIS & DIVERTICULOSIS & DIVERTICULITISDIVERTICULITIS
Nursing InterventionsNursing InterventionsCBRCBRNPO then progressive diet NPO then progressive diet as orderedas ordered
Diet: If inflammation Diet: If inflammation resolves- Soft, resolves- Soft, fiber foods fiber foods (whole grains), Force fluids(whole grains), Force fluids
If with inflammation: If with inflammation: Avoid Avoid fiber foods (can fiber foods (can irritate the mucosa furtherirritate the mucosa further
DIVERTICULOSIS & DIVERTICULOSIS & DIVERTICULITISDIVERTICULITIS
Nursing InterventionsNursing InterventionsAvoid gas forming-foods, Avoid gas forming-foods, indigestible roughage, seeds indigestible roughage, seeds or nuts (can be trapped in the or nuts (can be trapped in the diverticula & cause diverticula & cause inflammation)inflammation)
Avoid any form of Valsalva Avoid any form of Valsalva maneuvermaneuver
WOF perforation, WOF perforation, hemorrhage, fistulas & hemorrhage, fistulas & abscessesabscesses
DIVERTICULOSIS & DIVERTICULOSIS & DIVERTICULITISDIVERTICULITIS
Nursing InterventionsNursing InterventionsAdminister as orderedAdminister as ordered
AntibioticsAntibioticsAnalgesicsAnalgesicsAnticholinergicsAnticholinergicsSmall amount of bran Small amount of bran ODOD
Bulk-forming laxativesBulk-forming laxatives
DIVERTICULOSIS & DIVERTICULOSIS & DIVERTICULITISDIVERTICULITIS
Surgical InterventionsSurgical InterventionsColon resection with Colon resection with primary anastomosisprimary anastomosis
Temporary or Temporary or permanent colostomy permanent colostomy (for (for bowel bowel inflammation)inflammation)
HEMORRHOIDSHEMORRHOIDSDilated varicose veins of the Dilated varicose veins of the anal canal, caused by portal anal canal, caused by portal HTN, straining, irritation, HTN, straining, irritation, venous or venous or abdominal pressureabdominal pressure
Internal: above the anal Internal: above the anal sphincter (can’t be seen on sphincter (can’t be seen on inspection of the perianal area)inspection of the perianal area)
External: below the anal External: below the anal sphinctersphincter
Prolapsed: can become Prolapsed: can become thrombosed or inflammedthrombosed or inflammed
HEMORRHOIDSHEMORRHOIDSSigns & SymptomsSigns & Symptoms
Bright red bleeding Bright red bleeding with defecationwith defecation
Rectal pain & itchingRectal pain & itching
HEMORRHOIDSHEMORRHOIDSNursing InterventionsNursing Interventions
Cold packs followed by Cold packs followed by Sitz bath as orderedSitz bath as ordered
Apply witch hazel soaks & Apply witch hazel soaks & topical anesthetics as topical anesthetics as orderedordered
Stool softeners as orderedStool softeners as orderedfiber-diet, force fluidsfiber-diet, force fluids
HEMORRHOIDSHEMORRHOIDSEndoscopic proceduresEndoscopic procedures
SclerotherapySclerotherapyEndoscopic ligationEndoscopic ligation
Surgical interventionsSurgical interventionsCryosurgeryCryosurgeryHemorrhoidectomyHemorrhoidectomy
HEMORRHOIDSHEMORRHOIDSPost-op Nursing Interventions Post-op Nursing Interventions
Position: prone or side-lyingPosition: prone or side-lyingIce packs over dressing as Ice packs over dressing as orderedordered
fiber-diet, force fluidsfiber-diet, force fluidsStool softeners as orderedStool softeners as orderedLimit sitting to short Limit sitting to short periods of timeperiods of time
Sitz bath 3-4X/day as Sitz bath 3-4X/day as orderedordered
WOF urinary retentionWOF urinary retention
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionWhen assessing a pt When assessing a pt who underwent who underwent colostomy several colostomy several months ago, a nurse months ago, a nurse would expect the would expect the stoma to appearstoma to appear
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. dryA. dry
B. redB. red
C. edematousC. edematous
D. retractedD. retracted
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
Which of the following Which of the following statements would a statements would a nurse include in the pre-nurse include in the pre-operative instructions operative instructions for a pt who is scheduled for a pt who is scheduled for an ileostomy?for an ileostomy?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. “Your urine will be collected in A. “Your urine will be collected in a pouch subsequent to surgery.”a pouch subsequent to surgery.”
B. “Your bowel will be visualized B. “Your bowel will be visualized with a laparoscope during with a laparoscope during surgery.”surgery.”
C. “You will have a NGT in your C. “You will have a NGT in your nose after surgery.”nose after surgery.”
D. “You can drink liquids within 24 D. “You can drink liquids within 24 hours following surgery.”hours following surgery.”
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
Which of the following Which of the following assessment techniques assessment techniques should a nurse use to should a nurse use to determine the determine the appropriate placement appropriate placement of NGT? of NGT?
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionA. Aspirating drainage A. Aspirating drainage through the NGTthrough the NGT
B. Auscultating for bowel B. Auscultating for bowel soundssounds
C. Palpating over the C. Palpating over the epigastric regionepigastric region
D. Inserting the open end of D. Inserting the open end of the NGT into waterthe NGT into water
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A RN would instruct a A RN would instruct a pt who had an pt who had an ileostomy to avoid ileostomy to avoid which of the following which of the following food?food?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. potatoesA. potatoes
B. beefB. beef
C. popcornC. popcorn
D. yogurtD. yogurt
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
Which of the following Which of the following serum lab results serum lab results would a nurse expect would a nurse expect to identify in a pt who to identify in a pt who has pancreatitis?has pancreatitis?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. A. cholesterol cholesterol
B. B. glucose glucose
C. C. amylase amylase
D. D. creatinine creatinine
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionWhich of the following Which of the following questions would be most questions would be most important for a nurse to ask important for a nurse to ask when gathering data from a when gathering data from a pt who is suspected of pt who is suspected of having acute pancreatitis?having acute pancreatitis?
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionA. “Have you had a recent blood A. “Have you had a recent blood work-up?”work-up?”
B. “Do you have a hx of diabetes?”B. “Do you have a hx of diabetes?”
C. “When was your last bowel C. “When was your last bowel movement.”movement.”
D. “How much alcohol do you drink D. “How much alcohol do you drink in a week?”in a week?”
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionThe nurse is caring for a pt The nurse is caring for a pt with a dx of pancreatitis. with a dx of pancreatitis. All of the following meds All of the following meds are ordered for the pt. are ordered for the pt. Which one should the Which one should the nurse question?nurse question?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. Meperidine HCl (Demerol)A. Meperidine HCl (Demerol)
B. Morphine SO4B. Morphine SO4
C. Propantheline Br C. Propantheline Br
(Pro-Banthine)(Pro-Banthine)
D. Cimetidine (Tagamet)D. Cimetidine (Tagamet)
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
The nurse should The nurse should teach a pt who has teach a pt who has acute pancreatitis to acute pancreatitis to avoid which of the avoid which of the following foods?following foods?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. Pasta & tomato juiceA. Pasta & tomato juice
B. Rice & green beansB. Rice & green beans
C. Steak & baked potatoC. Steak & baked potato
D. Bread & baked appleD. Bread & baked apple
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionWhich of the following Which of the following factors, if noted in a pt’s factors, if noted in a pt’s hx, would indicate a hx, would indicate a predisposition for predisposition for developing cholecystitis?developing cholecystitis?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. obesityA. obesity
B. hypertensionB. hypertension
C. depressionC. depression
D. childlessnessD. childlessness
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionA 10-y/o boy is admitted A 10-y/o boy is admitted to the hospital with a hx to the hospital with a hx of fever & RLQ of fever & RLQ abdominal pain. Which abdominal pain. Which of the following comfort of the following comfort measures would be measures would be taken until a dx is made?taken until a dx is made?
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionA. maintain the child in A. maintain the child in recumbent positionrecumbent position
B. apply warm compress to the B. apply warm compress to the affected areaaffected area
C. obtain an order for an age C. obtain an order for an age appropriate analgesicappropriate analgesic
D. distract the child with an age D. distract the child with an age appropriate videoappropriate video
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
When a 12-year old child When a 12-year old child has a dx of appendicitis, has a dx of appendicitis, which of the following which of the following manifestations would be manifestations would be most important for the most important for the RN to follow-up?RN to follow-up?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. tympanic temp of 101.2 F A. tympanic temp of 101.2 F (38.4 C)(38.4 C)
B. absence of stool for 24 hrsB. absence of stool for 24 hrs
C. nausea when exposed to C. nausea when exposed to food odorsfood odors
D. cessation of abdominal D. cessation of abdominal painpain
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
Which of the following Which of the following statements, if made by a pt statements, if made by a pt who has gastroesophageal who has gastroesophageal reflux disease (GERD), reflux disease (GERD), would support a nursing dx would support a nursing dx of Knowledge Deficit?of Knowledge Deficit?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. “I will lie down for 30 minutes A. “I will lie down for 30 minutes after meals.”after meals.”
B. “I will restrict spicy foods in my B. “I will restrict spicy foods in my diet.”diet.”
C. “I should sleep with the head of C. “I should sleep with the head of the bed elevated.”the bed elevated.”
D. “I should decrease my intake of D. “I should decrease my intake of caffeine.”caffeine.”
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
Which of the following Which of the following findings in a pt who has findings in a pt who has Chron’s disease would Chron’s disease would indicate that indicate that corticosteroid therapy corticosteroid therapy has been effective?has been effective?
CGFNS/NCLEX QuestionCGFNS/NCLEX QuestionA. expansion of muscle massA. expansion of muscle mass
B. increase in the bulk of B. increase in the bulk of stoolstool
C. moon-like appearance of C. moon-like appearance of the facethe face
D. decreased complaints of D. decreased complaints of abdominal painabdominal pain
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
Which of the following Which of the following explanations should a explanations should a nurse give to a pt nurse give to a pt regarding the primary regarding the primary cause of peptic ulcer cause of peptic ulcer disease?disease?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. “A spicy diet contributes to ulcer A. “A spicy diet contributes to ulcer development.”development.”
B. “Seasonal changes are B. “Seasonal changes are associated with ulcer disease.”associated with ulcer disease.”
C. “Executive job positions C. “Executive job positions predispose people to ulcer predispose people to ulcer formation.”formation.”
D. “Infection with Helicobacter D. “Infection with Helicobacter pylori causes ulcers.”pylori causes ulcers.”
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
The nurse should The nurse should monitor a pt who is monitor a pt who is receiving lactulose receiving lactulose (Cephulac) for which of (Cephulac) for which of the following adverse the following adverse side effects?side effects?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. DiarrheaA. Diarrhea
B. PetechiaeB. Petechiae
C. PolyuriaC. Polyuria
D. FlushingD. Flushing
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A nurse should expect a A nurse should expect a Sengstaken Blakemore Sengstaken Blakemore tube to be ordered for a tube to be ordered for a pt who has bleeding pt who has bleeding esophageal varices in esophageal varices in order toorder to
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. cause vasoconstriction to A. cause vasoconstriction to the splenic arterythe splenic artery
B. ensure airway patencyB. ensure airway patency
C. provide for enteral C. provide for enteral nutritionnutrition
D. apply direct pressure to D. apply direct pressure to the areathe area
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
Which of the following Which of the following nursing measures would nursing measures would be most appropriate for be most appropriate for a pt who has ascites?a pt who has ascites?
CGFNS/NCLEX QuestionCGFNS/NCLEX Question
A. withholding fluidsA. withholding fluids
B. measuring abdominal B. measuring abdominal girthgirth
C. encouraging ambulationC. encouraging ambulation
D. monitoring for pedal D. monitoring for pedal edemaedema