Gastrointestinal Disorders Review

GASTROINTESTINAL DISORDERS NCLEX - RN

REVIEW

11/14/2008

BY NIO C. NOVENO, RN, MAN 1

Gastrointestinal DisordersRN REVIEW

Nio C. Noveno, RN, MAN

REVIEW OF PARTS & FUNCTIONS

GI DISORDERS 2

G I T

THE MAJOR PARTS

�MOUTH / ESOPHAGUS

�STOMACH

�SMALL INTESTINE

�LARGE

INTESTINE

ACCESSORY ORGANS

�PANCREAS

�LIVER

�GALLBLADDER

GI DISORDERS 3

GI DISORDERS

GI DISORDERS 4


REVIEW

11/14/2008


STOMATITIS

CAUSES• INFECTIONS• IRRITANTS• CHEMOTHERAPY

DIAGNOSIS• C & S

TREATMENT• XYLOCAINE• ANTIBIOTICS• BLAND DIET

GI DISORDERS 5

NURSING DIAGNOSES

• PAIN

• IMBALANCED NUTRITION

• IMPAIRED ORAL MUCOUS

MEMBRANE

ESOPHAGEALVARICES

• MOST COMMONLOCATION

– DISTALVEINS OF THEESOPHAGUS

– OFTEN DUE TO CIRRHOSIS

*WALLS OF THEVEINSWEAKEN

– WOF: BLEEDING & ULCERATION

GI DISORDERS 6

ESOPHAGEALVARICESMEDICAL MANAGEMENT

1. SCLEROTHERAPY

2. LIGATION

3. BALLOONTAMPONADE

GI DISORDERS 7

IFVARICESAREACTIVELY BLEEDING

SENGSTAKEN-BLAKEMORETUBE MINNESOTA TUBE

GI DISORDERS 8


REVIEW

11/14/2008


ESOPHAGEALVARICESSURGICAL MANAGEMENT

TTRANSJUGULAR

IINTRAHEPATIC

PPORTOSYSTEMIC

SSHUNT

• USES THE RIGHT INTERNALJUGULARVEIN

• CONNECTION BETWEEN

HEPATIC & PORTALVEINS

• DONE IN X-RAY

GI DISORDERS 9

ESOPHAGEALVARICESPHARMACOLOGICAL MANAGEMENT

• OCREOTIDE (SANDOSTATIN) I.V.– DECREASES BLOOD FLOW

• ANALGESICS

• SUCRALFATE (CARAFATE)

• I.V. REHYDRATION

• AVOID:– ASPIRINS, NSAIDS, ANTICOAGULANTS

GI DISORDERS 10

ESOPHAGEALVARICESNURSING MANAGEMENT

• RISK FOR FLUIDVOLUME DEFICIT

• DEFICIENT FLUIDVOLUME

• ANXIETY

GI DISORDERS 11

GASTROESOPHAGEAL REFLUX DISEASE

POSSIBLE CAUSES:

1. FATTY FOODS

2. CAFFEINE

3. NICOTINE

4. CCBS

5. NSAIDS

GI DISORDERS 12


REVIEW

11/14/2008


GASTROESOPHAGEAL REFLUX DISEASE

SIGNS & SYMPTOMS

• BELCHING

• FLATULENCE

• ESOPHAGITIS

• DYSPHAGIA

• EPIGASTRIC PAIN

• HEARTBURN

• BLEEDING

• MELENA

NURSING CONSIDERATIONS

1. INSTRUCT PT TO LOSE

WEIGHT

2. AVOID FATTY FOODS, ALCOHOL, NICOTINE, CAFFEINE, SPICY FOODS

3. TAKE MEDICATIONS AS RX

4. ELEVATE HOB

5. AVOIDWEARINGCONSTRICTIVE CLOTHING

GI DISORDERS 13

GASTROESOPHAGEAL REFLUX DISEASEMANAGEMENT

FUNDOPLICATION SURGERY

A LAPAROSCOPIC PROCEDURE

DONE TOTIGHTEN THE LES

– FUNDUS OF THE STOMACH ISWRAPPED & SUTURED AROUNDTHE ESOPHAGUS

GI DISORDERS 14

PEPTIC ULCERS

GI DISORDERS 15

GASTRIC ULCER DUODENAL ULCER

INCIDENCELESS COMMON

55-77 YO

MORE COMMON

30-50 YO

BLEEDING MORE LIKELY LESS LIKELY

PERFORATION LESS LIKELY MORE LIKELY

PAIN RELIEFFOOD INCREASES PAIN;

WEIGHT LOSS

FOOD RELIEVES PAIN;

WEIGHT GAIN

PAIN PATTERN

PAIN: ½ - 1 H AFTER A MEAL;

RARELY OCCURS AT NIGHT;

MAY BE RELIEVED BY

VOMITING

PAIN: 2-3 H;

OFTEN AWAKENED AT1-2 AM

MALIGNANCY OCCASIONALLY RAREGI DISORDERS 16


REVIEW

11/14/2008


PEPTIC ULCER DISEASE

CAMPYLOBACTER PYLORI OR HELICOBACTER PYLORI

ZOLLINGER-ELLISON SYNDROME [GASTRINOMA]

AASPIRIN, SSTEROIDS, INDOMETHACIN, NSAIDS

SMOKING

PERSONALITY

GI DISORDERS17


GNAWING OR BURNING EPIGASTRIC PAINTHAT OCCURS 1 TO 2 HOURS AFTER EATING

ERUCTATION, VOMITING, FOOD, OR ANTACIDS

NAUSEA

BLEEDING[COLOR PULSE TEMPERATURE]

VOMITING

GI DISORDERS 18


DIAGNOSIS

GI DISORDERS 19


SURGICAL MANAGEMENT

GI DISORDERS 20


REVIEW

11/14/2008



NURSING MANAGEMENT

PREOPERATIVE POSTOPERATIVE

GI DISORDERS 21

PEPTIC ULCER DISEASE:

THERAPEUTIC INTERVENTIONS

THERE IS ANID NID NID NID NID NID NID NID TO:

NNNNNNNNEUTRALIZE OR BUFFER HYDROCHLORIC ACID

IIIIIIIINHIBIT ACID SECRETION

DDDDDDDDECREASE THE ACTIVITY OF PEPSIN AND HCL

CALCIUM AND IRON SUPPLEMENTS

[IF MEDICATION INCREASES GASTRIC PH]

GI [email protected] 22

GERD & ULCERSPHARMACOLOGICAL MANAGEMENT

MEDICATION PURPOSE NURSING IMPLICATIONS

ANTACIDS•ALUMINUMOH (AMPHOGEL)•ALUMINUMOH & MAGNESIUM OH (MAALOX)•DIHYDROXYALUMINUM SODIUM(ROLAIDS)

SEAL IMPAIRED MUCOSA

NEUTRALIZEACIDS

CONSTIPATIONDIARRHEAMONAKAVOID GIVINGWITH OTHER MEDS

H2BLOCKERS•RANITIDINE HCL (ZANTAC)•CIMETIDINE (TAGAMET)•NIZATIDINE (AXID)•FAMOTIDINE (PEPCID)

DECREASE GASTRICACIDSECRETION

DO NOT GIVEWITHANTACIDS

PROTON PUMP INHIBITOR

•OMEPRAZOLE (LOSEC)•ESOMEPRAZOLE (NEXIUM)•LANSOPRAZOLE (ZOTON)•PANTOPRAZOLE (PROTIUM)•RABEPRAZOLE SODIUM (PARIET)

STOP GASTRIC ACIDPRODUCTION

INCREASE EFFECTS OF PHENYTOIN, WARFARIN, DIAZEPAMDELAYSABSORPTION OFVALIUM

PROSTAGLANDINS•MISOPROSTOL (CYTOTEC)

DECREASE GASTRICACIDSECRETION

ENHANCES MUCOSAL DEFENSESNSAID-INDUCED ULCERS

BISMUTH COMPOUNDS•BISMUTH SUBSALICYLATE (PEPTO-BISMOL)

INHIBITS H. PYLORI GROWTH

ANTIBIOTICS•AMPICILLIN (OMNIPEN)•METRONIDAZOLE (FLAGYL)

ELIMINATE H. PYLORI TAKENWITH FOODGI DISORDERS 23


DIETARY MANAGEMENT

GI DISORDERS 24


REVIEW

11/14/2008



TYPE AND CROSS-MATCH[GASTRIC HEMORRHAGE]

NGT & SALINE LAVAGE / VASOCONSTRICTORS[CONTROL BLEEDING ]

TTTTTTTTRANQUILIZERSAAAAAAAANTICHOLINERGICS

AAAAAAAANALGESICS

SSSSSSSSEDATIVES[PAIN AND RESTLESSNESS]

GI DISORDERS 25


ANTIEMETICS

[NAUSEA AND VOMITING]

ANTIBIOTICS: TETRACYCLINE, METRONIDAZOLE, AND BISMUTH

BED REST

[REDUCE PHYSICAL ACTIVITY]

COUNSELING OR PSYCHOTHERAPY

[EXPLORE THE EMOTIONAL COMPONENTS OF THE ILLNESS]

GI DISORDERS 26

PEPTIC ULCER DISEASE: NURSE IT!

1. ALLOW EXPRESSION OF FEELINGS AND CONCERNS

2. ADMINISTER AND ASSESS EFFECTS OF MEDICATIONS

3. ENCOURAGE HYDRATION

a. REDUCES ANTICHOLINERGIC SE

b. DILUTE THE HCL IN THE STOMACH

4. EAT SMALL TO MEDIUM-SIZED MEALS

5. REPLACE WITH DECAFFEINATED SOFT DRINKS AND TEAS

6. USE SEASONINGS LIKE THYME, BASIL, SAGE

7. AVOID SALICYLATES, PHENYLBUTAZONE, STEROIDS, ACTH

GI DISORDERS 27


MVS; MIO

ASSESS THE DRESSING FOR DRAINAGE

MAINTAIN A PATENT NGT TO THE SUCTION APPARATUS[PREVENT STRESS ON THE SUTURE LINE]

OBSERVE THE COLOR AND AMOUNT OF NG DRAINAGE[BRIGHT RED BLOOD AFTER 12 HOURS SHOULD BE REPORTED]

COUGH, DEEP BREATHE, & CHANGE POSITION FREQUENTLYAPPLY ANTIEMBOLISM STOCKINGS & AMBULATE

GI DISORDERS 28


REVIEW

11/14/2008



TO PREVENT DUMPING SYNDROME:

FREQUENT FEEDINGS OF SMALL AMOUNTS

AVOID HIGH-CHO INTAKE

CONSUME LIQUIDS ONLY BETWEEN MEALS

(AT LEAST 1 HOUR BEFORE OR AFTER MEALS)

LIE DOWN OR REST AFTER EATING

PECTIN OR GUAR GUM (5-G DOSE) WITH MEALS

[WATER-SOLUBLE FIBER WHICH DELAYS GASTRIC EMPTYING ANDABSORPTION OF CARBOHYDRATES

GI DISORDERS 29

U L C E RUUUUPSET STOMACH

LLLLOW APPETITE

CCCCAUSES:

CHEMICALS, COFFEE, ALCOHOL, ALLERGENS, UREMIA, BACTERIA, DRUGS, SMOKING, STRESS, SPICES

EEEEMESIS

RRRREDUCE ACID

ANTI-ACID MEDICATIONS

CARAFATE

IRRITANTS

Decompression

GI DISORDERS 30

APPENDICITISTHE CAUSES…• OBSTRUCTION

– LYMPHOID HYPERPLASIA (RELATED TOVIRAL ILLNESSES, INCLUDING UPPER RESPIRATORY INFECTION, MONONUCLEOSIS, GASTROENTERITIS)

– FECALITHS– PARASITES– FOREIGN BODIES

– CROHN‘S DISEASE– PRIMARY OR METASTATIC CANCER AND CARCINOIDSYNDROME

– LYMPHOID HYPERPLASIA IS MORE COMMON IN CHILDRENANDYOUNGADULTS

GI DISORDERS 31

COMMON SIGNSOFAPPENDICITIS

OTHER CONFIRMATORY PERITONEAL SIGNS

(ABSENCE OF THESE SIGNS DOES NOT EXCLUDE APPENDICITIS)

• RIGHT LOWER QUADRANT PAIN ON

PALPATION (THE SINGLE MOST

IMPORTANT SIGN)

• LOW-GRADE FEVER (38°C [OR100.4°F])

• PERITONEAL SIGNS

• LOCALIZEDTENDERNESSTOPERCUSSION

• GUARDING

• PSOAS SIGN--PAIN ON EXTENSION OF

RIGHTTHIGH (RETROPERITONEALRETROCECAL APPENDIX)

• OBTURATOR SIGN--PAIN ON INTERNAL

ROTATION OF RIGHT THIGH (PELVICAPPENDIX)

• ROVSING'S SIGN--PAIN IN RIGHT LOWER

QUADRANTWITH PALPATION OF LEFT

LOWER QUADRANT

• DUNPHY'S SIGN--INCREASED PAINWITH

COUGHING

• FLANKTENDERNESS IN RIGHT LOWER

QUADRANT (RETROPERITONEALRETROCECAL APPENDIX)

• PATIENT MAINTAINS HIP FLEXIONWITHKNEES DRAWN UP FOR COMFORT

GI DISORDERS 32


REVIEW

11/14/2008


APPENDICITIS

ABDOMINAL PAIN

ANOREXIA

NAUSEA

VOMITING

PAIN MIGRATION

CLASSIC SYMPTOM SEQUENCE

• VAGUE PERIUMBILICAL PAIN TO ANOREXIA/NAUSEA/ UNSUSTAINEDVOMITING TO MIGRATION OF PAIN TO RIGHT LOWER QUADRANT

TO LOW-GRADE FEVER

GI DISORDERS 33

APPENDICITISNURSING IMPLICATIONS

1. PAIN:– NO ANALGESICS

– NOWARM COMPRESS

– NO ENEMA

– RUPTURED APPENDIX• NO PAIN

• POSITION HOB

• REFER STAT!

2. DIET– NPO STATUS

• LONGERWITH PERITONITIS

• NGT INSERTION

– CLEAR TO REGULAR DIET

AFTER SURGERY

3. ACTIVITY– TURNING

– DEEP BREATHING & COUGHING EXERCISES

WITH SPLINTING

GI DISORDERS 34

DIVERTICULAR DISEASES

DIVERTICULOSIS DIVERTICULITIS

• MULTIPLE DIVERTICULA AREPRESENT

• LOW FIBER DIET

• 30-40% OF ELDERLYPOPULATION

• ASYMPTOMATIC

GI DISORDERS 35

•INFLAMMATION OF ONE OR

MORE DIVERTICULA

•SIGMOID COLON

•STOOL IMPACTED IN THE

DIVERTICULA

DIVERTICULAR DISEASES

DIVERTICULOSIS

• RECURRENT LLQ PAIN

• RELIEVED BY DEFECATION OR

PASSAGE OF FLATULENCE

• ALTERNATING CONSTIPATION

& DIARRHEA

DIVERTICULITIS

• MODERATE LLQ PAIN

• MILD NAUSEA, GAS

• IRREGULAR BOWEL HABITS

• LOW-GRADE FEVER

• INCREASEDWBC

• RUPTURE (IF SEVERE)

• FIBROSIS & ADHESIONS (CHRONICDIVERTICULITIS)

GI DISORDERS 36


REVIEW

11/14/2008


DIVERTICULAR DISEASESNURSING MANAGEMENT

FOR DIVERTICULSOSIS

1. BLAND OR LIQUID DIET

2. HIGH-RESIDUE DIET

3. PSYLLIUM

– ABSORBSWATER AND EXPANDTO PROVIDE

INCREASED BULK IN STOOL

– ENCOURAGES NORMAL PERISTALSIS AND BOWEL

MOTILITY

GI DISORDERS 37


FOR DIVERTICULITIS

1. WITHOUT PERFORATION

a. PREVENT CONSTIPATION & INFECTION• BED REST

• LIQUID DIET

• STOOL SOFTENERS

• BROAD-SPECTRUM ANTIBIOTICS

• MEPERIDINE

• DICYCLOMINE (BENTYL, BYCLOMINE, DIBENT, DI-SPAZ, DILOMINE)

• HYOSCYAMINE (LEVSIN® /SL TABLETS)

GI DISORDERS 38


2. COLON RESECTION

3. COLOSTOMY

4. F & E MONITORING

5. WOF SIGNS OF BLEEDING

– ANGIOGRAPHY

– VASOPRESSIN

GI DISORDERS 39

ABDOMINALAPPLIANCE

COLOSTOMY ILEOSTOMY

GI DISORDERS 40


REVIEW

11/14/2008


INFLAMMATORY BOWEL DISEASEPARAMETER CROHN’S ULCERATIVE COLITIS

INVOLVEMENT SMALL & LARGE INTESTINELOWER COLON ONLY

(THEN, ASCENDS)

TISSUE AFFECTED ENTIRE THICKNESS MUCOSA

LONG-TERM

COMPLICATIONS

OBSTRUCTION, FISTULAS, ABSCESSES, PERFORATIONCANCER RISK INCREASES WITHAGE

FISSURES, ABSCESSES, INCREASED RISK OF

COLORECTAL CANCER

SURGICAL

INTERVENTION

DOES NOT CURE OR LIMIT THEDISEASE

CURES THE DISEASE

CAUSEUNKNOWN; ALTERED IMMUNE

STATE

UNKNOWN; E. COLIINFECTION

STOOLS3-4 SEMISOFT/DAY; STEATORRHEIC AND MUCOID

15-20 LIQUID/DAY; BLOODYGI DISORDERS 41

INFLAMMATORY BOWEL DISEASE

PHARMACOLOGY

• 5-ASA COMPOUNDS

– SULFAZALAZINE (AZULFIDINE)

– MESALAMINE (ROWASA, PENTASA, ASACOL)

– OLSALAZINE SODIUM(DIPENTUM)

• CORTICOSTEROIDS

• IMMUNOSUPPRESANTS

• IVF REPLACEMENT

• TPN

DIET

• HIGH PROTEIN

• INCREASE FE & VIT B12

• LOW-RESIDUE DIET

• HIGH PROTEIN DIET

• LOW FAT

GI DISORDERS 42

ADVERSE EVENTS

HEADACHE

PHOTOSENSITIVITY

SERUM SICKNESS-LIKE SYNDROME

GIT DISTURBANCE

ORANGE-YELLOW DISCOLORATION

IRRITABLE BOWEL SYNDROME

REFERTO A GROUP OF SYMPTOMS:

ABDOMINAL PAIN

BLOATING

CONSTIPATION / CRAMPING

DIARRHEA

GI DISORDERS 43

IRRITABLE BOWEL SYNDROMECRITERIA FOR DIAGNOSIS

1. ABDOMINAL PAIN OR DISCOMFORT

– AT LEAST 12 WEEKS OUT OF THE PREVIOUS 12 MONTHS

2. AT LEAST 2 OF THE FOLLOWING:

a. PAIN IS RELIEVED BY BM

b. WITH PAIN, BM PATTERN CHANGES

c. WITH PAIN, STOOL CHARACTERISTICS CHANGE

GI DISORDERS 44


REVIEW

11/14/2008


IRRITABLE BOWEL SYNDROMEMEDICAL MANAGEMENT

1. ANTICHOLINERGIC A.C.

2. TEGASEROD MALEATE (ZELNORM) X 4 WEEKS

3. PSYLLIUM (METAMUCIL)

4. ALOSETRON HCL (LOTRONEX)

GI DISORDERS 45

IRRITABLE BOWEL SYNDROMEDIETARY MANAGEMENT

AVOID THE FOLLOWING

ALCOHOL

BARLEY

CAFFEINATED DRINKS

CHOCOLATES

MILK PRODUCTS

RYE & WHEAT

GI DISORDERS 46

IRRITABLE BOWEL SYNDROMEDIETARY MANAGEMENT

MAKE SURE TO…

1. TEACHTHE CLIENTTO LIST DOWN FOOD EATEN

2. EAT 5-6 TIMES; SMALL, FREQUENT FEEDINGS

3. EXERCISE REGULARLY

4. PROMOTE STRESS RELIEF

GI DISORDERS 47

INTESTINAL OBSTRUCTION

VOLVULUS

INTUSSUSCEPTION

ADHESIONS

GI DISORDERS 48


REVIEW

11/14/2008


INTESTINAL OBSTRUCTION

1. NEUROGENIC OBSTRUCTION

– PARALYTIC ILEUS

• TRAUMA

• INFECTION

• MEDICATION

2. VASCULAR OBSTRUCTION

– ATHEROSCLEROSIS

– NECROSIS

GI DISORDERS 49

INTESTINAL OBSTRUCTIONMANAGEMENT

1. MEDICAL

– NG DECOMPRESSION

– IV REHYDRATION

– ENEMAS

2. SURGERY

– BOWEL RESECTION

GI DISORDERS 50

HERNIAS

LOCATION TYPES

GI DISORDERS 51

HERNIASMANAGEMENT

1. SURGERY

– HERNIORRHAPHY

– BOWEL RESECTION

2. DIET

– SMALL, FREQUENT FEEDINGS

– LIE DOWN FOR 2 HOURS AFTER EATING

– AVOID HIGHLY IRRITATING FOODS

GI DISORDERS 52


REVIEW

11/14/2008


HEMORRHOIDS

EXTERNAL INTERNAL

GI DISORDERS 53

HEMORRHOIDSMANAGEMENT

1. MEDICAL

– HOT SITZ ORWARM COMPRESS X 20 MINUTES, 4 TIMES A DAY

2. SURGERY

– HEMORRHODECTOMY

• EXTERNAL: OPD

• INTERNAL: OVERNIGHT

– SCLEROTHERAPY, CRYOTHERAPY, LASER

GI DISORDERS 54

HEMORRHOIDSMANAGEMENT

3. PHARMACOLOGY

– CREAMS & SUPPOSITORIES

– CORTICOSTEROIDS

4. DIET

– 20-30 GRAMS OF FIBER/DAY

– 2.5 L OF FLUID PER DAY

GI DISORDERS 55

ACCESSORY ORGANS

DISORDERS OF THE

GI DISORDERS 56


REVIEW

11/14/2008


LIVER FUNCTIONS

� Storage of vitamin A, B, D; iron and copper

� Synthesis of plasma proteins, including albumin and globulins

� Synthesis of clotting factors, vitamin K and prothrombin

� Storage of glycogen and synthesis of glucose from other nutrients

� Breakdown of fatty acids for energy

� Production of bile

� Detoxification and excretion of waste products

CAUSES OF CIRRHOSIS

1. LAENNEC’S [OR, PORTAL ,NUTRITIONAL, ALCOHOLIC]

2. BILIARY

3. PIGMENT

4. DRUG- / TOXIN-INDUCED

GI DISORDERS 58

CIRRHOSIS

GI DISORDERS 59

CIRRHOSISASSESSMENT

1. CNS– PROGRESSIVE SIGNS OF HEP ENCEPH

• LETHARGY, MENTAL CHANGES, SLURRED SPEECH & ASTERIXIS, PERIPHERAL NEURITIS, PARANOIA, HALLUCINATIONS, COMA

2. GIT– ANOREXIA, INDIGESTION, N & V, CONSTIPATION OR

DIARRHEA, DULL ABDOMINAL PAIN

3. RESPIRATORY– PLEURAL EFFUSION

GI DISORDERS 60


REVIEW

11/14/2008


CIRRHOSISASSESSMENT

4. HEMATOLOGIC

5. ENDOCRINE

– “FEMINIZATION”

6. SKIN

– JAUNDICE, PRURITUS, DRYNESS, SPIDER ANGIOMAS, PALMAR ERYTHEMA,

GI DISORDERS 61

CIRRHOSISASSESSMENT

ADDITIONAL DATA

1. MUSTY BREATH

2. CAPUT MEDUSAE

3. MUSCLE ATROPHY

4. RUQ PAIN AGGRAVATED BY SITTING OR LEANING

5. PALPABLE SPLEEN

6. T: 1010TO 1030 F (38.30TO 39.40 C )

7. ESOPHAGEALVARICESWITH BLEEDING

GI DISORDERS 62

DIAGNOSIS OF CIRRHOSIS

1. LIVER BIOPSY

2. LIVER SCAN

3. CHOLECYSTOGRAPHY & CHOLANGIOGRAPHY

4. CT SCAN

5. HEMATOLOGIC TESTS

6. ABNORMAL GTT

7. URINE TESTS

8. FECALYSIS

GI DISORDERS 63

TREATMENT OF CIRRHOSIS

AIMS OFTREATMENT

1. ALLEVIATE THE CAUSE

2. PREVENT FURTHER DAMAGE

3. PREVENT OR TREAT COMPLICATIONS

GI DISORDERS 64


REVIEW

11/14/2008



1. VARICEAL BLEEDING– MEDICATIONS

– BALLOONTAMPONADE

– SURGERY

2. DIET– HIGH PROTEIN [NOTWITH HEP ENCEPH]

– NA RESTRICTION [200 – 500 MG/D]

– FLUID RESTRICTION [1 – 1.5 L/D]

GI DISORDERS 65


2. DIET CONT…

– TPN [WITH DETERIORATION]

– A, B COMPLEX, C, K

– VIT B12, FOLIC ACID & THIAMINE

3. ACTIVITIES

– REST & MODERATE EXERCISE

GI DISORDERS 66


4. ANTIEMETICS– TRIMETHOBENZAMIDE (TIGAN, TEBAMIDE)

– BENZQUINAMIDE (BZQ, BENZCHINAMIDE, EMETICON, PROMECON, QUANTRIL)

5. VASOPRESSIN

6. DIURETICS– FUROSEMIDE & SPIRONOLACTONE

GI DISORDERS 67


7. PARACENTESIS

8. LEVEEN SHUNT

9. SURGERY

10. LIVER TRANSPLANT

11. LIFESTYLE MANAGEMENT

GI DISORDERS 68


REVIEW

11/14/2008


VIRAL HEPATITIS

HEPATOTROPIC VIRUSES

HEPATITIS VIRUSA-E AND G

HEPATITIS B (HEPADNA): DNA VIRUS

RNA VIRUSES:

HEPATITISA (PICORNAVIRUS)

HEPATITIS C (FLAVIVIRUS)

HEPATITIS E (CALICIVIRUS)

HEPATITIS G

HEPATITIS D: INCOMPLETE RNA VIRUS

GI DISORDERS 69

SYMPTOMS OF ACUTEVIRAL HEPATITIS

NONSPECIFIC SIGNS & SYMPTOMS

LOSS OF APPETITE NAUSEA FATIGUE MILD FEVER

JAUNDICE DARK URINE

CLAY-COLORED STOOLS (LIGHTYELLOW)

GI DISORDERS 70

LABORATORY STUDIES

↑AST / ALT [3 – 5 TIMES > N]

AST > 1000 U / L IS COMMON IN SEVERE HEPATITIS

[REVERSIBLE OVER SEVERAL MONTHS]

MODEST ↑ INALKALINE PHOSPHATASE & GGT

VARIABLE INCREASE IN BILIRUBIN

BILIRUBIN IN URINE

GI DISORDERS 71

A B C D E

TRANSMISSION

FECAL-ORAL

BLOOD & FLUIDS

BLOODBLOOD; NEEDLES

FECAL-ORAL

INCUBATION 15-50 45-160 14-180 15-60 15-60

INFECTIOUS PERIOD

<2 MOS BEFORE SX APPEAR NOT DETERMINED

DXTESTIGM; ANTIHAV

HBSAGSERUMALTINC 10X

IGG ANTIHDV / IGM ANTIHDV

NONE

PREVENTION

SP, ENTERICPRECAUTIO

NS; HEPA VAC; IG

SP; SAFEPRACTICES; HEPB VAC; IG

SP; REDUCERISK

BEHAVIOR; NOVAC

SP; REDUCERISK; HEP B VAC

SP; NOVAC

TREATMENTIG IN 2 WEEKS

HBIGALPHA

INTERFERON

LAMIVUDINE(EPIVI HBV)

ADEFOVIRDIPIVOXIL (HEPSERA)

PERINTERFERONALFA

2A(PEGASYS)RIBAVIRIN(VIRAZOLE)

ALPHAINTERFERON NONE

GI DISORDERS 72


REVIEW

11/14/2008


HEPATITIS

OTHER CAUSES OF HEPATITIS

CHEMICAL AGENTS [I.E., HALOTHANE]

CARBON TETRACHLORIDE

GOLD COMPOUNDS [I.E., AUROTHIOGLUCOSE]

ARSENIC

GI DISORDERS 73

PHASES OF HEPATITIS

1. PRODROMAL (PREICTERIC) PHASE

ANV, MALAISE, WEIGHT LOSS

SYMPTOMS OF URTI

INTOLERANCE FOR SMOKING

2. ICTERIC PHASE

JAUNDICE

BILE-COLORED URINE THAT FOAMS WHEN SHAKEN

ACHOLIC (CLAY-COLORED) STOOLS

3. RECOVERY PHASE: EASY FATIGABILITY

GI DISORDERS 74

HEPATITIS

THERAPEUTIC INTERVENTIONS

1. REST

2. ABSTINENCE FROM ALCOHOL

3. DIET THERAPY

GI DISORDERS 75

HEPATITIS: 2,500 -3,000 KCAL / DAY

HIGH PROTEIN [75 TO 100 G]

HEALING OF LIVER TISSUE

DAILY: 1 QT MILK; 2 EGGS

8 OZ LEAN MEAT, FISH, OR CHEESE

HIGH CARBOHYDRATE [300 TO 400 G]

ENERGY NEEDS, RESTORE GLYCOGEN RESERVES

DAILY: 4 SERVINGS VEGETABLES, POTATO, 4 SERVINGS FRUIT WITH FREQUENT JUICES,

6 TO 8 SERVINGS BREAD OR CEREAL

MODERATE FAT [100 TO 150 G DAILY]

2 TO 4 TABLESPOONS BUTTER OR FORTIFIED MARGARINE

MODERATE AMOUNT OF WHOLE MILK, CREAM, BUTTER, MARGARINE, OR VEGETABLE

OIL IS BENEFICIAL

GI DISORDERS 76


REVIEW

11/14/2008


HEPATITIS: INVESTIGATE!

1. HISTORY

a. OF EXPOSURE TO VIRUS

b. OF EMPLOYMENT OVER PREVIOUS 6 MONTHS

2. RUQ FOR LIVER TENDERNESS, FIRMNESS

3. JAUNDICE IN SKIN, SCLERA, AND MUCOUS MEMBRANES

4. TEMPERATURE:

a. FEVER (WITH TYPE A)

b. LOW-GRADE FEVER (WITH TYPES B AND C)

GI DISORDERS 77

HEPATITIS: ACTION!

1. ATTEMPT TO STIMULATE THE APPETITEa. PROVIDE ORAL HYGIENE

b. BASED ON THE CLIENT'S PREFERENCES

c. PROVIDE A PLEASANT, UNHURRIED ATMOSPHERE FOREATING

d. PROVIDE SMALL, FREQUENT FEEDINGS

2. USE PRECAUTIONS TO PREVENT THE SPREAD OFHEPATITIS TO OTHERS

a. USE STANDARD (UNIVERSAL) PRECAUTIONS

b. HAV: CONTACT PRECAUTIONS

GI DISORDERS 78

HEPATITIS: ACTION!

3. ADMINISTRATION OF IMMUNE SERUM GLOBULIN (ISG) AFTER EXPOSURE TO TYPE A HEPATITIS

4. VACCINATION OF INDIVIDUALS AT RISK FOR TYPE B HEPATITIS (HEP-B, RECOMBIVAX HB)

5. ENCOURAGE THE USE OF CONDOMS

GI DISORDERS 79

'GET SMASHED‘ TO KNOWTHE CAUSES

GGALLSTONESALLSTONES

EETHANOLTHANOL

TTRAUMARAUMA

SSTEROIDSTEROIDS

MMUMPSUMPS

AAUTOIMMUNEUTOIMMUNE CAUSESCAUSES

SSCORPIONCORPION VENOMVENOM

HHYPERLIPIDAEMIASYPERLIPIDAEMIAS

EERCPRCP

DDRUGSRUGS (S(SUCHUCH ASAS AAZATHIOPRINEZATHIOPRINE))

GI DISORDERS 80


REVIEW

11/14/2008


ACUTE PANCREATITIS

2 FORMS

1. INTERSTITIAL (EDEMATOUS)

2. NECROTIZING

2 THEORIES

1. TOXIC AGENT

2. REFLUX OF DUODENAL

CONTENTS

GI DISORDERS 81

ASSESSMENT OFACUTE PANCREATITIS

MILD

• EPIGASTRIC PAIN, RADIATING BETWEENTHE

T10 & L6 UNRELIEVED BY

VOMITING

SEVERE

• EXTREME PAIN• PERSISTENTVOMITING• ABDOMINAL RIGIDITY• ILEUS

• DIMINISHED BOWEL ACTIVITY• CRACKLESAT LUNG BASES• TACHYCARDIA• EXTREME MALAISE• RESTLESSNESS• MOTTLED SKIN

• LOW-GRADE FEVER• COLD, SWEATY EXTREMITIES

GI DISORDERS 82

DIAGNOSIS OF PANCREATITIS

• ELEVATED

– SERUMAMYLASE & LIPASE

–WBC

– HCT

• LOW SERUM CALCIUM

• HYPERGLYCEMIA

• CT-SCAN

• X-RAYS

GI DISORDERS 83

TREATMENT OF PANCREATITIS

GOAL OF TREATMENT

1. MAINTAIN CIRCULATION & FLUIDVOLUME

2. RELIEVE PAIN

3. DECREASE PANCREATIC SECRETIONS

GI DISORDERS 84


REVIEW

11/14/2008



MAINTAIN CIRCULATION & FLUIDVOLUME

1. ELECTROLYTE REPLACEMENT

2. PROTEIN SUPPLEMENTATION

3. CALCIUM REPLACEMENT

*SHOCK CAUSES DEATH IN EARLY STAGES

*METABOLIC ACIDOSIS

GI DISORDERS 85


ADDITIONAL MANAGEMENT

1. CONTINUE 5-7 DAYS OF HYDRATION

2. TPN

3. GAVAGE FEEDINGS

4. PROCEDURES:

– LAPAROTOMY

– PANCREATECTOMY

– CHOLECYSTOSTOMY & GASTROSTOMY

GI DISORDERS 86

GALLBLADDER & BILIARYTRACT DISORDERS

5 MAJOR DISORDERS1. CHOLECYSTITIS

– STONE IN THE CYSTIC DUCT

2. CHOLANGITIS– INFECTION OF THE BILE DUCT

3. CHOLELITHIASIS– STONE IN THE GALLBLADDER

4. CHOLEDOCHOLELITHIASIS– STONE IN THE CBD

5. GALLSTONE ILEUS– SMALL BOWEL OBSTRUCTION DUE TO GALLSTONE

GI DISORDERS 87


CAUSE: UNKNOWN

RISK FACTORS

1. OBESITY

2. ELEVATED ESTROGEN LEVELS

3. GENETICS

4. USE OF:– ANTILIPEMIC DRUGS

– WEIGHT REDUCTION PILLS

5. DISEASES

GI DISORDERS 88


REVIEW

11/14/2008



AGE ESTROGEN OBESITY

INCREASED BILE PRODUCTION

EXCESSWATER & BILE SALTS ARE REABSORBED

GALLSTONES

[CHOLESTEROL CALCIUM BILIRUBIN]

GI DISORDERS 89


MANIFESTATIONS• SEVERE MIDEPIGASTRIC PAIN OR RUQ PAIN RADIATING TO THEBACK

• FLATULENCE• INDIGESTION• NAUSEA• DIAPHORESIS• BELCHING• CHILLS & LOW-GRADE FEVER• INDIGESTION OF FAT

• JAUNDICE & CLAY-COLORED STOOLS

GI DISORDERS 90

DIAGNOSIS OFGALLBLADDER & BILIARYTRACT DISORDERS

• UTZ OF THE GALLBLADDER

• CT SCAN

• ERCP

• CHOLESCINTIGRAPHY

• ORAL CHOLECYSTOGRAPHY

• BLOOD STUDIES

GI DISORDERS 91

TREATMENT OFGALLBLADDER & BILIARYTRACT DISORDERS

• CHOLECYSTECTOMY

• CHOLANGIOGRAPHY

• T-TUBE PLACEMENT

• LOW FAT DIET; GIVE VIT K

• NGT

• LITHOTRIPSY

• URSODIOL

GI DISORDERS 92


REVIEW

11/14/2008


NURSING CARE OF PATIENTSWITHGALLBLADDER & BILIARYTRACT DISORDERS

1. REINFORCE HEALTHTEACHINGS ON:

a. LOW FAT DIET

b. MEDICATION COMPLIANCE

c. POST-OP ACTIVITIES

• DEEP BREATHING & COUGHING

• REST & ACTIVITY

d. WEIGHT REDUCTION

2. CARE OF T-TUBE & SKIN CARE

GI DISORDERS 93

"Realize that true happiness lies within you.

Waste no time and effort searching for peace and

contentment and joy in the world outside.

Remember that there is no happiness in having or in

getting, but only in giving.

Reach out. Share. Smile. Hug.

Happiness is a perfume you cannot pour on others without getting a few drops on yourself."

Og Mandino

1923-1996, Author and Speaker

THANK YOU!!!

GI DISORDERS 95

Gastrointestinal Disorders Review

Education

Transcript of Gastrointestinal Disorders Review