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Lips and Cheeks • made up of skeletal muscles covered by a skin • keep food in mouth while chewing Palate a. Hard • Covers bone and provides hard surface against which the tongue forces food b. Soft • Ends at uvula • When food is swallowed, soft palate rises as a reflex to close oropharynx Tongue • Contains mucus and serous glands, taste buds • Mixes food and saliva during chewing, forms the food into a mass (bolus) • Initiates swallowing Produced by the salivary gland Moistens food to form bolus Dissolves food substances that begin chemical breakdown of starches
Saliva • • • 4.
Teeth • Used to chew (masticate) • 32 permanent • embedded at the gingiva Nasopharynx and oropharynx Provide passageway for food, fluids and air Its skeletal muscles move food to the esophagus (peristalsis) It has mucus producing glands that provide fluid for easy swallowing
Pharynx • • • •
Esophagus • A muscular tube about 10 inches (25 cm) • Serves as passageway of food • Descends through the thorax and diaphragm 1. Epiglottis • A flap of cartilage over the top of larynx • Keeps food out of larynx during swallowing Gastroesophageal sphincter- between esophagus and stomach
Stomach • Located high on the left side of the abdominal cavity • A distensible organ – can hold up to 4 liters • Regions: a. cardiac region b. fundus c. body d. pylorus Pyloric sphincter- controls emptying of the stomach into the duodenum Functions: 1. Storage reservoir for food 2. Mechanical digestion 3. Gastric glands has 4 cells: a. Mucous • Alkaline mucus • Serves as protection against gastric juice b. Zymogemic cells • Pepsinogen (inactive pepsin-protein digesting enzyme) c. Parietal HCI • Increases the activity of protein digesting cells Intrinsic factor • Absorption of vitamin B12 d. Enteroendocrine • Gastrin, histamine, endorphirs, serotonin and sonatoslatin • Gastrin- regulates secretion and motility of the stomach Small Intestine • Starts at pyloric sphincter and ends at ileocecal junction • About 20 feet, one inch by diameter • Divisions: a. Duodenum • Begins at the pyloric sphincter up to around the head of the pancreas • Pancreatic enzymes and bile from the liver enter the small intestine b. Jejunum - middle part c. Ileum - terminal end of small intestine Gastro-intestinal System Page 1 of 12
clear with high bicarbonate content . salts and vitamins formed by the bacteria Liver • Largest gland • Approximately 3 pounds (1. toxins 3. Stomatitis = Mouth inflammation & erosions Etiology: trauma. steroid hormones and plasma membranes 9. Cerum .lined with Kaupffer cells (phagocytic cells) Functions: 1. circular folds Breaks carbohydrates and proteins Enzymes a. Synthesizes fats from carbohydrates and protein energy or adipose tissue 8. drugs. Goblet cells produce mucus. microvilli b. Colon o Ascending o Transverse o Descending o Sigmoid Functions: 1.facilitates lubrication b. Stores fat-soluble vitamins 3.4 kg) • Located at the right side • Made up of lobules (composed of plates of hepatocytes) • Sinusoids . Mechanical = trauma 2. Chemical = irritants. villi c. Synthesizes cholesterol production of bile salts. Secretes bile 2. Triglycirides • Enters as fat globules • Coated by bile salts and emulsified • • Large Intestine (Colon) • Divisions a. II. Absorbs water. Eliminates indigestible food residue a. renal.Medical Surgical Nursing • Site of chemical digestion and absorption through a. Detoxification 13.first part b. Pancreatic enzymes • breaks protein peptides c. Pancreatic juice . Stores iron as ferritin (necessary for RBC production) Pancreas • Triangular gland extending across the abdomen Functions 1. irritants as tobacco and alcohol. Conjugates bilirubin 4. Produces 1-1. Pancreatic lipase • breaks lipids d. Synthesizes protein albumin 6. Defecation reflex • stretching of the rectal wall • can be suppressed voluntarily • expulsion can be attained by Valsalva maneuver 2.blood filled spaces .5 L of pancreatic juice everyday 2. Pancreatic amylase • acts on starchy b. Biological = infections HS virus I & II Spirochete Bacteria .can digest all categories of food ALTERATIONS IN GASTROINTESTINAL SYSTEM INGESTION PROBLEMS ORAL INFLAMMATORY LESIONS Etiology: 1. chemotherapy. VII. Deamination (Amino acid carbohydrates) 10.Staphylococcus. Fibrinogen and factors I. soreness of mouth. Synthesizes Prothrombin. S/S: halitosis. excessive salivation Gastro-intestinal System Page 2 of 12 . Stores blood and releases during hemorrhage 5. IX and X 7. Releases during hypoglycemia 11. liver and blood dis. Takes up glucose during hyperglycemia 12. Streptococcus 1.
Delayed gastric emptying time (eg. M. Description: inflammation of the esophagus. Hiatal hernia c.Medical Surgical Nursing 2. N/V 2. 3. fever. 5. sub-acute or chronic Aphthous Ulcer Very painful. sore mouth yeasty halitosis 4. Lower esophageal sphincter (LES) tone is decreased or relaxed. (1cm) shallow erosions of called “canker sores” circumscribe with white or yellow center. Etiology: • Commonly caused by gastroesophageal reflux disease (GERD) . foul breath. may radiate to the back. irritants Gingivitis = Gum inflammation & ulcers Etiology: poor dental care. anorexia. abscess. bluish-white milk curd membranous lesion at oral mucosa/larynx. Acyclovir. loose teeth) Herpes Simplex: Etiology: HS virus I & II Also called “cold sore or Fever blisters” Classified as STD S/S: Vesicles on an erythematous base. 3. < BR At least 1. digestive disturbances. with brushing. low fiber diet S/S: Bleeding esp. Pain after eating and at night when in a supine position. Glossitis = Tongue inflammation & ulcers Etiology: trauma. swelling. B. heat. redness. malocclusion.a syndrome caused by a reflux of gastric contents into the esophagus: a. irregular teeth. Emesis d. infectious process (eg. Periodontitis (pus. Steroids Mild oral antiseptics Prof’l dental care Fibrous rather than soft diet Adequate fluid intake Conscientious brushings habits with flossing ESOPHAGITIS A. food allergies. Ingestion of hot or corrosive substances f. menses. NCP: Oral Inflammations NDx1 = Pain: Topical Xylocaine Analgesics Bland. e. 8. Pyrosis (hallmark symptom). No salivation Pus exudates Oral Candidiasis Moniliasis or thrush Etiol: prolonged high-dose antibiotic tx or steroids S/S: Pearly. 7. common in diabetics. may be acute or chronic. Soft/liquid diet Mild antiseptic mouthwash NDx2: Nutrition.500 cal/d Fluid intake at least 2l/d NDx3: Imp. lesions @ junction of lips & face Activated by: sunlight. Spirochetes (Borrelia vincentii) Purple-red gums with pseudomembrane S/S: fever. gastroparesis). Oral M. or jaw. Pathophysiology and manifestations Backflow of HCl / intake of corrosive agents ↓ Damage of the epithelial cells of esophagus ↓ Frequent exposure to chemicals ↓ Pain Signs and Symptoms: 1. cervical lymphadenopathy Maybe acute. pain. Vincent’s Angina Known as “ Trench Mouth” / Acute necrotizing ulcerative gingivitis Etiol: Fusiform bacteria. neck. Oral care q 4h Gingival massage (gingivitis) Antibiotics for infections. encircle by a red ring Parotitis = inflammation of parotid glands Etiology: Staphylococcus (usual)/ Streptococcus S/S: Pain at ear and area of gland. herpes or monilial invasion) A. 6. Gastro-intestinal System Page 3 of 12 . b.
Sliding esophageal hernia (90% of occurrences): herniated portion of the stomach slides back and forth upward through the hiatus secondary to positional changes. no spices • high-Fowler’s during and 1 hour eating Weight reduction Avoid activities that increase intraabdominal pressure. Regurgitation 4. • Symptoms are related to increased intrathoracic pressure: 1. • avoid wearing tight. 1. 6. Tachycardia with subsequent impaired gas exchange. • weakening of the muscles of the esophageal hiatus due to the aging process (more than 60%) • Trauma • Hereditary factors • Symptoms are associated with gastro-esophageal reflux: 1. Types: 1. Pain aggravated by an increase in intraabdominal pressure (eg. lifting). 5. Shortness of breath 3. strangulations. • Chest pain is characteristic because it mimics anginal pain and usually is not relieved when the patient is recumbent. Medications Antacids H2-receptor antagonists – Tagamet (Cimetidine) Gastro-intestinal System Page 4 of 12 .Medical Surgical Nursing 4. 5. straining. 3. no caffeine. B. 4. Dysphagia 2. or obstruction. if applicable. Nursing Interventions: 1. Bloating Rolling / paraesophageal esophageal hernia: fundus and possibly the greater curvature of the stomach herniated alongside the esophagus into the thorax • Occurs less commonly • Complications are high and include gastric volvulus. Chest pain 2. ESOPHAGEAL HIATAL HERNIA • Refers to herniation or displacement of a portion of the lower esophagus or the stomach into the thoracic cavity. Pyrosis 3. Encourage the patient to: • stop smoking. 2. restrictive clothing 2. Bleeding Strictures may also occur Overview of nursing interventions: Medications • Antacids • H2-receptor antagonists – Tagamet (Cimetidine) Diet • Low-fat • Small frequent feedings • no alcohol.
2. Avoid foods contributing to gastric distress. • Associated with mucosal hemorrhages and erosions. 4. 5. no spices high-Fowler’s during and 1 hour eating Advise patient to: Reduce weight. It is an acute response to medical or surgical stress. • Related to chronic use of local irritants (eg. 8. May lead to PUD if not relieved e. C. no caffeine. 1.Medical Surgical Nursing 2. 2.) b. alcohol. H2-receptor antagonist PEPTIC ULCER DISEASE A. Description: Inflammation of the stomach mucosa. Diet Low-fat Small frequent feedings no alcohol. B. 4. Diet therapy. 1. Local irritants (eg. Medications: a. or less frequently. Gastro-intestinal System Page 5 of 12 . Antacids b. drugs) Pathophysiology processes and manifestations Prolonged exposure to irritants / HCl ↓ Irritation of gastric mucosa ↓ Erosion ↓ S/Sx S/Sx may include: a. b. Avoid oral feeding until emesis subsides. 3. Intolerance to spicy or high-fat food. c. Nursing Interventions Correct fluid and electrolyte disorders. of the lower esophagus and jejunum. drugs. Allergy and bacterial endotoxin invasion (eg. duodenum. Mild to severe abdominal discomfort or pain (may or may not be accompanied by N/V and diarrhea. Hemorrhage (as hematemesis or melena) anemia D. Chronic gastritis • Secondary to bile acid reflux or to peptic ulcer disease. Avoid cigarette smoking and alcohol consumption. alcohol. Prepare for herniorrhapy / hernioplasty Analgesics 3. corrosive substances). Parenteral therapy Teach the patient about diet and lifestyle changes to prevent exacerbation. 7. Alcohol and cigarette use. Etiology Acute (transient intermittent inflammation) • Caused by: a. Nissen Fuldoplicaion GASTRITIS A. 2. A chronic condition characterized by an ulceration of the gastric mucosa. if indicated Avoid wearing tight-fitting or restricted clothing. Diarrhea FVD if unabated d. Description 1. Escherichia coli). 6. Salmonella.
injure or alter gastric mucosa b. Duodenal – aggravated by eating 6. Complications include hemorrhage.hallmark sign 2. Belching 3. D. Zantac (Ranitidine) Gastro-intestinal System Page 6 of 12 3. pancreatitis. medications Medical Management Medications a. Milk of Magnesia (Mg-PH). ingestion of specific foods (spicy or fried) b. Stress ulcers 1. 1. 2. Duodenal ulcers. Vomiting 5. Multiple ulcerations felt to be erosions develop secondary to gastric ischemia. 4. Pathophysiology and manifestations Gastric ulcers Injury ↓ Histamine release ↓ Production of HCl by the parietal cells ↓ More injury 2.) 2. Bloating 2. Pain may be associated with: a. obstruction. or perforation. Etiology and incidence Unknown Infection (H. 1. Pain (usually described as burning or aching) a. S/Sx common to all PUDs: 1. C. 3. Nausea 4. . Antacids • Neutralizes HCl • Taken 1-2 hours pc • Examples: Amphogel (AL-OH). pylori) mucosal breakdown Genetic predisposition Tobacco use Ingestion of food or drugs that: a. in part because of poor circulation to the ulcerative site. Coffee ground aspirate . Crohn’s disease) Duodenal ulcers are thought to occur more prevalent than gastric ulcers and usually occur between the 2nd and 5th decades of life. Increased rate of gastric acid secretion (increased number of parietal cells or secondary to vagal stimulation. 1. Dumping syndrome reduces the buffering effects of food. Maalox (AL-MG-OH) • Magnesium-based diarrhea • Aluminum-based constipation b.Medical Surgical Nursing B. H2 receptor antagonists • Reduces HCl secretion • Taken with meals • Examples: Tagamet (Cimetidine). Basaljel (AL-Carbonate). Alcohol c. Erosion of gastric mucosa Stricture Hematemesis and Melena Pyloric obstruction and perforation Gastric ulcers are slow to heal. increase hydrochloric acid production Stress Diseases that alter gastric secretion (eg. Gastric – relieved by eating b. affects gastric release. 1.
5. Spices. Liberal bland diet during exacerbation 2. c. A. Infection can last anywhere from 2 to 7 days. Quit smoking Coping • Stress Therapy (a) Recreation and hobbies (b) Regular pattern of exercise (c) Stress reduction at home and at work E. Eat slowly and chew food properly 3. Coffee. Alcohol e. Bedtime snacks f. Is an inflammation of the GI. 2. 3. Fever depends on microorganism. cola drinks. S/Sx of viral gastroenteritis include • Headache • Weakness • muscle aches and pains • abdominal distention and tenderness (but no rebound tenderness) 6. GASTROENTERITIS A. Binge eating g. Viral gastroenteretits • rotavirus and parvovirus-type • by way of the respiratory system. 1. red /black pepper d. 2. Surgeries b. History – will differentiate from other conditions Etiology and Incidence 1. it most commonly affects the small intestine. Pyroplasty – surgical dilatation of the pyloric sphincter d. frequent feedings during exacerbation 4.A Traveler’s diarrhea. Symptoms common to all types of gastroenteritis include: • Nausea • Vomiting • Diarrhea 2. Avoid the following: a. Description 1. dysentery. tea.K. Vagotomy • Resection of the vagus nerve • Decreases cholinergic stimulation decreases HCL secretion c. bacterial usually causes higher temp. Pylori Drug Treatment • Pepto-Bismul • Amoxicillin/Tetracycline • Flagyl c. 2. Diet 1. Coli – Traveler’s Diarrhea • Shigellosis – Bacillary Dysentery • By way of fecal-oral • Affects all ages • Affects in warm climates 2. Bacterial – stool specimens with high WBC. Viral . 1. d. Gastro-intestinal System Page 7 of 12 B. Antrectomy • Billroth I • Billroth II • Subtotal Gastrectomy o Removal of 75% of the distal stomach Nursing Interventions Relieve pain: Take prescribed medications as ordered Promote a healthy lifestyle a. Small. . chocolate c. Bacterial • E. Large quantities of milk (400 mls/day is allowed) b. possibly high RBC 3. Fatty foods b. • Affects primarily infants and the aged • Crowded living conditions Pathophysiology and manifestations.Medical Surgical Nursing • Side effects: Diarrhea Abdominal cramps Confusion Dizziness Weakness Cytoprotective drugs • Coats ulcer • Taken on an empty stomach (30-60 mins ac) • Example: Carafate (Sucralfate) H.high WBC and the presence of pus 4. C.
B. Institute dietary management: a. D. Antispasmodics 2. Dietary changes • intake of clear liquids initially • lactose-free foods for 1 to 2 weeks (after symptoms subside) 5. analgesics. Exact cause unknown. B. Institute dietary management: a. Prepare for surgery and institute postoperative care. Chronic narrowing of lumen 3. Observe for fluid and nutritional status 4. 3-5 / day without blood. Other symptoms: a. a. Administer medications. Genetic predisposition d. TPN if needed 3. Antimicrobial c. Healing lesions result in scar tissue formation obstruction of GI tract 3. Infection b. Collect stool specimen 5. Etiology and Incidence: Gastro-intestinal System Page 8 of 12 C. Elemental type c. Provide patient teaching covering: • Adherence to medication regimen • Appropriate sanitary methods for cooking and personal hygiene ULCERATIVE COLITIS Description: Is an inflammatory process affecting the mucosa of the colon and rectum. 8. Genetic predispositions Pathophysiologic Processes and Manifestations 1. Antidiarrheal b. Watch out for F & E imbalances 4. Anorexia f. Antidiarrheal b. as ordered. lactose-free b. 6. Incidence is higher in young adults (15 to 20 years old) Pathophysiologic Processes and Manifestations 1. No drugs to suppress gastric motility. Administer medications. Fever e. Fever with leukocytosis Overview of Nursing Interventions 1. N/V d. 2. Elemental type (fast GI absorption) b. C.Medical Surgical Nursing 7. Diarrhea. Monitor weight 6. and electrolyte replacement medications (eg. Chronic inflammatory bowel disease affecting segmental areas along the entire wall of the GI tract. Antimicrobial c. Description 1. usually associated with: a. A. D. Collect stool specimen. Weight loss c. Weight loss Overview of Nursing Interventions 1. a. Thickening and inflammation is present (Telescoping) 2. Monitor bowel movement consistency. Allergy or autoimmune disorders c. Monitor I & O 3. 7. Nutritional deficits e. Autoimmune dysfunction c. Malaise b. 4. Antispasmodics 2. D. REGIONAL ENTERITIS (CROHN’S DISEASE) A. Low-residue. Monitor I & O 4. Weakness d. In diarrhea and vomiting become severe FVD Nursing Intervention Drugs – anti-infective agents. TPN if necessary 3. Psychological stressor 2. Exact cause unknown but closely associated with: a. Diffuse inflammation of intestinal mucosa swelling of epithelial cells necrosis crypt formation site of abscess ulceration 2. Description: An inflammation of the diverticula or herniations within the wall of the intestinal tract. . Provide meticulous perianal skin care. Infectious process b. frequency and volume. B. 1. Lactose-free d. Low-residue c. Etiology and Incidence: 1. Symptoms include: a. Etiology 1. Parenteral therapy for severe cases. DIVERTICULITIS A. Abdominal tenderness c. Bloody diarrhea (15-20 times daily) – with or without pus b. potassium). as ordered.
Etiology: 1. Observe fluid status and bowel movement.Medical Surgical Nursing 1. Intermittent rectal bleeding c. Commonly affects the sigmoid colon. Fecal impaction b. 7. 3. commonly caused by chronic alcohol abuse. Bed rest 2. 2. Diverticula occurs more in adult. Infections C. heat application and laxatives . PANCREATITIS A. Prepare for colostomy. B. Fever (with leukocytosis) Overview of Nursing Interventions D. antibiotics. Pathophysiology and Manifestations 1. C. Exact cause is unknown. 3. Avoid enemas. Dietary regimen: a.5 oC) • Leukocytosis (more than 10. Encourage fluid intake 5. Pain on LUQ b. later on clear liquids 3. C. Eliminate foods with seeds and nuts. Low fiber diet b.prevent rupture.000 / cu mm D. prepare for exploratory laparotomy. Kinking of the appendix c. IVF therapy 5. If the diagnosis is not definitive. Bulk-forming laxatives 3. Pathophysiology and manifestations Disruptions of pancreatic ducts Pancreatic enzymes spill out the pancreatic tissues Autodigestion (hallmark sign) Incapacitating pain Hemorrhage Gastro-intestinal System Page 9 of 12 Spill out to the peritoneum . Chronic constipation Increased incidence associated with ulcerative colitis and Crohn’s disease. Bed rest 2. APPENDICITIS Description: Is the inflammation of the vermiform appendix. Low fiber 4. Pathophysiologic processes and manifestations 1. NPO. 2. Constipation d. Appendectomy to avoid peritonitis. Etiology: Results from alterations in the structure or function of the pancreas. Antibiotic therapy 6. Administer antimicrobial agents as ordered. 6. Factors may include: a. Overview of Nursing Interventions 1. Analgesics. 2. • Done under spinal anesthesia • Flat on bed (6-8 hours) • NPO until peristalsis returns • Institute postoperative care. During an acute phase: 1. Description: Is acute / chronic inflammation of the pancreas. B. 3. anticholinergics Everyday life: 1. 4. 2. Psoas sign (lateral position with right hip flexion) Severe abdominal pain with rebound tenderness at Mcburney’s point (RLQ) – Blumberg Sign Other symptoms: • Rigid abdomen. • Activities can be resumed within 2-4 weeks. guarding • Anorexia • N/V • Fever (38-38. Parasites d. institute postoperative care. NPO 3. Increased luminal pressure (chronic constipation) formation of diverticula / herniation through a weak structure bacteria formation through a weak muscular structure local abscess intraabdominal perforation and peritonitis. A. 4. Symptoms include: a.
Mucous secretion from the anus 6. 5. HEMORRHOIDS • • • Dilated blood vessels beneath the lining of the skin in the anal canal Two Types of Hemorrhoids – External hemorrhoids – occur below the anal sphincter – Internal hemorrhoids – occur above the anal sphincter Causes – Chronic constipation – Pregnancy – Obesity – Prolonged sitting or standing – Wearing constricting clothings – Disease conditions like liver cirrhosis. Bulk laxatives 3. 4. pancreatitis or tumor.) 2.acute viral or chemical hepatitis Primary biliary cirrhosis: inflammation and intrahepatic bile duct destruction. 2. Avoid morphine as it stimulates release of pancreatic juice 3. Demerol for pain. Anal pain 3. Local anesthetic application – Nupercaine 5. Necrosis Overview of Nursing Interventions 1. Patient Teaching • Clean rectal area thoroughly after each defecation • Sitz bath at home especially after defecation • Avoid constipation: o High – fiber diet o High fluid intake o Regular exercise o Regular time for defecation • Use stool softener until healing is complete • Notify physician for the following: o Rectal bleeding o Continued pain on defecation o Continued constipation LIVER CIRRHOSIS Irreversible chronic inflammatory disease characterized by massive degeneration and destruction of hepatopcytes. Monitor for signs of shock. Occurs primarily in middle-aged men Postnecrotic cirrhosis 1. Preop Care • Low residue diet to reduce the bulk of stool • Stool softeners 7. liberal fluid intake 2. Caused by the liver’s toxic to alcohol 2.Medical Surgical Nursing Peritonitis Neurogenic shock D. Surgery • Hemorrhoidectomy • Sclerotherapy (5% phenol in oil) • Cryosurgery • Rubber – band ligation 6. Laennec’s cirrhosis – the most common 1. 3. Postop Care a. Results from severe liver disease 2. Sensation of incomplete evacuation of the rectum Collaborative Management: 1. Cardiac cirrhosis results from right-sided CHF. Types: 1. warm compress 4. Constipation ( in an effort to prevent pain or bleeding associated with defecation. RSCHF Signs and Symptoms: 1. Avoid excessive food intake to prevent autodigestion. High fiber diet. Pathohysiology and Manifestations 1. Anal itchiness 5. Promotion of comfort • Analgesics as prescribed • Side – lying position • Hot Sitz bath 12 to 24 hrs. Rectal bleeding 4. Promotion of elimination • Stool softener as prescribed • Encourage the client to defecate as soon as the urge occurs • Analgesic before initial defecation • Enema as prescribed. Laennec’s Cirrhosis Gastro-intestinal System Page 10 of 12 . Hot Sitz bath. postop b. Secondary biliary cirrhosis: chronic partial or complete common bile duct obstruction due to gall stones. using a small – bore rectal tube c. Post . 2.
Jaundice 3. fibrosis and hepatocellular destruction scar tissue destruction hepatomegaly 1. Teach ways to decrease bleeding tendencies. Avoidance of alcohol c. Nursing Interventions: 1. ascites and pruritus. 4. N/V • flatulence • steatorrhea 2. 14. 7. poor calcium transport 3. Cardiac cirrhosis Enlarged liver congested venous blood flow failure of the heart to pump blood to different areas of the body. visual disturbances Depletion of glycogen hypoglycemia Decreased albumin decreased COP anasarca Increased HP ascites Decreased bilirubin metabolism hyperbilirubinemia jaundice 2. 10. Use preventive measures to keep skin intact. 11. Diuretics 6. Scar tissue formation and irregular hepatocyte regeneration compression of portal vein obstruction portal hypertension Decreased Vitamin ADEK absorption 1. creatininine) 3. 8. Signs and symptoms needing medical intervention. Assess the patient for signs of impaired breathing related to congestion or infection. Observe for signs of encephalopathy (lethargy. 12. Pruritus 4. decreased renal function and electrolyte imbalances. 5. 3.Medical Surgical Nursing Alcohol causes changes fatty infiltration of the hepatocytes liver cell necrosis and scarring as it progresses. irritability). Monitor V/S and laboratory results (platelets. 15. Nutritional needs b. clay-colored stools 5. d. Assess for signs of bleeding 2. bleeding tendencies 2. Monitor daily weight and abdominal girth to detect ascites. Vitamin K 2. 4. Hyperbilirubenemia 2. Drug interactions related to decreased liver function. Biliary cirrhosis Chronic obstruction increased pressure in the hepatic bile duct accumulation of bile areas of necrosis edema. Monitor I/O. depression. Assess for changes in cardiac output. CHOLELITHIASIS/CHOLECYSTITIS • • • • Cholelithiasis is stone formation in the GB Cholecystitis is inflammation of the GB Cause: unknown Predisposing factors female fat forty fair complexion fertile Theories • Metabolic factors • Biliary stasis • Inflammation Composition of Gall stone cholesterol bile salts Ca bilirubin protein • • Signs and Symptoms: 1. Congestion causes anoxia to the liver necrosis and fibrosis Hepatorenal syndrome A major complication of cirrhosis characterized by renal failure in an anatomically normal kidneys progressive oliguria and azotemia. RUQ pain. poor skin turgor 4. Patient teaching: a. Manifestations postnecrotic . Administer the following as ordered to combat symptoms: 1. Relieve breathing difficulty. personality changes. 9. Decreased fat emulsification • fat intolerance • anorexia.same as Laennec’s cirrhosis. Increased serum bilirubin • Jaundice • Pruritus • Tea-colored urine Gastro-intestinal System Page 11 of 12 . Stool softeners 3. Decreased bile flow in colon • acholic stool • poor absorption of fat soluble vitamins 4. confusion. Enough rest e. motor changes. Provide counseling for the patient and family. inflammation decreases but fibrosis increases liver distortion structural (biliary channel) and vascular changes. Inflammation • pain (RUQ) • fever • leukocytosis 3. Assess for impaired skin integrity related to edema.
Medical Surgical Nursing 5. Diet: low fat diet 3. DBCT 3. IVF to replace loss in vomiting 2. Relief of pain • Meperidine HCL. Vit K injection Postop Care 1. T tube if with CBD exploration • Purpose is to drain bile • Drainage: o Brownish red for 1st 24 hrs o 300-500 ml of bile drainage for 1st 24 hrs o Drainage bottle should be placed in bed at level of incision to drain excess but not all of the bile Gastro-intestinal System Page 12 of 12 . Bile salts: chenodeoxycholic acid. NGT for decompression 3. Infection • Cholecystitis • Pancreatitis Management: 1. not MorphineSO4 2. Surgery: cholecystectomy Preop care: 1. Diet: low fat for 2-3 months 4. ursodioxycholic acid given after meals 4. Low or semi-fowler’s position 2. Ambulation after 24 hrs post op 5.
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