This action might not be possible to undo. Are you sure you want to continue?
Care of Clients with Disorder of the Mouth A. Disorder includes inflammation, infection, neoplastic lesions B. Pathophysiology 1. Causes include mechanical trauma, irritants such as tobacco, chemotherapeutic agents 2. Oral mucosa is relatively thin, has rich blood supply, exposed to environment C. Manifestations 1. Visible lesions or erosions on lips or oral mucosa 2. Pain
Nursing Care of Clients with Upper Gastrointestinal Disorders
D. Collaborative Care 1.Direct observation to investigate any problems; determine underlying cause and any coexisting diseases 2.Any undiagnosed oral lesion present for > 1 week and not responding to treatment should be evaluated for malignancy 3.General treatment includes mouthwashes or treatments to cleanse and relieve irritation a.Alcohol bases mouthwashes cause pain and burning b.Sodium bicarbonate mouthwashes are effective without pain 4. Specific treatments according to type of infection a.Fungal (candidiasis): nystatin ³swish and swallow´ or clotrimazole lozenges b.Herpetic lesions: topical or oral acyclovir
Nursing Care of Clients with Upper Gastrointestinal Disorders
E. Nursing Care 1. Goal: to relieve pain and symptoms, so client can continue food and fluid intake in health care facility and at home 2. Impaired oral mucous membrane a. Assess clients at high risk b. Assist with oral hygiene post eating, bedtime c. Teach to limit irritants: tobacco, alcohol, spicy foods 3. Imbalanced nutrition: less than body requirements a. Assess nutritional intake; use of straws b. High calorie and protein diet according to client preferences
viruses (human papilloma virus) . mortality b. marijuana use.Client with Oral Cancer 1. occupational exposure to chemicals. drinking alcohol. Uncommon (5% of all cancers) but has high rate of morbidity. Risk factors include smoking and using oral tobacco.Background a. Highest among males over age 40 c.
Squamous cell carcinomas b. Non-healing lesions should be evaluated for malignancy after one week of treatment . oropharynx. Begin as painless oral ulceration or lesion with irregular. Lesions start in mucosa and may advance to involve tongue. mandible.Client with Oral Cancer 2. maxilla d. Pathophysiology a. ill-defined borders c.
Plan early for home care post hospitalization. tumor stage. Elimination of causative agents b. chemotherapy. general health and client¶s preference. Based on age. refer to American Cancer Society. Advanced carcinomas may necessitate radical neck dissection with temporary or permanent tracheostomy. Surgeries may be disfiguring f. Determination of malignancy with biopsy c. Determine staging with CT scans and MRI d. and/or radiation therapy e. support groups . treatment may include surgery. Collaborative Care a.Client with Oral Cancer 3. teaching family and client care involved post surgery.
Nursing Diagnoses 1. Risk for ineffective airway clearance 2.Client with Oral Cancer 4. Imbalanced Nutrition: Less than body requirements 3. Health promotion: 1. Impaired Verbal Communication: establishment of specific communication plan and method should be done prior to any surgery 4. early precancerous oral lesions are very treatable b. Need to seek medical attention for all nonhealing oral lesions (may be discovered by dentists). Nursing Care a. Disturbed Body Image . Teach risk of oral cancer associated with all tobacco use and excessive alcohol use 2.
. 10% persons experience daily heartburn and indigestion d. GERD common.Gastroesophageal Reflux Disease (GERD) 1. Because of location near other organs symptoms may mimic other illnesses including heart problems a. Gastroesophageal reflux is the backward flow of gastric content into the esophagus. affecting 15 ± 20% of adults c. Definition b.
Increased gastric pressure (obesity or tight clothing) 4.Position pushing gastric contents close to gastroesophageal juncture (such as bending or lying down) 3.Gastroesophageal Reflux Disease (GERD) 2.Hiatal hernia .Increased gastric volume (post meals) 2. Pathophysiology a. Factors contributing to gastroesophageal reflux 1. sphincter. Gastroesophageal reflux results from transient relaxation or incompetence of lower esophageal sphincter. or increased pressure within stomach b.
during sleep and with gastroesophageal reflux esophageal mucosa is damaged and inflamed. Bronchospasm and laryngospasm . Sore throat with hoarseness e. pain with swallowing c. or recumbent b. Heartburn after meals. and bleeding. friable mucosa. prolonged exposure causes ulceration. May have regurgitation of sour materials in mouth. Manifestations a. while bending over. untreated there is scarring and stricture 3.Normally the peristalsis in esophagus and bicarbonate in salivary secretions neutralize any gastric juices (acidic) that contact the esophagus. Atypical chest pain d.Gastroesophageal Reflux Disease (GERD) c.
Gastroesophageal Reflux Disease (GERD)
4. Complications a. Esophageal strictures, which can progress to dysphagia b. Barrett¶s esophagus: changes in cells lining esophagus with increased risk for esophageal cancer 5. Collaborative Care a. Diagnosis may be made from history of symptoms and risks b. Treatment includes 1.Life style changes 2.Diet modifications 3.Medications
Gastroesophageal Reflux Disease (GERD)
6. Diagnostic Tests a. Barium swallow (evaluation of esophagus, stomach, small intestine) b. Upper endoscopy: direct visualization; biopsies may be done c. 24-hour ambulatory pH monitoring d. Esophageal manometry, which measure pressures of esophageal sphincter and peristalsis e. Esophageal motility studies
ranitidine.Gastroesophageal Reflux Disease (GERD) 7. nizatidine c. e. Antacids for mild to moderate symptoms.g. omeprazole (prilosec). Proton-pump inhibitors: reduce gastric secretions. Maalox. famotidine. given BID or more often. promote healing of esophageal erosion and relieve symptoms. metoclopramide (reglan) . Promotility agent: enhances esophageal clearance and gastric emptying. Mylanta. cimetidine.Medications a. Gaviscon b. lansoprazole (Prevacid) initially for 8 weeks. e.g.g. e. or 3 to 6 months d.g. H2-receptor blockers: decrease acid production. e.
Elevate head of bed on 6 ± 8t blocks to decrease reflux f. citrus foods. Maintain ideal body weight d. coffee) b. No smoking g. Eat small meals and stay upright 2 hours post eating. peppermint. alcohol) c. chocolate. spicy. Avoiding food which relax esophageal sphincter or delay gastric emptying (fatty foods. Elimination of acid foods (tomatoes. no eating 3 hours prior to going to bed e. Avoiding bending and wear loose fitting clothing .Gastroesophageal Reflux Disease 8. Dietary and Lifestyle Management a.
Nursing Care a. Assist client to institute home plan .Surgery indicated for persons not improved by diet and life style changes a.Gastroesophageal Reflux Disease (GERD) 9. Pain usually controlled by treatment b. Open surgical procedure: Nissen fundoplication 10. Laparoscopic procedures to tighten lower esophageal sphincter b.
Part of stomach protrudes through the esophageal hiatus of the diaphragm into thoracic cavity b.Hiatal Hernia 1.Definition a. Predisposing factors include: Increased intra-abdominal pressure Increased age Trauma Congenital weakness Forced recumbent position .
Hiatal Hernia c. hernia can become strangulated. Paraesophageal hiatal hernia: the gastroesophageal junction is in normal place but part of stomach herniates through esophageal hiatus. Sliding hiatal hernia: gastroesophageal junction and fundus of stomach slide through the esophageal hiatus e. client may develop gastritis with bleeding . incidence increases with age d. Most cases are asymptomatic.
If medical treatment is not effective or hernia becomes incarcerated. usually Nissen fundoplication by thoracic or abdominal approach Anchoring the lower esophageal sphincter by wrapping a portion of the stomach around it to anchor it in place . Similar to GERD: diet and lifestyle changes. then surgery. Barium swallow b. Diagnostic Tests a. Upper endoscopy 4. Treatment a. Manifestations: Similar to GERD 3. medications b.Hiatal Hernia 2.
Endoscopically guided injection of botulinum toxin Denervates cholinergic nerves in the distal esophagus to stop spams b. Treatment a.Impaired Esophageal Motility 1. Types a. Manifestations: Dysphagia and/or chest pain 3. Balloon dilation of lower esophageal sphincter May place stents to keep esophagus open . Achalasia: characterized by impaired peristalsis of smooth muscle of esophagus and impaired relaxation of lower esophageal sphincter b. Diffuse esophageal spasm: nonperistaltic contraction of esophageal smooth muscle 2.
Pathophysiology a.Most common affecting middle or distal portion of esophagus 2. Adenocarcinoma 1.Associated with Barrett¶s esophagus. Definition: Relatively uncommon malignancy with high mortality rate.Esophageal Cancer 1.Nearly as common as squamous cell affecting distal portion of esophagus 2.Risk factors cigarette smoking and chronic alcohol use b. Squamous cell carcinoma 1.More common in Caucasians 3.More common in African Americans than Caucasians 3. usually diagnosed late 2. complication of chronic GERD and achalasia .
radiation therapy. Choking. Anorexia. Manifestations a. hoarseness. cough c. Progressive dysphagia with pain while swallowing b.Esophageal Cancer 3. and/or chemotherapy . Collaborative Care: Treatment goals a. Maintaining nutritional status while treating carcinoma (surgery. weight loss 4. Controlling dysphagia b.
MRI: determine tumor metastases d. Liver function tests: elevated with liver metastasis .Esophageal Cancer 5. Serum albumin: low levels indicate malnutrition f. Barium swallow: identify irregular mucosal patterns or narrowing of lumen b. Diagnostic Tests a. CT scans. Chest xray. Complete Blood Count: identify anemia e. Esophagoscopy: allow direct visualization of tumor and biopsy c.
Treatments: dependent on stage of disease. radiation and chemotherapy to control dysphagia and pain c. Early (curable) stage: surgical resection of affected portion with anastomosis of stomach to remaining esophagus. Complications of radiation therapy include perforation. client¶s condition and preference a. may also include radiation therapy and chemotherapy prior to surgery b. hemorrhage. stricture . More advanced carcinoma: treatment is palliative and may include surgery.Esophageal Cancer 6.
Anticipatory Grieving (dealing with cancer diagnosis) c. education regarding risks associated with smoking and excessive alcohol intake 8. Nursing Diagnoses a. Imbalanced Nutrition: Less than body requirements (may include enteral tube feeding or parenteral nutrition in hospital and home) b. Nursing Care: Health promotion.Esophageal Cancer 7. Risk for Ineffective Airway Clearance (especially during postoperative period if surgery was done) .
Gastric mucosa rapidly regenerates. Acute Gastritis 1. superficial erosions 2. Types a.Disruption of mucosal barrier allowing hydrochloric acid and pepsin to have contact with gastric tissue: leads to irritation. self-limiting disorder . inflammation. Definition: Inflammation of stomach lining from irritation of gastric mucosa (normally protected from gastric acid and enzymes by mucosal barrier) 2.Gastritis 1.
Erosive: not associated with pain. Mild: anorexia. signs of peritonitis .Gastritis 3. gastric mucosa becomes ischemic and tissue is then injured by acid of stomach 5. alcohol. If perforation occurs. Causes of acute gastritis a. melena c. mild epigastric discomfort. caffeine b. certain chemotherapeutic agents 4. complication of life-threatening condition (Curling¶s ulcer with burns). More severe: abdominal pain. Manifestations a. Ingestion of corrosive substances: alkali or acid c. Erosive Gastritis: form of acute which is stress-induced. corticosteroids. bleeding occurs 2 or more days post stress event d. vomiting. Irritants include aspirin and other NSAIDS. hematemesis. Effects from radiation therapy. nausea. belching b.
no vomiting . coats and protects gastric mucosa c. NPO status to rest GI tract for 6 ± 12 hours. Treatment a. If gastritis from corrosive substance: immediate dilution and removal of substance by gastric lavage (washing out stomach contents via nasogastric tube). reintroduce clear liquids gradually and progress. sucralfate (carafate) acts locally. Medications: proton-pump inhibitor or H2-receptor blocker. intravenous fluid and electrolytes if indicated b.Gastritis 6.
Chronic Gastritis 1. Progressive disorder beginning with superficial inflammation and leads to atrophy of gastric tissues 2. develops pernicious anemia Parietal cells normally secrete intrinsic factor needed for absorption of B12. Type A: autoimmune component and affecting persons of northern European descent. when they are destroyed by gastritis pts develop pernicious anemia . loss of hydrochloric acid and pepsin secretion.
associated with risk of peptic ulcer disease and gastric cancer .Chronic Gastritis 3. Type B: more common and occurs with aging. caused by chronic infection of mucosa by Helicobacter pylori.
Chronic Gastritis 4. pylori infection with combination therapy of two antibiotics (metronidazole (Flagyl) and clarithomycin or tetracycline) and proton± pump inhibitor (Prevacid or Prilosec) . epigastric heaviness not relieved by antacids b. Fatigue associated with anemia. Vague gastric distress. symptoms associated with pernicious anemia: paresthesias Lack of B12 affects nerve transmission 5. Manifestations a. Treatment: Type B: eradicate H.
Teaching regarding use of prescribed medications. Teach food safety measures to prevent acute gastritis from food contaminated with bacteria c. treatment of alcohol abuse . Management of acute gastritis with NPO state and then gradual reintroduction of fluids with electrolytes and glucose and advance to solid foods d. Usually managed in community b. smoking cessation.Chronic Gastritis Collaborative Care a.
identify areas of bleeding. red blood cell indices: anemia including pernicious or iron deficiency c. Hemoglobin. Upper endoscopy: visualize mucosa. obtain biopsies. Imbalanced Nutrition: Less than body requirements . may treat areas of bleeding with electro or laser coagulation or sclerosing agent 5. Gastric analysis: assess hydrochloric acid secretion (less with chronic gastritis) b. Deficient Fluid Volume b. hematocrit. Nursing Diagnoses: a.Chronic Gastritis Diagnostic Tests a. Serum vitamin B12 levels: determine pernicious anemia d.
ulcers found near pyloris c.Peptic Ulcer Disease (PUD) Definition and Risk factors a. affect mostly males ages 30 ± 55. ASA. Gastric ulcers: affect older persons (ages 55 ± 70). alcohol. familial pattern. users of NSAIDS. found on lesser curvature and associated with increased incidence of gastric cancer d. affects 10% of US population b. Break in mucous lining of GI tract comes into contact with gastric juice. Common in smokers. cigarettes . Duodenal ulcers: most common.
Use of NSAIDS: interrupts prostaglandin synthesis which maintains mucous barrier of gastric mucosa b.Peptic Ulcer Disease (PUD) 2. fecaloral routes) damages gastric epithelial cells reducing effectiveness of gastric mucus 2. infection. Chronic with spontaneous remissions and exacerbations associated with trauma.H. Pathophysiology a. Ulcers or breaks in mucosa of GI tract occur with 1. physical or psychological stress . pylori infection (spread by oral to oral.
Peptic Ulcer Disease Diagnosis Endoscopy with cultures Looking for H. Pylori Upper GI barium contrast studies EGD-esophagogastroduodenoscopy Serum and stool studies .
dysphagia. Manifestations a. weight loss. burning.Peptic Ulcer Disease (PUD) 3. occurs when stomach is empty and relieved by food (pain: food: relief pattern) b. Symptoms less clear in older adult. may have poorly localized discomfort. Pain is classic symptom: gnawing. presenting symptom may be complication: GI hemorrhage or perforation of stomach or duodenum . aching hungerlike in epigastric region possibly radiating to back.
Peptic Ulcer Disease
Rest and stress reduction Nutritional management Pharmacological management
Proton pump inhibitors (Prilosec, Prevacid)
Block gastric acid secretion
Peptic Ulcer Disease
Histamine blockers (Tagamet, Zantac, Axid)
Blocks gastric acid secretion
Forms protective layer over the site
Mucosal barrier enhancers (colloidal bismuth, prostoglandins)
Protect mucosa from injury
Antibiotics (PCN, Amoxicillin, Ampicillin)
Treat H. Pylori infection
Peptic Ulcer Disease
NG suction Surgical intervention
Minimally invasive gastrectomy
Partial gastric removal with laproscopic surgery
Bilroth I and II
Removal of portions of the stomach
Cutting of the vagus nerve to decrease acid secretion
Widens the pyloric sphincter
Billroth II .
dizziness. nausea.Hemorrhage: frequent in older adult: hematemesis. with significant bleed loss may develop hypovolemic shock b.Peptic Ulcer Disease (PUD) 4. orthostatic hypotension and anemia.Symptoms: feelings of epigastric fullness. weakness.Obstruction: gastric outlet (pyloric sphincter) obstruction: edema surrounding ulcer blocks GI tract from muscle spasm or scar tissue 1. hematochezia (blood in stool). fatigue. Complications a.Gradual process 2. worsened ulcer symptoms . melena.
chemical at first (inflammatory) and then bacterial in 6 to 12 hours 1.Perforation: ulcer erodes through mucosal wall and gastric or duodenal contents enter peritoneum leading to peritonitis. symptoms of shock 3.Abdomen becomes rigid.Older adults may present with mental confusion and non-specific symptoms .Peptic Ulcer Disease c. boardlike with absent bowel sounds.Time of ulceration: severe upper abdominal pain radiating throughout abdomen and possibly to shoulder 2.
esophageal varacies. PUD.Upper GI Bleed Mortality approx 10% Predisposing factors include: drugs. gastritis and carcinoma . esophagitis.
Hgb Confusion syncope . tarry stools Melena Decreased B/P Vertigo Drop in Hct.Upper GI Bleed Signs and Symptoms Coffee ground vomitus Black.
vomitus studies Endoscopy .Upper GI Bleed Diagnosis History Blood. stool.
normal saline Blood transfusions NG lavage EGD Endoscopic treatment of bleeding ulcer Sclerotheraphy-injecting bleeding ulcer with necrotizing agent to stop bleeding .Upper GI Bleed Treatments Volume replacement Crystalloids.
Upper GI Bleed Treatments Sengstaken-Blakemore tube Used with bleeding esophageal varacies Surgical intervention Removal of part of the stomach .
Sengstaken-Blakemore Tube .
Cancer of Stomach 1. Adenocarcinoma most common form involving mucus-producing cells of stomach in distal portion b. males twice as often as females c. spreads to lymph nodes and metastasizes early in disease to liver. lungs. Incidence highest among Hispanics. Older adults of lower socioeconomic groups higher risk 2. but less common in US b. Asian Americans. Begins as localized lesion (in situ) progresses to mucosa. African Americans. Worldwide common cancer. Incidence a. Pathophysiology a. ovaries. peritoneum .
Colon Cancer .
pain after meals not responding to antacids c. Later symptoms weight loss. Diet high in smoked foods and nitrates Manifestations a. pylori infection b. Risk Factors a. Disease often advanced with metastasis when diagnosed b. gastric polyps d. H. indigestion. vomiting. pernicious anemia. cachexia (wasted away appearance). Genetic predisposition c. Chronic gastritis. Achlorhydria (lack of hydrochloric acid) e. 4. Early symptoms are vague: early satiety. abdominal mass. anorexia. stool positive for occult blood .Cancer of Stomach 3.
Upper GI series. Diagnostic Tests a. Support client through testing b. Assist client to maintain adequate nutrition 6.CBC indicates anemia b. ultrasound identifies a mass c.Upper endoscopy: visualization and tissue biopsy of lesion . Collaborative Care a.Cancer of Stomach 5.
Partial gastrectomy with anastomosis to duodenum: Bilroth I or gastroduodenostomy 2.Total gastrectomy (if cancer diffuse but limited to stomach) with esophagojejunostomy .Cancer of Stomach 7. Surgery.Partial gastrectomy with anastomosis to jejunum: Bilroth II or gastrojejunostomy 3. if diagnosis made prior to metastasis 1. Treatment a.
diaphoretic c. hypertonic. hypotensive. dizzy. and diarrhea.Occurs with partial gastrectomy.Manifestations 5 ± 30 minutes after meal: nausea with possible vomiting. client becomes tachycardic. epigastric pain and cramping. Dumping Syndrome a. undigested chyme bolus rapidly enters small intestine and pulls fluid into intestine causing decrease in circulating blood volume and increased intestinal peristalsis and motility b.Manifestations 2 ± 3 hours after meal: symptoms of hypoglycemia in response to excessive release of insulin that occurred from rise in blood glucose when chyme entered intestine . flushed. Complications associated with gastric surgery 1. borborygmi.Cancer of Stomach b.
Liquids and solids taken separately 2. Limit amount of food taken at one time . Treatment: dietary pattern to delay gastric emptying and allow smaller amounts of chyme to enter intestine 1.Cancer of Stomach d. sedatives. Client to rest recumbent or semi-recumbent 30 ± 60 minutes after eating 5. Carbohydrates. Increased amounts of fat and protein 3. Anticholinergics. especially simple sugars. antispasmodic medications may be added 6. reduced 4.
Cancer of the Stomach
Common post-op complications
Pneumonia Anastomotic leak Hemorrhage Relux aspiration Sepsis Reflux gastritis Paralytic ileus Bowel obstruction Wound infection Dumping syndrome
Cancer of Stomach
Nutritional problems related to rapid entry of food into the bowel and the shortage of intrinsic factor 1 Anemia: iron deficiency and/or pernicious 2 Folic acid deficiency 3. Poor absorption of calcium, vitamin D c. Radiation and/or chemotherapy to control metastasic spread d. Palliative treatment including surgery, chemotherapy; client may have gastrostomy or jejunostomy tube inserted 7. Nursing Diagnoses a. Imbalanced Nutrition: Less than body requirement: consult dietician since client at risk for protein-calorie malnutrition b. Anticipatory Grieving
Nursing Care of Clients with Bowel Disorders
Factors affecting bodily function of elimination A. GI tract 1. Food intake 2. Bacterial flora in bowel B. Indirect 1. Psychologic stress 2. Voluntary postponement of defecation
C.Normal bowel elimination pattern
Varies with the individual 2 ± 3 times daily to 3 stools per week
Irritable Bowel Syndrome (IBS) (spastic bowel. Functional GI tract disorder without identifiable cause characterized by abdominal pain and constipation. Affects up to 20% of persons in Western civilization. or both b. more common in females . diarrhea. functional colitis) Definition a.
Lower visceral pain threshold causing abdominal pain and bloating with normal levels of gas c. Some linkage of depression and anxiety . Appears there is altered CNS regulation of motor and sensory functions of bowel 1.Hypersecretion of colonic mucus b.Increased sensations of chyme movement through gut 3.Increased bowel activity in response to food intake. hormones. functional colitis) Pathophysiology a. stress 2.Irritable Bowel Syndrome (IBS) (spastic bowel.
excess gas c. fatigue. hard or watery stool. Management of distressing symptoms b. passage of mucus. abdominal bloating. anxiety d. Collaborative Care a. functional colitis) Manifestations a. Elimination of precipitating factors. vomiting. Abdominal pain relieved by defecation. Altered bowel habits including frequency. anorexia. straining or urgency with stooling. dull or continuous b. headache. incomplete evacuation. Nausea. stress reduction . Tenderness over sigmoid colon upon palpation 4. occurring in spasms.Irritable Bowel Syndrome (IBS) (spastic bowel. may be colicky.
Irritable Bowel Syndrome (IBS) (spastic bowel. possible hyperemia without lesions d. bacterial infection. marked spasms.Sigmoidoscopy or colonoscopy 1.CBC with differential. obtain biopsies if indicated 2. measure intraluminal pressures. IBS: increased motility . functional colitis) 5.Small bowel series (Upper GI series with small bowel-follow through) and barium enema: examination of entire GI tract.Visualize bowel mucosa. Diagnostic Tests: to find a cause for client¶s abdominal pain. Erythrocyte Sedimentation Rate (ESR): to determine if anemia. changes in feces elimination a. ova and parasites.Findings with IBS: normal appearance increased mucus. culture b. intraluminal pressures. or inflammatory process c.Stool examination for occult blood.
given before meals d. Anticholinergic drugs (dicyclomine (Bentyl). Antidepressant medications f. Research: medications altering serotonin receptors in GI tract to stimulate peristalsis of the GI tract . Antidiarrheal medications (loperamide (Imodium). hyoscyamine) to inhibit bowel motility and prevent spasms. functional colitis) Medications a. diphenoxylate (Lomotil): prevent diarrhea prophylactically e.Irritable Bowel Syndrome (IBS) (spastic bowel. normalize bowel movement in number and form c. Bulk-forming laxatives: reduce bowel spasm. Purpose: to manage symptoms b.
caffeinated beverages 8. Some benefit from elimination of lactose. medications. Nursing Care a.Irritable Bowel Syndrome (IBS) (spastic bowel. stress management. sorbitol c. Contact in health environments outside acute care b. functional colitis) Dietary Management a. Often benefit from additional dietary fiber: adds bulk and water content to stool reducing diarrhea and constipation b. Home care focus on improving symptoms with changes of diet. Limiting intake of gas-forming foods. fructose. seek medical attention if serious changes occur .
lining that covers wall (parietal peritoneum) and organs (visceral peritoneum) of abdominal cavity b.Peritonitis Definition a. ruptured appendix) . Enteric bacteria enter the peritoneal cavity through a break of intact GI tract (e.g. perforated ulcer. Inflammation of peritoneum.
Peritonitis Causes include: Ruptured appendix Perforated bowel secondary to PUD Diverticulitis Gangrenous gall bladder Ulcerative colitis Trauma Peritoneal dialysis .
leading to hypovolemia. Klebsiella. Proteus. Inflammatory process causes fluid shift into peritoneal space (third spacing). then septicemia . Release of bile or gastric juices initially causes chemical peritonitis. Pseudomonas d.Peritonitis Pathophysiology a. infection occurs when bacteria enter the space c. Bacterial peritonitis usually caused by these bacteria (normal bowel flora): Escherichia coli. Peritonitis results from contamination of normal sterile peritoneal cavity with infections or chemical irritant b.
Peritonitis 3. Manifestations a. Depends on severity and extent of infection. Entire abdomen is tender with boardlike guarding or rigidity of abdominal muscle . age and health of client b. Presents with ³acute abdomen´ 1. severe abdominal pain 2.Intensifies with movement c.Pain may localize near site of infection (may have rebound tenderness) 3.Abrupt onset of diffuse.
At risk for delayed diagnosis and higher mortality rates . Systemically: fever.Vague abdominal complaints 5. bowel sounds are diminished or absent with progressive abdominal distention.Peritonitis d.Decreased urinary output 4. malaise. disorientation. Decreased peristalsis leading to paralytic ileus. oliguria with dehydration and shock f. pooling of GI secretions lead to nausea and vomiting e. Older or immunosuppressed client may have 1. tachycardia and tachypnea.Increased confusion and restlessness 3.Few of classic signs 2. restlessness.
Prevention of complications . septic shock. mortality rate overall 40% b. May be life-threatening. Fibrous adhesions d. Diagnosis and identifying and treating cause b. Septicemia. fluid loss into abdominal cavity leads to hypovolemic shock 5. Abscess c.Peritonitis 4. Complications a. Collaborative Care a.
Analgesics . Diagnostic Tests a.Broad-spectrum before definitive culture results identifying specific organism(s) causing infection 2. serum electrolytes: evaluate effects of peritonitis d. Diagnostic paracentesis 7. Medications a.000. Antibiotics 1. Abdominal xrays: detect intestinal distension. Liver and renal function studies.Specific antibiotic(s) treating causative pathogens b. free air under diaphragm (sign of GI perforation) e. shift to left b. Blood cultures: identify bacteria in blood c. WBC with differential: elevated WBC to 20.Peritonitis 6. airfluid levels.
removed inflamed tissue) b. Laparotomy to treat cause (close perforation. Surgery a.Peritonitis 8. Peritoneal Lavage: washing out peritoneal cavity with copious amounts of warm isotonic fluid during surgery to dilute residual bacterial and remove gross contaminants c. Often have drain in place and/or incision left unsutured to continue drainage .
Intestinal decompression with nasogastric tube or intestinal tube connected to suction 1. Treatment a. Bed rest in Fowler¶s position to localize infection and promote lung ventilation c. NPO with intravenous fluids while having nasogastric suction . Relieves abdominal distension secondary to paralytic ileus 2.Peritonitis 9. Intravenous fluids and electrolytes to maintain vascular volume and electrolyte balance b.
Home intravenous antibiotics . Anxiety 11. Home health referral 3. Home care often includes 1. Home Care a. nasogastric drainage is considered when ordering intravenous fluids c. Nursing Diagnoses a. Deficient Fluid Volume: often on hourly output. Wound care 2. Pain b. Ineffective Protection d. Client may have prolonged hospitalization b.Peritonitis 10.
may be related to infectious agent and altered immune responses c. Etiology is unknown but runs in families.Client with Inflammatory Bowel Disease Definition a. Includes 2 separate but closely related conditions: ulcerative colitis and Crohn¶s disease. Chronic disease with recurrent exacerbations . second peak 60 ± 80 d. both have similar geographic distribution and genetic component b. Peak incidence occurs between the ages of 15 ± 35.
Inflammatory Bowel Disease .
bleeding is common 4. narrowing. Mucosa becomes red. Inflammatory process usually confined to rectum and sigmoid colon 2.Ulcerative Colitis Pathophysiology 1. which leads to necrosis and sloughing of bowel mucosa 3. friable. and shortening of colon . and ulcerated. Chronic inflammation leads to atrophy. Inflammation leads to mucosal hemorrhages and abscess formation.
Fatigue. 10 ± 20 bloody stools per day leading to anemia. tenesmus. hypovolemia. Diarrhea with stool containing blood and mucus. weakness . LLQ cramping 3. anorexia. malnutrition 2.Ulcerative Colitis Manifestations 1. Fecal urgency.
Increased risk for colorectal cancer (20 ± 30 times).Ulcerative Colitis Complications 1. Colon perforation: rare but leads to peritonitis and 15% mortality rate 4. Abcess. Hemorrhage: can be massive with severe attacks 2. Toxic megacolon: usually involves transverse colon which dilates and lacks peristalsis (manifestations: fever. hypotension. Bowel obstruction 7. tachycardia. dehydration. need yearly colonoscopies 5. abdominal cramping) 3. change in stools. fistula formation 6. Extraintestinal complications Arthritis Ocular disorders Cholelithiasis .
Ulcerative Colitis Diet therapy Goal to prevent hyperactive bowel activity Severe symptoms NPO TPN Less severe Vivonex Elemental formula absorbed in the upper bowel Decreases bowel stimulation .
smoking .Ulcerative Colitis Diet therapy Significant symptoms Low fiber diet Reduce or eliminate lactose containing foods Avoid caffeinated beverages. pepper. alcohol.
Continent (or Kock¶s) ileostomy: has intraabdominal reservoir with nipple valve formation to allow catheter insertion to drain out stool . Name of ostomy depends on location of stoma 4. Stoma is the surface opening which has an appliance applied to retain stool and is emptied at intervals 3. may be permanent with total proctocolectomy or temporary (loop ileostomy) 5. Ileostomy: opening in ileum. Surgically created opening between intestine and abdominal wall that allows passage of fecal material 2.Ulcerative Colitis Ostomy 1. Ileostomies: always have liquid stool which can be corrosive to skin since contains digestive enzymes 6.
anus removed Closure of anus Stoma in right lower quadrant In selected patients an ileoanal anastamosis or ileal reservoir to preserve the anal sphincter J-shaped pouch is created internally from the end of the ileum to collect fecal material Pouch is then connected to the distal rectum .Ulcerative Colitis Surgical Management 25% of patients require a colectomy Total proctocolectomy with a permanent ileostomy Colon. rectum.
Ulcerative Colitis Surgical management Total colectomy with a continent ileostomy Kock¶s ileostomy Intra-abdominal pouch where stool is stored untile client drains it with a catheter .
Ulcerative Colitis Surgical management Total colectomy with ileoanal anastamosis Ileoanal reservoir or J pouch Removes colon and rectum and sutrues ileum into the anal canal .
adequate nutrition. support group and home care referral . if client has ostomy: care and resources for supplies. Inflammatory bowel disease is chronic and day-to-day care lies with client b. Teaching to control symptoms.Ulcerative Colitis Home Care a.
Ulcerative Colitis Treatment Medications similar to treatment for Crohn¶s disease .
Imbalanced Nutrition: Less than body requirement d. related to diarrhea or ostomy .Ulcerative Colitis Nursing Care: Focus is effective management of disease with avoidance of complications Nursing Diagnoses a. Risk for sexual dysfunction. Risk for Impaired Tissue Integrity: Malnutrition and healing post surgery e. diarrhea may control all aspects of life. Disturbed Body Image. client has surgery with ostomy c. Diarrhea b.
Inflammatory aphthoid lesion (shallow ulceration) of mucosa and submuscosa develops into ulcers and fissures that involve entire bowel wall 3. bowel and bladder (enterovesical fistulas). Fibrotic changes occur leading to local obstruction. but terminal ileum and ascending colon are more commonly involved 2. bowel and skin (enterocutaneous fistulas) 5.Crohn¶s Disease (regional enteritis) Pathophysiology 1. Absorption problem develops leading to protein loss and anemia . Can affect any portion of GI tract. Fistulas develop between loops of bowel (enteroenteric fistulas). abscess formation and fistula formation 4.
Crohn¶s disease .
liquid or semi-formed. malaise. Fissures. fatigue.Crohn¶s Disease (regional enteritis) Manifestations 1. Often continuous or episodic diarrhea. fistulas. abdominal pain and tenderness in RLQ relieved by defecation 2. Fever. abscesses . anemia 3. weight loss.
Crohn¶s Disease (regional enteritis) Complications 1. Perforation of bowel may occur with peritonitis 4. recurrent urinary tract infection if bladder involved 3. Fistulas lead to abscess formation. Intestinal obstruction: caused by repeated inflammation and scarring causing fibrosis and stricture 2. Increased risk of bowel cancer (5 ± 6 times) . Massive hemorrhage 5.
sigmoidoscopy: determine area and pattern of involvement. Colonoscopy. Many clients need surgery Diagnostic Tests a. Establish diagnosis b. leukocytosis from inflammation and abscess formation e. tissue biopsies. barium enema c. folic acid: lower due to malabsorption . Serum albumin. CBC: shows anemia. Stool examination and stool cultures to rule out infections d. Upper GI series with small bowel follow-through.Crohn¶s Disease (regional enteritis) Collaborative Care a. small risk of perforation b. Supportive treatment c.
Sulfasalazine (Azulfidine): salicylate compound that inhibits prostaglandin production to reduce inflammation b. cyclosporine) for clients who do not respond to steroid therapy alone Used in combination with steroid treatment and may help decrease the amount of steroid use . Immunosuppressive agents (azathioprine (Imuran). intravenous steroids are given with severe exacerbations c.Crohn¶s Disease (regional enteritis) Medications: goal is to stop acute attacks quickly and reduce incidence of relapse a. Corticosteroids: reduce inflammation and induce remission. with ulcerative colitis may be given as enema.
anti-inflammatory cyctokines e.Crohn¶s Disease d. Anti-diarrheal medications . New therapies including immune response modifiers. Metronidazole (Flagyl) or Ciprofloxacin (Cipro) For the fistulas that develop f.
With acute exacerbations. Individualized according to client. Dietary fiber contraindicated if client has strictures c.Crohn¶s Disease (regional enteritis) Dietary Management a. eliminate irritating foods b. client may be made NPO and given enteral or total parenteral nutrition (TPN) Surgery: performed when necessitated by complications or failure of other measures removal of diseased portion of the bowel .
may have bowel resection and repair for obstruction. Disease process tends to recur in area remaining after resection . abscess 2. fistula.Crohn¶s disease 1.Crohn¶s Disease a. Bowel obstruction leading cause. perforation.
S. Large intestine and rectum most common GI site affected by cancer 2. Client with Polyps 1. Definition a.Neoplastic Disorders Background 1. Polyp is mass of tissue arising from bowel wall and protruding into lumen b. 30% of people over 50 have polyps . Most often occur in sigmoid and rectum c. B. Colon cancer is second leading cause of death from cancer in U.
< 1% become malignant but all colorectal cancers arise from these polyps b. near 100% malignancy by age 40 . or tubularvillous c. untreated. Polyp types include tubular. Familial polyposis is uncommon autosomal dominant genetic disorder with hundreds of adenomatous polyps throughout large intestine. Most polyps are adenomas. villous.Neoplastic Disorders Pathophysiology a. benign but considered premalignant.
Client with Polyps Manifestations a. Repeat every 3 years since polyps recur . Most asymptomatic b. Intermittent painless rectal bleeding is most common presenting symptom Collaborative Care a. Diagnosis is based on colonoscopy b. Most reliable since allows inspection of entire colon with biopsy or polypectomy if indicated c.
Client with Polyps Nursing Care a. All clients advised to have screening colonoscopy at age 50 and every 5 years thereafter (polyps need 5 years of growth for significant malignancy) b. Bowel preparation ordered prior to colonoscopy with cathartics and/or enemas .
Diet high in fat. with early diagnosis and treatment Risk Factors a. calories. Family history b. Affects sexes equally c. Five-year survival rate is 90%.Client with Colorectal Cancer Definition a. Third most common cancer diagnosed b. Inflammatory bowel disease c. protein .
Presenting manifestation is bleeding. bones. anemia . Spread by direct extension to involve entire bowel circumference and adjacent organs c. also change in bowel habits (diarrhea or constipation). anorexia. and kidneys Manifestations a. Metastasize to regional lymph nodes via lymphatic and circulatory systems to liver. Most malignancies begin as adenomatous polyps and arise in rectum and sigmoid b. pain. Often produces no symptoms until it is advanced b. lungs.Client with Colorectal Cancer Pathophysiology a. palpable abdominal or rectal mass. weight loss. brain.
Colon Cancer .
peritonitis c. Fecal occult blood testing beginning at age 50.Client with Colorectal Cancer Complications a. annually c. every 3 ± 5 years . Direct extension of cancer to adjacent organs. reoccurrences within 4 years Collaborative Care: Focus is on early detection and intervention Screening a. annually b. Colonoscopies or sigmoidoscopies beginning at age 50. Bowel obstruction b. Perforation of bowel by tumor. Digital exam beginning at age 40.
ultrasounds: to determine tumor depth. polyps e. CBC: anemia from blood loss. monitor treatment. Colonoscopy or sigmoidoscopy. Chest xray. but is a tumor marker and used to estimate prognosis. Fecal occult blood (guiac or Hemoccult testing): all colorectal cancers bleed intermittently c. detect reoccurrence may be elevated in 70% of people with CRC d. metastasis . MRI. organ involvement. tissue biopsy of suspicious lesions. tumor growth b. Carcinoembryonic antigen (CEA): not used as screening test.Client with Colorectal Cancer Diagnostic Tests a. CTscans.
Client with Colorectal Cancer Pre-op care Consult with ET nurse if ostomy is planned Bowel prep with GoLytely NPO NG .
rectum. Whenever possible anal sphincter is preserved and colostomy avoided. and regional lymph nodes is treatment of choice b. Tumors of rectum are treated with abdominoperineal resection (A-P resection) in which sigmoid colon. adjacent colon. anastomosis of remaining bowel is performed c.Client with Colorectal Cancer Surgery a. Surgical resection of tumor. and anus are removed through abdominal and perineal incisions and permanent colostomy created .
Named for area of colon is which formed a. temporary.Client with Colorectal Cancer Colostomy 1. temporary d. Permanent means for fecal evacuation if distal colon and rectum removed 2. only proximal colostomy is brought to abdomen as stoma. Double-barrel colostomy: 2 stomas: proximal for feces diversion. distal is mucous fistula c. colon reconnected at later time when client ready for surgical repair . Ostomy made in colon if obstruction from tumor a. loop suspended over a bridge. Hartman procedure: Distal portion is left in place and oversewn. Temporary measure to promote healing of anastomoses b. Sigmoid colostomy: used with A-P resection formed on LLQ b. Transverse loop colostomy: emergency procedure.
Client with Colorectal Cancer Post-op care Pain NG tube Wound management Stoma Should be pink and moist Drk red or black indicates ischemic necrosis Look for excessive bleeding Observe for possible separation of suture securing stoma to abdominal wall .
solid stool .Client with Colorectal Cancer Post-op care Evaluate stool after 2-4 days postop Ascending stoma (right side) Liquid stool Transverse stoma Pasty Descending stoma Normal.
rectal cancer has high rate of regional recurrence if tumor outside bowel wall or in regional lymph nodes b. Used as adjunct with surgery. Used preoperatively to shrink tumor C. does not improve survival rates Chemotherapy: Used postoperatively with radiation therapy to reduce rate of rectal tumor recurrence and prolong survival .Client with Colorectal Cancer Radiation Therapy a. Provides local control of disease.
Seek medical attention for bleeding and warning signs of cancer 4. Anticipatory Grieving d. Client teaching 1. whole grains. Risk may be lowered by aspirin or NSAID use Nursing Diagnoses for post-operative colorectal client a. Imbalanced Nutrition: Less than body requirements c. Screening recommendations 3. legumes 2. Alteration in Body Image e. red meat. Pain b.Client with Colorectal Cancer Nursing Care a. Prevention is primary issue b. Risk for Sexual Dysfunction . increase amount of fiber. refined sugar. Diet: decrease amount of fat. diet high in fruits and vegetables.
Client with Colorectal Cancer Home Care a. Referral for home care b. Referral to hospice as needed for advanced disease . Referral to support groups for cancer or ostomy c.
gas and fluid accumulate proximal to and within obstructed segment causing bowel distention d. third-spacing leads to hypovolemia. most common site is small intestine c. Bowel distention. Failure of intestinal contents to move through the bowel lumen. With obstruction. vomiting. shock .Client with Intestinal Obstruction Definition a. hypokalemia. renal insufficiency. May be partial or complete obstruction b.
Client with Intestinal Obstruction Pathophysiology a. Problems outside intestines: adhesions (bands of scar tissue). Problems within intestines: tumors. Foreign bodies d. Volvulus: twisted bowel c. Obstruction of intestinal lumen (partial or complete) a. hernias 2. Intussusception: telescoping bowel b. Strictures . Mechanical 1. IBD 3.
Hypokalemia d. Tissue anoxia or peritoneal irritation from hemorrhage. Accounts for most bowel obstructions 3. Failure of peristalsis to move intestinal contents: adynamic ileus (paralytic ileus. Medications: narcotics. Spinal cord injuries.Client with Intestinal Obstruction Functional 1. Causes include a. uremia. anticholinergic drugs. Post gastrointestinal surgery b. antidiarrheal medications e. alterations in electrolytes . ileus) due to neurologic or muscular impairment 2. peritonitis. or perforation c.
Distal obstruction vomiting may become feculent Bowel sounds 1. diminished or absent bowel sounds throughout Signs of dehydration . e. c. b. intensifying Vomiting 1. with paralytic ileus. Early in course of mechanical obstruction: borborygmi and high-pitched tinkling. Later silent. may have visible peristaltic waves 2. Proximal intestinal distention stimulates vomiting center 2. Manifestations Small Bowel Obstruction Vary depend on level of obstruction and speed of development Cramping or colicky abdominal pain. d.Client with Intestinal Obstruction a. intermittent.
Client with Intestinal Obstruction Complications a. impaired ventilation. possible septic shock c. peritonitis. death) b. perforation. Delay in surgical intervention leads to higher mortality rate . Hypovolemia and hypovolemic shock can result in multiple organ dysfunction (acute renal failure. Strangulated bowel can result in gangrene.
inflammatory disorders.Client with Intestinal Obstruction Large Bowel Obstruction a. volvulus. Only accounts for 15% of obstructions b. Causes include cancer of bowel. localized tenderness or palpable mass may be noted . fecal impaction c. severe. cramping pain. continuous pain signals bowel ischemia and possible perforation. Manifestations: deep. diverticular disease.
osmolality. Laboratory testing to evaluate for presence of infection and electrolyte imbalance: WBC. Abdominal Xrays and CT scans with contrast media 1. Serum amylase. indicates free air under diaphragm 2. check for allergy to iodine. need BUN and Creatinine to determine renal function b. electrolytes. Supportive care Diagnostic Tests a. arterial blood gases c. Successfully relieves many partial small bowel obstructions . If CT with contrast media meglumine diatrizoate (Gastrografin). confirm mechanical obstruction. Show distended loops of intestine with fluid and /or gas in small intestine. Relieving pressure and obstruction b.Client with Intestinal Obstruction Collaborative Care a. Treatment with nasogastric or long intestinal tube provides bowel rest and removal of air and fluid b. Barium enema or colonoscopy/sigmoidoscopy to identify large bowel obstruction Gastrointestinal Decompression a.
Restore fluid and electrolyte balance. Laparotomy: inspection of intestine and removal of infarcted or gangrenous tissue 4. correct acid and alkaline imbalances 3. foreign bodies. tumors. abdominal distention. Preoperative care 1. Insertion of nasogastric tube to relieve vomiting.Client with Intestinal Obstruction Surgery a. strangulated or incarcerated obstructions of small bowel. Removal of cause of obstruction: adhesions. gangrenous portion of intestines and anastomosis or creation of colostomy depending on individual case . persistent incomplete mechanical obstructions b. Treatment for complete mechanical obstructions. and to prevent aspiration of intestinal contents 2.
Deficient Fluid Volume b. fluid intake b. Ineffective Breathing Pattern Home Care a. Prevention includes healthy diet.Client with Intestinal Obstruction Nursing Care a. Exercise. Ineffective Tissue Perfusion. especially in clients with recurrent small bowel obstructions Nursing Diagnoses a. Teaching about signs of recurrent obstruction and seeking medical attention . gastrointestinal c. Home care referral as indicated b.
Incidence increases with age. Cultural changes in western world with diet of highly refined and fiber-deficient foods b. less than a third of persons with diverticulosis develop symptoms Risk Factors a.Client with Diverticular Disease Definition a. Postponement of defecation . Diverticula are saclike projections of mucosa through muscular layer of colon mainly in sigmoid colon b. Decreased activity levels c.
causing outpouchings b. Diverticulosis is the presence of diverticula which form due to increased pressure within bowel lumen causing bowel mucosa to herniate through defects in colon wall. the inflammation of the diverticular sac .Client with Diverticular Disease Pathophysiology a. Complications of diverticulosis include hemorrhage and diverticulitis. Muscle in bowel wall thickens narrowing bowel lumen and increasing intraluminal pressure c.
more extensive perforation may lead to peritonitis or abscess formation . inflammation is localized.Clients with Diverticular Disease d. Diverticulitis: diverticulum in sigmoid colon irritated with undigested food and bacteria forming a hard mass (fecalith) that impairs blood supply leading to perforation e. With microscopic perforation.
abdominal distention. Peritonitis b. left-sided. Hemorrhage .Client with Diverticular Disease Manifestations a. Fistula formation e. Older adult may have vague abdominal pain Complications a. Bowel obstruction d. tenderness and palpable LLQ mass d. Constipation or frequency of defecation c. Abscess formation c. May also have nausea. vomiting. low-grade fever. Pain. mild to moderate and cramping or steady b.
Hemocult or guiac testing: determine presence of occult blood . location of abscess. Barium enema contraindicated in early diverticulitis due to risk of barium leakage into peritoneal cavity. WBC count with differential: leukocytosis with shift to left in diverticulitis e. but will confirm diverticulosis c. Abdominal Xray: detection of free air with perforation. sigmoidoscopy or colonscopy used in diagnosis of diverticulosis d.Client with Diverticular Disease Collaborative Care: Focus is on management of symptoms and complications Diagnostic Tests a. fistula b. Abdominal CT scan.
Client with Diverticular Disease Medications a. Fluids to correct dehydration d. Broad spectrum antibiotics against gram negative and anaerobic bacteria to treat acute diverticulitis. oral or intravenous route depending on severity of symptoms Flagyl plus Bactrim or Cipro b. Stool softener but not cathartic may be prescribed (nothing to increase pressure within bowel) e. Analgesics for pain (non-narcotic) c. Anticholinergics to decrease intestinal hypermotility .
Diet modification may decrease risk of complications b. commercial bulk-forming products such as psyllium seed (Metamucil) or methycelluose) c. Some clients advised against foods with small seeds which could obstruct diverticula . High-fiber diet (bran.Clients with Diverticular Disease Dietary Management a.
to soft. 2 stage Hartman procedure done with temporary colostomy. re-anastomosis performed 2 ± 3 months later . As symptoms subside reintroduce food: clear liquid diet.Client with Diverticular Disease Treatment for acute episode of diverticulitis a. Client initially NPO with intravenous fluids (possibly TPN) b. low-roughage diet psyillium seed products to soften stool and increase bulk c. Surgical intervention indicated for clients with generalized peritonitis or abscess that does not respond to treatment b. High fiber diet is resumed after full recovery Surgery a. With acute infection.
may be contraindicated for persons with known conditions Nursing Diagnoses a.Client with Diverticular Disease Nursing Care: Health promotion includes teaching high-fiber foods in diet generally. gastrointestinal b. Anxiety. Impaired Tissue Integrity. Teaching regarding prescribed diet. Referral for home health care agency. if new colostomy client . possible surgery Home Care a. medications b. Pain c. fluid intake. related to unknown outcome of treatment.
Nausea and vomiting can sometimes be symptoms of more serious diseases such as heart attacks. . and some forms of cancer. Nausea and vomiting are not diseases. central nervous system disorders. kidney or liver disorders. brain tumors. but rather are symptoms of many different conditions.
Table 42-2 page 993 .
Nursing Diagnosis Nausea Deficient fluid volume Imbalanced Nutrition Less than body requirements Risk for injury (aspiration) .
Goals Decrease in nausea and vomiting Normal Fluid and Electrolyte balance Maintain body weight Maintain airway .
Interventions Position the patient: To prevent aspiration Conscious: semi fowler¶s Unconscious: lateral Provide good oral care measures .
Suction mouth as needed if the client is unable to expel vomitus. Relieve sensation of nausea by providing any of the following: Ice chips Hot tea with lemon Hot ginger ale Dry toast or crackers Cold cola beverage .
concentrated urine High specific gravity of urine Poor skin turgor Altered LOC (level of consciousness) Elevated BUN. Replace fluid-electrolyte loss (oral or intravenous fluid infusion) Observe for potential complications as follows: Dehydration Thirst (first sign) Dry mouth and mucus membrane Warm. flushed dry skin Fever. tachycardia. serum creatinine Elevated hematocrit . low BP Weight loss Sunken eyeballs Oliguria Dark.
raw carrot. raw tomato. citrus fruits and dried fruits. baked potatoes.Hypokalemia Initial manifestation in muscle weakness in the legs or leg cramps Provide postssium-rich foods such as banana. Administer antiemetic as ordered by the physician Plasil (Metochlopramide) Tigan (Trimethobenzamide) Phenergan (Promethazine) Compazine (Prochlorperazine maleate) .
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.