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