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