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GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008

REVIEW

Gastrointestinal Disorders
RN REVIEW

REVIEW OF PARTS & FUNCTIONS
Nio C. Noveno, RN, MAN

GI DISORDERS 2

G IT

THE MAJOR PARTS
MOUTH /
ESOPHAGUS
STOMACH
SMALL
INTESTINE
LARGE
INTESTINE

ACCESSORY
ORGANS
GI DISORDERS
PANCREAS
LIVER
GALLBLADDER

GI DISORDERS 3 GI DISORDERS 4

BY NIO C. NOVENO, RN, MAN 1
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

STOMATITIS ESOPHAGEAL VARICES
CAUSES • MOST COMMON
• INFECTIONS
LOCATION
• IRRITANTS
• CHEMOTHERAPY – DISTAL VEINS OF THE
ESOPHAGUS
DIAGNOSIS – OFTEN DUE TO CIRRHOSIS
NURSING DIAGNOSES • C&S
• PAIN *WALLS OF THE VEINS
TREATMENT
• IMBALANCED NUTRITION • XYLOCAINE WEAKEN
• IMPAIRED ORAL MUCOUS • ANTIBIOTICS – WOF: BLEEDING &
MEMBRANE • BLAND DIET ULCERATION

GI DISORDERS 5 GI DISORDERS 6

ESOPHAGEAL VARICES
IF VARICES ARE ACTIVELY BLEEDING
MEDICAL MANAGEMENT
SENGSTAKEN-BLAKEMORE
TUBE MINNESOTA TUBE
1. SCLEROTHERAPY

2. LIGATION

3. BALLOON TAMPONADE

GI DISORDERS 7 GI DISORDERS 8

BY NIO C. NOVENO, RN, MAN 2
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

ESOPHAGEAL VARICES ESOPHAGEAL VARICES
SURGICAL MANAGEMENT PHARMACOLOGICAL MANAGEMENT
TRANSJUGULAR • OCREOTIDE (SANDOSTATIN) I.V.
INTRAHEPATIC – DECREASES BLOOD FLOW
PORTOSYSTEMIC
• ANALGESICS
SHUNT
• SUCRALFATE (C ARAFATE)
• USES THE RIGHT INTERNAL • I.V. REHYDRATION
JUGULAR VEIN
• CONNECTION BETWEEN
HEPATIC & PORTAL VEINS • AVOID:
• DONE IN X-RAY – ASPIRINS, NSAIDS, ANTICOAGULANTS

GI DISORDERS 9 GI DISORDERS 10

ESOPHAGEAL VARICES
GASTROESOPHAGEAL REFLUX DISEASE
NURSING MANAGEMENT
POSSIBLE CAUSES:
• RISK FOR FLUID VOLUME DEFICIT 1. FATTY FOODS
2. CAFFEINE
3. NICOTINE
• DEFICIENT FLUID VOLUME
4. CCBS
5. NSAIDS
• ANXIETY

GI DISORDERS 11 GI DISORDERS 12

BY NIO C. NOVENO, RN, MAN 3
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

GASTROESOPHAGEAL REFLUX DISEASE
GASTROESOPHAGEAL REFLUX DISEASE
MANAGEMENT
SIGNS & SYMPTOMS NURSING CONSIDERATIONS FUNDOPLICATION SURGERY
• BELCHING 1. INSTRUCT PT TO LOSE
• FLATULENCE WEIGHT A LAPAROSCOPIC PROCEDURE
• ESOPHAGITIS 2. AVOID FATTY FOODS, DONE TO TIGHTEN THE LES
• DYSPHAGIA ALCOHOL, NICOTINE, – FUNDUS OF THE STOMACH IS
• EPIGASTRIC PAIN CAFFEINE, SPICY FOODS WRAPPED & SUTURED AROUND
THE ESOPHAGUS
• HEARTBURN 3. TAKE MEDICATIONS AS RX
• BLEEDING 4. ELEVATE HOB
• MELENA 5. AVOID WEARING
CONSTRICTIVE CLOTHING

GI DISORDERS 13 GI DISORDERS 14

GASTRIC ULCER DUODENAL ULCER
PEPTIC ULCERS
LESS COMMON MORE COMMON
INCIDENCE
55-77 YO 30-50 YO
BLEEDING MORE LIKELY LESS LIKELY
PERFORATION LESS LIKELY MORE LIKELY

FOOD INCREASES PAIN; FOOD RELIEVES PAIN;
PAIN RELIEF
WEIGHT LOSS WEIGHT GAIN

PAIN: ½ - 1 H AFTER A MEAL;
PAIN: 2-3 H;
RARELY OCCURS AT NIGHT;
PAIN PATTERN OFTEN AWAKENED AT1-2
MAY BE RELIEVED BY AM
VOMITING

GI DISORDERS 15 GI DISORDERS 16
MALIGNANCY OCCASIONALLY RARE

BY NIO C. NOVENO, RN, MAN 4
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

PEPTIC ULCER DISEASE PEPTIC ULCER DISEASE
GNAWING OR BURNING EPIGASTRIC PAIN
CAMPYLOBACTER PYLORI OR HELICOBACTER PYLORI THAT OCCURS 1 TO 2 HOURS AFTER EATING

ZOLLINGER-ELLISON SYNDROME [GASTRINOMA] ERUCTATION, VOMITING, FOOD, OR ANTACIDS

ASPIRIN, STEROIDS, INDOMETHACIN, NSAIDS NAUSEA

SMOKING BLEEDING
[COLOR PULSE TEMPERATURE]
PERSONALITY VOMITING
GI DISORDERS
17 GI DISORDERS 18

PEPTIC ULCER DISEASE PEPTIC ULCER DISEASE
DIAGNOSIS SURGICAL MANAGEMENT

GI DISORDERS 19 GI DISORDERS 20

BY NIO C. NOVENO, RN, MAN 5
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

PEPTIC ULCER DISEASE PEPTIC ULCER DISEASE:
NURSING MANAGEMENT THERAPEUTIC INTERVENTIONS
PREOPERATIVE POSTOPERATIVE THERE IS A NID TO:
NEUTRALIZE OR BUFFER HYDROCHLORIC ACID
INHIBIT ACID SECRETION
DECREASE THE ACTIVITY OF PEPSIN AND HCL

CALCIUM AND IRON SUPPLEMENTS
[IF MEDICATION INCREASES GASTRIC PH]
nionoveno@hotmail.com GI DISORDERS 22
GI DISORDERS 21

MEDICATION PURPOSE NURSING IMPLICATIONS
ANTACIDS
GERD & ULCERS
•ALUMINUM OH (AMPHOGEL)
SEAL IMPAIRED MUCOSA
CONSTIPATION
DIARRHEA PEPTIC ULCER DISEASE
•ALUMINUM OH & MAGNESIUM OH MONAK
(MAALOX)
PHARMACOLOGICAL MANAGEMENT
•DIHYDROXYALUMINUM SODIUM
NEUTRALIZE ACIDS
AVOID GIVING WITH OTHER MEDS
DIETARY MANAGEMENT
(ROLAIDS)
H2BLOCKERS
•RANITIDINE HCL (ZANTAC)
DECREASE GASTRIC ACID
•CIMETIDINE (TAGAMET) DO NOT GIVE WITH ANTACIDS
SECRETION
•NIZATIDINE (AXID)
•FAMOTIDINE (PEPCID)
PROTON PUMP INHIBITOR
INCREASE EFFECTS OF PHENYTOIN,
•OMEPRAZOLE (LOSEC)
STOP GASTRIC ACID WARFARIN, DIAZEPAM
•ESOMEPRAZOLE (NEXIUM)
PRODUCTION DELAYS ABSORPTION OF VALIUM
•LANSOPRAZOLE (ZOTON)
•PANTOPRAZOLE (PROTIUM)
•RABEPRAZOLE SODIUM (PARIET)
PROSTAGLANDINS DECREASE GASTRIC ACID
•MISOPROSTOL (CYTOTEC) SECRETION NSAID-INDUCED ULCERS
ENHANCES MUCOSAL DEFENSES
BISMUTH COMPOUNDS
•BISMUTH SUBSALICYLATE (PEPTO- INHIBITS H. PYLORI GROWTH
BISMOL)
ANTIBIOTICS
•AMPICILLIN (OMNIPEN)
GI DISORDERS
ELIMINATE H. PYLORI TAKEN WITH FOOD 23 GI DISORDERS 24
•METRONIDAZOLE (FLAGYL)

BY NIO C. NOVENO, RN, MAN 6
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

PEPTIC ULCER DISEASE PEPTIC ULCER DISEASE
TYPE AND CROSS-MATCH ANTIEMETICS
[GASTRIC HEMORRHAGE]
[NAUSEA AND VOMITING]
NGT & SALINE LAVAGE / VASOCONSTRICTORS
[CONTROL BLEEDING ] ANTIBIOTICS: TETRACYCLINE, METRONIDAZOLE, AND BISMUTH

TRANQUILIZERS BED REST
ANTICHOLINERGICS [REDUCE PHYSICAL ACTIVITY]

ANALGESICS COUNSELING OR PSYCHOTHERAPY
SEDATIVES [EXPLORE THE EMOTIONAL COMPONENTS OF THE ILLNESS]
[PAIN AND RESTLESSNESS]
GI DISORDERS 25 GI DISORDERS 26

PEPTIC ULCER DISEASE: NURSE IT! PEPTIC ULCER DISEASE
1. ALLOW EXPRESSION OF FEELINGS AND CONCERNS MVS; MIO
2. ADMINISTER AND ASSESS EFFECTS OF MEDICATIONS
ASSESS THE DRESSING FOR DRAINAGE
3. ENCOURAGE HYDRATION
a. REDUCES ANTICHOLINERGIC SE MAINTAIN A PATENT NGT TO THE SUCTION APPARATUS
b. DILUTE THE HCL IN THE STOMACH [PREVENT STRESS ON THE SUTURE LINE]
4. EAT SMALL TO MEDIUM-SIZED MEALS OBSERVE THE COLOR AND AMOUNT OF NG DRAINAGE
5. REPLACE WITH DECAFFEINATED SOFT DRINKS AND TEAS [BRIGHT RED BLOOD AFTER 12 HOURS SHOULD BE REPORTED]
6. USE SEASONINGS LIKE THYME, BASIL, SAGE
COUGH, DEEP BREATHE, & CHANGE POSITION FREQUENTLY
7. AVOID SALICYLATES, PHENYLBUTAZONE, STEROIDS, APPLY ANTIEMBOLISM STOCKINGS & AMBULATE
ACTH
GI DISORDERS 27 GI DISORDERS 28

BY NIO C. NOVENO, RN, MAN 7
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

PEPTIC ULCER DISEASE ULCER
UPSET STOMACH
TO PREVENT DUMPING SYNDROME:
LOW APPETITE
FREQUENT FEEDINGS OF SMALL AMOUNTS
CAUSES:
CHEMICALS, COFFEE, ALCOHOL, ALLERGENS, UREMIA,
AVOID HIGH-CHO INTAKE BACTERIA, DRUGS, SMOKING, STRESS, SPICES

CONSUME LIQUIDS ONLY BETWEEN MEALS EMESIS
(AT LEAST 1 HOUR BEFORE OR AFTER MEALS) REDUCE ACID
LIE DOWN OR REST AFTER EATING ANTI-ACID MEDICATIONS
CARAFATE
PECTIN OR GUAR GUM (5-G DOSE) WITH MEALS
IRRITANTS
[WATER-SOLUBLE FIBER WHICH DELAYS GASTRIC EMPTYING AND
ABSORPTION OF CARBOHYDRATES
Decompression
GI DISORDERS 29 GI DISORDERS 30

APPENDICITIS COMMON SIGNS OTHER CONFIRMATORY PERITONEAL SIGNS
(ABSENCE OF THESE SIGNS DOES NOT EXCLUDE APPENDICITIS)

THE CAUSES… OF APPENDICITIS • PSOAS SIGN--PAIN ON EXTENSION OF
RIGHT THIGH (RETROPERITONEAL
• OBSTRUCTION • RIGHT LOWER QUADRANT PAIN ON RETROCECAL APPENDIX)
PALPATION (THE SINGLE MOST
– LYMPHOID HYPERPLASIA (RELATED TO VIRAL ILLNESSES, IMPORTANT SIGN)
• OBTURATOR SIGN--PAIN ON INTERNAL
INCLUDING UPPER RESPIRATORY INFECTION, ROTATION OF RIGHT THIGH (PELVIC
MONONUCLEOSIS, GASTROENTERITIS) APPENDIX)
• LOW-GRADE FEVER (38°C [OR
– FECALITHS 100.4°F]) • ROVSING'S SIGN--PAIN IN RIGHT LOWER
QUADRANT WITH PALPATION OF LEFT
– PARASITES LOWER QUADRANT
• PERITONEAL SIGNS
– FOREIGN BODIES • DUNPHY'S SIGN--INCREASED PAIN WITH
– CROHN‘S DISEASE • LOCALIZED TENDERNESS TO COUGHING
PERCUSSION
– PRIMARY OR METASTATIC CANCER AND CARCINOID • FLANK TENDERNESS IN RIGHT LOWER
SYNDROME QUADRANT (RETROPERITONEAL
• GUARDING RETROCECAL APPENDIX)
– LYMPHOID HYPERPLASIA IS MORE COMMON IN CHILDREN
AND YOUNG ADULTS • PATIENT MAINTAINS HIP FLEXION WITH
KNEES DRAWN UP FOR COMFORT

GI DISORDERS 31 GI DISORDERS 32

BY NIO C. NOVENO, RN, MAN 8
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

APPENDICITIS
APPENDICITIS
NURSING IMPLICATIONS
ABDOMINAL PAIN 2. DIET
ANOREXIA – NPO STATUS
• LONGER WITH PERITONITIS
NAUSEA 1. PAIN:
• NGT INSERTION
VOMITING – NO ANALGESICS
– NO WARM COMPRESS
PAIN MIGRATION – CLEAR TO REGULAR DIET
– NO ENEMA AFTER SURGERY
– RUPTURED APPENDIX
3. ACTIVITY
CLASSIC SYMPTOM SEQUENCE • NO PAIN
• POSITION HOB – TURNING
• VAGUE PERIUMBILICAL PAIN TO ANOREXIA/NAUSEA/ UNSUSTAINED
– DEEP BREATHING &
• REFER STAT!
VOMITING TO MIGRATION OF PAIN TO RIGHT LOWER QUADRANT COUGHING EXERCISES
TO LOW-GRADE FEVER WITH SPLINTING

GI DISORDERS 33 GI DISORDERS 34

DIVERTICULAR DISEASES DIVERTICULAR DISEASES
DIVERTICULOSIS DIVERTICULITIS DIVERTICULOSIS DIVERTICULITIS
•INFLAMMATION OF ONE OR • MODERATE LLQ PAIN
• MULTIPLE DIVERTICULA ARE • RECURRENT LLQ PAIN
MORE DIVERTICULA PRESENT • MILD NAUSEA, GAS

• RELIEVED BY DEFECATION OR • IRREGULAR BOWEL HABITS
•SIGMOID COLON
• LOW FIBER DIET PASSAGE OF FLATULENCE
• LOW-GRADE FEVER
•STOOL IMPACTED IN THE
• INCREASED WBC
DIVERTICULA • 30-40% OF ELDERLY • ALTERNATING CONSTIPATION
POPULATION & DIARRHEA • RUPTURE (IF SEVERE)

• FIBROSIS & ADHESIONS (CHRONIC
DIVERTICULITIS)
• ASYMPTOMATIC

GI DISORDERS 35 GI DISORDERS 36

BY NIO C. NOVENO, RN, MAN 9
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

DIVERTICULAR DISEASES DIVERTICULAR DISEASES
NURSING MANAGEMENT NURSING MANAGEMENT
FOR DIVERTICULSOSIS FOR DIVERTICULITIS
1. BLAND OR LIQUID DIET 1. WITHOUT PERFORATION
a. PREVENT CONSTIPATION & INFECTION
2. HIGH-RESIDUE DIET • BED REST
3. PSYLLIUM • LIQUID DIET
• STOOL SOFTENERS
– ABSORBS WATER AND EXPAND TO PROVIDE • BROAD-SPECTRUM ANTIBIOTICS
INCREASED BULK IN STOOL • MEPERIDINE
– ENCOURAGES NORMAL PERISTALSIS AND BOWEL • DICYCLOMINE (BENTYL, BYCLOMINE, DIBENT, DI-SPAZ,
DILOMINE)
MOTILITY • HYOSCYAMINE (LEVSIN® /SL TABLETS)

GI DISORDERS 37 GI DISORDERS 38

DIVERTICULAR DISEASES
ABDOMINAL APPLIANCE
NURSING MANAGEMENT
2. COLON RESECTION COLOSTOMY ILEOSTOMY
3. COLOSTOMY
4. F & E MONITORING
5. WOF SIGNS OF BLEEDING
– ANGIOGRAPHY
– VASOPRESSIN

GI DISORDERS 39 GI DISORDERS 40

BY NIO C. NOVENO, RN, MAN 10
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

PARAMETER CROHN’S ULCERATIVE COLITIS
INFLAMMATORY
INVOLVEMENT
BOWELLOWER
SMALL & LARGE INTESTINE
DISEASE
COLON ONLY INFLAMMATORY BOWEL DISEASE
(THEN, ASCENDS)
TISSUE AFFECTED ENTIRE THICKNESS MUCOSA
PHARMACOLOGY DIET
OBSTRUCTION, FISTULAS, • 5-ASA COMPOUNDS • HIGH PROTEIN
FISSURES, ABSCESSES, – SULFAZALAZINE (AZULFIDINE) • INCREASE FE & VIT B12
LONG-TERM ABSCESSES, PERFORATION
INCREASED RISK OF – MESALAMINE (ROWASA,
COMPLICATIONS CANCER RISK INCREASES WITH • LOW-RESIDUE DIET
COLORECTAL CANCER PENTASA, ASACOL)
AGE • HIGH PROTEIN DIET
– OLSALAZINE SODIUM
SURGICAL DOES NOT CURE OR LIMIT THE
(DIPENTUM)
ADVERSE EVENTS • LOW FAT
CURES THE DISEASE CORTICOSTEROIDS
•HEADACHE
INTERVENTION DISEASE
PHOTOSENSITIVITY
IMMUNOSUPPRESANTS
•SERUM SICKNESS-LIKE SYNDROME
UNKNOWN; ALTERED IMMUNE UNKNOWN; E. COLI
C AUSE • IVF
GIT DISTURBANCE
REPLACEMENT
STATE INFECTION ORANGE-YELLOW DISCOLORATION
• TPN
3-4 SEMISOFT/DAY; 15-20 LIQUID/DAY;
STOOLS
GI DISORDERS 41 GI DISORDERS 42
STEATORRHEIC AND MUCOID BLOODY

IRRITABLE BOWEL SYNDROME
IRRITABLE BOWEL SYNDROME
CRITERIA FOR DIAGNOSIS
REFER TO A GROUP OF SYMPTOMS: 1. ABDOMINAL PAIN OR DISCOMFORT
– AT LEAST 12 WEEKS OUT OF THE PREVIOUS 12
MONTHS
ABDOMINAL PAIN
BLOATING
2. AT LEAST 2 OF THE FOLLOWING:
CONSTIPATION / CRAMPING a. PAIN IS RELIEVED BY BM
DIARRHEA b. WITH PAIN, BM PATTERN CHANGES
c. WITH PAIN, STOOL CHARACTERISTICS CHANGE

GI DISORDERS 43 GI DISORDERS 44

BY NIO C. NOVENO, RN, MAN 11
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

IRRITABLE BOWEL SYNDROME IRRITABLE BOWEL SYNDROME
MEDICAL MANAGEMENT DIETARY MANAGEMENT
1. ANTICHOLINERGIC A.C. AVOID THE FOLLOWING
ALCOHOL
2. TEGASEROD MALEATE (ZELNORM) X 4 WEEKS BARLEY
C AFFEINATED DRINKS
3. PSYLLIUM (METAMUCIL) CHOCOLATES
MILK PRODUCTS
4. ALOSETRON HCL (LOTRONEX) RYE & WHEAT

GI DISORDERS 45 GI DISORDERS 46

IRRITABLE BOWEL SYNDROME
INTESTINAL OBSTRUCTION
DIETARY MANAGEMENT
MAKE SURE TO… VOLVULUS
1. TEACH THE CLIENT TO LIST DOWN FOOD EATEN

2. EAT 5-6 TIMES; SMALL, FREQUENT FEEDINGS
INTUSSUSCEPTION
3. EXERCISE REGULARLY

4. PROMOTE STRESS RELIEF ADHESIONS

GI DISORDERS 47 GI DISORDERS 48

BY NIO C. NOVENO, RN, MAN 12
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

INTESTINAL OBSTRUCTION
INTESTINAL OBSTRUCTION
MANAGEMENT
1. NEUROGENIC OBSTRUCTION 1. MEDICAL
– PARALYTIC ILEUS – NG DECOMPRESSION
• TRAUMA – IV REHYDRATION
• INFECTION – ENEMAS
• MEDICATION
2. VASCULAR OBSTRUCTION
2. SURGERY
– ATHEROSCLEROSIS
– BOWEL RESECTION
– NECROSIS

GI DISORDERS 49 GI DISORDERS 50

HERNIAS
HERNIAS
MANAGEMENT
LOCATION TYPES 1. SURGERY
– HERNIORRHAPHY
– BOWEL RESECTION

2. DIET
– SMALL, FREQUENT FEEDINGS
– LIE DOWN FOR 2 HOURS AFTER EATING
– AVOID HIGHLY IRRITATING FOODS

GI DISORDERS 51 GI DISORDERS 52

BY NIO C. NOVENO, RN, MAN 13
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

HEMORRHOIDS
HEMORRHOIDS
MANAGEMENT
EXTERNAL INTERNAL 1. MEDICAL
– HOT SITZ OR WARM COMPRESS X 20 MINUTES, 4
TIMES A DAY

2. SURGERY
– HEMORRHODECTOMY
• EXTERNAL: OPD
• INTERNAL: OVERNIGHT
– SCLEROTHERAPY, CRYOTHERAPY, LASER

GI DISORDERS 53 GI DISORDERS 54

HEMORRHOIDS
MANAGEMENT
3. PHARMACOLOGY
– CREAMS & SUPPOSITORIES
– CORTICOSTEROIDS

4. DIET DISORDERS OF THE
– 20-30 GRAMS OF FIBER/DAY
ACCESSORY ORGANS
– 2.5 L OF FLUID PER DAY

GI DISORDERS 55 GI DISORDERS 56

BY NIO C. NOVENO, RN, MAN 14
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

LIVER FUNCTIONS CAUSES OF CIRRHOSIS
 Storage of vitamin A, B, D; iron and copper 1. LAENNEC’S [OR, PORTAL ,NUTRITIONAL,
 Synthesis of plasma proteins, including albumin and ALCOHOLIC]
globulins
 Synthesis of clotting factors, vitamin K and 2. BILIARY
prothrombin
 Storage of glycogen and synthesis of glucose from
3. PIGMENT
other nutrients
 Breakdown of fatty acids for energy
 Production of bile
4. DRUG- / TOXIN-INDUCED
 Detoxification and excretion of waste products
GI DISORDERS 58

CIRRHOSIS CIRRHOSIS ASSESSMENT
1. CNS
– PROGRESSIVE SIGNS OF HEP ENCEPH
• LETHARGY, MENTAL CHANGES, SLURRED SPEECH & ASTERIXIS,
PERIPHERAL NEURITIS, PARANOIA, HALLUCINATIONS, COMA

2. GIT
– ANOREXIA, INDIGESTION, N & V, CONSTIPATION OR
DIARRHEA, DULL ABDOMINAL PAIN

3. RESPIRATORY
– PLEURAL EFFUSION

GI DISORDERS 59 GI DISORDERS 60

BY NIO C. NOVENO, RN, MAN 15
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

CIRRHOSIS ASSESSMENT CIRRHOSIS ASSESSMENT
4. HEMATOLOGIC ADDITIONAL DATA
1. MUSTY BREATH
5. ENDOCRINE 2. CAPUT MEDUSAE
– “FEMINIZATION” 3. MUSCLE ATROPHY
4. RUQ PAIN AGGRAVATED BY SITTING OR LEANING
5. PALPABLE SPLEEN
6. SKIN
6. T: 1010 TO 1030 F (38.30 TO 39.40 C )
– JAUNDICE, PRURITUS, DRYNESS, SPIDER ANGIOMAS,
PALMAR ERYTHEMA, 7. ESOPHAGEAL VARICES WITH BLEEDING

GI DISORDERS 61 GI DISORDERS 62

DIAGNOSIS OF CIRRHOSIS TREATMENT OF CIRRHOSIS
1. LIVER BIOPSY AIMS OF TREATMENT
2. LIVER SCAN
3. CHOLECYSTOGRAPHY & CHOLANGIOGRAPHY 1. ALLEVIATE THE CAUSE
4. CT SCAN
5. HEMATOLOGIC TESTS
2. PREVENT FURTHER DAMAGE
6. ABNORMAL GTT
7. URINE TESTS
8. FECALYSIS 3. PREVENT OR TREAT COMPLICATIONS

GI DISORDERS 63 GI DISORDERS 64

BY NIO C. NOVENO, RN, MAN 16
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

TREATMENT OF CIRRHOSIS TREATMENT OF CIRRHOSIS
1. VARICEAL BLEEDING 2. DIET CONT…
– MEDICATIONS – TPN [WITH DETERIORATION]
– BALLOON TAMPONADE – A, B COMPLEX, C, K
– SURGERY – VIT B12, FOLIC ACID & THIAMINE

2. DIET
3. ACTIVITIES
– HIGH PROTEIN [NOT WITH HEP ENCEPH]
– NA RESTRICTION [200 – 500 MG/D] – REST & MODERATE EXERCISE
– FLUID RESTRICTION [1 – 1.5 L/D]
GI DISORDERS 65 GI DISORDERS 66

TREATMENT OF CIRRHOSIS TREATMENT OF CIRRHOSIS
4. ANTIEMETICS 7. PARACENTESIS
– TRIMETHOBENZAMIDE (TIGAN, TEBAMIDE)
– BENZQUINAMIDE (BZQ, BENZCHINAMIDE, 8. LEVEEN SHUNT
EMETICON, PROMECON, QUANTRIL)
9. SURGERY
5. VASOPRESSIN
10. LIVER TRANSPLANT
6. DIURETICS 11. LIFESTYLE MANAGEMENT
– FUROSEMIDE & SPIRONOLACTONE

GI DISORDERS 67 GI DISORDERS 68

BY NIO C. NOVENO, RN, MAN 17
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

VIRAL HEPATITIS SYMPTOMS OF ACUTE VIRAL HEPATITIS
HEPATOTROPIC VIRUSES NONSPECIFIC SIGNS & SYMPTOMS
HEPATITIS VIRUS A-E AND G

HEPATITIS B (HEPADNA): DNA VIRUS LOSS OF APPETITE NAUSEA FATIGUE MILD FEVER
RNA VIRUSES:
HEPATITIS A (PICORNAVIRUS)
JAUNDICE DARK URINE
HEPATITIS C (FLAVIVIRUS)
HEPATITIS E (CALICIVIRUS)
HEPATITIS G CLAY-COLORED STOOLS (LIGHT YELLOW)
HEPATITIS D: INCOMPLETE RNA VIRUS
GI DISORDERS 69 GI DISORDERS 70

A B C D E
TRANSMISSIO FECAL- BLOOD & BLOOD; FECAL-
LABORATORY STUDIES N ORAL FLUIDS
BLOOD
NEEDLES ORAL
INCUBATION 15-50 45-160 14-180 15-60 15-60
↑ AST / ALT [3 – 5 TIMES > N] INFECTIOUS
PERIOD <2 MOS BEFORE SX APPEAR NOT DETERMINED

AST > 1000 U / L IS COMMON IN SEVERE HEPATITIS IGM; ANTI SERUM ALT IGG ANTIHDV /
DX TEST HBSAG NONE
HAV INC 10X IGM ANTIHDV
[REVERSIBLE OVER SEVERAL MONTHS]
SP, ENTERIC SP; REDUCE
SP; SAFE
MODEST ↑ IN ALKALINE PHOSPHATASE & GGT PRECAUTIO RISK SP; REDUCE SP; NO
PREVENTION PRACTICES; HEP
NS; HEP A BEHAVIOR; RISK; HEP B VAC VAC
VAC; IG
B VAC; IG
NO VAC
VARIABLE INCREASE IN BILIRUBIN
HBIG
PERINTERFE
ALPHA
RON ALFA
BILIRUBIN IN URINE INTERFERON ALPHA
IG IN 2 2A
TREATMENT LAMIVUDINE INTERFERON NONE
WEEKS (PEGASYS)
(EPIVI HBV)
GI DISORDERS 71 RIBAVIRIN
GI DISORDERS ADEFOVIRDIPIVO 72
(VIRAZOLE)
XIL (HEPSERA)

BY NIO C. NOVENO, RN, MAN 18
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

HEPATITIS PHASES OF HEPATITIS
1. PRODROMAL (PREICTERIC) PHASE
OTHER CAUSES OF HEPATITIS
ANV, MALAISE, WEIGHT LOSS
SYMPTOMS OF URTI
CHEMICAL AGENTS [I.E., HALOTHANE] INTOLERANCE FOR SMOKING

2. ICTERIC PHASE
CARBON TETRACHLORIDE
JAUNDICE
BILE-COLORED URINE THAT FOAMS WHEN SHAKEN
GOLD COMPOUNDS [I.E., AUROTHIOGLUCOSE] ACHOLIC (CLAY-COLORED) STOOLS

ARSENIC 3. RECOVERY PHASE: EASY FATIGABILITY

GI DISORDERS 73 GI DISORDERS 74

HEPATITIS HEPATITIS: 2,500 -3,000 KCAL / DAY
HIGH PROTEIN [75 TO 100 G]
THERAPEUTIC INTERVENTIONS
HEALING OF LIVER TISSUE
1. REST DAILY: 1 QT MILK; 2 EGGS
8 OZ LEAN MEAT, FISH, OR CHEESE
HIGH CARBOHYDRATE [300 TO 400 G]
2. ABSTINENCE FROM ALCOHOL ENERGY NEEDS, RESTORE GLYCOGEN RESERVES
DAILY: 4 SERVINGS VEGETABLES, POTATO, 4 SERVINGS FRUIT WITH FREQUENT JUICES,
6 TO 8 SERVINGS BREAD OR CEREAL
MODERATE FAT [100 TO 150 G DAILY]
3. DIET THERAPY
2 TO 4 TABLESPOONS BUTTER OR FORTIFIED MARGARINE
MODERATE AMOUNT OF WHOLE MILK, CREAM, BUTTER, MARGARINE, OR VEGETABLE
OIL IS BENEFICIAL

GI DISORDERS 75 GI DISORDERS 76

BY NIO C. NOVENO, RN, MAN 19
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

HEPATITIS: INVESTIGATE! HEPATITIS: ACTION!
1. HISTORY 1. ATTEMPT TO STIMULATE THE APPETITE
a. OF EXPOSURE TO VIRUS a. PROVIDE ORAL HYGIENE
b. OF EMPLOYMENT OVER PREVIOUS 6 MONTHS b. BASED ON THE CLIENT'S PREFERENCES
c. PROVIDE A PLEASANT, UNHURRIED ATMOSPHERE FOR
2. RUQ FOR LIVER TENDERNESS, FIRMNESS EATING
d. PROVIDE SMALL, FREQUENT FEEDINGS
3. JAUNDICE IN SKIN, SCLERA, AND MUCOUS MEMBRANES 2. USE PRECAUTIONS TO PREVENT THE SPREAD OF
HEPATITIS TO OTHERS
4. TEMPERATURE: a. USE STANDARD (UNIVERSAL) PRECAUTIONS
a. FEVER (WITH TYPE A)
b. LOW-GRADE FEVER (WITH TYPES B AND C) b. HAV: CONTACT PRECAUTIONS
GI DISORDERS 77 GI DISORDERS 78

HEPATITIS: ACTION! 'GET SMASHED‘ TO KNOW THE CAUSES
3. ADMINISTRATION OF IMMUNE SERUM GLOBULIN (ISG) GALLSTONES
AFTER EXPOSURE TO TYPE A HEPATITIS ETHANOL
TRAUMA
4. VACCINATION OF INDIVIDUALS AT RISK FOR TYPE B STEROIDS
HEPATITIS (HEP-B, RECOMBIVAX HB)
MUMPS
AUTOIMMUNE CAUSES
5. ENCOURAGE THE USE OF CONDOMS
SCORPION VENOM
HYPERLIPIDAEMIAS
ERCP
DRUGS (SUCH AS AZATHIOPRINE)

GI DISORDERS 79
GI DISORDERS 80

BY NIO C. NOVENO, RN, MAN 20
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

ACUTE PANCREATITIS ASSESSMENT OF ACUTE PANCREATITIS
2 FORMS 2 THEORIES MILD SEVERE
• EXTREME PAIN
• EPIGASTRIC PAIN, • PERSISTENT VOMITING
1. INTERSTITIAL (EDEMATOUS) 1. TOXIC AGENT RADIATING BETWEEN THE • ABDOMINAL RIGIDITY
T10 & L6 UNRELIEVED BY • ILEUS
• DIMINISHED BOWEL ACTIVITY
VOMITING
2. NECROTIZING • CRACKLES AT LUNG BASES
2. REFLUX OF DUODENAL • TACHYCARDIA
CONTENTS • EXTREME MALAISE
• RESTLESSNESS
• MOTTLED SKIN
• LOW-GRADE FEVER
• COLD, SWEATY EXTREMITIES

GI DISORDERS 81 GI DISORDERS 82

DIAGNOSIS OF PANCREATITIS TREATMENT OF PANCREATITIS
• ELEVATED GOAL OF TREATMENT
– SERUM AMYLASE & LIPASE 1. MAINTAIN CIRCULATION & FLUID VOLUME
– WBC
– HCT
2. RELIEVE PAIN
• LOW SERUM CALCIUM
• HYPERGLYCEMIA
3. DECREASE PANCREATIC SECRETIONS
• CT-SCAN
• X-RAYS
GI DISORDERS 83 GI DISORDERS 84

BY NIO C. NOVENO, RN, MAN 21
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

TREATMENT OF PANCREATITIS TREATMENT OF PANCREATITIS
MAINTAIN CIRCULATION & FLUID VOLUME ADDITIONAL MANAGEMENT
1. CONTINUE 5-7 DAYS OF HYDRATION
1. ELECTROLYTE REPLACEMENT
2. TPN
2. PROTEIN SUPPLEMENTATION 3. GAVAGE FEEDINGS
4. PROCEDURES:
3. CALCIUM REPLACEMENT
– LAPAROTOMY
*SHOCK CAUSES DEATH IN EARLY STAGES – PANCREATECTOMY
*METABOLIC ACIDOSIS – CHOLECYSTOSTOMY & GASTROSTOMY
GI DISORDERS 85 GI DISORDERS 86

GALLBLADDER & BILIARY TRACT DISORDERS GALLBLADDER & BILIARY TRACT DISORDERS

5 MAJOR DISORDERS CAUSE: UNKNOWN
1. CHOLECYSTITIS RISK FACTORS
– STONE IN THE CYSTIC DUCT
2. CHOLANGITIS 1. OBESITY
– INFECTION OF THE BILE DUCT 2. ELEVATED ESTROGEN LEVELS
3. CHOLELITHIASIS 3. GENETICS
– STONE IN THE GALLBLADDER
4. CHOLEDOCHOLELITHIASIS 4. USE OF:
– STONE IN THE CBD – ANTILIPEMIC DRUGS
5. GALLSTONE ILEUS – WEIGHT REDUCTION PILLS
– SMALL BOWEL OBSTRUCTION DUE TO GALLSTONE 5. DISEASES
GI DISORDERS 87 GI DISORDERS 88

BY NIO C. NOVENO, RN, MAN 22
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

GALLBLADDER & BILIARY TRACT DISORDERS GALLBLADDER & BILIARY TRACT DISORDERS

MANIFESTATIONS
AGE ESTROGEN OBESITY • SEVERE MIDEPIGASTRIC PAIN OR RUQ PAIN RADIATING TO THE
BACK
INCREASED BILE PRODUCTION
• FLATULENCE
• INDIGESTION
EXCESS WATER & BILE SALTS ARE REABSORBED • NAUSEA
• DIAPHORESIS
• BELCHING
GALLSTONES • CHILLS & LOW-GRADE FEVER
• INDIGESTION OF FAT
[CHOLESTEROL C ALCIUM BILIRUBIN] • JAUNDICE & CLAY-COLORED STOOLS
GI DISORDERS 89 GI DISORDERS 90

DIAGNOSIS OF TREATMENT OF
GALLBLADDER & BILIARY TRACT DISORDERS GALLBLADDER & BILIARY TRACT DISORDERS
• UTZ OF THE GALLBLADDER • CHOLECYSTECTOMY
• CT SCAN • CHOLANGIOGRAPHY
• ERCP • T-TUBE PLACEMENT
• CHOLESCINTIGRAPHY • LOW FAT DIET; GIVE VIT K
• ORAL CHOLECYSTOGRAPHY • NGT
• BLOOD STUDIES • LITHOTRIPSY
• URSODIOL

GI DISORDERS 91 GI DISORDERS 92

BY NIO C. NOVENO, RN, MAN 23
GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

NURSING C ARE OF PATIENTS WITH
"Realize that true happiness lies within you.
GALLBLADDER & BILIARY TRACT DISORDERS
Waste no time and effort searching for peace and
1. REINFORCE HEALTH TEACHINGS ON: contentment and joy in the world outside.
a. LOW FAT DIET
Remember that there is no happiness in having or in
b. MEDICATION COMPLIANCE
getting, but only in giving.
c. POST-OP ACTIVITIES
• DEEP BREATHING & COUGHING Reach out. Share. Smile. Hug.
• REST & ACTIVITY
Happiness is a perfume you cannot pour on others
d. WEIGHT REDUCTION without getting a few drops on yourself."
2. C ARE OF T-TUBE & SKIN CARE Og Mandino
1923-1996, Author and Speaker

GI DISORDERS 93

THANK YOU!!!

GI DISORDERS 95

BY NIO C. NOVENO, RN, MAN 24