Xavier University - Ateneo de Cagayan

College of Nursing

In Partial Fulfillment of the Requirements in

NCM 116

CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GI, METABOLISM AND ENDOCRINE, PERCEPTION

CONCEPT MAP

SUBMITTED BY:

Dirige, Megan Raphaela Grabato, Kristine Marie

Fabre, Edgie Jeric Gupalor, Liv Julia

Galgo, Jane Antonitte Gustilo, Dara Lorraine

Gantalao, Maegan Pearl Leonero, Janne Gayle

Gicaraya, Tristan Matthew Leuterio, John Wilford

Gonzalez, Mary Margareth Mantilla, Alexi Nicole

Monje, Ira

SUBMITTED TO:

Gemma V. Panal, RN, MN, LPT

December 10, 2020

 Predisposing factors Precipitating factors

• Age Abnormalities of Fecal Elimination  Non-traumatic anal sphincter weakness (e.g.,

scleroderma)
• Gender (common in females)  Dementia, Neurologic diseases
 Immobility
• Congenital diarrheal disorders  Stress
• Nutritional and malabsorptive  Medications
 Sedentary lifestyle
disorders  Inadequate fluid & fiber intake
 Fecal Incontinence Conditions of Malabsorption

Chronic Difficult Direct Aging: Inflammatio Chronic Chronic Sensory Altered

bowel vaginal internal anal Degeneratio n of colon diarrhea, constipation Neuropathy mental
straining delivery sphincter n of muscle (Ulcerative diarrhea- (e.g., condition TTG alters prolamin Wheat prolamin(gliandin)
predominan Diabetes) (e.g., Stroke,
impairment fibers colitis, interacts with and
(controls Radiation t irritable Dementia)
proctitis) bowel activates zonulin signaling
70% of anal
syndrome, Buildup of
resting tone)
Stretch Pelvic laxatives solid,
injury of Trauma immobile
mass of
pudendal Gut epithelium becomes more
nerve stool in the Altered protein fits more easily into
Movement Decreased porous
(innervating
disorders capacity of
rectum Decreased HLA
the pelvic perception of
Pelvic Decreased restricts rectal Stool
muscles and rectal distention
surgery anal resting mobility smooth volume
external anal tone which muscle to
sphincter) (Rectal
decreases stretch leads
↑ Hyposensitivity)
HLA activates adaptive immunity Large dietary proteins in epithelium
timely to decreased
access to capacity to loose disrupt tight junctions
bathrooms. store stool stools
Rectal
(e.g.,
Prolapse
Arthritis,
lgA generated against prolamin-
Parkinson’s)
Local TTG
neuronal Increased
damage Direct urgency of
external and defecation
Sphincter
impairment

INFLAMMATION OF INTESTINAL EPITHELIUM

Patient fails
↑reflex Loose stool is Overflow to sense
relaxation of more prone to diarrhea. rectal
Impaired Voluntary external anal sphincter internal anal escape through fullness and DIAGNOSTIC TESTS
pelvic contraction is no longer sufficient
muscle and in closing the anus
sphincter anal canal
Loose stool is voluntarily SIGNS AND SYMTPOMS Inflammation disrupts structure of bowel
compared to solid releases
external
stool
able to flow
mucosa  Serology testing
around their
anal
external  Diarrhea  Genetic testing
sphincter impacted
stool, exiting anal  Steatorrhea  Endoscopy
motor
control anal canal sphincter  Abdominal distention  Capsule endoscopy
 Flatulence
Villi of intestine atrophy
 Weight loss
 Hypothyroidism
Continence mechanisms are impaired Continence mechanisms are intact, but overwhelmed or ignored  Fatigue
 General malaise NURSING MANAGEMENT
Malabsorption
 Depression
 Dermatitis herpetiformis  Provide patient and family education
Fecal incontinence: unexpected leakage of feces from the rectum Skin Infection  Migraine headaches regarding adherance to a gluten-free diet
 Osteopenia and how to avoid other gluten products.
Skin Erosion
 Anemia  Emphasize the importance of carefully
 Seizures MEDICAL MANAGEMENT reading and understanding labels on both
Inability to control fundamental ↑ skin contact  Paresthesia in the food and nonfood products to determine
activities of daily living (ADLs) with acidic irritant hands and feet if they contain gluten
 Refer to a dietician for a meal plan to refrain
(stool) Skin  Red shiny tongue  Monitor dietary intake, fluid intake and
Erythema exposure to gluten foods.
 Discoloration of teeth or output, weight, serum electrolytes, and
 For patients who presents anemia may be
yellowing hydration status.
prescribed folate, cobalamin, or iron
 Maintain NPO status during initial
Caretaker Social stigma Skin Inflammation supplements.
treatment of celiac crisis or during
burdern/admission to  For patients with osteopenia may require
diagnostic testing.
long term care treatment for osteoporosis.
institution  Provide meticulous skin care after each
 Steroids may be prescribed to ease severe
loose stool and apply lubricant to prevent
Low confidence, Increased stress and anxiety, low social signs and symptoms of celiac disease while
skin breakdown.
activity, low help seeking mindset for treatment the intestine heals.
 Explain that the toddler may cling to
 Endoscopy with biopsies to determine
infantile habits for security. Allow this
whether intestine has healed.
behavior, it may disappear as physical
 Dapsone may be prescribed for dermatitis
condition improves.
herpetiformis
 Stress that the disorder is lifelong; however,
changes in the mucosal lining of the
intestine and in general clinical conditions
are reversible when dietary gluten is
avoided.
Medical Management Nursing Management

Correcting the underlying cause

Pharmacological intervention:
 psyllium (Metamucil) as a fiber supplement
 loperamide 30 mins prior to meals
Surgical Interventions:
 Surgical reconstruction of anal sphincter  Obtain patient’s health history using the Bristol chart


 Artificial sphincter implantation
 Fecal diversion Perform manual checkup for fecal impaction
 Sacral nerve stimulation
 Anal sphincter bulking
 Provide a high-fiber diet under the direction of physician

 Ensure fluid consumption of at least 3000 mL/day, unless contraindicated

 Encourage the intake of natural bulking agents to thicken stools (e.g., banana, rice, yoghurt).

Nursing Diagnoses  Keep bedside commode and assistive device on sight

 Initiate bowel training program

 Assist patient for mobility or exercise, if tolerated.

 Bowel incontinence R/T lack of
voluntary sphincter control, secondary
 Encourage bowel elimination at the same time each day.
to Cerebrovascular accident AEB
patient unable to control passage of
 Place patient in an upright position for defecation

stool  Maintain skin integrity esp. in debilitated and elderly patients

 Bowel incontinence R/T Dementia
AEB occasional leakage of stool
o Incontinence briefs for brief periods
before bowel movement o Instruct about meticulous skin hygiene
 Bowel incontinence R/T Diabetes AEB
weak pelvic floor muscles and loose o Perineal skin cleansers and skin protection products
bowel actions
 Assist in acceptance and coping when continence cannot be achieved

 For Pt w/ dementia: toileting assistance such as prompted or timed voiding and habit training

 fecal incontinence devices: external collection anal pouch, intra anal stool bag, rectal tubes
and catheters, and rectal trumpets

Diagnostic Tests

 Anal Manometry
 Endoluminal Ultrasound/ Anal
ultrasound
 Pudendal Nerve Terminal Motor
Latency Test
 Anal Electromyography (EMG)
 Flexible Sigmoidoscopy/
Proctosigmoidoscopy
 Defecography
 MRI
0
ACUTE INFLAMMATORY INTESTINAL DISORDERS
Predisposing Factors Precipitating Factors
 Age  Low fiber diet
 Sex  Traumatic injury
 Family History/Genetics  Smoking

Appendicitis Diverticular Disease Peritonitis

Obstruction of appendiceal lumen (by fecalith, Age Related Chronic Wall Abnormal Colonic Motility Altered Fiber Diet secrection of
Alterations
fibrosis, neoplasia, foreign bodies, or lymph chemoxines
nodes).

Colonic Bacterial Overgrowth Colonic Microflora Activation of Inflammatory influx of neutrophils influx of monocytes
Cascade
Imbalance

Appendix Increased lumen pressure and

distention and decreased blood flow to Increased Nitric Oxide
Diverticular Inflammation induction of apoptopic inflammatory macrophages
spasms appendix programs

Decreased relaxation and

Ischemia, tissue necrosis, loss of Bacterial invasion of the appendix wall, increased muscle spasm of breaching of cytokines,
appendix structural integrity causing transmural inflammation and longitudinal muscle bacteria and microbial
ABDOMINAL
necrosis SYMPTOMS products into the
circulation
 Pain, which may be constant
and persist for several days. The
If appendix is not surgically removed, lower left side of the abdomen
perforation of colon wall, causing Stretching of visceral peritoneum, Nursing Management: Systemic Inflammatory Intra-abdominal Sepsis
is the usual site of the pain.
peritonitis, abscesses or death, may stimulation of autonomic nerves T9- Response from perforated viscus
Sometimes, however, the right
T10
occur side of the abdomen is more  Administer nothing by mouth
painful, especially in people of  Administer IV fluids Syndrome (SIRS)
Asian descent.  Institute nasogastric suctioning
Irritation of parietal Progression of inflammation  Nausea and vomiting.  Keep the client on bed rest Bacterial Translocation
peritoneum, stimulation of over several days (variable  Fever.  Encourage daily exercise such as
Clinical Manifestation: Nursing Mngmt:
somatic nerves length of time)  Abdominal tenderness. walking, which increases bowel
 Constipation or, less commonly, peristalsis.
Abdominal pain Blood pressure
diarrhea.  Offer a low-fiber diet until signs of anti-inflammatory responses
monitoring.
infection decrease; then gradually
DIAGNOSTIC TEST SIGNS AND SYMPTOMS
increase fiber until the client is Tenderness
Complete history and Vague periumbilical pain (visceral pain
eating a high-fiber diet. If a high-fiber Medications.
physical examination that is dull and poorly localized)
diet alone prevents constipation, Fever extensive apoptosis of lymphocytes
CBC Right lower quadrant pain
encourage medication with caution, Pain management.
C- reactive protein levels Nausea and vomiting
especially in elderly clients. Nausea, vomiting,
CT scan Low grade fever
Urinalysis Rebound tenderness Diarrhea I&O monitoring.
Diagnostic laparoscopy Diarrhea Medical Management strong immunosuppression
Constipation Diagnostic Tests: Low urine output IV fluids.
Anorexia • Administering one or more of the following:
Bulk laxatives, Stimulant laxative, Stool softeners, • Abdominal and Pelvic CT Thirs Drainage monitoring.
Saline laxatives At least 8 oz of water with any Peritonitis
• Colonoscopy
MEDICAL MANAGEMENT NSG INTERVENTIONS agent • X-ray - Lower GI tract
• Administer medications, which may include • Blood and Urine tests
Appendectomy with either • Provide IV infusion as ordered to antibiotics, opioid analgesics, and antispasmodics. • Pregnancy test (If you are
laparotomy or laparoscopy. replace fluid loss and promote • Ciprofloxacin plus metronidazole. of childbearing age, your
Antibiotics and IV fluids are adequate renal function. • Trimethoprim-sulfamethoxazole plus doctor may ask you to take Medical Management
given until surgery is • Administer antibiotic therapy to metronidazole. a pregnancy test. This will
performed. prevent infection • Amoxicillin-clavulanate. help rule out pregnancy as Analgesics.
Surgical drain. • Administer analgesic agents for • Moxifloxacin (use in patients intolerant of both a cause of abdominal pain.) Intubation and suction
pain metronidazole and beta lactam agents) Fluid.
• Place in high Fowler position after • Options for definitive surgery involve resection Oxygen therapy.
surgery of the affected colon with or without Antibiotic therapy.
• Auscultate for return of bowels anastomosis. The two-stage approach, commonly
sound and ask patient for passing called HP, refers to sigmoid colectomy with end
of flatus. colostomy and later colostomy reversal.
 Disorders of the esophagus
Predisposing factors Precipitating factors
 Mental Retardation  Smoking
 Advanced Age  Fatty diet
 Children aged 1-3  Poor dentition
 Swallowing of strong acid or base

Foreign bodies Chemical burns GERD

Release of pro-inflammatory cytokines Primary GERD Excessive or prolonged Secondary GERD

transient lower
Swallows foreign body such as fish
esophageal sphincter
bones.
relaxation
Counter anti-inflammatory response Intake of coffee, Intake of beta-agonists Eating of large meal,
alcohol, chocolate, drugs, calcium channel delayed gastric
mint, fatty meals, spicy blockers, anti- emptying
Objects may subsequently change foods, or intake of cholinergics
position or migrate distally. Destruction of cells and tissue citrus

HCl in stomach can be Buildup of gas in

Abnormal lower pushed up by the stomach which
esophageal sphincter increased intra- increases pressure on
Distal to Obstruction • Cough Accompanied by severe burns of the lips, mouth, and abdominal pressure or
the occurs. pharynx, with pain on swallowing relaxation
• Wheeze positional changes
obstructio
• Stridor
n heartburn
• Dyspnea Difficulty in breathing due to either edema of the Acid regurgitation
•Cyanosis throat or a collection of mucus in the pharynx
Air tapping may occur Local inflammation, edema, cellular Repeated damage to
infiltration, ulceration, and granulation •Asphyxia the esophagus
tissue formation may contribute to •Pain
airway obstruction. Aspiration of acid into
•Local emphysema The patient, who may be profoundly toxic, febrile, and larynx, lungs

•Mediastinitis in shock, is treated immediately for shock, pain, and Normal squamous Scarring form
•Atelectasis respiratory distress epithelium replaced esophageal stricture
Airway more likely to bleed with manipulation
with columnar cells
•Tracheoesophageal
•Hypoxic Irritation of upper
fistulas
vasoconstriction MEDICAL MANAGEMENT DIAGNOSTIC TESTS respiratory tract

Object is removed, but inflammatory May progress to Stricture may Mechanical

•Post-obstructive changes may not be completely •NPO status •Esophagoscopy adenocarcinoma boleed dysphagia
Nursing Management:
pneumonia reversible. •NGT insertion
•Antibiotics if infection is detected •Barium Swallow Chronic cough and
•Encourage patient to cough •Reconstruction may be accomplished by hoarseness of
forcefully and persist with esophagectomy and colon interposition voice
Scar carcinoma may develop over time. spontaneous coughing and to replace the portion of esophagus Nursing Management:
breathing efforts as longs as removed Medical Management
good air exchange exists. •Instruct to eat a low-fat diet & maintain
normal body weight •Antacids/acid neutralizing agents (ex. Calcium
Diagnostic Tests: Medical Management: •Reposition patient’s head to •Encourage small frequent meals of high carbonate, Aluminum hydroxide, magnesium,
prevent the tongue from NURSING MANAGEMENT calories and high protein foods. hydroxide and Simethicone)
• Chest x-ray •Heimlich maneuver obstructing the pharynx. •Instruct patient to eat slowly and masticate •H2 Receptor Antagonists (ex. Famotidine, Ranitidine
foods well. and Cimetidine)
•Administer IV fluids
• Inspiratory and •Inhalation of broncodilator •Abdominal thrusts, the head- •Elevate the head of the bed by at least 30 •Prokinetic agents (Metoclopramide)
•Nutritional support via enteral or parenteral feedings
expiratory phase X-ray. followed by postural drainage tilt-chin-lift or jaw-thrust degrees •Proton Pump Inhibitors---PPIs (Pantoprazole,
•Dilation by bougienage
with chest therapy. maneuver, or insertion of •Educate client about what to avoid: Omeprazole, Esomeprazole, Lansoprazole,
•Report labored respirations, decreased depth of respirations, or signs of
specialized equipment. a) caffeine Rabeprazole, Dexlansoprazole)
• Bronchoscopy hypoxia to physician immediately
b) tobacco, beer, milk •Reflux Inhibitors (ex. Bethanechol chloride)
•Bronchoscopic inspection. •Prepare to assist with intubation and escharotomies
c)foods containing peppermint or spearmint •Surface Agents/ Alginate-based barrires (ex.
•Radiographs •Provide patient and family •Maintain IV lines and regular fluids at appropriate rates, as prescribed.
d)carbonated beverages Sucralfate)
•Tracheotomy incision. education Document intake, output, and daily weight
e) eating or drinking 2 hours before bedtime
•Alleviate pain, avoid movement in affected area
•Laryngoscopy f) tight-fitting clothes
•Provide humidifies oxygen, and monitor arterial blood gases (ABGs), pulse
•Dilation techniques
oximetry, and carboxyhemoglobin levels Diagnostic Tests:
(bougienage procedure).
•Upper endoscopy.
•Ambulatory acid (pH) probe test.
• Administer
•Esophageal manometry.
Glucagon. •X-ray of your upper digestive system.

• Emergency
endotracheal intubation.
 CONDITIONS OF MALABSORPTION (CELIAC DISEASE)

1. Define the disease condition

Celiac disease, sometimes called celiac sprue or gluten-

sensitive enteropathy, is an immune reaction to eating gluten, a
protein found in wheat, barley and rye. If you have celiac disease,
eating gluten triggers an immune response in your small intestine.
Over time, this reaction damages your small intestine's lining and
prevents it from absorbing some nutrients (malabsorption).

Celiac disease has become more common in the past

decade, with an estimate prevalence of 1% in the United States.
Women are afflicted twice as often as men. This disease is more
common among Caucasians, although the rates of celiac disease
are on the rise among non-Caucasians. Celiac disease also has a
familial risk component, particularly among first-degree relatives.
Others are heightened risk include those with type 1 diabetes, down
syndrome and turner syndrome. Celiac disease may manifest at any
age in a person who is genetically predisposed.

2. Identify Causative agent

Celiac disease (CeD) is an immune mediated enteropathy

triggered by ingestion of gluten in genetically predisposed individuals
carrying human leucocyte antigen (HLA) DQ2 or DQ8. When the body's
immune system overreacts to gluten in food, the reaction damages the
tiny, hair like projections (villi) that line the small intestine. Villi absorb
vitamins, minerals and other nutrients from the food you eat. If your villi are
damaged, you can't get enough nutrients, no matter how much you eat.

3. Signs and symptoms

Diarrhea Dermatitis herpetiformis

Steatorrhea Migraine headaches

Abdominal distention Osteopenia

Flatulence Anemia

Weight loss Seizures

Hypothyroidism Paresthesia in the hands and feet

Fatigue Red shiny tongue

General malaise Discoloration of teeth or yellowing

Depression

4. Medical and Nursing Management

Medical Management

Celiac disease is a chronic, noncurable, lifelong disease. There are no drugs that induce remissions. The best thing to do is to consult with
dietician for a meal plan to refrain exposure to gluten foods. For patients who presents anemia may be prescribed folate, cobalamin, or iron
supplements. While patients with osteopenia may require treatment for osteoporosis. Steroids can ease severe signs and symptoms of celiac disease
while the intestine heals. Other drugs, such as azathioprine (Azasan, Imuran) or budesonide (Entocort EC, Uceris), might be used. Furthermore, if you
continue to have symptoms or if symptoms recur, you might need an endoscopy with biopsies to determine whether your intestine has healed.

Nursing Management

The nurse provides patient and family education regarding adherence to a gluten-free diet and how to avoid other gluten products. For
instance, oats are not contraindicated in gluten-free diets; however, many oat products are produces in facilities that are cross-contaminated with
wheat or other contraindicated grains. Likewise, gluten-free foods prepared in restaurants or dining areas that share preparatory space can become
gluten-contaminated. Products that are not food can also contain gluten. Many generic and over-the-counter drugs can be prepared with gluten
gels. Also toothpaste, communion wafers, some cosmetics and art supplies. Nurses must emphasize the importance of carefully reading and
understanding labels on both food and nonfood products to determine if they contain gluten.
 CONSTIPATION

1. Define the disease condition

- Constipation occurs when bowel movements become less frequent and stools
become difficult to pass. It happens most often due to changes in diet or routine, or
due to inadequate intake of fiber.
- It is also defined as fewer than three bowel movements weekly or bo0wel movements
that hard, dry, small, or difficult to pass. Approximately 42 million Americans are
constipated, making it a very common GI disorder. People more likely to become
constipated are women, particularly pregnant women, patients who recently had
surgery, older adults, non-Caucasians, and those of lower socioeconomic status.
Notably, constipation is a symptom and not a disease, however, constipation can
indicate and underlying disease or motility disorder of the GI tract.
2. Identify the causative agents
- Constipation occurs when bowel movements become less frequent and stools
become difficult to pass. It happens most often due to changes in diet or routine, or
due to inadequate intake of fiber.
- Common lifestyle causes of constipation include:
 Eating foods low in fiber.
 Not drinking enough water (dehydration).
 Not getting enough exercise.
 Changes in your regular routine, such as traveling or eating or going to bed
at different times.
 Eating large amounts of milk or cheese.
 Stress.
 Resisting the urge to have a bowel movement.
3. Signs and symptoms
- You have fewer than three bowel movements a week.
- Your stools are dry, hard and/or lumpy.
- Your stools are difficult or painful to pass.
- You have a stomach ache or cramps.
- You feel bloated and nauseous.
- You feel that you haven’t completely emptied your bowels after a movement.
4. Medical and nursing management
- Medical Management
 Bulk-forming agents (fiber laxatives)
- These laxatives increase fluid, gaseous, and solid bulk of intestinal contents.
 Saline
- Used for acute treatment of constipation in the absence of bowel obstruction.
These agents may also be used as part of a bowel evacuation protocol for
invasive procedures or surgery. These agents increase peristaltic activity of
the colon by promoting osmotic retention of fluid. (Medscape.com)
 Osmotic agents (ex. Glycerin, Glycerin rectal, Lactulose, Polyethylene glycol and
electrolytes)
- They pull water back into the colon to soften stool. That makes it easier to
pass. But research has found that they only help with constipation.
(WebMD.com)
 Lubricants (Mineral oil)
 - Mineral oil is used to treat constipation. It is known as a lubricant laxative. It
works by keeping water in the stool and intestines. This helps to soften the
stool and also makes it easier for stool to pass through the intestines.
(WebMD.com)
 Stimulants
- These laxatives function by causing the intestinal muscles to rhythmically
contract and help push out, or “stimulate” a bowel movement.
(Healthlie.com)
 or Fecal softeners
- These laxatives soften stool and lubricate intestinal mucosa
- Surgical Management
 Colectomy
- Surgery may be an option if you have tried other treatments and your chronic
constipation is caused by a blockage, rectocele or stricture. For people who
have tried other treatments without success and who have abnormally slow
movement of stool through the colon, surgical removal of part of the colon
may be an option.

- Nursing Management
 Encourage the patient to take in fluid 2000 to 3000 mL/day, if not
contraindicated medically
- Adequate fluid is needed to keep the fecal mass soft. But take note of some
clients or older patients having cardiovascular limitations requiring less fluid
intake.
 Assist patient to take at least 25-30 g of dietary fiber (e.g., raw fruits, fresh
vegetable, whole grains) per day.
- Fiber increases bulk to the stool and makes defecation easier because it
passes through the intestine essentially unchanged.
 Urge patient for some physical activity and exercise. Consider isometric
abdominal and gluteal exercises.
- This stimulates peristalsis. Abdominal exercises toughen abdominal muscles
that aid defecation.
 Bowel habit training
- Encourage a regular period for elimination. Most people defecate following
the first daily meal or coffee, as a result of the gastrocolic reflex.
 Privacy for defecation
- Privacy allows the patient to relax, which can help promote defecation.
 Digitally eliminate the fecal impaction.
 Stool that remains in the rectum for long periods becomes dry and hard;
debilitated patients, especially older patients, may not be able to pass these
stools without manual assistance.
 Warm sitz bath
 The warmth of the water eases muscles before defecation attempts.
 Abdominal massage (for patients with neurological disorders)
 Abdominal massage has been known to be helpful in neurogenic bowel
disorder but not for constipation in older adults.
  A gloved lubricated finger is lightly inserted into the rectum and moderately
rotated in a circular motion. This is performed for about 15 to 20 seconds until
flatus/stool is passed.
 Digital anorectal stimulation
 Digital stimulation increases muscular activity in rectum by raising rectal
pressure to aid in expelling fecal matter.
 Biofeedback
 a technique that can be used to help patients learn to relax the sphincter
mechanism to expel stool. It is considered firstline therapy once anorectal
structural lesions have been excluded as the cause for constipation.
 Educate patient for judicious use of laxatives
 This is indicated for short-term management of constipation.
 IRRITABLE BOWEL SYNDROME

1. Define the disease condition.

Irritable bowel syndrome (IBS) is one of the most

common GI problems. It is a group of symptoms that
occur together, including repeated pain in your abdomen
and changes in your bowel movements, which may be
diarrhea, constipation, or both. IBS occurs more
commonly in women than in men, and the cause is still
unknown. Although no anatomic or biochemical
abnormalities have been found that explain the common
symptoms, various factors are associated with the
syndrome: heredity, psychological stress or conditions such
as depression and anxiety, a diet high in fat and stimulating
or irritating foods, alcohol consumption, and smoking. The
small intestine has become a focus of investigation as
an additional site of dysmotility in IBS, and cluster contractions in the jejunum and ileum are being studied.

2. Identify the Causative agent.

The exact cause of irritable bowel syndrome is unknown and may be due to multiple factors. Although
no anatomic or biochemical abnormalities have been found that explain the common symptoms, various factors
are associated with the syndrome: heredity, psychological stress or conditions such as depression and anxiety,
a diet high in fat and stimulating or irritating foods, alcohol consumption, and smoking.

IBS results from a functional disorder of intestinal motility. The change in motility may be related to the
neurologic regulatory system, infection or irritation, or a vascular or metabolic disturbance. The peristaltic waves
are affected at specific segments of the intestine and in the intensity with which they propel the fecal matter
forward. There is no evidence of inflammation or tissue changes in the intestinal mucosa.

3. Signs and symptoms.

There is a wide variability in symptom presentation. Symptoms range in intensity and duration from mild
and infrequent to severe and continuous.

 The primary symptom is an alteration in bowel patterns—constipation, diarrhea, or a combination of both.

 Pain, bloating, and abdominal distention often accompany this change in bowel pattern.
 The abdominal pain is sometimes precipitated by eating and is frequently relieved by defecation.

4. Medical and Nursing management.

Medical Management

The goals of treatment are aimed at relieving abdominal pain, controlling the diarrhea or constipation,
and reducing stress. Restriction and then gradual reintroduction of foods that are possibly irritating may help
determine what types of food are acting as irritants (eg, beans, caffeinated products, fried foods, alcohol, spicy
foods). A healthy, high-fiber diet is prescribed to help control the diarrhea and constipation. Exercise can assist
in reducing anxiety and increasing intestinal motility. Patients often find it helpful to participate in a stress
reduction or behavior-modificationprogram.

 Hydrophilic colloids (ie, bulk) and antidiarrheal agents (eg, loperamide) may be given to control the
diarrhea and fecal urgency.
 Antidepressants can assist in treating underlying anxiety and depression.
  Anticholinergics and calcium channel blockers decrease smooth muscle spasm, decreasing
cramping and constipation.

Nursing Management

 The nurse’s role is to provide patient and family education.

 The nurse emphasizes teaching and reinforces good dietary habits.
 The patient is encouraged to eat at regular times and to chew food slowly and thoroughly.
 The patient should understand that, although adequate fluid intake is necessary, fluid should not be taken
with meals because this results in abdominal distention.
 Alcohol use and cigarette smoking are discouraged.
 DIARRHEA
1. Define the disease condition. - Diarrhea is an increased frequency of bowel movements (more than
three per day), an increased amount of stool (more than 200 g/day), and altered consistency of stool.
It is usually associated with urgency, perianal discomfort, incontinence, or a combination of these
factors. - Diarrhea may be acute which is most often associated with infection, usually self-limiting, and
lasts up to 7 to 14 days and it can also be chronic which persists for more than 2 to 3 weeks and may
return sporadically. - It is usually a symptom of an infection in the intestinal tract. Infection is spread
through contaminated food or drinking-water, or from person-toperson as a result of poor hygiene.
2. Identify the causative agent. - Caused by a variety of bacterial (Campylobacter, E. coli, Salmonella,
Shigella), viral (norovirus, rotavirus, viral gastroenteritis) and parasitic organisms (Cryptosporidium
enteritis, Entamoeba histolytica, Giardia lamblia) - Any condition that causes increased intestinal
secretions, decreased mucosal absorption, or altered motility can produce diarrhea. Irritable bowel
syndrome, inflammatory bowel disease, and lactose intolerance are frequently the underlying disease
processes that cause diarrhea. - Diarrhea can be caused by certain medications such as stool
softeners and laxatives, certain tube-feeding formulas, metabolic and endocrine disorders. - Also
associated with nutritional and malabsorptive disorders such as celiac disease, anal sphincter defect,
Zollinger-Ellison syndrome, paralytic ileus, intestinal obstruction, and AIDS.
3. Signs and symptoms - Increased frequency and fluid content of stools - Abdominal cramps,
distention, intestinal rumbling, anorexia, and thirst - Painful spasmodic contractions of the anus -
Ineffective straining with defecation - Watery stools (disorders of the small bowel) - Loose, semisolid
stools (disorders of the large bowel) - Voluminous, greasy stools (intestinal malabsorption) - Presence
of blood, mucus, and pus in stool (inflammatory enteritis or colitis) - Dehydration and fluid and
electrolyte imbalances
4. Medical and nursing management
Medical management
- Antibiotics - Anti-inflammatory agents - Antidiarrheals (eg, loperamide [Imodium], diphenoxylate
[Lomotil]) may be used to reduce the severity of the diarrhea and treat the underlying disease
Nursing management
- Assess and monitor the characteristics and pattern of diarrhea.
- Auscultate the abdomen and palpate for tenderness, and assess the perianal area. - Inspection the
abdomen, mucous membranes, and skin to determine hydration status. - Obtain stool samples for
testing. - Encourage bed rest and intake of liquids and foods low in bulk until the acute attack subsides.
- Recommend a bland diet of semisolid and solid foods and avoid caffeine, carbonated beverages, and
very hot and very cold foods, because they stimulate intestinal motility. - Restrict milk products, fat,
whole-grain products, fresh fruits, and vegetables for several days. - Administer antidiarrheal
medications such as diphenoxylate or loperamide as prescribed. - IV fluid therapy may be necessary
for rapid rehydration in some patients, especially in elderly patients and in patients with - preexisting GI
conditions - Monitor serum electrolyte levels closely. - Report evidence of dysrhythmias or change in
patient’s level of consciousness.
 CONDITIONS OF MALABSORPTION (CELIAC DISEASE)

1. Define the disease condition

Celiac disease, sometimes called celiac

sprue or gluten-sensitive enteropathy, is an
immune reaction to eating gluten, a protein
found in wheat, barley and rye. If you have celiac
disease, eating gluten triggers an immune
response in your small intestine. Over time, this
reaction damages your small intestine's lining and
prevents it from absorbing some nutrients
(malabsorption).

Celiac disease has become more common in

the past decade, with an estimate prevalence of
1% in the United States. Women are afflicted twice
as often as men. This disease is more common among Caucasians, although the rates
of celiac disease are on the rise among non-Caucasians. Celiac disease also has a
familial risk component, particularly among first-degree relatives. Others are heightened
risk include those with type 1 diabetes, down syndrome and turner syndrome. Celiac
disease may manifest at any age in a person who is genetically predisposed.

2. Identify Causative agent

Celiac disease (CeD) is an immune mediated enteropathy triggered by ingestion of

gluten in genetically predisposed individuals carrying human leucocyte antigen (HLA) DQ2
or DQ8. When the body's immune system overreacts to gluten in food, the reaction
damages the tiny, hair like projections (villi) that line the small intestine. Villi absorb vitamins,
minerals and other nutrients from the food you eat. If your villi are damaged, you can't get
enough nutrients, no matter how much you eat.

3. Signs and symptoms

Diarrhea Dermatitis herpetiformis

Steatorrhea Migraine headaches
Abdominal distention Osteopenia
Flatulence Anemia
Weight loss Seizures
 Hypothyroidism Paresthesia in the hands and
feet
Fatigue Red shiny tongue
General malaise Discoloration of teeth or
yellowing
Depression

4. Medical and Nursing Management

Medical Management

Celiac disease is a chronic, noncurable, lifelong disease. There are no drugs that
induce remissions. The best thing to do is to consult with dietician for a meal plan to refrain
exposure to gluten foods. For patients who presents anemia may be prescribed folate,
cobalamin, or iron supplements. While patients with osteopenia may require treatment for
osteoporosis. Steroids can ease severe signs and symptoms of celiac disease while the
intestine heals. Other drugs, such as azathioprine (Azasan, Imuran) or budesonide (Entocort
EC, Uceris), might be used. Furthermore, if you continue to have symptoms or if symptoms
recur, you might need an endoscopy with biopsies to determine whether your intestine has
healed.

Nursing Management

The nurse provides patient and family education regarding adherence to a gluten-free diet
and how to avoid other gluten products. For instance, oats are not contraindicated in gluten-
free diets; however, many oat products are produces in facilities that are cross-contaminated
with wheat or other contraindicated grains. Likewise, gluten-free foods prepared in restaurants
or dining areas that share preparatory space can become gluten-contaminated. Products
that are not food can also contain gluten. Many generic and over-the-counter drugs can be
prepared with gluten gels. Also toothpaste, communion wafers, some cosmetics and art
supplies. Nurses must emphasize the importance of carefully reading and understanding labels
on both food and nonfood products to determine if they contain gluten.
 APPENDICITIS

1. Define the disease condition.

The appendix is a small, vermiform (wormlike) appendage about 8 to 10 cm (3 to 4 inches) long
that is attached to the cecum just below the ileocecal valve. The appendix fills with byproducts of digestion
and empties regularly into the cecum. Because it empties inefficiently and its lumen is small, the appendix
is prone to obstruction and is particularly vulnerable to infection (appendicitis). Appendicitis, the most
frequent cause of acute abdomen in the United States, is the most common reason for emergency
abdominal surgery. Although it can occur at any age, it typically occurs between the ages of 10 and 30
years. Its incidence is slightly higher among males and there is a familial predisposition

2. Identify the causative agent.

The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by
a fecalith (hardened mass of stool), lymphoid hyperplasia (secondary to inflammation or infection), or
rarely, foreign bodies (fruit seeds) or tumors. The inflammatory process increases intraluminal pressure,
causing edema and obstruction of the orifice. Once obstructed, the appendix becomes ischemic, bacterial
overgrowth occurs, and eventually gangrene or perforation occurs.

3. Signs and symptoms

 Vague periumbilical pain (visceral pain that is dull and poorly localized)
 Right lower quadrant pain
 Nausea and vomiting
 Low grade fever
 Rebound tenderness
 Diarrhea
 Constipation
 Anorexia
 Local tenderness at McBurney point when pressure is applied

4. Medical and Nursing Management

Medical Management

Immediate surgery is typically indicated if appendicitis is diagnosed. Moreover, to correct or prevent fluid
and electrolyte imbalance, dehydration, and sepsis, antibiotics and IV fluids are given until surgery is
performed. Appendectomy (surgical removal of the appendix) is performed as soon as possible to decrease
the risk of perforation. It is typically performed using general anesthesia with either a low abdominal incision
(laparotomy) or by laparoscopy. Both laparotomy and laparoscopy are safe and effective in the treatment of
appendicitis with or without perforation. However, recovery after laparoscopic surgery is generally quicker.
For complicated appendicitis (with gangrene or perforation), the patient is typically treated with a 3- to 5-day
course of antibiotics postoperatively. Although it had been common practice for the surgeon to place a
surgical drain, recent research findings suggest there is no improvement in outcomes but longer hospital
lengths of stay when drains are used.
Nursing Management

Nursing goals include relieving pain, preventing fluid volume deficit, reducing anxiety, preventing or
treating surgical site infection, preventing atelectasis, maintaining skin integrity, and attaining optimal nutrition.
The nurse prepares the patient for surgery, which includes an IV infusion to replace fluid loss and promote
adequate renal function, antibiotic therapy to prevent infection, and administration of analgesic agents for pain.
An enema is not given because it can lead to perforation. After surgery, the nurse places the patient in a high
Fowler position. This position reduces the tension on the incision and abdominal organs, helping to reduce pain.
It also promotes thoracic expansion, diminishing the work of breathing, and decreasing the likelihood of
atelectasis.

Furthermore, any patient who was dehydrated before surgery receives IV fluids. When tolerated, oral fluids are
given. Food is provided as desired and tolerated on the day of surgery when bowel sounds are present. To add
that, the nurse auscultates for the return of bowel sounds and queries the patient for passing of flatus. Urine
output is monitored to ensure that the patient is not hampered by postoperative urinary retention and to ensure
that hydration status is adequate. The patient is encouraged to ambulate the day of surgery to reduce risks of
atelectasis and venous thromboemboli (VTE) formation. Moreover, the nurse instructs the patient to make an
appointment to have the surgeon remove any sutures and inspect the wound between 1 and 2 weeks after
surgery. Incision care and activity guidelines are discussed such as heavy lifting is to be avoided
postoperatively, although normal activity can usually be resumed within 2 to 4 weeks. Lastly, when the patient
is ready for discharge, the patient and family are educated about how to care for the incision and perform
dressing changes and irrigations as prescribed.
 DIVERTICULAR DISEASE
5. Define the disease condition
Diverticular disease is the general name for a common condition that causes small bulges (diverticula) or sacs to
form in the wall of the large intestine (colon). Although these sacs can form anywhere in the colon, they are
most common in the sigmoid colon (part of the large intestine closest to the rectum).
6. Identify the causative agents
The infection in diverticulitis results from normal colonic flora released into the peritoneal cavity through a
colonic perforation. This is, therefore, a polymicrobial infection. The most common organisms cultured include
anaerobes, such as Bacteroides fragilis, and gram negatives, such as Escherichia coli.
7. Signs and symptoms
 Pain, which may be constant and persist for several days. The lower left side of the abdomen is the usual
site of the pain. Sometimes, however, the right side of the abdomen is more painful, especially in people
of Asian descent.
 Nausea and vomiting.
 Fever.
 Abdominal tenderness.
 Constipation or, less commonly, diarrhea.
8. Medical and nursing management
- Nursing management
 Administer nothing by mouth
 Administer IV fluids
 Institute nasogastric suctioning
 Keep the client on bed rest
 Encourage daily exercise such as walking, which increases bowel peristalsis.
 Offer a low-fiber diet until signs of infection decrease; then gradually increase fiber until the
client is eating a high-fiber diet. If a high-fiber diet alone prevents constipation, encourage
medication with caution, especially in elderly clients.
- Medical management
 Administering one or more of the following: Bulk laxatives, Stimulant laxative, Stool softeners,
Saline laxatives At least 8 oz of water with any agent
 Administer medications, which may include antibiotics, opioid analgesics, and antispasmodics.
 Ciprofloxacin plus metronidazole.
 Trimethoprim-sulfamethoxazole plus metronidazole.
 Amoxicillin-clavulanate.
 Moxifloxacin (use in patients intolerant of both metronidazole and beta lactam agents)
 Options for definitive surgery involve resection of the affected colon with or without
anastomosis. The two-stage approach, commonly called HP, refers to sigmoid colectomy with
end colostomy and later colostomy reversal.
 Peritonitis
1. Define the disease condition. Peritonitis is defined as an inflammation of the serosal membrane that
lines the abdominal cavity and the organs contained therein. The peritoneum, which is an otherwise
sterile environment, reacts to various pathologic stimuli with a fairly uniform inflammatory response.
Depending on the underlying pathology, the resultant peritonitis may be infectious or sterile.
Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of ascitic fluid. Contamination of
the peritoneal cavity is thought to result from translocation of bacteria across the gut wall or mesenteric
lymphatics and, less frequently, via hematogenous seeding in the presence of bacteremia. There are
two types of peritonitis a spontaneous bacterial peritonitis, which develops as a complication of liver
disease, such as cirrhosis, or of kidney disease or a secondary peritonitis, which results from rupture
or perforation in your abdomen, or as a complication of other medical conditions.
2. Identify the Causative agent.
Infection of the peritoneum can happen for a variety of reasons. In most cases, the cause is a rupture
or perforation within the abdominal wall. Common causes of ruptures that lead to peritonitis include
medical procedures, such as peritoneal dialysis. Peritoneal dialysis uses catheters to remove waste
products from your blood when your kidneys can no longer adequately do so. An infection may occur
during peritoneal dialysis due to unclean surroundings, poor hygiene or contaminated equipment.
Peritonitis may also develop as a complication of gastrointestinal surgery, the use of feeding tubes, or
a procedure to withdraw fluid from your abdomen, and rarely as a complication of a colonoscopy or
endoscopy. A ruptured appendix, stomach ulcer or perforated colon can allow bacteria to enter into the
peritoneum through a hole in your gastrointestinal tract. Pancreatitis is an inflammation of your
pancreas complicated by infection may lead to peritonitis if the bacteria spreads outside the pancreas.
Diverticulitis, an infection of small, bulging pouches in your digestive tract may cause peritonitis if one
of the pouches ruptures, spilling intestinal waste into your abdominal cavity. Injury or trauma may cause
peritonitis by allowing bacteria or chemicals from other parts of your body to enter the peritoneum.
Another common cause of peritonitis is peritoneal dialysis therapy by which following good hygiene
before, during and after dialysis can help prevent or lessen the risk of peritonitis.
3. Signs and symptoms.
Signs and symptoms of peritonitis include:
• Abdominal pain or tenderness • Bloating or a feeling of fullness in your abdomen • Fever • Nausea
and vomiting • Loss of appetite • Diarrhea • Low urine output • Thirst • Inability to pass stool or gas •
Fatigue • Confusion • Cloudy dialysis fluid • White flecks, strands or clumps (fibrin) in the dialysis fluid
4. Medical and Nursing management.
Medical Management: The management approach to peritonitis and peritoneal abscesses targets
correction of the underlying process, administration of systemic antibiotics, and supportive therapy to
prevent or limit secondary complications due to organ system failure. Treatment success is defined as
adequate source control with resolution of sepsis and clearance of all residual intra-abdominal infection.
Operative management is used to address and control the infectious source and to purge bacteria and
toxins. The type and extent of surgery depends on the underlying disease process and the severity of
intra-abdominal infection. Definitive interventions to restore functional anatomy involve removing the
source of the antimicrobial contamination and repairing the anatomic or functional disorder causing the
infection. Nonoperative interventions include percutaneous abscess drainage, as well as percutaneous
and endoscopic stent placements.
The treatment of peritonitis is multidisciplinary, with complementary application of medical, operative,
and nonoperative interventions. Medical support includes systemic antibiotic therapy, intensive care
with hemodynamic, pulmonary, and renal support, nutrition and metabolic support, inflammatory
response modulation therapy
Nursing Management: Nursing's role begins with the prevention of peritonitis by the development of
sound program policies and procedures and effective patient education. Nursing activities at the time
of infection focus on assessment and patient education. Nurses are also responsible for maintaining
peritonitis data as well as directing or participating in related quality improvement activities.
Nursing interventions focus on monitoring the patient’s blood pressure by arterial line if shock is present,
administering analgesic and anti emetics can be done as prescribed, analgesics and positioning could
help in decreasing pain, accurate recording of all intake and output could help in the assessment of
fluid replacement, administers and closely monitors IV fluids, and monitor and record the character of
the drainage postoperatively.
 Foreign body
Foreign body ingestion can be defined as materials swallowed accidentally or intentionally, or objects swallowed
naturally when taking medication or food. It is frequently seen in the emergency department and occurs
commonly in the pediatric population. Foreign body aspiration can be a life-threatening emergency. An aspirated
solid or semisolid object may lodge in the larynx or trachea. If the object is large enough to cause nearly complete
obstruction of the airway, asphyxia may rapidly cause death. Lesser degrees of obstruction or passage of the
obstructive object beyond the carina can result in less severe signs and symptoms.

1. Identify the causative agent.

 A foreign body aspiration is caused when a person inhales a foreign object into their airways. This is
most often done by accident, usually while eating or when a non-edible object is placed in the mouth.
Food is the most frequently aspirated type of object, with nuts and seeds being particularly common.
Raisins, grapes and sweets are other food items which are often seen aspirated. Liquids, such as
water, can also be inhaled into the airways. In addition to edible objects, other non-edible items which
are commonly retrieved from the airways include:
o Balloons can be particularly dangerous when inhaled and account for roughly 29 percent of
aspiration deaths in children
o Other small toys, such as marbles
o Coins
o Pins
o Dental appliances, such as crowns, fillings and orthodontic retainers.

2. Signs and symptoms.

 The symptoms experienced during a foreign body aspiration are variable and usually depend on
three main factors:

o Where in the airways the object has settled. Most foreign bodies settle in the bronchi, which is
considered a lower airway obstruction. Obstructions higher up in the airways, such as in the larynx
or trachea, are typically more severe.
o The size and nature of the foreign body inhaled. Whether it is big or small, sharp or blunt, hard or
soft.
o The time since the object was inhaled. Whether the aspiration has only just taken place, if it
occurred within the last few days or weeks, or further in the past.
Immediate symptoms of foreign body aspiration:
o Choking
o Coughing
o Difficulty breathing and shortness of breath
o Difficulty speaking
o Wheezing or stridor. Stridor is a particular kind of wheeze that often produces a loud, single-
pitch noise, usually during inhalation. A wheeze is a high-pitched, continuous sound, usually
heard during exhalation
o Bluish tinge to the skin.
Any symptoms experienced will typically occur immediately after the foreign body has been inhaled. If
the blockage to the airways is significant enough, symptoms may occur in quick succession, become severe and
can eventually lead to loss of consciousness and even death, unless the object is dislodged.
 In milder cases, where the obstruction is less significant, the symptoms experienced may be less severe.
However, anyone who is displaying immediate symptoms of having inhaled a foreign body should still seek
emergency help.
If the affected person is displaying immediate choking symptoms, it can be useful to distinguish between
the signs of a mild or significant obstruction.
If the person is experiencing a mild obstruction, they are often able to:
o Breathe
o Talk
o Cough
o Be responsive and answer questions
More severe obstructions in the airways may be indicated by:
o An inability to breathe
o An inability to speak or properly vocalise
o Coughs that are particularly quiet or silent
o Blushing tinge to the skin
o Loss of consciousness.

3. Medical and Nursing Management

Treatment of foreign body aspiration involves managing the person's ability to breathe and removing the foreign
body. It is extremely important to respond quickly if the affected person has a significant obstruction that is
affecting their ability to breathe, as this can quickly become life-threatening.
Medical Management
o If further attempts at first aid are unsuccessful and once medical help arrives, an emergency endotracheal
intubation may be attempted. This process involves passing a flexible tube, known as an endotracheal
tube, through the person’s mouth and into the airways. The tube can assist in opening the airways to
provide oxygen and can also be used to remove blockages.

In the most severe cases of choking, an emergency tracheotomy may be performed. A tracheotomy
involves creating a small opening at the front of the neck. A tube is then inserted through this opening
into the trachea, helping the person to breathe.

Bronchoscopy treatment
o Removal of the foreign body during a bronchoscopy is a common, and usually successful, treatment
method for inhaled objects located in the trachea or bronchi.
A bronchoscope is a long, thin tube with a camera and light source on one end. This tube can be flexible
or rigid and is inserted into a person’s airways to access and look into the respiratory tract. A
bronchoscopy is typically performed under general anesthesia, although local anesthesia and/or
sedatives may be used for more simple procedures.
As well as helping to locate the foreign body, certain surgical instruments, such as forceps or a suction
pad can be attached to the bronchoscope to enable removal of the object. Once the item is removed, the
doctor will usually return the bronchoscope to the airway to ensure no fragments of the foreign body
remain.
If the object is located in the larynx, a similar treatment method known as a laryngoscopy may be used
instead.
 Surgery
o Surgical removal is rarely necessary for foreign body aspiration. However, if the inhaled item is
particularly large, sharp or difficult to remove, surgery may be required.

A tracheotomy is a surgical procedure that involves making a small opening in the front of a person’s
neck, known as a tracheostomy, in order to access the trachea. Removal of an aspirated foreign body
located in this region can then be attempted through the surgical opening. Tracheotomies are usually
performed under general anesthetic, meaning the patient is unconscious.
A thoracotomy is a surgical procedure that involves making an incision between a person’s ribs, in order
to open the chest and access the lungs. This is also performed under general anesthesia and is usually
only suggested if the foreign body is located in the bronchi, and bronchoscopic attempts to remove the
foreign body have been unsuccessful.
Medication
o Medication is typically not prescribed to treat foreign body aspirations. However, antibiotics may be
prescribed to target any bacterial infections that arise as a result of the condition.
Nursing Management
If an airway obstruction is suspected, it is important to deliver first aid quickly. Both mild and severe choking can
be successfully treated at the scene, and this should take precedence over immediately calling for emergency
medical care.
When someone is displaying signs of choking, the following steps can be used to help remove the object:
o Encourage the person to keep coughing. If the obstruction is mild, they are usually able to cough and
clear the blockage themselves.
o Back blows. If the person is unable to cough, or coughing is unsuccessful, lean the person slightly forward
and give up to five sharps blows to their back, between the shoulder blades. Deliver these blows with the
heel of one hand, while supporting the person’s chest with the other hand.
o Abdominal thrusts/Heimlich Maneuver. If back blows are unsuccessful, give up to five abdominal thrusts.
Stand behind and slightly to the side of the person and wrap both arms around their waist. Clench a fist
with one hand, cover it with the other hand, and pull sharply inwards and upwards just above their navel.
If the above measures are unsuccessful, call for emergency medical help and then continue alternating between
back blows and abdominal thrusts until assistance arrives. If the person becomes unconscious, lay them on a
flat surface and begin to deliver cardiopulmonary resuscitation (CPR), even if a pulse is present.
Provide patient education such as:
o Keep small objects that may be a choking hazard, such as coins, buttons and marbles, away from
children.
o Teach children not to place foreign objects in their mouth, nose or other body openings.
o Avoid giving children under three years of age high-risk foods, such as nuts, seeds, small fruits and
sweets.
o Avoid talking, laughing or playing while eating.
o Avoid running or exercising while eating.
 GERD
9. Define the disease condition
- GERD is a fairly common disorder marked by backflow of gastric or duodenal contents into the esophagus
that causes troublesome symptoms or mucosal injury to the esophagus. Excessive reflux may occur
because of an incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia, or a motility
disorder. The incidence of GERD seems to increase with aging and is seen in patient with irritable bowel
syndrome and obstructive airway disorders, peptic ulcer disease, and angina. GERD is also associated with
tobacco use, coffee drinking, alcohol consumption, and gastric infection with H. Pylori.
10. Identify the causative agents
- Helicobacter Pylori is a type of bacteria which is responsible for the majority of peptic ulcers, as well as
chronic gastritis.
- There are also factors that can aggravate acid reflux which includes smoking, eating large meals or
eating late at night, eating certain food such as fatty or fried foods, drinking certain beverages such as
alcohol or coffee, and taking certain medications such as aspirin
11. Signs and symptoms
- Symptoms may include a burning sensation in your chest, usually after eating, which might be worse at
night
- Dyspepsia or indigestion
- Regurgitation of food
- Dysphagia or odynophagia
- Hypersalivation
- Esophagitis
- Symptoms may also mimic those of a heart attack
- GERD can also result in dental damage, esophageal strictures, adenocarcinoma, and pulmonary
complications
12. Medical and nursing management
- Nursing management
o Instruct to eat a low-fat diet & maintain normal body weight
o Instruct patient to eat slowly and masticate foods well.
o Encourage small frequent meals of high calories and high protein foods.
o Elevate the head of the bed by at least 30 degrees
o Educate client about what to avoid:
 caffeine
 tobacco, beer, milk
 foods containing peppermint or spearmint
 carbonated beverages
 eating or drinking 2 hours before bedtime
 tight-fitting clothes
- Medical management
o Antacids/acid neutralizing agents (ex. Calcium carbonate, Aluminum hydroxide, magnesium,
hydroxide and Simethicone)
o H2 Receptor Antagonists (ex. Famotidine, Ranitidine and Cimetidine)
o Prokinetic agents (Metoclopramide)
o Proton Pump Inhibitors---PPIs (Pantoprazole, Omeprazole, Esomeprazole, Lansoprazole,
Rabeprazole, Dexlansoprazole)
o Reflux Inhibitors (ex. Bethanechol chloride)
o Surface Agents/ Alginate-based barrires (ex. Sucralfate)
 CHEMICAL BURNS

1.Define Disease Condition

Chemical burns are injuries to the skin, eyes, mouth, or internal organs caused by contact with a corrosive substance.
They may also be called caustic burns. Chemical burns can happen in the home, at work, or at school. They can result
from an accident or an assault. Although few people in the United States die after contact with chemicals in the home,
many substances common in living areas and in storage areas can do serious harm. Many chemical burns happen
accidentally through misuse of products such as those for hair, skin, and nail care. Although injuries do happen at home,
the risk of sustaining a chemical burn is much greater in the workplace, especially in businesses and manufacturing
plants that use large quantities of chemicals.

2. Causative Agent

• Ammonia
• Battery acid
• Bleach
• Concrete mix
• Drain or toilet bowl cleaners
• Metal cleaners
• Pool chlorinators
• Tooth-whitening products

3. Signs and symptoms

 Redness, irritation, or burning at the site of contact
 Pain or numbness at the site of contact
 Formation of blisters or black dead skin at the contact site
 Vision changes if the chemical gets into your eyes
 Cough or shortness of breath
4. Medical Management

 NPO status
 NGT insertion
 Antibiotics if infection is detected
 Reconstruction may be accomplished by esophagectomy and colon interposition to replace the portion of
esophagus removed

NURSING MANAGEMENT

•Administer IV fluids
•Nutritional support via enteral or parenteral feedings
•Dilation by bougienage
•Report labored respirations, decreased depth of respirations, or signs of hypoxia to physician immediately
•Prepare to assist with intubation and escharotomies
•Maintain IV lines and regular fluids at appropriate rates, as prescribed. Document intake, output, and daily
weight
•Alleviate pain, avoid movement in affected area
•Provide humidifies oxygen, and monitor arterial blood gases (ABGs), pulse oximetry, and carboxyhemoglobin
levels