PEPTIC ULCER

 PEPTIC ULCER
A break in the mucous lining of the
gastrointestinal tract when it comes in contact
with gastric juice
 peptic ulcer occurs in any area of the
gastrointestinal tract exposed to acid- pepsin
secretions, including esophagus, stomach or
duodenum.
 RISK FACTORS
 H. pylori infection
 Low socioeconomic status
 Crowded, unsanitary living conditions
 Unclean food or water
 Use of NSAIDs
 Advance age
 History of ulcer
 Cigarette smoking
 Family history of PUD
 Psychological stress, alcohol, caffeine consumption
 PATHOPHYSIOLOGY
 MANIFESTATIONS
 pain- gnawing, burning, aching or hungerlike
located at the epigastric region sometimes
radiating at the back
 pain occurs when the stomach is empty 2-3
hours after meals and in the middle of the night
 Relieved by eating
MANIFESTATIONS OF PUD
complications
 HEMORRHAGE
 Occult or obvious blood in the stool
 hematemesis
 Weakness, dizziness
 orthostatic hypotention
 hypovolemic shock
 OBSTRUCTION
 sensation of epigastric fullness
 nausea and vomiting
 electrolyte imbalances
 metabolic alkalosis
 PERFORATION
 severe upper abdominal pain, radiating to the
shoulder
 rigid boardlike abdomen

 absence of bowel sounds

 diaphoresis

 tachycardia

 fever
DIAGNOSTIC TESTS
 Upper GI series – using barium as a
contrast can detect 80%- 90% of peptic
ulcers.
 Gastroscopy- allows visualization of the
esophagus, gastric and duodenal mucosa
and direct inspection of ulcers. Tissue can
be obtained for biopsy
 MEDICATIONS
 eradication of H. pylori combination of two
antibiotics – bismuth or proton – pump inhibitors
( omeprazole, metronidazole and clarithromycin
or bismuth subsalicylate, tetracycline and
metronidazole
 medications that decrease gastric acid content
include proton pump inhibitors and H2 receptor
antagonist
 agents that protect mucosa – sucralfate,
bismuth, antacids and prostaglandin analogs
TREATMENTS
 dietary management
 Clients are encourage to maintain good
nutrition, consuming balanced meals at regular
intervals.
 alcohol intake

 smoking should be discourage as it slows the

rate of healing and increases the frequency of
relapses.
Nursing diagnoses and Interventions
 PAIN –typically experienced 2-4 hours after
eating , a high levels of gastric acid and pepsin
irritate the exposed mucosa.
 assess pain, including location, type, severity,
frequency, and duration and its relationship to food
intake
 administer proton- pump inhibitors, H2 receptor
antagonists, antacids. Monitor foe effectiveness and
side effects or adverse reactions.
 teach relaxation, stress reduction and lifestyle
management techniques.
 SLEEP PATTERN DISTURBANCES- night time
ulcer pain, typically occurs between 1- 3 am,
may disrupt the sleep cycle and result in
inadequate rest.
 the importance of taking the medications as prescribed
( bedtime dose)
 instruct the client to limit food intake after the evening
meal, eliminating bedtime snacks. (stimulate the
production of gastric acid and pepsin)
 encourage use of relaxation techniques
 IMBALANCE NUTRITION:LESS THAN BODY
REQUIREMENTS
 assess current diet, including pattern of food intake,
eating schedule and food that precipitate pain or being
avoided.
 refer to dietician for meal planning and meet nutritional
needs
 monitor for complaints of anorexia, fullness, nausea,
and vomiting
 monitor laboratory values for indications of anemia or
other nutritional deficits.
 DEFICIENT FLUID VOLUME- bleeding can lead
to hypovolemia and volume deficit, which can
lead to decrease in cardiac output and impaired
tissue perfusion.
 monitor stool and gastric drainage ( vomitus or
nasogastric tube)
 Bright red with possible clots – acute hemorrhage
 dark red or coffee ground – blood has been in the
stomach for a period of time
 hematochezia- stool containing blood and clots( acute
hemorrhage
 melena – black tarry stool ( less acute bleeding)
 maintain IVF with volume and electrolyte solutions,
administer whole blood or PRBC as ordered.
 insert NGT and maintain its position and patency( if
ordered may irrigate with sterile normal saline until
return flow is clear)
 monitor hgb and hct, serum electrolyte BUN and CREA.
( digestion and absorption of blood in the GI tract may
result to elevated BUN and CREA.
 assess abdomen, including bowel sounds, distention,
girth and tenderness.
 maintain bedrest with the head of bed elevated
DIVERTICULAR DISEASE
 are saclike projections of mucosa through
the muscular layer of the colon.
 diverticula may occur anywhere in the
gastrointestinal tract
 affect the large intestine with 90% - 95%
occurring in the sigmoid colon.
 PATHOPHYSIOLOGY

 DIVERTICULOSIS
 presence of diverticula
 asymptomatic
 episodic pain ( usually left- sided), constipation or
diarrhea, abdominal cramping, occult bleeding in the
stools, weakness and fatigue
 complications include hemorrhage and diverticulitis
 DIVERTICULITIS- inflammation in and around
the diverticular sac.
 undigested food and bacteria collect in the
diverticula , forming a hard mass ( fecalith) that
impairs he mucosal blood supply, allowing
bacterial invasion
 mucosal ischemia can lead to perforation,
bacterial contamination and can lead to
abscess formation or peritonitis.
 pain it is usually left- sided and may be mild to
severe and either steady or cramping.
 constipation or increase frequency in defecation

 nausea, vomiting and fever may occur

 abdomen is distended with tenderness and s

palpable mass in the left lower quadrant resulting

from inflammatory response
 COMPLICATIONS
 peritonitis
 abscess formation

 bowel obstruction( fistula formation and

hemorrhage)
 severe or repeated episodes can lead to
scarring and fibrosis of the bowel wall
Diagnostic tests

 WBC count – leukocytosis ( increase in

the number of immature wbc) due to
inflammation
 hemoccult or guaiac testing
 barium enema\abdominal x-ray
 CT scan
 sigmoidoscopy or colonoscopy
Medications
 antibiotics – broad spectrum
 Metronidazole
 Ciprofloxacin
 Septra – bactrim
 second- generation cephalosporin
 analgesic- causes less increase in colonic
pressure
 stool softener
Dietary Management
 a high fiber diet is recommended- increases
stool bulk , decreases intraluminal pressure and
may reduce spasm.
 avoid foods with small seeds like popcorn,
berries which could obstruct diverticula
 bowel rest is prescribed put patient on NPO with
IVF and possibly TPN
 feeding is resumed initially clear liquid then soft,
low roughage diet
Nursing diagnoses and Interventions
 Impaired tissue integrity: gastrointestinal
 MonitorVS every 4 hours – Tachycardia and
tachypnea may be early indications of increase
inflammation and resulting to fluid shift. Fever
may indicate increase or spread of inflammation
 assess abdomen every 4 hours, measure
abdominal girth, auscultating bowel sounds,
palpating for tenderness
 assess for lower intestinal bleeding
 maintain IVF, TPN and accurate I and O
 pain
 Ask the client to rate the pain using the pain
scale, document level of pain and note for any
changes in location or character of pain
 administer prescribed analgesics or PCA, use
relaxation, positioning and distractions.
 maintain bowel rest and total body rest
 reintroduce oral foods and fluids slowly,
providing a soft, low fiber diet with bulk forming
agents
 anxiety
 assess and document the level of anxiety
 demonstrate empathy and awareness of the perceived
threat to health
 attend to physical care needs
 spend as much time as possible to client
 encourage supportive family and friends to remain with
the client
 assist client to use and identify appropriate coping
mechanism

 involve the client and family in care decisions

CHOLELITHIASIS/ CHOLECYSTITIS
 CHOLELITHIASIS – is the formation of stones within the
gallbladder or biliary tract system.

Bile is formed by the liver and stored in the gallbladder. Bile

contains bile salts, bilirubin, water, electrolytes,
cholesterol, fatty acids and lecithin. In the gallbladder,
some of the water and electrolytes are absorbed, food
entering the intestine stimulates the gallbladder to
contract and release bile through the common bile duct
and sphincter of oddi in the intestine. The bile salts in the
bile increases the solubility and absorption of dietary
fats.
 PATHOPHYSIOLOGY
 RISK FACTORS
 age
 family history of gallstones
 race
 obesity, hyperlipidemia
 rapid weight loss
 female gender
 biliary stasis
 diseases or conditions
 CHOLECYSTITIS- is the inflammation of the
gallbladder.
 Acute cholecystitis usually follows obstruction of the
cystic duct by a stone. The obstruction increases
pressure within the gallbladder leading to ischemia of
the gallbladder wall and mucosa. Ischemia can lead to
necrosis and perforation of the gallbladder.
 biliary colic- pain involves the entire RUQ and may
radiate to the backright scapula or shoulder.
 movement or deep breathing may aggravate the pain
 last longer 12- 18 hours
 anorexia, nausea and vomiting are common
 fever with chills
 chronic cholecystitis – result from repeated
bouts of acute cholecystitis or from persistent
irritation of the gallbladder wall by the stones.
 bacteria may be present

 asymptomatic

 complications include empyema a collection of

infected fluid in the gallbladder, gangrene and
perforation with resulting peritonitis or abscess
formation
Diagnostic Tests
 serum bilirubin – elevated direct bilirubin may
indicate obstructed bile flow in the biliary duct
 CBC- elevated may indicate infection and
inflammation
 abdominal x-ray – gall stones with a high
calcium content
 serum amylase and lipase- possible
pancreatitis related to common duct obstruction
 UTZ of the gallbladder- accurately diagnose
cholethiasis
medications
 ursodiol( actigall) and chenodiol
( chenix)- reduce the cholesterol content of
gall stones, leading to gradual dissolution
 side effects diarrhea and hepatotoxic
 disadvantages long duration ( 2 years or
more) and a high incidence of recurrent
stone formation when treatment is
discontinued.
 antibiotics
treatment
 laparoscopic cholecystectomy ( removal
of the gallbladder)
 cholecystostomy – drain the gallbladder
 choledochostomy- remove stones and
position a T tube in the common bile duct
 dietary management
 food may be eliminated during an acute attack
 NGT is inserted to relieve nausea and vomiting
 dietary fat intake may be limited

Shock wave lithotripsy

Nursing diagnoses and Interventions
 pain
 Discuss the relationship between fat intake and the
pain- fat entering the duodenum initiates gallbladder
contractions causing pain when gallstones are present
in the ducts
 withhold oral food and fluid during episodes of acute
pain
 administer analgesic or narcotic analgesia – morphine
causes spasm of the colon
 place in fowlers position
 monitor vs including temp.
 imbalanced nutrition : less than body requirements
 assess nutritional status
 evaluate laboratory results
 refer to dietician or nutritionist
 risk for infection
 monitor vs including temp
 assess abdomen every 4 hours
 assist to cough and deep breath or use of spirometer, splint
abdominal incision with blanket or pillow while coughing
 place in fowlers position and encourage ambulation
 administer antibiotics
PANCREATITIS
 inflammation of the pancreas, that
involves self- destruction of the pancreas
by its own enzymes through autodigestion.
 characterized by release of pancreatic
enzymes into the tissue of the pancreas
itself leading to hemorrhage and necrosis.
 interstitial edematous pancreatitis- leads
to inflammation and edema of pancreatic
tissue.
 necrotizing pancreatitis – inflammation ,
hemorrhage and ultimately necrosis of
pancreatic tissue.
 PATHOPHYSIOLOGY
 MANIFESTATIONS
 ACUTE
 Abrupt onset of severe epigastric pain and LUQ pain, may radiate to
back
 nausea and vomiting, fever
 decrease bowel sounds, abdominal distention, rigidity
 tachycardia, hypotension,cold clammy skin
 possible jaundice
 CHRONIC
 recurrent epigastric and LUQ pain, radiates to the back
 anorexia, nausea, vomiting, weight loss
 Flatulence, constipation
 steatorrhea
Diagnostic Tests
 UTZ can identify gallstones, pancreatic mass,
pseudocyst( abnormal collection of fluid, dead
tissue, pancreatic enzymes and blood that can
lead to a painful mass in the pancreas)
 CT scan – identify pancreatic enlargement, fluid
collections
 Endoscopic retrograde
cholangiopancreatography ERCP – perform to
diagnose chronic pancreatitis
 endoscopic UTZ
 percutaneous fine needle aspiration biopsy-
differentiate from cancer
medications
 narcotic analgesics
 antibiotics
 H2 blocker and proton – pump inhibitor –
to neutralize or decrease gastric
secretions
 synthetic hormone-
octreotide( sandostatin) suppresses
pancreatic secretion and may relieve pain
fluid and dietary management
 oral food and fluids are withheld during
acute episodes
 NGT may be inserted
 IVF , TPN
surgery
 endoscopic transduodenal
sphincterotomy- performed if the result of
a gallstone lodge in the sphincter of oddi
to remove the stone
nursing diagnoses and interventions
 pain
 obstruction of pancreatic ducts and inflammation ,
edema and swelling of the pancreas caused by
pancreatic autodigestion, severe epigastric pain, left
upper abdominal or midscapular back pain. Nausea and
vomiting
 assess pain using the pain scale, location,radiation,
duration, and character
 NPO and maintain the patency of NGT- gastric
secretions stimulate hormones that stimulate pancreatic
secretion , aggravating pain. NGT decreases nausea,
vomiting, and intestinal distention.
  maintain on bed rest
 assist on comfortable position

Imbalanced nutrition: less than body requirements

 monitor laboratory values
 weigh daily
 maintain stool charting
 monitor bowel sounds – return of bowel sounds
indicates return of peristalsis
 administer prescribed IVF to maintain hydration, TPN to
provide fluids, electrolytes and kilocalories
STOMATITIS
 inflammation of the oral mucosa,
common disorder of the mouth.
 may cause viral ( herpes simplex), fungal
infections ( candida albicans), mechanical
trauma ( cheek biting), irritants like
tobacco or chemotherapeutic agents.
 manifestations and treatment

1. cold sore, fever blister

 cause- herpes simplex virus
 initial burning at site
 clustered vesicular lesions on lip or oral mucosa
 self- limiting
 acyclovir to shorten course
2. aphthous ulcer (canker sore, ulcerative
stomatitis)
 unknown, maybe type of herpes virus

 well circumscribed, shallow erosions with white

or yellow center encircled by red ring
 less than 1cm in diameter
 painful
 topical steroid ointment
 amlexanox oral paste (aphthasol)
 oral prednisone
3. candidiasis (thrush)
 candida albicans

 creamy white, curdlikepatches

 red, erythematous mucosa
 fluconazole ( diflucan)
 ketonazole( nizoral)
 clotrimazole troches
 nystatin vaginal troches
4. necrotizing ulcerative gingivitis ( trench mouth,
vincent’s infection)
 infection with spirochetes bacilli or systemic
infection
 acute gingival inflammation and necrosis
 bleeding, halitosis
 fever
 cervical lymphadenopathy
 correct any underlying disorders
 warm, half- strength peroxide mouthwashes
 oral penicillin
 medications
 TOPICAL ORAL ANESTHETICS
 oragel
 Viscous lidocaine

 anbesol

 triamcinolone acetonide

 This drug reduce the pain. They provide

temporary relief of pain.

 nursing responsibilities
 instruct the client to seek medical attention for
any oral lesion that does not heal within 1 week
 monitor for oral hypersensitivity reactions, and
discontinue use
 Apply every 1 -2 hours as needed

 perform oral hygiene after meals and at

bedtime
  TOPICAL ANTIFUNGAL AGENTS
 clotrimazole
 nystatin

- This drugs help in topical treatment of

candidiasis. Effects are primarily local than
systemic
Nursing responsibilities
- instruct the client to dissolve lozenges in
the mouth
- instruct the client to rinse mouth with oral
suspension for at least 2 minutes and
expectorate or swallow as directed
- contraindicated in pregnancy
 take medication as prescribed
 Do not eat or drink 30 mints after medicaiton
 contact physician if symptoms worsen
 perform good oral hygiene after meals and at bedtime
remove dentures

 ANTIVIRAL AGENT
 acyclovir (zovirax)
Useful in treatment of oral herpes simplex virus-
helps reduce severity and frequency of infection.
 start therapy as soon as herpetic lesions are
noted
 administer with food or on an empty stomach

 the virus remain latent and can recur during

stressful events, fever, trauma, sunlight
exposure
nursing diagnoses and interventions
 impaired oral mucosal membrane

 assess and document oral mucous membranes and

the character of any lesions every 4-8 hours
 assist with thorough mouth care after meals and
bedtime.
 assess knowledge and teach about condition, mouth
care and treatments. Instruct to avoid alcohol,
tobacco and hot spicy or irritating foods.
 less than body requirements
 assess food intake as well as clients ability to chew
and swallow. Weigh daily. Provide straws or feeding
syringes.
 encourage a high calorie, high protein diet. Offer

soft, lukewarm or cool foods or liquids.

OBESITY
 an excess of adipose tissue. Adipose
tissue is created when the energy
consumption exceeds energy expenditure.
 0ne – third of the population in the united
states is obese, higher in women
 health related problems in Obesity
 arthritis
 atherosclerosis
 cancer
 heart failure
 diabetes, mellitus type 2
 hiatal hernia
 hypertension
 low back pain
 muscle strains and sprains
 stress incontinence
 varicosities
 risk factors
 genetic- one obese parent has 40% of
becoming obese
 physiologic -

 environmental

 sociocultural factors
 complications-
 diagnostic tests
 Body mass index- identify excess adipose
tissue. BMI dividing the weight (in kilogram) by
the height in meters squared(m2)
BMI= wt (kg)/ht2(m2)
normal= BMI 18.5-24.9kg/m2
over wt= BMI 25-29.9kg/m2
obese= BMI> 30kg/m2
Morbidly obese =BMI > 40kg/m2
 anthropometry- skinfold or fatfold
measurements, uses calipers to measure
skinfold thickness at various sites of the body
 underwater weighing (hydrodensitometry) the
most accurate way to determine body fat.
Submerging the whole body and then
measuring the amount of displaced water
 bioelectrical impedance- uses a low energy
electrical impulses to determine the percentage
of the body fat by measuring the electrical
resistance of the body.
 other diagnostic test
 Thyroid profile
 serum cholesterol- HDL levels are reduced in obese
clients, LDL are very high
 ECG- detects effects of obesity on the heart, such as
rate, or rhythm disruptions

 treatments
 exercise
 dietary management
 behavior modification
 medications
  medications
 appetite suppressant ( sibutramine meridia)
 lipase inhibitor orlistat( xenical)
 surgery – to reduce stomach capacity
 gastroplasty
 vartical banding
 gastric bypass
 maintaining weight loss
behavioral changes strategies for the
obese
 controlling the environment
 purchase low- calorie foods
 shop from a prepared list and on a full stomach
 keep all foods in the kitchen avoiding eating when
watching television or reading

 physiologic responses to food

 eat slowly by taking small bites
 eat a salad or hot beverages before meal
 chew each bite thoroughly and slowly
 psychologic responses to food
 use attractive dinnerware , and prepare a
formal setting for eating
 use small plates and cups

 concentrate on conversations and socialization

during meal
nursing diagnoses and interventions
 imbalanced nutrition: more than body
requirements
 encourage the client to identify the factors that
contribute to excess food intake
 establish realistic weight loss goals and exercise/
activity.
 assess the clients knowledge and discuss well-
balanced diet plans.
 discuss behavior modification strategies like self
monitoring and environmental mngt.
 activity intolerance
 assess current activity level and tolerance of the
activity. Assess vital signs.
 medically cleared plan with the client program of
regular, gradually increasing exercise. Consult with a
physiologist.
 ineffective therapeutic regimen mngt
 discuss the ability and willingness to incorporate
changes into daily patterns of diet, exercise and lifestyle
 help the client identify behavior modification strategies
and support system for weight loss and maintenance.
 establish strategies for dealing with stress eating or
interruptions in the therapeutic regimen
 chronic low self- esteem
 encourage the client to verbalize the
experience of being over weight and validate
the clients experience.
 Set small goals with the client and offer positive
feedback and encouragement
 Refer for counselling as appropriate
MALNUTRITION

results from inadequate intake of nutrients.

Lack of major nutrients ( calories,
carbohydrates, proteins, and fats) or
micronutrients such as vitamins and
minerals. May be caused by inadequate
nutrient intake, impaired absorption and
use of nutrients or increased metabolic
needs.
 conditions associated with malnutrition
 acute respiratory failure
 Aging
 AIDS
 alcoholism
 burns
 COPD
 eating disorders
 gastrointestinal disorders
 neurological disorders
 renal disease
 risk factors
 age
 poverty, homeless, inadequate food storage and
preparation facilities
 functional health problems that limit mobility and vision
 oral or gastrointestinal problems
 chronic pain or diseases such as pulmonary,
cardiovascular, renal or endocrine disorders
 medications or treatments that affects appetite
 acute problems like infection, surgery or trauma
Manifestations of Specific Nutrient Deficiencies

 Calorie Weight loss

Weakness , listlessness
loss of subcutaneous fat
muscle wasting
 Protein Thin or sparse hair
flaking skin
hepatomegaly
 Vitamin A night blindness
altered taste and smell
dry, scaling, rough skin
 Thiamine confusion, apathy
cardiomegaly, dyspnea
muscle cramping and
wasting
paresthesia,neuropathy
ataxia
 Riboflavin cheilosis, stomatitis
neuropathy, glossitis
 Vitamin C swollen, bleeding gums
delayed wound healing
weakness, depression
easy bruising
 Iron smooth tongue
listlessness, fatigue
dyspnea
 Collaborative Care
 The goal for the malnourished client is to
restore ideal body weight while replacing and
restoring depleted nutrients and minerals.
 treatment may include oral supplementation,
tube feedings or TPN.
 Diagnostic Tests
1. Serum albumin
2. total lymphocyte count
3. serum electrolyte

SPECIALIZED PROCEDURES
1. bioelectric impedance analysis
2. total daily energy expenditure
 Medication Administration
Vitamin and mineral supplements
> fat- soluble vitamins
vit. A
vit. D
vit. E
vit. K
Fat soluble vitamins are absorbed in the gastrointestinal
tract. Vitamin A and D are stored in the liver. All fat
soluble vitamins may become toxic if taken in excess
amounts.
 nursing responsibilities
 monitor for manifestations of vitamin excess as
well as for adverse effects from vitamin
administration.
 monitor carefully for hypersensitivity reactions

 administer vitamin A with food

 teach the importance of eating a well balanced

diet
> Water Soluble Vitamins
 vitamin C( ascorbic acid)
 vitamin B complex
 thiamine B1
 Riboflavin B2
 Niacin ( nicotinic acid0
 Pyridoxin hydrochloride B6
 Pantothenic acid
 Biotin

Used to prevent or treat deficiency problems. Mostly

absorbed from the gastrointestinal tract.
 nursing responsibilities
 monitor for responses to replacement therapy
 monitor for hypersensitivity reactions from
parenteral administration.
 do not exceed the recommended daily
allowances for specific vitamin.
 Minerals
 sodium
 potassium
 magnesium
 calcium
 copper
 fluoride
 iodine
 zinc

Minerals are inorganic chemicals that are vital to a variety of

physiologic functions. The dosage of prescribed minerals
depends on the specific deficiency, route of administration and
the clients general health.
 nursing responsibilities
 monitor for manifestations of mineral imbalance
 prior administration dilute oral mineral
preparations
 prior to administration of iodine assess for
history of hypersensitivity to iodine or seafood
 avoid exceeding
 nursing diagnoses and interventions
 imbalanced nutrition: less than body
requirements
 provide an environment and nursing measures that
encourage eating. Eliminate foul odors, provide oral
hygiene before and after meals, make meals
appetizing and offer frequent small meals.
 provide a rest period before and after meals

 assess knowledge and provide appropriate teaching

 risk for infection
 monitor temp and assess for manifestations of
infection every 4 hours
 maintain medical asepsis when providing care and

surgical asepsis when carrying out procedures.

 teach signs and symptoms of infections, good

handwashing technique and factors that increase the

risk for infection
 risk for deficient fluid volume
 monitor oral mucous membranes, urine specific gravity,
levels of consciousness and laboratory findings every 4-8
hours.
 weight daily and monitor intake and output
 if allowed offer fluids frequently in small amounts
 risk for impaired skin integrity
 assess skin every 4 hours
 turn and position at least every 2 hours . Encourage
passive and active range of motion exercises.
 keep skin dry and clean. Keep linens smooth, clean and
dry. Provide therapeutic beds, mattresses or pads.
EATING DISORDERS
 Characterized by severely disturbed eating
behavior and weight management
 women are more commonly affected than men

 ANOREXIA NERVOSA – weight less than 85%

of expected for age and height, and an intense
fear of gaining weight
 BULIMIA NERVOSA- recurring episodes of
binge followed by purge behaviors - self
induced vomiting, use of laxatives or diuretics,
fasting or excessive exercise
manifestations and complications of
anorexia and bulimia
ANOREXIA
 weight < 85% of normal, muscle wasting
 fear of weight gain, refusal to eat
 disturbed body image, excessive exercise
 amenorrhea
 skin and hair changes
 hypotension
 hypothermia
 Constipation
 insomiaa
Complications
 electrolyte and acid base disturbances
 reduced cardiac muscle mass, low cardiac
output, dysrhythmias
 anemia

 hypoglycemia, elevated serum uric acid

 osteoporosis

 delayed gastric emptying

 abnormal liver function

BULIMIA
 weight often normal, may slightly overweight
 binge- purge behavior
 amenorrhea
 lacerations of palate, callous on fingers

Complications
 enlarged salivary glands
 stomatitis, loss of dental enamel
 F and E, acid base imbalances
 dysrhythmias
 esophageal tears, stomach rupture
nursing diagnoses and interventions
 Imbalanced nutrition: less than body
requirements
 chronic low self- esteem

 disturbed body image

 ineffective family therapeutic regimen

management
 regularly monitor weight,
 monitor food intake during meals, recording
percentage of meal and snack consumed,
maintain close observation for at least 1 hour
following meals, do not allow client alone in
bathroom
 serve balance meals, including all nutrient
groups. Increase serving size gradually
 serve frequent , small feedings of cold or room
temp. foods.
 administer multivitamins and mineral supplement
to replace losses.
GASTRITIS
inflammation of the stomach lining, results from irritations of the
gastric mucosa.
Acute gastritis benign, self limiting disorder associated with the
ingestion of gastric irritants such as aspirin, alcohol, caffeine or
foods contaminated with certain bacteria. Asymptomatic to mild
heartburn to severe gastric distress, vomiting, and bleeding with
hematemesis.
Chronic gastritis progressive and irreversible changes in the
gastric mucosa. More common in elderly, chronic alcoholics and
cigarette smokers. Feeling of heaviness in the epigastic region after
meals to gnawing , burning, ulcerlike epigastric pain unrelieved by
antacids.
 pathophysiology
 acute gastritis
 erosive gastritis
 chronic gastritis
 manifestations
 acute
Gastrointestinal systemic

 Anorexia possible shock

 Nausea and vomiting

 Hematemesis

 Melena

 Abdominal pain
 chronic
Gastrointestinal systemic

Vague discomfort after eating anemia

Maybe asymptomatic fatigue
 diagnostic tests
1. gastric analysis
2. hemoglobin and hematocrit
3. serum vitamin B12
4. Upper endoscopy

 medications
 proton –pump inhibitor
 histamine2 receptor blocker
 sucralfate
 eradication of H. pylori infection
 treatments
 acute
 gastrointestinal rest is provided by 6 to 12 hours of
NPO
 slow reintroduction of clear liquids follow by

ingestion of heavier liquids and finally gradual

reintroduction of solid food.
 nausea and vomiting threaten fluid and electrolyte

balance, IVF as ordered

 gastric lavage
 nursing diagnoses and interventions
 Deficient fluid volume
 monitor skin turgor, color and condition and status of
the mucous membranes. Provide skin and mouth
care frequently
 Monitor laboratory values for electrolytes and acid

base balance . Report significant changes or

deviation from normal
 administer oral fluids as ordered

 administer antiemetics and drugs that relieve

vomiting and facilitate oral feeding

 imbalance nutrition: less than body
requirements
 monitor and record food and fluid intake and any
abnormal losses.
 Monitor weight and laboratory studies such as serum
albumin, hemoglobin and red blood cells
 arrange for dietary consultation to determine caloric
and nutrient needs and develop plan
 provide nutritional supplements between meals or
frequent small feeding as needed.
 maintain tube feeding or TPN
LOWER GASTROINTESTINAL SYSTEM
assessing bowel functions
 medical conditions that may influence the clients bowel elimination
 psychosocial history
 lifestyle for any pattern of psychologic stress and depression
 activities of daily living
 described the frequency and character of stool
 history of diarrhea, constipation or bleeding from the rectum
 use of laxatives, suppositories or enemas
 ostomy
 clients nutritional status
 weight
 Appetite
 food preferences
 food intolerance
 special diets
 nausea and vomiting in related to food intake
 used of antacids or over the counter
medications, herbal medications
 history of colon cancer, gallbladder dse. or
malabsorption syndromes
physical assessment
 assessment includes inspection of the
abdomen and auscultation of the bowel
sounds
 equipments
 water soluble lubricants
 materials for testing the stool
 disposable gloves
 explain
 inspection
 retention of flatus or stool may cause generalized
abdominal distention
 scaphoid abdomen
 auscultate
 4 quadrants
 normal bowel sound every 5-15 seconds, listen for at
least 5 minutes each quadrant
 high pitched, tinkling, rushing bowel sound may be
heard in client with diarrhea or experiencing onset
bowel obstruction
 bowel sounds may be absent in later stages of a bowel
obstruction
perianal assessment with abnormal findings
 inspect( wearing gloves)

 swollen, painful, longitudinal breaks in the anal

area may appear in clients with anal fissures.
 dilated anal veins appear with hemorrhoids
 red mass may appear with prolapsed internal
hemorrhoids
 doughnut – shaped red tissue at anal area may
indicate prolapsed rectum
 palpate anus and rectum
 movable, soft masses may be polyps
 hard firm , irregular embedded masses may indicate
carcinoma

 inspect feces
 positive occult blood test may indicate colon cancer, or
gastrointestinal bleeding due to PUD, diverticulosis
 odor- foul odors may be noted for stools containing
blood or extra fat or in cases with colon cancer
 color
 blood on the stool result from bleeding in the sigmoid colon,
anus,or rectum
 black tarry stool (melena) occurs with upper GI bleeding
 grayish or whitish- can result from biliary tract obstruction due to
lack of bile in stool
 greasy, frothy, yellow stools ( steatorrhea) may appear with fat
malabsorption
 consistency
 hard stools or long, flat stool may result from spastic colon or
bowel obstruction due to tumor or hemmoroids
 mucousy, slimy feces may indicate inflammation
 watery, diarrhea stool- appear with malabsorption problem,
ingestion of spoiled foods
ENEMA
 Chronic or a fecal impaction may require
administration of enema. Enema should be used
in acute situations and only on short – term
basis. Must be ordered to prepare the bowel for
diagnostic testing or examination
 Is the procedure of introducing liquids into the
rectum and colon via the anus. The increasing
volume of the liquid causes rapid expansion of
the lower intestinal tract, often resulting in very
uncomfortable bloating, cramping, powerful
peristalsis, a feeling of extreme urgency and
complete evacuation of the lower intestinal tract.
 types
 saline enema using 500ml to 2000ml of warmed
physiologic saline solution is the least irritating to the
bowel
 tap water enemas use 500ml- 1000ml of water to soften
feces and irritates the bowel mucosa , stimulating
peristalsis and evacuation
 soap sud enemas consist of tap water solution to which
soap is added as irritant
 phosphate enemas ( fleet) – irritate the mucosa leading
to evacuation
 oil retention enemas instill mineral or vegtable oil into
the bowel to soften the fecal mass
 bowel stimulant not unlike laxatives that is
orally administered while enemas are
administered directly into the rectum, the patient
expels feces along with the enema in the
bedpan or toilet
 enemas may be used to relieve constipation
and fecal impaction
 cleansing the lower bowel prior to asurgical
procedure such as sigmoidoscopy or
colonoscopy because of speed and
convenience, enema used for this purpose are
commonly the more costly
COLOSTOMY
an opening that is made in the colon with
surgery. After the opening the colon is brought to
the surface of the abdomen to allow stools to
leave the body. The opening at the surface is
called stoma. The stool leaves the colon through
the stoma and drains into flat, changeable,
watertight bag or pouch. The pouch is attached
to the skin with an adhesive.
indication
 cancer
 diverticular disease
 crohn’s disease
 trauma or injury

 a temporary colostomy may be needed to allow

the colon to rest and heal for a period of time.
temporary colostomy may be in place for weeks,
months, or years. Will eventually be closed and
bowel movements will return to normal
Types of colostomy- colostomy types are related to the
place on the colon where the surgery is done.
 ascending colostomy- this colostomy has a stoma
( opening ) that is located on the right side of the
abdomen. The output that drains from this stoma is in
liquid form.
 transverse colostomy-stoma that is located at the upper
abdomen towards the middle or right side. The output
that drains from this stoma may be loose or soft.
 descending colostomy- stoma that is located on the
lower side of the abdomen. The output that drains from
this stoma is firm.
Problems
 stoma retraction- retractions happens when the
height of the stoma goes down to the skin level
or below the skin level.
 prolapse- bowel becomes longer and protrudes
out of the stoma and above the abdomen
surface.
 stenosis- narrowing or tightening of the stoma at
or below the skin level. Mild stenosis can cause
noise as stool and gas is passed. Severe
stenosis can cause obstruction of stool.