This action might not be possible to undo. Are you sure you want to continue?
Inflammation of gastric mucosa Acute Gastritis Cause: Often cause by dietary indiscretion the person eat food that is irritating, too highly seasoned or contaminated with disease causing microorganism. May also be due to : Overuse of NSAID Excessive alcohol intake Bile reflux Radiation therapy Chronic Gastritis Cause: Benign or malignant ulcer of stomach or by Helicobacter pylori. Also associated disease such as : Pernicious anemia Dietary factor such as a caffeine Use of medication Alcohol Smoking Chronic reflux of pancreatic & bile secretion into the stomach
abdominal discomfort a. therapy is supportive & may include NG intubation. emergency treatment consist of diluting & neutralizing the offending agent 4. lassitude c. Hiccupping f. Vomiting Assessment & Diagnostic Finding 1. headache b. heartburn after eating c. anorexia e. modifying patient diet 2. histologic examination of a tissue specimen obtained by biopsy Medical Management 1. non irritating diet is recommended 3. It secretes scanty amount of gastric juice. anorexia b. promoting rest 3. avoidance of alcohol & NSAID . sour taste in the mouth e. containing very little acid but much mucus. reducing stress 4. upper GI x ray series or endoscopy 2. Superficial ulceration may occur and lead to hemorrhage. nausea & vomiting d.Pathophysiology In gastritis the gastric mucous membrane becomes edematous & hyperemic and undergone superficial erosion. nausea f. sedative antacid & IVF Chronic Gastritis is managed by: 1. if gastritis is caused by ingesting of strong alkali or acid. analgesic agent. belching d. ask the patient to refrain alcohol & food until symptoms subside 2. Clinical Manifestation Acute Gastritis Chronic Gastritis a.
borborygmi i. abdominal pain h. starch. abdominal fullness & distention g. frank rectal bleeding f. nausea & vomiting d. fat or strong cathartic C. peri anal itching B documents habit the person has that affect intestinal function like excessive intake of alcohol. ask the person about weakness & anorexia .LOWER GASTROINTESTINAL SYSTEM Nursing History A. changes in bowel habit b. carefully question the person concerning : a. abdominal cramping c. blood or mucus in the stool e.
constipation b. malaise 8. collect specimen for 2 3 days b patient is in low roughage diet c.is a defect in the mechanism by which food is absorbed by intestinal mucosa as it passes to the small bevel Sign and Symptoms 1. abdominal masses f. weight loss 5. pulse 7. do not administer vit c pain . bleeding varies from a quantities that cause the stool to be bright red to tarry black . inflammation or a growth that erode to blood vessel .may be caused by trauma. weakness 3. pallor 9.obstruction & occlusion of blood supply cause pain nausea & vomiting malabsorption . steatorrhea (bulky. ulceration. c. gray. Anorexia e. cramping 6.Assessment Data a. d. abnormalities in fecal content g. . Major manifestation of dysfunction hemorrhage .usually manifested blood in the stool rather than emesis. malodorous stools that float in the toilet) 2. diarrhea h.Hemaccults & fecal test for occult blood a. dehydration 4.
Psychological factor e. abnormal hardening of stool that makes their passage difficult & sometimes painful. suggest a small glass of prune juice or lemon juice in warm water each morning 3. hard. pain & pressure 3. avoid talking laxative if at all possible . Constipation . Altered routine in dietary & activity pattern b. Fatigue 6. swimming 4. Drug such as morphine. straining at stool 8. Appetite 4. Headache 5. bread 2. if possible. Cause a. abdominal distention 2. 3 movement per week 1. Mechanical obstruction or surgery d. Strong laxative abuse Manifestation 1. Indigestion 7. correct dietary habits to include adequate fluid.MAINTAINING ELIMINATION A. fresh fruit & vegetable whole grain cereals. lumpy. encourage a regular time of evacuation each day 5. dry stool Nursing Intervention 1.an abnormal infrequency or irregularity of defecation. encourage the patient to participate in active daily exercise brisk walking. codeine & athropine c.
ENEMA Purpose 1. 2. 4. to cleanse the bowel in preparation for diagnosis test or surgery ( cleansing ) relieve gas ( carminative enema ) soften stool or relieve constipation or fecal impaction ( retention / emollient ) administer medication like neomycin & kayexalate ( medicated ) Adult Children Infant Fr 22 to 32 catheter Fr 14 to 18 Fr 12 ( or bulb syringe ) Amount of Enema Solution Infant = 50 to 150 ml Toddler = 250 to 350 ml Child = 300 to 500 ml Adolescent = 500 to 750 ml Adult = 750 1000 ml . 3.
and position in left lateral Sim s with right knee flexed 2. abdominal pain. nausea and vomiting . For small volume enema. Repeat. Encourage client to hold solution as long as possible ( 5 10 for cleansing enema. no more than 4 inches ) 5. NEVER FORCE! 7. encourage client to take deep breaths and run small amount of solution.Contraindicated for suspected appendicitis ( increases abdominal pressure ). fill enema container with appropriate amount of solution of lukewarm (tepid) temperature ( 105 110 degrees Fahrenheit ) 3. Then assist in evacuating the bowel. Remove tube ( when desired amount is infused ) and squeeze buttocks together firmly 8. 30 minutes for retention enema ) 9. lubricate and ask patient to take slow deep breath as rectal tube is inserted gently ( 3 -4 inches in adult.Procedures in Giving Enema 1. if ordered until clear but allow time to rest 10. open clam on tubing to allow solution to flow ( and remove air that cause discomfort ) then clamp 4. if resistance is felt. provide privacy. squeeze bottle to empty content ( about 240 ml ) into rectum 11. open clamp to allow solutions to flow slowly from container at maximum 18 inches height 6.
water soluble lubricant ) in anticipation of strong odor and large quantity of stool 2. Rule out contraindications related to vagal stimulation ( 10th cranial nerve innervating GIT that decreases PR and lead to dysrythmia among weak client and those with cardiac problems ) 3. bedpan. Side lying position. gloves. insert index finger with gentle hooking position ( careful as perforation may occur ) 4.FECAL IMPACTION REMOVAL 1. Prepare for quick evacuation as hardened stool blocking the lumen is removed . Prepare all materials (gown. pallor. Note for any signs of fatigue. diaphoresis and changes in pulse rate 5.
occurring one after the other. shorten & thickens because of muscular hypertrophy & fat deposits . Pathoyphysiology ulcerative colitis affect the superficial mucosa of the colon & characterized by multiple ulceration. The disease process usually begins in the rectum & spread proximally to involve the entire colon. Eventually the bowel narrows. clumps of neutrophils found in the lumen of the crypt. diffuse inflammation & desquamation or shedding of the colonic epithelium. The mucosa became edematous & inflamed. ULCERATIVE COLITIS is a recurrent ulcerative & inflammatory disease of the mucosa & submucusal layer of the colon & rectum. Abscesses form & filtrate is seen in the mucosa & submucusa. The lesion are contagious.INFLAMMATORY BOWEL DISEASE A.
hypokalemia. Colonoscopy may reveal friable. a stool is positive for blood 2. tenesmus ( painful straining ) sense of urgency & cramping 2. Diarrhea ( may be bloody ). Barium enema may show mucosal irregularities. Laboratory test reveals low hematocrit & hemoglobin. Bowel sound . There is often weight loss. fecal stricture or fistula shortening of the colon & dilatation of bowel loops 4. iron deficiency anemia Diagnostic Evaluation 1. dehydration. anorexia.Clinical Manifestation 1. fever. abdomen may appears flat but as condition continues abdomen may become distended 3. low albumin level 3. inflamed mucosa exudates & ulceration . Stool examination to ruled out bacillary or amebic dysentery . Multiple crypt abscesses of intestinal mucosa that may become necrotic and lead to ulceration 4. increase WBC . nausea and vomiting.
REGIONAL ENTERITIS (CRONHS DISEASE) A chronic inflammatory disease of the small intestine. usual consistency is soft or semi liquid 3. Abdominal tenderness esp in the RUQ . weight loss and possibly anemia 2. causing the patient to eat in small amount or even avoid eating result in malnutrition. Melena & malabsorption syndrome may occur . The lesions are not in continues contact one another & are separated by normal tissue. usually affecting the terminal ileum at the region just before the ileum joins the colon. occult blood may be seen in stool 5. Pathophysiology The disease process begins with edema & thickening of mucosa. chemically or mechanically irritating food may aggravate the problem 4. Lymphodenitis occurs in mesenteric nodes 7. As the disease advances the bowel wall thickens & become fibrotic & the intestinal lumen narrows. Ulcers begin to appear to the inflamed mucosa. Low grade fever if abscesses are present 6. Chronic diarrhea . Milk product. Clinical Manifestation 1.B. Crampy pain after meal.
Endoscopy. parenteral nutrition may be indicated . where it reveal a classic string sign on an x ray film of terminal ileum indicating constriction of a segment of intestine 4.oral fluid. high protein. any food that exacerbate diarrhea are avoided 4. high calorie diet supplemental vitamin & iron replacement are prescribed 2. . smoking & cold food are avoided cause it may increase intestinal motility 5. CBC reveals low hemoglobin. increase ESR . Proctosigmoidoscopy is usually performed initially to determine if rectosigmoid area is inflamed 2. low residue. Barium study of upper GI is the most conclusive diagnostic aid in RE. decrease albumin & protein ( indicating malnutrition Medical Management of Chronic Inflammatory Bowel Disease Nutritional Therapy 1. increase WBC . Barium enema may show ulceration ( cobble stone appearance ) fissure & fistula 6. Stool exam may reveal steatorrhea & occult blood 3. colonoscopy & intestinal biopsy is use to confirm the diagnosis 5.Assessment & Diagnostic Finding 1.and hematocrit. fluid & electrolyte imbalance are corrected by IVF 3.
consider antimicrobial and sulfonamides to control inflammatory process 3. sedatives & anti.Pharmacologic Therapy 1. steroids & mercaptopurine ( an immunomodulators ) Surgical Management 1. some clinic treat this patient prednisone. 2. 4.diarrheal & anti peristaltic medication are given to minimized peristalsis to rest inflammatory bowel 2. 3. 5. For strictures of small intestine a laparascope guided strictureplasty is performed Small bowel resection In cases of severe RE a procedure of choice is colectomy & ileostomy If rectum is severely diseased a protocolectomy ilestomy is recommended rate of occurrence after surgery is approximately 28 % in the first 5 years .
local hot compress. Risk for impaired skin integrity related to malnutrition & diarrhea Nursing Intervention 1. anorexia & diarrhea 4. may administer anti cholinergic 30 minute before meal to analgesic as prescribed b. Maintain normal elimination pattern 2.Nursing Diagnosis 1. Diarrhea related to the inflammatory process 2. Relieving pain a. position change. monitor daily weight c. Acute pain related to increase peristalsis & GI inflammation 3. Maintaining fluid intake a. encourage oral intake of fluid & monitor IV flow rate intestinal motility and . monitor 1 & 0 b. divertional activities 3. Fluid volume deficit related to nausea. Alteration in nutrition less than body requirement related to dietary restriction & malabsorption 5.Nursing Management A. Activity intolerance related to fatigue 6.
Promoting Rest > the nurse recommend intermittent rest period during the day schedules or restrict activities to conserve energy and reduce metabolic rate > encourage patient on passive exercise & ROM activities 6. parental nutrition is used when symptoms of IBD are severe > monitor input & output & monitor the weight of the patient > monitor glucose level since parenteral nutrition cause hyperglycemia > once symptom of exacerbation of IBD stops or patients stabilized weight parenteral nutrition stopped and elemental feeding is started ( elemental feeding are high CHON. low fat &residue ) 5. Maintaining optimal nutrition a. Reduce anxiety > allows the patient to ask question & express feelings > if surgery is planned pictures & illustration help explain the surgical procedure and help visualize how stoma looks like .4.
Preventive skin breakdown .7. Enhance coping measure .monitor serum electrolyte level .monitor bp for hypertension . obstruction & toxic megacolon .report evidence of dysrhythmias or change in level of consciousness .monitor hemoglobin & hemetocrit .monitor for rectal bleeding and administer blood component therapy & volume expander .the nurse examine the patients skin frequently especially the perianal skin a. Monitor & managing potential complication . apply petroleum ointment after each movement 9.help patient cope up stress 8.monitor indication of perforation .
intestinal obstruction or stricture formation peri anal disease fluid & electrolyte imbalance malnutrition from malabsorption fistula & abscess formation colon cancer Ulcerative Colitis 1. 5.Complication of IBD Regional Enteritis 1. 6. 3. 2. 2. 4. 3. toxic megacolon perforation bleeding as a result of ulceration vascular engorgement osteoporotic fracture . 4. 5.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.