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Prepared by: John Gil B. Ricafort, RN
• Review of Digestive System • Common Assessment Findings • Common Diagnostic Tests/ Procedures • Disturbances
1. Review of Digestive System 2. Common Assessment Findings a. Pain – a major symptom of GI disease b. Indigestion - refers to abdominal discomfort or distress associated with eating - most common symptom of GI dysfunction
c. Intestinal Gas d. Nausea and vomiting e. Change in bowel habits and stool characteristics f. Jaundice g. Pruritus h. Increased bleeding
Common Diagnostic Tests
a. Stool Tests b. Breath Tests - Hydrogen Breath Test -used to evaluate CHO absorption and bacterial overgrowth.
- Urea Breath Test - detects the presence of H. Pylori Note: The person takes a capsule of carbon labeled urea and then provides breath sample 10 to 20 minutes after. *AVOID antibiotics *AVOID Sucralfate/ Omeprazole *AVOID Tagamet/ Pepcid/ Zantac
c. Abdominal Ultrasonography d. Upper GI Series (Barium Swallow) - it’s a fluoroscopic examination of the upper GI tract to determine structural problems and gastric emptying time; Client must swallow barium sulfate or other contrast medium.
- sequential films taken as it moves through the system. Nursing Responsibilities: PRETEST 4. Keep NPO after midnight or 6-8 hours pretest. 5. Explain that the barium will taste chalky.
Nursing Responsibility: POSTTEST 2. Administer laxatives to enhance elimination of barium and prevent obstruction or impaction. e. Lower GI Series ( Barium Enema) - Barium is instilled into the colon by enema; client retains the contrast while x-rays are taken to identify abnormalities
Nursing Responsibilities: PRETEST 2. Keep on NPO for 8 hours pretest 3. Give enemas until clear the morning of test 4. Administer laxative or suppository 5. Explain that cramping may be experienced during the procedure.
Nursing Responsibility: POSTTEST 2. Administer laxatives and fluids to assist in expelling barium. f. Endoscopic studies g. Liver Biopsy - invasive procedure where a needle is inserted into the liver to remove a small piece of tissue for study.
Nursing Responsibilities: PRETEST 2. Ensure the client has signed the consent form. 3. Keep NPO 6-8 hours pretest. 4. Instruct the client to HOLD BREATH during the procedure. Nursing Responsibilities: POSTTEST 1. VS taking every hour for 8-12 hours
2. Place client on his RIGHT SIDE for a few hours with a pillow against his abdomen to provide pressure on the liver. 3. Observe the punctured site for hemorrhage. 4. Assess for complications of shock and pneumothorax.
1. Gastritis - inflammation of the gastric or stomach mucosa, is a common GI problem. Clinical Manifestation: abdominal discomfort headache nausea and vomiting
Hiccuping Anorexia Heartburn Sour taste in the mouth Nausea and vomiting Assessment and Diagnostic Findings: Endoscopy Upper GI radiographic Study Histologic Exam
Medical Management: The gastric mucosa is capable of healing itself for about 1 day after gastritis. Ingestion of acid – neutralization Ingestion of alkaline – neutralization NG Intubation Analgesic Agents/ Sedative Antacids Antibiotics Modify Diet, STRESS management
3. Anxiety related to treatment 4. Altered Nutrition: Less than Body Requirement related to inadequate intake of nutrients. 5. Acute Pain related to irritated stomach mucosa
1. 2. 3. 4. Reducing anxiety Promoting optimal nutrition Promoting fluid balance Relieving pain
2. Peptic Ulcer Disease (PUD) - is an excavation that forms in the mucosal wall of the stomach, in the pylorus, in the duodenum and in the esophagus. Types: a. Lower Esophageal Ulcer b. Gastric Ulcer c. Duodenal Ulcer
Clinical Manifestations: Same with gastritis Burning sensation in the midepigastrium Pain relived by eating Pyrosis Vomiting Constipation or diarrhea Bleeding
Assessment and Diagnostic Findings Endoscopy Breath Test Stool Exam Medical Management Antibiotics Antacid Proton Pump Inhibitors Histamine Receptor Antagonist
Other Managements: Stress Reduction and Rest Smoking Cessation Dietary Modification Surgery Billroth 1(Gastroduodenostomy) Billroth 2(Gastrojejunostomy)
Nursing Diagnoses: 3. Acute Pain related to the effect of gastric acid secretion on damaged tissue. 4. Anxiety related to coping with an acute disease. 5. Imbalance Nutrition related to changes in diet.
1. 2. 3. 4. Relieving pain Reducing anxiety Maintaining optimal nutritional status Monitoring & managing complications Hemorrhage Perforation Pyloric Obstruction
3. Appendicitis - inflammation of the appendix due to intraluminal obstruction with subsequent bacterial infection. Clinical Manifestation Mc Burney Sign Rovsing’s Sign Low grade fever Constipation or Diarrhea
Assessment and Diagnostic Findings Complete PE Laboratory Studies X-ray Medical Management Antibiotics IV administration Analgesics (after surgery) Surgery (APPENDECTOMY)
Complications of Appendicitis: Perforation – most common Septicemia Abscess formation 4. Inflammatory Bowel Disease a. Crohn’s Disease b. Ulcerative Colitis
Crohn’s Disease - also known as Regional Enteritis - a chronic inflammatory bowel disease that can affect both the large and small intestines, but most COMMON in the megacolon area. - UNKNOWN cause - onset: 20-30 years and 40-60 years - both sexes are affected
- characterized by GRANULOMAS that may affect all the bowel wall layers with resultant thickening, narrowing, and scarring of the intestinal wall. Clinical Manifestations Right lower quadrant tenderness Abdominal distention Decrease skin turgor Dry mucous membrane Increase peristalsis
Nausea and Vomiting 3-4 semisoft stools (ribbon-like)/ day with mucus and pus Diagnostic Tests Decreased Hgb and Hct Barium enema shows narrowing with areas of strictures
Medical Management Diet: High Calorie, High vitamin, High protein, Low residue, Milk free; Supplementary iron Pharmacologic Agent Antimicrobials (Sulfasalazine) Corticosteroids Antidiarrheals Anticholinergics Surgery: Resection of the diseased portion and ileostomy
Nursing Interventions 2. Provide appropriate nutrition while reducing bowel motility. 3. Promote comfort/ rest. 4. Provide care for the client with bowel surgery
Ulcerative Colitis - inflammatory bowel disease characterized by inflammation and ulceration that starts in the rectosigmoid area and spreads upward. The mucosa of the bowel becomes edematous, thickened with eventual scar formation. The colon consequently loses its elasticity and absorptive capabilities.
- UNKNOWN cause - occurs more often in women - onset is usually 15-40 years Clinical Manifestations Severe diarrhea (15-20 liquid stools/ day containing mucus, blood and pus) Severe tenesmus Weight loss
Anorexia Weakness Crampy discomfort Decreased skin turgor Dry mucous membrane Low-grade fever Abdominal tenderness Diagnostic Tests Decreased Hgb and Hct Sigmoidoscopy reveals mucosa that bleeds easily with ulcer development
Management Mild to Moderate from Diet: Low-roughage diet; NO milk products Pharmacologic Agents Severe form Diet: NPO with IVs and electrolyte replacement, NG tube with suction, Blood transfusion Surgery
Course Pathology Early Late Manifestation Location Bleeding Fistulas Diarrhea
Prolonged, variable Transmural Deep Ileum, Right Colon Usually not Common Less severe
Exacerbations Mucosal Mucosal Rectum, Left colon Common/severe Rare Severe
Nursing Diagnoses 3. Diarrhea related to inflammatory process. 4. Acute Pain related to increased peristalsis and GI inflammation. 5. Imbalance Nutrition: Less than body requirements related to dietary restrictions, nausea and malabsorption.
Nursing Interventions: 2. Maintaining elimination patterns. 3. Relieving pain. 4. Maintaining fluid intake. 5. Maintaining optimal nutrition. 6. Promoting rest. 7. Reducing anxiety. 8. Monitoring and managing potential complications.
5. Hemorrhoids - are dilated portions of veins in the anal canal usually due to impairment of blood flow. - common between 20-50 years old Types: e. Internal Hemorrhoids f. External Hemorrhoids Manifestations Pain Protrusion Itching and Bleeding
Management Antibiotic Anti-inflammatory Analgesics Stool softeners Surgery Hemorrhoidectomy
6. Ascites - accumulation of fluid in the abdominal cavity Due to: a. Portal hypertension b. Increase capillary pressure c. Obstruction in the venous blood flow
Clinical Manifestation Increased abdominal girth Rapid weight gain Shortness of breath Striae Distended neck vein Fluid and electrolyte imbalances
Diagnostic Findings Ultrasound Fluid Wave Testing Medical Management Dietary Modification Diuretics Bed rest Paracentesis LeVeen Shunt (Peritoneal-venous Shunt)
Nursing Interventions 1. Monitor nutritional status/ provide adequate nutrition with modified diet. Sodium = 200-500mg/day Fluid = 1000-1500ml/day Promote high calorie food 2. Monitor/ prevent increasing edema 3. Monitor/ promote skin integrity 4. Promote comfort
7. Esophageal Varices - are dilated, tortuous veins usually found in the submucosa of the lower esophagus, but may develop higher in the esophagus or extend into the stomach. - usually caused by portal hypertension - bleeding varices lead to hemorrhagic shock, producing decrease cerebral, hepatic and renal perfusion.
Clinical Manifestation Hematemesis Melena General Disorientation Signs and symptoms of shock Diagnostic Findings: Endoscopy Ultrasonography CT Scan Angiography
Management Ice normal saline lavage Administration of Vit. K Blood transfusion Oxygen administration Fluid replacement Vasopressin – vasoconstriction Nitroglycerin Balloon Tamponade - it controls the bleeding by using a double-balloon (Sengstaken-Blakemore)
Caring for Patient with SengstakenBlakemore Tube: 2. Facilitate placement of the tube; check and lubricate tip and elevate the head of the bed 3. Prevent dislodgement of the tube by placing the patient in semi-fowler’s position; secure the tube properly
3. Keep SCISSORS at the bedside at all times 4. Monitor respiratory status 5. Label each lumen to avoid confusion 6. Observe nares for skin breakdown and provide oral and nasal care every 1-2 hours.
Endoscopic Sclerotherapy -injection of sclerosing agent to promote thrombosis and sclerosis Esophageal Banding Therapy 8. Hepatic Cirrhosis - a chronic degenerative disease in the liver in which the lobes are covered with fibrous tissue, the parenchyma degenerates and the lobules are infiltrated with fat.
- occurs twice in men in women - onset: 40-60 years ols Types: 5. Laennec Cirrhosis 6. Postnecrotic Cirrhosis 7. Cardiac Cirrhosis 8. Biliary Cirrhosis
Clinical Manifestations Intermittent fever Spleenomegaly Vascular spiders Abdominal pain Firm, enlarged liver Ascites Jaundice Epistaxis Hypotension
Weight loss Edema Muscle wasting Weakness
Diagnostic Test: Ultrasound CT Scan MRI Laboratory Studies Increased Liver enzyme Medical Management Management is based on the presenting symptoms. COLCHICINE
Nursing Interventions 1. Provide sufficient rest and comfort 2. Promote nutritional intake a. encourage small frequent feeding b. High calorie, low to moderate protein, high carbohydrate, low-fat diet, supplemental vitamin 3. Prevent infection 4. Monitor/ prevent bleeding 5. Administer diuretics
9. Cholelithiasis - refers to stones in the gallbladder Risk Factors: Obesity Multiple Pregnancy Rapid weight loss Estrogen therapy Cystic Fibrosis Diabetes Mellitus
Clinical Manifestation Epigastric distress Abdominal distention Vague pain in the RUQ of the abdomen Pain and Biliary Colic Jaundice Vitamin Deficiency Changes in urine and stool color
Diagnostic Findings: Ultrasound Abdominal X-ray Medical Management Nutritional and Supportive Pharmacologic Ursodeoxycholic Acid Chenodeoxycholic Acid
Nonsurgical Removal of Stones Dissolving Stones (Methyl Tertiary Butyl Ether) MTBE Lithotripsy Surgical Cholecystectomy
Nursing Interventions 2. Administer pain medications as ordered. 3. Administer IV fluids as ordered 4. Provide small frequent meals 5. Provide care to relieve pruritus
10. Pancreatitis - refers to inflammation of the pancreas due to self-destruction. - Severe abdominal pain is the major symptom of pancreatitis Diagnostic Finding Based on history Laboratory studies
Medical Management Directed towards relieving the symptom. Parenteral Nutrition Anti-ulcer drugs Pain management (DEMEROL) Respiratory Care
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