GI Part 2 2016 Student

7/24/2019 GI Part 2 2016 Student

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Lesson 3Nursing Management: Patients with Gastric and Duodenal

Disorders

Pellico Chapter 23ATI Med urg Chapters !"# !$ % &'

ATI Nutrition Chapter (3

ATI Pharm Chapter 2)

*arch Chapter &$

Shauna Winchester, MSN, RN


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+,-ecti.es Compare the etiology, clinical manifestations,

and management of acute gastritis, chronicgastritis, and peptic ulcer.

Describe the management of the patient with

gastritis. Describe the dietary, pharmacologic, and

surgical treatment of peptic ulcer.

Describe the nursing management of patients

who undergo surgical procedures to treatobesity.

se the nursing process as a framewor! for careof patients undergoing gastric surgery.

"ducate patient regarding an acute or chronicastric or duodenal condition.


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+,-ecti.es

Describe the therapeutic actions, indications,pharmaco!inetics contraindications, most commonad#erse reactions, and important drug$ drug interactionsassociated with the following types of gastrointestinalmedications%

& Drugs that affect '( secretions

Compare and contrast the prototype drugs with the otherdrugs in that class for the following types ofgastrointestinal medications%

& Drugs that affect '( secretions )utline the nursing considerations and teaching needs

for patients recei#ing the following%

& Drugs that affect '( secretions


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Gastritis

(nflammation of gastric mucosa& (rritants

*spirin, NS*(DS, "+cessi#e alcohol use, caffeine

Result of brea! in protecti#e barrier

ypes%

*cute 'astritisChronic 'astritis


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Mani/estations o/ Gastritis

*cute% abdominal discomfort, headache, lassitude, nausea,#omiting, hiccuping.

Chronic% epigastric discomfort, anore+ia, heartburn aftereating, belching, sour taste in the mouth, nausea and#omiting, intolerance of some foods. May ha#e #itamindeficiency due to malabsorption of -/.

May be associated with achlorhydria, hypochlorhydria, or

hyperchloryhydria. Diagnosis is usually by '( 0$ray or endoscopy andbiopsy.


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Medical Management o/ Gastritis

(f acute "ducation& (nstruct patient to refrain from alcohol and food

until symptoms subside then nonirritating diet. (f

symptoms remain (1 fluids. reatment

& (f r2t ingestion of strong acids or al!alis Neutrali3e

& Supporti#e therapy& 4iberoptic "ndoscopy

& 'astro5e5unostomy N', analgesics, sedati#es, antacids, (1 fluids


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Medical Management o/ Gastritis

(f chronic$ may re6uire #itamin -/ for pre#ention ortreatment of pernicious anemia.

"ducation

& Diet$ non irritating, rest, reduce stress, a#oid alcoholand smo!ing, and NS*(DS

Drug therapy& 7harmacologic therapy 8See able /9$:

H2 Receptor Antagonists We discussed

PPIs these in Part 1.

Antacids

Mucosal protectant


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GI Protectant

Sucralfate 8Carafate:

Coats in5ured area in the stomach to pre#entfurther in5ury from acid& 7)

& + of duodenal ulcers, maintenance of duodenal

ulcers after healing, t+ of oral and esophagealulcers due other factors such as chemo, underin#estigation for t+ of gastric ulcers and gastricdamage r2t NS*(DS, and stress ulcers in acutely ill


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GI Protectant


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Prostaglandin

Misoprostol 8Cytotec:

(nhibits gastric acid secretion and increasesbicarb and mucous production in the stomach& 7)

& 7re#ention of NS*(D induced ulcers in adults at

high ris! for de#eloping gastric ulcers, underin#estigation for t+ of duodenal ulcers in pts whoare not responsi#e to other treatment


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Prostaglandins


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0uestion

he nurse is teaching a patient about healthpromotion and maintenance to pre#ent chronic

gastritis. Which information should the nurseinclude= 8Select all that apply:

*. >* balanced diet can help pre#ent gastritis.?

-. o pre#ent gastritis, you should limit you calcium

inta!e.? C. (f you stop smo!ing, there is less of a chance you will

de#elop gastritis.?

D. >@oga has been found to be effecti#e.?

". >Drin! alcohol only A days a wee!.?


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Peptic 1lcer

"rosion of a mucous membrane forms an e+ca#ation inthe stomach, pylorus, duodenum, or esophagus

*ssociated with infection ofH. pylori

Manifestations include a dull gnawing pain or burning inthe mid$epigastriumB heartburn and #omiting may occur& Comparison of duodenal and gastric ulcer 8able /9$/ p 9:

Mucosal lesion of the stomach or duodenum

ypes

'astric ulcers

Duodenal ulcers

"S

Stress$related mucosal disease 8SRMD:


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is 4actors )ccurs in those EF$F years of age

ncommon in women of childbearing age

;as been obser#ed in children and infants *fter menopause women and menG

;$pylori

"+cessi#e secretion of ;CH

4amilial tendency -lood type ) more susceptible

*ssociated with chronic renal or pulmonary disease

)ther factors

& Chronic use of NS*(Ds, alcohol ingestion, and e+cessi#e smo!ing


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Clinical Mani/estations

May ha#e no symptoms or may last days, wee!s,months and then disappear and reappear

Complains of dull, gnawing pain or burningsensation in the midepigastrium or in the bac!

)ther symptoms

& 7yrosis, #omiting, constipation, or diarrhea, andbleeding


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1lcer Comparison

Duodenal Ulcer Gastric Ulcer

Most common

Hypersecretion of stomachacid

May have wt gain

Pain 2-3 hours after a meal

Often pain will awaken 1-2am

Ingestion of food relieves pain

omiting uncommon

Hemorrhage less likely

Melena more common thanhematemesis

!ess common

"ormal to hyposecretion ofstomach acid

#eight loss may occur

Pain $-1hr after a meal

Pain rare at night

Pain may %e relieved %yvomiting

Ingestion of food does not helpsometimes increases pain

omiting common

Hemorrhage more common

Hematemesis more common

than melena


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0uestion Which assessment data supports to the nurse the clientIs

diagnosis of gastric ulcer.

*. 7resence of blood in the clientIs stool for the pastmonth.

-. Reports of a burning sensation mo#ing li!e a wa#e.

C. Sharp pain in the upper abdomen after eating a hea#y

meal. D. Complaints of epigastic pain 9F$F minutes after

ingesting food..


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Diagnostics

-arium study of upper '(

"ndoscopy preferred -iopsy

'astric secretory studies

; pylori

& Serologic testing for antibodies& Stool antigen test

& rea breath test


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Nursing Management

reatment of peptic ulcers with antibiotics toeradicate ;. pylori& Hower reoccurrence rate

reatment includes

& Hifestyle changes& Medications 8See able /9$9:

lcer healing$ ;/ receptor antagonists 8dine: and77(Is along with bismuth salts to suppress or

eradicate ; pylori 7rophylactic therapy for NS*(D ulcers 77(Is and

7rostaglandin analog misoprostol

;$pylori t+

)ccasionally surgery 8See able /9$E:


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Gastric urger5

'astrectomy$ remo#al of all or part of stomach

*ntrectomy$ remo#al of antrum portion ofstomach

1agotomy$ se#ere branches of the #agus ner#e 7yloroplasty$ enlargement of the openingbetween the stomach and small intestine


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urgical Procedures /or Peptic 1lcers


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Complications

;emorrhage 8Most common:J'( bleedK& ;ematemesis

& Melena

Management of hemorrhage& *ssess for e#idence of bleeding, hematemesis or melena, and

symptoms of shoc!2impending shoc! and anemia.

& reatment includes (1 fluids, N', and saline or water la#ageB

o+ygen, treatment of potential shoc! including monitoring of1S and )B may re6uire endoscopic coagulation or surgicalinter#ention.


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Complications

Management of perforation& Signs include se#ere upper abdominal pain that may be referred

to the shoulder, #omiting and collapse, tender board$li!eabdomen, and symptoms of shoc!2impending shoc!.

& 7atient re6uires immediate surgery. Management of penetration

& -ac! and epigastic pain not relie#ed by meds that were effecti#ebefore

& 7atient re6uires immediate surgery.

7yloric obstruction& Symptoms include nausea and #omiting, constipation,

epigastric fullness, anore+ia, and 8later: weight loss.

& (nsert N' tube to decompress the stomach, pro#ide (1 fluids

and electrolytes. -alloon dilation or surgery may be re6uired.


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0uestion@ou are pro#iding discharge teaching to you client

regarding ta!ing a proton pump inhibitors.Which information would you want to stress to

the client=

a. -efore meals

b. With a meal

c. (mmediately after the meald. )ne to three hours after the meal


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Mor,id +,esit5

7eople who are L /+ their ideal body weight8(-W:

More than FF pounds greater than (-W

-ody mass inde+ 8-M(: e+ceeds 9F Ris! factors

& Diabetes

& Cardio#ascular disease

& Cancer& )steoarthritis

& *sthma

& Sleep apnea

& Depression


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Medical Management

Weight loss regimen -eha#ioral modification

"+ercise program

*ntidepressants

*ppetite Suppressants& May ha#e a F in wt reduction

Sibutramine ;CH 8Meridia:$ inhibits reupta!e of serotonin andnorepineprhine and appetite. Recently pulled from themar!et lin!ed to heart attac! and stro!e

)rilast 80enical: $ pre#ents digestion of fats by binding togastric and panreatic lipase 8alli o#er the counter:

Rimonabant8*complia:$ newest bloc!s the cannabinoid$receptor that is thought to play an important role inmetabolism


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6ariatric urger5

*#erage wt loss after s+ is (mpro#ement seen in comorbid conditions

$/ months of counseling and education prior to s+

*fter s+ will re6uire lifelong monitoring of wt loss

Ris! of malnutrition and wt gain Surgery is preformed only after nonsurgical methods

ha#e failed.

Selection factors include body weight, patient history,and failure to lose weight using other means, absence ofendocrine disorders, and psychological stability

able /9$A Selection criteria


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Procedures

4igure /9$9 pg EE Combined restricti#e and malabsorpti#e procedure

& Rou+$en$@ gastric bypass

Restricti#e procedures& 'astric banding

& 1ertical banded gastroplasty

'astric restriction with intestinal malabsorption& -iliopancreatic di#ersion with duodenal switch

May be performed

& Haparoscopy

& )pen surgical techni6ue Surgical inter#ention after wt loss%

& 7anniculectomy

& Hipoplasty


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Complications

Most common& -leeding, blood clots, bowel obstruction,

incisional or #entral hernias, and infection.

)ther symptoms& Nausea

& Dumping syndrome

& Diarrhea

& Constipation

& Nutritional deficiencies able /9$


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Nursing Mgmt: post op

Monitor complications

small feedings consisting of a total of FF$FFcalories after bowel sounds ha#e returned andoral inta!e is resumed

Monitor fluid inta!e to help pre#ent dehydration

sually discharged /9$O/ hrs after laparoscopicprocedure


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Patient 7ducation a/ter 6ariatric urger5

7t education% See chart /9$/& "ating fast or too much can cause esophageal distention and

#omiting

& DonIt drin! fluids with meals

& Drin! plenty of water PF min after each meal

A min before the ne+t meal

& "at three meals per day containing protein and fiber

& "at only foods pac!ed with nutrients

& *#oid li6uid calories such as alcohol, fruit drin!s, regular sodas& (nclude two protein snac!s per day

& otal meal si3e less than cup

& "at slowly

& Chew thoroughly

& Wal! for at least 9F min per day


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Gastric Cancer More common in people o#er age EF

(ncidence has decreased in S (ncreased ris! in men

(ncreased incidence in Qapanese

Nati#e *mericans, *frican *mericans, ;ispanic

population at greater ris! for gastric ca than Caucasians 7oor prognosis

Ris! factors& Diet

& Chronic inflammation of stomach

& 7ernicious anemia

& *chlorhydria

& 'astric ulcers

& ;. pylori infection

& ;+ of subtotal gastrectomy&


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Gastric Cancer 7atho

& Most are *denocarcinomas& May occur in any portion of the stomach but most occur in

the lesser cur#ature of the stomach

& Metastases often present at time of diagnoses

& Most common sites of mets are pancreas, li#er, esophagus,and duodenum

Clinical Manifestations& May be asymptomatic in early stages

& Dyspepsia& "arly satiety

& Wt loss

& *bdominal pain abo#e umbilicus

& appetite

& -loating after meals, N, 1


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Assessment

"'D test of choice

-arium +$ray of upper '( tract

C to detect mets

*scites and hepatomegaly may be present if li#erin#ol#ement

May be able to palpate nodules around theumbilicus 8Sister Mary QosephIs nodules:


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urgical management

Diagnostic laparoscopy to e#aluate disease May be curati#e if tumor locali3ed to stomach

May be palliati#e if distant mets

otal gastrectomy


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Treatment radiation therapy$ palliati#e

Chemotherapy$ A4, cisplatin, do+orubicin,

etoposide, and mitomycin$C

(mpro#ed response Combination therapy A4 and other agents

umor mar!er assessment to monitoreffecti#eness of treatment%& C* P$P

& C* AF

& C"*


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Patient 1ndergoing Gastric urger5

*ssessment& 7t and family !nowledge pre and post op

& *ssess nutritional status Host weight= (f so obtain more info Nausea2#omiting

;ematemesis

*bdominal assessment -owel sounds and palpates abdomen

& *fter surgery ;emorrhage, infection, abdominal distention,

atelectasis or impaired nutritional status


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Planning

Ma5or goals include reduced an+iety, increased!nowledge, optimal nutrition, management of

complications that can interfere with nutrition,relief of pain, a#oidance of hemorrhage andsteatorrhea, and enhanced self$care s!ills athome.


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Inter.entions

Reduce an+iety& 7ro#ide a rela+ed, nonthreatening atmosphere.& *llow patient to e+press fears and concerns.

& 7ro#ide support and encourage family support.

& 7romote positi#e coping measures.& "+plain treatments and procedures. 7ain

& *dminister analgesic as prescribed Monitor effecti#eness

& Nonpharmacologic pain relief measures 7osition

& Maintain N' tube 7re#ent distention

eaching& "+plain pre and post op procedures


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Inter.entions Resuming enteral inta!e

& May already be malnourished "nteral27arenteral *fter return of bowel sounds and N'

remo#al& May gi#e fluids and small amount of food

& 4oods gradually added until pt cantolerate si+ small meals a day and drin!

/FmH between meals


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Inter.entions Recogni3ing obstacles to ade6uate nutrition

& Dysphagia

& 'astric retention$nausea, #omiting, abdominal distention May re6uire reinstatement of N7) and Ng suction. se low$

pressure suction

& -ile reflu+ May occur with remo#al of pylorus

-urning epigastric pain and #omiting

0 with cholestyramine 8uestran:, antacid, metoclopramidehydrochloride 8Reglan:

& Dumping Syndrome Due to rapid passage of food into the 5e5unum and drawing of fluid

into the 5e5unum due to hypertonic intestinal contents. Causes #asomotor and '( symptoms with reacti#e hypoglycemia *#oid fluid with meals

*#oid high carbohydrate2sugar inta!e


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Dietar5 el/8Management A/ter Gastric urger5

o delay stomach emptying and dumping syndrome assume

low 4owlerIs position after mealsB lie down for /F$9Fminutes.

a!e antispasmodics as prescribed.

*#oid fluid with meals.

Meals should contain more dry items than li6uid items.

"at fat as tolerated, but !eep carbohydrate inta!e low, and

a#oid concentrated carbohydrates.

"at small, fre6uent meals.

a!e dietary supplements as prescribedB #itamins, medium$

chain triglycerides, and -/ in5ections.


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0uestion

Which statement about general principles of diet therapyfor patients with dumping syndrome is true=

*. 7atients with dumping syndrome should ha#e li6uidsbetween meals only.

-. 7atients with dumping syndrome should beencouraged to eat a diet high in roughage.

C. 7atients with dumping syndrome should eat a highcarbohydrate diet.

D. he diet for a patient with dumping syndrome mustbe low in fat and protein.


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Inter.entions

)bstacles to ade6uate nutrition& Steatorrhea

& Reduce fat inta!e and administer loperamide

& Malabsorption of #itamins and minerals

& Supplementation of iron and other nutrients

& 7arenteral administration of #itamin -/due to lac!

of intrinsic factor May re6uire 4e and 1itamin -/ supplements (M -/ +mo in pts with total gastrectomy


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Inter.entions

Monitoring for s2s+ of potential complications& ;emorrhage

Monitor for s2s of shoc! Monitor N' output and abd drsg


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Duodenal Tumors

sually benign& ncommon& *symptomatic most of the time

(f symptomatic

(ntermittent pain or occult blood& May place at higher ris! for malignancy

Malignant& Cause signs and symptoms& Many times not disco#ered until metastasi3ed to distant sites

& Clinical manifestations Weight loss Malnutrition -leeding 7ain


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Duodenal Tumors

Diagnosis& pper '(

& "ntercolysis& *bdominal C

Nursing management&

-enign tumors (f symptomatic "+cision2resection or electrocautery


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Duodenal tumors Malignant tumor

& Most common$adenocarcinoma

Second and third portion of the duodenum in#ol#ed Symptoms

& -leeding or duodenal obstruction

(f located in *mpulla of 1ater$Qaundice

reatment& Surgery

& Chemo and radiation

Nursing care

Lesson !: Nursing Management: Patients with Intestinal and


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Lesson !: Nursing Management: Patients with Intestinal and

ectal Disorders

Pellico Chapter 2!

ATI Chapter Med urg &( and &2

ATI Nutrition Chapter (3

ATI Pharm Chapter 2$

Shauna Winchester, MSN, RN


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+,-ecti.es Describe the health care needs of patients with

constipation, diarrhea, or fecal incontinence.

Compare the conditions of malabsorption with regard totheir pathophysiology, clinical manifestations, and

management. Describe di#erticular disease and the care of patients

with di#erticulitis.

Compare and contrast regional enteritis and ulcerati#e

colitis regarding their pathophysiology, and medical,surgical, and nursing management.

(dentify the care needs of the patient with inflammatorybowel disease.


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+,-ecti.es Describe the responsibilities of the nurse in meeting the

needs of the patient with an ileostomy.

Describe the #arious types of intestinal obstructions, aswell as their medical and nursing management.

Describe the pathophysiology, assessment, andmanagement in regards to cancer of the colon or rectum.

Describe anorectal conditions including fissures, fistulas,hemorrhoids, and se+ually transmitted anorectal

diseases.

(dentify the complications of gastric surgery and theirpre#ention and management.

"ducate patient regarding an acute or chronic intestinal

or rectal condition.


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+,-ecti.es

Describe the therapeutic actions, indications, pharmaco!ineticscontraindications, most common ad#erse reactions, and importantdrug$ drug interactions associated with the following types ofgastrointestinal medications%& Ha+ati#es and antidiarrheals

& *ntiemetic agents.

Compare and contrast the prototype drugs with the other drugs in thatclass for the following types of gastrointestinal medications%

& Ha+ati#es and antidiarrheals


)utline the nursing considerations and teaching needs for patientsrecei#ing the following%

& Ha+ati#es and antidiarrheals



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Irrita,le 6owel 5ndrome

& 4unctional disorder of intestinal motility.

& Ris! factors& ;eredity

& ;igh fat diet or stimulating or irritating foods

& *lcohol

& Smo!ing

& Stress

& Depression

& *n+iety

& Symptoms range% constipation, diarrhea or a combination of both.7ain, bloating, abdominal distention, abdominal pain often caused

by eating and is relie#ed by defecation.

& *ssessment and diagnostic findings


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Irrita,le 6owel 5ndrome

Medical management% relie#e abdominal pain,control diarrhea or constipation, reduce stress,good dietary habits, !eep symptom and food

diary, fluids not ta!en at meals and medications.& -ul! forming la+ati#e 8Metamucil:

& *ntidiarrheal agents loperamide 8(modium:

& *nticholinergics

& *ntidepressants

& tegaserod 8elnorm: withdrawn from mar!et

& alosetron 8Hotrone+: *( pg AO arch pg PPF

&lubiprostone 8*miti3a: *( pg AO/ arch pg PPF


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*ntidepressants

egaserod 8elnorm:& Remo#ed from mar!et


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0uestion he nurse is teaching a patient with (-S aboutways to help manage the (-S. Which patient

statements indicate that teaching has beeneffecti#e=

*. >( should eat a low$fiber diet.?

-. >4ish oil can be used to ease constipation.?

C. >( should e+ercise regularly to help managethe disease.?

D. >( should drin! with my meals.?


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Mala,sorption (nability to absorb one or more of the ma5or#itamins, minerals, and nutrients.

7atho Ris! factors

& *bdominal diseases or deformities, surgery,radiation, and certain meds that inhibit bacterialgrowth such as antibiotics. se of mineral oil orla+ati#es increase peristalsis.


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Mala,sorption Clinical manifestations 8able /E$/:

& Diarrhea, or fre6uent, loose, bul!y, foul$smelling, stoolsincreased fat and gray in color. *bdominal distention, pain,increased flatus, wea!ness, weight loss, decreased sense ofwell$being. Malnutrition and weight loss.

Diagnostic test& "ndoscopy with biopsy of the mucosa

Medical and nursing management& *#oiding dietary substances that aggra#ate and usingsupplements. Managing primary diseases. *ntibiotics,antidiarrheal agents and parenteral fluids.

& "ducation and ongoing assessment


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Mala,sorption Complications

& sing corticosteroids ;ypertension ;ypo!alemia insomnia "uphoria

& sing antibiotics Reduce #it producing intestinal flora

7rolonged 7 and (NR with pts ta!ing Warfarin

& sing anticholinergics rinary retention *ltered mental status 'laucoma


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Appendicitis

*cute inflammation of the #ermiform appendi+Tthe blind pouch attached to the cecum of the colon

& S2S% #ague, dull or poorly locali3ed epigastric orperiumbilical pain progresses to RH pain that is

sharp, well locali3ed, loss of appetite, localtenderness at Mc-urneyIs point, poss reboundtenderness, Ro#singIs sign, fe#er of FF4 or greater,nausea

& (f appendi+ has ruptured, the pain becomes morediffuse, abdominal distention, pt condition worsens.


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Appendicitis& Constipation$ Do not administer la+ati#es or

cathartics to a pt who has fe#er, nausea and

abdominal pain.& Cause perforation& Diagnostic testing

& 7hysical e+am and imaging studies, C-C 8ele#ated W-C withele#ated neutrophils:, abdominal +$ray, ultrasound, C, or

laparoscopy& *cute appendicitis is uncommon in elderly

7erforation is higher because #ague symptoms andnot see!ing healthcare.


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Appendicitis Nursing management

& 4luids antibiotic therapy are administered until surgery.

& (mmediate surgery if appendicitis is diagnosed& *#oid enemas can cause perforation& 7ost$op

& ;igh 4owlerIs$reduce tension on incision& 7ain relief$)pioid

& )ral fluids when tolerated& (1 fluids for the pt that was dehydrated& )nce normal bowel sounds$food as tol& Discharge teaching$follow up A$O days suture remo#al, care

for incision, may resume normal acti#ity /$E wee!s.


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Appendicitis Complications 8able /E$9 p 9:

& 7eritonitis

& 7el#ic abscess& Subphrenic abscess

& (lleus


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Di.erticular disease 7atho

& Di#erticula, Di#erticulitis, Di#erticulosis Ris! factors

& ;+ of di#erticulitis

& Congenital predisposition in those under EF

Clinical Manifestations of di#erticulosis& May ha#e no symptoms& Mild symptoms

-owel irregularities, with diarrhea, nausea, anore+ia and abdominaldistention.

& Repeated inflammation Harge bowel can narrow$cramps, narrow stools, and increased

constipation or obstruction.

Wea!ness, anore+ia, and fatigue

Clinical manifestations of di#erticulitis

& *cute onset of mild to se#ere pain in HH, nausea, #omiting, fe#er,chills and leu!oc tosis


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Di.erticular disease Diagnostic

& Colonoscopy$ #iew and biopsy to rule out other diseases& -arium enema$a#oided if there are symptoms of peritoneal

irritation$ lead to perforation.& C scan test of choice if di#erticulitis is suspected& *bdominal 0$rays& C-C

"le#ated W-C and "SR

'erontologic considerations& (ncreased incidence with aging& Symptoms less pronounced& Delay reporting symptoms& -lood in stool is often o#erloo!ed


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Di.erticular disease Nursing management

& Di#erticulitis Diet

Medication& *cute di#erticulitis ;ospitali3ation Rest bowel -road spectrum antibiotics O$F days )poid

*#oid NS*(DS$increased ris! of perforation *ntispasmodics Supplement dietary fiber for normal stools

Metamucil Stool softeners Warm oil in rectum Suppository


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Di.erticular disease (f medical management does not wor!

& Surgery for complications

& C guided percutaneous abscess drainage andantibiotics if no complications

& ypes of surgery )ne staged resection

Multiple stage 84igure /E$9p E:& Complications 7eritonitis *bscess formation -leeding


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0uestion he nurse is wor!ing in an outpatient clinic.Which client is most li!ely to ha#e a diagnosis of

di#erticulosis=*. * F year old male with a sedentary lifestyle.

-. * O/ year old female with multiplechildbirths.

C. * 9 year old female with hemorrhoids.

D. * EF year old male with a family history ofdi#erticulosis.


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Peritonitis& (nflammation of the peritoneum, the serous membrane

lining the abdominal ca#ity and co#ering the #iscera.& Hife threatening

& Caused by a lea!age of contents from abdominal organsinto the abdominal ca#ity, usually result of%& (nflammation, infection, ischemia, trauma, or tumor

perforation.


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Peritonitis

Hife$threatening 7rimary or secondary

Diffuse abdominal pain& Constant locali3ed and more intense Rigid, boardli!e abdomen Distended abdomen emperature 8FF$F:

sually NU1 achycardia Nausea and #omiting


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Peritonitis& Diminished perception of pain

& a!ing corticosteroids, analgesics, diabetics withneuropathy, and pts with cirrhosis who ha#e ascites

& *ssessment and Diagnostic 4indings& W-C, hgb, hct, electrolytes, abdominal 0$ray, ultrasound,

and C


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Peritonitis Nursing management

& 4luid, colloid, and electrolyte replacement& (sotonic solution is emergent due to hypo#elemia

& *naglesics& *ntiemetics$N U 1& N' with suction$relie#e distention& )/2intubation& Harge doses of broad spectrum antibiotics

& *ntifungicide& Surgical t+% remo#ed infected material& Complications

7erforation *bscess


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Peritonitis Monitor -7 #ia arterial line if shoc! ( U ), C17, 7*7, monitor (1 response )ngoing assessment

& 7ain, '( function, fluid and lytes balance, and position& Watch for signs subsiding& )bser#e drainage& Drains from being dislodged& (ncision care& Discharge teaching

& ;ome care Complications

& Sepsis& Shoc!& 7ulmonary emboli


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es


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0uestion he client diagnosed with di#erticulitis is

complainant of se#ere pain in the left lower

6uadrant and has an oral temp of FF. 4.Which inter#ention should the nurse implementfirst=

*. Notify the health care pro#ider

-. Document the finding in the chart

C. *dminister an oral antipyretic

D. *ssess the clients abdomen


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In/lammator5 ,owel disease 9I6D

Regional enteritis 8ChrohnIs disease: andulcerati#e colitis& (ncidence has increased in S

& 7resents during childhood or later in life and isassociated with a high morbidity and decreased 6ualityof life

& 4amily history predisposes

& Smo!ers ChrohnIs disease& Non$smo!ers ulcerati#e colitis

& Cause un!nown riggered by

Radiation, tobacco, food additi#es, and pesticides


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egional enteritis 9Chrohn;s disease

sually first diagnosed in adolescents or young adults,but can appear at any age.

(nflammation and ulceration of the '( tract

Can occur anywhere in the '( tract

Can in#ol#e the entire '( tract from the mouth to anus )ften at the distal ileum 8most common:& Can appear in the ascending colon

Cobblestone not continuous separated by normal tissue

4istulas, fissures, and abscesses form

(nflammation e+tend into the peritoneum

'ranulomas occur in AF& -owel wall thic!ens and intestinal lumen narrows


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egional enteritis 9Chrohn;s disease

& Clinical manifestations& sually characteri3ed by periods of remission and

e+acerbation& RH abd pain unrelie#ed by defecation and diarrhea& Cramping pain

& *bdominal distention, tenderness and2or firmnessupon palpation

& 4e#er& *nore+ia

& Weight loss

& Malnutrition& *nemia

& Disrupted absorption causes chronic diarrhea andnutritional deficits

& Diarrhea in about /F

& A loose stools per day with mucus or pus


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egional enteritis 9Chrohn;s disease& (nflamed intestine may perforateintra$abdominal and anal

abscesses, fe#er, and leu!ocytosis& Chronic symptomssteatorrhea

& S2s+ e+tend beyond '( tract and affect other organs and areas ofbody.& *rthritis, s!in lesions, con5uncti#itis, oral ulcers

Diagnosis& 7roctosigmoidoscopy, endoscopy, colonoscopy& Stool sample steatorrhea or occult blood&

-arium study of upper '( most conclusi#e Shown constriction of the ileum& -arium enema$cobblestone& C scan bowel wall thic!ening and fistula formation& C-C decreased hgb and hct, ele#ated W-C, "SR ele#ated, albumin and

protein decreased


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egional enteritis 9Chrohn;s disease Complications

& (ntestinal obstruction or stricture, perianal

disease, fluid electrolyte imbalances, malnutrition,fistula and abscess formation

& Most common fistula "nterocutaneous fistula

& (ncreased ris! of colon cancer


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1lcerati.e colitis& lcerati#e colitis$recurrent ulcerati#e and inflammatory

disease of the mucosal and submucosal layers of the colonand rectum.& *ffects the superficial mucosa of the colon& Characteri3ed by multiple ulcerations, diffuse

inflammations, and des6uamation or shedding of the colonicepithelium

& -leeding

& Mucosa edematous and inflamed& Hesions one after another touching& *bscesses& -egins in the rectum spreads to the entire colon

& -owel narrows, shortens, thic!ens


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1lcerati.e colitis

& *bdominal pain HH& Cramping& sually characteri3ed by diarrhea

& p to A$/F stools per day

& 7assage of mucus blood or pus can be present& Rectal bleeding which can be mild to se#ere

& 7allor, anemia, and fatigue result

& Rebound tenderness in RH may occur& sually presents with intermittent e+acerbations and remissions.& Classified

& Mild& Se#ere& 4ulminant

& May affect other organs or areas of body.& *rthritis, s!in lesions, eye lesions, li#er disease


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1lcerati.e colitis *ssessment Diagnostics

& Stool $ positi#e for blood or parasites

& Habs& *bdominal 0$rays& Sigmoidoscopy, colonoscopy, and barium enema& C scans, MR(, ultrasounds

Complications& o+ic megacolon& 7erforation& -leeding #ascular engorgement& ;ighly #ascular granulation tissue& )steoporotic fracture


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In/lammator5 6owel Disease

Management%& Nutritional

& 7harmacological

A$aminosalicyllic acid A *S* sulfa free

*ntibiotics

Corticosteroids

(mmunosuppressants *ntidiarrheals

(mmunomodulators


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In/lammator5 6owel Disease& Management

& Surgical

Colectomy otal proctocolectomy with a permanent ileostomy

7ostoperati#e care%& Hoose, dar! green li6uid, with some blood in stool& 7ouch system worn at all times

& S!in care (leostomy 8-F+ /E$/ p O9$OE:

oc! pouch


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0uestionWhich signs symptoms would the nurse e+pect

to find in a client diagnosed with ulcerati#e

colitis=*. F$/F bloody stools per day

-. Steatorrhea

C. ;ard, rigid abdomen

D. rinary stress incontinence.


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Masses in the colon and rectum 7olyps

& Neoplastic and Non$neoplastic polyps

Non$neoplastic polyps& -enign epithelial growth occur mostly in large intestine andsmall intestine

& More common in men and increase with age 8AF:

Clinical manifestations& Depends on si3e

& Symptoms$rectal bleeding, lower abd pain, obstruction

Nursing management& Remo#al of polyp and repair as needed


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Colorectal Cancer he third most common cause of cancer deaths

in the nited States.

(mportance of screening procedures. 7atho

& Most colon cancer adenocaricoma& May start as benign polyp

& Malignant cells in#ade and destroy normal tissue& Cancer cells brea! away from the primary site and

spread to other parts of the body& Most often metastasi3es to the li#er


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Colorectal Cancer Ris! factors

& (ncreasing age 8highest in those o#er A:

& 4amily h+& 7re#ious colon cancer or polyps

& ;+ of inflammatory bowel disease

& ;igh$fat, low fiber diet, high alcohol consumption,

and smo!ing


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Change in bowel habits

-lood in stool

*nemia*nore+ia

Weight loss

4atigue

Colorectal Cancer


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Colorectal Cancer Right$Sided Hesions

& Dull abdominal pain& Melena

Heft sided lesions2associated with obstruction& -right red blood in stool

& Distention& Change in stool 8narrow:

& Constipation

& *bdominal pain and cramping

Rectal lesions& enesmus& Rectal pain

& 4eeling of incomplete e#acuation after -M

& Constipation alternating with diarrhea

& -loody stool


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Diagnostic and La,*bdominal and rectal e+am

stool for occult blood

-arium enema 7roctosigmoidoscopy

Colonoscopy

Carcioembryonic antigen 8C"*:


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Nursing management (f intestinal obstruction

& (1 fluids, N' with suction, blood if needed

0 depends on stage$surgery, supporti#e therapy, andad5u#ant therapy& chemo$regimen containing A4 in combination with other

chemo drugs

& Radiation may be done before, during, and after surgery

& Radiation may be done for palliation& Surgery is primary treatment for colorectal cancersTmay be

palliati#e

& Colostomy may be indicated


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Complications o/ colorectal cancer 7artial or complete bowel obstruction

;emorrhage

7erforation*bscess formation

7eritonitis

Sepsis Shoc!

C l i


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Colostomies


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Complications o/ elderl5

(f colostomy indicated%& Decreased #ision& (mpaired hearing& Difficulty with fine motor mo#ements

& (ncreased potential for s!in brea!down& Watch for s2s of decreased blood flow to stoma& Delayed elimination after irrigation

R2t decreased peristalsis and mucus production


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0uestion he nurse is admitting a client to a medical floor with a

diagnosis of adenocarcinoma of the colon. Whichassessment data support this diagnosis=

*. he client reports up to /F bloody stools per day.

-. he client has a feeling of fullness after a hea#y meal

C. he client has diarrhea alternating with constipation .

D. he client complains of right lower 6uadrant pain.


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Intestinal o,struction Mechanical% caused by occlusion of the lumen of

the intestinal tract 84igure /E$P p O:8able /E$A p OP:

& "+amples% adhesions, hernias, intussusception,polypoid tumors or neoplasms, stenosis,strictures, and abscesses

4unctional obstruction% impairment of muscletone cannot propel the contents and causes abloc!age& "+amples% diabetes, neuro disorders, muscular

dystrophy, amyloidosis

6owel +6


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6owel +6 Most occur in small intestines

May be partial or complete obs

Small bowel obstruction most common cause%& *dhesions

4ollowed by%

& ;ernias

& Neoplasms

& (ntrussusception

& 1ol#ulus

Harge intestine obs occur in sigmoid& Carcinoma

& Di#erticulitis

& (-D


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6+ Patho 4luid, intestinal contents, gas accumulate abo#e

the obstruction

(ncreased pressure in bowel Decreased #enous and arteriolar pressure Causes edema and necrosis "#entually rupture or perforation causing

peritonitis


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96+ Clinical Mani/estations Crampy, wa#eli!e and colic!y pain

-lood or mucous from rectum but no stool or

flatus1omiting 8fecal #omiting if obs complete:

*bdominal distention

Dehydration

;ypo#olemic shoc! if untreated


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0uestion * OA$year$old male patient presents at the emergency

department with symptoms of a small bowel obstruction.*n emergency room nurse is obtaining assessment datafrom this patient. What assessment finding ischaracteristic of a small bowel obstruction=

*. 1omiting

-. (ncreased urine output

C. Moist mucous membranes

C. Mucus in stool


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6+ Diagnostics Clinical manifestations

*bdominal +$rays

C scan Hab$ s2s of dehydration


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6+ Medical Mgmt N' to suction

(1 therapy 8fluid and electrolyte replacement:

Surgery to remo#e or treat obs May remo#e portion of bowel


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6+ Nursing Mgmt Maintain N'

Monitoring fluid and electrolyte balance

*ssessment of bowel function Monitor nutritional status

7ost$op surgical care


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Large 6owel+,s Patho

Similar to S-)

Dehydration occurs more slowly May not be manifested unless blood supply to

colon is cut off< this is life-threatening.

*denoidcarcinomas are most common cause


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Large 6owel +6


Symptoms de#elop and progress slowly

Constipation may be only symptom for months& (f located in sigmoid colon or rectum

Stool altered from passing obs

Wea!ness, wt loss, anore+ia

-lood in stool may lead to anemia


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Large 6owel +6


1omiting uncommon until ad#anced$then fecal

#omiting*bdomen mar!edly distended

Crampy lower abdominal pain

4ecal #omiting

Symptoms of hypo#olemic shoc! if untreated


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Large 6owel +6

Diagnostic 4indings Clinical manifestations

*bd 0$rays

C scan MR(

-" is contraindicated


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Large 6owel +6

Medical Mgmt (1 fluid and electrolyte replacement

N' to suction

Colonoscopy Cecostomy

Rectal tube

Surgical resection

May re6uire colostomy


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Large 6owel +6

Nursing Mgmt Monitor s2s

(1 fluids and electrolytes

"motional support Comfort

& (f condition does not respond Surgery

7reop teaching

7ost$op care


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Anal /istula iny, tubular, fibrous tract that e+tends into the anal

canal from an opening located beside the anus 84igure/E$F* p F:

& sually related to infection& Can be from trauma, fissures, or regional enteritis

Symptoms& 7us or stool lea!ing& May pass flatus or feces from #agina or bladder

Depending on where it is

& Can cause systemic infection if untreated

Surgery$fistulectomy always recommended& Most do not heal spontaneoulsy


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Anal /issure Hongitudinal tear or ulceration in the anal canal lining 84igure /E$

F- pF:& rauma& 7assing a large firm stool

& 7ersistent tightening of the anal canal because of stress or an+iety& Childbirth& rauma& )#eruse of la+ati#es

Symptoms& 7ainful defecation, burning, bleeding bright red blood on tissue

reatment$most heal with& Dietary modification


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0uestion Which information does the nurse include when

teaching a patient with new onset hemorrhoids aboutpre#ention and flare ups= Select all that apply.

*. (ncrease the fiber in your diet to pre#entconstipation.

-. Do not participate in any physical e+ercise.

C. Maintain a healthy weight.

D. (ncrease your fluid inta!e.

". 7rolonged sitting or standing will not affect thede#elopment of hemorrhoids.


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e=uall5 Transmitted Anorectal Diseases 7roctitis$ in#ol#es the rectum

& *nal$recepti#e intercourse with an infected partner Mucopurulent discharge, bleeding, pain in area, diarrhea

7roctocolitis$in#ol#es the rectum and lowers portion ofdescending colon& Similar to proctitis and includes watery or bloody

diarrhea, cramps, abdominal tenderness "nteritis$in#ol#es more of the descending colon

& Watery, bloody diarrhea, abdominal pain, wt loss Sigmoidoscopy& Samples and cultures

reatment&


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Pilonidal inus or C5st 4ound in intergluteal cleft on the posterior surface of the lower

sacrum 84igure /E$ p 9:& Result from local trauma

Causes penetration of hairs into the epithelium and S tissue

& May be congenitally formed& ;air protrudes from openings& Rarely causes symptoms until adolescents or early adulthood

when infection& Symptoms

(rritating drainage or abscess

& reatment *ntibiotics (f abscess

Surgery$*bscess incised and drained then further surgery to e+cisecyst and secondary sinus tracts


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Anorectal disorders Nursing Management of 7atients with *norectal

conditions 8-o+ /E$9 p :.

& Relie#ing constipation& Reducing an+iety

& Relie#ing pain

& 7romoting urinary elimination

& reating patients self$care& Continuing care

GI Part 2 2016 Student

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Transcript of GI Part 2 2016 Student