GI system HESI

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Differences between PUD and GERD?

-PUD is not precipitated by any kind of food or beverage, GERD is precipitated by caffeine, spicy, strawberries, chocolate)
-PUD is caused by H.PYLORI, GERD is caused by loosening of esophageal funciton
-PUD actually has ulcer that goes through GI linning

Interventions for PUD or GERD?

Semi-fowlers
-sit up for 1 hour after meals
-antacids
-H2 blockers

Risk factors for PUD

-alcohol
-NSAIDS, aspirin, corticosteroids
-Smoking

S/S of PUD

-belching
-bloating
-epigastric pain radiates to the back and is relieved with antacids

Complications of PUD?

Hemorrhage
perforation
obstruction

PUD nursing diagnosis

Acute Pain....

Nursing interventions for PUD

-assess stool, urine, occult blood
-no bedtime snacks
-small frequent meals

Dumping syndrome

-Following postoperatively gastric resection or vagotomy
-Vertigo
-Syncope
-Diaphoresis
-Tachycardia
-Pallor
-Lye down after meals to help

Diverticulosis vs Diverticulitis

Losis: Presence of pouches in the intestine wall
Itis: Actual inflammation of pouches in the wall, may cause bowel perforation!!!!

Rectal bleeding is more common in?

Ulcerative Colitis

Fistulas more common in?

Chrones

Malnutrition more common in?

Chrones (Vitamins, food, illium)
TPN

Dehydration and diarrhea more common in?

Ulcerative Colitis
Large intestine is involved in water and electrolyte absorption
Blood, pus, and liquid stools are common

Diverticulosis/litis assessment findings

-LLQ abdominal pain
-flatulance
-rectal bleeding

Signs of intestinal obstruction?

Diarrhea alternating with constipation
Abdominal distention
Anorexia
Low-grade fever

What should you keep the patient with diverticulitis?

NPO, risk for perforation or obstruction of bowel

Interventions for diverticulitis?

Acute: NPO
Recovery: NO fiber
Long-term: High-fiber diet and bulk forming laxatives to prevent pooling of foods in the pouches where the ycan become inflamed
-Metamucil (bulk-forming lax)
-Increase Fluid intake to 3 L/day
-Monitor I&O

Illeostomy feces will be?

Liquidy
-Prone to skin breakdown!!!!

Colostomy feces will be?

More formed

Antacids

Maalox, Aluminum hydroxide, magnesium hydroxide
-Buffer the PH in the esophagus (keep at 3.5)
-take 1 hour after meals
-contraindicated in renal disease

Sulcrafrate

Works on secreting and protecting the mucous lining
-Take 1 hour before meals
-Antacids interfere with absorption

PPIs

"PRAZOLE" (Lansoprazole, Prilosec, nexium)
-Many side effects includding tinnitis, chest pain, dyspnea, diarrhea, constipation, heartburn, vertigo, confusion

How do antyhypertensives effect PUD?

They increase the risk of developing ulcers

Nursing Diagnosis for Divertiula Disease

Ineffective tissue perfusion....

S/S of intestinal obstruction

-sudden abdominal pain
-abdominal guarding
-sudden tenderness

Nursing DIagnosis for obstruction

Impaired tissue perfusion

When will ABG's show alkalosis vs acidosis in an obstruction?

-Alkalosis will be if the obstruction is high up in the small intestine because gastric acid is secreted there, leaving an alkalotic environment
-Acidosis if it is lower in the bowel because base is secreted there so the acid will be left over

Interventions for obstruction?

NPO!!!!
-Iv fluids, electrolyte therapy
-Monitor I&O
-NG tub intubation *suction 80mmhg
-reposition client ever 2 hours to assist with placement of tube

Assessment findings in Colorectal cancer

-Bleeding
-Change in bowel pattern, consistancy, color
-Abdominal distention or Ascites
-Pain, Nausea, vomitting
-History of Polyps
-family history of cancer

Surgical procedure for colocrectal cancer

-Laxatives or gut lavage
-High-calorie and high-protein diet
-Prevent constipation with high-fiber diet
-Screen with hemooccult Guaaric test

Cirrhosis

Degenerative liver disease causing fibrosis, scaring

Assessment findings

-Jaundice
-Ascities
-Weakness, malaise
-Anorexia, weight loss
-Increased abdominal girth (measure it)
-Fector hepaticus (fruity breath)
-Dark colored urine (amber) (Presence of billibrubin)
-Clay colored or chalky stools (absence of bilirubin)
-Asterixis (hand flapping)
-Mental/behavior changes
-Gynomastocia
-Esophageal varices

Fector Hepaticus

Fruity breath that is seen on patients with cirrhosis

Asterixis

Hand flapping, seen with cirrhosis

Labs and clotting defects with cirrhosis?

-Low H&H
-Elevated BUN, Creatine, bilirubin, AST, ALT, alkaline phospatase, PT, and ammonia
-They can not break down ammonia because the liver is damaged so they will have increased ammonia
-Drug metabolism is longer because the liver can not break it down

Nursing diagnosis for cirrhosis

Excess fluid volume....

Interventions for cirrhosis

-Restrict sodium/fluids (<1,500/day)
-High-carbohydrate diet (energy)
-Low-potassium
-Observe for change in mental status frequently
-Observe for signs of bleeding and be cautious of causing a bleed (small bore for needles)
-Pressure on puncture sites for 5+ minutes
-Electric razor
-Soft tootbrush
-Measure abdominal girth
-weigh daily (signs of edema)

Cirrhosis patients are prone to what? Therefor you need to take precautions....

Bleeding (pressure on site, toothbrush, razor, small needles)

Cirrhosis and elimination

-They need to not strain when they are pooping
-Use stool softners
-High-fiber diet if they do not have

Nursing diagnosis/interventions for Hepatitis

Activity intolerance R/T fatigue, discrimination, joint pain, myalgia
-Plan periods of rest between activity
-High calorie and high-carb diet
-Do not share personal items in case of spreading

Hep A, B, C

A: Food contaminal (oral, fecal route), abrupt onset
B: Blood products (needles, sex, mother to child)
C: Blood, Dialysis (Sex, parenternal) Insididuous onset, no vaccine!!!!

Patients with Hepatitis should avoid what kind of substances because of damage to what organ?

-Hepatoxic substances (aspirin, acetaminophen, sedatives, alcohol)
-Liver damage

Pancreatitis may cause what electrolyte imblance?

Hypocalcemia
-Muscle spams
-tetany
-twitching
-change in deep tendon reflexes
-cramping
-grimacing

What position is best for patient with pancreatitis?

Sit them up and lean them forward

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