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pnp GI

Terms in this set (54)

functions of digestive system
food processing & storage

manufacture

absorption

reabsorption & elimination
upper GI series lab & diagnostics test
series of radiographs of the lower esophagus, stomach, duodenum using barium as a contrast medium

detects abnormalities ex: tumors or ulcerative lesions

NSG:
NPO after midnight
increase fluids after the procedures
MOM after the procedure
clear fluids given to clean out GI tract
Go lytely given
drink nothing red
stool exam
stool is collected in appropriate container

can be tested for occult blood, bacteria, toxins, ova & parasites


NSG:
instruct pt to keep specimen free of urine (urinate 1st)

diet free of red meat 24-48 hrs before specimen collection
Esophogagastrodudoenscopy (EDG, UGI, Endoscopy, Gastroscopy)
direct visualization of upper Gi tract via a scope

uses include removal of polyps, pics and specimen collection

NPO after midnight to keep GI clean & prevent vomiting

administration of pre-op sedative (phenyl)

past procedures assess for gag reflex

observe for s/s of perforation

bleeding, fever, dysphagia, post procedure
ERCP
looks at liver and gall bladder and pancreas
endoscopy of the lower GI tract
tissue specimen can be obtained polyps removed

visualization of the anus, rectum and sigmoid colon

NSG;
bowel prep prior to surgery
post procedure- monitor bowel perforation (bleeding, pain, discomfort)
Barium enema (lower GI series)
white chalky stool

series of radiographs of the colon

use to demonstrate the presence & location go polyps, tumors & diverticula

NSG;
bowel prep evening prior to test

MOM prrocedure

stoll will be light colored until all barium expelled

low restricted diet

clear diet 2 days before procedure
colonoscopy
visualizes the entire colon

used to detect lesions, benign & malignant neoplasm, inflammation and ulceration

cramping may be last several hrs, blood may b left in colon

NSG
-clear liquid diet 1-3 days prior to exam
-NPO after midnight prior procedure
-enemas or golytely bowel prep
-pre-procedure- IV sedation
-post procedure-observe for sign of bowel perforation
Barium swallow
more through examination than the UGI

uses barium to detect esophageal varies, strictures, hiatal hernias

NSG:
-NPO after midnight
-increase fluid intake after procedure
-MOM after procedure
Liver enzymes
-apsparate aminotrnsferase (AST) 8-20 u/l (elevated in MI, hepatitis, cirrhosis hepatic cancer & pancreatitis) AFTS

-alanine aminotransferease (ALT)5-35 IU/DL (ELEVATED in hepatitis, hepatic tumors, hepatotoxic drugs
lactic dehydrogenase LDH
increase MI, pancreatic , hepatitis
alkaline phosphates
increase hyperparathyroid, hepatitis, cerosis, bilary tactile disorders
hiatal hernia
-stomach slides up through the hiatus into thoracic cavity

-SLIDING HERNIA: most common w subsides rest

-para-esophageal stomach squeezes through the hiatus causing strangulation

CAUSES:
coughing, straining at stool, lifting heavy objects

OCCURS IN:
smokers, >50 yrs, obesity & pregnancy

-people w/ hiatal hernia often have GERD
s/s of hiatal hernia
pain
heartburn
feeling of fullness or reflux


DX test
xray studies
fluroscopy
hiatal hernia nursing diagnosis
acute pain
imbalanced nutrition: less than body requirements
bowel incontinence
self cafe deficit
anxiety
hiatal hernia nsg care
-LIFESTYLE CHANGES: loose wt, take antacids, eat small meals
-tch not recline for 3-4 hrs after eating
-eleveate HOB to prevent reflux
-avoid bedtime snacks, spicy food, alcohol, caffeine and smoking
-if hernia repair is done (general post op care is provided)
-if dysphagia occurs- notify MD
-repai may be too tight
-don't lay down after eating
-no heavy lifting
GERD
-gastric secretion reflux into esophagus. backward flow of gastrointestinal contents into esophagus

-esaphagus can be damaged by acidic gastric secretions/enzymes

-caused by hiatal hernia inability of lower esophageal to close tightly
s/s & complications of GERD
s/s
heartburn
regurgitation
dysphagia
bleeding

Complications
Barret syndrome (pernicanceroius lesion)
respiratory problems ex: bronchospasm & asthma
esophagitis
medical Tx for GERD
-lifestyle changes
-elevate HOB, sleep on left side
small frequent meals
limit/avoid carb beverages, coffee, chocolate, fats, mints, spicy or acidic food
-avoid smoking/alcohol
-avoid tight or restrictive clothing
-loose weight
-low/fat, high-protein diet
-avoid late meals/snacks
GERD medical management
ANATACIDS
-mylanta

HISTAMINE 2 (H2) RECEPTOR ANTAGONISTS
-Pepcid
-zantac

PROTON PUMP INHIBITORS (PPI)
-protonix
-prilosec
-nexium
-prevacid
acute gastritis
gastritis (stomach inflammation) or indigestion could be primary symptom of many disorders

CAUSES:
overeating
ingesting
Medications (NSAIDs)
Abusing Alcohol
Infection (H. Pylori)

s/s
abdominal pain
anorexia & nausea
dyspepsia (heartburn , bloating, nausea, ab pain)

TX;
removing the offending food, H.pylori & meds
Peptic ulcers
are erosions that form in the esophagus, stomach, or duodenum resulting from acid/pepsin imbalance
gastric ulcers
refers to erosions in the stomach and are correlated to exposure to irritants including smoking, alcohol, food and allergens, toxic chemicals
duodenal ulcers
increased gastric secretions of HCL, caused by NSAIDS or plavix
Dumping syndrome
complications after gastric surgery

-rapid gastric emptying causing distention of duodenum & jejunum

-epigastric pain, explosive diarrhea

-total/partial


Tx/nsg care
-monitor.ng tube
-after surgery -i.e. measure drainage & replacement w/iv fluids cc; irrigate prn
-6 small meals/day avoid fluids during meals
-recline 1 hr after meals
-antichollinergics to reduce gastric motiltity
cancer of the stomach
usually an adenocarcinoma in the pyloric area

cause unknown:
-H, Pylori may be a factor

s/s
-asymptomatic early on
-epigastric discomfort
-anorexia
-weakness
-wt loss
-intermitten sharp/buring/gawning pain
-pain in left & relieved by food
-change in appetite
-N&V
-bloody stools
-frequent burping & bloating
-duodenal pain right of epigastrium 90mins-3hrs after eating
-pain wakes pt up at night
stomach cancer DX test
-history & physical (family history)
- edocscopy (EGD)
-stool for occult blood
-H-pylori test
-gastric secretion studies
-biopsy
inflammatory Bowel disease
-aka crowns disease & ulcerative colitis (UC)
-affects mucosa and submucosa of colon
-begins in rectum & distal colon
-begins in the rectum & rectal colon
-2x more common than crohns disease
-tiny abscesses grow & produce purulent drainage sloughing of mucosa w/ulcerations
-capillaries bleeding causing diarrhea containing mucous, pus & blood
ulcerative s/s
-diarrhea 15-20/day -stool contains blood, pus, & mucous
-fluid & electrolyte imbalance
-abdominal cramps
-anorexia
-wt loss
-anemia
-high risk for cancer
ulcerative colitis Diagnosis & tx
DIAGNOSIS:
stool specimen(check blood, mucous), CBC, sigmoid or colonoscopy

TX;
medications: anti inflammatory (sulfasalazine, asacol) steroids, antidiarrheal (imodium)

DIETARY MANAGEMENT:
-exclude high fiber foods, caffeine, spicy foods and milk products, increase protein/cal
-may need TPN

SURGERY:
-colon restriction
-ileostomy
-colostomy
ulcerative colitis nsg care
-client NPO or limited to clear liquids
-check bowel elimination,
-i&O
-diet( high protein, calories, low residue & lactose
-pre-op bowel prep(golytely, ABT)
-post op check bowel sounds, maintain NGT & monitor drainage, assess color/amt/odor, ostomy, ostomy care
IBD crohns disease's
-not as common as ulcerative colitis
-affecte people 15-30 yrs
-family history, autoimmune
-occurs anywhere in GI tract
-usually occurs in small intestine (illium)
-entire thickness of intestinal wall is involved
-inflammation, scarring, fibrosis, malabsorption
crohns disease's s/s
-abdominal crmaps
-malabosprtion (vit b12)
-diarrhea 3-4 stools/day
-fluid/elect imbalance ( K & Na)
-loss of appetite, wt loss
-RLQ pain
-stetatorrhea(excess fat in feces)
-GI symptoms (arthritis, skin lesions)
-inflammation of eye condition
crohns disease's nsg care
-mointor nutrition
-Monitor fluid/electrolyte balance, check I&O
-Monitor elimination
-pain assessment & management
-be aware of psychologic factors, give emotional support
Appendicitis
Inflammation of appendix which can lead to perforation & peritonitis

State the location of the appendix

CLINICAl MANIFESTATIONS:
-generalized abdominal pain
-pain RT Lowe quadrant
-low grade temp
-pain at Mcburney point (between umbilicus & iliac crest)
-N&V
-Rebound tenderness
-increase leukocyte (5000-10000)

ASSESSMENT & Dx
-CBC
-Ct of abdomen
-ultrasound
Appendicitis medical tx
Prompt surgery - Laparoscopy appendectomy
Iv fluids& antibiotics
Analgesics

Nsg Care
Relieve pain
Fluid & elec imbalance
Monitor for infection
Peritonitis
-inflammation of the peritoneum
-usually from perforation of the appendix or intestine
-other causes IBD, cancer, diverticula, ruptured etopic pregnancy

S/S
Severe abdominal pain/bored like rigidity
N & V
decreased bowel sounds
fever, leukocytosis
increaesed pulse, decreased BP, shallow respiratory & DEATH

MEDICAL TX
surgery, NGT to suction for decompression, npo, ivt w/ abt

NSG CARE
antibiotics, analgesics, rest
semi-fowlers
surgical asepsis for wound care
no heavy lifting
hydration, fluid & elect
diverticulitis
diverticulitis refers to the inflammation of one or more of the diverticula generally in the sigmoid colon

CLINICAL MANIFESTATIONS:
-nagging, cramping pain
-tenderness in LLQ
-abdominal distention
-flatulence
-elevated temp

ASSESSMEMNT & DIAGNOSTIC
-ct scan procedure of choice
-CBC
diverticulitis medical tx & nsg care
antispasmodics, antibiotics
bulk laxatives
-surgery may be necessary w/abscess formation or perforation and no response to medical tx

NSG CARE:
6-8 glass of water/day
regular bowel/exercise
-avoid nuts & foods w/small seeds
-encourage high fiber diet
-post op-NPO, NGT,IVF & i&o, pain management, ostomy care, ck stoma. teach care
diverticulosis
a condition of the colon in which multiple diverticula are present
diverticula
saclike protrusions of the intestinal wall
colostomy
opening in the colom
ilostomey
opening into the ileum
intestinal obstruction
-intestinal contents cannot pass through GI tract
- peristalsis is defective

MECCHNAICAL OBSTRUCTION:
blockage in the lumen
stenosis, volvulus
foriegn objects
intussusception
polyps/tumors
abscesses

FUNCTIONAL OBSTRUCTION
-paralytic ileus
-muscle spasms
-disorders such as DM, parkinson disease & muscle dystophy
intestinal obstruction Tx
-obstruction to small intestine = surgery
-lareg intestine = intestinal decompression restongof bowels

NSG CARE
-fluids & elec replacement
-note bowel sounds if absent
-perp for surgery
-post op nsg care
irritable bowel sound IBS
-pattern of symptoms affecting large intestine
-has no identifiable cause
-occurs in females more than male
-triggers such as (gas producing foods, or food sensitives)
-physical & psychological stressors

s/s;
abdominal pain
n&v
diarrhea & constipation
cramping bloating/gas

More severe s/s
-GI bleeding
-unexplained wt loss
-worsening abdominal pain
irritable bowel sound IBS tx
-palliatvie care
-educate pt. to avoid caffeine, fatty foods, diary, alcohol and OTC meds (common triggers)
-avoid gas producing food (cabbage broccoli, cauliflower
-dietary fiber is beneficial
-can be controlled with dietary choices
-lifestyle adjustment & meds
-provide positive feedbacks
hemorrhoids
-swollen vascular tissues in the rectal area

-may be internal or external & may be caused from straining w/ constipation

-frequently occur w/pregnancy

-2 types:
internal & external

-cause itching & pain, most common cause of bright red bleeding w/defecation

-high fiber diet, increase fluids , bulk laxatives, sites baths, may require rubber band ligation or extensive surgery
colorectal cancer
-malignant growth of the colon, rectum & appendix

-polyps at time usually benign but then progressed to malignancy

risk factors includes
-family hx of cancer
- change in bowel habits
-rectal bleeding or blood in stool
-high fat diet
low residue diet

s/s
-n&v
-wt loss
-abdominal cramps or fullness
-change in bowels habits
-tenesums (ineffective straining at stool)
excessive flatus
anemia & rectalbleeding
ractal pain
anorexia & cachexia
nsg tx for colorectal cancer
-relates to stage of disease & course of tx
-monitor v/s hemorrhage
-colostomy
-ng suctioning
-wound care
-turn & position (ambulate asap)

MEDICAL MANAGEMENT:
-decrease tumor growth
-chemotherpay & radiation

SURGICAL MANAGEMENT
-Resection
-colostomy
-abdominal-perineal resection
liver failure
occurs when liver cells fail to clear toxins

waste products builds uo causing decreased cerebral function

hepatitis maybe causative agent
s/s of liver failure
tremors
mental changes
seizures, stupor & coma
somnolent
ascites
edema
coagulopathy
shrinking liver
mortality rates are high
increased blood ammonia levels
tx for liver failure
sympotmatic
control bleeding'
low protein diet
fluid & elect
administer antibiotics & corticosteroids
cirrhosis
chronic degenerative changes in the liver cells

thickening of surrounding tissue

CAUSES
chronic hepatitis

repeated exposure to toxic sunstances

cancer and chronic alcohol abuse
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