What things should a nurse expect to be monitoring for a patient with a GI bleed?
Increase heart rate
Which GI disorder can be life threatening and most common in middle-aged men?
What are the most primary causes of pancreatitis?
biliary tract disease
What are some other causes of Pancreatitis?
penetrating duodenal ulcer
cysts & abscesses
post operative GI surgeries
Which procedure can also give a patient pancreatitis?
How does alcohol cause pancreatitis?
Stimulates secretion and excess production of HCI
A decrease in gastric pH causes a release of hormone Secretin
Secretin cause regurgitation of duodenal contents into the pancreatic duct causing inflammation
Which drugs can cause pancreatitis?
What is a primary role of the pancreas?
produce digestive enzymes
What happens if the pancreas doesn't work right?
digestive enzymes stay inside pancreas and start digesting pancreas
What does the enzyme TRYPSIN cause if it auto digest the pancreas?
What does the enzyme ELASTASE cause if it auto digest the pancreas?
What does the enzyme PHOSPHOLIPASE cause if it auto digest the pancreas?
What does the enzyme LIPASE cause if it auto digest the pancreas?
What are signs/symptoms of acute pancreatitis?
abdominal pain-sudden, sever, steady, piercing, deep
pain in left upper quadrant- may be in midepigastrium radiates to back
pain aggravated by eating
pain not relieved by vomiting
low grade fever
What can you tell a patient if they ask why does their pain gets worse when they eat with pancreatitis?
Because eating stimulates digestive enzymes and will cause more auto digestion to the pancreas
Which labs do we look at when diagnosing Pancreatitis?
Amylase >200 rapid rise then gradually go down
Lipase >5-10 x normal steady rise within 24-48 hrs and stay elevated for 5-7 days
What are our goal for a patient with acute pancreatitis?
relief of pain
prevent or alleviate shock
reduce pancreatic secretions
maintain fluid & electrolytes
treat underlying cause
What other condition might you see a patient have that has a elevated serum lipase
what are some nursing interventions we can do to help reduce pancreatic secretions with acute pancreatitis?
place a NGT
or keep NPO
What type of diet would you expect a patient with acute pancreatitis to have?
small frequent feedings
high carb and protein, low fat
What type of disorder can cause a partial or complete intestinal obstruction?
What makes an intestine obstructed?
When there is a pathologic impediment to the flow of intestinal contents. Partial or complete obstruction
What are types of mechanical things that can cause an intestinal obstruction?
intrinsic lesions-occurs within the lumen, tumors, stricture
extrinsic lesions- external pressure on the lumen
blockage of lumen-foreign bodies, gallstones, fecal or barium impactation
What are types of vascular things that can cause an intestinal obstruction?
acute occlusion of a major mesenteric artery or venous thrombosis that causes ischemia of the intestines-leads to decreased oxygen and nutrient supply
sepsis from leakage of bowel contents in the peritoneal cavity
What are types of neurogenic things that can cause an intestinal obstruction?
peristalsis is decreased or absent
GI contents or stopped or slowed
What types of things can cause peristalsis to be decreased or stopped?
medications (anesthesia, opiates)
infections or toxins (obstruction, peritonitis, pancreatitis)
trauma & severe pain
spinal cord lesions
What will happen if you have a GI obstruction?
severe electrolyte imbalances
fluid leaking out causing reduced circulating blood volume
increased risk of peritonitis
What are signs/symptoms a patient will experience if they have a GI obstruction?
colicky, cramping abdominal pain
vomit/may vomit stool
hypo/hyperactive bowel sounds
If the obstruction is proximal to the ileum what types of problems will arise?
fluid regurgitates into the stomach causing vomiting increasing fluid and electrolyte imbalances
If the obstruction is distal to the ileum what types of problems will arise?
lead to perforation or reflux into the ileum
perforation will cause peritonitis, sepsis, and endotoxic shock
What test can be done to diagnose a GI obstruction?
barium enema only not swallowed
check for decreased electrolytes
How do we treat a GI obstruction?
1. Give fluid (normal saline) to correct the balances
2. relieve the obstruction by medical or surgical
4. pain medications-OPIOIDS only for severity d/t constipation
5. soft/low residue diet
How does a NGT help treat a GI obstruction?
on suction to evacuate gas & fluid from the stomach & upper ileum
prevents aspiration of gastric content, lessens further progression of intestinal distention
helps with partial obstruction due to inflammation or infection
What type of surgery is done to treat GI obstruction?
removal of tumors
lysis of adhesions
temporary or permanent colostomy or ileostomy
What are risk factors of colorectal cancer?
high fat diet
What are signs/symptoms of a person with colorectal cancer?
iron deficiency anemia
vague pain radiating to lower back
How can colorectal cancer be diagnosed?
50% rectal exam
liver scan to see if mestasize
Which labs will be used to diagnose colorectal cancer?
What treatments are done for colorectal cancer?
surgery:resection end to end anastomosis or
temporary or permanent colostomy
Radiation: done before surgery to reduce the size of the tumor or to prevent spread to the lymphs
done after surgery for palliation for an unresectable tumor with extensive mestatsize
What is the nurse going to assess post operatively after treatment of colorectal cancer?
diet from NPO>soft>regular
compression stockings/lovenox (blood clots)
monitor stools for blood
What is ulcerative colitis?
recurrent inflammatory and ulcerative disorder
inflammation distribution is diffuse
mucosa has ulcerations and abscesses that can later necrose
primarily located in the left colon and rectum
What are signs/symptoms of ulcerative colitis?
diarrhea 4-5 times/day or severe cases 10-12 times/day
diarrhea with blood, mucus, & pus
low grade fever
What may cause an exacerbation of ulcerative colitis?
What is crohn's disease?
A subacute and chronic inflammation of segments of the GI tract
inflammation is focal symmetrical involves the entire circumference of the bowel
mucosa has granulomas, tumor like growths
located anywhere on the GI tract from the mouth to the anus predominantly the right colon
What are risk factors for ulcerative colitis or crohn's disease?
mainly in teens and young adults
Jewish & whites
What are ways to diagnose ulcerative colitis or Crohn's disease?
How do we treat Ulcertaive colitis or Crohn's Disease?
control inflammation -mesalamine & steroids
fluids correct blood volumes and electrolytes
placed on a low residue, low fat, high protein high calorie diet (anorexia)
replace minerals and vitamins
What are some complications with surgery for ulcerative colitis or crohn's disease?
increased risk for colorectal cancer
What's the main complication with having surgery to treat Crohn's disease?
you can remove the part that is inflamed at the time but may likely to reoccur in another part of the bowel later
Which type of diverticular disorder is a sac-like outpouch or ballooning of the intestinal mucosa through the muscle layer. and acts as a reservoir for trapped fecal material
What is the purpose of a diverticula?
can be a reservoir for trapped fecal material
How is a diverticular disorder diagnosed?
What is the treatment for diverticulitis?
rest the bowel (NPO or clear liquid diet)
Where is a diverticula located?
anywhere in the GI tract except the rectum
primarily in the descending colon and sigmoid
Which diverticular disorder is asymptomatic diverticula in the colon the are NOT inflamed?
Which diverticular disorder is acute inflammatory process occurring in the wall of the sac like diverticular pouches with microperferations causing inflammation and abscess formation of the adjacent tissue?
What are signs and symptoms of a diverticular disorder?
left lower abdominal pain-relieved with BM or passing gas