GI (Callahan)

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NurseFaith
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269674
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GI (Callahan)
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2014-04-07 22:28:35
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GI (Callahan)
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  1. Subjective Data for Diagnosing of GI disorders
    • •Past Medical History
    •    -GI disorders
    •    -Hepatic/biliary disorders
    •    -Anemia
    •    -Other medical problems

    • •Family History
    •    -Autoimmune diseases
    •    -GI Cancer
    •    -Genetic disorders

    • •Medication
    •    -Current or prior tx for ulcer
    •    -Hepatotoxic drugs
    •    -NSAIDs, ASA, APAP
    •    -Goody, etc. powders
    •    -Herbals/supplements
    •    -Laxative/antacid use

    • •Surgical procedures
    •    -GI diagnostic procedures

    • •Social History:
    •    -ETOH use
    •    -Illicit drug use
    •    -Tobacco
    •    -caffeine

    • •Nutritional status
    •    -Change in appetite
    •    -Typical diet, eating patterns
  2. Review of Symptoms (Assessment for GI disorders) for subjective data
    • •Abdominal pain
    •    -Severity, location, duration, character, alleviating and exacerbating factors
    •    -Associated factors
    • •N/V
    •    -What foods tolerated?
    • •Change in bowel patterns
    •    -What is patient’s baseline normal?
    •    -Diarrhea
    •    -Constipation
    •    -Different appearance of stool
    • •Hematemesis/Melena/Hematochezia
    • •Anemia
    • •Jaundice
    • •Swelling or protrusion
    • •Bloating
    • •Increased flatulence
    • •Unplanned weight gain/loss
  3. What to look for/do in oral assessment: (objective data)
    • •Mouth
    •    -Moist/dry
    •    -Lesions/ulcers
    •    -Dentition
    •    -Gingival tissue (gums)
    •    -breath

    • •Older Adults
    •    -Decreased moisture
    •    -Gingival atrophy
  4. What to look for/do in abdominal assessment
    •Inspect

    • •Auscultate
    •    -4 quadrants
    •    -Bowel sounds:
    •        Normoactive
    •        Hypoactive
    •        Hyperactive (borborygmi)
    •        Absent bowel sounds
    •    -Always listen 5 minutes to verify
    • •Light palpation
    •    -Tenderness
    •    -Masses
    •    -Swelling
    •    -Fluid wave sometimes if ascites

    • •Deep palpation
    •    -abdominal organs and masses
    •    -Rebound tenderness

  5. Nursing Considerations for Diagnostic Studies:
    • •Requirements
    •    -NPO? How long?
    •    -Informed consent?
    •    -Contrast?
    •    -Bowel prep?

    • •Special considerations
    •    -older adult
    •    -diabetic
    •    -hydration status
  6. Radiologic Diagnostic Studies for GI disorders
    • Upper GI series (with or without small bowel follow-through)
    •    -Barium swallow
    • Lower GI series (barium enema)
    • Abdominal ultrasound
    • CT scan
    • MRI
    •    -Virtual colonoscopy
  7. Endoscopic Studies for GI disorders
    • •Assess, diagnose and treat
    • •Informed consent necessary
    • •Main complication is perforation
    • •Most require
    •    -IV conscious sedation

    • •Endoscopic procedures
    •    -EGD
    •    -ERCP
    •    -Colonoscopy
    •    -Capsule endoscopy
  8. Other Diagnostics for GI disorders
    • Barrium Swallow
    • •Manometry
    •    -Lower esophagus
    • •Esophageal pH monitoring
  9. Span of the Upper GI disorders
    Mouth to Duodenum
  10. Gastritis
    • Inflammation of the gastric mucosa
    •    -Acute or Chronic
    •    -Diffuse or Localized
  11. Causes of Gastritis
    • •Drug Related- NSAIDS, ASA, Corticosteroids
    • •ETOH
    • •Diet- Spicy Foods
    • •Smoking
    • •Radiation
    • •Bacteria, such as Helicobacter pylori  (H. pylori)
    • •Autoimmune Atrophic Gastritis
    • •Viral
  12. Manifestations of Gastritis
    • -Nausea
    • -Vomiting
    • -Anorexia
    • -Epigastric Pain
    • -Fullness and bloating
    • -Bleeding can occur if severe
  13. Management of Acute Gastritis
    • Re-hydrate and rest the gastric mucosa
    • •NPO, advancing diet as tolerated
    • •IV Fluids for hydration
    • •NG Tube may be needed to decompress
  14. Medications for Acute Gastritis
    • Treat symptoms and reduce gastric mucosa irritation
    • •Antiemetic
    • •Antacids
    • •Proton Pump Inhibitors (PPIs)
    • •Histamine 2 Receptor Blockers (H2R blockers)
  15. Medications for Chronic Gastritis
    • Eradicating H. pylori: H. Pylori Treatment Regimen
    • •Triple Therapy (7-10 days)
    •    -Omeprazole, Amoxicillin, Clarithromycin
    •    -Bismuth subsalicylate, tetracycline, omeprazole
    •    -Lansoparole, clarithromycin, amoxicillin
    • •Quadruple Therapy (10-14 days)
    •    -Bismuth subsalicylate, metronidazole, tetracycline, omeprazole

    • Treating pernicious anemia
    •    •B12
  16. Complications of Gastritis
    • •Exacerbations
    • •Pernicious Anemia
    • •Gastric Cancer
  17. Nursing Management for Gastritis
    • •Prevention Education
    • •Diet Modification
    • •Smoking Cessation
    • •CBC Monitoring
    • •Drug Regimen Adherence
    • •Encourage Rest
    • •Support
  18. Peptic Ulcer Disease
    • -Can be gastric, duodenal or esophageal
    • -Duodenal most common area
    • -Causative factors:
    •    NSAIDS/ASA use (decreases secretion of mucus that protects against gastric HCL)
    •    H. pylori infection
    •    Stress ulcers – caused by physiologic stress
    • (Why many hospitalized patients are prescribed a PPI)
  19. Manifestations of Gastric Peptic Ulcers
    • •Burning or gaseous pressure in epigastrium, back, and/or upper abdomen
    • •Pain immediately after eating
    • •Nausea
    • •Vomiting
    • •Less common to have relief from pain by eating or taking antacid
  20. Manifestations of Duodenal Peptic Ulcer
    • •Burning and cramping pain in midepigastrium and/or back
    • •Pain 2-4 hrs after meals
    • •Nighttime awakening with pain common
    • •More likely to have relief from eating/antacids
  21. Management of Peptic Ulcer Disease
    • Pain Control
    • NPO
    • Clear Liquids/ Bland Diet
  22. Medications for Peptic Ulcer Disease
    • •H. pylori Regimen
    • •Antacids
    • •H2- blockers
    • •PPIs
    • •Cytoprotective- sucralfate (Carafate) and bismuth subsalicylate (Pepto-Bismol)
  23. Major Complication of Peptic Ulcer Disease
    • GI Bleeding:
    • •Hematemesis (coffee ground) or melena (stool)
    • •Monitor H/H, VS
    • •NG insertion may be necessary
    • •Endoscopic evaluation
    • •Potential for shock
  24. Complications of Peptic Ulcer Disease
    • GI Bleeding
    • Perforation
    • Gastric Outlet Obstruction
  25. Perforation Identification/Treatment
    • •Sudden/severe abd pain, may radiate to rt shoulder
    • •Boardlike abdomen
    • •Tachycardia, hypotension
    • •Chemical peritonitis » bacterial peritonitis
    • Immediate surgical intervention
  26. Patient Education for Peptic Ulcer Disease
    • •Smoking Cessation
    • •Stress Management
    • •Diet
    • •Medication Adherence
    • •Pre and post-op Teaching
  27. Gastric Outlet Obstruction Identification/Treatment
    • •Distal to pyloric sphincter
    • •Spasm, edema or scar tissue
    • •N/V, constipation, epigastric fullness, anorexia
    • •NG tube to decompress stomach
    • •Manage fluid/electrolyte balance
    • •Endoscopy or surgery may be necessary to manage
  28. Upper GI Disorders
    • Gastritis
    • Peptic Ulcer Disease
  29. Constipation Identification/Treatment
    • •Decrease in stool frequency from normal pattern
    • •Hard stools, straining to pass stool
    • •Abdominal discomfort
    •    -often “perceived” by individual
    • •Inactivity, inadequate fiber intake, aging contribute
    • •“functional” or idiopathic when no medical cause
    • •Chronic laxative use can contribute
    • •Impaction may result
  30. Diarrhea Identification/Treatment
    • •Increase in number, volume or liquidity of movements
    • •IBS, IBD, food intolerances (ex. Lactose) as causes
    • •Also infectious causes
    • •Antibiotic-related diarrhea (C. difficile)
    • •Manage fluid and electrolyte balance
    • •Chronic diarrhea can lead to metabolic acidosis
    • •r/t bicarbonate loss
    • •Skin assessment important! Excoration risk
  31. Irritable Bowel Syndrome Identification/Treatment
    • •IBS-D, IBS-C, or IBS-A
    • •Chronic functional bowel disorder
    • •“Diagnosis of exclusion”, Rome Criteria
    • •Relationship to stress/anxiety
    • •Nursing management: symptom management
    • •Food/symptom diary may be helpful
  32. Malabsorption Disorders Identification/Treatment
    • •Multiple causes
    • •Often frequent, loose, bulky, foul-smelling stools
    • •Fatty stools…may float (steatorrhea)
    • •Also abd distension, discomfort, flatus, weight loss
    • •If not diagnosed and treated can lead to malnutrition
  33. Appendicitis Manifestations
    • Inflammation of the appendix
    • Peri-umbilical Pain and/or RLQ Pain
    • Anorexia
    • Nausea
    • Vomiting
    • May have fever
    • Local and rebound tenderness
  34. Clinical Management Prior to Appendicitis Rupture:
    •NPO

    •Pain Control

    •Appendectomy

    •Assess & re-assess Pain

    •Enforce NPO Status

    •Pre and Post-op Teaching

    •Post-op Ambulation
  35. Complication of Appendicitis
    • Perforation
    •    •Peritonitis
    •    •Abscess

    • Management
    • •Antibiotic therapy
    • •IV Hydration therapy
    • •Appendectomy
  36. A dilation or outpouching of the mucosathrough the smooth muscle of the intestinal wall (Diverticular Disorders)
    • •Diverticulosis- non-inflamed diverticula
    • •Diverticulitis- infection
    •    -Sigmoid colon most common
  37. Manifestations of DiverticuLOSIS
    • •Mostly Asymptomatic
    • •Often chronic constipation
    • •No evidence of inflammation
    • •Progression to diverticulitis
  38. Manifestations of DiverticuLITIS
    • •Abdominal Pain – may be severe
    • •N/V
    • •Fever, may have chills
    • •Leukocytosis
  39. Complications of Diverticulitis
    • •Perforation
    • •Peritonitis
    • •Abscess
    • •Fistula
    • •Bowel Obstruction
    • •Urethral Obstruction
    • •Bleeding
  40. Causes of Peritonitis
    • -Bacterial, fungal, mycobacterial
    • -Trauma
    • -Bowel perforation, ruptured appendix or diverticulitis, perforated ulcer (ALL bacterial
    • perforation)
  41. Manifestations of Peritonitis
    • Rigid abd, rebound tenderness, pain, ileus
    • Fever
    • Elevated WBC
    • Can lead to sepsis, shock
  42. Management of Peritonitis
    drain infection, monitoring
  43. Inflammatory Bowel Diseases
    • -Crohn’s Disease and Ulcerative Colitis
    • (Autoimmune diseases...Family history of Crohns/UC/other autoimmune dz)
  44. Manifestations of Ulcerative Colitis
    Inflammation of colon and rectum

    •Continuous inflammation

    •Involvement ranges from anorectal area to entire colon (pancolitis)

    •Exacerbations

    •Bloody diarrhea

    •Abdominal Pain

    •Removal of colon curative if pancolitis
  45. Manifestations of Chrohn's
    • Occurs anywhere in the GI tract
    • “skip lesions”
    • Diarrhea – may be bloody
    • Colicky Abdominal Pain
    • Weight Loss
  46. Complication of Chrohn's Disease
    • Inflammation of colon and rectum
    • •Perineal Abscess
    • •Fistulas
    • •Small Bowel Cancer
  47. Clinical Management for Inflammatory Bowel Diseases
    •Rest Bowel

    •Control Inflammation

    •Prevent Infection

    •Correct Malnutrition

    •Prevent Stress

    •Treat Symptoms

    •Improve Quality of Life

    •Medications

    •Surgery
  48. Medications used for Chrohn's and UC
    • Aminosalicylates
    •    (Orally for Crohn’s)
    •    Pentasa, Asacol
    •    (May be administered rectally in UC (Rowasa)

    Corticosteroids

    • Immune modulators – severe Crohn’s
    •    Remicade 
    •    6-mercaptopurine (6-MP)
    •    Aziothrapine (Imuran)
  49. Nursing Implications for Inflammatory Bowel Disease
    • •Medication Adherence
    • •Hydration
    • •Pre and Post-op Teaching
    • •Emotional Support
    • •Pain Control
    • •Encourage Rest
    • •Maintaining normal elimination
    • •Pain control
    • •Fluid balance
    • •Promoting rest
    • •Preventing skin breakdown
    • •Enhancing coping/reducing anxiety
    • •Teaching self-care measures
  50. Surgical Interventions for IBD
    • •Following total colectomy:
    •    •Ileostomy
    •    •Ileal pouch anal anastomosis
    •    •Kock pouch ileal reservoir – drained by catheter
  51. Resources for Pt with IBD
    • •www.ccfa.com – Crohn’s and Colitis Foundation of America
    • •Advocacy
    • •Patient education
  52. Pre-Op Care for Stoma Pt
    Marking stoma site by WOC nurse or surgeon

    Low residue diet

    Preoperative teaching on what to expect from surgery, immediately postop and with stoma

    Allow patient to verbalize feelings and ask questions

    Involve S/O and/or family in education

    Patient may have concerns about body image/sexuality
  53. Post-Op Care for Stoma Pt
    •General post-surgical care

    •Pain management

    •Monitor stoma site – stoma should be shiny and pink to red in color

    •Fecal drainage begins 24-48 h after surgery

    •Indwelling catheter drainage for 2-3 weeks after Kock pouch

    •I & O strictly monitored
  54. Occurs when a blockage prevents intestinal contents from passing through GI tract
    Intestinal Obstruction
  55. Types of Intestinal Obstructions
    • •Mechanical or Non-mechanical
    •    •Hernia
    •    •Neoplasms
    •    •Adhesions
    •    •Neurologic or neuropathic (DM, MD)

    • •Fluid, gas and intestinal contents accumulate above obstruction
    • •Can eventually result in rupture or perforation
  56. Manifestations of an Intestinal Obstruction
    •Cramping abd pain r/t peristalsis

    •No flatus or stool passed

    •Vomiting

    •Abdominal distension

    •Severe fluid loss/electrolyte imbalance
  57. Nursing Management of Intestinal Obstruction
    •Patient NPO

    •NG tube for decompression

    •Maintain IV fluid therapy as ordered

    •Strict I & O including IV fluids, NG drainage, urine

    •Monitor electrolytes, WBC, VS

    •Measuring abdominal girth may be necessary

    •Pain Control

    •High fiber/ fruits and vegetables

    •Decrease red meat and fat

    •Stool softeners

    Pre and post-op teaching
  58. Clinical Management for intestinal obstruction
    •Pain Control

    •Antibiotics

    •NPO

    •IV Fluids

    •NG Tube

    •Bed rest

    •Surgery- Colon resection
  59. A protrusion of an organ or part of an organ through the wall that usually contains it
    • Hernia
    •    •Umbilical
    •    •Inguinal

    •Commonly hernias involve a loop or section of colon

    •Reducible hernia – able to push back into place manually

    • •Warning signs
    •    -Irreducible
    •    -Warmth, redness or other signs of infection
  60. Complications of Hernia
    Strangulation

    •Acute Intestinal Obstruction

    •Decrease in Blood Flow

    •Severe Pain/ Cramping

    •Necrosis

    •Vomiting

    •Distension
  61. Pre-Op care for hernia patient
    •Truss

    •Skin breakdown

    •Education
  62. Post Op Care for Hernia Pt
    •Education

    •Bladder Checks

    •Ostomy Care

    •Deep breathing only

    •Splinting

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