1. Nursing of Adult Patients with Medical & Surgical Conditions
Gastrointestinal
Disorders
Part I

2. Laboratory & Diagnostic Examinations
Upper GI Series
Rationale
Series of radiographs of the lower esophagus, stomach, and duodenum using barium sulfate as the medium contrast
Nursing Interventions
NPO after midnight
Ensure pt. Expels barium
increase fluid intake
Milk of Magnesia

3. Gastric Analysis Rationale Nursing Interventions
Aspiration of stomach contents to determine the amount of acid produced gy the parietal cells in the stomach, estimate acid secretory capacity for intrinsic factor
Nursing Interventions
No anticholinergic medications for 24 hours before the test
NPO after midnight
No smoking

4. Esophagogastroduodenoscopy (EGD)
Rationale
Direct visualization of the upper GI tract by means of a long, fiberoptic, flexible scope
Assess for disease, remove abnormalities, dilate strictures
Nursing Interventions
NPO after midnight
Informed consent
IV sedative as ordered
Do not allow pt. to eat or drink until gag reflex returns (2-4 hrs)
Assess for s/s of perforation (pain, bleeding)

5. Barium Swallow Rationale Nursing Interventions
Through study of the esophagus using barium contrast
Assess for anatomical abnormalities
Use Gastrografin if perforation is suspected
water soluble and easily absorbed
Nursing Interventions
NPO after midnight
Ensure pt. expels barium
increase fluids
Milk of Magnesia

6. Bernstein Test Rationale Nursing Interventions
Reproduces the symptoms of gastroesophageal reflux
Differentiates esophageal pain from angina
Tube is inserted to the lower esophagus and hydrochloric acid is inserted
Nursing Interventions
NPO for 8 hours prior to test
Hold any antacids and analgesics
No sedation (pt must describe the pain)

7. Stool for Occult Blood Rationale Nursing Interventions
Detect hidden blood in the stool
May be caused from tumors, ulcerations, and inflammation
Nursing Interventions
Stool should be free of urine, toilet paper, etc.

8. Sigmoidoscopy Rationale Nursing Interventions
Visualization of the anus, rectum, and sigmoid colon
May obtain biopsies, remove polyps, or specimens of ulcerations
Nursing Interventions
Informed consent
Enemas the evening before and/or the morning of the exam
Observe for s/s of perforation (pain, bleeding)

9. Barium Enema Rationale Nursing Interventions
Series of radiographs of the colon using barium contrast
Assess for presence of polyps, tumors, and diverticula
Nursing Interventions
Administer cathartics
Magnesium citrate
Cleansing enema the evening before and/or the morning of the exam
Ensure pt. expels barium
Increase fluids
Milk of Magnesia

10. Colonoscopy Rationale Nursing Interventions
Visualization of the colon from anus to cecum
Detection of neoplasms, inflammations, ulcerations, and bleeding
Biopsies can be obtained and small tumors removed
Nursing Interventions
Informed consent
Clear liquid diet 1-3 days prior to exam
NPO 8 hours before exam
Administer cathartic
GoLYTELY
Enemas as ordered
IV sedative as ordered

11. Stool Culture and Sensitivity; Stool for Ova and Parasites
Rationale
Stool examined for bacteria, ova, and parasites
Nursing Interventions
Use only normal saline enemas if required to obtain specimen
Take to lab within 30 minutes

12. Flat Plate of the Abdomen
Rationale
Group of radiographic studies on the abdomen of pts. suspected of bowel obstruction, paralytic ileus, perforation, or abcess
Nursing Interventions
Schedule before any barium studies

13. Dental Plaque and Caries
Etiology/Pathophysiology
Erosive process that results from the action of bacteria on carbohydrates in the mouth, which produces acids that dissolve tooth enamel

14. Dental Plaque and Caries
Cause
Presence of plaque
Strength of acids and ability of saliva to neutralize them
Length of time acids are in contact with the teeth
Susceptibility of tooth to decay

15. Dental Plaque and Caries
Treatment
Removal of affected area and replace with dental material

16. Candidiasis Etiology/Pathophysiology
Infection caused by a species of Candida, usually Candida albicans
Fungus normally present in the mouth, intestine, vagina, and on the skin
Also refered to as thrush and moniliasis

17. Candidiasis Signs and Symptoms
Small white patches on the mucous membrane of the mouth
Thick white discharge from the vagina

18. Candidiasis Treatment Nystatin
oral suspension
vaginal tablets
Half strength hydrogen peroxide/saline mouth wash
Ketoconazole oral tablets
Meticulous handwashing

19. Carcinoma of the Oral Cavity
Etiology/Pathophysiology
Malignant lesions on the lips, oral cavity, tongue, or the pharynx
Usually squamous cell epitheliomas
grow rapidly and metastasize quickly

20. Carcinoma of the Oral Cavity
Signs and Symptoms
Leukoplakia
white, firmly attached patch
on the mouth or tongue
mucosa
Roughened area on the tongue
Difficulty chewing, swallowing, or speaking
Edema, numbness, or loss of feeling in the mouth
Earache, faceache, and toothache become constant

21. Carcinoma of the Oral Cavity
Treatment
Stage I
Surgery or radiaiton
Stage II & III
Both surgery and radiation
Stage IV
palative

22. Carcinoma of the Esophagus
Etiology/pathophysiology
Malignant epithelial neoplasm that has invaded the esophagus
90% are squamous cell carcinoma associated with alcohol intake and tobacco use
6% are adenocarcinomas associated with reflux esophagitis
Other causes are environmental carcinogens, nutritional deficiencies, chronic irritation, and mucosal damage

23. Carcinoma of the Esophagus
Signs & Symptoms
Progressive dysphagia over a six month period
Sensation of food sticking in throat

24. Carcinoma of the Esophagus
Treatment
Radiation
May be curative or pallative
Complication
Fistula formation may cause aspiration
Surgery
may be palliative, increase longevity, or curative
Types of Surgical Procedures
Esophagogastrectomy: remove a portion of the esophagus and stomach
Esophagogastrostomy: remove a portion of the esophagus with anastomosis to the stomach
Esophagoenterostomy: remove the esophagus with anastomosis to the colon
Gastrostomy: insertion of a feeding tube into the stomach through the abdominal wall

25. Esophagoenterostomy
Esophagogastrostomy

27. Achalasia Etiology/Pathophysiology
Inability of the cardiac sphincter of the stomach to relax
Also called cardiospasm
Possible causes: nerve degeneration, esophageal dilation, and hypertrophy

28. Achalasia Signs and Symptoms Dysphagia Regurgitaion of food
Substernal chest pain
Loss of weight
Poor skin turgor
Weakness

29. Achalasia Treatment Medications Dilation of cardiac sphincter Surgery
Anticholinergics, nitrates, and calcium channel blockers
Dilation of cardiac sphincter
Balloon is inflated and remains in place for 1 minute; 1-2 times
Surgery
Cardiomyectomy
Incision of the muscular layer

30. Acute Gastritis Etiology/Pathophysiology
Inflammation of the lining of the stomach
May be associated to alcoholism, smoking, and stressful physical problems
Usually a single occurance, resolving when offending agent is removed

31. Acute Gastritis Signs and Symptoms Fever Epigastric pain Nausea
Vomiting
Headache
Coating of the tongue
Loss of appetite

32. Acute Gastritis Treatment Antiemetics Antacids & Tagamet or Zantac
Compazine
Tigan
Antacids & Tagamet or Zantac
Antibiotics
IV fluids
NG tube and administration of blood, if bleeding
NPO until s/s subside

33. Peptic Ulcers Gastric Ulcers & Duodenal Ulcers
Ulcerations of the mucous membrane or deeperstructures of the GI tract
Most commonly occur in the stomach and duodenum
Result of acid and pepsin imbalances
Excess of gastric acid or
Decrease in protection from acid and pepsin
H.pylori
Bacterium found in 70% of pts. with gastric ulcers and 95% of pts. with duodenal ulcers

34. Peptic Ulcers (Gastric)
Etiology/Pathophysiology
Most common site is the distal half of the stomach
Risk factors:
Irregular diet
Genetic predisposition
Excessive use of salicylates
Use of tobacco
H.pylori
Gastric mucosa is damaged, acid is secreted, mucosa errosion occurs, and an ulcer develops

35. Peptic Ulcers (Duodenal)
Etiology/Pathophysiolosy
Excessive production or release of gastrin
Increased sensitivity to gastrin
Decreased ability to buffer the acid secretions
Risk factors:
H.pylori
NSAID’s
Smoking
Coffee

36. Peptic Ulcers (Gastric & Duodenal)
Signs & Symptoms
Pain
Dull, burning, boring, or gnawing
Epigastric
Occurs between meals with gastric ulcers
Duodenal ulcer pain may awaken pt. at night
Dyspepsia
Nausea, eructation, and distention
Hematemesis
Melena

37. Peptic Ulcers (Gastric & Duodenal)
Treatment
Antacids
Neutralize or reduce the acidity of the stomach
Maalox, Gaviscon, Rolaids, Tums, Mylanta, Riopan
Histamine H2 Receptor Blockers
Decrease acid secretion by blocking the histamine H2 receptors
Tagamet, Zantac, Pepcid, and Axid
Proton Pump Inhibitor
Antisecretory agent ot inhibit secrtion of gastrin by the parietal cells of the stomach
Prilosec, Losec, and Prevacid

38. Peptic Ulcers (Gastric & Duodenal)
Mucosal Healing Agents
Heal ulcers without antisecretory properties
Adhere to the proteins in the ulcer base
Carafate and Cytotec
Antibiotics
Eradicates H.Pylori
Flagyl, tetracycline, amoxicillin, and Biaxin
Usually combined with some of the other medications

39. Peptic Ulcers (Gastric & Duodenal)
Diet
High in fat and carbohydrates
Low in protein and milk products
Small frequent meals
Limit coffee, tobacco, alcohol, and aspirin use

40. Peptic Ulcers (Gastric & Duodenal)
Surgery
Antrectomy
Removal of entire antrum(gastric producing portion of the lower stomach)
Gastrodudodenostomy (Billroth I)
Fundus of the stomach is directly anastomosed to the duodenum
Gastrojejunostomy (Billroth II)
Duodenum is closed, and the fundus of the stomach is anastomosed into the jejunum

41. Billroth Procedures

42. Peptic Ulcers (Gastric & Duodenal)
Total Gastrectomy
Removal of the entire stomach
Vagotomy
Removal of the vagal innervation to the fundus
Decreases acid production
Pyloroplasty
Surgical enlargement of the pylorus to provide drainage of the gastric contents

43. Peptic Ulcers (Gastric & Duodenal)
Complications
Dumping Syndrome
Rapid gastric emptying causing distention of the duodenum or jejunum produced by a bolus of hypertonic food
Increased intestinal motility and peristalsis and changes in blood glucose levels
Diaphoresis, nausea, vomiting, epigastric pain, explosive diarrhea, borborygmi (noises from gas), and dyspepsia

44. Peptic Ulcers (Gastric & Duodenal)
Dumping Syndrome
Treatment
Six small meals a day
Diet high in protein and fat, low in carbohydrates
No fluids during meals
Anticholenergics
Lying down for approximately 1 hour after meals

45. Peptic Ulcers (Gastric & Duodenal)
Pernicious Anemia
Caused by a deficiency of the intrinisic factor
Aids in absorption of Vitamin B12
Treatment
Vitamin B12 Injections
Iron Deficiency Anemia
Caused by impaired absorption in the duodenum and jejunum as a result of rapid gastric emptying
Oral iron replacement
Ferrous sulfate

46. Cancer of the Stomach Etiology/Pathophysiology
Most commonly adenocarcinoma
Primary location is the pyloric area
Risk Factors:
History of polyps
Pernicious anemia
Hypochlorhydria
Gastrectomy
Chronic gastritis
Gastric ulcer
Diet high in salt, perservatives, and carbohydrates
Diet low in fresh fruits and vegetables

47. Cancer of the Stomach Signs & Symptoms
Early stages may be asymptomatic
Vague epigastric discomfort or indigestion
Postparandial fullness
Ulcer-like pain that does not respond to therapy
Anorexia
Weakness
Weight loss
Blood in stools
Hematemesis
Vomiting after fluids and meals

48. Cancer of the Stomach Treatment Surgery Chemotherapy
Partial or total gastric resection
Post-Op Complications
Dehiscence
Separation of wound edges
Evisceration
Viscera protrudes through the wound
Caused by coughing, straining, malnutrition, obesity, and infection
Nursing Interventions: Pt. should remain quite and calm, position with knees bent and semi-fowlers postion, cover eviseration with a warm sterile saline soaked dressing
Chemotherapy
Chemotherapy and radiation

49. Infection of the Intestines
Etiology/Pathophysiology
Invasion of the alimentary canal by pathogenic microorganisms
Most commonly enters through the mouth on food or water
Person to person contact
Fecal-Oral transmission
due to poor handwashing
Long-term antibiotic therapy can cause an overgrowth of the normal intestinal flora (c.difficile)

50. Infection of the Intestines
Signs & Symptoms
Diarrhea
May contain blood and mucus
Rectal urgency
Tenesmus
Ineffective and painful straining with defecation
Nausea & vomiting
Abdominal cramping
Fever

51. Infection of the Intestines
Treatment
Antibiotics
Stool postive for leukocytes
Fluid and electrolyte replacement
Oral or IV
Kaopectate
Increase stool consistency
Pepto-Bismol
Decrease intestinal secretions and decrease diarrhea

52. Irritable Bowel Syndrome
Etiology/Pathophysiology
Episodes of alteration in bowel function
Low pain threshold to intestinal distention caused by abnormal intestinal sensory neural circuitry
May be associated with psychological problems
Spastic and uncoordinated muscle contractions of the colon, usually due to excessively course or highly seasoned foods

53. Irritable Bowel Syndrome
Signs & Symptoms
Abdominal pain
Relieved after bowel movement
Frequent bowel movements
Sense of incomplete evacuation
Flatulance
Constipation and/or diarrhea

54. Irritable Bowel Syndrome
Treatment
Diet and Bulking Agents
Increase dietary fiber
Administer fiber agents
Avoid food which cause exacerbation
Medications
Anticholinergics
Relieve abdominal cramps
Milk of Magnesia, fiber, or mineral oil for constipation
Opioids for diarrhea
Antianxiety drugs for panic attacks