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

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Presentation on theme: "Nursing of Adult Patients with Medical & Surgical Conditions Gastrointestinal Disorders Part I."— Presentation transcript:

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 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 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 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 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 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 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 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 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 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 NSAIDs 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 H 2 Receptor Blockers Decrease acid secretion by blocking the histamine H 2 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 Treatment –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 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

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