Presentation on theme: "Care of patients with Gastrointestinal Problems"— Presentation transcript:
1 Care of patients with Gastrointestinal Problems Nursing 1930Brendalyn BrownerMuriel Mitchell
2 GI Focused Assessment Health History Current GI SymptomsPrevious GI ProblemsFamily History of GI ProblemsMedication Use: prescription and OTCDiet and Nutrition (Food Allergies)Use of Alcohol, street drugs, CaffeineBowel Elimination PatternSocial\Cultural Factors
3 GI Focused Assessment Physical Vital SignsHeight and WeightLab and diagnostic test resultsEmesis ,amount, color, consistencyStool,amount, color, consistency, odor.Oral AssessmentAbdominal AssessmentRectal Assessment
4 COMMON “GI OFFENDERS” Caffeine (coffee, tea, cola) Dairy products ChocolatePepper (black and green)AlcoholSpicy foodsTobaccoDrugs
6 GI Charting ExerciseDocument an assessment of the mouth in a person with normal findings.
7 EFFECTS OF AGING Physiologic Changes in the GI Tract MouthTeeth loosen, reduced circulation to gums, teeth darken and fractureDecreased output of salivary glandsDecreased stimulation of taste budsStomachAtrophy of gastric mucosaDecreased secretion of hydrochloric acidDecreased bile secretionDecreased muscle tone and strength
13 Common Causes of Bleeding in the GI Tract EsophagusInflammation (esophagitis)Tear (Mallory-Weiss syndrome)CancerStomachUlcersInflammation (gastritis)Small IntestinesDuodenal ulcerInflammation (Crohn’s disease)Large Intestines and RectumHemorrhoids, infections, inflammation (ulcerative colitis)Colorectal polyps, colorectal cancerDiverticular disease
18 Gastroesophageal REFLUX DISEASE (GERD) Lifestyle Modifications:Avoid fried and fatty foods, garlic and onionsAvoid chocolate, caffeine and alcoholAvoid citrus fruits and juices, tomato products and pepperReduce food portions, eat 2-3 hours before bedtimeLose excess weight, avoid tight clothingRaise the head of your bed with 6-inch blocks
19 Gastroesophageal REFLUX DISEASE (GERD) Nursing Interventions and Patient Education:Offer emotional supportReinforce lifestyle modificationsTeach about prescribed medicationsAdvise patient to sit or stand when taking pills, tablets or capsules and follow with at least 100mL of liquid
21 PEPTIC ULCER DISEASE GASTRIC DUODENAL (80%) Decreased gastric acid secretion.2/3 as many parietal cells.Pain 1/2-1 hour after eating.Not relieved by food.More likely to be malignantPeak age yrsMay cause weight lossHemorrhage, perforation, obstructionDUODENAL (80%)Increased gastric secretion, between meals, after meals, during night.Twice as many parietal cells.Pain 2-3 hours after meal.Relieved by food.Peak age yrsMay cause weight gainHemorrhage, perforation, outlet obstruction, intractability
25 Peptic Ulcer Disease Signs of Complications Signs of PerforationSevere pain in the stomach, shoulders or bothA rigid, boardlike abdomenA flushed sweaty sensationFever and dizzinessSigns of BleedingDizzinessPalenessBloody, black or tarry stoolsCoffee ground vomitusSweating and/or chillsRestlessness/anxiety
28 GI JEOPARDYClients with resection of the ileum are susceptible to this vitamin deficiency
29 Peptic Ulcer Disease: POST-OP COMPLICATIONS Dumping SyndromeVitamin B12 DeficiencyLeaking from suture lineShock and HemorrhageDehiscenceEvisceration
30 Peptic Ulcer Disease: DUMPING SYNDROME SYMPTOMS: ( Weakness, faintness, dizziness, flushing, palpitations, gastric fullness,nausea, cramping pains, diarrhea)TREATMENT: (Teach the patient to eat meals low in simple carbohydrates, Hi in protein and moderate in fat, eat small frequent meals, lie down after eating, fluids only between meals. Sedatives, antispasmodics, surgery)
31 Peptic Ulcer Disease: Nursing Interventions and Patient Teaching Alleviate PainEnsure Adequate NutritionAvoid Fluid Volume DeficitI&ODecrease diarrheaMonitor for bleeding (emesis, stool)Monitor hemoglobin, hematocrit and electrolytesMonitor NG tube drainageMonitor for S&S of complicationsHemorrhage, shock, perforation, gastric outlet obstructionImplement measures to reduce stressPatient teaching related to disease, treatment and procedures
32 Peptic Ulcer Disease: Nursing Diagnoses: Pain R/T Increased Secretion of Gastric AcidDiarrhea R/T Gastrointestinal BleedingAltered Nutrition: Less Than Body Requirements R/T Nausea, Vomiting or Pain or more than body requirements R/T……..Fluid Volume Deficit R/T Gastrointestinal BleedingKnowledge Deficit R/T Management and Treatment of Peptic Ulcer Disease
33 Peptic Ulcer Disease: Outcome-Based Evaluation Pain FreeVital Signs StableFluid Volume MaintainedEnjoys Meals Without PainReports No Weight LossComplies With Treatment RegimenCan Describe Peptic Ulcer Disease, its Treatment and Complications
34 INFLAMMATORY BOWEL DISEASE CROHNS DISEASEAffects any part of the GI tract, all parts of the bowelDiarrhea, non-bloody,mucous and pus, less than 5/dayNot cured by surgeryULCERATIVE COLITISAffects colon and rectumSevere bloody diarrhea with mucus and pus stools per dayCan be cured with surgery, colectomy and ileostomy
35 INFLAMMATORY BOWEL DISEASE (Con’t) CROHNS DISEASE Regional ileitis, Regional enteritis, Crohns ColitisMost often seen in terminal ileum, jejunum, colon, but can occur anywhere in bowelComplications of Crohns can occur outside the bowel, i.e.,arthritis, Inflammatory disorders of the eye, gallstonesULCERATIVE COLITISUsually begins in rectum and sigmoid colon, involves mucosa and submucosaComplications include hemorrhage, fistulas, obstruction, strictures perianal/perirectal abscesses, toxic megacolon, colon cancer
36 GI JEOPARDYIncreased values of this laboratory test finding is normal during fetal life but may indicate colorectal cancer or inflammatory bowel disease in adults.
37 INFLAMMATORY BOWEL DISEASE: DRUG THERAPY AMINOSALICYLICS (contain 5-aminosalicyclic acid or 5-ASA) Sulfasalazine is an anti-inflammatory, olsalazine, mesalamine or balsalazide maybe used in patients allergic to sulfaSULFASALAZINE (azulfadine) sulfa and aspirin like compound, anti-inflammatory, anti-bacterialTOPICAL 5-ASA (Rowasa suppositories or enemas) distal colitisCORTICOSTEROIDS anti-inflammatory, (IV, PO or enema)Immunomodulators azathioprine and 6-mercapto-purine (6-MP) used for patients who do not respond to 5-ASA or corticoids takes 6-months to see benefitsMETRONIDAZOLE (Flagyl) anti-bacterialLOPERAMIDE (Imodium) antidiarrhealBULK AGENTS(Metamucil) To absorb fluid from colon and add bulkINFIXIMAB (Remicade) ( New Drug) a monoclonal antibody with serious side effects
38 Inflammatory Bowel Disease Nursing Diagnoses Diarrhea R\T inflamed intestinal mucosaAltered nutrition: Less than body requirements R\T diarrhea and malabsorptionPain R\T inflamed bowelRisk for ineffective individual coping R\T exacerbations of the disease
39 INFLAMMATORY BOWEL DISEASE Nursing Dx = Diarrhea R/T ……… Nursing InterventionsAdminister medicationsNote # and appearance of stoolsMonitor I&OMonitor lab valuesMake sure pt is near restroom or has bedpan nearProvide perianal care, wipes, topical anestheticsEmpty bedpan immediatelyUse room deodorizerDiet as ordered or TPNMonitor for potential complications, i.e. F&E imbalance,obstruction, abscess, etc.
40 INFLAMMATORY BOWEL DISEASE Outcome-Based Evaluation The Patient:Reports decrease in # of stoolsHas less pain and crampingMaintains fluid balanceMoves toward optimum nutritionCopes successfully with diagnosisUnderstands disease
42 APPENDICITIS Signs and Symptoms may be abrupt! Characterized by pain around the umbilicus but may be generalized abdominal painRebound tendernessLow grade temp,vomiting, nausea, constipationRuptured Appendix
43 APPENDICITIS Treatment and Nursing Intervention No Medical ManagementSurgery ASAP to prevent ruptureNursing InterventionsNPO until surgeryBedrestApply ice pack for comfort, NEVER HEAT!Never give an enema unless ordered by MDAdminister pain med only after diagnosis is made
44 APPENDICITIS Nursing Diagnosis, Outcome-Based Evaluation NURSING DIAGNOSES:Pain R\T InflammationOutcomes = client describes decreased postoperative painRisk for fluid volume deficit R\T vomitingOutcomes = client maintains fluid and electrolyte balanceRisk for InfectionOutcomes = client will receive prompt treatment to prevent rupture, client will not develop infection
45 PERITONITIS Inflammation of the peritoneal membrane Caused by leakage of content from abdominal organs into the abdominal cavityMay be caused by appendicitis, perforated ulcer, diverticulitis, bowel perforations, acute salpingitis, trauma, CAPDS&s= pain, rigid abdomen,rebound tenderness, paralytic ileus, increased temp, pulse, WBCMassive doses of antibiotics initiated early to prevent death from Sepsis
46 CLIENT Able to eat Unable to eat Dietary consult Functional GI tract Nonfunctional GI tractNo aspirationAspirationTotal parenteral nutritionNasogastric tube orGastrostomyorPEGGastrostomyorJejunostomy tubeIntermittent enteral feedingsContinuous enteral feedings
47 GI JEOPARDYThe single most important factor in nutrient deficiencies in the United States
49 STATISTICS: COLON AND RECTAL CANCER The American Cancer Society Reports:Colorectal cancer is the third most common type of cancer in both men and women.It predicts 57, 100 deaths from colon cancer in 2003.105, 500 new cases of colon cancer and 42, 000 new cases of rectal cancer will be diagnosed in 2003.The 5-year survival rate is 90% for people whose cancer is treated in the early stages but only 37% are found in the early stage.Spread to nearby organs or lymph nodes, survival rate is 65%Spread to distant part of the body (liver, lungs), survival rate is only 9%.
50 What is Colorectal Cancer? Cancer develops when cells in a part of the body grow and divide out of control.Colorectal cancer is a disease in which abnormal or malignant cells form in the tissues of the colon, rectum or anus.Most colorectal cancers begin as polyps or adenomas.These polyps may slowly change to cancer after 5-10 years
51 Types of Colorectal Cancers 95% are AdenocarcinomasLess Common Types Are:Carcinoid Tumors - develop from hormone producing cells of the intestines.Gastrointestinal Stromal Tumors – develop in the connective tissue and muscle layers in the wall of the colon and rectum.Lymphomas - are cancers of the immune system cells, usually develop in the lymph nodes but may start in the colon or rectum
52 RISK FACTORS: Colorectal Cancer Family HistoryFamilial adenomatous polyposis (FAP)Hereditary nonpolyposis colorectal cancer (HNPCC)Ethnic BackgroundJews of Eastern European decentPersonal History of:Colorectal cancerIntestinal polypsInflammatory bowel diseaseAgingDietPhysical InactivityObesityDiabetes30-40% increased chance of developing colon cancerSmokingAlcohol
53 Possible Signs/Symptoms Colorectal Cancer Change in bowel habitsBlood in stoolDiarrhea, constipationFeeling of incomplete evacuation of bowelNarrow stoolsGeneral abdominal discomfortFrequent gas, bloating, fullness, crampsWeight lossConstant tirednessVomiting
54 TREATMENT OPTIONS: Colorectal Cancer SURGERYResection/AnastomosisOstomiesCHEMOTHERPYRADIATION THERAPYBIOLOGICAL THERAPYTreatment to stimulate the immune system to fight cancer, also called immunotherapy
56 Care of the patient/client with an Ostomy Before surgeryAfter surgeryCheck the stoma and the skin around it daily during your assessment.A healthy stoma should be shiny, moist and a deep rich red.Monitor the output and stool consistencyPouching and skin carePatient Teaching:MedicationsDiet modificationIrrigations
57 GI JEOPARDYOstomy clients may want to avoid this alcoholic beverage because of excessive odor
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