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NURS 3525- Gastrointestinal Disorders Exam Latest Update
Most common manifestation of a GI problem nausea complications from nausea dehydrated, electrolyte imbalance, metabolic alkalosis treatment focus for nausea identify underlying cause and complications assessment for nausea precipitating factors, content of emesis, time common predicating factors with nausea pregnancy, injury to the brain, gallbladder, MI, medications, motion sickness types of emesis content bright red color, coffee ground like, partially digested food positioning for pt who is unable to move independently with nausea side lying or high fowlers S/S of GERD
- burning sensation in throat/chest
- chest pain
- vomiting
- difficulty swallowing
- feel like lump is in throat
- chronic cough
- laryngitis
- new/worsening asthma
- disrupted sleep risk factors for GERD obesity, distal hernia, pregnancy, connective tissue disorder, delayed stomach emptying things that aggravate GERD alcohol, smoking, aspirin, fast food, eating late at night pyrosis heartburn Bretz esophagus damage to the esophagus causing changes in the cell and increasing risk for cancer T/F dentation can be effected by GERD true diagnostics for GERD patient experience, endoscopy
management for hiatal hernia lifestyle modifications, reduce intraabdominal pressures, avoid lifting/straining, surgical options Peptic Ulcer Disease (PUD) erosion of the GI mucosa from the digestive action of HCl acid and pepsin types of peptic ulcer disease acute, chronic, gastric, duodenal Acute PUD Superficial erosion Minimal inflammation Short duration, resolves quickly when cause is identified and removed Chronic PUD Long duration—present continuously for many months or intermittently More common than acute erosion Gastric PUD location is in the stomach Duodenal PUD location is in the duodenal Causes of PUD H. pylori and NSAIDs, and smoking Clinical Manifestations of duodenal ulcers Discomfort below diploid process, may cause back pain Pain is "burning" or cramp like S/S occurs 2 - 5 hours after eating S/S occur when gastric acid comes in contact with ulcers Food may act as buffer for pain
S/S may be weeks - months Epigastric pain Clinical manifestations of Gastric Ulcers High epigastric discomfort Pain is "burning" or "gaseous" 1 - 2 hours after meals Food exacerbates pain
- early S/S may be due to a serious complication diagnostics for PUD endoscopy, H. pylori testing (biopsy, serology, stool, breathing test) management for PUD rest, medication, smoking cessation, diet modification medication for PUD antibiotics for H. pylori infection PPIs cytoprotectives H2 receptor blockers antacids teaching for endoscopy NPO 8 hours before, signed consent is needed light, not full sedation don't allow food until gag reflex has returned post-procedure complications with PUD GI bleeding, perforation, gastric outlet obstruction S/S of perforation side dramatic increased pain, no bowel sounds, tenderness in palpation of abdomen, N/V, weaker pulses
prevention of respiratory complications post-op incentive spirometer, respiratory assessments, encourage splinting, early ambulation When to call doctor about blood in NG tube after surgery? When it is more than 75 ml/hour Gastritis Inflammation of the stomach S/S of gastritis Abdominal pain, heaviness in stomach, decreased appetite, heartburn Causes of gastritis Pours in food, medications used uncontrollably, H. pylori, alcohol Tx for gastritis Rest, NPA, iv fluids, N/V medications Diarrhea 3 loose or liquid stools per day Types of diarrhea Viral, bacterial, parasitic, food intolerances Labs for diarrhea Na+, basic metabolic panel, CBC, WBD, stool cultures
interventions for diarrhea H&P, maintain adequate fluid, antidiarrheal medications, infection control measures, monitor for skin breakdown C.diff Clostridium difficile. antibiotics wipe out the normal flora and C.diff takes resident in GI tract S/S of C.diff N/V, cramping, abdominal pain, spores Tx for C.diff oral vancomycin fecal incontinence involuntary loss of stool interventions for fecal incontinence H&P, bowls management, high fiber diet, bulk forming laxatives, skin assessment, offer support what skin condition is related to fecal incontinence? incontinence associated dermatitis (IAD) biofeedback therapy for fecal incontinence electrical stimulation to encourage continence
abdominal distention excessive flatus diarrhea or constipation mucus in the stool types of IBS IBS-C (constipation) IBS-D (diarrhea) IBS-M (mixed) IBS-undefined management of IBS H&P, dietary changes, lifestyle changes, probiotics, antispasmodics diagnostics for acute abdominal pain physical assessment, CBC, UA, abdominal x-ray, ultrasound, CT, pregnancy test acute abdominal pain clinical manifestations pain, N/V/D/C, passing gas, lethargy, fever, rebound tenderness, distension goal of acute abdominal pain tx identify and treat cause, while monitoring/tx complications assessment for acute abdominal pain VS, I/O, mentation, inspection of abdomen, palpation, pain management of post-op laparotomy NG tube output, N/V management, monitor VS, abdominal distention S/S of appendicitis dull periumbilcal pain, anorexia, N/V, McBurney point pain, low grade fever, rigid
abdomen, rebound tenderness, muscle guarding diagnostics for appendicitis elevated WBCs, UA, CT scan management of appendicitis prevent fluid volume deficit, manage pain, prevent complications causes of peritonitis
- ruptured appendix
- ruptured diverticulum
- trauma
- peritoneal dialysis
- ruptured peptic ulcer
- gastric perforation diagnostics for peritonitis CBC, abdominal x-ray, ultrasound/CT scan clinical manifestation of peritonitis
- severe, continuous abdominal pain
- rebound tenderness
- rigid abdomen
- movement worsens pain
- abdominal distention
- VS changes
- N/V inflammatory bowel disease (IBD)
contributing factors of diverticulitis lack of fiber and constipation, lifestyle factors clinical manifestations of diverticulitis abdominal pain, bloating, farting, change in bowel habits, may have bleeding, acute pain, distention, N/V management of diverticulitis colon rest, clear liquids or NPO, fluids, antibiotics, tx systemic symptoms (fever), surgery if indicated hernias loop of bowel extended through abdominal muscle wall diagnostics for hernias H&P, US/CT/MRI celiac disease autoimmune disease triggered by wheat, rye, barley clinical manifestation for celiac disease foul smelling diarrhea, abdominal pain and distention, farting, malnutrition, joint pain, osteoporosis, anemias, rashes, fatigue, peripheral neuropathy nursing care of celiac disease
- Gluten free diet
- support the pt
lactase deficiency lack of enzyme to break down lactulose clinical manifestations of lactase deficiency bloating, flatulence, cramping, abdominal pain, diarrhea nursing care for lactose deficiency avoid milk products, OTC lactic products, read nutritional labels Short bowel syndrome inadequate surface area of the small bowel to absorb nutrients from damage to mucosal lining, surgical resection, or congenital defect nursing care for short bowel syndrome
- maintain adequate nutrition/hydration
- TPN via central line
- enteral feedings via nasogastric or gastrostomy tube S/S of short bowel syndrome Fatigue, diarrhea, dehydration, weight loss, abdominal pain, malabsorption, anemia.
