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West Coast University BSN Program NURS 120 . Medical Surgical Nursing Gastrointestinal System - Gastroesophageal Reflux Disease Gastroenteritis Constipation Hemorrhoids Diarrhea. Anatomy of Gastrointestinal system . The GI System.

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west coast university bsn program nurs 120

West Coast University BSN Program NURS 120

Medical Surgical Nursing

Gastrointestinal System

- Gastroesophageal Reflux Disease

Gastroenteritis

Constipation

Hemorrhoids

Diarrhea

the gi system
The GI System
  • Tube approximately 30 feet ( 9 meter) long from mouth to the anus.
  • Innervated by parasympathetic ( excitatory) and sympathetic nervous system (inhibitory) of the ANS.
  • Enteric Nervous system – GI tract own nervous system that contains numerous neurons and has the ability to control movement and secretion of the GI tract.
  • Two types of movements of the GI tract – mixing (segmentation) and propulsion (peristalsis).
  • Blood Supply- Upper GI receives blood from

Splanchnic artery.

Blood draining the GI tract empties into the

portal vein, then perfuse to liver.

Small intestine receives from hepatic and

superior mesenteric arteries.

Large intestine receives from superior and inferior

mesenteric arteries.

the gi system1
The GI System
  • Secretions of GI systems – enzymes, hormones for digestions, mucus to provide protection and lubrication, and water and electrolytes.
  • Physiology (Functions)

- Ingestion and Propulsion of food (Mouth, Pharynx and Esophagus).

- Digestion and Absorption (Mouth, Stomach, Small Intestine)

- Elimination (Large Intestine)

gi system physiology
GI System Physiology
  • Ingestion and Propulsion of food- intake of food.

Saliva is use for food lubrication.

Mechanical breakdown of food.

  • Digestion – begins in the mouth, in the stomach the

digestion of protein begins with the

release of pepsinogen turn to pepsin.

-Food stay in the stomach 3-4 hours.

- When food enters stomach and small

intestine,hormones are release into the

bloodstream.

- Digestion is complete at the small

intestine. Bile is necessarry for digestion of

fats.

- Cholecystokinin – stimulates pancrease to

synthesize and secretes enzymes for digestion of

carbohydrates, fats and protein.

gi system physiology1
GI System Physiology
  • Digestion – Enzyme present at the microvilli

completes digestion process. These

enzymes hydrolyze disaccharides to

monosaccharides and peptides to amino

acids for absorption.

  • Elimination – large intestine is responsible for

absorption of water and electrolytes.

Large intestine also serve as reservoir for

fecal mass until defecation occurs.

Defecation is a reflex action involving

voluntary and involuntary control.

Defecation can be facilitated by Valsalva

Maneuver. This maneuver involves contracation

of the chest muscles on a close glottis with

simultaneous contraction of the abdominal

muscle.

gi system physiology2
GI System Physiology
  • Valsalva Maneuver increases intraabdominal

pressure. Maybe contraindicated in a client

with head injury, eye surgery, cardiac

problems, hemorrhoids, abdominal

surgery,or liver cirrhosis.

  • Constipation – is common in the older adult and is due to many factors including slower peristalsis, inactivity, decreased dietary fibers, decreased fluids, depression, constipating medications, and laxative abuse.
gi secretions related to digestion page 929
GI Secretions Related to Digestion page 929
  • Salivary Glands – Salivary amylase, Pepsinogen
  • Stomach- HCl acid, Lipase, Intrinsic Factor
  • Small Intestine - Enterokinase, Amylase, Peptidases,

Aminopeptidases, Maltase, Sucrase,

Lactase, Lipase

  • Pancrease - Trypsinogen, Chymotrypsin,

Amylase, Lipase

  • Liver and Gallbladder - Bile
factors that affects the gi system functioning
Factors that affects the GI System Functioning
  • Main function – supply nutrients to body cells.
  • Factors outside GI system can influence its functioning e.g. stress and anxiety.
  • Stress can be experienced as anorexia, epigastric pain and abdominal pain.
  • Physical factors that affect GI functioning includes dietary intake, ingestion of alcohol and caffeine containing products, cigarette smoking, poor sleep, and fatigue.
gerontologic considerations effects of aging on the gi system
Gerontologic Considerations : Effects of Aging on the GI System.

Expected Aging Changes:

Mouth – Gingival Retraction

Decreased taste buds

Decrease volume of saliva

Atrophy of gingival tissue

Esophagus – Decreased esophageal sphincter pressure,

Motility decreased.

Abdominal Wall – Thinner and less taut.

Decrease in number and sensitivity

of sensory receptors.

gerontologic considerations effects of aging on the gi system1
Gerontologic Considerations : Effects of Aging on the GI System.
  • Stomach – Atrophy of gastric mucosa, decrease in

blood flow.

  • Small Intestine- Slight decrease in secretion of most

digestive enzymes and motility.

  • Liver – Decrease size and lowered in position.

Decrease in protein synthesis, ability to

regenerate decreased.

  • Large Intestine, Anus, Rectum – Decreased anal

sphincter tone and nerve supply to rectal area

Decrease muscular tone, decreased motility,

Increase in transit time, sensation to defecation

decreased.

gerontologic considerations effects of aging on the gi system2
Gerontologic Considerations : Effects of Aging on the GI System.
  • Pancreas – Pancreatic duct distended, lipased

production decrease, pacreatic reserve

impaired.

Differences in Assessment Findings:

  • Loss of teeth, presence of dentures, diminish sense of taste.
  • Dry oral mucosa.
  • Epigastic distress, dysphagia, potential for hiatal hernia and aspiration.
  • Food intolerances, signs of anemia resulting from cobalaminmalabsorption, decreased gastric emptying.
  • Complaints of indigestion, slowed intestinal transit.
gerontologic considerations effects of aging on the gi system3
Gerontologic Considerations : Effects of Aging on the GI System.

Differences in Assessment Findings: Cont.

  • Delayed absorption of fat-soluble vitamins.
  • Liver is easier to palpate due to lower border.
  • Liver - Decrease in drug metabolism.
  • Fecal Incontinence
  • Flatulence, abdominal distention, relaxed perineal musculature, constipation, fecal impaction.
  • Impaired fat absorption, decreased glucose tolerance.
factors that determine whether gerd is present
Factors that determine whether GERD is present
  • Efficiency of antireflux mechanism
  • Volume of gastric contents
  • Potency of refluxed material
  • Effeciency of esophageal clearance
  • Resistance of the esophageal tissue to injury and the abilityn to repair tissue

The client must have several episodes of reflux for GERD to be present.

assessment functional health patterns table 39 8
Assessment: Functional health Patterns Table 39-8
  • Health perception- health management Patterns:

- Nurse should ask about health practices related to GI system e.gmaintenace of normal body weight.

  • Nutritional Metabolic Patterns:

- Dietary history should be taken and compared with the food pyramid.

  • Elimination Patterns:

-Client should be asked on the frequency, time of day, and usual consistency of stool should be noted.

  • Activity –Exercise Patterns.

- The pt. ambulatory status should be checked.

assessment functional health patterns table 39 81
Assessment: Functional health Patterns Table 39-8
  • Sleep-rest Patterns:

- The pt. should be asked if GI symptoms affects sleep

or rest.

  • Cognitive-Perceptual Patterns:

- The pt. should be assess with sensory adequacy, change in smell or taste. Pain should also be assessed.

  • Self-Perception/Self-Concept Pattern:

- Assess the pt’s willingness to engage in self-care and

to discuss this situation.

assessment functional health patterns tbl 39 8
Assessment:Functional Health Patterns Tbl: 39-8
  • Role-Relationship Pattern:

- Assess availability of and satisfaction with support.

  • Sexuality- reproductive Pattern:

- Assess for effect of problems related to GI on pt’s sexuality and reproductive status.

  • Coping-Stress Tolerance Pattern;

- Determine what is the stressor for the pt. and what

coping mechanisms the pt. uses to function with

these stressors.

  • Value-Belief Pattern:

Pt’s spiritual and cultural beliefs regarding food preparation should be assessed.

different diets for gi system disorders
Different Diets for GI System Disorders
  • Diet for constipation –High Fiber diet e.g.

Raw Fruits and Fruit juices esp. prune and

grape juice, raw vegetables, cabbage, sweets,

alcohol and highly spicy foods stimulates

stool production.

  • Foods that can contribute fecal incontinence

e.g. chocolate, coffee, tea, and other

caffeinated beverages stimulates the anal

sphincters to relax .

  • Food that can thickened stool e.g.

bananas, rice, bread, potatoes, cheese, yogurt,

oatmeal, oatbran, boiled milk and pasta.

different diets for gi system disorders1
Different Diets for GI System Disorders
  • Odor-causing foods include cabbage family vegetables, beans, garlic, eggs, fish, and turnips.
  • Gas –producing foods include beans, beer, carbonated beverages, cucumbers, cabbage, broccoli, dairy products and corn.
  • Ileostomy diet – avoid excess gas, maintain a soft stool, and avoid obstruction of the catheter. Pt should avoid: coffee, alcohol, and gas forming foods, skins, seeds and nuts including corn, olives and peas, pineapple, berries, fresh fruits, milk products is cause excessive gas.
different diets for gi system disorders2
Different Diets for GI System Disorders
  • Diet for Peptic Ulcer – permit the client almost any foods that do not produce discomfort.

- Avoid foods that stimulate acid secretions but do not neutralize acids.

- Foods include coffee, tea, meat broth, and alcohol.

  • Lactose Intolerance – Avoid milk and milk products. Use soymilk products.

- Restricting milk may result in Calcium , riboflavin and Vit. D deficiency.

  • Gluten-Free Diet - diet completely free of ingredients derived from gluten-containing cereals/ wheat, barley, rye, Malts , as well as the use of gluten as a food additive in the form of a flavoring, stabilizing or thickening agent. It is the only medically accepted treatment for celiac disease and wheat allergy.
different diets for gi system disorders3
Different Diets for GI System Disorders
  • Low residue diet is a special diet, which is low in fiber and high in other dietary elements.
  • The low residue diet is used as a preparation for certain medical examinations as well as an aid to cure certain health problems. The low residual diet is thus prescribed under certain special conditions only.
  • The low residue diet contains less than 10-15 grams of fiber per day.What does the low residue diet aim at?Basically, by lowering the dietary fiber contents, the low residue diet is designed to reduce the frequency and volume of the stools. The low residue diet helps to prolong the intestinal transit time. Simply, the low residue diet aims to reduce the bowel activity.
gastrointestinal disorders
Gastrointestinal Disorders
  • GERD
  • PUD
  • Gastroenteritis
  • Constipation
  • Diarrhea
  • Inflammatory Bowel Diseases
  • Colorectal Cancer
  • Hemorrhoids
gastroesophageal reflux disease gerd
Gastroesophageal Reflux Disease (GERD)
  • GERD– results of an incompetent lower esophageal sphincter that allows regurgitation of acidic gastric contents into the esophagus.
  • Condition characterized by gastric contents and enzyme leakage into esophagus.
  • Corrosive fluids (stomach acid)irritate the esophageal tissue and limit its ability to clear the esophagus.
  • Causes prolonged or frequent transiet relaxation of the lower esophageal sphincter (LES) at the base of the esophagus, or delayed gastric emptying.
symptoms of gerd
Symptoms of GERD
  • Frequent and prolonged retrosternal heartburn

(dyspepsia) and regurgitation (acid reflux) in relation to eating or activities.

  • Chronic cough
  • Dysphagia
  • Belching ( eructation)
  • Flatulence (gas)
  • Atypical chest pain
  • Asthma exacerbation.
nursing assessment of gerd
Nursing Assessment of GERD
  • Heartburn after eating
  • Feeling of fullness and discomfort after eating
  • Positive diagnosis determined by fluoroscopy or Barium Swallow.

Fluoroscopy is a type of medical imaging that shows a

continuous x-ray image on a monitor, much like an x-

ray movie. It is used to diagnose or treat patients by

displaying the movement of a body part or of an

instrument or dye (contrast agent) through the body.

During a fluoroscopy procedure, an x-ray beam is

passed through the body. The image is transmitted to a

monitor so that the body part and its motion can be

seen in detail.

etiology cause of gerd
Etiology (Cause) of GERD
  • Any factor that relaxes the LES such as:

SMOKING

CAFFEINE

ALCOHOL

DRUGS

  • Any factor that increases the abdominal pressure:

OBESITY

TIGHT CLOTHING AT THE WAIST

ASCITES

PREGNANCY

  • OLDER AGE and/or debilitating condition that weakens the LES tone.
contributing factor
Contributing Factor
  • Diet: Excessive ingestion of foods that relaxes the LES.

- Fatty and fried foods

- Chocolate

- Caffeinated beverages such as coffee

- Peppermint

- Spicy foods

- Tomatoes

- Citrus foods

- Alcohol

contributing factors
Contributing Factors
  • Distended abdomen from overeating or delayed emptying.
  • Increased abdominal pressure e.g. ascites, obesity, pregnancy, bending at the waist, tight clothing at the waist.
  • DRUGS that relaxes the LES e.g. Theophylline, Nitrates, Calcium Channel Blockers, anticholenergics, and Diazepam.
  • Drugs such as NSAIDS, or events like stress that increase gastric acid.
contributing factors1
Contributing Factors
  • Debilitation or age related conditions resulting in weakened LES tone.
  • Hiatal Hernia – herniation of the esophagogastric junction and the portion of the stomach into the chest through the esophageal hiatus of the diaphragm.

Hiatal Hernia –LES displacement into the thorax with delayed esophageal clearance.

  • Lying flat
diagnostic procedures for gerd and nsg interventions
Diagnostic Procedures for GERD and Nsg. Interventions
  • Hx : Symptoms 4 to 5 times per week on a

consistent basis

  • Improvement after a 6 week-course of Proton pump inhibitors (PPI) main action is a pronounced and long-lasting reduction of gastric acid production e.g. Omeprazole (Prilosec) , Lansoprazole (Prevacid), Pantoprazole (Protonix).
  • Barium Upper GI : Pre-Procedure:Fiber diet for 2-3 days before the barium swallow test. You will be asked not to eat or smoke after midnight before the exam. Post procedure: assess for BS and potential constipation.
  • Endoscopy – pt. under conscious sedation to observe for tissue damage.
  • Esophageal Manometry – used to measure muscle tone of LES and pH monitoring.
esophageal manometry
Esophageal Manometry
  • The exam is often done before and after medical or surgical treatment of the esophagus. Esophageal manometry is very effective in evaluating the contraction function of the esophagus in many situations.
  • Manometry is the recording of muscle pressures within an organ. So esophageal manometry measures the pressure within the esophagus. It can evaluate the action of the stripping muscle waves in the main portion of the esophagus as well as the muscle valve at the end of it.
therapeutic interventions
Therapeutic Interventions
  • Surgery (Fundoplication) - surgeon wraps the fundus of the stomach around and behind the esophagus through laparoscopy to create a physical barrier.

Nursing Interventions

  • Assessments

-Monitor for sign and symptoms – classic

sign: Dyspepsia especially after eating.

chronic cough from irritation, hypersalivation, eructation, flatulence, , atypical chest pain,

assessment
Assessment
  • Assess client’s dietary intake pattern. Attention to food containing caffeine and fat.
  • Smoking history.
  • Alcohol use.
  • Weight

NANDA Nursing Diagnosis

  • Acute pain
  • Deficient knowledge
  • Anxiety
nursing plans and interventions
Nursing Plans and Interventions
  • Determine eating patterns that alleviates symptoms:
  • Encourage small frequent meals.
  • Encourage elimination of foods that are determined to aggravate symptoms.
  • Encourage client to sit up while eating and remain in an upright position for at least an hour after eating.

A fowler or semi-fowler position is beneficial in reducing the amount of regurgitation as well as in preventing the encroachment of the stomach upward through the opening of the diaphragm.

4. Encourage client to stop eating three hours before bedtime.

5. Teach about commonly prescribed medications ( H2 antagonist, antacids).

teaching plans for client and family
Teaching Plans for client and family
  • Differentiate between the symptoms of hiatal hernia and those of MI.
  • Alert to the possibility of aspirations.
  • Diet – avoid offending foods

avoid large meals

remain upright after eating

avoid eating before going to bed.

  • Lifestyle – avoid tight fitting clothing

Lose weight if applicable.

Elevate the head of the bed with blocks.

Use of pillow is not recommended as this

rounds the back, bringing the stomach

contents up closer to the chest.

medications
Medications
  • Antacids – e.g. Mylanta Neutralize excess acids.

administer 1-3 hours after eating and at HS.

Should be separated with other meds at

least 1 hour.

  • Histamine 2 receptor antagonist – e.g. Zantac

(Ranitidine). Reduce the secretion of acid.

  • Proton Pump Inhibitors (PPIs) – e.gProtonix

(Pantoprazole).

  • Reglan (Metochlopramide HCL) to increase motility of the esophagus and stomach.
complications
Complications
  • Aspiration
  • Asthma exacerbation
  • Frequent URI, sinus or ear infections.
  • Aspiration pneumonia
  • Esophageal stricture (scarring)
  • Erosive esophagitis (ulceration and hemorrage).
  • Barrett’s epithelium (premalignant) and esophageal carcinoma.
peptic ulcer disease
Peptic Ulcer Disease
  • Ulceration that penetrates the mucosal wall of the GI tract.
  • Gastric Ulcer- occurs in the lessaer curvature of the GI tract.
  • Doudenal Ulcer – occurs in the doudenum
  • Esophageal Ulcers – occurs in the esophagus
cause of pud
Cause of PUD
  • Peptic Ulcer – some causes are unknown.
  • Gastric Ulcers – significant numbers are caused by

Helicobacter Pylori (H. Pylori).

Risk Factors in the Development of PUD:

  • Drugs ( NSAIDS, Corticosteroids)
  • Alcohol
  • Cigarette Smoking
  • Acute medical Crisis or trauma (Stress)
symptoms common to all types of ulcers
Symptoms Common to all types of Ulcers
  • Belching
  • Bloating
  • Epigastric pain radiating to the back (not associated with the type of food eaten) and relieved by antacid

Nursing Assessment:

  • Determine how food intake affects pain.
  • Take Hx of antacid or histamine antagonist use.
  • Determine presence of melena (blood in the stool).
  • Determine presence and location of peptic ulcer.
diagnostic test
Diagnostic Test
  • Barium Swallow
  • Upper endoscopy
  • Gastric Analysis -indicating increased levels of stomach acid.

Potential Complications

  • Hemorrhage
  • Perforation ( which always require surgery)
  • Obstruction
nanda nursing diagnosis
NANDA Nursing Diagnosis
  • Pain related to …
  • Imbalance Nutrition: Less than body requirements
  • Deficient knowledge deficit
  • Risk for injury

NURSING PLANS and INTERVENTIONS

  • Determine symptom onset and how symptoms are relieved.
  • Monitor color, quantity, consistency of stools and emesis. Test for occult blood.
nursing plans and interventions cont
Nursing Plans and Interventions cont:
  • Administer medications as prescribed.

- Antacids (Maalox): Need to take several times a day.

Administer after meals

Assess Hx of renal disease for Mg

products. Electrolyte adjustment can

result in renal insufficiency and

calcinosis.

- H2 receptor Antagonist – Cigarette smoking can

interferes with drug action.

Expensive.

nursing interventions
Nursing Interventions

PUD Medications:

  • Mucosal healing agent (Sucralfate) – to be taken at

leats 1 hour prior to meals.

Antacids interfere with absorption.

  • PPI s - Taken before meals

Do not crush or chew

IV Pantoprazole to be given over 3 min period.

Inhibit absorption of other drug

Resume oral therapy as soon as feasible.

  • Antiemetics
  • Cough suppressants
  • Stool Softeners
nursing management cont
Nursing Management cont”
  • Administer mucosal healing agent as prescribed.
  • Encourage small , frequent meals, no bedtime snack and avoid beverages containing caffeine.
  • Prepare for surgery for uncontrolled bleeding, obstruction, or perforation occurs.

- Gastric resection

- Vagotomy

- Pyloroplasty

  • Teach client that DUMPING SYNDROME may occur postoperatively.
dumping syndrome
Dumping Syndrome
  • Secondary to rapid entry of hypertonic food into jejunum (pull water out of bloodstream)
  • Occurs 5-30 min after eating.
  • Characterized by vertigo, syncope, sweating, pallor, tachycardia.
  • Minimized by small frequent meals, high protein, high fat, low carb diet.
  • Exacerbate by consuming liquids with meals. Helped by lying down after eating.
pud nursing management cont
PUD Nursing Management cont.
  • Teach client to avoid medications that increase risk for developing peptic ulcer.

- Salicylates

- NSAIDS e.g. Ibuprofen

- Corticosteroid in high dosage

- Reserpine (antihypertensive)

- Anticoagulants

  • Teach client lifestyle modification:

- Cessation of smoking and stress management.

  • Teach client of symptoms of GI bleeding.

- Dark tarry stools

- coffee ground emesis

- bright red rectal bleeding

- Fatigue

- Pallor

- Severe abdominal pain ( report immediately) could denote perforation.

gastroenteritis
Gastroenteritis
  • Definition - Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract). Diarrhea, crampy abdominal pain, nausea, and vomiting are the most common symptoms.
  • Causes:

- Viral infection

- Bacterial infection (Salmonella)

- Parasites

- Food-borne illness (such as shellfish) can be the

offending agent.

causes of gastroenteritis
Causes of Gastroenteritis
  • Viruses and bacteria are very contagious and can spread through contaminated food or water. Gastroenteritis caused by viruses may last one to two days. Bacterial cases can last for a longer period of time.

Virus e.g. Norovirus, Rotavirus

Bacteria e.g Staphylococci, E. Coli, Shigella, Salmonella, Campylobacter. Clostridium Difficile.

Parasite – Giardia (Giardiasis)

  • Improper handwashing following a bowel movement or handling a diaper can spread the disease from person to person.
  • Gastroenteritis that is not contagious to others can be caused by chemical toxins, most often found in seafood, food allergies, heavy metals, antibiotics, and other medications.
sign and symptoms
Sign and Symptoms

Common symptoms may include:

  • Low grade fever to 100°F (37.7°C)
  • Nausea with or without vomiting
  • Mild-to-moderate diarrhea
  • Crampy painful abdominal bloating

More serious symptoms:

  • Blood in vomit or stool
  • Vomiting more than 48 hours
  • Fever higher than 101°F (40°C)
  • Swollen abdomen or abdominal pain
  • Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and lack of sweat and tears are characteristic findings.
  • Signs and symptoms of both include pain, cramping, belching, nausea, and vomiting. Severe cases may include hematemesis. Diarrhea may occur with gastroenteritis.
exams and diagnostic tests
Exams and Diagnostic Tests
  • Blood and stool tests to determine the cause of the vomiting and diarrhea.
  • Physical examination.
  • Complete Blood Count
  • Ask if other family or friends have similar exposure or symptoms. Ask about the duration, frequency, and description of the patient's bowel movements and whether they are vomiting.
  • Travel history: Travel may suggest E. coli bacterial infection or a parasite infection from something that client ate or drank.
  • Exposure to poisons or other irritants: Swimming in contaminated water or drinking from suspicious fresh water such as mountain streams or wells may indicate infection from Giardia - an organism found in water that causes diarrhea.
  • Diet change, food preparation habits, and storage.
tests for gastroenteritis
Tests for Gastroenteritis
  • In general, symptoms caused by bacteria or their toxins will become apparent after the following amount of time: Staphylococcus aureus in 2-6 hours Clostridium 8-10 hours Salmonella in 12-72 hours
  • Medications: If the patient has used broad-spectrum or multiple antibiotics recently, they may have antibiotic-associated irritation of the gastrointestinal tract.
other conditions associated with gastroenteritis
Other conditions associated with Gastroenteritis
  • Physical examination will provide reasons for symptoms that may not be related to infection. If there are specific tender areas in the abdomen appendicitis, gallbladder disease, pancreatitis, diverticulitis, or other conditions that may be the cause of the patient's symptoms.
  • Other noninfectious gastrointestinal diseases like Crohn's disease or ulcerative colitis must also be considered.
treatment
Treatment
  • If the client cannot take fluids by mouth because of vomiting, may insert an IV to put fluid back into the body (rehydration).
  • In infants, depending upon the level of dehydration, intravenous fluids may be delayed to consider trying oral rehydration therapy. Frequent feedings, as small as a 1/6 ounce (5cc) at a time, may be used to restore hydration.
treatments for gastroenteritis
Treatments for Gastroenteritis
  • Antibiotics are not usually prescribed until bacteria have been identified.
  • Antibiotics may be given for certain bacteria, specifically Campylobacter, Shigella, and Vibriocholerae, if properly identified through laboratory testing. Otherwise, using any antibiotic or the wrong antibiotic can worsen some infections or make them last longer.
  • Infections, like salmonella, are not treated with antibiotics. Supportive care of fluids and rest, the body is able to resolve the infection without antibiotics.
  • For adults, medications to stop vomiting (antiemetics) such as promethazine (Phenergan, Anergan), prochlorperazine (Compazine), or Ondansetron (Zofran). These medications are prescribed as a suppository.
treatments for gastroenteritis1
Treatments for Gastroenteritis
  • Usually antiemetics are not recommend for infants. Children who are a little older may be offered antiemetic medication.
  • Avoid antidiarrheal medications for all age groups if they suspect the infection is caused by a toxin.
  • Most common antidiarrheal agents for people older than three years are over-the-counter medications such as diphenoxylate atropine (Lomotil, Lofene, Lonox) or loperamide hydrochloride (Imodium).
nursing care
Nursing Care
  • Acute gastritis is the irritation and inflammation of the stomach's mucous lining. Gastritis may be caused by a chemical, thermal, or bacterial insult. For example, drugs such as alcohol, aspirin, and chemotherapeutic agents may cause an attack of gastritis. Likewise, hot, spicy, rough, or contaminated foods may bring about an attack. Management involves symptomatic treatment measures after removal of the causative agent.
nursing management of gastroenteritis
Nursing Management of Gastroenteritis
  • Stop all P.O. intakes until symptoms subside.
  • Assess the client's symptoms and administer the prescribed symptomatic relief medications such as antacids and antiemetics.
  • Monitor intake and output closely. Excessive vomiting or diarrhea may result in severe electrolyte depletion that will require replacement therapy.
  • Administer and monitor IV therapy when ordered to replace lost fluids.
  • Weigh daily to monitor weight loss.
  • Encourage the prescribed diet to maintain nutrition.
constipation and diarrhea
Constipation and Diarrhea
  • Constipation – bowel movements that are infrequent, hard or dry, and difficult to pass.
  • Diarrhea – increased number of loose liquid stools.
  • Causes of Constipation:

- Frequent use of Laxatives

- Advance age

- Inadequate fluid intake

- Inadequate fiber intake

- Immobilization due to injury

- A sedentary lifestyle

  • Causes of Diarrhea:

- Viral Gastroenteritis

- Overuse of laxatives/laxative abuse

- Use of certain antibiotics

- Inflammatory bowel disease (Cronh’s disease – subacute, chronic inflammation extending throughout the entire intestinal mucosa (Terminal Ileum).

diagnostic procedures
Diagnostic Procedures
  • Fecal Occult Blood Test ( OB) – fecal sample is obtained using a medical aseptic technique and wearing disposable gloves. e.g. Hemoccult slide test and record result.

Certain food like red meat, raw vegetable and medication (aspirin, NSAIDS) can cause false positive. Bleeding can be a sign of CANCER (others include anal fissures, hemorrhoids, inflammatory bowel disease, malignant tumor, peptic ulcer) which can be contributing factor to constipation.

An early sign of COLON cancer is rectal bleeding. Encourage client 50 years of age and older and those with increased risk factor to be screen with FOBT yearly and Routine Colonoscopy at 50.

clinical manifestation of gi bleeding
Clinical Manifestation of GI Bleeding
  • Pallor: conjunctiva, mucous membranes, nail beds,

Dark tarry stools ( Peptic Ulcer due to mixture

of gastric acid and the blood) Macroscopic

Bright –red (constipation, bleeding from

anal fissure or sigmoid area).

Abdominal mass or bruit

Decreased BP, rapid pulse, cool ext. (s/s of

shock)

  • Stress can cause or exacerbate ULCERS. Teach client on stress-reduction methods and encourage those with family of ULCERS to obtain medical survillance for ulcer formation.
diagnostic procedures1
Diagnostic Procedures
  • Digital Rectal Examination – Checks for impaction. Client position on the left side with knee flex. Client V/S and response should be monitored.
  • Stool Cultures – obtaining fecal samples using a medical aseptic technique. Specimen should be labeled promptly sent to the laboratory. Intestinal bacteria can be a contributing factor for diarrhea.
signs and symptoms nursing assessments
Signs and Symptoms/Nursing Assessments
  • Constipation:

- Abdominal bloating

- Abdominal cramping

- Straining at defecation

  • Diarrhea:

- s/s of dehydration

- Frequent loose stools

- Abdominal cramping

Nursing Assessments:

  • PE of the abdomen for BS and tenderness (auscultate before palpation).
  • S/S of fluid deficit
  • Skin integrity around the anal area
  • Collection of detailed history of the client’s diet, exercise, and bowel habits.
nanda nursing diagnosis constipation and diarrhea
NANDA Nursing Diagnosis (Constipation and Diarrhea)
  • Constipation
  • Diarrhea
  • Fluid Volume Deficit
  • Impaired skin integrity
nursing interventions constipation and diarrhea
Nursing Interventions (Constipation and Diarrhea)
  • Closely monitor client fluid status (D)
  • Monitor for client s/s of dehydration (D)
  • Closely monitor elimination pattern ( C) and (D)
  • Observe and document the character of BM ( C) and (D)
  • Carefully check for blood or pus. If the client is experiencing diarrhea, measure the volume of the stool. (D)
  • Administer laxatives or enemas as prescribed ( C)
  • Encourage adequate fluid intake ( C)
  • Monitor skin integrity ( D)
  • Suggest that client’s who are taking ATB to eat yogurt to help re-establish an intestinal balance of beneficial bacteria.
complications1
Complications
  • Constipation:

- Fecal Impaction

- Development of hemorrhoids and/or rectal fissure

- Bradycardia, hypotension, and syncope associated

with the Valsalva Maneuver (bearing down)

stimulation of Vagus Nerve..

- Monitor constipation carefully and take measures

to treat and prevent constipation

- Removing fecal impaction. Break apart the impact

slowly. Monitor V/S and response. Preceded by application of glycerin or Bisacodyl (Dulcolax supp.)

complications2
Complications
  • Diarrhea:

- Dehydration. Monitor for s/s of fluid and electrolyte imbalance. Monitor for metabolic acidosis cause by excessive loss of bicarbonate.

- Skin breakdown around the anal area. Carefully

follow skin protocol.

- Replace losses as prescribed.

Replacing Fluids and Electrolytes

  • Drinking fluids is important during bouts of diarrhea to prevent dehydration, which is the loss of vital fluids and electrolytes (sodium and potassium). Proper hydration is especially important in children with diarrhea because they can die from dehydration within a couple of days.
  • Although water is extremely important in preventing dehydration, it does not contain electrolytes.
  • Good choices to help maintain electrolyte levels include broth or soups (which contain sodium) and certain fruit juices, soft fruits, or vegetables (which contain potassium).
  • For children, often recommend a special rehydration solution that contains the nutrients they need. You can buy this solution without a prescription.
  • Examples of rehydration solutions include Pedialyte®, CeraLyte®, and Infalyte®.
older adults
Older Adults
  • Older adults clients are more susceptible to developing constipation as bowel tone decreases with age and more at risk for developing fecal impaction.
  • Adequate fluid and fiber intake and exercise are important. Instruct proper diet.

Vegetables, fruits (especially dried fruits), and some cereals (whole wheat, bran, or oatmeal) are excellent sources of fiber. It is easy to remember that the harder a vegetable is (like celery), the more fiber it has. To reap the benefits of fiber, it is very important to drink an adequate amount of water to help with the passage of stool in the intestines.

crohn s disease sign and symptoms
Crohn’s Disease Sign and Symptoms
  • Abdominal pain
  • Diarrhea and weight loss with patient becoming emaciated. Non- bloody diarrhea, crampy abdominal pain. Weight loss is insidious.
  • Constant fluid loss.
  • Perforation of the intestine occurring due to severe inflammation: constitute a medical emergency.
  • Fatigue
  • Low grade fever
  • Definitive Dx – shows intermittent granulomas, and classic cobblestone appearance.
other gi conditions that manifest constipation or diarrhea
Other GI Conditions that manifest Constipation or Diarrhea
  • Ulcerative Colitis – Affects the superficial mucosa of the colon, causing bowel to eventually narrow, shorten and thicken due to muscular hypertrophy. Occurs in the large bowel and rectum.
  • Characteristic: Liquid stools containing blood, mucus, and pus (10 to 20 stools per day).

Goal/Nursing Management Interventions

  • Determine bowel elimination pattern and control diarrhea with diet and medication.
  • Provide nutritious well-balanced, low residue , low-fat, high-protein, high calorie diet; NO DAIRY products.
ulcerative colitis goal nursing management interventions
Ulcerative Colitis -Goal/Nursing Management Interventions
  • Administer Vit. Supplements and iron.
  • Advise client to avoid food known to cause diarrhea such as milk products and spicy foods.
  • Advise client to avoid smoking caffeinated beverages, pepper, and alcohol.
  • Provide CBR with Intravenous hyperalimentation if necessary ( TPN)
  • Total Parenteral Nutrition (TPN)

Provides body with nutrition such as protein, sugar, vitamins, minerals, and sometimes fat (lipids). TPN is used when unable to eat or cannot get enough nutrition from the foods you eat. TPN always goes into vein (blood vessel) through an intravenous (IV) line. It may be given to you in the hospital, long-term care center, or at home. May need TPN for several days or longer.

ulcerative colitis goal nursing management interventions1
Ulcerative Colitis -Goal/Nursing Management Interventions
  • Administer medication as prescribed. Azulfidine(Sulfasalizine). Sulfasalazine is used to treat bowel inflammation, diarrhea (stool frequency), rectal bleeding, and abdominal pain in patients with ulcerative colitis
  • Monitor I and O and serum electrolytes.
  • Weigh at least 2x weekly.
  • Provide emotional support.
  • Encourage to talk with the enterostomal therapist before surgery.
  • If Ileostomy is performed, teach stoma care
stoma care
Stoma Care
  • The more distal the stoma is , the greater the chance for continence.
  • Ileostomy drains liquid material. Periostomal area is prone to skin breakdown.
  • Preoperative Care- Client and family must be informed what to expect post operatively. Location, size, what it will look like. Teach about how to care for stoma.
  • Pouch Care

-The adhesive-backed opening is designed to cover the

stoma. Should be 1/8 clearance from the stoma.

- A rubber band or clip is use to secure the bottom.

- A simple squirt bottle is used to remove effluence from sides of the bag. Pouch system is changed q 3-7 days.

- Client should maintain extra supply of pouches.

- Empty pouch is 1/3 to ½ full.

stoma care ileostomy
Stoma Care - Ileostomy
  • Irrigation – Descending colon colostomies can be irrigated to provide control over effulence.

- Irrigate same time daily.

- Use warm water (cold or hot can cause cramping)

- Wash around stoma with lukewarm water and a mild

soap.

- Commercial skin barriers may be purchased for home use.

  • Odor Control – Commercial preparation are available.

Eliminate foods that can cause offensive odors.

  • Diet – Ileostomy : high fiber foods can cause diarrhea and

maybe eliminated (popcorn, peanuts, unpeeled

vegetables.

Colostomy: Client should resume regular diet

gradually. Problem food preoperatively should be tried

cautiously.

special colostomy or colectomy diet after surgery
Special Colostomy or Colectomy Diet After Surgery
  • Typically, a person will receive only IV fluids for 2-3 days after a colectomy or colostomy, to give the colon time to heal.
  • After that, client can try clear liquids, such as soup broth and juice, followed by easy-to-digest foods, such as toast and oatmeal.
  • Client will be able to go back to your normal diet after this, but should avoid certain foods that cause odors or gas, which can over-inflate the colostomy bag and make it more difficult to manage.
  • Foods that sometimes need to be limited, in order to make it easier to manage your colostomy, include:
  • Raw vegetables
  • Skins and peels of fruit (fruit flesh is OK)
special colostomy or colectomy diet after surgery1
Special Colostomy or Colectomy Diet After Surgery
  • Foods that sometimes need to be limited, in order to make it easier to manage your colostomy, include:
  • Dairy products
  • Very high fiber food such as wheat bran cereals and breads
  • Beans, peas, and lentils
  • Corn and popcorn
  • Brown and wild rice
  • Nuts and seeds
  • Cakes, pies, cookies, and other sweets
  • High fat and fried food such as fried chicken, sausage, and other fatty meats
special colostomy or colectomy diet after surgery2
Special Colostomy or Colectomy Diet After Surgery
  • Other foods can be helpful after a colostomy, to thicken the stool and minimize odors, include:
  • Yogurt (with live and active cultures)
  • Cranberry juice
  • Bananas
  • Applesauce
  • Well-cooked, sticky white rice
  • Buttermilk
  • Tapioca
  • White toast
special colostomy or colectomy diet after surgery3
Special Colostomy or Colectomy Diet After Surgery
  • Finally, instruct the client to thoroughly chew everything she/he eat. Chewing is an important part of the digestive process and we all chew our food to some degree. However, if the client make a special effort to chew food very well, it will help manage the colostomy more easily. Instruct to try to chew everything until it is liquid in your mouth.
diverticular diseases
Diverticular Diseases
  • Diverticulosis and Diverticulitis
  • Diverticulosis – bulging pouches in the GI wall which push the mucosa lining through the surrounding muscle.
  • Diverticulitis – inflamed diverticula, which may cause obstruction, infection and hemorrhage.
diverticular diseases1
Diverticular Diseases

Nursing Assessment

  • Left Lower Quadrant pain
  • Increased flatus
  • Rectal Bleeding
  • S/s of Intestinal Obstruction – alternating constipatuion and diarrhea, abdominal distention, anorexia,& low grade fever.
diverticulitis
Diverticulitis
  • Diagnostic Procedure – Barium Enema or Colonospy.
  • Perforation is confirmed by radiograph (Barium not used during acute phase).

NANDA NURSIN DIAGNOSIS

  • Ineffective tissue perfusion
  • Pain
  • Imbalance Nutrition: less than body requirements.
nursing plan and interventions
Nursing Plan and Interventions
  • Provide a well-balanced diet, high fiber diet unless inflammation is present. Inflammation present – NPO followed by LOW Residue, bland foods.
  • Include bulk forming laxatives such as Metamucil in daily regimen.
  • Increase fluid intake to 3 L/day.
  • Monitor I and O and bowel elimination.
  • Avoid constipation.
  • Observed for Complications:

- Obstruction.

- Peritonitis

- Hemorrhage

- Infection

other conditions bowel obstruction
Other Conditions: Bowel Obstruction
  • Non-Mechanical: Paralytic Ileus
  • Mechanical : Bowel Obstruction within the Bowel

Tumors or Diverticulitis. Outside the bowel: Hernia and adhesions.

Assessment:

-Sudden onset of abdominal pain.

- Hx of abdominal surgeries

- Distention

- Increase peristalsis when obstruction first occur then peristalsis becomes absent when paralytic ileus occurs.

- Bowel sound are high-pitched

nursing plans and interventions1
Nursing Plans and Interventions
  • Maintain client NPO with IV fluids and electrolyte therapy.
  • Monitor I and O. FC maintains strict output.
  • Implement Nasogastric Intubation. Ensure that client has patent airway to prevent cyanosis. Check for presence of deviated septum of the nares.

Proper placement needs to be determined via X-Ray.

Canto, Miller-Abbot, or Harris tubes are passed through the nose into the stomach usually by HCP. Advance tube every 1-2 hours.

nursing plan and interventions ngt
Nursing Plan and Interventions (NGT)

Do not secure to nose until reaches specified position.

Reposition q 2 hours to assist with placement of the tube

Connect to suction.

Irrigate with air only

Note amount, color, consistency and any unusual odor of drainage.

Cont/Management of Bowel Obstruction

  • Document pain. Medicate as prescribed.
  • Assess abdomen regularly for distention, rigidity, change is bowel sounds.
  • If conservative treatment fails surgery is indicated.
nursing management
Nursing Management
  • Client admitted with c/o constipation, thready stools, and rectal bleeding for few months is diagnosed with rectal mass. Priority is:

-Place client on NPO

- NG Tube

- IV fluids

- Surgical preparation of bowels (if obstruction is complete).

- Teaching ( preoperative, nutrition, etc.)

colorectal cancer
Colorectal Cancer
  • Colorectal Cancer is 2nd most common cancer and the second leading cause of death in Western countries including U.S.
  • They are adenocarcinomas(colon epithelium).
  • Grows slowly. Client at many times can be asymptomatic, but occult blood is discovered in the stools during a rectal exam.
colorectal cancer1
Colorectal Cancer
  • CRC can metastasize (through blood or lymph) to the liver (most common).
  • Spread can also occur as a result of peritoneal seeding

(seeding can occur during surgical resection of tumor).

  • Can be cured with early detection.
  • Regular colorectal screening is recommended for individuals older than 50 years of age or with a family history of colorectal cancer.
risk factors for colorectal cancer
Risk factors for Colorectal Cancer
  • Colon cancer is more common in women while rectal cancer is more common in men.
  • Risk Factors: Adenomatous colon polyps.

Family Hxof colorectal cancer.

Inflammatory Bowel Diseases

(Ulcerative colitis, Crohn’s Disease)

High Fat, Low Fiber diet.

Older than 50 year of age.

Hx of ovarian or breast cancer

Most Common Area is the rectosigmoidal region.

diagnostic procedures and nsg intervention
Diagnostic Procedures and Nsg. Intervention
  • Fecal Occult Blood Test (FOBT)

- 2 stool samples within 3 consecutive days.

- Instruct the client to avoid ingestion of some food or drugs because result can be false positive. In, general, instruct to avoid meat, NSAID’s, and Vitamin C are avoided for the 48 hour period prior to testing.

diagnostic procedures and nsg intervention1
Diagnostic Procedures and Nsg. Intervention
  • Carcinoembryonic Antigen (CEA) serum test – CEA levels are elevated.
  • CEA is a type of protein molecule that can be found in many different cells of the body, but is typically associated with certain tumors and the developing fetus.
  • CEA is most frequently tested in blood. It can also be tested in body fluids and in biopsy tissue.
  • The normal range for CEA in an adult non-smoker is <2.5 ng/ml and for a smoker <5.0 ng/ml.
  • The best use of CEA is as a tumor marker, especially for cancers of the gastrointestinal tract.
  • When the CEA level is abnormally high before surgery or other treatment, it is expected to fall to normal following successful surgery to remove all of the cancer.
  • A rising CEA level indicates progression or recurrence of the cancer. In addition, levels >20 ng/ml before therapy are associated with cancer which has already spread (metastatic disease).
diagnostic procedures and nsg intervention2
Diagnostic Procedures and Nsg. Intervention
  • Sigmoidoscopy/Colonoscopy
  • Provides definitive diagnosis of CRC. This scope procedure permits visualization of tumors, removal of polyps, and tissue biopsy.
  • Bowel is cleansed prior to procedures with GoLYTELY or other cathartics.
  • Barium Enemas – CT scan of the abldomen, pelvis, lung, and liver; chest X-Rays, and liver scan maybe done to further identify the specific location of cancer and to identify sites of metastases.
slide96

Colorectal cancer is the third most frequently diagnosed cancer in men and women and the second highest cause of cancer deaths in the U.S. Yet, when found early, it is highly curable. This type of cancer occurs when abnormal cells grow in the lining of the large intestine (colon) or rectum.

slide97

Colorectal cancers often begin as polyps – benign growths on the surface of the colon. The two most common types of intestinal polyps are adenomas and hyperplastic polyps.

slide98

Colorectal Cancer ScreeningBecause colorectal cancer is stealthy, screenings are the key to early detection. Beginning at age 50, most people should have a colonoscopy every 10 years. This procedure uses a tiny camera to examine the entire colon and rectum. These tests not only find tumors early, but can actually prevent colorectal cancer by removing polyps (shown here).

slide99

Virtual ColonoscopyThere is now an alternative to colonoscopy that uses CT scan images to construct a 3-D model of your colon. Called virtual colonoscopy, the procedure can reveal polyps or other abnormalities without actually inserting a camera inside your body. The main disadvantage is that if polyps are found, a real colonoscopy will still be needed to remove and evaluate them.

slide100

X-Rays of the Colon (Lower GI)X-Rays of the colon -- using a chalky liquid known as barium as a contrast agent -- allow your doctor a glimpse at the interior of the colon and rectum, offering another way to detect polyps, tumors, and changes in the intestinal tissue. Shown here is an "apple core" tumor constricting the colon. Like the virtual colonoscopy, any abnormalities that appear on the X-rays will need to be followed up with a conventional colonoscopy.

slide101

Staging Colorectal CancerIf cancer is detected, it will be "staged," a process of finding out how far the cancer has spread. Tumor size may not correlate with the stage of cancer. Staging also enables your doctor to determine what type of treatment you will receive.Stage I – Cancer has not spread beyond the inside of the colon or rectumStage II – Cancer has spread into the muscle layer of the colon or rectumStage III - Cancer has spread to one or more lymph nodes in the areaStage IV – Cancer has spread to other parts of the body, such as the liver, lung, or bones. This stage does NOT depend on how deep the tumor has penetrated or if the disease has spread to the lymph nodes near the tumor.

slide102

Colorectal Cancer SurgeryIn all but the last stage of colorectal cancer, the usual treatment is surgery to remove the tumor and surrounding tissue. In the case of larger tumors, it may be necessary to take out an entire section of the colon and/or rectum. The good news is that surgery has a very high cure rate in the early stages. If the cancer has spread to the liver, lungs, or other organs, surgery is not likely to offer a cure -- but removing the additional tumors, when possible, may reduce symptoms.

slide103

Treating Advanced Colorectal CancerWhen colorectal cancer has spread to one or more lymph nodes (stage III), it can still be cured. Treatment typically involves a combination of surgery, radiation (being administered here), and chemotherapy. If the cancer comes back after initial treatment or spreads to other organs, it becomes much more difficult to cure. But radiation and chemotherapy can still relieve symptoms and help patients live longer

slide104

Radiofrequency AblationRadiofrequency ablation (RFA) uses intense heat to burn away tumors. Guided by a CT scan, a doctor inserts a needle-like device that delivers heat directly to a tumor and the surrounding area. This offers an alternative for destroying tumors that cannot be surgically removed. In patients with a limited number of liver metastases that cannot be removed by surgery, chemotherapy is sometimes combined with RFA for tumor destruction.

slide105

Preventing Colorectal Cancer: DietThere are steps you can take to dramatically reduce your odds of developing colorectal cancer. Researchers estimate that eating a nutritious diet, getting enough exercise, and controlling body fat could prevent 45% of colorectal cancers. The National Cancer Institute recommends a low-fat diet that includes plenty of fiber and at least five servings of fruits and vegetables per day.

therapeutic procedures and nsg interventions
Therapeutic Procedures and Nsg. Interventions
  • Colon resection, colectomy, colostomy, and abdominoperineal (AP) resection surgeries maybe performed to removed all or portions of CRC. Post surgery complication – monitor for s/s of Dumping Syndrome.
  • Preoperatively the client is on CLEAR LIQUIDs for a couple of days prior to surgery, bowel prep with cathartics (GoLYTELY) is performed, and antibiotocs such as neomycin and metronidazole (FLAGYL), are administered to eradicate intestinal flora (prevent infection).
  • Chemotherapy – monitor for myelosuppression and pantocytopenia. (decreased WBC production leads to decreased ability to fight infection, RBC – anemia characterized by fatigue, SOB and platelets (easy bleeding)
  • Radiation – monitor for fatigue and diarrhea.

Above are all posiible adjuvant therapies.

colorectal assessment
Colorectal Assessment
  • Monitor for s/s of:

- fatigue due to occult blood loss.

- Change in bowel habits ( constipation or diarrhea)

- Visible blood in the stool.

- Mass of digital rectal examination.

- S/s due to metastases – partial bowel obstruction (high pitched tingling bowel sound), complete bowel obstruction ( no BS in 5 minutes).

postoperatively
Postoperatively:
  • If there is stoma:

- assess the color and integrity of the stoma.

(stoma should be reddish pink, moist, and may have small amount of visible blood immediately postoperative):

- report any evidence of stoma ischemia or necrosis e.g dark or cyanosis color.

nursing interventions1
Nursing Interventions
  • Instruct client with strong hx of colorectal cancer to reduce intake of fats and meat proteins.
  • Explain the need for, and side effects of, chemotherapy, surgery, and radiation therapy.
  • Closely monitor intake and output and the client’s elimination pattern.
  • Closely observe for visible or occult signs of bleeding.
post operative care
Post –operative Care
  • Maintain NGT suction (decompression).
  • Parovide pain management, generally with PCA.
  • Monitor output from drain(s).
  • Provide wound care.
  • Provides measure to reduce risk for respiratory complications (turn, cough, deep breath, ambulate, splint).
  • Promotes measures to reduce risk for embolic complications (compression stockings, low level anticoagulation).
post operative care1
Post- Operative Care
  • Slowly progress diet, monitoring client response.
  • Provide client education regarding activity limits (no lifting, use of stool softeners to avoid straining).
  • Provide ostomy teaching (signs of ischemia to report, expected output, appliance management), if applicable.
  • Support the client with disturbed body image.
complications and nursing implications
Complications and Nursing Implications
  • Bowel Obstruction

- monitor for high-pitched BS before site of obstruction with hypoactive BS after, or overall hypoactive bowel sounds.

- decompression and/or surgical intervention.

  • Perforation (erosion of the wall of the intestine) resulting to lower GI bleeding and peritonitis.

- Monitor hemoglobin, hematocrit, and stools for evidence of bleeding.

- replace losses ( fluid replacement or blood transfusion).

- Support the client during and following surgical intervention.

- Administer antibiotics as prescribed.

  • Abscess or Fistula

- Prepare the client for incisional/surgical drainage.

- provide antibiotic as prescribed.

implication to older adults
Implication to Older Adults:
  • Older adults have more difficult postoperative course and are at a greater risk for intraoperative complications.
  • Older adult clients may be less able to handle fluid volume deficits.
  • Management of colostomy maybe more difficult with older adult clients due to impaired vision and the need for fine motor skills.
hemorrhoids
Hemorrhoids
  • Hemorrhoids

- Enlarged veins located in the lower part of the rectum and the anus.

- They become swollen because of increased pressure within them, usually due to straining at stools and during pregnancy because of the pressure of the enlarged uterus.

Classification

  • Internal
  • External
internal hemorrhoids
Internal Hemorrhoids
  • Located in the inside lining of the rectum.
  • Cannot be felt.
  • Usually painless and make their presence known by causing bleeding with a bowel movement.
  • Internal hemorrhoids can prolapsed or protrude through the anus.
external hemorrhoids
External Hemorrhoids
  • Located underneath the skin that surrounds the anus
  • Can be felt when they swell and may cause itching or pain with a bowel movement, as well as bleeding.
  • A thrombosed external hemorrhoid occurs when blood within the vein clots, and can cause significant pain.
hemorrhoids diagnostic test
Hemorrhoids Diagnostic Test
  • Diagnosis of hemorrhoids is usually made by history and physical examination.
  • Inspection of the anus and a digital rectal examination are often performed.
  • Sometimes anoscopy may be required where a small, lighted scope is introduced into the anus to examine the inner lining of the anus and rectum.
  • If there is the potential that the bleeding source originated above the rectum from other parts of the colon, sigmoidoscopy or colonoscopy by a gastroenterologist may be recommended.
diagnostic procedures2
Diagnostic Procedures
  • If there is concern that significant bleeding has occurred, a CBC (complete blood count) to measure hemoglobin and hematocrit levels is obtained.
  • If the patient is on warfarin (Coumadin), a prothrombin time (PT) or INR may be done to measure the blood clotting levels.
sign and symptoms1
Sign and Symptoms
  • Painless bleeding -may be bright red blood on the outside of the stools, on the toilet paper, or dripping into the toilet. The bleeding usually is self-limiting.

Bleeding with a bowel movement is never normal and should prompt a visit to a health care practitioner.

NANDA Nursing Diagnosis

  • Pain
  • Knowledge Deficit
  • Anxiety
hemorrhoid treatment
Hemorrhoid Treatment
  • Warm Sitz Baths

- Sitting in a few inches of warm water three times a day for 15-20 minutes may help decrease the inflammation of the hemorrhoids.

- It is important to dry off the anal area completely after each Sitz bath to minimize irritation of the skin surrounding the anus.

  • Dietary Changes

- Increased fluid intake and dietary fiber (roughage) will decrease the potential for constipation

hemorrhoids treatments
Hemorrhoids Treatments
  • Stool Softeners

- Stool softeners may help but once hemorrhoids are present, liquid stools may cause inflammation and infection of the anus.

  • Activity Suggestions

-Teach client with hemorrhoids should not sit for long

periods of time.

- May benefit from sitting on an air or rubber donut. Exercise is helpful in relieving constipation and in

decreasing pressure on the hemorrhoidal veins.

Individuals should be encouraged to have a bowel

movement as soon as possible after the urge arises.

hemorrhoids treatment
Hemorrhoids Treatment

Surgery

  • Rubber band ligation
  • Sclerotherapy:Sclerotherapy describes a procedure when a chemical is injected into the hemorrhoid causing it to scar.
  • Laser therapy: Laser therapy can be used to scar and harden internal hemorrhoids.
  • Hemorrhoidectomy:Hemorrhoidectomy is a surgical procedure done in the operating room. Most aggressive approach and there is a markedly decreased chance of the hemorrhoids returning.
  • Stapled hemorrhoidectomy: Stapled hemorrhoidectomy is the newest surgical technique for treating hemorrhoids, and it has rapidly become the treatment of choice for third-degree hemorrhoids.
prevention
Prevention
  • Prevention
  • The risk of hemorrhoids can be decreased by eating a high fiber diet, staying well hydrated, getting regular exercise, and trying to have a bowel movement as soon as possible after the urge arises.
practice questions question 1
Practice Questions Question # 1

In preparing for colonoscopy procedure, which task is most suitable for the nurse to delegate to the UAP?

a. Explain the need for clear liquids 1-3 days prior to

procedure.

b. Reinforce NPO status 8 hours prior to procedure.

c. Administer laxatives 1-3 days prior to procedure.

d. Administer and enema the night before the

procedure.

question 2
Question # 2
  • The nurse is preparing for a client with peptic ulcer disease. Which assessment finding requires immediate intervention?

a. Projectile vomiting.

b. Burning sensation 2 hours after eating.

c. Coffee-ground emesis.

d. Board-like abdomen with should pain?

question 3
Question # 3
  • In educating a client with GERD, the nurse will teach the client that the drug therapy is a “step up” approach that depends on the response to the medication. For the drug listed, which is the anticipated order that the HCP will try in the treatment plan?

a. MagnisiumTrisilicate (Gaviscon) and Famotidine

(Pepcid AC)

b. Ranitidine (Zantac)

c. Pantoprazole (Protonix)

__________, __________, ___________

question 4
Question # 4
  • You are preparing to give an enteral feeding through a NGT. Place steps in correct order:

a. Assess for bowel sounds.

b. Auscultate tube for placement and check pH.

c. Flush the tube with water.

d. Reflush the tube with water.

e. Administer the feeding.

f. Check for residual volume.

____,______,______._____,_____,_____

question 5
Question # 5
  • The nurse is assigning care for the am shift. Which of these clients is most appropriate to assign to the LPN/LVN?

a. A client with oral cancer who is scheduled in the

morning for glossectomy.

b. An obese client returned from surgery following

vertical banded gastroplasty.

c. A client with anorexia nervosa with muscle

weakness and decreased urine output.

d. A client with intractable nausea and vomiting

related to chemotherapy.

question 6
Question # 6
  • The nurse is teaching the client and family how to do a colostomy irrigation. Place the information in correct order.

a. Hang the container at about shoulder height.

b. Allow the solution to flow slowly and steadily for

5-10 minutes.

c. Put 500 to 1000 ml of lukewarm water in the

container.

d. Allow 30 -45 minutes for evacuation.

e. Lubricate the stoma cone and gently insert the

tubing tip into the stoma.

f. Cleanse, rinse, and dry skin, and apply a new drainage

pouch.

g. Put on a pair of clean gloves.

_______,______,______,______,_______,______,______

question 7
Question # 7
  • In planning a treatment and prevention program of chronic fecal incontinence for an elderly client, which intervention should the nurse try first?

a. Administer glycerin suppository 15 minutes

before evacuation time.

b. Insert a rectal tube at specified intervals each day.

c. Assist the client to the bedpan or toilet 30

minutes after meals.

d. Use incontinence brief pads or adult-sized

diapers.

question 8
Question # 8
  • A client with cirrhosis is at risk for developing complications. Which condition if noted by the nurse requires immediate intervention?

a. Black, tarry stools and decreased urination from

unusually low blood pressure.

b. Shortness of breath and increasing abdominal girth

and size.

c. Edematous lower extremities.

d. Sudden relaxation of muscles of the hand and hold

a sustained posture.

question 9
Question # 9
  • For clients coming to the ambulatory care GI clinic, the nurse would be most appropriate if will assign which task to the LPN/LVN?

a. Teach the client self-care measures for

hemorrhoids.

b. Assist the HCP in incision and drainage of a

pilonidal cyst.

c. Evaluate the client’s response to sitz bath for an

anorectal abscess.

d. Describe the basic pathophysiology of an anal

fistula to a client.

question 10
Question # 10
  • A client underwent an exploratory laparotomy 2 days ago. Which physical assessment finding should the nurse immediately report to the HCP?

a. Abdominal distension and rigidity.

b. NG tube intentionally displaced by client.

c. Absent or hypoactive bowel sounds.

d. Nausea and occasional vomiting.

question 11
Question # 11
  • The nurse is assigning rooms for several clients. Which two client would be best suited to put in the same room?

a. A 35 –year old female with copious, intractable

diarrhea and vomiting.

b. A 43-year old female second day post-op with

cholecystectomy.

c. A 53-year old female with pain related to alcohol-

associated pancreatitis.

d. A 62-year old female with colon cancer receiving

chemotherapy and radiation.

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