1 / 73

The Gastrointestinal System: Digestive Disorders

The Gastrointestinal System: Digestive Disorders. Part I. J. Carley MSN, MA, RN, CNE. “Air-Fluid Levels” seen in small bowel obstruction. The G-I System. Supplemental Learning Objects : Flash Cards (Terminology ) See the email I sent you yesterday G-I System Games

marvin
Download Presentation

The Gastrointestinal System: Digestive Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. The Gastrointestinal System: Digestive Disorders Part I J. Carley MSN, MA, RN, CNE “Air-Fluid Levels” seen in small bowel obstruction

  2. The G-I System • Supplemental Learning Objects: • Flash Cards (Terminology) • See the email I sent you yesterday • G-I System Games • Meds for the Gastro Intestinal Systemhttp://www.quia.com/rr/612817.html • G-I System Part Ihttp://www.quia.com/rr/612592.html • GI System Part 2http://www.quia.com/rr/612897.html • G-I System Part 3http://www.quia.com/rr/612899.html

  3. LEARNING OUTCOMESAt the conclusion of this learning activity, the nurse will be able to: 1. Describe the mechanism of action, signs and symptoms, complications, treatments and nursing interventions for gastrointestinal disorders 2. Compare and describe the pathophysiology for Crohn’s Disease and ulcerative colitis 3. Explain pathophysiology, types, risk factors, and treatment for gastritis

  4. LEARNING OUTCOMESAt the conclusion of this learning activity, the nurse will be able to: 4. Explain the use of radiography in diagnosis of GI health problems 5. Discuss the physical assessment findings in a client with digestion, nutrition, and elimination health problems 6. Describe procedures, risk factors, potential complications, nursing monitoring, and interventions for scope procedures

  5. LEARNING OUTCOMESAt the conclusion of this learning activity, the nurse will be able to: 7. Describe preparation, post-op interventions, and teaching needs for a patient with a new colostomy 8. Analyze medications, usage, precautions, side effects, and mechanism of action 9. Apply the nursing process to medication administration and usage

  6. LEARNING OUTCOMESAt the conclusion of this learning activity, the nurse will be able to: 10. Explain causes, sign/ symptoms, nursing interventions, treatments, and complications of a bowel obstruction 11. Explain pathophysiology, risk factors, and medical management of gastrointestinal disorders 12. Explain causes of bowel obstruction

  7. A Rough Outline:For the Left Hemispheric Dominant Learners • Terminology • A&P • GI Disorders • GERD • Hiatal Hernias • PUD • G-I Pharmacology • Antacids • Prokinetic Agents • H 2 Receptor Antagonists • Proton Pump Inhibitors • Mucosal Barriers • G-I Diagnostic Testing

  8. Key Terms & word roots* • -algia • -dynia • volvulus • dyspepsia • regurgitation • hypersalivation • pyrosis • eructation • dysphagia • odynophagia • -enter/o • -col/o • -gastr/o • -esophag/o • ulceration • aspiration • ischemia • diverticula • diverticulitis • colostomy • illeostomy • tenesmus • steatorrhea • diarrhea • fistula • defecation • --rrhea • steato-

  9. Anatomy and Pathophysiology Length = 27-30 feet (9-10 meters)

  10. GI Tract Functions Secretion Digestion Absorption Motility Elimination

  11. CN X: Vagus Nerve Involves: esophagus, stomach, small intestines, gallbladder, and large intestines Parasympathetic: stimulates motor and secretory activity, relaxes sphincters

  12. Oral Cavity Teeth: chewing Mucin and amylase: breaks down food Tongue Pharynx Esophagus: 2 sphincters

  13. Esophagus

  14. Stomach

  15. Function of Stomach Ingestion of food Food reservoir Digestive process: -movement -gastrin secretion: hydrochloric acid and pepsin -chyme

  16. GI Disorders

  17. Concept Map: Selected Topics in Gastro-Intestinal Nursing Pathophysiology PHARMACOLOGY ASSESSMENT Physical Assessment Inspection Palpation Percussion Auscultation KEY ASSESSMENTS Lab Monitoring Upper GI Lower GI Anti-Acids (Antacids) Prototype: aluminum hydroxide gel (Amphojel) Inflammatory Inflammatory G.E.R.D. Peptic Ulcers Gastric Ulcers Duodenal Ulcers Gastritis Prokinetic Agents: Prototype: metoclopramide (Reglan) Acute Appendicitis Peritonitis Ulcerative colitis Crohn’s Disease Diverticulitis Histamine 2 Receptor Agonists Prototype: ranitidine hydrochloride (Zantac) ***Diagnostic Testing Proton Pump Inhibitors) Prototype: omeprazole (Prilosec) Non-Inflammatory Non-Inflammatory G.E.R.D. Hiatus Hernias Constipation & Diarrhea Irritable Bowel Syndrome Dumping Syndrome Intestinal Obstruction Hemorrhoids & Polyps Malabsorption Mucosal Barriers Prototype: sucralfate (Carafate) Disease Specific Medications: Care Planning Plan for client adl’s, Monitoring, med admin., Patient education, more…based On Nursing Process: A_D_O_P_I_E ***Preparing for Diagnostic Tests Nursing Skills: NG Tube Insertion Enteral Feedings Nursing Interventions & Evaluation Execute the care plan, evaluate for Efficacy, revise as necessary

  18. GI Disorders Inflammatory Non-Inflammatory Upper GI • Gastroesphageal Reflux Disease • Ulcers • Gastritis Upper GI • Gastroesphageal Reflux Disease • Hiatus Hernia/hernias

  19. GI Disorders Inflammatory Non-inflammatory Lower GI • Acute Appendicitis • Peritonitis • Ulcerative colitis • Crohn’s Disease • Diverticulitis Lower GI • Constipation & Diarrhea • Irritable bowel syndrome • Dumping syndrome • Intestinal Obstruction • Hemorrhoids and polyps • Malabsorption syndrome

  20. The Inflammatory Process Acute local inflammation: -edema, pain, heat, and redness -exudates may or may not be present Acute systemic inflammation: -fever -leukocytosis (increased WBC) -plasma protein synthesis

  21. Inflammatory Process Chronic Inflammation: -increased duration>2 weeks -proceeds after unsuccessful acute inflammatory response -may occur without distinct inflammation

  22. Overview:Gastroesophageal Reflux Disease (GERD) • GERD : common condition (affects 14% of Americans) characterized by gastric content and enzyme leakage into the esophagus. • These corrosive fluids irritate the esophageal tissue and limit its ability to clear the esophagus. • Causes are related to the weakness or transient relaxation of the lower esophageal sphincter (LES) at the base of the esophagus, or delayed gastric emptying. • The chief symptom of GERD is frequent and prolonged retrosternal heartburn (dyspepsia) and regurgitation (acid reflux) in relationship to eating or activities. • Other symptoms can include chronic cough, dysphagia, belching (eructation), flatulence (gas), atypical chest pain, and asthma exacerbations.

  23. Gastroesophageal Reflux Disease(GERD) Backward flow of gastrointestinal contents into esophagus

  24. Cause of GERD Inappropriate relaxation of lower esophageal sphincter (food, medication, etc)

  25. GERD: Etiology • ETIOLOGY: • Any factor that relaxes the LES, such as smoking, caffeine, alcohol, or drugs. • Any factor that increases the abdominal pressure, such as obesity, tight clothing at the waist, ascites, or pregnancy. • Older age and/or a debilitating condition that weakens the LES tone. • CONTIBUTING FACTORS: • Excessive ingestion of foods that relax LES, e.g., fatty / fried foods, chocolate, tomatoes, alcohol • Distended abdomen from overeating or delayed emptying • Increased abdominal pressure resulting from obesity, pregnancy, bending at the waist, ascites or tight clothing at the waist • Drugs that relax the LES, such as theophylline, nitrates, calcium channel blockers, anticholinergics, and diazepam (Valium) • Drugs, such as NSAIDs, or events (stress) that increase gastric acid • Debilitation or age-related conditions resulting in weakened LES tone • Hiatal hernia (LES displacement into the thorax with delayed esophageal clearance) • Lying flat

  26. Signs & Symptoms of GERD • Classic symptoms: • Dyspepsia, especially after eating an offending food / fluid, and regurgitation. • Other symptoms: • Symptoms from throat irritation (chronic cough, laryngitis), hypersalivation, eructation, flatulence, or atypical chest pain from esophageal spasm. • Chronic GERD can lead to dysphagia (difficulty swallowing).

  27. Complications of GERD Barrett’s Esophagus Irritation to esophagus and mucosal injury Aspiration Barrett’s esophagus Esophageal erosions, ulcerations, or tears Chronic bronchitis Asthma (adult onset)

  28. Diagnostic Testing History and Physical Dietary monitoring 24 hour ambulatory pH monitoring Esophageal manometry Endoscopy

  29. Diagnostic Interventions : GERD • Barium Upper GI: • Prepare the client for the procedure. • Post procedure: Assess for bowel sounds and potential constipation. • Endoscopy : • Conscious sedation to observe for tissue damage • Post procedure: Verify gag response prior to providing oral fluids or food.

  30. Barium Sulfate (Ba SO4)

  31. Medical Management for GERDNon-surgical Goals: relief of symptoms and prevent complications Life style changes: -Diet: smaller meals more frequent, limit or avoid carbonated beverages, coffee, chocolate, fats, mints, spicy or acidic food

  32. Medical Management Continued Life Style Changes: -Elevate HOB, sleep on LEFT side -AVOID smoking and ETOH -Avoid tight or restrictive clothing -Lose weight

  33. Medical Management • Antacids, • E.g., aluminum hydroxide (Mylanta), neutralize excess acid. -- should be administered when the acid secretion is highest (1 to 3 hr after eating and at bedtime). --Antacids should be separated from other medications by at least 1 hr. • Histamine 2 (H2) receptor antagonists • E.g., ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid), and cimetidine (Tagamet), reduce the secretion of acid. • The onset is longer than antacids, but the effect has a longer duration. • Proton Pump inhibitors (PPI) • E.g., pantoprazole (Protonix),omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid) reduce gastric acid by inhibiting the cellular pump necessary to secrete it. • Studies show that PPI are more effective than H2 antagonists. • Other Medications • E.g., metoclopramide hydrochloride (Reglan), increase the motility of the esophagus and stomach.

  34. Invasive Interventions for GERD Endosopic therapy: BESS (Bard EndoCinch Suturing System), Stretta, and Enteryx procedures Surgery: Laparoscopic NissenFundoplication (The”Gold Standard”)

  35. Nursing Interventions Post operative or procedure management: - Monitor vital signs -Monitor swallow/gag reflex -Assess for abdominal pain -Monitor for bleeding -Assess incision sites -Assess and monitor NG tube

  36. Nursing Diagnosis Altered Nutrition Acute or Chronic pain Risk for aspiration Alteration in sleep patterns Knowledge Deficit Impaired Swallowing Potential for complications

  37. Nursing Interventions EDUCATION: -Medication Compliance -Dietary changes -Lifestyle changes Post operative or procedure management

  38. Normal Esophagus

  39. GERD

  40. Barrett’s Esophagitis

  41. Hiatal Hernia Involve protrusion of the stomach wall through the esophageal hiatus of the diaphragm

  42. Types of Hiatal Hernias Sliding: (Most Common) esophagogastric junction and portion of the fundus slide upward through the esophageal hiatas Rolling: the fundus and portions of the stomach rolls through the esophageal hiatas

  43. Causes of Hernias Muscle weakness Anatomic defects Congenital weakness Prolonged increased abdominal pressure Surgery Trauma Obesity

  44. Symptoms of Hernias Sliding Rolling • Adult onset asthma • Symptoms worse after meals • Symptoms worse in recumbent position • Feeling full after eating • Breathlessness or feeling of not be able to breath • Chest pain like angina • feeling of suffocation • Symptoms worse in recumbent position

  45. Diagnostic Testing Barium Swallow Study

  46. Medical Management Diet Medications (GERD) Weight Loss Avoid late night food Avoid straining/vigorous exercise No restrictive or binding clothes Surgical repair: Laparoscopic NissenFundoplication

  47. Nursing Interventions Education: -Medication compliance -Dietary changes and monitoring -Lifestyle changes and monitoring Post-op management Assess coping mechanisms

More Related