PEPTIC ULCER TX:

-A break in the mucous lining of the gastrointestinal tract 1. dietary management

when it comes in contact with gastric juice  Clients are encourage to maintain good
- occurs in any area of the gastrointestinal tract exposed to nutrition, consuming balanced meals at
acid- pepsin secretions, including esophagus, stomach or duodenum. regular intervals.
RISK FACTORS  alcohol intake
 H. pylori infection  smoking should be discourage as it slows the
 Low socioeconomic status rate of healing and increases the frequency of
 Crowded, unsanitary living conditions relapses.
 Unclean food or water NURSING DX & MNGT
 Use of NSAIDs  PAIN –typically experienced 2-4 hours after
 Advance age eating , a high levels of gastric acid and
 History of ulcer pepsin irritate the exposed mucosa.
 Cigarette smoking  assess pain, including location, type,
severity, frequency, and duration and
 Family history of PUD
its relationship to food intake
 Psychological stress, alcohol, caffeine consumption
 administer proton- pump inhibitors,
MANIFESTATIONS
H2 receptor antagonists, antacids.
 pain- gnawing, burning, aching or hungerlike located
Monitor foe effectiveness and side
at the epigastric region sometimes radiating at the back
effects or adverse reactions.
 pain occurs when the stomach is empty 2-3 hours after
meals and in the middle of the night  teach relaxation, stress reduction and
lifestyle management techniques.
 Relieved by eating
COMPLICATIONS:  SLEEP PATTERN DISTURBANCES- night time
ulcer pain, typically occurs between 1- 3 am,
 HEMORRHAGE
may disrupt the sleep cycle and result in
 Occult or obvious blood in the stool
inadequate rest.
 hematemesis
 the importance of taking the
 Weakness, dizziness medications as prescribed ( bedtime
 orthostatic hypotention dose)
 hypovolemic shock  instruct the client to limit food intake
 OBSTRUCTION after the evening meal, eliminating
 sensation of epigastric fullness bedtime snacks. (stimulate the
 nausea and vomiting production of gastric acid and pepsin)
 electrolyte imbalances  encourage use of relaxation
 metabolic alkalosis techniques
 PERFORATION  IMBALANCE NUTRITION:LESS THAN BODY
REQUIREMENTS
 severe upper abdominal pain, radiating to the shoulder
 assess current diet, including pattern
 rigid boardlike abdomen
of food intake, eating schedule and
 absence of bowel sounds
food that precipitate pain or being
 diaphoresis
avoided.
 tachycardia
 refer to dietician for meal planning
 fever and meet nutritional needs
DX TEST/S:  monitor for complaints of anorexia,
 Upper GI series – using barium as a contrast can detect fullness, nausea, and vomiting
80%- 90% of peptic ulcers.  monitor laboratory values for
 Gastroscopy- allows visualization of the esophagus, gastric indications of anemia or other
and duodenal mucosa and direct inspection of ulcers. nutritional deficits.
Tissue can be obtained for biopsy  DEFICIENT FLUID VOLUME- bleeding can lead
MEDICATIONS to hypovolemia and volume deficit, which can
 eradication of H. pylori combination of two antibiotics – lead to decrease in cardiac output and
bismuth or proton – pump inhibitors ( omeprazole, metronidazole impaired tissue perfusion.
and clarithromycin or bismuth subsalicylate, tetracycline and  monitor stool and gastric drainage
metronidazole ( vomitus or nasogastric tube)
 medications that decrease gastric acid content include proton  Bright red with possible clots
pump inhibitors and H2 receptor antagonist – acute hemorrhage
agents that protect mucosa – sucralfate, bismuth, antacids and
 prostaglandin analogs
def.fluid volume…
• maintain IVF with volume and electrolyte solutions,
administer whole blood or PRBC as ordered.
Dietary Management
• insert NGT and maintain its position and patency
 a high fiber diet is recommended- increases
( if ordered may irrigate with sterile normal saline until
stool bulk , decreases intraluminal pressure and
return flow is clear)
may reduce spasm.
• monitor hgb and hct, serum electrolyte BUN and CREA.
 avoid foods with small seeds like popcorn,
( digestion and absorption of blood in the GI tract may
berries which could obstruct diverticula
result to elevated BUN and CREA.
 bowel rest is prescribed put patient on NPO
• assess abdomen, including bowel sounds, distention, girth
with IVF and possibly TPN
and tenderness.
 feeding is resumed initially clear liquid then
• maintain bedrest with the head of bed elevated soft, low roughage diet

DIVERTICULAR DISEASE NURSING DX & MNGT

-are saclike projections of mucosa through the muscular layer of the Impaired
colon. tissue integrity: gastrointestinal
-diverticula may occur anywhere in the gastrointestinal tract
 Monitor VS every 4 hours – Tachycardia
-affect the large intestine with 90% - 95% occurring in the sigmoid colon.
and tachypnea may be early indications
DIVERTICULOSIS
of increase inflammation and resulting to
presence of diverticula
fluid shift. Fever may indicate increase or
asymptomatic
spread of inflammation
episodic pain ( usually left- sided), constipation or diarrhea,
 assess abdomen every 4 hours, measure
abdominal cramping, occult bleeding in the stools, weakness and fatigue
abdominal girth, auscultating bowel
complications include hemorrhage and diverticulitis
sounds, palpating for tenderness
DIVERTICULITIS-
 assess for lower intestinal bleeding
inflammation in and around the diverticular sac.
undigested food and bacteria collect in the diverticula , forming  maintain IVF, TPN and accurate I and O
a hard mass ( fecalith) that impairs he mucosal blood supply, a Pain
llowing bacterial invasion  Ask the client to rate the pain using the
mucosal ischemia can lead to perforation, bacterial contamination pain scale, document level of pain and
and can lead to abscess formation or peritonitis. note for any changes in location or
-pain it is usually left- sided and may be mild to severe and either character of pain
steady or cramping.  administer prescribed analgesics or PCA,
- constipation or increase frequency in defecation use relaxation, positioning and
-nausea, vomiting and fever may occur distractions.
-abdomen is distended with tenderness and s palpable mass in  maintain bowel rest and total body rest
the left lower quadrant resulting from inflammatory response  reintroduce oral foods and fluids slowly,
COMPLICATIONS providing a soft, low fiber diet with bulk
 peritonitis forming agents
 abscess formation anxiety
 bowel obstruction( fistula formation and hemorrhage)  assess and document the level of anxiety
 severe or repeated episodes can lead to scarring and  demonstrate empathy and awareness of
fibrosis of the bowel wall the perceived threat to health
DX TEST/S  attend to physical care needs
 WBC count – leukocytosis ( increase in the number of  spend as much time as possible to client
immature wbc) due to inflammation  encourage supportive family and friends
 hemoccult or guaiac testing to remain with the client
 barium enema\abdominal x-ray  assist client to use and identify
 CT scan appropriate coping mechanism
 sigmoidoscopy or colonoscopy  involve the client and family in care
Medications decisions
 antibiotics – broad spectrum CHOLELITHIASIS/ CHOLECYSTITIS
 Metronidazole CHOLELITHIASIS – is the formation of stones within
 Ciprofloxacin the gallbladder or biliary tract system.
 Septra – bactrim
Bile is formed by the liver and stored in the
 second- generation cephalosporin
gallbladder. Bile contains bile salts, bilirubin, water,
 analgesic- causes less increase in colonic pressure
electrolytes, cholesterol, fatty acids and lecithin. In
the gallbladder, some of the water and electrolytes
are absorbed, food entering the intestine stimulates
  stool softener

 RISK FACTORS (chole) NURSING DX & MNGT

 age  pain
 family history of gallstones  Discuss the relationship between fat
 race intake and the pain- fat entering the
 obesity, hyperlipidemia duodenum initiates gallbladder
 rapid weight loss contractions causing pain when
gallstones are present in the ducts
 female gender
 withhold oral food and fluid during
 biliary stasis
episodes of acute pain
 diseases or conditions
 administer analgesic or narcotic
 4F’S fair fat female forty
analgesia – morphine causes spasm of
 chronic cholecystitis – result from repeated bouts of the colon
acute cholecystitis or from persistent irritation of the
 place in fowlers position
gallbladder wall by the stones.
 bacteria may be present
 monitor vs including temp.
 asymptomatic  imbalanced nutrition : less than body
requirements
 complications include empyema a collection of infected
 assess nutritional status
fluid in the gallbladder, gangrene and perforation with resulting
peritonitis or abscess formation  evaluate laboratory results
DX TEST/S:  refer to dietician or nutritionist
 serum bilirubin – elevated direct bilirubin may indicate  risk for infection
obstructed bile flow in the biliary duct  monitor vs including temp
 CBC- elevated may indicate infection and inflammation  assess abdomen every 4 hours
 abdominal x-ray – gall stones with a high calcium content  assist to cough and deep breath or use
 serum amylase and lipase- possible pancreatitis related to of spirometer, splint abdominal incision
common duct obstruction with blanket or pillow while coughing
 place in fowlers position and encourage
UTZ of the gallbladder- accurately diagnose cholethiasis
ambulation
 ursodiol( actigall) and chenodiol ( chenix)- reduce the
cholesterol content of gall stones, leading to gradual dissolution  administer antibiotics
 side effects diarrhea and hepatotoxic
PANCREATITIS
 disadvantages long duration ( 2 years or more) and a high
-inflammation of the pancreas, that involves self-
incidence of recurrent stone formation when treatment is discontinued.
destruction of the pancreas by its own enzymes
 antibiotics through autodigestion.
MEDS: - characterized by release of pancreatic enzymes
 ursodiol( actigall) and chenodiol ( chenix)- reduce the into the tissue of the pancreas itself leading to
cholesterol content of gall stones, leading to gradual dissolutionhemorrhage and necrosis.
 side effects diarrhea and hepatotoxic  interstitial edematous pancreatitis- leads to
 disadvantages long duration ( 2 years or more) and a high inflammation and edema of pancreatic
 incidence of recurrent stone formation when treatment is discontinued.tissue.
 antibiotics  necrotizing pancreatitis – inflammation ,
TX: hemorrhage and ultimately necrosis of
 laparoscopic cholecystectomy ( removal of the gallbladder) pancreatic tissue.
 cholecystostomy – drain the gallbladder MANIFESTATIONS
 choledochostomy- remove stones and position a T tube in the  ACUTE
common bile duct  Abrupt onset of severe epigastric pain
 dietary management and LUQ pain, may radiate to back
o food may be eliminated during an acute attack  nausea and vomiting, fever
o NGT is inserted to relieve nausea and vomiting  decrease bowel sounds, abdominal
o dietary fat intake may be limited distention, rigidity
 tachycardia, hypotension,cold
Shock wave lithotripsy- non-invasive treatment of kidney stones (
clammy skin
urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver)
 possible jaundice
 CHRONIC
 recurrent epigastric and LUQ pain,
radiates to the back
using an acoustic pulse.

 CT scan – identify pancreatic enlargement, fluid collections

 Endoscopic retrograde cholangiopancreatography(ERCP)
– perform to diagnose chronic pancreatitis
 endoscopic UTZ
 percutaneous fine needle aspiration biopsy- differentiate
from cancer
MEDS
 narcotic analgesics
 antibiotics
 H2 blocker and proton – pump inhibitor – to neutralize
or decrease gastric secretions
 synthetic hormone- octreotide( sandostatin) suppresses
pancreatic secretion and may relieve pain
fluid and dietary management
 oral food and fluids are withheld during acute episodes
 NGT may be inserted
 IVF , TPN
SURGICAL TX:
 endoscopic transduodenal sphincterotomy-
performed if the result of a gallstone lodge in the sphincter
of oddi to remove the stone
NURSIN DX &MNGT
 pain
 obstruction of pancreatic ducts and inflammation
, edema and swelling of the pancreas caused by pancreatic
autodigestion, severe epigastric pain, left upper abdominal
or midscapular back pain. Nausea and vomiting
o assess pain using the pain scale, location,radiation,
duration, and character
 NPO and maintain the patency of NGT- gastric secretions
stimulate hormones that stimulate pancreatic secretion ,
aggravating pain. NGT decreases nausea, vomiting,
and intestinal distention.
 maintain on bed rest
 assist on comfortable position
 Imbalanced nutrition: less than body requirements
 monitor laboratory values
 weigh daily
 maintain stool charting
 monitor bowel sounds – return of bowel sounds
 indicates return of peristalsis
 administer prescribed IVF to maintain hydration,
 TPN to provide fluids, electrolytes and kilocalories
  TOPICAL ANTIFUNGAL AGENTS

 clotrimazole

 nystatin

 This drugs help in topical

treatment of candidiasis.
Effects are primarily local
than systemic
STOMATITIS
inflammation of the oral mucosa, common disorder of the mouth. Nursing responsibilities
 may cause viral ( herpes simplex), fungal infections( candida
albicans), mechanical trauma ( cheek biting), irritants - instruct the client to dissolve lozenges in the
like tobacco or chemotherapeutic agents. mouth
- instruct the client to rinse mouth with oral
 MANIFESTATIONS and TX: suspension for at least 2 minutes and
1. cold sore, fever blister expectorate or swallow as directed
 cause- herpes simplex virus - contraindicated in pregnancy
 initial burning at site - take medication as prescribed
o clustered vesicular lesions on lip or - Do not eat or drink 30 mints after
oral mucosa medicaiton
- contact physician if symptoms worsen
 self- limiting
- perform good oral hygiene after meals and
 acyclovir to shorten course
at bedtime remove dentures
-
2. aphthous ulcer (canker sore, ulcerative stomatitis)
ANTIVIRAL AGENT
 unknown, maybe type of herpes virus
- acyclovir (zovirax)
 well circumscribed, shallow erosions with - Useful in treatment of oral herpes simplex
 white or yellow center encircled by red ring virus- helps reduce severity and frequency
o less than 1cm in diameter of infection.
o painful - start therapy as soon as herpetic lesions are
 topical steroid ointment noted
o amlexanox oral paste (aphthasol) - administer with food or on an empty
o oral prednisone stomach
3. candidiasis (thrush) - the virus remain latent and can recur during
 candida albicans stressful events, fever, trauma, sunlight
 creamy white, curdlikepatches exposure
o red, erythematous mucosa -
 nursing diagnoses and interventions
 fluconazole ( diflucan)
impaired oral mucosal membrane
o ketonazole( nizoral)
- assess and document oral mucous
o clotrimazole troches
membranes and the character of any lesions
o nystatin vaginal troches
every 4-8 hours
4. necrotizing ulcerative gingivitis ( trench mouth, vincent’s infection)
- assist with thorough mouth care after meals
 infection with spirochetes bacilli or systemic infection and bedtime.
 acute gingival inflammation and necrosis - assess knowledge and teach about
o bleeding, halitosis condition, mouth care and treatments.
o fever Instruct to avoid alcohol, tobacco and hot
o cervical lymphadenopathy spicy or irritating foods.
 correct any underlying disorders
o warm, half- strength peroxide mouthwashes - less than body requirements
o oral penicillin - assess food intake as well as clients ability
 medications to chew and swallow. Weigh daily. Provide
straws or feeding syringes.
- encourage a high calorie, high protein diet.
Offer soft, lukewarm or cool foods or liquids.
-
  TOPICAL ORAL ANESTHETICS
o oragel
o Viscous lidocaine
o anbesol
o triamcinolone acetonide
o This drug reduce the pain. o gastric bypass
They provide temporary relief of pain.  maintaining weight loss
 nursing responsibilities
 instruct the client to seek medical attention behavioral changes strategies for the obese
for any oral lesion that does not heal within 1 week  controlling the environment
 monitor for oral hypersensitivity reactions, and o purchase low- calorie foods
discontinue use o shop from a prepared list and on a
 Apply every 1 -2 hours as needed full stomach
 perform oral hygiene after meals and at bedtime o keep all foods in the kitchen
avoiding eating when watching
television or reading
 physiologic responses to food
o eat slowly by taking small bites
OBESITY o eat a salad or hot beverages before
 an excess of adipose tissue. Adipose tissue is created when meal
the energy consumption exceeds energy expenditure.
o chew each bite thoroughly and
 0ne – third of the population in the united states is obese,
slowly
higher in women
 psychologic responses to food
 health related problems in Obesity
o use attractive dinnerware , and
 arthritis prepare a formal setting for eating
 atherosclerosis o use small plates and cups
 cancer o concentrate on conversations and
 heart failure socialization during meal
 diabetes, mellitus type 2 nursing diagnoses and interventions
 hiatal hernia  imbalanced nutrition: more than body
 hypertension requirements
 low back pain o encourage the client to identify the
 muscle strains and sprains factors that contribute to excess
 stress incontinence food intake
 varicosities o establish realistic weight loss goals
 risk factors and exercise/ activity.
 genetic- one obese parent has 40% of becoming obese o assess the clients knowledge and
 physiologic - discuss well- balanced diet plans.
 environmental o discuss behavior modification
strategies like self monitoring and
 sociocultural factors
environmental mngt.
 diagnostic tests
 activity intolerance
 Body mass index- identify excess adipose tissue. o assess current activity level and
BMI dividing the weight (in kilogram) by the height in tolerance of the activity. Assess vital
meters squared(m2) signs.
BMI= wt (kg)/ht2(m2) o medically cleared plan with the
normal= BMI 18.5-24.9kg/m2 client program of regular, gradually
over wt= BMI 25-29.9kg/m2 increasing exercise. Consult with a
obese= BMI> 30kg/m2 physiologist.
**Morbidly obese =BMI > 40kg/m2  ineffective therapeutic regimen mngt
 anthropometry- skinfold or fatfold measurements, o discuss the ability and willingness to
uses calipers to measure skinfold thickness at incorporate changes into daily
various sites of the body patterns of diet, exercise and
 underwater weighing (hydrodensitometry) the lifestyle
 most accurate way to determine body fat. Submerging o help the client identify behavior
the whole body and then measuring the amount of modification strategies and support
displaced water system for weight loss and
maintenance.
o establish strategies for dealing with
stress eating or interruptions in the
  bioelectrical impedance- uses a low energy
impulses to determine the percentage of the body
fat by measuring the electrical resistance of the body.
 other diagnostic test
o Thyroid profile
o serum cholesterol- HDL levels are reduced in  Collaborative Care
obese clients, LDL are very high  The goal for the malnourished client is
o ECG- detects effects of obesity on the heart, to restore ideal body weight while
such as rate, or rhythm disruptions replacing and restoring depleted
o treatments nutrients and minerals.
o exercise  treatment may include oral
o dietary management supplementation, tube feedings or TPN.
o behavior modification  Diagnostic Tests
o medications 1. Serum albumin
 medications 2. total lymphocyte count
 appetite suppressant ( sibutramine meridia) 3. serum electrolyte
 lipase inhibitor orlistat( xenical)  SPECIALIZED PROCEDURES
 surgery – to reduce stomach capacity 1. bioelectric impedance analysis
o gastroplasty 2. total daily energy expenditure
o vartical banding 3. Medication Administration
 Vitamin and mineral supplements
MALNUTRITION  fat- soluble vitamins
results from inadequate intake of nutrients. Lack of vit. A
major nutrients ( calories, carbohydrates, proteins, and fats) or vit. D
micronutrients such as vitamins and minerals. May be caused by vit. E
inadequate nutrient intake, impaired absorption and use of nutrients vit. K
or increased metabolic needs. Fat soluble vitamins are absorbed in the
gastrointestinal tract. Vitamin A and D are stored in
 conditions associated with malnutrition the liver. All fat soluble vitamins may become toxic
 acute respiratory failure if taken in excess amounts.
 Aging  nursing responsibilities
 AIDS  monitor for manifestations of
 alcoholism vitamin excess as well as for
 burns adverse effects from vitamin
administration.
 COPD
 monitor carefully for
 eating disorders
hypersensitivity reactions
 gastrointestinal disorders
 administer vitamin A with food
 neurological disorders
 teach the importance of eating a
 renal disease well balanced diet
 risk factors > Water Soluble Vitamins
 age  vitamin C( ascorbic acid)
 poverty, homeless, inadequate food  vitamin B complex
storage and preparation facilities o thiamine B1
 functional health problems that limit o Riboflavin B2
mobility and vision o Niacin ( nicotinic acid0
 oral or gastrointestinal problems o Pyridoxin hydrochloride B6
 chronic pain or diseases such as pulmonary, o Pantothenic acid
cardiovascular, renal or endocrine disorders o Biotin
 medications or treatments that affects appetite Used to prevent or treat deficiency problems. Mostly
 acute problems like infection, surgery or trauma absorbed from the gastrointestinal tract.
 Manifestations of Specific Nutrient Deficiencies  nursing responsibilities
o Calorie Weight loss o monitor for responses to
Weakness , listlessness replacement therapy
loss of subcutaneous fat o monitor for hypersensitivity
muscle wasting reactions from parenteral
o Protein Thin or sparse hair administration.
o do not exceed the recommended
daily allowances for specific vitamin.
 Minerals
 flaking skin
hepatomegaly
o Vitamin A night blindness
altered taste and smell
dry, scaling, rough skin
o Thiamine confusion, apathy  hypothermia
cardiomegaly, dyspnea  Constipation
muscle cramping and
 insomiaa
wasting
 Complications
paresthesia,neuropathy
o electrolyte and acid base
ataxia
disturbances
o Riboflavin cheilosis, stomatitis
o reduced cardiac muscle mass, low
neuropathy, glossitis
cardiac output, dysrhythmias
o Vitamin C swollen, bleeding gums
o anemia
delayed wound healing o hypoglycemia, elevated serum uric
weakness, depression
acid
easy bruising
o osteoporosis
o Iron Smooth tongue
o delayed gastric emptying
listlessness, fatigue
o abnormal liver function
dyspnea
BULIMIA
 weight often normal, may slightly
overweight
 binge- purge behavior
Minerals are inorganic chemicals that are vital to a variety  amenorrhea
of physiologic functions. The dosage of prescribed minerals  lacerations of palate, callous on
depends on the specific deficiency, route of administration fingers
and the clients general health.  Complications
 nursing responsibilities o enlarged salivary glands
 monitor for manifestations of mineral o stomatitis, loss of dental enamel
imbalance o F and E, acid base imbalances
 prior administration dilute oral o dysrhythmias
mineral preparations o esophageal tears, stomach rupture
 prior to administration of iodine assess
for history of hypersensitivity to iodine or seafood  nursing diagnoses and interventions
 avoid exceeding o Imbalanced nutrition: less than
 nursing diagnoses and interventions body requirements
 imbalanced nutrition: less than body requirements o chronic low self- esteem
o provide an environment and nursing measures o disturbed body image
that encourage eating. Eliminate foul o ineffective family therapeutic
odors, provide oral hygiene before and after meals, regimen management
make meals appetizing and offer frequent small meals. o regularly monitor weight,
o provide a rest period before and after meals o monitor food intake during meals, recording
o assess knowledge and provide appropriate teaching percentage of meal and snack consumed,
 risk for infection maintain close observation for at least 1
o monitor temp and assess for hour following meals, do not allow client
manifestations of infection every 4 hours alone in bathroom
o maintain medical asepsis when providing o serve balance meals, including all nutrient
care and surgical asepsis when carrying out groups. Increase serving size gradually
procedures. o serve frequent , small feedings of cold or
o teach signs and symptoms of infections, good room temp. foods.
handwashing technique and factors that increaseo administer multivitamins and mineral
the risk for infection supplement to replace losses.
 risk for deficient fluid volume GASTRITIS
o monitor oral mucous membranes, urine s inflammation of the stomach lining, results from
pecific gravity, levels of consciousness and irritations of the gastric mucosa.
laboratory findings every 4-8 hours.
Acute gastritis benign, self limiting disorder
associated with the ingestion of gastric irritants such
as aspirin, alcohol, caffeine or foods contaminated
with certain bacteria. Asymptomatic to mild
 o weight daily and monitor intake and output
o if allowed offer fluids frequently in small amounts
 risk for impaired skin integrity
o assess skin every 4 hours
o turn and position at least every 2 hours .
Encourage passive and active range of
motion exercises.
o keep skin dry and clean. Keep linens smooth,
clean and dry. Provide therapeutic beds, mattresses or pads.
EATING DISORDERS
Characterized by severely disturbed eating behavior and
weight management
women are more commonly affected than men
ANOREXIA NERVOSA – weight less than 85% of expected
for age and height, and an intense fear of gaining weight
BULIMIA NERVOSA- recurring episodes of binge followed by
purge behaviors - self induced vomiting, use of laxatives or
diuretics, fasting or excessive exercise
 manifestations and complications of anorexia and bulimia
ANOREXIA
 weight < 85% of normal, muscle wasting
 fear of weight gain, refusal to eat
 disturbed body image, excessive exercise
 amenorrhea
 skin and hair changes
 hypotension
 pathophysiology
 acute gastritis
 erosive gastritis
 chronic gastritis
 manifestations
 acute
Gastrointestinal systemic

 Anorexia possible shock

 Nausea and vomiting
 Hematemesis
 Melena
 Abdominal pain
 chronic
Gastrointestinal systemic
Vague discomfort after eating anemia
Maybe asymptomatic fatigue
 diagnostic tests
1. gastric analysis
2. hemoglobin and hematocrit
3. serum vitamin B12
4. Upper endoscopy
 medications
 proton –pump inhibitor
 histamine2 receptor blocker
 sucralfate
 eradication of H. pylori infection
 treatments
 acute
o gastrointestinal rest is provided by
 6 to 12 hours of NPO
o slow reintroduction of clear liquids follow
by ingestion of heavier liquids and finally
gradual reintroduction of solid food.
o nausea and vomiting threaten fluid and
electrolyte balance, IVF as ordered  greasy, frothy, yellow stools
o gastric lavage ( steatorrhea) may appear with fat
 nursing diagnoses and interventions malabsorption
 Deficient fluid volume  consistency
o monitor skin turgor, color and condition and  hard stools or long, flat stool may
status of the mucous membranes. Provide skin a result from spastic colon or bowel
nd mouth care frequently obstruction due to tumor or
o Monitor laboratory values for electrolytes and hemmoroids
acid base balance . Report significant changes  mucousy, slimy feces may indicate
or deviation from normal inflammation
o administer oral fluids as ordered  watery, diarrhea stool- appear with
o administer antiemetics and drugs that relieve malabsorption problem, ingestion of
vomiting and facilitate oral feeding spoiled foods
 imbalance nutrition: less than body requirements ENEMA
o monitor and record food and fluid intake and any Chronic or a fecal impaction may require
abnormal losses. administration of enema. Enema should be used
o Monitor weight and laboratory studies such as serum a in acute situations and only on short – term
albumin, hemoglobin and red blood cells basis. Must be ordered to prepare the bowel for
o arrange for dietary consultation to determine caloric diagnostic testing or examination
and nutrient needs and develop plan  Is the procedure of introducing liquids into
o provide nutritional supplements between meals or the rectum and colon via the anus. The
frequent small feeding as needed. increasing volume of the liquid causes rapid
o maintain tube feeding or TPN expansion of the lower intestinal tract, often
resulting in very uncomfortable bloating,
LOWER GASTROINTESTINAL SYSTEM cramping, powerful peristalsis, a feeling of
Assessing bowel functions extreme urgency and complete evacuation
 medical conditions that may influence the clients bowel of the lower intestinal tract.
elimination  types
 psychosocial history o saline enema using 500ml to
 lifestyle for any pattern of psychologic stress and depression 2000ml of warmed physiologic saline
 activities of daily living solution is the least irritating to the
bowel
 described the frequency and character of stool
o tap water enemas use 500ml-
 history of diarrhea, constipation or bleeding from the rectum
1000ml of water to soften feces and
 use of laxatives, suppositories or enemas
irritates the bowel mucosa ,
 ostomy
stimulating peristalsis and
 clients nutritional status evacuation
o weight o soap sud enemas consist of tap
o Appetite water solution to which soap is
o food preferences added as irritant
o food intolerance o phosphate enemas ( fleet) – irritate
o special diets the mucosa leading to evacuation
o nausea and vomiting in related to food intake o oil retention enemas instill mineral
o used of antacids or over the counter medications, or vegtable oil into the bowel to
herbal medications soften the fecal mass
o history of colon cancer, gallbladder dse. or  bowel stimulant not unlike laxatives that is
malabsorption syndromes orally administered while enemas are
Physical assessment administered directly into the rectum, the
 assessment includes inspection of the abdomen and auscultation patient expels feces along with the enema in
of the bowel sounds the bedpan or toilet
 equipments  enemas may be used to relieve constipation
o water soluble lubricants and fecal impaction
o materials for testing the stool  cleansing the lower bowel prior to asurgical
procedure such as sigmoidoscopy or
colonoscopy because of speed and
convenience, enema used for this purpose
 o disposable gloves
 explain
 inspection
o retention of flatus or stool may cause generalized
abdominal distention
o scaphoid abdomen
 auscultate
o 4 quadrants
o normal bowel sound every 5-15 seconds, listen
for at least 5 minutes each quadrant
o high pitched, tinkling, rushing bowel sound may be
heard in client with diarrhea or experiencing
onset bowel obstruction
o bowel sounds may be absent in later stages
of a bowel obstruction
*perianal assessment with abnormal findings
 inspect( wearing gloves)
o swollen, painful, longitudinal breaks in the anal
area may appear in clients with anal fissures.
o dilated anal veins appear with hemorrhoids
o red mass may appear with prolapsed
internal hemorrhoids
o doughnut – shaped red tissue at anal area may
indicate prolapsed rectum
 color
o blood on the stool result from bleeding
in the sigmoid colon, anus,or rectum
o black tarry stool (melena) occurs with
upper GI bleeding
o grayish or whitish- can result from biliary
o tract obstruction due to lack of bile in stool
indication
 cancer
 diverticular disease
 crohn’s disease
 trauma or injury
 a temporary colostomy may be needed to allow
the colon to rest and heal for a period of time.
temporary colostomy may be in place for weeks,
months, or years. Will eventually be closed and
bowel movements will return to normal
 Types of colostomy- colostomy types are related to the place on the
colon where the surgery is done.
 ascending colostomy- this colostomy has a stoma ( opening )
that is located on the right side of the abdomen. The output that
drains from this stoma is in liquid form.
 transverse colostomy-stoma that is located at the upper
abdomen towards the middle or right side. The output that
drains from this stoma may be loose or soft.
 descending colostomy- stoma that is located on the lower
 side of the abdomen. The output that drains from this stoma is firm.
 Problems
 stoma retraction- retractions happens when the height of
the stoma goes down to the skin level or below the skin level.
 prolapse- bowel becomes longer and protrudes out of the
stoma and above the abdomen surface.
 stenosis- narrowing or tightening of the stoma at or below
the skin level. Mild stenosis can cause noise as stool and
gas is passed. Severe stenosis can cause obstruction of stool.