NCM 116 SIDEnotes Leonoras
NCM 116 SIDEnotes Leonoras
NCM 116 SIDEnotes Leonoras
blood
Disease ● Changes in bowel
❖ Diarrhea- color of the stool
● LES- Lower Esophageal Sphincter is
❖ Constipation- last time client
also known as cardiac sphincter
had bowel movement
❖ The tone is decreased that is
❖ Is there medication taken?
why it is affected in GERD
Anticholinergic?
❖ The factor that reduce the
❖ Semi loose, Loose, Soft,
LES pressure are the ones
Formed)
that would cause the reflux
❖ Assess if px takes meds
● Stomach- located in upper portion of
● Physical Assessment
abdomen, left of the midline and
❖ Inspection
under the left diaphragm
❖ Auscultation
● 1500 cc capacity of stomach
❖ Palpation
● Sympathetic - inhibitory effect,
❖ Percussion
constrict the sphincters and blood
❖ Usually IPPA but ma alter
vessels (gastric secretion and GI
Ang bowel motility that is why
motility decreased)
IAPP is use in abdominal
● Parasympathetic- causes peristalsis,
examination
increased secretory activities,
● Supine position and knees flexed-
sphincters are relax, increase GI
abdominal examination position
motility
● Tympany sound- percussion
Acetylcholine- neurotransmitter of
● Dull sound- liver
parasympathetic
● Resonance- normal sound (Lung
● Pain
sound)
❖ Assess the location
❖ Type of pain
Medications that cause gastric irritation
❖ Severity of pain- pain scale
● Aspirin (ASA-acetylsalicylic acid)-
of 1-10
should not be taken in peptic ulcer
❖ Factors that trigger by pain
disease and gastritis, NSAID
● Indigestion
● Ibuprofen
Upper abdominal discomfort
● indomethacin
associated with eating
● Colchicine- anti gout medication,anti
Assess what the patient eat,how
inflammatory, drug,
long and ano kadamo
immunosuppressant
–Fatty acids stays longer in the
● Corticosteroid - prone to infection,
stomach
immunosuppressant
● Intestinal Gas
● Cancer chemotherapeutic agents
❖ Will cause discomfort
● anticoagulant
❖ Can expel through the mouth
in the form of belching
laboratory/diagnostic procedure
❖ Can expel through lower GI
● Abdominal X Ray
tract in the Form of flatulence
❖ Intestinal gases
❖ Check for bowel sounds- 15
❖ Fluid masses
to 20 sec or 5 to 20 sec
❖ Size and position
❖ Assess bowel sound-high
● Abdominal CT scan - T scan – x-ray
pitch and gurgling sound
images taken at different angles,
❖ Hyperactive- every 3
then synthetized by computer to
seconds
produce an accurate picture of the
❖ Hypoactive-1 for every
structure that is assessed; contrast
minute
material may be used orally, rectally
❖ absent - no bowel sounds for
or intravenously.
3-5 minutes
Sodium Bicarbonate- medication to
● Nausea and Vomiting
protect the kidney
❖ Odor and color
Check for allergy for iodine prep
❖ Color of vomitus
(give antihistamine and
❖ Volume of vomitus
corticosteroids)
❖ What trigger
❖ Is there blood?
Serum creatinine will be used to ❖ Barium- has the constipating
assess effect
Fasting for 2-4 hours ❖ Client has given laxatives
Risk - allergic reaction and kidney ❖ Increase fluid intake to
injury. Before ct scan, client may be prevent dehydration (NS)
given premedicated (antihistamine ● Barium Enema- lower GI study
and corticosteroid) corticosteroid has ❖ Cleansing of the bowel
anti allergic properties. Client may ❖ Clear liquid diet
also be given sodium bicarbonate ❖ NPO
and mucomyst ●
● Ultrasound ● Oral cholecystography – oral
❖ Fluid and air will hinder the ingestion of a radiopaque dye is
soundwaves administered to a client and then
❖ Fluids and air will hinder the x-rays are taken of the gallbladder
travel of waves ● Stool analysis- assess blood
❖ 8-12 hrs fasting pathogen or fats
❖ Sound waves cannot travel in ● Schillings test- used in pernicious
the bony tissue because anemia
bones prevent the sound ❖ evaluates small bowel
waves to travel deeper. absorption of vitamin B12
❖ FAT FREE MEAL is and possible lack of intrinsic
appropriate for the client factor
cause fat will stimulate the ● Hydrogen breath test- evaluate CHO
release of bile through the absorption
action of cholecystokinin ● Antacids- neutralize gastric acid
● MRI ❖ Commonly taken 1 hour after
❖ Magnetic Resonance meal (best taken) and at
Imaging bedtime
❖ Remove metal object on the ❖ Aluminum based- can cause
client (watch, earrings) constipation
● Endoscopy ❖ Magnesium based- can
❖ direct visualization of an area cause diarrhea
of GIT with a fiberoptic ❖ Also given for GERD
scope; ● Combination antacids- composed of
❖ Midazolam- medication magnesium and aluminum
given. Throat anesthetic ● Antidiarrheal agents
spray induce temporary loss ❖ Slows intestinal motility and
of gag reflex prevent peristalsis
aspiration ❖ Expected effect: decreased
➢ Amnestic Effect- episodes of diarrhea
patient tend to forget ❖ Loperamide (Imodium)
➢ Provide written ❖ Increase fluid intake to
instruction to the prevent dehydration
client (Nursing res.) ❖ Instruct client not to drive it
A. Esophagogastroduodenoscopy can cause drowsiness
(EGD)– esophagus, stomach and ● Antiemetics
duodenum ❖ Prevent decrease nausea
B. Proctosigmoidoscopy–rectumand and vomiting
sigmoid colon ❖ Ex. Prochlorperazine
C. Colonoscopy–entire length of the (Compazine)
colon ❖ Warn client for drowsiness
D. Endoscopic Retrograde and avoid driving
Cholangiopancreatography (ERCP) machineries
– esophagus, stomach and ● Inhibitor of gastric secretions
duodenum visualized; dye injected ❖ H2 receptor- reduce GI
into pancreatic and bile ducts and secretions
x-rays taken ❖ Can cause drowsiness and
● Barium Swallow- upper GI study headache and constipation
❖ Commonly taken 30 minutes A- ADMINISTER on an empty
before or just prior to meals stomach
and at bedtime R- RISK for aluminum toxicity
❖ Ex. cimetidine (tagamet) A- ADMINISTER ANTACIDS 30
❖ Ranitidine (zantac) mins before or after medications
❖ Omeprazole (prilosec)-
proton pump inhibitor Melena ano to sa melena basta Ang smell
(decreases the GI sang stool langsa (difference between dark
secretions) stool caused by Iodine)
❖ Omeprazole- decrease the gi
secretions para ma stop ang melena - blood in the stool ( black color)
reflux
❖ Proton pump- inhibit the Meat Protein Dark brown
secretion?
❖ Take medication within the Spinach Spinach
gap of 30 minutes per
Carrots and Beans Red
medication
● Laxatives Cocoa Dark red and
❖ Used to prevent or treat Brown
constipation or to prepare for
bowel examination Senna Yellow
❖ Magnesium Citrate- Bismuth, Iron, Black
commonly used as to prep Licorice, Charcoal
before lower GI x-rays
❖ Assess for bowel sounds or Barium Milky white
distention
Melena Black tarry stools
❖ Increase fluid intake to
prevent dehydration
GERD- GASTROESOPHAGEAL REFLUX
● Anticholinergics
DISEASE
❖ Inhibit the action of
acetylcholine
● Regurgitation of stomach contents
❖ Effects: decrease the GI
into the lower esophagus
secretions
● Etiology:
❖ May cause drowsiness and
● alcohol
blurred vision
● Anticholinergic drugs
❖ Increase fluids, bulk and
● Caffeine
roughage to counteract the
● Increased estrogen levels
constipating effects of the
● smoking
drug.
❖ Can’t pee, can’t see, can’t CLINICAL MANIFESTATIONS
spit, can’t shit
● Mucosal Healing agents HEARTBURN – midsternal area – MOST
❖ Adhere ulcer to protect from COMMON FEATURE
acid
❖ Sucralfate- Take the ● -May become more severe with
medication on an empty vigorous exercise, bending, or
stomach 40-45 mins before ● lying down; relieved by antacids or
eating sitting upright
❖ Avoid antacids within 30 mins ● pain radiation into the back, neck,
of taking the drug jaw, or both arms
❖ Prostaglandin E2- cause in ● Discomfort changes to an aching
the production of mucus so feeling
that it will not easily eroded ● Usually relieved within 3- 5 minutes
❖ Stimulate prostaglandin to ● Relieved with liquid antacids
increase mucosal defense
❖ Pepsin- secreted by the chip
cells in the stomach
C- CONSTIPATION undesirable
effects ● Aspirin-NSAID
● Naproxen- is an ibuprofen also ● Aging is one of the factors-
irritating in the stomach the elasticity or tone of
● ASA -acetylsalicylic acid - aspirin muscles is weakened
● Fats- are the last digested in the ● Trauma- due to heredity,
stomach. Would cause reflux in the surgery
stomach. ● Obesity- the muscle will be
❖ Low fat milk or not fat milk is overstretched
the recommended diet in the
patient. Types of Hernia:
❖ Highly acidic food should
also be avoided ● Type 1 (Sliding)- portion of upper
● Anti flatulence medication is stomach and the gastroesophageal
prescribed junction are DISPLACED UPWARD
● Simethicone- used to treat into the thorax.
symptoms of gas such as ❖ Presence of incompetent
uncomfortable or painful pressure, gastroesophageal spincter
fullness or bloating. ❖ Pyrosis (Heartburn)- occurs
● Low dose ethanol- accelerate the form 1-4 hours after eating
gastric emptying time or can improve ● Type 2 (Paraesophageal)- the reflux
motility. This is not indicated. does not occur
● Chocolate- affect the sphincter tone ❖ Client is asymptomatic
gastric acid secretion beb gna ❖ The sphincter is in place
increase ya
Diagnostic Procedure:
● Lying on right or left- increase in
intra abdominal pressure ● Chest Xray
● Mint- increase in acid production ● Barium study
● Carbonated beverages- can produce ● Endoscopy and Biopsy- beneficial in
increase production of carbon hiatal hernia, can determine other
dioxide lesions. Can visualize if there is
● Constricting clothing- will increase herniation
intra abdominal pressure
● Avoid anticholinergic medications- Treatment:
delay the stomach emptying, slow
down GI motility ● Antacids
● Pharmacologic goal: Neutralize acid ❖ Modify the reflux into the
● Nursing Goal: decrease esophagus
intra-abdominal pressure ● H2 blockers
● Stress hormones- increase acid ● Cholinergic agents
production ● Surgical repair- in some cases.
● Exercise moderately not vigorously- Depending on the type of hernia
vigorously can cause reflux and
pressure Interventions:
● Antacids
● Small feedings
❖ Tums
● Not to RECLINE for 1 hour after
❖ Riopan- can help in reflux
eating
❖ Mylanta
● Elevate the head of the bed on 4-8
● Anticholinergic
inch
❖ Betanechol (urecholine)-
● Avoid acidic food
increase LES pressure,
stimulates smooth muscle
REVIEW
contraction
❖ Atropine sulfate Omeprazole given to GERD patient -
omeprazole is a proton pump inhibitor and it
Hiatal Hernia works by decreasing the GI secretions
Achalasia
● Absent or ineffective peristalsis ● Watch out for bleeding
● The defect is in the lower esophagus ● Prostaglandin protects the mucosa
● Failure of the esophageal sphincter prostaglandin E2 protective
to relax mechanism of the mucosa
● Esophageal constriction- defect ● If there is no prostaglandin- Factor
● Aspiration- need to watch out that would cause loss protection of
● Manometry- esophageal pressure is the stomach
measured ● Prostaglandin synthesis- production
❖ Confirmatory of achalasia that would inhibit prostaglandin
❖ Goal standard for achalasia release
● Gastritis- can easily be treated by
Interventions: medications in a week or day
● Reduce size of stomach cells or
● Drink fluids with meals mucosa cells which lead to scaring
● Instruct client to eat slowly formation
● Calcium channel blockers and
nitrates Causes:
❖ decrease the esophageal
pressure ● Alcoholic intake- effect in gi motility
❖ improve swallowing ● Bile reflux- would cause gastritis
● Injection of botulinum toxin- injected ● Radiation therapy- around 2/9
in the quadrants of esophagus to months, some patient develop acute
relax the esophageal sphincter. gastritis
❖ Block the signal of the nerve ● Ingestion of strong acid or alkali-
impulse that would cause the mucosa become gangrenous or to
contraction of esophageal perforate
muscle. ● Dietary indiscretion
❖ Relax the esophageal ❖ Helicobacter pylori gastritis
sphincter infection (the person eats
❖ Inhibits the contraction of food that is contaminated or
smooth muscle that is irritating or too highly
● Surgical approach seasoned)
❖ Pneumatic dilatation
● Client will be given tranquilizer and Common Causes:
analgesic
● Pneumatic (forceful) dilation or ● Benign or malignant ulcers in
surgical separation stomach that have been infected
● Perforation- sudden sharp lead to helicobacter pylori
abdominal pain ● Autoimmune disease like pernicious
anemia (lack of vitamin b12)
TREATMENT ● Dietary factors- hot or irritating
foods, spices
Calcium-nitrate-botulinum ● Drugs- NSAIDS (advil, ibup, aspirin)
DO NOT RELY AND BE ADDICTIVE
-goal is to relax sphincter, ● Alcohol
● Smoking
-decrease pressure in the esophagus ● Reflux or intestinal contents into the
stomach- intestinal contents contain
-improve swallowing
bile
● DrPresence of fats in the duodenum
Gastritis will stimulate (cholecystokinin)-
hormone
● Inflammation of the gastric mucosa ❖ Steatorrhea- increase in fat
● Maybe acute or chronic excretion in the stool.
❖ Acute- self limiting, the ❖ Pancreastatin- stimulate the
symptoms are sudden pancreatic juice
❖ Chronic- resulting from ❖ Pancreas down to duodenum
repeated exposure to to digest the protein increase
irritating agents or recurring bicarbonate secretion
episodes of acute gastritis
❖ If Wala bicarbonate there will 1. Endoscopy- provide definitive
be gastritis diagnosis
2. Upper Gi series- esophagus down to
3 major types of chronic gastritis: stomach for any inflammation that it
is present
● Helicobacter pylori gastritis 3. Biopsy
● Autoimmune gastritis- own 4. Serologic testing for antibodies for h.
antibodies will destroy gastric Pylori antigen
mucosa 5. Urea breath test- carbon labeled
● Chemical gastropathy- urea; test to determine the presence
destroy by NSAIDS and of h.pylori in the stomach
aspirin ● Carbon labeled urea is given
to ingest and the expired
Signs and symptoms:
breath (amount of carbon
● What will happen to the motility? it dioxide) is going to be
will decrease expect indigestion, measured as the h.pylori
inflammation metabolizes the UREA faster.
● What happens to the gasses ? there (10-20 mins)
will be abdominal distension and ● The client should not take
bloating antibiotics before 1 month
● Is there is inflammation you will
Medical Management
expect burning sensation, abdominal
discomfort ● Dietary modifications
● Anorexia and vomiting- imbalance in ● Maintenance of blood volume
the chemicals ● Fluid replacement
● Neutralization of the acid
1. Instruct the client to refrain from
alcohol until symptoms subside.
Acute Gastritis Chronic Gastritis 2. Non-irritating diet
Gastrointestinal ● Belching 3. Adequate hydration (IV fluids)
symptoms: ● Early satiety 4. If bleeding is present, management
● Anorexia ● Intolerance is the same with GI hemorrhage.
● Epigastric of spicy and ● Hemoglobin and hematocrit
pain (rapid fatty foods decrease- laboratory findings
onset) ● Nausea and need to assess
● Hematemes vomiting
5. If gastritis is due to ingestion of
is ● Pyrosis
● Hiccups ● Sour taste strong acid, alkali, treat consists of
● Melena or in mouth diluting and neutralizing the
hematochez ● Vague offending agent.
ia epigastric ● Corrosive agents- can cause
● Nausea and discomfort burning from the throat down
vomiting relieved by to the stomach. Do not
eating
induce vomiting.
Systemic ● Anemia ● For stronger acid that ingest-
symptoms: ● fatigue take antacids like aluminum
hydroxide
● Possible ● For alkaline- neutralize those
signs of highly alkaline, dilute lemon
shock
juice with water or dilute
vinegar.
● More severe symptoms will be 6. Nasogastric intubation (NPO)
present in acute gastritis than ● For acute phase the stomach
chronic gastritis should rest
● Acute gastritis: GI symptoms + ● Lavage- draining the
bleeding accumulated secretions
● Chronic GI atrophy of the mucosa 7. Sedatives
cells 8. Antacids
Assessment findings and Diagnostic MEDICAL MANAGEMENT
10. Emergency surgery – remove statements made by the nurse is
gangrenous or perforated tissue TRUE for chronic gastritis?
The nurse is preparing to give an antacids Antacids are usually given to patient with
to the client. She knows that this medication upper GI disorders. Which of the following is
is best given the action of these medications?
● spinach
The client was prescribed with ● Loperamide (immodium)
cimetidine(tagamet). which of the ff
classification of drug belong Sympathetic stimulation has which of the
following effects on the GIT?
● histamine 2 receptor antagonist
● Decreased GI secretion
The client is to undergo a test to evaluate
small bowel absorption of Vitamin B12 and The client is scheduled for EGD. Which of
possible lack of intrinsic factor. Which test is the following statements is correct about the
probably prescribed for the client? procedure?
● Proton-pump inhibitor
● ultrasonography
● Loperamide (immodium)
● decreased GI secretion