MED SURG EXAM 2 - Review of the gastrointestinal disorders (including upper and lower GI disorders). Comprehensive Information for Exam Quick read and revision.

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MED SURG EXAM 2 MED SURG EXAM 2 - Review of the gastrointestinal disorders (including upper and lower GI disorders) UPPER GI DISORDERS (Ingestion & Digestion Disorders) CH. 46 + 47 GI SERIES Pr... imary Concepts Of Adult Nursing (Nova Southeastern University) • Radiographic studies done with or without contrast that define anatomic or functional abnormalities o Upper GI Series  an upper fluoroscopy delineates entire GI tract after introduction of a o Barium Enema  for visualization of the lower GI tract • Indications • Nursing Actions o Pre procedure  Upper GI Series:  Barium Enema: o Post procedure  Upper GI series:  Barium Enema: • ) ENDOSCOPY o Esophagogastroduodenoscopy (EGD)  o Endoscopic Retrograde Cholangiopancreatography (ERCP)  o Colonoscopy  o Sigmoidoscopy  ENDOSCOPIC NURSING ACTIONS • Pre procedure • Post procedure o After colonoscopy  bed rest until fully alert.  Pt might have abdominal cramps b/c of the air insufflated into the bowel during procedure. Hiatal hernia = muscle weakness of the diaphragm at the esophageal hiatus … *in this condition, the opening in the usually feel a sense of fullness or chest pain after eating (or no symptoms)  reflux doesn’t usually occur b/c the gastro-esophageal sphincter is intact • Diagnostic Testing • Medical Management • Antacids  neutralize • Fundoplication  surgical procedure in which the upper portion of the stomach is wrapped around the lower end of the esophagus and sutured in place • Hiatal Hernia - ASSESSMENT • Heartburn • Monitor: • Diet Modifications • Lifestyle Changes • after eating to prevent reflux or movement of the hernia • Untreated GERD  • Risk Factors • Contributing Factors • Clinical Manifestations • Diagnostic Testing • Medical Management • Diet • Lifestyle Changes • Education • Complications  esophageal cancer Gastritis = o and biopsy. • Medical o elimination of the causative factors o Medications  H2 Blockers  Antacids  PPI  Triple therapy for H. pylori infection o Surgical Management  Gastrectomy  Pyloroplasty  Vagotomy o Monitor fluid intake and urine output  to detect early signs of dehydration o Provide IVFs as prescribed o Monitor electrolytes • Nursing Management o Peptic Ulcer Disease (PUD) • Erosion of the mucosal lining of the stomach or duodenum  eroded to point epithelium is exposed to • Collaborative Care: o Medications o Decrease environmental stress o • Complications o Hemorrhage/perforation   EGD with laser treatment o Pyloric Obstruction  “gastric outlet obstruction” occurs when are distal to pyloric sphincter of residual aspirated from NG tube  Residual of more than 400 mL = obstruction • Interventions o Surgical Management  surgery usually recommended for pts with intractable ulcers (those failing to heal after 12-16 weeks of TX), life threatening hemorrhage, perforation or obstruction  Gastroenterostomy  surgical creation of a connection between the stomach and the jejunum.  Vagotomy  vagus nerve is cut where it enters the stomach in order to decrease gastric acid  ) portion of the stomach with anastomosis (surgical connection) to the jejunum o Complications – “malabsorption of b12…if they cut something the intrinsic factor will be lost so you’ll have malabsorption of B12” GI Bleeding • Etiology: Gastritis, hemorrhage from PUD • Clinical manifestations o Faintness, dizziness o o Two, large-bore IV catheters o bleeding o Surgery: ulcer removed or bleeding vessels ligated • Nursing Management o o NGT insertion o NPO Bariatric Surgery – surgery for obesity • Morbid • Bariatric Surgery Procedures: * o Roux-en-Y gastric bypass  a horizontal row of staples across the fundus of the stomach creates a pouch with a capacity of 20 to 30 mL  only a small part of the stomach is used to create a new stomach pouch, roughly the size of an egg. The smaller stomach is connected directly to the middle portion of be missing, meaning malabsorption of B12” • Post-Op Nursing Care o Monitor for infections o Monitor bowel sounds o Provide pain medication as prescribed o May Maintaining Normal Bowel Pattern • Identify relationship between diarrhea and food, activities, or emotional stressors. • Provide ready access to bathroom/commode. • Encourage bed rest to reduce peristalsis. • Administer medications as prescribed. • Record frequency, consistency, character, and amounts of stools. IBD: Nursing Management • Assessment and treatment of pain/discomfort ▫ Positioning, diversion activities, and prevention of fatigue • Pharmacology ▫ Anticholinergic medications prior to meals, analgesics, • Hydration Status ▫ Fluid deficit, I&O, daily weight ▫ Assessment of symptoms of dehydration/fluid loss ▫ Encourage oral intake, measures to decrease diarrhea • Optimal nutrition ▫ Elemental feedings = High in protein and low residue  they are digested primarily in the jejunum + do not stimulate intestinal secretions so allow the bowel to continue to rest! ▫ PPN/TPN may be needed – with parenteral nutrition, nurse maintains accurate record of I&O + daily weight…blood glucose levels are monitored every 6 hours (b/c parenteral nutrition is very high in glucose and can cause hyperglycemia) • Reduce anxiety ▫ Calm manner ▫ Allow patient to express feelings ▫ Listening, patient teaching • Prevent skin breakdown  nurse examines patients skin frequently (especially perianal skin!) • Perianal care (including use of a skin barrier like Vaseline) is important after each BM* • Monitor and manage potential complications ▫ Monitor for rectal bleeding ▫ Monitor BP for hypotension ▫ H&H levels + coag. Levels frequently ▫ Monitor for indications of PERFORATION = acute increase in abdominal pain, rigid abdomen, vomiting, or hypotension) • Promote rest INTESTINAL OBSTRUCTION • A blockage that prevents the normal flow of intestinal contents through the intestinal tract • Two types: ▫ Mechanical = an intraluminal obstruction or a mural obstruction from pressure on the intestinal wall occurs • Something is physically blocking the movement of food ▫ Functional = the intestinal musculature cannot propel the contents along the bowel • There’s no physical blockage, but the bowels are not moving food through the digestive tract • Obstructions can be partial or complete • Most bowel obstructions occur in the small bowel • Etiology: ▫ SBO: adhesions, hernias, neoplasm ▫ LBO: carcinoma, diverticulitis, IBD, benign tumors • Mechanical ▫ Intraluminal obstruction ▫ Mural obstruction ▫ Ex. • Functional • Intussusception • Neoplasm • Stenosis • Strictures • Adhesions • Hernias • Abscess ▫ Intestinal musculature cannot propel the contents along the bowel ▫ Ex. • Muscular dystrophy • Endocrine disorders (DM) • Neurologic disorders (Parkinson’s) • Small Bowel Obstruction PATHO ▫ Obstruction  intestinal contents, fluid, and gas accumulate  abdominal distention and retention of fluid  reduces the absorption of fluids  stimulates more gastric secretion  increases distention  intestinal lumen pressure increases  venous and arteriolar capillary pressure decreases  edema & congestion  necrosis  rupture or perforation  peritonitis • Large Bowel Obstruction PATHO ▫ Obstruction  intestinal contents, fluid, and gas accumulate  severe abdominal distention and perforation (unless some gas/fluid back flows through the ileal valve)  if blood supply is cut off  intestinal strangulation and necrosis occurs SBO manifestations – initial symptom is a crampy pain that is wavelike and colicky due to persistent peristalsis both above and below the blockage; patient may pass blood + mucus but no fecal matter and no flatus; vomiting occurs; if the obstruction is COMPLETE – peristalsis reverses in direction + intestinal contents propelled toward mouth instead of toward rectum. If the obstruction is in the ILEUM, fecal vomiting takes place first patient vomits stomach contents, then bile, then finally fecal contents of ileum. Vomiting results in loss of H+ ions & K+ ions from stomach, leading to reduction of chlorides + potassium in the blood and to metabolic alkalosis LBO manifestations – differs from SBO b/c symptoms develop SLOWLY; shape of the stool is altered as it passes the obstruction that is gradually increasing in size; blood loss in the stool may result in iron-deficiency anemia; patient may experience weakness, weight loss, and anorexia; Eventually the abdomen becomes markedly distended, loops of large bowel become visibly OUTLINED through the abdominal wall; patient has crampy lower abdominal pain; Finally - fecal vomiting develops Medical Management: • SBO o decompression of the bowel w/ NGT is necessary o Monitoring for bowel ischemia  when the bowel is completely obstructed, the possibility of strangulation and tissue necrosis warrants surgical intervention o IV fluids are necessary to replace the depleted water, sodium, chloride, and potassium • LBO o NGT aspiration + decompression o Colonoscopy may be performed to untwist + decompress the bowel o Rectal tube may be used to decompress an area that is lower in the bowel o As alternative, metal colonic stent may be used as either palliative intervention or bridge to definitive surgery o The USUAL TX = surgical resection to remove the obstructing lesion o A temporary or permanent colostomy may be necessary Intestinal Obstructions- Nursing Management • Maintain function of NGT • Assessing NGT output • Assessing for F &E imbalances • Monitoring nutritional status • Assessing outcomes/improvement (ex. return of normal bowel sounds, decreased abdominal distention, subjective improvement of abdominal pain + tenderness, passage of flatus or stool) • Monitoring I/O • Post-operative care COLON CANCER • Incidence increases with age, family history of IBD or polyps • 95% adenocarcinoma (i.e. arising from the epithelial lining of the intestine) • May start as benign polyp • Metastasize to liver, peritoneum, lungs • Clinical Manifestations ▫ Change in bowel habits ▫ Blood in stools: melena or BRB • Diagnostic Findings ▫ Fecal occult blood testing ▫ Double-contrast barium enema36 ▫ Colonoscopy ▫ CEA studies (carcinoembryonic antigen (CEA) is a tumor marker that is useful in assessing progression or recurrence of cancers, esp. GI cancers) • Medical Management ▫ Depends on the stage (see chart 48-10) ▫ Chemotherapy, radiation, immunotherapy ▫ Surgery – main TX for most colorectal cancers ▫ Colostomy  surgical opening into the colon by means of a stoma to allow drainage of bowel contents • it is one type of fecal diversion (can be temp or perm) • allows the drainage or evacuation of colon contents to the outside of the body • Nursing Interventions ▫ Post operative management  same as most abdominal surgeries ▫ Maintain optimal nutrition  the patient avoids foods that cause excessive odor + gas, including foods in the cabbage family, eggs, asparagus, fish, beans, and high cellulose products such as peanuts  Nurse advises the patient to experiment several times with an irritating food before restricting it b/c an initial sensitivity may decrease with time  Nurse may be able to help patient ID foods/fluids that may be causing diarrhea – fruits, high-fiber foods, soda, coffee, eat, or carbonated beverages ▫ Providing wound care • Examine abdominal dressing frequently during first 24 hours after surgery to detect signs hemorrhage • Help the patient splint the abdominal incision during coughing + deep breathing to lessen the tension on incision edges • If patient has a colostomy, stoma examined for swelling, color, and bleeding ▫ Monitoring and managing complications (see p. 1324) • Rectal bleeding  indicates hemorrhage • H&H + WBC levels • Frequent activity, deep breathing, coughing, and early ambulation – decrease risk of pulmonary complications like pneumonia or atelectasis [Show More]

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