Med surg exam 3- GI

C. diff

-bacterial infection causing diarrhea and colitis, often triggered by antibiotic use that disrupts gut flora

-leading to symptoms like watery diarrhea, fever, and cramps

-spreads through contaminated surfaces or contact, requiring strict hygiene, specific antibiotics, or sometimes fecal transplants for treatment, with hand washing with soap and water being crucial for prevention

GI bleed

-bleeding from any part of the GI tract, from the esophagus to the anus

-symptoms vary based on the location and severity, including vomiting blood, black/tarry stools, or bright red blood in the stool

-causes range from ulcers and hemorrhoids to more serious conditions like cancer

-medical attention is crucial, especially for acute or severe bleeding, as treatment depends on the cause and may involve medication, endoscopic procedures, or surgery

general GI post op care

-gradual return to eating, starting with liquids and progressing to solids, focusing on hydration, managing pain, gentle movement (like walking), and careful wound care

-watch for signs of infection or complications like severe constipation or vomiting, and following specific physician instructions for a smooth recovery

NG tube care

-assess the nares and mucosa for inflammation and bleeding every shift

-assess for placement and patency

-ensure it is secured with safety pin to clients gown

-provide oral/nasal care

-assess for level of comfort

-flush with tap water per doctors orders

-aspirate and record residuals as ordered

tube feeding care

-check for placement of EFT

-aspirate gastric secretions

-measure residuals

-auscultate air over LUQ of stomach

-flush tube with 30 cc water Q4 hrs

-record all administered volumes and residuals on I/O record

-confirm placement with CXray

-keep HOB elevated at all times

-turn off feedings when repositioning client

-routinely assess lung sounds and bowel sounds

ulcerative colitis

-chronic inflammation of mucosa and submucosa in the colon and rectum

-peak incidence is between 15 and 35 years of age with a second peak in people aged 50 to 70

-characterized by periods of exacerbation and remission

-symptoms can be mild or severe

-cause unknown or may be related to stress, genetics, infection, dietary factors

bowel obstruction

-failure of bowel contents to move forward

-can be complete or partial

-mechanical: resulting from forces outside intestine, blockage in lumen itself

-non-mechanical/paralytic ileus: impairment of muscle tone or nervous system innervation preventing forward movement

-most often occur in ileum (where intestinal diameter is smallest)

-peristalsis increases in the intestine above blockage leading to increase secretions, edema, and increase capillary permeability

stoma care

-monitor the stoma's appearance (e.g., color, size, and output), ensure proper drainage and skin care, and manage initial wound healing

-stoma will initially be swollen and shrink over time, and its color should be light to dark pink and moist

-prevent and treat skin irritation around the stoma

general care for N/V

focus on comfort, hydration, nutrition, and symptom management, involving bland diets (crackers, toast, broth), small frequent meals, clear liquids, eliminating odors, oral hygiene, positioning (sitting up after eating), antiemetic medication administration, and recognizing the underlying cause to prevent dehydration and manage symptoms effectively

GERD

-backward movement of stomach contents or even bile into the esophagus without vomiting

-gastric contents are irritating to esopjagus and causes breakdown of the mucosal barrier leading to inflammation and erosion

-healing of the erosion causes the substitution of normal squamous epithelial tissue for columnar epithelial tissue

peptic ulcer disease

-generic term for ulcers or breaks in the mucosal lining in the GI tract that come in contact with gastric juices

-3 forms:

• stomach (gastric ulcers): by pylorus, associated with gastritis and gastric cancer, results from disruption in normal protective mechanism that keeps the gastric epithelial pH normal

• duodenum (duodenal ulcers): chronic break in duodenal mucosa, most common form, associated with chronic H. pylori infection

• lower esophagus (esophageal ulcers)

obesity education

-biggest health problem of modern society

-65% of americans over age of 20 suffer from it

-caused by excess of body fat

-BMI over 30 considered obese

-can be caused by diet, genetics, neuroendocrine, drugs, and social factors

risk facors of GERD

-over 50, obesitey, H2 receptor antagonists, nicotine, caffeine, chcolate, fatty foods, alcohol, nitrates, calcium channel blockers, high levels of estrogen, etc

-many of these decrease lower esophageal sphincter tone

manifestations of GERD

-heartburn or substernal burning pain

-regurgitation without N or V

-bad or sour taste upon awakening

-coughing, hoarseness, wheezing at night

-belching

-flatulence

-asthma

-dysphagia

GERD nursing care

-avoid foods or medications that reduce LES tone

-dont eat 2 hrs before bed

-dont bend over after eating

-lose weight

-dont lie down immediately after eating

-avoid restrictive clothing

-avoid large meals

-elevate HOB

-stop smoking

bowel obstruction manifestations

-early bowel sounds may be high pitched

-late bowel sounds silent

-abd pain can be colicky and may increase

-vomiting

-fecal odor

-abd distention

-vital signs may progress to signs of shock

PUD risk factors and causes

-H. pylori

-chronic NSAID use

-cigarette smoking

-family history

-blood group O

-alcohol use

-peaks during 60s

PUD manifestations

-gnawing, burning, aching, hunger like

-duodenal: pain relieved by eating

-gastric: pain exacerbated by food

-observe for complications: perforation, hemorrhage, pyloric obstruction

manifestations of ulcerative colitis

-diarrhea 1- to 20 liquid stools a day often containing blood and mucus

-nocturnal diarrhea

-fatigue from blood loss or lack of sleep

-patient may be afraid to go out