Gastrointestinal: Ingestion & Digestion Disorders

Gastrointestinal (GI) Series

-Radiographic studies done with or without contrast that define anatomic or functional abnormalities

1.Upper GI Series- patient swallows and has xray done (takes pictures of upper GI throughout the day)

2.Lower GI Series - Barium Enema (looks at colon and inserted through rectum can cause white stools) (bowel prep)

-take lots of liquids and monitor for contrast elimination

GI series Indications

-Gastric ulcers

-peristaltic disorders

-tumors

-varices

-intestinal enlargements or constrictions

-C/O:

-abdominal pain

-altered elimination habits

- GI bleeding

when patients complain of abdominal pain or altered elimination habits what should you do?

-may need to do GI series because they are supposed to go every 3 days

-ask patient when was their last void?

Nursing actions are most prominent when during the GI series?

pre and post op

endoscopy

-Allows direct visualization of body cavities, tissues and organs

-diagnostic and therapeutic purposes

-can be M2A endoscopy where the person swallows a small camera

-risk for bleeding

-check for gag reflex once patient wakes up

colonoscopy

-after age 50

-patient should be on clear liquid diet so stools will be clear

-no red/orange/purple or green foods can be confused with blood

-no solid material should be in poop

-NPO the night before

-discontinue NSAIDS

colonoscopy and endoscopy require what type of sedation?

moderate

indications for endoscopy

-Potential Diagnoses

-Client Presentation

endoscopy nursing pre-procedure

-Verify informed consent is obtained for proper procedure

-Assess vital signs and verify allergies

-Assess history for risks of complications

-Evaluate baseline laboratory values and report unexpected or abnormal results

-verify F/E and chem 7

-Verify patient NPO status

how long should a patient be NPO for before an endoscopy

6-8 hrs

colonoscopy pre procedure

-consent

-drink alot of fluids

-make sure stools are clear

-NPO the night before

-give patient bedside camode because they will need to empty bowels alot

for colonoscopy how long before should a patient be NPO

NIGHT BEFORE

for a endoscopy which colors should the patient avoid consuming

-red

-orange

-purple

endoscopy during the procedure

left side lying with head elevated for the procedure

surgeon will order

-CBC

-electrolyte panel

-BUN/creatinine

-PT/PTT

- liver function

b4 and after procedures

post procedure endoscopic nursing actions

-Monitor vital signs

-Assess for complications (leaking/wound open)

-If biopsy taken, may have food restrictions

-make sure gag reflex returns

EGD and ERCP post procedure

-Withhold fluids until gag reflex returns

post procedure Colonoscopy/Sigmoidoscopy

-Monitor for rectal bleeding

-Instruct that there may be increased flatulence due to air instillation during the procedure

-check CBCs again after

chem 7 test includes

-creatinine

-potassium

-glucose

-sodium

can a patient drive or take uber after having a procedure?

no they need family to give them a ride

GI bleed interventions

-NPO

-NGT- to suction blood

-IV fluid

-two IV sites: one for blood the other for fluid and meds

-BLOOD

-cauterize bleeding site

-ligate bleeding vessels

what symptoms does a patient with GI bleed have

-bleeding

-cool/pale skin

-dizziness

-tachycardia

-hypotension

what is the major risk factor for GI bleeds?

duodenal ulcers

which tests should be monitored for a patient with a GI bleed

-BP

-H/H every 6-8 hrs to check for improvement

-fecal occult blood/stool guiac test

what do we give in the IVs of GI bleed patient

-blood

-isotonic fluids (LR/NS)

sites for referred abdominal pain

pain that starts in your thumb but moves to other areas

Hiatal Hernia

-Muscle weakness of the diaphragm at the esophageal hiatus

-muscle protrudes

diagnostic testing hernia

•X-rays

•Barium Swallow (swallow camera to monitor what is going on)

•Fluoroscopy

medical management hernia

-last resort

-Surgical hernia repair

hernia CM

-Pyrosis/Heartburn

-Regurgitation

-Belching

-Pain

-Dysphagia

-hiccups

-dental carries

when do symptoms worsen for a hiatial hernia

-after eating

-reccumbent

-side lying

monitor (hernia)

-Nutritional status

-Aspiration

-Pain

complications of hernia

-Strangulation (tight and closed)

-Incarceration

-Hemorrhage

hernia diet modifications

-Frequent small feedings that pass easily through esophagus

-NO:

-oil

-spicy food

-soda

-citrus

-Alcohol

hernia lifestyle changes

-Do not recline 1 hour after eating

-Elevate HOB 4-8"

Gastroesophageal Reflux Disease (GERD)

-gastric content and enzyme leakage into the esophagus

-irritates the esophageal tissue

-limits ability to clear contents from esophagus

medical management of GERD

-DIET (small frequent meals)

-lifestyle changes (exercise)

-meds

-surgery

which foods should a GERD patient avoid (foods that affect LES pressure)

-dairy products

-chocolate

-coffee

-peppermint

-soda

-spicy food

-fried food

-sauces

untreated GERD can lead to

-inflammation

-breakdown

-long term complications including:

-adenocarcinoma of the esophagus

-barretts esophagus

GERD RISK FACTORS

-Diet

-Tobacco use

-Coffee Drinking

-Alcohol

-H. Pylori

Clinical Manifestation

-Dyspepsia

-Acid reflux

-Throat irritation

-Hypersalivation

-Eructation (belching)

-Flatulence

-Bitter taste in mouth

-Atypical chest pain

-Dysphagia

-Tooth erosion

-Hoarseness

GERD diagnostic testing

-EGD

-Esophageal manometry

-24 hour ambulatory pH monitoring

-Barium swallow

-TEST FOR H. PYLORI

GERD DIET

-low fat

-avoid foods that decrease LES pressure

-4-6 small meals

GERD lifestyle changes

-Maintain normal weight

-No smoking or alcohol

-Elevate HOB 6-8 inches

Education for GERD

-Avoid situations that causes esophageal irritation

-Avoid eating/drinking 2 hours before bedtime

-Elevate upper body on pillows

GERD complications

-Barrett’s epithelium (premalignant)

-esophageal adenocarcinoma

Reflux of gastric fluids can cause esophagitis, chronic condition resulting in continuing healing of inflamed tissue, replaces normal tissue with premalignant tissue or malignant adenocarcinoma

Gastritis

-Inflammation of the stomach mucosa

-A common GI problem (NSAIDS)

-Can be acute or chronic; non-erosive or erosive

non erosive

associated with infection by Helicobacter pylori (H. pylori)

Erosive

-associated with long-term NSAID use

-alcohol abuse

-gastric radiation therapy (burns the lining of the stomach)

acute

rapid

caused by :

-dietary indescretion

-meds

-alcohol

-bile reflux

-radiation therapy

-Ingestion of strong acid or alkali may cause serious complications.

acute gastritis CM

-epigastric pain/discomfort

-dyspepsia

-hiccups

-n/v/a

-Melena or hematochezia

chronic

over a period of time

-prolonged inflammation from repeated exposure to irritating agents or recurring episodes of acute gastritis.

-associated with autoimmune diseases

CHRONIC gastritis CM

-fatigue

-pyrosis

-belching

-sour taste in the mouth

-early satiety

-n/v/a

-May have vitamin deficiency due to malabsorption of B12

-intolerance of spicy foods

-epigastric pain relieved by eating

with gastritis when is the pain relieved

by eating

DIAGNOSTIC TEST

-endoscopy histologic examination of tissue specimen by biopsy

-CBC

-Testing for H. Pylori infection

ACUTE medical management

-Refrain from alcohol and food until symptoms subside

-If due to strong acid or alkali treatment to neutralize the agent

- avoid emetics (anything that causes vomit) and lavage

-Supportive therapy

Chronic Medical management

-Modify diet

-promote rest

-reduce stress

-avoid alcohol and NSAIDs

-Pharmacologic therapy

primary treatment of gastritis

identification and elimination of the causative factors

gastritis nursing management

-Monitor fluid intake and urine output

-Provide IVFs

-Monitor electrolytes

-identifying triggering foods

-Provide small, frequent meals and eat slowly

- avoid alcohol, caffeine, and foods that cause gastric irritation

-identifying reduction of stress

-Monitor for gastric bleeding and anemia

peptic ulcer disease

-Erosion of the mucosal lining of the stomach or duodenum

-epithelium is exposed to gastric acid and pepsin

-bleeding and perforation

perforation that extended through all layers and leads to

peritonitis

PUD is associated with

infection of H. pylori

if ulcer is in the stomach it causes pain

immedietly after eating

if ulcer is in duodenum causes pain

1-2 hrs after eating

PUD risk factors

-excessive secretion of stomach acid

-dietary factors

-chronic use of NSAIDs

-alcohol

-smoking

-familial tendency

CM PUD

-dull gnawing pain/burning in the mid-epigastrium

-heartburn

-vomiting may occur

LAB TESTS PUD

-H. pylori

- H & H

- Stool Hemoccult (FECAL OCCULT)

Diagnostic studies PUD

-Barium studies

-endoscopy (with possible biopsy)

LIFESTYLE CHANGES

-smoking cessation

-avoid alcohol

-avoid extremes of temperature

-coffee

-Bland nonirritating diet

-USE NATURAL SPICES (SCALLIONS, ONION, THYME)

PUD complications

-Hemorrhage/perforation

-Emergency situation

-Fluid deficit management

-NGT/Saline lavage

-EGD with laser treatment

GI bleeding etiology

-Gastritis

-hemorrhage from PUD

CM GI bleed

-Faintness/dizziness

-Nausea

-Tachycardia

-hypotension

-tachypnea

-Emesis

-Bright red

-Coffee-ground

-Small quantities: Passed in stool → tarry black (digested hemoglobin)

GI Bleed: Medical Management: Treatment of hemorrhagic shock

-Two, large-bore IV catheters

-Isotonic crystalloid solution for volume

-Blood products

-Endoscopic evaluation

-Injection of the bleeding site with epinephrine, gelfoam

-Cauterizing the site of bleeding

-Clipping the ulcer

arteriography

embolization for severe and persistent bleeding

GI bleed nursing management

-Monitoring and early recognition of complications

-Preventing and/or managing bleeding, perforation (check dressing for excessive blood)

-Possible surgical treatment

-Monitor lab values

-Testing for gross or occult blood in the stool

-Recording hourly urinary output to detect anuria or oliguria (should be eliminating well)

-Acid-suppressive agents

-NGT insertion-to decompress

-NPO-IVF

will physician let patient eat if they have GI issues

no

-NPO

Gastric Cancer risk factors

-Diet

-H. pylori

-Chronic inflammation

-Pernicious anemia

-Smoking

-Obesity

-Achlorhydria

-Gastric ulcers

-Previous partial gastrectomy

-Genetics

Adenocarcinoma

Begins with lesion in top layer of stomach, penetrates to stomach wall, and metastasis via lymphatic and vascular networks of stomach

CM cancer

-Pain relieved by antacids

-early satiety

-weight loss

-abdominal pain

-loss of appetite

-bloating

-N/V

Assessment and diagnostic findings cancer

-H&P

-EGD for biopsy and cytology

-Barium X-ray of UGI

-CT scan

-CBC

-Tumor markers

medical management of GC

-MULTIMODAL uses all 3

-surgery

-chemo

-radiation

obesity

-abnormal or excessive fat accumulation that may impair health

-BMI exceeding 30

-BMI exceeding 40 considered to have severe or extreme obesity

risks for obesity

-complex & multifactorial; behavioral, environmental, physiological, and genetic factors

-Associated with increased risk of mortality

medical management of obesity

-life-style modifications

-pharmacotherapy

-nonsurgical interventions

-bariatric surgery

bariatric surgery

preformed only after nonsurgical methods have failed.

selection criteria for bariatric surgery

-Include BMI >= 40 without excessive surgical risk

-BMI >= 35 and one or more severe associated obesity conditions

-BMI >=30 with type 2 diabetes or metabolic syndrome

-Ability to perform ADL and self-care

-Failure at nonsurgical attempts at weight loss

-Expectations that will adhere to postoperative care, follow-up visits, and recommended medical management

post operative nursing care

-Reducing Anxiety

-Relieving Pain

-Ensuring Fluid Volume Balance

-Prevention Infection/Anastomotic Leak

-Ensuring Adequate Nutritional Status

-Supporting Body Image Changes

-Ensuring Maintenance of Bowel Habits

post op complications/Monitoring and Managing Potential Complications

-Monitoring and Managing Potential Complications

-Hemorrhage

-VTE

-Bile Reflux

-Dumping Syndrome

-Dysphagia

-Bowel and Gastric Outlet Obstruction

Dumping syndrome

Rapid transit of food bolus from stomach into small intestine causes a rapid and exuberant release of metabolic peptides

-associated with sweets and sugars

CM manifestations dumping syndrome

-Symptoms occur 15 minutes – 2 hours after eating

-Tachycardia, dizziness, sweating, N/V, bloating, abdominal cramping, diarrhea

-Symptoms resolve upon defecation

-Reactive hypoglycemia

The RN charge nurse is making assignments. Staffing includes a registered nurse with 5 years of medical-surgical experience, a newly graduated registered nurse, and two unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse?

1.The 39-year-old client diagnosed with lower esophageal dysfunction reporting pyrosis.

2.The 54-year-old client diagnosed with Barrett’s esophagus scheduled to have an endoscopy this morning

3.The 46-year-old client diagnosed with gastroesophageal reflux disease wheezing in all five lobes

4.The 68-year-old client 3 days postoperative for hiatal hernia needs to be ambulated four times today

3.The 46-year-old client diagnosed with gastroesophageal reflux disease wheezing in all five lobes

The nurse is planning care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? Select all that apply.

1.Allow any of the client’s favorite food as long as the amount is limited

2.Have the client perform eructation exercises several times a day

3.Eat four to six meals a day and limit fluids during mealtimes

4.Encourage the client to consume a glass of red wine with one meal a day

5.Maintain an ideal body weight with a healthy diet and exercise

3.Eat four to six meals a day and limit fluids during mealtimes

5.Maintain an ideal body weight with a healthy diet and exercise

A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (Select all that Apply)

A. Rigid abdomen

B. Tachycardia

C. Elevated blood pressure

D. Circumoral cyanosis

E. Rebound tenderness

A. Rigid abdomen

B. Tachycardia

E. Rebound tenderness

A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching?

A.Eat three moderate-sized meals a day.

B.Drink at least one glass of water with each meal.

C.Eat a bedtime snack that contains a milk product.

D.Increase protein in the diet.

D.Increase protein in the diet.