Medical Surgical Nursing: Gastrointestinal Issues

Normal Function of the GI Tract

absorption of nutrients and fluids

The GI Tract is exposed to the environment the most, so the GI tract has the greatest

immune system in the body

Hiatal Hernia

upper part of the stomach protrudes upward through the diaphragm

What does a hiatal hernia cause

GERD

What causes hiatal hernia's?

Increased intra-abdominal pressure: pregnancy, extreme coughing, straining

Clinical Manifestations of Hiatal Hernias

- Chest pain

- "Heart Burn"

- Early satiety

- Difficulty Breathing

With Chest pain, what do we assess first?

Cardiac

What is early satiety?

Fullness after small amount of food

Medical Treatment of Hiatal Hernia

Antacids, PPIs, H2 Blockers

Surgical Repair of a Hiatal Hernia

Nissen fundoplication

Nissen fundoplication is preformed only if the hernia is

severe, > 30% of stomach is protruding

Major Complication of HH

Barrett's Esophagus

Barrett's esophagus

Precancerous metaplastic change in the cells of the esophagus

Physical Symptoms of HH

- Dysphagia

- GERD

- N/V

- Iron Deficiency Anemia

- Eructation

What causes Iron deficiency anemia in HH

The patients who are continuously throwing up

eructation

gastric contents returning up to the mouth

What Lab would be lower with Hiatal Hernia

H/H due to the covert bleeding

Diagnostics of Hiatal Hernia

barium swallow, EGD

Nursing Goal for HH

Pt will remain free from complications and maintain a stable weight

Nursing Diagnosis of Hiatal Hernia

Impaired Swallowing, Knowledge Deficit, Anxeity

Nursing Interventions for Hiatal Hernia

Medication Management, Supine on right side with HOB elevated.

Teachings for hiatal hernia

- Limit chocolate, spicy foods, alcohol, carbonation and peppermint

- Eat meals 2 hours prior to laying down

- avoid restrictive clothes and extreme weight barring exercise

What medications should those with a HH Avoid?

NSAIDS, Prednisone, Aspirin

Cimetidine

- H2 receptor antagonist

- Blocks histamine causing a decrease in the acidity of gastric acid

- Can take anytime

Omeprazole

- PPI

- Blocks protons from producing acid in the stomach

- Take 2 hours before meals in the AM

Aluminum Hydroxide

- Antacid

- Take 2 hours before any other medication

Sucrafate

- Sticks to the raw area of the irritated stomach lining and coats it to decrease damage

- Give one hour prior to food and at bedtime

- Best in pill form

GERD

Gastroesophageal reflux disease causing heartburn.

GERD Clinical Manifestations

- Heartburn

- Eructation

Medical Treatment of GERD

- Antacids

- H2 blockers

- PPI

- Prokinetic Medications

Prokinetic Medication for GERD

Metoclopramide

Metaclopramide

- Reglan

- Stimulates movement of the GI tract

Warning for Metaclopramide

Do not take longer then 8 weeks due to the risk of Tardive Dyskinesia

Surgical Treatment of GERD

Laparoscopic Nissen Fundoplication

Complications of GERD

Barrett's epithelium and strictures.

Physical Assessment of GERD

o Heartburn after a meal

o Eructation

o Dysphagia

o Regurgitation

o Halitosis

o Dental Cavities

o Asthma Symptoms ( Rx of aspiration )

GERD Diagnostics

- Upper abdominal X-Ray

- Endoscopy

- EGD

- CBC

GERD Nursing Diagnosis

- acute/chronic pain

- risk for aspiration

- impaired swallowing

- imbalanced nutrition: less than body requirements

GERD: Nursing Interventions

- Admin Medication as ordered

- Position pt on right side with HOB Elevated

- Provide small, frequent meals

Nursing Teaching for GERD

- Limit Irritating Foods

- Avoid smoking and alcohol

- Eat meals 2 hours before laying down

Peptic Ulcer Disease ( PUD)

Ulcers in stomach or duodenum causing pain.

What is the cause of PUD

H. pylori infections usually drill "holes" and then erosion occurs due to gastric juices

pH of gastric juice

1.5 - 2

Food alleviates pain from ulcers in the

duodenum

Food Worsens pain in the

stomach

Medical Treatment of PUD

-Antacids, H2 blockers, PPIs

- DRUG OF CHOICE: Sucralfate

Sucralfate

Antiulcer Agent

Complications of PUD

• GI hemorrhage

• Abdominal or intestinal infarction

• Perforation and penetration into attached structures

• Obstruction

• Peritonitis

Physical Assessment of PUD

- Abdominal Pain

- Referred Pain in the RIGHT SHOULDER

- N/V

"Gold Standard" for ATI/Boards of PUD Diagnostics

Gastric pH strips

Peritonitis/perforation d/t PUD Assessment

- Abdominal Rigidity

- Absent Bowel Sounds

- Fever

- Low Urine Output

- Thirst

- Inability to pass stool or gas

PUD Nursing Goal

Patient will have stable weight and adequate nutrition without signs and symptoms of perforation

Nursing Diagnosis of PUD

- Acute/Chronic Pain

- Knowledge Deficit

- Risk for deficient fluid volume

Nursing Interventions for PUD

- Maintain IV

- Admin Medications

- Assist with gastric lavages through NG

- Prepare for endoscopy

How to prepare for endoscopy

pt needs to be NPO

Gastric Lavage

cleansing procedure in which the stomach is irrigated with a prescribed solution

What type of lavage do patients with PUD get?

Iced saline to help stop GI bleeding

Teach Patients with PUD to avoid eating

2 hours prior to bed

What should patients with PUD avoid?

- NSAIDS

- ETOH

- Caffeine

- Spicy Foods

Why do we avoid NSAIDS with PUD?

Inhibits COX 1 and COX 2 which stops mucus from being produced, allowing gastric acid to produce ulcers

When documenting the suction secretions, where are we looking?

Inside of the tube

Suction PUD

Low intermitted - 80

Upper GI Bleed Color

coffee ground

Lower GI Bleed Color

bright red

Irritable Bowel Syndrome

group of gastrointestinal symptoms associated with stress and tension

Clinical Manifestations of IBS

- Diarrhea

- Constipation

- Flatus

- Abdominal Pain

Complications of IBS

- Social Isolation

- Spasms, Constipation, Diarrhea

- Fluid Volume Deficit

- Hypokalemia

Medications for IBS

- Dicyclomine

- SSRI

- Linaclotide

- Psyllium

- Aldosterone

- Lubiprostone

Linaclotide

Pulls water into the bowels

Alosterone is good for

Diarrhea

Lubiprostone is good for

Constipation

What Labs to watch for with IBS

Potassium

Goal for IBS

The patient will have a formed, soft stool on a regular basis, without abdominal pain.

Nursing Diagnosis for IBS

-chronic pain

-ineffective coping

-ineffective health maintenance

Patient Teaching for IBS

- Keep a food diary

- Establish a regular bowel routine ( go to the bathroom same time and do not leave until you have a bowel movement

Foods IBS pts find helpful

- Fish

- Green Veggies

- Non-Citrus Fruit

- Rice

- Brown Bread

- Yogurt

- Cereals

- Pasta

- Bran

- Bananas

Foods IBS pts find bad

- Spicy Food

- Citrus Fruits

- Cheese

- Onions

- Chocolate

- Nuts

- Beef

- White Bread

- Eggs

- Dairy

Inflammatory Bowel Disease

Chronic inflammation of the gastrointestinal tract.

Chrons Disease

chronic inflammation of the intestinal tract

Ulcerative Colitis

chronic inflammation of the colon with presence of ulcers

Clinical Manifestations of IBD

- Bloody Diarrhea

- Fever

- Weight Loss

- Fluid Imbalance

- Malnutrition

- Anemia

- Blood In rectum

Medical Treatment for IBD

- Steroids

- Azulfidine

- Metronidazole

Surgical Treatment for IBD

Colectomy or Colostomy if damaged

Complications of IBD

- Perineal Abscess

- Peritonitis

- Fistulas

- Strictures

Steroids are used for

Inflammation

Sulfasalazine is used for

IBD inflammation

Metronidazole is used

antimicrobial

Electrolytes to look out for with IBD

Magnesium, Calcium and potassium

What lab for IBD

ESR rate

a high ESR rate indicates what

inflammation is present

Normal ESR rate

5-20

IBD Goal

the patient will be nutritionally stable, and hydrated with regular bowel movements without blood or pain.

Nursing Diagnosis for IBD

- Deficient Fluid Volume

- Diarrhea

- Imbalanced Nutrition

- Ineffective coping

- Disturbed body image

Color of an Ostomy

Pink and Red, Moist

Blue Ostomy

Indicated Cyanosis, call provider

when to "burp" the ostomy bag

when it is half full or less

ileostomy

creation of an artificial opening into the ileum, liquid stool

Ascending Colostomy

Semiliquid stool

transverse colostomy

semiliquid to semiformed stool

descending ostomy

semi-formed