Caring for Patients with Gastrointestinal Disorders

The digestive system consists of

A muscular tube extending from mouth to anus

What is included in the digestive system?

Mouth, pharynx, esophagus, stomach, small intestine, large intestine, & the anus.

What aids in digestion?

Accessory Organs

Accessory organs of the digestive system includes

Liver, gallbladder, & pancreas

What does an occult blood stool sample look for?

Any blood that is hidden.

Patients who are undergoing a barium swallow study, or anything else involving barium, should be educated on...

Constipation may occur, stools may be white/chalky (NORMAL), & to increase their fluid intake.

Disorders of the mouth include

Dental plaque/caries, candidiasis, & carcinoma of oral cavity.

When obtaining a stool sample

Avoid contaminating with urine.

GI tests require patients to be...

NPO along with bowel prep

After a GI procedure, nurse should monitor for

Bleeding, perforation, & signs of normal bowel processes.

Disorders of the esophagus include

Achalasia, carcinoma of esophagus, & GERD.

Disorders of the stomach include

Gastritis, peptic ulcer disease, & cancer of the stomach.

Medical management for cancer of the stomach

Gastric Surgeries.

Dumping syndrome

Rapid emptying of gastric contents into small intestines.

What is a possible complication that occurs after gastric surgeries?

Dumping syndromes

Inflammatory Bowel Disease (IBS) includes

Ulcerative colitis and Crohn's Disease

When working with patients with a stoma, a nurse should assess

Skin integrity, for any allergies to powder/adhesives, along with the peristomal area for any signs of infection.

Oral leasons may be found on

Gums, tongue, or palate.

Individuals with stomas should be educated on

How to change the pouch

Acute abdominal inflammations include...

Appendicitis, diverticulitis, and periontitis.

Second leading cause of cancer deaths

Colorectal Cancer

Where are the most growths from colorectal cancer found?

In the sigmoid & rectal regions of the colon.

Cause of colorectal cancer

REMAINS UNKNOWN

Risk factors of colorectal cancers

Adenomatous polyps, ulcerative colitis, diverticulitis, and hereditary.

Colorectal cancer clincal manifestations

Are non specific

Mechanical intestinal obstructions are caused by

An occlusion of the lumen of the intestinal tract.

Nonmechanical intestinal obstructions are caused by

Anything that decreases the muscle action of bowel.

Individuals who smoke and drink along with a GERD diagnosis are at an increased risk for

Esophageal Cancer

Achalasia

Motility disorder where lower esophageal sphincter fails to properly relax.

Nonmechanical intestinal obstructions may be a...

Neurologic or vascular disorder

Early phases of mechanical intestinal obstruction include

Auscultation of the abdomen revealing loud, frequent, high pitched sounds.

In later stages of mechanical intestinal obstruction

Bowel sounds become absent.

Esophageal Dilation

Procedure to widen narrowed esophagus.

Causes of fecal incontinence

External sphincter is relaxed, voluntary control of defecation is disturbed, distension of the rectum, along with paralysis.

Main treatment for stomach cancer

Surgeries

Chemotherapy & radiation

Often are used together

What does treating esophageal disorders provide?

Patients with a means for eating along with treating the disorder.

Why are nasogastric (NG) tubes inserted?

To keep the stomach empty until peristalsis resumes after general anesthetic/any other condition that interferes with peristalsis.

Gastroesophageal Reflux Disease (GERD)

Backward flow of stomach acid into the esophagus

What does GERD cause?

Burning & pressure behind the sternum.

What causes GERD?

Relaxation or weakness of the lower esophageal sphincter (LES).

Achalasia

An abnormal condition characterized by the inability of a muscle to relax.

What surgical procedure could a nurse anticipate in a patient with achalasia?

Esophageal Dilation.

What condition suggests a need for an esophageal manometry?

Dysphagia

After esophageal surgery, when should a nurse report blood oozing from an NG tube?

If it lasts over 12 hours.

Why is early detection of cancer in the GI system (along with all cancers....) so important?

It facilitates for earlier treatment and for a better prognosis.

Which individuals are at an increased risk for developing cancer of the bowel?

Individuals who are diagnosed with Inflammatory Bowel Disease.

Carcinoma of the esophagus

Malignant epithelial neoplasm that has invaded the esophagus.

What is carcinoma of the esophagus diagnosed as?

Squamous cell carcinomaladenocarcinoma

Which cancer is typically asymptomatic in the early stages?

Gastric (stomach) Cancer

What is the treatment of choice for gastric cancers?

Surgery.

If a patient is radiation therapy and has increased WBCs, increased o2 requirements, decreased lung sounds, & a chest x-ray that reveals aspiration pneumonia, what condition would the nurse suspect the patient to have?

Tracheoesophageal Fistula

What condition is associated with dumping syndrome?

Post gastric resection surgery.

What substance is deficient in a patient with pernicious anemia after gastric surgery?

Intrinsic Factors.

What is the most common type of peptic ulcer disease (PUD) ?

Duodenal Ulcers.

Peptic ulcers

Ulcerations of the mucous membrane/deeper structures of the GI tract.

Although gastric & duodenal ulcers have similar symptoms, what do they differ in?

Timing, degree, and factors that worsen/improve the symptoms.

What causes ulcers of the gastric mucosal lining?

Stress, erosive gastritis, and Helicobacter pylori (H. pylori.)

What condition would a nurse suspect in a patient with gastritis that indicates a need for fluid and blood replacement along with nasogastric lavage?

Gastrointestinal Bleeding.

Which condition would a nurse expect when noticing undigested food in the emesis of a patient?

Gastric Outlet Obstruction.

What tests are used to diagnose peptic ulcer disease?

Fiberoptic endoscopy/esophagogastrodupdenoscopy (EGD)

Noninvasive Breath Tests

Fecal Assay Antigen Tests

Barium Contrast Studies/Upper gastrointestinal (UGI) series

Stool for occult blood

What does effective post-op care BEGIN with?

Patient education during the PREoperative period.

What is the main cause of peptic ulcer disease?

H. pylori

How is H. pylori treated?

With antibiotics

What does treating H.pylori do?

Decreases the likelihood of recurrence.

What must patients with recurrent ulcer disease even after initial healing learn?

How to live with a chronic disease.

What medication would the nurse anticipate to be ordered for a patient with peptic ulcer disease?

Bismuth.

What instruction would a nurse give to a patient with peptic ulcer disease?

Have 6 SMALL meals daily.

What should a nurse anticipate setting the pressure of intermittent suction for an NG tube to?

100-125mmHg

What is the most severe complication of peptic ulcer disease?

Perforation.

What statement could a nurse use to help relieve anxiety in a patient with carcinoma of the esophagus who is nervous about what to expect immediately after an esophagogastroectomy?

"When you wake up, we will be monitoring you very closely and be doing everything to keep you as comfortable as possible."

What is the most important nursing action to implement after a patient undergoes a partial gastrectomy to prevent further complication?

Measure their blood serum vitamin B12 level.

What surgical procedures are performed to remove stomach cancer?

Vagotomy

Antrectomy

Gastrojejunostomy

Gastroduodenostomy

What instruction is important to provided to a patient who has been prescribed misoprostol to prevent an NSAID induced ulcer?

Use a reliable form of contraception while taking this medication.

What are the signs and symptoms indicating carcinoma of the esophagus?

Weight loss, hemorrhage, odynophagia, and coughing while swallowing.

To prevent dumping syndrome, what should patients be instructed to do following a gastrectomy?

Divide up meals into six small feedings at a time.

What medications are commonly prescribed for severe cases of GERD?

Sucralfate

Rabeprazole

Esomeprazole

Metoclopramide

What is important to teach a patient prescribed lansoprazole and sucralfate for stomach ulcers included by GERD?

"Take your lansoprazole about 30mins before you take the sucralfate."

What does the digestive tract begin with and go through?

Mouth, extending through the thoracic and abdominal cavities, ending with the anus.

Where does digestion of proteins occur?

The stomach

Where do the major processes of both digestion and absorption occur?

The small intestine.

What is the large intestine responsible for?

The preparation and evacuation of feces.

What are the structures in the alimentary canal?

The esophagus, anus, and the large intestine

Which accessory organ of the digestive tract manufactures cholesterol?

The liver.

Which diagnostic procedure is relatively new to the healthcare world?

Capsule Endoscopies

What is a capsule endoscopy?

A patient swallows a small capsule that is equipped with a camera used to visualize the small intestines.

What does an upper gastrointestinal series detect?

Any abnormal conditions in the GI tract.

What is an EDG used to visualize?

The esophagus, stomach, and the duodenum for routine screenings along with identifying any problems/abnormalities.

What is a barium swallow?

A series of radiographs that focuses on the esophagus.

What is the Bernstein test used for?

Differentiating cardiac pain from esophageal pain.

What are common occult blood tests that are ran?

Stool guaiac test

Hemocult test

Hematest

What may alter the results of a guaiac test?

Consumption of organ meat prior to test.

Sigmoid Colonoscopy

Endoscopy of the lower GI tract that allows for visualization and biopsies of the sigmoid colon.

What do standard/virtual colonoscopies allow for?

Visualization of the entire colon, from anus to cecum.

What is the obstruction series?

A group of radiographic studies performed on the abdomen.

What do stool samples examine for?

The presence of any bacteria, ova, or parasites.

What dietary instructions should be given to a patient who is scheduled for a colonoscopy?

Prior to the procedure, maintain a clear liquid diet for 1-3days.

Which diagnostic test does the nurse anticipate to be ordered for a patient experiencing diarrhea and an intestinal infection?

A stool culture.

What is a nonobjective finding that indicates oral candidiasis?

Angular Cheilitis.

Angular Cheilitis

A painful inflammation causing cracks, redness, and crusting at the corners of the mouth (crusting is typically white).