Gastric & Intestinal Disorders

exam 2

clinical manifestations for peptic ulcer disease

dull burning pain in mid-epigastrium/back

vomiting, constipation, diarrhea, bleeding, burping

duodenal ulcer

pain occurs 2-3 hours after meals, awake during the night, express relief of pain after eating or after taking an antacid

gastric ulcer

pain occurs immediately after eating

upper endoscopy allows what

visualization of any inflammatory changes, ulcers, lesions

biopsy can be obtained and can identify

h.pylori

PUD meds

Combination antibiotics, PPIs, and bismuth salts

PUD management

stop smoking

avoid extreme temps for food and drink

avoid alc, coffee, caffiene

eat 3 regular intervals

The nurse is providing teaching for the client who has diarrhea. Select the 4 instructions that the nurse should include in the teaching.

Increase intake of high-calcium foods.

Eat probiotic foods, such as yogurt.

Avoid alcohol while experiencing diarrhea.

Eat raw vegetables.

Eat three large meals a day.

Avoid caffeine while experiencing diarrhea.

Drink hot liquids several times a day.

Drink carbonated beverages to replace lost fluids.

Follow a low-fiber diet.

Eat probiotic foods, such as yogurt.

Avoid alcohol while experiencing diarrhea.

Avoid caffeine while experiencing diarrhea.

Follow a low-fiber diet.

if peritonitis gets too bad, there is a risk of

sepsis & septic shock

Appendicitis expected vs unexpected signs

expected: Vague/deep periumbilical pain that progresses to RLQ

Low-grade fever, anorexia, nausea & sometimes emesis

unexpected: diarrhea, chills, painful urination, sudden pain relief, shock, rigid/swollen belly

how to diagnose appendicitis

CT scan

WBCs

CRP

Medical Management of appendicitis

Antibiotics/IV fluids >> Prevention of electrolyte imbalances and dehydration

Surgery! Lap appy (laparoscopic appendectomy

Postop laparoscopic appendectomy plan of care:

High-Fowler’s= optimal positioning for the patient

Home care activity restrictions

Return of bowel function= advance diet as tolerated

DVT prevention

Incisional care: glue and/or steri-strips

when appendix ruptures,

pain relieved temporarily and then returns with abd distention

The nurse is assessing a client with suspected acute appendicitis. Which of the following findings would warrant immediate intervention? Select all that apply.

BP 80/48, HR 130

RLQ pain and rebound tenderness

Increased abdominal girth

Diffuse abdominal rigidity

Temp 99.9 F

Frank blood with defecation

BP

increased abdominal girth

diffuse abdominal rigidity

frank blood with defecation

Clinical Manifestations of Diverticulosis

chronic constipation

asymptomatic/mild symptoms

can have intervalled diarrhea

nausea and anorexia

bloating/abd distension

Clinical Manifestations of Diverticulitis

LLQ pain

Nausea, vomiting, fever, chills, leukocytosis

diagnosing diverticulosis

Colonoscopy

diagnosing diverticulitis

Assessments: GI-focused, stool patterns/color? Symptoms of infection? Pain?

CT with contrast

Abdominal x-rays

Elevated WBCs, CRP, & ESR

If frank blood in stools check hgb.

Diet for diverticulosis

NPO for severe manifestations

Clear liquids (initially after NPO) then advance to high-fiber diet

Avoid undigestible material

Avoid personal irritants

pharmalogical treatments diverticulosis

antibiotics, analgesics, bulk forming laxative

remove affected of the colon

diverticulosis

abscess, fistula, peritonitis, bleeding, bowel obstruction, perforation

CM for small bowel obstructions

initial crampy pain

peristaltic waves

projectile vomiting, bile color, fecal matter

upper abd distention

hyperactive bowl sounds proximally

hypoactive distally

you got ab abd x-ray or a CT for a patient with small bowel obstruction. what can you expect to find

• to see large quantities of gas/fluid in the intestines

• collapsed bowel

what labs would u order for a patient with small bowel obstruction. why

CMP to see electrolyte imbalances and dehydration

CBC to see infection and loss of plasma volume

small bowel obstruction management

replace fluids/electrolytes

decompress with NG tube

surgery

CM of large bowel obstruction

Symptoms progress slower compared to SBO presentation

Initially, constipation may be the only symptom

There can be diarrhea or “ribbon-like” stool around impaction

Lower abdominal distention and cramping

Weight loss, anorexia, weakness

The nurse is inserting a nasoenteric tube for a patient with a paralytic ileus. How long does the nurse anticipate the tube will be required? Select all that apply.

Until bowel sounds are present

Until flatus is passed

Until peristalsis is resumed

Until the patient stops vomiting

Until the tube comes out on its own

Until bowel sounds are present

Until flatus is passed

Until peristalsis is resumed

A client is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this client's care, which of the following nursing diagnoses should the nurse prioritize?

A. Ineffective tissue perfusion related to bowel ischemia

B. Imbalanced nutrition: Less than body requirements related to impaired absorption

C. Anxiety related to bowel obstruction and subsequent hospitalization

D. Impaired skin integrity related to bowel obstruction

D. Impaired skin integrity related to bowel obstruction