NURS-433: Management of Care 3 (Module 7)

What occurs during digestion in the mouth and pharynx?

Chewing forms a food bolus, and swallowing moves it toward the esophagus

How does food move through the esophagus?

Peristalsis moves the food bolus into the stomach

What occurs during digestion in the stomach?

Gastric juices and mixing break food down into chyme

What substances support further digestion in the duodenum?

Bile and pancreatic enzymes

What is Barrett’s esophagus, and what contributes to its development?

A condition in which the esophageal lining changes to resemble intestinal tissue due to chronic reflux injury and repeated tissue repair

What are the risk factors associated with Barrett’s esophagus?

GERD, central obesity, smoking, family history, and male sex

What type of cancer is associated with Barrett’s esophagus?

Esophageal adenocarcinoma

What symptoms should the nurse assess in a patient with suspected Barrett’s esophagus?

Patients are often asymptomatic but may experience heartburn, regurgitation, dysphagia, or painful swallowing

What aspects of the patient's history should the nurse assess when evaluating Barrett’s esophagus?

Symptom frequency, severity, duration, and effects on sleep and eating

How is Barrett’s esophagus diagnosed?

Upper endoscopy visualizes tissue changes, and biopsy confirms the diagnosis

What nursing interventions are recommended for patients with Barrett’s esophagus?

Administer prescribed PPIs, review reflux triggers, support medication adherence, and collaborate on dietary changes

What are the expected outcomes of nursing care for Barrett’s esophagus?

Fewer reflux symptoms, improved comfort with eating, understanding of dietary changes, and a clear medication routine

What should the nurse do if a patient with Barrett’s esophagus continues experiencing symptoms despite treatment?

Reassess the patient's condition and treatment plan

What is gastritis?

Acute or chronic inflammation of the gastric lining

What are the common causes and manifestations of acute gastritis?

Causes include NSAIDs or aspirin, heavy alcohol use, smoking, infection, and physiologic stress; manifestations include epigastric pain, nausea, vomiting, and fullness after meals

What are the common causes and manifestations of chronic gastritis?

Causes include H. pylori infection, autoimmune disease, Crohn’s disease, gastric surgery, and other infections; patients are often asymptomatic

What complications can develop from untreated gastritis?

Ulcers, bleeding, and perforation

How does the timing of pain differ between gastric and duodenal ulcers?

Gastric ulcer pain typically occurs soon after eating, whereas duodenal ulcer pain occurs approximately 2–3 hours after eating

What additional manifestations may occur in patients with peptic ulcer disease?

Heartburn, dyspepsia, chest discomfort, hematemesis, melena, fatigue, and dyspnea

What information should the nurse obtain when assessing a patient with suspected gastritis or PUD?

Symptoms, timing of symptoms relative to meals, medication use, alcohol consumption, smoking, and stress

What is the purpose of endoscopy with biopsy in patients with gastritis or PUD?

To directly assess gastric tissue and evaluate the underlying cause

What diagnostic tests can identify H. pylori infection?

Urea breath testing and endoscopic biopsy-based testing

What laboratory and diagnostic studies may be used to evaluate gastritis or PUD?

CBC and iron studies to assess anemia, stool testing to check for blood or infection, and additional studies to evaluate suspected causes

What is the priority nursing response when GI bleeding is suspected?

Promptly assess the patient and immediately notify the provider when blood is present in vomit or stool

What additional alarm findings require timely evaluation in patients with upper GI disorders?

Anemia, early satiety, progressive dysphagia or odynophagia, recurrent vomiting, unexplained weight loss, and family history of GI cancer

What assessment cues should the nurse recognize in a patient with gastritis?

Pain, nausea, oral intake, changes in emesis or stool, and exposure to irritants

What nursing actions are recommended for patients with gastritis?

Administer prescribed therapy, teach avoidance of gastric irritants, and support cessation of harmful exposures

How should the nurse evaluate the effectiveness of gastritis treatment?

Compare symptom timing and severity, reassess patient understanding, and modify care as needed

What is the mechanism of action of proton pump inhibitors (PPIs)?

PPIs inhibit the gastric hydrogen–potassium ATPase (proton pump), reducing gastric acid secretion

What is the clinical purpose of PPIs in upper GI disorders?

To control reflux, reduce acid-related irritation, and support H. pylori treatment when combined with prescribed antibiotics

What nursing considerations are important when administering PPIs?

Review drug interactions, assess medication adherence, monitor for long-term magnesium deficiency, and complete other ordered safety checks

What are the common indications and nursing considerations for pantoprazole?

Used for GERD, Zollinger–Ellison syndrome, and H. pylori regimens; monitor drug interactions and recognize that IV therapy may worsen zinc deficiency

What are the common indications and nursing considerations for rabeprazole?

Used for GERD, peptic or esophageal ulcers, erosive esophagitis, H. pylori infection, and Zollinger–Ellison syndrome; monitor kidney concerns, drug interactions, and vitamin B12 deficiency

What are the common indications and nursing considerations for dexlansoprazole?

Used for GERD and the treatment or prevention of esophageal erosion; monitor drug interactions

What are the common indications and nursing considerations for esomeprazole?

Used for GERD, stomach or peptic ulcers, esophageal erosion, and Zollinger–Ellison syndrome; monitor kidney concerns, vitamin B12 deficiency, and drug interactions

What are the common indications and nursing considerations for lansoprazole?

Used for GERD, esophageal erosion, Zollinger–Ellison syndrome, gastric or duodenal ulcers, and H. pylori infection; monitor drug interactions

What are the common manifestations of gastric cancer?

Symptoms may appear late and include weight loss, anorexia, persistent abdominal pain, early satiety, indigestion, dysphagia, nausea, and hematemesis

What are the risk factors associated with gastric cancer?

H. pylori infection, obesity, smoking, heavy alcohol use, and dietary exposures

How do intestinal and diffuse gastric adenocarcinomas differ?

Intestinal adenocarcinoma has more clustered cells, whereas diffuse adenocarcinoma has more scattered cells

How is gastric cancer diagnosed and staged?

Endoscopy with biopsy confirms the diagnosis, while CT, endoscopic ultrasound, and other studies assess the spread of cancer

What is the primary goal of surgical treatment for gastric cancer?

To remove the tumor and affected tissue with margins free of cancer cells

What surgical approaches may be used to treat gastric cancer?

Total or partial gastrectomy, esophagogastrectomy, lymph node dissection, and bypass or feeding access when needed

What nonsurgical treatments may be used for gastric cancer?

Chemotherapy, chemoradiation, targeted therapy, and immunotherapy

What are the primary nursing responsibilities when caring for a patient undergoing gastric cancer treatment?

Coordinate care, provide patient education, and continually reassess the patient throughout treatment

What are the four primary nursing priorities when caring for patients with upper GI disorders?

Assess symptoms and their effects on eating, promptly escalate suspected GI bleeding, teach prescribed medication and dietary plans, and reassess outcomes while coordinating changes in care

What are the four primary functions of the intestines?

Transit through peristalsis, digestion supported by the microbiome, water absorption by the colon, and stool storage/elimination through the rectum

What information should the nurse collect during a focused bowel assessment?

Usual bowel pattern, last stool, stool frequency/consistency, blood, pain, diet, fluids, medications, recent surgery, vital signs, hydration, abdominal findings, intake/output, weight trends, and laboratory values

How is constipation defined, and what causes hard, dry stools?

Fewer than three bowel movements per week; slowed intestinal transit allows increased water absorption

What factors contribute to constipation?

Dehydration, low fiber intake, reduced activity, opioids, depression, and abdominal procedures

What are the four nursing priorities when managing constipation?

Assess contributing factors, support an individualized bowel routine, administer prescribed oral/rectal therapies, and evaluate stool passage and patient comfort

What is fecal impaction, and what contributes to its development?

Accumulated stool blocks the rectum, often associated with retained stool or failure to respond to the urge to defecate

What is a mechanical bowel obstruction, and why can it become life-threatening?

A physical blockage prevents intestinal passage and may compromise blood supply, requiring surgery

What is paralytic ileus, and what factors increase its risk?

Temporary cessation or significant slowing of peristalsis, commonly associated with abdominal surgery, opioids, and electrolyte imbalances

What findings suggest an urgent bowel complication, and what should the nurse do?

Distention, vomiting, inability to pass gas, or worsening pain/cramping; reassess vital signs and abdomen, notify the provider promptly, and prepare for ordered treatment

How is diarrhea defined?

More than three frequent, unformed stools within 24 hours

What are the common causes and manifestations of diarrhea?

Causes include infection, food poisoning, medications, intolerance, allergies, and anxiety; manifestations include urgency, cramping, nausea, thirst, decreased urine output, and possible fever

What findings indicate mild to moderate dehydration?

Thirst, dry mucous membranes, decreased urine output, dark urine, dry/cool skin, headache, and muscle cramps

What findings indicate moderate to severe dehydration?

Minimal/absent urine output, sunken eyes, dizziness, fainting, tachycardia, tachypnea, hypotension, fatigue, and confusion

What are the nursing priorities for managing diarrhea?

Monitor stool characteristics and intake/output, replace fluids orally or intravenously as ordered (fluid balance is the immediate care priority), collect stool studies, monitor electrolytes, protect skin integrity, and evaluate medication appropriateness

What is irritable bowel syndrome (IBS), and what symptoms are associated with it?

A functional bowel disorder characterized by abdominal pain and changes in bowel frequency/form, with possible cramping, gas, bloating, and fullness

What are the three subtypes of IBS?

IBS-C (constipation-predominant), IBS-D (diarrhea-predominant), and IBS-M (mixed bowel patterns)

How does IBS differ from IBD in pathophysiology and treatment goals?

IBS involves altered bowel habits and pain, often triggered by food/stress, with treatment focused on symptom control; IBD involves chronic inflammation, possible ulceration/bleeding, and treatment focused on remission and complication prevention

What alarm findings require further evaluation rather than assuming uncomplicated IBS?

Blood in stool, unexplained weight loss, or iron deficiency

What is the pathophysiology of celiac disease?

Gluten exposure triggers immune-mediated injury to intestinal villi, resulting in reduced nutrient absorption

What clinical manifestations are associated with celiac disease?

Abdominal pain, bloating, gas, chronic diarrhea, fatty stools, weight loss, fatigue, anemia, and possible extraintestinal symptoms

What is the lifelong treatment for celiac disease?

Strict avoidance of gluten

What grains and flours must patients with celiac disease avoid?

Barley, farina, farro, rye, semolina, spelt, triticale, and wheat varieties including durum, einkorn, emmer, graham flour, Khorasan wheat, and wheat berries

What foods are appropriate examples of gluten-free alternatives?

Rice, quinoa, corn, millet, sorghum, buckwheat, amaranth, potato, tapioca, gluten-free oats, arrowroot, beans, cassava, chia, flax, nut flours, soy, teff, and yucca

What two educational priorities help prevent accidental gluten exposure?

Reading food labels and preventing gluten cross-contact

What diagnostic methods support a diagnosis of celiac disease?

Serologic testing, duodenal biopsy, and assessment for nutrient deficiencies

What nursing interventions and evaluation measures are important for celiac disease?

Assess GI symptoms, weight, stool patterns, and hydration; provide gluten-free diet education and prescribed replacement therapy; evaluate symptom improvement, intake/output, laboratory trends, and understanding through teach-back

What are the warning signs of colorectal cancer?

Changes in bowel habits, blood in stool, unexplained weight loss, fatigue, persistent abdominal pain, bloating, and cramping

What diagnostic procedures and studies are used to evaluate colorectal cancer?

History/physical examination, colonoscopy with biopsy, CBC, metabolic/liver studies, and CT/MRI for staging

Why is colorectal cancer screening important?

It can detect disease before symptoms develop

What are the primary nursing priorities during colorectal cancer treatment and recovery?

Pain relief, symptom control, monitoring adverse effects, infection/dehydration surveillance, bowel function assessment, nutritional support, stoma care, and body-image support

What determines the treatment approach for colorectal cancer?

The patient's disease characteristics and treatment goals

What clinical manifestations suggest appendicitis?

Periumbilical or right lower quadrant pain, localized tenderness, anorexia, nausea, vomiting, fever, and possible bowel/urinary changes

What diagnostic findings and tests may support appendicitis?

Possible positive Rovsing sign, vital signs, WBC count, and ultrasound or CT when ordered

What serious complications can result from appendiceal perforation?

Abscess, peritonitis, and sepsis

How does intestinal perforation cause peritonitis?

Intestinal contents enter the peritoneal cavity and cause inflammation

What findings indicate possible peritonitis and require immediate communication?

Guarding, rebound tenderness, rigid abdomen, fever, worsening pain, distention, or unstable vital signs

What is the difference between diverticulosis, diverticular disease, and diverticulitis?

Diverticulosis is the presence of diverticula; diverticular disease occurs when diverticula cause symptoms/complications; diverticulitis is inflammation of one or more diverticula

How is uncomplicated diverticulitis managed, and what should nurses monitor?

Diet adjustments, fluids, pain relief, and selective antibiotics; monitor pain, temperature, hydration, and intake tolerance

How may diverticulitis complicated by abscess, perforation, or significant bleeding be managed?

Abscess/perforation may require drainage or surgery; significant bleeding may require blood products or other interventions with hemodynamic monitoring

What diagnostic and follow-up procedures are associated with diverticulitis?

CT supports acute evaluation, and endoscopic follow-up may occur after recovery when indicated

How do Crohn's disease and ulcerative colitis differ in location, inflammation pattern, and depth?

Crohn's affects any GI segment with patchy skip lesions and inflammation across multiple bowel-wall layers; ulcerative colitis affects the colon/rectum with continuous inflammation primarily involving the mucosa

What complications are associated with Crohn's disease versus ulcerative colitis?

Crohn's: strictures, fistulas, and abscesses; ulcerative colitis: bleeding and severe colitis

How can both Crohn's disease and ulcerative colitis affect patients?

Both can impair nutrition, fluid balance, and daily functioning

What diagnostic procedures are used in IBD evaluation, and what nursing considerations accompany them?

Upper endoscopy visualizes the upper GI lining and requires monitoring breathing/swallowing; colonoscopy visualizes the colon/rectum and requires monitoring cramping/bloating and encouraging gas passage; labs/imaging assess inflammation, infection, and complications

What are the primary nursing priorities for patients with IBD?

Assess pain, diarrhea, bleeding, weight loss, and hydration; escalate fever, tachycardia, hypotension, or worsening symptoms; support nutrition/fluids, administer prescribed treatment, and evaluate symptom trends and understanding

What are the goals and possible treatments for inflammatory bowel disease?

Induce remission, maintain control, and prevent complications using anti-inflammatory medications, biologics, immunosuppressants, antibiotics for infection, nutrient replacement, and individualized dietary/surgical interventions

What four clinical priorities apply across lower GI disorders?

Fluid/electrolyte balance, recognition of acute abdominal complications, monitoring inflammation/infection, and supporting long-term self-management

What findings indicate successful management of lower GI disorders?

Bowel patterns approach baseline, pain/abdominal symptoms improve, fluid balance/laboratory trends stabilize, and patients demonstrate understanding of treatment, prevention, diet, medications, and urgent symptoms

What should the nurse do if expected clinical outcomes are not achieved?

Collaborate with the healthcare team and revise the care plan

What should guide clinical decisions for patients with lower GI disorders?

Patient assessment, current clinical guidance, and local protocols

What are the primary functions of the liver?

Metabolism, protein synthesis, storage of fat-soluble vitamins, detoxification, and bile production

What are the primary functions of the gallbladder?

Stores and concentrates bile and releases it into the duodenum to assist with fat digestion

What are the primary functions of the pancreas?

Produces insulin to regulate blood glucose and digestive enzymes to support nutrient absorption

What are the systemic consequences of liver, gallbladder, or pancreatic dysfunction?

Impaired nutrition, altered fluid balance, and dysfunction of multiple body systems

What causes jaundice?

Excess accumulation of bilirubin