Gastric and Intestinal Disorders

Differential Diagnosis of Gastric Ulcers and Duodenal Ulcers

  • Differentiation of gastric and duodenal ulcers is crucial in management.
  • Review material from ATI as it may be relevant and part of examinations.
  • Urea Breath Test:
    • To diagnose H. pylori infection.
    • Recommended to take before meals to protect the ulcer.

H. Pylori Infection and Treatment

Teaching Reinforcement for Clients with H. Pylori Infection

  • Understanding of Treatment:
    • Client Statement Analysis:
    • A: "I will stop taking my medication as soon as I feel better."
      • Incorrect. Antibiotic courses must be completed to prevent resistance.
    • B: "I will take my medication with my morning coffee."
      • Incorrect. Coffee is an irritant and can exacerbate symptoms.
    • C: "I will take a combination of medications for treatment."
      • Potentially correct. A combination approach is often used.
    • D: "I will take an antacid at the same time as my antibiotic medication."
      • Incorrect. Antacids can interfere with antibiotic absorption.

Gastritis Overview

Types of Gastritis

  • Nonerosive (Acute or Chronic):
    • Often caused by infections, especially H. pylori.
    • Chronic gastritis considers autoimmune factors, such as pernicious anemia.
  • Erosive Gastritis:
    • Common causes include NSAID usage, alcohol use disorder, and radiation treatment.

Acute Gastritis

  • Sudden onset, short duration.
  • Complications include bleeding and perforation, especially concerning pyloric stenosis.
  • Symptoms:
    • Dyspepsia (heartburn), abdominal discomfort, hiccups, nausea, vomiting, weight loss, anemia, intolerance to spicy/fatty foods, bloody stools (black and tarry).

Chronic Gastritis

  • Slow progression and may lead to anemia due to malabsorption.

Monitoring Clients

Clinical Monitoring for bloody stools

  • Look for black and tarry stools, indicating digested blood.
  • Bright red blood indicates acute bleeding (e.g., hemorrhoids).

Laboratory Tests for Gastritis

  • Test Types:
    • CBC (monitor anemia), blood and stool tests for H. pylori, stool for occult blood.
  • Nursing Interventions for Occult Blood Testing:
    • Collect three samples from different bowel movements.
    • Avoid vitamin C-rich foods, red meat, aspirin, and fresh fruits/vegetables for three days before testing.
    • Refrigerate samples to prevent contamination.

Diagnostic Procedures and Findings

  • Upper Endoscopy:
    • Essential for direct visualization of the stomach and diagnosis.
    • Inflammation is the hallmark of gastritis.

Health Promotion and Disease Prevention

  • Strategies Include:
    • Stress reduction due to its known impact on GI issues.
    • Following a prescribed diet that reduces irritants, especially alcohol.
    • Regular follow-up care for monitoring symptoms and medication adherence.

Nursing Interventions for Gastritis

  • Monitoring I&O:
    • Important for electrolyte balance due to potential vomiting or bleeding.
  • Maintain hydration:
    • IV fluids may be necessary if oral intake isn't tolerated.
  • Dietary Recommendations:
    • Small, frequent meals, avoidance of known irritants (e.g., alcohol, coconut, spicy foods, coffee).

Pharmacological Treatments for Gastritis

  • Medications:
    • Histamine 2 antagonists (e.g., famotidine), antacids, PPIs (e.g., omeprazole), and antibiotics for H. pylori.
    • Prostaglandins may be used to prevent gastric damage related to NSAID use.
  • Surgical Interventions:
    • Considered for clients with severe ulcerations or bleeding.

Upper Endoscopy Preparation

Nurse Instructions for Patient

  • Expect use of moderate sedation, not general anesthesia.
  • NPO from midnight prior to the procedure to reduce risk of aspiration.

Post-Endoscopy Complications to Monitor

  • Observations of Complications:
    • Elevated temperature (potential infection).
    • Patient reports sore throat (common, not indicative of complications).

Aluminum Hydroxide Teaching Reinforcement

  • Antacid Information:
    • Caution against taking with food - should wait at least two hours before other oral medications.
    • Monitor for constipation as a side effect.

Famotidine Comprehensive Understanding

  • Medication Functions:
    • Correct Understanding: "I will take this pill at bedtime."

Addressing Client Statements about Pain Management

Client Teaching Review

  • Identifying Problematic Statements:
    • D: Use of ibuprofen is contraindicated due to the gastric inflammation present in gastritis.

Noninflammatory vs. Inflammatory Bowel Disorders

Non-Inflammatory Bowel Conditions (Chapter 46)

  • Conditions Include:
    • Hemorrhoids, cancer, hernias, IBS, and intestinal obstruction.

Hemorrhoids Overview

  • Causes:
    • Increased intra-abdominal pressure due to factors like constipation and obesity.

IBS Overview

  • Manifestations:
    • Includes diarrhea, constipation, bloating, abdominal pain often relieved by bowel movements. Clients must keep diaries of food intake and symptoms to identify triggers.
    • Nursing education should focus on managing stress and avoiding known irritants such as alcohol and spicy foods.

Intestinal Obstruction Types

  • Mechanical & Nonmechanical:
    • Mechanical occurs with physical blockage; nonmechanical (often due to paralytic ileus) occurs when peristalsis diminishes.

Expected Findings & Nursing Care for Obstruction

  • Look for signs of dehydration or electrolyte imbalances.
  • Promote NPO status and prepare for possible surgical intervention.

Inflammatory Bowel Disease (IBD) Overview (Chapter 47)

Key Types: UC, Crohn's, Diverticulitis

  • Ulcerative Colitis:
    • Inflammation primarily in the rectum and rectosigmoid region. Expect 15-30 episodes of loose stools per day, often with blood.
  • Crohn's Disease:
    • Inflammation affecting the distal ileum. Expect fewer episodes of diarrhea (5). Pain often in the right lower quadrant.
  • Diverticulitis:
    • Clients may either experience diarrhea or constipation.

Nursing Interventions and Dietary Recommendations for IBD

  • Diets Should Consist Of:
    • High protein, high calories, low fiber (due to diarrhea).
    • Medications include steroids for inflammation; monitor carefully for immunosuppression impacts.

Patient Education for Clients with IBD

  • Encouragement to Keep Food Diaries:
    • Helps tailor dietary needs specifically to the client's gastrointestinal response.

Important Nursing Considerations

  • Recognize signs of complications such as infection and dehydration as priority concerns.
  • Provide patient support and education tailored to unique presentations and condition management strategies.