Gastrointestinal System Review: Key Concepts and Clinical Considerations

Definition/Clinical Manifestations: Characterized by substernal pain, heartburn, regurgitation, burning dry cough, sore throat, bitter taste in the mouth, wheezing, hoarseness, a full feeling in the throat, and a sensation of food being stuck.
Diagnosis (DX): Barium swallow, NG tube.
**Medications:
- H_2 Receptor Antagonists: (e.g., Ranitidine) Can cause drowsiness.
- Proton Pump Inhibitors (PPIs): (e.g., Mezropazole, Pantropazole, Omeprazole). Generally, avoid NSAIDs while on PPIs due to potential gastric irritation.
- Sucralfate (Carafate):
  - Mechanism of Action: Coats the stomach lining to protect against ulcer disease.
  - Administration: Taken orally as a "swish and swallow" medication.
  - Patient Teaching: Important not to eat 1 hour before taking the medication and to wait 1 hour after taking it before eating again. Also used in Peptic Ulcer Disease (PUD).

H. Pylori: A bacterium recognized as the main cause of peptic ulcer disease.
Diagnostic Testing: Urea test, breathing test.
Patient Education for PUD:
- Avoid NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): NSAIDs are a major concern as they can irritate the stomach, contribute to bleeding, ulcer formation, and perforation of the stomach lining.
- Lifestyle Modifications: Stop smoking, limit spicy foods, reduce caffeine intake, and avoid alcohol.
Complications of Ulcers: These are serious and require immediate attention.
- Infection
- Bleeding: Leads to potential hemorrhagic shock. Vomiting blood (hematemesis), especially due to esophageal varices, is a medical emergency.
- Perforation: Classic signs include abdominal distension, rigidity, severe abdominal pain, fever, chills, nausea, swelling, and a tender abdomen.
Contributing Factors for PUD: Hypotension, ischemia (which affects capillaries due to impaired gas exchange), and severe injury (such as burns) can contribute to ulcer development.
Medical Emergency (Hemorrhage/Rupture): If esophageal varices rupture, the main concern is bleeding. Controlling the bleeding is the first priority to prevent hypovolemic shock; vital signs assessment is not the initial action in this acute scenario.

Medication Administration (e.g., Nystatin):
- Method: Swish and swallow.
- Duration: Swish for 30 seconds.
- Important Note: Do not spit out the medication; swallowing ensures it reaches affected areas in the esophagus and prevents medication waste.

Definition: Inflammation of the tongue.
Cardinal Signs: Smooth, shiny change in color of the tongue, occurring with edema and inflammation.

Definition: Inflammation of the gallbladder.
Causes: Alcohol consumption, obstruction (e.g., gallstones), surgery, hemorrhage, or certain medications.
Medications: Antiemetics and antispasmodics (e.g., Dicyclomine).
Clinical Manifestations: Steatorrhea (fatty stools), dark urine, pain in the left upper quadrant (LUQ), and pain radiating to the scapula.

Purpose: Detects tumors, ulcers, and strictures.
Post-Procedure Care and Patient Education:
- Fluids: Instruct patients to significantly increase their fluid intake to help flush the barium out of the body.
- Stool Appearance: Expect chalky or clay-colored stools for up to 48 hours post-procedure. This is an expected finding and does not need to be reported to the nurse within this timeframe.

NPO Status: Patients must be NPO (nothing by mouth) for 6 to 8 hours prior to a GI procedure; the exact duration depends on the specific test.
Vital Signs: Always assess vital signs before and after procedures.
Consent: The doctor is responsible for explaining the procedure and obtaining informed consent. The nurse's role is to ensure the patient fully understands and has signed the consent form.
Allergies: Always check for patient allergies before any procedure or medication administration.

Procedure: Performed by accessing the intercostal space on the right side of the body.
Patient Positioning (During Procedure): A pillow can be placed under the abdomen or a rolled towel can be used.
Post-Procedure Care:
- Immobilization: Patients should lie on their right side for 2 full hours immediately after the procedure to apply pressure to the biopsy site.
- Assessment: Assess the patient for bleeding every 15 minutes (or every 30 minutes if specifically ordered) for a period of 42 hours (implying initial frequent monitoring followed by less frequent monitoring over this duration).

Definition: Characterized by delayed emptying of the stomach, where the stomach contents become