GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
Gastrointestinal Disorders RN REVIEW REVIEW OF PARTS & FUNCTIONS Nio C. Noveno, RN, MAN GI DISORDERS
2
G IT THE MAJOR PARTS MOUTH / ESOPHAGUS STOMACH SMALL INTESTINE LARGE INTESTINE
GI DISORDERS
ACCESSORY ORGANS PANCREAS LIVER GALLBLADDER GI DISORDERS
BY NIO C. NOVENO, RN, MAN
3
GI DISORDERS
4
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
STOMATITIS
ESOPHAGEAL VARICES
CAUSES • INFECTIONS • IRRITANTS • CHEMOTHERAPY
• MOST COMMON LOCATION
– DISTAL VEINS OF THE ESOPHAGUS
NURSING DIAGNOSES • PAIN • IMBALANCED NUTRITION • IMPAIRED ORAL MUCOUS MEMBRANE
– OFTEN DUE TO CIRRHOSIS
DIAGNOSIS • C&S
*WALLS OF THE VEINS
TREATMENT
WEAKEN
• XYLOCAINE • ANTIBIOTICS • BLAND DIET
GI DISORDERS
– WOF: BLEEDING & ULCERATION 5
ESOPHAGEAL VARICES MEDICAL MANAGEMENT
GI DISORDERS
6
IF VARICES ARE ACTIVELY BLEEDING SENGSTAKEN-BLAKEMORE TUBE
MINNESOTA TUBE
1. SCLEROTHERAPY 2. LIGATION 3. BALLOON TAMPONADE
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
7
GI DISORDERS
8
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
ESOPHAGEAL VARICES PHARMACOLOGICAL MANAGEMENT
ESOPHAGEAL VARICES SURGICAL MANAGEMENT TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT
• OCREOTIDE (SANDOSTATIN) I.V. – DECREASES BLOOD FLOW
• ANALGESICS • SUCRALFATE (C ARAFATE) • I.V. REHYDRATION
• USES THE RIGHT INTERNAL JUGULAR VEIN
• CONNECTION BETWEEN HEPATIC & PORTAL VEINS • DONE IN X-RAY GI DISORDERS
• AVOID: – ASPIRINS, NSAIDS, ANTICOAGULANTS 9
ESOPHAGEAL VARICES NURSING MANAGEMENT
GI DISORDERS
GASTROESOPHAGEAL REFLUX DISEASE POSSIBLE CAUSES: 1. FATTY FOODS 2. CAFFEINE 3. NICOTINE 4. CCBS 5. NSAIDS
• RISK FOR FLUID VOLUME DEFICIT • DEFICIENT FLUID VOLUME •
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
10
ANXIETY
11
GI DISORDERS
12
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
GASTROESOPHAGEAL REFLUX DISEASE MANAGEMENT
GASTROESOPHAGEAL REFLUX DISEASE SIGNS & SYMPTOMS • BELCHING • FLATULENCE • ESOPHAGITIS
NURSING CONSIDERATIONS 1. INSTRUCT
FUNDOPLICATION
PT TO LOSE
A LAPAROSCOPIC PROCEDURE DONE TO TIGHTEN THE LES
WEIGHT
2. AVOID FATTY FOODS, ALCOHOL, NICOTINE, CAFFEINE, SPICY FOODS 3. TAKE MEDICATIONS AS RX 4. ELEVATE HOB 5. AVOID WEARING
• DYSPHAGIA
• EPIGASTRIC PAIN • HEARTBURN
• BLEEDING • MELENA
SURGERY
– FUNDUS OF THE STOMACH IS WRAPPED & SUTURED AROUND THE ESOPHAGUS
CONSTRICTIVE CLOTHING
GI DISORDERS
13
GI DISORDERS
14
GASTRIC ULCER
DUODENAL ULCER
INCIDENCE
LESS COMMON 55-77 YO
MORE COMMON 30-50 YO
PEPTIC ULCERS BLEEDING
MORE LIKELY
LESS LIKELY
PERFORATION
LESS LIKELY
MORE LIKELY
PAIN RELIEF
FOOD INCREASES PAIN; WEIGHT LOSS
FOOD RELIEVES PAIN;
PAIN PATTERN
PAIN: ½ - 1 H AFTER A MEAL; RARELY OCCURS AT NIGHT; MAY BE RELIEVED BY VOMITING
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
15
GI DISORDERS MALIGNANCY
OCCASIONALLY
WEIGHT GAIN
PAIN: 2-3 H; OFTEN AWAKENED AT1-2 AM RARE
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
PEPTIC ULCER DISEASE
PEPTIC ULCER DISEASE GNAWING OR
CAMPYLOBACTER PYLORI OR HELICOBACTER PYLORI
BURNING EPIGASTRIC PAIN
THAT OCCURS
1 TO 2 HOURS AFTER
EATING
ERUCTATION, VOMITING, FOOD, OR ANTACIDS
ZOLLINGER-ELLISON SYNDROME [GASTRINOMA] ASPIRIN, STEROIDS, INDOMETHACIN, NSAIDS
NAUSEA
SMOKING
BLEEDING [COLOR PULSE TEMPERATURE]
PERSONALITY
VOMITING GI DISORDERS 17
GI DISORDERS
PEPTIC ULCER DISEASE DIAGNOSIS
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
18
PEPTIC ULCER DISEASE SURGICAL MANAGEMENT
19
GI DISORDERS
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
PEPTIC ULCER DISEASE NURSING MANAGEMENT PREOPERATIVE
PEPTIC ULCER DISEASE: THERAPEUTIC INTERVENTIONS THERE IS A NID TO:
POSTOPERATIVE
NEUTRALIZE OR BUFFER HYDROCHLORIC ACID INHIBIT ACID SECRETION DECREASE THE ACTIVITY OF PEPSIN AND HCL CALCIUM AND IRON SUPPLEMENTS
[IF MEDICATION INCREASES GASTRIC PH]
[email protected] GI DISORDERS
MEDICATION
PURPOSE
H2BLOCKERS •RANITIDINE HCL (ZANTAC) •CIMETIDINE (TAGAMET) •NIZATIDINE (AXID) •FAMOTIDINE (PEPCID) PROTON PUMP INHIBITOR •OMEPRAZOLE (LOSEC) •ESOMEPRAZOLE (NEXIUM) •LANSOPRAZOLE (ZOTON) •PANTOPRAZOLE (PROTIUM) •RABEPRAZOLE SODIUM (PARIET) PROSTAGLANDINS •MISOPROSTOL (CYTOTEC)
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NURSING IMPLICATIONS
GERD & ULCERS PHARMACOLOGICAL MANAGEMENT
ANTACIDS •ALUMINUM OH (AMPHOGEL) •ALUMINUM OH & MAGNESIUM OH (MAALOX) •DIHYDROXYALUMINUM SODIUM (ROLAIDS)
GI DISORDERS
21
SEAL IMPAIRED MUCOSA NEUTRALIZE ACIDS
DECREASE GASTRIC ACID SECRETION
STOP GASTRIC ACID PRODUCTION
PEPTIC ULCER DISEASE DIETARY MANAGEMENT
CONSTIPATION DIARRHEA MONAK AVOID GIVING WITH OTHER MEDS
DO NOT GIVE WITH ANTACIDS
INCREASE EFFECTS OF PHENYTOIN, WARFARIN, DIAZEPAM DELAYS ABSORPTION OF VALIUM
DECREASE GASTRIC ACID SECRETION
NSAID-INDUCED ULCERS
ENHANCES MUCOSAL DEFENSES BISMUTH COMPOUNDS •BISMUTH SUBSALICYLATE (PEPTOBISMOL)
INHIBITS H. PYLORI GROWTH
ANTIBIOTICS •AMPICILLIN (OMNIPEN) GI DISORDERS •METRONIDAZOLE (FLAGYL)
ELIMINATE H. PYLORI
BY NIO C. NOVENO, RN, MAN
TAKEN WITH FOOD
23
GI DISORDERS
24
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
PEPTIC ULCER DISEASE
PEPTIC ULCER DISEASE
TYPE AND CROSS-MATCH [GASTRIC HEMORRHAGE]
ANTIEMETICS [NAUSEA AND VOMITING]
NGT & SALINE LAVAGE / VASOCONSTRICTORS [CONTROL BLEEDING ]
ANTIBIOTICS: TETRACYCLINE,
TRANQUILIZERS ANTICHOLINERGICS ANALGESICS SEDATIVES [PAIN AND
[REDUCE
BED REST PHYSICAL ACTIVITY]
COUNSELING OR PSYCHOTHERAPY [EXPLORE THE EMOTIONAL COMPONENTS OF THE
RESTLESSNESS] GI DISORDERS
METRONIDAZOLE, AND BISMUTH
GI DISORDERS
25
PEPTIC ULCER DISEASE: NURSE IT!
PEPTIC ULCER DISEASE
1. ALLOW EXPRESSION OF FEELINGS AND CONCERNS 2. ADMINISTER AND ASSESS EFFECTS OF MEDICATIONS 3. ENCOURAGE HYDRATION a. REDUCES ANTICHOLINERGIC SE b. DILUTE THE HCL IN THE STOMACH 4. EAT SMALL TO MEDIUM-SIZED MEALS 5. REPLACE WITH DECAFFEINATED SOFT DRINKS AND TEAS 6. USE SEASONINGS LIKE THYME, BASIL, SAGE 7. AVOID SALICYLATES, PHENYLBUTAZONE, STEROIDS, ACTH
MVS; MIO
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
ILLNESS]
ASSESS THE
26
DRESSING FOR DRAINAGE
MAINTAIN A PATENT NGT TO THE SUCTION APPARATUS [PREVENT STRESS ON THE SUTURE LINE] OBSERVE THE COLOR AND AMOUNT OF NG DRAINAGE [BRIGHT RED BLOOD AFTER 12 HOURS SHOULD BE REPORTED] COUGH, DEEP BREATHE, & CHANGE POSITION FREQUENTLY APPLY ANTIEMBOLISM STOCKINGS & AMBULATE 27
GI DISORDERS
28
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
ULCER
PEPTIC ULCER DISEASE UPSET STOMACH LOW APPETITE CAUSES:
TO PREVENT DUMPING SYNDROME:
FREQUENT FEEDINGS
OF SMALL AMOUNTS
AVOID HIGH-CHO
CHEMICALS, COFFEE, ALCOHOL, ALLERGENS, UREMIA, BACTERIA, DRUGS, SMOKING, STRESS, SPICES
INTAKE
EMESIS REDUCE ACID
CONSUME LIQUIDS ONLY BETWEEN MEALS (AT LEAST 1 HOUR BEFORE OR AFTER MEALS)
ANTI-ACID MEDICATIONS CARAFATE IRRITANTS Decompression
LIE DOWN OR REST AFTER EATING PECTIN OR GUAR GUM (5-G DOSE) WITH MEALS [WATER-SOLUBLE FIBER WHICH DELAYS GASTRIC EMPTYING AND ABSORPTION OF CARBOHYDRATES GI DISORDERS
GI DISORDERS
29
APPENDICITIS THE CAUSES…
COMMON SIGNS OF APPENDICITIS
• OBSTRUCTION
•
– LYMPHOID HYPERPLASIA (RELATED TO VIRAL ILLNESSES, INCLUDING UPPER RESPIRATORY INFECTION, MONONUCLEOSIS, GASTROENTERITIS) – FECALITHS – PARASITES – FOREIGN BODIES – CROHN‘S DISEASE – PRIMARY OR METASTATIC CANCER AND CARCINOID
•
RIGHT LOWER QUADRANT PAIN ON PALPATION (THE SINGLE MOST IMPORTANT SIGN) LOW-GRADE FEVER (38°C [OR 100.4°F])
•
•
•
PSOAS SIGN--PAIN ON EXTENSION OF RIGHT THIGH (RETROPERITONEAL RETROCECAL APPENDIX) OBTURATOR SIGN--PAIN ON INTERNAL ROTATION OF RIGHT THIGH (PELVIC APPENDIX) ROVSING'S SIGN--PAIN IN RIGHT LOWER LOWER QUADRANT
PERITONEAL SIGNS
• •
LOCALIZED TENDERNESS TO PERCUSSION
– LYMPHOID HYPERPLASIA IS MORE COMMON IN CHILDREN
•
DUNPHY'S SIGN--INCREASED PAIN WITH COUGHING
•
GUARDING
•
AND YOUNG ADULTS
BY NIO C. NOVENO, RN, MAN
OTHER CONFIRMATORY PERITONEAL SIGNS (ABSENCE OF THESE SIGNS DOES NOT EXCLUDE APPENDICITIS)
QUADRANT WITH PALPATION OF LEFT
•
SYNDROME
GI DISORDERS
30
FLANK TENDERNESS IN RIGHT LOWER QUADRANT (RETROPERITONEAL RETROCECAL APPENDIX) PATIENT MAINTAINS HIP FLEXION WITH KNEES DRAWN UP FOR COMFORT
31
GI DISORDERS
32
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
APPENDICITIS NURSING IMPLICATIONS
APPENDICITIS
2. DIET
ABDOMINAL PAIN ANOREXIA NAUSEA VOMITING PAIN MIGRATION
NO ANALGESICS NO WARM COMPRESS NO ENEMA RUPTURED APPENDIX
– – – – • • •
UNSUSTAINED
VOMITING TO MIGRATION OF PAIN TO RIGHT LOWER QUADRANT TO LOW-GRADE FEVER
GI DISORDERS
DIVERTICULITIS
DIVERTICULOSIS
• MULTIPLE DIVERTICULA ARE
• RECURRENT LLQ PAIN
PRESENT
PASSAGE OF FLATULENCE
IN THE
• 30-40% OF ELDERLY
• ALTERNATING & DIARRHEA
POPULATION
• ASYMPTOMATIC GI DISORDERS
BY NIO C. NOVENO, RN, MAN
– –
TURNING DEEP BREATHING &
DIVERTICULAR DISEASES
• LOW FIBER DIET
DIVERTICULA
AFTER SURGERY
3. ACTIVITY
34
• RELIEVED BY DEFECATION OR
•SIGMOID COLON
CLEAR TO REGULAR DIET
GI DISORDERS
DIVERTICULAR DISEASES
•STOOL IMPACTED
NO PAIN POSITION HOB REFER STAT!
–
LONGER WITH PERITONITIS NGT INSERTION
COUGHING EXERCISES WITH SPLINTING
33
MORE DIVERTICULA
• •
1. PAIN:
CLASSIC SYMPTOM SEQUENCE • VAGUE PERIUMBILICAL PAIN TO ANOREXIA/NAUSEA/
DIVERTICULOSIS •INFLAMMATION OF ONE OR
NPO STATUS
–
35
GI DISORDERS
CONSTIPATION
DIVERTICULITIS •
MODERATE LLQ PAIN
•
MILD NAUSEA, GAS
•
IRREGULAR BOWEL HABITS
•
LOW-GRADE FEVER
•
INCREASED WBC
•
RUPTURE (IF SEVERE)
•
FIBROSIS & ADHESIONS (CHRONIC DIVERTICULITIS)
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
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DIVERTICULAR DISEASES NURSING MANAGEMENT
DIVERTICULAR DISEASES NURSING MANAGEMENT
FOR DIVERTICULITIS 1. WITHOUT PERFORATION
FOR DIVERTICULSOSIS 1. BLAND OR LIQUID DIET 2. HIGH-RESIDUE DIET 3. PSYLLIUM
a. PREVENT CONSTIPATION & INFECTION
– ABSORBS WATER AND EXPAND TO PROVIDE INCREASED BULK IN STOOL
– ENCOURAGES NORMAL PERISTALSIS AND BOWEL MOTILITY
GI DISORDERS
BED REST LIQUID DIET STOOL SOFTENERS BROAD-SPECTRUM ANTIBIOTICS MEPERIDINE DICYCLOMINE (BENTYL, BYCLOMINE, DIBENT, DI-SPAZ, DILOMINE) HYOSCYAMINE (LEVSIN® /SL TABLETS)
• • • • • • • 37
GI DISORDERS
DIVERTICULAR DISEASES NURSING MANAGEMENT 2. 3. 4. 5.
38
ABDOMINAL APPLIANCE
COLON RESECTION COLOSTOMY F & E MONITORING WOF SIGNS OF BLEEDING
COLOSTOMY
ILEOSTOMY
– ANGIOGRAPHY – VASOPRESSIN
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
39
GI DISORDERS
40
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
PARAMETER
CROHN’S
11/14/2008
ULCERATIVE COLITIS
INFLAMMATORY BOWELLOWER DISEASE COLON ONLY INVOLVEMENT SMALL & LARGE INTESTINE
INFLAMMATORY BOWEL DISEASE
(THEN, ASCENDS)
TISSUE AFFECTED ENTIRE THICKNESS LONG-TERM COMPLICATIONS
MUCOSA
OBSTRUCTION, FISTULAS, ABSCESSES, PERFORATION CANCER RISK INCREASES WITH AGE
SURGICAL
DOES NOT CURE OR LIMIT THE
INTERVENTION
DISEASE
C AUSE
UNKNOWN; ALTERED
STOOLS GI DISORDERS
IMMUNE
• 5-ASA COMPOUNDS
FISSURES, ABSCESSES, INCREASED RISK OF COLORECTAL CANCER
3-4 SEMISOFT/DAY;
15-20 LIQUID/DAY;
STEATORRHEIC AND MUCOID
BLOODY
• • • • •
HIGH PROTEIN INCREASE FE & VIT B12 LOW-RESIDUE DIET HIGH PROTEIN DIET LOW FAT
•HEADACHE CORTICOSTEROIDS PHOTOSENSITIVITY •SERUM IMMUNOSUPPRESANTS SICKNESS-LIKE SYNDROME GIT DISTURBANCE • IVF REPLACEMENT ORANGE-YELLOW DISCOLORATION • TPN
UNKNOWN; E. COLI INFECTION
– SULFAZALAZINE (AZULFIDINE) – MESALAMINE (ROWASA, PENTASA, ASACOL) – OLSALAZINE SODIUM (DIPENTUM) ADVERSE EVENTS
CURES THE DISEASE
STATE
DIET
PHARMACOLOGY
41
GI DISORDERS
42
IRRITABLE BOWEL SYNDROME
IRRITABLE BOWEL SYNDROME
CRITERIA FOR DIAGNOSIS 1. ABDOMINAL PAIN OR DISCOMFORT
REFER TO A GROUP OF SYMPTOMS:
– AT LEAST 12 WEEKS OUT OF THE PREVIOUS 12 MONTHS
ABDOMINAL PAIN BLOATING CONSTIPATION / CRAMPING DIARRHEA
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
2. AT LEAST 2 OF THE FOLLOWING: a. PAIN IS RELIEVED BY BM b. WITH PAIN, BM PATTERN CHANGES c. WITH PAIN, STOOL CHARACTERISTICS CHANGE 43
GI DISORDERS
44
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
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IRRITABLE BOWEL SYNDROME MEDICAL MANAGEMENT
IRRITABLE BOWEL SYNDROME DIETARY MANAGEMENT
1. ANTICHOLINERGIC A.C.
AVOID THE FOLLOWING ALCOHOL BARLEY C AFFEINATED DRINKS CHOCOLATES MILK PRODUCTS RYE & WHEAT
2. TEGASEROD MALEATE (ZELNORM) X 4 WEEKS 3. PSYLLIUM (METAMUCIL) 4. ALOSETRON HCL (LOTRONEX) GI DISORDERS
45
GI DISORDERS
IRRITABLE BOWEL SYNDROME DIETARY MANAGEMENT
46
INTESTINAL OBSTRUCTION
MAKE SURE TO…
VOLVULUS
1. TEACH THE CLIENT TO LIST DOWN FOOD EATEN 2. EAT 5-6 TIMES; SMALL, FREQUENT FEEDINGS INTUSSUSCEPTION
3. EXERCISE REGULARLY ADHESIONS
4. PROMOTE STRESS RELIEF GI DISORDERS
BY NIO C. NOVENO, RN, MAN
47
GI DISORDERS
48
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
INTESTINAL OBSTRUCTION MANAGEMENT
INTESTINAL OBSTRUCTION
1. MEDICAL
1. NEUROGENIC OBSTRUCTION
– NG DECOMPRESSION – IV REHYDRATION – ENEMAS
– PARALYTIC ILEUS • • •
TRAUMA INFECTION MEDICATION
2. VASCULAR OBSTRUCTION
2. SURGERY
– ATHEROSCLEROSIS – NECROSIS
– BOWEL RESECTION
49
GI DISORDERS
GI DISORDERS
HERNIAS
HERNIAS LOCATION
50
MANAGEMENT 1. SURGERY
TYPES
– HERNIORRHAPHY – BOWEL RESECTION
2. DIET – SMALL, FREQUENT FEEDINGS – LIE DOWN FOR 2 HOURS AFTER EATING – AVOID HIGHLY IRRITATING FOODS GI DISORDERS
BY NIO C. NOVENO, RN, MAN
51
GI DISORDERS
52
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
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HEMORRHOIDS MANAGEMENT
HEMORRHOIDS EXTERNAL
1. MEDICAL
INTERNAL
– HOT SITZ OR WARM COMPRESS X 20 MINUTES, 4 TIMES A DAY
2. SURGERY – HEMORRHODECTOMY • •
EXTERNAL: OPD INTERNAL: OVERNIGHT –
GI DISORDERS
53
SCLEROTHERAPY, CRYOTHERAPY, LASER
GI DISORDERS
54
HEMORRHOIDS MANAGEMENT 3. PHARMACOLOGY – CREAMS & SUPPOSITORIES – CORTICOSTEROIDS
4. DIET
DISORDERS OF THE
– 20-30 GRAMS OF FIBER/DAY – 2.5 L OF FLUID PER DAY
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
ACCESSORY ORGANS
55
GI DISORDERS
56
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
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LIVER FUNCTIONS
CAUSES OF CIRRHOSIS 1. LAENNEC’S [OR, PORTAL ,NUTRITIONAL, ALCOHOLIC]
Storage of vitamin A, B, D; iron and copper Synthesis of plasma proteins, including albumin and globulins Synthesis of clotting factors, vitamin K and prothrombin Storage of glycogen and synthesis of glucose from other nutrients Breakdown of fatty acids for energy Production of bile Detoxification and excretion of waste products
2. BILIARY 3. PIGMENT 4. DRUG- / TOXIN-INDUCED GI DISORDERS
CIRRHOSIS
58
CIRRHOSIS ASSESSMENT 1. CNS PROGRESSIVE SIGNS OF HEP ENCEPH
–
LETHARGY, MENTAL CHANGES, SLURRED SPEECH & ASTERIXIS, PERIPHERAL NEURITIS, PARANOIA, HALLUCINATIONS, COMA
•
2. GIT –
ANOREXIA, INDIGESTION, N & V, CONSTIPATION OR DIARRHEA, DULL ABDOMINAL PAIN
3. RESPIRATORY – GI DISORDERS
BY NIO C. NOVENO, RN, MAN
59
PLEURAL EFFUSION
GI DISORDERS
60
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
11/14/2008
CIRRHOSIS ASSESSMENT
CIRRHOSIS ASSESSMENT
4. HEMATOLOGIC
ADDITIONAL DATA 1. 2. 3. 4. 5. 6. 7.
5. ENDOCRINE – “FEMINIZATION”
6. SKIN – JAUNDICE, PRURITUS, DRYNESS, SPIDER ANGIOMAS, PALMAR ERYTHEMA, GI DISORDERS
1. 2. 3. 4. 5. 6. 7. 8.
61
MUSTY BREATH CAPUT MEDUSAE MUSCLE ATROPHY RUQ PAIN AGGRAVATED BY SITTING OR LEANING PALPABLE SPLEEN T: 1010 TO 1030 F (38.30 TO 39.40 C ) ESOPHAGEAL VARICES WITH BLEEDING
GI DISORDERS
62
DIAGNOSIS OF CIRRHOSIS
TREATMENT OF CIRRHOSIS
LIVER BIOPSY LIVER SCAN CHOLECYSTOGRAPHY & CHOLANGIOGRAPHY CT SCAN HEMATOLOGIC TESTS ABNORMAL GTT URINE TESTS FECALYSIS
AIMS OF TREATMENT
GI DISORDERS
BY NIO C. NOVENO, RN, MAN
1. ALLEVIATE THE CAUSE 2. PREVENT FURTHER DAMAGE 3. PREVENT OR TREAT COMPLICATIONS 63
GI DISORDERS
64
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
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TREATMENT OF CIRRHOSIS
TREATMENT OF CIRRHOSIS
1. VARICEAL BLEEDING
2. DIET CONT…
– MEDICATIONS – BALLOON TAMPONADE – SURGERY
– TPN [WITH DETERIORATION] – A, B COMPLEX, C, K – VIT B12, FOLIC ACID & THIAMINE
2. DIET
3. ACTIVITIES
– HIGH PROTEIN [NOT WITH HEP ENCEPH] – NA RESTRICTION [200 – 500 MG/D] – FLUID RESTRICTION [1 – 1.5 L/D] GI DISORDERS
– REST & MODERATE EXERCISE
65
GI DISORDERS
TREATMENT OF CIRRHOSIS
66
TREATMENT OF CIRRHOSIS 7. PARACENTESIS
4. ANTIEMETICS – TRIMETHOBENZAMIDE (TIGAN, TEBAMIDE) – BENZQUINAMIDE (BZQ, BENZCHINAMIDE, EMETICON, PROMECON, QUANTRIL)
8. LEVEEN SHUNT 9. SURGERY
5. VASOPRESSIN
10. LIVER TRANSPLANT
6. DIURETICS
11. LIFESTYLE MANAGEMENT
– FUROSEMIDE & SPIRONOLACTONE GI DISORDERS
BY NIO C. NOVENO, RN, MAN
67
GI DISORDERS
68
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
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VIRAL HEPATITIS
SYMPTOMS OF ACUTE VIRAL HEPATITIS
HEPATOTROPIC VIRUSES HEPATITIS VIRUS A-E AND G
NONSPECIFIC SIGNS & SYMPTOMS
HEPATITIS B (HEPADNA): DNA VIRUS
LOSS OF APPETITE
RNA VIRUSES: HEPATITIS A (PICORNAVIRUS) HEPATITIS C (FLAVIVIRUS) HEPATITIS E (CALICIVIRUS) HEPATITIS G
NAUSEA
FATIGUE
MILD FEVER
JAUNDICE DARK URINE CLAY-COLORED STOOLS (LIGHT YELLOW)
HEPATITIS D: INCOMPLETE RNA VIRUS GI DISORDERS
GI DISORDERS
69
LABORATORY STUDIES ↑ AST / ALT [3 – 5 TIMES > N] AST > 1000 U / L IS COMMON IN SEVERE HEPATITIS [REVERSIBLE OVER SEVERAL MONTHS]
A
B
C
TRANSMISSIO N
FECALORAL
BLOOD & FLUIDS
BLOOD
INCUBATION
15-50
45-160
14-180
INFECTIOUS PERIOD
<2 MOS
DX TEST
IGM; ANTI HAV
SP, ENTERIC
MODEST ↑ IN ALKALINE PHOSPHATASE & GGT
PREVENTION
VARIABLE INCREASE IN BILIRUBIN
TREATMENT
BY NIO C. NOVENO, RN, MAN
HBSAG
SP; SAFE PRACTICES; HEP B VAC; IG HBIG ALPHA
BILIRUBIN IN URINE GI DISORDERS
PRECAUTIO NS; HEP A VAC; IG
BEFORE SX APPEAR
71
GI DISORDERS
IG IN 2 WEEKS
INTERFERON
LAMIVUDINE (EPIVI HBV) ADEFOVIRDIPIVO XIL (HEPSERA)
SERUM ALT INC 10X
70
D
E
BLOOD;
FECAL-
NEEDLES
ORAL
15-60
15-60
NOT DETERMINED IGG ANTIHDV / IGM ANTIHDV
NONE
SP; REDUCE RISK BEHAVIOR; NO VAC
SP; REDUCE RISK; HEP B VAC
SP; NO VAC
PERINTERFE RON ALFA 2A (PEGASYS) RIBAVIRIN (VIRAZOLE)
ALPHA INTERFERON
NONE 72
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
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HEPATITIS OTHER CAUSES
PHASES OF HEPATITIS 1. PRODROMAL (PREICTERIC)
OF HEPATITIS
CHEMICAL AGENTS [I.E., HALOTHANE]
2. ICTERIC
CARBON TETRACHLORIDE GOLD COMPOUNDS [I.E.,
ARSENIC
3. RECOVERY
PHASE: EASY FATIGABILITY GI DISORDERS
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HEPATITIS THERAPEUTIC 1. REST
PHASE
JAUNDICE BILE-COLORED URINE THAT FOAMS WHEN SHAKEN ACHOLIC (CLAY-COLORED) STOOLS
AUROTHIOGLUCOSE]
GI DISORDERS
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HEPATITIS: 2,500 -3,000 KCAL / DAY HIGH PROTEIN [75 TO 100 G]
INTERVENTIONS
HEALING OF LIVER TISSUE
HIGH CARBOHYDRATE
2. ABSTINENCE
PHASE
ANV, MALAISE, WEIGHT LOSS SYMPTOMS OF URTI INTOLERANCE FOR SMOKING
FROM ALCOHOL
DAILY: 1 QT MILK; 2 EGGS 8 OZ LEAN MEAT, FISH, OR CHEESE [300 TO 400 G]
ENERGY NEEDS, RESTORE GLYCOGEN RESERVES DAILY:
4 SERVINGS VEGETABLES, POTATO, 4 SERVINGS 6 TO 8 SERVINGS BREAD OR CEREAL
FRUIT WITH FREQUENT JUICES,
MODERATE FAT [100 TO 150 G DAILY] 2 TO 4 TABLESPOONS BUTTER OR FORTIFIED MARGARINE
3. DIET THERAPY
MODERATE AMOUNT OF WHOLE MILK, CREAM, BUTTER, MARGARINE, OR VEGETABLE OIL IS BENEFICIAL GI DISORDERS
BY NIO C. NOVENO, RN, MAN
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GI DISORDERS
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GASTROINTESTINAL DISORDERS NCLEX - RN REVIEW
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HEPATITIS: INVESTIGATE!
HEPATITIS: ACTION! 1. ATTEMPT TO STIMULATE THE APPETITE
1. HISTORY
a. OF EXPOSURE TO VIRUS b. OF EMPLOYMENT OVER PREVIOUS 6 MONTHS 2. RUQ FOR
a. PROVIDE ORAL HYGIENE b. BASED ON THE CLIENT'S PREFERENCES c. PROVIDE A PLEASANT, UNHURRIED ATMOSPHERE FOR
LIVER TENDERNESS, FIRMNESS
EATING
d. PROVIDE SMALL, FREQUENT FEEDINGS 3. JAUNDICE
IN SKIN, SCLERA, AND MUCOUS MEMBRANES
2. USE PRECAUTIONS TO PREVENT THE SPREAD OF HEPATITIS TO OTHERS
4. TEMPERATURE:
a. USE STANDARD (UNIVERSAL) PRECAUTIONS
a. FEVER (WITH TYPE A) b. LOW-GRADE FEVER (WITH TYPES B AND C) GI DISORDERS
b. HAV: CONTACT PRECAUTIONS GI DISORDERS
77
HEPATITIS: ACTION!
'GET SMASHED‘ TO KNOW THE CAUSES GALLSTONES ETHANOL TRAUMA
3. ADMINISTRATION OF IMMUNE SERUM GLOBULIN (ISG) AFTER EXPOSURE TO TYPE A HEPATITIS 4. VACCINATION OF INDIVIDUALS AT RISK FOR TYPE B HEPATITIS (HEP-B, RECOMBIVAX HB)
STEROIDS MUMPS AUTOIMMUNE CAUSES SCORPION VENOM HYPERLIPIDAEMIAS ERCP DRUGS (SUCH AS AZATHIOPRINE)
5. ENCOURAGE THE USE OF CONDOMS
GI DISORDERS
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79
GI DISORDERS
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ACUTE PANCREATITIS 2 FORMS
ASSESSMENT OF ACUTE PANCREATITIS
2 THEORIES
MILD
• 1. INTERSTITIAL (EDEMATOUS)
2. NECROTIZING
1. TOXIC AGENT
2. REFLUX OF DUODENAL CONTENTS
GI DISORDERS
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DIAGNOSIS OF PANCREATITIS
GI DISORDERS
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2. RELIEVE PAIN
LOW SERUM CALCIUM HYPERGLYCEMIA CT-SCAN X-RAYS
BY NIO C. NOVENO, RN, MAN
ILEUS
DIMINISHED BOWEL ACTIVITY CRACKLES AT LUNG BASES TACHYCARDIA EXTREME MALAISE RESTLESSNESS MOTTLED SKIN LOW-GRADE FEVER COLD, SWEATY EXTREMITIES
GOAL OF TREATMENT 1. MAINTAIN CIRCULATION & FLUID VOLUME
– SERUM AMYLASE & LIPASE – WBC – HCT
GI DISORDERS
SEVERE EXTREME PAIN PERSISTENT VOMITING ABDOMINAL RIGIDITY
TREATMENT OF PANCREATITIS
• ELEVATED
• • • •
• EPIGASTRIC PAIN, • RADIATING BETWEEN THE • T10 & L6 UNRELIEVED BY • • VOMITING • • • • • • •
3. DECREASE PANCREATIC SECRETIONS
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GI DISORDERS
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TREATMENT OF PANCREATITIS
TREATMENT OF PANCREATITIS
MAINTAIN CIRCULATION & FLUID VOLUME
1. 2. 3. 4.
1. ELECTROLYTE REPLACEMENT 2. PROTEIN SUPPLEMENTATION 3. CALCIUM REPLACEMENT
– LAPAROTOMY – PANCREATECTOMY – CHOLECYSTOSTOMY & GASTROSTOMY
*SHOCK CAUSES DEATH IN EARLY STAGES *METABOLIC ACIDOSIS GI DISORDERS
ADDITIONAL MANAGEMENT CONTINUE 5-7 DAYS OF HYDRATION TPN GAVAGE FEEDINGS PROCEDURES:
85
GI DISORDERS
GALLBLADDER & BILIARY TRACT DISORDERS
GALLBLADDER & BILIARY TRACT DISORDERS
5 MAJOR DISORDERS
CAUSE: UNKNOWN RISK FACTORS 1. OBESITY 2. ELEVATED ESTROGEN LEVELS 3. GENETICS 4. USE OF:
1. CHOLECYSTITIS –
STONE IN THE CYSTIC
DUCT
2. CHOLANGITIS –
INFECTION OF THE BILE DUCT
3. CHOLELITHIASIS –
STONE IN THE GALLBLADDER
4. CHOLEDOCHOLELITHIASIS –
– –
STONE IN THE CBD
5. GALLSTONE ILEUS –
SMALL BOWEL OBSTRUCTION
GI DISORDERS
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ANTILIPEMIC DRUGS WEIGHT REDUCTION PILLS
5. DISEASES
DUE TO GALLSTONE
87
GI DISORDERS
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GALLBLADDER & BILIARY TRACT DISORDERS
AGE
ESTROGEN
GALLBLADDER & BILIARY TRACT DISORDERS MANIFESTATIONS • SEVERE MIDEPIGASTRIC PAIN OR RUQ PAIN RADIATING TO THE
OBESITY
BACK
INCREASED BILE PRODUCTION
• • • • • • • •
EXCESS WATER & BILE SALTS ARE REABSORBED GALLSTONES [CHOLESTEROL C ALCIUM BILIRUBIN] GI DISORDERS
89
GI DISORDERS
DIAGNOSIS OF GALLBLADDER & BILIARY TRACT DISORDERS • • • • • •
FLATULENCE INDIGESTION NAUSEA DIAPHORESIS BELCHING CHILLS & LOW-GRADE FEVER INDIGESTION OF FAT JAUNDICE & CLAY-COLORED STOOLS 90
TREATMENT OF GALLBLADDER & BILIARY TRACT DISORDERS
UTZ OF THE GALLBLADDER CT SCAN ERCP CHOLESCINTIGRAPHY ORAL CHOLECYSTOGRAPHY BLOOD STUDIES
• • • • • •
CHOLECYSTECTOMY CHOLANGIOGRAPHY T-TUBE PLACEMENT LOW FAT DIET; GIVE VIT K NGT LITHOTRIPSY • URSODIOL
GI DISORDERS
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GI DISORDERS
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NURSING C ARE OF PATIENTS WITH GALLBLADDER & BILIARY TRACT DISORDERS
"Realize that true happiness lies within you. Waste no time and effort searching for peace and contentment and joy in the world outside.
1. REINFORCE HEALTH TEACHINGS ON: a. LOW FAT DIET b. MEDICATION COMPLIANCE c. POST-OP ACTIVITIES • •
Remember that there is no happiness in having or in getting, but only in giving. Reach out. Share. Smile. Hug.
DEEP BREATHING & COUGHING REST & ACTIVITY
Happiness is a perfume you cannot pour on others without getting a few drops on yourself."
d. WEIGHT REDUCTION
2. C ARE OF T-TUBE & SKIN CARE GI DISORDERS
Og Mandino 1923-1996, Author and Speaker 93
THANK YOU!!!
GI DISORDERS
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