Download - GASTROINTESTINAL NURSING
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GASTROINTESTINAL NURSING
Digestive Tract Disorders
2013
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Anatomy and Physiology of the Digestive Tract
Mouth Where teeth, tongue, and salivary glands begin food digestion
Pharynx Muscular structure shared by the digestive and respiratory tracts It joins the mouth and nasal passages to the esophagus
Esophagus Long muscular tube that passes through the diaphragm into the
stomach
Stomach Churns and mixes food with gastric secretions until a semiliquid
mass called chyme
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Anatomy and Physiology of the Digestive Tract
Small intestine Chemical digestion and absorption of nutrients
take place Approximately 20 feet long and consists of
three sections: the duodenum, the jejunum, and the ileum
Liver and pancreatic secretions enter the digestive tract in the duodenum
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Anatomy and Physiology of the Digestive Tract
Large intestine and anus The first section of the large intestine is the cecum Ascending colon goes up right side of the
abdomen Transverse colon crosses abdomen just below
waist Descending colon goes down left side of abdomen The last 6 to 8 inches of the large intestine is the
rectum, which ends at the anus, where wastes leave the body
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Age-Related Changes Teeth are mechanically worn down with age The jaw may be affected by osteoarthritis A significant loss of taste buds with age Xerostomia (dry mouth) is common Walls of esophagus and stomach thin with aging, and
secretions lessen Production of hydrochloric acid and digestive enzymes
decreases Gastric motor activity slows Movement of contents through the colon is slower Anal sphincter tone and strength decrease
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Nursing Assessment and Health History ?? Common complaints of GI system Why is past medical history important?? What family history might be relevant?? What are some common questions you
need to ask in your review of systems???
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Diagnostic Tests & Procedures
Gastrointestinal
System
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Stool Specimens O&P OB Fecal Fat C & S
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RADIOGRAPHIC TESTS Most common tests:
1) Barium swallow or UGI
2) Small Bowel series
3) Barium enema
Others: CTS,US abd. X-rays
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ENDOSCOPIC TESTS (for upper GI system) Esophagoscopy Gastroscopy Gastroduodenoscopy EGD ERCP
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ENDOSCOPIC TESTS ( for lower GI system)
Colonoscopy Proctoscopy Sigmoidoscopy
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Laboratory Tests Gastric Analysis CBC PT (prothrombin time) INR PTT (partial thromboplastin
time)
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Bilirubin Blood proteins Alkaline Phosphatase LDH GGT
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AST ALT Cholesterol & Triglycerides Amylase CEA
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Abnormal Assessment Findings Distention Firmness Tenderness Altered bowel sounds
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Therapeutic Measures & Related Nursing Interventions
With GI Patients
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Gavage or Enteral Nutrition (Tube Feedings) Provide nutritional support
through a tube Short or long term In conditions that prohibit
oral nourishment
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Gastric Decompression Types of tubes ( pg. 780 ) What is the purpose of
gastric decompression? ??Nursing Interventions??
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Types of Tubes Nasogastric - (NG) Gastrostomy – (G-tube) Jejunal – (J-tube) Percutaneous – (PEG)
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Figure 38-6
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Total Parenteral Nutrition – (TPN) Nutritionally complete Used when GI system not
functioning Short or long term
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Figure 38-9
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Critical Thinking Exercise A 71 y.o. woman who underwent a bowel
resection for the removal of a tumor is receiving TPN through a central venous catheter. The patient’s fingerstick blood glucose is 250 mg/dl, and the patient’s temp is 102 F and the nurse notes puralent drainage at the catheter insertion site.
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Pre-Op Nursing Interventions
For GI surgery patients
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GI tract cleansing Assess vital signs Liquids for 24 hrs. or NPO IV Antibiotics NGT insertion
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Post-Op Nursing Interventions
For GI surgery patients
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Relieve pain Detect complications Prevent gastric distention Replace lost fluids Maintain urine elimination
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Digestive Disorders
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Medical Anorexia Loss of Appetite Caused by:
Nausea, decreased sense of taste or smell, mouth disorders, and medications
Emotional problems such as anxiety, depression, or disturbing thoughts
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Anorexia Medical diagnosis
Physician assesses for malnutrition Weight may be monitored over several weeks Complete history and physical examination Serum hemoglobin, iron, total iron-binding
capacity, transferrin, calcium, folate, B12, zinc
Thyroid function tests
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Anorexia Assessment
Record chronic and recent illnesses, hospitalizations, medications, and allergies
Female patient’s obstetric history Symptoms: pain, nausea, dyspnea, extreme
fatigue The functional assessment reveals patterns of
activity and rest, usual dietary patterns, current stressors, and coping strategies—all can affect appetite
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Anorexia Interventions
Assist with oral hygiene before and after meals Teach proper oral hygiene; refer for dental care Relieve nausea before presenting a meal tray Before serving meal tray, remove bedpans/emesis
basins from sight, conceal drains and drainage collection devices, deodorize room if necessary
Socialization during mealtime Respect food likes and dislikes Position patient comfortably with easy access to
food
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Obesity 20% over ideal body wt. Morbid obesity= 2X
normal body wt.
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Complications CV disease Diabetes Respiratory difficulties Musculoskeletal problems Emotional and social
isolation
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Causes Caloric intake > expenditure Heredity Emotional stress/psychosocial
factors Slowed metabolism
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Medical Management Weight reduction diet Exercise Medication Counseling
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Surgical Treatment RNYGBP VBG LBP Liposuction Dumping Syndrome
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Show what you know… List 3 Nursing Diagnosis & related
Nursing Interventions for the:
OBESE PATIENT
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Disorders of the Mouth
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Dental Caries Destructive process of tooth
decay Causes: Bacteria Poor oral hygiene
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Prevention Frequent brushing and
flossing Dentist visit 2X/yr Good nutrition Fluoride
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Treatment Removal of diseases
portion of tooth and filling May need dentures If untreated, may lead to
periodontal disease
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Stomatitis Inflammation of the oral
mucosa Causes are??? Treatment is ??? What is Aphthous
Stomatitis?
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Herpes Simplex HSV Type 1 Vesicles around the mouth &
lips Tx is comfort not curative Zovarax ointment (antiviral)
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Candidiasis Fungal infection (Thrush) Candida Albicans White patches in mouth Immunosuppression Abx therapy
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DISORDERS OF THE
TEETH & GUMS
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Periodontal Disease Gingivitis(inflammation of
gums and supporting tissues) Gums are red, swollen,
painful and bleed easily Cause poor oral hygiene &
nutrition
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SHOW WHAT YOU KNOW…
Assessment…?
Nursing Diagnosis….?
Interventions….?
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Oral Cancer 2 types of malignant tumors Squamous and Basal cell Early s/s may be ignored Tongue irritation, loose teeth,
pain in ear or in tongue
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Risk Factors Tobacco use Alcohol use Poor nutrition Chronic irritation http://www.oralcancerfoundation.org/
dental/slide_show.htm
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Treatment
Chemo
Radiation
Surgery
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Post Op Care Radical Neck Impaired oral mucous
membrane Ineffective breathing pattern Acute pain NGT, PEG, or TPN Disturbed Body Image
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Disorders of Esophagus
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Esophageal Cancer Not common, poor
prognosis Middle or lower portion of
esophagus No known cause
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Predisposing Factors Cigarette smoking Excessive alcohol intake Poor oral hygiene Eating spicy foods
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Signs and Symptoms Progressive dysphagia Weight loss may be dramatic TX Chemo or surgery Esophagectomy,
Esophagogastrostomy, or Esophagogastrectomy
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Nursing Care of the patient with Esophageal CA Assessment….? Nursing Diagnosis….? Interventions….? Nutrition Anxiety Risk for infection, injury
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Esophageal Diverticulum Esophageal out-pouching Zenker’s Diverticulum “Bad breath” due to
accumulation of food in diverticulum
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http://en.wikipedia.org/wiki/Zenker's_diverticulum
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Treatment Bland diet Antacids Anti-emetics Surgery
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Pre-Op Nursing Measures Semi-fowlers Small meals Loose clothing
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Disorders Affecting Digestion
And Absorption
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Hiatal Hernia Protrusion of the lower
esophagus and stomach upward through the diaphragm
Two types: Sliding and Rolling
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Causes Weakness of muscles of
diaphragm Exact cause is unknown Excessive intra-abdominal
pressure
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Contributing Factors Obesity Pregnancy Abdominal tumors, ascites or
repeated heavy lifting
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Signs and Symptoms Feeling of fullness Eructation Heartburn Dysphagia Regurgitation
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Medical Treatment Avoid increased intra-
abdominal pressure HOB ^ 6-12 inchesprevents
nighttime reflux Drug Therapy Diet
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Surgical Treatment Nissen Fundoplication Angelchik Prosthesis Figure 38-14 & 38-15
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Nissen Fundoplication
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THINK !! Describe your Post-Op Nrsg
Interventions for this patient?
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GERD Gastroesophageal Reflux
Disease Backward flow of stomach
contents into the espohagus Sometimes occurs with a
sliding hiatal hernia
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WHAT IS “NERD” ???
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Signs & Symptoms Burning sensation that
moves up and down, commonly after meals
Intermittent dysphagia belching
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Diagnosis Based on symptoms Sx relief w/ PPI; return
when DC’d Endoscopy Gastric analysis
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Med Treatment & Nrsg Care Same as for hiatal hernia Drug therapy may include:
Zantac, Reglan, Prilosec & antacids
Fundoplication if required
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Patient Teaching Avoid ASA and NSAIDS Chew food well Avoid eating 2 hrs. before
bedtime
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Gastritis Inflammation of the stomach
mucosa/lining Several types; same
pathophysiology H-pylori prime culprit;
NSAIDS, stress, ETOH
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Signs & Symptoms N/V Abdominal pain Anorexia Feeling of fullness
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Treatment Meds Replacement of fluids after
N,V & diarrhea subsides Elimination of the cause Tx & nrsg. Interventions
same as for Ulcer Disease
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THINK….. List 3 Nursing Diagnosis and related
interventions when caring for the patient with gastritis
What teaching would you do with this patient???
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Peptic Ulcer Lesion on either the mucosa of
stomach or duodenum 80% are in duodenum May be acute or chronic Classified as gastric or duodenal See Table 38-4
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Causes Bacterium H. pylori ASA, NSAIDS Physical trauma (shock,burns) Foods or conditions that cause
excessive gastric acid secretions
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Comparison of Peptic Ulcers
GASTRIC Incidence
Ulcer depth
S/S
Complications
DUODENAL Incidence
Ulcer depth
S/S
Complications
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Very Important Patient Teaching 1) Limit milk products
2) No baking soda
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Complications of Peptic Ulcers
Hemorrhage Perforation Peritonitis Obstruction
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Medical Treatment Drug therapy Diet therapy NGT hemorrhage Saline Lavage Surgical treatment options Table
38-6 Fig. 38-16
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Complications after Gastrectomy Dumping syndrome pg. 813 Sx occur within 20 min of eating Bloating, flatulence, cramps &
diarrhea Diaphoresis, anxious, shaky Malabsorption--> Malnutrition
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THINK… What teaching would you provide to the patient experiencing Dumping Syndrome??
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Stomach Cancer “Silent neoplasm” Poor prognosis No early s/s Late s/s: vomiting, ascites,
abd. Mass, enlarged liver
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Risk Factors H-pylori infection Pernicious anemia Chronic gastritis Family history
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TreatmentChemoRadiationSurgery
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Health Promotion Considerations What are some things we can do and or
teach others to do which might reduce the risk of developing several types of Cancer not just stomach Cancer???/
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ABSORPTION & ELIMINATION
Disorders Affecting
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Malabsorption Intestinal absorption of
nutrients is reduced Two examples are:
1) Celiac sprue/disease
2) Lactase deficiency
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Signs & Symptoms Steatorrhea Malnutrition & weight loss Abdominal pain, cramping Bloating diarrhea
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Treatment Sprue diet and drug
therapy, avoid foods w/ gluten(wheat, barley, oats)
Lactase avoid milk products & take lactase enzyme ( Lactaid)
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Critical Thinking QuestionA nurse enters the room of a 72-year-old
patient who is receiving a continuous tube feeding and finds the patient lying flat in bed. The nurse questions the nurse assistant and discovers that the patient requested to be placed flat. What is significant about this situation? Why? How should the nurse handle the situation?
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THAT’S IT…!!
YOUR DONE
WITH GI UNIT 1
ON TO UNIT 2…..