gastrointestinal alterations for medical surgical nursing
DESCRIPTION
Nursing Powerpoints for GI AlterationsTRANSCRIPT
Gastroesophageal Reflux Disease(GERD)Ch.42 pp. 931-935
GERDReflux of stomach acid into
esophagus◦Causes mucosal damage
Possible causes◦Incompetent LES◦Obesity◦Cigarette and cigar smoking◦Hiatal hernia
GERD
What clinical manifestations may the pt. with GERD exhibit?
GERDComplicationsEsophagitis
◦Can lead to strictures, scar tissue, and dysphagia
Esophageal ulcerationsBarrett’s esophagus
◦Precancerous lesionRespiratory complicationsDental erosion
GERDDiagnostic StudiesHistory and PhysicalUpper GI endoscopy with biopsyEsophagram (barium swallow)Motility StudiespH monitoringRadionuclide studies
GERDCollaborative CareLifestyle modificationNutritional TherapyDrug therapySurgery
GERDCollaborative CareLifestyle modification
◦Avoid triggers◦Weight reduction◦Smoking cessation◦Manage stress
GERDCollaborative Care Nutritional Therapy
◦ Avoid foods /items that decrease LES pressure (Table 42-7) Alcohol Anticholinergics Chocolate Fatty foods Nicotine Peppermint
◦ Avoid milk◦ Small frequent meals◦ Increase saliva production◦ Avoid late evening meals◦ Fluid between rather than with meals◦ Avoid foods that irritate esophagus◦ Positioning
GERDCollaborative CareDrug Therapy
◦Goals of drug therapy Decrease volume and acidity of reflux Improve LES function Increase esophageal clearance Protect esophageal mucosa
GERDCollaborative Care Drug Therapy
◦ Proton Pump Inhibitors (eg. Prevacid, Prilosec, Protonix, Nexium)
◦ Histamine (H2)- Receptor Blockers (eg. Tagamet, Pepcid, Zantac)
◦ Prokinetic Agents (eg. Reglan)
◦ Antiulcer, Protectants (eg. Carafate)
◦ Cholinergics (eg. Urecholine)
◦ Antacids (eg. Amphojel, Tums, Alka-Seltzer, Maalox, Mylanta)
◦ Prostaglandins (eg. Cytotec)
GERD Collaborative Care
Surgical Therapy◦Nissen and Toupet fundoplications
Fundus of stomach wrapped around lower portion of esophagus
◦LINX reflux management system Titanium beads with magnetic core implanted into LES
Endoscopic Therapy◦Endoscopic mucosal resection◦Photodynamic therapy◦Cryotherapy◦Radiofrequency ablation
GERDNursing ManagementPt Teaching
◦ Elevation of head of bed 30 degrees◦ Not lying down for 2–3 hours after eating◦ Avoidance of late-night eating◦ Evaluating effectiveness of medications◦ Observing for side effects of medications◦ Avoidance of factors that cause reflux
Stop smoking Avoid alcohol and caffeine Avoid acidic foods
◦ Stress reduction techniques◦ Weight reduction, if appropriate◦ Small, frequent meals
GERDNursing ManagementPostop Care
◦Prevent respiratory complications◦Maintain F & E balance◦Prevent infection◦Respiratory assessment◦Deep breathing◦Pain management◦Meds to prevent N & V◦Fluids (peristalsis present) then gradually
progress to solids◦Avoid gas producing foods
APPENDICITISCh.43 pp.973-974
APPENDICITISETIOLOGY & PATHOPHYSIOLOGY Most common cause of RLQ pain
Opening of the appendix is obstructed or blocked
Initial obstruction associated with:Fecaliths (most common cause)
APPENDICITISETIOLOGY & PATHOPHYSIOLOGY Perforation
PeritonitisElevation in temperature Increased pulse
MCBURNEY’S POINT
APPENDICITISDiagnostics Collaborative Care
History and Physical Laboratory findings
CBC including WBC with diff.
Serum electrolytes Abdominal paracentesis
and culture of fluid Imaging Diagnostics
Abdominal X-ray Ultrasound CT scan
Appendectomy Antibiotics Fluid replacement
APPENDICITISNONSURGICAL MANAGEMENT Hospitalized and examined by HCP
Keep pt NPO
DO NOT…..Give laxative or enema
Post-op managementEarly ambulationAdvance diet as tolerated
PeritonitisCh.43 pp.974-975
PeritonitisEtiology & Pathophysiology
Life threatening
Bacterial contamination of peritoneum
Massive fluid shifts
PeritonitisClinical Manifestations
What clinical manifestations may the pt. with peritonitis exhibit?
PeritonitisDIAGNOSTIC STUDIES
CBC WBC Peritoneal aspiration Abdominal X-ray Ultrasound CT scans
COLLABORATIVE CARE Antibiotics NG suction Analgesics IV fluids Surgery
PeritonitisNursing Management
What findings should the nurse assess for in the pt. with suspected peritonitis?
Nursing Diagnosis Acute pain Risk for deficient fluid volume Anxiety
PeritonitisNursing Management
Planning: Pt. goals Resolve inflammation Relieve abdominal pain No complications Normal nutritional status
PeritonitisNursing Management Nursing Implementation
IV access▪ Fluid replacement▪ Antibiotics
Pain management Pt. may be positioned with knees flexed Decrease anxiety Monitor I & O Monitor VS Antiemetics NPO NG tube Oxygen therapy Post-op care for laparotomy