Gastrointestinal Assessment & Stomach Disorders
What are Nursing Intervention(s) (with rationale) for Steatorrhea?
1) Encourage small, frequent feedings. Small, frequent feedings help prevent steatorrhea. 2) Assess for diarrhea. Diarrhea may be steatorrhea. Excessive diarrhea can lead to dehydration.
List the three (3) laboratory assessments to detect H. pylori
1) Serologic testing for H. pylori antibodies 2) The urea breath test 3) The stool antigen test
Identify the priority NANDA-I nursing diagnoses & collaborative problems for patients with peptic ulcer disease (PUD)
1. Acute Pain or Chronic Pain related to gastric and/or duodenal ulceration 2. Upper GI bleeding related to perforation
What is the normal ALBUMIN lab value for adults?
3.5-5.0 g/dL
What is the normal POTASSIUM lab value for adults?
3.5-5.0 mEq/L
What is the normal CALCIUM lab values for adults?
9.0-10.5 mg/dL (values decrease in older adults)
Identify age-related physiologic change(s) to the Liver.
A decrease in the number and size of hepatic cells leads to decreased liver weight and mass.
Characterize atrophy of the gastric mucosa
A decrease in the ratio of the gastrin-secreting cells to the somatostatin-secreting cells. This change leads to decreased hydrochloric acid levels in the stomach (hypochlorhydria)
What is Sucralfate?
A mucosal barrier fortifier: The mucosal barrier is the name given to the barrier in the stomach that resists the back-diffusion of hydrogen ions. The barrier is a layer of thick mucus secreted together with an alkaline fluid. Since the mucus is a gel, it entraps the alkaline fluid so that the stomach is coated.
Define PEPTIC ULCER
A peptic ulcer is a mucosal lesion of the stomach or duodenum.
What is omeprazole?
A proton pump inhibitor to suppress gastric acid secretion
What is pantoprazole?
A proton pump inhibitor to suppress gastric acid secretion
What are Nursing Intervention(s) (with rationale) for decreased liver enzyme function?
Assess for adverse effects of all drugs. Assessment can help detect drug toxicity.
What causes Atrophic Gastritis?
Atrophic Gastritis occurs as a result of bacterial overgrowth.
List the signs & symptoms of ADVANCED gastric cancer.
Advanced Gastric Cancer • Nausea & vomiting • Obstructive symptoms • Iron deficiency anemia • Palpable epigastric mass • Enlarged lymph nodes • Weakness & fatigue • Progressive weight loss
What is Clarithromycin/Biaxin?
An ANTIMICROBIAL: Treats H. pylori infection
What is Metronidazole/Flagyl?
An ANTIMICROBIAL: Treats H. pylori infection
Describe ATROPHIC GASTRITIS
Atrophic gastritis is a type of chronic gastritis that is seen most often in older adults. It can occur after exposure to toxic substances in the workplace (e.g., benzene, lead, nickel) or H. pylori infection, or it can be related to autoimmune factors. Atrophic gastritis can lead to two types of cancer: gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma.
Identify an age-related physiologic change to the stomach
Atrophy of the gastric mucosa
An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a. Check with the pharmacist before taking other medications. b. Increase intake of calcium and vitamin D. c. Report any worsening of symptoms to the provider. d. Take the medication as prescribed by the provider.
B ~ All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any medication and are not specific to the use of esomeprazole.
DEFINE the term FRANK BLOOD
Frank blood is used to describe the obvious, visible presence of blood. Examples include fresh blood in vomit, urine, or feces, or blood that is found on the examiners hand upon examining an internal or external wound.
A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority? a. Document the findings in the chart. b. Request an electrocardiogram (ECG). c. Facilitate a serum potassium test. d. Place the client on bedrest.
B ~ Pyloric stenosis can lead to hypokalemia, which is manifested by muscle weakness. The nurse first obtains an ECG because potassium imbalances can lead to cardiac dysrhythmias. A potassium level is also warranted, as is placing the client on bedrest for safety. Documentation should be thorough, but none of these actions takes priority over the ECG.
The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the clients abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs.
B ~ This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client medical attention. The nurse can take a set of vital signs while someone else calls the provider. The nurse should not percuss the abdomen or give pain medication since the client may need to sign consent for surgery.
What is the BRAND NAME for Clarithromycin?
BIAXIN
How would the bowel sounds be characterized in the nurses notes?
Bowel sounds are characterized as normal, hypoactive, or hyperactive. They are diminished or absent after abdominal surgery or in the patient with peritonitis or paralytic ileus.
Describe the normal bowel sounds a nurse would hear when auscultating the abdomen.
Bowel sounds are created as air & fluid move through the GI tract. They are normally heard as irregular gurgles every 5-15 seconds, with a normal frequency range of 5-30 per minute.
A nurse answers a clients call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs.
C All of the actions are appropriate; however, the nurse should put on a pair of gloves first to avoid contamination with blood or body fluids.
The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? a. Gastric acid inhibitor b. Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor
C Sucralfate is a mucosal barrier fortifier (protector). It is not a gastric acid inhibitor, a histamine receptor blocker, or a proton pump inhibitor.
The nurse auscultates a client's abdomen and hears a loud bruit near the umbilicus. What is the nurse's best action based on this assessment finding? A Document the assessment finding in the medical record. B Palpate the abdomen lightly in all four quadrants. C Report the finding to the health care provider. D Place the client in a semi-Fowler's position.
C Report the finding to the health care provider. It may indicate an Abdominal Aortic Aneurysm (AAA)
A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate? a. Assess the client for iodine or shellfish allergies. b. Educate the client on the side effects of sedation. c. Inform the client a second scan may be needed. d. Teach the client about bowel preparation for the scan.
C ~ A second scan may be performed in 1 to 2 days to see if interventions have worked. The nuclear medicine scan does not use iodine-containing contrast dye or sedation. There is no required bowel preparation.
A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The clients blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? a. Administer ibuprofen (Motrin). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the client to remain lying down.
C ~ This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.
What is the BRAND NAME for Misoprostol?
CYTOTEC
What is the significance of elevated SERUM AMMONIA lab values?
Increased values indicate possible: Hepatic disease such as cirrhosis
What is the consequence of decreased liver enzyme activity?
Decreased enzyme activity depresses drug metabolism, which leads to accumulation of drugs—possibly to toxic levels.
What is a consequence of decreased hydrochloric acid levels in the stomach? (hypochlorhydria)
Decreased hydrochloric acid levels lead to decreased absorption of iron and vitamin B12 and to proliferation of bacterial growth.
What is the consequence of decreased lipase production?
Decreased lipase level results in decreased fat absorption and digestion. Steatorrhea, or excess fat in the feces, occurs because of decreased fat digestion.
List the signs & symptoms of EARLY gastric cancer. NOTE: Many patients with early gastric cancer have no clinical manifestations.
Early Gastric Cancer • Indigestion • Abdominal discomfort initially relieved with antacids • Feeling of fullness • Epigastric, back, or retrosternal pain
What is the BRAND NAME for Metronidazole?
FLAGYL
Define GASTRITIS
Gastritis is the inflammation of gastric mucosa (stomach lining). It can be scattered or localized & can be classified according to cause, cellular changes, or distribution of the lesions. Gastritis can be erosive (causing ulcers) or nonerosive. Although the mucosal changes that result from acute gastritis typically heal after several months, this is not true for chronic gastritis.
What is Ranitidine/Zantac?
H2 Antagonists (Blockers) Decreases gastric acid secretions by blocking histamine receptors in parietal cells
What is Axid/nizatidine?
H2 antagonists, sometimes referred to as H2RA and also called H2 blockers, are a class of medications that block the action of histamine at the histamine H2 receptors of the parietal cells in the stomach. ... H2 antagonists can be used in the treatment of dyspepsia, peptic ulcers and gastroesophageal reflux
What is Pepcid/famotidine?
H2 antagonists, sometimes referred to as H2RA and also called H2 blockers, are a class of medications that block the action of histamine at the histamine H2 receptors of the parietal cells in the stomach. ... H2 antagonists can be used in the treatment of dyspepsia, peptic ulcers and gastroesophageal reflux
What is the most common cause of ANEMIA in adults?
In adults, GI BLEEDING is the most frequent cause of anemia.
Define BORBORYGMUS
Increased bowel sounds, especially loud, gurgling sounds, result from increased motility of the bowel.
What is the significance of increased BILIRUBEN lab values?
Increased values indicate possible: Hemolysis Biliary obstruction Hepatic damage
What is the significance of elevated CHOLESTEROL lab values?
Increased values indicate possible: Pancreatitis Biliary obstruction
What is the significance of elevated SERUM AMYLASE lab values?
Increased values indicate possible: Acute pancreatitis
What is the significance of elevated SERUM LIPASE lab values?
Increased values indicate possible: Acute pancreatitis
What is a special side-effect of Pepto-Bismol that a nurse should educate the patient about?
It can change the appearance of the bowel causing it to become darker similar to the black tarry stool
With which physiological disorders/diseases is GI BLEEDING associated?
It is associated with GI cancer, peptic ulcer disease, diverticulitis, and inflammatory bowel disease.
What is the most common cause of ACUTE GASTRITIS?
Long-term NSAID use.
Identify BRAND NAME antacids that contain Magnesium hydroxide with aluminum hydroxide
Maalox & Mylanta
Define MELENA
Melena refers to the dark black, tarry feces that are associated with upper gastrointestinal bleeding. The black color & characteristic strong odor are caused by hemoglobin in the blood being altered by digestive enzymes & intestinal bacteria.
What is Bismuth Subsalicylate/Pepto-Bismol?
Mucosal Barrier Fortifiers. Stimulates mucosal protection and prostaglandin production Inhibits H. pylori from binding to mucosal lining
What is the BRAND NAME for Esomeprazole?
NEXIUM
What is the BRAND NAME for famotidine?
PEPCID
What is the BRAND NAME of Bismuth Subsalicylate?
PEPTO-BISMOL
What is the BRAND NAME for Lansoprazole?
PREVACID
What is the BRAND NAME for omeprazole?
PRILOSEC
What is the BRAND NAME for pantoprazole?
PROTONIX
What is a special nutritional consideration for patients with CHRONIC GASTRITIS?
Patients with chronic gastritis may require vitamin B12 for prevention or treatment of pernicious anemia.
Describe PEPTIC ULCER DISEASE
Peptic ulcer disease (PUD) results when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin.
Identify an age-related physiologic change to the Large Intestine.
Peristalsis decreases and nerve impulses are dulled.
What is Esomeprazole/Nexium?
Proton Pump Inhibitor. Suppresses H,K-ATPase enzyme system of gastric acid secretion Indications for short-term and long-term use for PUD, symptomatic heartburn, and H. pylori treatment
What is Lansoprazole/Prevacid?
Proton Pump Inhibitor. Suppresses H,K-ATPase enzyme system of gastric acid secretion Indications for short-term and long-term use for PUD, symptomatic heartburn, and H. pylori treatment
What is Misoprostol/Cytotec?
Synthetic prostaglandin that stimulates mucosal protection and decreases gastric acid secretions Helps resist mucosal injury in patients taking NSAIDs and/or high-dose corticosteroids
Describe the JEJUNUM
The 8-foot (2.5-m) portion of the small intestine that follows the sphincter of Oddi is the jejunum.
Describe the DUODENUM
The duodenum is the first 12 inches (30 cm) of the small intestine and is attached to the distal end of the pylorus. The common bile duct and pancreatic duct join to form the ampulla of Vater, emptying into the duodenum at the duodenal papilla. This papillary opening is surrounded by muscle known as the sphincter of Oddi.
Describe the three (3) main functions of the SMALL INTESTINE.
The small intestine has three main functions: movement (mixing and peristalsis), digestion, and absorption. Because the intestinal villi increase the surface area of the small intestine, it is the major organ of absorption of the digestive system.
Define HEMATEMESIS
The vomiting of blood
Define BRUITS
When auscultating the abdomen, also listen for vascular sounds or bruits ("swooshing" sounds) over the abdominal aorta, the renal arteries, and the iliac arteries. A bruit heard over the aorta usually indicates the presence of an aneurysm. If this sound is heard, do not percuss or palpate the abdomen
What is the BRAND NAME of Ranitidine?
ZANTAC
Identify the four (4) regions of the COLON.
ascending colon, transverse colon, descending colon, and sigmoid colon. The sigmoid colon empties into the rectum.
Identify the three (3) regions of the small intestine.
duodenum, jejunum, and ileum
What is JAUNDICE?
yellowing of skin caused by bilirubin pigments
Upper GI bleeding often requires the primary care provider or nurse to insert a large-bore nasogastric tube (NGT) to:??
• Determine the presence/absence of blood • Assess the rate of bleeding • Prevent gastric dilation • Administer lavage
Describe Nursing Education to patients & their families preparing for self-management of GASTRITIS PREVENTION
• Eat a well-balanced diet. • Avoid excessive amts of alcoholic beverages. • Use caution taking aspirin & NSAIDs • Avoid excessive intake of coffee • Manage stress levels • Stop smoking. • Avoid toxic substances such as lead & nickel. • Seek medical treatment if you are experiencing symptoms of esophageal reflux
Describe the SELF-MANAGEMENT education for someone who has just had a total or partial gastrectomy
• Eat small, frequent meals • Avoid drinking liquids with meals • Avoid foods that cause discomfort • Eliminate caffeine & alcohol consumption • Don't smoke • Receive B12 injections, as prescribed • Lie flat after eating for a short time
Which anatomical structures are located in the LEFT UPPER QUADRANT (LUQ) of the abdomen?
• Left lobe of the liver • Stomach • Spleen • Body & tail of the pancreas • Splenic flexure of the colon • Part of the transverse & descending colon
What might you NOTICE if the patient is experiencing impaired digestion and nutrition as a result of a stomach disorder?
• Report of epigastric pain or indigestion before or after a meal • Report of inability to tolerate certain foods • Nausea and/or vomiting (with or without blood) • Melena or frank blood in stools
Teach the patient who has peptic ulcer disease to seek immediate medical attention if experiencing any of these symptoms: ??
• Sharp, sudden, persistent & severe epigastric or abdominal pain • Bloody or black stools • Bloody vomit or vomit that looks like coffee grounds
What is the PATIENT TEACHING for someone who is being treated for GASTRITIS?
Teach the patient to monitor for symptom relief and side effects of drugs to treat gastritis and to notify the health care provider of any adverse effects or worsening of gastric distress. The dose, frequency, or type of drug may need to be changed if symptoms of gastric irritation appear or persist. Remind patients not to take additional over-the-counter (OTC) drugs such as Pepcid AC or Axid AR if they are taking similar prescribed drugs. Avoid NSAIDS, Caffeine, Acidic foods, Alcohol & Nicotine.
What is the significance of decreased CALCIUM lab values?
Decreased values indicate possible: Malabsorption Kidney failure Acute pancreatitis
Identify the four (4) abdominal assessment techniques IN ORDER.
The abdomen is assessed by using the four techniques of examination, but in a sequence different from that used for other body systems: inspection, auscultation, percussion & then palpation. This sequence is preferred so that palpation and percussion do not increase intestinal activity and bowel sounds.
What is the normal BILIRUBEN lab value for adults?
0.3-1.0 mg/dL
Identify the plasma proteins produced by the liver
The liver synthesizes several plasma proteins, including albumin, prothrombin, and fibrinogen.
List the signs & symptoms of UPPER GI BLEEDING
• Bright red or coffee-ground vomitus • Melena (tarry or dark, sticky) stools • Decreased blood pressure • Increased heart rate • Weak peripheral pulses • Acute confusion (in older adults) • Vertigo • Dizziness or light-headedness • Syncope (loss of consciousness) • Decreased hemoglobin & hematocrit
List some commonly used homeopathic remedies for Gastritis & Peptic Ulcer Disease
• Carbo vegetabilis • Ipecacuanha • Nux vomica • Pulsatilla
Which anatomical structures are located in the RIGHT LOWER QUADRANT (RLQ) of the abdomen?
• Cecum • Appendix • Right ureter • Right ovary & fallopian tube • Right spermatic cord
List some commonly used Vitamin & Herb remedies for Gastritis & Peptic Ulcer Disease
• Cranberry • DGL (deglycyrrhizinated licorice) • Ginger • Probiotics • Slippery elm • Vitamin C
Which anatomical structures are located in the RIGHT UPPER QUADRANT (RUQ) of the abdomen?
• Most of the liver • Gallbladder • Duodenum • Head of the pancreas • Hepatic flexure of the colon • Part of the ascending & transverse colon
Which anatomical structures are located in the LEFT LOWER QUADRANT (LLQ) of the abdomen?
• Part of the descending colon • Sigmoid colon • Left ureter • Left ovary & fallopian tube • Left spermatic cord
Describe the KEY features of ACUTE GASTRITIS
• Rapid onset of epigastric pain or discomfort • Nausea and vomiting • Hematemesis (vomiting blood) • Gastric hemorrhage • Dyspepsia (heartburn) • Anorexia
Describe the KEY features of CHRONIC GASTRITIS
• Vague report of epigastric pain that is relieved by food • Anorexia • Nausea or vomiting • Intolerance of fatty & spicy foods • Pernicious anemia
What is the medical treatment for ACUTE GASTRITIS?
Acute gastritis is treated symptomatically & supportively because the healing process is spontaneous, usually occurring within a few days. When the cause is removed, pain & discomfort usually subside. If bleeding is severe, a blood transfusion may be necessary. Fluid replacement is prescribed for patients with severe fluid loss. Surgery, such as partial gastrectomy, pyloroplasty, and/or vagotomy, may be needed for patients with major bleeding or ulceration.
The lab value "PT" stands for PROTHROMBIN TIME .. what does PT measure?
PT measures the rate at which prothrombin is converted to thrombin, a process that depends on vitamin K-associated clotting factors. Severe acute or chronic liver damage leads to a prolonged PT
What is a Nursing Intervention (with rationale) for Atrophic Gastritis?
Encourage bland foods high in vitamins and Iron (bland foods help prevent gastritis)
A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy
D ~ Treatment for this infection involves either triple or quadruple drug therapy, which may make it difficult for clients to remain adherent. The nurse should assess the clients willingness and ability to follow the regimen. The other assessment findings are not as critical.
What is the consequence of decreased peristalsis and dulled nerve impulses to/from the large intestine?
Decreased sensation to defecate can result in postponement of bowel movements, which leads to constipation and impaction.
What is the significance of decreased POTASSIUM lab values?
Decreased values indicate possible: Vomiting Gastric suctioning Diarrhea Drainage from intestinal fistulas
What is the significance of decreased ALBUMIN lab values?
Decreased values indicate possible: Hepatic disease
What is the significance of decreased CHOLESTEROL lab values?
Decreased values indicate possible: Liver cell damage
Identify age-related physiologic change(s) to the Pancreas
Distention & dilation of pancreatic ducts change. Calcification of pancreatic vessels occurs with a decrease in lipase production.
Define DYSPEPSIA
Dyspepsia (indigestion) is the most commonly reported symptom associated with PUD. It is typically described as sharp, burning, or gnawing pain. Some patients may perceive discomfort as a sensation of abdominal pressure or of fullness or hunger. Older adults often have more nausea and vomiting rather than abdominal discomfort
What are Nursing Intervention(s) (with rationale) for age-related decrease in large intestine peristalsis and dulled nerve impulses from the large intestine?
Encourage a high-fiber diet and 1500 mL of fluid intake daily (if not contraindicated). Encourage as much activity as tolerated. These interventions increase the sensation of needing to defecate.
Describe the structure & function of the GALLBLADDER
The gallbladder is a pear-shaped, bulbous sac that is located underneath the liver. It is drained by the cystic duct, which joins with the hepatic duct from the liver to form the common bile duct (CBD). The gallbladder collects, concentrates, and stores the bile that has come from the liver. It releases the bile into the duodenum via the CBD when fat is present.
Describe the LARGE INTESTINE.
The large intestine extends about 5 to 6 feet in length from the ileocecal valve to the anus and is lined with columnar epithelium that has absorptive and mucous cells.
Describe the ILEUM
The last 8 to 12 feet (2.5 to 4 m) of the small intestine is called the ileum. The ileocecal valve separates the entrance of the ileum from the cecum of the large intestine
Why does the risk of drug toxicity increase as people age?
The liver detoxifies potentially harmful compounds (e.g., drugs, chemicals, alcohol). Therefore the risk for drug toxicity increases with aging because of decreased liver function.
Describe how/where bile is made, stored and secreted
The liver forms & continually secretes bile, which is essential for the breakdown of fat. The secretion of bile increases in response to gastrin, secretin & cholecystokinin. Bile is secreted into small ducts that empty into the common bile duct & into the duodenum at the sphincter of Oddi. However, if the sphincter is closed, the bile goes to the gallbladder for storage.
What is the most common cause of TYPE B CHRONIC GASTRITIS?
The most common form of chronic gastritis is type B gastritis, caused by H. pylori infection.
Identify the different types of ulcers
There are three types of peptic ulcers: 1)gastric ulcers: ulcers that develop inside the stomach. 2)esophageal ulcers: ulcers that develop inside the esophagus. 3)duodenal ulcers: ulcers that develop in the upper section of the small intestines, called the duodenum.
What is the consequence of age-related decrease in liver weight and mass?
This change and an increase in fibrous tissue lead to decreased protein synthesis and changes in liver enzymes. Enzyme activity and cholesterol synthesis are diminished.
What is the most common cause of TYPE A CHRONIC GASTRITIS?
Type A chronic gastritis has been associated with the presence of antibodies to parietal cells and intrinsic factor. Therefore an autoimmune cause for this type of gastritis is likely.
Define PERNICIOUS ANEMIA
Vitamin B12 deficiency anemia, of which pernicious anemia is a type, is a disease in which not enough red blood cells are present due to a lack of vitamin B12. The most common initial symptom is feeling tired. The most common cause of pernicious anemia is the loss of stomach cells that make intrinsic factor. Intrinsic factor helps the body absorb vitamin B12 in the intestine. The loss of parietal cells may be due to destruction by the body's own immune system.
Which patients may require VITAMIN B12 to prevent pernicious anemia?
patients with CHRONIC GASTRITIS
Define STEATORRHEA
the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine.
