Med surge gastrointestinal disorders chapter 32-35 Williams and Hopper
Hepatitis A (infectious) period
2-3 weeks
Hepatitis A incubation period
2-6 weeks
Signs of Bowel Perforation
- Guarding of abd - ^ fever and chills - Pallor - Abd distention and pain - Restlessness - Tachycardia and tachypnea
symptoms of hiatal hernia
-Heartburn -Regurgitation -Reflux -Dysphagia -Chest pain -But 50% are asymptomatic.
Nursing care for pancreatitis
-NPO (possibly TPN), when resuming foods. -NG tube -no ETOH or smoking -treat pain -monitor for hyperglycemia and give insulin PRN
symptoms of cholecystitis
-Pain is always present and is located in RUQ or epigastrium; it may radiate to the right shoulder or scapula (BOAS SIGN) -n/v/anorexia elevated temperature tachycardia
spider angioma
-red center with radiating red legs -up to 2 cm -can be raised
Total Serum Bilirubin (TSB)
0.1-1.0mg/dL increased in liver and gallbladder disease with red blood cell destruction
Interventions for ulcerative colitis
1. Acute phase: Maintain NPO status and administer fluids and electrolytes intravenously or via parenteral nutrition as prescribed. 2. Restrict the client's activity to reduce intestinal activity. 3. Monitor bowel sounds and for abdominal tenderness and cramping. 4. Monitor stools, noting color, consistency, and the presence or absence of blood. 5. Monitor for bowel perforation, peritonitis, and hemorrhage. 6. Following the acute phase, the diet progresses from clear liquids to a low-fiber diet as tolerated. 7. Instruct the client about diet; usually a low-fiber, high-protein diet with vitamins and iron supplements are prescribed. 8. Instruct the client to avoid gas-forming foods, milk products, and foods such as whole wheat grains, nuts, raw fruits and vegetables, pepper, alcohol, and caffeine-containing products. 9. Instruct the client to avoid smoking. 10. Administer medications as prescribed , which may include a combination of medications such as salicylate compounds , corticosteroids, immunosuppressants, and antidiarrheals.
Interventions for hemorrhoids
1. Apply cold packs to the anal-rectal area followed by sitz baths as prescribed. 2. Apply witch hazel soaks and topical anesthetics as prescribed. 3. Encourage a high-fiber diet and fluids to promote bowel movements without straining. 4. Administer stool softeners as prescribed.
gavage
The process of giving a tube feeding
BMI (body mass index)
Underweight - Less than 18.5 Normal - 18.5 - 24.9 Overweight - 25 - 29.9 Obese - 30 - 39.9
Paracentesis Nursing Care
Void bladder prior to procedure, in high-fowler/sitting, do V/S before, during, and after, record amt. of fluid taken, monitor for hypovolemia. Measure abdominal girth and weight
Potassium levels
3.5-5.0 mEq/L decreased in diarrhea intestinal fistula vomiting suctioning
upper GI Series
X-ray exam of esophagus, stomach, duodenum, jejunum using an oral liquid radiopaque contrast medium used to detect tumors ulcers polyps strictures hiatal hernias and motility problems used with fluroscope
ulcerative colitis
a chronic condition of unknown cause in which repeated episodes of inflammation in the rectum and large intestine cause ulcers and irritation results in poor absorption of nutrients
Colonoscopy prep
a colonoscopy is to cleanse the bowel and prevent infection clear liquids 1-2 days prior NPO midnight before day of surgery enemas, laxatives til clear (neomycin/antibiotics if pre surgery)
hiatal hernia
a condition in which a portion of the stomach protrudes upward into the chest, through an opening in the diaphragm
Symptoms of gastric ulcers
abdominal burning pain
ascites
abnormal accumulation of fluid in the abdomen
diverticulosis
abnormal outpouchings in the intestinal wall of the colon
pancreas enzymes
amylase and lipase
Hepatitis A
an inflammation of the liver usually caused by a viral infection
duodenal ulcer
an ulcer, or erosion, in the wall of the duodenum of the small intestine
liver biopsy post procedure
assist client to a right-side lying position for several hours 2 hours assess for respiratory complaints assess for abdominal pain/ abdominal bleeding Monitor for peritonitis No heavy lifting for 1 week
gastroesophageal reflux disease (GERD)
backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus
Clostridium difficile (C. diff)
bacteria which causes severe watery diarrhea and other intestinal disease when competing bacteria have been wiped out by antibiotics; It is spread by spores that are difficult to kill and can be carried on the hands of caregivers who have direct contact with residents or an environmental surface (i.e., floors, toilets, bedpans).
Functions of the liver
bile production, storage, nutrient interconversion, detoxification, phagocytosis, synthesis stores vitamins A D E and K and B12
Vitamin K
blood clotting
Transmission of Hep B
blood, IVDU, sex
Prevention of hepatitis A
chlorination of drinking water, cooking food, good sanitation, vaccination
Complications of hep B
cirrhosis and liver cancer
gastrostomy
creation of an artificial opening into the stomach
symptoms of pancreatitis
epigastric pain radiating to *back* N/V, fever (*SIRS*) grey turner's/Cullen's sign
symptoms of gastritis
epigastric pain, nausea, vomiting, hematemesis, or melena, belching, vitamin B12 deficiency, sour taste
steatorrhea
fat in the feces
Transmission of Hepatitis A
fecal-oral
fetor hepaticus
fruity, musty breath odor of severe chronic liver disease
duodenal ulcer symptoms
gnawing or burning upper abd pn that occurs 1-3 hrs after a meal; pain is worse when the stomach is empty & disappears w/ ingestion of food; nighttime pain, N/V are uncommon; blood in emesis or black, tarry stools may happen with deeper erosion of mucosa; these ulcers mostly heal spontaneously but frequently recur after months of remission; long-term medical follow up not necessary; common in males 30-50s years old; H. pylori likely to cause
Symptoms of GERD
heartburn, regurgitation, dysphagia, hyper-salivation, difficult swallowing
Complications of hep C
hepatocellular carcinoma secondary to post-necrotic cirrhosis
Hepatic encephalopathy
impaired ammonia metabolism causes cerebral edema. s/s: change in LOC, memory loss, asterixis (flapping tremor) impaired handwriting, hyperventilation w/ resp alkalosis. Rx: lactulose, low protein, safety, rest lactulose is given
Diverticulitis
inflammation of the diverticula
gastritis
inflammation of the stomach lining
GI assessment order
inspection, auscultation, percussion, palpation (only Doctor does percussion)
icterus
jaundice
Body Mass Index (BMI) calculation
mass (in kg) divided by height sqaured (in m) or multiply height in inches by height and divide by the weight in pounds then multiply by 703
abdominal girth
measurement around the abdomen at the umbilicus for ascitis
Liver biopsy (prior)
must have lab results for prothrombin time Administer sedatives Client is placed in left lateral position
Symptoms of vitamin B12 deficiency
pallor and jaundice, glossitis, fatigue, weight loss, paresthesias (abnormal sensations) in feet and hands and poor balance, smooth beefy red tongue
stomach enzymes
pepsin and hydrochloric acid
Vitamin B12 deficiency
pernicious anemia due to inadequate intake of vitamin B12
Incubation of HCV
5-10 weeks
Nursing actions for dumping syndrome
6 small meals per day high in protein and fat and low in sugar do not give fluid with meals 1 hour before meals or 2 hours after meals recline 30-60 minutes after meal provide vitamins B12 D Calcium Iron and folic acid may last up to 6 months after gastric surgery
Incubation period of hepatitis B
6-24 weeks
Aspartate aminotransferase (AST)
8-20 U/L increased in chronic liver failure, viral hepatitis, acute pancreatitis
Calcium levels
9-10.5 mg/dL decrease with pancreatitis, liver disease
Cholesterol
<200 mg/dL increase in pancreatitis and gallbladder disease decrease in liver disease
Peptic Ulcer Disease
A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum
Chron's disease
A chronic inflammatory bowel disease that affects the lining of the digestive tract.
portal hypertension
A potential complication of chronic alcoholism resulting in liver damage and obstruction of venous blood flow through the liver. The rising blood pressure in the veins between the gastrointestinal tract and liver causes engorgement of veins around the umbilicus (navel). The characteristic radiating pattern of veins is called a "caput medusae" (head of Medusa). Medusa was the "snake-haired lady" in Greek mythology.
cirrhosis of the liver
A severe medical condition where scar tissue in the liver replaces functional tissue.
Ammonia
A small, very toxic molecule (NH3) produced by nitrogen fixation or as a metabolic waste product of protein and nucleic acid metabolism. Can cross blood brain barrier in liver failure and cause hepatic encephalopathy
Ammonia
A small, very toxic molecule (NH3) produced by nitrogen fixation or as a metabolic waste product of protein and nucleic acid metabolism. Determine serum levels 12-55 mol/L
symptoms of diverticulitis and diverticulosis
Abdominal pain that increase with coughing etc. elevated temperature, nausea and vomiting, flatulent, bloody stools
symptoms of ulcerative colitis
Abdominal pain/cramping (LLQ) Anorexia Weight loss Fever Diarrhea Abdominal distention Abdominal tenderness & firmness High pitched bowel sounds Rectal bleeding
large intestine
Absorbs water and forms feces
Lab tests for pancreatic and hepatobiliary disorders
Alanine aminotransferase Albumin Amylase Ammonia Asparate Bilirubin Calcium Cholesterol Lipase Potassium Prothrombin time
Pancreatitis (chronic)
Alcohol (adults), cystic fibrosis (kids)
Right Lower Quadrant Organs
Appendix colon small intestine ureter major vein and artery
pancreas function
Assists in the digestion of foods by secreting enzymes that help to break down many foods (esp. fats and proteins); Also secretes a large amount of sodium bicarbonate to neutralize the stomach acid that reaches the small intestine
Client education of gastric ulcers
Avoid alcohol Avoid smoking Avoid caffeine Obtain rest Reduce stress
Interventions for gastroesophageal reflux disease
Avoid factors that irritate the esophagus Eat low fat high fiber diet Avoid eating and drinking 2 hours before bed No tight clothing Avoid NSAIDS
Interventions for gastritis
Avoid irritating food and beverages Monitor for signs of hemorrhagic B12 injections
Interventions for dumping syndrome
Avoid sugar salt and milk, eat a high protein diet, eat small meals, no fluids with meals, lie down after meals, take prescribed antispasmodic medication
Interventions for diverticulosis And diverticulitis
Bed rest NPO clear liquid diet, fiber gradually, administer antibiotics, analgesics, and anticholinergics, no lifting, coughing, strains, or bending, monitor for perforation, hemorrhage, etc. increase fluid intake 2500-3000 mL a day, eat soft fiber foods, take bulk forming laxatives
Liver enzymes
Bile salts
Signs of perforation
Bleeding fever dysphagia
Carcinoembryonic antigen
Blood test to detect protein found in fetal gut tissue should be less than 5ng/ml
Lipase
Detect and monitors pancreatitis 0-110 unit/L increased in pancreatitis and cholecystitis
Amylase
Detects and monitors status of pancreatitis 53-123 unit/L increase in pancreatitis, gallstones
small intestine
Digestive organ where most chemical digestion and absorption of food takes place 99%
caput medusae
Dilated veins around the umbilicus, associated with cirrhosis of the liver.
Individuals at risk for hep C
Drug users, frequent transfusions, healthcare personnel
Interventions for cirrhosis
Elevate head of bed, high protein diet, provide vitamin supplements, no sodium, monitor I&O, daily weight, monitor LOC monitor for bleeding
Cholecystectomy post procedure
Encourage early ambulation, clear liquids to solids, encourage deep breathing and coughing
Symptoms of Chron's disease
Fever, cramps after meals, diarrhea, abdominal distention, nausea,anorexia, vomiting, weight loss, dehydration, anemia, electrolyte imbalance, care is same as ulcerative colitis
Alanine aminotransferase (ALT)
Found in liver, with liver injury, atl is released into blood stream normal range is 5-35 units/dl
Pancreatitis (acute)
Gallstones, alcohol
Causes of gastric ulcers
H. pylori and NSAIDs smoking corticosteroids family history
Patient with constipation
High fiber diet 2-3 liters of fluid a day exercise stool softeners
Groups at risk for hepatitis B
IV drug users, hemodialysis patients, organ transplants, healthcare workers
Interventions for B12 deficiency
Increase foods rich in vitamin B12, citrus fruits, dried beans, green leafy vegetables, liver, nuts, organ meats and administer b12 injection
Cholecystitis
Inflammation of the cholecyst (gallbladder)
Right Upper Quadrant Organs
Liver gallbladder colon pancreas right kidney
Upper GI endoscopy postprocedure
Monitor vitals NPO 1-2 hours until gag reflux returns Monitor for signs of perforation Maintain bed rest
Postprocedure colonoscopy
Monitor vitals Provide bed rest Monitor for signs of bowel perforation and peritonitis Flatus, abdominal cramping, and fullness are expected for several hours
Interventions of gastric ulcers
Monitor vitals and signs of bleeding Administer small frequent feedings Administer proton pump inhibitors or antacids
Gastric post procedure
Monitor vitals place in Fowler's position administer fluids IV check bowel sounds monitor NG suction maintain NPO status for 1 -3 days monitor for postoperative complications, gradually increase food intake slowly
Interventions for duodenal ulcer
Monitor vitals, bland diet, rest, no alcohol, no caffeine, no NSAIDS, no aspirin, no corticosteroids
Interventions of gastric ulcers
Monitor vitals, signs of dehydration, hypovolemia shock, sepsis, maintain NPO, assist with IV fluid replacement, monitor I&O
Patient teaching upper GI Series
NPO 6-8 hours before procedure no smoking the morning of procedure patient drinks barium during procedure while standing in front of a fluoroscope tube films are taken procedure may take several hours laxative after procedure patient drinks 12 eight ounce glasses of water per day stool is white due to barium should return to normal in 3 days
Interventions of cholecystitis
NPO, NG tube for severe vomiting, no gas forming food
kosher dietary laws
No eating pork, rabbit, camel, or shellfish. No eating meat with dairy. Slaughtering must be done right. Grape and salt products must be processed by Jews. Use paper products
Complications of cirrhosis
Portal Hypertension, esophageal/ gastric varices, hepatic encephaopathy
hepatorenal syndrome
Progressive renal failure associated with hepatic failure characterized by a sudden decrease in urinary output, elevated blood urea nitrogen and creatinine levels, decreased urine sodium excretion, and increased urine osmolarity
Dumping syndrome
Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.
Groups at risk for hepatitis A
Crowded places- daycare, nursing homes
hemorrhoids
swollen, twisted, varicose veins in the rectal region
prothrombin time
test of the ability of blood to clot 11-13.5 seconds increased in liver disease and vitamin K deficiency
Colonoscopy
the direct visual examination of the inner surface of the entire colon from the rectum to the cecum
capsule endoscopy
the use of a tiny video camera in a capsule that the patient swallows
Hepatitis C Virus (HCV)
the virus that causes hepatitis C infection and is transmitted by contact with infected blood or other body fluids
gastric ulcer
ulcer in the stomach
Hepatitis B virus
virus that causes inflammation of the liver; transmitted through any body fluid, including vaginal secretions, semen, and blood
endoscopy
visual examination of a body cavity or canal using a specialized lighted instrument called an endoscope conscious sedation is used to relax and ease pain monitor vitals Assess for signs of perforations
Gastroscopy
visual examination of the stomach
Left Lower Quadrant Organs
Colon small intestine ureter major vein and artery
Dumping syndrome
Common after gastric surgery Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia and high blood sugar
Parencentisis
Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites camera. Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis. Call your doctor immediately if you have: A fever higher than 100°F (38°C). Severe belly pain. More redness or tenderness in your belly. Blood in your urine. Bleeding or a lot of drainage from the site.
Upper GI endoscopy (EGD)
Passed down esophagus to view gastric wall, sphincters, and duodenum NPO 6-8 hours Anesthetic maybe administered Client on left side Monitor airway and oxygen levels Keep emergency equipment nearby
Urea breath test
Patient ingests Urea with radio labeled Carbon Measures exhaled radio labeled Carbon 10-20 minutes later Tests for H. Pylori Avoid antibiotics 1 month before test Avoid sucralfate and omeprazole 1 week before test Avoid cimetidine, famotidine, ranitidine, and nizatidine 24 hours before test
Interventions for hiatal hernia
Small frequent meals and limit liquids no reclining for 1 hour after eating
Ascites Treatment
Spironolactone and furosemide (100:40) sodium restrictions, paracentesis or shunt
percutaneous liver biopsy
procedure in which a small core of liver tissue is obtained by placing a needle directly into the liver through the lateral abdominal wall
Albumin
protein in blood; maintains the proper amount of water in the blood 3.1-4.3 g/dL decrease in liver failure
fluroscopy
radiographic procedure that uses a fluorescent screen instead of a photographic plate to produce a visual image from x-rays that pass through the patient, resulting in continuous imaging of the motion of internal structures and immediate serial images
Left Upper Quadrant Organs
stomach, left kidney, spleen, colon, pancreas
Gastric analysis
study of the stomach content to determine the acid content and to detect the presence of blood, bacteria, bile, and abnormal cells
esophageal varices
swollen, twisted veins in the esophagus that are especially susceptible to ulceration and hemorrhage Must stop bleeding immediately, given vitamin K and vasopressin, antibiotic for hemorrhage Banding of varices during endoscopy is done to stop bleeding