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