week 6 GI/Elmination stoma/enteral

GERD complication

Barrett's esophagus - intestinal lining replaces esophageal greater cancer chance loss of tooth enamel risk for esophageal strictures and cancer

PEG concerns

immediate risk of PEG is aspiration, then nec fac greatest concern post PEG is dislodgement (sepsis) pain w/feeding=migration of tube peritonitis w/pain, tenderness, fever clearn daily w/saline and gauze x10d, then soap and h2o

The most frequent reason for admission to skilled care facilities includes which of the following: incontinence, stroke, CHF, MI

incontinence

diverticulitis complications, risks, treatment

more serious than diverticulosis (benign) abscesses, infection, perforation of bowel, most commonly in descending and sigmoid colons aging and not enough fiber are risk factors probiotics might help

motility definition, disorders, affected by

moves food from mouth to anus. can be affected by tumors, infection, inflammation, obstruction disorders: GERD, impaired esophageal motility, IBS, diarrhea, obstruction, constipation

absorption disorders, definition

moving nutrients and fluid from external GI tract to internal environment. disorders: lactose intolerance, Crohn, pancreatitis, liver failure, cirrhosis.

A client is being treated for prolonged diarrhea. Which of the following foods should the nurse encourage the client to consume? Protein-rich foods Potassium-rich foods High-fiber foods High-fat foods

potassium rich

End-to-end anastomosis

preserves more bowel

crohn disease aka

regional enteritis

sigmoid colostomy

removal of anus, colon, rectum

malabsorption categories and examples

mucosal: celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders. Examples of infectious diseases causing generalized malabsorption include small-bowel bacterial overgrowth, tropical sprue, and Whipple disease. Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger-Ellison syndrome, and pancreatic insufficiency. Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.

gastroparesis s/s

- nausea - bloating - vomiting - diarrhea or constipation

A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? -Notify the physician.-Reposition the tube.-Irrigate the tube.-Increase the suction level.

-Notify the physician.The nurse should notify the physician because an NG tube that fails to drain during the postoperative period may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.

Normal urine output

30 mL/hr, 800-1500 mL/day

what is UC

5-30 stools/day; 6-10 bloody is severe. extensive colon involvement cramping LLQ relieved by pooping complications of hemorrhage, perforation, bowel rupture

Which client is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)? 32-year-old mother who reports intermittent abdominal pain that is worse during her menstrual period. A 51-year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache." A 44-year-old man who works the evening shift at a factory and who states that his lower abdominal pain is much worse at night than during the day. A 24-year-old man who has a stressful job but whose diarrhea and cramping does not worsen during periods of high stress.

A 51-year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache.". IBD symptoms not nocturnal and stress exacerbates A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend?

A. Ensuring intake of food and fluids ends 2 to 3 hours before bed C. Avoiding foods that intensify symptoms D. Maintaining an upright position following meals

what is GERD s/s, lifespan, manifestations

Backflow of gastric contents into the esophagus protein deficiency results heartburn symptoms most common GI issue w/kids manifests with cough, asthma, sore throat, d swallow, pneumonia

risk factors for GI function

CNS issues, mobility, immune system, stroke, AIDS, IBS, Crohn, food allergies conditions that result in cognitivie, neuro impairment

A 28-year-old man presents with reports of diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect?

Crohn disease

hallmarks of Crohn disease

Crohn disease, like ulcerative colitis, causes diarrhea, fecal urgency, weight loss, and systemic symptoms such as erythema nodosum and arthritis. Unlike ulcerative colitis, it also causes steatorrhea but is not as likely to cause blood in the stool. The granulomatous "skip" lesions confirm the diagnosis of Crohn disease.

priority nursing for Crohn

avoid fistula development but obstruction, abscess and fistula common enough to be considered part of disease process deficient fluid volume imbalanced nutrition

IBS management

avoid low-fiber diet, alcohol, dairy, caffiene, stress eat smaller meals avoid carbonated beverages, gum, stress

priority nursing for UC

avoid toxic megacolon deficient fluid volume imbalanced nutrition

colorectal cancer

IBD increases risk for some genetic factors carcinogenic (bacon) diet linked, lack of fiber major cause grows very slowly, more frequently > 50y most common symptom=change in bowel habits

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes?

Inflammation of all layers of intestinal mucosa

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? -Three meals and 120 ml fluid daily-Three meals and three snacks and 120 mL fluid daily-Six small meals and 120 mL fluid daily-Six small meals daily with 120 mL fluid between meals

Six small meals daily with 120 mL fluid between meals

Crohn treatment

Sulfasalizine initially. Considered first-line treatment for inflammatory bowel disease, 5-ASA drugs contain salicylate, which is bonded to a carrying agent that allows the drug to be absorbed in the intestine. These drugs work by decreasing the inflammatory response. Methotrexate or azathioprine are used when failure to maintain remission necessitates the use of an immune-modulating agent.

Crohn diagnosis

The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

The nurse is conducting a gastrointestinal assessment. When the patient complains of the presence of mucus and pus in his stools, the nurse assesses for additional signs/symptoms of which of the following disease/conditions? small bowel disease, UC, colon disorders, intestinal malabsorb

UC. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

stool in areas of large intestine and impact on stoma

ascending - liquid to semiliquid stool - irritating to stoma transverse - liquid to semiformed - less irritating to stoma as less digestive enzymes descending - semi formed - less irritating to stoma

celiac patho, risks, s/s

autoimmune, develops at any age, absorption of fats impaired sensitivity to gluten intestinal inflammation can affect liver, joints, brain

what is GERD treatment

avoid alcohol, smoking, pregnancy, obesity eat small and fq meals avoid eating close to bed (w/in 2-3h) elevate head of bed antacids, prilosec, prevacid, omeprazole, surgery to inhibit gastric acid elevate head of bed but not with pillows

colorectal cancer issues

bacon carcinogenic, lack of fiber, smoking implicated, IBS increases risk, no need for screening after age 85

what is considered a stimulant laxitave

bisacodyl

other GI interventions for gastroparesis

botox around pylorus (not recommended) gastric pacemaker (last resort)

duodenum issues

carb, protein, lipid, vitamin absorption

malabsorbtion disorders

celiac, lactose intolerance, short bowel syndrome

IBD

chronic inflammatory disease - both UC and Crohn exacerbations+remissions

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

constipation, diarrhea or both. use high-fiber diet to control chronic changes in muscles and nerves

best clinical measure of kidney function: creat or volume of urinary output

creatinine

Gastroparesis

delayed gastric emptying chronic complication of diabetes

gastroparesis management

diabetes specialist, dietician glycemic control (hyperBG slows gastric emptying) eat little and often soft and liquid foods do not lie down after meals avoid high fiber metoclopramide and domperidone enteral feeds - often jejunem used

celiac nursing management

diarrhea perianal skin test family promote breastfeeding high cal/protein diet assess fluid balance risk w/o autoimmune disorders (thyroid, DM, lupus, RA, Down)

colorectal cancer nursing care

do not eat large meal at end of day, avoid carbonated beverages, yogurt decreases gas assess F/E, food intake, Is and Os, TPN if malnourished

ileostomy

don't use enteric coated meds harder to stay hydrated. eat yogurt to decrease gas. empty pouch when 1/3-1/2 full

IBS

females more than males dx of exclusion a pain, bloating, diarrhea/constipation pain over colon stool changes many have hx anxiety and depression

common physical assessment procedures to examine digestive health

fq/amt/type stools weights monitor for dehydration monitor perianal area

chronic diseases of GI tract

gastropareisis, Crohn, GERD, constipation, IBS, short bowel, pancreatitis, hepatitis, cirrhosis, gastric bypass, celiac, cancer

IBD management

initially supportive w/meds, diet lots of fluids (3L/day) surgery

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: A small bowel disorder. Intestinal malabsorption. Inflammatory colitis. A disorder of the large bowel.

intestinal malabsorption

celiac complications

iron deficient anemia GI malignancies but less with gluten free diet malnutrition mostly in kids dermatitis Tcell lymphoma osteoporosis

what is Crohn

less severe than UC, no blood or mucus cramping RLQ pain fever, malaise, persistent diarrhea with no blood complications of obstruction, abscess, fistula

colostomy

low residue diet during first 8-10w with strained fruits/veg hard to digest and high-fiber foods result in stomal obstruction irrigation not needed

Which of the following are functions of saliva?

lubrication, protection against harmful bacteria, and digestion.

mineral oil should not be taken with

meals - delay gastric emptying, inhibit absorption of fat-soluble vitamins

independent and collaborative interventions for GI health

meds, high-calorie, high-protein, low-fat diet lactose free TPN

ilestomy issues

more dehydration as person losing more fluid color, rectum, anus removed. eat yogurt to decrease gas

IBS therapies

peppermint oil, acupumcture, stress management, exercise

medical definition of regularity

stool consistency and client comfort

jejunum issues

sugar, amino acids, fatty acid absorption

what is UC treatment

supportive, Infliximab, antidiarrheals for mild and chronic but not acute (megacolon risk) monitor for anemia

what is Crohn treatment

supportive, dietary, highcal/protein, lowfat, daily weights monitor for s/s dehydration 3L h2o/day Remicade or Humira monitor Hgb, lytes, TP

Which symptom characterizes regional enteritis? severe diarrhea, transmural thickening, rectal bleeding, diffuse involvement

transmural thickening first and then deep, penetrating granulomas. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue. severe diarrhea, rectal bleeding=UC

ileum issues

vitamins, B12, bile acids absorption