Gastrointestinal Alterations

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Gastrointestinal Alterations

• Betty Baluski

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GERD
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GERD

• NANDA
• Pain - heartburn r/t reflux of gastric contents.
• Imbalance nutrition less than body requirements
  r/t discomfort of heartburn.

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GERD

• Interventions
• Diet changes
• Stop Smoking
• Medication
• Possible surgery

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Nissen Fudoplication
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Hiatal Hernia
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Hiatal Hernia

• NANDA
• Ineffective health maintenance r/t deficient
  knowledge
• Interventions are the same as those with GERD

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Gastritis

• NANDA
• Deficient Fluid Volume
• Imbalanced Nutrition less than body requirements
  

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Gastritis

• Interventions
• Record IO and Daily Weight
• Rest GI tract NPO advance diet as tolerated
• Monitor for dehydration
• Fluids IV until p.o. can be established

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Gastritis

• Labs
• Medications

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Take a minute to compare notes

• Break into pairs and compare notes

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Peptic Ulcer Disease
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Peptic Ulcer Disease

• NANDA What would you put for your NANDA
  diagnosis?
• Pain
• Imbalance nutrition - Nausea
• Sleep pattern disturbance

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Peptic Ulcer

• Interventions
• Break into pairs
• Come up with three interventions you would for a
  peptic ulcer client.

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Peptic Ulcer

• Interventions
• Monitor Labs
• Education
• The use of NSAID
• Smoking
• Diet - reduce Coffee and alcohol, small frequent
  meals, reduce intake after evening meal and bland
  
• Medications
• Carafate
• Protonix
• PPI, H2 blockers, Motility drugs

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Peptic Ulcer

• Surgery
• Vegotomy
• Gastrectomy
• The patient will be on nasograstric tube suction
  to keep the stomach empty and at rest after
  surgery. After several days and when the stomach
  starts to function normally again the tube will
  be removed and the patient will begin ingesting
  clear liquids and gradually progress to a full
  and normal diet.

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Peptic Ulcer

• Acute bleeding What would you do for bleeding in
  a peptic ulcer patient ?
• Monitor stools and gastric contents for acute
  bleeding.
• Monitor VS and Labs
• IV fluids to maintain Fluid deficient
• Whole blood if needed
• NG tube with irrigation

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Concept Map

• Break into groups of two or three.
• Put together a concept map comparing two upper GI
  disease.
• Include lab test and medications

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Cholelithiasis

• NANDA
• Pain
• Risk for infection
• Imbalanced nutrition
• Which would the
• patient rank first?

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Cholelithiasis

• Interventions
• Diet education
• Low Fat diet
• Low carb
• High protein
• Fat soluble vitamins
• Position for comfort
• Fowlers

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Cholelithiasis

• Monitor Labs and VS
• Bilirubin level
• CBC
• Administer antibiotic as ordered
• Antiemetics
• Pre and Post op care

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Cholelithiasis

• Which of the previous intervention where
  independent nursing?

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Hepatitis a, b, c, and e

• NANDA What are some nursing diagnosis for
  Hepatitis client?
• Risk for infection-transmission
• Imbalanced nutrition
• Disturbed body image -Jaundice
• Disturbed thought processes Hepatic
  Encephalopathy

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Hepatitis a, b, c, and e

• Interventions
• Education
• Vaccine for A and B for all household members
• Watch for reaction. Immune globulin and HBIG
• Prevent transmission

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Hepatitis a, b, c, and e

• Medications some anti viral
• Epivir HBV
• Hepsera
• Diet
• Decreased protein
• Decreased alcohol consumption
• Surgery

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Take a minute to compare notes

• Break into pairs and compare notes
• ANY FUZZY SPOTS?

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Appendicitis

• NANDA
• Risk for infection
• Pain

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Appendicitis

• Interventions
• Ruptured vs. non-ruptured
• Monitor VS
• Maintain IV fluids
• Monitor test results US, CBC,
• Assess pain -McBurneys point

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Appendicitis

• Pre-op and post-op teaching
• Assess wound post-op
• Medications
• Analgesics
• Antibiotics -Flagyl and one other

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Peritonitis

• NANDA What would you put as your NANDA
  diagnosis?
• Pain
• Deficient Fluid Volume

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Peritonitis

• Interventions
• Same as appendicitis plus
• Post procedure care for paracentisis
• Monitor Culture results and sensitivity
• Paritoneal lavage
• NJ tube

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Inflammatory bowel disease
Crohns Disease
Ulcerative colitis
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Inflammatory bowel disease

• NANDA
• Disturbed body image
• Diarrhea
• Imbalance nutrition

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Inflammatory bowel disease

• Diet management
• Identifying antigens
• Increased fiber
• NPO during acute episode
• Maintain fluids
• Medications
• Anti-inflammatory -Asulfidine, Dipentum
• Corticosteroids

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Inflammatory bowel disease

• Surgery
• Pre-op and post op teaching for removal of
  partial or total colon
• Ostomies care for colostomy or ileostomy
• Post-op diet Low-residual
• Support groups
• Monitor nutritional status possible Malabsorption
  Syndrome

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• Which interventions are independent nursing?
• How would you priorities the interventions.

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Intestinal obstruction

• NANDA How does origination apply to the NANDA
  diagnosis?
• Ineffective breathing pattern
• Deficient fluid volume
• Ineffective tissue perfusion

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Intestinal obstruction

• Interventions
• Monitor IO closely
• Monitor VS
• NPO status
• Position fowlers
• Maintain NG or NJ tube patency, position, and
  suction pressure
• Monitor Abdominal Girth

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Diverticular disease

• NANDA
• Impaired Tissue Integrity
• Pain

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Diverticular disease

• Interventions
• Monitor test results Barium enema, CBC CT
  scan,Sigmoidoscopy
• Medications
• Antibiotics
• Analgesics Talwin
• Dietary Management
• High Fiber
• Avoid seeds
• Prevent complications peritonitis, bleeding

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Compare Interventions

• Compare interventions on three lower intestinal
  disorders.
• What are similar?
• What are different?

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GI FACTS

• Approximately 50 of patients with gastric reflux
  develop esophagitis.
• Barrett esophagus is one of the most serious
  complications of GERD because it may progress to
  cancer.

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GI FACTS

• Gastritis affects all age groups. The incidence
  of H pylori infection increases with age.
• Because of gravity, the inciting agents lie on
  the greater curvature of the stomach. This partly
  explains the development of acute gastritis
  distally on or near the greater curvature of the
  stomach in the case of orally administered
  NSAIDs.

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GI FACTS

• Currently, 70 of all gastric ulcers in the
  United States can be attributed to H pylori
  infection.
• NSAID-induced ulcers account for approximately
  25 of gastric ulcers, and PUD is believed to
  develop secondary to the decrease in
  prostaglandin production resulting from the
  inhibition of cyclooxygenase.

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GI FACTS

• Gallstones are 2-3 times more frequent in females
  than in males, resulting in a higher incidence of
  calculous cholecystitis in females.
• Because of the rapid progression of acute
  acalculous cholecystitis to gangrene and
  perforation, early recognition and intervention
  are required.

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GI FACTS

• Appendectomy for patients with a history of
  persistent abdominal pain, fever, and clinical
  signs of localized or diffuse peritonitis,
  especially if leukocytosis is present.
• C-reactive protein (CRP) has been reported to be
  useful in the diagnosis of appendicitis. This
  protein is physiologically produced by the liver
  when bacterial infections occur and rapidly
  increases within the first 12 hours.

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Endoscopic retrograde cholangiopancreatography

• ERCP may be useful in patients at high risk for
  common duct gallstones if signs of common bile
  duct obstruction are present.
• A study performed by Sahai et al (1999) found
  that ERCP was preferred over endoscopic
  ultrasound and intraoperative cholangiography for
  patients at high risk for common duct stones
  undergoing laparoscopic cholecystectomy.
• ERCP allows visualization of the anatomy and may
  be therapeutic by removing stones from the common
  bile duct.
• Disadvantages include the need for a skilled
  operator, high cost, and complications such as
  pancreatitis, which occurs in 3-5 of cases.