Interventions for clients with stomack and intestinal disorders.

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Interventions for clients with stomack and
intestinal disorders.
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Stomach Disturbances

• Gastritis
• Peptic Ulcer Disease
• Gastric Surgery
• Zollinger-Ellison Syndrome
• Dumping Syndrome

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Gastritis

• Gastritis is defined as inflammation of the
  gastric mucosa two types
• Acute gastritis
• Chronic gastritis
• Type A gastritis
• Type B gastritis
• Atrophic gastritis
• Helicobacter pylori, Escherichia coli can cause
  gastritis.

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Clinical Manifestations

• Bloating
• Hematemesis
• Abdominal tenderness
• Melena
• Intravascular depletion and shock

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Nonsurgical Management

• Primary treatment identification and elimination
  of causative factors
• Drug therapy
• H2-receptor antagonists
• Antacids
• Antisecretory agents
• Vitamin B12
• Triple therapy for H. pylori infection

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Other Therapies

• Diet therapy
• Limit intake of foods and spices that cause
  distress (tea, coffee, cola, chocolate, mustard,
  paprika, cloves, pepper, and hot spices), as well
  as tobacco and alcohol.
• Stress reduction

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Surgical Management

• Partial gastrectomy
• Pyloroplasty
• Vagotomy
• Total gastrectomy

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Peptic Ulcer Disease

• PUD is a mucosal lesion of the stomach or
  duodenum as a result of gastric mucosal defenses
  impaired and no longer able to protect the
  epithelium from the effects of acid and pepsin.
• Acid, pepsin, and Helicobacter pylori infection
  play an important role in the development of
  gastric ulcers.

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Duodenal Ulcers

• Most duodenal ulcers occur in the first portion
  of the duodenum.
• Duodenal ulcers present as deep, sharply
  demarcated lesions that penetrate through the
  mucosa and submucosa into the muscularis propria.

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Differentiating Gastric and Duodenal Ulcers

• Gastric Ulcer
• Increase of pain with eating, antacids 30min
• Hematemesis

• Duodenal Ulcer
• Relief with food, antacids 90min-3hr
• Pain awakens at night
• Melena

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Stress Ulcers

• Acute gastric mucosa lesions occurring after an
  acute medical crisis or trauma
• Associated with head injury, major surgery,
  burns, respiratory failure, shock, and sepsis.
• Principal manifestation bleeding caused by
  gastric erosion

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Complications of Ulcers

• Hemorrhagehematemesis
• Perforationa surgical emergency
• Pyloric obstructionmanifested by vomiting caused
  by stasis and gastric dilation
• Intractable diseasethe client no longer responds
  to conservative management, or recurrences of
  symptoms interfere with ADLs

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Clinical Manifestations

• Epigastric tenderness usually located at the
  midline between the umbilicus and the xiphoid
  process
• Dyspepsia
• Typically described as sharp, burning, or gnawing
  pain
• Sensation of abdominal pressure or of fullness or
  hunger

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Acute or Chronic Pain

• One of the primary purposes for employing drug
  therapy is to eliminate or reduce pain.
• Analgesics are not the mainstay of pain relief
  for PUD.
• Ulcer drug regimen itself promotes relief of pain
  by eradicating H. pylori infection and promoting
  healing of the gastric mucosa.

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Drug Therapy

• Four primary goals for drug therapy
• Provide pain relief
• Eradicate H. pylori infection
• Heal ulcerations
• Prevent recurrence

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Hyposecretory Drugs

• Hyposecretory drugs produce a reduction in
  gastric acid secretion.
• Antisecretory agents
• H2-receptor antagonists
• Prostaglandin analogues

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Antisecretory Agents

• Antisecretory agents, also called proton pump
  inhibitors, include
• Prilosec
• Prevacid
• Aciphex
• Protonix
• Nexium
• H2-Receptor Antagonists
• Drugs that block histamine-stimulated gastric
  secretion
• May be used for indigestion and heartburn
• Block the action of the H2-receptors of the
  parietal cells, thus inhibiting gastric acid
  secretion
• The most common Zantac, Pepcid, and Axid

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Prostaglandin Analogues

• These agents reduce gastric acid secretion and
  enhance gastric mucosal resistance to tissue
  injury.
• Misoprostol (Cytotec) helps prevent NSAID-induced
  ulcers.
• Uterine contraction is a significant adverse
  effect of misoprostol.

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Antacids

• Antacids buffer gastric acid and prevent the
  formation of pepsin they are effective in
  accelerating the healing of duodenal ulcers.
• The most widely used preparations are mixtures of
  aluminum hydroxide and magnesium hydroxide, such
  as Mylanta or Maalox.
• For optimal effect, take about 2 hr after meals.
• Antacids can interact with certain drugs and
  interfere with their effectiveness.

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Mucosal Barrier Fortifiers

• Sucralfate (Carafate) is a sulfonated
  disaccharide that forms complexes with proteins
  at the base of a peptic ulcer this protective
  coat prevents further digestive action of both
  acid and pepsin.
• Sucralfate binds bile acids and pepsins, reducing
  injury from these substances.
• The main side effect of sucralfate is
  constipation.

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Diet Therapy

• Diet therapy may be directed toward neutralizing
  acid and reducing hypermotility.
• A bland, nonirritating diet is recommended during
  the acute symptomatic phase.
• Avoid bedtime snacks.
• Avoid alcohol and tobacco.

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Irritable Bowel Syndrome (IBS)

• IBS is a chronic gastrointestinal disorder
  characterized by chronic or recurrent diarrhea,
  constipation, and/or abdominal pain and bloating.
• Manning criteria are present
• Abdominal pain relieved by defecation
• Abdominal distention
• The sense of incomplete evacuation of stool
• The presence of mucus with stool passage
• A flare-up of symptoms usually brings the client
  to the health care provider.

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Treatment

• Educationteaching the client to avoid problem
  stimulants
• Diet therapyelimination of offending or
  upsetting foods
• Drug therapybulk-forming laxatives,
  antidiarrheal agents, anticholinergic agents,
  tricyclic antidepressants, and 5-HT4 agonists.
• Stress management based on the clients current
  and ongoing stressors
• Complementary and alternative therapies used to
  reduce symptoms and discomfort

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Herniation

• Weakness in the abdominal muscle wall through
  which a segment of bowel or other abdominal
  structure protrudes
• Types of hernia include
• Indirect inguinal
• Direct inguinal
• Femoral
• Umbilical
• Incisional or ventral

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Surgical Management

• Preoperative careNPO day of surgery
• Operative procedure
• Minimally invasive inguinal hernia repair (MIIHR)
• Conventional herniorrhaphy
• Postoperative care in minimally invasive inguinal
  hernia repair includes
• Elevate scrotum to prevent and control swelling.
• Address difficulties in voiding that may occur.
• Observe for signs and symptoms of complications.

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Colorectal Cancer

• Colorectal refers to the colon and the rectum,
  which together make up the large intestine.
• 95 of cancers of the colon or rectum are
  adenocarcinomas.
• Etiology
• Genetic considerations
• Personal factors
• Dietary factors
• Inflammatory bowel disease

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Clinical Manifestations

• Rectal bleeding, hematochezia, passage of red
  blood via the rectum
• Anemia
• Change in stool texture
• Mass in abdomen

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Laboratory Assessment

• Hemoglobin and hematocrit values usually
  decreased
• Fecal occult blood test
• Possible elevation of carcinoembryonic antigen
• Radiographic assessment
• Other diagnostic assessments

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Surgical Management

• Colon resection
• Colectomy
• Abdominoperineal resection
• Colostomy
• Transanal approach

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Surgical Management

• Preoperative care includes
• Consultation with enterostomal therapist
• Discussions with surgeon of risk of sexual and
  urinary dysfunctions
• Bowel prep
• Nasogastric tube and IV line placed for use after
  surgery
• Assignment of case manager for long-term
  consequences

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Surgical Management

• Postoperative care includes
• Colostomy and wound management
• Nasogastric tube
• Colostomy management
• Wound management

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Colostomy Care

• Normal appearance of the stoma
• Signs and symptoms of complications
• Measurement of the stoma
• Choice, use, care, and application of appropriate
  appliance to cover stoma
• Measures to protect the skin
• Dietary measures to control gas and odor
• Resumption of normal activities

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Intestinal Obstruction

• Mechanical obstruction
• Nonmechanical obstruction, known as paralytic
  ileus
• Strangulated obstruction resulting from tumors,
  hernias, fecal impactions, strictures,
  intussusception, volvulus, fibrosis, vascular
  disorder, and adhesions

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Clinical Manifestations of Mechanical Obstruction

• Midabdominal pain or cramping
• Vomiting
• Obstipation
• Diarrhea
• Alteration in bowel pattern and stool
• Abdominal distention
• Borborygmi
• Abdominal tenderness

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Clinical Manifestations of Nonmechanical
Obstruction

• Constant diffuse discomfort
• Abdominal distention
• Decreased to absent bowel sounds
• Vomiting
• Obstipation

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Assessment

• Laboratory assessment
• Radiographic assessment
• Endoscopy
• Barium enema
• Computed tomography

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Surgical Management

• Preoperative care
• Teaching
• Nasogastric intubation and suction if time
  permits
• Operative procedure exploratory laparotomy to
  determine procedure
• Postoperative care
• Exploratory laparotomy
• Nasogastric tube in place
• Usual postoperative care

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Abdominal Trauma

• Injury to the structures located between the
  diaphragm and the pelvis, including the large or
  small bowel, liver, spleen, duodenum, pancreas,
  kidneys, and urinary bladder
• Blunt abdominal trauma, which often occurs in
  motor vehicle accidents
• Penetrating abdominal trauma caused by gunshot
  wounds, stabbing

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Assessment

• Assess airway, breathing, and circulation
• Assess for the following
• Hypovolemic shock
• Cullens sign
• Turners sign
• Ballances sign
• Kehrs sign

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Emergency Care Abdominal Trauma

• Two large-bore intravenous lines are placed
• Central venous catheter
• Balanced saline solution, crystalloids, and
  possibly blood
• Arterial blood gas assessment
• Fluid and electrolyte management
• Continuous hemodynamic monitoring
• Surgical management

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Polyps

• Small growths in the intestinal tract that are
  covered with mucosa and are attached to the
  surface of the intestine
• Various types
• Usually asymptomatic, but can cause gross rectal
  bleeding, intestinal obstruction, and
  intussusception
• Nursing care focused on teaching

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Hemorrhoids

• Unnaturally swollen or distended veins in the
  anorectal region
• Internal hemorrhoids
• External hemorrhoids
• Nonsurgical management
• Surgical management hemorrhoidectomy

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Malabsorption Syndrome

• Syndrome associated with a variety of disorders
  and intestinal surgical procedures
• Primary clinical manifestations Diarrhea and
  steatorrhea
• Interventions
• Dietary management
• Surgical or nonsurgical management
• Drug therapy