VN235

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VN235

• UPPER
• GASTROINTESTINAL
• DISORDERS
• Edited by Susan Radloff, MSN, RN

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GI TRACT

• Oral cavity and pharynx
• Esophagus
• Stomach
• Small intestine
• Large intestine

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ORAL CAVITY PHARYNX

• Mechanical digestion
• Amylase starch to maltose
• Swallowing

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Esophagus

• Food from pharynx to stomach
• Peristalsis
• LES lower esophageal sphincter,
  gastro-esophageal sphincter or cardiac sphincter

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STOMACH

• Reservoir
• Rugae
• Mucosa
• Pepsinogen
• Hydrochoric acid
• Gastrin
• Carbohydrates

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SMALL INTESTINE

• Stomach to cecum
• Bile from liver
• Enzymes from pancreas
• Sucrase, maltase, lactase
• Complete digestion
• Absorption

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Large Intestine

• Ileum to anus
• Cecum with appendix
• Ascending, transverse
• and descending colon
• Stores
• Eliminates
• Absorbs water, minerals and vitamins

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AGE-RELATED CHANGES

• Mouth
• Esophagus
• Stomach
• Large and small intestines

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LABORATORY TESTS

• CEA
• CBC
• Electrolytes
• Stools for occult blood
• Stools for ova and parasites
• Stool cultures

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RADIOGRAPHIC TESTS

• Flat plate of ABD
• UGI
• Lower GI
• Computed Tomography
• Endoscopy

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FLAT PLATE OF ABD

• Detect abnormalities
• No metal attachments on client
• Avoid if pregnant

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UPPER GI

• Esophagus, stomach, duodenum and jejunum
• Oral radiopaque contrast medium barium
• Strictures, ulcers, tumors, hiatal hernias
• Liquid supper and NPO 6-8 hours before
• Laxative and increase water intake after

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LOWER GI SERIES

• Barium enema
• Tumors, diverticula, stenosis, obstructions,
  inflammation, ulcerative colitis, polyps
• Low residue to clear liquid diet for 2 days
• GoLYTELY and enemas before
• Increase water intake after

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COMPUTED TOMOGRAPHY

• CT scan
• Diluted oral barium
• Abnormal masses
• Clear liquid diet before
• Consent for IV contrast medium allergy?
• NPO 2-4 hours before

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COLONOSCOPY

• Flexible endoscope
• Conscious sedation
• Biopsy polyps
• Liquids 24 hours NPO after MN GoLYTELY
  Dulcolax enema before
• Monitor for pain
• bleeding after

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ULTRASONOGRAPHY

• Noninvasive diagnostic technique
• Detect cholelithiasis, cholecystitis,
  appendicitis
• Endoscopic stage GI cancers
• NPO 8-12 hours before

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GI INTUBATION

• Decompression remove flatus and fluids
• Diagnosis GI motility and analysis
• Treat obstructions or bleeding
• Dietary gavage feeding
• Prevent postoperative distention
• Lavage irrigate stomach to remove toxins

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NASOGASTRIC FEEDING
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FEEDING TUBE SITES
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ENTERAL NUTRITION

• Indications
• Inability to swallow
• Severe burns,cancer or trauma to face or jaw
• Debilitation
• Neurological disorders
• Respiratory failure with prolonged intubation

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ENTERNAL FORMULAS

• Basic formula
• 54 carbohydrate
• 16 protein
• 30 fat
• 1 cal / ml 1.5 cal /ml 2 cal /ml

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ENTERNAL FORMULAS

• Low residue Isocal Osmolite
• Concentrated Magnacal TwoCal HN
• Fiber supplemented Jevity Ultracal
• Renal Nephro
• Glucose intolerant Glucerna
• Pulmonary Pulmocare
• Others?

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NURSING CARE

• Verify placement
• Semi-Fowlers position
• Auscultate while injecting air
• Aspirate secretions return secretions
• Some facilities pH testing X-ray
• Check residual hold if over 50 mL

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NURSING CARE

• Intermittent 300-500 ml at intervals
• Continuous infusion pump
• Cyclic 12-16 hours at night with regular diet
  during day
• Bowel rest continuous feeding turned off for 4
  hours at night
• Provide adequate amount of water

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PARENTERAL NUTRITION

• TPN total parenteral nutrition contains
  dextrose, amino acids, vitamins, minerals and
  fats (central line)
• Burns, trauma, cancer, AIDS, malnutrition,
  anorexia nervosa, certain surgeries
• Peripheral parenteral nutrition less than 12
  dextrose (peripheral line)
• LVN responsibility glucose monitoring

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ORAL INFLAMMATORY DISORDERS

• Stomatitis
• Canker sores small white painful ulcers
• Topical tetracycline or benzocaine
• Herpes Simple Virus Type I Cold sores or fever
  blisters
• Acyclovir ointment PO acyclivir

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ORAL AND ESOPHAGEAL CANCER

• First noted by Dentist or Dental Hygienist
• Common cause is alcohol and tobacco
• Dietary deficiencies and smoked meats
• Squamous cell cancer
• Biopsy, radiation, chemotherapy, surgery

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HIATAL HERNIA

• Signs and symptoms
• Pain, heartburn, feeling of fullness, reflux
• Treatment
• Antacids, small meals, sit up after eating
• Avoid bedtime snacks, spices, alcohol, caffeine,
  smoking
• Surgical repair

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HIATAL HERNIA
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GASTRITIS

• Inflammation of the gastric mucosa
• Irritating foods
• ASA NSAIDS
• Excessive alcohol intake
• Helicobacter pylori
• Bile reflux
• May be acute or chronic

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GASTRITIS

• Symptoms
• Abdominal discomfort
• Nausea
• Anorexia
• Treatment
• Bland diet
• Antacids

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GASTROESOPHAGEAL REFLUX DISEASE

• Related to hiatal hernia
• Heartburn, regurgitation, dysphagia,
  hypersalivation. R/O heart attack!
• Antacids, sucralfate, histamine reception
  blockers, gastric acid pump inhibitors

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PEPTIC ULCER

• Erosion of a circumscribed area of the mucous
  membrane and possibly muscle tissue
• Esophagus, pylorus, lesser curvature,
• duodenum
• Stress ulcer in gastroduodenal area

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CAUSATIVE FACTORS

• H. pylori 80 of gastric ulcers and 90 duodenal
  ulcers
• Excessive secretion of hydrochloric acid
• and pepsin

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CLINICAL MANIFESTATIONS

• Dull gnawing pain or burning sensation in high
  left epigastrium or in the back
• Pain relieved by eating (3 AM snack)
• Sharp localized tenderness with palpation
• Pyrosis (heartburn)
• Vomiting of undigested food
• Diarrhea or constipation
• Bleeding (tarry stools)

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DIAGNOSTIC TESTS

• Upper GI
• Endoscopy
• Stool for occult blood
• H. pylori breath test
• H. pylori serum test for antigen

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H. PYLORI BREATH TEST
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MEDICATIONS

• H. Pylori
• Triple therapy with two antibiotics
• H/2 receptor antagonists decrease acid secretion
• Proton pump inhibitor decrease acid secretion
• Cytoprotective agents protect mucosa
• Pepto-Bismol

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NURSING DIAGNOSES

• Acute pain R/T disruption of GI mucosa
• Risk for injury R/T complications of peptic ulcer
  activity such as hemorrhage or perforation
• Deficient knowledge R/T lack of exposure to
  peptic ulcer disease and its treatment

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GASTRIC BLEEDING

• Caused by ulcer perforations, tumors, gastric
  surgery
• Mild bleeding slight weakness or diaphoresis
• Hemorrhage hypotension weak, thready pulse
  chills palpitations diaphoresis

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CAUSES OF GASTRIC CANCER

• H. pylori infection
• Pernicious anemia
• Diet high in smoked fish low in fruits and
  vegetables
• Exposure to occupational substances

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SURGICAL COMPLICATIONS

• Distention
• Hemorrhage
• Dumping syndrome
• Nutritional problems/deficiencies
• Pernicious anemia
• Steatorrhea
• Pyloric obstruction

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BARIATRIC SURGERY

• Indicated for clients who do not respond to
  medical methods of weight loss or BMI is 40 or
  above
• Produce weight loss by restriction or
  malabsorption
• Roux-en-Y
• Vertical banded gastroplasty
• www.asbs.org

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GROUP WORK

• Nursing Diagnoses