GastroIntestinal Disturbances

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Gastro-Intestinal Disturbances

• Nutrition Elimination

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Function

• Digestion
• Transportation
• Absorption
• Elimination

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Structure

• Upper
• Mouth
• Esophagus
• Duodenum (start of small intestine)

• Lower
• Small intestine
• Large intestine

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Assessment

• Physical
• Diagnostic Tests Procedures
• Care/Concerns

• History
• Labs Calcium, Amylase, lipase, CBC,
• Liver function tests, lytes, PH
• Nursing Process

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Nursing Care

• Endoscopy Esophageal, Colon, ERCP, EGD
• Prep and Teaching
• Administering Sedation
• Post-Procedure GAG REFLEX, BP, HYPOVOLEMIA

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Stomach Disturbances

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

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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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Problems associated with Peptic Ulcer Disease

• Hemorrhage
• Perforation
• Obstruction
• Pain
• Surgical Complications
• Nutritional Deficits

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Intestinal Disorders

• Inflammatory
• Crohns Disease
• Diverticuar Disease
• Ulcerative Colitis

• Non-Inflammatory
• Irritable Bowel syndrome
• Obstruction
• Tumors
• Trauma
• Malabsorption

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Irritable Bowel Syndrome

• Women
• Sx pain, diarrhea, constipation,
• DX R/O sigmoidoscopy, colonoscopy
• Interventions Medications, Diet therapy Exercise
  Lifestyle modifications

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Intestinal Obstruction

• Types Partial or Total, Mechanical or
  Non-mechanical
• Complications electrolyte imbalances,
  peritonitis, hypovolemia, death
• Interventions N-G tube, N-I tube, Surgery,

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Obstructions

• Small Bowel
• Abd pain, upper and mid abd.
• Distention
• N/V profuse vomiting
• Obstipation
• SEVERE F/E IMBALANCE
• ALKALOSIS

• Large Bowel
• Intermittent cramping
• Minimal vomiting
• Obstipation or ribbon like stool
• F/E (Usually ok)
• ACIDOSIS
• PG1256

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Intestinal Inflammatory Disorders

• Gastroenteritis
• Diverticular Disease
• Food Poisoning

• Appendicitis
• Crohns Disease
• Ulcerative Colitis

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Inflammatory Intestinal Disorders

• Crohns
• Regional enteritis (any part)
• 5-6 stools/day
• Pg 1275

• Ulcerative Colitis
• Affects mucosal lining and works up
• 10-20 stools/day Psychosocial
• Interventions
• Medications
• Diet

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Peritonitis

• Acute inflammation of the lining
• Complications Fluid Shift-
• Electrolyte Disturbances, Respiratory
• Sx Pain, board like abdomen, N/V, Fever,
• Tachycardia, Fever, Rebound tenderness
• Lack of Bowel Sounds
• Emergency!!!

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Cellular Overgrowth

• Tumors, Carcinoma, Gastric, Liver, Pancreas,
  Colorectal
• Nursing Care DX Depends on treatment
• Medical Surgical resection, medications
• Assessment anemia, upper GI series, EGD
  Esophogastroduodenoscopy, Colonoscopy

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Colostomy Ileostomy Care

• Cellular Overgrowth
• Crohns
• Colitis
• Diverticulitis

• Assess color of stoma and site
• Skin Care
• Function Colostomy in 2-4 days
• Diet
• Self-Image

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Gallbladder Disease

• Cholecystitis
• Sx Pain, N/V
• Rebound Tenderness
• Jaundice
• Labs, Tests
• Diet therapy, Surgery
• T-Tube care

• Cholelithiasis
• Sx Pain
• Jaundice
• DX ultrasound, X-ray
• Diet therapy
• Medications
• Lithotripsy
• Surgery

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Acute pancreatitis

• History Physical Pain, Wt. Loss, N/VLabs
  Amylase, Lipase,glucose, Calcium, bilirubin,
  phosphataseCT, MRI
• Assessment jaundice, history, cullens sign,

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Pancreatic Disorders

• Pain, Altered Nutrition,
• NG tube, NPO, IV therapy AB, Meds of choice for
  pain Demerol
• TPN
• Rest
• Manage DM

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Liver Disorders

• Cirrhosis Laennecs
• Esophageal VariciesNP5 NP5
• Lab Values AST, ALT, bili, NH3, Protein
• Hepatitis 5 types
• Diet, Medications, Comfort, Interventions

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Cirrhosis

• Laennecs
• Complications
• Portal HTN, bleeding
• Coagulation defects
• Portal systemic encephalopathy

• Assess weight, GI, weak, pain, bleeding
• Melena, asterixis
• LOC, personality
• Labs
• RX Diet therapy, lactulose, diuretics,
• Paracentesis, laveen shunt

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Hepatitis

• Clinical Presentation Prevention
• Diagnostic Evaluation
• Complications
• Assessment DX
• Interventions
• Evaluation Education