Chapter 5 Nursing Care of Patients With Digestive

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Chapter 5Nursing Care of Patients With Digestive
Gastrointestinal Disorders
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Acute Gastritis

• Causes
• 1. Eating too much or too rapid.
• 2. Eating contaminated foods.
• 3. Alcohol, NSAID, and bile reflux.
• Clinical Manifestations
• 1. Abdominal discomfort.
• 2. Nausea, vomiting, and anorexia.
• 3. Headache.
• 4. Hiccuping.

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Acute Gastritis (contd)

• Management
• 1. The patient usually recovers within few days
  
• spontaneously.
• 2. If bleeding present, it needs surgery.

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Chronic Gastritis

• Causes
• 1. Benign or malignant ulcers of stomach.
• 2. Bacteria Helicobacter Pylori (H. Pylori).
• 3. Smoking and alcohol.
• Diagnostic Investigation
• 1. Upper GIT endoscopy and biopsies.
• 2. Serologic testing for H. Pylori antigen-
  antibodies.

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Chronic Gastritis (contd)

• Clinical Manifestations
• 1. Heart burn after eating.
• 2. Anorexia, nausea and vomiting.
• 3. Sour taste in the stomach.
• 4. Belching.
• 5. Vitamin B12 deficiency.
• Medical Management
• 1. No irritating diet.
• 2. Antibiotics.
• 3. Vit. B12 IM injection.

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Chronic Gastritis (contd)

• Nursing Management
• 1. Stress reduction techniques.
• 2. Promoting optimal nutrition
• a. Keep patient NPO.
• b. When the symptoms subside , offer ice
  chips
• followed by clear fluid diet then
  regular diet.
• 3. Promoting fluid and electrolytes balance.
• 4. Relief pain
• a. Avoid irritating foods.
• b. Discourage smoking and alcohol.

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Gastric Duodenal Ulcers

• Peptic ulcer is excavation in mucosal wall of
  stomach, pylorus, duodenum, or esophagus.
• Causes
• 1. Result from infection with H. pylori or
  Zollinger-
• Ellison syndrome.
• 2. Stress ulcer caused by stressful event such
  as
• a. Burns.
• b. Shock.
• c. Sever sepsis.
  

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Gastric Duodenal Ulcers (contd)

• Predisposing Factors
• 1. Heredity.
• 2. Blood group O.
• 3. Smoking and alcohol.
• 4. Long use of NSAIDs.
• 5. Anxiety.
• Clinical Manifestations
• 1. Epigastric pain or in the back.
• 2. Vomiting ( in duodenal ulcer).
• 3. Constipation.
• 4. Bleeding.

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Gastric Duodenal Ulcers (contd)

• Medical Management
• 1. Smoking cessation encouraged.
• 2. Medications
• a. Histamine receptor antagonists ( H2
  receptor
• antagonist) ranitidine.
• b. Proton pump inhibitors (Omeprazole)
• c. Antibiotics.
• 3. Surgical intervention is recommended for
  intractable
• ulcers( those who fail to heal after
  12-16 weeks).
• Vagotomy, Pyloroplasty, Partial or total
• gastroectomy.

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Gastric Duodenal Ulcers (contd)
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Gastric Duodenal Ulcers (contd)
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Gastric Duodenal Ulcers (contd)
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Gastric Duodenal Ulcers (contd)

• Nursing Management
• 1. Preoperative care
• a. preparing patient for diagnostic
  procedures.
• b. Limiting oral intake.
• c. Clearing and emptying the GIT.
• - NGT inserting.
• - Mechanical (Gumco) and manual /2hrs
  suctioning.
• - enema for emptying colon.
• 2. Monitoring and managing complications of
• hemorrhage, perforation, and pyloric
  obstruction.

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Gastric Cancer

• Causative Factors
• 1. Heredity.
• 2. Gastric ulcers.
• 3. Pernicious anaemia.
• 4. Chronic gastritis.
• 5. Foods lacking fruits and vegetables.
• Clinical Manifestations
• 1. Indigestion, abdominal pain.
• 2. Anorexia, weight loss.
• 3. Anaemia, constipation.

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Gastric Cancer (contd)

• Diagnostic Evaluation
• 1. Endoscopy and biopsy.
• 2. Barium swallow.
• 3. CT scan to the other organs to evaluate the
  extent of
• the metastasis.
• Medical Management
• 1. Surgical removal of tumour.
• 2. Chemotherapy.
• 3. Radiotherapy.

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Gastric Cancer (contd)

• Nursing Management
• 1. Providing optimal nutrition.
• a. Provide small frequent diet
  (nonirritating)
• b. Supplements high calories, high vitamin
  A, C and
• iron diet.
• c. Intake and output monitoring and weight
  daily.
• d. Administer B12 IM inj. If total
  gastrectomy
• performed.
• 2. Relief of pain.
• a. Pharmacologic (analgesics, opiods in
  severe pain)
• b. Non pharmacologic (relaxation techniques)
• 3. Psychosocial support.

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Hepatic Dysfunction

• Clinical Manifestations
• 1. Jaundice- hemolytic, hepatocellular,
  obstructive, and
• hereditary hyperbilirubinemia.
• 2. Portal hypertension.
• 3. Esophageal varices.
• 4. Ascites.
• Hepatitis refers to inflammation of the liver.

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Hepatic Dysfunction (contd)
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Hepatitis (contd)

• Hepatitis Causes
• 1. Infection.
• 2. Chemical.
• 3. Radiation.
• Viral Hepatitis
• 1. Hepatitis A Virus (HAV)
• 2. Hepatitis B Virus (HBV)
• 3. Hepatitis C Virus (HCV)
• 4. Hepatitis D Virus (HDV)
• 5. Hepatitis E Virus (HEV)

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Hepatitis (contd)

• Hepatitis A Virus (HAV)
• - Transmitted through faecal- oral route.
• - Incubation period 1-7 weeks.
• - Prognosis rarely progress to acute liver
  necrosis or death. No carrier state exists.
• Hepatitis B Virus (HBV)
• - Transmitted through blood.
• - Incubation period 4-12 weeks.

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Hepatitis (contd)

• - Prognosis
• a. Mortality rate is 10.
• b. 10 of patients progress to carrier state
  or chronic
• hepatitis.
• c. It is the main cause of cirrhosis and
  hepatocellular
• carcinoma.
• - Signs symptoms
• a. Jaundice, abdominal pain.
• b. Fever, loss of appetite.

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Hepatitis (contd)

• - Prevention
• a. Preventing transmission.
• b. Active immunization (hepatitis B vaccine)
• c. Passive immunity (hepatitis B immune
  globulin)
• Hepatitis C Virus (HCV)
• - Transmitted through blood, needles, sharp
  objects.
• - Incubation period 15-160 days.
• - Signs symptoms are similar to HBV.
• - Prognosis
• a. Liver cirrhosis and cancer.
• b. Chronic carrier state occurs frequently.

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Hepatic Encephalopathy and Coma

• Results from accumulation of ammonia and other
  toxic metabolites in the blood.
• Hepatic coma represents most advanced stage of
  hepatic encephalopathy.
• Clinical manifestations
• 1. Mental changes.
• 2. Motor disturbances.
• 3. Asterixis.
• 4. Constructional apraxia.

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Cholecystitis Cholelithiasis

• Inflammation of gallbladder and stone formed in
  the gallbladder.
• Clinical Manifestations
• 1. Changes in the urine and stool colour.
• 2. Fat soluble vitamin deficiency.
• 3. Pain and billiary colic.
• 4. Jaundice.
• Diagnostic Evaluation
• 1. Abdominal X ray.
• 2. Ultrasonography.

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Cholecystitis Cholelithiasis (contd)

• Medical Management
• 1. Medications to dissolve stone.
• 2. Antibiotics.
• 3. Removal of gallbladder (cholecystectomy)
• Nursing Management
• 1. Provide rest.
• 2. NG suctioning.
• 3. Provide low fat diet.
• 4. Provide pre post op. care.

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Appendicitis

• Appendicitis is an inflammation of appendix.
• Causes
• 1. Kinking.
• 2. Occlusion.
• Clinical Manifestations
• 1. Right lower quadrant pain.
• 2. Nausea, vomiting and anorexia.
• 3. Lower grade fever.
• 4. Rebound tenderness.

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Appendicitis (contd)

• Diagnostic Evaluation
• 1. CBC (WBCs gt 10,000/mm³)
• 2. X-ray and abdominal ultrasound.
• Medical Management
• 1. IV fluids and antibiotics.
• 2. Surgical removal of appendix (appendectomy)
• Nursing Management
• Pre postoperative patient care (see chapt.
  1)

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Haemorrhoids

• Haemorrhoids are dilated portions of veins in the
  anal canal.
• Causes
• 1. Pregnancy.
• 2. Obesity.
• 3. Chronic constipation.
• 4. long sitting or standing.
• Clinical Manifestations
• 1. Itching and pain with defecation.
• 2. Bright red bleeding with defecation.

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Haemorrhoids (contd)

• Medical Management
• Surgical removal of haemorrhoids
  (haemorrhoidectomy)
• Nursing Management
• 1. Provide high fibers diet and increase fluids
  intake.
• 2. Administer stool softeners, analgesics as
  prescribed.
• 3. Provide sitz baths or warm compresses.
• 4. Instruct the patient to do proper personal
  hygiene and
• to avoid excessive straining during
  defecation