Download Care of the Patient Experiencing Problems with the Gastrointestinal

RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
1.
2.
3.
Behavioral Objectives
Apply the terms listed in the content
column appropriate to the client
situations.
Compare and contrast the normal
anatomy and physiology to the
pathophysiology of the disease
processes in the gastrointestinal
system across the lifespan.
Analyze factors included in the
assessment of the client experiencing
complex problems of the
gastrointestinal system, including the
developmental and cultural
considerations.
I.
Content Outline
Application of terms
A. Anasarca
B. Anastomosis
C. Asterixis
D. Bariatric
E. Biliary atresia
F. Celiac disease
G. Esophageal atresia
H. Fistula
I. Gluten free diet
J. Hernias
K. Interstitial edema
L. Ileus
M. Obstipation
N. Osmolatity
O. Steatorrhea
P. Tenesmus
Q. Third spacing
R. Volvulus
II. Anatomy & Physiology of the Gastrointestinal/
accessory organ system
A. Developmental considerations
1. Infant
2. Child
3. Adolescent
4. Adult
5. Older adult
B. Pathophysiology of gastrointestinal system
and accessory organs
III. Gastrointestinal/accessory organs assessment
A. Interview
1. Chief complaint
2. History of present illness
3. Prior medical history
Clinical Objectives
Apply knowledge of how
changes in clients’ personal
behavior improve client’s health.
Learning opportunities
READ:
Lewis (2011)
Lehne (2010)
Identify client’s unmet needs
from a holistic perspective.
Participate in peer review and
quality improvement processes.
Communicate plan of care to
nurses and other
interdisciplinary health care
team members.
McKinney (2009)
VIDEO:
#0159-Dealing With Problems During
Laparoscopic Cholecystectomy
#0164-Laparoscopic Treatment of
Common Duct Stones
Promote a safe, effective
environment conducive to the
optimal health and dignity of the
client.
#0107-Nurse’s View of Endoscopy
Select and carry out safe and
appropriate activities to assist
client to meet basic physiologic
needs, including: circulation,
nutrition, oxygenation, activity,
elimination, comfort, rest and
sleep.
#1113-The Operation: Colon Resection
Use interdisciplinary resources
within the institution to address
ethical and legal concerns.
#1112-The Operation: Liver Transplant
COMPUTER SIMULATION:
#5027-Physical Examination of the
Abdomen
#5041-Apply Critical Thinking to
Nursing Skills: Nutrition and
Elimination
Use current technology to
enhance client care
MEDCOM ONLINE FILMS:
VIDM216-T Caring for the Stoma,
Caring for the Patient: Enterostomal
RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
Behavioral Objectives
4.
5.
6.
7.
Content Outline
Medication history
(prescription/nonprescription)
Family/social/occupational history
Knowledge of health maintenance
Identify risk factors
Clinical Objectives
Identify and communicate
reasons and rationales for
deviation from plan of care to
interdisciplinary health care
team.
Learning opportunities
Nursing
VIDM231-T Diabetes in Clinical Practice
VIDM140-T Nasogastric Intubation,
Balloon Gastronomy Tube Replacement
VIDM133-T Nurses' Guide to Enteral
Feeding Tubes
Review Level II Gastrointestinal
medications
B. Physical exam
1. Bowel sounds
2. Size, shape, and abdominal girth
3. Tenderness/rebound tenderness
4. Pain
5. Nausea/vomiting
6. Hydration status
7. Vital signs
8. Skin color
9. Fluid wave (tympanic wave)
C. Diagnostic tests
1. Laboratory studies
a. Stool
b. Electrolytes
c. Complete blood count (CBC)
d. Liver function tests (LFT)
e. Amylase/lipase
f. Serum albumin
g. Gastric analysis
h. H pylori
i. Serum ammonia
j. Bilirubin
2. Radiology/Imaging
a. Upper GI with/without small bowel
follow through
Promote the effective
coordination of client-centered
health care.
Identify priorities and make
judgments concerning the needs
of multiple clients in order to
organize care.
RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
Behavioral Objectives
4.
Differentiate between the etiology,
pathophysiology, and clinical
manifestations of selected complex
gastrointestinal/accessory problems
Content Outline
b. Barium swallow
c. Barium enema
d. Gall bladder series
e. Gall bladder sonogram
f. Sonogram
g. Flat plate of the abdomen
h. Computed axial tomography (CT)
i. Magnetic resonance imaging (MRI)
3. Invasive
a. Liver biopsy
b. GI biopsy
4. Endoscopic
a. Esophagogastroduodenoscopy
(EGD)
b. Endoscopicretrogradecholangiopancreatgram (ERCP)
c. Colonoscopy (sigmoidoscopy,
proctoscopy, anoscopy)
D. Cultural influences
1. Hereditary
2. Environmental
3. Health beliefs/practices
E. Developmental
1. Age specific assessment data
a. Muscle tone
b. Vital signs
c. Fluid /electrolytes
d. Nutritional
2. Behavioral/emotional response to health
care providers
IV. Complex Gastrointestinal/accessory organ
problems
A. Peptic ulcer disease
B. Gallbladder disease
C. Inflammatory bowel disease
1. Regional enteritis (Crohn’s)
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
Behavioral Objectives
5.
Discuss analysis, planning,
implementation and evaluation for the
nursing management of clients with
complex gastrointestinal
problems/accessory organs.
Content Outline
2. Ulcerative colitis
D. Diverticulosis/diverticulitis
E. Diabetes Mellitis
F. Hepatitis
G. Liver Failure
H. Pancreatitis
I. Morbid Obesity
V. Selected nursing diagnoses/selected nursing
implementation
A. Fluid and electrolyte imbalance
1. Independent interventions
a. Abdominal assessment
b. Age related hydration status
c. Intake and output
d. Monitor pertinent diagnostic tests
e. Maintain skin integrity
2. Collaborate interventions
a. Administer replacement fluid
(1) Intravenous therapy
(2) Total parenteral nutrition (TPN)
b. Administer medications and monitor
for desired effects/adverse
effects/side
(1) Antidiarrheal
(2) Steroids
(3) H-2 receptor antagonist
(4) Antisecretory
(5) Mucosal barriers
(6) Antacids
(7) Antibiotics
(8) Vitamins
(9) Stool softeners
(10) Laxatives
(11) Anticholinergic
(12) GI stimulant
(13) Antiemetic
(14) Proton pump inhibitors
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
Behavioral Objectives
3.
4.
Content Outline
(15) Pancreatic enzymes
(16) Insulins
(17) Antidiabetics
c. Gastric therapy
(1) Lavage
(2) Nasogastric
(3) Sengstaken-Blakemore
d. Paracentesis
Recognition of complications
a. Hemorrhage
b. Portal hypertension
(1) Esophageal varices
(2) Ascites
(3) Anasarca
c. Hepatic encephalopathy
d. Clotting disorders
e. Paracentesis
f. Pernicious anemia
g. Perforation/peritonitis
h. Hypovolemic shock
i. Hyperglycemia
j. Hypercalcemia
k. Malnutrition
l. Bowel obstruction
m. Impaired skin integrity
n. Infection
o. Septic shock
p. Skin excoriation
q. Diabetic Ketoacidosis (DKA)
r. Hyperglycemic hyperosmolar nonketotic coma (HHNK)
The client will have improved fluid and
electrolyte balance as evidenced by
a. Demonstrate no signs and symptoms
of dehydration
b. Improved laboratory studies
c. Increase intake of fluids to a
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
Behavioral Objectives
Content Outline
specified
d. amount according to age and
metabolic
e. needs
f. Maintains adequate bowel
elimination
g. Vital signs
B. High risk for post op complications
1. Surgical modalities
a. Cholecystectomy
b. Gastrectomy
c. Pyloroplasty
d. Colostomy
e. Ileostomy
f. Colon resection /Colectomy
g. Peritoneal venous shunt
h. Inguinal herniorrhaphy
i. Porta-caval anastomosis
j. Liver transplant
k. Gastric by-pass surgery
2. Independent interventions
a. Review all pertinent assessments
b. NG tube maintenance / mouth care
c. I &0
d. V/S
e. Foley care
f. Anti embolic stockings
g. Ankle exercises; ROM
h. Incentive spirometry
i. Monitor IV / site care
j. Position for comfort
k. Assessment wound; wound care
l. See NCP for pain
m. Encourage activity as tolerated
n. Safety considerations
o. Monitor pertinent lab values
p. Colostomy care
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
Behavioral Objectives
Content Outline
q. Report unexpected observations
3. Collaborative interventions
a. Administer medications and monitor
for desired effects/adverse effects/
side effects
(1) Antibiotics
(2) Narcotics
(3) Prophylactic heparin / lovenox
b. Collaborate with enterostomal
therapist
c. Collaborate with registered dietitian
d. Oxygen support
4. Recognition of complications
a. Hemorrhage
b. Infection: wound and systemic
c. Paralytic ileus
d. Peritonitis
e. Delayed wound healing:
dehiscence, evisceration
f. Malnutrition
g. Dumping syndrome
h. Bowel obstruction
i. Adhesions
j. Pernicious anemia
5. The client will not experience post-op
complications as evidenced by:
a. Wound healing
b. Vital signs
c. Bowel sounds
d. Abdominal girth
e. Homans sign
f. Tolerates diet
g. Laboratory studies
C. Altered health maintenance: Knowledge
deficit
1. Client teaching
a. Assess readiness to learn, ability,
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
Behavioral Objectives
Content Outline
knowledge
b. Avoid aggravating factors
c. Promotion of alleviating factors
avoid activities that increase
intra-abdominal pressure (lifting)
d. Reportable signs/symptoms
e. Wound care
f. Ostomy care
g. Medication teaching
h. Rest/activity
i. Risk factors
j. Life style modifications
k. Nutritional
(1) High fiber / high residue
(2) Low fiber/low residue
(3) High protein
(4) Regular diet
(5) Low fat
l. Maintenance of fluid balance
(age specific)
m. Diabetic teaching
2. Community Resources
a. American Ostomy Association
b. National Foundation for Ileitis and
Colitis
c. Alcoholics Anonymous
d. Public Health Department
e. Home health
f. American Diabetes Association
g. Juvenile Diabetes Association
h. National Bariatric Association
3. The client will have improved health
maintenance as evidenced by:
a. Identifying aggravating and
alleviating factors
b. Identifying reportable signs and
symptoms
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit IV - Care of the Client Experiencing Problems with the Gastrointestinal System and its Accessory Organs
Behavioral Objectives
Content Outline
Describing the purpose, correct
administration and side effects of
meds
d. Ability to discuss diagnosis, surgical
procedure, and post care
e. Demonstrates osmotic care
f. Increasing activity as tolerated
g. Achieves optimum level of nutrition
through prescribed diet
h. Utilizing community resources
D. Ineffective Individual coping: anxiety, fear
powerlessness, dependence.
Review Unit III-Care of the Client
Experiencing Respiratory Problems
E. Body Image Disturbance.
Review Unit V-Care of the Client
Experiencing Cancer
Clinical Objectives
Learning opportunities
c.
n:soph\fall\Unit IV Gastro
Revised 07/11