Download Gastroesophageal Reflux Disease (GERD)

Gastronintestinal Issues and
Management

What are the primary areas of concern for the
patient with any stomach disorder?

Major stomach disorders Iggy p. 1126-1128
 Gastritis
 Peptic ulcer
Gastric
Duodenal
Stress
disease
1
Gastroesophageal Reflux
Disease (GERD)
 Esophageal
assessment
 Evidence-based
information
Noninvasive diagnostic procedures
Antacids, histamine antagonists
 Priority
nursing interventions
2
Ulcer Formation
3
Peptic Ulcers
4
Benign Gastric Ulcer
5
Duodenitis
6
Duodenal Ulceration
7
Irritable Bowel Syndrome Iggy p. 1144

Most common digestive disorder
 One in five people in the U.S.

Classifications:
 IBS-D (diarrhea)
 IBS-C (constipation)
 IBS-A (alternating diarrhea/constipation)
 IBS-M (mix of diarrhea/constipation)

Etiology: Unclear
 Thought to associated with maladaption to stressors
8
Irritable Bowel Syndrome (Cont.)

Health teaching
 30-40 grams of fiber daily
 Promote normal bowel function

Drug therapy
 Symptom specific

Stress reduction
 Relaxation
 Meditation
 Yoga
9
Common Abdominal Hernias Iggy p. 1146
10
Colostomies Iggy p. 1153, HF p. 752
11
Colostomy Care

Normal appearance of stoma

Signs and symptoms of complications

Measurement of stoma

Choice, use, care, application of appropriate
appliance to cover stoma

Measures to protect skin

Dietary measures to control gas and odor

Resumption of normal activities
12
Diarrhea HF. 758

Causes
 Spoiled foods or excessively spicy foods
 Bacteria
(Escherichia coli), virus, toxins (c.
diff.)
 Drug
reactions
 Fecal
impaction, laxative abuse
 Malabsorption
disorders, bowel tumor,
inflammatory bowel disease
 Stress,
anxiety
Antidiarrheals
 Purpose
Decrease
hypermotility
 Caution
Should
not be used for more than
2 days or if fever is present
 Types
Opiates and opiate-related agents
Somatostatin analog
Adsorbents
Antidiarrheals (cont’d) Iggy p. 1166

Opiates and opiate-related agents
 Camporated opium tincture (Paregoric)
 Only used with enteral feeding associated
diarrhea
 Diphenoxylate
with atropine (Lomotil)
 Loperamide (Imodium)
 Opiates decrease GI
motility
 Opiates may cause respiratory depression
 Especially children and older adults
 May cause physical dependence
 Atropine contraindicated in glaucoma
Antidiarrheals (cont’d)

Somatostatin analog
 Octreotide (Sandostatin)
 Use: for severe diarrhea from cancer or
malabsorption disorders
 Keep refrigerated

Adsorbents
 Bismuth subsalicylate (Pepto-Bismol)
 Kaolin-pectin (Kapectolin)
 Action: coats GI tract, absorbs bacteria or
toxins

Combination agents
 Parepectolin (paregoric, Kaolin-pectin)
Antidiarrheals (cont’d)

Nursing interventions
 Monitor BP, R.
 Report more than 10 to 15 mm Hg decrease in
BP.
 Monitor frequency of bowel movements and
bowel sounds.
 Assess for evidence of dehydration.
 Monitor electrolytes.
 Avoid fried and/or spicy foods, milk, and
sedatives.
 If diarrhea persists after 48 hours, notify
healthcare provider (or sooner if chronically
ill)
Constipation
 Causes
Bowel
obstruction, fecal
impaction
Chronic laxative use, ignoring
urge to defecate
Neurologic disorders
Side effect of drugs
Lack of exercise
Insufficient consumption of fiber
and/or water
Constipation
HF p. 749

Laxatives
 Laxatives: soft stool
 Cathartics: soft to watery stool with
cramping
 Purgatives: watery stool with cramping

Types of laxatives
 Osmotic (saline)
 Stimulant (irritants)
 Bulk-forming
 Emollient (stool softeners)
Osmotic (Saline) Laxatives

Polyethylene glycol (Miralax and GoLYTELY)
 Used as a prep for colonoscopy

Lactulose (Chronulac)
Action
 Hyperosmolar salts pull water into colon and
increase water in feces to increase bulk,
which stimulates peristalsis.
 Draws ammonia out of the blood and dumps
it into the gut
Side effects
 Fluid and electrolyte imbalances,
hypotension, weakness


Stimulant (Irritant) Laxatives


Bisacodyl (Dulcolax), Senna (Senokot)
Action
 Increase peristalsis by irritating sensory nerve
endings in intestinal mucosa

Results
 Orally every 6 to 12 hours or daily,
suppository until results

Side effects
 Abdominal cramps, weakness, reddish brown
urine, diarrhea
Bulk-Forming Laxatives
 Psyllium
hydrophilic mucilloid
(Metamucil)
 Calcium polycarbophil (Fiber-Con)
Action
Absorb water into intestines,
increase bulk and peristalsis
Must have sufficient water
intake
Results
8 to 12 hours
Bulk-Forming Laxatives (cont’d)
 Administration
Mix
in glass of water or juice.
Stir and drink immediately.
Follow with 1 glass water.
 Side
effects
Abdominal cramps
Excess laxative
Nausea, vomiting, gas, diarrhea
Emollients (Stool Softeners)
 Docusate
(Colace)
 Action
Lowers
surface tension
Promotes water accumulation in
intestine
Emulsifies and lubricates feces for
easier passage
Emollients (Stool Softeners) (cont’d)
 Use
Prevent
constipation
Reduce straining post surgery or
myocardial infarction
 Side
effects
Abdominal cramping, nausea,
vomiting, diarrhea
Laxatives
 Contraindications
Undiagnosed
abdominal pain
Inflammatory disorders of the GI
tract
Appendicitis, diverticulitis,
ulcerative colitis
Spastic colon
Bowel obstruction
Pregnancy
Antiulcer Drugs Iggy p. 1133 - 1134

Antacids
 Aluminum (Al) hydroxide (Amphojel)
 Magnesium
(Mg) hydroxide/aluminum
hydroxide (Maalox)
 Calcium
 Sodium
carbonate (Tums)
bicarbonate (Alka-Seltzer)
(systemic)
Antiulcer Drugs (cont’d)

Action
 Neutralize gastric acid, reduce pepsin
activity

Systemic side effects
 Sodium excess, water retention,
metabolic alkalosis, acid rebound

Nonsystemic side effects
 Mg: diarrhea; Al: constipation
 Combination: none
Antiulcer Drugs (cont’d)

Histamine2 blockers

Cimetidine (Tagamet), Ranitidine (Zantac)

Famotidine (Pepcid)

Action
 Reduce gastric acid by blocking H2 receptors of parietal
cells in stomach
 Promote healing of ulcer by eliminating cause
 Also used to manage allergic reactions with H1 blockers
(diphenhydramine)

Side effects
 Headaches, dizziness, diarrhea, constipation, reversible
impotence, gynecomastia
Antiulcer Drugs (cont’d)

Proton pump inhibitors
 Esomeprazole
(Nexium), Pantoprazole
(Protonix)
 Omeprazole (Prilosec), Lansoprazole
(Prevacid)
 Action
 Reduce
gastric acid by inhibiting
hydrogen/potassium ATPase
 Side effects
 Headache,
insomnia, dizziness, dry mouth,
flatulence, abdominal pain
Antiulcer Drugs (cont’d)

Pepsin inhibitors

Sucralfate (Carafate)

Action
 Combines with protein to form thick paste
covering ulcer, protects from acid and pepsin

Side effects
 Constipation

Nursing interventions
 Given 30 minutes before meals and bedtime