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GASTROINTESTINAL NURSING
Anatomy & Physiology Review
Mouth
Pharynx
Esophagus
Stomach
Small & large intestines
Anus
Diagnostic Tests & Procedures
Gastrointestinal
System
Stool Specimens
O&P
OB
Fecal Fat
C & S
RADIOLOGIC STUDIES
3 Most commom tests
1) Barium swallow or UGI
2) Small Bowel series
3) Barium
Others: CTS,US abd. X-rays
ENDOSCOPIC TESTS
Esophagoscopy
Gastroscopy/gastroduodenoscopy
EGD
ERCP
Esophageal Motility Studies
ENDOSCOPIC TESTS (cont’d)
Colonoscopy
Proctoscopy
Sigmoidoscopy
Laboratory Tests
Gastric Analysis
CBC
PT (prothrombin time)
INR
PTT (partial thromboplastin time)
Bilirubin
Blood proteins
Alkaline Phosphatase
LDH
GGT
AST
ALT
Cholesterol & Triglycerides
Amylase
CEA
Nursing Assessment
Chief complaint
Past Medical history
Family history
Review of systems/PE
Evaluation of diagnostic data
Abnormal Assessment Findings
Distention
Firmness
Tenderness
Altered bowel sounds
Therapeutic Measures & Related Nursing Interventions
With GI Patients
Gastric Decompression
Types of tubes:
Saunders, pg. 661
Nursing interventions:
Saunders, pg. 663
Gavage or Enteral Nutrition
Provide nutritional support through a tube
Short or long term
In conditions that prohibit oral nourishment
Types of Tubes
Nasogastric - (NG)
Gastrostomy – (G-tube)
Jejunal – (J-tube)
Percutaneous – (PEG)
Total Parenteral Nutrition - TPN
Nutritionally complete
Used when GI system not functioning
Short or long term
TPN LINES
Peripheral
Central
Review important points
1-6
(pg. 664)
Pre-Op Nursing Interventions
For GI surgery patients
GI tract cleansing
Assess vital signs
Liquids for 24 hrs. or NPO
IV
Antibiotics N
NGT insertion
Post-Op Nursing Interventions
For GI surgery patients
Relieve pain
Detect complications
Prevent gastric distention
Replace lost fluids
Maintain urine elimination
Digestive Disorders
Anorexia
Lack of appetite
Cause: physical or emotional
Contributing factors:
Special diet
Illness
Unpleasant odors
Social isolation
Decreased sense of taste or smell
Significant Symptoms
Pain
Nausea
Dyspnea
Extreme fatigue
Malnutrition
Weight loss
Dental caries
Hypotension
Bradycardia
Medical Treatment
Treat the cause
Counseling
Pleasant environment for meals
Diet preferences
Company of others during meal
Position comfortably during meal
May require TPN
Obesity
20% over ideal body wt.
Morbid obesity= 2X normal body wt.
Complications
CV disease
Diabetes
Respiratory difficulties
Musculoskeletal problems
Emotional and social isolation
Causes
Caloric intake exceeds expenditure
Emotional stress/psychosocial factors
Slowed metabolism
Medical Management
Weight reduction diet
Exercise
Medication
Counseling
Surgical Treatment
Gastric bypass
Gastroplasty
Liposuction
Disorders of the Mouth
Dental Caries
Destructive process of tooth decay
Causes:
Bacteria
Poor oral hygiene
Prevention
Frequent brushing and flossing
Dentist visit 2X/yr
Good nutrition
Fluoride
Treatment
Removal of diseases portion of tooth and filling
May need dentures
Stomatitis
Inflammation of the oral mucosa
Mechanical trauma from dentures
Excessive tobacco or ETOH use
Poor oral hygiene
Inadequate nutrition
Radiation or drug therapy
Emotional tension or fatigue
Treatment
Determine cause
ABX if bacterial
Analgesics
Topical anesthetics
Herpes Simplex
HSV Type 1
Vesicles around the mouth & lips
Tx is comfort not curative
Zovarax ointment (antiviral)
Apthous Stomatitis
“canker sores”
Painful ulcers
Cause: possible viral, allergic
Tx topical or systemic steroids
Candidiasis
Fungal infection (Thrush)
Candida Albicans
White patches in mouth
Immunosuppression
Abx therapy
Periodontal Disease
Gingivitis(inflammation of gums and supporting tissues)
Gums are red, swollen, painful and bleed easily
Cause poor oral hygiene & nutrition
Treatment
ABX
Good oral hygiene
Surgical scraping
Extraction
Oral Neoplasms
Precancerous lesions:
Leukoplakia
s/s: creamy white patch on mucus membrane of mouth
“smokers patch”
Oral Cancer
2 types of malignant tumors
Squamous and Basal cell
Early s/s may be ignored
Tongue irritation, loose teeth, pain in ear or in tongue
Risk Factors
Tobacco use
Alcohol use
Poor nutrition
Chronic irritation
Treatment
Surgery
Radiation
Chemo
Radical Neck
Post op Nursing Care:
Tracheostomy
Check for hemorrhage
Monitor respiratory status
Nutrition- NGT, PEG, or TPN
Emotional Support
Communication board
High fowlers
Mouth care
Incentive spiro. ( no coughing)
Disorders of Esophagus
Esophageal Cancer
Not common, poor prognosis
Middle or lower portion of esophagus
No known cause
Predisposing Factors
Cigarette smoking
Excessive alcohol intake
Poor oral hygiene
Eating spicy foods
Signs and Symptoms
Progressive dysphagia
Pain with swallowing
TX  Chemo or surgery
Esophagectomy, Esophagogastrostomy, or Esophagoenterostomy
Nursing Interventions
Observe while eating
Teach to eliminate irritating foods to eliminate reflux
Assess for hoarseness, cough, anorexia, wt. loss or regurgitation
Esophageal Diverticulum
Esophageal out-pouching
“Bad breath” due to accumulation of food in diverticulum
Treatment
Bland diet
Antacids
Anti-emetics
Surgery
Nursing Measures
Semi-fowlers
Small meals
Loose clothing
Disorders of the Stomach
Hiatal Hernia
Protrusion of the lower esophagus and stomach upward through the diaphragm
Two types: Sliding and Rolling
Causes
Excessive intra-abdominal pressure
Obesity
Pregnancy
Abdominal tumors, ascites or repeated heavy lifting
Signs and Symptoms
Feeling of fullness
Eructation
Heartburn
Dysphagia
Regurgitation
Medical Treatment
Avoid increased intra-abdominal pressure
HOB ^ 6-12 inchesprevents nighttime reflux
Drug Therapy
Diet
Surgical Treatment
Nissen Fundoplication
Angelchik Prosthesis
See page 681 figure 36-14 &
36-15
GERD
Gastroesophageal Reflux Disease
Backward flow of stomach contents into the espohagus
Sometimes occurs with a sliding hiatal hernia
Signs & Symptoms
Burning sensation that moves up and down, commonly after meals
Intermittent dysphagia
belching
Diagnosis
Based on symptoms
24 hour pH monitoring
Endoscopy
Gastric analysis
Treatment
Same as for hiatal hernia
Drug therapy may include: Zantac, Reglan, Prilosec & antacids
Fundoplication if required
Patient Teaching
Avoid ASA and NSAIDS
Chew food well
Avoid eating 2 hrs. before bedtime
Avoid caffeine, ETOH, nicotine
Supine with HOB ^ 30 degrees
Gastritis
Inflammation of the stomach mucosa/lining
Causes:
Meds, spicy foods, alcohol, stress, H.pylori
Signs & Symptoms
N/V
Abdominal pain
Anorexia
Feeling of fullness
Treatment
Meds
Replacement of fluids after N,V & diarrhea subsides
Elimination of the cause
Surgical intervention if all else fails
Peptic Ulcer
Lesion on either the mucosa of stomach or duodenum
80% are in duodenum
May be acute or chronic
Classified as gastric or duodenal
See Table 36-6, pg. 685
Causes
Bacterium H. pylori
Drugs
Physical trauma (shock,burns)
Conditions that cause excessive gastric acid secretions
Gastric S/S
Epigastric pain 1-2 hrs after a meal
Pain relieved by food or fluids
Nausea, anorexia and weight loss
Duodenal S/S
Burning or cramping pain 2-4 hrs after a meal
Pain relieved by antacids or food
Teach : 1) limit milk products
2) no baking soda
Complications of Peptic Ulcers
Hemorrhage
Perforation
Peritonitis
obstruction
Medical Treatment
Drug therapy
Diet therapy
NGT  hemorrhage
Lavage
Surgical intervention
Complications after Gastrectomy
Dumping syndrome
Sx occur ½ hr after eating
Abdominal pain, N & V
Explosive diarrhea, diaphoresis
Malabsorption--> Malnutrition
Treatment
6 meals/day
Low carb. high protein diet
No fluids with meals
Lie down for 30’ after eating
Stomach Cancer
“Silent neoplasm”
Poor prognosis
No early s/s
Late s/s: vomiting, ascites, abd. Mass, enlarged liver
Risk Factors
Pernicious anemia
Chronic gastritis
Lack of HCL
Billroth II procedure
Treatment
Surgery
Chemo
Radiation
Malabsorption
Intestinal absorption of nutrients is reduced
Two examples are:
•Celiac sprue
•Lactase deficiency
Signs & Symptoms
Steatorrhea
Malnutrition & weight loss
Abdominal pain, cramping
Bloating
diarrhea
Treatment
Sprue diet and drug therapy, avoid foods w/ gluten(wheat, barley, oats)
Lactase  avoid milk products & take lactase enzyme ( Lactaid)