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DISORDERS OF THE GASTROINTESTINAL SYSTEM DIGESTIVE SYSTEM • FUNCTIONS: ingest food – DIGESTION:break it down into small molecules – ABSORPTION:absorb nutrient molecules – ELIMINATION:eliminate nondigested wastes • ASSESSORY ORGANS : – pancreas, liver, gallbladder Disorders affecting Ingestion • ANOREXIA: lack of appetite, could be from emotional or physical factors • lab tests may be done to assess nutritional status • Medical treatment: supplements may be ordered, TPN or enteral feedings • Nursing Interventions: – oral hygiene, clean room, determine cause of nausea and treat, include family and friends(socialization), respect likes and dislikes, education STOMATITIS • Inflammation of the oral mucosa (mouth) • Causes: trauma, organisms, irritants, nutritional deficiency, diseases, chemotherapy • S/S: swelling, pain, ulcerations, excessive salivation, halitosis, sore mouth • Treatment: • pain relief, removal of causative factor, oral hygiene, medications, soft bland diet GINGIVITIS • Inflammation of the gums • Causes: poor oral hygiene, poorly fitting dentures, nutritional deficiency • S/S: red, swollen, bleeding gums, painful • Treatment: dental hygiene, prevention of complications Nursing Interventions: Stomatitis and Gingivitis • Assess mouth condition • Administer medications • Mouth care • Soft bland diet, no spicy foods • Observe for complications • Teach importance of mouth and gum care HERPES SIMPLEX TYPE 1 • Infection affecting the lips and mucous membranes of the mouth • Causes: Herpes simplex virus • S/S: Vesicles on the mouth, nose or lips, malaise, edema of surrounding area • Treatment: Antiviral medication(Zovirax), analgesics, symptomatic relief • Nsg Interventions: Administer meds, keep lesions dry, provide symptomatic relief LEUKOPLAKIA • Abnormal thickening and whitening of the epithelium of the mucous membranes of the cheeks and tongue • Causes: Chronic irritation • S/S: Thickened white or reddish lesions on the mucous membrane, lesions can not be rubbed off • Treatment: May be surgically removed or treated with chemotherapy, meticulous oral hygiene • Interventions: Assess mouth frequently, assist with oral hygiene, discuss removal of sources of irritation ORAL CANCER • Malignant lesions may develop on the lips, oral cavity, tongue and pharynx. Generally squamous cell carcinomas • Causes: high alcohol consumption, tobacco use, external irritants • S/S: Leukoplakia, swelling, edema, numbness, pain • Diagnosis: biopsy • Treatment: – Surgery – Radiation or chemotherapy • depends on the size and location and the lesion • Interventions: consult MD for special mouth care, monitor respiratory status, keep HOB elevated, administer pain med, assess ability to swallow and talk, assess for infection at incision site, education ESOPHAGITIS • Inflammation or irritation of the esophagus • Causes: Reflux of stomach contents, irritants, fungal infections, trauma, malignancy, intubation • S/S: heartburn, pain, dysphagia • Treatment: treat underlying cause • Interventions: soft bland diet, administer meds, elevate HOB, observe for complications ESOPHAGEAL VARICIES • Tortuous, distended vessels of the esophagus – may rupture and bleed • causes: Portal hypertension caused by cirrhosis of the liver • S/S Hematemesis, hemorrhage from UGI, black tarry stools, pain, shock • Treatment: – Sengstaken-Blakemore tube to controll bleeding – Iced saline lavage – Medications( Vasopressin, antibiotics, analgesics) – Surgeries: ligation, injection sclerotherapy – Blood transfusions • Interventions: – administer meds – provide pre/post op care – administer blood transfusions – monitor tube placement – assess vital signs, bleeding CANCER OF THE ESOPHAGUS • Prognosis is very poor, diagnosed at late stages • Causes- no known cause, predisposing factors; irritation, poor oral hygiene • S/S- progressive dysphagia, painful swallowing, weight loss, vomiting, hoarseness, coughing, iron deficiency, anemia, occult bleeding or hemmorage Treatment of CA of Esophagus • Palliative treatment is common • Radiation, chemotherapy • surgery: – Esophagectomy – Esophagogastrostomy – Esophagoenterostomy – Gastrostomy Interventions • Maintain NG tube after surgery • Assess for signs of hemorrahage • Monitor respiratory status • monitor adequacy of nutritional intake ( high protein, high calorie diet) • assess ability to swallow • allow patient to ventilate feelings DISORDERS OF DIGESTION AND ABSORPTION • N/V • Hiatal Hernia • Gastritis • Peptic Ulcer • Stomach Cancer • Obesity NAUSEA AND VOMITING • Nausea: unpleasant sensation usually preceding vomiting, may have abdominal pain, pallor, sweating, clammy skin • Causes: irritating food, infection, radiation, drugs, hormonal changes, surgery, inner ear disorders, distention of the GI tract • Vomiting: forceful expulsions of stomach contents through the mouth. Occurs when vomiting reflex in the brain is stimulated. • Projectile vomiting- is forceful ejection of stomach contents. • Regurgitation- gentle ejection of stomach contents without nausea or retching Complications and Treatment • May lead to dehydration, metabolic alkalosis, aspiration • Treatment: Antiemetics( Phenergan, Dramamine, Scopolamine patch Reglan), IV fluids, NG tube, TPN • Nursing care: through assessment, keep patient comfortable, offer liquids, position on side, suction setup in the room HIATAL HERNIA • Protrusion of the lower esophagus and stomach upward through the diaphragm into the chest – SLIDING-gastroesophageal junction above the hiatus – ROLLING( paraesophageal)-junction in place portion of stomach rolls up through diaphram • Causes; weakness in the lower esophageal sphincter, related to increased abdominal pressure, long term bedrest, trauma Signs and Symptoms • • • • • • Feelings of fullness dysphagia eruption regurgitation heartburn Complications: Ulcerations, bleeding, aspiration • seen in 50% of people over 60. Treatment for Hiatal Hernia • Drug therapy – H2 receptor antagonists:Tagamet,Zantac, Pepsid- reduce stomach secretions – Urecholine- increase LES tone – Antacids- neutralize stomach acids – Reglan, Propulsid- increase stomach emptying • diet therapy- decrease caffeine fatty foods, alcohol( reduce LES tone), acidic and spicy foods • • • • SURGERY Nissen Fundoplication Angelclik prothesis NURSING CARE: assessment, pain relief, watch for aspiration, nutrition, education GASTRITIS • Inflammation of the lining of the stomach • ACUTE: excessive intake of food or alcohol. Food poisoning, chemical irritation • CHRONIC: repeated episodes of acute, H Pylori Signs/Symptoms and Complications • Nausea, vomiting, feeling of fullness, pain in stomach, indigestion. With chronic may have only mild indigestion • changes in stomach lining with decrease in acid and intrinsic factor ( high risk for pernicious anemia) Treatment • Treat symptoms, and fluid replacement • Medications: antacids, H2 receptor blockers, B 12 injections, corticosteroids analgesics, antibiotics if H Pylori • bland diet, frequent meals • Eliminate the cause • surgical intervention • BEST DIAGNOSIS IS GASTROSOPY & BIOPSY NURSING CARE • Good HX and review of present S/S • pain relief, adequate nutrition, hydration, stress management, education PEPTIC ULCER • Loss of tissue from the lining of the digestive tract. May be acute or chronic. • Classified as gastric or duodental (stress- develop 24-48hr. After event) • CAUSES: drugs, stress, heavy alcohol and tobacco use, infection (H .pylori bacteria) Conditions that cause high gastric acid concentration Peptic Ulcer comparison • Gastric Ulcers • burning pain 1-2 hrs. after meals, upper left abd/back,relieved by food • N/V, anorexia, wt loss • Shallow/ gastric secretions deceased • Older men, working class, bld type A, under stress • Duodenal Ulcers • burning/ cramping pain 2-4hrs. P meal, beneath xiphoid and back, relieved by antacids/food • increased gastric acid • Young men, all social classes, bld type O, chronic illnesses PEPTIC ULCER COMPLICATIONS • HEMORRHAGE • PERFORATION • PYLORIC OBSTRUCTION TREATMENT • Drug therapy – Antacids – H2 RECEPTOR BLOCKERS – ANTICHOLINERGICS-Pro-Banthine, Robinul, Bentyl – SUCRALFATE- Carafate – Antibiotics –Flagyl, tetracycline, Biaxin • treatment goals- relieve symptoms, promote healing, prevent complications and recurrence Nursing Interventions • Three meals a day – decreases acid production • decrease foods that stimulate acid secretions and cause discomfort • treat pain with rest, diet and drug therapy • educate on stress management and relaxation Surgical options for gastric ulcers • To decrease acid secretion: – vagotomy – pyloroplasty – gastroenterostomy – antrectomy – subtotal gastrectomy • Billroth I • Billroth II Nursing care after gastric surgery • No signs of complications – Gastric dilation – Obstruction – Perforation • Maintenance of NG tube: – Suction – do not irrigate or reposition tube – type of drainage • Adequate nutrition: – NPO gradually advance from clear liquids to full liquids then solid foods – Assess for N/V, abdominal distention – Size of meals changes depending on type of surgery – Gastric surgeries can have serious effects on absorption of vit. B12, folic acid, iron, calcium, vit, D • Decreased cardiac output – Dumping syndrome common after gastric surgery: • small stomach size causes chyme to move rapidly into intestine (15-30min.), draws fluid from the blood. Results- drop in bld volume, weakness, dizziness, sweating. ^ in fluid in intestine causes cramping, loud BS abd urge to defecate . Later ^ bld sugar – Treatment: 6 small meals qd, low in carbs and refined sugars, mod. Fat/high protein – fluids between and not with meals – lie down for 30 min. after meal education • Reinforce diet • teach signs of complicatons • Avoid risk factors STOMACH CANCER • Rare(25,000/yr.), common in males, African American, over 70 and low socioeconomic status. 60% decrease in past 40 yrs. • No S/S in early stages • Late stages S/S: N/V, ascities, liver enlargement, abd. Mass • Mets to bone and lung • 10% survival rate after 5 yrs. • Risk factors: pernicious anemia, chronic gastritis, cigarette smoking, diet high in starch, salt, salted meat, pickled foods, nitrates • Treatment: surgery/ chemotherapy/ radiation – subtotal gastrectomy, total gastrectomy OBESITY • Increase in body weight, 20% over ideal, caused by excessive fat. Morbid obesity twice ideal • Causes: heredity, body build, metabolism, psychosocial factors. Calorie intake exceeds demands. • Treatment and nursing care • Weight reduction diet • drug therapy, mainly Amphetamines • Surgical procedures: – Liposuction – Lipectomy – Jaw wiring – Intragastric balloon – Gastric bypass – gastroplasty – jejunoileal bypass • Nursing care-assessment, diet monitoring, education DISORDERS AFFECTING ABSORPTION AND ELIMINATION MALABSORPTION • CONDITION WHEN ONE OR MORE NUTRIENTS ARE NOT DIGESTED OR ABSORBED – multiple causes – lactase deficiency – sprue: celiac/tropical • treatment/care: depends on type – lactase- hold milk products – celiac sprue- hold gluten products – tropical sprue- antibiotics, folic acid DIRRHEA • The passage of loose liquid stools with increased frequency, associated with cramping, abd, pain • Causes; (many), foods, allergies, infections, stress, fecal impaction, tube feedings, medications • Complications- usually temporary/ can be dehydration, malnutrition Treatment/Nursing care • Treatment; GI rest, antidiarrheal drugs(Lomotil, Imodium, Kaolin, Aluminum hydroxide) • Nursing Care: help determine cause, assessVS, weight, skin turgor, abdominal destention, perianal irritation, skin integrity CONSTIPATION • HARD DRY INFREQUENT STOOLS PASSED WITH DIFFICULTY • Causes: (many),inactivity, ignored urge, drugs,age related changes • Complications: straining (Valsalva maneuver) and fecal impaction Treatment/Nursing care • Laxatives, suppositorys, enemas for prompt results • stool softeners, increase fluids,dietary fiber • Nursing care: assessment, monitor fluids and diet, education, check for impaction INTESTINAL OBSTRUCTION • Exists when there is obstruction in the normal flow of intestinal contents through the intestinal tract – Mechanical- Pressure on the intestinal wall – Paralytic- Intestinal musculature unable to propel contents along the bowel • May be partial or complete Intestinal obstruction causes • SMALL BOWEL: – adhesions most common – intussusception – volvulus – paralytic ilieus – abdominal hernia • LARGE BOWEL: – carcinoma – diverticulitis – inflammatory bowel disorders – volvulus Small Bowel vs Large Bowel • Small: – abdominal pain – vomiting – pass blood and mucous, no stool, no gas – over time signs of dehydration • Large: – symptoms develop slowly – constipation – distended abdomen – crampy lower abdominal pain – fecal vomiting Management of bowel obstruction • Small – decompression – is strangulated then surgery • Large – surgical resection with formation of colostomy • Nursing care: same as gastric surgery, management of NG tube APPENDICITIS • Inflammation of the appendix – appendix has no known function in the body – opening becomes obstructed – obstruction interferes with the drainage of secretions from the appendix Signs and symptoms • Generalized epigastric pain at first that shifts to the RLQ • pain at McBurney’s point • elevated temp, N/V, elevated WBC’s( over 10,000) Treatment/nursing care • • • • • • NPO surgical removal IV’s and antibiotics ice pack to the abd. LAXATIVES AND HEAT ARE CONTRAINDICATED Nursing Care: – pain relief, fluid balance – absence of infection, effective breathing PERITONITIS • Inflammation of the peritoneum • Causes; – chemical – bacterial contamination • S/S pain, rebound tenderness, rigidity, distention, fever, tachcardia, tachypnea,N/V Treatment/Nursing care • NG tube, IV fluids, antibiotics, analgisics, surgery if indicated • Nursing care; – Assessment- VS, pain, abd distention, BS, I/O, monitor cardiac output ABDOMINAL HERNIA • A protrusion of the intestine through a weakness in the abdominal wall – reducible – irreducible • Inguinal, umbilical, femoral, incisional • S/S: smooth lump in the abdomen, usually not painful. If incarcerated, severe pain present Treatment/nursing care • Treatment: Herniorrhaphy, Hernioplasty • Nursing care; – absence of strangulation, monitor activity – general surgery interventions with surgery