gastrointestinal system
TRANSCRIPT
Medical Surgical Medical Surgical NursingNursing
The GASTRO-INTESTINAL The GASTRO-INTESTINAL SystemSystem
Nurse Licensure Examination Nurse Licensure Examination ReviewReview
The Gastro-Intestinal The Gastro-Intestinal SystemSystem
Review of the GIT Anatomy and Review of the GIT Anatomy and PhysiologyPhysiology
Review of Common laboratory Review of Common laboratory proceduresprocedures
Review of Common Symptoms and Review of Common Symptoms and their nursing interventionstheir nursing interventions
Review of common disorders of the:Review of common disorders of the: EsophagusEsophagus -gallbladder-gallbladder StomachStomach -exocrine pancreas-exocrine pancreas Small intestineSmall intestine -liver-liver Large IntestineLarge Intestine
The GIT System: Anatomy and The GIT System: Anatomy and PhysiologyPhysiology
The GIT is composed of two general The GIT is composed of two general partsparts
The main GIT starts from the The main GIT starts from the mouthmouthEsophagusEsophagusStomachStomachSISILILI
The accessory organs are the The accessory organs are the Salivary glandsSalivary glands LiverLiver GallbladderGallbladder PancreasPancreas
The GIT ANATOMYThe GIT ANATOMY
The MouthThe Mouth Contains the lips, cheeks, palate, Contains the lips, cheeks, palate,
tongue, teeth, salivary glands, tongue, teeth, salivary glands, masticatory/facial muscles and masticatory/facial muscles and bonesbones
Anteriorly bounded by the lipsAnteriorly bounded by the lips Posteriorly bounded by the Posteriorly bounded by the
oropharynxoropharynx
The GIT PhysiologyThe GIT Physiology
The MouthThe Mouth Important for the mechanical Important for the mechanical
digestion of fooddigestion of food The saliva contains SALIVARY The saliva contains SALIVARY
AMYLASE or PTYALIN that starts AMYLASE or PTYALIN that starts the INITIAL digestion of the INITIAL digestion of carbohydrates carbohydrates
The GIT ANATOMYThe GIT ANATOMY
The EsophagusThe Esophagus A hollow collapsible tubeA hollow collapsible tube Length- 10 inchesLength- 10 inches Made up of stratified Made up of stratified
squamos epitheliumsquamos epithelium
The GIT ANATOMYThe GIT ANATOMY
The EsophagusThe Esophagus The upper third contains The upper third contains
skeletal musclesskeletal muscles The middle third contains mixed The middle third contains mixed
skeletal and smooth musclesskeletal and smooth muscles The lower third contains smooth The lower third contains smooth
muscles and the esophago-muscles and the esophago-gastric/ cardiac sphincter is gastric/ cardiac sphincter is found herefound here
The GIT PHYSIOLOGYThe GIT PHYSIOLOGY
The EsophagusThe Esophagus Functions to carry or propel Functions to carry or propel
foods from the oropharynx to the foods from the oropharynx to the stomachstomach
Swallowing or deglutition is Swallowing or deglutition is composed of three phases:composed of three phases:
The GIT ANATOMYThe GIT ANATOMY
The stomachThe stomach J-shaped organ in the epigastriumJ-shaped organ in the epigastrium Contains four parts- the fundus, the Contains four parts- the fundus, the
cardia, the body and the pyloruscardia, the body and the pylorus The cardiac sphincter prevents the The cardiac sphincter prevents the
reflux of the contents into the reflux of the contents into the esophagusesophagus
The pyloric sphincter regulates the The pyloric sphincter regulates the rate of gastric emptying into the rate of gastric emptying into the duodenumduodenum
Capacity is 1,500 ml!Capacity is 1,500 ml!
The GIT PHYSIOLOGYThe GIT PHYSIOLOGY
The functions of the stomach The functions of the stomach are generally to digest the are generally to digest the food (proteins) and to propel food (proteins) and to propel the digested materials into the digested materials into the SI for final digestionthe SI for final digestion
The Glands and cells in the The Glands and cells in the stomach secrete digestive stomach secrete digestive enzymes:enzymes:
The GIT PHYSIOLOGYThe GIT PHYSIOLOGY
Stomach:Stomach: 1. Parietal cells- HCl acid and 1. Parietal cells- HCl acid and
Intrinsic factorIntrinsic factor 2. Chief cells- pepsin2. Chief cells- pepsin
digestion of PROTEINS!digestion of PROTEINS! 3. Antral G-cells- gastrin3. Antral G-cells- gastrin 4. Argentaffin cells- serotonin4. Argentaffin cells- serotonin 5. Mucus neck cells- mucus5. Mucus neck cells- mucus
The GIT ANATOMYThe GIT ANATOMY
The Small intestineThe Small intestine Grossly divided into the Grossly divided into the
Duodenum, Jejunum and IleumDuodenum, Jejunum and Ileum The duodenum contains the two The duodenum contains the two
openings for the bile and openings for the bile and pancreatic ductspancreatic ducts
The ileum is the longest part The ileum is the longest part (about 12 feet)(about 12 feet)
The GIT physiologyThe GIT physiology
The intestinal glands secrete The intestinal glands secrete digestive enzymes that finalize the digestive enzymes that finalize the digestion of all foodstuffdigestion of all foodstuff
Enzymes for carbohydratesEnzymes for carbohydrates disaccharidasesdisaccharidases
Enzymes for proteinsEnzymes for proteins dipeptidases and aminopeptidasesdipeptidases and aminopeptidases
Enzyme for lipidsEnzyme for lipids intestinal intestinal lipaselipase
The GIT ANATOMYThe GIT ANATOMYThe Large intestineThe Large intestine Approximately 5 feet long, with parts:Approximately 5 feet long, with parts: 1. The cecum1. The cecum widest diameter, prone to widest diameter, prone to
rupturerupture 2. The appendix2. The appendix 3. The ascending colon3. The ascending colon 4. The transverse colon4. The transverse colon 5. The descending colon5. The descending colon 6. The sigmoid6. The sigmoid most mobile, prone to most mobile, prone to
twistingtwisting 7. The rectum7. The rectum
The GIT PhysiologyThe GIT Physiology
Absorbs waterAbsorbs water Eliminates wastesEliminates wastes Bacteria in the colon synthesize Bacteria in the colon synthesize
Vitamin KVitamin K Appendix participates in the Appendix participates in the
immune systemimmune system
The GIT PhysiologyThe GIT Physiology
SYMPATHETICSYMPATHETIC Generally Generally
INHIBITORY!INHIBITORY! Decreased gastric Decreased gastric
secretionssecretions Decreased GIT Decreased GIT
motilitymotility
But: Increased But: Increased sphincteric tone and sphincteric tone and constriction of blood constriction of blood vesselsvessels
PARASYMPATHETICPARASYMPATHETIC Generally Generally
EXCITATORY!EXCITATORY! Increased gastric Increased gastric
secretionssecretions Increased gastric Increased gastric
motilitymotility
But: Decreased But: Decreased sphincteric tone and sphincteric tone and dilation of blood dilation of blood vesselsvessels
The GIT ANATOMYThe GIT ANATOMY
The LiverThe Liver The largest internal organThe largest internal organ Located in the right upper Located in the right upper
quadrantquadrant Contains two lobes- the right and Contains two lobes- the right and
the leftthe left The hepatic ducts join together The hepatic ducts join together
with the cystic duct to become the with the cystic duct to become the common bile ductcommon bile duct
The GIT Physiology: The GIT Physiology: LIVERLIVER
Functions to store excess glucose, fats Functions to store excess glucose, fats and amino acidsand amino acids
Also stores the fat soluble vitamins- A, Also stores the fat soluble vitamins- A, D and the water soluble- Vitamin B12D and the water soluble- Vitamin B12
Produces the BILE for normal fat Produces the BILE for normal fat digestiondigestion
The Von Kupffer cells remove bacteria The Von Kupffer cells remove bacteria in the portal bloodin the portal blood
Detoxifies ammonia into ureaDetoxifies ammonia into urea
The GIT anatomyThe GIT anatomy
The gallbladderThe gallbladder Located below the liver Located below the liver The cystic duct joins the hepatic The cystic duct joins the hepatic
duct to become the bile ductduct to become the bile duct The common bile duct joins the The common bile duct joins the
pancreatic duct in the sphincter pancreatic duct in the sphincter of Oddi in the first part of the of Oddi in the first part of the duodenumduodenum
The GIT PhysiologyThe GIT Physiology
Stores and concentrates bileStores and concentrates bile Contracts during the digestion of Contracts during the digestion of
fats to deliver the bilefats to deliver the bile CholecystokininCholecystokinin is released by is released by
the duodenal cells, causing the the duodenal cells, causing the contraction of the gallbladder contraction of the gallbladder and relaxation of the sphincter of and relaxation of the sphincter of OddiOddi
The GIT anatomyThe GIT anatomy
The pancreasThe pancreas A retroperitoneal glandA retroperitoneal gland Functions as an endocrine and Functions as an endocrine and
exocrine glandexocrine gland The pancreatic duct (major) joins The pancreatic duct (major) joins
the common bile duct in the the common bile duct in the sphincter of Oddisphincter of Oddi
The GIT PhysiologyThe GIT Physiology The exocrine function of the pancreas The exocrine function of the pancreas
is the secretion of digestive enzymes is the secretion of digestive enzymes for carbohydrates, fats and proteinsfor carbohydrates, fats and proteins
Pancreatic amylasePancreatic amylase carbohydrates carbohydrates Pancreatic lipase (steapsin)Pancreatic lipase (steapsin) fats fats Trypsin, Chymotrypsin and Trypsin, Chymotrypsin and
PeptidasesPeptidases proteins proteins BicarbonateBicarbonate to neutralize the acidic to neutralize the acidic
chyme. Stimulated by SECRETIN!chyme. Stimulated by SECRETIN!
Gastrointestinal Gastrointestinal AssessmentAssessmentLaboratory ProceduresLaboratory Procedures
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
FECALYSISFECALYSIS Examination of stool Examination of stool
consistency, color and the consistency, color and the presence of occult blood.presence of occult blood.
Special tests for fat, Special tests for fat, nitrogen, parasites, ova, nitrogen, parasites, ova, pathogens and otherspathogens and others
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
FECALYSIS: Occult Blood FECALYSIS: Occult Blood TestingTesting
Instruct the patient to adhere Instruct the patient to adhere to a 3-day meatless dietto a 3-day meatless diet
No intake of NSAIDS, aspirin No intake of NSAIDS, aspirin and anti-coagulantand anti-coagulant
Screening test for colonic Screening test for colonic cancercancer
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Upper GIT study: barium Upper GIT study: barium swallowswallow
Examines the upper GI Examines the upper GI tracttract
Barium sulfate is Barium sulfate is usually used as contrastusually used as contrast
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Upper GIT study: barium Upper GIT study: barium swallowswallow
Pre-testPre-test: NPO post-midnight: NPO post-midnight Post-testPost-test: Laxative is ordered, : Laxative is ordered,
increase pt fluid intake, increase pt fluid intake, instruct that stools will turn instruct that stools will turn white, monitor for obstructionwhite, monitor for obstruction
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Lower GIT study: barium Lower GIT study: barium enemaenema
Examines the lower GI tractExamines the lower GI tract Pre-testPre-test: Clear liquid diet : Clear liquid diet
and laxatives, NPO post-and laxatives, NPO post-midnight, cleansing enema midnight, cleansing enema prior to the testprior to the test
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Lower GIT study: barium Lower GIT study: barium enemaenema
Post-test:Post-test: Laxative is Laxative is ordered, increase patient ordered, increase patient fluid intake, instruct that fluid intake, instruct that stools will turn white, stools will turn white, monitor for obstructionmonitor for obstruction
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Gastric analysisGastric analysis Aspiration of gastric juice to Aspiration of gastric juice to
measure pH, appearance, volume measure pH, appearance, volume and contentsand contents
Pre-test:Pre-test: NPO 8 hours, avoidance NPO 8 hours, avoidance of stimulants, drugs and smokingof stimulants, drugs and smoking
Post-test:Post-test: resume normal resume normal activitiesactivities
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
EGDEGD(esophagogastroduodenoscopy(esophagogastroduodenoscopy))
Visualization of the upper GIT Visualization of the upper GIT by endoscopeby endoscope
Pre-testPre-test: ensure consent, NPO : ensure consent, NPO 8 hours, pre-medications like 8 hours, pre-medications like atropine and anxiolyticsatropine and anxiolytics
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
EGDEGDesophagogastroduodenoscoesophagogastroduodenosco
pypy Intra-test:Intra-test: position : position : LEFTLEFT
lateral to facilitate lateral to facilitate salivary drainage and easy salivary drainage and easy accessaccess
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
EGD EGD (esophagogastroduodenoscopy(esophagogastroduodenoscopy))
Post-testPost-test: NPO until gag reflex : NPO until gag reflex returns, place patient in returns, place patient in SIMS SIMS position until he awakensposition until he awakens, , monitor for complications, monitor for complications, saline gargles for mild oral saline gargles for mild oral discomfortdiscomfort
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Lower GI- scopyLower GI- scopy Use of endoscope to Use of endoscope to
visualize the anus, rectum, visualize the anus, rectum, sigmoid and colonsigmoid and colon
Pre-test:Pre-test: consent, NPO 8 consent, NPO 8 hours, cleansing enema hours, cleansing enema until return is clearuntil return is clear
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Lower GI- scopyLower GI- scopyIntra-test:Intra-test: position is position is LEFTLEFT lateral, right leg is bent lateral, right leg is bent and placed anteriorlyand placed anteriorly
Post-test:Post-test: bed rest, bed rest, monitor for complications monitor for complications like bleeding and like bleeding and perforationperforation
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
CholecystographyCholecystography Examination of the gallbladder Examination of the gallbladder
to detect stones, its ability to to detect stones, its ability to concentrate, store and release concentrate, store and release the bilethe bile
Pre-test:Pre-test: ensure consent, ask ensure consent, ask allergies to iodine, seafood and allergies to iodine, seafood and dyes; dyes; contrast medium is contrast medium is administered the night prioradministered the night prior, , NPO after contrast NPO after contrast administrationadministration
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
CholecystographyCholecystographyPost-test:Post-test: Advise that Advise that dysuria is common as dysuria is common as the dye is excreted in the dye is excreted in the urine, resume the urine, resume normal activitiesnormal activities
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
ParacentesisParacentesisRemoval of Removal of peritoneal fluid peritoneal fluid for analysisfor analysis
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
ParacentesisParacentesis
Pre-test:Pre-test: ensure ensure consent, instruct to consent, instruct to VOID and empty VOID and empty bladder, measure bladder, measure abdominal girthabdominal girth
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
ParacentesisParacentesisIntra-test:Intra-test: Upright Upright on the edge of the on the edge of the bed, back supported bed, back supported and feet resting on a and feet resting on a foot stoolfoot stool
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Liver biopsyLiver biopsyPretestPretestConsentConsentNPONPOCheck for the bleeding Check for the bleeding parametersparameters
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Liver biopsyLiver biopsy IntratestIntratest
Position: Semi fowler’s Position: Semi fowler’s LEFT lateral to expose LEFT lateral to expose right side of abdomenright side of abdomen
COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES
Liver biopsyLiver biopsyPost-testPost-test: position on : position on RIGHT RIGHT lateral with pillow lateral with pillow underneath,underneath, monitor VS and monitor VS and complications like bleeding, complications like bleeding, perforation. Instruct to avoid perforation. Instruct to avoid lifting objects for 1 weeklifting objects for 1 week
The NURSING PROCESS in The NURSING PROCESS in GIT DisordersGIT Disorders
AssessmentAssessmentHealth history Nursing Health history Nursing HistoryHistory
PEPELaboratory proceduresLaboratory procedures
The ABDOMINAL The ABDOMINAL examinationexamination
The sequence to follow The sequence to follow is:is:
InspectionInspectionAuscultationAuscultationPercussionPercussionPalpationPalpation
CONSTIPATIONCONSTIPATION
DIARRHEADIARRHEA
DUMPING SYNDROMEDUMPING SYNDROME
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
CONSTIPATIONCONSTIPATIONAn abnormal An abnormal infrequency and infrequency and irregularity of irregularity of defecationdefecation
Multiple causationsMultiple causations
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
CONSTIPATION: CONSTIPATION: PathophysiologyPathophysiology
Interference with three Interference with three functions of the colonfunctions of the colon
1. Mucosal transport1. Mucosal transport 2. Myoelectric activity2. Myoelectric activity 3. Process of defecation3. Process of defecation
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Assist physician in treating the 1. Assist physician in treating the
underlying cause of constipationunderlying cause of constipation 2. Encourage to eat HIGH fiber 2. Encourage to eat HIGH fiber
diet to increase the bulkdiet to increase the bulk 3. Increase fluid intake3. Increase fluid intake 4. Administer prescribed 4. Administer prescribed
laxatives, stool softenerslaxatives, stool softeners 5. Assist in relieving stress5. Assist in relieving stress
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
DiarrheaDiarrhea Abnormal fluidity of the stoolAbnormal fluidity of the stool
Multiple causesMultiple causes Gastrointestinal DiseasesGastrointestinal Diseases HyperthyroidismHyperthyroidism Food poisoningFood poisoning
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
DiarrheaDiarrheaNursing InterventionsNursing Interventions
1. Increase fluid intake- 1. Increase fluid intake- ORESOL is the most important ORESOL is the most important treatment!treatment!2. Determine and manage the 2. Determine and manage the causecause3. Anti-diarrheal drugs3. Anti-diarrheal drugs
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
DUMPING SYNDROMEDUMPING SYNDROMEA condition of rapid emptying A condition of rapid emptying of the gastric contents into of the gastric contents into the small intestine usually the small intestine usually after a gastric surgery after a gastric surgery
Symptoms occur 30 minutes Symptoms occur 30 minutes after eatingafter eating
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
PATHOPHYSIOLOGYPATHOPHYSIOLOGYFoods high in CHO and Foods high in CHO and electrolytes must be electrolytes must be diluted in the jejunum diluted in the jejunum before absorption takes before absorption takes place.place.
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
PATHOPHYSIOLOGYPATHOPHYSIOLOGYThe rapid influx of The rapid influx of
stomach contents will stomach contents will cause distention of the cause distention of the
jejunumjejunum
early symptomsearly symptoms
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
PATHOPHYSIOLOGYPATHOPHYSIOLOGYThe hypertonic food bolusThe hypertonic food bolus
will draw fluid from the will draw fluid from the blood vessels to dilute the blood vessels to dilute the
high concentrations of CHO high concentrations of CHO and electrolytes in the food and electrolytes in the food
bolusbolus
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
Later, there is increased Later, there is increased blood glucoseblood glucose
stimulating the stimulating the increased secretion of increased secretion of
insulininsulin
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
Then, blood glucose will Then, blood glucose will fallfall
causing reactive causing reactive hypoglycemiahypoglycemia
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
DUMPING SYNDROMEDUMPING SYNDROME
ASSESSMENT FINDINGS: early ASSESSMENT FINDINGS: early symptomssymptoms
1. Nausea and Vomiting1. Nausea and Vomiting 2. Abdominal fullness2. Abdominal fullness 3. Abdominal cramping3. Abdominal cramping 4. Palpitation4. Palpitation 5. Diaphoresis5. Diaphoresis
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
DUMPING SYNDROMEDUMPING SYNDROMEASSESSMENT FINDINGS: ASSESSMENT FINDINGS: LATE symptoms: LATE symptoms:
6. Drowsiness 6. Drowsiness 7. Weakness and 7. Weakness and DizzinessDizziness
8. 8. HypoglycemiaHypoglycemia
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
DS NURSING INTERVENTIONSDS NURSING INTERVENTIONS 1. Advise patient to eat1. Advise patient to eat LOW- LOW-
carbohydratecarbohydrate HIGH-fat and HIGH-fat and HIGH-protein dietHIGH-protein diet
2. Instruct to eat 2. Instruct to eat SMALL SMALL frequentfrequent meals, include meals, include MORE MORE dry itemsdry items..
3. Instruct to 3. Instruct to AVOID consuming AVOID consuming FLUIDS with mealsFLUIDS with meals
COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT
DS NURSING INTERVENTIONSDS NURSING INTERVENTIONS
4. Instruct to 4. Instruct to LIE LIE DOWN after mealsDOWN after meals
5. Administer anti-5. Administer anti-spasmodic medications spasmodic medications to delay gastric to delay gastric emptyingemptying
GIT SYMPTOMS AND GIT SYMPTOMS AND MANAGEMENTMANAGEMENT
PERNICIOUS ANEMIAPERNICIOUS ANEMIA Results from Deficiency of Results from Deficiency of
vitamin B12 due to vitamin B12 due to autoimmune destruction of autoimmune destruction of the parietal cellsthe parietal cells, , lack of lack of INTRINSIC FACTORINTRINSIC FACTOR or or total removal of the stomachtotal removal of the stomach
GIT SYMPTOMS AND GIT SYMPTOMS AND MANAGEMENTMANAGEMENT
PERNICIOUS ANEMIA PERNICIOUS ANEMIA ASSESSMENTASSESSMENT
Severe pallorSevere pallor FatigueFatigue Weight lossWeight loss SMOOTH BEEFY-RED TONGUESMOOTH BEEFY-RED TONGUE Mild jaundiceMild jaundice Paresthesia of extremitiesParesthesia of extremities Balance disturbanceBalance disturbance
GIT SYMPTOMS AND GIT SYMPTOMS AND MANAGEMENTMANAGEMENT
NURSING NURSING INTERVENTION for INTERVENTION for Pernicious AnemiaPernicious Anemia
Lifetime injection of Lifetime injection of Vitamin B 12 weekly Vitamin B 12 weekly initially, then MONTHLYinitially, then MONTHLY
Conditions of the Conditions of the GITGIT
UPPER GI UPPER GI systemsystem
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
HIATAL HERNIAHIATAL HERNIA Protrusion of the esophagus Protrusion of the esophagus
into the diaphragm thru an into the diaphragm thru an openingopening
Two types- Sliding hiatal Two types- Sliding hiatal hernia hernia
( most common) and Axial ( most common) and Axial hiatal herniahiatal hernia
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
ASSESSMENT Findings in ASSESSMENT Findings in Hiatal herniaHiatal hernia
1. Heartburn1. Heartburn 2. Regurgitation2. Regurgitation 3. Dysphagia3. Dysphagia 4. 50%- without symptoms4. 50%- without symptoms
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
DIAGNOSTIC TESTDIAGNOSTIC TESTBarium swallow and Barium swallow and fluoroscopyfluoroscopy
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Provide 1. Provide small frequent feedingssmall frequent feedings 2. 2. AVOID supine positionAVOID supine position for 1 hour for 1 hour
after eatingafter eating 3. 3. Elevate the headElevate the head of the bed on 8- of the bed on 8-
inch blockinch block 4. Provide pre-op and post-op care4. Provide pre-op and post-op care
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
Esophageal VaricesEsophageal Varices Dilation and tortuosity of the Dilation and tortuosity of the
submucosal veins in the distal submucosal veins in the distal esophagus esophagus
ETIOLOGY: commonly caused ETIOLOGY: commonly caused by PORTAL hypertension by PORTAL hypertension secondary to liver cirrhosissecondary to liver cirrhosis
This is an Emergency condition!This is an Emergency condition!
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
ASSESSMENT findings for EVASSESSMENT findings for EV 1. Hematemesis1. Hematemesis 2. Melena2. Melena 3. Ascites3. Ascites 4. jaundice4. jaundice 5. hepatomegaly/splenomegaly5. hepatomegaly/splenomegaly
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
ASSESSMENT findings for ASSESSMENT findings for EVEV
Signs of Shock- Signs of Shock- tachycardia, hypotension, tachycardia, hypotension, tachypnea, cold clammy tachypnea, cold clammy skin, narrowed pulse skin, narrowed pulse pressurepressure
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
DIAGNOSTIC DIAGNOSTIC PROCEDUREPROCEDURE
EsophagoscopyEsophagoscopy
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
NURSING NURSING INTERVENTIONS FOR EVINTERVENTIONS FOR EV
1. Monitor VS strictly. 1. Monitor VS strictly. Note for signs of shockNote for signs of shock
2. Monitor for LOC2. Monitor for LOC3. Maintain NPO3. Maintain NPO
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
NURSING INTERVENTIONS FOR EVNURSING INTERVENTIONS FOR EV
4. Monitor blood 4. Monitor blood studiesstudies
5. Administer O25. Administer O26. prepare for blood 6. prepare for blood transfusiontransfusion
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
INTERVENTIONS FOR EVINTERVENTIONS FOR EV 7. prepare to administer 7. prepare to administer Vasopressin and Vasopressin and NitroglycerinNitroglycerin
8. Assist in NGT and 8. Assist in NGT and Sengstaken-Blakemore tube Sengstaken-Blakemore tube insertion for balloon insertion for balloon tamponade tamponade
CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS
NURSING INTERVENTIONS NURSING INTERVENTIONS FOR EVFOR EV
9. Prepare to assist in 9. Prepare to assist in surgical management:surgical management:Endoscopic sclerotherapyEndoscopic sclerotherapyVariceal ligationVariceal ligationShunt proceduresShunt procedures
Conditions of the Conditions of the StomachStomach
Gastro-esophageal refluxGastro-esophageal reflux Backflow of gastric contents into Backflow of gastric contents into
the esophagusthe esophagus Usually due to incompetent lower Usually due to incompetent lower
esophageal sphincter , pyloric esophageal sphincter , pyloric stenosis or motility disorderstenosis or motility disorder
Symptoms may mimic ANGINA or Symptoms may mimic ANGINA or MIMI
Conditions of the Conditions of the StomachStomach
ASSESSMENT ( for GERD)ASSESSMENT ( for GERD) HeartburnHeartburn DyspepsiaDyspepsia RegurgitationRegurgitation Epigastric painEpigastric pain Difficulty swallowingDifficulty swallowing PtyalismPtyalism
Conditions of the Conditions of the StomachStomachDiagnostic testDiagnostic test
Endoscopy or barium swallowEndoscopy or barium swallow Gastric ambulatory pH analysisGastric ambulatory pH analysis
Note for the pH of the esophagus, Note for the pH of the esophagus, usually done for 24 hoursusually done for 24 hours
The pH probe is located 5 inches The pH probe is located 5 inches above the lower esophageal sphincterabove the lower esophageal sphincter
The machine registers the different The machine registers the different pH of the refluxed material into the pH of the refluxed material into the esophagusesophagus
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Instruct the patient to AVOID 1. Instruct the patient to AVOID
stimulus that increases stomach stimulus that increases stomach pressure and decreases GES pressure and decreases GES pressurepressure
2. Instruct to avoid spices, coffee, 2. Instruct to avoid spices, coffee, tobacco and carbonated drinkstobacco and carbonated drinks
3. Instruct to eat LOW-FAT, 3. Instruct to eat LOW-FAT, HIGH-FIBER dietHIGH-FIBER diet
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONSNURSING INTERVENTIONS4. Avoid foods and drinks 4. Avoid foods and drinks TWO hours before bedtimeTWO hours before bedtime
5. Elevate the head of the 5. Elevate the head of the bed with an approximately bed with an approximately 8-inch block8-inch block
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONSNURSING INTERVENTIONS6. Administer prescribed 6. Administer prescribed H2-blockers, PPI and H2-blockers, PPI and prokinetic meds like prokinetic meds like cisapride, cisapride, metochlopromidemetochlopromide
7. Advise proper weight 7. Advise proper weight reductionreduction
Conditions of the Conditions of the StomachStomach
GASTRITISGASTRITIS Inflammation of the gastric mucosaInflammation of the gastric mucosa May be Acute or ChronicMay be Acute or Chronic Etiology: Acute- bacteria, irritating Etiology: Acute- bacteria, irritating
foods, NSAIDS, alcohol, bile and foods, NSAIDS, alcohol, bile and radiationradiation
Etiology: Chronic- Ulceration, Etiology: Chronic- Ulceration, bacteria, Autoimmune disease, diet, bacteria, Autoimmune disease, diet, alcohol, smokingalcohol, smoking
Conditions of the Conditions of the StomachStomach
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF GastritisGastritis
InsultsInsults cause gastric cause gastric mucosal damagemucosal damage inflammation, hyperemia and inflammation, hyperemia and edemaedema superficial erosions superficial erosions decreased gastric secretions, decreased gastric secretions, ulcerations and bleedingulcerations and bleeding
Conditions of the Conditions of the StomachStomach
ASSESSMENT ASSESSMENT
(Acute)(Acute) DyspepsiaDyspepsia HeadacheHeadache AnorexiaAnorexia Nausea/Nausea/
VomitingVomiting
ASSESSMENT ASSESSMENT (Chronic)(Chronic)
PyrosisPyrosis SingultusSingultus Sour taste in the Sour taste in the
mouthmouth DyspepsiaDyspepsia N/V/anorexiaN/V/anorexia Pernicious Pernicious
anemiaanemia
Conditions of the Conditions of the StomachStomach
DIAGNOSTIC PROCEDUREDIAGNOSTIC PROCEDURE EGD- to visualize the gastric EGD- to visualize the gastric
mucosa for inflammationmucosa for inflammation Low levels of HClLow levels of HCl Biopsy to establish correct Biopsy to establish correct
diagnosis whether acute or diagnosis whether acute or chronicchronic
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Give 1. Give BLANDBLAND diet diet 2. Monitor for signs of 2. Monitor for signs of
complications like bleeding, complications like bleeding, obstruction and pernicious obstruction and pernicious anemiaanemia
3. Instruct to avoid spicy foods, 3. Instruct to avoid spicy foods, irritating foods, alcohol and irritating foods, alcohol and caffeinecaffeine
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONSNURSING INTERVENTIONS 4. Administer prescribed 4. Administer prescribed
medications- H2 blockers, medications- H2 blockers, antibiotics, mucosal antibiotics, mucosal protectantsprotectants
5. Inform the need for 5. Inform the need for Vitamin B12 injection if Vitamin B12 injection if deficiency is presentdeficiency is present
Conditions of the Conditions of the StomachStomach
PEPTIC ULCER DISEASEPEPTIC ULCER DISEASE An ulceration of the gastric and An ulceration of the gastric and
duodenal liningduodenal lining May be referred as to location as May be referred as to location as
Gastric ulcer in the stomach, or Gastric ulcer in the stomach, or Duodenal ulcer in the duodenumDuodenal ulcer in the duodenum
Most common Peptic ulceration: Most common Peptic ulceration: anterior part of the upper anterior part of the upper duodenumduodenum
Conditions of the Conditions of the StomachStomach
PATHOPHYSIOLOGY of PUDPATHOPHYSIOLOGY of PUD Disturbance in acid secretion Disturbance in acid secretion
and mucosal protectionand mucosal protection Increased acidity or decreased Increased acidity or decreased
mucosal resistancemucosal resistance erosion erosion and ulcerationand ulceration
Conditions of the Conditions of the StomachStomach
GASTRIC ULCERGASTRIC ULCERUlceration of the Ulceration of the gastric mucosa, gastric mucosa, submucosa and submucosa and rarely the muscularisrarely the muscularis
Conditions of the Conditions of the StomachStomach
GASTRIC ULCERGASTRIC ULCER Risk factors: Stress, smoking, Risk factors: Stress, smoking,
NSAIDS abuse, Alcohol, NSAIDS abuse, Alcohol, Helicobacter pylori infection, Helicobacter pylori infection, type A personality and History type A personality and History of gastritis of gastritis
Incidence is high in older adultsIncidence is high in older adults Acid secretion is NORMALAcid secretion is NORMAL
Conditions of the Conditions of the StomachStomach
ASSESSMENT (Gastric Ulcer)ASSESSMENT (Gastric Ulcer) Epigastric painEpigastric pain
Characteristic: Gnawing, Characteristic: Gnawing, sharp pain in the mid-sharp pain in the mid-epigastrium 1-2 hours epigastrium 1-2 hours AFTERAFTER eating, often eating, often NOT RELIEVEDNOT RELIEVED by food intake, sometimes by food intake, sometimes AGGRAVATING the pain!AGGRAVATING the pain!
Conditions of the Conditions of the StomachStomach
ASSESSMENT (Gastric ASSESSMENT (Gastric Ulcer)Ulcer)
Nausea Nausea Vomiting is more commonVomiting is more common HematemesisHematemesis Weight lossWeight loss
Conditions of the Conditions of the StomachStomach
DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES 1. EGD to visualize the 1. EGD to visualize the
ulcerationulceration 2. Urea breath test for H. 2. Urea breath test for H.
pylori infectionpylori infection 3. Biopsy- to rule out 3. Biopsy- to rule out
gastric cancergastric cancer
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Give BLAND diet, small 1. Give BLAND diet, small
frequent meals during the frequent meals during the active phase of the diseaseactive phase of the disease
2. Administer prescribed 2. Administer prescribed medications- H2 blockers, medications- H2 blockers, PPI, mucosal barrier PPI, mucosal barrier protectants and antacidsprotectants and antacids
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONSNURSING INTERVENTIONS 3. Monitor for 3. Monitor for
complications of bleeding, complications of bleeding, perforation and intractable perforation and intractable painpain
4. provide teaching about 4. provide teaching about stress reduction and stress reduction and relaxation techniquesrelaxation techniques
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONS NURSING INTERVENTIONS FOR BLEEDINGFOR BLEEDING
1. Maintain on NPO 1. Maintain on NPO 2. Administer IVF and 2. Administer IVF and
medicationsmedications 3. Monitor hydration status, 3. Monitor hydration status,
hematocrit and hemoglobinhematocrit and hemoglobin
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONS NURSING INTERVENTIONS FOR BLEEDINGFOR BLEEDING
4. Assist with SALINE 4. Assist with SALINE lavagelavage
5. Insert NGT for 5. Insert NGT for decompression and lavagedecompression and lavage
Conditions of the Conditions of the StomachStomach
NURSING INTERVENTIONS FOR NURSING INTERVENTIONS FOR BLEEDINGBLEEDING
6. Prepare to administer blood 6. Prepare to administer blood transfusiontransfusion
7. Prepare to give VASOPRESSIN 7. Prepare to give VASOPRESSIN to induce vasoconstriction to to induce vasoconstriction to reduce bleedingreduce bleeding
8. Prepare patient for SURGERY if 8. Prepare patient for SURGERY if warrantedwarranted
Conditions of the Conditions of the StomachStomach
SURGICAL SURGICAL PROCEDURES FOR PUDPROCEDURES FOR PUD
Total gastrectomy, Total gastrectomy, vagotomy, gastric vagotomy, gastric resection, Billroth I and resection, Billroth I and II, pyloroplastyII, pyloroplasty
Conditions of the Conditions of the StomachStomach
SURGICAL PROCEDURES FOR PUDSURGICAL PROCEDURES FOR PUD
Post-operative Nursing managementPost-operative Nursing management 1. Monitor VS1. Monitor VS 2. Post-op position: FOWLER’S2. Post-op position: FOWLER’S 3. NPO until peristalsis returns3. NPO until peristalsis returns 4. Monitor for bowel sounds4. Monitor for bowel sounds 5. Monitor for complications of 5. Monitor for complications of
surgery surgery
Conditions of the Conditions of the StomachStomach
Post-operative Nursing Post-operative Nursing managementmanagement
6. Monitor I and O, IVF6. Monitor I and O, IVF 7. Maintain NGT7. Maintain NGT 8. Diet progress: clear liquid8. Diet progress: clear liquid
full liquidfull liquid six bland meals six bland meals 9. Manage DUMPING 9. Manage DUMPING
SYNDROMESYNDROME
Condition of the Condition of the DuodenumDuodenum
DUODENAL ULCERDUODENAL ULCERUlceration of duodenal Ulceration of duodenal mucosa and submucosamucosa and submucosa
Usually due to Usually due to increased gastric increased gastric acidityacidity
Condition of the Condition of the DuodenumDuodenum
DUODENAL ULCER DUODENAL ULCER ASSESSMENTASSESSMENT
PAIN characteristic:PAIN characteristic:Burning pain in the mid-Burning pain in the mid-epigastrium 2-4 HOURS after epigastrium 2-4 HOURS after eating or during the night, eating or during the night, RELIEVEDRELIEVED by food intake by food intake
Condition of the Condition of the DuodenumDuodenum
DIAGNOSTIC TESTSDIAGNOSTIC TESTSEGD and BiopsyEGD and Biopsy
Condition of the Condition of the DuodenumDuodenum
NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Same as for gastric ulceration1. Same as for gastric ulceration 2. Patient teaching-avoid alcohol, 2. Patient teaching-avoid alcohol,
smoking, caffeine and smoking, caffeine and carbonated drinkscarbonated drinks
Take NSAIDS with mealsTake NSAIDS with meals
Adhere to medication regimenAdhere to medication regimen
UlcersUlcersGASTRICGASTRIC DUODENALDUODENAL
OlderOlder YoungerYounger
Normal AcidityNormal Acidity INCREASED acidityINCREASED acidity
Pain early after Pain early after eatingeating
Pain late after eating Pain late after eating (2-4 hours)(2-4 hours)
WORSENS by food, WORSENS by food, RELIEVED by RELIEVED by VOMITINGVOMITING
RELIEVES by foodRELIEVES by food
Bleeding, weight Bleeding, weight loss and vomitingloss and vomiting
Less likely bleeding Less likely bleeding and vomitingand vomiting
(+) cancer(+) cancer (-) cancer(-) cancer
Conditions of the Conditions of the Lower TractLower Tract
Small and Large IntestineSmall and Large Intestine
CONDITIONS OF THE CONDITIONS OF THE SMALL INTESTINESMALL INTESTINE
CROHN’S DISEASECROHN’S DISEASEAlso called Regional Also called Regional EnteritisEnteritis
An inflammatory disease An inflammatory disease of the GIT affecting of the GIT affecting usually the small intestineusually the small intestine
CONDITIONS OF THE CONDITIONS OF THE SMALL INTESTINESMALL INTESTINE
CROHN’S DISEASECROHN’S DISEASE ETIOLOGY: unknownETIOLOGY: unknown The terminal ileum The terminal ileum
thickens, with scarring, thickens, with scarring, ulcerations, abscess ulcerations, abscess formation and narrowing formation and narrowing of the lumenof the lumen
CONDITIONS OF THE CONDITIONS OF THE SMALL INTESTINESMALL INTESTINE
ASSESSMENT findings for CDASSESSMENT findings for CD 1. Fever1. Fever 2. Abdominal distention2. Abdominal distention 3. Diarrhea3. Diarrhea 4. Colicky abdominal pain 4. Colicky abdominal pain 5. Anorexia/N/V5. Anorexia/N/V 6. Weight loss6. Weight loss 7. Anemia7. Anemia
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
ULCERATIVE COLITISULCERATIVE COLITIS Ulcerative and inflammatory Ulcerative and inflammatory
condition of the GIT usually affecting condition of the GIT usually affecting the large intestinethe large intestine
The colon becomes edematous and The colon becomes edematous and develops bleeding ulcerationsdevelops bleeding ulcerations
Scarring develops overtime with Scarring develops overtime with impaired water absorption and loss of impaired water absorption and loss of elasticityelasticity
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
ASSESSMENT findings for UCASSESSMENT findings for UC 1. Anorexia1. Anorexia 2. Weight loss2. Weight loss 3. Fever3. Fever 4. SEVERE diarrhea with Rectal 4. SEVERE diarrhea with Rectal
bleedingbleeding 5. Anemia5. Anemia 6. Dehydration6. Dehydration 7. Abdominal pain and cramping7. Abdominal pain and cramping
NURSING INTERVENTIONS NURSING INTERVENTIONS for CD and UCfor CD and UC
1. Maintain NPO during the active phase1. Maintain NPO during the active phase 2. Monitor for complications like severe 2. Monitor for complications like severe
bleeding, dehydration, electrolyte bleeding, dehydration, electrolyte imbalanceimbalance
3. Monitor bowel sounds, stool and 3. Monitor bowel sounds, stool and blood studiesblood studies
4. Restrict activities4. Restrict activities 5. Administer IVF, electrolytes and TPN 5. Administer IVF, electrolytes and TPN
if prescribedif prescribed
NURSING INTERVENTIONS NURSING INTERVENTIONS for CD and UCfor CD and UC
6. Instruct the patient to AVOID gas-6. Instruct the patient to AVOID gas-forming foods, MILK products and forming foods, MILK products and foods such as whole grains, nuts, RAW foods such as whole grains, nuts, RAW fruits and vegetables especially fruits and vegetables especially SPINACH, pepper, alcohol and caffeineSPINACH, pepper, alcohol and caffeine
7. Diet progression- clear liquid7. Diet progression- clear liquid LOW LOW residue, high protein dietresidue, high protein diet
8. Administer drugs- anti-inflammatory, 8. Administer drugs- anti-inflammatory, antibiotics, steroids, bulk-forming antibiotics, steroids, bulk-forming agents and vitamin/iron supplementsagents and vitamin/iron supplements
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
APPENDICITISAPPENDICITISInflammation of Inflammation of the vermiform the vermiform appendixappendix
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
APPENDICITISAPPENDICITISETIOLOGY: usually ETIOLOGY: usually fecalith, lymphoid fecalith, lymphoid hyperplasia, foreign hyperplasia, foreign body and helminthic body and helminthic obstructionobstruction
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
APPENDICITISAPPENDICITIS
PATHOPHYSIOLOGYPATHOPHYSIOLOGY Obstruction of lumenObstruction of lumen
increased pressureincreased pressure decreased blood supplydecreased blood supply bacterial proliferation and bacterial proliferation and mucosal inflammationmucosal inflammation ischemiaischemia necrosis necrosis rupture rupture
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
ASSESSMENT FINDINGS for ASSESSMENT FINDINGS for AppendicitisAppendicitis
1. Abdominal pain: begins in 1. Abdominal pain: begins in the umbilicus then localizes in the umbilicus then localizes in the RLQ (Mc Burney’s point)the RLQ (Mc Burney’s point)
2. Anorexia2. Anorexia 3. Nausea and Vomiting3. Nausea and Vomiting
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
ASSESSMENT FINDINGS for ASSESSMENT FINDINGS for AppendicitisAppendicitis
4. Fever4. Fever 5. Rebound tenderness and 5. Rebound tenderness and
abdominal rigidity (if abdominal rigidity (if perforated)perforated)
6. Constipation or diarrhea6. Constipation or diarrhea
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
DIAGNOSTIC TESTSDIAGNOSTIC TESTS1. CBC- reveals 1. CBC- reveals increased WBC countincreased WBC count
2. Ultrasound2. Ultrasound3. Abdominal X-ray3. Abdominal X-ray
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
NURSING INTERVENTIONSNURSING INTERVENTIONS
1. Preoperative care1. Preoperative careNPONPOConsentConsentMonitor for perforation and Monitor for perforation and signs of shocksigns of shock
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
NURSING INTERVENTIONSNURSING INTERVENTIONS1. Preoperative care1. Preoperative care Monitor bowel sounds, fever Monitor bowel sounds, fever
and hydration statusand hydration status POSITION of Comfort: RIGHT POSITION of Comfort: RIGHT
SIDELYING in a low FOWLER’SSIDELYING in a low FOWLER’S Avoid Laxatives, enemas & HEAT Avoid Laxatives, enemas & HEAT
APPLICATIONAPPLICATION
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
2. Post-operative care2. Post-operative care Monitor VS and signs of Monitor VS and signs of
surgical complicationssurgical complications Maintain NPO until bowel Maintain NPO until bowel
function returnsfunction returns If rupture occurred, expect If rupture occurred, expect
drains and IV antibioticsdrains and IV antibiotics
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
2. Post-operative care2. Post-operative care POSITION post-op: POSITION post-op: RIGHT RIGHT side-lying, semi- fowler’s to side-lying, semi- fowler’s to decrease tension on incision, decrease tension on incision, and legs flexed to promote and legs flexed to promote drainagedrainage
Administer prescribed pain Administer prescribed pain medicationsmedications
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
HemorrhoidsHemorrhoidsAbnormal dilation and Abnormal dilation and weakness of the veins of weakness of the veins of the anal canalthe anal canal
Variously classified as Variously classified as Internal or External, Internal or External, Prolapsed, Thrombosed Prolapsed, Thrombosed and Reducibleand Reducible
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
HemorrhoidsHemorrhoidsPATHOPHYSIOLOGYPATHOPHYSIOLOGYIncreased pressure in Increased pressure in the hemorrhoidal the hemorrhoidal tissue due to straining, tissue due to straining, pregnancy, etcpregnancy, etc dilatation of veinsdilatation of veins
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
Internal hemorrhoidsInternal hemorrhoidsThese dilated veins lie These dilated veins lie above the internal anal above the internal anal sphinctersphincter
Usually, the condition Usually, the condition is PAINLESSis PAINLESS
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
External hemorrhoidsExternal hemorrhoidsThese dilated veins lie These dilated veins lie below the internal anal below the internal anal sphinctersphincter
Usually, the condition Usually, the condition is PAINFULis PAINFUL
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
ASSESSMENT findings for ASSESSMENT findings for HemorrhoidsHemorrhoids
1. Internal hemorrhoids- cannot 1. Internal hemorrhoids- cannot be seen on the peri-anal areabe seen on the peri-anal area
2. External hemorrhoids- can be 2. External hemorrhoids- can be seenseen
3. Bright red bleeding with each 3. Bright red bleeding with each defecationdefecation
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
ASSESSMENT findings ASSESSMENT findings for Hemorrhoidsfor Hemorrhoids
4. Rectal/ perianal pain4. Rectal/ perianal pain5. Rectal itching5. Rectal itching6. Skin tags6. Skin tags
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
DIAGNOSTIC TESTDIAGNOSTIC TEST1. Anoscopy1. Anoscopy2. Digital rectal 2. Digital rectal examinationexamination
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
NURSING INTERVENTIONSNURSING INTERVENTIONS1. Advise patient to apply 1. Advise patient to apply cold packs to the cold packs to the anal/rectal area followed anal/rectal area followed by a SITZ bathby a SITZ bath
2. Apply astringent like 2. Apply astringent like witch hazel soakswitch hazel soaks
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
NURSING NURSING INTERVENTIONSINTERVENTIONS
3. Encourage HIGH-3. Encourage HIGH-fiber diet and fluidsfiber diet and fluids
4. Administer stool 4. Administer stool softener as prescribed softener as prescribed
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
Post-operative care for Post-operative care for hemorrhoidectomyhemorrhoidectomy
1. Position: 1. Position: Prone or Prone or Side-lyingSide-lying
2. Maintain dressing 2. Maintain dressing over the surgical siteover the surgical site
CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE
Post-operative care for Post-operative care for hemorrhoidectomyhemorrhoidectomy
3. Monitor for bleeding3. Monitor for bleeding 4. Administer analgesics and 4. Administer analgesics and
stool softenersstool softeners 5. Advise the use of SITZ bath 5. Advise the use of SITZ bath
3-4 times a day3-4 times a day
CONDITIONS OF THE LARGE CONDITIONS OF THE LARGE INTESTINEINTESTINE
DIVERTICULOSIS AND DIVERTICULOSIS AND DIVERTICULITISDIVERTICULITIS
DiverticulosisDiverticulosis Abnormal out-pouching of the Abnormal out-pouching of the
intestinal mucosa occurring in any intestinal mucosa occurring in any part of the LI most commonly in the part of the LI most commonly in the sigmoidsigmoid
DiverticulitisDiverticulitis Inflammation of the diverticulosisInflammation of the diverticulosis
CONDITIONS OF THE LARGE CONDITIONS OF THE LARGE INTESTINEINTESTINE
PATHOPHYSIOLOGYPATHOPHYSIOLOGY Increased intraluminal pressure, Increased intraluminal pressure,
LOW volume in the lumen and LOW volume in the lumen and Decreased muscle strength in the Decreased muscle strength in the colon wallcolon wall herniation of the herniation of the colonic mucosa colonic mucosa
CONDITIONS OF THE LARGE CONDITIONS OF THE LARGE INTESTINEINTESTINE
ASSESSMENT findings for D/DASSESSMENT findings for D/D 1. Left lower Quadrant pain1. Left lower Quadrant pain 2. Flatulence2. Flatulence 3. Bleeding per rectum3. Bleeding per rectum 4. nausea and vomiting4. nausea and vomiting 5. Fever5. Fever 6. Palpable, tender rectal mass 6. Palpable, tender rectal mass
CONDITIONS OF THE LARGE CONDITIONS OF THE LARGE INTESTINEINTESTINE
DIAGNOSTIC STUDIESDIAGNOSTIC STUDIES 1. If no active inflammation, 1. If no active inflammation,
COLONOSCOPY and Barium COLONOSCOPY and Barium EnemaEnema
2. CT scan is the procedure of 2. CT scan is the procedure of choice!choice!
3. Abdominal X-ray3. Abdominal X-ray
CONDITIONS OF THE LARGE CONDITIONS OF THE LARGE INTESTINEINTESTINE
NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Maintain NPO during acute phase1. Maintain NPO during acute phase 2. Provide bed rest2. Provide bed rest 3. Administer antibiotics, analgesics 3. Administer antibiotics, analgesics
like meperidine (morphine is not like meperidine (morphine is not used) and anti-spasmodicsused) and anti-spasmodics
4. Monitor for potential 4. Monitor for potential complications like perforation, complications like perforation, hemorrhage and fistulahemorrhage and fistula
5. Increase fluid intake5. Increase fluid intake
CONDITIONS OF THE LARGE CONDITIONS OF THE LARGE INTESTINEINTESTINE
NURSING INTERVENTIONSNURSING INTERVENTIONS 6. Avoid gas-forming foods or 6. Avoid gas-forming foods or
HIGH-roughage foods containing HIGH-roughage foods containing seeds, nuts to avoid trappingseeds, nuts to avoid trapping
7. introduce soft, high fiber foods 7. introduce soft, high fiber foods ONLY after the inflammation ONLY after the inflammation subsidessubsides
8. Instruct to avoid activities that 8. Instruct to avoid activities that increase intra-abdominal pressureincrease intra-abdominal pressure
Conditions of the Conditions of the GIT accessory GIT accessory
organsorgansThe liverThe liver
CONDITION OF THE CONDITION OF THE LIVERLIVER
Liver CirrhosisLiver Cirrhosis A chronic, progressive disease A chronic, progressive disease characterized by a diffuse characterized by a diffuse damage to the hepatic cellsdamage to the hepatic cells
The liver heals with scarring, The liver heals with scarring, fibrosis and nodular fibrosis and nodular regenerationregeneration
CONDITION OF THE CONDITION OF THE LIVERLIVER
Liver CirrhosisLiver Cirrhosis
ETIOLOGY: ETIOLOGY:
Post-infection, Alcohol, Post-infection, Alcohol, Cardiac diseases, Cardiac diseases, Schisostoma, Biliary Schisostoma, Biliary obstructionobstruction
Liver physiology and Liver physiology and PathophysiologyPathophysiology
Normal Function Normal Function Abnormality in Abnormality in functionfunction
1. Stores glycogen1. Stores glycogen = Hypoglycemia= Hypoglycemia
2. Synthesizes 2. Synthesizes proteinsproteins
= Hypoproteinemia= Hypoproteinemia
3. Synthesizes 3. Synthesizes globulinsglobulins
==Decreased Antibody Decreased Antibody formationformation
4. Synthesizes Clotting 4. Synthesizes Clotting factorsfactors
= Bleeding = Bleeding tendenciestendencies
5. Secreting bile5. Secreting bile = Jaundice and = Jaundice and prurituspruritus
6. Converts ammonia to 6. Converts ammonia to ureaurea
=Hyperammonemia=Hyperammonemia
7. Stores Vit and 7. Stores Vit and mineralsminerals
==Deficiencies of Vit Deficiencies of Vit and minand min
8. Metabolizes 8. Metabolizes estrogenestrogen
= = Gynecomastia, testes Gynecomastia, testes atrophyatrophy
CONDITION OF THE CONDITION OF THE LIVERLIVER
ASSESSMENT FINDINGSASSESSMENT FINDINGS1. Anorexia and weight 1. Anorexia and weight lossloss
2. Jaundice2. Jaundice3. Fatigue3. Fatigue
CONDITION OF THE CONDITION OF THE LIVERLIVER
ASSESSMENT FINDINGSASSESSMENT FINDINGS4. Early morning nausea and 4. Early morning nausea and vomitingvomiting
5. RUQ abdominal pain5. RUQ abdominal pain6. Ascites6. Ascites7. Signs of Portal 7. Signs of Portal hypertensionhypertension
CONDITION OF THE CONDITION OF THE LIVERLIVER
NURSING INTERVENTIONSNURSING INTERVENTIONS1. Monitor VS, I and O, 1. Monitor VS, I and O, Abdominal girth, weight, Abdominal girth, weight, LOC and BleedingLOC and Bleeding
2. Promote rest. 2. Promote rest. Elevated the head of the Elevated the head of the bed to minimize dyspneabed to minimize dyspnea
CONDITION OF THE CONDITION OF THE LIVERLIVER
NURSING INTERVENTIONSNURSING INTERVENTIONS3. Provide Moderate to 3. Provide Moderate to LOW-protein (1 LOW-protein (1 g/kg/day) and LOW-g/kg/day) and LOW-sodium dietsodium diet
4. Provide supplemental 4. Provide supplemental vitamins (especially K) vitamins (especially K) and mineralsand minerals
CONDITION OF THE CONDITION OF THE LIVERLIVER
NURSING INTERVENTIONSNURSING INTERVENTIONS
5. Administer prescribed5. Administer prescribedDiuretics= Diuretics= to reduce ascites and edemato reduce ascites and edema
Lactulose= Lactulose= to reduce NH4 in the bowelto reduce NH4 in the bowel
Antacids and Antacids and NeomycinNeomycin= = to kill to kill bacterial flora that cause NH productionbacterial flora that cause NH production
CONDITION OF THE CONDITION OF THE LIVERLIVER
NURSING INTERVENTIONSNURSING INTERVENTIONS
6. Avoid hepatotoxic 6. Avoid hepatotoxic drugsdrugs
ParacetamolParacetamolAnti-tubercular drugsAnti-tubercular drugs
CONDITION OF THE CONDITION OF THE LIVERLIVER
NURSING INTERVENTIONSNURSING INTERVENTIONS7. Reduce the risk of injury 7. Reduce the risk of injury
Side rails reorientationSide rails reorientationAssistance in ambulationAssistance in ambulationUse of electric razor and Use of electric razor and soft-bristled toothbrushsoft-bristled toothbrush
CONDITION OF THE CONDITION OF THE LIVERLIVER
NURSING INTERVENTIONSNURSING INTERVENTIONS8. Keep equipments ready 8. Keep equipments ready including Sengstaken-including Sengstaken-Blakemore tube, IV fluids, Blakemore tube, IV fluids, Medications to treat Medications to treat hemorrhagehemorrhage
CONDITION OF THE CONDITION OF THE LIVERLIVER
Nursing Nursing InterventionsInterventions
RationaleRationale
1. Low sodium Diet1. Low sodium Diet To reduce edemaTo reduce edema
2. Low protein diet2. Low protein diet To reduce NH To reduce NH productionproduction
3. Benadryl and 3. Benadryl and mild soapmild soap
To relieve pruritusTo relieve pruritus
4. Pressure onto 4. Pressure onto injection siteinjection site
To prevent bleedingTo prevent bleeding
5. Assist in 5. Assist in paracentesisparacentesis
Done to relieve abdominal Done to relieve abdominal pressurepressure
6. Administer 6. Administer Medications:Medications:
Diuretics, Diuretics, Neomycin, LactuloseNeomycin, LactuloseAlbumin, Amino Albumin, Amino acidacidVitamin K Vitamin K (menadione)(menadione)
Conditions of the Conditions of the Accessory organsAccessory organs
The The GallbladderGallbladder
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
CholecystitisCholecystitisInflammation of the Inflammation of the gallbladdergallbladder
Can be acute or chronicCan be acute or chronic
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
CholecystitisCholecystitis
Acute cholecystitis Acute cholecystitis usually is due to usually is due to gallbladder stonesgallbladder stones
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
CholecystitisCholecystitisChronic cholecystitis Chronic cholecystitis is usually due to long is usually due to long standing gall bladder standing gall bladder inflammationinflammation
CholelithiasisCholelithiasis
Formation of Formation of GALLSTONES in the GALLSTONES in the biliary apparatusbiliary apparatus
Predisposing FACTORSPredisposing FACTORS
““F”F”FemaleFemaleFatFatFortyFortyFertileFertileFairFair
PathophysiologyPathophysiology
Supersaturated bile, Biliary Supersaturated bile, Biliary stasisstasis
Stone formationStone formation
Blockage of GallbladderBlockage of Gallbladder
Inflammation, Mucosal Damage Inflammation, Mucosal Damage and WBC infiltration and WBC infiltration
PathophysiologyPathophysiologyLess bile in the duodenumLess bile in the duodenum
Impaired fat digestion and Impaired fat digestion and absorptionabsorption
Vitamin ADEK mal-absorption, Vitamin ADEK mal-absorption, STEATORHEA with increased gas STEATORHEA with increased gas
formationformation
JaundiceJaundice
ACHOLIC stoolsACHOLIC stools
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
ASSESSMENT findings ASSESSMENT findings for cholecystitisfor cholecystitis
1. Indigestion, belching 1. Indigestion, belching and flatulenceand flatulence
2. Fatty food 2. Fatty food intolerance, steatorrheaintolerance, steatorrhea
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
ASSESSMENT findings ASSESSMENT findings for cholecystitisfor cholecystitis
3. Epigastric pain that 3. Epigastric pain that radiates to the scapula radiates to the scapula or localized at the RUQor localized at the RUQ
4. Mass at the RUQ4. Mass at the RUQ
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
ASSESSMENT findings ASSESSMENT findings for cholecystitisfor cholecystitis
5. Murphy’s sign5. Murphy’s sign6. Jaundice6. Jaundice7. dark orange and 7. dark orange and foamy urinefoamy urine
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES
1. Ultrasonography- 1. Ultrasonography- can detect the stones can detect the stones
2. Abdominal X-ray2. Abdominal X-ray3. Cholecystography3. Cholecystography
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES
4. WBC count increased4. WBC count increased 5. Oral cholecystography 5. Oral cholecystography
cannot visualize the cannot visualize the gallbladdergallbladder
6. ERCP: revels inflamed 6. ERCP: revels inflamed gallbladder with gallstonegallbladder with gallstone
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
NURSING NURSING INTERVENTIONSINTERVENTIONS
1. Maintain NPO in the 1. Maintain NPO in the active phaseactive phase
2. Maintain NGT 2. Maintain NGT decompressiondecompression
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
NURSING INTERVENTIONSNURSING INTERVENTIONS 3. Administer prescribed 3. Administer prescribed
medications to relieve pain. medications to relieve pain. Usually Demerol Usually Demerol (MEPERIDINE)(MEPERIDINE)
Codeine and Morphine may Codeine and Morphine may cause spasm of the Sphinctercause spasm of the Sphincter increased pain. Morphine cause increased pain. Morphine cause MOREPAINMOREPAIN
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
4. Instruct patient to 4. Instruct patient to AVOID AVOID HIGH- fat diet and GAS-HIGH- fat diet and GAS-forming foodsforming foods
5. Assist in surgical and non-5. Assist in surgical and non-surgical measuressurgical measures
6. Surgical procedures- 6. Surgical procedures- Cholecystectomy, Cholecystectomy, Choledochotomy, laparoscopyCholedochotomy, laparoscopy
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
PHARMACOLOGIC PHARMACOLOGIC THERAPYTHERAPY
1.1. Analgesic- MeperidineAnalgesic- Meperidine
2.2. Chenodeoxycholic acid= to Chenodeoxycholic acid= to dissolve the gallstonesdissolve the gallstones
3.3. AntacidsAntacids
4.4. Anti-emeticsAnti-emetics
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
Post-operative nursing interventionsPost-operative nursing interventions
1. Monitor for surgical 1. Monitor for surgical complicationscomplications
2. Post-operative 2. Post-operative position after recovery position after recovery from anesthesia- from anesthesia- LOW LOW FOWLER’sFOWLER’s
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
Post-operative nursing Post-operative nursing interventionsinterventions
3. Encourage early ambulation 3. Encourage early ambulation 4. 4. Administer medication Administer medication
before coughing and deep before coughing and deep breathing exercisesbreathing exercises
5. Advise client to splint the 5. Advise client to splint the abdomen to prevent abdomen to prevent discomfort during coughingdiscomfort during coughing
CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER
Post-operative nursing interventionsPost-operative nursing interventions6. Administer analgesics, 6. Administer analgesics, antiemetics, antacidsantiemetics, antacids
7. Care of the biliary 7. Care of the biliary drainageor T-tube drainageor T-tube drainagedrainage
8. Fat restriction is only 8. Fat restriction is only limited to 4-6 weeks. limited to 4-6 weeks. Normal diet is resumedNormal diet is resumed
Conditions of the Conditions of the accessory organsaccessory organs
The pancreas: The pancreas: Exocrine Exocrine functionfunction
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
PancreatitisPancreatitisInflammation of Inflammation of the pancreasthe pancreas
Can be acute or Can be acute or chronicchronic
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
PancreatitisPancreatitis Etiology and predisposing Etiology and predisposing factorsfactorsAlcoholismAlcoholismHypercalcemiaHypercalcemiaTraumaTraumaHyperlipidemiaHyperlipidemia
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
PancreatitisPancreatitis Etiology and predisposing Etiology and predisposing factorsfactorsBiliary tract diseaseBiliary tract disease - - cholelithiasischolelithiasis
Bacterial diseaseBacterial diseasePUDPUDMumpsMumps
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
PATHOPHYSIOLOGY of PATHOPHYSIOLOGY of acute pancreatitisacute pancreatitis
Self-digestion of the Self-digestion of the pancreas by its own pancreas by its own digestive enzymes digestive enzymes principally TRYPSINprincipally TRYPSIN
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
PATHOPHYSIOLOGY of acute PATHOPHYSIOLOGY of acute pancreatitispancreatitis
Spasm, edema or block in Spasm, edema or block in the Ampulla of Vaterthe Ampulla of Vater reflux reflux of proteolytic enzymesof proteolytic enzymes auto digestion of the auto digestion of the pancreaspancreas inflammation inflammation
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
PATHOPHYSIOLOGY of acute pancreatitisPATHOPHYSIOLOGY of acute pancreatitis
Autodigestion of pancreatic tissueAutodigestion of pancreatic tissue
Hemorrhage, Necrosis and InflammationHemorrhage, Necrosis and Inflammation
KININ ACTIVATION will result to increased KININ ACTIVATION will result to increased permeabilitypermeability
Loss of Protein-rich fluid into the Loss of Protein-rich fluid into the peritoneumperitoneum
HYPOVOLEMIAHYPOVOLEMIA
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
ASSESSMENT findingsASSESSMENT findings1. Abdominal pain- 1. Abdominal pain- acute onset, occurring acute onset, occurring after a heavy meal or after a heavy meal or alcohol intakealcohol intake
2. Abdominal guarding2. Abdominal guarding
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
ASSESSMENT findingsASSESSMENT findings 3. Bruising on the flanks and 3. Bruising on the flanks and
umbilicusumbilicus 4. N/V, jaundice4. N/V, jaundice 5. Hypotension and 5. Hypotension and
hypovolemiahypovolemia 6. 6. HYPERGLYCEMIA, HYPERGLYCEMIA,
HYPOCALCEMIAHYPOCALCEMIA 7. Signs of shock7. Signs of shock
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
DIAGNOSTIC TESTSDIAGNOSTIC TESTS 1. Serum amylase and serum 1. Serum amylase and serum
lipaselipase 2. Ultrasound2. Ultrasound 3. WBC3. WBC 4. Serum calcium4. Serum calcium 5. CT scan5. CT scan 6. Hemoglobin and hematocrit6. Hemoglobin and hematocrit
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
NURSING INTERVENTIONSNURSING INTERVENTIONS1. Assist in pain 1. Assist in pain management. Usually, management. Usually, Demerol is givenDemerol is given. . Morphine is AVOIDEDMorphine is AVOIDED
2. Assist in correction of 2. Assist in correction of Fluid and Blood lossFluid and Blood loss
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
NURSING INTERVENTIONSNURSING INTERVENTIONS
3. 3. Place patient on NPOPlace patient on NPO to to inhibit pancreatic stimulationinhibit pancreatic stimulation
4. 4. NGT insertion to NGT insertion to decompress distention and decompress distention and remove gastric secretionsremove gastric secretions
5. Maintain on bed rest5. Maintain on bed rest
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
NURSING INTERVENTIONSNURSING INTERVENTIONS 7. Position patient in 7. Position patient in SEMI-SEMI-
FOWLER’s to decrease FOWLER’s to decrease pressure on the diaphragm pressure on the diaphragm
8. Deep breathing and 8. Deep breathing and coughing exercisescoughing exercises
9. Provide parenteral nutrition9. Provide parenteral nutrition
CONDITION OF THE CONDITION OF THE PANCREASPANCREAS
NURSING INTERVENTIONSNURSING INTERVENTIONS
10. Introduce oral feedings 10. Introduce oral feedings gradually- HIGH carbo, gradually- HIGH carbo, LOW FATLOW FAT
11. Maintain skin integrity11. Maintain skin integrity12. Manage shock and 12. Manage shock and other complicationsother complications
Quick SummaryQuick Summary
Peptic UlcerPeptic Ulcer Ulceration of mucosa; In the stomach Ulceration of mucosa; In the stomach
or duodenumor duodenum Outstanding Symptom: PAINOutstanding Symptom: PAIN Nursing Goal: Allow ulcer to heal, Nursing Goal: Allow ulcer to heal,
prevent complicationprevent complication Rest: physical and MentalRest: physical and Mental Eliminate certain foodsEliminate certain foods Medications: antacid, H2 blockers, Medications: antacid, H2 blockers,
Proton Pump inhibitors, antibiotics, Proton Pump inhibitors, antibiotics, mucosal protectantsmucosal protectants
Surgery: Vagotomy, Billroth 1 and 2Surgery: Vagotomy, Billroth 1 and 2
Quick SummaryQuick Summary
Liver CirrhosisLiver Cirrhosis Destruction of liver with replacement Destruction of liver with replacement
by scarsby scars Common causes: alcoholism, post-Common causes: alcoholism, post-
hepatitichepatitic Manifestations related to liver Manifestations related to liver
derangementsderangements Jaundice, Ascites, splenomegaly, Jaundice, Ascites, splenomegaly,
bleeding, encephbleeding, enceph Nursing goal: Control manifestations Nursing goal: Control manifestations
and maximize liver functionand maximize liver function
Quick SummaryQuick Summary
Liver CirrhosisLiver Cirrhosis Encourage restEncourage rest Avoid hepatotoxic drugsAvoid hepatotoxic drugs Diet: HIGH calorie, Restricted protein, LOW Diet: HIGH calorie, Restricted protein, LOW
NaNa Weight client and measure abdominal girth Weight client and measure abdominal girth
dailydaily Provide skin care for jaundice and edemaProvide skin care for jaundice and edema Assess for bleeding: esophageal, rectal, Assess for bleeding: esophageal, rectal,
cutaneouscutaneous DRUGS: Antacids, Diuretics, Albumin, DRUGS: Antacids, Diuretics, Albumin,
Neomycin and LactuloseNeomycin and Lactulose
Quick SummaryQuick Summary
CholecystitisCholecystitis Inflammation of the gallbladder Inflammation of the gallbladder
commonly caused by cholelithiasis commonly caused by cholelithiasis (Female, Fat, Forty, Fertile, Fair)(Female, Fat, Forty, Fertile, Fair)
Manifestations: Fat intolerance, RUQ Manifestations: Fat intolerance, RUQ pain, Nausea and vomiting, Jaundice, pain, Nausea and vomiting, Jaundice, Murphy’s signMurphy’s sign
Nursing Goal: Relieve symptoms and Nursing Goal: Relieve symptoms and assist in stone removalassist in stone removal
Quick SummaryQuick Summary
CholecystitisCholecystitis Administer MEPERIDINE, avoid Administer MEPERIDINE, avoid
morphinemorphine Maintain Fluid and electrolyte balanceMaintain Fluid and electrolyte balance Maintain a LOW fat dietMaintain a LOW fat diet Semi-fowler’s positionSemi-fowler’s position Assist in surgeryAssist in surgery Care of the T-tubeCare of the T-tube
Quick SummaryQuick Summary
PancreatitisPancreatitis Inflammation of the pancreas brought Inflammation of the pancreas brought
about by the digestion of the organ by about by the digestion of the organ by the enzyme it producesthe enzyme it produces
Common causes: Alcoholism, stoneCommon causes: Alcoholism, stone Manifestations: Extreme upper Manifestations: Extreme upper
abdominal pain radiating into the back, abdominal pain radiating into the back, vomiting, nausea, Abdominal vomiting, nausea, Abdominal distention, Steatorrhea and weight lossdistention, Steatorrhea and weight loss
Laboratory: ELEVATED lipase and Laboratory: ELEVATED lipase and amylaseamylase
Quick SummaryQuick Summary
PancreatitisPancreatitis Nursing Goal : relieve symptoms, Nursing Goal : relieve symptoms,
maintain blood volume and GIT restmaintain blood volume and GIT rest NPONPO Provide IVF and Parenteral nutritionProvide IVF and Parenteral nutrition Drugs: MEPERIDINE, never morphine, Drugs: MEPERIDINE, never morphine,
Antacids, anticholinergicsAntacids, anticholinergics After Acute phase: LOW fat diet, avoid After Acute phase: LOW fat diet, avoid
alcohol, fat and vitamin replacementsalcohol, fat and vitamin replacements