Nursing Care of Clients with Gastrointestinal Disorders – Flashcards
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What physical assessments need to be done to assess gastrointestinal function?
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Height/Weight Oral assessment Inspect assessment Auscultate abdomen Percuss abdomen Palpate abdomen Perianal assessment Fecal assessment
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What are characteristics of normal fecal matter?
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Brown Formed, soft, semisoft, moist Small amount of undigested roughage
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What are characteristics of abnormal fecal matter?
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Clay, melena, steatorrhea Hard, dry Pus, large amounts of mucus, parasites, blood, foreign objects, large amounts of fat
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What are factors that affect bowel elimination?
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Age, diet, fluid intake, physical activity, depression, personal habits, position during defecation, pain, pregnancy, surgery/anesthesia, medications, diagnostic tests, pathological conditions
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What are diagnostic tests for the esophagus and stomach?
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Barium swallow or upper GI series Esophageal acidity, Bernstein test Gastric emptying studies MRI Upper GI Endoscopy
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What are diagnostic tests for the intestines?
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Abdominal ultrasound Barium enema Colonoscopy Stool sample MRI- Abdominal Sigmoidoscopy Small-Bowel series
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What are diagnostic tests for Gastrointestinal systems?
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Gallbladder ultrasound Cholecystography Computed Tomography Endoscopic Retrograde Cholangiopancreatography
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What are nursing diagnosis of Gastrointestinal disorders?
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Fluid volume deficit Diarrhea Constipation Impaired skin integrity Imbalanced nutrition: Less than Pain Disturbed body image Dysfunctional Gastrointestinal mobility
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What are common gastrointestinal problems?
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Dehydration Nausea and vomiting Diarrhea Constipation
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What is dehydration?
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Loss of water from circulation
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What can cause dehydration?
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Inability to maintain fluid Concentrated tube feedings Vomiting/diarrhea Endocrine disorder Renal failure Fever Exercise GI suctioning and intestinal draining Diuretics Third spacing
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What commonly causes dehydration in children?
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Vomiting, diarrhea, diaphoresis without fluid replacement
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What causes dehydration to occur more rapidly?
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Increased percentage of extracellular fluid Increased basal metabolic rate Immature renal system Increased temperature causing increased insensible fluid loss Increased body surface area
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What do laboratory values for dehydration/fluid volume deficit?
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Increased sodium Increased potassium Increased BUN Increased Osmolality Increased hematocrit/hemoglobin Increased urine specific gravity/osmolality
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What are manifestations of dehydration/fluid volume deficit?
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Thirst Dark urine color Decreased skin color and skin turgor Oral mucosa is dry Capillary refill decreased Elevated temperature Decreased intake Little output Decreased blood pressure Increased Heart rate Weight drops Orthostatic hypotension Altered LOC Sunken in fontanels
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What can help dehydration/fluid volume deficit?
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Water -tap water, milk, fruit juice Carbohydrate/electrolyte solution Intravenously
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What are nursing interventions for dehydration/fluid volume deficit?
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Assess VS every 4 hours Daily weights Monitor intake and output Monitor laboratory values Turn cleint every 2 hours Assess signs and symptoms of fluid volume deficit Position change slowly Avoid prolonged standing Avoid stooping
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What can cause vomiting?
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Infections GERD, Gastritis, Slowed peristalsis Pregnancy Diabetic ketoacidosis Concussion, subdermal hematoma Food poisoning, bulimia
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What are pharmacological interventions of nausea and vomiting?
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Antihistamines Serotonin receptor antagonists Antiemetics Dopamine antagonists
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What are complementary and alernative medicines for nausea and vomiting?
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Biofeedback, music therapy, hypnosis, distraction, ginger
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What are nursing diagnosis for nausea?
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Monitor for dehydration Consume small quality of clear liquids and dry food at separate times Avoid food odors Oral cares Positioning
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What is Diarrhea?
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Passage of liquid feces and increased frequency of defecation
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How long does acute diarrhea last?
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Less than one week
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How long does chronic diarrhea last?
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Longer than 3 weeks
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What conditions cause diarrhea?
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Antibiotic Enternal nutrition Food allergies Diseases, surgeries. diagnostic tests
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What are manifestations of diarrhea?
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Spasmodic cramping Increased bowel sounds Fatigue Weakness
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What are factors associated with diarrhea?
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Fluid and electrolyte or acid-base imbalance Skin irritation to the perineum and buttocks
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What medications are used to treat diarrhea?
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Lomotil Imodium Pepto-Bismol -which can cause darkening of tongue and stool.
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What are nutritional guidelines for someone with diarrhea?
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Gatorade, Pedialyte Increase fluid intake Use small frequent feedings Avoid milk. raw fruits. veggies, fried food, fiber, alcohol, because they stimulate peristalses
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What are complementary and alternative therapies for diarrhea?
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Tea of black pepper, rosemary, sandalwood Probiotics
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What is essential in determining if someone is constipated?
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Determine the client's regular elimination pattern
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What are defining characteristics of constipation?
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Decreased frequency of defecation Hard, dry stool Straining to stool Painful defecation Reports of rectal fullness after defication Abdominal pain, cramps, or distention Use of laxatives Decreased appetite Headache
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What factors contribute to constipation?
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Insufficient fiber intake Insufficient fluid intake Insufficient activity or immobility Irregular defecation habits Lack of privacy Tumors Partial bowel obstruction Change in daily routine Chronic use of laxatives or enemas Emotional disturbance Medications
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What medications are used to treat constipation?
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Wetting agents/stool softener-Colace Osomotic and saline laxatives- Milk of Mag Bulk-forming agents-Citrucel, Metamucil Laxatives- Ducolax, Senna Enema Fluids at least 2500 CCs
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What nutrition wise should be done for constipation?
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Foods high in fiber Raw fruits and vegtables Cereal bran Prune juice and apple juice
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What are complimentary and alternative therapies for constipation?
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Flaxseed, acupuncture, massage. reflexology, aromatherapy, stress management Ambulation
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What is GERD and what causes it?
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GERD is the backward flowing of gastric contents into the esophagus It may result from the relaxation of the lower esophageal sphincter.
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What factors can contribute to GERD?
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Increased gastric volume Positioning Increased gastric pressure
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What are manifestations of GERD in adults?
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Heartburn, Regurgitation, Difficulty and or pain with swallowing, Atypical chest pain. Sore throat, Hoarseness
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What are manifestations of GERD in children?
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Recurrent vomiting Regurgitation Weight loss Irritability Respiratory symptoms Chronic sinusitis Otitis media Feeding refusal
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What medications are used to treat GERD?
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Anacids H2 Receptor blockers Metoclopromide Proton Pump inhibitor
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What are dietary and life style changes for GERD?
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Avoid certain foods Maintain ideal body weight Eat smaller meals No eating 3 hours before bed Stay upright for 2 hours after meals Elevate head of bed Stop smoking Avoid wearing tight clothing, bending over
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What are surgical procedures that can be used to treat GERD?
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Laparoscopic fundoplication Nissen fundoplication
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What are complications of GERD?
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Espophageal strictures Barrett's esophagus Esophageal cancer
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What is a hiatal hernia?
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Stomach protrudes through the esophageal hiatus of the diaphragm into the thoracic cavity
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Does a hiatal hernia have any symptoms?
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No it is asymptomatic
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What are manifestations of hiatal hernias?
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Reflux Heartburn Feeling of fullness Substernal chest pain Dysphagia Occult bleeding Belching Indigestion
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How are hiatal hernias treated?
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The same as GERD but with surgery
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What are complications of hiatal hernias?
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Gastritis Gastrointestinal bleeding
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What are risk factors for esophageal cancer?
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Excessive alcohol consumption Cigarette smoking GERD Ingested carcinogens Smoked opiates Physical mucosal damage Congenital disorders
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What are manifestations of esophageal cancer?
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Dysphagia Anemia Weight-loss GERD symptoms Regurgitation Anorexia Chest pain Persistent cough Traceoesophageal fistulas Hypercalcemia
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What is treatment for Esophageal cancer?
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Chemotherapy Radiation Surgery Palliative care
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What is stomach cancer?
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Adenocarcinoma involving mucus producing cells Begins as a localized lesion Metastasis
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What are risk factors for stomach cancer?
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H Pylori Genetic predisposition Chronic gastritis Perninicious anemia Gastric polyps Carcinogenic factors in diet Lack of hydrochloric acid in the stomach Partial gastric resection
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What are early symptoms of stomach cancer?
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Feelings of early satiety Anorexia Indigestion Vomiting Ulcerlike pain that occurs during meals
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What are progressive symptoms of stomach cancer?
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Weight loss Poor health Malnourished Palpable abdominal mass Occult blood in stool
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What are treatments for stomach cancer?
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Surgery Partial gastrectomy Total gastrectomy Chemotherapy Radiation Pallative care
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What are complications of stomach cancer?
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Dumping syndrome Anemia Nutrition deficiency
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What are localized manifestations dumping syndrome?
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Nausea Vomiting Epigastric pain Cramping Diarrhea
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What are systemic manifestations of dumping syndrome?
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Tachycardia Othrostatic hypotension Dizziness Flushing Diaphoresis
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What is nursing management for dumping syndrome?
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Small, frequent meals Limit fluids with meals Increase fat and protein Reduce carbs Rest in a recumbent or semirecumbent Medications
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What is oral cancer?
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Malignancy of oral mucosa Develops on lips, tongue, floor of mouth, other oral tissues
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What are risk factors for oral cancers?
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Smoking Drinking alcohol Chewing tobacco Marijuana use Occupational exposure to chemicals Virus-HPV
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What are early manifestations of oral cancers?
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Painless oral ulceration of lesions
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What are late manifestation of oral cancer?
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Difficultly speaking Difficulty swallowing or chewing Swollen lymph nodes Blood tinged sputum
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How is 1-2 stage oral cancer treated?
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Radiation or surgery
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How is stage 3-4 oral cancer treated?
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Combination of surgery, radiation and chemotherapy
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What are signs of an upper GI bleed?
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Hematemesis Coffee ground vomit
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What are signs of a lower GI bleed?
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Melena Hematochezia
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What are manifestations of a GI bleed?
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Decreased cardiac output Elevated BUN
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What are nursing interventions for GI Bleeds?
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Assess and evaluate stool and vomit Blood loss and fluid replacement Gastric lavage Monitor vitals
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What are post operative nursing cares for Upper/Lower GI surgery?
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Routine post operative care Abdominal assessment NG tube Maintain tubes and drains Ambulation Re-feeding
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What is the number one thing that should be assessed after GI surgery?
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Bowel sounds
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What should you not do with with a NG tube in the upper GI?
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Never suction No NG tubes Never irrigate or replace unless surgeon tells you.
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How do you know if an NG tube is working?
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They are not nauseated
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What do you do to the NG tube when you are listening for bowel sounds?
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Pinch the tube.
