julie c.

yu-santos

GASTROINTESTINAL SYSTEM
JULIE C. YU-SANTOS, M.D.

Main organ includes : mouth, pharynx, esophagus, stomach , small intestine and large intestine Function: 1. Normally, It is the only source of intake for the body 2. Provide the body with fluids, nutrients, and electrolytes 3. Provides means of disposal for waste residues
julie c. yu-santos

Physiology of digestion and absorption :

1.

digestion: physical and chemical breakdown of food into absorptive substances

1.

2.

3.

4.

Initiated in the mouth where the food mixes with saliva and starch is broken down Food then passes into the esophagus where it is propelled into the stomach In the stomach, food is processed by gastric secretion into the substance called CHYME In the small intestine , carbohydrates are hydrolyzed to monosaccharides, fats to glycerols and fatty acids, CHON to amino acids to complete the digestive process julie c. yu-santos

 When

chyme enters the duodenum, mucus is secreted to neutralize HCL acid , in response to release of secretin , pancreas releases HCO3 to neutralize acid chyme and pancreozymin (CCK-PZ) are also produced by the duodenal mucosa, stimulate the contraction of GB along with relaxation of the sphincter of Oddi and stimulates release of pancreatic enzymes
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Cholecystokinin

Blood supply to GIT

5

GIT receives blood from arteries that originates along the entire length of the thoracic and abdominal aorta Venous drainage portal vein Blood flow to the GI tract is about 20% of total cardiac output, increases significantly after eating

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Nerve innervation to GIT

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ANS-both parasympathetic and sympathetic system innervate the GI tract Only portion of the tract that are under voluntary control are the upper esophagus and external anal sphincter

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The GIT Physiology

LIEZEL ADAJAR CASTILLO R.N.M.D.

SYMPATHETIC

Generally INHIBITORY! Decreased gastric secretions Decreased GIT motility Sphincters and blood vessels constrict

PARASYMPATHETIC Generally EXCITATORY! Increased gastric secretions Increased gastric motility Sphincters relax

julie c. yu-santos

A clinic nurse is performing an abdominal assessment on client and preparing to auscultate bowel sounds. The nurse places the stethoscope in which quadrant first?
a. Right upper quadrant b. Right lower quadrant c. Left lower quadrant d. Left upper quadrant
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julie c. yu-santos

GASTROINTESTINAL ASSESSMENT
Laboratory Procedures

COMMON LABORATORY PROCEDURES

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FECALYSIS
Examination of stool consistency, color and the presence of occult blood. Special tests for fat, nitrogen, parasites, ova, pathogens and others

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COMMON LABORATORY PROCEDURES

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FECALYSIS: Occult Blood Testing

Instruct the patient to adhere to a 3day meatless diet No intake of NSAIDS, aspirin and anticoagulant Screening test for colonic cancer

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COMMON LABORATORY PROCEDURES

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Upper GIT study: Barium swallow Examines the upper GI tract Barium sulfate is usually used as contrast
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COMMON LABORATORY PROCEDURES

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Upper GIT study: Barium swallow Pre-test: NPO post-midnight Post-test: Laxative is ordered, increase pt fluid intake, instruct that stools will turn white, monitor for obstruction
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COMMON LABORATORY PROCEDURES

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Lower GIT study: Barium enema Examines the lower GI tract Pre-test: Clear liquid diet and laxatives, NPO post-midnight, cleansing enema prior to the test
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COMMON LABORATORY PROCEDURES

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Lower GIT study: barium enema

Post-test: Laxative is ordered, increase patient fluid intake, instruct that stools will turn white, monitor for obstruction

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LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

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COMMON LABORATORY PROCEDURES Gastric analysis

Aspiration of gastric juice to measure pH, appearance, volume and contents Pre-test: NPO 8 hours, avoidance of stimulants, drugs and smoking Post-test: resume normal activities

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COMMON LABORATORY PROCEDURES

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EGD esophagogastroduodenoscopy
Visualization of the upper GIT by endoscope Pre-test: ensure consent, NPO 8 hours, pre-medications like atropine and anxiolytics

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Gastroscopy
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COMMON LABORATORY PROCEDURES

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EGD

esophagogastroduodenoscopy Intra-test: position : LEFT lateral to facilitate salivary drainage and easy access

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

COMMON LABORATORY PROCEDURES

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EGD(esophagogastroduodenoscop y) Post-test: NPO until gag reflex returns, place patient in SIMS position until he awakens, monitor for complications, saline gargles for mild oral discomfort
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COMMON LABORATORY PROCEDURES

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Lower GI- scopy Use of endoscope to visualize the anus, rectum, sigmoid and colon Pre-test: consent, NPO 8 hours, cleansing enema until return is clear
LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

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LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

Colonoscopy
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LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

COMMON LABORATORY PROCEDURES

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Lower GI- scopy Intra-test: position is LEFT lateral, right leg is bent and placed anteriorly Post-test: bed rest, monitor for complications like bleeding and perforation
LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

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LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

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COMMON LABORATORY PROCEDURES Cholecystography Examination of the gallbladder to detect stones, its ability to concentrate, store and release the bile Pre-test: ensure consent, ask allergies to iodine, seafood and dyes; fat free meal night before the test; contrast medium is administered the night prior, NPO after contrast administration
LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

COMMON LABORATORY PROCEDURES

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Cholecystography Post-test: Advise that dysuria is common as the dye is excreted in the urine, resume normal activities
LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

A client is scheduled for an oral cholecystogram. A nurse would order what type of diet for the evening meal before the test?
a. Low protein b. Fat free c. High carbohydrates d. Liquid
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COMMON LABORATORY PROCEDURES

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Paracentesis Removal of peritoneal fluid for analysis

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COMMON LABORATORY PROCEDURES

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Paracentesis Pre-test: ensure consent, instruct to VOID and empty bladder, measure abdominal girth

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COMMON LABORATORY PROCEDURES

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Paracentesis

Intra-test: Upright on the edge of the bed, back supported and feet resting on a foot stool

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COMMON LABORATORY PROCEDURES

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Liver biopsy
Pretest Consent NPO Check for the bleeding parameters

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COMMON LABORATORY PROCEDURES

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Liver biopsy Intratest

Position:

Semi fowlers LEFT lateral to expose right side of abdomen

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COMMON LABORATORY PROCEDURES

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Liver biopsy

Post-test: position on RIGHT lateral with pillow underneath, monitor VS and complications like bleeding, perforation. Instruct to avoid lifting objects for 1 week

julie c. yu-santos

An ambulatory nurse is preparing to assist in physician performing liver biopsy. The client is receiving local anesthetic for the procedure. The nurse would assist the client for the position?
a. Right lateral side lying b. Left lateral side lying c. Prone with the hands crossed under the head d. Supine with the right hand under the head
julie c. yu-santos

MOUTH, PHARYNX and ESOPHAGUS

Buccal cavity includes: 1. Cheeks 2. Hard and soft palates 3. Muscles 4. Maxillary bones 5. Tongue Pharynx- tube like structure that extends from the base of the skull to the esophagus Has 3 types: nasopharynx, oropharynx, laryngopharynx
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Buccal acvity

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Larynx
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Function: 1. Serving as a pathway for the respiratory and digestive tracts 2. Playing an important role in phonation Esophagus: begins at the lower end of the pharynx and is a collapsible muscular tube about 10 inches long ( 25cm) Function: Convey food from the mouth to the stomach
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Oral infection
Stomatitis- is an inflammation of the mouth Glossitis- inflammation of the tongue Gingivitis- inflammation of the gums Causes: maybe mechanical, chemical, or infectious Types: 1. Herpes Simplex- group of vesicles on an erythematous base

Usually located at the mucocutaneous junctions of the lips and face Cause by a virus Treated with acyclovir, treated symptomatically
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2. Vincents angina (Trench mouth)- purplish red gums covered by pseudomembrane

Caused

by fusiform bacteria and spirochetes Symptoms include fever, anorexia, CLAD, foul breath Treated with antibiotic

3. Apthous ulcer( canker sores)

Unknown

etiology Usually less than 1cm in diameter Duration is weeks to months Very painful ,shallow erosion of the mucous membrane Well circumscribed julie with a white or yellow center c. yu-santos

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1.

2.

3.

Nursing intervention: Provide and teach the client with good oral hygiene, including avoidance of commercial mouthwash Rinse with viscous lidocaine before meals to provide an analgesic effects Advise client to suck on popsicles to provide moisture

julie c. yu-santos

Cancer of the mouth

-occur in the lips, or with in the mouth( tongue, floor of mouth, buccal mucosa, pharynx and tonsils) -most common is squamous cell carcinoma( lower lip) Etiology: 1. Excessive sun exposure 2. Tobacco (cigar, pipe, cigarette) julie c. yu-santos 3. Excessive alcohol intake

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Assessment findings: 1. Ulceration (often painless) on the lip; tongue or buccal mucosa 2. Pain or soreness of the tongue upon eating hot or highly seasoned foods 3. Erythroplakia, leukoplakia 4. Difficulty chewing/speaking, dysphagia 5. Positive toluidine blue test
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Early detection (very important) Medical mgt: 1. Radiation therapy (affect primary lesion and affected lymph nodes) 2. Chemotherapy 3. Surgery- depend on location and extent of tumor a. Mandibulectomy- removal of the mandible b. Hemiglossectomy- removal of half the tongue
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c. Glossectomy- removal of entire tongue d. Radical neck dissection

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Nursing intervention: 1. Routine pre-op care 2. Post-op care: a. Promote drainage a. place in sidelying position initially then fowlers b. Suction mouth c. Maintain patency of drainage tubes

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b. Promote oral hygiene/comfort a. Provide mouth irrigations with sterile water,diluted peroxide ,normal saline b. Avoid use of commercial mouthwashes, lemon and glycerine swabs c. Monitor/promote optimum nutritional status a. Provide tube feedings following a hemiglossectomy b. Place oral fluids in back of the throat with an asepto syringe julie c. yu-santos c. Provide foods/fluids that are nonirritating

d. Monitor for signs and symptoms of facial nerve damage( drooping, uneven smile, circumoral numbness or tingling)

julie c. yu-santos

Hiatal hernia

Sliding hiatal hernia- occurs when a portion of the stomach and vagus nerve slide upward into the thorax through an enlarged hiatus in the diapragm Occurs often in women (40-70) Cause: 1. Congenital weakening of the muscles in the diaphragm around the esophagogastric opening 2. Increased intraabdominal pressure( obesity, pregnancy, ascites )
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Pathophysiology: causative factor reflux of gastric juices and inflamamtion of the lower portion of the esophagus sign/symptoms
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Diagnosis: barium swallow- protrusion of the gastric mucosa through a hiatus esophagoscopy- reveals an incompetent cardiac sphincter Assessment: 1. heartburn especially after meals at night or with position changes 2. dysphagia 3. regurgitation several hours after meals without vomiting
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Medical mgt: 1. Drug therapy- Antacids to reduce acidity and relieve discomfort, cholinergic drug 2. Modification of diet- elimination of spicy foods and caffeine 3. Surgery- Reduction of the hiatal hernia via abdominal or thoracic approach

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 1. 2. 3.

4.

Nursing intervention: Provide a bland diet with six feeding Administer medication as order Provide pre-op and post-op care Provide client teaching and discharge planning concerning:
1.

2.

3.

4.

5.

Modification of diet Sitting up for meals and for 2 hours after meals will help reduce gastric acid reflux Use of antacids Eating small frequent meals slowly to help prevent gastric distention Need to avoid carbonated beverages and anti c. yu-santos cholinergic drugs(julie OTC)

A client with hiatal hernia chronically experiences heartburn following meals. The nurse would plan to teach the client to avoid which of the following , which is contraindicated with hiatal hernia?
a.Taking in small frequent , blands diet b.Lying recumbent following meals c.Racing the head of the bed 6 inch blocks d.Taking histamine H2 receptors antagonist medication julie c. yu-santos

A client is diagnosed with hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? a. I eat 3 large meals without food restriction b. Ill lie down immediately after meal c. III gradually increase the amount of heavy lifting I do d. III eat small bland meal that are high in fiber julie c. yu-santos

GERD
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Backflow of gastric or duodenal contents into esophagus Cause: Incompetent lower esophageal sphincter Pyloric stenosis Motility disorder

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

gastroesophageal reflux
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Sign and symptoms: Pyrosis( burning sensation in the esophagus ) Dyspepsia Regurgitation Dysphagia or odynophagia Hypersalivation Esophagitis

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Diagnostic studies: endoscopy Barium swallow- evaluate damage to esophageal mucosa Ambulatory 12-36hours esophageal Phevaluate the degree of acid reflux

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Diagnostics
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Endoscopy

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Barium swallow
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Management: Low fat diet avoid caffeine ,tobacco, beer, milk, carbonated drinks Avoid eating 2 hours before bedtime Maintain normal weight Avoid tight fitting clothes Medication Surgery (nissen fundoplication-wrapping of a portion of gastric fundus around the sphincter area of the esophagus)
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Medication
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Antacids or H2 receptors antagonist: Famotidine ,nizatidine, ranitidine PPI-decrease the release of gastric acid Lansoprazole ,esomeprazole Prokinetic agents accelerate gastric emptying (bethanicole )domperidone (motilium)

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A client has been diagnosed with GERD. The nurse interprets that the client has dys function of which of the following part of digestive system.
a. Chief cells of stomach b. Parietal cells of stomach c. Lower esophageal sphincter d. Upper esophageal sphincter
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Stomach

located on the left side of the abdominal cavity occupying the hypochondriac ,epigastric and umbilical region Store and mixes food with gastric juices and mucus producing chemical and mechanical changes in the bolus of food Has fundus, body and antrum 2 phases of digestion: 1. Cephalic phase of digestion- secretion of digestive juices is stimulated by smelling, tasting, and chewingjulie food c. yu-santos

2. Gastric phase stimulated by the presence of food in the stomach ;regulated by neural stimulation via PNS and hormonal stimulation through secretion of gastrin by gastric mucosa

Chyme ingested food plus the gastric juices

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Gastric secretions: 1. Pepsinogen- secreted by chief cells ,located in fundus, aids in protein digestion 2. Hydrochloric acid- secreted by parietal cells, function in CHON digestion, released in response to gastrin 3. Intrinsic factor- secreted by parietal cells, promote absorption of Vit.B12 4. Mucoid secretions: coat stomach wall and prevent autodigestion

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stomach

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stomach
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A client has been diagnosed with pernicious anemia. In planning care for the client, a nurse anticipates that the client will be treated with? a. thiamine b. iron c. Vitamin B12 d. Folic acid
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Gastritis

An acute inflammatory condition that causes a breakdown of the normal gastric protective barriers with subsequent diffusion of HCL acid into gastric lumen Etiology: excessive ingestion of certain drugs(salycilates, steroids),alcohol; food poisoning, large quantities of spicy, irritating food in the diet
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Pathophysiology: Causative agent acute inflammation in the gastric mucosa He, ulcerations and adhesion of the gastric mucosa sign and symptoms
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Diagnostic :Endoscopy- inflammation and ulceration of gastric mucosa Gastric analysis- HCL acid usually increased except in atrophic gastritis Assessment: 1. anorexia 4. epigastric fullness 2. nausea and vomiting 5. epigastric tenderness 3. hematemesis julie c. yu-santos

1.
2.

3. 4.

Nursing intervention: Monitor and maintain F and E balance Nausea and vomiting(NPO, until food is tolerated) Administer medication as ordered Discharge teaching ( avoidance of food and medication )

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Peptic ulcer disease

1.

2.

Gastric ulcer-ulcerations of the lining of the stomach;antrum Pathophysiology: Rapid diffusion of gastric acid from the gastric lumen into the gastric mucosa inflamation and tissue breakdown Reflux into the stomach of bile containing duodenal contents

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Occurs more often in men, in unskilled laborers and in lower socioeconomic groups Predisposing factor:
1.

smoking 2. Alcohol abuse 3. Emotional tension 4. drugs( salicylates, steroids)

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Diagnostic :Endoscopy-reveals ulcerations gastric analysis- normal HCL acid level Upper GI series- (+) of ulcer confirmed Assessment: 1. Epigastric pain ,radaiting to the back,usually 1-2 hours after meal 2. weight loss julie c. yu-santos 3. nausea and vomiting

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Medical mgt: 1. Supportive: rest, bland diets, stress mgt. 2. Drug therapy: antacids ,H2receptors antagonist, sucralfate, antibiotic (metronidazole, amoxicillin for ulcer cause by H-pylori) 3. surgery: gastrectomy, Vagotomy,
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Nursing intervention: 1. administer medication as ordered 2. Provide client teaching and discharge planning: 1. medical regimen: a. Take medication at all times b. Avoid ulcerogenic drugs c. know proper dosage , action and side effects julie c. yu-santos

2. Proper diet: a. bland diet( 6 small feeding) b. Eat meals slowly c. Avoid acid producing substances d. Avoid stressful situations at mealtime e. Avoid late bedtime snacks

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Duodenal ulcer

Most commonly found in the first 2cm of the doudenum Characterized by gastric hyperacidity and significant increased rate of gastric emptying Commonly occur in younger men, peak age 35-45 years of age Predisposing factor: smoking , alcohol abuse, bacterial infection

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Diagnosis: Diagnostic :Endoscopy-reveals ulcerations gastric analysis- increase HCL acid level Upper GI series- (+) of ulcer confirmed assessment:
1.

epigastric pain, described as burning ,cramping, usually occurs 2-4 hours after meal, relieved by food
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Nursing intervention: 1. administer medication as ordered 2. Provide client teaching and discharge planning: 1. medical regimen: a. Take medication at all times b. Avoid ulcerogenic drugs c. know proper dosage , action and side effects julie c. yu-santos

2. Proper diet: a. bland diet( 6 small feeding) b. Eat meals slowly c. Avoid acid producing substances d. Avoid stressful situations at mealtime e. Avoid late bedtime snacks

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Medication
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**Antibiotic, PPI and Bismuth salts

Antibiotics Amoxicillin (bactericidal) Tetracycline (bacteriostatic) Clarithromycin (bactericidal)

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

Proton Pump Inhibitor dec acid secretion by slowing H-K Atpase 102 pump - 4-8 weeks medications

ie Omeprazole (Prilosec) Lansoprazole (Prevacid) LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

Antacids (non absorbable) gastric acidity 103 Chew thoroughly then swallow Taken 1 hour after meals/at bedtime Aluminum Hydroxide Dont give other drugs within 1-2 hour after taking antacids SE: constipation Magnesium Oxide Taken in between meals or at bedtime May increase serum Magnesium level in RF client Chew follow with water SE: diarrhea
LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

104

Calcium Carbonate Taken in between meals or at bedtime with milk SE: uric acid

NaHCO3 SE: metabolic alkalosis and tetany

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

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Histamine H2 receptors antagonists ( po/iv)

HCl production by blocking histamine on histamine receptors Taken with meals or at h.s. cigarettes reduce the action. SE: headache, skin rash, bleeding and diziness 8 weeks medication (if s/sx will not improve start antibiotics)

Ie Cimetidine (Tagamet),Ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid)

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

Cytoprotectives
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Sucralfate (Carafate) creates a mucosal barrier and prevents digestion by pepsin 30 min interval before taking antacids SE: constipation, nausea Give 1-2 hour after meal or during bedtime on an empty stomach 5 hours duration

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

107

Misoprostol (Cytotec) Protects gastric mucosa, inc mucus and hco3 levels Administer w/ food SE: diarrhea and cramping

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

A client with Peptic ulcer is about to start a therapeutic regimen that includes bland diet, antacids and famotidine. Before the client discharged, the nurse should provide , which instruction? a. eat 3 balanced meals 3x aday b. stop taking the drugs when symptoms subsides c. avoid aspirin and products that contain aspirin julie c. yu-santos d. increase intake of fluid containing

Gastric surgery

Performed when the medical regimen fail Types: 1. Vagotomy- Severing of part of the vagus nerve innervating the stomach to decrease gastric acid secretion 2. Antrectomy-Removal of the antrum of the stomach to eliminate the gastric phase of digestion 3. Pyloroplasty- Enlargement of the pyloric sphincter with acceleration of gastric emptying julie c. yu-santos

4. Gastrojejunostomy (billroth II)-removal of the antrum and distal portion of the stomach and duodenum with anastomosis of the remaining portion of stomach to the jejunum 5.Gastroduodenustomy-(billroth I)- removal of the lower portion of the stomach with anastomosis of the remaining portion of duodenum 6. Gastrectomy- Removal of 60-80% of the stomach 7. Esophagojejunostomy-(total gastrectomy)removal of entire stomach with c. yu-santos the loop of jejunumjulie anastomosed to the

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LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

A client with peptic ulcer is schedule for vagotomy. The client ask the nurse about the procedure. The nurse tell the client that the procedure is?
a.Decreases food absorption in the stomach b.Heals the gastric mucosa c.Halts the stress reaction d. Remove the stimulus for acid production
julie c. yu-santos

A client has been advanced to a solid diet after subtotal gastrectomy. A nurse caring for the client would do which of the following to minimize the risk of dumping syndrome?
a.Remove fluids from the meal tray b.Ask the client to sit up for an hour after eating c.Provide concentrated , high carbohydrates food julie c. yu-santos

Dumping syndrome

Abrupt emptying of the stomach contents into the intestine ;Common complication of gastric surgery

Associated with the presence of hyperosmolar chyme in the jejunum ,which draws fluid from the ECF( by osmosis) into the bowel that result in decreased plasma volume , distension of the bowel, stimulates increased intestinal motility
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Sign and symptoms : 1. Weakness 5. feeling of fullness 2. faintness 6. nausea 3. palpitations 7. Diarrhea(15-30mins after 4. diaphoresis meal and last for 20 to 60 mins)

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1.
2. 3. 4.

5.

Medical mgt: Avoidance of concentrated sweets Adherence to six, small dry meals /day Maintenance of modified diet Refraining from taking fluids during meals but rather 2 hours after meals Assuming a recumbent position for hour after meals
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A nurse is providing instruction to a client about measure to minimize the risk of Dumping syndrome. The nurse tells the client to do which of the following ?
a.Increase fluid intake particularly at mealtime b.Maintain a high CHO diet c.Maintain a low fowlers position while eating d. Ambulate of at least 30 mins after each meal
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A nurse is monitoring a client for the early sign symptoms of dumping syndrome. Which of the following symptoms indicates this occurrence ?
a.Abdominal cramping and pain b.Bradycardia and indigestion c.Sweating and pallor d.Double vision and chestpain
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A nurse is preparing diet plan for postgastrectomy client with dumping syndrome. Which of the following would not be a component of this teaching plan?
a.Lie down after eating b.Drink liquid with meals c.Eat small meal six times daily d.Avoid concentrated sweets
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Stress ulcer
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Term given to the acute mucosal ulceration of duodenal or gastric area that occurs after physiologcally stressful events Cushing ulcers- common in patient having trauma in the brain Curling ulcers-seen in patient 72hrs after extensive burns

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

Cancer of the stomach

Most commonly affect distal third More common in men than women Etiology: Excessive intake of highly salted or smoked foods Diet low in quantity of vegetables and fruits Atrophic gastritis Achlorydia julie c. yu-santos H. pylori infection

1.

2.

3.
4. 5.

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1.
2. 3. 4.

Diagnosis: Stool for occult blood CEA- positive Hgb and Hct- decreased Gastric analysis-reveal histologic changes ( anaplasia)

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Assessment:
1. 2. 3. 4. 5. 6. 7. 8.

Fatigue Weight loss Indigestion Epigastric fullness Feeling of early satiety when eating Epigastric pain( later) Palpable epigastric mass pallor

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1.
2. 3.

4.

Medical mgt: Chemotherapy Radiation therapy Treatment for anemia, gastric decompression, fluid and electrolyte maintenance Surgery- subtotal gastrectomy (billroth I or II) total gastrectomy
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Small intestine

1.

Composed of duodenum, jejunum and ileum Extend from the pylorus to the ileo cecal valve, which regulates flow into the large intestine and prevents reflux into the small intestine Major function- for digestion and absorption Structural features: villi- functional unit of SI - contain goblets cell that secrete mucus -also absorptive cell that absorb digested food stuffs julie c. yu-santos

2. Crypts of Lieberkuhn- produce secretion containing digestive enzymes 3. Brunners glands- found in the submucosa of the duodenum ,secrete mucus

julie c. yu-santos

small intestine
julie c. yu-santos

A client who has had gastrectomy is not producing sufficient intrinsic factors. The nurse interprets that the client has lost the ability to absorb Cyanocobalamin( Vit B12) in which of the following?
a.Stomach b.Small intestine c.Large intestine d.Colon
julie c. yu-santos

Hernia
1.

2.

3.

Protrusion of the viscus from its normal cavity through an abnormal opening/weaknend area Types : Reducible- Can be manually placed back into the abdominal cavity Irreducible-Cannot be placed back into the abdominal cavity Inguinal occurs when there is weakness in the abdominal wall where the spermatic cord in men and round ligaments in women emerge
julie c. yu-santos

4.

5.

6. 7.

femoral- protrusion through the femoral ring ;more common in female Incisional - occurs at the site of a previous surgical incision as a result of inadequate healing postoperatively Umbilical most commonly found in children Strangulated- irreducible with obstruction to intestinal flow and blood supply

julie c. yu-santos

julie c. yu-santos

julie c. yu-santos

julie c. yu-santos

Diagnosis: clinical Assessment: Vomiting Protrusion of involved area( obvious after coughing) Crampy abdominal pain Abdominal distention ( if strangulated with bowel obstruction)
julie c. yu-santos

1. 2.

3. 4.

1.
2. 3.

Medical mgt: Manual reduction Bowel surgery when strangulated Herniorrhaphy- surgical repair of hernia by suturing the defect

julie c. yu-santos

1.
2. 3.

Nursing intervention: Observe for complication Prepare client for surgery Post-op care:
1.

2.

3.

4.

Assess for possible distended bladder( inguinal hernia) Discourage coughing but deep breathing Apply ice bags to scrotal area to decrease edema Assist to splint incision when coughing or julie c. yu-santos sneezing

Discharge teaching: 1. Need to avoid strenuous physical activity for at least 6 weeks 2. Need to report any difficulty with urination

julie c. yu-santos

Intestinal obstruction
Types : 1. Mechanical physical blockage of the passage of intestinal contents with subsequent distention by fluid and gas ex. Adhesion, hernia, volvulus ,intussusception , neoplasm ,fecal impaction 2. Paralytic ileus interference with nerve supply to the intestine resulting in decreased or absent peristalsis ex. Surgery, peritonitis, shock, electrolytes imbalance julie c. yu-santos

3. Vascular obstruction- interference with the blood supply to a portion of the intestine resulting in ischemia and gangrene of the bowel ex. Caused by embolus, atherosclerosis

julie c. yu-santos

julie c. yu-santos

1.

2. 3. 4.

Diagnosis: Flat plate of the abdomen-reveals presence of gas/fluid Hct increased Serum Na,K,Cl- decreased BUN - increased

julie c. yu-santos

Assessment:

1.

Small intestine- nonfecal vominting

colicky intermittent abd. Pain abdominal distention and rigidity, high pitched bowel sound obstruction above the level of

decreased or absent BS distal to obstruction 2. Large intestine Cramplike abdominal pain Fecal-type vomitus unable to pass stool or flatus abdominal distention rigidity, high pitched bowel sound above the level obstruction ,decreased or absent BS distal to obstruction

of

julie c. yu-santos

julie c. yu-santos

julie c. yu-santos


1. 2.

3.

4.

5.

Nursing intervention: Monitor fluid and electrolytes Keep client on NPO Place client in fowlers position to alleviate pressure on the diaphragm Institute comfort measure associated with NG intubation and intestinal decompression Prevent complication
1.

2.
3.

Measure abdominal girth Assess for sign and symptom of peritonitis Monitor UO
julie c. yu-santos

Chronic inflammatory bowel disease

Regional enteritis( crohns disease)

Chronic

inflammatory bowel disease that affect both the large and small intestine ( terminal ileum, cecum and ascending colon) Both sexes are equally affected Causes: unknown - contributing factor : Food allergies Autoimmune reaction

julie c. yu-santos

julie c. yu-santos

julie c. yu-santos

Pathophysiology: causation (+) granuloma that may affect all the bowel wall layers thickening, narrowing and scarring of intestinal wall sign /symptoms
julie c. yu-santos

julie c. yu-santos

1.
2. 3.

Diagnostic: Hgb and Hct ( if with anemia) decreased Sigmoidoscopy- scattered ulcers Barium enema- narrowing with areas of strictures separated by segment of normal bowel

julie c. yu-santos

1.

2.

3. 4. 5.

Assessment: Right lower quadrant pain, abdominal distention Nausea and vomiting( 3-4 semisoft stools/day with mucus and pus) Decreased skin turgor Increased peristalsis pallor
julie c. yu-santos

1.

2.

Medical mgt: Diet High calorie, high vitamins , high protein, low residue, milk free, with supplementary iron Drug therapy :
1. 2.

3.
4.

antibiotics (sulfasalazine)- control infection Corticosteroids Antidiarrheal Anticholinergics

julie c. yu-santos

3.

4.

Supplemental and parenteral nutrition Surgery resection of diseased portion of bowel and temporary or permanent ileostomy

julie c. yu-santos

1.

2. 3.

4.

5.

Nursing intervention: Provide appropriate nutrition while reducing bowel motility Administer medication Record number and characteristic of stools daily Provide tepid fluids to avoid stimulation of the bowel Provide care for client undergone bowel surgery julie c. yu-santos

Bowels surgery
1.

2.

3.

Abdominoperineal resection- distal sigmoid colon,rectum, and anus are removed through a perineal incision and permanent colostomy is created; (cancer of the colon /rectum) Ileostomy- opening of the ileum onto the abdominal surface (ulcerative colitis, regional enteritis) Continent ileostomy(kocks pouch)- an intra abdominal resevoir with a nipple valve is julie c. yu-santos formed from the distal ileum

julie c. yu-santos

4. Cecostomy - an opening between the cecum and abdominal base temporarily diverts the fecal flow to rest the distal portion of the colon after some types of surgery 5. Temporary colostomy- usually located in the ascending or transverse colon; done to rest the bowel 6. Double barreled colon is resected and both ends are brought through the abdominal wall creating two stomas( proximal and distal)

julie c. yu-santos

julie c. yu-santos

Ulcerative colitis

Inflammation and ulcerations that start in the rectosigmoid area and spreads upward Common in women Causes: unknown Contributing factors:
Autoimmune Viral

infection Allergies Emotional stress

julie c. yu-santos

julie c. yu-santos

Diagnostic test:
Sigmoidoscopy-

reveals mucosa that bleeds easily with ulcer development Hgb and Hct- decreased

Assessment:
Severe

diarrhea(15-20 liquid stools/day containing blood mucus and pus) Severe tenesmus Weight loss Anorexia, weakness Low grade fever Left lower quadrant pain
julie c. yu-santos

Medical mgt:
Mild

to moderate form:

Low-roughage

diet with no milk Drug therapy- Ab, antidiarrheal, corticosteroids, anticholinergics , immunosuppresive drugs)
Severe
Client

form:

kept on NPO with IV and electrolytes replacement Blood transfusion surgery

julie c. yu-santos

1.

2. 3.

4.

5.

Nursing intervention: Provide appropriate nutrition while reducing bowel motility Administer medication Record number and characteristic of stools daily Provide tepid fluids to avoid stimulation of the bowel Provide care for client undergone bowel surgery julie c. yu-santos

Sulfasalazine ( azulfidine ) is prescribed to client with ulcerative colitis. The nurse instruct the client about the medication. Which statement made by the client need further education?
a.Sensitivity to sunlight may occur b.I need to take the medication with meals c.This medication should be taken when prescribed d.The medication will cause julie c. yu-santosconstipation

A nurse is caring for a hospitalized client with diagnosis of ulcerative colitis. Which findings if noted on assessment of the client, would the nurse report on the physician?
a.Bloody diarrhea b.Hypotension c.Hemoglobin level of 12 mg/dl d.Rebound tenderness
julie c. yu-santos

Lomotil ( diphenoxylate hydrochloride and atropine sulfate) is prescribed for the client with ulcerative colitis. The nurse monitors the client, knowing that which of the following is a therapeutic effect of this medication?
a.Elimination of peristalsis b.Decreased diarrhea c.Decreased cramping julie c. yu-santos d.Improved intestinal tone

Large intestine

Divided into 4 parts:

Cecum
Colon Rectum

Anus

Function
Serve

as reservoir for fecal material until defecation occurs; Absorb water and electrolytes
julie c. yu-santos

Has microorganism:
acids deaminated by bacteria resulting in ammonia Aid in the synthesis of vit K
Amino

Feces:
75%

fluids and 25% solid material Internal anal sphincter and external anal sphincter

julie c. yu-santos

172

Elimination of stool-distention of rectum Internal anal sphincter- ANS External anal sphincter- cerebral cortex Average frequency of defecation in humanonce a day or it may varies

LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

173

defecation reflex walls of rectum are stretched; walls of sigmoid and rectum contract, internal anal sphincter relaxes; 25% filled urge to defecate; convenient to defecate, external anal sphincter relaxes, forcing feces out -gastrocolic reflex food in the stomach increases motility in colon and frequency of mass movement
LIEZEL ADAJAR CASTILLO julie c. yu-santos R.N.M.D.

large

intestine
julie c. yu-santos

Diverticulosis/diverticulitis

Diverticulum- an outpouching of the intestinal mucosa: sigmoid colon Diverticulosis- multiple diveirticula Diverticulitis- inflammation of diverticula Causes:
Stress Congenital

weakening Dietary deficiency of roughage and fiber

julie c. yu-santos

julie c. yu-santos

julie c. yu-santos

Diagnosis: 1. Barium enema- indicate inflammatory process 2. Hgb and Hct- decreased Assessment:
Intermittent

lower left quadrant pain Alternate constipation and diarrhea with blood and mucus Fever
julie c. yu-santos

Medical mgt:
High

residue diet with no seeds for diverticulosis Low residue diet for diverticulitis Drug therapy: bulk laxatives, stool softener, anticholinergics, antibiotic

Surgical treatment: resection of deseased portion of colon with temporary colostomy

julie c. yu-santos

Nursing intervention:
Administer

medication as ordered Provide nursing care for client with bowel surgery

Discharge planning:
Importance

of adhering to dietary regimen Prevention of increased intrabdominal pressure Teach sign and symptoms of peritonitis

julie c. yu-santos

Peritonitis

Local or generalized inflammation of part or all of the parietal and visceral surfaces of the abdominal cavity

Causes:
Trauma Inflammation

intestinal obstruction

Volvulus
Intestinal

ischemia
julie c. yu-santos

Pathophysiology: causes

initial response: edema, vascular congestion, hypermotility,outpouring of plasmalike fluid from ECF into peritoneal space Later response: abdominal distention, hypovolemia (UO)
julie c. yu-santos

Diagnostic:
WBC-

elevated Hct elevated ( if hemoconcentration)

Assessment:
Severe

abdominal pain Rebound tenderness Muscle rigidity Absent bowel sounds Anorexia, nausea and vomiting Shallow respiration Fever, rapid pulse

julie c. yu-santos

Medical mgt: NPO with fluid replacement Drug therapy: antibiotics ,analgesics Surgery: Laparotomy- determine the cause Bowel resection

julie c. yu-santos

1.
2. 3. 4. 5. 6.

Nursing intervention: Assess respiratory status Assess characteristics of abdominal pain Administer medicatio as ordered Perform frequent abdominal assessment Palce pt on fowlers position Maintain patency of NG tubes

julie c. yu-santos

Cancer of the colon/rectum

Adenocarcinoma- most common type Spread through direct extension or lymphatic system Often metastasis to the liver Causes: diverticulosis chronic ulcerative colitis familial polyposis
julie c. yu-santos

Diagnosis:
Stool

for occult blood- positive Hgb and Hct- decreased CEA- positive Sigmoidoscopy- reveals mass Barium enema- shows colon mass DRE-indicates a palpable mass

julie c. yu-santos

julie c. yu-santos

Assessment:
Alternating

diarrhea and constipation Lower abdominal cramps Abdominal distention Weakness Anorexia, weight loss Pallor Dyspnea

julie c. yu-santos

Medical mgt:
Chemotherapy
Radiation

therapy Bowel surgery

Nursing intervention:
Administered

chemotherapy as ordered Provide care for client receiving radiation therapy Provide care for client with bowel surgery

julie c. yu-santos

appendicitis

Inflammation of the appendix that prevents mucus from passing into the cecum that result to ischemia, gangrene, rupture and peritonitis Common among school age children

Causes:1. mechanical obstruction-fecalith, intestinal parasites julie c. yu-santos

 1. 2. 3. 4. 1. 2.

3.

4.

Diagnostic : WBC increased (+) Rovsing sign (+) Mc burneys point tenderness (+) psoas and obturator sign Assessment: diffuse pain loc. At the RLQ Nausea and vomiting Guarding of abdomen, rebound tenderness, walk stooped over Fever and decreased bowel sounds julie c. yu-santos

Nursing intervention : 1. Administer ab and antipyretic as ordered 2. Prevent perforation of appendix( do not give enema/cathartic/or using heating pad) 3. Prepare pt for surgery( appendectomy) 4. Post op care: a. position in semi fowlers position or lying on right side to facilitate drainage b. monitor penrose drain ( rupture AP) c. Administer ab as ordered

julie c. yu-santos

A client with severe abdominal pain is being evaluated for appendicitis. What is the most common cause of appendicitis? a. Rupture of appendix b. Obstruction of appendix c. A high fat diet d. A duodenal ulcer

julie c. yu-santos

Hemorrhoids

Congestion and dilation of the veins of the rectum and anus Commonly occur bet. Ages 20 and 50 years of age Causes: impairment of flow of blood through the venous plexus Predisposing factor:
Occupation

requiring prolong standing Inc. intra abdominal pressure 2 to prolonged constipation , pregnancy, heavy lifting ,obesity
julie c. yu-santos

Diagnosis:
proctoscopy-

(+) of internal Hemorrhoids Protrusion of external hemorrhoids upon inspection

Assessment:
Bleeding

with defecation Hard stool with streaks of blood Pain with defecation, sitting or walking
julie c. yu-santos

Medical mgt:
Stool

softeners Diet modifications: high fibers, adequate liquids hemorrhoidectomy_- ( prolapse, severe pain and excessive bleeding

Nursing intervention : pre-op

Prepare

client for surgery

Post-op care
Assess

for rectal bleeding q 2-3 hrs

julie c. yu-santos

Assist client to side-lying position or prone position Administer stool softeners as ordered( give analgesics before first post-op bowel movement) Dietary modification- high fiber diet and ingestion of at least 2000 ml/day Sitz bath after each bowel movement for atleast 2 weeks after surgery Instruct the client to report any complication like rectal bleeding, continue pain on defecation, puslike drainage from rectal area julie c. yu-santos

Accessory organ of digestion

Largest internal organ, located in the right hypochondriac and epigastric regions of the abdomen

Kupffers cell- carry out the process of phagocytosis Portal circulation brings blood to the liver from the stomach, spleen, pancreas and intestines julie c. yu-santos

julie c. yu-santos

1.
2. 3. 4.

5. 6.

Functions: Metabolism of fats CHO and CHON Production of bile Conjugation and excretions of bilirubin Storage of vitamins fat soluble vitamins and iron Synthesis of coagulation factors Detoxification of many drugs and conjugation of sex hormones
julie c. yu-santos

Cirrhosis of the liver

Chronic progressive disease characterized by inflammation , fibrosis and degeneration of the liver parenchymal cells

Occurs twice as often in men as in women; ages 40-60

julie c. yu-santos


1.

2.

3.

4.

Pathophysiology: depend on types Laennecs cirrhosis- associated with alcohol abuse and malnutrition ;characterized by accumulation of fats in the liver cells- progress to widespread scar formation Postnecrotic cirrhosis- result in severe inflammation with massive necrosis as a complication of viral hepatitis Cardiac cirrhosis- occurs as a consequences of RSHF; manifested by hepatomegaly with some fibrosis Biliary cirrhosis- assoc. with biliary obstruction(CBD);result in chronic impairment julie c. yu-santos of bile excretion

julie c. yu-santos

1.

2. 3. 4. 5.

Diagnostic: SGOT(AST), SGPT(ALT),LDH,alkaline phosphatase increased Serum bilirubin increased PT- prolonged Serum albumin decreased Hgb and Hct- decreased

julie c. yu-santos

stages of alcoholic cirrhosis

julie c. yu-santos

 1. 2. 3.

4. 5.

6.

7.
8.

Assessment: Hepatomegaly(early) Right upper quadrant pain Atrophy of the liver( later)-hard nodular liver upon palpation Increased abdominal girth Changes in mood, alertness, and mental ability Gynecomastia in male, amenorrhea in young female Jaundice ;pruritus Easy bruising, spider angiomas, palmar erythema julie c. yu-santos

 1. 2.

3.

4.

5.

6. 7.

Nursing intervention: Institute measures to relieve pruritus Do not use soaps and detergents, bath in tepid water ff by application of an emollient lotion; provide cool ,light, nonrestrictive clothing; keep nail short Encourage small frequent feeding Diet: High calorie, low-mod CHON, high CHO, low fat diet with supplemental vitamins Prevent infection- reverse isolation ( pt c severe leukopenia) Monitor/prevent bleeding Give diuretics as ordered julie c. yu-santos

julie c. yu-santos

1.

2.

3. 4. 5.

Discharge planning: Avoidance of agent that maybe hepatotoxic (sedatives, opiates) How to assess weight gain and increased abdominal girth Avoidance of person c URTI Avoidance of all alcohol Avoidance of straining at stool, vigorous blowing of nose and coughing
julie c. yu-santos

Ascites

Accumulation of free fluid in the abdominal cavity Causes: CHF. Liver cirrhosis, increase portal venous pressure , hyperaldosteronism Diagnostic:
Potassium

and serum albumin- decreased PT- prolonged LDH, SGOT, SGPT, BUN,Na - increased

julie c. yu-santos

julie c. yu-santos

Assessment:
Positive

fluid wave and shifting dullness on percussion Flat or protruding umbilicus Abdominal distension/tautness with striae and prominent veins Peripheral edema Shortness of breath

julie c. yu-santos

1.

2. 3.

Medical mgt: supportive: modify diet ,bed rest, salt-poor albumin Diuretic therapy Surgery:
1.

2.

Paracentesis (fluid assess for cell count, specific gravity, CHON and microorganism) LeVeen shunt( peritoneal venous shunt)

julie c. yu-santos

LeVeen shunt:
Permits

continous reinfusion of ascitic fluid back into the venous system through the silicone catheter with one-way pressure sensitive valve

One

end of the catheter is implanted into the peritoneal cavity and is channeled through the subcutaneous tissue to the SVC, where the other end of the catheter is implanted The valve opens when the pressure in the peritoneal cavity is 3-5 cm H2O- allowing ascitic fluid to flow into the venous system
julie c. yu-santos

LeVEEN SHUNT

julie c. yu-santos

1.
2. 3. 4. 5. 6. 7.

Nursing intervention: Provide adequate nutrition with modified diet Restrict fluid to 1L -1.5L/day Restrict Na to 200-500mg/day Promote high calorie food/snacks Administer diuretics Measure abdominal girth Place client in mid- to high fowlers position
julie c. yu-santos

Hepatic encephalopathy

Frequent terminal complication in liver disease Causes: cirrhosis, GI he, hyperbilirubinemia, BT, thiazide diuretics, uremia, DHN

Diagnostic:
Serum

ammonia-increased PT prolonged julie c. yu-santos

Pathophysiology: causes liver unable to convert ammonia to urea

Large quantities of urea remain in the systemic circulation and cross the blood/brain barriers (+) neurologic symptoms
julie c. yu-santos

Assessment findings: Early in the course of dse. changes in mental functioning, insomia, slowed affect, slow slurred speech, impaired judgement, slight tremors, hyperreactive reflexes Progressive disease: Asterixis, disorientation, apraxia, tremors, fetor hepaticus, facial grimacing Late stage: Coma , absent reflexes
julie c. yu-santos


1. 2.

3.

4.

5.

6.

Nursing intervention: Assess neurological status of patient Restrict CHON in the diet: provide high carbohydrates and vit k supplements Administer enema, intestinal ab and lactulose as ordered to reduced ammonia level Protect client from injury: keep siderails up, provide eye care Avoid administration of drug detoxified in liver( phenothiazines, methyldopa, acetaminophen) Maintain client on bedrest- decreased julie c. yu-santos metabolic demands of liver

Vasopressin (Pitressin ) is prescribed to client diagnosed with bleeding esophageal varices. The nurse is preparing to administer the medication to client. Which of the following essential item is needed during the administration of this edication?
a.A cardiac monitor b.An airway c.A suction set up d. A tracheotomy tube
julie c. yu-santos

A nurse is reviewing the record of client admitted to the nursing unit and notes that the client has history of laennecs cirrhosis. The nurse plans care knowing that this type of cirrhosis is most commonly caused by long-term?
a.Chronic alcoholism b.Biliary obstruction c.Chonic hepatitis infection d.All of the above julie c. yu-santos

The physician prescribed lactulose 30ml 3x daily, when the client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor? a. Urine output b. Abdominal girth c. Stool frequency d. Level of consciousness
julie c. yu-santos

Cancer of the liver

Primary cancer of the liver is rare, but it is the common site of metastasis Higher incidence in male Prognosis is poor- well advanced before dx Diagnostic: AFP- increased liver biopsy- (+) cancer cell
julie c. yu-santos

1.
2. 3. 4. 5. 6.

Assessment: Weight loss Slight increase in temperature RUQ pain, hepatomegaly Jaundice Peripheral edema Blood tinged ascites

julie c. yu-santos

1.

2.

Medical mgt: Chemotherapy and radiation therapydecrease tumor size and pain Resection of tumor if tumor is localized

julie c. yu-santos

 1. 2.

3.

4.

Nursing intervention: Provide emotional support to the client Provide care for client receiving chemotherapy Provide care for client with a abdominal surgery Pre-op:
1.
2.

Perform bowel prep to decreased ammonium Administer vit K

5.

Post-op:
1.

2.

3.

Administer 10% glucose for the 1st 48 hrs to avoid rapid blood sugar drop Monitor for hyper /hypoglycemia julie c. yu-santos Assess for sign of hepatic encephalophaty

Biliary system

Gallbladder- lies on the under surface of the liver; function is to concentrate and store bile Ductal system- provide route for bile to reach the intestine
bile is formed in the liver excreted into the hepatic duct Hepatic duct joints with the cystic duct to form CBD If sphincter of oddi is relaxed, bile enter the duodenum ,if contracted, bile is stored in julie c. yu-santos gallbladder

Cholecystitis/ cholelithiasis

Cholecystitis- acute or chronic inflammation of the gallbladder; commonly associated with gallstones Cholelithiasis- formation of gallstones Common among women after age 40 ( 4 Fs) Causes: genetic defect of bile composition gallbladder/bile stasis julie c. yu-santos infection

Pathophysiology: causes inflammation within the wall of the gallbladder thickening and edema of the gallbladder impaired circulation, ischemia and necrosis
julie c. yu-santos

1.

2.

Diagnostic: Direct bilirubin transaminase, alkaline phosphatase , WBC ,amylase , lipaseincreased Oral cholecystogram- positive for gallstone

julie c. yu-santos

1.

2. 3. 4. 5.

Assessment: Epigastric or RUQ pain precipitated by a heavy meal or occurring at night Intolerance for fatty foods Pruritus, easy bruising, jaundice Dark amber urine steatorrea

julie c. yu-santos

1.

2.

3.

Medical mgt: Supportive treatment: NPO with NG intubation and IV fluid Diet modification with administration of fat soluble vitamins Drug therapy:
1.

2.

3.

Narcotics analgesic ( demerol) Anticholinergic (tropine) for pain relaxes smooth muscles and open bile ducts Antiemetic
julie c. yu-santos

Surgery- cholecystectomy/choledochostomy

Nursing intervention: 1. Administer medication as ordered 2. Provide small frequent meals of modified diet( if oral intake is allowed) 3. Provide care to relieve pruritus

julie c. yu-santos

A nurse would assess a client experiencing an acute episode of cholecystitis for pain that is located on the right
Upper

quadrant and radiate to the left scapula and shoulder Upper quadrant and radiate to the right scapula and shoulder Left upper quadrant pain radiating to back Left upper quadrant radiating to groin julie c. yu-santos

Pancreas

Positioned transversely in the upper abdominal cavity Consist of head, body and tail Has exocrine and endocrine function
Exocrine

cell of the pancreas secrete trypsinogen, chymotrypsin for protein digestion, amylase to breakdown starch to disaccharides and lipase for fat digestion Endocrine function is related to islets of lanferhans
julie c. yu-santos

Pancreatitis

Inflammatory process with varying degree of pancreatic edema, fat necrosis or he Proteolytic /lipolytic enzymes are activated in the pancreas rather than in the duodenum resulting in tissue damage and autodigestion of pancreas Occur most often in middle aged
julie c. yu-santos

1.
2. 3. 4. 5. 6.

Causes: Alcoholism Biliary tract disease Trauma Viral infection Penetrating duodenal ulcer Drugs ( steroids, thiazide, diuretics, oral contraceptives )
julie c. yu-santos

Diagnostic:
Serum

amylase, lipase, blood sugar lipidincrease Serum calcium decrease CT scan- shows enlargement of the pancreas

Assessment:
LUQ

pain radiating to the back, flank mybe accompanied by DOB and aggravated by eating Vomiting, tachycardia ,abdominal tenderness with muscle guarding (+)grey turners spot( ecchymoses on flanks) (+) cullens sign (ecchymoses on the periumbilical area) Absent bowel sounds
julie c. yu-santos

1.
2. 3.

4.

5. 6.

Medical mgt: Drug therapy: Analgesic to relieve pain Smooth muscle relaxant( nitroglycerine )relieve pain Anticholinergic agent( atropine, propantheline bromide ) to decrease pancreatic stimulation Antacids- decrease pancreatic stimulation H2 antagonist, vasodilators, calcium julie c. yu-santos gluconate

1.
2.

3. 4.

Nursing intervention: Administer medication as ordered Withhold food /fluid and eliminate odor and sight of food to decrease pancreatic stimulation Maintain NG tube and assess for drainage Place pt in comfortable position( fetal position/knee chest position)
julie c. yu-santos

5. Discharge planning: a. Dietary regimen when oral intake permitted a. High carbohydrates , high CHON low fat diet b. eating small frequent feeding c. avoid caffeine product d. eliminate alcohol consumption

julie c. yu-santos

A nurse is performing an assessment of client suspected to have acute pancreatitis. The nurse assesses the client knowing that the hallmark sign of this disorder is?
Severe

abdominal pain relieved by vomiting Severe abdominal pain unrelieved by vomiting Hypothermia Hypogastric pain radiating to the back
julie c. yu-santos

thank

you !!!!!

julie c. yu-santos