Gastrointestinal Disorders

Diagnostic Testing

Information will be in Angel in separate GI

Testing folder for all GI conferences

Peptic Ulcer Disease

Gastroesophageal Reflux
Disease
Peritonitis(review)
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MEDICATIONS
Review preconference
1. Protonix
2. Prilosec
3. Pepcid
4. Reglan
5. Carafate

Peptic Ulcer Disease

Gastric Ulcers: in the stomach
Duodenal Ulcers: proximal part of the
duodenum

VIEW VIDEOTAPE

Treating Your Peptic Ulcer - VHS-104

(10 minutes)

Notetaking Guide Provided

Causes of PUD

Assessment Findings: Gastric

Ulcer
Burning or gaseous
pain in L epigastric
Pain 1-2 hours after
meals
If deep ulcer pain
with food
Occasional N/V

Assessment Findings: Duodenal

Ulcer
Burning, cramping
pain
Midepigastric
Pain 2-4 hours after
eating
Pain relief with
antacids and food

Diagnostic Tests for PUD

EGD
Serum Antibody test
for H. Pylori
Urea Breath Test

Review test
information on ANGEL

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Common Nursing Dx

Acute pain r/t gastric inflammation & irritation

Deficient fluid volume r/t bleeding, vomiting

Nausea r/t acute exacerbation of disease

Deficient knowledge (specify) r/t lack of exposure

Nursing Intervention:
Assessment
Signs and Symptoms: nausea, vomiting,
timing of symptoms
Pain assessment
Signs of hemorrhage

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NI:Teaching: Medications

Review written list of medications including use,

action, side effects, dose, frequency

Antacids
Histamine H2 Receptor Blockers
Mucosal protective
Antibiotics
Proton pump inhibitors
Antibiotic (if H. Pylori)

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NI:Teaching: Nutrition
No specific diet restrictions
Eliminate foods that cause
discomfort & symptoms
Foods known to irritate gastric
mucosa
hot, spicy foods
alcohol
carbonated beverages
caffeine

Signs & Symptoms to Report

to MD

Increased pain

N/V

Black tarry stools

Bloody emesis

TNI:Teaching: Lifestyle
Changes
Avoiding alcohol
Avoiding tobacco

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Surgical Management of PUD

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PUD VIDEO CLIP

http://video.about.com/ibdcrohns/Gastric-Ulcers.htm

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Common Complications:
Hemorrhage

Vital Sign Changes?

Pulse fast
BP low
RR fast

Common Complications:
PERFORATION
Pain
Distention
Temp rise

Vitals
P fast
BP low
RR fast
T elevated
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Common Complications:
Gastric Outlet Obstruction

GERD

VIEW VIDEOTAPE

GERD Gastroesophageal Reflux

Disease - VHS-059 (10 minutes)

GERD: CAUSES
hiatal hernia
incompetent lower
esophageal sphincter
(LES)
decreased
esophageal clearance
decreased gastric
emptying

Assessment of GERD
Heartburn
Heartburn (pyrosis)
burning sensation
beneath lower
sternum

Pulmonary
Symptoms
wheezing, coughing,
dyspnea

Children:
Recurrent vomiting
Regurgitation
Dysphagia
Abdominal pain
Heartburn
Refusal to eat/Poor
weight gain
Hoarseness
Chronic cough
25

Diagnostic Tests for GERD

Barium swallow
Endoscopy
Esophageal pH monitoring.

Review Test info on ANGEL

26

GERD Common Nursing Dx

Acute pain r/t irritation of esophagus from

gastric acids

Risk for aspiration r/t entry of gastric

contents in tracheal or bronchial tree

Deficient knowledge (specify) r/t lack of

exposure

NI: Assessment
Signs and symptoms
Pain assessment
Respiratory
assessment

28

NI:Teaching: Medications
Review medication list
Antacid
Antiemetic
Histamine receptor antagonist
Mucosal protectant
Proton pump inhibitor

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NIs - Nutrition
High protein, low fat diet

Small, frequent meals

Avoid chocolate, peppermint, caffeine, alcohol

NI:Teaching: Signs and

Symptoms to Report
Chronic heartburn and regurgitation
Persistent dysphagia, epigastric fullness
and bloating

31

NI:Teaching: Prevention
Instruct patient to keep HOB elevated for
2-3 hours after eating
Eat small, frequent meals to prevent
gastric distention
Sleep with HOB elevated on 4-6 inch
blocks

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Surgical Management:
Nissen fundoplication

Wrap top portion of

stomach around LES
to tighten LES

PERITONITIS(post conference
review)
Common Causes of
Peritonitis

Ruptured appendix
Perforated ulcer
Postoperative
rupture or breakage
of anastomosis in
abdominal/pelvic
cavity

Perforation from
endoscopic
procedures
Penetrating trauma
to abdomen

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Peritonitis: Assessment

Abdominal pain
Rebound tenderness
Muscular rigidity
Spasms
Shallow respirations
due to pain
Abdominal distention
Fever
n/v
tachypnea,
tachycardia

Review

NIs,
diagnostic
testing in guide
and textbook

35

Critical Thinking Case Study 1:

PUD
You are visiting a resident of a retirement
community. She tells you that she has
begun to have symptoms of a peptic ulcer
just like she had many years ago and that
she is treating the ulcer as she did before,
with a bland diet and antacids.

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Critical Thinking: Case Study 1:

PUD
1.

Based on your knowledge of peptic

ulcers, how would you advise patient?
Most peptic ulcers are caused by H.
Pylori. Pt. should be advised to see
provider for testing for H. Pylori! If
untreated 95% will recur. Requires
antibiotics for treatment

Case Study 2
A young female comes to the health clinic
with complaints of epigastric pain and
malaise. She works under stress and
smokes heavily. She is in a hurry and wants
quick action. The physician recommends
famotidine (Pepcid) and an upper
gastrointestinal x-ray to rule out duodenal
ulcer.

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Case Study 2
What risk factors for a duodenal ulcer
does the patient display?
Under stress
Smokes
2. What further nursing assessment is
needed?
P-A-I-N assessment
Dietary habits
S+S bleeding
1.

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Case Study 2
3. What nursing interventions are indicated
for patient?
Review answers:Teaching,Teaching,
Teaching!

40

Case Study 3
A 43-year-old male patient is being evaluated for peptic
ulcer disease (PUD). He has a history of recurrent
duodenal ulcers. Last night he awakened at 0200 and
requested an antacid. This morning after breakfast, he
passed a large, dark, liquid stool that tested positive for
occult blood. Just before 1100, he turns on his call light.
When the RN enters the room, he is lying on his side with
his knees drawn up, moaning and holding his pillow against
his abdomen. He is diaphoretic, pale, and breathing rapidly
and shallowly. The patient states, Its never hurt like this
before. I feel as though Ive been stabbed.

41

Case Study 3
1.

What has likely happened to patient?

Perforation!

2. What should RNs actions be?

Obtain VS and pain assessment
Call MD(emergency situation)

42

Case Study 4
A 61-year-old woman is being treated as an
outpatient for gastroesophageal reflux
disease (GERD). She tells the nurse that
the doctor told her to take Carafate but
did not tell her how else to treat her
condition.

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Case Study 4
1.

What should RN teach client?

High protein, low fat diet
Small frequent meals
HOB up 4-6 inches
Ideal body weight
Do not lie down 2-3 hours pc
Avoid tight clothing around waist
Avoid smoking
Medication teaching
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Critical Thinking Question:

Peritonitis
A client with suspected PUD undergoes an EGD
procedure. Post procedure the nurse is
conducting an abdominal assessment. The
following finding is indicative of a possible
perforation with early signs of peritonitis:
a. Diarrhea and hyperactive bowel sounds
b. Nausea and vomiting
c. Guarding and rebound tenderness
d. Redness and warmth of the abdominal skin

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ANSWER
Answer: C
Rationale: Stomach or bowel
perforation is a possible result of and
endoscopic procedure. Perforation
could lead to signs of peritonitis such
as guarding and rebound tenderness of
the abdomen.

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ADPIE for PUD

Work in pairs and go through the nursing

process for a patient with PUD

Return to large group to discuss and

write answers on the board

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