Gi linton ch38_pp4_digestive_disorders


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Gi linton ch38_pp4_digestive_disorders

  1. 1. Linton GI Ch 38 Powerpoint 4 Mrs. Powell
  2. 2. Gastrointestinal Surgery <ul><li>PREOP NURSING CARE: </li></ul><ul><ul><li>Radiographic exams done </li></ul></ul><ul><ul><li>Prep </li></ul></ul><ul><ul><ul><li>Monitor Vital Signs </li></ul></ul></ul><ul><ul><li>NPO for specified period </li></ul></ul><ul><ul><ul><li>IV fluids may be ordered </li></ul></ul></ul><ul><ul><li>Antibiotics may be ordered </li></ul></ul><ul><ul><li>NG tube may be inserted before or during surgery </li></ul></ul>
  3. 3. POSTOPERATIVE CARE <ul><li>Acute Pain </li></ul><ul><li>Fear—re disease, surgery and outcome </li></ul>
  4. 4. Nursing Care After Gastric Surgery <ul><li>Monitor Vital Signs </li></ul><ul><li>Respiratory Status (atelectasis results from guarding and shallow breathing) </li></ul><ul><li>Control Pain (helps ability to cough/db) </li></ul><ul><li>Intake and Output </li></ul><ul><ul><li>IV fluids; Foley catheter </li></ul></ul><ul><li>Incisional Site—observe for drainage/bleeding </li></ul>
  5. 5. Nursing Care After Gastric Surgery (cont’d) <ul><li>NG Tube Care </li></ul><ul><ul><li>Monitor suction; Inspect, describe and measure drainage </li></ul></ul><ul><ul><li>Do not irrigate or reposition unless ordered to do so </li></ul></ul><ul><li>Ambulate Early-quicker recovery by improving respiratory and GI function </li></ul><ul><li>Monitor Abdominal Status </li></ul><ul><ul><li>Prevent distention </li></ul></ul><ul><li>Education—incision care, activity, diet, meds </li></ul>
  6. 6. Complications of Gastric Surgery <ul><li>Hemorrhage—s/s restlessness, cold skin, increased pulse and respirations, decreased Temp and B/P; Altered LOC; vomiting blood </li></ul><ul><li>Gastric Distention—s/s enlarged abd, epigastric pain, tachycardia, hypotension; c/o feeling full; hiccups/gagging; (monitor NG tube) </li></ul><ul><li>Nutritional Problems—NPO until return of bowel function; may need TPN; introduce foods gradually </li></ul><ul><ul><li>Pernicious Anemia—if some/all of stomach removed (intrinsic factor reduced/absent); s/s anemia, weakness, sore tongue, numbness/tingling, gastric upset </li></ul></ul>
  7. 7. Complications of Gastric Surgery (cont’d) <ul><li>Steatorrhea (fat in stools)—result of rapid gastric emptying </li></ul><ul><li>Pyloric Obstruction—result of scarring, edema, inflammation; s/s vomiting, fullness, distention, nausea after eating, anorexia, weight loss </li></ul><ul><li>Dumping Syndrome—rapid entry of food into jejunum w/out mixing w/ digestive juices; rapid shift of fluid as fluids leave blood to dilute high concentration of electrolytes and sugars; s/s after eating: dizziness, tachycardia, fainting, sweating, nausea, diarrhea, feeling of fullness, abd cramping. Then blood sugar rises, excessive insulin released causing hypoglycemia 2hrs later. </li></ul><ul><li>Treatment: small, frequent meals high in protein and fat and low in carbs </li></ul>
  8. 8. DRUG THERAPY <ul><li>TABLE P 746-749 </li></ul>
  9. 9. Anorexia <ul><li>Lack of Appetite: common symptom of many diseases </li></ul><ul><li>Can be caused by noxious odors, meds, emotional stress, fear, psychological problems, infections </li></ul><ul><li>Prolonged anorexia: </li></ul><ul><ul><li>electrolyte imbalances, which can lead to cardiac dysrhythmias </li></ul></ul><ul><ul><li>Assess for evidence of malnutrition: glossitis (inflammation of the tongue), cheilosis (cracked lips), edema, jaundice, and muscle wasting </li></ul></ul><ul><li>Treatment: Eating, Tube Feeding, IV infusion </li></ul>
  10. 10. Anorexia (cont) <ul><li>Accurate I/O </li></ul><ul><li>Monitor VS </li></ul><ul><li>Electrolytes </li></ul><ul><li>Electrocardiograms </li></ul><ul><li>Monitor IV and TF rates </li></ul>
  11. 11. Eating Disorders <ul><li>Anorexia Nervosa </li></ul><ul><li>Bulimia Nervosa </li></ul>
  12. 12. FEEDING PROBLEMS <ul><li>Assess each pt’s ability to feed him/herself independently </li></ul><ul><li>Encourage patients to be as independent in feeding as possible </li></ul><ul><li>Proper positioning, assistive devices </li></ul><ul><li>Provide mouth care; record I/Os </li></ul>
  13. 13. Oral Health Care <ul><li>Important to Overall Health </li></ul><ul><ul><li>Nutritional needs; respiratory illness and cardiac disease associated w/ pathogens in the mouth </li></ul></ul><ul><li>Often Neglected in Daily Care </li></ul><ul><li>Oral Hygiene with Chlorhexidine Gluconate </li></ul><ul><ul><li>Prevents Pneumonia </li></ul></ul><ul><ul><li>Reduces Ventilator Associated Pneumonia </li></ul></ul><ul><ul><li>Inexpensive way to promote pt health </li></ul></ul>
  14. 14. Oral Health <ul><li>Aging changes, disease, and treatment can result in oral inflammation and infection </li></ul><ul><li>Immunocompromised, AIDS, chemotherapy, vitamin deficiencies more at risk </li></ul><ul><li>Cadidiasis </li></ul><ul><li>Note any oral s/s of inflammation or infection for prompt treatment—preserve oral comfort and nutrition </li></ul>
  15. 15. Oral Inflammation and Infections <ul><li>STOMATITIS </li></ul><ul><li>Inflammation of the oral mucosa </li></ul><ul><ul><li>Poorly fitting dentures, excessive tobacco or alcohol use, poor oral hygiene, inadequate nutrition, pathogenic organisms, radiation therapy, drug therapy, or disorders of the kidney, liver or blood </li></ul></ul><ul><li>Eliminate the cause, antibiotics or antiviral agents </li></ul><ul><li>Soft, bland diet </li></ul>
  16. 16. Vincent’s Infection <ul><li>Bacterial infection </li></ul><ul><li>Metallic taste, bleeding ulcers in mouth, foul breath, increased salivation </li></ul><ul><li>Topical antibiotics and mouthwashes; good oral hygiene </li></ul>
  17. 17. Herpes Simplex Type I <ul><li>Painful “cold sores” or “fever blisters” on face, lips, inside mouth, cheeks, nose or conjunctivae </li></ul><ul><li>Last a few days, continue to recur </li></ul><ul><li>May be provoked by fever or stress </li></ul><ul><ul><li>Upper respiratory tract infections, excessive sun exposure </li></ul></ul><ul><li>Acyclovir ointment used to ease pain; does not cure lesions </li></ul><ul><li>Oral acyclovir may reduce recurrences </li></ul><ul><li>Topical steroids </li></ul><ul><li>Lesions infectious, use Standard precautions when applying ointment or giving oral care </li></ul>
  18. 18. Apthous Stomatitis (canker sore) <ul><li>Small, white, painful ulcers on inner cheeks, lips, tongue, gums, palate or pharynx </li></ul><ul><li>Several days-2 weeks </li></ul><ul><li>Self induced trauma i.e. biting lips and cheeks, stress, exposure to irritating foods </li></ul><ul><li>Topical tetracycline several X daily shortens healing time </li></ul><ul><li>Topical anesthetic i.e. benzocaine or lidocaine provides pain relief and allows eating </li></ul><ul><li>Topical or systemic steroids </li></ul>
  19. 19. Candida <ul><li>Candida Albicans (Yeast Infection)—Thrush or candidiasis </li></ul><ul><li>High risk: steroids, long-term antibiotics </li></ul><ul><ul><li>Nystatin </li></ul></ul>
  20. 20. Disorders of Teeth and Gums <ul><li>Dental caries—tooth decay </li></ul><ul><li>Periodontal Disease—Gingivitis </li></ul><ul><ul><li>Gingivitis—gums bleed; Progressive: bone loss may occur (periodontitus) </li></ul></ul><ul><ul><ul><li>Flossing Daily </li></ul></ul></ul>
  21. 21. Oral Cancer <ul><li>Squamous cell carcinomas </li></ul><ul><ul><li>lips, buccal mucosa, gums, floor of mouth, tonsils, tongue </li></ul></ul><ul><li>Basal cell carcinoma—lips </li></ul><ul><li>S/S tongue irritation, loose teeth, pain, lesions, leukoplakia (hard white patches) </li></ul><ul><li>Diagnosed by biopsy </li></ul>
  22. 22. Oral Cancer (cont) <ul><li>Treatment based on individualized diagnosis </li></ul><ul><li>Radiation, chemotherapy, and surgery </li></ul><ul><li>Radical or modified neck dissection performed if CA metastasized to cervical lymph nodes </li></ul>
  23. 23. Oral Cancer—Nursing Care <ul><li>Impaired Oral Mucous Membrane </li></ul><ul><ul><li>Mouth Care </li></ul></ul><ul><li>Ineffective Breathing Pattern </li></ul><ul><ul><li>Monitor respiratory status frequently r/t edema, secretions </li></ul></ul><ul><ul><li>Suction </li></ul></ul><ul><li>Acute Pain </li></ul><ul><ul><li>Medications, relaxation, imagery </li></ul></ul><ul><li>Imbalanced Nutrition: Less Than Body Requirements </li></ul><ul><ul><li>Soft or Liquid Diet, Feeding Tube, TPN </li></ul></ul>
  24. 24. Oral Cancer—Nursing Care (cont) <ul><li>Impaired Verbal Communication </li></ul><ul><ul><li>Assist pt to communicate </li></ul></ul><ul><li>Disturbed Body Image </li></ul><ul><li>Risk for Infection </li></ul><ul><ul><li>Monitor for s/s of infection; antibiotics </li></ul></ul><ul><li>Ineffective Tissue Perfusion r/t grafts </li></ul>
  25. 25. Parotitis <ul><li>Painful swelling of salivary glands below ear </li></ul><ul><ul><li>At risk: Pts unable to take oral fluids for a prolonged time </li></ul></ul><ul><li>Treatment: antibiotics, mouthwashes, warm compresses, possible surgery </li></ul>
  26. 26. Achalasia <ul><li>Progressively worsening dysphagia (difficulty swallowing) </li></ul><ul><li>Failure of the lower esophageal muscles and sphincter to relax during swallowing </li></ul><ul><li>Treatment: Medications, Dilation, Surgery </li></ul>
  27. 27. Esophageal Cancer <ul><li>Risk: Alcohol or Tobacco Use </li></ul><ul><li>Detected Late </li></ul><ul><li>Location near many lymph nodes that allow it to metastasize to liver and lung </li></ul><ul><li>Obstruction of esophagus may occur, w/ possible perforation or fistula development that may cause aspiration </li></ul><ul><li>Lesion may extend to aorta </li></ul>
  28. 28. Signs and Symptoms <ul><li>Appearance of s/s usually means that CA is in late stages </li></ul><ul><li>Difficulty Swallowing, Feeling Full, Pain in Chest after eating, Foul Breath, Food Regurgitation, Weight Loss </li></ul><ul><li>Diagnosis: Barium swallow, Esophagoscopy, Biopsy </li></ul><ul><ul><li>Endoscopic examination of mediastinum used to determine if spread to lymph nodes and surrounding structures </li></ul></ul>
  29. 29. Esophageal Cancer (cont’d) <ul><li>Radiation </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Surgery </li></ul><ul><ul><li>Esophagogastrostomy—esophageal resection </li></ul></ul><ul><ul><li>Dacron Esophageal Replacement—prosthesis </li></ul></ul><ul><ul><li>Esophagoenterostomy—use of a section of colon to replace esophagus </li></ul></ul><ul><ul><li>If inoperable tumor, esophageal dilation or stent placement can be done to relieve dysphagia and allow food to pass through esophagus </li></ul></ul>
  30. 30. Esophageal Cancer (cont’d) <ul><li>Nursing Diagnoses p.757-758 </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Risk for Deficient Fluid Volume </li></ul></ul><ul><ul><li>Imbalanced Nutrition: Less Than Body Requirements </li></ul></ul><ul><ul><li>Evaluation: goals met if pt reports pain relieved and fluid volume and nutritional needs met </li></ul></ul>