Gastrointestinal Disorders Review

GASTROINTESTINAL DISORDERS NCLEX - RN 11/14/2008
REVIEW

Gastrointestinal Disorders
RN REVIEW

REVIEW OF PARTS & FUNCTIONS
Nio C. Noveno, RN, MAN

GI DISORDERS 2

G IT

THE MAJOR PARTS
MOUTH /
ESOPHAGUS
STOMACH
SMALL
INTESTINE
LARGE
INTESTINE

GI DISORDERS
ACCESSORY
ORGANS
PANCREAS
LIVER
GALLBLADDER

GI DISORDERS 3 GI DISORDERS 4

BY NIO C. NOVENO, RN, MAN 1

REVIEW

STOMATITIS ESOPHAGEAL VARICES
CAUSES • MOST COMMON
• INFECTIONS
LOCATION
• IRRITANTS
– DISTAL VEINS OF THE
• CHEMOTHERAPY
ESOPHAGUS
– OFTEN DUE TO CIRRHOSIS
DIAGNOSIS
NURSING DIAGNOSES • C&S
• PAIN *WALLS OF THE VEINS
TREATMENT
• IMBALANCED NUTRITION WEAKEN
• XYLOCAINE
• IMPAIRED ORAL MUCOUS – WOF: BLEEDING &
• ANTIBIOTICS
• BLAND DIET ULCERATION
MEMBRANE


ESOPHAGEAL VARICES
IF VARICES ARE ACTIVELY BLEEDING
MEDICAL MANAGEMENT
SENGSTAKEN-BLAKEMORE
MINNESOTA TUBE
TUBE

1. SCLEROTHERAPY

2. LIGATION

3. BALLOON TAMPONADE



REVIEW

ESOPHAGEAL VARICES
ESOPHAGEAL VARICES
PHARMACOLOGICAL MANAGEMENT
SURGICAL MANAGEMENT
TRANSJUGULAR • OCREOTIDE (SANDOSTATIN) I.V.
INTRAHEPATIC – DECREASES BLOOD FLOW
PORTOSYSTEMIC
• ANALGESICS
SHUNT
• SUCRALFATE (CARAFATE)
• I.V. REHYDRATION
• USES THE RIGHT INTERNAL
JUGULAR VEIN
• CONNECTION BETWEEN
• AVOID:
HEPATIC & PORTAL VEINS
– ASPIRINS, NSAIDS, ANTICOAGULANTS
• DONE IN X-RAY


ESOPHAGEAL VARICES
GASTROESOPHAGEAL REFLUX DISEASE
NURSING MANAGEMENT
POSSIBLE CAUSES:
1. FATTY FOODS
• RISK FOR FLUID VOLUME DEFICIT
2. CAFFEINE
3. NICOTINE
• DEFICIENT FLUID VOLUME
4. CCBS
5. NSAIDS
• ANXIETY



REVIEW

MANAGEMENT
SIGNS & SYMPTOMS NURSING CONSIDERATIONS FUNDOPLICATION SURGERY
• BELCHING 1. INSTRUCT PT TO LOSE
• FLATULENCE A LAPAROSCOPIC PROCEDURE
WEIGHT
2. AVOID FATTY
• ESOPHAGITIS DONE TO TIGHTEN THE LES
FOODS,
ALCOHOL, NICOTINE,
• DYSPHAGIA – FUNDUS OF THE STOMACH IS
WRAPPED & SUTURED AROUND
CAFFEINE, SPICY FOODS
• EPIGASTRIC PAIN
THE ESOPHAGUS
3. TAKE MEDICATIONS AS RX
• HEARTBURN
4. ELEVATE HOB
• BLEEDING
5. AVOID WEARING
• MELENA
CONSTRICTIVE CLOTHING


GASTRIC ULCER DUODENAL ULCER
PEPTIC ULCERS
LESS COMMON MORE COMMON
INCIDENCE
55-77 YO 30-50 YO
BLEEDING MORE LIKELY LESS LIKELY
PERFORATION LESS LIKELY MORE LIKELY

FOOD INCREASES PAIN; FOOD RELIEVES PAIN;
PAIN RELIEF
WEIGHT LOSS WEIGHT GAIN

PAIN: ½ - 1 H AFTER A MEAL;
PAIN: 2-3 H;
RARELY OCCURS AT NIGHT;
PAIN PATTERN OFTEN AWAKENED AT1-2
MAY BE RELIEVED BY AM
VOMITING

MALIGNANCY OCCASIONALLY RARE


REVIEW

PEPTIC ULCER DISEASE PEPTIC ULCER DISEASE
GNAWING OR BURNING EPIGASTRIC PAIN
CAMPYLOBACTER PYLORI OR HELICOBACTER PYLORI 1 TO 2 HOURS AFTER
THAT OCCURS EATING

ERUCTATION, VOMITING, FOOD, OR ANTACIDS
ZOLLINGER-ELLISON SYNDROME [GASTRINOMA]

NAUSEA
ASPIRIN, STEROIDS, INDOMETHACIN, NSAIDS
BLEEDING
SMOKING
[COLOR PULSE TEMPERATURE]
PERSONALITY VOMITING
GI DISORDERS
17 GI DISORDERS 18

DIAGNOSIS SURGICAL MANAGEMENT



REVIEW

PEPTIC ULCER DISEASE PEPTIC ULCER DISEASE:
NURSING MANAGEMENT THERAPEUTIC INTERVENTIONS
THERE IS A NID TO:
PREOPERATIVE POSTOPERATIVE

NEUTRALIZE OR BUFFER HYDROCHLORIC ACID
INHIBIT ACID SECRETION
DECREASE THE ACTIVITY OF PEPSIN AND HCL

CALCIUM AND IRON SUPPLEMENTS
[IF MEDICATION INCREASES GASTRIC PH]
nionoveno@hotmail.com GI DISORDERS 22
GI DISORDERS 21

MEDICATION PURPOSE NURSING IMPLICATIONS

GERD & ULCERS PEPTIC ULCER DISEASE
ANTACIDS CONSTIPATION
•ALUMINUM OH (AMPHOGEL) DIARRHEA
SEAL IMPAIRED MUCOSA
•ALUMINUM OH & MAGNESIUM OH MONAK

PHARMACOLOGICAL MANAGEMENT DIETARY MANAGEMENT
(MAALOX) AVOID GIVING WITH OTHER MEDS
NEUTRALIZE ACIDS
•DIHYDROXYALUMINUM SODIUM
(ROLAIDS)
H2BLOCKERS
•RANITIDINE HCL (ZANTAC)
DECREASE GASTRIC ACID
DO NOT GIVE WITH ANTACIDS
•CIMETIDINE (TAGAMET)
SECRETION
•NIZATIDINE (AXID)
•FAMOTIDINE (PEPCID)
PROTON PUMP INHIBITOR
INCREASE EFFECTS OF PHENYTOIN,
•OMEPRAZOLE (LOSEC)
WARFARIN, DIAZEPAM
STOP GASTRIC ACID
•ESOMEPRAZOLE (NEXIUM)
DELAYS ABSORPTION OF VALIUM
PRODUCTION
•LANSOPRAZOLE (ZOTON)
•PANTOPRAZOLE (PROTIUM)
•RABEPRAZOLE SODIUM (PARIET)
PROSTAGLANDINS DECREASE GASTRIC ACID
•MISOPROSTOL (CYTOTEC) NSAID-INDUCED ULCERS
SECRETION
ENHANCES MUCOSAL DEFENSES
BISMUTH COMPOUNDS
•BISMUTH SUBSALICYLATE (PEPTO- INHIBITS H. PYLORI GROWTH
BISMOL)
ANTIBIOTICS
ELIMINATE H. PYLORI TAKEN WITH FOOD
•AMPICILLIN (OMNIPEN)
•METRONIDAZOLE (FLAGYL)


REVIEW

TYPE AND CROSS-MATCH ANTIEMETICS
[GASTRIC HEMORRHAGE]
[NAUSEA AND VOMITING]
NGT & SALINE LAVAGE / VASOCONSTRICTORS
ANTIBIOTICS: TETRACYCLINE, METRONIDAZOLE, AND BISMUTH
[CONTROL BLEEDING ]

TRANQUILIZERS BED REST
ANTICHOLINERGICS [REDUCE PHYSICAL ACTIVITY]

ANALGESICS COUNSELING OR PSYCHOTHERAPY
SEDATIVES [EXPLORE THE EMOTIONAL COMPONENTS OF THE ILLNESS]
[PAIN AND RESTLESSNESS]
GI DISORDERS GI DISORDERS
25 26

PEPTIC ULCER DISEASE: NURSE IT! PEPTIC ULCER DISEASE
MVS; MIO
1. ALLOW EXPRESSION OF FEELINGS AND CONCERNS
2. ADMINISTER AND ASSESS EFFECTS OF MEDICATIONS
ASSESS THE DRESSING FOR DRAINAGE
3. ENCOURAGE HYDRATION
MAINTAIN A PATENT NGT TO THE SUCTION APPARATUS
a. REDUCES ANTICHOLINERGIC SE
[PREVENT STRESS ON THE SUTURE LINE]
b. DILUTE THE HCL IN THE STOMACH
4. EAT SMALL TO MEDIUM-SIZED MEALS OBSERVE THE COLOR AND AMOUNT OF NG DRAINAGE
5. REPLACE WITH DECAFFEINATED SOFT DRINKS AND TEAS [BRIGHT RED BLOOD AFTER 12 HOURS SHOULD BE REPORTED]
6. USE SEASONINGS LIKE THYME, BASIL, SAGE
COUGH, DEEP BREATHE, & CHANGE POSITION FREQUENTLY
7. AVOID SALICYLATES, PHENYLBUTAZONE, STEROIDS, APPLY ANTIEMBOLISM STOCKINGS & AMBULATE
ACTH
27 28


REVIEW

ULCER
PEPTIC ULCER DISEASE
UPSET STOMACH
TO PREVENT DUMPING SYNDROME:
LOW APPETITE
FREQUENT FEEDINGS OF SMALL AMOUNTS
CAUSES:
CHEMICALS, COFFEE, ALCOHOL, ALLERGENS, UREMIA,
AVOID HIGH-CHO INTAKE BACTERIA, DRUGS, SMOKING, STRESS, SPICES

EMESIS
CONSUME LIQUIDS ONLY BETWEEN MEALS
REDUCE ACID
(AT LEAST 1 HOUR BEFORE OR AFTER MEALS)
ANTI-ACID MEDICATIONS
LIE DOWN OR REST AFTER EATING
CARAFATE
PECTIN OR GUAR GUM (5-G DOSE) WITH MEALS
IRRITANTS
[WATER-SOLUBLE FIBER WHICH DELAYS GASTRIC EMPTYING AND
Decompression
ABSORPTION OF CARBOHYDRATES
29 30

COMMON SIGNS
APPENDICITIS OTHER CONFIRMATORY PERITONEAL SIGNS
(ABSENCE OF THESE SIGNS DOES NOT EXCLUDE APPENDICITIS)

OF APPENDICITIS
THE CAUSES… PSOAS SIGN--PAIN ON EXTENSION OF
•
RIGHT THIGH (RETROPERITONEAL
• OBSTRUCTION RIGHT LOWER QUADRANT PAIN ON
• RETROCECAL APPENDIX)
PALPATION (THE SINGLE MOST
– LYMPHOID HYPERPLASIA (RELATED TO VIRAL ILLNESSES, OBTURATOR SIGN--PAIN ON INTERNAL
•
IMPORTANT SIGN)
ROTATION OF RIGHT THIGH (PELVIC
INCLUDING UPPER RESPIRATORY INFECTION,
APPENDIX)
MONONUCLEOSIS, GASTROENTERITIS) LOW-GRADE FEVER (38°C [OR
•
ROVSING'S SIGN--PAIN IN RIGHT LOWER
•
FECALITHS
– 100.4°F])
QUADRANT WITH PALPATION OF LEFT
PARASITES
– LOWER QUADRANT
PERITONEAL SIGNS
•
FOREIGN BODIES
– DUNPHY'S SIGN--INCREASED PAIN WITH
•
CROHN‘S DISEASE
– LOCALIZED TENDERNESS TO
• COUGHING
PERCUSSION
PRIMARY OR METASTATIC CANCER AND CARCINOID
– FLANK TENDERNESS IN RIGHT LOWER
•
QUADRANT (RETROPERITONEAL
SYNDROME
GUARDING
• RETROCECAL APPENDIX)
– LYMPHOID HYPERPLASIA IS MORE COMMON IN CHILDREN
PATIENT MAINTAINS HIP FLEXION WITH
•
AND YOUNG ADULTS
KNEES DRAWN UP FOR COMFORT
GI DISORDERS 32
GI DISORDERS 31


REVIEW

APPENDICITIS
APPENDICITIS
NURSING IMPLICATIONS
2. DIET
ABDOMINAL PAIN
NPO STATUS
–
ANOREXIA
LONGER WITH PERITONITIS
•
1. PAIN:
NAUSEA NGT INSERTION
•
NO ANALGESICS
–
VOMITING
NO WARM COMPRESS
–
PAIN MIGRATION CLEAR TO REGULAR DIET
–
NO ENEMA
– AFTER SURGERY
RUPTURED APPENDIX
–
3. ACTIVITY
CLASSIC SYMPTOM SEQUENCE NO PAIN
•
TURNING
–
POSITION HOB
•
• VAGUE PERIUMBILICAL PAIN TO ANOREXIA/NAUSEA/ UNSUSTAINED
DEEP BREATHING &
–
REFER STAT!
•
VOMITING TO MIGRATION OF PAIN TO RIGHT LOWER QUADRANT COUGHING EXERCISES
TO LOW-GRADE FEVER WITH SPLINTING


DIVERTICULAR DISEASES DIVERTICULAR DISEASES
DIVERTICULOSIS DIVERTICULITIS DIVERTICULOSIS DIVERTICULITIS
MODERATE LLQ PAIN
•
•INFLAMMATION OF ONE OR • MULTIPLE DIVERTICULA ARE • RECURRENT LLQ PAIN
MORE DIVERTICULA PRESENT MILD NAUSEA, GAS
•

• RELIEVED BY DEFECATION OR IRREGULAR BOWEL HABITS
•
•SIGMOID COLON
• LOW FIBER DIET PASSAGE OF FLATULENCE
LOW-GRADE FEVER
•
•STOOL IMPACTED IN THE
INCREASED WBC
•
• 30-40% OF ELDERLY • ALTERNATING CONSTIPATION
DIVERTICULA
& DIARRHEA RUPTURE (IF SEVERE)
•
POPULATION
FIBROSIS & ADHESIONS (CHRONIC
•
DIVERTICULITIS)
• ASYMPTOMATIC



REVIEW

DIVERTICULAR DISEASES
NURSING MANAGEMENT
NURSING MANAGEMENT
FOR DIVERTICULITIS
FOR DIVERTICULSOSIS
1. WITHOUT PERFORATION
1. BLAND OR LIQUID DIET
a. PREVENT CONSTIPATION & INFECTION
2. HIGH-RESIDUE DIET BED REST
•
LIQUID DIET
•
3. PSYLLIUM
STOOL SOFTENERS
•
– ABSORBS WATER AND EXPAND TO PROVIDE BROAD-SPECTRUM ANTIBIOTICS
•
INCREASED BULK IN STOOL MEPERIDINE
•
DICYCLOMINE (BENTYL, BYCLOMINE, DIBENT, DI-SPAZ,
•
– ENCOURAGES NORMAL PERISTALSIS AND BOWEL
DILOMINE)
MOTILITY HYOSCYAMINE (LEVSIN® /SL TABLETS)
•


ABDOMINAL APPLIANCE
NURSING MANAGEMENT
2. COLON RESECTION COLOSTOMY ILEOSTOMY
3. COLOSTOMY
4. F & E MONITORING
5. WOF SIGNS OF BLEEDING
– ANGIOGRAPHY
– VASOPRESSIN



REVIEW

PARAMETER CROHN’S ULCERATIVE COLITIS
INFLAMMATORY BOWEL DISEASEONLY INFLAMMATORY BOWEL DISEASE
LOWER COLON
INVOLVEMENT SMALL & LARGE INTESTINE
(THEN, ASCENDS)
TISSUE AFFECTED ENTIRE THICKNESS MUCOSA
PHARMACOLOGY DIET
• 5-ASA COMPOUNDS HIGH PROTEIN
•
OBSTRUCTION, FISTULAS,
FISSURES, ABSCESSES, – SULFAZALAZINE (AZULFIDINE) INCREASE FE & VIT B12
•
LONG-TERM ABSCESSES, PERFORATION
INCREASED RISK OF – MESALAMINE (ROWASA,
CANCER RISK INCREASES WITH LOW-RESIDUE DIET
•
COMPLICATIONS
COLORECTAL CANCER PENTASA, ASACOL)
AGE HIGH PROTEIN DIET
•
– OLSALAZINE SODIUM
LOW FAT
(DIPENTUM) •
SURGICAL DOES NOT CURE OR LIMIT THE ADVERSE EVENTS
CURES THE DISEASE CORTICOSTEROIDS
•HEADACHE
INTERVENTION DISEASE
PHOTOSENSITIVITY
IMMUNOSUPPRESANTS
•SERUM SICKNESS-LIKE SYNDROME
UNKNOWN; ALTERED UNKNOWN; E. COLI
IMMUNE
CAUSE • IVF REPLACEMENT
GIT DISTURBANCE
STATE INFECTION ORANGE-YELLOW DISCOLORATION
• TPN
3-4 SEMISOFT/DAY; 15-20 LIQUID/DAY;
STOOLS
STEATORRHEIC AND MUCOID BLOODY

IRRITABLE BOWEL SYNDROME
CRITERIA FOR DIAGNOSIS
1. ABDOMINAL PAIN OR DISCOMFORT
REFER TO A GROUP OF SYMPTOMS:
– AT LEAST 12 WEEKS OUT OF THE PREVIOUS 12
MONTHS
ABDOMINAL PAIN
BLOATING
2. AT LEAST 2 OF THE FOLLOWING:
CONSTIPATION / CRAMPING a. PAIN IS RELIEVED BY BM
DIARRHEA b. WITH PAIN, BM PATTERN CHANGES
c. WITH PAIN, STOOL CHARACTERISTICS CHANGE



REVIEW

IRRITABLE BOWEL SYNDROME IRRITABLE BOWEL SYNDROME
MEDICAL MANAGEMENT DIETARY MANAGEMENT
1. ANTICHOLINERGIC A.C. AVOID THE FOLLOWING
ALCOHOL
2. TEGASEROD MALEATE (ZELNORM) X 4 WEEKS BARLEY
CAFFEINATED DRINKS
3. PSYLLIUM (METAMUCIL) CHOCOLATES
MILK PRODUCTS
4. ALOSETRON HCL (LOTRONEX) RYE & WHEAT


INTESTINAL OBSTRUCTION
DIETARY MANAGEMENT
MAKE SURE TO… VOLVULUS
1. TEACH THE CLIENT TO LIST DOWN FOOD EATEN

2. EAT 5-6 TIMES; SMALL, FREQUENT FEEDINGS
INTUSSUSCEPTION
3. EXERCISE REGULARLY

ADHESIONS
4. PROMOTE STRESS RELIEF



REVIEW

MANAGEMENT
1. NEUROGENIC OBSTRUCTION 1. MEDICAL
– PARALYTIC ILEUS – NG DECOMPRESSION
TRAUMA
• – IV REHYDRATION
INFECTION
• – ENEMAS
MEDICATION
•
2. VASCULAR OBSTRUCTION
2. SURGERY
– ATHEROSCLEROSIS
– BOWEL RESECTION
– NECROSIS

49
GI DISORDERS GI DISORDERS 50

HERNIAS
HERNIAS
MANAGEMENT
1. SURGERY
LOCATION TYPES
– HERNIORRHAPHY
– BOWEL RESECTION

2. DIET
– SMALL, FREQUENT FEEDINGS
– LIE DOWN FOR 2 HOURS AFTER EATING
– AVOID HIGHLY IRRITATING FOODS

GI DISORDERS 52
GI DISORDERS 51


REVIEW

HEMORRHOIDS
HEMORRHOIDS
MANAGEMENT
1. MEDICAL
EXTERNAL INTERNAL
– HOT SITZ OR WARM COMPRESS X 20 MINUTES, 4
TIMES A DAY

2. SURGERY
– HEMORRHODECTOMY
EXTERNAL: OPD
•
INTERNAL: OVERNIGHT
•
SCLEROTHERAPY, CRYOTHERAPY, LASER
–


HEMORRHOIDS
MANAGEMENT
3. PHARMACOLOGY
– CREAMS & SUPPOSITORIES
– CORTICOSTEROIDS

4. DIET DISORDERS OF THE
– 20-30 GRAMS OF FIBER/DAY
ACCESSORY ORGANS
– 2.5 L OF FLUID PER DAY



REVIEW

LIVER FUNCTIONS CAUSES OF CIRRHOSIS
1. LAENNEC’S [OR, PORTAL ,NUTRITIONAL,
Storage of vitamin A, B, D; iron and copper
ALCOHOLIC]
Synthesis of plasma proteins, including albumin and
globulins
Synthesis of clotting factors, vitamin K and 2. BILIARY
prothrombin
Storage of glycogen and synthesis of glucose from
3. PIGMENT
other nutrients
Breakdown of fatty acids for energy
4. DRUG- / TOXIN-INDUCED
Production of bile
Detoxification and excretion of waste products
GI DISORDERS 58

CIRRHOSIS CIRRHOSIS ASSESSMENT
1. CNS
PROGRESSIVE SIGNS OF HEP ENCEPH
–
LETHARGY, MENTAL CHANGES, SLURRED SPEECH & ASTERIXIS,
•
PERIPHERAL NEURITIS, PARANOIA, HALLUCINATIONS, COMA

2. GIT
ANOREXIA, INDIGESTION, N & V, CONSTIPATION OR
–
DIARRHEA, DULL ABDOMINAL PAIN

3. RESPIRATORY
PLEURAL EFFUSION
–

GI DISORDERS 60
GI DISORDERS 59


REVIEW

CIRRHOSIS ASSESSMENT CIRRHOSIS ASSESSMENT
4. HEMATOLOGIC ADDITIONAL DATA
1. MUSTY BREATH
2. CAPUT MEDUSAE
5. ENDOCRINE
3. MUSCLE ATROPHY
– “FEMINIZATION”
4. RUQ PAIN AGGRAVATED BY SITTING OR LEANING
5. PALPABLE SPLEEN
6. SKIN
T: 1010 TO 1030 F (38.30 TO 39.40 C )
6.
– JAUNDICE, PRURITUS, DRYNESS, SPIDER ANGIOMAS,
7. ESOPHAGEAL VARICES WITH BLEEDING
PALMAR ERYTHEMA,


DIAGNOSIS OF CIRRHOSIS TREATMENT OF CIRRHOSIS
1. LIVER BIOPSY AIMS OF TREATMENT
2. LIVER SCAN
3. CHOLECYSTOGRAPHY & CHOLANGIOGRAPHY 1. ALLEVIATE THE CAUSE
4. CT SCAN
5. HEMATOLOGIC TESTS
2. PREVENT FURTHER DAMAGE
6. ABNORMAL GTT
7. URINE TESTS
3. PREVENT OR TREAT COMPLICATIONS
8. FECALYSIS



REVIEW

TREATMENT OF CIRRHOSIS TREATMENT OF CIRRHOSIS
1. VARICEAL BLEEDING 2. DIET CONT…
– MEDICATIONS – TPN [WITH DETERIORATION]
– BALLOON TAMPONADE – A, B COMPLEX, C, K
– SURGERY – VIT B12, FOLIC ACID & THIAMINE

2. DIET
3. ACTIVITIES
– HIGH PROTEIN [NOT WITH HEP ENCEPH]
– REST & MODERATE EXERCISE
– NA RESTRICTION [200 – 500 MG/D]
– FLUID RESTRICTION [1 – 1.5 L/D]

TREATMENT OF CIRRHOSIS TREATMENT OF CIRRHOSIS
7. PARACENTESIS
4. ANTIEMETICS
– TRIMETHOBENZAMIDE (TIGAN, TEBAMIDE)
8. LEVEEN SHUNT
– BENZQUINAMIDE (BZQ, BENZCHINAMIDE,
EMETICON, PROMECON, QUANTRIL)
9. SURGERY
5. VASOPRESSIN
10. LIVER TRANSPLANT
6. DIURETICS 11. LIFESTYLE MANAGEMENT
– FUROSEMIDE & SPIRONOLACTONE



REVIEW

VIRAL HEPATITIS SYMPTOMS OF ACUTE VIRAL HEPATITIS
HEPATOTROPIC VIRUSES NONSPECIFIC SIGNS & SYMPTOMS
HEPATITIS VIRUS A-E AND G

HEPATITIS B (HEPADNA): DNA VIRUS LOSS OF APPETITE NAUSEA FATIGUE MILD FEVER
RNA VIRUSES:
HEPATITIS A (PICORNAVIRUS)
JAUNDICE DARK URINE
HEPATITIS C (FLAVIVIRUS)
HEPATITIS E (CALICIVIRUS)
CLAY-COLORED STOOLS (LIGHT YELLOW)
HEPATITIS G

HEPATITIS D: INCOMPLETE RNA VIRUS
69 70

A B C D E
FECAL- BLOOD & BLOOD; FECAL-
TRANSMISSIO
LABORATORY STUDIES BLOOD
N FLUIDS
ORAL NEEDLES ORAL

15-50 45-160 14-180 15-60 15-60
INCUBATION

↑ AST / ALT [3 – 5 TIMES > N] INFECTIOUS
<2 MOS BEFORE SX APPEAR NOT DETERMINED
PERIOD

SERUM ALT IGG ANTIHDV /
AST > 1000 U / L IS COMMON IN SEVERE HEPATITIS IGM; ANTI
NONE
DX TEST HBSAG
INC 10X
HAV IGM ANTIHDV
[REVERSIBLE OVER SEVERAL MONTHS]
SP; REDUCE
SP, ENTERIC SP; SAFE
SP; REDUCE SP; NO
MODEST ↑ IN ALKALINE PHOSPHATASE & GGT PRECAUTIO RISK
PREVENTION PRACTICES; HEP
NS; HEP A RISK; HEP B VAC
BEHAVIOR; VAC
B VAC; IG
VAC; IG NO VAC
VARIABLE INCREASE IN BILIRUBIN
HBIG
PERINTERFE
ALPHA
RON ALFA
BILIRUBIN IN URINE ALPHA
INTERFERON
IG IN 2 2A
LAMIVUDINE NONE
TREATMENT INTERFERON
(PEGASYS)
WEEKS
(EPIVI HBV)
RIBAVIRIN
GI DISORDERS 71
ADEFOVIRDIPIVO
GI DISORDERS 72
(VIRAZOLE)
XIL (HEPSERA)


REVIEW

HEPATITIS PHASES OF HEPATITIS
1. PRODROMAL (PREICTERIC) PHASE
OTHER CAUSES OF HEPATITIS
ANV, MALAISE, WEIGHT LOSS
SYMPTOMS OF URTI
[I.E., INTOLERANCE FOR SMOKING
CHEMICAL AGENTS HALOTHANE]

2. ICTERIC PHASE
CARBON TETRACHLORIDE
JAUNDICE
BILE-COLORED URINE THAT FOAMS WHEN SHAKEN
[I.E., AUROTHIOGLUCOSE]
GOLD COMPOUNDS
ACHOLIC (CLAY-COLORED) STOOLS

ARSENIC 3. RECOVERY PHASE: EASY FATIGABILITY

73 74

HEPATITIS HEPATITIS: 2,500 -3,000 KCAL / DAY
HIGH PROTEIN [75 TO 100
THERAPEUTIC G]
INTERVENTIONS
HEALING OF LIVER TISSUE
1. REST DAILY: 1 QT MILK; 2 EGGS
8 OZ LEAN MEAT, FISH, OR CHEESE
HIGH CARBOHYDRATE [300 TO 400 G]
2. ABSTINENCE FROM ALCOHOL ENERGY NEEDS, RESTORE GLYCOGEN RESERVES
4 SERVINGS VEGETABLES, POTATO, 4 SERVINGS
DAILY: FRUIT WITH FREQUENT JUICES,
6 TO 8 SERVINGS BREAD OR CEREAL
MODERATE FAT [100 TO 150 G DAILY]
3. DIET THERAPY
2 TO 4 TABLESPOONS BUTTER OR FORTIFIED MARGARINE
MODERATE AMOUNT OF WHOLE MILK, CREAM, BUTTER, MARGARINE, OR VEGETABLE
OIL IS BENEFICIAL

75 76


REVIEW

HEPATITIS: INVESTIGATE! HEPATITIS: ACTION!
1. HISTORY 1. ATTEMPT TO STIMULATE THE APPETITE
a. OF EXPOSURE TO VIRUS a. PROVIDE ORAL HYGIENE
b. OF EMPLOYMENT OVER PREVIOUS 6 MONTHS b. BASED ON THE CLIENT'S PREFERENCES
c. PROVIDE A PLEASANT, UNHURRIED ATMOSPHERE FOR
2. RUQ FOR EATING
LIVER TENDERNESS, FIRMNESS
d. PROVIDE SMALL, FREQUENT FEEDINGS
3. JAUNDICE 2. USE PRECAUTIONS TO PREVENT THE SPREAD OF
IN SKIN, SCLERA, AND MUCOUS MEMBRANES
HEPATITIS TO OTHERS
4. TEMPERATURE: a. USE STANDARD (UNIVERSAL) PRECAUTIONS
a. FEVER (WITH TYPE A)
b. LOW-GRADE FEVER (WITH TYPES B AND C) b. HAV: CONTACT PRECAUTIONS
77 78

HEPATITIS: ACTION! 'GET SMASHED‘ TO KNOW THE CAUSES
GALLSTONES
3. ADMINISTRATION OF IMMUNE SERUM GLOBULIN (ISG)
AFTER EXPOSURE TO TYPE A HEPATITIS ETHANOL
TRAUMA
4. VACCINATION OF INDIVIDUALS AT RISK FOR TYPE B STEROIDS
HEPATITIS (HEP-B, RECOMBIVAX HB)
MUMPS
AUTOIMMUNE CAUSES
5. ENCOURAGE THE USE OF CONDOMS
SCORPION VENOM
HYPERLIPIDAEMIAS
ERCP
DRUGS (SUCH AS AZATHIOPRINE)
(SUCH ZATHIOPRINE)

GI DISORDERS 79
GI DISORDERS 80


REVIEW

ACUTE PANCREATITIS ASSESSMENT OF ACUTE PANCREATITIS
2 FORMS 2 THEORIES MILD SEVERE
EXTREME PAIN
•
EPIGASTRIC PAIN,
• PERSISTENTVOMITING
•
1. INTERSTITIAL (EDEMATOUS) 1. TOXIC AGENT RADIATING BETWEEN THE • ABDOMINAL RIGIDITY
T10 & L6 UNRELIEVED BY • ILEUS
DIMINISHED BOWEL ACTIVITY
•
VOMITING
CRACKLES AT LUNG BASES
•
2. NECROTIZING 2. REFLUX OF DUODENAL TACHYCARDIA
•
CONTENTS EXTREME MALAISE
•
RESTLESSNESS
•
MOTTLED SKIN
•
LOW-GRADE FEVER
•
COLD, SWEATY EXTREMITIES
•


DIAGNOSIS OF PANCREATITIS TREATMENT OF PANCREATITIS
• ELEVATED GOAL OF TREATMENT
– SERUM AMYLASE & LIPASE 1. MAINTAIN CIRCULATION & FLUID VOLUME
– WBC
– HCT
2. RELIEVE PAIN
LOW SERUM CALCIUM
•
HYPERGLYCEMIA
•
3. DECREASE PANCREATIC SECRETIONS
CT-SCAN
•
X-RAYS
•


REVIEW

TREATMENT OF PANCREATITIS TREATMENT OF PANCREATITIS
MAINTAIN CIRCULATION & FLUID VOLUME ADDITIONAL MANAGEMENT
1. CONTINUE 5-7 DAYS OF HYDRATION
1. ELECTROLYTE REPLACEMENT
2. TPN
2. PROTEIN SUPPLEMENTATION 3. GAVAGE FEEDINGS
4. PROCEDURES:
3. CALCIUM REPLACEMENT
– LAPAROTOMY
– PANCREATECTOMY
*SHOCK CAUSES DEATH IN EARLY STAGES
– CHOLECYSTOSTOMY & GASTROSTOMY
*METABOLIC ACIDOSIS


GALLBLADDER & BILIARY TRACT DISORDERS GALLBLADDER & BILIARY TRACT DISORDERS

5 MAJOR DISORDERS CAUSE: UNKNOWN
1. CHOLECYSTITIS RISK FACTORS
STONE IN THE CYSTIC
– DUCT
1. OBESITY
2. CHOLANGITIS
2. ELEVATED ESTROGEN LEVELS
INFECTION OF THE BILE DUCT
–
3. CHOLELITHIASIS 3. GENETICS
STONE IN THE GALLBLADDER
–
4. USE OF:
4. CHOLEDOCHOLELITHIASIS
ANTILIPEMIC DRUGS
–
STONE IN THE CBD
–
WEIGHT REDUCTION PILLS
–
5. GALLSTONE ILEUS
SMALL BOWEL OBSTRUCTION
– 5. DISEASES
DUE TO GALLSTONE



REVIEW


MANIFESTATIONS
AGE ESTROGEN OBESITY • SEVERE MIDEPIGASTRIC PAIN OR RUQ PAIN RADIATING TO THE
BACK
INCREASED BILE PRODUCTION
FLATULENCE
•
INDIGESTION
•
EXCESS WATER & BILE SALTS ARE REABSORBED NAUSEA
•
DIAPHORESIS
•
BELCHING
•
GALLSTONES CHILLS & LOW-GRADE FEVER
•
INDIGESTION OF FAT
•
[CHOLESTEROL CALCIUM BILIRUBIN] JAUNDICE & CLAY-COLORED STOOLS
•

DIAGNOSIS OF TREATMENT OF
UTZ OF THE GALLBLADDER CHOLECYSTECTOMY
• •
CT SCAN CHOLANGIOGRAPHY
• •
ERCP T-TUBE PLACEMENT
• •
CHOLESCINTIGRAPHY LOW FAT DIET; GIVE VIT K
• •
ORAL CHOLECYSTOGRAPHY NGT
• •
BLOOD STUDIES LITHOTRIPSY
• •
• URSODIOL



REVIEW

NURSING CARE OF PATIENTS WITH
quot;Realize that true happiness lies within you.
GALLBLADDER & BILIARY TRACT DISORDERS
Waste no time and effort searching for peace and
1. REINFORCE HEALTH TEACHINGS ON: contentment and joy in the world outside.
a. LOW FAT DIET
Remember that there is no happiness in having or in
b. MEDICATION COMPLIANCE
getting, but only in giving.
c. POST-OP ACTIVITIES
Reach out. Share. Smile. Hug.
DEEP BREATHING & COUGHING
•
REST & ACTIVITY
•
Happiness is a perfume you cannot pour on others
d. WEIGHT REDUCTION without getting a few drops on yourself.quot;
2. CARE OF T-TUBE & SKIN CARE Og Mandino
1923-1996, Author and Speaker

GI DISORDERS 93

THANK YOU!!!

GI DISORDERS 95


Gastrointestinal Disorders Review

Recommended

Recommended

More Related Content

More from Nio Noveno

More from Nio Noveno (20)

Recently uploaded

Recently uploaded (20)

Gastrointestinal Disorders Review