The document discusses gastrointestinal disorders, beginning with an overview of the anatomy and physiology of the gastrointestinal system. It then covers disorders of the mouth and esophagus, including stomatitis, gingivitis, periodontitis, periapical abscess, parotitis, oral cavity cancer, and achalasia. Nursing assessments and interventions are provided for various disorders. The document also discusses disorders of the stomach, small intestine, large intestine, and hepatobiliary system.
Urinary Tract Infection with Nursing ManagementSwatilekha Das
Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
Urinary Tract Infection with Nursing ManagementSwatilekha Das
Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
Gallstones are hardened deposits of digestive fluid that can form in the gallbladder. The gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath the liver. The gallbladder holds a digestive fluid called bile that's released into the small intestine.
Therapeutic environment can be defined as the total of all external conditions and influences affecting an individual in the illness situation.Infection prevention in the operating room is achieved through prudent use of aseptic techniques in order to prevent contamination of the open wound.
Isolate the operating site from the surrounding unsterile physical environment.
Create and maintain a sterile field in which surgery can be performed safely.
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
This is a presentation about gastrointestinal tract disorders concerning a medical informations about an important disorders that affect GIT of human being.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
cancer of the larynx is also known as the cancer of voice box and basic knowledge about this is important to treat the patient and give better care for the patient this knowledge will help the nursing students to give better care, to improve their academic performance and to improve their skills in their clinical practice
Gallstones are hardened deposits of digestive fluid that can form in the gallbladder. The gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath the liver. The gallbladder holds a digestive fluid called bile that's released into the small intestine.
Therapeutic environment can be defined as the total of all external conditions and influences affecting an individual in the illness situation.Infection prevention in the operating room is achieved through prudent use of aseptic techniques in order to prevent contamination of the open wound.
Isolate the operating site from the surrounding unsterile physical environment.
Create and maintain a sterile field in which surgery can be performed safely.
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
This is a presentation about gastrointestinal tract disorders concerning a medical informations about an important disorders that affect GIT of human being.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
cancer of the larynx is also known as the cancer of voice box and basic knowledge about this is important to treat the patient and give better care for the patient this knowledge will help the nursing students to give better care, to improve their academic performance and to improve their skills in their clinical practice
Parotitis is the inflammation of the parotid glands. It is the most common inflammatory condition of the salivary glands, although inflammation can occur in the other salivary glands as well.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. objectives
At the end of this presentation students will be able
to:
• Review the anatomy and physiology of
gastrointestinal system.
• Discuss the causes, pathophysiology and
manifestation of the following.
1. Disorders of mouth and esophagus.
2. Disorders of stomach
3. Disorders of small and large intestine.
3. Continue…
4. Alteration in hepatobiliary system.
• Discuss the diagnostic, medical and surgical
management of the below mentioned
disorders:
1. Disorders of mouth and esophagus.
2. Disorders of stomach
3. Disorders of small and large intestine.
4. Alteration in hepatobiliary system.
4. Continue…
• Apply nursing process including assessment,
planning, implementation and evaluation of
care provided to the clients with GIT
disorders.
7. Continue…
• Enzymes that digest fat (triglyceride)
1. Pharyngeal lipase
2. Steapsin
3. Pancreatic lipase
4. Bile
8. Assessment of the gastrointestinal
System
• Health history:
• GI assessment begins with complete history
information about abdominal pain.(referred
pain)
Dyspepsia (indigestion)
Gas, nausea and vomiting
Diarrhea
Constipation
Fecal incontinence
9. Pass health, family and social history
• Nurse ask’s about the:
• Brushing and flossing routine
• Frequency of dental visits
• Lesions or irritation in mouth, tongue or throat
• Recent history of sore throat or bloody sputum
• Discomfort
• Daily food intake
• Use of alcohol or tobacco(type, length of use,
amount and date of discontinuation)
10. Continue…
• Past and current medication
• Previous Diagnostic tests, surgeries and
treatment
• Current nutritional status
• Appetite or eating patterns
• Unexplained weight loss or gain
• Laboratory tests( Assignment)
11. Physical assessment
• The physical examination includes assessment of
the mouth, abdomen and rectum
Requirements:
1. good source of light
2. full exposure of abdomen
3. Warm hands with short fingernails
4. Stethoscope
5. Tongue depressor
6. Gloves
7. Patient with empty bladder
12. Oral cavity examination
• Lips: inspect the lips for moisture, hydration,
color, texture, symmetry & the presence of
ulceration and fissures.
• Gums: check the inflammation, bleeding,
retraction and discoloration. Hard palate for color
and shape. Mouth odor is also checked
• Tongue: texture, color and lesions, symmetry and
strength.
• Pharynx: depress the tongue with the tongue
depressor and visualize pharynx, tonsils and
uvula.
13. Abdominal examination
• Position: patient lies supine with knees flexed
slightly.
• The examination proceeds in the following
order:
1. inspection
2. Auscultation
3. Percussion
4. Palpation
14. Continue…
Inspection
• is performed first noting
• skin changes
• Nodules
• Lesions
• Scarring
• Discolorations
• Inflammation
• Bruising
Auscultation
• always precedes percussion
and palpation.
• hear the sounds to
determine the character,
location and frequency of
bowel sounds
• They occur irregularly
ranging from (5-35/min)
15. Continue…
Percussion
• Percussion is used to assess
the size and density of the
abdominal organs.
• To detect the presence of
air filled, fluid filled or solid
masses
• All quadrants are purcussed
for over all tympani and
dullness
Palpation
• Light palpation is used to
identify area of tenderness
and muscular resistance.
• Deep palpation is used to
identify masses.
16. Rectal inspection and palpation
• The final part of the examination is the
evaluation of the terminal portion of the GI
tract.
• Requirement: gloves, water, soluble
lubrication, a penlight and drapes
• Positions for the rectal examination: knee
chest, left lateral with hips and knees flexed,
standing with hips flexed and upper body
supported by examination table.
17. Diagnostic evaluation
• GI diagnostic studies can confirm, rule out or
diagnose disease.
• General nursing interventions for the patients
who are undergoing a GI diagnostic evaluation.
1. Establishing the nursing diagnosis
2. Providing needed information about the test
and the activities required of the patient
3. Providing instruction about post procedure care
and activity restrictions
18. Continue…
3. Providing health information and procedural
teaching to patients and significant others
4. Helping the patient cope with discomfort and
alleviating anxiety.
5. Informing the primary care provider of known
medical condition or abnormal laboratory values
that may affect the procedure.
6. Assessing for adequate hydration before, during,
and immediately after the procedure, and
providing education about maintenance of
hydration.
21. Disorder of mouth and esophagus
• Stomatitis: mild redness (erythema) and edema;
if severe, painful ulcerations, bleeding and
secondary infection.
• Gingivitis: painful, inflamed, swollen gums;
usually the gums bleed in response to light
contact.
• Periodontitis: little discomfort at onset; may have
bleeding, infection, gum recession and loosening
of teeth, later in the disease tooth loss may occur.
22. Nursing interventions
• Prophylactic mouth care, including brushing,
flossing and rinsing.
• Teach patient proper oral hygiene, including
the use of soft-bristled toothbrush and
nonabrasive toothpaste for painful ulcers.
• Avoid hot or spicy foods
• Apply topical anti-inflammatory, antibiotic,
and anesthetic agents as prescribed.
23. Periapical abscess
• Dentoalveolar abscess referred to as an
abscessed tooth, involves a collection of pus in
the apical dental periosteum and the tissues
surrounding the apex of the tooth.
• Clinical manifestation: dull, gnawing,
continues pain with surrounding cellulitis and
the edema of the adjacent facial structure,
mobility of involved teeth.
24.
25. MEDICAL MANAGMENT
Medical management
• needle aspiration or drill an opening into the
pulp chamber to relieve pressure and pain and
to provide drainage.
• Tooth extraction/root canal therapy
• Antibiotics and opioids.
26. Nursing management
• Assess the patient for bleeding after
treatment
• Instruct the patient to use a warm saline or
water mouth rinse to keep the area clean.
• Take liquid diet to a soft diet as tolerated.
• Keep follow up appointments.
27. Parotitis
• Inflammation of the parotid gland which is most
common inflammatory condition of the salivary
glands. E.g. MUMPS (epidemic parotitis)
• MEDICAL management: discontinuation of
tranquilizers and diuretics, Antibiotic therapy is
necessary. Drainage by procedure known as
parotidectomy.
• Nursing management: maintaining adequate
nutritional and fluid intake, good oral hygiene,
compliance with prescribed medicine.
28.
29. Oral cavity cancer/tumor
• Cancer of oral cavity which can occur any part of
the mouth or throat.
• Risk factors includes: cigarette, cigar and pipe
smoking, use of tobacco, excessive use of alcohol.
• Increase risk in men older than 50 years.
• Pathophysiology: malignancies of the oral cavity
are usually squamous cell cancers. Any area of
the orophayrnx can be a site of malignant
growths, but the lips, the lateral aspects of the
tongue, and the floor of the mouth are the most
commonly affected.
30. Clinical manifestations
• Many oral cancers produce few or no symptoms
in the early stages. Later on the most frequent
symptoms are:
• painless sore or mass that does not heal.
• It may bleed easily
• Presented as a red or white patch
• Typical lesion in oral cancer is painless hardened
ulcer with raised edges.
• Xerostomia
• Stomatitis because of chemotherapy.
32. Medical management
• Surgical resection
• Radiation therapy
• Chemotherapy
• Neck dissection and reconstructive surgery of
the oral cavity
33. Nursing management
• Assess the nutritional status.
• Patient may need enteral or parenteral
nutrition.
• In case of radial graph perform Allen test.
• Assess the patients writing ability before the
surgery because of verbal communication
impairment
• Assessing patent airway after the surgery
34. General nursing management of
patient with conditions of oral cavity
• Promote mouth care
• Ensure adequate food and fluid intake
• Supporting a positive self image
• Minimizing pain and discomfort
• Preventing infection
• Promoting home and community based care
• Relieving pain
• Promoting wound care
• Supporting coping measures
• Maintaining physical mobility
• Promoting effective communication
35. Nursing diagnosis
• Deficient knowledge about preoperative and postoperative
procedures
• Ineffective airway clearance related to obstruction by mucus,
hemorrhage or edema
• Acute pain related to surgical incision
• Risk for infection related to surgical intervention secondary to
decreased nutritional status
• Impaired tissue integrity secondary to surgery and grafting
• Imbalance nutrition, less than body requirements related to disease
process or treatment.
• situational low self esteem related to diagnosis or prognosis
• Impaired verbal communication secondary to surgical resection
• Impaired physical mobility secondary to nerve injury.
36. Disorders of esophagus
• Achalasia: absence or ineffective peristalsis of the
distal esophagus, accompanied by failure of the
esophageal sphincter to relax in response to
swallowing.
• Odynophagia: (pain on swallowing)
• Clinical manifestation: difficulty in
swallowing, sensation of food sticking in the
lower portion of esophagus, regurgitation,
distention of esophagus, chest pain and heart
burn (pyrosis)
37.
38. Assessment and diagnostic findings
• X-ray
• Barium swallow
• Computed tomography (CT) of the chest
• manometry
39. Med./ Nursing Management
• Patient is instructed to eat slowly and to drink
fluids with meals
• Calcium channel blockers and nitrates to
reducesophageal pressure
• Injection of botulinum ( BOTOX ) into
quadrants of the esophagus
• Pneumatic dilation
• Esophagomyotomy
40. Hiatal Hernia
• In this condition the opening in the diaphragm
through which the esophagus passes
becomes enlarged, and part of the upper
stomach tends to move up into the lower
portion of the thorax.
• There are two Types of Hiatal hernia:
1. Sliding
2. Paraesophageal.
41.
42. Clinical manifestation
• Patients with sliding hernia may experience:
• Heart burn
• Regurgitation
• Dysphagia
• Sense of fullness or chest pain
• Hemorrhage
• Obstruction can occur with any type of hernia.
• Strangulation
• Diagnostic findings are based upon x-ray studies, barium
swallow, and fluoroscopy.
43. Med./nursing management
• Management of hiatal hernia includes
frequent, small feedings that can pass through
esophagus easily.
• Not to recline after 1 hour of eating.
• Elevate the head of the bed on 4 to 8 inch.
• Med. And surgical management is similar to
that of gastroesophageal reflux.
44.
45. GERD
• Gastroesophageal reflux disease:
• the backflow of gastric or duodenal contents
into the esophagus without belching or
vomiting. Excessive reflux may occur because
of incompetent lower esophageal sphincter,
pylori stenosis or motility disorder.
• Also known as heart burn
• Incidence increase with aging.
46.
47. Assessment and diagnostic findings
• It may include:
• Endoscopy
• Barium swallow
• Ambulatory 12-36 hours esophageal PH
monitoring.
• Bilirubin monitoring to measure bile reflux.
48. Medical management
• Antacids
• H2 receptor antagonists e.g. famotidine (pepcid), nizatidine
(axid), or ranitidine (zantac).
• Proton pump inhibitor that reduce the release of gastric acid.
e.g. lansoprazole (prevacid), rabeprazole (AcipHex),
esomeprazole (Nexium), omeprazole (prilosec), pantoprazole
(prtonix).
• Prokinetic agents which accelerate gastric emptying. E.g.
Bethanechol (utrecholine). Domperidone (motillium),
metoclopramide (reglan).
49. Surgical management
• If medical management is unsuccessful,
surgical intervention may be necessary.
Surgical management involves a nissen
fundoplication ( wrapping a portion of the
gastric fundus around the sphincter area of
the esophagus. Done by laparoscopy.
51. Cancer of the esophagus
• Esophageal cancer can be of two cell types:
Adenocarcinoma and squamous cell carcinoma.
• Risk factors for esophageal cancer include chronic
esophageal irritation.
• Chronic ingestion of hot liquid or foods,
nutritional deficiencies, poor oral hygiene,
exposure to nitrosamines in the environment or
food, cigarette smoking or chronic alcohol
exposure.
52. Clinical Manifestation
• Symptoms include:
• Dysphagia
• Sensation of mass in the throat.
• Painful swallowing
• Substernal pain or fullness
• Regurgitation of undigested food with foul breath and hiccups.
• Proceeding obstruction.
• Hemorrhage
• Progressive loss of weight
• Persistent hiccups
• Respiratory difficulty
• The delay between onset of symptoms and patient seeking medical
advice is often 12 to 18 months.
53. Assessment and diagnostic findings
• diagnosis is conformed by EGD with biopsy
and brushings.
• CT of the chest and abdomen
• Positron emission tomography PET
• Endoscopic ultrasound
• Exploratory laparoscopy
54. Medical management
• Treatment may include surgery, radiation,
chemotherapy or combination of both depending
upon the type of cancer cell, the extent of the
disease and the patients condition.
• A standard treatment plan for a person who is
newly diagnosed with esophageal cancer include
the following:
• Pre operative combination therapy of 4-6 weeks;
followed by a period of no medical intervention
for 4 weeks and lastly surgical resection of the
esophagus.
55. Surgical Management
• Total resection of the esophagus
(esophagectomy).
• When tumors occur in the cervical or upper
thoracic area, esophagus continuity may be
maintained by a free jejunal graft transfer in
which the tumor is removed and the area is
replaced with a portion of the jejunum.
56. Continue…
• Surgical resection of the esophagus has a relatively
high mortality rate because of infection, pulmonary
complication, or leakage through the anastomosis.
Postoperatively, the patient has a nasogastric tube in
place that should not be manipulated. The patient
should not be given anything by mouth until x-ray
studies confirm the anastomosis is free from esophgeal
leak, no obstruction and there is no evidence of
pulmonary aspiration
• Laser therapy
• Placement of an endoprostheses (stent) via EGD.
57. Nursing management
• Interventions are directed toward improving the
patients nutritional and physical status.
• A program to promote weight gain ( high calorie high
protein diet.
• Soft diet
• Parentral or enteral nutrition initiation
• Nutritional status monitoring
• Patient is informed about the postoperative equipment
that will be used ( closed chest drainage, nasogastric
suction, parental food therapy and gastric intubation.
58. Continue…
• Place patient in fowler’s position
• To prevent aspiration do incentive spirometery,
sitting up in a chair, nebulizer treatments
• Chest physiotherapy
• Nasogastric tube care
• After each meal patient should stay upright at
least 2 hours.
59. Gastric Disorders
• Gastritis
– Inflammation of the gastric mucosa
– Classification
• Severity
• Site involvement
• Inflammatory cell type
• Can be acute or chronic.
• Causing factors: dietary indiscretion, disease
causing microorganisms (H.pylori), Usage of
NSAIDS, alcohol intake, bile reflux, radiation
therapy.
23/12/2010 59
61. Assessment and diagnostic finding
• Upper GI x-ray studies
• Endoscopy
• Histological examination by biopsy.
62. Medical Management
• Refrain from alcohol and food.
• Nonirritating diet
• If reason is strong acid or alkalies dilute and
neutralize it.
• Nasogastric intubation
• Analgesic agents
• Sedatives
• Antacids
• Iv fluids
63. Nursing Management
• Reduce anxiety
• Promote optimal nutrition
• Promote fluid balance
• Relieving pain
• Promote home and community based care
64. Peptic ulcer disease
• A peptic ulcer may be referred to as a gastric,
duodenal, or esophageal ulcer, depending
upon its location.
• It forms in the mucosal wall of the stomach.
• This erosion may extend deeply as the muscle
layers or through the muscle to the
peritoneum.
• Mostly occur in the duodenum than in the
stomach.
65. Pathophysiology
• Peptic ulcers occur mainly in the
gastroduodenal mucosa this tissue cannot
withstand the digestive action of gastric acid
(HCL) and pepsin.
• The erosion is caused by the increased
concentration or activity of acid pepsin or by
decreased resistance of the mucosa.
66. Clinical manifestation
• Dull, gnawing pain
• Burning sensation in the midepigastrium or the
back.
• Pain that is relieved by eating,
• Pyrosis (heart burn)
• Vomiting
• Constipation or diarrhea
• Bleeding
• Melena (tarry stools)
67. Assessment and diagnostic finding
• Physical examination may reveal pain, epigastric
tenderness or abdominal distention.
• Barium study
• Endoscopy
• Biopsy of gastric mucosa
• Stool test
• Gastric secretory studies
• Urea breath test
• Stool Antigen test
68. Medical management
• Commonly used therapy is a combination of
antibiotics + proton pump inhibitors + bismuth
salts.
• Recommended therapy for 10 to 14 days include
triple therapy with two antibiotics e.g.
metronidazole or amoxcillin plus proton pump
inhibitor e.g. lansoprazole.
• Histamine -2 (H2) receptor antagonist and
proton pump inhibitor are used to treat NSAID
induced ulcers and other ulcers that are not
associated with H.pylori infection.
69. Continue…
• Adherence and completion of regimen.
• Stress reduction and rest
• Smoking cessation
• Dietary modification
• Surgical management
• Follow up care
70. Surgical management
• Surgical procedures include:
• Vagotomy, with or without pyloroplasty.
• Antrectomy with anastomosis to either the
duodenum or jejunum.
71. Nursing Management
Assessment:
• Ask about the pain(usually starts after two hours of eating meal)
• Vomiting (coca)
• Presence of Bloody or tarry stools.
• Describe food habits(speed of eating, regularity of meals,
preference for spicy foods , use of caffeine)
• 72 h usual food intake chart.
• Lifestyle
• Smoking habits
• Use of NSAID
• Anxiety & stress
• Vital signs (report tachycardia & hypotension)
72. Nursing Diagnosis
Based on assessment data, the patient’s nursing
diagnosis may include:
• Acute pain related to the effect of gastric acid
secretion on damaged tissue.
• Anxiety related to acute illness.
• Imbalanced nutrition related to change in diet
• Deficient knowledge about prevention of
symptoms and management of the condition.
73. Planning and goals
• The goals of the patient may include relief of
pain, reduced anxiety, maintenance of
nutritional requirement, knowledge about the
management and prevention of ulcer
recurrence, and absence of complications.
74. Nursing interventions
• Relieving pain
• Reducing anxiety
• Maintaining optimal nutritional status
• Monitoring and managing potential
complications.
• Promoting home and community based care.
75. Evaluation
• Expected patient outcome may include:
• Reports freedom from pain between meals
• Reports feeling less anxiety
• Complies with therapeutic regimen
1. Avoid irritating foods and beverages
2. Eats regularly scheduled meals
3. Take medications as prescribed
• Maintains weight
• Show no complications.
76. Morbid Obesity
Morbid obesity is the term applied to people
who are more than two times than their ideal
weight.
Or morbid obesity is body weight that is more
than 100 pounds greater than the ideal body
weight (Fabricatore & wadden, 2006; kushner,
2007).
77. Continue…
• Patients with morbid obesity are at high risk of
health complications, such as diabetes, heart
disease, stroke, hypertension, gallbladder
disease, osteoarthritis, sleep apnea, breathing
problems.
78. Medical/surgical management
• Management of obesity consists of placing the
person on a weight loss diet along with
behavioral modification and exercise.
• Bariatric surgery is performed if nonsurgical
treatments have failed.
79. Nursing Management
• Provide dietary guidelines
• Reduce anxiety
• Advise Lifestyle modification
• Pre/post operative care for patients
undergoing surgery.
• Follow up appointments.
80. Gastric cancer
• Most gastric cancers are adenocarcinomas.
They can occur anywhere in the stomach.
• The tumor can infiltrate the surrounding
mucosa, penetrating the wall of the stomach
and adjacent organs and structures.
81. Clinical manifestation
• Earlier symptoms such as pain are relieved by
antacids,
• Symptoms of progressive disease include
dyspepsia (indigestion), early satiety, weight
loss, abdominal pain just above the umbilicus,
loss or decrease in appetite, bloating after
meals, nausea & vomiting.
82. Assessment and diagnostic finding
• Esophagogastroduodenoscopy biopsy
• Cytologic washing
• Barium x-ray examination
• Endoscopic ultrasound
• CT of chest, abdomen and pelvis.
84. Nursing management
• Reduce anxiety
• Promoting optimal nutrition
• Relieving pain
• Providing psychosocial support
• Promoting home and community based care.
• Recognizing obstacles to adequate nutrition
• Resuming enteral intake.
85. constipation
• Abnormal infrequency or irregularly of
defecation, abnormal hardening of stools that
make their passage difficult and sometimes
painful.
86. Causes
• Certain medication
• Rectal or renal
• Metabolic neurologic or
neuromuscular
conditions
• Endocrine disorders
• Lead poisoning
• Connective tissue
disorder
• Appendicitis
• Weakness, fatigue or
immobility
• Ignorance to the urge to
defecate.
87. Clinical manifestation
• Abd. Distention
• Borborygmus. Intestinal rumbling
• Pain and pressure
• Decreased appetite
• Headache
• Feeling of fullness
• Restlessness
• Indigestion
• Straining at stool
• Elimination of small volume hard and dry stools.S
90. Medical Management
• Increase fiber intake
• Discontinue laxatives
• Enema and rectal suppository
• Patient is encouraged to learn to relax the
sphincter mechanism to expel stools.
91. Nursing Management
• History of onset and duration of constipation
• Past elimination patterns
• Life style changes
• Relieve anxiety
• Stress coping
• Restore and maintain regular pattern of
elimination
92. Diarrhoea
• Increase frequency of bowel movement more
than 3 per day.
• Causes : medication, tube feeding, infection,
nutritional or malabsorptive disorder,
• Types: acute / chronic
93. Clinical manifestation
• Increased frequency & loose stools
• ABD. Cramps, distention
• Anorexia & thrust
• Spasmodic contraction of anus
94. Assessment and diagnostic findings
• Routine stool examination
• Urinalysis
• Complete blood count
• Stool examination for micro-organisms, blood,
fats etc.
96. Medical management
• Control symptoms
• Antibiotics, anti-inflammatory agents
• Iv therapy
• Electrolyte replacement
• Milk products, fat, whole grain product and
fresh vegetable restricted.
97. Nursing Management
• Assess and monitor the characteristics and
pattern of diarrhoea
• Assess the skin of abdomen and mucus
membrane to determine dehydration status
• Encourage the pt. for bed rest, intake of fluids,
low fiber diet
98. Irritable bowel syndrome
• It is common problem of GI, most common in
female, causes are unknown some factors are
associated with:
• Hereditary
• Psychological stress or illness
• Alcohol intake and smoking
• Diet rich in irritating foods
99. Clinical manifestation
• Constipation, diarrhoea or both
• Pain i.e. relieve by defecation
• Abdominal distension
• Diagnostic finding: x-ray, barium enema,
colonoscopy, proctoscopy, manometry.
100. Medical management
• Exercises to reduce anxiety and increase
intestinal motility is recommended
• Special diet which should not involve irritants
such as caffeinated products, spicy foods,
beans.
• To relieve abdominal pain, calcium channel
blocker and anti-cholinergic are given
• Anti depressants.
• Anti diarrhoea.
101. Nursing Management
• Provide health education
• Chew food slowly and thoroughly.
• Discourage, alcohol & cigarette use.
• Adequate fluid intake but restrict fluid intake
between meals to avoid distension.
102. Inflammatory disease of intestine
• Appendicitis: small structure about 4 inches,
attached to cecum, below the ileocecal valve.
• Sometimes food particles enter in it and due
to small lumen size it empties inefficiently.
• That’s why it is always vulnerable to infection.
103. Clinical manifestations
• Right lower quadrant pain is present
• Low grade fever
• Nausea & vomiting
• Local tenderness
• Loss of appetite
• Rebound tenderness
• Constipation or diarrhoea
• Mcburney’s point
107. Nursing management
• Iv infusion
• Antibiotic therapy
• Pain relief opoids
• Contradiction of enemas
• Place the patient in semi fowler’s position
• Monitor the pt for any discharge
• Instruct the pt for revisit on fifth & seventh
day for the removal of sutures.
108. Diverticulitis
• Diverticulum is a sac like pouch of the lining of
intestine that extends through a defect in
muscle layer.
• Complications: peritonitis, abscess formation,
localized abdominal pain, loss of bowel
sounds, massive rectal bleeding, sign &
symptoms of Shock.
109. Clinical manifestations
• Chronic constipation
• Bowel irregularities
• Diarrhoea
• Abrupt onset of crampy pain in left quadrant of
abdomen
• Low grade fever
• Nausea & vomiting
• Abdominal distension
• Weakness, fatigue
• Narrow stool.
112. Nursing Management
• Life style changes
• Dietary modification
• Help to cope with the sign and symptoms.
113. Peritonitis
• Assignment: Define peritonitis, explain its
causing factors, sign & symptoms
complications, clinical and nursing
management.
114. Inflammatory bowel Disease
• Consists of two main diseases:
1. Regional Enteritis (crohn’s Disease)
2. Ulcerative Colitis.
115. Crohn’s Disease
• Can occur anywhere along the GI tract
• Most common site is: distal ileum and colon
• Subacute or chronic inflammation, extends
through intestinal wall from the intestinal
mucosa.
• Mucosa has cobble stone appearance, as the
disease progress the wall thickens, become
fibrotic and lumen narrows.
116. Clinical manifestation
• Abd. Pain & diarrhoea relieved by defecation
• Decrease food intake to avoid pain
• Malnutrition, weight loss and anemia
• Fever & leucocytosis.
• Inflammed intestine.
• Perforation which may result intra abdominal
and anal abscess.
118. Management
• Management is aimed at relieving symptoms
such as:
• Inflammation and diarrhoea.
• Dehydration and malnutrition
• Abd pain and cramping
125. Medical management
• Treatment for both aims at reducing
inflammation, suppressing in appropriate
immune response and providing rest to
diseased bowel so that healing take place.
• Nutrition therapy
• Fluid and electrolyte
• Pharmacological therapy
• Surgical management : Total colectomy,
segmental colectomy
126. Nursing Management
• Patient is assessed for parental nutrition, fluid
replacement, possible surgery.
• Management of normal elimination pattern.
• Relieve pain
• Maintain fluid intake an accurate
• Maintain nutrition
• Promote rest
• Reduce anxiety
• Enhance coping measures
• Prevent skin breakdown
• Monitor and manage possible complications.
127. Hernia
• A hernia is an abnormal protection of an organ or
structure from normal cavity through a congenital
or acquired defect.
• No blood supply: strangulated hernia.
a. indirect inguinal Hernia.
b. Direct inguinal Hernia.
c. Femoral Hernia.
d. Umbilical Hernia.
e. Incisional Hernia.
128. Clinical Manifestation
• Complain of having lump in the groin around
umbilicus.
• Protrusion from an old surgical incision.
• Swelling suddenly after coughing, straining,
lifting or exertion.
• Pain
• Nausea, vomiting & distention may appear.
129. Medical Management
• Truss, a pad made of firm material may be
placed over the opening through which the
Hernia protrudes and is held in place with a
belt.
• Hernio-plasty
• Fluid and food restriction
• Narcotics to reduce pain
• Antibiotics
130. Hemorrhoids
• Hemorrhoids are dilated portion of veins in
the anal canal, congestion occurs in the veins
of hemorrhoidal plexus and leads to varicosity
within the lower rectum and anus.
• Causes: Heredity, long periods of sitting or
standing, structural abscess, inc. intra-
abdominal pressure such as in constipation,
straining at defecation and Pregnancy.
131. Types
• Internal Hemorrhoids: they appear above the
internal sphincter and are not visible.
• External Hemorrhoids: they appear outside
the anal-sphincter.
• SIGN/SYMPTOMS: Itching, pain, Bright red
bleeding, discomfort, ischemia of the area.
134. Reference
• 1. Brunner, L.S., & Suddarth, D.S. (2001). Text
Book of Medical- Surgical Nursing (9th
Edition). Philadelphia: Lippincott.
• 2.lakhwinder kaur, sukhminder kaur, Kanta
Ajay Kumar text book of Medical Surgical
Nursing
Anastomosis, colectomy with ileostomy or colectomy with ileorectal anastomosis.
Nutritional therapy includes: oral fluids, low residue high protein, high calorie diet along with supplemental vitamin therapy and iron replacement.
Fluid and electrolyte imbalance is corrected by nutritional therapy. Any food that causes diarrhoea is avoided, milk, cold foods and smoking is prohibited. TPN may be indicated.
Pharmacological therapy includes sedatives, anti diarrhoea, antiperistatic, anti inflammatory, antibiotic (to reduce secondary infections) and corticosteroids (to reduce acute inflammatory peristaltic ) medications