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COLLABORATIVE MANAGEMENT
• High fiber diet, liberal fluid intake
• Bulk laxatives
• Hot Sitz bath, warm compress
• Local anesthetic application – Nupercaine
• Surgery
– Sclerotherapy (5% phenol in oil)
– Cryosurgery
– Rubber – band ligation
– Hemorrhoidectomy
] ✗ constipation
-
Liquid nitrogen ] external
-
internal 1 external](https://image.slidesharecdn.com/04-gastrointestinal-2-3-240219010918-3e2b31f5/75/The-Gastrointestinal-Files-and-Materials-71-2048.jpg)
![• Administer the following as ordered:
• Vitamin K
• Stool softeners
• Diuretics
• Lactulose
• Neomycin SO4
• Position:
• Decrease bleeding tendencies
-
Aquamephyton
~
,
=
=
↓ E. coli ] ↓ ammonia in the
LI
Semi -
Fowler's
↳
bleeding protocols](https://image.slidesharecdn.com/04-gastrointestinal-2-3-240219010918-3e2b31f5/75/The-Gastrointestinal-Files-and-Materials-90-2048.jpg)
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The Gastrointestinal Files and Materials
- 1.
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- 5. Stomach Located high onthe left side of the abdominal cavity A distensible organ – can hold up to 4 liters Regions: cardiac region fundus body pylorus 1. Fluids 2. Food 3. Air
- 6. Pyloric sphincter -controls gastric emptying
- 7. Functions: Storage reservoir forfood Mechanical digestion
- 8. Notes Phases of Digestivecycle sight I. cephalic sensory - " " ☒fYs¥ thought 0 ① Mucus cells 1. Alkaline -
- 9. Notes II. Gastric motor .vn/0mladiYityTstresspiio1ine.svbstnnos/ caffeine ② Eatenendocrine cells [ tryptophan) . ' Histamine 2 Serotonin Gastrin Pylons ↓ ↓ puode.nu Parietal cells sedation Gastric motility Hy #ntriusic Factor - Hit.biz
- 10. Notes III. Intestinal stomach ④ zymogeniccells ↓ pepsinogen protein ◦ i. small intestines trypsin Pepsin . ↓ Peptides [pancreas) ( Liyer)
- 11.
- 12. © Lester R.L. Lintao, RN 9
- 13. Notes Peritonitis common cause iperforated ulcer Hallmark ! Rigid , board - like complications : a) Regpi. depression * septicemia
- 14. © Lester R.L. Lintao, RN 10
- 15. © Lester R.L. Lintao, RN 11
- 16. © Lester R.L. Lintao, RN 12
- 17. Etiology and Incidence: •Unknown • Predisposing factors: • Personality type • Blood type • Infection • Cigarette smoking • Medications • Other diseases : Type A i Type 0 : Helicobacter Pylori : GI upset i Pancreatitis
- 18. • Duodenal ulcers •More prevalent • Usually affects men at middle-age ↳ stress-related
- 19. • Pain (burningor aching) • Associated with: • spicy or fried food • alcohol • medications • Gastric: • Aggravated by __________ • Relieved by ____________ • Duodenal: relieved by _____________ Manifestations: + gnawing eating vomiting eating ↳ Pain i 2- 4° pic.
- 20. © Lester R.L. Lintao, RN 16 • Eructation: 1. Bloating 2. Belching - pyrosis 3. Nausea 4. Vomiting
- 21. •Stress ulcers –Other name: –Cause: –Hallmark: –Secondaryto 1.Ante Her Curling ulcer stress - burns 120 . % TBSA) coffee - ground aspirate (AGT - lavage) gastric ischemia
- 22. Notes SNS : shook 1.PAR A. mtdna / 1. Peripheral VC 2. SNS activation b 3. PAAS ' Physiologic Epi 4 ME - 2. Visceral yc shunting ↓ pith * Gastric ischemia 1- HCl ulceration
- 23. © Lester R.L. Lintao, RN 18 MANAGEMENT: • Diet and Lifestyle Changes – Diet •Liberal bland •SFF •Avoid: – Fatty foods – Caffeine – Alcohol – Bedtime snacks – Binge eating – Milk (Allowed: 400 mL) - ✗ spices
- 24. – Quit smoking –Coping & relaxation • Administer medications, as ordered:
- 25. 1. Medications a. Antacids •Neutralize HCl • Taken 1-2 hours pc • Examples: /rebound period Example SIE calcium - based on Bicarbonate Urolithinsis Magnesium - based Milk of Magnesia Diarrhea Autumn ;Ymbr& Basnelgetamphogol constipation ' nation Maalox 5¥: Metabolic Alkalosis
- 26. b. H2 receptorantagonists • Reduces HCl secretion • Taken with meals • Examples: – Tagamet (Cimetidine) – Zantac (Ranitidine) c. Proton Pump Inhibitors • Reduces gastric acidity • Taken with meals • Example: Omeprazole • , ODHS Sl Ei Metabolic alkalosis Longterm: Pernicious anemia it 4 I 2 SIE : Insomnia
- 27. © Lester R.L. Lintao, RN 22 d. Cytoprotective drugs • Coats ulcer • Taken on an empty stomach ( ) • Example: Carafate (Sucralfate) e. H. Pylori Drug Treatment • Pepto-Bismul • Amoxicillin/Tetracycline • Flagyl a- Muscles → alkaline cells 30 -60min ac SIE: Uterine contrition _ . Abortion cervical relaxation [ Dxi Endoscopy c- biopsy) 1. 1Bismuth Ma) 2- / Doxycycline . % / Mebondawe / Cotrimoxazole
- 28. © Lester R.L. Lintao, RN 23 2. Surgeries a. Vagotomy • Resection of the vagus nerve b. Antrectomy • Billroth I • Billroth II - Gastric - - Duodenal -
- 29.
- 30. DUMPING SYNDROME • Tachycardia •Weakness • Sore feelings • 3 D’s • - rapid merit of food towards the jejunum 1. lie down pie. 2. Separate . Solids c- liquids when eating Dizziness 3. Diet :P fat ① Diaphoresis ① Diarrhea
- 31. d. Subtotal Gastrectomy •Removal of 75% of the distal stomach → requires TPM
- 32. Notes Total Parenteral Nutrition/ Hyperalimentation/ Dentro tipo amino PF line: Central ( subclavian → Svc → ⑧ atrium) Order: Doctor sowtiomi Prepare i RND / Nutritionist 1. caloric - 24A 2. Emulsified Fats E. Amino Afids Administer i RM - _ 484 Complications: 3. Supplements - Hits. 4 mineral, 1. Hyperglycemia - se. insulin 2. septicemia - aseptic technique discard solutions
- 33. Small Intestines • Startsat pyloric sphincter and ends at ileocecal junction • About 20 feet, 1 inch by diameter • Divisions: • Duodenum - pancreatic enzymes and bile from the liver enter the small intestine • Jejunum - middle part • Ileum - terminal end of small intestine
- 34.
- 35. Enzymes Pancreatic amylase -acts on starchy foods Pancreatic enzymes - breaks protein peptides Pancreatic lipase - breaks lipids Triglycerides ‣Enters as fat globules ‣Coated by bile salts and emulsified I trypsin)
- 37. Notes / spleen go - Miner 1. ltonogbbin →blood → new Hagb 1. Home t iron t plasma billiard in = vnoonjvgated bilirubin 1 Dark yellow/
- 38. Notes up → CB → Bite 1700-1000%9 . ) Wight) (Dmr)90% - Fat emulsification Fats - Fatty nails 50% i. storage a) ADEK transport 2. concentration b) A. tissues A c) A. cortex # ¥ 350 ytt-iEWitbik-vit.cm -500 " Gen . circulation _:¥¥n - urine
- 39. Large Intestines Divisions: Cecum -first part Colon ๏Ascending ๏Transverse ๏Descending ๏Sigmoid mushy/Paste semi-Formal Liquid Formed
- 41.
- 42. 34 Ulcerative Colitis RegionalEnteritis (Crohn’s Disease) Cause Predisposing Factor Area Affected unknown unknown stress Heredity : Jews Large Intestines LI 9 SI . - . www.nsiteithffhhn → continuous → segmental
- 43. 35 Ulcerative Colitis RegionalEnteritis (Crohn’s Disease) Pathophysiologic Changes Classic Symptom Complications Mucosal ulceration scar formation Bloody diarrhea Mucoid diarrhea 115-20×1day) 13-5 ✗ Hay - Hemorrhage - strictures [ severe obstruction - Bloodloss anemia . - fistula / septicemia
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- 45.
- 46.
- 47. 39 Symptoms: a. Abdominal distention b.Weakness c.Nutritional deficits d.Fever with leukocytosis c- pain ( spastic) IWBC )
- 48. 40 Diagnostics: 1. Barium enema 2.Colonoscopy 3. UTZ c- biopy - differential
- 49. Nursing Interventions • Priority: •Administer medications, as ordered • Antimicrobial • Antispasmodics • Antidiarrheal • Steroids Acute. : Restore F 4E chronic : Restore nutrition - Neomycin 504 - Bus Corgan 1- toporamide Anti motility I DO C)
- 50. 42 • Diet: • Low-residue •Lactose-free • Elemental type • TPN if necessary / tortoni - Fast- absorbing
- 51.
- 52. 44 DIVERTICULITIS • An inflammationof the diverticula
- 53.
- 54. 47 Etiology and Incidence: •Chronic constipation • IBD • Common in adults • Common site: sigmoid (formed /
- 55.
- 56. 49 Symptoms: • Pain onLQ (crampy) • N/V • Intermittent rectal bleeding • Constipation • Fever (with leukocytosis) lhematochezin ) ✗
- 57. 50 During an acutephase: • CBR • NPO, later on clear liquids • Low fiber • Medications, as ordered: • Analgesics • Antibiotics • Anticholinergics I diverticulitis ) } ✗ perforation - - Neomycin / Antispasmodic
- 58. 51 Diverticulosis • Antimicrobials, asordered • Bulk-forming laxatives • Diet: • High fiber • Eliminate foods with seeds and nuts 4 Mos . ↳ Prophylactic - Neomycin go, / 7 d" " " ery -
- 59. 52 • Encourage fluidintake (2-3 L) • Weight reduction • Surgery: Colectomy → Colostomy - -
- 60.
- 61.
- 62. 55 Etiology and Incidence: 1.Males (10-30 years) 3. Exact cause: unknown 5. Predisposing factors: a. Fecal impaction b. Kinking of the appendix c. Parasites d. Infections - diet - related Gci * Abdominal pain - - AGE - RLQ [ McBurney's Point)
- 63.
- 64. 57 • Psoas’ sign •Blumberg’s sign • Rovsing’s sign • Anorexia • N/V • Low grade fever • Leukocytosis - more pain ion Rl Q upon ④ lateral hip flexion I - rebound tenderness - palpation in the LLQ → A pain RLQ 112,3 - • Triad :
- 65. 58 Nursing Interventions • Bedrest • NPO • Avoid: HELP • IVF therapy • Antibiotic therapy } ↓ intestinal motility Heat application }, perforation / Enema Laxatives Pain meds. - ✗ masking pain
- 66. • Appendectomy toavoid peritonitis • Anesthesia type: • Flat on bed • NPO until peristalsis • Activities can be resumed within 2-4 weeks. • For non-definitive diagnosis: spiral (6-84) - ✗ spinal headache / Exploratory laparotomy rupture
- 67.
- 68. • Dilated bloodvessels beneath the lining of the skin in the anal canal • Types: • Causes – Chronic constipation – Pregnancy – Obesity – Prolonged sitting or standing – Wearing constricting clothings – Diseases: liver cirrhosis, RSCHF Internal External 0
- 69.
- 70. 63 ASSESSMENT • Constipation • Analpain • Rectal bleeding • Mucous secretion • Anal itchiness • Intestinal fullness
- 71. 64 COLLABORATIVE MANAGEMENT • Highfiber diet, liberal fluid intake • Bulk laxatives • Hot Sitz bath, warm compress • Local anesthetic application – Nupercaine • Surgery – Sclerotherapy (5% phenol in oil) – Cryosurgery – Rubber – band ligation – Hemorrhoidectomy ] ✗ constipation - Liquid nitrogen ] external - internal 1 external
- 72. Liver Largest gland Approximately 3pounds (1.4 kg) Located at the right side Cells: 1. Hepatocytes 2. Vwpfter cells
- 73. Functions: Detoxification center Secretes Conjugates Stores glycogen fat-soluble vitamins blood Synthesizesprotein - albumin, globulin, amino acids Synthesizes clotting factors I, II, VII, IX and X ( krptter cells) ✓ bile ✓ bilirubin colloid - Colloidal Osmotic Pressure 7 = • Transport of Ab - Ig 1. Tissue building 9 • repair 2. Amine derivatives - [ peptides ↳ " Ine " L. platelets t yit. *
- 74. Notes Toxins Harmful 1. Liver (K.c. ) ↓ Free radicals / oxidants Less harmful 1. phagocytosis in oxidation to Hji? I armless
- 75. Notes Colloids 114) - • ↑Yisoosity → A osmolarity + osmosis - - Hyo ↓ → ↑ concentration ↑ Colloidal / Colloid ÉAlbumin) Hydrostatic, osmotic ' pull A Pressure Pish . . . i. ↓ Pressure B • Hvo t Ab = 3000 cc H2O 2700 CC Kw tab = 300 cc
- 76. Pancreas Triangular gland extendingacross the abdomen Functions: Produces 1-1.5 L of pancreatic juice everyday Pancreatic juice clear with high bicarbonate content can digest all categories of food ,
- 77. LIVER CIRRHOSIS • Irreversiblechronic inflammatory disease ⑨ progressive
- 78. Normal Fatty livercirrhosis 1 Fibrotic) =
- 80. Types • Laennec’s cirrhosis •Postnecrotic cirrhosis • Biliary cirrhosis • Primary • Secondary • Cardiac cirrhosis + most common /Alcoholic → chronic alcoholism • a) Ethanol b) Aldehyde ↳ other liver problems ( Hepatitis I - backflow of bite I obstruction - CHD - CBD go to backflow of blood ✗ from the heart
- 81.
- 82.
- 83. Pathophysiology • Collateral vessels –Esophageal varices – Caput medusae – Hemorrhoids • Portal hypertension – Ascites • Decreased albumin production – Anasarca HWY evident : a
- 84. • Splenomegaly • Impairedbile synthesis –Malabsorption of –Impaired metabolism of sex hormones • Female: • Male: –Steatorrhea –Acholic stools - compensation → ✗ emulsification → to tatty acids the ADEK Amenorrhea Impotence , gynecomastia - fatty feces → ↓ Hit. C 4K - gray , clay - colored stone
- 85. • Decreased clottingfactor synthesis • Failure to conjugate bilirubin • Loss of liver glycogen → bleeding tendencies - Icterus - sclera - Jaundice - skin - Ten - colored urine - fasting hypoglycemia
- 86. • Loss ofdetoxification properties –Hepatic encephalopathy – Motor – Psychotic – Neurologic = Azotemia lit ammonia) - asterixis 1 liver flap) - Hallucination, illusion , delusion 2. A. Loc → hepatic coma l irreversible/ Earliest : 1 . Asterix is 2. Fetor hepatiws (Fetid breath) - ammoniacal
- 87. Nursing Interventions • Assessfor signs of bleeding • Esophageal bleeding • Management –Sengstaken-Blakemore Tube –Vasopressin - frequent swallowing - Melena - hemostatic
- 88.
- 89. • Monitor –V/S –Laboratory results –Sensitive: –Indicative: –Definitive: –Intakeand output –Daily weight and abdominal girth P total bilirubin ALT ↑ Liver enzymes LAST Biopsy 1 cc = I gm i - _
- 90. • Administer thefollowing as ordered: • Vitamin K • Stool softeners • Diuretics • Lactulose • Neomycin SO4 • Position: • Decrease bleeding tendencies - Aquamephyton ~ , = = ↓ E. coli ] ↓ ammonia in the LI Semi - Fowler's ↳ bleeding protocols
- 91. • Diet: a.Avoidance ofalcohol b.Low-sodium c.Low-fat d.Giordano Giovannetti - ✗ edema poultry - ✗ steratorrheu / eggs lean meats to protein = 20g ↓ - high - biologic values ↑ caloric = 2000 P
- 92. PANCREATITIS • Is acute/ chronic inflammation of the pancreas.
- 93.
- 94. Etiology and Incidence •Exact cause: Unknown 5M's Males Middle age: 20-40 - medicine/substance:alcohol Meat / heanlymeal Midnight:11am-2 am
- 95. Pathophysiology Disruptions of pancreaticducts Spill of pancreatic enzymes Hemorrhage Hypovolemic shock Neurogenic shock Incapacitating pain Release of chemical mediators Peritoneal Spill Peritonitis Respiratory Distress Septic shock Autodigestion Hyperglycemia Hypocalcemia -hallwark ⑰ ↳ Prostaglandin Brud, Kinin ③ ⑦ ⑪ Lactic and Failure
- 96.
- 97. Manifestations • Abrupt pain –burning,stabbing and pressing –epigastric area –radiates to the shoulder, substernal area, back and flank –relieved knee-chest position
- 98. • Cullen’s Sign –Bluishdiscoloration of the periumbilical area • Grey-Turner’s Sign –Bluish discoloration of the flank • Anorexia • N/V • Signs of shock • Signs of respiratory distress
- 99. • Assess: –abdominal, cardiac,and respiratory status • Monitor and record: –vital signs –laboratory studies –Sensitive: –Indicative: –Definitive: –blood glucose level Nursing Interventions 9 lipase (0-160v() ↑ amylase (200 mcg/dL6) Autopsy ( S0-120,ng/dL)
- 100. • Administer thefollowing, as ordered: • IVF • Drug of choice: • Diet: –to rest the pancreas –prevent nausea and vomiting • Position: • Environment: –Quiet –Restful Morphine S04(4-8 mg/dL) given I WOF:despi. Failure NPD Antidote:Naloxone (Marcan) Buscopan Zp 2. 1:1 Semi-Fowler's event further autodigestion Dorsal recumbent
- 101. • Administer thefollowing, as ordered: • Drug of choice: Morphine Sulfate • IVF • Diet: NPO –to rest the pancreas –prevent nausea and vomiting • Semi-Fowler’s position • Environment: –Quiet –Restful 7
- 102. Cholelithiasis Cholecystitis •Cholelithiasis = stoneformation •Cholecystitis = inflammation
- 103. Etiology and Incidence •Exact cause: Unknown 7's Females Forty and above Fair complexion Fat Fertile Fatty diet Family planning OCP / I
- 104.
- 107. Assessment •Decreased fat emulsification •fatintolerance •anorexia •N/V •flatulence •steatorrhea •Inflammation •pain (RUQ) •fever •leukocytosis
- 108. • Decreased bileflow in colon –acholic stool –poor absorption of fat soluble vitamins Igray/ day-colored ( (bADEK)
- 109. Collaborative Management •Relief ofpain: •Diet: low fat diet •Bile salts after meals • chenodeoxycholic acid • ursodioxycholic acid •Surgery: cholecystectomy •Postop complication: Morphine S04 (1-2 (g) - At'electsis
- 110.