Gastrointestinal Disorders: Nursing Interventions

• Nursing care for patients with upper gastrointestinal disorders is crucial due to the potential for a variety of complications and the need for comprehensive management strategies.

Anorexia

• Anorexia is characterized by a lack of appetite and can be a symptom of various diseases or a side effect of medications.
• Nursing care include monitoring intake and output of food and fluids, vital signs, electrolytes, and electrocardiogram (ECG), as well as the rate of IV infusion or enteral feeding.

Nausea and Vomiting

• Nausea is the urge to vomit, while vomiting involves expelling stomach contents through the esophagus and mouth.
• Coffee ground emesis indicates bleeding in the gastrointestinal tract.
• Prolonged nausea and vomiting can lead to dehydration and electrolyte imbalance, with the very young and very old at increased risk.
• Loss of hydrochloric acid from the stomach can lead to metabolic alkalosis.
• Therapeutic interventions may include medications (antiemetics, ginger), IV fluids, and nasogastric (NG) tube for stomach decompression.
• A diet of clear liquids is typically introduced first, followed by crackers or dry toast as tolerated.
• Nursing diagnoses include nausea, risk for aspiration, and deficient fluid volume.

Obesity

• Obesity is defined as weight exceeding 20% of ideal body weight, waist circumference greater than 35 inches for women and 40 inches for men, and a body mass index (BMI) greater than 30 kg/m².
• Overweight is a BMI of 25-29.9 kg/m², while morbid obesity is a BMI greater than 40.
• Obesity can lead to comorbidities such as atherosclerosis, gallbladder disease, heart disease, hypertension, osteoarthritis, sleep apnea, type 2 diabetes mellitus, depression, and decreased mobility.
• Therapeutic interventions include weight loss through diet, exercise, support groups, behavior modification, and bariatric surgery.

Surgical Management for Obesity

• Surgical options include restrictive, malabsorption, and combination procedures.
• Adjustable gastric banding involves placing a band around the upper part of the stomach to limit food intake.
• Gastric bypass reduces stomach size and bypasses part of the small intestine to decrease calorie absorption.
• Gastric plication folds the stomach inwardly and sutures it in place to reduce stomach volume.
• Sleeve gastrectomy removes approximately 75% of the stomach.
• Biliopancreatic diversion with duodenal switch creates a small stomach pouch and bypasses most of the small intestine.
• Complications of gastric restrictive surgeries include vomiting, bloating/heartburn, obstruction, dumping syndrome, gallstones, osteoporosis, erosion of gastric tissue, staple disruption, leaking of stomach secretions, infection, or death.
• Postoperative care involves a clear liquid diet initially, progressing to full liquids, pureed foods, and regular foods at about 6 weeks.

Oral Health Care

• Oral health is important for overall health and can affect nutritional intake.
• Regular mechanical oral hygiene prevents pneumonia, reduces ventilator-associated pneumonia, and prevents decay, tooth loss, and abscesses.
• Conditions such as angular cheilosis, dental implants, dentures, gingival recession, gingivitis, thrush, and xerostomia require specific oral care interventions.
• Angular cheilosis presents as red/raw corners of the mouth, and may relate to riboflavin deficiency.
• Gingivitis can lead to periodontitis and tooth loss.
• Xerostomia (dry mouth) is a common side effect of medications and can cause tooth decay.

Oral Inflammatory Disorders

• Aphthous stomatitis (canker sores) are oral inflammations causing white, painful ulcers, triggered by dental work, vitamin deficiencies, H. pylori, or stress.
• Topical anesthetics like lidocaine can be used for symptomatic relief.
• Herpes simplex virus type one (cold sores) onset can be provoked by stress, and oral acyclovir can reduce occurrences.

Oral Cancer

• Oral cancer can occur anywhere in the mouth and is curable if detected early.
• Risk factors include alcohol and tobacco use.
• Signs and symptoms include painless sores, difficulty in chewing, swallowing, or speaking, and sores not healing in 2 weeks.
• Diagnostic tests include biopsies.
• Therapeutic interventions include radiation, chemotherapy, and surgery (radical or modified neck dissection).
• Nursing care includes referral for alcohol/tobacco cessation, preoperative teaching (tracheostomy, communication), and postoperative care (airway, nutrition).

Esophageal Cancer

• Esophageal cancer is often detected late and metastasizes due to many nearby lymph nodes.
• Risk factors include alcohol and tobacco use, being overweight or obese, and Barrett’s esophagus.
• Signs and symptoms include difficulty swallowing, feeling full, pain in the chest, foul breath, and food regurgitation.
• Diagnostic tests include barium swallow, biopsy, and endoscopy (EGD, mediastinoscopy).
• Therapeutic interventions include radiation, chemotherapy, and surgery (esophageal resection, esophagogastrostomy, Dacron esophageal replacement, esophagoenterostomy).
• Nursing care includes referral for alcohol/tobacco cessation and postoperative care (airway patency, pain management, swallowing ability, nutrition and fluid needs, communication methods).

Hiatal Hernia

• Sliding hiatal hernia involves the lower esophagus/stomach sliding up through the hiatus of the diaphragm into the thorax.
• Paraesophageal (rolling) hernia involves part of the stomach squeezing through the hiatus and is at risk for strangulation.
• Hiatal hernias are most common in smokers, those over 50, obese individuals, and during pregnancy.
• Gastroesophageal reflux disease (GERD) is often secondary to hiatal hernia.
• Signs and symptoms include pain, heartburn, fullness, and reflux.
• Diagnosis involves X-ray and fluoroscopy.
• Therapeutic interventions include antacids, small meals, no reclining 1 hour after eating, raising the head of the bed, and avoiding certain foods and substances.
• Surgical management involves fundoplication.
• Nursing care includes teaching, preoperative care, and postoperative monitoring for dysphagia.

Gastroesophageal Reflux Disease (GERD)

• GERD involves gastric secretions refluxing into the esophagus, causing damage due to a poorly closing lower esophageal sphincter (LES).
• Signs and symptoms include heartburn, regurgitation, sour taste, and dysphagia.
• Diagnosis includes barium swallow, esophagoscopy, and pH monitoring.
• Complications include respiratory issues (asthma, aspiration pneumonia, bronchospasm, laryngospasm) and Barrett’s esophagus (precancerous).
• Therapeutic interventions include lifestyle changes (avoiding caffeine, nicotine, alcohol, trigger foods, elevating the head while sleeping, not eating 3 hours before bed, maintaining ideal weight) and medications (antacids, H2-receptor antagonists, proton pump inhibitors).
• Transoral incisionless fundoplication (TIF) and endoscopic procedures can also be used.
• Nursing care includes education on lifestyle changes, diet, and avoiding irritants.
• Radiofrequency ablation can remove Barrett's tissue.

Mallory-Weiss Tear

• A Mallory-Weiss tear is a longitudinal tear in the mucous membrane of the esophagus at the stomach junction, often caused by sudden, powerful, or prolonged force (cough, vomit, seizure).
• Excessive alcohol use is a factor in 75% of cases.
• Signs and symptoms include bright red, bloody emesis (hematemesis) and bloody or tarry stools.
• Diagnosis involves EGD (Esophagogastroduodenoscopy) and assessment of hemoglobin and hematocrit levels.
• Therapeutic interventions include PPIs, antiemetics, and bleeding control (epinephrine, endoscopy with endoclips).
• Nursing care includes monitoring for bleeding and teaching patients to avoid alcohol.

Gastritis

• Gastritis is inflammation of the stomach mucosa, which can be acute or chronic.
• Acute gastritis occurs when the protective mucosal barrier is broken, leading to autodigestion by hydrochloric acid (HCL) and pepsin.
• Severe cases can lead to perforation and peritonitis or scarring and pyloric obstruction.
• Signs and symptoms include abdominal pain, nausea, vomiting, anorexia, abdominal tenderness, feeling of fullness, reflux, belching, and hematemesis.
• Therapeutic interventions include treating the cause, avoiding alcohol and irritating foods, and using antacids or H2 receptor antagonists and antiemetics.
• Chronic gastritis type A (autoimmune) often occurs in the fundus and may lead to pernicious anemia due to difficulty absorbing B12.
• Chronic gastritis type B is the most common type, caused by H. pylori infection in the lower stomach (pyloris).
• Stress-induced gastritis occurs in critically ill patients due to decreased blood flow to the stomach and small intestine.
• Treatment of stress-induced gastritis includes quick trauma care, early feeding, prophylactic antacids, histamine blockers, and sucralfate.

Peptic Ulcer Disease

• Peptic ulcer disease involves erosion of the gastrointestinal lining in the stomach, pylorus, duodenum, or esophagus due to increased HCL and pepsin concentration or activity.
• Primary cause is H. pylori infection, with increased risk from smoking and NSAID use.
• Pain characteristics differ between gastric and duodenal ulcers: gastric ulcers cause upper abdominal burning/gnawing pain increased 1-2 hours after meals or with food, while duodenal ulcers cause pain increased 2-4 hours after a meal/middle of the night and are relieved with food or antacids.
• Signs and symptoms include anorexia, nausea/vomiting, and bleeding.
• Complications include bleeding, perforation, and obstruction.
• Diagnostic tests include detecting H. pylori through urea breath test, stool test, immunoglobulin G antibody detection test, and EGD with biopsy, as well as detecting peptic ulcers through upper GI series and EGD.
• Therapeutic interventions include antibiotics, PPIs, H2-receptor antagonists, bismuth subsalicylate, sucralfate, and antacids.
• Nursing concerns include acute pain, risk for injury due to complications, and deficient knowledge.

Gastric Bleeding

• Gastric bleeding can result from ulcer perforation, tumor, gastric surgery, or bleeding peptic ulcer (most common).
• Signs and symptoms vary by severity, from slight weakness to hypovolemic shock.
• Therapeutic interventions include NPO, IV fluids, CBC, urinary catheter, NG tube, and oxygen.
• The goal is to prevent hypovolemic shock, dehydration, electrolyte imbalance, and further bleeding.
• Nursing concerns include deficient fluid volume.

Focus on key nursing interventions for managing gastrointestinal disorders. Covers nausea, hiatal hernia, peptic ulcer complications, gastritis, Mallory-Weiss tear, and coffee ground emesis. Includes immediate actions and patient teaching.