Gastrointestinal Disorders Review

• Preventative measures for GERD include maintaining ideal weight, chewing food completely, avoiding high-fat and spicy foods, and identifying/avoiding trigger foods like citrus or tomato.
• Further preventative measures include avoiding alcohol, chocolate, coffee, peppermint, and spearmint, not eating within 3 hours of bedtime, elevating the head of the bed on 4-6 inch blocks, and quitting smoking.
• Helicobacter pylori is a bacterium that causes Peptic Ulcer Disease (PUD) that involves erosion of the stomach or duodenal lining.
• H. pylori is associated with environmental gastritis, which can cause inflammation of the stomach mucosa.
• H. pylori can play a role in the development of gastric cancer.
• Patients with chronic gastritis caused by H. pylori have an increased risk of developing stomach cancer.
• Inability to absorb vitamin B12 is associated with chronic gastritis and pernicious anemia.
• Autoimmune gastritis attacks the parietal cells in the stomach.
• Parietal cells are responsible for producing intrinsic factor, a substance necessary for vitamin B12 absorption.
• Reduced intrinsic factor due to damaged parietal cells prevents vitamin B12 from being properly absorbed in the intestines.
• Vitamin B12 deficiency leads to the development of pernicious anemia.
• A risk factor for Gastritis B is alcohol use.
• Medications like aspirin, NSAIDs, corticosteroids, digitalis, and chemotherapy agents are risk factors for Gastritis B.
• Infections from microorganisms, such as Helicobacter pylori and Salmonella, are risk factors for Gastritis B.
• Further risk factors include endoscopic procedures, nasogastric suctioning, radiation, reflux of bile, smoking, stress, trauma, and Crohn's disease.
• Gastritis is defined as the inflammation of the stomach mucosa.
• Stool color of someone with upper GI bleeding is black and tarry, a condition known as melena.
• Initial confirmation of NG tube placement is done by aspirating gastric contents or X-ray imaging.
• Rebound pain in the right lower quadrant indicates appendicitis.
• Rebound tenderness is the intensification of pain when pressure is released after palpation.
• Risk factors for acute diverticulitis include being older than 60, a diet low in fiber and high in fats and red meat, and obesity.
• A sedentary lifestyle and smoking are risk factors for diverticulitis.
• Certain medications like nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and steroids can increase diverticulitis risk.
• Chronic constipation may lead to increased pressure within the bowel, potentially contributing to diverticula development.
• The biggest nursing concern for a patient with large blood loss due to GI bleed is hypovolemic shock.

Hypovolemic Shock

• Significant blood loss (more than 1 liter in 24 hours) can lead to hypovolemic shock.
• Signs and symptoms of hypovolemic shock include hypotension, tachycardia, tachypnea, weak/thready pulse, chills, palpitations, dizziness, confusion, cold/clammy extremities, and changes in consciousness.
• Nursing actions for hypovolemic shock include maintaining NPO status, administering IV fluids and blood products, administering oxygen, close monitoring of vitals and I/O, avoiding NG tube insertion, and positioning the patient on their side with elevated head.
• Blood loss can lead to dehydration signs of dehydration include dry mucous membranes, fatigue, and thirst.
• GI bleeding can cause electrolyte imbalances, so monitor laboratory values and report abnormal findings.
• Electrolyte imbalance and dehydration are concerns for a patient with large blood loss due to GI bleed.

Anemia

• Blood loss leads to decreased hemoglobin and hematocrit levels, so ongoing monitoring is important.
• Monitor and observe stools for occult blood, melena (black, tarry stools), or hematochezia (bright red blood).
• Observe vomitus for hematemesis (vomiting blood) or coffee-ground emesis.

Aspiration

• Patients with GI bleeding have a risk for aspiration from vomiting, so position the patient on their side to prevent it.
• Patients may experience abdominal pain, so monitor and manage pain as needed.
• GI bleeding can lead to complications such as peritonitis or perforation, so monitor for signs.
• Educate the patient about medications and avoiding alcohol.
• Instruct the patient to report new bleeding or changes in vital signs.
• Severe GI bleeding will cause a decrease in blood pressure.

Teaching Points for UTI and Antibiotic Use

• Complete the full course of antibiotics, even if feeling better to avoid recurrence and antibiotic resistance.
• Take the antibiotics as prescribed with correct dosage/frequency.
• Be aware of potential side effects.
• Report any adverse reactions to healthcare provider.
• Antibiotics can disrupt normal flora of the bowel that may cause diarrhea
• Do not share antibiotics with those who are not prescribed.
• Probiotic supplements may help restore the normal flora.

Nursing Interventions for Appendicitis (Preoperative)

• Keep the patient NPO in preparation for surgery.
• Avoid heat, laxatives, or enemas, as they can complicate or cause rupture.
• Monitor the patient's pain level using a rating scale and administer analgesics as ordered.
• Administer IV fluids to prepare for surgery.

Nursing Interventions for Appendicitis (Postoperative)

• Monitor for signs of infection such as temperature, redness, swelling, or drainage at the surgical site
• Continue to assess and manage pain
• Closely monitor fluid intake and output, and administer IV fluids as prescribed
• Observe for complications such as peritonitis, increased abdominal pain, fever, increased WBCs, and dehydration
• If a drain is inserted, provide wound care and monitor the drainage.
• Encourage coughing and deep breathing (splinting for less pain) to prevent atelectasis and infections.
• Encourage early ambulation to promote recovery.
• Lab tests specific to renal function include Kidneys-Ureter-Bladder X-Ray (KUB) to detect tumors, swollen kidneys, and kidney stones
• A pyelogram can provide imaging of the renal pelvis, calyces, and ureter. Use IV, retrograde, or antegrade contrast in urine culture
• Stress incontinence is the involuntary loss of urine due to an increase in abdominal pressure, which can occur with coughing, laughing, or sneezing.
• Fecal impaction occurs when dry fecal mass cannot be passed, often resulting from constipation.
• Signs & Symptoms of Fecal Impaction Small amounts of liquid stool, Abdominal Pain, Distention, decreased appetite Indigestion, Intestinal rumbling, Rectal pressure, Straining, and Headache.
• A urinalysis of someone with a urinary tract infection will show organisms or bacteria present.
• Stress ulcers are a specific type of gastrointestinal mucosal that occurs in critically ill patients.
• An esophagogastroduodenoscopy (EGD) is a diagnostic endoscopic procedure that allows visualization of the esophagus, stomach, and upper duodenum to detect abnormalities.
• A Semi-Conscious or Unconscious Patient during oral care should be placed on their side, so fluids or secretions can drain out of the mouth.
• Diverticulitis is the inflammation/ infection of a diverticulum, patients are educated to proceed with a liquid diet, and introduce solids as tolerated.
• A high-fiber diet can help prevent constipation, but fiber must be limited during a flare-up.
• Patients should avoid alcohol and irritating foods (acidic, greasy, spicy), and should increase fluid intake to 2-3 liters per day, unless contradicted.
• Avoiding nuts and seeds and quitting smoking can improve health.

Lab findings of a patient with anemia related to peptic ulcer disease include:

• Decreased Hemoglobin and Hematocrit Bleeding from peptic ulcers results in lower-than-normal hemoglobin and hematocrit levels expect to see both levels decreased in lab results.
• Fecal Occult Blood: Stool may test positive for occult blood , indicating chronic bleeding within the GI tract.
• It detects blood that isn't visibly apparent in the stool.
• Red Blood Cell Count may be lower than normal, reflecting the loss of red blood cells due to bleeding.
• Iron Studies can reveal low serum iron, low ferritin and increased total iron-binding capacity (TIBC).
• Vitamin B12 Deficiency can result from chronic gastritis, particularly autoimmune gastritis, leading to a deficiency in intrinsic factor, hindering vitamin B12 absorption and resulting in pernicious anemia.

Test your knowledge of gastrointestinal disorders with these multiple-choice questions. Topics include GERD, gastritis, appendicitis, and H. pylori. Review lifestyle modifications, vitamin deficiencies, and diagnostic methods.