Gastrointestinal Meds & Post-Op Care

Nursing Care of Clients with Digestive Problems

• The digestive system starts at the mouth, continues through the pharynx, esophagus, stomach, small intestine, and large intestine, ending at the anus.
• Accessory digestive organs: teeth, salivary glands, pancreas, liver, and gallbladder
• The gastrointestinal tract facilitates ingestion and mastication in the mouth.
• The pharynx serves as a passageway for air, food, and fluids.
• The epiglottis prevents food or fluids from entering the trachea.
• The esophagus secretes mucus and aids in food movement.
• The stomach temporarily stores and breaks down food into CHYME.
• Stomach parts: lower esophageal sphincter, fundus, body, pylorus, and pyloric sphincter
• Gastric lining contains gastric pits and glands.
• Parietal cells in intestinal cells produce hydrochloric acid (pH1) and intrinsic factor (Vit. B12 binding protein).
• Mucous neck cells produce mucus to protect from HCL.
• Chief cells produce protein-digesting enzymes (Pepsin).

Small Intestine Function and Parts

• Chemical digestion and absorption of nutrients, vitamins, and electrolytes occur in the small intestine.
• Small intestine parts: duodenum with the pancreatic duct, ampulla of Vater, common bile duct, jejunum, ileum, and ileocecal valve
• Pancreatic duct secretes pancreatic enzymes like trypsin (protein breakdown), amylase (starch), and lipase (fats).
• Pancreatic secretions are alkaline due to bicarbonate, neutralizing acid.
• The gallbladder stores and secretes bile, emulsifying fats and absorbing fat-soluble vitamins (ADEK).
• The liver produces bile, a yellow to green fluid containing bile salts, bile pigments (Bilirubin), and cholesterol.

Contractions and Large Intestine

• Peristalsis propels contents towards the colon.
• Segmentation produces mixing waves for churning.
• The large intestine absorbs water and sodium ions, storing fecal matter for elimination.
• Large intestine parts: ileocecal valve, cecum, appendix, colon (ascending, transverse, descending, sigmoid), and rectum.

Intestinal Gas, Assessment, and Pain Types

• Belching expels gas from the stomach to the mouth.
• Flatulence expels gas from the rectum.
• Assess for nausea, vomiting, changes in bowel habits and stool characteristics.
• Key assessment questions include onset, location, duration, and severity of abdominal pain.
• Visceral pain results from distension of hollow organs or stretching of solid organs and is described as crampy, achy, dull, and poorly localized.
• Parietal pain occurs due to inflammation or irritation of the parietal peritoneum and is sharp, stabbing, steady, severe, and well-localized.
• Referred abdominal pain occurs, travels, or refers from the primary site and becomes highly localized at distant sites.

Health History and Abdominal Regions

• Health history should include present health concern, past health history, family history, and lifestyle/health patterns.
• The COLDSPA mnemonic helps elicit information about current symptoms.
• Abdominal regions: right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right iliac, hypogastric, and left iliac.
• Abdominal quadrants used for organ location include the right upper, left upper, right lower, and left lower quadrants.

Abdominal Assessment Techniques and Observations

• Explain each aspect of the examination, ensure privacy, position supine with knees flexed.
• Follow this sequence: inspection, auscultation, percussion, and palpation.
• Have the patient void first, and observe verbal and non-verbal cues.
• Observe skin coloration for redness, paleness, yellowness, bruises, and hematomas.
• Inspect for stretch marks/scars, non-healing areas, redness, inflammation, keloids, changes in mole size/color/border.
• Purple/bluish discoloration around the umbilicus, or Cullen's Signs, indicates intra-abdominal bleeding.

Abdominal Contour and Pulsations

• Inspect abdominal contour: distension, protuberance, scaphoid/sunken appearance, symmetry.
• Note organ enlargement, large masses, bulging, abdominal wall movement during breathing, and aortic pulsation.
• Diminished and exaggerated pulsations can indicate underlying conditions.

Vomitus and Diarrhea

• Nature of vomitus: Note color, taste, and consistency related to possible sources of issues in the digestive tract.
• Diarrhea causes: infectious agents, food poisoning, drugs, fecal impaction, bowel disease
• Characteristics of stool: observe appearance, such as tarry black (melena) or bright red blood, and other characteristics related to specific problems.

Dysphagia, Constipation, and Stomatitis

• Dysphagia: difficulty in swallowing; note onset and duration.
• Constipation: note frequency, consistency, color, blood/mucus, size and possible causes.
• Stomatitis: inflammation of the oral cavity can be primary (canker sores) or secondary (candidiasis).
• Stomatitis etiology: related to infection, allergies, vitamin deficiencies, systemic diseases, irritants, chemotherapy, radiation or trauma

Stomatitis Characteristics and Interventions

• Canker sores have a whitish gray center and erythematous ring.
• Candidiasis presents as whitish plaques that appear red and sore when wiped away.
• Symptoms: Dysphagia, dry or hot sensation, elevated temperature (rare), and pain
• Lab assessment: CBC revealing infection
• Nursing care: oral care every 2 hours, soft-bristled toothbrush/foam swabs, sodium bicarbonate solution rinses, soft/bland/non-acidic foods.
• Apply topical analgesics/anesthetics as prescribed; administer pain medication as prescribed

GERD Characteristics, Causes, and Treatment

• GERD: backward flow (reflux) of GI contents into the esophagus
• GERD more common in people over age 45
• Considered a disease process when acid is excessive
• Cause: inappropriate relaxation of the lower esophageal sphincter
• Factors that relax lower esophageal sphincter: fatty foods, chocolates, caffeinated beverages, citrus fruits, tomatoes, alcohol, nicotine, high estrogen/progesterone.
• Onset: variable.
• Location: substernal
• Intensity can be affected by certain foods.
• Undesirable signs and symptoms: pain and respiratory distress.

GERD Assessment and Interventions

• Subjective: heartburn and dysphagia indicate narrowing of the lumen
• Objective: dyspepsia is most common
• Diagnostic tests: pH monitoring, endoscopy, and esophageal manometry
• Diet therapy: avoid caffeine, carbonation, spicy and acidic foods; small, frequent feedings
• Lifestyle: elevate head of bed, don't lie down 3-4 hours after eating, lose weight, wear non-restrictive clothing.

Medication and Surgical Management of GERD

• Medication: antacids, histamine receptor antagonists, proton pump inhibitors
• Surgical management: laparoscopic Nissen fundoplication to wrap lower esophageal sphincter
• Elevate the head of the bed, insert an NGT tube to prevent fundoplication tightening
• Monitor NGT drainage and placement; avoid alcohol, caffeine, and carbonated foods; Monitor for dysphagia and gas bloat syndrome.
• Stretta procedure: reduces activity of vagus nerve/tightens tissue
• Enteryx: tightens the lower esophageal sphincter through permanent implants

Post-Endoscopic Care and Hiatal Hernia

• After endoscopic therapies: clear liquids, then soft diet; avoid NSAIDs and aspirin, avoid NGT insertion
• Watch for chest/abdominal pain, bleeding, dysphagia, shortness of breath, nausea/vomiting. Hiatal hernia: opening in diaphragm widens and part of upper stomach moves into the thorax.
• Can be sliding or paraesophageal.
• Clinical manifestations include pyrosis, regurgitation, dysphagia, epigastric pain, fullness after eating, nausea/vomiting.

Gastritis: Types and Characteristics

• Gastritis is inflammation of the stomach mucosa, classified as acute or chronic.
• Type A chronic gastritis: inflammation of glands in the fundus and body.
• Type B chronic gastritis: inflammation from fundus to antrum.
• Atrophic gastritis: diffuse inflammation and destruction of glands.
• Acute gastritis: Rapid onset epigastric pain is not relieved by food.
• Chronic gastritis: vague epigastric pain, relieved by food
• Both also experience anorexia, nausea/vomiting, dyspepsia, and possibly hemorrhage.

Vomitus ,Appendicitis & Chon's

• Electrolyte imbalances Hormonal abnormalities
• Mechanical bowel obstruction, ileus
• Drugs (laxative abuse, anticholinergic agents, -opiates)
• Loss of innervation -(Hirschsprung's disease)
• Neuromuscular (paralysis,spinal cord injury or sacral lesion, - Multiple sclerosis)
• Anorectal disorders(hemorrhoids, feccal impaction, cancer, abscess, fissures)
• Antacid is a brand name. It elevates Gastric Ph and deactivates pepsin also can cause constipation. Histamine Receptors- Famotidine &ranitidine/ Nizatidine also suppress secretion of Gastric by blocking Gastric acid, Action Cimetidine .may with -Warfarin Triple therapy(most successful region)
• Bismuth compound or proton pump inhibitor( omeprazole)
• Metronidazole
• Tetracycline or clarithromycin and amoxicillin
• Esophagitis is the term for inflammation of the esophagus.
• Appendicitis - More common in males & inflammation of the vermiform appendix. caused by
• Obstruction by faecal impaction, - Kinking of the appendix
• parsities or infection
• low fibre diet.
• Chron's disease( Regional enteritis) - subacute or chronic inflammatory. bowel disease
• Affecting segmental areas along the entire well the Gi. Tract. Most commonly noted within the terminal ileum.

Questions cover adverse effects of steroids, immunosuppressants, and infliximab. It also includes post-operative care instructions after proctocolectomy and Stretta procedures, and diet recommendation.