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• Preventative measures for Gastroesophageal Reflux Disease (GERD):
• Maintain ideal body weight
• Chew food completely
• Avoid high-fat and spicy foods
• Identify and avoid trigger foods like citrus or tomato products
• Avoid alcohol, chocolate, coffee, peppermint, and spearmint
• Do not eat within 3 hours of bedtime
• Elevate the head of the bed on 4-6 inch blocks while sleeping
• Quit smoking
• Helicobacter Pylori causes:
• Peptic Ulcer Disease (PUD): H. pylori is a major cause, leading to erosion of the stomach or duodenal lining
• Gastritis: H. pylori is associated with environmental gastritis and can inflame the stomach mucosa
• Gastric Cancer: H. pylori can contribute to the development of gastric cancer, increasing the risk in patients with chronic gastritis
• Pernicious anemia and chronic gastritis can cause an inability to absorb:
• Vitamin B12
• Autoimmune gastritis attacks the parietal cells in the stomach
• Parietal cells are responsible for producing intrinsic factor, which is necessary for the absorption of vitamin B12
• Reduced intrinsic factor, due to damage of parietal cells, prevents proper absorption of vitamin B12 in the intestines
• Vitamin B12 deficiency leads to pernicious anemia

Gastritis B Risk Factors

• Alcohol use
• Medications like aspirin, NSAIDs, corticosteroids, digitalis, and chemotherapy agents
• Infections from microorganisms like Helicobacter pylori and Salmonella
• Endoscopic procedures
• Nasogastric suctioning
• Radiation
• Reflux of bile
• Smoking
• Stress (both emotional and physiological)
• Trauma
• Crohn's disease
• Gastritis is the inflammation of the stomach mucosa
• Upper GI bleeding results in black and tarry stool, known as melena
• Initially confirm NG tube placement by:
• Aspirating gastric contents
• X-ray imaging
• Rebound tenderness in the right lower abdominal quadrant can indicate appendicitis
• Rebound tenderness is intensified pain when pressure is released after palpation

Risk Factors for Acute Diverticulitis

• Age: People older than 60 are commonly affected, and the incidence increases with age
• Diet: Low fiber, high fats and red meat diet increases risk, but the role of low fiber is unconfirmed by research
• Obesity: a risk factor
• Sedentary lifestyle: may increase risk
• Smoking: a risk factor
• Medications: NSAIDs, opioids, and steroids can increase the risk
• Chronic constipation: may lead to increased pressure within the bowel, which may contribute to the development of diverticula

Hypovolemic Shock Due to GI Bleed

• Significant blood loss (more than 1 liter in 24 hours) can lead to hypovolemic shock.
• Signs and symptoms of hypovolemic shock include:
• Hypotension (low blood pressure)
• Tachycardia (rapid heart rate)
• Tachypnea (rapid breathing)
• Weak, thready pulse
• Chills
• Palpitations
• Dizziness and confusion
• Cold, clammy extremities
• Changes in level of consciousness
• Nursing actions for hypovolemic shock:
• Maintain NPO (nothing by mouth) status
• Administer intravenous fluids and blood products as prescribed
• Administer oxygen therapy
• Monitor vital signs closely
• Monitor input and output, including gastric secretions, stool, and urine Position patient on their side and elevate head of bed to prevent aspiration
• Avoid NG tube insertion
• Blood loss can lead to dehydration
• GI bleeding can cause electrolyte imbalances which require monitoring laboratory values
• Blood loss leads to decreased hemoglobin and hematocrit levels, so monitor hemoglobin and hematocrit
• Ongoing Bleeding: Monitor the patient for continued bleeding.
• Observe stools for occult blood, melena (black, tarry stools), or hematochezia (bright red blood).
• Observe vomitus for hematemesis (vomiting blood), or coffee-ground emesis.
• Patients with GI bleeding are at risk for aspiration if they vomit.
• Patients with abdominal pain related to the GI bleed should be monitored and managed.
• GI bleeding can lead to complications such as peritonitis or perforation, monitor for signs of these complications
• Teach the patient about medications and the importance of avoiding alcohol and to report new bleeding or change in vital signs
• Severe GI bleeding will cause a decrease in blood pressure

Teaching Points for Antibiotics and UTI

• Complete the full course of antibiotics
• Take the antibiotics as prescribed
• Be aware of potential side effects
• Report any adverse effects
• Do not share antibiotics
• Antibiotics may cause diarrhea

Nursing Interventions for Appendicitis

• Preoperative:
• Keep the patient NPO
• Avoid heat, laxatives, or enemas
• Administer analgesics and monitor pain
• Administer IV fluids
• Postoperative:
• Monitor for signs of infection
• Administer analgesics and manage pain
• Monitor fluid balance
• Monitor for complications such as peritonitis, increased WBCs, and dehydration
• Provide wound care if a drain is inserted
• Encourage coughing and deep breathing

Renal Function Lab Tests

• Kidneys-ureter-bladder x-ray (KUB) to detect tumors, swollen kidneys, and kidney stones
• Pyelogram to provide imaging of the renal pelvis, calyces, and ureter, using IV, retrograde, or antegrade contrast
• Urine culture to identify organisms present
• Urine tests
• Stress incontinence is the involuntary loss of urine due to an increase in abdominal pressure during activities like coughing, laughing, or sneezing.
• Fecal impaction is when a dry fecal mass is so dry that it cannot be passed due to constipation.
• Signs and symptoms of fecal impaction:
• Small amounts of liquid stool can ooze around the fecal mass, causing incontinence of liquid stools.
• Abdominal pain and distention
• Indigestion
• Intestinal rumbling
• Rectal pressure
• A sensation of incomplete emptying
• Straining
• Elimination of hard, dry stool
• Headache
• Fatigue
• Decreased appetite
• A urinalysis of someone with a urinary tract infection will show organisms or bacteria.
• Stress ulcers, also known as stress-induced gastritis, are a specific type of gastrointestinal mucosal damage 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 various abnormalities and conditions
• A semi-conscious or unconscious person should be placed on their side during oral care to prevent aspiration

Diverticulitis and Patient Education

• Diverticulitis is the inflammation or infection of a diverticulum, a small outpouching of the bowel mucous membrane through weak areas in the colon wall.
• Patient education:
• During the initial acute phase, a liquid diet is typically recommended
• After the acute phase, a progressive diet is started, gradually reintroducing solid foods as tolerated
• A high-fiber diet can help prevent constipation and promote regular bowel movements
• Patients should avoid alcohol and irritating foods (acidic, greasy, spicy)
• Patients should increase fluid intake to 2 to 3 liters per day, unless contraindicated, to prevent hard stools
• Avoid nuts and seeds
• Maintain a healthy weight to reduce the risk of diverticulitis
• Regular physical activity to improve bowel function and overall health is useful, sedentary lifestyle is a risk factor
• Quitting smoking can improve overall health and reduce risk, since smoking is a risk factor for diverticulitis.

Anemia Related to Peptic Ulcer Disease Lab Findings

• Decreased Hemoglobin and Hematocrit:
• Bleeding from peptic ulcers often results in lower-than-normal hemoglobin and hematocrit levels
• Hemoglobin is the protein in red blood cells that carries oxygen, and hematocrit measures the proportion of red blood cells in the blood
• Expect to see decreased levels of both in lab results
• Fecal Occult Blood:
• Stool may test positive for occult blood, indicating slow, chronic bleeding within the GI tract
• This test detects blood that isn't visibly apparent in the stool
• Red Blood Cell Count:
• The red blood cell (RBC) count may be lower than normal, reflecting the loss of red blood cells due to bleeding
• Iron Studies:
• Chronic blood loss can lead to iron deficiency
• Iron studies might reveal low serum iron, low ferritin (a measure of iron stores), and increased total iron-binding capacity (TIBC)
• Vitamin B12 Deficiency: Chronic gastritis, particularly autoimmune gastritis, can lead to a deficiency in intrinsic factor, hindering vitamin B12 absorption and resulting in pernicious anemia