Medical-Surgical Nursing II: GIT

• Study notes for Medical-Surgical Nursing II: GIT

Gastrointestinal System Overview:

• Organs in the abdomen include the spleen, liver, gallbladder, stomach, small intestine, large intestine, transverse colon, ascending colon, descending colon, appendix, and urinary bladder
• Abdominal pain necessitates thorough assessment to determine the source

Abdominal Anatomy and Assessment:

• Abdomen is divided into four quadrants: Right Upper (RUQ), Left Upper (LUQ), Right Lower (RLQ), and Left Lower (LLQ)
• IAPP: Inspection, Auscultation, Percussion, and Palpation
• Landmarks: Xiphoid Process, Costal Margin, Midline, Anterior and Superior Iliac Spine, Umbilicus, Inguinal Ligaments, and Superior Margin of your Pubic Bones
• RUQ organs: Liver, Gallbladder, Stomach (Pylorus, Duodenum), Head of Pancreas, Portions of Right Kidney, Hepatic Flexure Colon, Portions of Ascending and Transverse Colon, and Right Renal Artery
• LUQ organs: Left lobe of Liver, Spleen, Stomach (leaning to the left), Body of Pancreas, Portions of Left Kidney, Left Renal Artery, and Portions of Ascending and Transverse Colon
• RLQ organs: Lower Portions of the Right Kidney, Appendix, Cecum, Uterus (Female), Right Iliac Artery, and Right Femoral Artery
• LLQ organs: Lower Portions of the Left Kidney, Sigmoid Colon, Salpinx (Female), Ovary (Female), Left Uterus, Left Iliac Artery, and Left Femoral Artery
• Empty the bladder before assessment for accurate visualization and minimize discomfort
• Supine position with slightly flexed knees for relaxation of abdominal muscles during assessment
• Warm stethoscope and keep nails short to prevent discomfort
• Ask about area of tenderness and examine it last to avoid false results
• IAPP sequence: Inspection, Auscultation, Percussion, Palpation
• Inspection looks for size, color, rashes, surgical scars, pulsations, and abnormalities
• Auscultation assesses bowel sounds for 5 minutes in each quadrant
• 6-34 bowel sounds in 5 minutes auscultate colon q5 mins each

Percussion and Palpation Techniques:

• Percuss each quadrant, listening for tympany or dullness
• Palpation includes light and deep palpation after quadrants assess the liver, spleen, and aorta
• Palpate carefully, especially with known or suspected aneurysms, to avoid rupture
• Only light palpation may be needed if there is pain
• Palpation and percussion should not be done first because it might alter bowel sounds
• Assess for ascites by percussing the abdomen for shifting dullness
• Proper draping is important during assessment
• purplish discoloration around the umbilical area, may suggest intraperitoneal bleeding.
• Bluish flanks (Grey Turner's sign) may indicate retroperitoneal bleeding
• Auscultate for bruits over the iliac and renal arteries
• Pain elicited with passive internal rotation of the flexed right thigh indicates obturator sign and possible appendicitis

Gastric Disorders - Gastritis:

• Is the inflammation of the gastric mucosa
• acute or chronic
• Common causes: H. pylori, NSAIDs, dietary indiscretions
• Clinical manifestations: Abdominal discomfort, nausea/vomiting, anorexia, headache, abdominal distention, heartburn, sour taste, and hiccups
• Diagnostic tests: Endoscopy, UGIS, serological tests
• Gastritis Types: Acute may be the first sign of systemic infection and Chronic secondary to prolonged inflammations or tumors
• Common causes: Dietary Indiscretions, NSAIDS, and Alcoholism
• Management involves dietary modifications, pharmacotherapy, and supportive care

Peptic Ulcer Disease (PUD):

• Definition and locations: Gastric, duodenal, or esophageal
• H. pylori, stress, smoking, and dietary habits
• Types are characterized as a hollow out area along the stomach walls
• Risk Factors: Stress, Smoking, poor dieting habits
• Complications: Hemorrhage, perforation/penetration, and pyloric obstruction

Management of Gastric Disorders:

• Pharmacologic approaches: Antibiotics, antacids, Proton Pump Inhibitors (PPI), Histamine 2 Blockers, and mucosal protective drugs
• Lifestyle modifications include dietary changes and smoking cessation

Complications of Peptic Ulcer Disease:

• Hemorrhage: Monitor for signs and symptoms, manage with blood transfusions and gastric lavage
• Perforation/Penetration: Look for symptoms of severe pain and shock, managed with emergency surgery
• Pyloric Obstruction: Look for Causes and symptoms, management may involve NGT decompression and balloon dilatation

Surgical Interventions and Post-Operative Care:

• Surgery is indicated for intractable ulcers or life-threatening complications, using procedures like vagotomy, antrectomy (Billroth I and II), or subtotal/total gastrectomy
• Post-operative care involves monitoring for complications, fluid/electrolyte management, and use of NGT and antibiotics

Gastritis:

• Normal Stomach Lining is glossy and wet with normal lining from mucus.
• Actual visualization involves endoscopy for actual visualization of the stomach and NPO the px for 8 hours only to avoid vomiting
• May be cause by dietary indiscretion, NSAIDs, and alcoholism
• Pylori gastritis is the appearance of gastric mucosa into the slides

Gastritis Managment:

• Diet: NPO and may also advance until DAT
• No vomiting for the client so do NPO for the Px
• Progressive Diet includes NPO, CL, Gen L. SD and DAT
• Give PPI while Px is on NPO and small frequent feedings while they are on a diet to acquire nutritional needs

Dietary and Lifestyle Modifications:

• Dilute and neutralize the agents that is causing damage
• Supportive therapy that NGT, IVF, and promoting rest
• The promotion of healthy lifestyle includes quitting smoking, refrain from consuming carbonated beverages, drink alcohol, and stress reduction since it will produce HCl inside the stomach

Pharmacotherapy Gastritis:

• PPI blocks the vital phase of producing gastric acids by blocking the process
• A peptic ulcer is one that results in Hollow out areas that form in the mucosal wall of the stomach (into pylorus, duodenum or esophagus)

Peptic Ulcers

• Due to the eriosion of area that's affected
• Some are single or multipke

Risk factors for PUD

• Stress since PXS and increase your increase the hydrocloric acids
• Diets
• Ingestion of fatty foods and alcohol since the stomach is vasoconstriction Also make sure the Px is eating in a regualr meal or schedule and not always consuming and chewing food fast for better PUD. If there is Hyperchlorhydria the Px will be hypersecretion of hydrochloric acid since they would need to identify it.